VOLUME 71 - ISSUE 1

PURPOSE: To evaluate de macular structural damage in Stargardt's disease by optical coherence tomography, correlating with visual acuity and disease duration. METHODS: Patients with Stargardt's disease were included and submitted to visual acuity (logMAR) measurement and complementary examinations performed were color fundus photographs, fluorescein angiography and optical coherence tomography. All cases were reexamined for diagnostic confirmation and the duration of symptoms was determined. The control group was composed of the same number of subjects, matched by sex and age, without any ophthalmologic alteration. RESULTS: The sample was composed of 22 patients (44 eyes) with Stargardt's disease, 11 (50%) males and 11 (50%) females. The duration of the disease varied from 3 to 21 years (mean of 11.4 ± 5.3 years). The groups did not show significant differences in age (p= 0.98) and sex. Concerning the macular thickness in optical coherence tomography, the variation in the study group differed significantly from the control group, presenting smaller values of thickness (p<0.001). There was negative and significant correlation between the duration of disease and the macular thickness assessed by optical coherence tomography (r=-0.57 and p=0.005). There was positive correlation between the duration of the disease and the visual acuity (r=0.50 and p=0.0167) and negative correlation between the visual acuity and the macular thickness in optical coherence tomography (r=-0.83 and p=0.0001). CONCLUSION: It was evidenced that patients with Stargardt's disease have a thinner macular thickness when compared to normal subjects, and this reduction is related to the duration of symptoms of the disease. Additionally, the thickness and also the duration of the disease influence the visual prognosis of the patients.

Keywords: Retina; Macula lutea; Retinal degeneration; Fluorescein angiography; Tomography, optical coherence; Visual acuity

PURPOSE: To determine the incidence of positive corneoscleral rim cultures preserved in Optisol GS medium, to identify pathogens involved and possible recipient eye infection. METHODS: A hundred sixty-three corneoscleral rim cultures penetrating keratoplasties performed from January 2001 to January 2003 in the Hospital de Clínicas de Porto Alegre were reviewed. Enucleations and corneal storage were done as aseptic as possible and gentamicin 0.3% was instilled. Corneoscleral rim was divided into two segments, half was inoculated into Sabouraud broth and the other half into thioglycolate broth; inoculation into blood agar, chocolate agar and MacConkey agar was done later if necessary for pathogen identification. The receiver's eye data were reviewed. RESULTS: There were eleven positive cultures (6.7%) out of 163 evaluated corneoscleral rim cultures. Of these, four were Staphylococcus epidermidis, one was Staphylococcus aureus, one was Serratia sp., one was Pseudomonas aeruginosa and the other four were different subtypes of Candida (two Candida sp., one Candida albicans and one Candida parapapilosis). All pathogens were resistant to gentamicin. None of the eleven cases of positive corneoscleral rim cultures resulted in ocular infection at the receiver's eyes (six months follow-up). CONCLUSIONS: We found low rates of positive corneoscleral rim cultures after penetrating keratoplasty at the Porto Alegre Clinical Hospital. The most frequent involved pathogens were Staphylococcus sp and Candida sp. Although we did not identify any postoperative infection at the receiver's eyes, we recommend corneoscleral rim culture for guidance of postoperative infection, a rare but possible devastating ocular event.

Keywords: Keratoplasty, penetrating; Surgical wound infection; Endophthalmitis; Organ preservation; Organ preservation solutions; Gentamicins; Eye banks; Cornea; Antifungal agents

