VOLUME 63 - ISSUE 4

Purpose: To compare, through a prospective, randomized and bilateral study, the effectiveness, safety and predic-tability of photorefractive keratectomy (PRK) and excimer laser in situ keratomileusis (LASIK) for correction of low and moderate myopia. Methods: Seventeen patients (34 eyes) with preoperative refractional spherical equivalent (SE) ranging from -2.00 to -6.00 diopters (D) were enrolled in this study. Each patient received PRK in one eye and LASIK in the other. Both eyes were treated by the same surgeon during the same operative session with the excimer laser VISX 20/20B and the Chiron Automated Corneal Shaper microkeratome.Results: Preoperatively the mean SE was the same for both groups (-3.57 ± 1.17D and -3.71 ± 0.98D, for PRK and LASIK groups, respectively). Pain was reported only by the PRK cases (8 eyes: 47.1%). The average follow-up was 14 ± 5 months (6 to 24) for the PRK group, and 14 ± 6 months (3 to 24) for the LASIK group. The mean residual refractive error was similar after both procedures (-0.34 ± 0.45D and -0.29 ± 0.52D, for PRK and LASIK, respectively). At 1 day after surgery, 15 LASIK eyes (100%) and 2 PRK eyes (13.3%) had an uncorrected visual acuity (UCVA) ³ 20/40 (n=15). At last follow-up, 15 eyes from the LASIK group (88.2%) and 11 from the PRK group (64.7%) reached a UCVA ³ 20/20 (n=17). The best spectacle corrected visual acuity remained unchanged in all cases. Conclusion: Both PRK and LASIK were found to be similarly safe, effective and predictable for the correction of low and moderate myopia. Patients preferred LASIK because of fast and painless visual recovery.

Keywords: Myopia; Excimer laser; LASIK; Refractive surgery

Purpose: To evaluate if the neuromuscular relaxing plate is effective in reducing the ophthalmic symptoms of patients with temporomandibular dysfunction (TMD) and to observe the possible correlation between TMD and ocular symptoms. Methods: A comparative analysis of TMD symptoms and ocular symptoms was performed in a sample of nineteen patients with TMD, ophthalmic signs and symptoms and absence of ocular diseases. Those patients were submitted to a reversible therapy using a neuromuscular relaxing plate. Results: It was observed that after the use of the plate during a longer period of time (60 days) the number of patients who showed 100% improvement or mild symptoms was statis-tically significant for both TMD and ocular symptoms. In contrast, in short periods of time (7-15, 15-30, 30-60 days) the plate's effectivity was not statistically significant to reduce TMD and ocular symptoms. The most frequent ophthalmic symptom (84.2%) shown by the patients with TMD of the sample was ocular pain. Conclusion: There is a correlation between TMD and ocular symptoms, because the improvement of the clinical status of the patients with TMD who used the reversible therapy, was statistically significant for both TMD and ocular symptoms in a longer period of time (7-60 days).

Keywords: TMD; Eye; Neuromuscular relaxing plate

Purpose: To add for the ophthalmologist an element for clinical evaluation of uveitis, affecting the anterior segment; contributing both to reveal the intensity of the inflammatory process and helping to guide the therapeutic management conduct. Methods: We studied 46 uveitis patients with cellular reaction in the anterior chamber. We observed the speed of the displacement of the cells in the aqueous humor and related it to the intensity of the inflammatory process, in comparison with the symptomatology and main clinical signs. Results: The results showed that there is an inverse correlation between the speed of cells in the anterior chamber and the degree of inflammation. The more serious was the inflammation, the less was the displacement of the cells. And we can apply this fact to the clinical evaluation of uveitis. In some situations it was easier to notice alterations in the speed of the cells than in the amount of cells or flare. Conclusions: Our study presents a new element in the semiology of uveitis, since we did not find references in the medical literature. On familiarizing with the speed of the cell movements in the anterior chamber, we may have a valuable resource that helps us in the patient's examination of uveitis. In some cases the change in the speed is the only element in-dicating a worsening or improvement in the clinical course.

