VOLUME 68 - ISSUE 3

PURPOSE: To quantify the palpebral alterations occurring in subjects after the age of 50 years. METHODS: An observational study was done with 325 subjects older than 50 years. The data comprised measurements of intercantal distance, palpebral fissure length and height, external and internal eyelid angles, margin reflex distance (MRD) and total palpebral fissure area. Digital images were obtained with a Sony Lithium movie camera at the frontal view in ocular primary position, with the object of observation being located at the height of the pupil. The images were saved on tape, transferred to a McIntosh G4 computer and processed with the NIH 1.58 program. The data were submitted to statistical analysis. RESULTS: The subjects presented dermochalasis (96.5%), eyebrow ptosis (60.8%), orbital fat prolapse (50.0%) or eyelid ptosis (39.1%). The alterations were bilateral in 68.8% of the subjects. The intercantal distance was higher with age; the eyelid fissure length, the margin reflex distance and the external angle decreased in the elderly. The differences were more important on evaluating each eye separately. CONCLUSION: Intercantal distance increase and palpebral fissure length, margin reflex distance and total eyelid area decrease with age.

Keywords: Eyelids; Measures; Diagnostic imaging; Quantitative analysis aged; Adult

PURPOSE: To determine the characteristics of patients with conjunctival pterygia in the Botucatu region (São Paulo State). METHODS: A retrospective study was conducted to evaluate the gender, occupation, complaints and lesion characteristics (primary or recurrent lesion, size, involutive or pulpous) of patients with pterygium. The data were submitted to statistical analysis. RESULTS: Approximately half of the patients were female and over 40 years old. The main complaint was the esthetic effect of the lesion. The majority of the lesions were primary (77.08%), grade 2 (69.6%) and pulpous (86.7%). Pterygium grade 4 was present in the 1.4% of the patients. CONCLUSION: Most patients were female, over 40 years old. Primary, grade 2 and pulpous lesion was the most frequently observed. Blindness caused by pterygium is still present in Brazil.

Keywords: Pterygium; Prevalence; Incidence

PURPOSE: To evaluate the feasibility of autologous extraocular muscle grafting as a type of muscle expansion surgery. METHODS: The left superior rectus muscle of twenty-nine rabbits was resected and this fragment was attached to the endpoint of the respective right superior rectus (test group). Thereafter, the superior rectus of the left eye was reattached to the sclera (control group). Both groups were examined during different postoperative periods in order to assess their outcomes. RESULTS: The presence of hyperemia was slightly more frequent in the grafted group. Secretion and muscle atrophy were negligible in both groups. Fibrosis was greater in grafted animals. These muscles were weaker than the control muscles, although the force required to split muscular parts was always greater than the physiological one. CONCLUSIONS: This surgical technique was reliable and useful if one intends to achieve muscle expansion without the intrinsic risks of dealing with heterologous/artificial materials.

Keywords: Esotropia; Oculomotor muscles; Transplantation; autologous; Ophthalmologic surgical procedures; Rabbits

PURPOSE: To establish the frequency of infantile cataract in the Low Vision Service of São Geraldo Hospital (HSG-HCUFMG) and to analyze basis of history, ophthalmologic examination and optical prescription in these patients. METHODS: Retrospective study of infantile cataract recorded in the Low Vision Service from January/1992 to December/2002. Age, sex, race, age at the first evidence of leukocoria and who noticed it, ages at diagnosis and phacectomy, family history of cataract, intraocular lens implantation, visual acuity (VA) and optic prescription were evaluated. RESULTS: There were 44 patients. The age ranged from 0-15 years: 19 (43.0%) 0-3, 14 (32.0%) 4-10 and 11 (25.0%) from 11-15 years. Twenty-eight (63.6%) were female and 19 (43.2%) leukodermic. The first evidence of leukocoria was observed by the mother in 17 patients (38.6%). Leukocoria was observed in the first 2 months of life in 45.5% of the patients; phacectomy was performed in 43.2% of the patients with more than 1 year of age. Optic prescription was performed in 61.4% of the cases with 9.1% of the patients below 1 year of age. Intraocular lens was implanted in 13.6% and 4 patients (9.1%) had a family history of congenital cataract. In 20.4% VA was lower than 20/400 and secondary glaucoma was observed in 18.2% of the cases. Low vision aids included two glasses and one telescope. CONCLUSION: More information about congenital cataract should be provided for families and pediatricians, and early surgical treatment, optic correction and treatment of amblyopia should be performed promptly.

