VOLUME 71 - ISSUE 3

PURPOSE: To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. METHODS: Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. RESULTS: The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. CONCLUSION: Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.

Keywords: Angioid streaks; Choroidal neovascularization; Indocyanine green; Photochemotherapy; Photosensitizing agents; Lasers; Tomography, optical coherence

PURPOSE: To validate a new fiber electrode prototype for clinical electroretinography (ERG). METHODS: A recently developed prototype of a disposable reference-coupled fiber electrode (patent pending Brazilian Institute of Industrial Property # PI0602186-7), including one fiber for corneal signals and a second fiber acting as reference was tested in a group of 20 healthy volunteers (17-31 years; mean 22.7 ± 4.5; 8 males). Standard electroretinography rod and cone responses were recorded from a fully dilated pupil simultaneously in both eyes with a reference-coupled fiber electrode prototype in one randomly assigned eye and a DTL® electrode in the other eye after 30 min of dark-adaptation. After presenting dark- and light-adapted stimuli, each response was analyzed for a- and b-wave amplitude and implicit time. The VERIS 5.1.9 system was used for electroretinography data acquisition and analysis. Electroretinography outcomes were analyzed by Mann-Whitney test. Slit-lamp examination was performed in both eyes right after electroretinography session to evaluate possible adverse effects. RESULTS: Responses recorded with reference-coupled fiber electrode prototypes were comparable to commercially available DTL® fiber electrodes. On a qualitative analysis, reference-coupled fiber electrodes provided recordings with less amount of noise. On average, scotopic electroretinography amplitude and b-wave implicit time recorded using DTL® were, respectively, 287.6 µV and 36.3 ms with similar findings for the reference-coupled fiber electrode prototype (287.9 µV and 36.3 ms). Under photopic conditions DTL® mean amplitude and implicit time were, respectively 108.9 µV and 24.5 ms with similar results for the reference-coupled fiber electrodes prototypes (116.4 µV and 24.5 ms). No corneal abrasions or any other significant adverse effects were found after electroretinography recording with both electrodes. CONCLUSIONS: The reference-coupled fiber electrode prototype provided stable and safe recordings of corneal electroretinograms compared to the commercially availabe DTL® electrode in healthy human subjects. The prototype is a feasible alternative instrument for clinical electroretinography recording to assess retinal function, however further analysis is recommended to validate its clinical usefulness in patients with retinal disorders.

Keywords: Electrodes; Electroretinography; Retina; Retinal diseases; Validation studies

PURPOSE: To establish the profile of patients with acute primary angle-closure glaucoma (APACG) and to assess comparatively clinical and morphometric parameters between eyes with APACG and contralateral eyes (CLEs). METHODS: Prospective study including patients attended from September 2005 to March 2007. Inclusion criteria: diagnosis of APACG. Exclusion criteria: presence of cataract (except for "glaukomflecken") that may cause low visual acuity or myopization, secondary glaucoma, previous APAGC or surgical procedure in the (CLE), no possibility to control the acute crisis of glaucoma clinically, plateau iris. The following were evaluated: incidence of APACG, age, gender, race, family history of glaucoma, corrected visual acuity (CVA) and uncorrected visual acuity (UVA), spherical equivalent (SE), cup/disc ratio (C/D), gonioscopy, keratometry (K), central corneal thickness (CCT), and echobiometric data [anterior central chamber depth (ACCD), axial length (AL), lens thickness (LT)] and relation between lens thickness and axial length (LT/AL). RESULTS: One thousand and three hundred and forty-three patients were examined from September 2005 to March 2006; 28 (2.1%) had the diagnosis of APACG. The incidence of the APACG was 20.8 cases per 1000 patients. The patients with APACG were manly white women with a negative familial history of glaucoma and with an average age of 59.6 years. When clinical aspects were compared between eyes with APACG and CLEs, statistical significance was observed: UVA (APACG: 0.27 ± 0.32; CLE: 0.57 ± 0.33, p=0.000); CVA (APACG: 0.53 ± 0.44; CLE: 0.88 ± 0.23, p=0.000); SE (APACG: +0.49 ± 1.98; CLE: +1.21 ± 2.03, p=0.007); C/D (APACG: 0.51 ± 0.28; CLE: 0.42 ± 0.20; p=0.031). Also, by gonioscopy, eyes with APACG demonstrated more frequently angle closure than CLEs. The eye of the crisis showed the following characteristics: average K of 45.21 ± 1.96 D, average CCT of 534.46 ± 34.15 mm, average ACCD of 2.43 ± 0.28 mm, average AL of 21.68 ± 0.96 mm, average LT 4.85 ± 0.32 mm and average LT/AL of 2.24 ± 0.16. The CLE presented average K of 44.92 ± 1.86 D, average CCT of 533.18 ± 31.41 µm, average ACCD of 2.51 ± 0.29 mm, average AL of 21.82 ± 0.92 mm, average LT 4.85 ± 0.36 mm and average LT/AL of 2.23 ± 0.18. There were statistically significant differences only in two parameters (K and ACCD) when affected and the CLE were compared. CONCLUSIONS: The incidence of the APACG was 20.8/1000. It was more frequent in white women, leu kodermics, without family history of glaucoma and with an age average of 59.6 years. The eyes with APACG showed, with statistical significance, worse visual acuity, higher C/D, lower hypermetropic SE, higher average K, and lower ACCD than CLEs.

