VOLUME 70 - ISSUE 4

PURPOSE: To describe an alternative surgical technique for the management of retinal detachment with no or minimal proliferative vitreoretinopathy (grade B) using transconjunctival retinopexy with active external drainage of subretinal fluid. METHODS: In a prospective, interventional study, eight consecutive patients with retinal detachment with no or minimal proliferative vitreoretinopathy (grade B) underwent transconjunctival retinopexy with active external drainage of subretinal fluid. Transconjunctival external drainage of subretinal fluid was achieved by using a 29 gauge needle placed in the subretinal space under indirect ophthalmoscopic monitoring. Active suction was performed (500 mmHg vacuum) using a vitrectomy line coupled to the needle. After retinal reattachment, cryotherapy was applied to the scleral region corresponding to the area of the retinal break(s). RESULTS: In all cases there was retinal attachment at the end of surgery. Retinal redetachment occurred in four pseudophakic patients who then underwent pars plana vitrectomy. The four phakic patients maintained retinal attachment during follow-up (13-20 months). CONCLUSION: Transconjunctival retinopexy with active external drainage of subretinal fluid represents a useful, faster, and cheaper alternative to scleral buckling for retinal detachments with no or minimal proliferative retinopathy in phakic patients and, unlike scleral buckling, is not associated with induced myopia.

Keywords: Retina; Retinal detachment; Drainage; Body fluids

PURPOSE: To report some cases of ocular histoplasmosis-like syndrome from a nonendemica area. DESIGN: Observational case series. METHODS: This is a prospective study of 16 eyes from 8 immunocompetent patients evaluated between January 2001 to September 2005. Six patients were female and 2 male aged between 20 to 44 years, average 28 years. All patients presented clinical features that resembled ocular histoplasmosis. All patients had a negative antibody test for histoplasmosis and negative medical and laboratory evaluation of toxoplasmosis, syphilis, and tuberculosis. All patients were submitted to a complete ocular examination including fluorescein angiography. One patient was submitted to indocyanine green angiography. RESULTS: Five patients presented the classical triad of clinical features that include peripapillary scarring, histo spots, choroidal neovascularization, one patient presentd enlargement of atrophic chorioretina scar, one patient presented multiple retinal pigment epithelial detachment, one, neovascularized retinal pigment epithelial detachment. Another patient presented only histo spots. CONCLUSION: These findings of ocular histoplasmosis-like syndrome in patients with negative antibody serum test from a nonendemica area suggest that other agents could cause these similar fundus findings of ocular histoplasmosis.

Keywords: Histoplasmosis; Histoplasma; Histoplasma; Eye infections, fungal; Choroiditis; Fluorescein angiography; Fundus oculi; Choroidal neovascularization; Observational studies

PURPOSE: To compare knowledge of medical students about the cornea donation process among those who already studied Ophthalmology and the others. METHODOS: A questionnaire containing data as: age, sex, graduation year, and 10 multiple-choice questions about the subject was applied to medical students from the interior of São Paulo state, Brazil. The questions were: age for donation, contraindication for transplants, the time limit to remove the cornea, among others. The knowledge regarding cornea donation was compared between the two groups: students who already studied Ophthalmology (Group A) and the others (Group B). RESULTS: The study group was composed of 402 students, of whom 140 were of group A and 262 of group B. Knowledge between the two groups was different, but not statistically significant (p=0.8328). CONCLUSION: Knowledge about the cornea donation process among the interviewed seemed to be insufficient, even those who had studied Ophthalmology. Information and education about transplants in Medical Schools should be improved.

Keywords: Cornea transplantation; Health education; Questionnaire; Tissue and organ procurement; Students, medical

PURPOSE: To describe the incidence, etiologies and follow-up of patients with paralytic strabismus. METHODS: Retrospective study of 519 strabismic patients with isolated III, IV or VI cranial nerve palsy of 11,000 charts of the Ocular Motility Section of the Department of Ophthalmology of "Faculdade de Ciências Médicas Santa Casa de São Paulo", Brazil, between January 1980 and October 2004. This study analyzed: the injured cranial nerve, affected eye, sex distribution, etiology and follow-up. RESULTS: It was found that 17.1% of the cases were congenital and 82.9% acquired. The VI cranial nerve was the most frequently affected (49.7%). The incidence was higher in males (58.1%). Traumatism was the most common cause of III (43.0%), IV (52.4%) and VI (48.8%) nerve palsy. Surgery was performed in the three groups: third nerve (42.9%), fourth nerve (73.2%) and sixth nerve (43.2%). CONCLUSIONS:The sixth cranial nerve was the most frequently affected and the most common cause was traumatism, the same as observed in the literature.

