PurposePurpose: Mucopolysaccharidosis (MPS) type II (Hunter syndrome) is a variable, progressive, multisystem disorder including severe airway obstruction, cardiomyopathy, skeletal deformities and neurological problems. It is an X‐linked recessive disease caused by deficiency of the lysosomal enzyme iduronate‐2‐sulphatase, leading to accumulation of glycosaminoglycans. Several ophthalmological disorders, including corneal opacities, glaucoma and retinal degeneration, have been previously reported. This is the first case of bilateral macular edema associated with MPS II. The patient underwent idursulfase enzyme replacement therapy with good response. We point out the utility of spectral domain optical coherence tomography (SD‐OCT) in the diagnosis and follow‐up of this condition.MethodsSD‐OCT, fundus autofluorescence and retinography were used in the diagnosis and follow‐up of the visual disorder.ResultsMacular edema was successfully managed with idursulfase enzyme replacement therapy stabilizing visual loss. Central macular thickness measured by SD‐OCT decreased significantly.ConclusionIdursulfase enzyme replacement therapy seems to be a good treatment option for macular edema associated with MPS II. Furthermore, SD‐OCT played a key role in the diagnosis and follow‐up of this condition.

PurposeIn modern medicine forceps‐induced birth trauma to the eye is a rare clinical event. Forceps injury to the cornea occurs during complicated forceps delivery. The break in Descemet's membrane is the most common complication.MethodsInterventional case report showing the rupture of Descemet's membrane due to a complicated forceps delivery.ResultsA 2 days‐old boy was referred for severe and diffuse corneal edema. Medical history was significant for forceps delivery. On examination, he was found to have a rupture of the Descemet's membrane. Conservative treatment and application of hypersomolar solution was decided. Corneal edema was resolved in three months. Actually the cornea remained clear but persists a residual corneal astigmatism of 6D.ConclusionsThe application of the forceps can cause accidental rupture of the cornea at the level of the Descemet's membrane. The edema resolves spontaneously within a few weeks or months eventually leaving the visible edges of the break and a clear cornea. Rupture of Descemet's membrane is not presented as an Ophtalmologic urgency but it′s crucial to follow these patients because failure to intervene leads to amblyopia or ‘lazy eye’.

PurposeMacular hole (MH) is a rare complication of cataract extraction. Various etiologies are discussed but it seems that the combination of vitreous traction and pseudophakic macular edema are the causes most likely involved in its pathogenesis. Pars plana vitrectomy (PPV) and internal limiting membrane peeling is the gold standard treatment option for patients with postoperative MH. Medical treatment has not been very effective in resolving this pathology. We present a case of post‐surgical MH treated with topical Nepafenac.MethodsInterventional case report showing the role of topical Nepafenac as a therapeutic tool in post‐surgical MH.ResultsAn 81‐year‐old female with a history of uncomplicated cataract surgery in RE. Four weeks after surgery there was a progressive visual deterioration with a best corrected visual acuity (BCVA): 0.05. SD‐OCT revealed a full‐thickness MH. Nepafenac 0.1 mg/ml, 3 times a day, was administered for 8 weeks in RE. Four months later, an improvement of her visual acuity (BCVA: 0.4) and a recovery of the retinal structure were observed. No recidive has been observed in a follow‐up of 1 year.ConclusionsWe propose the therapeutic use of topical NSAIDs as a possible alternative to surgery for macular holes whose etiology is related to inflammatory processes.

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PurposeTo compare dilatation pupil devices implemented on cataract surgery, their advantages and disadvantages.MethodsProspective, interventional study to analyze the following pupil dilatation techniques: iris‐retractor hooks and Morcher‐5s, Perfect‐pupil, Graether, Malyugin and Oasis dilator ring. The following properties were studied: handiness, dilatation obtained, stability, and facility to remove the dilator ring in relation with the form, material, size and length of the necessary incision to proceed with the insertion.ResultsIris‐retractor hooks are the best option in cases of zonular instability and retropulsion syndrome. The principal advantage is their versatility. Dilator‐rings obtained similar results in stability and dilatation. Malyugin and Oasis dilator rings had the best handiness results. Graether and Oasis were the easiest to remove and Morcher and Perfect‐pupil the most complicated.ConclusionsHaving a small pupil is one of the main causes of complications in cataract surgery. There are different surgical devices that allow minimizing intra‐operative risks. Each surgeon needs to select the best option compatible with to his surgical technique. Our study revealed that the most used devices were the iris‐retractor hooks due to the capsular stability that they provides and the Oasis dilator‐ring because of its flexibility and how easy they are to remove.