VOLUME 70 - ISSUE 5

PURPOSE: To define characteristics of the fundus autofluorescence examination, verifying usefulness in the diagnosis and care of hereditary retinal diseases. METHODS: 28 patients, adults, divided equally into four groups with diagnoses of Stargardt macular dystrophy, cone dystrophy, retinitis pigmentosa and healthy volunteers for the establishment of the normality pattern. An average of nine images with the filter for fluorescein angiography was obtained for the formation of the image autofluorescence using Heidelberg Retina Angiograph2. The images of each group of patients were analyzed to verify common characteristics. RESULTS: The fundus autofluorescence of healthy volunteers showed the foveal area darker than the surrounding retina. The images of Stargardt macular dystrophy, in general, presented an oval central lesion, with reduced autofluorescence. The main alterations of the autofluorescence in patients with cone dystrophy were reduced foveal autofluorescence with a parafoveal ring of increased autofluorescence. In general, the images of retinitis pigmentosa showed outlying pigments with reduced autofluorescence, and of the foveal area, in some cases disorganization or reduced autofluorescence. CONCLUSION: The study showed the existence of patterns of fundus autofluorescence in the hereditary retinal diseases that allow the diagnosis and better interpretation of the pathogenesis of these diseases.

Keywords: Retinal diseases; Lipofuscin; Pigment epithelium of eye; Eye diseases; Hereditary; Fluorescein angiography

PURPOSE: To evaluate the behavior of the modified capsular tension ring (MCTR) in traumatic subluxated cataracts analyzing the visual acuity, centration of the capsular bag, pseudophacodonesis, postoperative follow-up and intra- and postoperative complications. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Twenty-two eyes of 22 patients with traumatic loss of zonular support had phacoemulsification using PCIOL and MCTR implantation. The preoperative examination included best correct visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration and vitreous prolapse. The postoperative evaluation included BCVA, the presence of pseudophacodonesis, PCIOL centration, necessity of vitrectomy and other complications. RESULTS: 21 eyes (95.45%) had an improvement in BCVA. The preoperative examination disclosed phacodonesis in 11 eyes (50%) and no eye presented pseudophacodonesis in the postoperative period. Preoperatively, symptomatic decentration was presented by 10 eyes (45.45%) and 22 eyes (100%) had no decentration after surgery. The preoperative examination revealed vitreous prolapse in the anterior chamber in 9 eyes (40.90%). Vitrectomy was required in 11 eyes (50%). CONCLUSIONS: The use of the MCTR resulted in a good centration of the capsular bag and the PC IOL in 22 eyes with traumatic cataract and loss of zonular support.

Keywords: Eye injuries; Visual acuity; Lens implantation, intraocular; Cataract extraction

PURPOSE: To evaluate the characteristics of patients with anophthalmic cavity who developed sphere extrusion. METHODS: A retrospective observational study was done evaluating 37 patients with anophthalmic cavity and sphere extrusion at the "Faculdade de Medicina de Botucatu-UNESP". RESULTS: Extrusion was observed in enucleated and eviscerated cavities. The majority of the patients had the eye removed because of phthisis bulbi or trauma and the extrusion happened 1 or 2 years after the surgery. Extrusion was preceded by conjunctival dehiscence and exposure of the sphere and occurred with all used implants. CONCLUSION: Complications after orbital implant placement are a possibility. Dehiscence and sphere extrusion may happen and another surgery would be necessary. The patient and the ophthalmologist have to be prepared for this.

Keywords: Eye enucleation; Orbital implants; Orbital diseases; Hydroxyapatites; Silicone elastomers; Sclera

