VOLUME 66 - ISSUE 5

PURPOSE: To evaluate the efficacy of a simplified intraoperative adjustable suture technique, under general anesthesia (GA) proposed by the authors. METHODS: A prospective study of 49 patients with horizontal strabismus, 22 esotropes and 27 exotropes. The same surgeon (MP) operated on all of the patients. The corneal light reflection was measured in millimeters (mm) from the limbus preoperatively and under GA: the esotropes from the temporal border and the exotropes from the nasal border. The adjustment was made or not based on these two measures if there was or not a difference between them. The authors calculated the adjustment on the measures in mm, not converting them in to prism diopters (PD) or taking the pupil as a reference point. RESULTS: 28 patients (57.1%) had the eye position modified under GA. In 25 of all of them (51.0%) surgery was adjusted. Surgical success was defined as orthotropia, eso- or exodeviation up to 10 PD, in a follow-up period of at least 6 months. The overall success rate was 75.6%. CONCLUSION: Results suggested this simplified procedure is effective. As an adjustable technique can conduct to more predictable outcomes, and being a simplified technique it can be employed in more cases, specially because it can be carried out by surgeons not used to the adjustable suture techniques.

Keywords: Suture techniques; Anesthesia general; Strabismus; Esotropia; Exotropia; Prospective studies; Adult

PURPOSE: The purpose of this study is to evaluate the safety, efficacy and recurrence after topical use of mitomycin C (MMC) for primary or recurrent corneal-conjunctival intraepithelial neoplasia (CIN) and recurrent squamous cell carcinoma (SCC). METHODS: Two groups of patients were trated. Group 1 patients with primary or recurrent CIN were treated with topical 0.02% MMC, qid for 28 days. Group 2, patients with recurrent SCC, were treated with topical 0.02% MMC, qid for 21 to28 days. RESULTS: Eight patients with CIN and 1with SCC had a total regression of the lesion and all of them had negative control exfoliative cytology for neoplastic cells. One patient with CIN and 2 with SCC had partial regression of the lesions, which were excised surgically, and the pathology was negative for neoplasia. Side effects were transient and subsided after descontinuation of the treatment. There was no recurrence of the lesions on a mean follow-up of 24.9 months. CONCLUSION: The preliminary results of this study suggest that the use of the topical MMC is safe and efficient for the treatment of primary and recurrent CIN and recurrent SCC, although it did not prevent surgery in almost all cases of CEC. There were no recurrences during the follow-up. Further studies with more patients and longer follow-up are necessary to confirm this results.

Keywords: Mitomycin; Eye neoplasms; Conjunctival neoplasms; Carcinoma, squamous cell

PURPOSE: To evaluate the efficacy, predictability and safety of posterior chamber phakic intraocular lens implantation in patients with hyperopia following radial keratotomy. METHODS: Retrospective analysis of six patients (10 eyes) previously submitted to radial keratotomy, who presented consecutive hyperopia and were treated with implantation of a posterior chamber phakic intraocular lens. RESULTS: The mean preoperative spherical equivalent manifest refraction was +4.65 D (ranging from +2.50 to +6.50 D) and the mean postoperative spherical equivalent obtained with manifest refraction was +0.3375D (ranging from -0.875 to +2.25 D). Comparing the preoperative and postoperative corrected visual acuity, we observed that three eyes (30%) gained two lines of visual acuity, two (20%) gained one line, one (10%) kept the same visual acuity, three eyes (30%) lost one line of visual acuity and one eye (10%) lost two lines. CONCLUSION: The implantation of posterior chamber phakic lens in order to correct hyperopia following to radial keratotomy is a new option of treatment for this undesirable complication but a larger number of eyes and a longer follow-up are required.