Keywords: Strabismus; Strabismus; Cranial nerves

PURPOSE: To assess the histopathological findings of conjunctival specimens from patients submitted to vitreoretinal surgery with intraocular silicone oil injection. METHODOS: Prospective analyses of 30 eyes of 30 patients were evaluated. Before the patients underwent removal of the intraocular silicone oil, conjunctival excision was performed and submitted to histopathologic examination. RESULTS: The presence of empty spaces corresponding to silicone oil location was positive in 10 (33%) specimens. The presence of inflammatory cells, vascular congestion, leukostases, lymphocyte and monocyte infiltrates were positive in 27 (90%) specimens. The presence of silicone oil was positive in 10 (33%) specimens. Therefore, in those patients who undergo vitreoretinal surgery, silicone oil may be present in the conjunctiva or subconjunctival space, even if biomicroscopic examination seems to be normal. According to our knowledge, this is the first study with the purpose to assess the histopathological findings of conjunctival specimens from patients submitted to vitreoretinal surgery with intraocular silicone oil injection. CONCLUSION: Ophthalmologists should be aware of this possible complication after intraocular use of silicone oil after vitreoretinal surgery.

Keywords: Silicone oils; Retina; Vitreous body; Biopsy; Postoperative care

PURPOSE: The purpose of our study was to detect circulating malignant cells (CMCs) in oversea-shipped blood samples of patients with uveal melanoma diagnosed in Brazil. METHODOS: Melan-A and tyrosinase were the two markers used for the detection of CMCs, using reverse transcriptase nested polymerase chain reaction (RT-nested-PCR) in 6 patients with uveal melanoma. The expression of beta-actin and GAPDH were used to assess the quality of the material. RESULTS: Five patients (83.33%) tested positive for the presence of CMCs. The RT-nested-PCR was positive for melan-A in 4 patients (66.7%) and positive for tyrosinase in 4 (66.7%) of the 6 patients. Three (50%) patients were positive for both markers. One (16.7%) patient was negative for both markers. All negative controls were negative. CONCLUSION: The quality of the blood samples shipped overseas, from patients with uveal melanoma, was preserved. The detection of CMCs using RT-nested-PCR was positive in the majority of the patients.

Keywords: Melanoma; Choroid neoplasms; Monophenol monooxygenase; Reverse transcriptase polymerase chain reaction; Sequence analysis; DNA; Neoplasm circulating cells

PURPOSE: To evaluate the indications, the results and the complications seen in the patients submitted to gold weight implantation to correct paralytic lagophthalmos. METHODS: Charts of 20 patients with lagophthalmos secondary to facial nerve palsy of diverse etiologies, which were submitted to gold weight implantation in the upper eyelid of the affected side, were retrospectively examined. RESULTS: The most frequent cause of paralytic lagophthalmos was acoustic neurinoma after surgery (40%). Early and late complications occurred in 40% of the implants. Four patients (20%) presented a local inflammatory reaction in the first 3 months after surgery. Two patients (10%) presented skin and orbicular muscle thinness over the gold weight 4 and 7 years after the implant, respectively. One patient (5%) presented gold weight displacement after 3 years and another patient (5%) had late gold weight extrusion after 10 years. CONCLUSIONS: In this series, the complication rate of gold weight implantation was high (40%). The complications were divided into early, possibly related to the material impurity and the late, due to the evolution of the facial nerve palsy that presented a decrease in muscle tonus.