Keywords: Glaucoma; Visual acuity; Corneal topography; Biometry

PURPOSE: To evaluate the clinical performance of Monocurve and Bicurve (Soper-McGuire design) rigid gas-permeable contact lens fitting in patients with keratoconus. METHODS: A prospective and randomized comparative clinical trial was conducted with a minimum follow-up of six months in two groups of 63 patients. One group was fitted with Monocurve contact lenses and the other with Bicurve Soper-McGuire design. Study variables included fluoresceinic pattern of lens-to-cornea fitting relationship, location and morphology of the cone, presence and degree of punctate keratitis and other corneal surface alterations, topographic changes, visual acuity for distance corrected with contact lenses and survival analysis for remaining with the same contact lens design during the study. RESULTS: During the follow-up there was a decrease in the number of eyes with advanced and central cones fitted with Monocurve lenses, and an increase in those fitted with Soper-McGuire design. In the Monocurve group, a flattening of both the steepest and the flattest keratometric curve was observed. In the Soper-McGuire group, a steepening of the flattest keratometric curve and a flattening of the steepest keratometric curve were observed. There was a decrease in best-corrected visual acuity with contact lens in the Monocurve group. Survival analysis for the Monocurve lens was 60.32% and for the Soper-McGuire was 71.43% at a mean follow-up of six months. CONCLUSIONS: This study showed that due to the changes observed in corneal topography, the same contact lens design did not provide an ideal fitting for all patients during the follow-up period. The Soper-McGuire lenses had a better performance than the Monocurve lenses in advanced and central keratoconus.

Keywords: Keratoconus; Contact lenses; Clinical evolution; Corneal topography; Visual acuity

PURPOSE: The main goal of this study was to develop and compare two different techniques for classification of specific types of corneal shapes when Zernike coefficients are used as inputs. A feed-forward artificial Neural Network (NN) and discriminant analysis (DA) techniques were used. METHODS: The inputs both for the NN and DA were the first 15 standard Zernike coefficients for 80 previously classified corneal elevation data files from an Eyesys System 2000 Videokeratograph (VK), installed at the Departamento de Oftalmologia of the Escola Paulista de Medicina, São Paulo. The NN had 5 output neurons which were associated with 5 typical corneal shapes: keratoconus, with-the-rule astigmatism, against-the-rule astigmatism, "regular" or "normal" shape and post-PRK. RESULTS: The NN and DA responses were statistically analyzed in terms of precision ([true positive+true negative]/total number of cases). Mean overall results for all cases for the NN and DA techniques were, respectively, 94% and 84.8%. CONCLUSION: Although we used a relatively small database, results obtained in the present study indicate that Zernike polynomials as descriptors of corneal shape may be a reliable parameter as input data for diagnostic automation of VK maps, using either NN or DA.

Keywords: Corneal topography; Statistical analysis; Neural networks (computer); Artificial intelligence; Discriminant analysis

PURPOSE: Retinal photocoagulation under poor visualization condition is often required. Transscleral infrared laser can be used as an alternative to regular transpupillary treatment. Based upon retinographic measurements, we proposed to estimate the reproducibility as well as ocular wall permeability rate for this treatment. Our primary goal was to evaluate whether this technique can deliver adequate photocoagulation at predetermined parameters without direct retinal visualization. METHODS: In New Zealand pigmented rabbits, optimal transscleral infrared diode laser settings were administered to the right eye. With the same parameters, transpupillary photocoagulation was repeated in the left eye. Retinographic and clinical examinations were performed immediately and two months later. RESULTS: Ocular wall permeability rate varied between 58.95 and 63.87%. Average permeability using a power of 300 mW (63.14%) was found to be higher than that encountered before its enhancement up to 500 mW (59.11%), (P<0.05). CONCLUSIONS: Setting parameters showed dose-response effect. No retinal hole or retinal detachment was noticed in any rabbit. Transscleral infrared photocoagulation appeared to be a reproducible and secure method in the experimental model.