Keywords: Lenses, intraocular; Lens implantation, intraocular; Hyperopia; Hyperopia; Refraction, ocular; Keratotomy, radial

PURPOSE: To evaluate the dioptric power of the normal central cornea. METHODS: Retrospective analysis of combined slit-scanning and Placido-ring topography in 30 normal eyes. RESULTS: Keratometric-mean, anterior-mean, thickness-mean, and total-mean powers; keratometric-optical and total-optical, keratometric-axial and total-axial, and total-tangential powers; equivalent power and the addition of anterior and posterior mean powers, were similar (p>0.8361) in the four analyzed central areas with 0.04, 1.0, 3.0, and 5.0 mm diameter. The posterior-mean power decreased (p=0.0030) from -6.62 D to -6.35 D. The average thickness increased (p=0.0231) from 524 µm to 554 µm, representing 0.13 D of total-mean corneal power. Keratometric-optical (p<0.0167), keratometric-axial (p<0.0099), and keratometric-mean powers (p<0.0030) were approximately 1.5 D more positive than the respective total powers. Total-mean power was equal to equivalent power (p>0.4907), and to the addition of anterior-mean and posterior-mean powers (p>0.3868). Anterior-mean power was about 7.5 greater than posterior-mean power. CONCLUSIONS: The real power of the cornea calculated using both surfaces, its thickness, and the physiologic refraction indices is smaller (less positive) than the power usually accepted and determined by the anterior corneal surface radius and the keratometric index of refraction (F

Keywords: Cornea; Corneal topography; Ocular refraction; Intraocular lenses

PURPOSE: A prospective study was conducted to compare the refractive changes after three different types of scleral buckling surgery. METHODS: A total of 100 eyes of 100 patients were divided into three groups according to the type of performed buckling procedure: Group 1, encircling scleral buckling (42 patients); Group 2, encircling with vitrectomy (30 patients); Group 3, encircling with additional segmental buckling (28 patients). Refractive examinations were performed before and at 1, 3 and 6 months after surgery. RESULTS: Changes in spherical equivalent and axial length were significant in all 3 groups. The amount of induced astigmatism was more significant in Group 3. No statistically significant difference was found in the amount of surgically induced changes between Groups 1 and 2, at any postoperative period. CONCLUSIONS: All three types of scleral buckling surgery were found to produce refractive changes. A correlation exists between additional segments and extent of refractive changes.

Keywords: Retinal detachment; Scleral buckling; Refraction; Biometry

PURPOSE: To analyze the incidence, clinical course, ophthalmic findings, and prognosis of the patients with intracranial bleeding and Terson's syndrome. METHODS: A prospective consecutive study of patients admitted to the emergency room with the diagnosis of acute subarachnoid hemorrhage. Neurological and funduscopic examinations were performed upon admission and at days 3, 7, 30 and 60 after the diagnosis. In all cases the clinical condition was graded according to the Hunt and Hess classification. RESULTS: Seventeen patients were enrolled in this study from July to October, 2000. Terson's syndrome was diagnosed in 5 of the patients (29.4%). Fifteen cases were associated with ruptured cerebral aneurysms, and the remaining two were caused by head trauma. There was no gender preponderance (9F:8M) and the median age was 48 years (range 22-80 years). Four of the five patients (80%) with Terson's syndrome died from intracranial complications, whereas 11 patients with intracranial bleeding and no ocular involvement survived. The leading cause of mortality was rebleeding. The ophthalmoscopic findings included intraretinal bleeding (3 cases), intraretinal and with subhyaloid hemorrhage (1 case) and intraretinal hemorrhage with cotton wool spots (1 case). CONCLUSIONS: In our study, the incidence of Terson's syndrome was 29.4% and it was associated with a high mortality rate (80%).

Keywords: Intracranial aneurysm; Craniocerebral trauma; Terson's syndrome; Vitreous body; Vitreous hemorrhage; Subarachnoid hemorrhage; Retinal hemorrhage; Prospective studies

PURPOSE: To investigate the possibilities of a teleophthalmology system to be used in a remote second referral program. METHODS: Digital images of the anterior segment were digitized by the Eyemail program and attached to the clinical description of the case and the file was sent to the website www.suportemedico.com.br for remote telediagnosis. The telediagnosis was then compared with the in loco diagnosis. RESULTS: The Eyemail system was able to capture images from the slit lamp and to send the files to the website. The website received the files and the operator was able to make the diagnosis using those files. CONCLUSION: The Eyemail system proved to have a potential use as a second referral program.