Keywords: Cataract; Cataract; Cataract; Vision low

PURPOSES: To evaluate the emergency resources of the clinics that perform fluorescein angiography in Pernambuco and, through a short multiple-choice questionnaire, to evaluate the ophthalmologists' performance to treat adverse reactions to contrast injection and to determine if the time after completing the specialization course in Ophthalmology influences in the results. METHODS: An interview with the eighteen ophthalmologists of the ten clinics where this examination is performed was made. The multiple-choice questionnaire had ten questions with five options each and only one correct answer. This questionnaire was about adverse reactions to fluorescein injection. RESULTS: One physician refused to participate and was excluded from the analysis. Among the others, fifteen physicians (88.2%) were certified specialists by the Brazilian Council of Ophthalmologists. All clinics had the basic structure for the initial care of adverse reactions to contrast injection. Half of these clinics (five) performed this examination with the presence of an anesthesiologist directly monitoring the patient and the other half had one on duty, if necessary. The number of correct answers varied between 3 and 8, with a mean of 5.2±1.6. Only four (23.6%) physicians gave more than seven correct answers. Specialists with five or less years of postgraduation in Ophthalmology had better results regarding the questionnaire (p<0.001). CONCLUSIONS: Despite appropriate material resources and support by anesthesiologist, the results of this study suggest that ophthalmologists who perform fluorescein angiography are not well-prepared to manage the possible adverse reactions, mainly doctors with more than five years after postgraduation in Ophthalmology.

Keywords: Fuorescein angiography; Fluorescein; Nausea; Vomiting; Contrast media; Anaphylaxis; Specialties; medical; Questionnaires

PURPOSE: To evaluate the percentage of ophthalmologic patients who search for a second opinion and to verify the main reason for this search. METHODS: The methodology of the present study consists of a direct interview with 806 ophthalmologic patients, attended at a specialized hospital, through an adequately elaborated questionnaire, containing variables that can be related to the search for this second opinion. RESULTS: It was observed that 32% of the ophthalmologic patients ask for a second opinion and, of these, 31% search for other physicians in order to confirm the diagnosis. CONCLUSION: Most search for the second opinion in Ophthalmology is directly linked to the doctor/patient relationship. Such situation serves to warn the present professional teaching, pointing to the need for dedication, effort and greater investment in learning, regarding both the present and the future professionals. In addition, it is important to emphasize the necessity in improving the working conditions and wages. Maybe, the review of these aspects can contribute to decrease the mentioned problems.

Keywords: Referral and consultation; Physician-patient relations; Patients; Patient acceptance of health care; Questionnaires

PURPOSE: To evaluate the number, shape and topography of leakage points in patients with central serous chorioretinopathy (CSC). METHODS: Digital photographic files of fluorescein angiography with the diagnosis of CSC were reviewed by the author. The cases considered in remission and the examinations related to the same episode were excluded. The author filled out a form containing medical record number, initials, sex, age, date of the examination and leakage point characteristics (number, shape, and topography) of the selected cases. RESULTS: The examinations of 418 patients (455 eyes) were included, with a male:female ratio of 2.32:1. Ninety-one point fifteen percent of the patients presented the disease unilaterally and 8.85% bilaterally. The mean age was 43.04 years (range, 19-68 years). Among the 455 selected eyes, 88.35% presented typical forms of CSC while 10.11% decompensation of the retinal pigment epithelium and 1.54% with isolated retinal pigment epithelium (RPE) detachment. The evaluation of typical forms of CSC showed a leakage point with uniform dye spread (inkblot) in 88.81% and 11.19% with a smoke-stack phenomenon. Regarding the leakage points, 46.01% were located in the upper nasal quadrant, 23.27% in the upper temporal quadrant, 19.18% in the lower nasal quadrant, 11.01% in the lower temporal quadrant and 0.53% in the subfoveal area. CONCLUSIONS: In our series men were affected approximately two times more often then women, most of them with a unilateral involvement and in around the fourth decade of life. About 90% of the patients presented the typical forms, with 1 or 2 inkblot points or leakage. The superior nasal quadrant was the most affected. The isolated RPE detachment rarely occurred. Decompensation of RPE affected about 10% of the patients.

