Carlos Alexandre de Amorim Garcia; Francisco Irochima Pinheiro; Daniel Alves Montenegro; Alexandre Henrique Bezerra Gomes; Fernando Oréfice
Arq. Bras. Oftalmol. 2005;68(2):
167-170
OBJECTIVE: To determine the prevalence of ocular findings of the external structures and anterior segment of the eye, detected by biomicroscopic examination in schoolchildren in Natal (RN) - Brazil. METHODS: After previous random selection, 1,024 pupils from elementary and secondary public and private schools in the city of Natal were evaluated from March to June 2001. All were submitted to preestablished standard research norms, consisting of identification, demographic information, ophthalmologic biomicroscopic examination, with slit lamp, performed by ophthalmologists from the "Onofre Lopes" University Hospital. RESULTS: Alterations of the conjunctival and palpebral conditions were the most prevalent (10.4% and 6.2% respectively). Follicles (4.2%) and papillae (3.0%) were the frequent conjunctival lesions, while blepharitis (3.5%) and meibomitis (1.1%) were the most detected abnormalities in the eyelids. Upon examining the cornea, iris, lens and anterior vitreous, the most encountered findings were nubecula (0.5%), papillary membrane reliquiae (0.5%), posterior capsula opacity (0.8%) and hyaloid arteria reliquiae (2.0%). CONCLUSION: The most prevalent findings affecting the external structures of the eye such as eyelids and conjunctiva, consisted of blepharitis followed by follicular reaction of the conjunctiva. The most prevalent abnormalities in the cornea, iris, lens and anterior vitreous were nubecula, papillary membrane reliquiae, posterior capsular opacity and hyaloid arteria reliquiae, in that order.
PURPOSE: Usher's syndrome (US) is a group of genetically distinct autossomal conditions, characterized by sensorineural hearing loss accompanied by a retinal dystrophy indistinguishable from retinitis pigmentosa (RP). The purpose of this study was to analyze full-field electroretinography (ERG) and visual acuity (VA) among patients with type I and II Usher's syndrome. METHODS: Electroretinography responses and visual acuity were studied in 22 patients (mean age at test = 26.8±16.8 years). Seventeen patients had SU type I and 5 patients were diagnosed as Usher's syndrome type II. RESULTS: Mean visual acuity was 0.9 logMAR (20/160, Snellen equivalent) for patients with Usher's syndrome type I and 0.4 logMAR (20/50, Snellen equivalent) for patients with Usher's syndrome type II. Scotopic rod and maximal responses were non-detectable in both groups. Mean amplitude for oscillatory potentials was 14.5 µV ±6.1 in Usher's syndrome type I and 12.6 µV±5.2 in Usher's syndrome type II. Cone responses were non-detectable in 95% of the patients with Usher's syndrome I and in 100% of patients with Usher's syndrome II. Mean amplitude for 30 Hz flicker photopic cone response was 3.1 µV±4.1 for Usher's syndrome type I and 1.0 µV±0.6 for type II with mean implicit time of 34.0 ms±6.2 (US I) and 35.8 ms±3.1 (type II). CONCLUSIONS: Visual acuity was relatively preserved in both groups, however Usher's syndrome II group showed better visual acuity results. Electroretinography findings were severely reduced in both groups, with most patients showing non-detectable rod and cone responses.
PURPOSE: To systematically study the anterior segment morphometric measurements by ultrasound biomicroscopy (UBM) in a large population of normal eyes, to evaluate their intra-observer reproducibility. Two new measurements are proposed and also tested concerning their intra-observer reproducibility. METHODS: One hundred ninety eyes of 101 patients with normal ophthalmic examination were studied by UBM. Anterior chamber depth (ACD) along with 11 different morphometric parameters that characterize the anterior segment morphometry were measured in the superior, nasal, inferior and temporal meridians. All measurements were performed twice with a minimum interval of four weeks between them. RESULTS: There were no statistical significant differences between the first (M1) and second (M2) measurements and regarding each studied parameter except for 2 variables in 2 meridians in the right eyes (OD) and 2 variables of one meridian in the left eyes (OS). Even in these cases, the largest difference between M1 and M2 was less than 0.006 mm, which was not clinically significant. The new tested parameters also presented a good intra-observer reproducibility. CONCLUSION: This study confirmed the good intra-observer reproducibility of the variables that characterize anterior segment morphometry by UBM.
