VOLUME 68 - ISSUE 4

PURPOSE: To compare two new biomaterials: Composite 10% (Engineering School - Universidade Federal de Minas Gerais - UFMG - Brazil) and Composite 20% (Engineering School - Universidade Federal de Minas Gerais - UFMG - Brazil), with two similar materials as control: MedporTM (Porex Surgical Inc. - USA) e PoliporeTM (Homus Com. Ind. Ltda - BRASIL). METHODS: In vivo randomized experimental double blind study: a transconjunctival approach was performed in both cartilaginous superior orbital walls of 28 rabbits for 56 implants divided into 4 groups: GI: Composite 10%/MedporTM; GII: Composite 10%/PoliporeTM; GIII: Composite 20%/MedporTM; GIV: Composite 20%/PoliporeTM. The mean rate for implant time of permanence was 19.7 weeks. The Student's t test was used for statistical analysis. RESULTS: Revealed similar biocompatibility of all materials and none of the implants was extruded; one Composite 20% had partial exposure. Histomorphometry showed a greater bioactivity of the composites with significantly thicker fibrous encapsulation, with more collagen and fibroblasts, exuberant angiogenesis, and a lower inflammatory cell mean compared to controls. The presence of precipitation of a hydroxycarbonate apatite layer, which acts as an implant-tissue bond was confirmed. Composites presented a smaller tissular invasion index of the pores compared to controls. CONCLUSIONS: The composites showed a good biocompatibility and some additional advantageover the MedporTM and PoliporeTM controls.

Keywords: Surgery, plastic; Composite resins; Biocompatible materials; Prostheses and Implants; Inflammation; Tissue adhesives; Randomized Controlled Trial [Publication Type]; Rabbits; Comparative study

PURPOSE: To detect normal values of red phenol thread test in the Brazilian population and compare it between different races, age and sex. METHODS: 280 white individuals (560 eyes) and 280 non-white individuals (560 eyes) were analyzed regarding sex and age, and analyzed using the Phenol Red test. Individuals with ocular diseases, contact lens or ocular drug users were excluded from this study. RESULTS: Of the 1,120 evaluated eyes, the mean ± standard deviation result was 19,77±7,90 mm. CONCLUSIONS: The mean result found in this study was an intermediate value compared to the previously studied populations (Japanese and American).

Keywords: Cornea; Phenolsulfonphthalein; Dry eye syndromes; Tears; Osmolar concentration; Diagnostic techniques, ophthalmological; Cross-cultural comparison; Comparative study

PURPOSE: To evaluate the contrast sensitivity and stereopsis tests in patients who underwent bilateral implantation of multifocal intraocular lens. METHODS: Tests of contrast sensitivity using the Pelli-Robson chart and stereopsis evaluation with the Titmus Stereo Test were performed in 20 patients 30-60 days after the bilateral implantation of Acrysof Restor® multifocal intraocular lens. RESULTS: The binocular contrast sensitivity test demonstrated that 6 patients (30%) presented 1.80 log units, 13 (65%) 1.65 and in only 1 (5%) the sensitivity was 1.50 log units. By the other hand, the monocular test in right eye showed 17 patients (85%) with 1.65 log units and 3 (15%) with 1.50. In the left eye, the test presented 16 patients (80%) with 1.65 log units and 4 (20%) with 1.50 log units. The average and the standard deviation of the contrast sensitivity were 1.63 (±0.05) for right eye, 1.62 (±0.06) for left eye and 1.69 (±0.08) for binocular test. Stereopsis test disclosed 12 patients (60%) presenting 40", 6 (30%) 50" and only 2 (10%) 60" (average: 45" and standard deviation: 6.88"). CONCLUSIONS:The Acrysof Restor® intraocular lens provided results of contrast sensitivity and stereopsis in accordance with the criteria of normality established previously in other studies for phakic and pseudophakic patients. Therefore, this intraocular lens does not decrease visual functionality.