Keywords: Choroid diseases; Choroid diseases; Incidence; Fluorescein angiography; Diagnostic imaging

PURPOSE: To determine the prevalence of refractive errors in the public and private school system in the city of Natal, Northeastern Brazil. METHODS: Refractometry was performed on both eyes of 1,024 randomly selected students, enrolled in the 2001 school year and the data were evaluated by the SPSS Data Editor 10.0. Ametropia was divided into: 1- from 0.1 to 0.99 diopter (D); 2- 1.0 to 2.99D; 3- 3.00 to 5.99D and 4- 6D or greater. Astigmatism was regrouped in: I- with-the-rule (axis from 0 to 30 and 150 to 180 degrees), II- against-the-rule (axis between 60 and 120 degrees) and III- oblique (axis between > 30 and < 60 and >120 and <150 degrees). The age groups were categorized as follows, in: 1- 5 to 10 years, 2- 11 to 15 years, 3- 16 to 20 years, 4- over 21 years. RESULTS: Among refractive errors, hyperopia was the most common with 71%, followed by astigmatism (34%) and myopia (13.3%). Of the students with myopia and hyperopia, 48.5% and 34.1% had astigmatism, respectively. With respect to diopters, 58.1% of myopic students were in group 1, and 39% distributed between groups 2 and 3. Hyperopia were mostly found in group 1 (61.7%) as well as astigmatism (70.6%). The association of the astigmatism axes of both eyes showed 92.5% with axis with-the-rule in both eyes, while the percentage for those with axis against-the-rule was 82.1% and even lower for the oblique axis (50%). CONCLUSION: The results found differed from those of most international studies, mainly from the Orient, which pointed to myopia as the most common refractive error, and corroborates the national ones, with the majority being hyperopia.

Keywords: Refractive errors; Myopia; Astigmatism; Hyperopia; Students

OBJETIVO: To study histopathological findings of enucleated eyes with retinoblastoma. METHODS: Twenty-eight cases of retinoblastoma treated by enucleation at the Federal University of São Paulo from December 2000 to October 2002 were histopathologically reviewed. Clinical data included age, gender, race, unilateral or bilateral involvement and previous treatment. The histopathological review evaluated the presence of iris and/or angle neovascularization, tumor differentiation and optic nerve and choroidal invasion according to Khelfaoui's classification. RESULTS: Of 27 patients, 13 (48.5%) were boys and 14 (59.3%) were girls, 16 were white, 6 were black and 5 were asiatic, age ranging from 2 to 96 months (mean, 22.7 months). 13 cases were bilateral and 14 cases were unilateral. All tumors were histologically characterized by a proliferation of small cells with high nuclear-to-cytoplasmic ratios and 20 (71.4%) of them were well differentiated. Choroidal involvement was observed in 18 (64.2%) cases (degree II, III) and optic nerve invasion in 8 (28.5%) cases (degree III, IV, V). CONCLUSION: Neovascularization, necrosis and calcification were the most commonly observed feature. The invasion into the optic nerve and choroid, which are the two most important predictors of patient outcome were found in 28.5% and 64.2% of the cases, respectively.

Keywords: Retinoblastoma; Choroid neoplasms; Optic nerve neoplasms; Neoplasms invasiveness; Risk factors

OBJETIVE: To evaluate the results of Müller's muscle-conjunctival resection for correction of blepharoptosis and to discuss the advantages of this procedure. METHODS: 38 patients (39 eyelids) were submitted to Müller's muscle-conjunctival resection. Blepharoptosis varied from 1.0 mm to 3.0 mm (mean: 2.0 mm). The amount of eyelid elevation produced by phenylephrine guided the amount of tissue to be resected. RESULT: 33 eyelids (85%) treated with this procedure were cosmetically acceptable. CONCLUSIONS: Müller's muscle-conjunctival resection procedure is a relatively simple technique for blepharoptosis, with good levator function and positive 10% phenylephrine test. The advantages are: preservation of tarsus and predictable results.