Keywords: Telemedicine; Diagnosis; computer-assisted; Computer communication networks

OBJECTIVE: To correlate the ophthalmic complications in patients with extra-orbital malignant tumors with the site of origin and histopathologic diagnosis of the tumors by computed tomography. METHODS: Twenty-nine patients diagnosed to have extra-orbital malignant neoplasms, with clinical and radiological evidence of orbital involvement, were studied by computed tomography. No patient had previous treatment of the tumor. RESULTS: Squamous cell carcinoma was the most common neoplasm (28%), followed by basal cell carcinoma (14%). The most frequent ophthalmic complications were proptosis (38%), epiphora (24%) and ocular pain (24%). Decreased visual acuity was noticed in 14% of the cases. The most common sites of origin of the tumors were the maxillary sinus (28%), ethmoidal sinus (17%) and skin and subcutaneous tissue of the face (17%). Ocular proptosis was mainly caused by non-carcinomatous and ethmoidal sinus tumors. Epiphora was more often noticed in carcinomas and maxillary sinus tumors. Decreased ocular motility, visual disturbance and ocular secretion were the commonest ophthalmic complications in patients with ocular anexial tumors. On the other hand, ocular pain was the most frequent feature in patients with soft tissue tumors of the face. CONCLUSION: The authors suggest that, in patients with epiphora and nasomaxillary mass, carcinoma of the maxillary sinus should be considered as the first diagnosis. Non-carcinomatous tumors, like sarcomas and lymphomas, should mainly be considered in patients with proptosis and nasoethmoidal mass.

Keywords: Neoplasms; Eye diseases; Computed tomography

PURPOSE: To evaluate the therapeutic response of ocular allergies through exfoliative cytology of conjunctival scrappings. METHOD: Conjunctival exfoliative cytology was performed through a prospective study in forty six eyes of twenty-three patients with clinical diagnosis of allergic conjunctivitis. Three scrappings were performed: (1) in the pre-treatment period, (2) after use of corticosteroids (treatment A) and (3) after use of mast cell stabilizer (treatment B); in two types of smears, with and without albumin. The smears were stained with Giemsa. RESULTS: Of the twenty-three patients, five (21.7%) were female and eighteen (78.3%) male, with an average of 10.8 years. Eighteen (78.3%) presented vernal conjunctivitis and five (21.7%) atopic keratoconjunctivitis. After statistical analysis of the conjunctival cytology, the number of degenerate epithelial cells was higher in the two treatment groups in relation to the pre-treatment period. The number of neutrophils was smaller in the A treatment group than in the B treatment and pre-treatment groups. Regarding the number of eosinophils, the two treatments presented a lower percentile distribution than that of the pre-treatment period. The number of monocytes was smaller after the A treatment than the B group and the pre-treatment period. CONCLUSION: Exfoliative conjunctival cytology is an appropriate test to evaluate the therapeutic response in ocular allergies.

Keywords: Conjunctivitis, allergic; Conjunctivitis, allergic; Cells count; Eosinophils; Cytological techniques

PURPOSE: To evaluate the effectiveness of free conjunctival grafting for leaking conjunctival blebs following trabeculectomy. METHODS: Retrospective study of seven patients with leaking conjunctival blebs that were repaired by free conjunctival grafting. The effectiveness of this procedure in stopping the bleb leak, maintaining satisfactory intraocular pressure (IOP), maintaining satisfactory anterior chamber depth, and preserving vision was evaluated. RESULTS: Free conjunctival grafting appeared to have stopped the bleb leak in 6 patients (85.7%), maintained satisfactory IOP in 5 patients (71.4%), maintained satisfactory anterior chamber depth in all patients, and preserved pretreatment vision in 3 patients. CONCLUSIONS: Free conjunctival grafting appears to be an effective method to treat leaking blebs, without loss of IOP control.