Keywords: Retina; Retinal diseases; Laser coagulation; Photoreceptors; Pigment epithelium of eye; Vision, low; Ophthalmologic surgical procedures; Dose-response relationship, radiation; Animals; Rabbits

PURPOSE: To describe the epidemiology of children submitted to contact lens fit. METHODS: Retrospective study of 73 children that had been submitted to contact lens fit at the "Universidade Federal de São Paulo". This study analyzed sex distribution, age, diagnosis, indications and contact lens fitted at first examination. RESULTS: 34 children (46.6%) were male and 39 (53.4%) female, aged between 2 and 12 years with mean of 10.2 and standard deviation of 2.42. The most common diagnosis was aphakia, in 16 (21.9%) cases. Keratoconus was present in 14 (19.1%), leucoma in 11 (15%), anisometropia in 10 (13.7%), refractive errors in 9 (12.3%), irregular astigmatism in 7 (9.5%), ectopia lentis in 4 (5.4%), high myopia in one case (1.3%) and one child (1.3%) had no ocular pathology, just wishing to change eye color. 52 (71.2%) had medical indication, 9 (12.3%) had optical indication and 12 (16.4%) had cosmetic indication. Contact lenses were fitted in 103 eyes, the most tested lens was rigid gas permeable in 43 (41.7%), soft lens in 41 (39.8%) and cosmetic soft lens in 11 (10.6%). CONCLUSION: Aphakia was the most common diagnosis among children in use of contact lens. The incidence of medical indication was higher than the others and the most tested lens was the rigid gas permeable one.

Keywords: Contact lenses; Epidemiology; Aphakia; Anisometropia; Child

PURPOSE: To compare the results of strabismus surgery under peribulbar and general anesthesia in cases of small and moderate angle of horizontal strabismus. METHODS: Medical records of eighty-four patients with small and moderate angle horizontal strabismus who underwent strabismus surgery were reviewed. Forty-two patients were submitted to the surgery under peribulbar anesthesia and forty-two under general anesthesia. The surgery was considered satisfactory when postoperative angle was 10 prism diopters or less. RESULTS: Surgery was satisfactory in all patients. Mann-Whitney test showed no difference in the preoperative angle of deviation (p=0.366) and in the postoperative results (p=0.800) between the two groups. Adjusting for the variables age and type of strabismus (esotropia and exotropia), ANCOVA (analysis of covariance) results showed no statistical difference (p=0.368). There were no complications due to surgery or anesthesia in either group. CONCLUSIONS: This study suggested that there was no difference between the postoperative results of strabismus surgery under peribulbar and general anesthesia in small and moderate angle of horizontal strabismus.

Keywords: Anesthesia, local; Strabismus; Ophthalmologic surgical procedures; Ocular motility disorders

PURPOSE: The purpose of this study is to build an automated clinical and surgical database which works with a computer-based program (software), where patients with 19 selected retina and vitreous diseases are included. METHODS: Textbooks from both international and national authors served as a basic structure for the protocol. Specific articles related to each disease, extracted from scientific journals and from specific clinical database sources, searched on the World Wide Web (the internet) were used, as well. Data automation was done by interface with SINPE© (Integrated electronic protocol system) - a software developed at the Informatics and Multimedia Laboratory of the Health Sciences Department at the Universidade Federal do Paraná. RESULTS: Along with the data automation the master protocol was created covering all contents in main folders, followed by 19 specific protocols which refer to individual specifications for each disease. The program allows to collect and record data from patients with their clinical characteristics, diagnostic aids, selected treatment as well as follow-up treatment. Likewise, any source of interest in the protocol can be crossed with the Microsoft Excel® program depending on the type of study. CONCLUSIONS: The objective of this study which was to create a wide and updated database of vitreoretinal pathologies of major importance, converting them to a specific software and interfacing it with the SINPE© has been achieved.

