VOLUME 66 - ISSUE 2

PURPOSE: To evaluate the therapeutic effect on amniotic membrane transplantation in symptomatic bullous keratopathy. METHODS: Nine patients with symptomatic bullous keratopathy, candidates or not for penetrating keratoplasty were evaluated before, 1, 3, 6 and 12 months after amniotic membrane transplantation. During each visit, patients have been asked about pain, photophobia, and foreign body sensation and were submitted to complete ophthalmological evaluation, esthesiometry and ultrasound pachymetry. RESULTS: Comparing evaluations performed previously and after the procedure regarding pain, photophobia, foreign body sensation and esthesiometry, there was a statistical significant reduction in symptoms and corneal sensitivity. Medium pachymetry showed an increased thickness soon after the procedure and decreasing between 6 and 12 months. It was observed that after 6 months of follow-up, the transplanted amniotic membrane became partially dissolved in 3 cases (33.3%) and totally dissolved in other 3 cases (33.3%). CONCLUSION: Amniotic membrane transplantation represents an effective alternative for the treatment of symptomatic bullous keratopathy up to 12 months of follow-up.

Keywords: Amnion; Transplantation, heterotopic; Corneal diseases

PURPOSE: To assess evaluate the accuracy of intravitreal drug administration in the treatment of endophthalmitis and to suggest a reproducible and accessible technique for this procedure. METHODS: To assess the retained volumes in needles used for the intravitreal injection of antibiotics using an analytical scale. RESULTS: Means and standard deviations of retained volumes in the 26, 22 ( 25 x 0.7 mm and 30 x 0.7 mm ) and 18 G were respectively 0.051±0.006, 0.056±0.005, 0.055±0.004 and 0.075±0.004 for needles Ryncos® and 0.050±0.003, 0.056±0.002, 0.063±0.002 and 0.084±0.004 for Becton-Dickinson®. There were statistically significant differences in the retained volumes between the two needle brands for 26, 22 (30 x 0.7 mm) and 18 G needles with p = 0.01, p < 0.01 and p < 0.01 respectively. No difference was found only for 25 x 0.7 mm 22 G needle with p = 0.83. CONCLUSION: Most needles used for intravitreal injection hold a retained volume in the reserve needle compartment that should be considered during the injection technique, therefore minimizing errors during intravitreal injection of antibiotics.

Keywords: Endophthalmitis; Vitreous body; Antibiotics; Injections; Medication errors

PURPOSE: To determine associations between degrees of severity and topographical patterns of keratoconus with fitted contact lenses (CL). METHODS: Retrospective study of 454 patients (881 eyes) with keratoconus, 746 fitted with contact lenses, from July 1996 to June 2000. Keratoconus was classified according to degrees of severity and topographical pattern. The first tested contact lens was the spherical rigid gas permeable. When it did not achieve the desired fitting, the bicurve rigid gas permeable and other designs were tried, in search of an apical clearance or slight apical touch fitting relationship. RESULTS: For 15 (3.3%) patients glasses were prescribed; 111 eyes (12.6%) remained uncorrected; 746 (84.68%) eyes were fitted with contact lenses; for 39 eyes (4.44%) of 39 patients (8.6%) penetrating keratoplasty was recommended. The most common degree of severity found was advanced (575 eyes - 66.86%), followed by the mild variety (160 eyes -18.6%). The average keratometric value of the flattest meridian (K) was 47.80 (±3.73) for the eyes fitted with soft CL; 49.03 (±3.7) for the spherical rigid gas permeable contact lenses; of 51.62 (±3.6) for the bicurve contact lenses and 51.14 (±3.5) for the piggyback system. Concerning the topographical pattern, the most frequent was inferior peripheral cone (436 eyes - 50.7%), followed by central asymmetrical cone (348 eyes - 40.46%). In the right eye, the analysis of the variables, topographical pattern and kind of fitted lens showed a statistically significant association (p=0.045) of toric soft contact lenses and piggyback system with a higher percentage of fittings in central cone. Concerning the rigid spherical and bicurve lenses, the fitting percentage was similar in relation to the found topographical pattern. In the left eye, statistically significant associations were not observed, only tendencies. CONCLUSION: Spherical contact lenses can be fitted to the majority of patients with keratoconus, but it is important to rely on other designs to fit the advanced and severe cases. This allows most patients to postpone the need for corneal transplant. Toric soft contact lenses and piggyback system were more frequently fitted to central cones; whereas in inferior peripheral cones, spherical and bicurve contact lenses were those more used.