PURPOSE: To compare the anatomical structure and the presence of growth factors and cytokines of amniotic membrane preserved in glycerol/MEM (1:1) or undiluted dimethyl sulfoxide through electron microscopy. METHODS: Amniotic membrane preserved in glycerol/MEM (1:1) or undiluted dimethyl sulfoxide were processed for transmission and scaning electron microscopy. As control, freshly collected amniotic membrane was fixed and processed for electron microscopy. The cytokines and growth factors assessed were: TGF-beta (transforming growth factor beta); TGF-b activ (activated transforming growth factor beta); EGF (epidermal growth factor); FGF-4 (fibroblast growth factor 4); bFGF (basic fibroblast growth factor); IL-4 (interleukin 4); PGE2 (prostaglandin E2); IL-10 (interleukin 10); KGF (keratinocyte growth factor); HGF (hepatocyte growth factor). RESULTS: Amniotic membrane from the control group showed intact epithelium, with surface microvilli and junctional complexes between the cells and the basal membrane. Glycerol/MEM preserved amniotic membrane had similar aspect to the control, with higher epithelial cells. Those amniotic membranes preserved in dimethyl sulfoxide disclosed less intercellular junction and detachment of the epithelium from the basal membrane. The cytokines and growth factors did not disclose significant differences, except for FGF-4, bFGF, PGE2 and KGF. CONCLUSIONS: Amniotic membrane preserved in glycerol/MEM showed a better tissue structure, with less detachment of the epithelium from the basal membrane, in comparison to undiluted dimethyl sulfoxide. The majority of the growth factors and cytokines were kept with both techniques of preservation.

Keywords: Amnion; Microscopy, electron; Glycerol; Dimethyl sulfoxide; Cytokines; Transforming growth factor beta

PURPOSE: To evaluate contrast sensitivity in patients with diabetic retinopathy (DR) treated with argon laser panphotocoagulation. METHODS: Prospective study of patients with diabetic retinopathy and 20/20 visual acuity, treated with retinal panphotocoagulation, following ETDRS criteria. The patients were submitted, initially, to complete ophthalmologic evaluation and contrast sensitivity testing (Vision Contrast Test System). After 3 months of treatment, they were reevaluated by means of visual acuity and contrast sensitivity. RESULTS: The sample comprised 28 patients (28 eyes), all with type II diabetes. A ranged from 45 to 77 years (mean 57.8 ± 8.0), 19 (67.9%) patients were male and 9 (32.1%) female. Regarding the type of retinopathy, 18 (64.3%) had proliferative DR and 10 (35.7%) very severe non proliferative RD. No visual acuity alteration was observed after treatment. In relation to contrast sensitivity, there were no alterations between pre and post-treatment in all evaluated spacial frequencies 1.5 (p=0.191); 3.0 (p=0.850); 6.0 (p=0.374); 12.0 (p=0.674) e 18.0 (p=0.443). CONCLUSION: There was no significant alteration in the contrast sensitivity of patients with diabetic retinopathy after panphotocoagulation with argon laser in the studied period.

Keywords: Diabetic retinopathy; Diabetic retinopathy; Laser coagulation; Diabetes mellitus; Visual acuity

PURPOSE: To evaluate findings of ophthalmologic examinations in cardiac transplant recipients, searching especially for changes in the retinal nerve fiber layer by means of Scanning Laser Polarimetry. METHODS: Fifteen cardiac transplant recipients were examined from September 2003 to July 2004. All of them underwent ophthalmologic examination, which consisted of visual acuity (VA), biomicroscopy, tonometry and fundoscopy. Fiber layer analyzer - GDx - examination was performed in eleven patients. Twelve patients were men. The mean age was 55.0 ± 13.5 years. The follow-up since transplantation lasted from 3 to 74 months; mean value 29.7 ± 20.8 months. RESULTS: VA with best correction in all patients attained at least 20/40. Subcapsular posterior cataract was seen in one patient; another presented corneal nubeculae secondary to herpes zoster. In one case a scar suggesting retinocoroiditis was seen at fundoscopy. Biomicroscopic and the fundoscopic findings were expected because of immunosuppressive treatment, following transplantation. GDx examination disclosed loss of fibers in the superior retinal fiber layer in 12 of the 22 examined eyes. CONCLUSION: These results support the hypothesis that reduction of oxygen inflow in retinal circulation before or during heart transplantation could lead to loss of fibers in the retinal nerve fiber layer.