Keywords: Blepharoptosis; Eyelids; Conjuctiva; Phenylephrine; Treatment outcome

PURPOSE: To verify the frequency of study design, applied statistical analysis and approval by institutional review offices (Ethics Committee) of articles published in the "Arquivos Brasileiros de Oftalmologia" during a 10-year interval, with later comparative and critical analysis by some of the main international journals in the field of Ophthalmology. METHODS: Systematic review without metanalysis was performed. Scientific papers published in the "Arquivos Brasileiros de Oftalmologia" between January 1993 and December 2002 were reviewed by two independent reviewers and classified according to the applied study design, statistical analysis and approval by the institutional review offices. To categorize those variables, a descriptive statistical analysis was used. RESULTS: After applying inclusion and exclusion criteria, 584 articles for evaluation of statistical analysis and, 725 articles for evaluation of study design were reviewed. Contingency table (23.10%) was the most frequently applied statistical method, followed by non-parametric tests (18.19%), Student's t test (12.65%), central tendency measures (10.60%) and analysis of variance (9.81%). Of 584 reviewed articles, 291 (49.82%) presented no statistical analysis. Observational case series (26.48%) was the most frequently used type of study design, followed by interventional case series (18.48%), observational case description (13.37%), non-random clinical study (8.96%) and experimental study (8.55%). CONCLUSION: We found a higher frequency of observational clinical studies, lack of statistical analysis in almost half of the published papers. Increase in studies with approval by institutional review Ethics Committee was noted since it became mandatory in 1996.

Keywords: Ophthalmology; Epidemiologic methods; Research design; Statistics; Periodicals

PURPOSE: To evaluate the efficacy of pure honey and 20% autologous serum and BSS® in corneal epithelial healing in rabbits after 48 hours. METHODS: All solutions were applied after an epithelial removal of 13-millimeters diameter area. Areas of epithelial healing were studied at 12, 24 and 48 hours. The eyes were treated every four hours during 2 days. All treated eyes were assigned to a control group (contralateral eye) treated with a balanced saline solution. RESULTS: All studied groups were not significantly differents. In group one, the eyes treated with honey and the control were similar (p<0.87). In the second group the eyes treated with autologos serum and the control presented no difference in the mean score (p<0.072). CONCLUSION: Corneal epithelial healing in rabbits did not show improvement after application of either honey or autologous serum. It was possible to stabilish that the autologous serum treated eyes were clinicaly better than the control group but without statistical significance.

Keywords: Epithelium; corneal; Wound healing; Corneal diseases; Wound infection; Honey; Ophthalmic solutions; Rabbits

PURPOSE: To describe the laboratory findings in patients with infectious keratitis, who underwent refractive surgery, correlating the surgical procedure and the time of infection manifestation, and the results of culture and smears. METHODS: The previous samples were obtained from patients submitted to radial keratotomy (RK), photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) at the Ophthalmology Department of UNIFESP. The infections were classified as early, when they occurred up to 30 days after the surgery, and late when diagnosed after 30 days. RESULTS: In 93 samples, 39 (42%) came from patients submitted to radial keratotomy, 14 (36%) being early infections and 25 (64%) late; 38 (41%) of LASIK, 21 (55%) being early and 17 (45%) late; 16 (17%) of photorefractive keratectomy, 10 (62.5%) being early and 6 (37.5%) late. Eighty-six samples were submitted to culture and smears for bacteria, 43 cultures (50%) and 43 smears (50%) were positive. Seventy-two samples were submitted to culture and smears for fungi, 2 cultures (3%) and 4 smears (6%) were positive. CONCLUSION: The agreement between culture and smear results was 80.2%; regarding the type of surgery there was no statistically significant relationship between time of onset of infection and surgery.