Keywords: Contrast Sensitivity; Depth Perception; Pseudophakia; Lens Implantation, Intraocular; Lenses, Intraocular; Cataract

PURPOSE: To compare the results of isolated antral-ethmoidal orbital decompression and that associated with orbital fat removal in patients with dysthyroid orbitopathy. METHODS: Nineteen isolated antral-ethmoidal orbital decompressions were performed in a group of 12 patients (19 orbits) with the diagnosis of dysthyroid ophthalmopathy in the quiescent stage. The same procedure, but in association with orbital fat removal, were performed in another group of 8 patients (10 orbits) also with the diagnosis of dysthyroid ophthalmopathy in the quiescent stage. The results of both groups were compared. RESULTS: In the first group the amount of retroplacement of the globe achieved 1-5 mm (mean 3.68±1.10 mm) and in the second group it achieved 1-5 mm (mean 3.25±1.36 mm). CONCLUSIONS: There was no significant difference between the results of the isolated antral-ethmoidal orbital decompression and that associated with orbital fat removal. The removal of 1ml of seems not to improve the retroplacement of the globe as an association with a 2-wall orbital decompression. However, many conditions must be considered to conclude any comparison between the two orbital decompression techniques, such as orbital soft tissue compliance, amount of fat removal and size of bone opening.

Keywords: Graves' disease; Decompression, surgical; Orbit; Ethmoid bone; Lipectomy; Comparative study; Retrospective studies

PURPOSE: To verify the topographical alterations in enucleated pig eye cornea after radiofrequency application. METHODS: A prototype radiofrequency modulator with 10 different energy possibilities was used. For each energy we used 10 enucleated pig eyes that were topographed before and after applyng radiofrequency, following a nomogram with 8 spots in step one, 16 spots in step 2, and 24 spots in step 3, in a total of 3 steps for each eye, 300 applications and 400 topographies. RESULTS: Corneal curvature variation occurred after radiofrequency applications for all utilized selections, demonstrated by the mean variation of initial KM (minimum dioptry) and final KM (35.78 and 37.37 respectively) with 1.59 dioptries of variation (p<0.001). The energy that demonstrated more stability was 0.625W/s (65ºC). CONCLUSION: The obtained topographic values demonstrated that the central corneal curvature increased after radiofrequency application, and the higher the energy and the more spots used, more curved became the cornea, despite homogeneity.

Keywords: Corneal topography; Refractive errors; Eye enucleation; Radio waves; Swine; Disease models, animal

PURPOSE: To determine the prevalence of dry eye in Hansen's disease patients from the "Hospital de Dermatologia Sanitária de Goiânia". METHODS: The sample of the present study included 70 patients with Hansen's disease, from the "Hospital de Dermatologia Sanitária de Goiânia", and 30 controls, from the "Fundação Banco de Olhos de Goiás", both located in Goiânia-GO, Brazil. Ophthalmologic examination and Schirmer I, break-up time (BUT) and rose Bengal staining tests were carried out for all patients in a single evaluation. For the diagnosis of dry eye the Schirmer I equal or less than 5 mm and rose Bengal grade II or III, in at least one eye were considered. RESULTS: Forty-four (63.0%) patients with Hansen's disease were male and 22 (73.3%) controls were female (p=0.001). The mean age of the patients with Hansen's disease was 61.1±12.5 years and in the control group, it was 55.7±9.6 years. Fifteen (21.4%) patients with Hansen's disease and four (13.3%) controls presented with dry eye diagnosis (p=0.429). The lepromatous type (74.2%) of Hansen's disease was the most prevalent and dry eye (66.7%) was more frequent in this clinical form of the disease. CONCLUSION: The dry eye disease was more prevalent in patients with Hansen's disease, although the difference was not statistically significant.

Keywords: Dry eye; Dry eye

PURPOSE: The purpose of this study was to identify, according to an sistematic review, the best treatment for acute retinal necrosis. METHODS: Following the methodologic guidance of the Cochrane Collaboration and its editorial subgroup "Eye and Vision Group", using search strategy for study identification, articles about the treatment of acute retinal necrosis were selected. RESULTS: 146 bibliographic references were selected, 13 studies were considered relevant. Among them 2 were considered to follow the inclusion criteria. The first study tested the possibility of using intravenous acyclovir associated with corticosteroids, protecting contralateral eye from being affected. Fifty-four patients who reported unilateral acute retinal necrosis have been studied, 31 treated and 23 not treated, the disease occurring in the contralateral eye in 12.9% of the patients of the treated group and in 69.5% of the patients in the non-treated group. The second study considered treatment with photocoagulation with argon laser to prevent retinal detachment, that was observed in 57.1% of the eyes. The second included study disclosed 19 eyes affected by acute retinal necrosis, considering that 12 of these eyes were treated with photocoagulation with argon laser to prevent retinal detachment. Among the 12 eyes, 2 developed retinal detachment (16.6%) while, in the non-treated group, 7 eyes, 4 developed retinal detachment (57.1%). CONCLUSION: The author concludes that both types of proposed interventions have proven to be effective. However, once the mentioned studies are methodologically considered weak, it is necessary to perform randomized clinical trials with the purpose of establishing the most suitable treatment for acute retinal necrosis.

