VOLUME 63 - ISSUE 1

Purpose: To report the experience on our first 329 eyes operated with the Lasik technique for myopia, astigmatism and hyperopia, with a minimum postoperative follow-up period of 6 months. Methods: We retrospectively analyzed the results of Lasik surgery of 110 eyes with low myopia (group I), 113 with moderate myopia (group II), 47 with high myopia (group III), 139 with low astigmatism (group IV), 31 with moderate astigmatism (group V), 27 with low hyperopia (group VI) and 25 with moderate hyperopia (group VII). Results: Mean preoperative refractive error of each group was, respectively, -3.56 ± 1.25 D, -8.31 ± 1.68 D, -14.95 ± 2.85 D, -1.57 ± 0.49 D, -3.98 ± 0.85 D, +2.32 ± 0.65 D, +5.05 ± 1.02 D. Twelve months after surgery, the mean residual refractive error of each group was, respectively, -0.11 ± 0.69 D, -0.42 ± 0.85 D, -0.69 ± 1.48 D, -0.42 ± 0.73 D, -0.73 ± 1.16 D, +0.35 ± 0.50 D, e +1.32 ± 1.03 D. Regression was clinically insignificant, except for the moderate hyperopia group (0.76 D). Re-operation was necessary in 4.9% of cases (3.4% for undercorrection, 0.6% for overcorrection, and 0.9% for interface cleaning). Loss of one or two best corrected visual acuity occurred in 3.7% of eyes with low myopia, 12.4% in moderate myopia, none in high myopia, 18.5% in low hyperopia and in 20% of the moderate hyperopia group. Other complications were rare: incom-plete disc cut (0.3%), irregular stromal bed because of loss of ring suction (0.3%), free cap (0.3%), regular induced astigmatism (7.4%), irregular induced astigmatism by decentered photoablation (0.3%), interface fragments (0.6%), and disc striae disturbing visual acuity (0.3%). Conclusions: Lasik seems to be a safe, effective, and predictable procedure for a variety of refractive errors.

Keywords: Lasik; Excimer laser; Keratomileusis, in situ; Refractive errors

Purpose: To describe the ophthalmoscopic and videoangio-graphic findings with sodium fluorescein and indocyanine green (ICG-V) in pregnancy toxemia (PT). Methods: Four female patients with PT underwent ophthal-mologic evaluation and fluorescein angiography, comple-mented in two of them with digital indocyanine green videoangiography (ICG-V). Results: All patients presented with bilateral serous retinal detachment that spontaneously regressed after arterial pressure stabilization. The fluorescein angiography disclo-sed early multiple patchy nonperfusion choroidal areas and hyperfluorescent spots with leakage and late pooling in the areas of serous retinal detachment. In the late lesions window defect hyperfluorescence and pigmentary blockage were observed. The ICG-V showed early choroidal nonper-fusion and multiple hyperfluorescent spots with late areas of dye pooling. Conclusions: PT is generally associated with recovery of vision after resolution of the disease, although some vision loss may persist due to pigmentary changes in the macular region. The ICG-V better shows the choroidal involvement in the pathogenesis of the serous retinal detachment in PT, previously suggested by fluorescein angiographic studies.

Keywords: Pregnancy toxemia; Opththalmoscopy fin-dings; Indocyanine green angiography; Fluorescein angiography

Purpose: To analyze the influence of cicloplegia on latanoprost ocular hypotensive effect in normal subjects. Patients, material and methods: The study included 17 normal volunteers without previous ocular diseases, trauma or surgeries. One drop of 0.005% latanoprost was given to both eyes and after 20 minutes one drop of 1% ciclopentolate was instilled only in right eyes. Intraocular pressure (IOP) was measured using Goldmann tonometry in both eyes at the following time points: before latanoprost, after 20 minutes, 1 hour and 20 minutes, 3 hours and 20 minutes and 4 hours and 20 minutes. IOP was compared between right and left eyes (Wilcoxon test) and among the different times of study for each eye (Friedman test). Percentual IOP change from initial reading was calculated and compared between OD and OS. Results: No statistical differences were detected regarding the initial, 20 minute, 1 hour and 20 minute and 3 hours and 20 minute measurements. For the 4 hours and 20 minute readings the comparison of IOP levels and their percentual change between OD and OS showed statistical differences. The mean IOP was lower in OD (IOPOD = 10.9 ± 2.2; IOPOS = 11.8 ± 2.2; p = 0.009). The right eyes showed statistically higher IOP percentual reduction than left eyes (delta%OD = -28.1±7.4; delta%OS = -21.6 ± 9.6; p = 0.006). Conclusion: The results showed a higher short-term latanoprost IOP reduction in eyes treated with ciclopento-late 1%, as compared to the contralateral eyes.