PURPOSE: Tear film can be altered by chronic medications that may disrupt the equilibrium responsible for the functioning of the lacrimal gland and ocular surface. The purpose of this study was to determine if antiglaucomatous chronic treatment induced alterations in the tear film and ocular surface. METHODS: After informed consent, 21 patients using antiglaucomatous eye drops for more than 8 months and 20 age- and sex-matched volunteers without eye and systemic medications (control group) were enrolled. The data of ocular discomfort, fluorescein and lisamine green staining, tear film break-up time and Schirmer test were collected and compared by Student's t test. The impression cytology data were graded and compared by chi-square test. RESULTS: Patients chronically using antiglaucomatous medications presented with significant higher fluorescein staining (p=0.003), lisamine green staining (p=0.02) and lower TFBUT (p=0.001). The other comparedparameters, including impression cytology were similar between the treated and control group (p>0.05). CONCLUSIONS: The present study shows that the tear film and the ocular surface are altered in patients under antiglaucomatous medications. In common, all medications were preserved with benzalkonium chloride. Efforts to minimize the adverse effects of chronic use of antiglaucomatous drugs must be addressed.

Keywords: Benzalkonium compounds; Benzalkonium compounds; Timolol; Timolol; Tears; Optic; Glaucoma; Dry eye syndromes; Indicators and reagents

PURPOSE: This study was designed to evaluate the use of human amniotic membrane for ocular surface reconstruction after conjunctival squamous cell carcinoma resection. METHODS: Amniotic membrane was obtained at the time of cesarean section and was preserved at -80ºC in glycerol and cornea culture media at a ratio of 1:1. The inclusion criteria were patients presenting proliferating lesions suggestive of squamous cell carcinoma (flat or elevated white lesions resembling "fish meat") that involve the conjunctiva, limbus and cornea. Eight eyes of 8 patients with conjunctival "squamous cell carcinoma" underwent tumor resection with amniotic membrane transplantation. Three of these cases underwent total corneal epitheliectomy and amniotic membrane transplantation associated with limbal autograft. RESULTS: Mean follow-up time was 17.8 months (range, 10-35 months). In four patients (71.4%) surgical treatment was successful, with good ocular surface stability. In two patients (28.6%) results were partially successful, with mild cicatricial alterations. One patient was excluded from the study due to aggressive tumor recurrence with intraocular invasion that needed to be removed with exenteration. CONCLUSION: This study suggests that amniotic membrane transplantation is a good alternative for ocular surface reconstruction after conjunctival squamous cell carcinoma resection.

Keywords: Conjunctival neoplasms; Carcinoma, squamous cell; Amnion; Conjunctiva

Penetrating keratoplasty has been the leading and the most successful type of transplant in the world, however corneal deficiency is a commom problem usually presented to corneal surgeons. PURPOSE: Impact evaluation of the number of corneal graft donations to the Sorocaba Eye Bank after the implementation of a corneal graft procurement system; to draw the socioeconomic profile of corneal graft donors of the Sorocaba Eye Bank (SEB). METHODS: Retrospective study on donations to SEB from its creation and after the development of media marketing. Prospective analysis of the socioeconomic profile of corneal graft donors by a questionnaire sent as letters to the families of the donors in a certain month. RESULTS: SEB began its work in 1971 by spreading need of organ donation through lectures in churches, shopping malls, community meetings, radio programs, television programs, etc. In the 70s, the number of retrieved corneal grafts was 1 or 2/month. Between 1984 - 1989 a procurement coordination team was trained to act in mortuaries and by 2000 they also began to work in public hospitals. In 1984 only 260 corneal grafts were retrieved. This number has been increasing to 2,778 corneal graft donations in 2004. The questionnaire was answered by 76 of the 93 donor families, with a response rate of 81.7%. Donor age had a mean of 65.1 ± 14.7 y/o, forty-two (55.3%) were men. Educational level of the donor families was an important factor for organ donation, once 36.8% had concluded high school and 34.2% completed university. The great majority, sixty-three (82.9%) of the corneal grafts were donated through the efforts of the procurement coordination team. CONCLUSION: The role of the media and institutional credibility are mandatory for public commitment to organ donation. The proficiency of the procurement coordination team requires intensive training, as the results show that 82.9% donations were made thanks to their efforts.