Keywords: Retinal necrosis syndrome acute; Retina; Acyclovir; Evidence Based Medicine; Treatment outcome; Meta-analysis

PURPOSE: To study the efficiency of botulinum toxin treatment in facial dystonia patients and their satisfaction along treatment. METHODS: Retrospective study of 42 facial dystonia cases followed at the Oculoplastic Surgery Department of the "Hospital das Clínicas" of the University of São Paulo. RESULTS: Following the first injections, 45.2% of the patients scored the improvement of the spasms between 9-10, 35.7% scored between 7-8, 16.7% between 5-6 and only one patient scored the improvement of the spasm as 4. According to the remission time of the symptoms, 4.8% of the patients reported between 5-6 months, 64.2% between 3-4 months and 31% reported the need for a new injection after 1-2 months of the previous injection. During treatment, 76.1% of the patients maintained the same score for spasm improvement after the botulinum toxin injection, 19.1% reported improvement and only 4.8% noted worsening of efficiency of the last injections. Along the follow-up, 64.2% reported no change in the time of return of the symptoms, 16.7% had increased and 19.1% had decreased remission time of the symptoms. After injections, 19% of the patients presented side effects and 73.8% of the patients complained of mild to moderate discomfort during the injection. CONCLUSIONS: Botulinum toxin was efficient and no change of efficiency along the time was observed. Side effects are few and the tolerance to injections are good. It is a good alternative in order to improve quality of life of these patients avoiding functional blindness caused by these diseases.

Keywords: Botulinum toxin type A; Botulinum toxin type A; Hemifacial spasm; Blepharospasm; Patient acceptance of health care; Patient satisfaction; Recurrence

PURPOSE: To analyze the costs of therapy for amblyopia for an outpatient using occlusion of the normal sighted eye and its visual results. METHODS: A prospective study was performed to evaluate the costs of therapy for amblyopia at the Strabismus Sector of the Hospital São Paulo - Universidade Federal de São Paulo/Escola Paulista de Medicina. Children with amblyopia ranging in age from 3 to 7 years were included in the study. The patients were followed since the diagnosis time until three consecutive visits. At the diagnosis time we prescribed glasses when necessary and total, direct and continuous occlusion of the normal sighted eye. Information about the therapy and the cost of therapy for amblyopia was collected at the following visits. To analyze the results the costs were separated into direct (glasses and occlusors) and indirect (transport, and cost of parent's/guardian's workday). RESULTS: Fourteen patients were analyzed. The mean age was 5.21 years (from 3 to 7 years) and 7 (50%) patients were male and 7 (50%) female. The average of the monthly cost of amblyopia therapy was R$ 59.49 and the average of the annual cost was R$ 714.47. The average monthly cost of therapy for amblyopia represented 12.20% of the monthly family income. CONCLUSIONS: The therapy for amblyopia is efficient and improves visual acuity of the amblyopic eye in 71.43% of the cases. The monthly cost of this therapy is R$ 59.49 being 12.20% of the patient's family income.

Keywords: Amblyopia; Amblyopia; Visual acuity; Cost-benefit analysis; Sensory deprivation; Health care costs

PURPOSE: To study the clinical effects of the secretion of transplanted labial glands used as ocular lubricant to treat severe dry-eye cases, to evaluate the duration of the results and to simplify the surgical technique. METHODS: Thirty-seven surgeries were performed in twenty-one patients during the period of July 2000 to January 2004. The graft, consisting of labial mucosa and underlying salivary glands, was transplanted to the previously prepared area in the conjunctival fornix. All procedures were recommended in severe dry-eye cases, that is, eyes with total or nearly total xerophthalmia. The preoperative and postoperative protocols are presented emphasizing the items which were used in the comparative analysis of the results as well as the technical description of the surgical procedure. RESULTS: The graft survival and integration into the host tissues were observed in 97.2% of the cases. The clinical improvement, demonstrated by the disappearance of the symptoms, better biomicroscopic aspect of the ocular surface, better vision and disuse of lubricant drops, was observed in 91.9% of the cases. The follow-up showed not only persistence but also stability of the results. Infection represented one case and ptosis represented three cases of the only four observed complications. CONCLUSION: The improvement of severe dry-eye cases detected after the transplantation of labial salivary glands is significant. It demonstrates that the lubricant ocular surface produced by the salivary secretion is efficient and well-tolerated. The follow-up shows that the result persists in the long term from which it is concluded that the production of the secretion is permanent. The surgical technique of transplanting the labial salivary gland to the conjunctival fornix is very simple and easily accessible to any ophthalmic surgeon.

