VOLUME 69 - ISSUE 3

PURPOSE: To investigate the phenotype of primary open-angle glaucoma (POAG) in Brazilian families with mutation in exon 3 of TIGR/MYOC. METHODS: Seventy-eight POAG patients with a positive family history and eighteen unrelated patients with POAG were screened by automated DNA sequencing for mutations in exon 3 of the TIGR/MYOC gene. The pedigrees of POAG patients with mutations that lead to amino acid change were built. All available relatives of the index cases were also examined and genotyped by sequencing. RESULTS: Four sequence variants were identified in exon 3 of the TIGR/MYOC gene (Tyr347Tyr, Pro370Pro, Lys398Arg and Cys433Arg) from the 96 initially screened patients. The Lys398Arg mutation was previously described as a polymorphism and in our study did not segregate with POAG. The most prevalent mutation was Cys433Arg, affecting 3 index cases (3.1% or 3/96). In two different families, 8/56 subjects presented Cys433Arg mutation and had POAG, 5/56 had ocular hypertension and 8/56 had no disease manifestation. POAG patients had a median age at diagnosis of 43.25 yr (17-58 yr) and intraocular pressure (IOP) with a mean of 36.3 ± 3.8mmHg for the right eye and 37.6 ± 9.75 mmHg for the left eye. The group of patients with Cys433Arg mutation had significantly higher IOP (p<0.0007) and vertical cup/disc ratio when compared to the patients without mutation (p<0.023). CONCLUSIONS: Cys433Arg mutation in exon 3 of the TIGR/MYOC gene is related to juvenile-onset POAG (J-POAG) in Brazilian families and autosomal dominant inheritance. The phenotype of this mutation is characterized by varied ages at diagnosis, causing J-POAG and late-onset POAG, associated with high IOP.

Keywords: Glaucoma, open-angle; Genes, Phenotype; Genotype; Mutation; Genetic screening; Brazil

PURPOSE: To investigate whether electroacupuncture can prevent selenite-induced cataract in an experimental model. METHODS: Fifty Wistar rat pups were randomized into 5 groups of 10 animals: Group 1 (control), no procedure was performed; Group 2 (selenite), sodium selenite (30 micromoles/kg body weight) was injected subcutaneously between postpartum days 10 to 12; Group 3 (anesthesia) received the same dose of selenite and underwent ether inhalation anesthesia during 10 minutes daily for one week; Group 4 (electroacupuncture) underwent the same procedure of Group 3, but also receiving electroacupuncture (2 Hz, 50 mA) applied to the Neiguan (PC6) and Guangming (GB37) acupoints during the anesthesia period; and Group 5 (Sham) underwent the same procedures of Group 4, but needles were applied to non-acupoints. The development of cataract was assessed one week later, and its density was graded by slit lamp biomicroscopy. RESULTS: All control rats lenses (Group 1) were clear. Groups 2, 3 and 5 rats developed more severe cataract or complete opacification. In Group 4 (electroacupuncture), 45% of eyes did not develop cataract while thirty per cent developed less severe cataract than Groups 2, 3 and 5. The between-group difference was statistically significant (p<0.001). Lens opacification grade in Groups 1 and 4 was lower than in the Groups 2, 3 and 5 (p<0.001). CONCLUSION: Electroacupuncture effectively decreased selenite-induced cataract formation rate in pup rats when needles were applied at specific acupoints.

Keywords: Cataract; Antioxidants; Electroacupuncture; Free radicals; Rats, Wistar

PURPOSE: To evaluate porous polyethylene implants as compared to solid and gel spheres in anophthalmic cavities. METHODS: Thirty-six white rabbits underwent a right eye enucleation with placement of 12 mm of porous (18 animals) or gel (18 animals) polyethylene spheres. The animals were submitted to weekly clinical evaluation. Ultrasound examinations were done 30, 60 and 90 days after surgery and the animals were sacrificed on the day 90th. Then, the orbit content was removed and submitted to light microscopy. RESULTS: Five animals (27.2%) which received porous polyethylene spheres presented sphere extrusion. With the gel polyethylene spheres, the extrusions happened in 94.4% of the animals and it was observed that the expelled gel spheres had higher diameter then the implanted ones. Ultrasound evaluation showed that the porous polyethylene implant becomes vascularized but the gel not, as confirmed by histological examination. CONCLUSION: Spheres of material in the gel state hydrate and increase in volume making it necessary to know the final size before the implantation. Ultrasound examination allows the evaluation of the implant-tissue integration.

