VOLUME 66 - ISSUE 3

In this project we are developing an instrument for measuring the wave-front aberrations of the human eye using the Hartmann-Shack sensor. A laser source is directed towards the eye and its diffuse reflection at the retina generates an approximately spherical wave-front inside the eye. This wave-front travels through the different components of the eye (vitreous humor, lens, aqueous humor, and cornea) and then leaves the eye carrying information about the aberrations caused by these components. Outside the eye there is an optical system composed of an array of microlenses and a CCD camera. The wave-front hits the microlens array and forms a pattern of spots at the CCD plane. Image processing algorithms detect the center of mass of each spot and this information is used to calculate the exact wave-front surface using least squares approximation by Zernike polynomials. We describe here the details of the first phase of this project, i. e., the construction of the first generation of prototype instruments and preliminary results for an artificial eye calibrated with different ametropias, i. e., myopia, hyperopia and astigmatism.

Keywords: Corneal topography; Ophthalmological diagnostic techniques; Astigmatism; Equipment design; Optometry; Retina; Computer-assisted image processing

PURPOSE: Standardization of limbal stem cell culture of donor eyes from Eye Bank of the "Santa Casa de São Paulo". METHODS: a 4-mm² biopsy was taken from the remaning corneal-scleral ring of donor eyes, and cells obtained by dissociation were cultivated and incubated at 37° under 5% CO2 .The cells were observed during 21 days, evaluating their cell adhesion, morphology and multiplication. RESULTS: We observed cellular multiplication, morphology modification during 21 days, passing from round to polygonal form, as in vivo. CONCLUSION: This experiment showed that culture of human limbal stem cells in vitro can be performed.

Keywords: Cultured cells; Epithelial cells; Limbus corneae; Corneal epithelium; Cell adhesion; Cornea; Cell transplantation

PURPOSE: To identify the main complications and causes of penetrating keratoplasty failure in interventions performed at Fundação Altino Ventura, Recife-PE. METHODS: Medical records of 205 patients submitted to penetrating keratoplasty at the Fundação Altino Ventura, between January 1999 and December 2000, and with a follow-up after surgery of at least six months were revised. We analyzed demographic and other associated data from the pre, inter and post intervention periods. RESULTS: The average age of patients was 48.4 ± 22.1 years, 108 (52.7%) being female. The main indications for penetrating keratoplasty were keratoconus (49 cases, 23.9%), bullous keratopathy after cataract extraction (48 cases, 23.4%) and dystrophies (24 cases, 11.7%). The most common post-surgery complication was glaucoma in 65 cases (31.7%). Fifty patients (24.4%) presented some clinical sign of rejection, leading to graft failure in 13 cases (26.0%). It was observed that 16.0% (n=8) of the patients with graft rejection had been submitted to at least three interventions, which shows a statistically significant difference from the group which showed no rejection (3.2%, n=5) (p<0.05). Forty-five (22.0%) cases developed corneal graft failure. CONCLUSION: The risk factors for graft failure identified in this study match those reported in the literature. Glaucoma was the main post-surgery complication and the main predisposing factor for rejection and graft failure.

Keywords: Keratoplasty penetrating; Post-operative complications; Treatment outcome

PURPOSE: To evaluate ocular toxicity of povidone-iodine eye drops at a concentration of 2.5% and 0.5% and to investigate the effects on corneal epithelial wound healing and histopathological alterations. METHODS: Each group (PVP-I 2.5% and 0.5%) consisted of 20 rabbits. A central circular corneal epithelial defect of 6.5 mm diameter was created and the povidone-iodine eyedrops (2.5% and 0.5) instilled in the right eye and distilled water in the left eye (control) of each rabbit, every hour, during 3 days. Biomicroscopical examinations were performed every day, focussing on the corneoconjunctival surface and the diameter of the lesion, using fluoresceine eye drops, photodocumentation, and a computerized image analyzer. After the third day the rabbits were sacrified and the excised corneas histopathologically evaluated. Statistical evaluation was performed using Friedman, Mann-Witney, Wilcoxon, Fisher and Chi-squared tests. RESULTS: Povidone-iodine eye drops, at a concentration of 2.5%, caused an increase in the wound healing time (p= 0.087) and conjuntivitis in 100% of the eyes with mucous secretion in 80%, punctate ceratitis in 40%, and discrete stromal edema in 10% of the cases. The histopathological examination showed corneal ulcers and vacuolic degeneration of the endothelial layer in 100%, as well as an inflammatory infiltrate with eosinophils in 80% of the cases. The eyes treated with povidone-iodine eye drops at a concentration of 0.5% and the control eyes showed complete epithelial wound healing after 72 hours, and histopathologically normal epithelization. Only in one case, a discrete perilimbar leucocytic infiltrate was observed. CONCLUSION: The ocular toxicity of povidone-iodine eye drops is concentration-dependent. The use of the eye drop at a concentration of 2.5% is not adequate for daily and repetitive use. In contrast, at a concentration of 0.5% no toxicity was observed.