Keywords: Refractive errors; Refractive errors; Keratitis; Keratomileusis, laser in situ; Eye infections, bacterial; Staphylococcus aureus; Staphylococcus epidermidis

PURPOSE: To identify the barriers in the access to treatment of senile cataract and to evaluate the patient's costs in this process. METHODS: A survey of 101 patients who would undergo cataract surgery at Altino Ventura Foundation was performed using a questionnaire. The economical and social aspects of the whole process of treatment were evaluated. RESULTS: The principal barriers of cataract treatment were: fear of surgery, patient's low income, the need for preoperative examinations and the number of times the patient had to return to the service (3.2±1.5), as well as the waiting time between the first examination and the surgery (3.2±2.6 months - Mean ±SEM). The examination costs varied from 5 to 170 reais (16.6±2.7 - Mean ±SEM). DISCUSSION: The main reasons for not seeking for cataract treatment, as the fear to undergo surgery and the lack of financial resources had been similar to other Brazilian institutions. The number of times that the patient had to return to the service increased the expenses of the patient and the difficulties faced by him. Altino Ventura Foundation mainly takes care of the poorest population of the State, therefore, the expenses of the patients with transportation and examinations become obstacles to the treatment of cataract. CONCLUSIONS: The fear of surgery and the patient's low income and the social level of the institution's users were the principal barriers in the access to cataract treatment in this study. The need for preoperative examinations, sometimes unnecessary, contributes to a lower efficiency of the medical services offered to individuals of low income and social conditions. The surgery carried out at the same day of the cataract diagnosis makes the solution of the illness quickly possible, diminishing the number of times necessary for the patient's return to health service from three or more, to only one.

Keywords: Cataract extraction; Cataract extraction; Blindness; Health services accessibility; Quality of health care

PURPOSE: To collect information and opinions from a group of diabetic patients regarding diabetic retinopathy and its treatment, in order to get reliable information that can help to improve programs and actions to control and prevent this ocular disease. METHODS: A cross-sectional study was performed. The sample was from 980 diabetic patients seen in a diabetic association. A previous questionnaire was made with general questions about the main subject. Thereafter, an appropriate questionnaire was prepared. RESULTS: The sample showed that among 299 patients with age ranging from 16 to 83 years, with a mean of 57 years, mainly female (67.91%) did not know how severe their disease was (30.8%), or believed that it was not a serious problem (19.7%). The laser technique to solve diabetic retinopathy was known by 60.2% of the patients. It was reported as the only treatment available by 24.1%. Among the reasons for no treatment 59.8% reported that they did not think it was necessary and 29.7% could not afford it. CONCLUSIONS: Patients showed lack of knowledge about how serious is diabetic retinopathy, the possibility of using laser technique for it and the severity of the disease. Some patients believed in the efficacy of the treatment and some patients did not, but all of them reported that they were afraid of submitting to it.

Keywords: Diabetic retinopathy; Diabetic retinopathy; Eye health; Diabetes mellitus; Public Health; Perception; Professional-patient relations; Cross-sectional studies

PURPOSE: To identify the frequency of ocular changes in patients with Hansen's disease, living in a colony hospital; to confirm the predilection for the anterior segment of the eye instead of the posterior segment. METHODS: Transversal study of 115 eyes of 58 in-patients at João Paulo II colony, Marituba - Pará, from August to October 1999. The epidemiologic data of this research were obtained from the patients' charts and from information obtained at clinical eye examination. All patients in this study were considered cured of Hansen's disease according to the Health Ministery criteria of cure. RESULTS: In 114 eyes (99.1%) ocular involvement was observed, the majority (77.2%) being the virchowian form. The most frequent ocular findings in the adnex were parcial madarosis (70.4%) and parcial eyebrow madarosis (59.1%). The most frequent ocular finding related to Hansen's disease was the decrease and/or absence of corneal sensitivity observed in 42.6% of the eyes, followed by paralytic midriasis (16.5%) found in the patients after surgery for cataract extraction; this finding was closely related to iris atrophy (8.7%), commonly found in these patients. CONCLUSION: The high prevalence of ocular involvement in Hansen patients, especially in virchowian form, indicates the need of complete assistance to these patients even after the resolution of the disease.

