VOLUME 68 - ISSUE 6

PURPOSE: To report the preliminary surgical results of pars plana vitrectomy with a transconjunctival technique using the TSV-25 Millennium system. METHODS: Twenty consecutive patients (20 eyes) that underwent transconjunctival vitrectomy with the TSV-25 Millennium system, between July 2003 and January 2004, were prospectively postoperatively followed for a minimum period of one month. Eyes with macular hole, epiretinal membrane, macular edema, rhegmatogenous retinal detachment, endophthalmitis, and vitreous hemorrhage with or without tractional retinal detachment were included. Intra and post-operative complications and difficulties were recorded. RESULTS: All 20 patients completed at least one month postoperative follow-up. There were 4 macular holes, 2 epiretinal membranes, 2 cystoid macular edemas post-cataract surgery, 1 diabetic macular edema, 5 rhegmatogenous retinal detachments, 5 vitreous hemorrhages (2 associated with tractional retinal detachment), and 1 endophthalmitis. Mean postoperative day one intraocular pressure was 15.7 mmHg (6 - 46 mmHg) and at one postoperative month it was 14.2 mmHg (8 - 22 mmHg). There were no cases of sclerotomy-related retinal breaks, postoperative endophthalmitis, or ocular hypotony. Three of 5 eyes (60%) with retinal detachment needed further surgical intervention (all pseudophakic) and 4 of 5 eyes (80%) with vitreous hemorrhage had postoperative residual hemorrhage. All cases with macular diseases and phakic retinal detachments were successful with one surgery. CONCLUSION: This transconjunctival vitrectomy technique showed as its main benefits the low incidence of sclerotomy-related breaks and postoperative ocular hypertension. An adequate case selection seems to be crucial.

Keywords: Vitreous body; Vitrectomy; Postoperative complications; Microscopy; Ultrasonography; Surgical procedure minimally invasive; Treatment outcome

PURPOSE: To perform the first Brazilian refractive surgery survey. METHODS: Between August 2001 and February 2002, a questionnaire was mailed to 7890 Brazilian ophthalmologists. The questionnaire presented questions about demographic aspects, technology, instruments, market, trends, practice patterns and cost of refractive surgery. RESULTS: Nine hundred and twenty questionnaires (11.67%) were answered. LASIK is the preferred technique for correction between +5.00 and -7.00 D. The mostly used excimer laser is Nidek® EC 5000, and Hansatome is the mostly used microkeratome. Others aspects like: demographic, techniques, practice patterns, trends, market, and pre-, intra- and postoperative care, were analyzed. CONCLUSION: With this survey, the Brazilian ophthalmologists can observe and monitor these aspects of refractive surgery in Brazil, and compare them with others surveys.

Keywords: Refractive errors; Laser surgery; Keratomileusis; laser in situ; Questionnaires; Ophthalmology; Physician's practice patterns; Data collection; Brazil

PURPOSE: To evaluate the efficacy of the use of intraocular lenses in the treatment of pediatric aphakia, according to postoperative visual acuity and refraction change. METHODS: A total of 33 eyes in 27 children were studied. Children with either unilateral or bilateral cataracts were submitted to lensectomy surgery via pars plana, with intraocular lens implant, associated with primary posterior capsulectomy and anterior vitrectomy. The intraocular lenses were calculated for emmetropia in the first postoperative month. All children were less than six years old at the time of the surgery and had a 2.9 year average follow-up. They were divided into 3 groups. Group I (10 eyes), children with unilateral cataracts and under three years old at the time of the surgery; group II (11 eyes), children with unilateral cataracts and above three years old; group III (12 eyes), children with bilateral cataracts and above three years old at the time of the surgery. RESULTS: On the last follow-up examination recorded visual acuity was equal to or above 20/40 in 85% of the eyes. A spherical equivalent close to emmetropia in the first postoperative month was obtained in 70% of the children of group III but only in 30% of group I. Regarding postoperative refraction variation, myopic shift was detected in 81.81% of the cases. The younger the children were when undergoing surgery, the greater the refractional alteration. CONCLUSION: Despite the myopic shift that happens with the use of intraocular lenses in the treatment of pediatric aphakia in children under six years old, the visual result is very good and the residual refraction correction is easily performed. A more prolonged postoperative follow-up would be necessary for long-term evaluation of the results.