Keywords: Glaucoma; Trabeculectomy; Conjunctiva; Conjunctiva

PURPOSE: To compare changes in the upper eyelid position after cataract surgery with phacoemulsification and extracapsular techniques. METHODS: The upper eyelid position was measured in two groups of patients before and 30 days after cataract surgery performed with phacoemulsification and extracapsular techniques. Palpebral fissure images (before and after the cataract surgery) were digitized and then processed using the NIH 1.62 software. Eyelid position was measured relative to a horizontal line passing through the pupil center and connecting both canthi of the palpebral fissure. RESULTS: The palpebral position was differently affected according to the techniques. In phacoemulsification the mean difference between eyelids position before and after surgery was -0.54 mm. In the extracapsular technique this difference increased to -1.41 mm.The paired Student t test showed that the difference between two means was significant (p=0.0068). CONCLUSION: The phacoemulsification technique induces less variation in the upper eyelid position than the extracapsular technique in the recent postoperative period.

Keywords: Blepharoptosis; Cataract extraction; Phacoemulsification; Eyelids; Image processing, computer-assisted; Ophthalmologic surgical procedures

PURPOSE: To establish a profile of the allergic patient based on clinical manifestations, epidemiological data, treatment response and complications of ocular allergy. METHODS: A retrospective and descriptive study, in which we analyzed data of 172 patients suffering from perennial conjunctivitis, seasonal conjunctivitis, atopic keratoconjunctivitis and vernal keratoconjunctivitis, with at least 6 months of follow-up. The study was performed at the Ocular Allergy Sector of the "Santa Casa de São Paulo". Statistical analysis was performed using variance method and qui-square test. RESULTS: The most frequent form of ocular allergy was vernal keratoconjunctivitis (n=95; 55.2%) and the male sex was predominant (n=117; 68.1%). Mean age was 111.7 years (± 8.7). Vernal keratoconjunctivitis was the disease that most impaired vision, also responsible for corneal complications in 60% of the patients (n=57). Among medications, corticosteroids were used by 21.6% (n=45) of patients and 36.8% of them had vernal keratoconjunctivitis. Disodium cromoglycate was not only the most used medication, but able to successfully control symptoms in most cases. Papilla resection with autologous transplantation had to be performed in 8 patients. CONCLUSIONS: Vernal keratoconjunctivitis showed to be the most frequent form of ocular allergy in our service. The most efficient drug in our experience seemed to be disodium cromoglycate. Corticosteroids were shown to be as potent anti-inflammatory drugs and sometimes were the only way to discontinue crises.

Keywords: Conjunctivitis, allergic; Conjunctivitis, allergic; Conjunctivitis, allergic; Keratoconjunctivitis; Disodium cromoglycate; Disodium cromoglycate

PURPOSE: To check the effect of correct eyedrop instillation on the intraocular pressure of chronic glaucoma patients. METHODS: Prospective study with 90 eyes of 47 patients. A diurnal tension curve was performed before, and a second one after each patient was taught how to correctly instill eyedrops. The mean intraocular pressure values obtained in each tension curve were then compared. RESULTS: There was asignificant 22.3% drop in the mean IOP levels of 35 (38.9%) eyes. Of the remaining, 35 (38.9%) showed a slight fall (-8.2%), and 20 (22.2%) a slight increase (+8.4%), both not statistically significant. CONCLUSIONS: It was noted that an expressive part of the studied population obtained an additional fall in their mean intraocular levels by correctly instilling the eyedrops. Therefore, it is necessary to teach all patients on how to correctly perform eyedrop instillation, as that may result in an extra benefit to those using ocular hypotensive drugs.