Keywords: Databases; Retina; Vitreous body; Clinical protocols; Medical informatics; Medical records systems, computerized

PURPOSE: To study the prevalence of eye manifestations in the local rheumatoid arthritis (RA) population, as well as to know if the presence of rheumatoid factor (RF) and antinuclear antibodies (ANA) affect this profile. To study if there is association between eye manifestations and patient's articular functional index, age at diagnosis and illness duration. METHODS: We reviewed 198 charts of rheumatoid arthritis patients followed-up from 2003 to 2006. They were studied for: prevalence of ophthalmologic manifestations, autoantibody profile, demographic data and Steinbrock's functional index. RESULTS: Secondary Sjögren's syndrome was seen in 12.1% of the patients being more common in women (p=0.049) and in patients with greater articular damage (p=0.016). Ulcerative keratitis and scleritis appeared in 2% of patients each. Antinuclear antibodies (ANA) and rheumatoid factor (RF) as well as illness duration and age at diagnosis had no influence in the appearance of eye manifestations. CONCLUSION: Secondary Sjögren syndrome was the most common ocular manifestation in patients with RA, mainly in women and patients with greater joint damage.

Keywords: Rheumatoid arthritis; Eye diseases; keratoconjunctivitis sicca; Sjögren's syndrome; Antibodies, antinuclear

PURPOSE: To report the clinical features of strabismus associated with Graves' orbitopathy, and the results of surgery with adjustable suture under drop anesthesia. METHODS: The charts of 13 patients who had surgical treatment for strabismus related to Graves' orbitopathy at Hospital das Clínicas of University of São Paulo were retrospectively reviewed. Ocular motility, sensorial examination and the follow-up after strabismus correction were studied. RESULTS: Preoperatively, the most common type of deviation was esotropia with hypotropia. Adjustable recession was done in nine patients and a second surgery occurred in 3 patients. After follow-up of at least six months, 8 of 13 patients were orthotropic or had a small phoria with some degree of binocular vision. CONCLUSION: In this study, 62% (8/13) of patients showed hypotropia with esotropia, probably because fibrotic and restrictive muscles (medial and inferior rectus). In nine of 13 patients adjustable recession with a good postoperative alignment of the eyes was performed. Adjustment of strabismus surgery under drop anesthesia in patients with Graves' orbitopathy was successful in restoring binocular vision with minimum complications.

Keywords: Anesthesia, local; Diplopia; Graves' disease; Strabismus; Vision, binocular

PURPOSE: To determine the prevalence of early and late-stage age-related macular degeneration (ARMD) and its association with risk factors such as age, gender, smoking, body mass index, hypertension and diabetes history, cataracts and pseudophakia. Design: Population-based cross-sectional study in an elderly Japanese-Brazilian population from Londrina (Paraná, Brazil). METHODS: The study included 483 (80.5%) of the 600 registered members of a local association for Japanese immigrants and their descendants, aged 60 years and up. The presence of early and late-stage age-related macular degeneration was determined using the standard protocol and the international classification system. RESULTS: The mean age of the study subjects was 71 years. The overall prevalence of age-related macular degeneration was 15.1% (CI 95%; 12-18.7). The prevalence of early-stage age-related macular degeneration was 13.8% (CI 95%; 10.9-17.3), geographic atrophy was present in 0.4% and neovascular age-related macular degeneration in 0.8%. Age-related macular degeneration was significantly (p=0.004) and linearly (p=0.001) associated with age. CONCLUSION: Our study population displays a prevalence of early and late-stage age-related macular degeneration and component lesions similar to those of other Western countries, and data suggest a higher prevalence than that reported for populations in Japan. Since the age-related macular degeneration prevalence tends to rise as the population ages, studies identifying risk factors and exploring prevention methods are becoming increasingly important.

Keywords: Macular degeneration; Risk factors; Prevalence, Macula lutea; Ethnic groups; Sex factors; Middle aged; Aged; Aged, 80 and over; Brazil

PURPOSE: To evaluate the eyeblink rate in patients with pterygium before and after the lesion exeresis. METHODS: Forty-one patients with pterygium were evaluated before and 60 days after the lesion exeresis. They were digitally videotaped during one minute in a standard setting using a Sony Digital 8 DCR - TRV110 and the images were transferred to a personal computer (McIntosh 400) and processed with the iMovie software. The patients stayed in primary gaze position, under artificial ilumination. Total blink, complete and incomplete blink and the opening and closure time were measured using frames scale. The data were submitted to statistical analysis. RESULTS: Before surgery, 36.36% of the patients with pterygium complained of foreign body and after that, 61.02% had no symptoms. The incomplete blink increased after surgery. The opening and closure time was similar before and after surgery. CONCLUSION: With pterygium exeresis the symptoms decreased and the incomplete blink increased a little. Nevertheless the blink rate barely changed. Further research needs to be provided to confirm this hypothesis.