Keywords: Postcataract aphakia; Cataract; Intraocular lenses; Cataract extraction

PURPOSE: Measure the extent of mioscleral adhesion on the fourtieth postoperative day. METHODS: Fifteen New Zealand rabbits were divided into three groups of five rabbits. They were operated on to server the insertion of the rectus muscle in the eye and then to reinsert it. Group SP, polyglactin (Vicryl®) was used as control. In group AF, fibrin adhesive (Beriplast-P®) was used, and in group AC, cyanoacrylate adhesive (Histoacryl®). Before severing muscle insertion, the distances between the muscle attachments of the limbus to the medial and lateral borders were measured. After forty-five days, the operation was again performed and the measurements were taken once more. RESULTS: There was no significant difference between the studied adhesives in terms of tissue adhesion and of the distances from the muscle to the limbus before and after surgery. CONCLUSION: The found tissue adhesion was probably due to the scarring process and was not dependent on the studied materials.

Keywords: Tissue adhesives; Fibrin tissue adhesive; Cyanoacrylates; Oculomotor muscles; Ophthalmic nerve; Rabbits

PURPOSE: To determine normative values for focal electroretinography in normal young adults, according to the standard protocol recommended by the International Society for Clinical Electrophysiology of Vision - IsCEV. METHODS: 33 normal volunteers aged from 14 to 38 years (mean 22.96±5.73) were included in this study. Focal electroretinography was recorded by corneal electrode after white flicker light stimulation in the macula at high temporal frequencies -42Hz and 31.25Hz. Focal electroretinography parameters as amplitude (nanovolts) and latency (milliseconds) were extracted and analyzed after discrete Fourier transformation. Median, values below 95% and above 95%; maximum; minimum and percentiles were calculated for both parameters; a t test was calculated between amplitudes and latencies for both frequencies. RESULTS: For 42Hz. Amplitude: median 614nV; below 95% 529nV; above 95% 650nV; minimum 370 nV; maximum 794 nV; 2.5th percentile 378.8nV; 97.5th percentile 779.6nV. Latency: median 26.4ms; below 95% 25.4ms; above 95% 26.8ms; minimum 23.4ms; maximum 28.2ms; 2.5th percentile 23.8ms; 97.5th percentile 27.88ms. For 31.25Hz. Amplitude: median 632nV; below 95% 429nV; above 95% 750nV; minimum 364nV; maximum 1036nV; 2.5th percentile 364.8nV; 97.5th percentile 1018.4nV. Latency: median 30.1ms; below 95% 29.3ms; above 95% 31.2ms; minimum 25.9ms; maximum 33.9ms; 2.5th percentile 27.18ms; 97.5th percentile 33.34ms. CONCLUSIONS: Normal limits for focal electroretinography according to the International Society for Clinical Electrophysiology of Vision, guidelines were established in a cohort of young adults. Comparable amplitude values were found for both 42 Hz and 31.25 Hz temporal frequencies. However, latencies was significantly faster for 42 Hz stimuli.

Keywords: Electroretinography; Electroretinography; Retina; Macula lutea; Reference values

PURPOSE: To investigate possible ophthalmologic alterations in patients who had severe malnutrition during the first six months of life. METHODS: 182 eyes of 91, 2 to 11-year-old, children who had had severe malnutrition during the first six months of life (study group) were analyzed. As a control group 88 children selected according to similar characteristics of age, gender, demographic and economic conditions were included. RESULTS: In the study group, a higher frequency of children with visual acuity from 0.3 to 0.1 and less than 0.1 (11.5% versus 0.7% - p<0.0001) was observed. There was a higher frequency of astigmatism and myopia in the study group. A higher frequency of astigmatism of one diopter or more in the study group (p<0.0001) was also observed. The fundoscopic alterations were pale optic nerve (2.2%), increased disc cup (4.4%), increased vascular tortuosity (6.6%), alteration of retina color (13.2%) and retinal pigment epithelium cell atrophy (12.0%). CONCLUSIONS: The present data support the concept that early malnutrition interferes in the individual's visual health. Further studies are necessary to establish a more precise cause-effect relationship.