Keywords: Eye banks; Directed tissue donation; Tissue donors; Tissue and organ procurement; Cornea; Social class; Marketing

PURPOSE: To measure the MRD (margin reflex distance) in rigid contact lens wearers and controls by a new method, based on computerized image processing. METHOD: The patients were selected from the Contact Lens Sector of the Ophthalmology Service at the "Complexo Hospitalar Santa Casa de Porto Alegre", and they were divided into two groups: the first was formed of rigid contact lens wearers (63 eyes) and the second of patients without previous history of contact lens wear (30 eyes). All patients were photographed with a digital camera (Nikon Coolpix 4300). The margin reflex distance was measured by a computerized image processing using the Image J program. The study excluded patients that underwent any kind of intraocular or eyelid surgery, patients with congenital ptosis and patients with giant papillae conjunctivitis. RESULTS: The method utilized to measure margin reflex distance seems simple and more accurate. The average value of the margin reflex distance in the case group was 2.46 mm and in the control group 2.72 mm. The study shows that there is a tendency of decreasing the margin reflex distance with contact lens wear although the data were not statistically significant (p=0.22). The margin reflex distance values show a greater variability in the case group (41.46%) than in the control group (28.96%), that is more homogeneous. CONCLUSION: This study introduced a new method to measure the margin reflex distance using computerized image processing. This method is accessible and could help in follow-up of the margin reflex distance in contact lens wearers, specially those rigid.

Keywords: Contact lenses; Blepharoptosis; Image processing computer-assisted

PURPOSE: To evaluate the behavior of the scotopic Oscillatory Potentials (OP) of total field electroretinogram (ERG) in hypertensive retinopathy. METHODS: Forty-four patients (n=44) were submitted to clinical evaluation and subdivided in to 2 groups: hypertensives (HT) and normotensives (NT). The hypertensives patients were maintained under placebo during the period of the study. Soon afterwards, they were submitted to ophthalmological evaluation and accomplishment of ERG. Total field electroretinogram (ERG), with recording of the answers: scotopic, maximum scotopic, OP scotopic, photopic and flicker.For analysis of the OP answer the latency of the first 2 peaks and the average value of the width of the first 3 peaks of the compound of 3 consecutive answers, denominated Oscillatory Index (OI) were considered. RESULTS: The sample was composed of 44 patients, with a mean age of 51.55 ± 7.2 range (34 to 68) years, 24 being females. Arterial hypertension affected 26 (59.1%) of the patients, while 18 (40.9%) were normotensives. The average of the obtained IO was 257.41 µv in the NT group and of 217.81 µv in HT (p=0.006). The averages of latencies obtained for peaks 1 (NT-18.42 and HT-17.91) and 2 (NT-24.54 and HT - 24.29) were not different between the groups (p>0.05). CONCLUSIONS: The hypertensive patients presented significantly smaller oscillatory index than the normotensives, suggesting that arterial hypertension might cause dysfunction of the internal retina.

Keywords: Hypertension; Electroretinography; Retinal diseases

PURPOSE: To describe clinical characteristics of posterior active uveitis presumptively by Toxoplasma gondii (PAUPT) in patients with typical lesion. Tranversal study. METHODS: Sixty-four patients with retinochoroiditis scatter and active satellite lesions examined in Pernambuco, Brazil. All were older than 10 years and immunocompetent. Gender, age, skin color, and residence were recorded. Previous uveitis, visual accuracy, intraocular pressure (IOP), and ocular examination were analyzed. RESULTS: 52% were males, most of them with white skin (68.8%). Mean age 29 years (±10.87). Eighty-four percent of the patients lived in the metropolitan area. 56.2% were having the first episode of uveitis. In the damaged eye, visual accuracy mean was 20/200, IOP mean 14.5 mmHg (±64). Hyperemia of the conjunctiva was observed in 29.7% of the patients and alterations of the cornea in 51.6%. There were cells in the aqueous humor in 62.7%. 6.2% had posterior synechiae. All had vitreous damage and 45.3% retinal vasculitis. In 42.2% of the patients, lesions were located in zone I of Holland and 90.6% had the size of one discus diameter or greater. Neuritis was observed in 28.2%. Uveitis was more frequent in the right eye (54.7%). CONCLUSION: PAUPT affects young people and the main symptom was reduction of visual acuity. IOP mean was normal. Alterations of the vitreous were observed in all cases. Injuries were equal to one discus diameter or greater and located in zone I of Holland.