Keywords: Povidone-iodine; Ophthalmic solutions; Epithelium corneal; Conjunctiva; Animal experimentation; Rabbits

PURPOSE: To determine the effects of posterior subtenon steroid injection (PSSI) according to intraocular pressure and visual acuity, in patients with uveitis. METHODS: Eighteen patients with diagnosis of uveitis were analized and submitted to posterior subtenon steroid injection of triancinolone acetonide (Kenalog® 40mg - 9 patients, 14 injections) or of methyl- prednisolone acetate (Depomedrol® 40mg - 9 patients, 15 in- jections) for the treatment of chronic eye inflammation or cystoid macular edema. RESULTS: Final visual acuity improved in 92% of the patients after the first injection; 50% improved one line, and 42% improved at least three lines. The mean time for improvement was three weeks. Increase of IOP occurred in 44% of the patients (8 patients), who showed a mean intraocular pressure of 31 mmHg and a range of 21 to 38 mmHg. It was more frequent among young patients, and in the Kenalog® group, with onset after 2.5 weeks on average. CONCLUSION: A subtenoninjection of corticosteroids appears to be an effective treatment for decreased vision associated with some types of uveitis, such as intermediate uveitis, Behçet's disease, Vogt-Koyanagi-Harada syndrome, retinal vasculitis and rheumatoid arthritis. However, it may contribute to increase in intraocular pressure in some cases, specially in children and young patients.

Keywords: Uveitis; Injections; Adrenal cortex hormones; Visual acuity; Glaucoma; Intraocular pressure; Cystoid macular edema; Triamcinolone

PURPOSE: To evaluate visual function by full-field electroretinography (ERG) and visual acuity in patients with cone dystrophy. METHODS: 23 (7 male and 16 female) patients with suspicion of cone dystrophy were evaluated at the Clinical Electrophysiology of Vision Laboratory of the Universidade Federal de São Paulo. Inclusion criteria were: clinical history, visual acuity measured by ETDRS or Snellen charts and retinal function assessed by full-field electroretinography. The peak-to-peak amplitude and b-wave implicit time values were compared with previously published age norms. RESULTS: Visual acuity measurement in the best eye ranged from 0.07 to 3.00 logMAR (HM to 20/25) with mean VA of 0.85±0.64 logMAR (20/140). Mean peak-to-peak amplitude for scotopic rod-response was 144.29±80.05 µV (normal for age) and mean of implicit time was 92.85±9.02 ms (normal for age). Mean peak-to-peak amplitude for single-flash cone response was 5.06±8.59 µV (reduced for age) and mean implicit time was 43.4±14.4ms (reduced for age) for detectable responses; for 30 Hz-flicker mean amplitude was 5.00±9.00 µV (reduced for age) and the mean of implicit time was 34.9±10.9 ms (reduced for age). CONCLUSION: Mean visual acuity was 0.85 logMAR (20/140) in this group of patients with cone dystrophy. Photophobia was the main complaint, followed by decreased vision and defective colour vision. Ten of 23 (10/23) patients had their final diagnosis only after full-field electroretinography recording, since the fundus examination was normal.