Keywords: Pterygium; Lacrimal apparatus; Blinking; Dry eye syndromes

PURPOSE: To perform a preliminary evaluation at the "Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP)" of an innovative equipment for low-vision developed at USP containing a reading stand and a magnifier that maintains in a stable position the reading line and focus. METHODS: 9 low-vision patients were evaluated using the above mentioned reading stand and a magnifier developed at USP comparing it with a hand magnifier of similar power taking into account the following evaluation parameters: etiology of low-vision, best corrected visual acuity for distance, patient's opinion comparing both low-vision aid resources, authors' opinion observing the patient using both low-vision aids. RESULTS: The numerical preference for the low-vision aids was: 5 patients for the reading stand and a magnifier that maintains at a stable position the reading line and focus; 2 patients for the hand magnifier; 1 patient indifferent regarding any of the resources; 1 patient inadequate for the evaluation of the low-vision aids. CONCLUSION: This preliminary study shows the preference of the majority of the patients for the reading stand and a magnifier that maintains at a stable position the reading line and focus showing that this innovative product makes reading easier; the evaluator doctor translates the patient's opinion as an expert and contributes to the improvement of the product so that it can be evaluated again in the future.

Keywords: Vision, low; Equipment and supplies; Equipment design; Reading; Sensory aids

PURPOSE: To determine the incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital, to establish the profile of these patients and to identify the possible risk factors. METHODS: Transversal study. Period of assessment: from September/2005 to August/2006. Inclusion criteria: diagnosis of primary angle-closure glaucoma. Exclusion criteria: presence of cataracts that cause low visual acuity or index-myopia, secondary glaucoma, plateau iris. Number of visits, incidence of primary angle-closure glaucoma, age, gender, race, family history of glaucoma, keratometric, and biometric data were assessed. RESULTS: Of 879 attended patients, 20 (2.3%) had the diagnosis of primary angle-closure glaucoma, therefore, the incidence of the primary angle-closure glaucoma was 22.7 cases per 1000 attended. Of those patients with primary angle-closure glaucoma: 6 (30.0%) were men and 14 (70.0%) women; the age varied from 40 to 73 years (average: 60.4 ± 8.1 years); 12 (60.0%) were leukodermics and 8 (40.0%) pheodermics; 5 (25.0%) with positive familiar history of glaucoma. The relative risk for women was 1.44 (95% IC). Eleven (55.0%) patients had primary angle-closure glaucoma of the right eye and 9 (45.0%) of the left. When biometric data and keratometry were compared between the affected and contralateral eye, no statistical significant difference was observed. CONCLUSIONS: The incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital was 22.7 cases per 1000 attended. It was more frequent in leukodermic women, without family history of glaucoma and with an average age of 60.4 years. The affected and contralateral eyes were biometrically similar.

Keywords: Glaucoma, angle-closure; Glaucoma, angle-closure; Biometry; Risk factors; Comparative study

PURPOSE: To compare the visual acuity and macular thickness in patients with diabetic retinopathy presenting and not presenting macular edema before treatment and submitted to argon laser retinal panphotocoagulation. Methods: Patients were included and classified into two groups before the treatment. All patients were submitted to ophthalmological examination and optical coherence tomography, following panphotocoagulation. The results were evaluated by measuring visual acuity at the end and by optical coherence tomography after one week, one and three months following the treatment. RESULTS: The sample was composed of 37 patients (37 eyes). Group 1 included 29 patients with diabetic retinopathy without macular edema; Group 2 included 8 patients with macular edema. The two groups were similar regarding gender, age, and the mean of argon laser spots treatment. The groups showed differences in visual acuity (p<0.001) and Group 2 patients presented decrease of visual acuity three months after the treatment (p<0.001). Group 2 patients showed a greater mean of macular thickness measurements on optical coherence tomography evaluation. CONCLUSION: Variation of the macular thickness as well as decrease in visual acuity was present in the patients with macular edema previously to panphotocoagulation. Only minimal increase in macular thickness was observed in the absence of macular edema.

