VOLUME 62 - ISSUE 5

Purpose: To analyze the intra- and inter-observer reprodu-cibility of retinal fiber layer measurements. Methods: Twenty-six normal eyes underwent retinal nerve fiber layer thickness measurements with the GDx scanning system. Three images of each eye were taken by three different observers. For each case, each observer was asked to choose the best image and also to use the mean of the three images for each case. Comparisons were made using the best image and also the mean image provided by the software. The mean thickness values in each quadrant and their ratios were compared using Friedman rank analysis of variance. Results: The comparison of results obtained from the three images taken by the same observer (intraobserver reprodu-tibility) did not show any statistically significant difference. The analysis of the data by the R (resident), T (technician) and G (ophthalmologist specialized in glaucoma) observers revealed respective-ly: pR( S = 0.89; I = 0.24; T = 0.89; N = 0.30), pT( S = 0.76; I = 0.70; T = 0.22; N = 0.63), and pG( S = 0.48; I = 0.89; T = 0.30; N = 0.89). Regarding the isolated values (superior, inferior, temporal and nasal), the analysis of the results considering the values obtained from the mean image did not reveal a statistically significant difference between the three investigators. But when relationships were considered a statistically significant difference was observed regarding the superior/inferior ratio (p S/I = 0.037). Statistically significant differences were detected when considering the best image. Inferior and temporal mean thickness values were statistically different between observers (p = 0.04 and 0.003 respectively). Also, the superior/temporal (S/T), inferior/temporal (I/T), tem-poral/nasal (T/N) and superior/inferior (S/I) ratios showed statistically significant differences between observers (p S/T = 0.02; p I/T = 0.03; p T/N = 0.007; p S/I = 0.037). Conclusion: The results showed good reproducibility of the GDx Scanning System results using the mean image pro-vided by the equipment software.

Keywords: GDx; Nerve fiber analyzer; Nerve fiber layer

Purpose: Amniotic membrane has been consolidated as an useful adjunct in the treatment of ocular surface disorders. Its use is based on the ability to improve epithelial healing and to decrease inflammatory, angiogenic and cicatricial processes. The purpose of this study was to report the surgical outcome of human amniotic membrane use for surface reconstruction in ocular cicatricial diseases. Methods: Amniotic membrane was obtained at the time of cesarean section and was preserved at -80ºC in glycerol and cornea culture media at a ratio of 1:1. Eleven eyes of 10 patients underwent amniotic membrane transplantation, associated (8 eyes) or not (3 eyes) with corneal limbal graft. Ocular surface reconstruction was performed after chemical burns (6 eyes), trauma (1 eye) and Stevens-Johnson's syndrome (SJS) (4 eyes). Results: Mean follow-up time was 5.22 months (range, 2-13 months). One case of SSJ developed early postoperative infection and was excluded from the analysis. Successful ocular surface reconstruction was achieved in 8 eyes (80%). Surgical failure was observed in 2 cases of SJS who presented corneal melting at the time of surgery (20%). Conclusions: This study suggests that amniotic membrane transplantation is an effective alternative for surface reconstruction in stable ocular cicatricial diseases. Larger studies with longer follow-up are necessary to further analyse this procedure.

Keywords: Cicatricial keratoconjunctivitis; Amniotic membrane; Limbal transplantation

Purpose: To analyze the efficacy and safety of intraope-rative mitomycin C (MMC) in combined procedures (extra-capsular cataract extraction + trabeculectomy). Methods: Twenty-four patients were randomized to either MMC (0.5 mg/ml) (n = 14) or saline solution (n = 10) for 3 minutes during the combined procedure. Results: Twelve months after surgery, mean IOP in the MMC group (13.2 ± 2.9 mmHg) was significantly lower than in the control group (16.3 ± 3.9 mmHg) (p = 0.02). The mean number of medications used during the 12-month follow-up in the control group (1.33 ± 0.5) was significantly higher than in the MMC-treated group (0.5 ± 0.5) (p = 0.005). Life table analysis showed a significantly higher probability of IOP control in the MMC group than in the control group (p < 0.01). Conclusions: Intraoperative MMC is safe and effective in pro-moting a better IOP control and reducing the need for postoperative antiglaucoma medications. We suggest intraope-rative MMC to be routinely employed in combined procedures.

Keywords: Glaucoma; Cataract; Surgery; Mitomycin C

Purpose: To establish safety parameters for stopping anti-CMV maintenance therapy in patients who had immune recovery after highly active antiretroviral therapy. Methods: The anti-CMV maintenance therapy was stopped in 24 patients who presented with inactive CMV retinitis, CD4+ > 200 cells./mm³ and indetectlabe viral load. The pa-tients were examined every 15 days with indirect ophthal-moscopy after maintenance therapy discontinuation until december 1998. Results: None of the 24 patients presented retinitis reactvation or progression. All of them kept CD4+ counts above 200 cells/mm³. One patient presented a viral load of 4000, the others maintained indetectable viral load. The average follow-up was 10,5 months. Conclusion: We believe that our established parameters are safe to stop anti-CMV maintenance therapy although other studies should be performed. Routine ophthalmologic exa- mination,CD4+ count and the viral load are fundamental in the follow-up of patients with inactive CMV retinitis after stopping maintenance therapy.

