RESUMENObjetivo: El límite inferior de edad del donante corneal resulta polémico. A pesar de la mayor densidad endotelial neonatal existen problemas quirúr-gicos (anatomía corneal infantil), refractivos (tendencia a miopización) y postoperatorios (mayor inmunogenicidad). Se analizan dos casos con empleo de tejido donante de 4 meses, con resultado refractivo postoperatorio atípico en ambos y desproporcionada respuesta inmune en uno. A propósi-to de los mismos, se realiza una revisión sobre el uso de injertos de donantes pediátricos en la queratoplastia penetrante. Métodos: Se presentan dos pacientes jóvenes con queratocono intervenidos de queratoplastia penetrante con injerto donante de 4 meses y alta densidad endotelial (4.500 cel/mm 2 ). Resultados: En el postoperatorio inmediato presentaron una elevada hipermetropía (se redujo posteriormente) con escaso astigmatismo. En uno aumentó notablemente el astigmatismo tras la excisión de sutura precisando queratotomía arcuata y puntos de refuerzo, mostrando al año y medio injerto transparente, agudeza visual corregida de V=1 y densidad endotelial alta (4.300 cel/mm 2 ). El otro presentó a los 7 meses un rechazo con edema del REVISIÓN ABSTRACT Objective: The lower recommended age of the donor cornea is a controversial matter. Although newborn corneas have a high endothelial cell density, there are anatomical, refractive (myopic shift) and postoperative problems. Two cases are analyzed; one had an atypical refractive result and the other an unexpectedly severe immune response. We also review the use of pediatric donor corneas in penetrating keratoplasty. Methods: Two young patients with keratoconus, in whom a penetrating keratoplasty was done using a 4-month-old newborn corneal donor with high endothelial cell density (4.500 cell/mm 2 ) are reported. Results: In the early postoperative period, both had high hypermetropy with weak astigmatism that improved over the next few months. In one patient a marked increase in the astigmatism after removal of the continuous suture was observed. One and a half years after the penetrating keratoplasty there was V=1 corrected vision and the endothelial population was almost unchanged (4,300 cell/mm 2 ). The other patient suffered an allograft reaction with corneal oedema in the seventh postoperative month, and subsequent rupture of the continuous suture made its early removal necessary. The oedema par-

Introduction: Conjunctival melanoma is extremely rare in children and has low rates of resolution. Definitive histopathological diagnosis based exclusively on microscopic findings is sometimes difficult. Thus, early diagnosis and adequate treatment are essential to improve clinical outcomes. Clinical case: We present the first case in which the fluorescent in situ hybridization (FISH) diagnostic technique was applied to a 10-year-old boy initially suspected of having amelanotic nevi in his right eye. Based on the 65% of tumor cells with 11q13 (CCND1) copy number gain and 33% with 6p25 (RREB1) gain as measured by the FISH analysis, and on supporting histopathological findings, the diagnosis of conjunctival melanoma could be made. Following a larger re-excision, adjuvant therapy with Mitomycin C (MMC), cryotherapy and an amniotic membrane graft, the patient has remained disease-free during 9 years of long-term follow-up. Case discussion: Every ophthalmologist should remember to consider and not forget the possibility of using FISH analyses during the differential diagnosis of any suspicious conjunctival lesions. Genetic techniques, such as FISH, have led to great advances in the classification of ambiguous lesions. Evidence-based guidelines for diagnosing conjunctival melanoma in the pediatric population are needed to determine the most appropriate strategy for this age group.

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