PURPOSE: To evaluate in suspected and glaucomatous patients the correlation between central corneal thickness (CCT) and intraocular pressure (IOP), measured during the daily curve of intraocular pressure (DCPo), including CCT and IOP measurements in bed at 6 am. The ocular axial length was also compared. METHODS: 114 eyes from 73 patients, 30 eyes suspected of glaucoma (group I) and 84 eyes with chronic open-angle glaucoma (group II) were prospectively studied. Both groups were subjected to DCPo with measurements of IOP at 9 am, 12 pm, 6 pm, 10:30 pm and on the next day at 6 am in bed and in darkness before the patient gets up. Using the ultrasonic DGH 5100® device, CCT measurements were performed at 9 am, 6 pm, 10:30 pm and the next day at 6 am in bed before the patient gets up. The ocular axial length was also measured. RESULTS: In the total sample and, separately in each group, the mean IOP was more elevated in bed at 6 am. There were no significant CCT changes during the day within each group or between both groups. No statistically significant difference was found between the mean ocular axial length of both groups. CONCLUSIONS: In suspected and glaucomatous patients, there were no statistically significant CCT variations during the day; therefore, only one CCT measurement is sufficient. Also, there was no statistically significant difference between ocular axial length of both groups.
PURPOSE: To evaluate, in a prospective fashion, the prevalence of intraocular metastasis: most frequent primary tumors and ocular tissue most frequently compromised by metastasis. METHODS: In-patients with malignant neoplasm and metastatic disease from a tertiary Oncology Hospital (HSR) were consecutively evaluated between January 2001 and July 2002. All patients underwent complete ophthalmologic examination, including indirect ophthalmoscopy under pharmacological mydriasis using a 28 diopter-lens and, in cases suspicious of neoplasia, ultrasonography and fluorescein angiography were performed. Those cases of diagnostic uncertainty were submited to fine needle aspiration biopsy. The diagnosis of metastatic ocular tumor was established based on the clinical features and the results of the mentioned ancillary studies. RESULTS: The 100 studied patients presented ages between 17 and 87 years, 71 being females and 29 males. There was a predominance of Caucasian individuals (n=88) in this group. Twenty-one patients presented ocular lesions suggestive of metastasis. The primary malignancy originating ocular metastasis most frequently was breast cancer (28.6%). Evaluating the tumor type separately, lung cancer presented a highest prevalence of metastasis to the eye (71.5%). The choroid was involved in 57% of the cases and the main ocular complaint of these patients was blurring or decrease in vision. There was no difference in the frequency of involvement between the right and the left eye. CONCLUSION: The prevalence of ocular metastasis in patients with malignancy and metastatic disease seemed significant in the studied group. The neoplasms more frequently causing ocular metastasis were: breast and lung carcinoma, and the choroid was involved more frequently.
PURPOSES: To evaluate the retina nerve fiber layer by laser polarimetry in patients in chronic use of chloroquine. METHODS: Forty-four eyes of twenty-two patients were studied. These were in use of chloroquine due to rheumatic diseases during at least one year. As a control group, twenty patients without use of chloroquine with similar characteristics (age, gender and race) were included. Patients who had a family history of ocular hypertension or glaucoma were not included in this group. Both eyes were submitted to analysis of the retina nerve fiber layer with a GDx Nerve Fiber Analyzer. RESULTS: In 28 eyes (63.6%) of chronic chloroquine users, alterations in more than two parameters by GDx were found. There was alteration in the Deviation from the normal graph with a loss of nerve fibers in 11 eyes (25%). When these results were compared with the control group, there was a significant statistical difference between the following parameters: Superior Ratio, Inferior Ratio, Superior Nasal, Elipse Modulation, The Number, Superior Average and Superior Integral. There was also a significant statistical association between the time of chloroquine use and loss of nerve fiber layer. CONCLUSIONS: From the results the following conclusion can be drawn: the chronic use of chloroquine was associated with alteration of the nerve fiber layer. Thus these results may contribute to early diagnosis of nerve fiber layer loss in chloroquine retinopathy.