Keywords: Diabetic retinopathy; Diabetic retinopathy; Macular edema, cystoid; Laser coagulation; Diabetes mellitus; Visual acuity; Tomography, optical coherence

PURPOSE: To identify the indications for penetrating keratoplasty at the Department of Ophthalmology of the Santa Casa of São Paulo from January 1996 to December 2005 and to compare them with those from January 1991 to December 1995. METHODS: Charts of patients who had undergone penetrating keratoplasty from January 1996 to December 2006 were retrospectively reviewed. RESULTS: There were 587 keratoplasties done in this period. The average age of patients was 49.6 ± 21.1 years (range 1 to 91 years). The most common indications were infectious keratitis (17.9%), trauma (16%), pseudophakic bullous keratopathy (14.7%), keratoconus (13.1%), regrafts (12.8%) and herpetic keratitis (6.6%). CONCLUSION: The leading indications for penetrating keratoplasty were infectious keratitis, trauma, bullous keratopathy, herpetic keratitis. There was a decreasing trend in penetrating keratoplasty for keratoconus and regraft during the last 10 years.

Keywords: Corneal transplantation; Cornea; Keratoplasty; penetrating; Trends

PURPOSE:To report the retrospective experience of a reference center in the diagnosis and treatment of orbital eosinophilic granuloma. METHODS: A review of the files in the Opththalmic Pathology Laboratory, of the Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, between 1974 and 2004, was conducted to identify cases of orbital eosinophilic granuloma. Data of diagnosis and treatment were collected. The hematoxilin and eosin stained sections were reviewed. RESULTS: Three cases with ages of 1, 6 and 11 years were retrieved. In none of them the clinical diagnosis of eosinophilic granuloma was suspected. All patients underwent diagnostic biopsy with characteristic histological aspect. In one case a orbital computed tomography after biopsy exhibited typical findings. All patients improved with systemic steroids./ CONCLUSIONS: This is a rare disease, with a difficult clinical diagnosis if radiological evaluation is not available. In spite of its aggressiveness at presentation, the disease shows good response to systemic steroids.

Keywords: Histiocytosis, Langerhans-cell; Histiocytosis, Langerhans-cell; Histiocytosis, Langer hans-cell; Orbit; Orbital diseases; Eosinophilic granuloma; Adrenal cortex hormones

PURPOSE: To report the visual outcomes in keratoconus after ipsilateral rotating penetrating autokeratoplasty technique (IRPAK) associated with resection of 0.5 mm of inferior corneal crescent. METHODS: According to a prospective, longitudinal, series of cases, the authors analyzed visual results of six patients with keratoconus, who underwent an IRPAK, by two trepanations superiorly coincident and with a difference of 0.5 mm inferiorly. After resection of this corneal crescent, a 180º rotation of the corneal disc was performed, which was fixed with 24 sutures diametrically opposed. The patients were followed-up for a mean period of 12.6 months. RESULTS: Comparing the data of first postoperative year to those of the preoperative, there were significant improvements in the medians of: far visual acuity (p=0.04) and maximum keratometric value (p=0.04). For the refractive spherical equivalent (p=0.25) and topographic astigmatism (p=0.67), the improvement was not significant. CONCLUSION: IRPAK associated with resection of 0.5 mm of inferior corneal crescent, after the first postoperative year, was effective in improving visual acuity and topographic maximum keratometric value. This technique has the advantages of eliminating the difficulties of obtaining donor corneal tissue and to avoid graft rejection.

Keywords: Keratoconus; Keratoplasty, penetrating; Treatment outcome; Transplantation, autologous; Visual acuity

PURPOSE: To evaluate the efficacy and safety of diamond burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions. METHODS: A retrospective review of 23 eyes (23 patients). Pre- and postoperative visual acuities and refractions, slit-lamp biomicroscopic findings, and the incidence of recurrence of disease after keratectomy were studied. RESULTS: Nineteen eyes had map-dot-fingerprint basement membrane dystrophy and 4 had Salzmann's nodular degeneration. All patients presented with decreased vision, as well as varying degrees of glare, halos, and monocular diplopia. Postoperative follow-up ranged from 3 to 39 months (mean 10.6 months), and no recurrence of the original disease occurred within this period. This procedure improved the best-corrected visual acuity from 20/36 (LogMar 0.250) to 20/24 (LogMar 0.076) by LogMar statistical evaluation (p<0.001) and caused a statistically non-significant (p=0.232) myopic change in the mean refractive spherical equivalent (-0.36 diopter ± SD 2.28 preoperatively to -0.71 ± 2.26 postoperatively). Glare and monocular diplopia were subjectively reduced or eliminated in all patients. One patient had mild anterior stromal haze which decreased the bestcorrected visual acuity from 20/25 to 20/30. CONCLUSION: Diamond burr superficial keratectomy appears to be an effective and safe method of removing visually-significant anterior corneal opacities.