Keywords: Infant nutrition disorders; Vision disorders; Child development; Eye manifestations; Child

PURPOSE: Investigations in the field of the learning competence that investigate the impact of the acquisition of new individual competence of those responsible for ophthalmologic clinics, by means of a MBA Administration in Health course, on the organizational modernity of ophthalmologic clinics. METHODS: Survey using questionnaires applied to students and former students of the course and to managers of ophthalmologic clinics not linked to the course (n=30 each one). The analysis was made by means of statistical methods: r of Pearson and Q of Yule; Student's t test, sum of series test, median test and U test of Mann-Whitney. RESULTS: Linear and positive correlation was observed between excellency of MBA Administration in Health and the development of the veteran students' capacities (rho correlation of Spearman at the level of 0.01); there is a significant difference (0.0364, by the Mann-Whitney test), between veteran students and freshmen regarding the need to extend the individual capacities provided by the MBA Administration in Health course, to the other operational employees of the ophthalmologic clinics; and there is a significant difference (0.0057, for the Mann-Whitney test), among veteran students of the MBA Administration in Health course and freshmen regarding the importance of the organizational modernity for the ophthalmologic clinics. CONCLUSIONS: The obtained results are consistent, in a general way, with the proposed model: MBA Administration's excellence in Health contributes significantly to the organizational modernity, to the development of competence of the veteran students, and, also in substantial way to the perception of organizational hiatuses.

Keywords: Professional competence; Learning; Quality; Management capacity; Organizational modernization; Private sector

PURPOSE: To observe torsional movements of the eye in refractive surgery, and their possible consequences in the surgery outcome. METHODS: In a prospective study, 49 eyes of 40 patients were submitted to surgical correction of astigmatism, by the LASIK technique. Patients were divided in two groups based on the cylindric power. Group A from -0.25 to -2.00D; group B from -2.25 to -6.00D. The occurrence of torsional movements was recorded in all patients, and based on this, the axis of treatment was corrected. RESULTS: Mean torsion was 3.5º+/- in group A; and 4.5º+/- in group B. There was no statistical difference between the two groups. CONCLUSION: Torsional movements occurred in almost all cases, and therefore should be corrected if one desires best results. This is specially important in matching personalized data captured in wave front analyzers for the eye at the time of surgery.

Keywords: Astigmatism; Eye movements; Posture; Rotation; Refractive errors; Reflex, vestibulo-ocular

PURPOSE: To describe the ophthalmologic involvement in patients with Acquired Immunodeficiency Syndrome - AIDS and central nervous system toxoplasmosis comparing the period before and after highly active antiretroviral therapy (HAART). METHODS: In a retrospective study, we compared 118 Acquired Immunodeficiency Syndrome patients with central nervous system toxoplasmosis who were examined at our institution before highly active antiretroviral therapy (from 1994 - 1996) with 24 patients with Acquired Immunodeficiency Syndrome and central nervous system toxoplasmosis who were being treated with highly active antiretroviral therapy (from 1996 -1999). All patients were submitted to a complete ophthalmological examination as well as specific tests to confirm the diagnosis and there was no intersection between the groups. RESULTS: In the pre- highly active antiretroviral therapy group, it was found that 23% of the patients with central nervous system toxoplasmosis had also ocular toxoplasmosis. Ocular involvement was bilateral in 37.2% of the cases. In the group of patients receiving highly active antiretroviral therapy, who had an average CD4 of 256 cells/mm³ and average of viral load of 52,620 copies, 16.6% had concomitant ocular and central nervous system toxoplasmosis. Ocular involvement was bilateral in 50% of the cases. CONCLUSIONS: Acquired Immunodeficiency Syndrome patients with central nervous system toxoplasmosis have a frequent association with ocular toxoplasmosis. Although the incidence of opportunistic infections has decreased since the introduction of recent antiretroviral therapeutic strategies ocular toxoplasmosis continues to be frequent in patients with cen.ral nervous system toxoplasmosis.