Keywords: Leprosy; Leprosy, lepromatous; Mycobacterium leprae; Ocular manifestations; Eye infections; bacterial; Eye diseases; Hospitals; Cross-sectional studies

PURPOSE: To verify the refractive alterations in eyes of children submitted to surgery with implant of intraocular lens (IOL) and to investigate prediction of biometry in these cases. METHODS: Thirty-three eyes were studied with previous measurement of visual acuity with indication for cataract surgery with implant of intraocular lens in the Outpatient Clinic of Congenital Cataract of the Federal of University of São Paulo/Paulista School of Medicine, (UNIFESP-EPM) from January, 1998 to December, 2000. After the surgery, refraction, prescription of glasses with appropriate treatment for visual stimulation of the children, and measurement of the final corrected visual acuity were performed. Final refraction, biometric accuracy and possible error factors were analyzed. RESULTS: Thirty-three surgeries in 29 children were performed. Mean follow-up time was 10.15 months ranging from 2 to 34±8.18 months. In 43% of the cases a vision equal to or grater than 20/50 was obtained. Forty-six percent of the patients presented a final refraction between +1.00 and -1.00 spherical diopters. CONCLUSION: Treatment of congenital cataract through implant of intraocular lens continues to be controversial, where long-term results are not known. A great number of patients were operated on at a late time and progressed with amblyopia and low visual acuity even after treatment with difficult access to early and adequate treatment. In spite of residual refraction the patients obtained good visual acuity. Twenty-one percent of the cases with refractive alteration with hyperopia will still have increase in their axial diameter and consequently myopia with reduction of their refraction.

Keywords: Cataract; Cataract extraction; Lens, implantation; intraocular lens; Visual acuity; Refraction, ocular refraction; Biometry; Child

Ophthalmic manifestations of neuroendocrine carcinoma. This case report describes the clinical apresentation, diagnosis and treatment of a case of neuroendocrine carcinoma. A 43-year-old man presented with ocular manifestation due to orbital and brain metastasis of neuroendocrine carcinoma. The histopatologic and imunohistochemical analysis suggested the diagnosis. Partial and temporary remission of the symptoms occurred after the first chemotherapy cycle. We discuss the importance of creating treatment guidelines for this type of neoplasm, that can be very agressive and fatal.

Keywords: Carcinoma, neuroendocrine; Orbital neoplasms; Orbital neoplasms; Vincristine; Prednisone; Eye manifestations; Case report

Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi spirochete, transmitted by ticks. Mainly described in the northern hemisphere and rarely in Brazil. The purpose of this report is to describe a patient with Lyme disease who developed bilateral tonic pupil as the only remaining sign. A 13-year-old female with Lyme disease, presented with bilateral peripheral facial and oculomotor paralysis. After recovery from neurological abnormalities the patient sustained anisocoria, reduced fotomotor reflex, less than normal amplitude of accommodation, tonic pupil constriction for near objects and slow redilatation in both eyes. Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. This is the first case report of bilateral tonic pupil caused by Lyme disease.

Keywords: Tonic pupil; Lyme disease; Lyme disease; Ceftriaxone; Lyme disease; Papilledema; Meningoencephalitis; Case report

The authors report a case of anophthalmia, congenital cataract and systemic malformations. Male patient, 6 months old, left anophthalmia and congenital posterior polar cataract in the right eye. The patient was treated with manual aspiration of the crystalline lens, with no intraocular lens implantation with primary posterior capsulorhexis and anterior vitrectomy through a small incision. The association of anophthalmia and congenital cataract is rare. The early diagnosis and management in these cases is very important for the best visual rehabilitation.

Keywords: Anophthalmos; Cataract; Orbit; Infant; Male; Case reports

The objective of this report is to demonstrate the effectiveness of an iris prosthesis to treat a refractory glaucoma induced by silicone oil in the anterior chamber. This case is about a patient who suffered a trauma caused by firearm shrapnel. A vitreous-retinal surgery was performed to remove intraocular foreign matter and to realign the retina that was detached. Due to the partial traumatic aniridia, silicone oil that was introduced in the vitreous chamber to keep the retina in place migrated to the anterior chamber, resulting in the decrease of endothelium cells and uncontrollable intraocular pressure. We performed transscleral fixation of the iris prosthesis to correct these problems. After a 45-month period of evolution, sight became stable at the 1 meter finger-count distance and intra-ocular pressure at 14 mmHg We may conclude that the triad that consists of lack of: iris diaphragm, aphakia and silicone oil that could not be removed because of inexorable occurrence of detachment of the retina should lead the surgeon to consider transscleral fixation of the iris prosthesis. This procedure might control intraocular pressure and/or preserve corneal transparency, preventing silicone oil from contact with the trabecular net and the corneal endothelium.