Keywords: Electroretinography; Cones (retina); Colour perception; Visual acuity; Low vision

OBJECTIVE: To evaluate the learning effect, short-term fluctuation and long-term fluctuation in healthy subjects undergoing frequency doubling perimetry (FDP). METHODS: Twenty healthy young subjects underwent FDT (program N30, full threshold) in one eye (right). Each subject was tested once in the first three sessions and three times in the fourth session. Both short- and long-term fluctuations were studied as the average fluctuation of all the tested points or as a point-to-point fluctuation. To study the learning effect, the MDs values of the first session were compared to the second, third and fourth sessions. RESULTS: In the short-term analysis (3 examination done in the last session), the total mean sensitivity was 31.91 ± 1.20 dB and the mean MD and PSD were 0.84 ± 1.85 and 3.73 ± 1.55 dB, respectively. The average short-term fluctuation was 1.72 ± 0.38 dB. When the four examination, performed at different visits, were compared, the average mean sensitivity of all sessions and the average long-term fluctuation were 31.75 ± 1.11 and 2.16 ± 0.26 dB, respectively. The MD averages of the first, second, third and fourth tests were 0.11 ± 2.14 dB, 0.47 ± 1.64 dB, 1.16 ± 1.62 dB and 0.98 ± 1.92 dB respectively. The MD difference between the first and the third and between the first and the fourth examinations were statistically significant (p<0.05). CONCLUSION: The threshold sensitivity detected by FDP is influenced by both short- and long-term fluctuations. We observed a mild learning effect that shoud be taken into account whenever a patient undergoes this test for the first time.

Keywords: Perimetry; Visual fields; Learning

PURPOSE: To accomplish a histopathological analysis of ocular structures, that is, uveal and retinal tract in a murine model that closely resembles human cerebral malaria and to correlate the ocular alterations with findings in the target organ such as the brain. METHODS: We used mice of isogenic lineage (CBA/J) for they develop malaria, actually the neurological form (cerebral malaria) when inoculated with Plasmodium berghei (ANKA). We performed an intraperitoneal inoculation and parasitemia was obtained daily. To correlate the changes with malaria development, the mice were sacrificed on the 3th, 7th and 9 th day of infection. After the enucleation, the eyeball was fixed in Bouin solution for later inclusion in paraffin. The obtained sections were stained with hematoxylin and eosin, Gomori's trichrome and Giemsa. RESULTS: Malarial pigments (hemozoyn) were observed in several ocular structures in the initial phase of the disease, also endothelial changes in retinal vessels, monocyte adhesion and parasitized erythrocyte clogging of retinal and choroid vessels (sequestration) in the latest stage of infection. Parasitemia levels showed an ascending and critical curve by the seventh day. In this model we observed similar changes that occur in other organs, such as the brain. CONCLUSION: The malaria murine model permits correlation of the ocular features with those other of target organs. The sequestration of late stage parasitized red cells accounts for most ocular changes in malaria, probably on the basis of obstructive phenomena, similar to the process which involves the central nervous system.

Keywords: Malaria; Malaria; Cerebral malaria; Plasmodium berghei; Eye; Retinal hemorrhage; Retinal diseases; Parasitic eye infections; Mice

PURPOSES: 1) To verify the impact of the creation of the Single Technical Record (STR) at the University of Campinas (Unicamp) Hospital das Clínicas, on the preservation period of corneas which were used in elective penetrating keratoplasties, and 2) to compare the primary failure incidence in cornea penetrating keratoplasties regarding the periods before and after the creation of STR. METHODS: A retrospective study was conducted at the Unicamp Hospital, which evaluated 15 consecutive cornea penetrating keratoplasties between January 1st and April 30th, 2000 and 24 consecutive penetrating keratoplasties between May 1st and September 20th of the same year (corneas under the control of the STR), totaling 39 keratoplasties. RESULTS: The mean time between cornea preparation and transplantation was 3.8 days (±1.78) in the period before STR creation, and 6.0 days (±2.97) after STR creation, representing a 36.7% increase in the preservation time. There was a statistically significant difference (p=0.02) between the two groups. No corneal primary failure was observed among the 39 transplanted patients in both groups. CONCLUSION: Based on the results of this study, it can be concluded that this new concept of the State Transplantation System has caused a statistically significant increase in the conservation period of corneas, which may reduce the period of a clear transplant due to an increased loss of endothelial cells, as well as increase the primary failure incidence or result in a high number of corneas that cannot be used due to having exceeded the preservation time recommended by the literature.