Keywords: Polyethylenes; Orbital implants; Rabbits; Ultrasonography

PURPOSE: To compare the safety and efficacy of human preserved amniotic membrane (AM) in the trabeculectomy for treatment of primary open-angle glaucoma. METHODS: A prospective, randomized clinical trial compared primary trabeculectomy with amniotic membrane (study group) and without amniotic membrane (control group) in the treatment of the glaucoma. Intraocular pressure (IOP), number of glaucoma medications and appearance of the bleb were compared between the two groups. Thirty-two patients divided into two groups of 16 patients were followed for a period of 12 months. RESULTS: The difference of the mean postoperative intraocular pressure between groups was not statistically significant (15.19 ± 3.33 in the control group and 12.81 ± 2.48 in the study group p=0.297) at one year follow-up. Postoperative number of medications decreased in both groups (p<0.001and p=0.007, study group and control respectively). At the end of a 12-month follow-up period, nine eyes (56.25%) showed thin, avascular blebs in the study group as compared to only one eye (6.25%) in the control group. CONCLUSIONS: Trabeculectomy with amniotic membrane and standard trabeculectomy promote lower postoperative intraocular pressure although results showed no statistically significant difference between groups regarding postoperative intraocular pressure after one year follow-up.

Keywords: Glaucoma, open-angle; Trabeculectomy; Intraocular pressure; Biological dressings; Postoperative complications

PURPOSE: To assess whether central corneal thickness is related to glaucomatous visual field loss severity among patients with office-controlled intraocular pressure in the normal range. METHODS: This transversal study included 85 eyes of 85 patients with treated primary open-angle glaucoma and documented intraocular pressure below 19 mmHg. The patients were divided into three groups according to Anderson criteria of field abnormality. The groups were composed of 30 eyes with mild defect, 28 eyes with moderate defect and 27 eyes with severe defect. Intraocular pressure and central cornea thickness were compared and evaluated between the three groups. RESULTS: Central corneal thickness was statistically thinner in the severe group (mean= 513 ± 26 µm) compared with the mild defect group (mean= 535 ± 35 µm) and the moderate group (mean= 533 ± 30 µm) (p = 0.0182). There was no statistically significant difference between intraocular pressures in the three groups (p = 0.0851). The severe group showed a statistically higher age and number of medications than the other groups. CONCLUSIONS: The central corneal thickness measurement is desirable when establishing target intraocular pressure of patients with open-angle glaucoma. Central corneal thickness is a clinical factor in determining glaucoma severity. Patients with severe field loss showed lower corneal thickness compared with patients with mild and moderate visual field loss.

Keywords: Glaucoma, open angle; Intraocular pressure; Cornea; Diagnostic techniques, ophthalmological; Visual fields; Tonometry, ocular

PURPOSE: To determine the effect of botulinum toxin injection in the eyelid on lacrimal film in patients with facial dystonia. METHODS: Twenty-four patients with essential blepharospasm and hemifacial spasm were submitted to botulinum toxin injection and lacrimal film tests were performed before the application and after seven and thirty days. RESULTS: There was improvement in symptoms of dry eye and rose bengal test, however, the breakup time and Schirmer's test did not show significant variation between pretreatment and after 1 month of follow-up. CONCLUSION: The dry eye symptoms in patients with facial dystonia may be attenuated by botulinum toxin due to its possible inhibitory effect on the orbicular muscle leading to a decrease in lacrimal pump.