Keywords: CMV; Maintenance therapy; Immune recovery; HAART

Purpose: To evaluate the epidemiology of patients with oculopalpebral injuries in the city of Curitiba. Methods: We studied, prospectively, 622 patients in the Ophthalmology Emergency Service at the Evangelic Uni-versity Hospital of Curitiba from March to July, 1998. Results: The most affected patients were those between 20 and 50 years of age (73.3%) and the males (6 males:1 female). Among the oculopalpebral traumas the most frequent were foreing body (54.6%), chemical keratocon-junctivitis (12.1%) and blunt trauma (8.8%). The oculopla-pebral injuries happened more frequently in the professional (67,4%) than in the domestic (21.2%) environment. We verified that the majority of the patients (67%) came to the Ophthalmology Service during the first 24 hours after the trauma, although ocular protection was not much used in the professional environment and it was not used at all in the domestic one. Conclusions: The authors stress the great socioeconomical impact of the oculars injuries and the necessity of alerting governmental institutions, physicians (ophthalmo-logists and others), entrepreneurs, workers and the general popu-lation about the importance of oculopalpebral trauma prevention to protect ocular health and to improve the human resources in our society.

Keywords: Oculopalpebral trauma; Ocular trauma; Epidemiology

Purpose: To describe the ocular findings in children with early toxoplasmosis and sistemic manifestation of the disease Methods: Fifty children with early congenital toxoplasmosis were included in this study and all data collected from their medical charts from the Hospital de Clínicas de Uberlândia. These children had their diagnosis based on clinical features and serological tests. All of them presented with systemic manifestations at birth and were examined by an ophthal-mologist. Results: Ocular manifestations were present in 86% of the patients. Retinochoroiditis was the most frequent lesion and was present in 76% of the patients that underwent indirect ophthalmoscopy, being bilateral in 54% of them. Neurolo-gical findings were seen in 69% of the patients with retino-choroiditis. Conclusion: The authors consider that ocular manifestations are common in children with early congenital toxoplasmosis showing systemic manifestations at birth. Ocular examination should be performed in all suspected or confirmed cases due to its important help not only in the diagnosis but also because it leads to early visual stimulation.

Keywords: Toxoplasmosis; Retinochoroiditis; Systemic alterations

Purpose: To compare the efficacy of 0.005% latanoprost and 1% apraclonidine in the prevention of an increase of intraocular pressure (IOP) after Nd: YAG laser capsulotomy in nonglaucomatous patients. Methods: Thirty-six patients were included and divided in to three groups. Patients received 0.005% latanoprost. 1% apraclonidine or placebo. Four measurements of IOP were made: before instillation of any drug, 30 minutes after cycloplegia, 1 hour and 4 hours after laser. Results: No significant difference was found between the three groups regarding age, initial intraocular pressure, pressure 30 minutes after cycloplegia and amount of laser energy used. In the apraclonidine group, at the first hour after laser, both the absolute and percentual intraocular pressure changes, were statistically lower than those of the control group (p<0.05). The latanoprost group had was not significantly different from the other groups (p>0.05). The IOP of the 3 groups was statistically similar at the fourth hour after the laser (p>0.05). There were no differences in the measurements of intraocular pressure between the four intervals. The amount of laser energy used during the procedure had no correlation with IOP rise (p>0.05). Conclusion: The authors conclude that 1% apraclonidine is more effective to control the IOP rise after YAG laser capsu-lotomy when compared to 0.005% latanoprost .

Keywords: Glaucoma; capsulotomy; ocular hipertension; apraclonidine; latanoprost prevention

Purpose: Horizontal strabismus is commonly associated with vertical deviations which can be a result of a dysfunction of the vertical rectus, oblique muscle or both. Overaction of the superior oblique muscle (SO) results in hypotropia (HoT) in primary position of gaze (PP). The aim of this study was to evaluate the correction of HoT in PP after unilateral tenectomy of the superior oblique muscle close to its scleral insertion. Patients and Methods: We retrospectively studied, from 1977 until 1996, charts of 15 patients with SO overaction and hypotropia in PP greater than 4D who underwent unilateral superior oblique tenectomy close to its insertion at Hospital Santa Casa de São Paulo (12 patients), University of Santo Amaro (2 patients) and private clinic of one of the authors (CSD, 1 patient). The mean preoperative deviation in PP was 9D. The mean preoperative superior oblique overaction was 1.7 (measured by a cross system rating). Results: The mean correction of the HoT was 4.67D ± 5.09D (-5D to 15D), (H = 6.032; p = 0.014). The mean correction of SO overaction was 0.87 ± 0.88 + (0 - 2). According to the horizontal deviation, ET and XT, there was no significant mdifference in the correction of the HoT. Conclusion: For HoT of 15D or less we found a mean correction of 51.82% of its preoperative value. Unilateral tenectomy has shown to be an effective technique for the correction of vertical deviation in PP in our study.