Keywords: Cornea; Corneal diseases; Ophthalmologic surgical procedures; Diamond; Visual acuity; Corneal opacity; Corneal dystrophies, hereditary

We report on a case of an congenital orbital tumor of impressive size, occurring in a newborn. The patient underwent orbital exenteration with a histopathologic diagnosis of cystic teratoma. The clinicopathological aspects of such a rare disease are commented.

Keywords: Orbital neoplasms; Teratoma; Teratoma; Teratoma; Teratoma; Case reports

Hemangiomas are the most commom benign tumors of infancy. Capillary hemangioma generally is presented as a spot or well-defined purple lesion. The diagnosis of these tumors is based on physical examination. Giant hemangioma is a rare and extensive variation of capillary hemangioma, that generally occurs in newborns and suckling infants. There are several therapeutical modalities, as the intralesional injection of steroids, laser therapy, intralesional injection of sclerosing solutions, surgery, radiotherapy and embolization. New therapeutical modalities have been developed, with the objective of getting better results and to make possible the treatment of the lesions of difficult surgical access or refractory cases to the used therapeutical modalities. The best results have been observed with interferon-alpha. This is a case of a patient with three months of age, that presented since birth, a purplish tumor in the superior eyelid of the right eye, plain and purplish cutaneous lesions in the temporal and parietal right region. On computed tomography of the skull, an orbital expansive vascularized process with intracranial extension could be observed. Systemic therapy with steroids was the initial treatment, during forty days, with gradual reduction for four weeks. With the practically unchanged clinical findings, the treatment with interferon-alpha was indicated, in the dose of subcutaneous 3.000.000 U/m², three times a week. After 9 months of treatment, a small residual orbital lesion was observed. In this case, interferon-alpha is presented as a good option for the treatment of craniofacial giant hemangioma.

Keywords: Hemangioma, capillar; Hemangioma, capillar; Interferon-alpha; Case reports

Angioid streaks are commonly related to Grönblad-Strandberg syndrome, that often shows dermatological characteristics, such as pseudoxanthoma elasticum. Choroidal neovascularization is uncommon, often occurring after ocular trauma. This is a case report of the successful use of intravitreal bevacizumab for the treatment of choroidal neovascularization secondary to Grönblad-Strandberg syndrome.

Keywords: Pseudoxanthoma elasticum; Angioid streaks; Choroidal neovascularization; Angiogenesis inhibitors; Case reports

This is the report of a case of bilateral Acanthamoeba keratitis in a 19-year-old woman who bought a pair of disposable soft contact lenses in a boutique. She wore this same pair of lenses for 3 months daily without the appropriate care. This led to bilateral corneal transplantation with cataract extraction and also trabeculectomy in the right eye. When last seen, both grafts were crystal clear but the visual acuities were far from satisfactory. She also had bilateral secondary glaucoma, barely controlled by topical medication. Actually, the physical features and the wearing time characteristics of the disposable soft contact lenses created unprecedented difficulties to the medical surveillance of their wearers. Without the right assistance they tend to become careless regarding routine cleaning. They also feel free to buy less expensive lenses, to use saline instead of lens solutions, to violate the limits of wearing time and to extend the use over the sleeping period. Additionally, the aggressive marketing and the wide distribution of these lenses increase the chances that economically or educationally unprepared people will acquire them. The question that remains is: Is the present case an accidental event or an example of what is likely to happen in the future if the indiscriminate selling of disposable soft contact lenses continues to evolve?