Keywords: Gold; Prosthesis and implants; Facial paralysis; Eyelid diseases; Postoperative complications; Human; Male; Female; Adult; Middle aged

PURPOSE: To evaluate clinical and refractive results of anterior chamber multifocal phakic intraocular lens Newlife® for presbyopia correction considering uncorrected far and near visual acuity and refraction data and also to evaluate safety of this intraocular lens considering distance and near corrected visual acuity, endothelial cell count and complications. METHODS: Retrospective analysis of a clinical database of 30 patients (51 eyes) who had received a foldable anterior chamber multifocal intraocular lens for presbyopia correction. Data were collected before surgery and at 1, 3, 6, 12 months after the procedure. Statistical variance analysis and multiple comparisons were used to verify possible associations. All complications were described. RESULTS: After surgery the mean spherical equivalent was -0.046 D (+/-0.48) and 87.5% of the eyes could read Parinaud 3 or better (equivalent to J2 or better) without the need of near glasses. Endothelial cell loss was 7.57%. The intraocular lens was explanted in 6 (11.5%) eyes for different reasons. Cataracts were the major cause of lens removal. CONCLUSION: Improvement of mean uncorrected visual acuity and refraction data after multifocal phakic intraocular lens Newlife® implantation for presbyopia correction was observed. Established safety criteria (distance and near corrected visual acuity, endothelial cell count and complications) did not confirm the safety of the procedure in the follow-up period.

Keywords: Presbyopia; Lens implantation, intraocular; Postoperative complications; Retrospective studies

PURPOSE: To evaluate the effect of peripheral limbar relaxing incisions (PLRI) in the reduction of the astigmatism during cataract surgery. METHODS: We studied prospectively 103 eyes of 103 patients submitted to PLRI, using the Nichamim nomogram during cataract surgery by phacoemulsification. After the first and sixth month we analized the changes in astigmatism topography, induction of astigmatism and sucess rate. The patients were divided into two groups according to the astigmatism (with-the-rule and against-the-rule), and studied separately. RESULTS: There was a statistically significant change in the mean astigmatism topography in the preoperative and postoperative periods in both groups. There was an induction of 1.10 ± 0.9 D and 37% of sucess rate in the with-the-rule group and 1.70 ± 0.80 D and 51% of sucess rate in the against-the-rule group after six months of follow-up. CONCLUSIONS: The peripherical relaxing limbal incisions (PLRI) are effective in reducing the preoperative astigmatism during cataract surgery. The procedure is safe and easy. The Nichamin nomogram caused hypocorrection in both types of preoperative astigmatism.

Keywords: Astigmatism; Astigmatism; Phacoemulsification; Cataract extraction

PURPOSES: To determine both the incidence of adverse reactions in patients who underwent fluorescein angiography for the first time and to determine whether systemic arterial hypertension, diabetes or allergy history increases the chance of reaction to intravenous fluorescein. METHODS:Data collection was carried out between January 2001 and October 2002 in Recife, Brazil. Patients with prior fluorescein angiography history, pregnant patients or patients in use of corticosteroids, immunosuppressive or antihistamine drugs were excluded. RESULTS: Out of 1,500 enrolled patients, 1,039 (69.3%) underwent the test for the first time. The mean age was 58 ± 16 years and the median age was 60 years. Of these, 628 (60.4%) were women. Nausea occurred in 71 (6.83%) patients, vomiting in 14 (1.35%), urticaria in 11 (1.06%), bronchospasm in 4 (0.38%) and laryngeal edema in 1 (0.01%). Five patients presented more than one adverse reaction. Higher incidences of adverse reactions were observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24-2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history [p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS: A cumulative incidence of 9.72% adverse reactions was observed in patients who had undergone this test for the first time. The presence of the allergy history, diabetes or systemic arterial hypertension increased the incidence of adverse reactions to the dye.

Keywords: Fluorescein angiography; Anaphylaxis; Drug hypersensitivity; Adverse reactions

PURPOSE: To analyze the anterior segment of refractive surgery candidates and establish the variability pattern in this population regarding corneal volume, anterior chamber volume and depth and corneal thickness, using the noncontact three dimensional analyzer Pentacam®. METHODS: A retrospective study of 297 eyes of 149 patients was conducted using Pentacam®. According to the spherical equivalent value two groups were created, myopia (n=242 eyes) and hyperopia (n=55 eyes), to analyze the variables of corneal volume, anterior chamber volume and depth and corneal thickness. RESULTS: The mean values of the myopia group were: corneal total volume 59.37 ± 3.51mm³, corneal volume at 3 mm 3.87 ± 0.23 mm³, at 5 mm 11.31 ± 0.67 mm³, and at 7 mm 24.30 ± 1.43 mm³, anterior chamber volume 198.74 ± 32.40 mm³, anterior chamber depth 3.19 ± 0.28 mm and corneal thickness 533.33 ± 33.47 mm. In the hyperopia group, the mean total corneal volume was 60.77 ± 3.31 mm³, corneal volume at 3 mm from the apex was 4.01 ± 0.20 mm³, at 5 mm was 11.73 ± 0.58 mm³, and at 7 mm was 25.09 ± 1.21 mm³, the anterior chamber volume was 146.61 ± 32.86 mm³, the anterior chamber depth was 2.76 ± 0.38 mm and the corneal thickness was 550.52 ± 29.49 mm. The difference between the groups was significant for all variables (p<0.05). CONCLUSION: We observed in this study that patients with myopia had lesser mean corneal volume and pachymetry, and greater anterior chamber depth and volume compared with hyperopic patients.