PURPOSE: To demonstrate the efficacy and possible complications of a surgical technique that includes the removal of the vertical portion of the lacrimal canaliculus in patients with dry eye syndrome. METHODS: A study was performed on six canaliculi of six eyes (four patients). Three patients had dry eye, associated with primary Sjögren syndrome. One of the four patients developed keratoconjuntivitis sicca due to lacrimal gland removal. The criteria included: patients with symptoms of dry eye that did not improve even with the continuous use of artificial tears, low results (less than 5 mm) with the Schirmer test, rose bengal staining and cases of recanalization after thermal occlusion with electrocauterium. The lacrimal puncta were examined after 7, 15, 30, 60, 90 and 180 days after surgery. RESULTS: None of the canaliculus recanalized at this time. Punctate keratitis, corneal filaments, Schirmer and rose bengal tests improved in 5 eyes. Difuse punctate keratitis was present in the patient with lacrimal gland removal even 2 months after of surgery. Eyelid margin complications were not observed. CONCLUSION: This technique is simple and effective in permanent lacrimal canaliculus occlusion. We did not note any complications compared to other procedures.
PURPOSE: The videokeratoscope is one of the most widely used instruments for the diagnosis of the human cornea. Results are usually plotted in the form of color-coded maps where each color is associated with a specific range of curvatures or elevations. Nevertheless there has been no thorough study in the literature demonstrating the advantages or disadvantages of different visualization techniques applied to the videokeratoscope. METHODS: A videokeratograph developed in our laboratory was used to collect in vivo data. The cornea of a patient with keratoconus was used as input data for all implemented visualization methods. RESULTS: The various methods of visualization were compared between each other for the same cornea and it was observed that for each method the corneal anomalies appear differently. DISCUSSION: The aspects related to the scientific visualization of the cornea have been a subject of very little attention both by the Brazilian and international community. Nevertheless, with the results presented in this first study, we believe it is not only important to extend the scope of these studies but also to apply these techniques to other medical areas. CONCLUSION: A simple choice of the visualization method can make the difference between a simple and correct diagnosis and a completely dramatic error in an apparently simple case. Therefore, the results obtained in this study make clear the importance of making the correct choice of the scientific visualization method for this kind of medical instrument.
OBJECTIVE: To determinate the predictive value of preoperative glucose test of diabetic patients, with age above 40 years, for visual acuity outcome and clinical perioperative complications, in cataract surgery with local anesthesia, in an academical medical center. METHODS: Type 2 diabetic patients, above 40 years of age, indicated for cataract surgery between February 10, 2000 and January 10, 2001, at the State University of Campinas, São Paulo, Brazil. All patients had a preoperative medical assessment by a physician one week before surgery, and were submitted to serum fasting glucose test and 12-lead electrocardiogram. There was no delay in the surgeries of patients with abnormal serum glucose test results, so, the result of the test alone was not a reason to cancel the surgery. According to the glucose test, the patients were assigned to one of two groups: Normal Glucose Test Group (60-115 mg/dL) or Abnormal Glucose Test Group (>115 mg/dL). Postoperative best-corrected visual acuity and clinical perioperative complications were recorded on a standardized form. RESULTS: The sample consisted of 193 patients. 67 (34.7%) had a serum glucose test within normal limits (normal glucose test group) and 126 (65.3%) outside normal limits (abnormal glucose test group). The mean result of the "normal glucose test group" was 98.5±17.3 mg/dL and 166.5±48.9 mg/dL for the "abnormal glucose test group" (p<0.001). We observed perioperative complications in 21 (10.7%) patients, all arterial hypertension cases; 7 (10.5%) of these in patients with normal glucose test result and 14 (11.1%) in patients with abnormal result (p<0.888). The postoperative best-corrected visual acuity was similar in both groups. CONCLUSION: There was no influence of the preoperative serum glucose level on perioperative clinical complications or visual acuity outcome.