Keywords: Toxoplasmosis; Cytomegalovirus retinitis; Central nervous system diseases; AIDS-related opportunistic infection; Acquired immunodeficiency syndrome; Antiretroviral therapy; highly active

PURPOSE: To create and to validate a version of the Minnesota Low Vision Reading Test (MNREAD) acuity chart for the Portuguese language. METHODS: The Minnesota Low Vision Reading Test acuity chart contain 19 sentences (logMAR 0.5 to 1.3) with 60 characters printed on three lines. All the sentences must have the same length with simple vocabulary. A total of 110 sentences were generated. The sentences were presented to 36 subjects (20 adults and 16 children) and mistakes and reading time were marked. 38 sentences were selected for a prototype (MNREAD-P). Sentences with extreme high and low mean reading time, large standard deviation, and with persistent mistakes by subjects were excluded. Validation: Twenty subjects with normal vision (logMAR 0 or 20/20 or better, with best refractive correction) were tested with the MNREAD-P and read a passage of text, representing normal, day-to-day reading. Reading speeds in words per minute were recorded for both the MNREAD and the text passage. RESULTS: Sentences in the MNREAD Portuguese chart are sufficiently consistent to provide reliable measures of reading abilities. Reading speeds for the passage (logMar = 0.6) were 197.8 words/minute and the maximum reading speeds calculated by the MNREAD-P were 200.1 words/minute. The correlation between the two measures was r = 0.82. CONCLUSION: The MNREAD-P was tested on normal vision subjects and the results were the same from the original Minnesota Low Vision Reading Test. The reading speed measured on the MNREAD-P was statistically equivalent to the reading speed of the passage.

Keywords: Visual acuity; Vision; Reading; Vision, low; Vision tests; Psychophysics; Predictive value of tests; Software validation

PURPOSE: To compare the measurement of the palpebral fissure done either manually and by computer analysis of image of individuals without lid alterations. METHODS: One hundred two palpebral fissures from 51 normal subjects have been analyzed. The patients' age ranged from 17 to 84 years, with 25 (49%) males and 26 (51%) females. RESULTS: There was no statistically significant difference between the measurements done either manually or by computer analysis of images, neither, when we grouped the patients by sex or age. Also we did not observe difference between males and females, and regarding age. CONCLUSIONS: The results obtained by both methods are comparable and reliable due to the statistical equivalence of the obtained measurements.

Keywords: Eyelids; Eyelid diseases; Image processing, computer-assisted; Measures; Comparative study

PURPOSE: To assess the impact of refractive surgery on quality of life using the National Eye Institute Refractive Error Quality of Life instrument (NEI-RQL) and to evaluate the responsiveness of our Portuguese version of the NEI-RQL instrument to surgical correction of refractive error. METHODS: In this prospective study, the NEI-RQL, a 42-item questionnaire with 13 scales, was self-administered by 96 patients of the Federal University of São Paulo - UNIFESP, between March 2002 and April 2003, before and after undergoing surgical correction of refractive error. An overall scale score was determined by calculating the mean of the 13 scale scores. Differences between preoperative and postoperative NEI-RQL scores were examined. Responsiveness was assessed by calculating the size of effect for each scale of the instrument. RESULTS: Refractive surgery was associated with statistically significant improvements in scores for all the scales of the NEI-RQL. The NEI-RQL has shown to be responsive to surgical correction of refractive error, and the calculated effect sizes ranged from 0.4 ("glare") to 4.19 ("expectations"). CONCLUSIONS: The NEI-RQL is highly responsive to changes in vision-related quality of life resulting from keratorefractive surgery. We observed improvements in all the scales of the NEI-RQL, after surgery.