Keywords: Corneal topography; Myopia; Hyperopia; Anterior eye segment

PURPOSE: To describe the results of therapeutic penetrating keratoplasty in patients with impending perforation or perforated infectious keratitis. METHODS: Fifty-nine charts of patients with infectious keratitis who were submitted to therapeutic penetrating keratoplasty were retrospectively reviewed at the Department of Ophthalmology of the Santa Casa of São Paulo from January 2000 to December 2004. Pre- and post operative visual acuity, biomicroscopy, echography, culture and bacterioscopy were analyzed. Patients with a minimum 9-month follow-up were included and were divided into 5 groups: herpetic, bacterial, fungal, bacterial-fungal keratitis and keratitis with negative culture bacterioscopy. RESULTS: Erradication of infection and restoration of ocular integrity were obtained in 95.2% of all bacterial keratitis; 100% fungal; 25.0% bacterial-fungal; 95.2% negative culture and 100% of all herpetic keratitis. Complications included: 2 rejections, 6 recurrences, 13 glaucomas and 1 perforation. CONCLUSION: In infectious keratitis with perforation or impending perforation that did not respond to conservative clinical therapy, therapeutic penetrating keratoplasty must be considered an alternative to erradicate infection and restore the ocular integrity.

Keywords: Corneal transplantation; Keratoplasty; penetrating; Keratitis; Keratitis; Visual acuity; Eye infections

PURPOSE: Analysis of the relevance of preoperative evaluation to prevent adverse clinical events, pre- and postoperative, on cataract surgery. METHODS: The study includes 1254 patients submitted to cataract surgery at the Instituto da Catarata do Departamento de Oftalmologia da UNIFESP - EPM, in the period of Jan - Dec 2004. Data referring to the preoperative evaluation and adverse clinical events related to anesthesia/surgical procedure were retrospectively collected. RESULTS: Sixteen patients (1.2%) showed an adverse clinical event. Nine hundred thirty-six patients (74.6%) showed at least one altered examination. This factor, nevertheless, did not show any relation to the adverse clinical event (p=0.334). CONCLUSION: Concerning the studied series, the altered laboratory tests, electrocardiogram and/or thorax x-ray has no correlation with the adverse clinical events related to the anesthesia/surgical procedure.

Keywords: Cataract extraction; Attitude of health personnel; Preoperative care; Diagnostic tests; routine

PURPOSE:To compare two sclera decontamination methods: treatment with glycerin versus treatment with gamma irradiation, alkali and glycerin, aiming to detect the clinical and histological alterations in rabbit anophthalmic sockets reconstructed with sclera-involved polymethylmethacrylate spheres. METHODS:Thirty-nine New Zealand-breed rabbits were divided into two groups: group I, whose animals were submitted to enucleation of one eye and reconstruction with a polymethylmethacrylate sphere involved in glycerin-treated sclera; group II, where there was enucleation, and reconstruction performed with a polymethylmethacrylate sphere involved in sclera treated with gamma irradiation, alkali and glycerin. The two groups were observed at four moments, at 7, 21, 42 and 84 days after surgery. Preset times elapsed, the rabbits were euthanized, sockets were exenterated, the material was processed for embedment in paraffin, cut into 5 µm sections thick and stained with hematoxylin-eosin and Masson's trichrome techniques. The scleras were submitted to morphometric and semiquantitative analysis. Results were compared by Mann-Whitney's non-parametric test. RESULTS: Comparative analysis of vascularization of the surgical interface pointed out a significative difference in the evaluation done 21 days after the implant (P<0.001), with group II showing greater neovascularization. Comparison of the fibrous capsule thickness displayed a significative difference at moments corresponding to 21 days (P<0.001) and 42 days (P<0.001). At both moments, group II presented a thicker fibrous capsule than group I. Likewise, there was variation in sclera thickness, being thicker in group II, at the 21-day post-implant (P=0.003) moment, and at the 42-day moment (P=0.024), as well. Along the experimental period, when groups were analyzed we could observe statistically significative diminution of vascularization in the surgical interface, in group I, as well as in group II, at the moment of 7, 21, 42 and 84 days. CONCLUSION: When used as coating on the polymethylmethacrylate implant for the reconstruction of rabbit anophthalmic socket, the sclera treated with gamma irradiation, alkali and glycerin reacted similarly to the traditionally used glycerin-treated sclera. The two treatments induced a similar inflammatory response. The formation of neovessels, thickness of fibrous capsule and of sclera developed differently in the two groups. Nevertheless, they presented similar results at the end of the 84-day observation period. There was no significant difference between the two groups, with regard to sclera preservation.