Keywords: Tissue preservation; Corneal transplantation; Tissue banks; Hospital information systems; Tissue donors

OBJECTIVE: To analyze the efficacy of the panoramic viewing system (PVS) Reinverting Operating Lens System (ROLS) and the plano-concave Landers lens system in pars plana vitectomy (PPV). METHODS: The authors retrospectively analyzed the records of 117 PPV, 87 patients, performed between December 1996 and August 1998. The PPV was divided into two groups. Group 1 included 54 surgeries, with the Landers system. Group 2 included 63 surgeries with the ROLS. RESULTS: There were no statistical significant differences between the two groups, regarding pre and postoperative parameters. Surgeries employing the Landers system had an average time significantly higher than the ROLS group (p<0.001). When the surgical time was analyzed according to the disease, surgeries lasted significantly longer when the Landers system was used (p<0.05), except for the Uveitis group (p= 0.262). Surgeries in group 2 required less air-fluid and lens exchanges, less use of perfluorocarbon liquid (PFCL), and less need for scleral depression during the procedure. CONCLUSION: The use of ROLS significantly reduced the time for PPV, lowering the need for air-fluid exchange, lens exchange, PFCL use, and scleral depression. The PVS ROLS offered several advantages over the Landers plano-concave lens system during the surgery, without changing the final results.

Keywords: Vitrectomy; Ophthalmologic surgical procedures; Retinal diseases

PURPOSE: To analyze the effects of chronic ethanol intake on the optic nerve in an adult rat model. METHODS: Twelve male, 30-day-old Wistar rats were randomly divided into 2 experimental groups: "treated" (TG), with 8 animals, fed standard laboratory rodent chow and a mixture of tap water and ethanol ad libitum; and "control" (CG), with 4 animals, fed the same chow and pure tap water ad libitum. After 40 weeks all rats were sacrificed, having their optic nerves prepared for both licht and electron microscopy. The cross-sectional area of each nerve, at a magnification of ´500, as well as the number of axons within 5 randomized field areas, at a magnification of ´2000, were measured by using an image digitizer. Randomized sampling was made for taking 10 photomicrographs of each nerve (5 central and 5 peripheral) at a magnification of ´4200 in a transmission electron microscope. RESULTS: Morphometric analysis showed no significant differences between both groups. In contrast with CG, the ultrastructural examination of TG optic nerves showed severe disarrangement of myelin sheaths, which became thicker, with separation of their lamellae, presenting sometimes electron-dense degenerations between them, and also many degenerated organellae. CONCLUSION: Our findings show ultrastructural alterations in the optic nerve of adult rats following chronic ethanol consumption, without morphometric changes.

Keywords: Optic nerve; Optical nerve; Microscopy, electron; Ethanol; Rats

The aim of blepharoplasty in young Asian patients is to create a superior palpebral fold. There are several surgical techniques to create double eyelids in Asian patients, and these techniques may be separated into two groups: cutting-type double eyelid surgery and non-incisional techniques or minimal incision techniques. PURPOSE: This paper will report the peculiarities of the non-incisional technique and emphasize the importance of pre-surgical planning. METHODS: From January 1989 to January 2002 (13 years), the authors have performed 647 cases using the non-incisional technique. Since 1996, when they began using only two sutures at the upper eyelid, 303 cases were performed (47,60%). The patients were followed-up for a period of 2 years. RESULTS: The results were considered very satisfactory albeit the fact 19 patients (2,93%) underwent reoperations due to fold assymetry and 12 cases (1.85%) due to a complaint of narrow and barely visible folds. During the presurgical planning the shape of the fold and number of sutures were determined taking into account the thickness of the eyelid skin. 97.84% of the patients desired the fold beginning at the epichantal fold, for this procedure yields the most natural results. CONCLUSION: The authors conclude that the technique is relatively simple and reproducible, is safer and presents longer-lasting results. However, indication for the procedure should be precise, and presurgical planning is the cornerstone for obtaining good results.