Keywords: Prostaglandins; Intraocular pressure; Mydriatics

Purpose: To analyze outcomes and incidence of compli-cations in 100 eyes submitted to phacoemulsification perfor-med by surgeons at the start of their career at the Hospital do Servidor Público Estadual de São Paulo. Methods: The first 100 consecutive cataract operations performed by five surgeons, in patients of the HSPE, using phacoemulsification were evaluated. The surgical technique included a scleral tunnel, continuous curvilinear capsulo-rhexis, nucleus removal by phacoemulsification using a peristaltic pump and intraocular lens implantation, under peribulbar anesthesia. Results: The incidence of complications was 15.2%: posterior capsule tear in 8.7%, vitreous loss in 5.4% and one case of posterior dislocation of the nucleus. Posterior chamber IOL were implanted in 96.7% of the eyes, 70.8% of these being in the capsular bag, 28% in the sulcus and 1.2% were fixed superiorly. The final visual acuity was 20/40 or better in 89% of the cases. None of them developed bullous keratopathy or retinal detachment. Conclusion: The complication rate was comparable to that of the literature, suggesting that this technique may be learned during the residency program.

Keywords: Phacoemulsification; Learning curve; Complication

Purpose: To evaluate healing of experimental corneal ulcer of rabbit eyes terated with homologous amniotic membrane (AM) graft. Methods: 18 rabbits were used and divided into two experimental groups: corneal ulcer (G1) and corneal ulcer treated with AM graft (G2). Corneal ulcer was induced by a total epithelial removal using a scalpel and absolute alcohol. The animals were sacrificed at three experimental moments: 7 days (M1), 15 days (M2) and 30 days (M3) after the induction of the ulceration. Corneal defects were evaluated with image analyzer Luzex-F and histopathologic examinations and the results were compared through variance analysis. Results: Morphometric results showed corneal ulcer in G2 at M1; corneal opacity was identified in the central area and was significantly larger in G1 at M3. New corneal vessels were more active in the G1 animals. Histopathologic evaluation revealed epithelial defects in two animals of G1 at M2, and in two of G2 at M1; stromal edema was more intense in G1, as well as the presence of new vessels. Conclusion: The use of homologous MA in the treatment of experimental corneal ulcer did not accelerate epithelial healing but it prevented stromal edema and new vessel formation. Epithelial healing was poorer in the central region of the cornea.

Keywords: Corneal ulcer; Amniotic membrane; Corneal cicatrization

Purpose: 58 cases with a diagnosis of endophthalmitis were reviewed in the attempt to obtain regional characte-ristics of this pathology. Predisposing factors, clinical presentation, ancillary examination, treatment and functional results were analyzed. Methods: Analysis of charts of patients treated in the Clinical Hospital of Ribeirão Preto's Medical School (USP), from 1993 to 1998. Results: Trauma and surgery were the most frequent causes (39.65% each one). The most common clinical presentation was pain and decrease of visual function associated with hypopyon and conjunctival injection. In 70.48% of cases samples for culture were collected and 85.36% of the specimens were positive. The most frequent microorganism was S. aureus (26.08%), followed by S. epidermidis and P. aeruginosa (13.04% each one). All isolated species were susceptible to vancomicyn and ceftazidime. In 65.51% of the cases no light perception was the final visual acuity. Conclusions: These results suggest some changes that might be performed to improve prognosis of endophthalmitis, such as using intraocular vancomicyn and ceftazidime

Purpose: To identify and analyze the major preventable and treatable causes of loss of vision in children. Methods: Children (174) from three institutions were examined in two Brazilians cities (Salvador and São Paulo) and data were recorded acording to the WHO protocol. Results: According to WHO visual impairment was found in 82% of the children. The most frequent preventable and treatable ocular diseases were retinopathy of prematurity and glaucoma. Conclusions: This pilot study shows similar charac-teristics to other developing countries, where at least 50% of ocular diseases are preventable or treatable with today's knowledge.

Keywords: Low vision; Retinopathy of prema-turity; Glaucoma

Purpose: Among all grafts, corneal transplantation is the most commonly performed. Graft outcome is usually good, but some cases failure due to rejection can be observed.There are some well-known risk factors for corneal graft rejection. The purpose of this study is to analyze cases of corneal graft rejection in our Service focusing on peculiar risk factors. Methods: We analyzed 113 cases of penetrating keratoplas-ties performed in 1998. Cases of corneal graft rejection were evaluated in relation to preoperative diagnosis, existence of synechia, corneal vascularization, increased intraocular pressure, previous graft rejection, donor age, time of enu-cleation and preservation of the donor cornea and the surgeon's surgical experience. Results: We were able to identify 20 (17.69%) cases of graft rejection. Among these 9 had synechia, 4 corneal neovas-cularization, 8 increased intraocular pressure and 7 pre-vious graft rejection. Conclusions: Our results are in agreement with those of the literature. It seems that the surgeon's experience plays a role in corneal graft rejection. It is important to call attention to the fact that reference services handle difficult and more complicated cases which may be at a higher risk to rejection.