Keywords: GDx; Heart transplantation; Eye manifestations; Nerve fibers; Diagnostic techniques, ophthalmological

PURPOSE: To compare the preferential hyperacuity perimeter (Preview PHP; Carl Zeiss Meditec, Dublin, CA) with the original Amsler grid in the detection of choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD). METHODS: Patients were classified into groups, based on the severity of the age-related macular degeneration and underwent preferential hyperacuity perimeter and Amsler grid testing. High sensitivity and or high specificity of a method were defined as the observation of at least 80% of each one the parameters. RESULTS: Sixty-five patients (65 eyes) were analyzed statistically. The sensitivity of detection of choroidal neovascularization was 70% by the Amsler grid and 90% by the preferential hyperacuity perimeter and the specificity of the Amsler grid was 85.5% and that of the preferential hyperacuity perimeter 81.8%. CONCLUSIONS: The preferential hyperacuity perimeter has greater sensitivity than the Amsler grid in the detection of choroidal neovascularization among patients over 50 years of age and is a promising method for monitoring patients with age-related macular degeneration. Although the original Amsler grid is less sensitive, it is a portable method, not expensive, accessible and presents reasonable sensitivity and high specificity in the diagnosis of choroidal neovascularization. Its use can be recommended for self-monitoring in patients with age-related macular degeneration as an alternative to preferential hyperacuity perimeter and when this method is not available.

Keywords: Macular degeneration; Vision tests; Choroidal neovascularization; Perimetry; Patient selection; Comparative study

PURPOSE: To evaluate the anatomy of idiopathic macular hole (IMH) using Optical Coherence Tomography (OCT) and to construct a prognostic index that can be correlated with the visual outcomes and the anatomical closing. METHODS: Prospective study, in which 22 eyes with IMH had been evaluated through OCT in the daily postoperative period of IMH surgery. The Prognostic of Macular Hole Index (PMHI) was created which was correlated with the anatomical result and the postoperative visual acuity (VA) six months after surgery. RESULTS: Sixteen eyes (72.7%) got anatomical closing at the end of six months of follow-up. On analysis of PMHI, there was significant difference between group 1 (open MH) and group 2 (closed MH) (p=0.0018). The risk for failure of anatomical closing is 11 times greater when the diameter of the internal base is over 600 µm or IPBM is less than 0.6 (p=0.0495). Regarding final VA, it was observed that the IPBM had a significant negative correlation with AV (p=0.001). CONCLUSIONS: IPBM showed to be the best predictor of anatomical closing and postoperative visual acuity among the studied variables. It predicted 41% of the postoperative final visual acuity, leading us to believe that other factors, such as the time of history and the degeneration of photoreceptors in these older BM, can be involved in the visual outcomes.

Keywords: Macular lutea; Macula lutea; Tomography, optical coherence; Visual acuity; Vitrectomy

PURPOSE: To assess the effect of intravitreal injections of triamcinolone on macular thickness (Stratus-OCT), intra-ocular pressure and visual acuity, in the treatment of diabetic macular edema non-responsive to previous laser photocoagulation, over a 6-month period. METHODS:The study included 21 subjects (22 eyes) who underwent complete ophthalmologic examination, measurements of visual acuity and intraocular pressure, and OCT, previously treated with at least 2 laser applications. The study participants were treated with 4 mg / 0.1 ml intravitreal triamcinolone. Follow-up visits were scheduled for the 1st day after treatment, and after 1, 3 and 6 months. Visual and anatomical results, as well as possible complications associated with the intravitreal injection procedure were studied. RESULTS: The study showed a significant reduction in mean macular thickness, assessed by OCT at 1, 3 and 6 months post-treatment (p=0.001), combined with an improvement of the mean visual acuity (p<0.001). Central macular thickness mean ± SD value on the first visit was 399 (±121 µm); it was reduced by 39.9% (239 ± 53 µm) at the first month (p<0.001), 35.5% (255 ± 93 µm) at the third month (p<0.001), and 18.1% (326 ± 135 µm) at the sixth month (p=0.001). The improvement in mean visual acuity was of 18 and 16 letters on the ETDRS table, on the 3rd and 6th month, respectively. Reported complications were an increase in intraocular pressure in seven eyes (33.3% of the cases). CONCLUSIONS: A reduction in mean retinal thickness was observed throughout the entire follow-up period, with significant increase in macular thickness between the 3rd and 6th month. The mean visual acuity showed statistically significant improvement at the end of the follow-up period, but no change was noticed between the 3rd and 6th month.