Keywords: Keratoconus; Ocular accommodation; Contact lenses; Penetrating keratoplasty, Hydrophilic contact lenses; Corneal topography

PURPOSE: To determine normative data for full-field electroretinogram (ERG) in a healthy young adult group, according to the guidelines of a standard protocol recommended by the International Society for Clinical Electrophysiology of Vision (ISCEV). METHODS: A group of 42 healthy normal volunteers aged from 15 to 26 years (mean=20.8 ± 2.9 years) was recruited. Full-field electroretinogram (ERG) was recorded using a bipolar contact lens electrode according to the International Society for Clinical Electrophysiology of Vision standard protocol, including the following responses: a) scotopic rod response; b) scotopic maximal response; c) scotopic response for oscillatory potentials; d) photopic single-flash cone response and e) photopic 30 Hz flicker for cone response. RESULTS: Mean (± 1 SD) peak-to-peak amplitude was 241.1 ± 66.9 µV for rod response; 385.4 ± 71.8 µV for maximal response; 180.6 ± 48.6 µV for oscillatory potentials; 102.6 ± 36.3 µV for single-flash cone response and 69.2 ± 26.6 µV for light adapted 30 Hz flicker response. Mean b-wave implicit time was 85.2 ± 7.6 ms for rod response; 45.6 ± 2.0 ms for maximal response; 27.8 ± 1.2 ms for single-flash cone response and 27.9 ± 1.2 ms for 30 Hz flicker response. Comparable values were obtained from males and females, but the scotopic maximal response of females showed statistically larger amplitudes (t=2.06; P=0.04). CONCLUSIONS: The results obtained in this study are comparable to those previously reported in the literature and will be helpful to evaluate patients with several retinal disorders. Inclusion of other age groups will provide extended normative data.

Keywords: Electroretinography; Reference values; Adult

PURPOSE: To determine the safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK), three years after surgery, to correct high myopia or high myopic astigmatism in children with high anisometropia in whom conventional treatments had failed. METHODS: Nine eyes of 9 patients, 3 boys and 6 girls with a mean age of 11.5 years (range, 8 to 15 years) underwent LASIK using the Chiron Technolas 217 excimer laser. Minimum follow-up was 36 months. RESULTS: Three years after LASIK, uncorrected visual acuity improved by at least five Snellen lines in all eyes; five eyes (55.5%) were 20/50 or better without correction. Six eyes (66.6%), were 20/50 or better with correction and five eyes (55.5%) improved at least 1 line in the best spectacle corrected visual acuity (BSCVA). Due to amblyopia, no eye had uncorrected visual acuity of 20/20 or better. The mean spherical refraction equivalent decreased from -7.66 (± 3.75) D to -1.02 (± 1.26) D, and mean preoperative astigmatism decreased from -3.11 (± 2.09) D to -0.75 (± 0.25) D. Highest anisometropia was 1.5 D. CONCLUSION: Three years after surgery, LASIK seems to be a safe and effective option for the correction of high anisometropia in children from 8 to 15 years old, in whom conventional therapy had failed. The natural change in refraction related to maturation did not affect the use of appropriate spectacle correction.