Keywords: Silicone oils; Aniridia; Iris diseases; Anterior chamber; Prosthesis implantation; Glaucoma; Case report

Corticosteroids can increase intraocular pressure when administered topically, systemically and even when inhaled. They are routinely used after refractive surgeries to lower or prevent an inflammatory action. In this case history, we present a 36-year-old patient who had a total myopic regression two weeks after LASIK for low myopia, caused by steroid-induced ocular hypertension. The purpose of this report is to describe how the case was managed, the diagnostic hypothesis, and to stress the importance of intraocular pressure measurement after LASIK.

Keywords: Myopia; Adrenal cortex hormones; Keratomileusis, laser in situ; Intraocular pressure; Glaucoma; Postoperative period; Case reports

A 7-year-old boy with sympathetic ophthalmia secondary to penetrating ocular trauma developed choroidal neovascularization in the macular region of the sympathizing eye. Posterior segment biomicroscopy disclosed a single, round, small, slightly elevated yellow-white lesion temporal to the fovea, linked to the temporal edge of the optic disc by a fibrotic band. On fluorescein angiography the round lesion showed a gradual hyperfluorescence, with late staining and leakage, and was interpreted as a fibrovascular scar from previous choroidal neovascularization. Despite intense immunosuppressive therapy, the patient's final visual acuity was 20/400. Although rarely associated with sympathetic ophthalmia, choroidal neovascularization and its cicatricial stages can occur and compromise the visual prognosis of an already debilitated eye. The best course of treatment for choroidal neovascularization in these types of cases has not yet been determined.

Keywords: Ophthalmia, sympathetic; Choroidal neovascularization; Immunosuppressive agents; Wound healing

We describe a clinical case of a patient with pachydermoperiostosis and bilateral palpebral ptosis. It is a hereditary, dominant autosomic disease, which affects skin, bones and soft tissues. In the eyelid, it causes an important tarsal hypertrophy. We discuss the physiopathology and treatment of the ptosis.

Keywords: Blepharoptosis; Blepharoptosis; Osteoarthropathy, primary hypertrophic; Case reports

Congenital retinal macrovessel is a rare vascular anomaly in which a large vessel and its tributaries cross the macula. We describe a case of retinal macrovessel in a patient complaining of decrease in visual acuity.

Keywords: Arteriovenous malformations; Retinal diseases; Retina; Retinal vessels; Regional blood flow; Visual acuity; Case report

To report a case of ocular toxicity due to chloroquine. The best visual acuity was measured in both eyes with the Snellen chart. Slit-lamp examination of anterior segment, refraction, dilated fundus examination, fluorescein angiography and retinography was done in a 53-year-old patient, female, with rheumatoid arthritis. She had used chloroquine during 6 years and had stopped for 1 year when she came to our service. She had best corrected visual acuity of 20/200 and 20/40. Slit-lamp examination showed intraocular lens in right eye and nuclear cataract (1+/4) in the other, and bilateral corneal subepithelial opacity inferior to the visual axis. Fundus examination showed macular area with retinal pigment epithelium atrophy. Fluorescein angiography showed a bull's eye maculopathy. Report of a typical keratopathy and maculopathy caused by chloroquine.

Keywords: Chloroquine; Chlroquine; Macular degeneration; Retinal diseases; Drug toxicity; Fundus oculi; Macula lutea; Case report

Diabetic retinopathy continues to be an important cause of adult blindness among Americans and Brazilians. There are determinant environmental factors in the development of diabetic retinopathy although increasing evidence suggests a genetic component in diabetic retinopathy. The advances made during the last two decades with the purpose of improving the understanding of the mechanisms involved in the development and progression of diabetic retinopathy have prompted this review. This article has the purpose of revising and updating concepts about the ocular physiopathology of diabetes mellitus.

Keywords: Diabetes mellitus; Diabetic retinopathy; Diabetic retinopathy; Retinal neovascularization