Keywords: Uveitis; Diagnosis of uveitis; Cells in anterior chamber; Examination of uveitis; Cellular movement

Purpose: To identify retinal manifestations of sickle cell hemoglobinopathy and compare their prevalences among different hemoglobinopathy genotypes in a population of a universitary hospital in Porto Alegre - Brazil. Methods: Ophthalmologic evaluation with fundoscopic examined and genotypic study were performed in sickle cell hemoglobinopathy patients. Results: 94 eyes from 47 patients with sickle cell hemoglobi-nopathy were examinated - 17 men and 30 women, aged 22.4 ± 16.8 (SD) years. 20 patients were found to have SS genotype, 10 SC, 10 AS and 7 SThal. The retinal abnorma-lities seen were salmon patch hemorrhage in 1 eye, black sunburst hyperpigmentation in 12 eyes, sea fan neovas-cularization in 3 eyes, vitreous haemorrhage in 1 eye and retinal detachment in 1 eye. Sixty percent of patients in the SC group presented fundoscopic alterations, showing a 4.0 times greater relative risk for retinopathy when com-pared with the homozygous group (SS) (p<0.05). All 5 eyes with proliferative disease had SC genotype. Conclusions: The frequency as well as the severity of retinal manifestations of sickle cell hemoglobinopathy are higher in the SC heterozigous group when compared with other genotypes.

Keywords: Sickle cell disease; Sickle cell retinopathy

Purpose: Vertical transpositions of the horizontal rectus muscles is the preferred operation in cases of A and V pattern strabismus in which oblique muscle dysfunction is inadequate to allow oblique surgery. The purpose of this study was to assess the results of performed transpositions and to point out factors that influence outcome so as to establish an equation correlating magnitude of transposition to be performed for a given pattern size. Methods: 43 patients with nonparetic horizontal strabismus associated with A or V pattern, without oblique muscle dysfunction, who underwent bilateral and symmetrical vertical transpositions of the horizontal rectus muscles, were retrospectively studied. Results: 81.4% of patients had esotropia of A pattern. The mean pattern size was 19 PD and most transpositions were 4 mm shifts, with a success rate of 66.7 to 79.5%, that is, residual A pattern up to 5 PD or V pattern up to 10 PD. The pattern correction is closely related to the preoperative pattern size and with the magnitude of transpostion carried out, mostly with the former, therefore suggesting that the procedure is self-adjustable. The linear equation with 3 variables was clinically incoherent and was, therefore, abandoned. Conclusions: Symmetrical vertical transpositions of the horizontal rectus muscles is a effective long term procedure for collapsing A and V pattern, whenever oblique muscle dysfunction is absent.

Keywords: Transposition; A and V pattern

Purpose: To compare global indices and duration of automated visual field tests in geriatric patients and in patients below 60 years old. Methods: 24-2 Humphrey visual field examinations were performed in 56 patients from the Geriatrics Department of UNIFESP-EPM and in 23 subjects aged below 60 years. Test reliability, duration and global indices were compared between groups for the right and left eyes. Among geriatric patients the same variables were studied between reliable and nonreliable fields and in those with bilateral reliable tests (OD x OS). Results: Mean age of geriatric patients was 77.7 ± 5.0 years and 50.0 ± 5.0 years in those below 60 years (p<0.001). PSD and CPSD differed statistically between geriatric and nongeriatric patients (PSDOD p = 0.02 and OS p =0.03; CPSDOD p =0.02 and OS p =0.44). Geriatric patients spent statistically more time to perform the test (t geriatrics OD= 11.8 ± 1.8min ¾ t below 60=11.1 ± 1.9min p = 0.04; t ge-riatric OS=11.4 ± 1.4 min - t below 60 OS = 10.8 ± 1.8 min p = 0.009). In geriatric patients, nonreliable exams had statistically higher PSD and CPSD values than reliable fields. In those geriatric cases with bilateral exams, there were no statistical differences in global indices or test duration (pMD = 0.4; pPSD = 0.9; pSF = 0.68; pCPSD = 0.92; p duration = 0.11). Conclusion: Geriatric patientes spent statistically more time to perform the test and had higher PSD and CPSD values, suggesting higher visual field variability.