Keywords: Sclera; Sclera; Decontamination; Eye enucleation; Orbital implants; Glycerol; Polymetylmethacrylate; Comparative study; Rabbits

PURPOSE: To evaluate if oral flaxseed oil (Linum usitatissimum), which reduces the inflammation in rheumatoid arthritis, may help keratoconjunctivitis sicca's treatment in Sjögren's syndrome patients. METHODS: In a randomized clinical trial, 38 female patients with rheumatoid arthritis or systemic lupus erithematosus associated with keratoconjunctivitis sicca and Sjögren's syndrome were consecutively selected from patients of the Departament of Reumatology of the Amazonas University Hospital. Keratoconjunctivitis sicca diagnosis was based on a dry-eye symptom survey score (Ocular Surface Disease Index - OSDI®), Schirmer-I test, fluorescein break-up time, 1% Rose Bengal staining of ocular surface measured by the van Bijsterveld scale. All patients had ocular surface inflammation evaluated and quantified by conjunctival impression cytology, before and after the study. The subjects were divided into three groups with 13 (Group I), 12 (Group II) and 13 (Group III) patients. Group I received flaxseed oil capsules with a final 1 g/day dosis, Group II flaxseed oil capsules with a final 2 g/day dosis and Group III - controls - placebo, for 180 days. RESULTS: Comparing the results at the beginning and at the end of the treatment, statistically significant changes (p<0.05) in symptoms (OSDI®), ocular surface inflammation quantified by conjunctival impression cytology, Schirmer-I test and fluorescein break-up time occurred in Groups I e II when compared to controls. CONCLUSIONS: Therapy with oral flaxseed oil capsules 1 or 2 g/day reduces ocular surface inflammation and ameliorates the symptoms of keratoconjunctivitis sicca in Sjögren's syndrome patients. Long-term studies are needed to confirm the role of this therapy for keratoconjunctivitis sicca in Sjögren's syndrome.

Keywords: Dry eye syndromes; Keratoconjunctivitis sicca; Flaxseed oil; Keratitis; Sjögren's syndrome; Tears

PURPOSE: To evaluate the effects of mitomycin C (MMC) on the internal ciliary epithelium (ICE) of the ciliary body of animals treated with two differents aqueous humor supressants. METHODS: The eyes of sixteen Norfolk albino rabbits divided into four experimental groups were studied. The right eyes (RE) of the four groups received 0.1 ml of MMC (0.5 mg/ml) under the scleral flap. The left eyes (LE) was the control group. Group 1 (G1) did not have any other treatment. To Group 2 (G2) and Group 4 (G4) acetazolamide was administered. To Group (G3) and Group 4 (G4) timolol maleate was administered. ICE was examined by transmission electron microscopy (TEM). RESULTS: The following aspects were observed in all groups, except in G1 LE: cell shrinkage and/or enlargement of intercellular spaces, rarefied mitochondria, clear vesicular structures and electron-dense bodies. The internal limitant membrane showed to be thickened, discontinued and separeted in all groups, except in G1 LE and G2 LE. Discharge of cytoplasmatic material was observed only in the groups treated with aqueous humor supressants. CONCLUSIONS: 1) MMC, acetazolamide and timolol maleate caused morphological alterations in the ciliary epithelium even when used alone. 2) The combination of MMC and acetazolamide caused more alterations than did isolated acetazolamide, but not more than MMC alone. 3) For the other combinations the alterations were similar.