PURPOSE: To study the efficacy of rigid gas-permeable contact lens (RGPCL) fitting in keratoconus patients and to determine treatment costs. METHODS: The records of 126 patients treated at the Hospital das Clínicas de Ribeirão Preto from January 2001 to June 2002 were retrospectively studied. Information about sex, age and treated eyes was collected. Visual acuity (VA) with and without correction was measured and plotted against corneal base curve (k) and toricity. Average price of the lenses was calculated. RESULTS: Fitting rigid gas-permeable contact lens was successful in 86.18% of the patients, resulting in VA=0.8 in 40.00% of them. Visual acuity improvement was observed in patients with steep base curve and in patients with high corneal toricity. Age of most patients ranged from 15 to 45 years; 60.31% of them were female. Corneal transplantation was indicated in 11.24% of the cases. Cost of each lens averaged R$ 40.00 (US$ 13.00). CONCLUSION: Rigid gas-permeable contact lens proved to be an efficient, low-cost resource for improving visual acuity in most of the treated patients.
PURPOSE: To harvest microorganisms from the microkeratome after LASIK. To induce experimental infectious keratitis and investigate the use of routine postoperative medication. METHODS: During eight consecutive days, we cultured the plate of the microkeratome after routine LASIK. Dilutions of the most frequent microorganism was prepared according to the MacFarland scale. Ten microliters were injected into both corneas of eight guinea pigs. The right cornea was used as control and the left cornea was treated with 0.3% ciprofloxacin associated with dexamethasone and ketorolac tromethamine every 4 hours for 24 hours (group 2). The animals were sacrificed and the corneas were divided into two halves, which were sent to analyzed by the microbiology and histopathology laboratory. RESULTS: In the control group, Staphylococcus aureus could be retrieved from all corneas, while in group 2, only 50% showed positive cultures (p=0.0128). Histopathology concerning polymorphonuclear cells showed an intense degree of inflammation in group 1 (p=0.0203) and regarding monomorphonuclear cells, it was also more intense in group 1 (p=0.0051). CONCLUSION: This study suggests that the use of wide-spectrum antibiotic associated with anti-inflammatory eye drops has a significant effect on the reduction of a potential infectious and inflammatory process after refractive surgery.
PURPOSE: To evaluate age-related macular degeneration (AMD) prevalence and its risk factors in two different populations, with distinct socioeconomic conditions, at two ophthalmological centers in Pernambuco state, Brazil. METHODS: A cross-sectional study was performed in 200 volunteers aged 55 years or older. One hundred were cared for by the Public Health System (in the Fundação Altino Ventura FAV-SUS) and 100 were cared for at a private hospital (Hospital de Olhos de Pernambuco - HOPE). There were 400 eyes altogether. Age-related macular degeneration was graded using fundoscopic examination using AREDS classification (Age-Related Eye Disease Study). RESULTS: Presence of age-related macular degeneration was observed in 61 eyes (30%) of the patients of the Fundação Altino Ventura and in 46 eyes (23%) of the patients of the Hospital de Olhos de Pernambuco. The age-related macular degeneration frequency difference between these populations, that are not similar regarding their socioeconomic level, was not significant (p=0.113). There was a positive association between aging and the age-related macular degeneration frequency (p<0.0001). This association was also present in the female gender (p=0.0451), the presence of cataract (p=0.0447), cataract surgery (p=0.0432) and obesity (p<0.0001). No age-related macular degeneration association with race (p=0.1367), hypertension (p=0.1985), diabetes (p=0.6712), smoking (p=0.6374), alcohol intake (p=0.7359), ocular sunlight exposure (p=0.9399), light-colored iris (p=0.1691), hyperopia (p=0.5098) and the usage of antioxidants (p=0.8251) was observed. CONCLUSIONS: The age-related macular degeneration frequency in the two studied ophthalmological centers varied from 23 to 30%. Age-related macular degeneration association with age; female gender; cataract; cataract surgery; and obesity was observed. No age-related macular degeneration association with socioeconomic level was found in this study.
