VOLUME 63 - ISSUE 5

Purpose: To describe the ultrasound biomicroscopic characteristics, incidence, distribution and location of primary cysts of the iris and ciliary body pigment epithelium, and to differentiate them from solid lesions. Methods: A retrospective study was performed through a review of charts of 73 patients, 82 eyes, with echographic diagnosis of primary cysts of the iris and ciliary body pigment epithelium during a 36-month period (January/97 through December/99). All examinations were performed using an ultrasound biomicroscope applying standard immersion techniques. Results: Ultrasound biomicroscopy revealed typical findings of the primary cysts of the pigment epithelium such as thin and regular walls with no internal content. Incidence was higher in individuals included in the interval of 20 to 29 years of age (28.8%). Forty-eight patients (65.7%) were female. The cysts were found most frequently in the inferior and temporal sectors. Conclusions: Ultrasound biomicroscopy was a useful tool for evaluating cystic lesions of the iris and ciliary body, also valuable in differentiating these lesions from anterior segment tumors and evaluating potential complications. The knowledge of the echographic criteria and epidemiological characteristic can assist in the diagnosis of these lesions.

Keywords: Ultrasound; Cysts; Iris and ciliary body; Pigment epithelium

Purpose: To examine the spherical equivalent of refractive errors in preterm children with threshold retinopathy of prematurity treated with cryotherapy or laser. Patients and Method: A group of 14 one-year-old children (selected from 761 preterm children born at the Hospital São Paulo of the Universidade Federal de São Paulo between 1988 and 1998) with stage 3 threshold retinopathy of prematurity treated with cryotherapy or laser photocoagulation was enrolled in the study and the spherical equivalent under cycloplegia was analyzed. Statistical analysis of the results was performed using Wilcoxon and Mann-Whitney tests. Results: 64.3% of the patients developed myopia. Of the patients who were treated with cryotherapy 80% showed high myopia and 20% low hyperopia. The mean of the spherical equivalent was --3.10 D in the right and --3.25 D in the left eye. There was no statistically significant difference between the two eyes regarding the refractive outcome. Concerning patients treated with laser, 55.6% showed myopia of which 20% was high myopia and 80% low myopia; 11.1% showed no refractive error and 33.3% developed low hyperopia. The mean of the spherical equivalent was --0.58 D in the right eye and --0.83 D in the left eye. A statistically significant diference was found between the two eyes. The correlation of refractive results in both groups of patients showed an increase in the amount of high degree myopia in patients treated with cryotherapy (P<0.05). Conclusions: Myopia is a frequent finding in children treated for retinopathy of prematurity. Myopia not only is more frequent but it appears with higher degrees in children treated with cryotherapy as compared with those treated with laser.

Keywords: Retinopathy; Prematurity; Cryotherapy; Laser

Purpose: To assess, through ultrasound biomicroscopy (UBM), the positioning of the intraocular lenses (IOL) haptics as related to the ciliary sulcus by using a scleral fixation technique; and to evaluate, as well, if two fixation points are sufficient to avoid tilting of the lenses. Methods: Sixteen aphakic eyes underwent an IOL implan-tation by means of the same scleral fixation technique, performed by the same surgeon. One month following surgery, both the positioning of the IOL haptics and the distances between the IOLs and the cornea were assessed by UBM. Results were statistically studied. Results: Of the 32 intraocular lenses haptics fixed to the sclera, eight were placed in the ciliary sulcus and 24 were placed out of the ciliary sulcus. There was no statistical difference in the distances measured between the intraocular lenses and the cornea for the haptics placed out of the ciliary sulcus as compared to the haptics placed in the ciliary sulcus, suggesting that other factors, besides the distance to the limbus, may be relevant in the positioning of haptics in the ciliary sulcus. The same measurements performed at 3, 6, 9, and 12 hours, on the periphery of the lenses, were also similar, suggesting that 2-point fixation is sufficient to avoid tilting of the lenses in the eye. Conclusions: Further factors (e.g. the ciliary sulcus opening angle), other than the distance of the limbus where the sclera is transfixed, are important for the placement of the lenses in the ciliary sulcus. Two fixation points are sufficient to avoid tilting of the IOL in the eye.