Keywords: Toxoplasmosis, ocular; Toxoplasma; Uveitis, posterior; Fluorescent antibody technique

PURPOSE: To report the efficacy and safety of green laser photocoagulation for threshold retinopathy of prematurity (ROP). METHODS: We reviewed the clinical records of the neonates who had undergone green laser photocoagulation for threshold ROP at the Federal University of Pernambuco in Brazil between January 2004 and January 2006. All procedures were conducted with local anesthetic drops. The neonates were monitored throughout the procedure by a neonatologist. A frequency-doubled solid state laser, diode-pumped, with 532 nm wavelength was used. The presence of tunica vasculosa lentis or cataract were excluded before laser treatment. The following preoperative data were obtained for each patient: age, birth weight and the grade of ROP. Postoperative data included complications associated with the laser treatment, grade of ROP and evaluation whether further surgery was necessary due to failure of laser photocoagulation. RESULTS: Twenty-two neonates underwent photocoagulation with green laser for threshold ROP. A total of 31 eyes were included in the study. The mean gestational age was 30 ± 3 weeks and the mean birth weight was 1120 ± 490 g. Regression of the disease after laser therapy was observed in 30 eyes (96.7%). Despite treatment one eye presented stage 4A. Only 7 eyes required repetitive laser therapy. No adverse effects such as burning anterior segment tissues or bleeding in the anterior chamber occurred. No posterior segment side-effects were observed. Cataract formation was not observed at the last follow-up examination. CONCLUSIONS: Green laser photocoagulation remains an effective and safe alternative to red laser photocoagulation and to cryotherapy in the treatment of threshold ROP.

Keywords: Retinopathy of prematurity; Laser coagulation; Treatment outcome

PURPOSE: To determine the outcomes and causes of visual impairment and blindness in cataract-operated patients who are living in the central-western zone of São Paulo state. METHODS: A transversal, observational, systematic study was done involving patients inhabitants of five cities from a central-western zone of São Paulo state. The random sample was based on the Demographic Census Data (IBGE, 1995). All patients underwent to visual screening and complete eye examination. The individuals who had cataract-operated eyes were separated for the present study. The results were statistically analyzed by descriptive methods, frequency of occurrence and concordance proportion with 95% confidence intervals. RESULTS: At examination 2.37% of the subjects had cataract-operated eyes. Of the 201 operated eyes 26.9% had visual acuity compatible with blindness or visual impairment. The visual acuity persisted <0.3 even with spetacles in 19% of the patients. Twenty-seven and 9% of the patients had visual acuity improved with refractive error correction. The main causes of poor vision were refractive error, posterior capsule opacification (19.4%), bullous keratophaty (8.3%), cicatricial chorioretinitis (8.3%), aphakic eyes (8.3%), age-related macular degeneration (5.5%), leukoma (5.5%), glaucoma (5.5%), optic atrophy (5.5%), retinal detachment (2.8%), retinal pigment epithelium atrophy (2.8%) and high myopia (2.8%). CONCLUSION: Cataract projects are effective in reducing preventable blindness caused by lens opacity. However, long-term scheduled evaluation of operated patients is necessary avoiding consequent blindness resulting from neglected follow-up.