Keywords: Refractive errors; Laser surgery; Refraction, ocular; Visual acuity; Quality of life; Activities of daily living; Patient satisfaction; Questionnaires

PURPOSE: Videokeratography (VK) has been a widespread technology for corneal surface analysis since the mid-80s. The objective of this study was to develop different techniques for Plácido image edge detection and compare the results of each algorithm in terms of the consequences for axial curvature computations. METHODS: Plácido images from an Eyesys system 2000 were captured for 4 different spherical surfaces.Each image was saved in bitmap format at the hard disk of an IBM computer. Six different image-processing algorithms were developed using different techniques well-documented in the literature. The six methods were as follows: (1) First order numerical derivative, (2) First and (3) Second order Fourier derivative, (4) the Marr-Hildreth filter, (5) Canny's Method, (6) Mathematical morphology. Each algorithm was tested on each of the Plácido images. RESULTS: Edge radial distance from center of Plácido image was compared for each algorithm and a computer simulation of the videokeratography system. Mean deviation in terms of pixels/millimeters/dioptric power for all spheres for methods (1)-(6) were, respectively: (1) 33.1695/0.7961/0.79, (2) 32.79/0.7870/0.7724, (3) 60.7150/1.4572/1.4192, (4)18.97/0.4553/0.4572, (5) 46.33/1.1119/1.0917, (6) 20.55/0.4932/0.48. CONCLUSION: Researchers and clinical ophthalmologists should be more careful when choosing commercial videokeratographs and also when comparing measurements of different instruments, given that there may be differences associated with the image processing technique. We have shown here that the Marr/Hildreth (method (4)) image processing method is more precise than other methods such as Fourier or first order numerical methods.

Keywords: Corneal topography; Algorithms; Cornea; Image processing computer-assisted

PURPOSE: Research on the field of organizational ethics to investigate to which extent ophthalmologic clinics, inserted in the competitive atmosphere, in the condition of organizations in search of survival, subordinate ethics to competitiveness in the managerial praxis, that is, in the administrative sphere. METHODS: Kohlberg is taken as theoretical reference, approaching the theme of ethical subordination to competitiveness. The instrument to evaluate moral behaviors of organizations, elaborated by Licht, is applied. The quantitative method is used, adopting analytic instruments, such as Q of Yule and non parametric tests, when dealing with the data of 41 ophthalmologic clinics. RESULTS: The results of the research seem to indicate that administrators of ophthalmologic clinics of greater performance subordinate ethical principles to competitiveness, seeking to assure the survival of the company and, when confronted with the instrument to evaluate their moral behavior, proposed by Kohlberg, have a significantly smaller presence in the postconventional stage than administrators of ophthalmologic clinics with a smaller performance. One may affirm, according to non parametric tests, at the level of significance of 0.05, that the levels of moral development of the two groups differ significantly. CONCLUSIONS: The obtained results are according to the literature, especially concerning the "paradox of the ethical subordination and competitiveness". They also suggest that the warrant of the survival of the company tends to reduce the perception of the groups in power regarding the problems that happen in the community, and that a reduction of the ethical values subordinated to competition occurs, and such reduction provokes growing feelings of economical disputes in the social sphere.

Keywords: Physicians office; Ethics institutional; Competitive behavior; Conscience; Morale; Dominance-subordination

PURPOSE: To evaluate effectiveness of the Low Vision the Benjamin Constant Institute (BCI) and confirm the real necessity of an Institute like BCI in the present inclusion policy. METHODS: Ecological study, analyzing 3 periods of Low Vision Assistance at the Benjamin Constant Institute from October 1, 1990 to december 20, 2002: a) 1991 - starting assistance; b) 1995 - medical pedagogic integration; c) 2002 - present-day situation. We considered in this analysis as indicators: I - Low Vision Assistance, II - Low Vision sector in the Benjamin Constant Institute, III - Associates. RESULTS: This study demonstrated an increase in assistance, reaching a wider spectrum of patients after medical-pedagogic integration. Other indicators, such as physician capacitation, participation in Benjamin Constant Capacitation Courses, increase in orienta tion to institutions, schools and others and referrals to the Benjamin Constant Institute, and Rehabilitation also attest the effectiveness of the Low Vision sector of the Benjamin Constant Institute. CONCLUSIONS: The Low Vision sector proved to be the interface between the Medical and Pedagogic Departments, and later on the Rehabilitation and Physical Education Coordination sectors. This has implied alterations in the way to manage the low-vision patient, not only regarding the regular Benjamin Constant Institute student as well as any other patient in the community. The Benjamin Constant Institute proved its importance as regards inclusion policy.