Keywords: Eye infections; Acanthamoeba keratitis; Corneal ulcer; Contact lenses, hydrophilic; Human; Female; Adult; Case reports

Case report of a woman with the diagnosis of primary open-angle glaucoma who was submitted to a successful surgical procedure of deep sclerectomy in the right eye. In the postoperative period, at month 3, the surgical procedure was evaluated with ultrasound biomicroscopy (UBM) utilizing two distinct equipments (UBM 840-Zeiss; UBM-VUMAX-Sonomed), with 50-MHz transducers. The diagnostic method of ultrasound biomicroscopy can be utilized as a non invasive method to evaluate the internal architecture of the eye at the topography of deep sclerectomy. It allows to identify the anterior segment structures, their anatomical relationship, and also the intact trabecular-Descemet membrane and the intrascleral space. Ultrasound biomicroscopy showed to be useful in evaluating postoperative status of the surgical procedure.

Keywords: Microscopy; Ultrasonography; Sclera; Glaucoma, open-angle; Sclerostomy; Postoperative period; Humans; Female; Aged; Case reports

A case of retinoblastoma with uncommon features is reported, aiming at improving follow-up. In 1993, SJMMF, 9-month-old white boy, presented a squint in the left eye. A retinal tumor was detected. The patient had a family history of retinoblastoma. Enucleation was performed and retinoblastoma was proved. The patient underwent examination for staging, all were normal. The fellow eye remained normal for 10 years. During routine examination the retina map revealed three retinoblastoma white lesions in the nasal retina. The patient underwent transpupillary thermotherapy with diode laser. After 30 days, the lesions became atrophic. After 60 days there was tumor recurrence on the border of the lesion. Sclera cryotherapy was performed. There was tumor regression for six months. During follow-up, condensations next to the atrophic tumor lesions were discovered, which were vitreous seeds. Brachitherapy with 125 iodine was done. The lesions disappeared after 30 days. New vitreous seeds appeared 3 months later, set on the retina surface. They were blocked with sclera cryotherapy and transpupillary thermotherapy. The patient presented with new vitreous seeds after six months, which adhered to the retina. They were blocked with transpupillary thermotherapy. Follow-up was for 38 months since the appearance of the bilateral tumor. The patient presents normal visual acuity and clinical examination. This case is important considering the low frequency of the disease at this age. It is essential to maintain alertness when cases of retinoblastoma are seen as cured.

Keywords: Retinoblastoma; Eye enucleation; Laser; Induced hyperthermia; Humans; Male; Infant; Case reports

To report a case of aberrant regeneration followed by acute palsy of the oculomotor nerve caused by intracranial aneurysm. A 59-year-old patient was attended in February 2006 complaining of headache with diplopia and blepharoptosis in the right eye. At the external ocular motility exam. Aduction, supraduction and infraduction defects with blepharoptosis in the right eye were observed. Regarding the internal ocular motility, mydriasis in the right eye. Acute palsy of the oculomotor nerve in the right eye was diagnosed and neurological examination was requested. At the Department of Neurosurgery, after having diagnosed aneurysm of the posterior communicating artery, the patient was submitted to an operation. In December 2006, it improvement of the aduction was observed, supraduction and infraduction defects remained and blepharoptosis improved during aduction of the right eye. In the internal ocular motility, miosis in the affected eye. The diagnosis of the aberrant regeneration of the oculomotor nerve after acute palsy was formulated based on anamnesis and ophthalmological follow-up tests.

Keywords: Oculomotor nerve; Nerve regeneration; Intracranial aneurysm; Blepharoptosis; Exotropia; Humans; Female; Middle aged; Case reports

The purposes of this article are: to inform ophthalmologists about the differences between the English and Portuguese list of equivalent terms for eye structures, approved by the Federative International Committee on Anatomical Terminology; to present the anatomical terms included in the list of medical subject headings published by the United States National Library of Medicine and translated by the Regional Library of Medicine (BIREME); propose a list of Portuguese terms of common usage by ophthalmologists.

Keywords: Terminology; Anatomy; Eye; Ophthalmology; Medical subject headings; Eponyms; History of medicine

Diabetic retinopathy is the leading cause of irreversible legal blindness in working-age adults. The number of people worldwide at risk of developing vision loss from diabetes is predicted to double over the next 30 years. Some elements suggest that neurodegenerative changes occur beyond vascular damage. These changes include increased apoptosis, glial cell reactivity, microglial activation, and altered glutamate metabolism, and could explain some of the functional abnormalities that begin soon after the onset of diabetes, as early changes in electroretinogram. This review article will present some evidences that point out neurodegeneration as a possible initial event in diabetic retinopathy.

Keywords: Diabetic retinopathy; Nerve degeneration; Vascular diseases; Apoptosis; Vision