Keywords: Diabetic retinopathy; Macular edema, cystoid; Triamcinolone; Injections; Vitreous body; Tomography, optical coherence; Macula lutea; Visual acuit

PURPOSE: To analyze the influence of diagnostic and prognostic communication and the awareness and affectivity of the patient with keratoconus and to verify the possible modifications in the social representation that the individual has of the disease, of himself and of his life. METHODS: The sample was consisted of 44 subjects, both genders, aged 13 to 53 years, with diagnosis of keratoconus who agreed to participate in this study. The study was carried out at the "Hospital das Clínicas", University of São Paulo Medical School, and at the "Hospital de Olhos Sadalla Amin Ghanem" (Eye Hospital), in Joinville, state of Santa Catarina. A questionnaire used to assess the information received by patients with keratoconus was specially developed for this study. A quantitative and qualitative analysis of the collected data was performed through descriptive and demonstrative analyses of speech, based mainly on Social-Historical Theory. RESULTS: In general, the patients did not consider the information provided by the doctors as being satisfactory. This fact may be related to how the information is transmitted and its contents. This is influenced by several variables, such as professional training, structural characteristics of the provided care, awareness by the doctor of the importance of language and social representation related to the condition of the patient, the socioeconomic and cultural level of the physician and the patient, etc. CONCLUSION: This study indicates that the way the information is transmitted influences the social representation that the individual has of the illness and of himself.

Keywords: Keratoconus; Keratoconus; Refractive errors; Physician-patient relations; Patients; Comunication

PURPOSE: To evaluate all the visits to the ophthalmic emergency service in Brasília, Distrito Federal, Brazil, through a 1-month period. METHODS: A retrospective chart review was carried out of all patients attending the ophthalmology emergency department of the "Hospital de Base de Brasília" during September 1 to 30, 2003. RESULTS: Mean age was 32.9 ± 18.0 years (ranging from zero to 90). Seventy per cent of patients were of the working age category (from 20 to 59 years-old). Sixty-two per cent of the patients were male (n=1,777) and 38% female (n=1,067). Seventeen per cent of the patients lived in another state, and 83% lived in the Distrito Federal itself. In 3% of the charts, no address was informed. In the group of patients residents of the Distrito Federal, 84% lived at least 30 km away from the "Hospital de Base". Ocular traumas of any nature were the most frequent occurrence (n=730/30%), followed by conjunctivitis (n=568/24%). Doctors have not filled out 457 charts (16%). CONCLUSION: The ophthalmic emergency service of the "Hospital de Base" de Brasília is not properly located. The great majority of patients presented with common pathologies, emphasizing the need for a primary care system. This aspects plus the lack of information in a great number of charts suggests that the ophthalmic public health system in the "Distrito Federal" requires changes.

Keywords: Emergency service, hospital; Eye diseases; Hospitals, general; Ophthalmology; Health services needs and demand

PURPOSE: To describe a topographically guided photorefractive keratectomy technique for the management of secon dary hyperopia following radial keratectomy. METHODS: A retrospective study was carried out in patients where a topographically guided photorefractive keratectomy technique was performed for the management of secondary hyperopia following radial keratectomy. The patients had preoperatively at least 3 diopters of hyperopia. The minimum follow-up was 3 months. RESULTS: Twenty-four eyes of 21 patients were evaluated. The mean age was 45.54 ± 6.03 years (range 36 to 55 years). The average follow-up was 7.71 ± 4.6 months (range 3 to 17 months). Preoperatively the average spherical equivalent was +3.92 ± 1.57 (range +1.25 D to +7.75 D), and postoperatively it was -0.29 ± 1.43 (range -3.75 D to +2.50 D) (p<0.01). Visual acuity of 20/25 or better was achieved in 45.83% of the eyes, 20/40 or better in 83.33% and 20/60 or better in 100%. All patients were satisfied with the results and stated subjective improvement in visual quality. CONCLUSION: Considering that it is a retreatment procedure performed in unstable and irregular corneas with high degrees of hyperopia, topographically guided photorefractive keratectomy showed good results and was safe and effective for the management of secondary hyperopia following radial keratectomy.