PURPOSE: To assess orbital volume in weaned rabbits, submitted to enucleation and evisceration, with orbital volume reconstitution using porous polyethylene (PP) spheres, analyzed by computed tomography, by the water displacement test and external orbital measures using Image-J software. METHODS: This experimental randomized study consisted of 48 albino rabbits, with 42 days of life, submitted to enucleation (EN) and evisceration (EV), with (WI) or without (NI) implantation of a 10 mm PP sphere. After 1 month (M1), 3 months (M2) and 6 months (M3), 4 animals of each group were sacrificed. The skulls were prepared for dry bone study using the maceration technique. The orbital volume was calculated by computed tomography and by the water displacement test. The results suggest that orbital development in rabbits above 42 days of life is not different regarding evisceration or enucleation, or when an orbital implant is used. The water displacement test showed similar results compared with computed tomography, making a morphometric method in experimental studies worthwhile.
PURPOSE: To evaluate the possibility of epiphora relief in congenital nasolacrimal obstruction according to the age of the beginning of epiphora complaint and treatment effectiveness. METHODS: Forty children with congenital nasolacrimal obstruction underwent treatment between 1997 and 1999 and were evaluated according to: age of start of epiphora, the results of the treatment and the possibility of successful outcome. The data were submitted to statistical analysis by the binomial proportional test between and within populations. RESULTS: The success rate was worst when the epiphora started after the age of 4 months and results were similar on massage and probing, cure occurring even beyond 3 years of age. CONCLUSION: According to our results, the relief of epiphora was worst when starting at age over 4 months. Massage and probing may have good results even in children older than 3 years.
PURPOSE: To compare two methods of botulinum toxin A (BTA) injection into the extraocular muscle (EOM): the electromyographically (EMG) guided injection and the injection using Mendonça's forceps. METHODS: Twenty-nine (29) patients with strabismus and low visual acuity in one eye were examined at the Department of Ophthalmology of UNIFESP. They were divided into 2 groups - group I with 17 patients receiving the botulinum toxin A injection using Mendonça's forceps, and group II with 12 patients receiving the toxin with electromyographical guidance. The patients of both groups were examined on the 7th and 14th day after intervention and the outcome of both methods of botulinum toxin A injection were compared. Friedman and Mann-Whitney correlation tests were used in the statistical analysis of the data. RESULTS: Although the follow-up examinations on the 7th and 14th days showed a different behavior between both methods, there was no statistically significant difference between the mean values of the correction attained in both groups at the end of this study. CONCLUSION: No statistically significant difference was shown between the two groups. Mendonça's forceps can be a safe alternative to electromyography to locate an extraocular muscle for botulinum toxin A injection.
Keywords: Strabismus; Botulinum toxin type A; Botulinum toxin type A; Injections; Oculomotor muscles; Electromyography; Amblyopia; Treatment outcome
Report on the development of pseudohypopyon immediately after intravitreal injection of triamcinolone acetonide (TAAC). Two phakic patients presenting with a transient pseudohypopyon after having been treated with intravitreal triamcinolone. One had a clinically significant macular edema with cystoid component (CSME with CMS) and the other, active Vogt-Koyanagi-Harada (VKH) with serous retinal detachment of the macula. One eye from each patient developed a pseudohypopyon with crystal deposits adherent to the corneal endothelium. In one case it appeared right after the injection and disappeared spontaneously in 24 hours. In the other patient it appeared on day 3 and disappeared also spontaneously within 2 days. The pseudohypopyon is an important sign that can be observed after intravitreal injection of TAAC, in phakic patients, with spontaneous resolution and without complication. The pseudohypopyon caused by the deposition of TAAC in the anterior chamber immediately after its injection into the vitreous should be differentiated from other forms of hypopyon associated with this type of treatment.
To describe a case of idiopathic polypoidal choroidal vasculopathy and the role of indocyanine green angiography findings in the differential diagnosis of exsudative maculopathies, particularly with age-related macular degeneration, and the extreme evolution of idiopathic polypoidal choroidal vasculopathy in one patient. A patient with vitreous hemorrhage was examined and evaluated by fluorescein and indocyanine green angiographies in the right eye and with hemorrhagic detachment of the retinal pigment epithelium in the left eye. The patient was treated by pars plana vitrectomy in the right eye which was followed by retinal detachment and vision loss. In the left eye an involution of the hemorrhagic detachment of the retinal pigment epithelium with preservation of the vision was seen. The idiopathic polypoidal choroidal vasculopathy seems to be a distinct clinical entity that can and should be differentiated from age-related macular degeneration and the fluorescein and indocyanine green angiographies should be performed to evaluate the choroidal vasculature in an attempt to establish a more definitive diagnosis. Particularly in this case the entity had an extreme clinical course in the patient.