Keywords: Drainage; Hemifacial spasm; Blinking; Rose Bengal; Botulinum toxin type A; Dystonia

PURPOSES: To evaluate the retinal nerve fiber layer using GDx in chronic alcohol and tobacco users. METHODS: Twenty-three chronic alcohol and tobacco users were studied (study group). As a control group, sixteen volunteers without use of alcohol and tobacco with similar characteristics (age, gender and race) were included. Both eyes were tested for analysis of the retinal nerve fiber layer with GDx. RESULTS: There was alteration in the Deviation from normal graph with a loss of nerve fibers in 43.4% of patients in the study group. In the control group this alteration was observed in 14 eyes (18.7%). As regards the parameters that allow comparison between the study and control groups there was a statistically significant difference regarding the following parameters: Ellipse modulation, Inferior ratio and Max modulation. CONCLUSIONS: The chronic use of tobacco and alcohol was associated with alteration of the nerve fiber layer. Thus, these results can contribute to the early diagnosis of nerve fiber layer loss in optic neuropathy.

Keywords: Nerve fibers; Retina; Smoking; Alcoholism; Optic nerve diseases; Perimetry; Lasers

PURPOSE: To quantify and compare the in vitro adherence of Staphylococcus epidermidis and Pseudomonas alcaligenes to different intraocular lenses (IOLs). METHODS: Fourteen intraocular lenses were used in the experiment. Four of polymethylmethacrylate (PMMA), four of silicone, four of hidrogel and two of acrylic. Eight intraocular lenses were placed in eight test tubes containing 4 ml of Pseudomonas alcaligenes suspension, and six intraocular lenses were placed in six test tubes containing 4 ml of Staphylococcus epidermidis suspension. The bacterial suspension used for adherence tests was 10(8) colony-forming units per milliliter (CFU/mL) which corresponds to 0.5 in the scale of McFarland. The lenses were incubated at 37° for two hours. After this, intraocular lenses were removed from the test tubes and dried twice with the use of distilled and sterile water. The material was spread on blood-agar for cultivation at 35-37°C and was evaluated every 24 hours up to 72 hours. In the samples where there was bacterial growth, the colonies were counted using the conventional laboratory methods. All assays were performed in duplicate. RESULTS: Adherence of Staphylococcus epidermidis to PMMA intraocular lenses was lower than to hydrogel and silicone intraocular lenses. Adherence of Pseudomonas alcaligenes to hydrogel intraocular lenses was lower than to PMMA, acrylic and silicone intraocular lenses. CONCLUSIONS: Results suggest that in vitro adherence of Staphylococcus epidermidis and Pseudomonas alcaligenes to intraocular lenses is influenced by type of material of the lens and by microorganism species. Bacterial adherence may play a role in the pathogenesis of some forms of endophthalmitis after cataract surgery. More in vitro and clinical studies are necessary to elucidate the mechanisms by which Staphylococcus epidermidis and Pseudomonas alcaligenes cause endophthalmitis.

Keywords: Cataract extraction; Bacterial adhesion; Endophthalmitis; Staphylococcus epidermidis; Pseudomonas alcaligenes; Eye infections, bacterial; Lenses, intraocular; Polymethylmethacrylate; Silicone elastomers

Leishmaniasis infection may involve destruction of nasal tissues resulting in lacrimal drainage system alteration. PURPOSE: To evaluate the frequency of lacrimal excretory system sequelae in patients treated for leishmaniasis. METHODS: Forty-five leishmaniasis-treated patients (90 nasolacrimal ducts) were submitted to lacrimal excretory system evaluation. All were evaluated by Jones I test and when it was abnormal, dacryocystography and nasal endoscopy were performed. This situation occurred in 13 patients (26 nasolacrimal ducts). RESULTS: The majority of evaluated patients had the cutaneous form (64.4%) of leishmaniasis, however, 69.23% of the patients with lacrimal excretory system alterations had the mucocutaneous form of infection before treatment. In these, the most common alteration detected was bilateral permeable and dilated nasolacrimal ducts (92.30%). Only 3.84% (1/26) of the evaluated nasolacrimal ducts were obstructed. Nasal endoscopy showed turbinate hypertrophy (53.84%), septum deviation (53.84%) and nasal septum perforation (23.07%). CONCLUSION: Permeable and dilated lacrimal excretory system were the most common sequelae related to leishmaniasis infection.