Keywords: Keratectomy, photorefractive, excimer laser; Keratotomy, radial; Hyperopia; Astigmatism; Refractive errors

PURPOSE: To assess the socioeconomic profile of individuals presenting with primary glaucoma at the ophthalmology service of the university hospital of the Feredal University of Juiz de Fora (MG), Brazil. METHODS: Submission of a questionnaire to 100 individuals during consultation in the ophthalmology service of the university hospital of Federal University of Juiz de Fora (MG), Brazil. RESULTS: Eighty-four per cent of individuals were pensioners or retired, 86% had a monthly income of 1 to 2 salaries, 29% had been spending 26 to 75 reais per month with glaucoma therapy, 78% presented with comorbidities and 41% had already abandoned treatment due to financial difficulties in buying the medication. CONCLUSION: The low-socioeconomic-level studied population presents with therapeutic compliance difficulties mainly due to financial situation and presence of comorbidities. The authors reinforce the urgent need of adopting sociopolitical measures that facilitate access to antiglaucoma medication, which prompts a better therapeutic compliance.

Keywords: Glaucoma; Glaucoma, open-angle; Ocular hypertension; Glaucoma, angle-closure

PURPOSE: To describe the evolution of a series of cases of diffuse unilateral subacute neuroretinitis (DUSN) treated with albendazole. METHODS: Interventional case series. The authors developed a non-randomized clinical trial protocol to investigate the clinical evolution of diffuse unilateral subacute neuroretinitis cases treated with albendazole. According to protocol criteria up to now, six patients were selected that will be described separately. RESULTS: Of the six studied patients, four presented the worm. All six patients treated with the antiparasitic drug showed improvement of visual acuity and of chorioretinal scars. During the weeks of treatment, evidence of worm inactivation was documented for the four patients with visible worms. No adverse drug side effects were observed. CONCLUSIONS: The antiparasitic drug albendazole seems to be beneficial and safe in patients with diffuse unilateral subacute neuroretinitis. More studies are necessary to evaluate the effectiveness of albendazole in the treatment of diffuse unilateral subacute neuroretinitis.

Keywords: Retinitis; Albendazole; Eye infections, parasitic; Retina; Low vision; Visual acuity

PURPOSE: The Project "Vision through the hands" was performed by the Altino Ventura Foundation, with the purpose of investigating the present child situation with multiple disabilities in the state of Pernambuco, Brazil. METHODS: Birth and social conditions, social problems, and difficulty in accessing the specialized services were evaluated, aiming to collect relevant data with the goal of posterior implantation of a specialized diagnosis and treatment center. Ophthalmologic care and proper treatment were offered. RESULTS: Three hundred and nine children from five reference institutions in disabilities were attended, on six non consecutive days. All cases underwent ophthalmologic examinations and parent interviews. During the waiting time between the ophthalmologic visits and parent interviews the patients performed activities with artists. A multidisciplinary team of 31 professionals was available. According to parent information 83.1% of the patients were considered included in the society and only 45.4% attended school (normal or special). The difficulty to get access to ophthalmologic service was reported by 51.1%. Two hundred and seventy children with multiple disabilities were indentified, 154 (56.2%) of whom underwent an ophthalmologic examination for the first time, and 33.0% had low visual acuity (inferior to 20/60 Snellen). The most frequent diagnoses were: refraction error, strabismus, ambliopia, alterations of optic nerve (glaucoma and atrophy), and cataract. Eighty-four glasses were prescribed. CONCLUSION: This project was pioneer in the region, allowing to obtain the information about important problems regarding multiple disabilities, and making possible ophthalmologic care and specialized treatment to the children.

Keywords: Healh promotion; Visual acuity; Vision, low; Primary prevention; Eye diseases; Eye health

PURPOSE: To study uveitis prevalence in the local population with spondyloarthritis and its temporal relationship with joint complaints. METHODS: We reviewed seventy-seven charts of spondyloarthropathy patients from the rheumatology clinic of the "Hospital Universitário Evangélico de Curitiba" for spondyloarthritis class, patients' sex and age, occurrence of uveitis and its location and relationship between the first episode of uveitis and initial joint complaints. RESULTS: Uveitis was found in 12 of 77 patients (15.6%) which was anterior in 83.3% of the cases, without preference for spondyloarthropathy class (p=0.72) and patients' sex (p=0.74). In patients with reactive arthritis, the mean time between uveitis appearance and joint complaints was 4.04 months and in ankylosing spondylitis 73 months (p=0.009). CONCLUSION: Spondyloarthropathy patients have uveitis that is anterior in most of the cases and that appears earlier in reactive arthritis than in ankylosing spondylitis.