Keywords: Ciliary body; Ciliary body; Epithelium; Epithelium; Microscopy, electron, transmission; Acetazolamide; Acetazolamide; Rabbits

PURPOSE: To evaluate different methods of oxacillin susceptibility testing of ocular isolates, considering polymerase chain reaction (PCR) as the 'gold standard', and to compare the in vitro susceptibility to oxacillin with that of other antimicrobials used in ophthalmologic practice. METHODS: The Vitek gram-positive identification card was used to identify ocular coagulase negative Staphylococcus species. The presence of the mecA gene was determined by the polymerase chain reaction assay with a combination of two primer sets (mecA and 16S rRNA) in a single region. Results were analyzed and compared with other oxacillin susceptibility methods: PBP2a detection by rapid slide latex agglutination test (SLA); oxacillin E-test; the Vitek automated gram-positive susceptibility card (GPS-105); the oxacillin salt agar screening test (OSAS) at a concentration of 6.0, 1.0 and 0.75 µg oxacillin per ml and the cefoxitin disk diffusion test (CDD). Automated susceptibility was also determined to other antimicrobial agents (fluoroquinolones, penicillin G, amoxicillin-ampicillin, cefazolin, ampicillin-sulbactam, erythromycin, clindamycin, gentamicin, tetracycline, trimethoprim-sulfamethoxazole, vancomycin and rifampin. RESULTS: Of the 69 CoNS isolates tested, 71% were mecA-positive and 29% mecA-negative. All methods tested had a statistically significant agreement with polymerase chain reaction. There was a tendency of positive polymerase chain reaction predomination among the S. epidermidis isolates in comparison to non-epidermidis isolates, although this was not statistically significant (78.3% vs. 56.5%; chi2= 2.54; P= 0.11). The oxacillin salt agar screening test (0.75 µg oxacillin/ml) showed the best performance, with 100% sensitivity and negative predictive value; 95% specificity and 98% positive predictive value. Using the E-test, the mecA-positive isolates were statistically significantly more resistant to ciprofloxacin, ofloxacin, gatifloxacin and moxifloxacin (P= 0.002; P= 0.008; P= 0.002 and P= 0.003, respectively). There was a statistically significant higher proportion of resistance of the coagulase negative Staphylococcus mecA-positives for: penicillin G, amoxicillin-ampicillin, cefazolin, ampicillin-sulbactam, erythromycin, clindamycin, gentamicin and tetracycline (P<0.05). All coagulase negative Staphylococcus species were susceptible to vancomycin and there was no statistically significant correlation between the mecA-positive isolates and resistance to trimethoprim-sulfamethoxazole or to rifampin. CONCLUSIONS: In the present study, we found that the E-test and the oxacillin salt agar screening test S (0.75 µg oxacillin per ml), when compared with polymerase chain reaction, were the most accurate currently available methods to phenotypically detect oxacillin resistance of coagulase negative Staphylococcus species. This study demonstrated that a good option for screening of ocular isolates for oxacillin resistance in the microbiology laboratory is the cefoxitin disk diffusion test and the automated Vitek system. We believe it is important to have available methods that accurately detect methicillin resistance of the less commonly encountered species, chiefly because of their increasing importance as opportunistic pathogens.

Keywords: Methicillin resistance; Sensitivity and specificity; Latex fixation tests; Oxacillin; Microbial sensitivity tests; Staphylococcus; Staphylococcus; Coagulase; Eye infections; bacterial; Comparative study

PURPOSE: To evaluate and compare refractive errors obtained through clinical subjective and automatized wavefront refraction analyses in eyes under cycloplegia. METHODS: Prospective study of 147 patients, 279 eyes, undergoing preoperative examination for refractive surgery. Clinical subjective refraction was performed first followed by wavefront refraction. Results on astigmatism obtained from refraction were decomposed in power vectors for statistical analyses. Data were first analyzed in one eye and then in both eyes. RESULTS: The mean difference between clinical subjective refraction and automatized wavefront refraction on cycloplegic eyes was of -0.19 SD combined with -0.06 CD in the 15º axis for data in one eye, and -0.17 SD combined with -0.05 CD in the 3º axis for data in both eyes of the same patient. CONCLUSION: In the present study clinical subjective refraction and automatized wavefront refraction under cycloplegia had similar numerical values.