Keywords: Glaucoma; Glaucoma; Intraocular pressure; Prescriptions drug; Ophthalmic solutions; Prospective studies

PURPOSE: To evaluate the profile and preferences of cataract surgeons working in southern Brazil. METHODS: A questionnaire about the routines of cataract surgery was elaborated by the authors and sent to 1,000 ophthalmologists of the three states of southern Brazil (Paraná, Santa Catarina and Rio Grande do Sul). A presentation letter signed by the authors and a pre-sealed envelope were attached to the questionnaire. Data analysis was done using the statistical package SPSS 8.0 for Windows®. RESULTS: Only 210 completely filled out questionnaires were sent back by the interviewees. Through the analysis of the gathered data, one could observe certain preferences of these surgeons such as the use of peribulbar anesthesia and extracapsular cataract extraction with 5 to 6 mm optic-plate-IOL implants and single stitch suture. Phacoemulsification is only used by 39% of these surgeons in about 60% of their cases. CONCLUSIONS: Regardless the constant technical developments seen in this area of medicine, it is clear that modern techniques employing phacoemulsification still are not used routinely by ophthalmologists in southern Brazil.

Keywords: Cataract; Cataract extraction; Phacoemulsification; Professional practice location; Physicians; Physician's practice patterns

PURPOSES: To evaluate Dextran 40 10% efficacy to maintain pig eye corneal transparency in order to indicate the best method (0.9% physiological saline, Dextran 40 10% and the mixture of both at equal parts) of conservation to maintain the transparency. METHODS: Twenty pig eyes, all of them prepared with Dextran injection in the anterior chamber and soaked in this solution for 20 minutes. Four groups, each group with five eyes and kept at 6ºC in the following solutions: Group 1 (0.9% physiological saline), Group 2 (Dextran 40 10% + 0.9% physiological saline at equal parts), Group 3 (Dextran 40 10%), Group 4 (humid chamber - control group). The eyes were observed after 12, 24, 48, 56, 72 hours and then classified according to their transparency. RESULTS: Corneal transparency occurred in 100% of the eyes with Dextran solution. 0.9% physiological saline and Dextran at equal parts achieved a longer period of transparency. CONCLUSIONS: Dextran 40 10% is an efficient solution to promote corneal transparency in post mortem pig eyes. The mixture of equal parts 0.9% physiological saline and Dextran can be used to keep feasible the prepared eyes for a period as long as 72 hours.

Keywords: Cornea; Corneal opacity; Dextrans; Organ preservation; Animal; Swine

PURPOSE: To evaluate how the implantation of a single regional list for corneal transplants influenced an eye bank of a university hospital. To analyze the influence of the regional list on the corneas (procurement and destiny), the number of transplantations made and the average waiting time for surgery. METHODS: A retrospective study was made to compare the records of patients who underwent penetrating keratoplasty and also the data of the eye bank of the Medical School of São José do Rio Preto, São Paulo, Brazil. The study compared the data of the service one year before and one year after the creation of the single regional list. RESULTS: The number of transplantations increased from 60 to 92 procedures. The monthly average of directly acquired corneas increased from 13.83 + 6.57 to 18.16 + 4.8 (p-value = 0.07). The number of corneas sent to other institutions was greater than the number of corneas received from other eye banks (p-value = 0.003). There was no significant difference between the waiting time for surgery before and after the creation of the list except for the period of adaptation. CONCLUSIONS: This eye bank served as a supplier of corneas for other institutions. By the end of the first year of operation of the single regional list, there was no alteration in the waiting time as compared to that before its creation. Nonetheless, a tendency of homogenization in the waiting time for penetrating keratoplasty among the patients was observed.