Keywords: Leishmaniasis; Lacrimal duct obstruction; Endoscopy; Nasal cavity

INTRODUCTION: Descemet's membrane detachment is a rare but serious complication following cataract surgery. Extensive detachments that affect the visual axis may result in poor vision and require penetrating corneal grafts. Some alternatives have been used to reattach Descemet's membrane: air bubble, transcorneal sutures and intracameral viscoelastic gel plus SF6 or C3F8 gas. PURPOSE: To describe the use of non-expanding (16%) intracameral C3F8 to reattach Descemet's membrane, in six patients, following cataract surgery. METHODS: The patient's mean age was 71.3 ± 9.3. Four of the patients were females and two masculine. Immediately afters the gas injection the patient was submitted to slit-lamp evaluation to verify the position of Descemet's membrane. The patients who had eyes with central or superior detachments were told to sit upright for two days. The patients whose eyes had inferior detachments were asked to lie on their back. RESULTS: All patients had successful reattachment of Descemet's membrane after the gas injection. We observed increase in intraocular pressure in one case. The corneal edema regressed after the second day with total resolution by the fourth day. Visual acuity improved in all cases after regression of the edema and remained stable after forty-five days. CONCLUSION: The use of non-expanding C3F8 alone for reattaching Descemet's membrane is reported for the first time in the Brazilian literature. Improvement in visual acuity is fast, the method is safe, effective and easily performed under topical anesthesia.

Keywords: Cataract extraction; Descemet's membrane; Fluorocarbons; Corneal edema; Injections

PURPOSE: To check the complications of cataract surgery with intraocular lens implantation in leprosy patients by the phacoemulsification technique, and to compare these results, with a control group. METHODS: The used method was a case control study, where 31 eyes from leprosy patients were submited to cataract surgery, from June 1999 to January 2003, called Case Group. On the other hand, 31 eyes of healthy patients were selected for the Control Group. The comparison between the groups was performed using Fisher's exact test. The used program was EPI INFO 6.04. RESULTS: Sphincter tear was the only postoperative complication higher in the leprosy group (p=0.024). The other alterations did not show statistic differences (p>0.05). Visual acuity improvement was the same in both groups. CONCLUSIONS: This study showed that the visual acuity and complications after cataract surgery with intraocular lens are the same in leprosy patients and healthy ones.

Keywords: Cataract; Leprosy; Phacoemulsification; Lenses, intraocular; Postoperative period; Case-control studies

PURPOSE: To compare the visual function and the answers to a questionnaire of quality of life of patients wearing a progressive contact lens or eyeglasses. METHODS: The Focus Progressive® contact lens had been fitted in 35 patients with far visual acuity with progressive-addition eyeglasses equal to zero (log MAR) and near J1 (Jaeger). The far and near visual acuities and the measurement of contrast sensitivity were compared when the patients were wearing the eyeglasses or the contact lens and the patients' results of the scores of the quality of life questionnaire (NEI VFQ-25) were analyzed statistically considering the type of ametropy and the age. RESULTS: The far and near visual acuities and the contrast sensitivity measurement were worse with the contact lens than with eyeglasses. The answers to the questionnaire did not differ when were comparing the same patients wearing eyeglasses or contact lens, no matter the type of ametropy. The myopic and the hyperopic subgroups had worse answers to the quality of life questionnaire when corrected with the contact lens than with eyeglasses, both with age equal to or less than their median. CONCLUSIONS: The visual function was worse with the contact lens. The type of ametropy did not influence the answers to the quality of life questionnaire considering the optical correction, but age did.