Keywords: Salivary glands; Conjunctiva; Keratoconjunctivitis Sicca; Lubrification; Tears; Lacrimal apparatus; Transplantation, Autologous

PURPOSE: To study keratoconus disease carrier patients in an age range under the usual one and try to detect any factor which can influence in disease evolution and prognosis. METHODS: Patients under 15 years old with a keratoconus diagnosis where analyzed. All of them answered a questionnaire, and were submitted to ocular examination and also computerized ceratoscopy. These patients were divided into three groups and went through a contact lens test: 1) it was possible for this group to adapt to contact lenses; 2) a cornea transplant for this group was recommended; 3) for this group it was suggested that they use glasses. RESULTS: Patients who had 20/40 or greater visual acuity usually did not progress to transplant in the studied period. On the other hand, patients who had 20/60 or less acuity, progress to a deep transplant very quickly. Other cases, related to a lower age range (10-15 years old) pregressed to a transplant. We can observe that the cornea apex has a very unsteady location, which explains the different difficulty levels regarding adaptation to contact lenses. In all patients who had a superior out of place apex and values greater than 66 D adaptation was successful. In the central apex eyes the adaptation was easier. In the inferior apex eyes it was not possible to set a standard to indicate the person for surgery. In the eyes which were adapted to the contact lenses and whose curvature was smaller than 51.10 D there were fewer chances of evolution to a cornea transplant, on comparison with patients who had a curvature of 57.60 or even greater. CONCLUSION: Patients who have curvatures greater than 57.40, acuity lower than 20/60 and are under 18 years old have more chances to evolve to a cornea transplant. When the ceratocone apex is central the contact lens adaptation becomes easier.

Keywords: Keratoconus; Prognosis; Corneal transplantation; Contact lenses; Visual acuity

PURPOSE: To assess the results as to visual acuity of two different surgical procedures for ectopia lentis. METHODS: Fifty-one eyes of 28 patients (16 males and 12 females, mean age 16.00± 8.5) with simple (19 cases) or Marfan syndrome-associated (9 cases) ectopia lentis with different levels of subluxation underwent lens extraction with implantation of intraocular lenses (IOL) with scleral fixation (21 cases) or by lens extraction with implantation of the intraocular lenses in the capsular bag expanded by endocapsular ring (RING) (30 cases). Result analysis emphasized pre- and postoperative visual acuity during a six-month follow-up. RESULTS: Both techniques showed significant increase of postoperative visual acuity with and without correction, but it was better among the cases operated on by scleral fixation of the intraocular lenses. More than the used technique, the preoperative subluxation grades were crucial as to the results. CONCLUSION: The two surgical techniques for correction of simple or Marfan syndrome-associated ectopia lentis are safe and effective, resulting in significant recovery of visual acuity, although surgical results are completely dependent on the preoperative lens subluxation grades.

Keywords: Ectopia lentis; Marfan syndrome; Lenses intraocular; Sclera; Lens capsule, crystalline; Prostheses and Implants; Visual acuity; Adolescent

PURPOSE: This study tends to identify the incidence of ocular open trauma at the emergency service of the "Complexo Hospitalar Padre Bento of Guarulhos, SP". METHODS: It is a descriptive transversal study performed in a period of four months at the "Complexo Hospitalar Padre Bento". All patients admitted at the emergency room with a diagnosis of open ocular trauma were included. After ophthalmologic examination, all patients hospitalized, with intravenous antibiotic therapy, occlusive tamper and preparation for surgery. RESULTS: Twenty-three patients with ocular perforating trauma were attended. Mean age was 34.35 years, with males representing 87.00% of all cases. Motor vehicle accidents were the most frequent type of trauma with 43.50% of the patients. Visual acuity loss was an important predictor of looking for early medical emergency service, with 92.30% of the patients doing this in less than twelve hours. CONCLUSION: Penetrating corneal trauma was the most frequent. Open ocular trauma was more frequent in young men, victims of automobile accident. The right eye was the most affected. Low vision was the mostly observed immediate complication.