Keywords: Vision, low; Blindness; Visually impaired persons; Information services; Academies and Institutes; Effectiveness

PURPOSE: To determine by bacterioscopy and culture the microorganisms carried by corneal foreign body and their sensitivity to antibiotics by antibiotic sensitivity test. METHODS: A prospective study was carried out and information was collected on 101 patients who presented with corneal foreign body at the São Paulo Hospital Eye Emergency Service. Prior to any treatment, a sample of the ipsilateral inferior conjunctival fornix and the foreign body were collected and immersed in thioglycolate broth. Samples were sown on solid culture media including blood, chocolate and Sabouraud agar. Bacterioscopic examination using Gram and Giemsa staining and sensitivity test were performed. Positive foreign body culture results were compared to ipsilateral conjunctival fornix culture to exclude possible normal flora growth. RESULTS: Approximately 92% of patients were males with a mean age of 35 years and in 62.4% (95% confidence interval: 52.2 - 71.8%) had the right eye was affected. Foreign body positive cultures were achieved in 32.7% (95% confidence interval: 23.7 - 42.7%) of the cases. The microorganisms isolated from the foreign body culture were identified as: Streptococcus, alpha-hemolytic (n=4), Staphylococcus aureus (n=4), Staphylococcus, coagulase-negative (n=4), Corynebacterium xerosis (n=3), unidentified Gram-positive bacillus (n=2), Moraxella sp (n=1), Serratia sp (n=1), Acynetobacter sp (n=1). The microbial sensitivity test showed that 95% of the cases were sensitive to chloramphenicol and 90% were sensitive to ciprofloxacin, these being antibiotics used in our routine service. CONCLUSION: Superficial corneal foreign body acts as important contaminant vector and the great majority of isolated bacteria were sensitive to the antibiotic prophylaxis used in the treatment.

Keywords: Eye foreign bodies; Eye foreign bodies; Eye injuries; Cornea; Culture media; Microbial sensitivity tests

PURPOSE: To evaluate de presence of conjunctival aerobic microbiota in patients with ocular allergy as compared to a control group. METHODS: One hundred and thirty-three patients were evaluated from April to June 2001 and divided into 2 groups. Sixty-three patients with allergic conjunctivitis (without medication) were in group A and 70 patients from the general outpatient clinic were in group B (control group). Samples from the conjunctival sac of the right eye were collected and cultured in solid media (blood, chocolate and Sabouraud agar). RESULTS: In group A, 30 cultures (47.7%) were positive and 6 (8.6%) in group B. Seven bacteria were isolated from group A and 4 from group B. Statistical analysis revealed significant association between positive cultures and allergic conjunctivitis. CONCLUSION: Bacterial microbiota was more frequently found in patients with ocular allergy.

Keywords: Conjunctivis, allergic; Conjunctiva; Keratoconjunctivitis; Colony count, microbial

PURPOSE: To describe the microbiologic aspects of infectious keratitis in children (0-18 years old) examined at the Department of Ophthalmology of the National University of Asunción - Paraguay, during a 14-year period (1988-2002). METHODS: The authors retrospectively studied 146 children, under 18 years old, with infectious keratitis at the Department of Ophthalmology of the National University of Asunción - Paraguay, from 1988 to 2002. RESULTS: The cultures were positive in 113 patients (77%) with 70% of bacterial and 30% of fungal etiology. Coagulase-negative Staphylococcus (23.1%), Staphylococcus aureus (19.2%), Pseudomonas aeruginosa (12.8%) and Streptococcus pneumoniae (12.8%) were the most common microorganisms isolated. Acremonium ssp (25%), Fusarium ssp (14%) and Aspergillus fumigatus (14%) were the fungi isolated. CONCLUSIONS: Ulcerative keratitis in children examined at the Department of Ophthalmology of the National University of Asunción - Paraguay is of bacterial origin in most of the cases.

Keywords: Keratitis; Keratitis; Corneal diseases; Corneal ulcer; Eye infections, fungal; Paraguay; Child

The authors report an unusual clinical presentation of pellucid marginal degeneration with 360º peripheral corneal thinning diagnosed in a younger male patient. We discuss the findings of topographic maps, ultrasound pachymetry and the proposed treatment.