Keywords: Presbyopia; Quality of life; Accommodation, ocular; Contact lenses; Eyeglasses; Visual acuity; Questionnaires; Comparative study

PURPOSE: To evaluate astigmatism variation between preoperative, 1st and 12th postoperative month of patients who underwent cataract surgery with limbal relaxing incisions (LRI) aiming to reduce the preoperative astigmatism. METHODS: Sixteen patients who underwent cataract surgery by the phacoemulsification technique with a 5.5 mm escleral incision, at the Altino Ventura Foudation, between April and July of 2002. The limbal relaxing incisions were performed according to Gills' modified nomogram (1D - 1 LRI of 6 mm; 1-2D - 2 LRI of 6 mm; 2-3D - 2 LRI of 8 mm). They were done in the most curved meridians, determined by preoperative corneal topography. RESULTS: Significant reduction in preoperative astigmatism was observed in the 1st postoperative month in 2 limbal relaxing incisions of the 6 mm group (57% topographic astigmatism and 87% refractional) and in 2 limbal relaxing incisions of the 8 mm group (50% topographic astigmatism and 65% refractional), maintaining the reduction with no significant alteration until the 12th postoperative month. The 1 limbal relaxing incision of the 6 mm group did not yield significant astigmatism reduction, but there was no significant alteration until de 12th postoperative month. There were also no complications such as postoperative discomfort, glare, aniseiconia, diplopia, incision infection and corneal thinning or ectasia. CONCLUSION: Two limbal relaxing incisions of 8 and 6 mm aiming to correct preoperative astigmatism of 2 to 3D and 1 to 2D, respectively, were safe and effective with a stable effect in the first postoperative follow-up year. The 1 limbal relaxing incision of 6 mm aiming to reduce 1 diopter of preoperative astigmatism was not effective, but it did not induce any significant postoperative complications.

Keywords: Astigmatism; Cataract extraction; Limbus corneae; Corneal topography; Preoperative care; Postoperative care; Comparative study; Follow-up studies

PURPOSE: To evaluate refractional astigmatism prevalence and its relationship with grating acuity in a cohort of non-verbal children. METHODS: 482 normal children, aged from 2 to 36 months, were submitted to ophthalmological examination. Fourteen subjects were excluded due to ocular disease and the sample remained with 468 subjects (936 eyes); 230 (49%) males e 238 (51%) females. Grating acuity was assessed binocularly and monocularly with Teller acuity cards. All children underwent eye examination including cycloplegic retinoscopy and fundus by indirect ophthalmoscopy. RESULTS: Astigmatism was found in 222 (47.43%) of the children, with the hyperopic and with the rule types most frequently found in all ages. Concerning magnitude, this condition was equal or greater than 1.00 cylindric diopter in 24.35% of the children; equal or greater than 2.00 cylindric diopter in 5.55%; lower than 1.00 in 26.92% and between 1.00 and 2.00 in 18.73%. Grating acuity was normal in 219 of the subjects, despite magnitude, type and orientation of astigmatism. CONCLUSION: Visual acuity assessed by the acuity card procedure was not influenced by astigmatism.

Keywords: Astigmatism; Prevalence; Visual acuity; Child

PURPOSE: To evaluate prospectively the results of expandable acrylic intraocular lenses in patients submitted to phacoemulsification as regard posterior capsule opacification. METHODS: The study group consisted of 830 patients, 1,200 eyes that underwent phacoemulsification from 1998 to 2002, by the same surgeon, using the same technique but with different diameters of capsulorrhexis, with expandable hydrophilic acrylic intraocular lens implantation. The mean follow-up was 2.4 years, ranging from 6 months to 4 years. RESULTS: The total number of posterior capsule opacification was 54 cases. CONCLUSIONS: The incidence of posterior capsule opacification was 4.6% in these patients.