Keywords: Eye injuries, penetrating; Emergency service, hospital; Cornea; Accidents, Traffic

PURPOSE: To determine retinal toxicity after intravitreous balanced salt solution, sulfur hexafluoride gas, and perfluorocarbon liquid injection in rabbit eyes. METHODS: Twenty-two eyes of sixteen New Zealand albino rabbits were divided into groups: balanced salt solution (7 eyes); sulfur hexafluoride gas (4 eyes); and perfluorocarbon liquid (5 eyes). After the introduction of a needle through the sclera the vitreous was aspirated (0.3 ml), balanced salt solution, sulfur hexafluoride gas 100% and perfluorocarbon liquid (0.3 ml) were injected into rabbit vitreous cavity. The control group (6 eyes) was not submitted to any procedure. After three weeks the vitreous was aspirated and submitted to biochemical analysis and the eyes prepared for histological analysis. RESULTS: The eyes submitted to perfluorocarbon liquid and sulfur hexafluoride gas injection showed a greater L-glutamate increase in the vitreous compared to balanced salt solution and control groups (p<0.05). Histological results confirmed small changes in the sulfur hexafluoride group and important lesions in perfluorocarbon liquid group, such as external photoreceptor segment disruption, external and internal plexiform layer thinning, ganglionar and internal nuclear layer decrease of nucleus number, edema, and presence of macrophages in the superficial layers. No major histological changes were observed with balanced salt solution and in control groups. CONCLUSION: Liquid intravitreous injection of sulfur hexafluoride gas and perfluorocarbon are potentially toxic to rabbit retina, compared to control and balanced salt solution groups.

Keywords: Retina; Retinal detachment; Vitreous body; Sulfur hexafluoride; Perfluorocarbon liquid; Glutamic acid; Rabbits

PURPOSE: The authors intend to evaluate the eyelid position before and after the external prosthesis adaptation, using digital image processing techniques. METHODS: Eighteen patients were evaluated at the "Faculdade de Medicina de Botucatu - Universidade Estadual Paulista - UNESP", with and without the external prosthesis. Qualitative and quantitative analysis were done using the Scion Image program. The superior eyelid sulcus distance, margin eyelid distance and eyelid medial and lateral canthus angles were evaluated. RESULTS: Pseudostrabismus and high eyelid sulcus were the most observed alteration. The superior eyelid sulcus distance had shorter values with the prosthesis and higher values were seen analyzing the other parameters when the external prosthesis was in place. CONCLUSION: All patients had some abnormalities, which show us how difficult it is to provide a normal aspect for anophthalmic cavity carriers. The image processing allowed objective evaluations of the measures contributing to the follow-up of the patients.

Keywords: Graves' disease; Blepharoptosis; Eye Enucleation; Eyelid diseases; Orbit; Image processing, computer-assisted; Prostheses and implants; Syndrome

PURPOSE: To observe the behavior of intraocular pressure according to the cardiopulmonary and hemodynamic effects induced by desflurane in dogs subjected to experimental hypovolemia. METHODS: Eighteen healthy male and female mongrel dogs, weighing between 10 and 15 kg were used. Hypovolemia was induced by withdrawal of 40 ml blood/kg body weight. Then anesthesia was induced with desflurane by mask until tracheal intubation was permitted. Intraocular pressure was measured with applanation tonometry. Heart rate, cardiac output, mean arterial pressure, central venous pressure, end-tidal concentration of CO2 and respiratory rate were recorded. Parameters were registered after animal instrumentation and before any procedure in the awake dogs (T0), fifteen minutes after experimental hemorrhage induction (T45), and after thirty minutes of desflurane anesthesia (T75). RESULTS: Intraocular pressure presented direct correlation only with pressure and end-tidal concentration of CO2. CONCLUSIONS: It was not possible to establish a correlation between alterations of mean arterial pressure and central venous pressure and intraocular pressure and there was a direct relationship between values of intraocular pressure and values of exhaled CO2.