Keywords: Cornea; Cornea; Diagnosis, differential; Visual acuity; Corneal topography; Diagnostic techniques, ophthalmological

The authors report a case of a patient who underwent cataract surgery with implantation of a posterior chamber intraocular lens and presented endophthalmitis on the second postoperative day. She was treated with intravitreal injection of amikacin, vancomycin and dexamethasone. After resolution of the infection the patient presented macular infarction and important loss of visual acuity due to amikacin toxicity.

Keywords: Endophthalmitis; Macular degeneration; Amikacin; Amikacin; Injections, intravenous; Aminoglycosides; Vancomycin; Visual acuity; Postoperative complications

The main purpose of this report is to describe a case of ectopia lentis et pupillae syndrome, highlighting the secondary ocular complications and their differential diagnoses. A 27-year-old man presented with complaint of low visual acuity. No evidence of the syndrome was found at presentation. The results of supplementary tests were normal. On ophthalmologic examination, visual acuity was finger count at 2 meters in the right eye and finger count at 1 meter in the left eye. Exotropia of 25 dioptrics. Corneal diameters of 10 mm and 9 mm in the horizontal and vertical meridians, respectively. Keratometry readings of 39.00 at 178 x 43.87 at 88 for the right eye and 37.64 at 22 x 42.75 at 122 for the left eye. The biomicroscopic examination revealed iris atrophy in both eyes, absence of crypt and absent iris transillumination. Centralized right pupil with regular form and left pupil with inferior-temporal dislocation. Opaque lenses with reduced sizes and superior-nasal dislocation. Normal intraocular pressure. Axial length of 26 mm and 30 mm and crystalline axial diameter of 5.4 and 4.5 mm in right and left eyes, respectively, as revealed by ultrasonography. The differential diagnosis encompasses exclusively ocular abnormalities, syndromes and metabolic disorders. Diagnosis of the ectopia lentis et pupillae is fundamental not only to evaluate the risk, prognosis and treatment, but also to assist in differentiating other syndromes with systemic impairment. A visual acuity reduction is normally caused by severe myopia development, cataract, corneal astigmatism, retinal detachment and glaucoma, justifying regular ophthalmologic support for these patients.

Keywords: Ectopia lentis; Eye abnormalities; Diagnosis,differential; Glaucoma; Iris

Retinal vasoproliferative tumor is a rare and benign disease that presents with an exsudative lesion in the retinal periphery. The lesion can be classified as primary (idiopathic) or secondary to a number of previous retinal injuries. Diagnosis is based on a careful ophthalmic examination. Therapeutic options include observation, cryotherapy, laser photocoagulation and brachytherapy. We present a case of idiopathic retinal vasoproliferative tumor associated with macular edema. The aspects of the tumor on fundus examination, fluorescent angiography, echography and optic coherence tomography are discussed.

Keywords: Retinal neoplasms; Hemangioma; Retinal neovascularization; Macular edema, cystoid; Fluorescein angiography; Visual acuity

Non-luetic interstitial keratitis, deafness and vertigo characterize Cogan's syndrome. The most common ocular findings in early Cogan's syndrome are bilateral, peripheral, subepithelial numular corneal opacities. The report presents a patient with the evolution of the classic form of Cogan's syndrome.

Keywords: Eye manifestations; Syndrome; Vasculitis; Deafness; Vertigo; keratitis; Corneal opacity

The popularization of bungee jumping is causing an increase in occurrences of lesions associated with its practice, including ocular lesions. The purpose of this study is to describe a case of acute decrease in vision and visual field defects following a bungee jump. The authors present a case of a 48-year-old woman, without history of systemic or ocular disorders, seen at an ophthalmologic emergency service with visual loss complaint following a bungee jump. On initial ophthalmologic evaluation, hemorrhages in the posterior pole of both eyes were found. Fluorescein angiography showed hypofluorescent areas, without other vascular alterations. The patient was evaluated after 14 weeks, the hemorrhages cleared up and there was atrophy of the pigmented epithelium of the retina in the posterior pole, but the patient remained with complaint of scotoma and visual field defects even 5 months after the initial event. The occurrence of body lesions, including ocular lesions, with risk of decrease in visual acuity should be informed to candidates for the practice of this sport, and it is a for the ophthalmologist to provide information to the population about possible ocular disorders, in this sport and in daily life.