Keywords: Uveitis; Eye manifestations; Spondylarthropathies; Spondylitis, ankylosing; Arthritis, reactive

PURPOSE: To compare artificial eye amplitudes in enucleated socket with porous polyethylene either spherical or quad-motility implant and study the characteristics of artificial eyes fit with the two orbital implants. METHODS: A total of 21 patients were prospectively studied who underwent enucleation because of an intraocular melanoma and the randomization defined a porous polyethylene either spherical or quad-motility orbital implant. Measurements of the amplitude of the artificial eye were obtained with prism and digital photos. The software Scion Image analyzed the digital photos (www.scioncorp.com) and the quantitative data were allocated to groups. The measurements (height, length, thickness) and weight of the 21 artificial eyes were analyzed. Student's t-test was performed to determine the significance of difference between groups (p<0.05). RESULTS: There was no statistically significant difference of the artificial eye amplitude analyzed by means of prisms between both orbital implants (p>0.05 for all directions). On analyzing the digital photos, the artificial eye with spherical implant showed higher artificial eye amplitude downward (p=0.009) among patients older than 55 years old, rightward (p=0.036) and downward (p=0.008) among the 9 patients with enucleated right eye. Height and length were similar in the 21 artificial eyes but those artificial eyes fit with quad-motility orbital implants were statistically significant thicker (p<0.001) and heavier (p=0.001). CONCLUSIONS: The similar amplitude of movement of artificial eyes was observed with both spherical and quad-motility orbital implants. Artificial eyes fit with quad-motility orbital implant are significantly thicker and heavier than those fit with spherical orbital implant.

Keywords: Eye enucleation; Orbital implants; Eye, artificial; Polyethelene; Image processing, computer-assisted

PURPOSE: Flashes of light and floaters are most commonly caused by posterior vitreous separation but may be associated with sight-threatening disorders. Prevention of severe sequelae requires prompt dilated eye examination. Thus, information dissemination is crucial. This study aimed to evaluate the quality of information about floaters and light flashes available for patients on the Internet. METHODS: Cross-sectional study. In July 2005 we evaluated information available on the Internet regarding floaters and light flashes, using two search engines (MetaCrawler and MSN) and three key terms ("floaters", "dark spots eye", and "light flashes eye"). The quality of each website was evaluated using a score system. The sites were classified as academic, organizational or commercial. Readability, general quality of the website (based on: ownership, purpose, authorship, author qualification, attribution, interactivity, and currency) and quality of the specific content (definition, causes, epidemiology, diagnosis, treatment, and prognosis) were analyzed. RESULTS: Of 145 websites evaluated, 49 were included. Four sites (8.2%) were academic, 9 (18.4%) organizational, and 36 (73.4%) commercial. In the majority of the sites (53.0%) information was poor and quality was not correlated with website classification. CONCLUSIONS: Information about floaters and light flashes available on the Internet is poor.

Keywords: Vitreous detachment; Vision disorders; Internet, Information systems; Patient education

PURPOSES: To evaluate the correlation between anatomical changes (hard druses, soft druses, hyperpigmentation, new vessels, detachment of retinal pigment epithelium, hypopigmentation and chorioretinal atrophy) and light sensitivity in patients with age-related macular degeneration (ARMD); analyze macular sensitivity in areas with no anatomical lesions in patients with ARMD and compared them to the control group in order to detect if there was any functional lesion in areas with no anatomical changes. METHODS: A cross-sectional, comparative, descriptive and analytic study was performed. The case group consisted of 31 subjects with ARMD aged between 51 and 88 years. The control group consisted of 31 "healthy" subjects, without ARMD aged between 61 and 80 years. The groups were matched for gender and age. We performed static macular perimetry, red-red, using a scanning laser ophthalmoscope (SLO). Results of macular perimetry were correlated with the anatomic lesion identified in the same site by infrared laser and color photographs. RESULTS: Areas with new vessels or atrophy showed a significantly different sensitivity in relation to areas without anatomical lesions in patients with ARMD. There was significant functional loss in areas with no anatomical lesions in patients with ARMD in relation to the control group. CONCLUSIONS: Areas with new vessels or atrophy could be distinct factors for worsening of the localized macular sensitivity. There might be functional loss even in areas with no apparent anatomical changes in ARMD patients.