Keywords: Lens implantation; Intraocular; Pseudophakia; Aphakia; Ultrasonography

Purpose: To evaluate the distribution of the central corneal thickness (CCT) and its relationship with the intraocular pressure (IOP) in a group of patients and to demonstrate the usefulness of the pachymeter to evaluate IOP in selected cases. Methods: The central cornea thickness of 167 patients over 40 years old (319 eyes) was determined using ultrasonic pachymetry. The intraocular pressure was measured by the "Goldmann" applanation tonometer.Results: The CCT average of the 319 eyes was 0.5173 + 0.0377mm, the maximum value being 0.656mm and the minimum value 0.430mm. The IOP average was 16.44 + 3.88 mmHg; the maximum pressure 30 mmHg and the mini-mum pressure 8 mmHg. A linear regression of 0.13677 of the analyzed variables (p=0.0145) was observed, with no difference between sex and age. The observations were divided in to two groups: group I -- IOP £ 21 mmHg -- with 285 eyes which presented a CCT average of 0.517 + 0.0376 mm; and group II -- IOP > 21 mmHg -- with 34 eyes which presented a CCT average of 0.519 + 0.0393 mm. Conclusion: A linear regression between IOP and CCT was observed, meaning that the higher the CCT the higher the IOP will be. The usefulness of corneal pachymetry for IOP evaluation was shown in those patients where it was falsely increased or decreased on applanation tonometry, directing therapy towards patients really with glaucoma.

Keywords: Intraocular pressure; Central corneal thickness

Purpose: To identify barriers in carrying out ophthalmologic evaluation of schoolchildren in a community project, aiming at improving plans for prevention and care of ophthal-mologic diseases in the community. Research Design and Methods: Descriptive survey of 227 pa-rents of students with ocular problems. The individuals were screened and interviewed during the "Veja Bem" project held at Hospital das Clínicas da Faculdade de Medicina da Uni-versidade de São Paulo (HCFMUSP), São Paulo, Brazil, 1998. Results: 77.1% of the subjects had not completed elementary school and 39.6% have a family income of less than U$ 230 per month. 48.0% of the students were males and 52.0% were females, 20.4% of ages of 8 and more; 67.8% of them were not previous ophthalmologic evaluation. Among the difficulties reported during the project were the lack of transportation (41.6%), lack of orientation (31.0%) and the loss of a working day (24.8%). The main reasons reported for not appearing at previous appointments were that the parents had not received adequate orientation (52.0%) and, again, the loss of a working day (19.4%). Conclusion: There were socioeconomic difficulties in carrying out ophthalmologic evaluation of schoolchildren in a community project. The solution or minimization of schoolchildren's ophthalmologic problems depends signifi-cantly on the joint efforts of schoolteachers, the family, and the community and health personnel.

Keywords: Public Health Ophthalmology; School health; Health Education; Visual rehabilitation

Purpose: To evaluate the surgical outcome of large angle esotropia (minimum of 60 prism diopters -- pd) associated with unilateral low visual acuity (LVA) in which the surgical strategy was applied in order to operate only the non-fixating eye. Patients and Methods: We selected 17 patients with non-accommodative esotropia, LVA (VA<= 0,4 in the non-fixating eye with the better visual correction) and no previous treatment. Patients were classified as good result if they had a postoperative deviation of maximally 10 pd with binocular rotations of up to --2 of medial rectus and +2 of lateral rectus. Exotropia/esotropia between 10 and 15 pd or binocular rotations of ±3 were considered as a regular outcome. Deviations greater than 15 pd or binocular rotations of ±4 were included regarded as poor results. Results: Thirteen (76.4%) patients had counts fingers VA in the non-fixating eye, 2 (11.7%) achieved 0.1 and another two had 0.4. Three of them were also highly myopic (spherical equivalent of --6.00 diopters) in both eyes. Among the 17 patients, 12 (70.5%) had a good surgical outcome, 3 (17.6%) were regular and 2 (11.7%) poor. Conclusions: Strabismus surgery under topical anesthesia proved to be reliable in these special cases of unilateral LVA and often one can avoid surgery of the fixating eye by using this method.