Keywords: Eyelids; Blepharoplasty; Surgery, plastic; Japan

PURPOSE: Determination of transmittance curves through spetrophotometric measurementes of color filtering lenses submitted to UVA and light visible radiation, and comparison of the results in the band between 320 and 800 nanometres (nm). METHODS: The filtering color of Danny yellow 1, orange, green and grey and Rio de Janeiro yellow 2 lenses have been analyzed using JEM Way model 6.400 spectrophotometer. RESULTS: All lenses showed distinct and variable transmittance in the spectrum of UVA and light visible radiation. In the bands between 320 and 400 nm all lenses showed less than 4% of transmittance. The yellow 1 showed the greatest average (3.7%) while the grey lens showed the smallest average (0.45%). Nevertheless no statistical differences were observed between those lenses. We analyzed the transmittance curve in three different lens positions and no statistically significant differences were found. CONCLUSION: Spectrophotometric properties need to be determined in order to indicate color-filtering lenses with safety. The capacity of filtering light radiation is more important than the fact of being colored or not.

Keywords: Hydrophilic contact lenses; Ultraviolet spectrophotometry; Eye protective devices; Intraocular lenses; Ultraviolet rays; Radiation; Retina; Light

PURPOSE: To correlate the cytologic findings of fine-needle aspiration biopsy (FNAB) of intraocular tumors with the histopathology specimen when enucleation or tumor resection was the treatment of choice. METHODS: Retrospective analysis of 51 patientssubmitted tofine-needle aspiration biopsy for diagnostic purposes or cyto-histologic correlation. Exclusion criteria were non-solid lesions, conservative treatment and ultrasound guided biopsies. After exclusions, 20 patients with intraocular solid lesions suspected to be malignant were studied, 12 of them were females, with ages between 2 and 78 years. All biopsies were performed by the first author under direct (operating microscope) or indirect (binocular indirect ophthalmoscope) visualization. The chosen route was transaqueous for anterior segment tumors and transvitreous through the sclera for posterior segment tumors except cases with suspicion of retinoblastoma biopsied through the peripheral cornea. Two samples were obtained from different areas of the tumor, in all cases with a 25-gauge needle. After fine-needle aspiration biopsy, samples were sent for processing, fixation, and staining with the Papanicolaou and hematoxylin-eosin (HE) methods. Histology specimens were stained with hematoxylin-eosin. RESULTS: Three cases consisted of anterior segment (iris) tumors and 17 of tumors situated in the posterior segment, 3 of them retinoblastomas. Nine patients were biopsied for diagnostic purposes and 11 for cytological-histological correlation after enucleation. In only two cases, fine-needle aspiration biopsy yielded insufficient material for diagnosis that subsequently proved to be a granuloma and a melanoma. CONCLUSIONS: Fine-needle aspiration biopsy seems to be a reliable procedure based on cytological-histological correlations in the studied group.

Keywords: Needle biopsy; Eye; Choroid neoplasms; Uveal neoplasms; Melanoma; Retinoblastoma

PURPOSE: Toreport our experience of the use of cyanoacrylate adhesive in 22 cases of corneal perforations and thinning, describing the used technique. METHODS: The study consisted of 22 eyes from 22 patients with corneal thinning and perforations from October 1998, to April 2000. All cases were treated with cyanoacrylate adhesive (Super Bonder® - Loctite, Brazil) at the Department of Ophthalmology of the "Santa Casa de São Paulo", Brazil. We evaluated best corrected visual acuity (BCVA) before and after adhesive application, conditions that led to corneal thinning or perforation, measurement of thinning or perforation in millimeters, need for corneal patches or keratoplasty, number of applications, interval in which the adhesive was kept, and adverse reactions. RESULTS: BCVA remained unchanged in 15 (68%) cases. Regarding wound size, 63% were less than of a 2 mm diameter and the remaining had a diameter up to 3.2 mm. Infection was the most frequent (50%) indication for adhesive application. Twelve (54%) patients did not need surgical procedures to maintain ocular integrity (e.g. patch or keratoplasty). Eleven (50%) patients received only one application of cyanoacrylate. CONCLUSION: Application of cyanoacrylate as a tissue adhesive is a safe and easy method. It is very useful in maintaining ocular integrity after corneal perforations and thinning.

Keywords: Cyanoacrylates; Tissue adhesives; Corneal transplantation; Cornea

The authors describe the use of a teflon catheter as an intracanalicular stent in order to increase its accessability to ophthalmologists.The technique is based on the identification of the canalicular borders followed by the introduction of a teflon catheter (22 or 24) into the canalicular lumen. Three full-thickness sutures are placed at the canaliculum using a 8-0 mononylon or a 8-0 vicryl. This technique can be used in cases of non-complicated lacerations, in which catheterization is still possible.