Keywords: Perimetry; Ophthalmoscopes; Macular degeneration; Choroidal neovascularization; Aging factors

The authors report a case of a patient with coronary insufficiency who developed central retinal artery occlusion following cardiac catheterism through the brachial artery and cineangiocoronography. This procedure can lead to embolic phenomena like that which was reported.

Keywords: Heart catheterization; Embolism; Retinal artery occlusion; Cineangiography; Risk factors; Case reports

The latex biomembrane is a material from Hevea brasiliensis and has angiogenic properties, cellular adhesion and extracellular matrix formation. It has been used for the treatment of ulcers in the inferior extremities caused by diabetes, chronic vascular insufficiency and timpanic perforations. In this study we report a case of biomembrane use to promote granulation in the orbital cavity after exenteration in a male, 72 years, who came into our service with a left eyelid lesion for two years. The ocular examination revealed a hyperemic conjunctiva, corneal thinning, cataract and ocular perforation in the left eye. The right eye had no alterations. There was an expansive and ulcerated lesion with orbital septum, frontal bone and lamina papiracea invasion confirmed by tomography. A total exenteration of the cavity was made and the biomembrane was applied to the affected site. Changes were made every 24 hours in the first seven days, and every other day in the following seven days. The biomembrane had to be taken from the patient because no granulation could be seen. Just one occurred and a half month later. Exenteration is a procedure in which all of the orbital content is removed. If the eyelids are included it is called total exenteration. There are many exenteration techniques as spontaneous granulation, skin grafts, miocutaneous flap, etc. In this case we used a material which has been successfully applied for other wounds, but with no efficiency in our experience. More studies are necessary so that we can present benefits to our patients in the ophthalmologic area with the latex biomembrane.

Keywords: Latex; Orbit evisceration; Eyelid neoplasms; Hevea; Case reports

PURPOSE: To describe the use of 4 mg intravitreal triamcinolone acetonide (IVTA) for gyrate atrophy-related macular edema (ME) and to report anatomic and functional outcomes, during a nine-month period. CASE REPORT: A 27-year-old female complained of decreased vision since diagnosis of gyrate athrophy (GA), six years before admission. At presentation visual acuity was 20/100 in OD and 20/80 in OS. Ophthalmological examination disclosed significant cataract in OD, pseudophakia in OS and typical GA findings. Fluorescein angiography (FA) disclosed ME that was confirmed by optical coherence tomography (OCT), which also showed subfoveal fluid. OS was treated with a 4-mg IVTA injection. One month later, vision improved to 20/50+1 and foveal thickness decreased, with less leakage in FA. This picture was maintained up to six months, when there was recurrence of ME to a level similar to the baseline. At nine months, visual acuity dropped to 20/80, and ME was maintained, with remodeling in macular profile. CONCLUSION:There is a transient therapeutic effect with 4-mg IVTA injection for GA-related ME. After drug clearance, edema recurs, with return of visual acuity to pretreatment level.

Keywords: Gyrate atrophy; Macular edema, cystoid; Triamcinolone acetonide; Case reports

Erdheim-Chester disease (ECD) is a granulomatous and infiltrative disorder of unknown etiology with proliferation of cholesterol-containing histiocytes and peculiar bone involvement. It is very similar to Langerhans cell histiocytosis (LCH) on histology but with a different immunohistochemical profile. This is the first report of intraocular involvement in this disease. MPSG, a 46 y.o. woman, presented with proptosis of the OD. She referred ulcerated lesions on the hard palate, symmetrical and bilateral osteosclerosis of the fibulae and tibiae and a nodule in the right breast (biopsy: xantomatous histiocytic infiltrate CD68+, S-100 and CD1a negative on immunohistochemistry compatible with ECD). MRI studies demonstrated an extraconal tumor in the juxta-bulbar temporal portion of the right orbit close to the lacrimal gland and hyperintense on T1. Vision was 20/20 OU, with numerous drusen in the posterior pole, similar to basal laminar drusen. Two regions of orange subretinal infiltrates that showed progressive staining on the angiogram were seen in the peripapillary region and also close to the fovea in the OD. Choroidal neovascular membranes were seen 2 years later in OU leading to severe visual loss in the OS and to a slight visual field loss in the OD, which retained 20/20 vision. This pioneer report depicts in vivo characteristics of histiocytic granulomas in ECD. Caution should be taken with patients with ECD as potentially blinding intraocular complications may arise.