Keywords: Keratomileusis laser in situ; Myopia; Astigmatism; Treatment outcome; Adolescence; Child

PURPOSE: To study cataract prevalence in rheumatic patients who used corticosteroid chronically and to correlate it with time and total corticosteroid dose as well as with the disease that required such treatment. METHODS: We studied 27 rheumatic patients regarding cataract using slit lamp and calculated the total dose of prednisone or equivalent steroids as well as the treatment time. RESULTS: We found an 18.52% prevalence and no correlation with cumulative dose (p=0.231) or with the underlying disease. Although the time of treatment was longer in the group with cataract, no statistically significant difference could be found (p=0.694). CONCLUSION: The authors conclude that cataract is a relativelly common complication of steroid use and that further studies are needed to understand the pathophysiologic process of its formation.

Keywords: Cataract; Cataract; Rheumatic diseases; Rheumatoid arthritis; Adrenal cortex hormones; Adrenal cortex hormones; Drug tolerance

PURPOSE: To evaluate the skills of postgraduation students of São Paulo University to correct Portuguese errors contained in given sentences. METHODS: The students were asked to make corrections in 18 fictitious sentences. RESULTS: 30 students answered the test, having made 92 mistakes. The average number of mistakes made per student was 3.066. CONCLUSION: One quarter of the students presented poor results in the correction of written Portuguese texts.

Keywords: Writing; Language; Verbal behavior; Handwriting; Language tests; Undergraduate education medical; Ophthalmology

In developing countries blindness prevalence could be reduced if access to ophthalmic assistance for the population were not impaired by the lack of organization of the resources. Besides the primary level, organization of ocular care establishes secondary and tertiary care levels, according to the complexity of the diagnosis and treatment of the ocular diseases. The Ophthalmic Secondary Reference Center (CERESO) of the Department of Ophthalmology, Federal University of São Paulo, according to an internal flow model of assistance, selects cases of low complexity to be seen on the same day, the others being referred to the tertiary level. PURPOSE: To evaluate CERESO's resolution and its user's satisfaction. METHODS: By means of applying a questionnaire based on the resolution of the main complaint and for the client's satisfaction, a sample of 238 users was interviewed from February to July, 1998. RESULTS: CERESO's resolution degree was 85.96%; the user's satisfaction was 100%; 6.8% of the users chose CERESO because it was close to their homes; 21.3% because they could be seen on the same day; 13.9% because they were already UNIFESP patients and 58.1% because they like UNIFESP or were indicated by another patient. CONCLUSIONS: The customers were very pleased with the assistance they were given, and their major aims were achieved. The organization of the ophthalmological services, with the secondary care service establishment, would certainly have a positive impact on the solution of ophthalmic problems - especially refractive errors. For this reason, this organization would case an important public health problem.

Keywords: Blindness; Health care levels; School health; Outcome and process assessment (health care); Health care quality assurance; Patient satisfaction; Health services; Delivery of health care

PURPOSE: To study the meaning of visual acuity evaluation in ocular health programs for the early detection of ophthalmic disorders. METHODS: In this cross-sectional descriptive survey, schoolchildren of 21 elementary schools of Pelotas, RS were evaluated. Age, sex, awareness about own vision, wearing glasses or contact lenses were recorded by application of a questionnaire. Visual acuity (VA) was assessed with Snellen E optotypes. Children with VA< 0.7 or symptoms of eye problems were referred to the specialist for a detailed ophthalmologic examination. RESULTS: Of the 1502 schoolchildren included in the research, 774 (51.5%) were male. The majority, 1328 (88.41%), was aged from 6 to 8 years. Approximately 90% of the children believed to have a good vision. VA of 227 children (15.1%) was below standard. Of them, 124 (54.6%) were female. Of those who thought they had no visual problem, 193 (14.23%) were referred to an ophthalmologist. CONCLUSION: Results of this study stress the importance of VA screening. The main purpose of ocular health campaigns consists of helping children to develop their full potentialities.

