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Resumen Caso clinico Varon de 68 anos con vasculopatia polipoidea coroidea idiopatica que requirio 7 inyecciones intravitreas de bevacizumab en el cuadrante nasal-superior. Posteriormente desarrollo una insuficiencia limbar localizada que requirio un autoinjerto limbar homolateral. A los dos meses de la cirugia, existia una discreta mejoria de la agudeza visual, observandose una cornea mas transparente, un epitelio integro y una notable mejoria en la alteracion de la superficie ocular. Discusion Los traumatismos quirurgicos repetidos sobre la region limbar o zonas proximas a ella pueden ocasionar una alteracion de las celulas madre limbares originando una epiteliopatia corneal por insuficiencia limbar yatrogenica, entre cuyas causas deben considerarse las inyecciones intravitreas frecuentes.

Different femtosecond laser platforms are nowadays available. Main differences as the particular approaches in anterior segment imaging techniques to focus the laser pulses precisely, interface designs to efficiently and safely dock the patient´s eye and software options in each platform will be presented and discussed.

Caso clínico: Varón de 68 años con vasculopatía polipoidea coroidea idiopática que requirió 7 inyecciones intravítreas de bevacizumab en el cuadrante nasal-superior. Posteriormente desarrolló una insuficiencia limbar localizada que requirió un autoinjerto limbar homolateral. A los dos meses de la cirugía, existía una discreta mejoría de la agudeza visual, observándose una córnea más transparente, un epitelio íntegro y una notable mejoría en la alteración de la superficie ocular. Discusión: Los traumatismos quirúrgicos repetidos sobre la región limbar o zonas próximas a ella pueden ocasionar una alteración de las células madre limbares originando una epiteliopatía corneal por insuficiencia limbar yatrogénica, entre cuyas causas deben considerarse las inyecciones intravítreas frecuentes. Case report: A 68 year-old male with idiopathic choroidal polypoidal vasculopathy received seven intravitreal injections of bevacizumab in the supero-nasal quadrant. He later developed a localized limbal stem cell deficiency which required limbal transplantation from the same eye. Two months after surgery, a slight improvement of visual acuity was noted, along with an intact ocular surface, clear cornea and decreased inflammation. Discussion: Repeated surgical trauma on the limbus and surrounding areas may damage the limbal stem cells, giving rise to a corneal epitheliopathy due to iatrogenic limbal deficiency. Repeated intravitreal injections may be considered as one of the possible causes.

Purpose To analyse the refractive and biomechanical changes in the cornea after implantation of intrastromal ring segments. Methods The study included 43 eyes of 36 patients (mean age 38 years); 7 eyes had received Intacs® and 36 KeraRings®. Visual acuity, spherical equivalent, K readings, corneal hysteresis (CH) and corneal resistance factor (CRF) were measured pre-op, at 6 and at 12 months post-op. CH and CRF were derived from the Ocular Response Analyser (ORA). Results UCVA improved from 1.10 logMAR to 0.65 at 6 months and 0.62 at 12 months post-op. BCVA improved from 0.32 logMAR to 0.25 at 6 months and 0.22 at 12 months post-op. Spherical equivalent improved from -5.28 to -1.30 at 6 months and -1.85 at 12 months post-op. Sim K improved from 5.81 to 3.64 at 6 months and 4.10 at 12 months post-op. Mean K improved from 48.9 to 46.3 at 6 months and 46.7 at 12 months post-op. All changes between pre-op and 6 months post-op were significant, but between 6 months and 12 months they were not. Pre-op CRF (mean 6.37) and CH (mean 7.34) did not change significantly up to 12 months post-op. Conclusion Intrastromal ring segments for keratoconus reduced the spherical equivalent refraction and improved the UCVA and BCVA at 6 months post-op and remained stable up to 12 months. ORA's biomechanical factors CH and CRF did not changed up to 12 months post intrastromal ring segment implantation.

Purpose To describe the indications, intraoperative complications, post-operative complications and anatomical and functional results of Type I Boston keratoprosthesis at our eye center in Barcelona. Methods Retrospective interventional case series on 24 eyes of 22 patients who underwent Boston keratoprosthesis implant from May 2006 to May 2008. Results The main indication for Boston keratoprosthesis implantation was a repeated failed graft (mean = 2.33 previous grafts). The most common principal pathologies were: bullous keratopathy, herpetic keratitis, aniridic keratopathy, corneal ectasia, calcific band keratopathy. No major intraoperative complications were noted and average time of surgery was 47 minutes. The mean follow-up time was 7.42 months. The major post-operative complications encountered were retroprosthetic membrane in 2 eyes, endophthalmitis in 2 eyes and corneal graft melting in 1 eye. The mean best corrected visual acuity improved from 0.015 pre-operatively to 0.1 post-operatively. Only one case of extrusion due to melting was encountered which was resolved by a reimplantation of the keratoprosthesis. Conclusion Our short-term experience with the type I Boston Keratoprosthesis is a good alternative for patients with repeated graft failures. Improvement in visual acuity is immediate and only minor complications were encountered.