Keywords: Cataract extraction; Health promotion; Blindness; Vision, low; Populational surveys; Community health services

PURPOSE: To evaluate the efficacy of intravenous 500 mg methylprednisolone in addition to topical treatment with 1% prednisolone in the treatment of the first episode of corneal endothelial rejection in patients that were submitted to corneal allograft transplantation. METHODS: Retrospective case-control study with 81 patients that presented the first episode of corneal endothelial rejection and were treated within the first 15 days of the onset of symptoms. RESULTS: 67 patients were treated with 1% topical prednisolone acetate and pulsed intravenous methylprednisolone 500 mg at the diagnosis of corneal allograft rejection. Fourteen patients were submitted to topical treatment only, thus forming the control group. Forty-one of 67 patients (61.2%) that were submitted to pulsed steroid had good outcome and 26 (38.8%) presented corneal graft failure while only 4 of 14 patients (28.57%) that received only topical steroids evolved with clear grafts and the remaining 10 patients (71.43%) with graft failure. Chi-square showed statistically significant association (p<0.05) to greater success with pulsed methylprednisolone. CONCLUSIONS: This study suggests that the use of 500 mg intravenous methylprednisolone in addition to 1% topical prednisolone acetate for the treatment of endothelial corneal allograft rejection presents better outcomes in reverting corneal allograft rejection when compared to isolated use of 1% topical prednisolone acetate.

Keywords: Corneal transplantation; Graft rejection; Methylprednisolone; Methylprednisolone; Postoperative complications; Adrenal cortex hormones

PURPOSE: Metabolic syndrome denotes a common cluster of naturally connected risk factors including obesity, elevated blood pressure, insulin resistance, dyslipidemia, proinflammatory state and prothrombotic state. Anterior ischemic optic neuropathy is an acute ischaemic disorder of the optic nerve head and may lead to severe visual loss. METHODS: We considered three patients with moderate degree of diabetic retinopathy and anterior ischemic optic neuropathy. They were submitted to endocrinological examination and the diagnosis of metabolic syndrome was established. RESULTS: Cardiological examination revealed that blood pressure control was not optimal. The signs of left ventricular hypertrophy and diastolic dysfunction were confirmed by echocardiography. They are possible markers of preclinical cardiovascular disease. CONCLUSION: We observed that a variety of well-known risk factors in metabolic syndrome may be involved in serious eye and cardiological complications. The early diagnosis and treatment of these patients can not only improve visual function but also prevent cardiovascular complications.

Keywords: Metabolic syndrome X; Optic neuropathy; ischemic; Cardiovascular diseases

PURPOSE: To determine the applicability of the international revised diagnostic criteria for Vogt-Koyanagi-Harada disease. METHODS: Retrospective study. Medical charts of 140 patients with the diagnosis of Vogt-Koyanagi-Harada disease, from the Uveitis Sector of the Federal University of Sao Paulo (UNIFESP), were revised and classified following the revised diagnostic criteria. RESULTS: Of the 140 patients, 12.85% fulfilled the criteria for complete disease, 29.28% incomplete disease, 28.57% "probable" Vogt-Koyanagi-Harada disease and 28.27% were considered not Vogt-Koyanagi-Harada disease. CONCLUSION: The authors consider that the international revised diagnostic criteria have good applicability and are very useful to help in the diagnosis of Vogt-Koyanagi-Harada disease.

Keywords: Uveomeningoencephalitis syndrome; Diagnostic techniques, ophthalmological; Uveitis; Granuloma

PURPOSE: To compare the measurement of contrast sensitivity at a distance in patients submitted to penetrating keratoplasty versus patients submitted to deep anterior lamellar keratoplasty for keratoconus treatment. METHODS: Contrast sensitivity of fourteen subjects submitted to penetrating keratoplasty and fourteen subjects submitted to deep anterior lamellar keratoplasty have been analyzed through the Functional Acuity Contrast Test (F.A.C.T®) 301. RESULTS: There was no statistically significant difference between the measurements of either penetrating keratoplasty or deep anterior lamellar keratoplasty. CONCLUSION: Contrast sensitivity was similar among the subjects submitted to penetrating keratoplasty and to deep anterior lamellar keratoplasty.