Keywords: Corneal transplantation; Rejection; Eye ban-king; Ocular surgery

Purpose: To present the frequency and type of identified fungi from infectious keratitis. Methods: Retrospective survey of the cases of mycotic keratitis in the period from 1995 to 1998, at the Laboratory of Ocular Microbiology of the Department of Ophthalmology of the Federal University of São Paulo. Description of the fungal isolations, analysis of the causative factors and relation to the number of infectious keratitis in the same period. Results/Conclusion: Mycotic keratitis was diagnosed in 61 (5.48%) of the 1,113 patients who presented ulcer of the cornea of infectious etiology, ranging from 3.4 to 9.25%, per year. Filamentous fungi were identified in 47 cases (77.04%) and yeasts in 14 (22.95%). Fusarium was the most frequent genus (50.82%), followed by Candida (22.95%) and Aspergillus (8.19%). Phaeosiaria sp, Phoma sp, Fonsecaea pedrosoi, Exserohilum rostratum, that are rare etiological fungal agents of keratitis, were also isolated.

Keywords: Fungal eye infections; Corneal ulcer; Keratitis; Cornea

Purpose: To evaluate the presence or absence of filtering blebs, its cavities, differences in diameter, height, wall thickness, seen on ultrasound biomicroscopy (UBM) of eyes submited to trabeculectomy, with or without using mitomicyn C (MMC), and to evaluate the effect of these caracteristics on the intraocular pressure (IOP). Methods: In a nonrandomized fashion, a six-month cohort study of 61 eyes of 44 glaucoma patients examined by UBM, all of which underwent trabeculectomy. Of these, 38 received MMC and 23 did not. All eyes were examined and evaluated post-operatively by UBM, with a 50 mHz probe, using the technique described by Pavlin in 1991 (Pavlin et al., 1991). Results: Bleb height was 1.80 ± 0.74 mm in eyes with MMC and 1.40 ± 0.53 mm in the ones without MMC. The thickness of the bleb wall was 0.91 ± 0.59 mm in eyes with MMC and 0.51 ± 0.45 mm in the ones without MMC. IOP measured was 12.37 ± 5.45 mmHg in eyes with MMC and 14.91 ± 5.48 mm in the ones without MMC. Conclusions: UBM study showed that bleb height was the main influencing factor in lowering IOP. The bleb wall was significantly thicker in eyes with MMC than in the ones without MMC. Decrease of IOP was significantly higher in eyes with MMC, with an average difference of 2.54 mmHg.

Keywords: Glaucoma; Glaucoma and trabeculectomy; Glaucoma and mitomycin; UBM and glaucoma; Intraocular pressure

Purpose: To evaluate the treatment by injection of botulinum toxin in acquired sixth and third nerve palsies. Methods: Fifteen patients were treated with botulinum toxin. They were studied prospectively during nine months, between August, 1998 and May, 1999. In addition to the strabismus examination, a complete ophthalmological evaluation was performed. The patients were followed for 2 to 7 months after the last injection or surgical procedure. Results: Eleven patients (73%) presented with sixth nerve palsy and four (27%) with third nerve palsy. Six cases were acute (40%) and 9 cases (60%) were chronic. Five acute cases (83%) obtained ocular alignment and controlled the deviation with toxin. Two of nine chronic cases (22%) obtained orthotropia after the last injection. Seven chronic cases were treated with toxin and surgery; 4 of these (46%) obtained acceptable ocular aligment and the remaining three cases (32%) did not obtain ocular aligment with this treatment. Conclusion: The toxin was the best treatment for the cases that had residual muscle function and good potential for fusion after sixth and third nerve palsies, because it controlled the deviation and then fusion was obtained without surgery.

Keywords: Botulinum toxin; Acquired paralytic strabismus

The authors present a case of acute myelogenous leukemia whose first symptom was infiltration of the conjunctiva. The clinical and ophthalmologic characteristics are discussed and reviewed.

Keywords: Leukemia, myelocytic; Conjunctiva; Chloroma; Granulocytic sarcoma

The authors describe a case of hypotony and ciliochoroidal detachment following aqueous supressant therapy (timolol and acetazolamide) in filtered patients (3 months before). As this case is the 6th or the 7th case described in the literature, the authors call attention to this rare "syndrome" that includes the ciliary body supersensitivity secondary to pharmacologic aqueous supressant as cause of hypotony and ciliochoroidal detachment in previously filtered patients. The authors also summmarize the literature cases.

Keywords: Ciliochoroidal detachment; Hypotony; Aqueous humor supressants; Trabeculectomy

Due to its rarety the author, present 2 cases of IV nerve palsy secondary to diabetes mellitus in young patients. Although cases of III and VI nerve palsy often recover to sponta-neously, our patients with IV nerve palsy developed secondary inferior oblique hyperaction, and were submitted to surgical procedure with good results.

Keywords: Diabetes mellitus; IV nerve palsy

Cicatricial keratoconjunctivitis is a group of diseases that induces six different types of ocular disorders: dry eye; eyelid blinking disturbances; destruction of limbal stem cells; destruction of basement membrane; inflammation; and neuroanatomic disintegration. These disorders cause corneal epithelial instability, neovascularization and chronic inflammation which result in loss of corneal transparency and decreased visual acuity. The author describes the six types of disorders and reviews the latest therapeutic approaches for each of them.

Keywords: Keratoconjunctivitis, cicatricial; Ocular surface