Keywords: Intraocular pressure; Intraocular pressure; Anesthesia; Eye; Aqueous humor; Anesthetics, inhalation; Hypovolemia; Hypovolemia; Hemodynamic processes; Respiration; Dogs

PURPOSE: To show the subperiosteal midface lift as an option to treat cicatricial eyelid ectropion. METHODS: Nine patients submitted to 12 surgeries to correct cicatricial eyelid ectropion, were evaluated according sex, age and treatment results. All the patients had the surgery done under local anesthesia and the midface was repositioned by sutures. RESULTS: According to our observations only two eyelids did not have good improvement with the procedure and few complications occurred. CONCLUSION: The subperiostal midface lift is effective and a good option to correct the cicatricial eyelid ectropion.

Keywords: Face; Eyelids diseases; Eyelids; Cicatrix; Ectropion; Oculomotor muscles; Plastic surgery

Our purpose is to report a case of cranial venous thrombosis causing pseudotumor syndrome, where the principal clinical manifestation was severe bilateral vision loss. A 24-year-old man presented with severe bilateral vision loss, transient obscuration of vision, headache, bilateral papilledema and constricted visual fields. Computed tomography as well as neurologic examination was unrevealing. A lumbar puncture disclosed an increased cerebrospinal fluid opening pressure and complete blood count (CBC) showed increased numbers of platelets. A brain magnetic resonance imaging disclosed characteristic sings of chronic papilledema and suggestive signs of superior sagital sinus thrombosis. A cranial magnetic resonance venography disclosed thrombosis of superior sagital, transvers and sigmoid sinuses. The patient was treated with an optic nerve sheath decompression in the left eye, acetazolamide and anticoagulation. His ocular evaluation showed reduction of the papilledema, but severe vision loss remained. Pseudotumor cerebri with severe vision loss can be the presenting sign of cranial venous thrombosis secondary to a potentially life-threatening hematologic disorder.

Keywords: Papilledema; Pseudotumor cerebri; Sinus thrombosis, intracranial; Intracranial pressure; Thrombocytosis; Visual acuity; Case report

To report a case of ocular copper deposition in both eyes at the level of Descemet's membrane associated with a monoclonal gammopathy of undetermined significance (MGUS). A 49-year-old white woman had golden-brown metallic dust-like deposits on Descemet's membrane of both eyes. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin and a normal level of total protein. Serum protein electrophoresis demonstrated a single peak (M-spike) in the gamma region (M-protein in serum = 11 g/l). Flow cytometric analysis of the marrow aspirate identified a monoclonal plasma cell population that represents approximately 2% of the total marrow cells consistent with the diagnosis of monoclonal gammopathy of undetermined significance. Copper deposits at the level of Descemet's membrane may be a finding in a patient with monoclonal gammopathy of undetermined significance.

Keywords: Copper; Blood protein electrophoresis; Descemet's membrane; Gama-globulins; Paraproteinemias

The authors describe a case of endogenous Candida albicans endophthalmitis in one extremely low birth-weight newborn refractory to endovenous amphotericin B treatment that presented resolution with the use of endovenous fluconazole. Clinical aspects of endogenous Candida albicans endophthalmitis are also pointed out by a review of the literature.

Keywords: Candidiasis; Endophthalmitis; Eye infections, fungal; Infant, premature; Candida albicans; Fluconazole

"Progressive esotropia fixus" is a disease present in high myopic patients with a large angle esotropia associated with hypotropia with poor surgical results. This paper has the purpose to describe Yamada's surgical technique (hemitranspositions of the superior rectus and lateral rectus) applied to 2 patients with good surgical results.

Keywords: Myopia; Esotropia; Esotropia; Case report

To report the presence of viable mycobacteria in a patient with keratitis treated for 6 months. Species identification was performed using the PRA method (polymerase chain reaction followed by restriction endonuclease analysis). Clonality was evaluated with RAPD (randomly amplified polymorphic DNA) and ERIC-PCR (enterobacterial repetitive intergenic consensus - polymerase chain reaction) methods. The patient reported trauma due to a metallic foreign body 3 weeks prior to presentation. Initial corneal scraping cultures revealed Mycobacterium abscessus. After 6 months of topical and systemic treatment the patient presented with no active inflammation and was considered clinically cured. An optic penetrating keratoplasty was performed. Culture of the excised cornea revealed Mycobacterium abscessus. Both isolates had the same clonal origin. The most interesting finding of this case report was the positive culture of the excised cornea after 6 months of intensive specific topical therapy. To our knowledge, this is the first report in the literature showing this possibility in the treatment of Mycobacterial keratitis. Thus, Mycobacterium abscessus may present viable bacteria after long-term treatment and should be followed carefully for a long period of time after tapering the medication.