Keywords: Visual acuity; Eye health; Vision screening; Prevalence; Schoolchildren

PURPOSE: Epiphora in patients with a patent lacrimal system as demonstrated by dacryocystography is still a challenge to the specialist, mainly in the absence of reflex tearing, external ocular diseases or lid diseases. In these patients, with probable incomplete obstructions, we wanted to evaluate the results of endoscopic endonasal dacryocystorhinostomy. METHODS: Twelve of these patients were treated with endonasal dacryocystorhinostomy. RESULTS: Seven of the patients became free of epiphora and three patients had their condition significantly improved. CONCLUSION: With no abnormalities of eyelids and puncta, endonasal endoscopic dacryocystorhinostomy is a valid treatment option for tearing with dacryocystographic patency.

Keywords: Dacryocystorhinostomy; Lacrimal apparatus diseases; Lacrimal duct obstruction; Nasolacrimal duct; Minimally invasive surgical procedures

PURPOSE: To determine the frequency of diagnostic categories obtained in a clinical vision electrophysiology laboratory at a university hospital. METHODS: Patients who underwent visual electrodiagnostic testing from October 1998 to October 2000 (N=570) were cross-sectionally studied. Electroretinogram (ERG) was performed in 385 (68%) patients and pattern and/or flash visually evoked potentials were performed in 185 (32%) patients. RESULTS: After electroretinogram assessment, the most frequently identified diagnostic categories were (in this order): retinitis pigmentosa, Stargardt's disease, cone dystrophy, cone-rod degeneration, retinotoxic effects due to several agents (chloroquine, tamoxifen, methanol, etc) and ocular trauma, besides unclear visual loss. In 23% of the cases, it was impossible to obtain a final diagnosis on the first examination. The largest group referred to electroretinogram testing was for documentation or exclusion of tapetoretinal degenerations (42%). In this group, 110 cases of RP were identified: 91 isolated and 19 syndromic cases. Visually evoked potential testing helped to identify the following diagnostic categories: diseases affecting only the optic nerve (optic nerve atrophy, optic neuritis, optic disk edema, etc); neurological conditions affecting the visual pathway (multiple sclerosis, cerebral palsy, blunt head trauma, tumors, etc): pediatric eye and/or neurological conditions (congenital cataract, cortical visual impairment, congenital glaucoma, etc) and opaque media (leucoma, ocular trauma, etc). CONCLUSIONS: Frequent and meaningful indications for visual electrophysiologic recording and diagnostic decisions arise from this relatively large group of studied patients. A number of diagnoses can hardly, if not all, be established without visual electrophysiologic testing. These include early stages of retinitis pigmentosa, progressive cone dystrophy, toxic retinopathy without fundus changes, optic nerve or retinal dysfunction in opaque media, optic nerve involvement in multiple sclerosis and pediatric eye disease with or without neurological damage.

Keywords: Retina; Visual evoked potentials; Vision; Electrophysiology; Vision tests; Retinal diseases; Retinitis pigmentosa

PURPOSE: To analyze the changes in corneal sensitivity and tear secretion after "laser in situ keratomileusis" (LASIK). METHODS: Thirty-eight eyes from nineteen patients, 9 men and 10 women, were submitted to myopic LASIK. The mean spherical equivalent before surgery was -3.79D (± 1.29). Corneal sensitivity was measured with a Cochet-Bonnet esthesiometer in the central region of the cornea. Tear secretion was evaluated by the Schirmer test, basal secretion, breakup time test and symptoms. Examinations were performed before and 7, 30, 90, 180, and 270 days after surgery, or until full recovery. RESULTS: Median preoperative corneal sensitivity was 60 mm (range, 50 to 60 mm); median Schirmer test was 21.5 mm (range, 10 to 30 mm); median basal secretion was 11.5 mm (range, 6 to 20 mm); median breakup time test was 16.0 seconds (range, 8 to 22 seconds). All patients recovered their preoperative corneal sensitivity and tear secretion values between 90 to 180 days after surgery. During 9 months of follow-up, 5 patients (10 eyes) did not present any dry eye symptom. CONCLUSION: After LASIK, the corneal sensitivity and tear secretion are decreased as long as for 6 months. During the postoperative period, 73.6% of the patients had dry eye symptoms. Further studies are required to best evaluate the effects on the corneal physiology.