Keywords: Refractive errors; Refraction, ocular; Optometry; Diagnostic techniques, ophthalmological; Comparative study

PURPOSE: To report outcomes of cataract extraction by phacoemulsification in patients with uveitis. METHODS: We retrospectively reviewed the charts of 189 patients (242 eyes) with uveitis who underwent cataract extraction by phacoemulsification at the Uveitis and Ocular Immunology Unit of McGill University Health Centre, Montreal, Quebec, Canada. RESULTS: Average follow-up was 46 ± 31.2 months. Average preoperative visual acuity was 20/100 and average postoperative visual acuity was 20/40. Hundred and forty-six eyes (59.9%) attained visual acuity better than 20/40. Visual loss occurred in 26 eyes. The most common peroperative complication was posterior capsule rupture with vitreous loss seen in 7 eyes (3%). Recurrence of uveitis was the most common postoperative complication seen in 73 eyes (30.16%). Other postoperative complications included iris atrophy (28.51%), ocular hypertension (28.09%), epiretinal membrane (26.44%), posterior capsule opacification (19%), cystoid macular edema (13.63%), ocular hypotony (12.80%), optic disc atrophy (8.67%) and posterior synechiae (6.61%). CONCLUSIONS: Cataract extraction by phacoemulsification is safe in patients with uveitis. Successful visual results are observed in long-term follow-up despite the prevalence of recurrence of uveitis, posterior capsule opacification and macular abnormalities. To the best of our knowledge this is the largest series presented to date.

Keywords: Cataract extraction; Phacoemulsification; Lens implantation, intraocular; Uveitis

We present a case of Urbach-Wiethe syndrome with typical findings, including ocular lesions. A 15-year-old girl was referred to our department complaining of itchy eyelid lesions (moniliform blepharosis) associated with other systemic manifestations. Diagnosis was confirmed by performing skin biopsy. Artificial tears were prescribed, with partial relief of the symptom. The objective of the present study is to describe a typical case of Urbach-Wiethe syndrome attended at the Ophthalmologic Sector of the Medical School of Marília.

Keywords: Lipoid proteinosis of Urbach and Wiethe; Lipidoses; Eyelids; Syndrome; Eye manifestations; Cases report

We describe a sixteen years old male patient that suffered a craniocerebral trauma and presented at the emergency room, with ocular pain, palpebral hematoma and left eye proptosis. Orbital computed tomography showed left subperiosteal orbital hematoma. A surgical drainage was performed. Subperiosteal hematoma of the orbit is a rare cause of proptosis; its early diagnosis must be made in order to avoid possible complications.

Keywords: Hematoma; Hemorrhage; Craniocerebral trauma; Exophthalmos; Orbital diseases; Case reports

A 51-year-old black woman was referred to our Retina Clinic for evaluation of loss of vision in her left eye. She was previously diagnosed with a ruptured retinal arterial macroaneurism (RAM) in the same eye. The ophthalmoscopic examination of the affected eye disclosed a subretinal lesion with some hemorrhage and exudation in the same area previously diagnosed with ruptured RAM. Fluorescein angiography revealed a gradually hyperfluorescent net of vessels located in the subfoveal region, consistent with the diagnosis of subretinal neovascular membrane. In this paper we stress the possibility of subretinal neovascularization following a ruptured RAM, even as a rare event.

Keywords: Retinal neovascularization; Retinal artery; Aneurysm, ruptured; Aneurysm, ruptured; Fluorescein angiography

Fabry's disease is a rare X-linked lisosomal storage disorder of glycosphingolipid (GL) metabolism, caused by a deficiency of alpha-galactosidase A activity. The progressive accumulation of GL in tissues results in the clinical manifestations of the disease, that are more evident in hemizygous males, and include angiokeratomas, acroparesthesia, cornea verticillata, cardiac and kidney involvement, cerebrovascular manifestations. A family with Fabry's disease including 2 female patients and 3 male patients is reported. The patients were submitted to complete medical history, ophthalmological examination and alpha-galactosidase activity test. Cornea verticillata was a constant finding in all patients. This demonstrates the important role of the ophtalmological examination for the diagnosis of Fabry's disease since the eye findings are so characteristic of the disease.