Keywords: Strabismus; Oblique superior muscle; Tenectomy

Background: Retinoblastoma is by far the most frequent malignant intraocular tumor of childhood. This study was performed to characterize the clinical, diagnostic, treatment and prognostic aspects in patients with retinoblastoma in three reference centers for this pathology in the city of Recife, Pernambuco - Brazil. Methods: A consecutive series of 85 patients with retinoblastoma was reviewed. The authors selected 66 patients (77.6%) that fulfilled the inclusion criteria for these study. Results: Of a total of 66 patients with retinoblastoma, 4.5% had a previous history of the disease in the family. Males were more affected than females at a ratio (male/female) of 1.12. The mean age of appearance of the first symptoms was 23.8 months, with leukocoria and ocular hyperemia being the most frequent. The mean age at time of diagnosis was 31.7 months and for surgical treatment 32.8 months. The right eye was affected in 42.4% of the cases and the left was involved in 37.9% of cases. The tumor was unilateral in 80.3% and bilateral in 19.7% of the cases. There was extraocular involvement in 62.1%, and it was intraocular in 37.9% of the patients. Treatment was surgery combined with chemotherapy in 47.0% of the patients. 27.3% of the patients died and 19.7% abandoned the treatment. Conclusions: The data on the epidemiology of retinoblastoma found in our city resembles that of other developing countries, concerning the epidemioloy of retinoblastoma.

Keywords: Retinoblastoma; clinic; diagnosis; treatment; prognosis

Purpose: To study the incidence and etiology of uveitis in Curitiba, PR, Brazil. Methods: Sixty-eight cases of uveitis were studied in Curitiba, PR between January and April, 1998. Clinical and laboratorial research was performed in order to establish the diagnosis. Results: In this study, we found that posterior uveitis was the most frequent (49%), followed by panuveitis (29%), and, less frequently, anterior uveitis (22%). The major etiology of posterior uveitis was toxoplasmosis, responsible for 88% of the cases; among panuveitis, toxoplasmosis also predomi-nated, representing 85% and, the main cause of anterior uveitis was ankylosing spondilytis with 20%. Conclusions: In Curitiba, posterior uveitis and panuveitis predominate, and the most frequent etiology is toxoplas-mosis. However, its important to emphasize that there are other important causes of uveitis which should be remem-bered by the ophthalmologist during the clinical investigation.

Keywords: Uveitis; Toxoplasmosis; Etiology

The authors report a case of a female patient with bloody tears. No organic cause could be detected, despite exten-sive diagnostic investigation. A comment about the diffe-rential diagnosis is also presented.

Keywords: Bloody tears

Purpose: To present a case of bilateral orbital compression syndrome secondary to subperiosteal hematoma in sickle cell disease. Methods: Case report of a child with sickle cell disease and asymmetric bilateral orbital compression syndrome, with extradural hematomas, ocular pain and proptosis. There was remission of symptoms and signs in about 20 days with symptomatic treatment alone. Radiological aspects in the acute and remission phases are presented. Conclusion: Sickle Cell disease should be included as a cause of orbital compression syndrome.

Keywords: Orbital compression syndrome; Sickle cell disease; Exophthalmos

A case report of an atipical inferior rectus congenital fibrosis associated with a generalized muscular hypotonia is presented. It shows mild hipotropia with a normal visual acuity and binocularity in infraversion position contrasting with the severe hipotropia and ambliopy found. The surgical procedure took these facts into consideration, so we performed a small retrocess of the muscle with the objective to correct the head position without changes in the reading position. The postoperative results were satisfactory.

Keywords: Inferior rectus fibrosis; Ambliopy; Generalized muscular hipotony

Purpose: To report a case of conjunctival synthetic fiber granuloma. Case Report: Six-year old female presented with an inferior conjunctival tumor in the right eye for six months. The lesion was excised and histopathological examination revealed granulomatous inflammation and multinucleated giant cells phagocy birefringent material, recognized as synthetic fibers. Discussion: Synthetic fiber granuloma of the conjunctiva is an uncommon lesion described mainly in children. Usually it occurs unilaterally and situated in the inferior conjunc-tival fornix. The contact of the eye with toys containing synthetic fibers in this age group could explain the origin of the lesion. Synthetic fiber conjunctival granuloma should be included in the differential diagnosis of conjunctival tumors in children.

Keywords: Conjunctiva; Foreign body granuloma; Synthetic fiber