Keywords: Humphrey perimeter; Age; Visual Field

Purpose: To study frequency and characteristics of ocular manifestations in patients with multiple sclerosis (MS) in the State of São Paulo. Methods: From March, 1996 to November, 1998, 64 patients (48 female, 16 male, age 17 - 59) with MS underwent ophthalmologic examination and computerized visual field perimeter testing. Results: Forty-four (68.75%) of 64 examined patients presented some kind of ocular manifestation. The most frequent manifestation was optic neuritis (28 patients - 43.75%). It was the first manifestation of MS in 18 (28.1%) patients. Alterations of ocular motility were the second most frequent finding. Eight (12.5%) patients suffered from diplopia, of which 6 (9.37%) presented this as their first manifestation of MS. Sixth nerve palsy occurred in 2 patients (3.1%), with esotropia as a first sign of the disease. Other findings can be listed: uveitis (4 patients - 6.25%), changes in iridian topography with anterior lens capsule pigmentation (3 patients - 4.6%). The most frequent visual field defect in the patients who presented optic neuritis was arcuate scotoma with paracentral defects (46.4%). Two patients presented central scotomas and peripheral changes. None of the patients presented nystagmus. Conclusion: Our data shows that ocular findings in MS are frequent and many times are the initial manifestation of this disease. Although optic neuritis was the most frequent finding, we must emphasize the possibility of other ocular manifestations to be either preceding or occuring at the same time as this disease.

Keywords: Multiple sclerosis; Ocular manifestations; Features

Purpose: The present study evaluates the frequency of ocular manifestations observed in HTLV-I seropositive patients in Rio de Janeiro. Methods: The study included 17 patients with TSP/HAM (tropical spastic paraparesis / HTLV-I associated myelopathy) and 55 seropositive patients to HTLV-I without TSP/HAM or ATLL (adult T-cell leukemia/lymphoma). Results: In the TSP/HAM patients sample we observed the frequency of 11.8% of anterior uveitis, 11.8% of retinal vasculitis and 5.9% of vitreous opacity. In the seropositive patients to HTLV-I without TSP/HAM or ATLL the frequency of 1.8% of retinal vasculitis and 1.8% of cotton-wool spot were observed. Conclusion: In conclusion, the HTLV-I must be considered as one of the etiological agents to be thought in these ocular manifestations in endemic areas such as Rio de Janeiro.

Keywords: HTLV-I; Uveitis; Retinal vasculitis; TSP/HAM

Purpose: To study the anatomical relationships of the anterior segment of the eye, using ultrasound biomicroscopy in patients with chronic simple glaucoma and nonglaucomatous eyes, after mydriatic and cycloplegic instillation. Patients and Methods: Thirty eyes with chronic simple glaucoma and 30 nonglaucomatous eyes were studied. Anterior chamber depth, iris-lens contact and iris-zonule distance were measured, in both groups, using ultrasound biomicroscopy, in the three following conditions: without mydriatic and cycloplegic instillation, with 1% tropicamide alone and with 1% tropicamide plus 10% phenylephrine chlorhydrate. Results: Ultrasound biomicroscopy examinations of glaucomatous and nonglaucomatous eyes, without mydriatic and cycloplegic instillation, showed no statistically significant difference in the central anterior chamber depth, iris-lens contact and iris-zonule distance. The difference between examinations without mydriatic and cycloplegic instillation, with 1% tropicamide and with 1% tropicamide plus 10% phenylephrine chlorhydrate was statistically significant regarding the variables measured in both groups. Conclusions: No anatomical difference was observed between the anterior segment of glaucomatous and nonglaucomatous eyes after mydriatic and cycloplegic instillation. The results of this clinical investigation, using ultrasound biomicroscopy were innovative, allowing a dynamic and quantitative evaluation of the anatomical relationships between intraocular structures when submitted to mydriasis and cycloplegy, which up to now were only qualitative.

Keywords: Anterior segment of the eye; Ultrasonography; Glaucoma; Open-angle; Mydriatics; Cycloplegics

We report herein an update on conjunctival transplantation, as regard to its technique as well as to its indication for pterigium, conjunctival tumors, vernal ulcers, superior limbic keratoconjunctivitis and conjunctival necrosis of trabeculectomy blebs.

Keywords: Conjunctiva; Graft; Pterigium

Amniotic membrane transplantation has been used as an alternative for ocular surface reconstruction. Indications for amniotic membrane transplantation include persistent epithelial defects, pterygium, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, chemical burns and pseudo-phakik bullous keratopathy.

Keywords: Amniotic membrane; Chemical burns; Surface reconstruction

This manuscript reviews the surgical management of ocular surface disease using limbal grafting. Inittialy, some considerations about the main causes of ocular surface disorders are discussed. After, reports showing the role of corneal stem cells and its location at the limbus and the different surgical techniques are described.

Keywords: Limbal grafting; Stem cells; Ocular surface