Keywords: Cornea; Corneal transplantation; Corneal diseases; Keratoconus; Contrast sensitivity

PURPOSE: To evaluate if posterior capsule opacification (PCO) would alter the analysis of nerve fiber layer using the scanning laser polarimetry (GDx). METHODS: Pseudophakic non-glaucomatosous eyes (37 patients) underwent nerve fiber layer analysis using GDx before and after posterior capsulotomy with Nd:YAG Laser. RESULTS: In five eyes, GDx did not obtain acceptable images using the device's parameters of acquisition. In the others, mean variable values did not reach significant difference before and after posterior capsulotomy. CONCLUSION: Moderate degrees of PCO and/or acceptable images in pseudophakic patients do not alter the analysis of nerve fiber layer by GDx. Only intense degrees of PCO that hinder analyzable images make the examination impracticable.

Keywords: Pseudophakia; Glaucoma; Nerve fibers; Diagnostic techniques; ophthalmological; Lasers

PURPOSE: To describe differences between number of cells, evaluated endothelial area and relative error comparing endothelial samples from one endothelial image with endothelial samples obtained by guidance of a specific software, with number of cells and images as many as necessary. METHODS: A transversal study was performed, comparing the endothelial samples with and without intervention of the software. The sample consisted of 157 eyes. They were divided into 2 groups. Group 1 consisted of data of the first image and group 2 consisted of data from as many images as necessary for a complete examination guided by the Cells Analyser software (95% confidence interval and 0.05 relative error). The evaluated data were number of counted cells, equivalent evaluated field (mm²) and relative error. Student's t test with 99% confidence interval (p<0.01) was used. RESULTS: The compared data showed statistically significant differences between groups 1 and 2 in cell count (p=4x10-24), evaluated endothelial field (p=2x10-18) and relative error (p=1x10-21). CONCLUSION: The study of the sample data with or without the analysis of the software Cells Analyzer® showed statistically significant differences showing clearly the importance of using it in order to obtain representative, standardized and reproducible results of specular microscopy examination.

Keywords: Endothelium, corneal; Microscopy; Statistical analysis; Software; Reproducibility of results; Comparative study

PURPOSE: To evaluate the quality of life, vision and stress before and after refractive surgery. METHODS: This is a longitudinal, observational study, where 100 patients were evaluated; 54 espectacles wearers, 21 contact lens users before surgery and 25 controls wearers spectacles or contact lenses, who did not want to undergo refractive surgery during one year despite refractive error. The applied questionnaires were Self Reporting Questionnaires SRQ-20 of quality of life and vision and National Eye Institute Visual Function Questionnaire NEI VFQ-25 for the assessment of mental health. The intervention group answered the questionnaires before surgery, three, six and twelve months after follow-up and the control group answered the questionnaires at six and twelve months after the baseline. The questionnaires of the intervention group were applied by an independent person. RESULTS: In the intervention group (54 spectacle wearers), 39 were treated by photorefractive excimer laserkeratectomy (PRK) and 15 by laser in situ keratomileusis (LASIK), of the 21 contact lens users: 12 received photorefractive excimer laser keratectomy and nine were treated by laser in situ keratomileusis (LASIK). The control group remained stable during the study. After three months of follow-up the intervention group showed improvement in quality of life, vision and reduction of stress. After one year of follow-up the assessments of quality of life and mental health were similar to the control group. After three months there was a significant reduction of psychiatric symptomatology in the intervention group. CONCLUSION: Patients operated for correction of ametropia showed a significant improvement in quality of life and mental health assessments.

Keywords: Keratomileusis, laser in situ; Keratectomy; photorefractive, excimer laser; Refractive errors; Myopia; Quality of life; Stress, psychological; Questionnaires