Keywords: Retina; Athletic injuries; Retinal hemorrhage; Scotoma; Fluorescein angiography; Play and playtings; Visual acuity; Deceleration; Leisure activities

Corneal anesthesia is a rare condition, therefore its diagnosis is frequently impaired or it is not noticed during the anterior segment examination. Case report of a 18-year-old patient referred to our Corneal and External Disease Department who complained of dry eye symptoms and with a suspicion of Sjögren's syndrome. She had amblyopia of the right eye, consequence of corneal leucoma over the visual axis secondary to a fingernail traumatism inflicted by herself in childhood. On the ophthalmologic examination corneal sensitivity was absent in both eyes. Severe dry eye and breakup time less than four seconds. Diagnosis of congenital corneal anesthesia was established, secondary to trigeminal anesthesia found on neurological evaluation of facial sensitivity. She also showed sudden movements of the chin which evidenced sensorial pathology of the trigeminal nerve. The general ophthalmologist and specially anterior segment specialists must perform tests for corneal sensitivity during the routine eye examination.

Keywords: Corneal diseases; Corneal diseases; Cornea; Hypesthesia; Autonomic nervous system diseases; Diagnostic techniques, ophthalmological

Lesions of the lateral geniculate body (LGB) are the most unusual lesions of the visual pathways. Imaging studies are very important in establishing the correct diagnosis. However, due to its small size and particular location, the lateral geniculate body and its lesions are sometimes difficult to detect in imaging studies possibly causing diagnostic confusion. The purpose of this paper is to document an unusual case of a lesion of the lateral geniculate body for which an optical coherence tomography study was very important in confirming the anatomic diagnosis of a lateral geniculate body lesion. A 39-year-old woman with a previous diagnosis of uveitis and central nervous system vasculitis was referred for investigation of a right temporal quadrantanopia. She had already been submitted to a magnetic resonance imaging (MRI) that did not show any lesion along the visual pathway. Ophthalmoscopy revealed retinal nerve fiber layer (RNFL) loss that was confirmed by optical coherence tomography. Such finding associated with the observations on the neurological examination strongly suggested a lateral geniculate body lesion. The patient was submitted to another new magnetic resonance imaging obtained with especially oriented thin sections and an ischemic lesion of the lateral geniculate body was observed establishing the correct diagnosis. This case serves to confirm the importance of optical coherence tomography in determining the pattern of retinal nerve fiber layer loss in neuro-ophthalmic diseases and therefore to help in locating a lesion along the visual pathway.

Keywords: Geniculate bodies; Hemianopsia; Retinal ganglion cells; Nerve fibers; Optic nerve diseases; Tomography, optical coherence; Visual pathways

We report a case of a 58-year-old man presenting with a spontaneous and late in-the-bag intraocular lens dislocation to the vitreous. A previous uneventful extracapsular cataract extraction with can-opener style capsulotomy and implantation of a polymethylmethacrylate three-piece lens was performed and, two years after the surgery, the patient developed capsule contraction syndrome with a fibrotic ring formation and dislocation of the intraocular lens. Although uncommon and related mainly to continuous curvilinear capsulorhexis, capsule contraction syndrome occurs in patients undergoing extracapsular cataract surgery with can-opener style and polymethylmethacrylate lens implantation, and can be the causative factor of intraocular lens dislocation.

Keywords: Cataract; Cataract extraction; Lens implantation; intraocular; Postoperative complications

Mitomycin C is an antimetabolite agent that blocks DNA and RNA replication and protein synthesis. It has been used in several ophthalmologic areas, and recently as a modulator of corneal wound healing in excimer laser surgeries. A single application of mitomycin C during surface corneal photoablative surgery seems a safe and efficient therapeutic option for eyes with corneal opacity and/or as prophylaxis in eyes with high risk for corneal opacity development. The use of this drug in photoablative surgery should be cautious until long-term safety results have been reported. The present text presents a review about corneal wound healing with the use of mitomycin C.

Keywords: Cornea; Wound healing; Mitomycin; Refractive errors; Excimer laser photorefractive surgery