Keywords: Myopia; Laser in situ keratomileusis; Postoperative complications; Dry eye syndromes; Tears; Cornea

PURPOSE: To evaluate safety and efficacy of limbal delamination management for post-keratoplasty astigmatism correction. METHODS: Five patients, three women and two men, between 21 and 42 years old, who showed refractive errors with a transparent cornea after penetrating keratoplasty were submitted to the technique. RESULTS: After a 12-month follow-up the graft remained transparent. Astigmatism was reduced to an average of 3.80 cylindric dioptries. CONCLUSION: Limbal delamination management seems to be an effective technique to correct astigmatism after successful penetrating keratoplasty.

Keywords: Penetrating keratoplasty; Astigmatism; Astigmatism; Cornea; Corneal topography

PURPOSE: To evaluate the ophthalmologic profile of "Alfabetização Solidária" - a program that teaches illiterate adults how to read and write; to identify the main causes of low visual acuity; to show our experience and the main results of promoting visual health in the community. METHODS: Ophthalmologic equipment (two automatic refractors, two Green refractors, two supports, two chairs, four ophthalmoscopes, one portable slit lamp, two applanation tonometers, one indirect ophthalmoscope. PARTICIPANTS: Teachers trained to assess visual acuity, ophthalmologists and residents in Ophthalmology, auxiliary personnel and secretaries. RESULTS: We observed that almost half of the students (46%) showed visual acuity equal to or below 0.8 in both eyes; 81.4% of the population needed optic correction and 37% needed corrective lenses for presbyopia. The majority of the population was between 41 and 50 years old, 56% of the students were female. Thirty-eight percent of the students showed some ophthalmologic pathology. We found that pterygium and cataracts were the most frequent. CONCLUSION: The program should include as prerequisite an ophthalmologic examination of each student prior to enrollment for best results.

Keywords: Visual acuity; Refraction; ocular; Cataract; Pterygium; Underachievement; Education

PURPOSE: To compare distant and near visual acuity between patients submitted to bilateral nonsimultaneous facoemulsification and implantation of multifocal or monofocal intraocular lenses (IOL). METHODS: Twenty patients with bilateral multifocal IOL and 20 patients with monofocal IOL with best corrected visual acuity (BCVA) of 20/30 or better, in separate measurements, within the first 3 months after surgery. Distant and near visual acuities with and without correction, contrast sensitivity and glare test were registered. RESULTS: The uncorrected distant visual acuity of the monofocal group had a mean of 0.82 (SD±0.16) and 0.9 (SD ±0.12) in the multifocal group, p-value 0,001. Both groups had BCVA of 1. In the multifocal group, 75% had Jaegger (J) 1 and 100% had J3 or better for uncorrected near visual acuity (UNVA). In the monofocal group 10% had J1 and 70% had J3 or better for UNVA. There was no significant difference between both groups regarding the contrast sensitivity test. Both groups had vision reduction in the glare test, which was more pronounced in the multifocal group. CONCLUSIONS: The corrected distant visual acuity in the multifocal and monofocal groups showed to be similar, although UNVA in the multifocal group was better than in the monofocal group. The contrast sensitivity test showed similar results in both groups, but the glare test showed more intense discomfort in the multifocal group.