Keywords: Eyelids; Lacrimal apparatus; Silicones; Suture techniques; Nasolacrimal duct; Methods; Intubation

PURPOSE: To study the incidence and risk factors (length of illness and arterial hypertension) for diabetic retinopathy in 1002 patients who were submitted to the diabetes program at the Onofre Lopes University Hospital from 1992 to 1995. METHODS: Retrospective study of patients diagnosed with diabetes mellitus referred by the university's diabetes Program to the Retina Department and were submitted to an ophthalmological examination, under the author's supervision, including: measurement of visual acuity, anterior and posterior biomicroscopy, Goldman applanation tonometry, and indirect ophthalmoscopy (tropicamide 1% + phenylephrine 10%) and analysis of the patients' records regarding length of disease and clinical arterial hypertension diagnosis. RESULTS: Of 1002 diabetic patients (in 24 fundoscopy was impossible to perform) 978 were divided into 4 groups: without diabetic retinopathy, 675 cases (69,01%); with non proliferative diabetic retinopathy, 207 cases (21,16%); with proliferative diabetic retinopathy, 70 cases (7,15%); and photocoagulated patients, 26 cases (2,65%). Of the total, 291 were males (29%) and 711 females (71%). These 4 groups were analyzed regarding gender, age, visual acuity, duration of the disease, presence of cataract and systemic hypertension.Concerning the type of diabetes, 95 were type I (9,4%), 870 were type II (86,8%), and in 37 cases (3,7%) the type of diabetes was not determined. CONCLUSION: It was shown that the longer patients had the disease, more likely they were to develop diabetic retinopathy and that hypertension systemic did not constitute a risk factor for the decrease of visual acuity in the hypertensive patients.

Keywords: Diabetes mellitus; D iabetic retinopathy; Primary health care; Blindness; Program evaluation

PURPOSE: To evaluate the incidence of eye posterior lesions in patients with tuberculosis in the Federal District, Brazil, and to identify the risk factors for the appearance of these lesions. METHODS: In a prospective study, indirect binocular ophthalmoscopy was performed in 292 patients with systemic tuberculosis. These patients were examined in five different Regional Hospitals of the Federal District, between August 1st, 1997 and July 30th, 1998. A multiple analysis was applied to identify associations between the variable "eye posterior lesion" and the variables "sex, age, bacilloscopy, HIV, tuberculosis site, patient hospitalization, duration of symptoms, origin of the patient and previous experience with treatment. RESULTS: The results showed a 5,5% incidence of posterior lesions in patients with tuberculosis. A multiple analysis showed that HIV co-infection, patient hospitalization and miliary tuberculosis were risk factors for the presence of eye posterior lesions. When these characteristics were simultaneously present, the probability of a patient to present these lesions was 66%. CONCLUSIONS: In the evaluation of the incidence of eye posterior lesions in patients with tuberculosis, certain individual characteristics should be taken in to account, since risk factors, such as HIV co-infection, miliary tuberculosis, and hospitalization, influenced the presence of these lesions.

Keywords: Tuberculosis; Fundus oculi; Choroid; Ocular tuberculosis; Miliary tuberculosis; Acquired immunodeficiency syndrome

PURPOSE: To study in vitro the efficacy of a pair of instruments designed to capture and split human nuclei obtained from extracapsular surgeries. METHODS: The sample is a compound of 47 cataract nuclei. They were classified as mature (4+) and immature (1 to 3+), and the visual acuity ranged from 20/60 to light perception. The instruments were used to split the nuclei. A methylcellulose over a gel base was made for this purpose. RESULTS: The average age was 67,38 years. Most patients (66%), had a visual acuity less than 20/400. 42,6% of the cataracts were mature. The capturing and splitting was easily done in over 90% of the nuclei. CONCLUSIONS: The designed instruments are effective to capture and split cataract nuclei.