Keywords: Keratoplasty penetrating; Eye Banks; Waiting periods; Waiting lists; Organ procurement; Tissue donors; Corneal transplantation

PURPOSE: To evaluate psychological disturbances caused by acquired unilateral anophthalmia, the struggle for aesthetic recuperation on use of the ocular prosthesis, as well as involved interpersonal factors and psychosocial reintegration of these patients. METHOD: Thirty (30) patients with acquired unilateral anophthalmia without any other deformities in the orbital region and users of ocular prosthesis (16 males, 14 females) aged between 12 and 66 years, mean age 31.6 years, were submitted to an ophthalmic examination and psychological evaluation through a standardized questionnaire focusing on 66 questions lasting two hours in the period from January, 2000 to March, 2001. RESULT: The highest incidence of acquired anophthalmia (47%) was in the age ranging from 0 to 6 years old. Seventy (70)% of the patients are in the process of elaboration of their loss (n=21). The most used mechanisms of defense in the current situation were rationalization, repression, denial and displacement. Thirty (30)% accept the present situation. After the triggering event (TE) 36% manifested a depressive state 64% of whom got over the symptoms of depression. Sixty percent (60%) adapted the ocular prosthesis right after the surgical treatment while 40% adapted it two or more years after the TE. Aesthetically 70% are satisfied while 30% are unsatisfied. Fifty-three (53)% show low self-steem, 37% distorted self-image. CONCLUSION: An integration among various elements of the multidisciplinary team made up of surgeons, ocularists, psychologists and support from family and friends is fundamental during the whole process of mourning due to the loss. A positive attitude towards the person dealing with the issue minimizes the loss in all of its aspects, offering recovery of interpersonal aspects and psychosocial reintegration as he/she is given adequate resources to become more secure. The prosthesis has two functions: on the one hand it returns to the patient self-image and self-steem allowing his/her exposure without discrimination, which allows his psychosocial reintegration. On the other hand it becomes an instrument, which removes the possibility of the loss to be lived in its totality, which contributes to behavior of repression of the patients instead of acceptance of the new reality - mainly when the prosthesis is adapted after the TE. There is no direct relationship between the obtained aesthetic result and the degree of satisfaction of the patients. Prejudice is another important factor because it may interfere or not in the rehabilitation.

Keywords: Eye, artificial; Orbital implants; Anophthalmos; Eye enucleation; Prejudice; Adult; Adolescent; Male; Female

PURPOSE: To report the antifungal susceptibility profile of yeast isolates obtained from cases of keratitis. METHODS: Susceptibility testing of 15 yeast strains isolated from corneal infections to amphotericin B, fluconazole, itraconazole and ketoconazole was performed using the NCCLS broth microdilution assay. RESULTS: Most episodes of eye infections were caused by Candida albicans. The antifungal drugs tested showed the following minimal inhibitory concentration values against yeast isolates: 0.125-0.5 µg/ml for amphotericin B; 0.125->64.0 µg/ml for fluconazole; 0.015-1.0 µg/ml for itraconazole and 0.015-0.125 µg/ml for ketoconazole. Despite the fact that all Candida isolates were judged to be susceptible to azoles, one isolate showed a minimal inhibitory concentration value significantly higher than a 90% minimal inhibitory concentration of all tested isolates. Rhodotorula rubra was resistant to fluconazole and itraconazole. CONCLUSIONS: Despite the fact that most yeast isolates from corneal infections are usually susceptible to amphotericin B and azoles, they exhibit a wide range of minimal inhibitory concentration values for antifungal drugs. The identification of strains at species level and their susceptibility pattern to antifungal drugs should be considered before determining the concentration to be used in topical antifungal formulations in order to optimize therapeutic response in eye infections.