Keywords: Visual acuity; Lens implantation; Lenses; Phacoemulsification; Adult

PURPOSE: To compare the results of "laser in situ keratomileusis" (LASIK) and "photorefractive keratectomy" (PRK) to correct myopia and astigmatism in eyes previously submitted to retinal detachment (RD) surgery with scleral "buckle". METHODS: Twenty-five eyes of 22 patients submitted to scleral buckling procedure with significant refraction changes after surgery were evaluated. Fourteen eyes of 13 patients underwent LASIK and 11 eyes of 9 patients underwent PRK. Minimum time between RD surgery and refractive surgery was 12 months. All patients were followed-up for at least 12 months. RESULTS: Twelve months after surgery, mean spherical equivalent in the LASIK group changed from -6.49D preoperatively to -0.17D and mean astigmatism decreased from -1.10D to -0.23D. Spherical equivalent in the PRK group decreased from -5.35D before surgery to +0,02D and average astigmatism changed from -1.38D to -0.54D. In both groups, uncorrected visual acuity (UCVA) improved at least 4 lines in 11 eyes. CONCLUSION: Both LASIK and PRK were safe and effective to correct refractive error after RD surgery. Our results showed no significant difference between procedures. Further studies with more patients and long-term follow-up are required to better evaluate the effects of refractive surgery in patients submitted to scleral buckling procedure.

Keywords: Keratomileusis laser in situ; Keratectomy photorefractive excimer laser; Retinal detachment; Myopia; Astigmatism; Adult

PURPOSE: To report a case of a patient with lung carcinoma in which the first detected metastasis was to the choroid, how it was diagnosed and confirmed. METHODS: A 35 year-old white male, while being treated for a solitary pulmonary condensation, reported sudden loss of vision, pain, discharge and red eye (right eye) for 10 days. During the ophthalmic examination a nonregmatogenous retinal detachment as well as multiple choroidal tumors were confirmed by diagnostic ocular ultrasound. Fine-needle aspiration biopsy (FNAB) was suggested to diagnose a possible metastatic disease. Fine-needle aspiration biopsy was performed under peribulbar anesthesia with sedation. A transvitreous route was chosen through a sclerotomy 4 mm from the limbus. The procedure was monitored via binocular indirect ophthalmoscopy. Two sample aspirates were obtained from different tumour foci. After fine-needle aspiration biopsy, the aspirates were sent for processing, fixation and stained with Papanicolaou and HE. RESULTS: Cytology confirmed the diagnosis of multiple metastatic tumors. Immunocytochemistry of ocular and lung aspirates revealed a common cell origin by a pankeratin (AE1/AE3) positive test. Regardless of systemic treatment with chemotherapy and improvement of the ocular status, the patient died 4 months after cytological diagnosis of metastatic carcinoma of the choroid. CONCLUSIONS: Fine-needle aspiration biopsy was efficient to diagnose and correlate ocular cytology with the primary tumor by imunohistochemical methods in this case. Fine-needle aspiration biopsy should still be used only in selected cases and further research will be necessary for it to become a standard diagnostic procedure in ophthalmology.

Keywords: Lung neoplasms; Choroid neoplasms; Choroid neoplasms; Immunohistochemistry; Ultrasonography; Needle biopsy; Eye; Carcinoma; Eye neoplasms; Hematoxylin; Eosine yellowish-(YS); Case report

PURPOSE: To describe 3 cases of children submitted to posterior subtenon steroid injection (PSSI) of triamcinolone acetonide (Kenalog® 40mg) for the treatment of intermediate uveitis, with development of refractory glaucoma. METHODS: Case report. RESULTS: Three children with the diagnosis of intermediate uveitis were treated with PSSI of triamcinolone for the control of a chronic vitreous inflammation and/or cystoid macular edema. After treatment they developed refractory glaucoma and were submitted to surgery, for removal of the steroid deposit and/or filtering surgery to control the intraocular pressure (IOP). CONCLUSION: The use of PSSI can represent a high risk for development of secondary glaucoma, with difficult control in children. Surgery to remove the remaining steroid may control IOP, but in some cases filtering surgery may be necessary.