Two cases of combined central retinal artery and vein occlusion after intraocular surgery are described. Both patients were submitted to peribulbar anesthesia. Due to the painful sensation and ocular mobility retrobulbar anesthesia was necessary. At the end of the surgery both patients received a subconjunctival injection of gentamicin associated with dexamethasone. On the very first day after the surgery the two patients showed pupillary areflexia and visual acuity of luminous perception when they were referred to our service. The confirmation of the diagnosis of combined vascular occlusion of the retina was obtained by fluorescein angiography test. The two patients never showed, any neurological alteration. However visual loss was severe and permanent. By means of surgical description, clinical history, fundus photography and fluorescein angiography we are able to discuss the possible causes of this severe retinal vascular injury emphasizing the presumed anesthesic injection that was given into the optical nerve during retrobulbar anesthesia. At the same time we discuss preventive measures to avoid such problem.
Fundus flavimaculatus is a progressive, bilateral, hereditary retinal dystrophy characterized by ill-defined, yellowish, pisciform flecks at the level of the retinal pigment epithelium. Since the disease process is at level of the retinal pigment epithelium, it is not surprising that subretinal macular neovascularizations might occur. Nevertheless, they have been rarely reported as complications of the disease. The following report describes a case of fundus flavimaculatus that progressed with blurred vision by a subretinal macular neovascularization.
Keywords: Pigment epithelium of eye; Retinal degeneration; Retinal neovascularization; Fundus oculi; Fluorescein angiography; Indocyanine green; Case reports
Report on a successful clinical case of a corneal penetrating keratoplasty using inadvertently a corneal graft that had undergone laser assisted in situ keratomileusis (LASIK). Review of a clinical case of a patient of the Cornea Department of the "Hospital Oftalmológico de Sorocaba" who underwent a penetrating keratoplasty (PK) to correct keratoconus in his left eye. A corneal graft from a donor who had LASIK surgery was used. Surgery was completed without complications, although a separation of the corneal lamellae was noted during surgery. Patient evolution was good with a final corrected visual acuity of 20/40. PAM was also 20/40. Epithelial growth was noticed on the flap interface, although, without progression of this finding. Eye Banks should improve screening techniques to rule out refractive surgery in the donor corneas; there was no impairment of the final result of this transplant until the 6th month after surgery; long-term follow-up is necessary to reveal if surgical success was impaired by prior refractive surgery.
Ana Luisa Höfling-Lima; Josep Guarro; Denise de Freitas; Patricio Godoy; Josepa Gené; Luciene Barbosa de Souza; Luis Zaror; Andre C. Romano
Arq. Bras. Oftalmol. 2005;68(2):
270-272
To report an unusual case of fungus keratitis due to Fonsecaea pedrosoi that developed after corneal trauma. Case report: A 18-year-old male presented with a corneal ulcer in the right eye, 28 days after a trauma with glass fragments. Corneal scrapings were collected for smears and culture. Dematiaceous hyphae were seen on wet mounts of the scrapings and dark pigmented colonies grew repetitively on the culture media; all colonies were identical, and were subsequently identified as Fonsecaea pedrosoi. Treatment was initiated with topical natamycin at one hour intervals, 200 mg oral ketoconazole per day and later changed to a combination of 200 mg ketoconazole and amphotericin B. In humid tropical regions Fonsecaea pedrosoi is one of the primary causes of human chronic cutaneous mycosis, chromoblastomycosis. Combination of systemic and topical antifungal medications may provide the best option for cure in corneal chromoblastomycosis.
The purpose of this article is inform ophthalmologists of the International Anatomical Terminology in the Portuguese language edited by the Federation Committee on Anatomical Terminology (FCAT). In Brazil the International Anatomical Terminology was translated by the Anatomical Terminology Commission of the Brazilian Society of Anatomy.
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