PURPOSE: To evaluate the visual performance by high contrast visual acuity, contrast sensitivity and wavefront in myopic patients with or without astigmatism corrected with spectacles and with three different soft contact lenses [Acuvue® 2 (Vistacon J&J Vision Care Inc., USA), Biomedics® 55 (Ocular Science, USA), and Focus® 1-2 week (Ciba Vision Corporation, USA)]. METHODS: An interventional prospective clinical trial studied a sample of 40 myopic patients (-1.00 to -4.50 sph, with or without astigmatism up to -0.75 cyl). Each patient had one eye randomized to visual performance evaluation. RESULTS: The Zywave aberrometer detected a over refraction and significant difference between Acuvue® 2 and Biomedics® 55 regarding spheric refractive components and spheric equivalent. Both soft contact lenses showed hypercorrection as compared to Focus® 1-2 week. Visual performance was not significantly different with spectacles and the three soft contact lenses in visual acuity and contrast sensitivity measurements. The wavefront analysis detected a significant difference in a third order aberration with and without soft contact lenses, with better visual performance with Acuvue® 2 and Biomedics® 55. CONCLUSION: In visual performance evaluation with spectacles and soft contact lenses the wavefront analysis was a more sensible measurement of visual function when compared to high contrast visual acuity and contrast sensitivity. The evaluation model of visual performance with wavefront analysis developed in this investigation may be useful for further similar studies.

Keywords: Myopia; Eyeglasses; Contact lenses; Visual acuity; Contrast sensitivity; Prospective studies

A 68-year-old man presented with a history of a right optic glioma. Eighteen months ago he underwent a lateral orbitotomy at another institution for removal of an optic nerve mass. At that time histology revealed that the tumor was an optic nerve glioma with a pilocytic pattern. No further treatment was instituted and one year after surgery he noticed that his right eye was proptotic again. Magnetic resonance imaging of the orbit showed that his right orbit was almost completely filled with a mass which extended through the optic canal to the chiasma. The tumor was excised by a combined neurosurgical and orbital approach. Histology proved that the neoplasm was a low grade pilocytic astrocytoma of the optic nerve.

Keywords: Optic nerve glioma; Astrocytoma; Optic nerve; Magnética resonance imaging; Aged; Case reports

Cryptococcal meningitis is caused by the yeast Cryptococcus neoformans. Two varieties are recognized: var. gattii and var. neoformans. It is usually associated with immunosuppressive states, particularly HIV infection. Cryptococcal infection of the central nervous system is uncommon in immunocompetent children and difficult to diagnose. Ocular complications are common. Optic disc swelling was found in 33%. The following report describes a case of meningitis caused by C. neoformans var. gattii in an 8 year-old immunocompetent child who developed optic atrophy. The patient was treated with amphotericin B associated with corticosteroids. Possible therapeutic strategies aimed at reducing visual loss in cryptococcal meningitis have great importance to avoid this important morbidity.

Keywords: Cryptococcosis; Blindness; Blindness; Meningoencephalitis; Meningitis; Intracranial hypertension; Papilledema

The authors describe a case of a pregnant patient with arterial hypertension that resists to the treatment and retinal bilateral serous detachment. It was confirmed to be a paraganglioma by anatomicopathological examination.

Keywords: Pheochromocytoma; Paraganglioma; Retinal detachment; Ocular hypertension; Tomography; x-ray computed; Adult; female; Case reports

Canaliculitis is a rare infection of the lacrimal canaliculus with Actinomyces israelii as its most common etiologic agent. The objective of this paper is to report a rare pathology, as well as its clinical and surgical management. Female patient, 44 years old, presenting clinical manifestations compatible with canaliculitis, was submitted to surgical treatment preserving the lacrimal punctum. Intubation was performed into the lacrimal channel with silicone tube for three months, associated with periodical pre-programmed bathings with antibiotic, in order to avoid complications and recurrence. This case confirms the literature reports in which the surgical treatment is more effective than the conservative treatment.