Keywords: Eye foreign bodies; Keratitis; Cornea; Eye infections, bacterial; Mycobacteria, atypical; Mycobacterium fortuitum; Mycobacterium chelonae; Case report

To report tamoxifen ocular toxicity. The best visual acuity was measured in both eyes with Snellen chart, slit-lamp examination of anterior segment, refraction, dilated fundus examination, fluorescein angiography and retinography in a 63-year-old patient, female, white, using tamoxifen 20 mg/day for 4 years, with 20/70 and 20/40 corrected visual acuity. The anterior segment examination showed corneal linear subepithelial opacity inferior to the visual axis and nuclear and posterior cortical cataract (1+/4) in both eyes. Fundus examination showed alteration of macular color in both eyes. Fluorescein angiography presented hyperfluorescence in the macular area at an early phase (window defect). Report of keratopathy and maculopathy caused by tamoxifen.

Keywords: Breast neoplasms; Tamoxifen; Tamoxifen; Drug toxicity; Macular degeneration; Fundus oculi; Macula lutea; Fluorescein angiography; Retinal diseases; Case report

Orbital granulocytic sarcoma is a localized tumor consisting of malignant cells of myeloid origin. This tumor may present in association with acute myelogenous leukemia. Granulocytic sarcoma may be found in a variety of locations throughout the body including the orbit and typically affects children and young adults. There is a slight male predominance in these cases. This is an uncommon case report of a 33-year-old Latin-American woman who was admitted to the Hospital for rapidly progressive orbital proptosis. There was no systemic manifestation of leukemia. The occurrence of orbital granulocytic sarcoma before the development of systemic leukemia in children and young adults is not uncommon and these cases frequently develop hematological evidence within 2 months after initial orbital disease. In this case report, there was no systemic manifestation of leukemia in the last 30 months, even in the presence of orbital tumors. Granulocytic sarcoma is most frequently confused with malignant lymphoma, rhabdomyosarcoma and neuroblastoma. The differential diagnosis of these cases can be challenging, particularly when there is no evidence of systemic leukemia, when imaging features are not sufficiently specific to distinguish granulocytic neoplasms from other tumors. To establish the diagnosis often a biopsy is required. The treatment in such cases (orbital granulocytic sarcoma) is not standardized. Orbital granulocytic sarcoma may be suspected in cases of orbital tumors even in the absence of systemic manifestations of leukemia at any age.

Keywords: Leukemia, myeloid; Orbital neoplasms; Sarcoma, granulocytic; Diagnosis, differential; Tomography, x-ray computed

We report the use of photodynamic therapy with verteporfin for subfoveal choroidal neovacularization in central serous chorioretinopathy. Visual acuity improved (0.5 to 1.0) 30 days after the first session. After 141 days, the choroidal neovascularization reactivated and the patient was retreated. Again, visual acuity improved (0.5 to 1.0) 30 days afterwards. It remains stable after 20 months. Photodynamic therapy can be efficient in the treatment of choroidal neovascularization in central serous chorioretinopathy.

Keywords: Choroid diseases; Choroidal neovascularization; Choroidal neovascularization; Retinal diseases; Retinal detachment; Photochemotherapy; Photosensitizing agents; Porphyrins

Normal tension glaucoma is an optic neuropathy in which the retinal nerve fiber layer thickness is reduced, the optic nerve is pathologically excavated, and the visual field is disturbed, although intraocular pressure is classified as normal. Patients with normal tension glaucoma are a heterogeneous group in which many systemic pathologic conditions may be present, and presenting ocular clinical signs that are difficult to be identified in the early stages of the disease. Treatment is more challenging than in hypertensive glaucomas. The authors sought to review the pathophysiology and differential diagnosis of this condition assessing vascular, rheumatic, neurological and genetic aspects that should be studied, as well as its treatment. The sources of references are PubMed (MEDLINE), LILACS and Cochrane Library (CENTRAL) databases.

Keywords: Glaucoma; Glaucoma; Glaucoma; Glaucoma; Glaucoma, open-angle; Diagnostic techniques, ophthalmological; Tonometry, ocular; Diagnosis, differential; Review