Keywords: Glaucoma; Uveitis intermediate; Uveitis intermediate; Case report; Children

PURPOSE: To report a case of Nocardia asteroides scleritis in a patient without risk factors for infeccious scleritis. METHODS: A 38-year old woman was initially examined for pain, discharge, photophobia of 1 month duration in her right eye. Her medical and ophthalmological history were unremarkable. The results of laboratory tests were normal. Surgical debridement of necrotic tissue was performed and material was sent for biopsy and culture confirmed as Nocardia asteroides. Treatment consisted of amikacin eyedrops, and systemic trimethropim-sulfamethoxazole. The infection resolved leaving scleral thinning and a subconjunctival fibrovascular scar. Best corrected visual acuity two months after referral had improved to LE, 20/20. CONCLUSION: Prompt evaluation and treatment is essential for successful management of Nocardia asteroides infectious scleritis.

Keywords: Scleritis; Scleritis; Scleritis; Nocardia asteroides; Eye infections; Ophthalmic solutions; Female; Case report

Aicardi Syndrome is a neuroretinal disorder of unknown etiology. The diagnosis is based on the finding of infantile seizures and chorioretinal lacunae associated with characteristic radiological alterations (agenesy of the corpus callosum). Till the present, all reported cases are in females, except one in a boy with a 47XXY karyotype; the children usually die before puberty. The objective is to describe a case of Aicardi syndrome. Chorioretinal lacunae are very important findings in this syndrome, considered pathognomonic in a young girl presenting seizures. The ophthalmologist has an important role in confirming the diagnosis of this syndrome.

Keywords: Eye abnormalities; Corpus callosum; Syndrome; Infantile spasms; Retina; Magnetic resonance imaging; X-ray computed tomography; Case report

PURPOSE: To describe a case of masquerade syndrome as the first manifestation of lung adenocarcinoma. METHODS: A 57- year-old female was referred with a 6-month history of blurred vision in her right eye. She was treated for relapsing uveitis but signs and symptons remained despite treatment with topical steroids. On physical examination she had conjuctival hyperemia, moderate cilliary injection and choroidal peripapillary lesion. Ancillary examinations were requested. RESULTS: A lung adenocacirnoma was diagnosed as the primary lesion. The choroidal peripapillary lesion in her right eye was consistent with the appearance of a choroidal metastatic lesion. CONCLUSIONS: The incidence of uveal metastasis ranges from 0.7 to 12% in patients with pulmonary tumors. Treatment depends on characteristics such as size of the lesion, number of metastases, visual acuity, bilaterality and the patient´s general health. As confirmed by this case, ocular involvement may be the first clinical manifestation of lung adenocarcinoma.

Keywords: Lung neoplasms; Adenocarcinoma; Choroid neoplasms; Neoplasm metastasis; Case report

Anterior uveitis describes a disease predominantly limited to the anterior segment of the eye. Conjunctival hyperemia, anterior chamber cell and flare, keratic precipitates, and iris abnormalities including posterior synechiae characterize the inflammation. This article discusses clinical aspects of the systemic diseases that cause anterior uveitis with review of the literature.

Keywords: Uveitis; Anterior uveitis; Anterior uveitis; Rheumatic diseases; Juvenile rheumatoid arthritis; Ocular toxoplasmosis; HLA-B27 antigen

Diabetic retinopathy (DR) is a chronic complication of diabetes mellitus (DM). After 20 years of diabetes duration Diabetic retinopathy, occurs in 90% of the type 1 diabetes mellitus patients and in 60% of the type 2 diabetes mellitus patients, being the main cause of blindness in adults. High glicemia and blood pressure levels, along with the long diabetes mellitus duration, are the main risk factors for diabetes mellitus Diabetic retinopathy. Other factors can also be associated with the loss of vision that occurs in diabetes mellitus. The risk factors can be classified as genetical or non-genetical, the latter including factors related or not to diabetes mellitus, environmental and ocular. Control of the known risk factors and effective treatment are the main basis of the Diabetic retinopathy management. The aim of this review is to provide to the ophthalmologist an up to date information of these factors, with emphasis in the preventive aspects of the visual loss in the patients with diabetes mellitus.

Keywords: Diabetes Mellitus; Diabetic retinopathy; Risk factors; Glucose tolerance test; Hypertension; Diabetic nephropathies; Low vision