Keywords: Eye infections; Keratitis; Antifungal agents; Yeasts infections; Antifungal susceptibility tests

PURPOSE: To compare the visual result in consecutive case series between two different excimer laser equipments in LASIK for myopia and astigmatism. METHODS: We analyzed the results of lasik of 11 eyes of 11 patients with myopia ranging from -0.50 to -11.25 and astigmatism from -0.50 to -4.25 who were submitted to Summit Apex Plus and 11 eyes of 11 patients with myopia ranging from -0.50 to -8.75 and astigmatism from -0.50 to -4.75 submitted to Meditec-Aesculap Mel 70.The follow-up was 1, 3 and 12 months. RESULTS: Preoperatively the mean spherical equivalent was -4.75 for Summit and -4.8 for Mel 70. At 1, 3 and 12 months after surgery, the residual error for the Summit group was 0.54; 0.58 and 0.014 and for the Mel 70 group it was 0.02; 0.04 and -0.43. There were no statistically significant differences between two excimer laser equipments regarding: spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) pre- and postoperatively. One year after surgery 90.9% presented BCVA =20/20 for Summit and 73% for Mel 70, 81.8% had UCVA =20/20 for Summit and 45.5% for Mel 70. The final mean postoperative SE was 73% within ±1.00 D for Summit and 82% within ±1,00 D for Mel 70. Loss of one or two lines BCVA was 9% for Summit and 27.3% for Mel 70. Complications: 9% cases of diffuse lamellar keratitis and 45.5% of epithelial ingrowth for Mel 70. DISCUSSION: Both Summit Apex Plus and Meditec-Aesculap Mel 70 were found to be similar, safe and efficient for the correction of myopia and astigmatism.

Keywords: Myopia; Astigmatism; Keratomileusis, laser in situ; Comparative study

PURPOSE: To compare three experimental models of limbal stem cell (SC) removal in rabbits in relation to morphologic aspects. METHODS: In the present study, 54 rabbits (108 eyes) were divided into 3 experimental groups - (G1), (G2) and (G3). Each group consisted of 18 rabbits whose left eyes were submitted to 3 different experimental techniques - (T1), (T2) and (T3), respectively. A control group was formed with the 54 remaining eyes (RE) of the G1, G2 and G3 rabbits. Four morphological parameters were assessed: epithelium, inflammatory response, vascularization and fibroblastic response. RESULTS: The limbal epithelium was not completely removed by T1, was almost totally removed by T2, and thoroughly removed by T3. Corneal surface was healed by conjunctival phenotype (conjunctivalization) in the three groups. Goblet cells started to appear on days 14 and their density peaked on day 28. The inflammatory response was more intense in G3 than in G1 and G2. Regression was faster in G1 and similar in G2 and G3 contributing to corneal opacity specially on days 14 and 28. It was mainly concentrated at the stromal anterior half, whereas the posterior half was spared. It peaked on day 28 and decreased from that moment on. In the beginning, it was characterized by a predominantly polymorphonuclear infiltrate, which, on day 56, changed to mononuclear. The new vessels started appearing on days 7. At first, they permeated the stromal upper half and progressed toward the surface as the stromal edema decreased. In the three groups, at the end of the experiment, vascularization was superficial in the stroma; but no thick sclerotic-fibrous tissue nor actual scars, distinct from the corneal stroma, were formed. CONCLUSIONS: Conjunctivalization and neovascularization occurred in all experimental models. T2 and T3 seemed to be adequate models for the removal of limbal SC and most studied parameters showed similar results. T1 was found to be an adequate model for the partial-thickness removal of limbal SC.

Keywords: Limbus corneae; Germ cells; Epithelium corneal; Stem cells; Corneal neovascularization; Rabbits

Episcleral osseous choristoma (COE) is a rare tumor, characterized by the presence of a plaque of mature bone in the episcleral tissues of the upper temporal quadrant. This is a case report of COE whose diagnosis was established after histological features.

Keywords: Choristoma; Sclera; Case report; Eye neoplasms; Bone and bones

To describe the treatment of localized bullous keratopathy secondary to iridoschisis with anterior stromal puncture in a 81-year-old female with iridoschisis and localized corneal edema, in whom anterior stromal puncture was performed. Ocular examination showed inferior iridoschisis in the right eye, with localized edema in the area of contact between the fibers and the endothelium. Photocoagulation of the fibers was performed but no biomicroscopic changes were observed. Anterior stromal puncture was performed and a complete resolution of symptoms was observed. We suggest that anterior stromal puncture should be considered as an option to reduce the symptoms of patients with localized corneal edema secondary to iridoschisis. Review of the literature about palliative treatments for bullous keratopathy was also performed.