Keywords: Cataract extraction; Lenses; intraocular; Adult

Small-pigmented lesions over the optic disc are very rare and may represent a diagnostic challenge. To report a case of a small malignant choroidal melanoma invading the optic nerve. A 60-year-old male presents with low vision in the left eye due to a small, pigmented lesion over the optic disc. At first the patient refused enucleation. One month later, after further drop in visual acuity, the patient was seen at another service, diagnosed as having a retinal detachment, and pars plana vitrectomy was proposed but also refused by the patient. Returning to our service, the eye was enucleated and a final diagnosis of choroidal melanoma with post-laminar optic nerve invasion was made. Although rare, pigmented lesions over the optic disc may represent a malignant melanoma. The prognostic significance of optic nerve invasion by choroidal melanoma is not clear yet. The differential diagnosis in these cases is usually difficult but a solid lesion is clear at ultrasonography and serous retinal detachment may predict a active tumor lesion. The management of these cases needs accuracy to avoid the unpleasant consequences of dissemination.

Keywords: Choroid neoplams; Choroid neoplasms; Choroid neoplasms; Optic nerve; Melanoma; Eye visceration; Neoplasm invasiveness; Case report

PURPOSE: To describe a rare complication at the donor site of conjunctival transplantation. METHODS: The authors report the clinical, surgical, postoperative and histologic aspects of a Tenon's granuloma that followed an uneventful pterygium excision with conjunctival transplantation. RESULTS: Histology identified an hemangiomatous-like structure with some areas of foreign body granuloma overlying necrotic epithelial cels, easily excised surgically. CONCLUSIONS: Pyogenic granuloma is an inadequate term to describe an inflammatory nonsuppurative reaction that may follow uneventful conjunctival surgery in susceptible individuals.

Keywords: Ganuloma, pyogenic; Pterygium; Conjunctiva

The authors report the case of a female patient, 39 years old, presenting bilateral transverse venous sinus stenosis, associated with papilledema, visual acuity deficit and headache. Cerebral angiographic finding of bilateral transverse venous sinus stenosis elucidated the diagnosis. The patient was treated with cerebral angiographic stent implant, with consequent remission of ophthalmologic and neurological clinical findings.

Keywords: Constriction pathologic; Cerebral angiography; Pseudotumor cerebri; Papilledema; Vision disorders; Case report; Female; Adult

The authors propose the use of absorptive and colored contact lenses as an aid to color defects in making color judgments and reduce glare sensitivity in dichromatic subjects, when the use of filter in glasses is not possible. Absorptive and colored contact lenses were adapted in two dichromatic subjects, one deutanope and the other with achromatopsia. In the former, a hard absorptive, red-colored, polymethacrylate lens was adapted monocularly, in the non-dominant eye to help color judgments. In the latter, a soft absorptive, dark brown-colored lens with amber pupil was worn in both eyes to reduce glare sensitivity. Subject # 1 remained with the same visual acuity and contrast sensitivity and demonstrated a better color perception on the PV-16 test. Subject # 2 showed an subjective reduced glare, in external and internal environment. Visual acuity and color vision remained the same. The findings suggest the use of absorptive colored contact lenses to increase color judgement and reduce glare sensitivity in dichromatic subjects.

Keywords: Contact lenses; Color perception tests; Color vision defects; Color perception

The conventional ophthalmic dosage forms are relatively simple: usually, water-soluble drugs are delivered in aqueous solution and water-insoluble drugs are prepared as suspensions or ointments. However, these delivery systems currently used present very low corneal bioavailability, systemic exposure because of nasolacrimal drainage and lack of efficiency in the posterior segment of ocular tissue. Recent research efforts have focused on the development of new ophthalmic drug delivery systems. As a result of these efforts, microemulsions are promising dosage forms for ocular use. These delivery systems are dispersions of water and oil that require surfactant and co-surfactant agents in order to stabilize the interfacial area. The microemulsions have a transparent appearance, thermodynamic stability and small droplet size of the dispersed fase (<1,0 mm), providing them with the capacity of being sterilized by filtration. Furthermore, these systems offer additional advantages that include: low viscosity, great ability as drug delivery vehicles, widened properties as absorption promoters and easiness of preparation, which do not require much energy and the use of special equipments. In this review, we present the technology and some preliminary studies of microemulsions in relation to ocular drug delivery systems.

Keywords: Topical administration; Absorption; Drug compounding; Pharmaceutical technology; Ophthalmic solutions; Biological availability; Emulsions; Pharmacokinetics; Solubility; Drug delivery systems; Cornea