A. Sánchez Pérez

Queratitis difusa de la interfase

espanolLa queratitis difusa de la interfase es una nueva entidad clinica. Es un cuadro cada vez mas frecuente debido al incremento de procedimientos LASIK en todo el mundo. El conocimiento que se tiene es cada vez mayor de esta complicacion poco habitual pero potencialmente amenazadora para la vision. Aparece en el postoperatorio precoz del LASIK, en procedimientos generalmente bien realizados. A partir de la revision de la literatura y de nuestra experiencia se presenta una actualizacion de la estrategia actual de diagnostico y tratamiento de este sindrome. La identificacion precoz, la valoracion de su gravedad, el conocimiento de su curso evolutivo y el tratamiento adecuado, contribuyen a evitar la perdida de agudeza visual asociada a este cuadro. EnglishDiffuse interface keratitis is a new clinical entity. It is becoming significantly more common due to the increasing of laser assisted in situ keratomileusis (LASIK) procedures. The knowledge we have about this uncommon but potentially sight-threatening complication is expanding. It appears in the early postoperatory LASIK, even in well-executed procedures. In this review we present an updated strategy for the diagnose and treatment of this syndrome, based on our own experience and an updated literature review. Early identification, evaluation, staging, and appropriate intervention, may help preventing visual loss associated with this entity.

Evaluation of visual quality parameters after Descemet membrane endotelial keratoplasty (DMEK)

Purpose and Objectives nTo evaluate progressive changes in visual quality parameters in patients who underwent DMEK for Fuchs endotelial dystrophy (FED), and to compare the visual quality results with healthy controls without corneal pathology. n nMethods nFourteen eyes with FED who underwent DMEK were evaluated for corneal topographic changes using Pentacam (OCULUS, Iberia SL), preoperatively, at 1 month and at 6 months after surgery. Mean keratometry (Km), corneal density (1-2 mm, central and total), high order aberrations (HOA), low order aberrations (LOA) and total aberrations (total RMS) were analyzed in the anterior and posterior cornea. Fourteen healthy subjects were evaluated using the same protocol and compared with the patients final evaluation data. n nResults nSignificant improvement was observed in patients at 1 month after surgery in the posterior Km (p=0.005), central posterior density (p=0.034), 1-2 mm posterior density (p=0.006) and central anterior density (p=0.045), and anterior LOA (p=0.026) and total aberrations (p=0.020). After 6 months all densities (anterior and posterior) had improved compared to preoperative results (p 0.05). Corneal aberrations (anterior and posterior)remained significantly higher in DMEK subjects (p>0.05) n nConclusions nDMEK surgery improves corneal visual quality parameters in FED patients after the first month postoperatively. Corneal density and mean keratometry values are not different from healthy corneas at 6 months after DMEK. However, despite corneal aberrations decrease after surgery they remain higher than those values found in healthy corneas.

Fourier-domain OCT and keratoconus

Purpose Optical coherence tomography (OCT) is an optical imaging technique that provides high resolution, cross‐sectional, in vivo, noninvasive measurements of the eye. The OCT is widely used in ophthalmology, especially in retina and neurophthalmology. For the study of anterior segment, Visante® OCT has so far been the most widespread, with the disadvantage of high cost and lacks posterior pole module.Currently one of the posterior pole tomographs, Cirrus HD‐OCT (Carl Zeiss Meditec Inc., Dublin, CA), has introduced an anterior segment high‐resolution module.

Late‐Onset Diffuse Lamellar Keratitis associated with cataract phacoemulsification

Purpose Diffuse lamellar keratitis (DLK) is characterized by the presence of a diffuse inflammatory infiltrate localized at the laser in situ keratomileusis interface, with a non-infectious etiology. Most cases of DLK occur within the first week following surgery but late-onset DLK has been associated with inflammatory conditions such as iritis, viral keratoconjunctivitis or interstitial keratitis; and it can occur even years after LASIK. n n n nMethods Prospective, interventional, single case report. A 67-year-old male patient, who had undergone bilateral LASIK 13 years earlier, developed an episode of DLK on the third day of the postoperative-cataract surgery on his left eye (LE). Slit-lamp biomicroscopy and optical coherence tomography (anterior segment mode) were performed to demonstrate the presence of highly-reflective multifocal infiltrates and the absence of fluid at the flap interface. The patient was treated with intensive topical corticosteroids. n n n nResults Treatment with topical 1.0% prednisolone acetate was instituted and continued for months, with improvement in patient symptoms and visual acuity. n n n nConclusion This is a case of DLK with an extremely delayed onset, which emphasizes the importance of following-up of these patients not only in the early postoperative period.Purpose Diffuse lamellar keratitis (DLK) is characterized by the presence of a diffuse inflammatory infiltrate localized at the laser in situ keratomileusis interface, with a non‐infectious etiology. Most cases of DLK occur within the first week following surgery but late‐onset DLK has been associated with inflammatory conditions such as iritis, viral keratoconjunctivitis or interstitial keratitis; and it can occur even years after LASIK.

Toxic keratopathy associated with abuse of topical anesthesic

Purpose OBJETIVE: To describe the clinical course and treatment of toxic keratopathy associated with abuse of tocical anethetic