Keywords: Lens implantation, intraocular; Contact lenses, hydrophilic; Lens capsule, crystalline; Visual acuity; Phacoemulsification; Capsulorrhexis

PURPOSES: To evaluate the importance of objective examinations in conjunction with ocular history and orbital and periorbital anatomy, to identify patients at risk of developing a post-blepharoplasty dry eye complication. METHODS: A prospective study was peformed on 29 patients with dermatochalasis who were studied before and three months after blepharoplasty. Changes in ocular symptoms, physical examination and in objective tests, like Schirmer's test, tear film break-up time and rose Bengal coloration were evaluated. RESULTS: No statistically significant alteration in results of objective tests, except Schirmer II test, was found between the pre- and postoperative period. Regarding eyelid anatomy, alterations in palpebral fissure and excursion of the upper eyelid were observed that were statistically significant postoperatively. CONCLUSIONS: It is possible to state that the palpebral fissure alterations happen frequently in patients submitted to esthetic blepharoplasty. It was also possible to conclude, by this study, that the objective tests for dry eye evaluation, did not show significant alterations postoperatively, except for Schirmer II test.

Keywords: Blepharoplasty; Dry eye syndromes; Rose Bengal; Prospective studies

PURPOSE: To determine the relationship between the length of ciliary processes as measured by ultrasound biomicroscopy and the duration, localization and severity of uveitis. METHODS: We analyzed in this prospective study, 58 individuals including patients with different stages of uveitis and normal patients (112 eyes including 18 normal), between August 2001 and August 2002, at the Cleveland Clinic Foundation - Ohio - USA. All patients were referred to ultrasound biomicroscopy by the Uveitis Department, after a complete ophthalmological examination. A 50 MHz-transducer UBM model 840 (Zeiss-Humphrey) was used under topical anesthesia and immersion technique. RESULTS: The most frequent etiology was idiophatic uveitis (27.8%). Recurrent, aggressive and diffuse uveitis lead to significant damage of the ciliary processes. The most significant loss of the ciliary processes was found in the inferior quadrant and the highest in normal patients and in the temporal quadrant. Hypotonic eyes have their ciliary processes reduced. CONCLUSIONS: Ultrasound biomicroscopy has proved to be useful in evaluating anatomical changes of ciliary processes in uveitis and in ocular hypotony, and provides a basis to, make recomendations regarding to baseline screening of uveitis patients. Patients who are found to have atrophy of the ciliary processes may need a more aggressive treatment for any signs of inflammation to prevent further damage and eventual hypotony.

Keywords: Ciliary body; Uveitis; Ocular hypotension; Anterior chamber; Microscopy; Prospective studies

PURPOSE: The techniques and results of cataract surgery have improved dramatically with technological advancements. One of the reasons for this improvement would be the reduced use of ultrasound with the new phacoemulsification devices. The objective of this study is to confirm the theoretical advantage of the NeoSoniX handpiece. METHODS: The authors compared the results of the parameters recorded by the Legacy phacoemulsification system during 300 cataract surgeries performed with the use of the conventional ultrasound handpiece and 100 performed with the innovative NeosonixTM. All surgeries were performed by the same senior surgeon, using the same surgical technique. The choice of handpiece was random. The handpieces were compared considering cataract grade of hardness, in relation to parameters of ultrasound time, amount of balanced saline solution, and percentage of average power used during surgery. RESULTS: The analysis performed retrospectively on a chronological series of cases showed that the time of ultrasound used with the NeoSoniX handpiece was inferior to that with the conventional handpiece, for any cataract grade of hardness (p<0.000001). The volume of balanced saline solution used during surgical procedures was smaller, favoring the NeoSoniX technology (p<0.000001). In relation to the percentage of ultrasound energy used with the different technologies, an inferior value was found in the group who underwent surgery with the use of the NeoSoniX handpiece (p<0.000001). CONCLUSIONS: Based on the information provided by these surgeries, we may claim that there was a significant superiority when using the NeoSoniX handpiece in comparison to the conventional Legacy machine handpiece in cataract surgeries, regardless of cataract grade.