Keywords: Corneal opacity; Fabry disease; Lysosomal storage diseases

This is a case report of a patient with Down's syndrome with an important mechanical ectropion and elongation of the lower lid related to chronic allergic conjunctivitis, besides cataract and keratoconus. The tarsal strip technique and ressection of redundant and thick conjunctiva was the surgical approach chosen for this case. Functional and cosmetic outcomes were considered satisfactory.

Keywords: Ectropion; Blepharoplasty; Conjunctiva; Conjunctivitis, allergic; Down syndrome; Case reports

Ocular non-Hodgkin's lymphoma is a rare condition that can involve the retina, the vitreous and the optic nerve. It can occur alone or can be associated with lymphoma of the central nervous system and a frequent manifestation is a posterior uveitis of difficult treatment. This kind of ocular tumor is difficult and a challenge to diagnosis. We describe a case of non-Hodgkin's intraocular B-cell lymphoma in a 47-year-old woman who had a posterior uveitis as the first manifestation. We emphasize the importance of a careful investigation and of the general clinical examination since this is the most common type in the eye. We expect to call the attention to this disease that many times appears in an unspecific form with unspecific symptoms.

Keywords: Uveitis; Central nervous system neoplasms; Lymphoma, non-Hodgkin; Paraneoplastic syndromes

PURPOSE: To describe the main intervening factors observed during the acquisition and analysis of multifocal electroretinogram (mfERG), that could affect the recorded signal, the obtained responses and their analysis. METHODS: The error factors observed during the acquisition of 100 sequential multifocal electroretinogram tests, in the period of May to July, 2005 were analyzed. The examinations of multifocal electroretinogram were carried out in agreement with international guideline recommendations, taking into account the established parameters of equipment, with 61 elements, and visual angle of 30º. All patients had been submitted to complete ophthalmologic examination, excluding those with inadequate transparency of ways, flat corneas and those incapable to visualize a central fixation target. RESULTS: The intervening factors, that could cause artifacts and errors in the interpretation of the obtained results, observed and corrected during the acquisition of multifocal electroretinogram were: eccentric or poor fixation, eye movements, orbicular contraction, cervical muscle contraction, inadequate transparency of the corneal electrode, electrode displacement, lens support decentralization, inadequate viewing distance in patients with high refractive errors, eye height inadequacy in relation to the center of the screen, electrical noise in 60 HZ frequency and electromagnetic field and high impedances. Excessive use of filters in wave processing for noise and artifact removal can interfere with the analysis of the obtained results. CONCLUSION: Simple observational cares during signal acquisition are of significant importance to ensure accuracy of the topographical electroretinogram information, good waveform morphology and low noise level register. Through their ready correction, the correct and adjusted analysis of the amplitude and of implicit time of peaks N1, P1 and N2 is reliable. Digital smooth system with specific frequency peak removal supply waves with more defined morphology with lower amplitude reduction than other available resources.

Keywords: Retinal diseases; Electroretinography; Retina; Evoked potentials, visual; Diagnostic errors

Antineoplastic agents offer an increase in the patients' survival rates, but may induce side effects in different organs and tissues. Mucositis is one of the most common side effects during chemotherapy with certain agents. The ocular toxicity induced by these drugs may manifest as changes in the ocular surface and in the tear film. The purpose of this research was to study the ocular surface changes induced by chemotherapy and to establish their clinical correlation with the chemotherapy and mucositis. The 39 selected patients underwent a full ophthalmological examination and supplementary tests. We compared 2 groups of patients: with (case) and without mucositis (control). Statistical analysis was performed with the Statistical Package for Social Sciences software. Mucositis was identified in 51.4% of the patients after chemotherapy. The brakeup time showed a statistically significant decrease after chemotherapy (p<0.0001). Punctate epitheliopathy was seen in 78.4% of cases. Schirmer test results did not show significant changes pre x post-chemotherapy. Chemotherapy may induce tear film changes, as shown in this study by the brakeup time, Schirmer test and biomicroscopy. Chemotherapy-induced mucositis involves also the conjunctival mucosa, which was subjectively characterized by the ocular symptoms and proved in our study by impression cytology and microbiology.

Keywords: Chemotherapy; Drug therapy, mucositis; Neoplasms; Conjunctiva