Keywords: Cornea; Endothelium corneal; Iris diseases; Palliative care; Edema; Case report

Bardet-Biedl syndrome is a hereditary autosomal recessive disease characterized by retinal dystrophy, polydactyly, obesity, mental retardation, and hypogenitalism. One or more of the clinical features characterizing the syndrome may be absent, but retinal dystrophy is a consistent finding. It becomes clinically manifest in early childhood, with progressive loss of visual function, leading to severe visual disability in early adolescence. The authors describe two cases of Bardet-Biedl syndrome, the results of visual acuity, slit-lamp examination, ophthalmoscopy, angiography, visual fields and electroretinograms. The literature was reviewed stressing the importance of identifying systemic signs, ocular involvement, electrophysiologic tests and genetic evaluation.

Keywords: Bardet-Biedl syndrome; Retinitis pigmentosa; Choroid; Child; Adult; Case report; Literature review

The authors report a case of a patient who presented with a slowly progressive expanding isolated orbital neurofibroma for 5 years, associated with incomitant endotropia of the left eye, without complaint of diplopia. Sensorial examination showed a normal visual acuity in both eyes and suppression of one eye. Orbital imaging (computed tomography and magnetic ressonance) depicted an elongated intraconal lesion adjacent to the left lateral muscle. The patient was submitted to an orbitotomy for the removal of the lesion. After surgery, the eye deviation decreased without changes in the suppression pattern.

Keywords: Neurofibroma; Orbital neoplasms; Esotropia; Case report; Literature review; Adult; Female

The paper starts from a schematic circuit establishing a relationship of the sensorial (visual, binocular) with the oculomotor systems, whose defects of their afferent or efferent pathways, or of their interactions, explain the emergence of strabismus with its consequences. The foundations and referentials of ocular movements are then examined: the concepts of axes and planes, of the centers of mass and of rotation, of monocular displacements of translation and rotation, of binocular version and vergence displacements. The functions of centers of command for voluntary or reflex ocular movements are also presented, as well as the innervation of extrinsic ocular muscles. In a second part (physiology of the extrinsic ocular muscles), activities of contraction or relaxation and the importance of Sherrington's law are commented. The concepts of primary position of gaze and of the referentials for rotations are retaken leading to the diversity of the several systems of measurements. There follows analysis of the rotational actions of the ocular muscles, based on the so-called planes of muscular actions and on the anatomic distribution of the muscles, leading to the results in primary position of gaze and others. The effects of fascias and intermuscular membranes are also commented. Conclusively the modern concept of the muscular actions is presented (simultaneous actions of all muscles in each ocular position). Based on the conditions of Hering's law the concept of positions for the diagnosis of the oculomotor disfunctions, which differs from the classical one is developed: the muscles are considered in pairs, according to their predominant actions ___ horizontal (horizontal recti), vertical (vertical recti) ou torsional (oblique muscles). For each corresponding pair, the actions in diametrally opposite conditions of ocular fixation and gaze position are compared. For example, supradextroversion, with fixation of the right eye and infralevoversion with fixation of the left eye in order to compare the actions of the right superior rectus and of the left inferior rectus, respectively. The influence of the head tilt upon such actions is also analyzed. The paper also studies the synkinetic relationship between accommodation and convergence, proximal convergence, and the units of those functions.

Keywords: Strabismus; Eye movements; Optical rotation; Measures; Oculomotor muscles; Oculomotor nerve; Accommodation, ocular; Convergence, ocular; Eye diseases

The author describes epidemiological, histopathological and clinical aspects of endogenous Candida albicans endophthalmitis. He also presents new diagnostic methods and therapeutical options to treat intraocular fungal infections, based on literature review.

Keywords: Endophthalmitis; Candida albicans; Eye infections, fungal