Keywords: Cataract; Cataract extration; Phacoemulsification; Ultrasonic therapy; Surgical instruments; Comparative study

Aspergillus endophthalmitis is usually related to systemic or local dissemination in immunosuppressed subjects. The authors report a rare case of severe bilateral glaucoma secondary to an intraocular infection with Aspergillus niger, in the absence of any detectable focus of aspergillosis, in an HIV-infected patient. There were no confirming signs of injection drug use, and the agent was isolated after inoculation in experimental animals. This case shows that Aspergillus endophthalmitis should be considered in non-injecting drug users and HIV-infected patients even in the absence of systemic aspergillosis.

Keywords: Aspergillus niger; Endophthalmitis; Glaucoma; Eye infections, fungal; HIV; Immunocompromised host; Case reports [publication type]

The authors describe a case of fungal keratitis that the in vivo confocal microscopy helped in the diagnosis and follow-up. Confocal microscopy was done in a patient's ulcer that did not improve with several topical medicines. Corneal scrapings were obtained and culture results were without conclusion. We observed hyphae and infectious collections on confocal microscopy. New corneal culture showed Fusarium sp ten days after confocal diagnosis.

Keywords: Microscopy, confocal; Córnea; Keratitis; Eye infections, fungal; Fusarium; Case reports [publication type]

Our aim was to study optical coherence tomographic findings in a case of Toxocara granuloma. A patient with a cicatricial macular lesion, diagnosed as ocular toxocariasis, was examined with optical coherence tomography. In optical coherence tomography images, the macular granuloma appeared as a highly reflective round mass protruding above the retinal pigment epithelium with two other surrounding masses. Optical coherence tomography may increase understanding of the pathophysiology of the retinal Toxocara granuloma and help in the clinical diagnosis and management of its macular complications.

Keywords: Granuloma; Retinal diseases; Eye infections, parasitic; Tomography, optical coherence; Toxocara; Case reports [publication type]

Three cases of corneal-conjunctival intraepithelial neoplasia treated differently with mitomycin C based on clinical presentation are reported. The selected patients were followed at the Department of Ophthalmology of the Casa de Saúde Santo Inácio. According to the clinical appearance of the lesions, 0.04% mitomycin C was employed in three different ways: 1) postoperative chemoablation; 2) preoperative chemoreduction; and 3) isolated chemoablation. Regression of the neoplastic lesion was observed in all cases with no recurrence detected during a follow-up time ranging from 18 to 29 months. Conjunctival hyperemia was the single side effect. The use of mitomycin C seems to be efficient and safe for the treatment of corneal-conjunctival intraepithelial neoplasia under several approaches.

Keywords: Eye neoplasms; Conjunctival neoplasms; Mitomycin; Corneal epithelium; Conjunctival neoplasms; Case reports [publication type]

We describe a case of progressive subretinal fibrosis and multifocal chorioretinitis along with its findings on both fluorescein and indocyanine green angiography. The progressive subretinal fibrosis syndrome is a severe subset of multifocal choroiditis. The clustering of lesions around the nerve optic head may mean that the disease is spread through the flow in and out of the eye around the optic nerve.

Keywords: Fibrosis; Retinal diseases; Choroiditis; Chorioretinitis; Case reports [Publication type]

Traumatic optic nerve avulsion occurs most commonly after blunt ocular trauma. Optic nerve avulsion by high caliber bullet is exceptional and must be thought of in the management of those patients victims of gunshot wounds to the globe and orbit. The present paper reports the first documented case of this singular condition of optic nerve injury and comments on several other related causes, pathophysiology mechanisms, histology and management.