Keywords: Histiocytosis; Histiocytosis, non-Langerhans-cell; Erdheim-Chester disease; Retinal diseases; Choroidal neovascularization; Case reports

Carotid cavernous fistulas are a rare entity occurring as result of head trauma and also spontaneously. The authors report a rare case of central retinal artery occlusion complicating traumatic carotid-cavernous fistula, resulting in severe visual acuity loss. Spontaneous closure of the fistula was observed. The possible mechanisms responsible for this complication are discussed.

Keywords: Retinal artery occlusion; Carotid-cavernous sinus fistula; Angiography; Visual acuity; Case reports

Retinal telangiectasias are idiopatic vascular abnormalities of the retina characterizad by irregular dilatation of the retinal vessels, intraretinal and subretinal exsudation. The aim of this article is to describe the uncommon association of Leber's miliary aneurysms and vitreomacular traction syndrome in a female patient. The diagnosis was established with angiofluoresceinography and optic coherence tomography. The patient was treated with focal photocoagulation with argon green laser directed to the perimacular aneurysms and pars plana posterior vitrectomy. The visual acuity showed great improvement after a four-month follow-up. The present report supports the importance of optic coherence tomography in cases where the vitreoretinal interface must be evaluated, including vascular pathologies, which allowed us to offer a better treatment to this patient.

Keywords: Telangiectasis; Aneurysm; Retinal vessels; Fluorescein angiography; Light coagulation; Vitreous body; Tomography, optical coherence; Adult; Case reports

Retinopathy of prematurity is one of the main causes of childhood blindness. Worldwide, there are more than 50,000 children blind due to retinopathy of prematurity. Visual impairment is a consequence of retinal detachment. It can be detected by serial ophthalmologic examination of infants at risk, and those identified with the severe form of the disease can be treated by laser or cryotherapy, which can decrease significantly the blindness due to ROP. The Brazilian Society of Pediatrics, Brazilian Council of Ophthalmology and Brazilian Society of Pediatric Ophthalmology suggest a guideline for the detection and treatment of retinopathy of prematurity in Brazil. This document was based on the results of the I Workshop of Retinopathy of Prematurity and presents the attributes for the implementation of an efficient diagnostic and treatment program.

Keywords: Retinopathy of prematurity; Retinopathy of prematurity; Infant, premature; Practice guidelines

PURPOSE: To report a specific line of research developed at the University of São Paulo/Brazil on fibrin glue used for sealing corneal perforations and the perspectives of use on non-perforated corneal ulcers and photorefractive keratectomy-operated corneas. METHODS: To describe fibrin glue manufacture, development of a device to test the glued perforated corneal area resistance, subsequent experimental investigations of the use of the fibrin glue in corneal perforations, reporting its efficacy, mechanical resistance experiments and histological study. Finally, the medical literature basis is searched to propose studies on the use of fibrin as a temporary basal membrane on non-perforated corneal surfaces like non-infectious corneal ulcers and on post-photorefractive keratectomy corneal surfaces. RESULTS: The development of fibrin glue, the device for resistance experiments, the efficacy, resistance and histological studies on fibrin glue used for sealing corneal perforations are reported as well as the scientific literature basis for the proposed studies on the use of fibrin as a temporary basal membrane on non-perforated corneas like non-perforated corneal ulcers and photorefractive keratectomy corneal surfaces. CONCLUSION: A specific line of research was reported on fibrin glue to seal corneal perforations at the University of São Paulo/Brazil and the theoretical perspectives for the use of fibrin in non-perforated corneal ulcers and on photorefractive keratectomy-operated corneas in an attempt to reduce corneal haze.

Keywords: Corneal ulcer; Fibrin tissue adhesive; Basement membrane; Cornea; Keratectomy, photorefractive, excimer laser