Keywords: Actinomyces; Eye infections, bacterial; Curettage; Lacrimal apparatus diseases; Adult; Female; Case reports

Epiphora (watering eye) is generally caused by insufficient drainage of tears. The most common cause of epiphora in adults is idiopathic inflammatory obstruction of the nasolacrimal duct. The traditional surgical treatment of nasolacrimal duct obstruction is an external dacryocystorhinostomy, which has an 85% to 95% success rate. To eliminate cutaneus wounds and scarring some techniques were introduced, for example the endonasal laser dacryocystorhinostomy and the nasolacrimal stent. The aim of this report was to evaluate the first case of nasolacrimal stent implantation in Brazil. The procedure was performed in the "Hospital das Clínicas" of the University of São Paulo - USP. A female patient with tearing of the right eye and secretion was submitted to a nasolacrimal stent implantation, with fluoroscopic guidance. The stent used in this procedure was the polyurethane Tearleader stent set. (Dr. Wilhelm type-PBN MEDICALS - Denmark). After 3 months, the patient started complaining of tearing, so the stent was removed and the patient was submitted to an external dacryocystorhinostomy. At present the patient does not have any symptoms or complaints. This procedure is less invasive and simple, causes no facial scars and avoids surgical trauma, but the long term success rates achieved using polyurethane nasolacrimal stents are low as compared with the external dacryocystorhinostomy. In addition, the patients usually complaint of tearing even having patent lacrimal system. In summary, long-term studies are needed to resolve some complications. Maybe a new stent design and new methods of unblocking the stent in situ would improve in the near future the levels of patency that currently are modest.

Keywords: Lacrimal duct obstruction; Polyurethanes; Lacrimal apparatus diseases; Dacryocystorinostomy; Prostheses and implants; Case reports

We report two cases of postoperative Alcaligenes xylosoxidans endophthalmitis. A 78-year-old woman in good general health developed A. xylosoxidans endophthalmitis one month after an uncomplicated phacoemulsification procedure with posterior chamber intraocular lens. It was performed on her left eye, at another institution. Removal of the intraocular lens and capsule was performed because of recurrent inflammation after vitrectomy and intravitreal antibiotic injections. Her son, a 55-year-old man, developed A. xylosoxidans endophthalmitis in his left eye, two months after an uncomplicated phacoemulsification procedure with posterior chamber intraocular lens (it also was performed by the same surgeon). He also required vitrectomy with removal of the intraocular lens and capsule because of persistent disease. A. xyloso - xidans can cause chronic low-grade and progressive endophthalmitis after cataract extraction that is often resistant to corrective antibiotic therapy. This kind of case is rare. There have been only previously reported seven cases worldwide to the best of our knowledge.

Keywords: Alcaligenes; Cataract extraction; Endophthalmitis; Eye infections, bacterial; Lens implantation, in-traocular; Reoperation; Vitrectomy; Vitreous body; Adult; Aged; Female; Male; Case reports

The authors describe for the first time in the Country a case of a 10-year-old female child, assisted at the Ophthalmology Clinic of the Hospital Universitário Clementino Fraga Filho UFRJ, with Leigh's syndrome that is part of a metabolic disease group known as mitochondrial encephalomyopathies. It is an hereditary disease transmitted by a different mode of inheritance: mitochondrial, X-linked recessive and autosomal recessive. The beginning of clinical manifestations is varied and occurs usually in the first two years of life, with progressive and insidious evolution and exacerbation periods. Diagnosis is difficult because pleomorphic presentation, based on clinical findings and complementary study related to mitochondrial production of ATP and cytochrome c oxidase deficiencies. Considering that there is no specific treatment, this is based on a palliative procedure. So, the identification of this syndrome is very important to keep it under control, since its evolution is progressive.

Keywords: Leigh disease; Mitochondrial encephalomyopathies; Metabolic diseases; Mitochondria; Cytochromes c; Case reports

Vision measurement is the basis for the study and standardization of visual sciences. Measurement of visual acuity has great value for research and for clinical practice. This paper (1) reviews the fundamental concepts to understand visual sense and the measuring units; (2) presents the fundamental limits to visual performance and the principles of aberration measurement of the eye; and (3) discusses methods for measuring and classifying vision with new technologies.

Keywords: Vision; Vision tests; Visual acuity; Optics; Refraction; ocular; Visual perception; Form perception; Contrast sensitivity; Pattern recognition, visual