Keywords: Eye injuries; Wounds, gunshot; Optic nerve injuries; Eye enucleation; Case reports [Publication type]

Ocular adnexal lymphoid tumors are slow-growing neoplasms that affect predominantly the elderly. The purpose of this study is to report a non-Hodgkin lymphoma from mantle zone cells, a rare ocular annexal B-cell lymphoma subtype. CASE REPORT: A 62-year-old male patient with superior eyelid, maxillary and oral tumours, had an initial diagnosis of Mikulics disease, developed lesion enlargement, despite immunosuppressant therapy. Left superior eyelid and bone marrow biopsy revealed non-Hodgkin lymphoma the mantle zone. In spite of dissemination (stage IV), chemotherapy and bone marrow transplant led to disease remission. CONCLUSIVE COMMENTARIES: Despite the availability of advanced complementary diagnostic methods, like immunophenotyping and molecular genetic analysis, lymphoma represents, for physicians and pathologists, a challenge regarding diagnosis and prognosis.

Keywords: Lymphoma, mantle-cell; Lymphoma, Non-Hodgkin; Lymphoma, B-cell; Aged; Case reports [Publication type]

Orbital fat prolapse is an uncommon benign entity that can cause esthetic defects. The authors present a 63-year-old patient with bilateral temporal orbital fat prolapse associated with a bilateral nasal pterygium. Clinical and surgical features are described. The clinical, imaging and histopathological diagnoses are discussed.

Keywords: Adipose tissue; Orbital diseases; Prolapse; Orbital disease; Pterygium; Case reports [Publication type]

A case of Aspergillus flavus keratitis was successfully treated with oral voriconazole and penetrating keratoplasty after conventional antifungal medical therapy failure.

Keywords: Fluconazole; Eye infections, fungal; keratitis; Antifungal agents; Case reports [publication type]

Proptosis and diplopia due to enlargement of extraocular muscles represent important presenting signs of many orbital disorders. Although dysthyroid ophthalmopathy is the most common cause of enlargement of extraocular muscles, the differential diagnosis is extensive. We report a patient with a 3-month history of diplopia and unilateral proptosis and a markedly enlarged inferior rectus muscle on imaging studies. A biopsy of the lesion followed by systemic evaluation established the diagnosis of metastatic renal cell carcinoma. There are few cases of metastatic tumors to the extraocular muscles reported in the literature and thus our objective is to report a new case, review the literature and reiterate the inclusion of this disorder in the differential diagnosis of enlargement of the extraocular muscles.

Keywords: Carcinoma, renal; Neoplasm Metastasis; Oculomotor muscles; Orbital neoplasms; Diplopia; Exophthalmos; Case reports [publication type]

A 64-year-old woman with a diagnosis of rheumatoid arthritis developed painless bilateral episcleral rheumatoid nodules without any flareup of her associated disease. Biopsy of the lesions disclosed a lymphocytic and plasmacytic infiltration within the conjunctiva, overlying palisading granulomas with multinucleated giant cells, and central necrobiotic degeneration of the collagen of the episclera and superficial sclera. The rheumatologic designation for the development of groups of nodules in inactive rheumatoid arthritis is rheumatoid nodulosis.

Keywords: Arthritis rheumatoid; Rheumatoid nodules; Scleral diseases; Eye manifestations; Granuloma; Case reports [publication type]

The author describes biochemical and structural effects of vitamins and antioxidants on the retina. The main substances present in diet food and vitamin supplies involved in the genesis of age-related macular degeneration are shown. Also reports on the outcomes of prospective studies related to the subject, by literature review are presented.

Keywords: Macular degeneration; Antioxidants; Antioxidants; Dietary supplements, Zinc; Copper; Diet

Pellucid marginal degeneration is characterized by a progressive stromal thinning of the inferior corneal segment, between 4 and 8 o'clock, with a crescentic shape. The area of corneal thinning has a width of about 1 to 2 mm, and it is separated from the corneoscleral limbus by an area of normal corneal tissue. The initial treatment consists of optical correction. However, when the disease progresses to advanced stages, surgical procedures are necessary such as wedge resection, lamellar crescentic resection, penetrating keratoplasty, lamellar keratoplasty, epikeratoplasty and, recently, intracorneal segments.

Keywords: Corneal diseases; Corneal diseases; Corneal topography; Ophthalmologic surgical procedures