Keywords: Large esotropias; Monocular surgery; Topical anesthesia

Purpose: Chemical injuries of the eye may produce exten-sive damage to the ocular surface, resulting in transient or per-manent visual impairment. Purposes: To obtain data about epidemiology and inicial treatment aplied to patients who have suffered from ocular chemical burns and have arrived at a universitary hospital. Methods: An ocular evaluation was performed 47 patients with ocular chemical burns in the ophthalmological emer-gency room of the Hospital São Paulo -- Escola Paulista de Medicina / Universidade Federal de São Paulo. Results: Most victims were young male adults and industrial accidents were quite frequent (46.8%). Alkaline agents were more often involved (55.32%). The cornea was affected in 95.7% of the cases and grade I and II of Hughes' classification were the most seen. Initial treatment of these patients was performed in 89.4% of the cases (ocular irrigation with physiological saline and debris removal) and 21 patients (44.68%) received topical medication. Conclusions: Several mistakes in the patients' initial approach were observed which may have influenced the prognosis of some patients.

Keywords: Ocular burns; Epidemiology; Emergency burn treatment

Purpose: To present an auxiliary electrical circuit (CAI) for lacrimal system intubation. Method: The device is described as well as its application to 40 patients with congenital and traumatic lacrimal obstruction. Results: An electrical characteristics study of CAI was performed and compared to other instruments reported in the literature, showing its advantages. Its use helped the retrieval of Crawford probes in all patients. Conclusions: CAI is safe and effective. Its use allows a quick localization and retrieval of Crawford probe even when performed by trainee physicians not familiar with lacrimal anatomy.

Keywords: Lacrimal system; Intubation

Purpose: To study ocular findings in patients with meningomyelocele. Methods: A retrospective study of 72 patients with myelomeningocele was performed to evaluate ocular motility disorders, refractive errors and indirect ophthalmoscopy findings. Results: In a group of 72 patients with myelomeningocele, aged 5 month -- 18 years, 64 (88.9%) had hydrocephalus. Of this group of 64 patients, 36 (56.3%) had strabismus, 21 (58.3%) of whom were esotropic, and 13 (36.1%) exotropic, 1 (2.8%) exophoric and 1 (2.8%) presented sometimes esotropia and sometimes exotropia. Of the total of 72 studied patients, 38 (52.8%) had strabismus. Anisotropia was found in 16 (22.2%) patients, 14 (87.5%) with an A pattern and 2 (12.5%) with a V pattern. The most frequent refractive error was hyperopia, found in 64 (44.4%) eyes. All the 16 patients with anisotropia had hydrocephalus. Atrophy of the optic nerve was found in 9 (12.5%) patients. Conclusion: Myelomeningocele associated with hydrocephalus had a higher percentage of strabismus than the normal population.

Keywords: Myelomeningocele; Hydrocephalus; Strabismus

Purpose: To describe the changes in ocular examination of patients with systemic lupus erythematosus (SLE), especially those related to fundoscopy. Method: A descriptive study of 41 lupus patients selected at random from May to July 1999 at the Collagen Disease Outpatient Clinic of the Rheumatology Service of the University Hospital, Federal University of Paraná. A protocol of clinical and ophthalmologic evaluation was applied. Results: Forty-one patients were included in the study; 40 were females (97.56%) and one was a male (2.44%). Mean age was 32.22 years (range: 16 to 54 years). Thirty-seven patients (87.80%) were white, two (4.89%) were black, and three (7.32%) were mulattoes. Time since SLE diagnosis ranged from two months to 18 years. Nineteen of the 41 patients (46.34%) presented fundoscopic alterations related to SLE. The major lesions detected were cotton-wool spots and arteriolar narrowing (68.42%) followed by increased excavation (10.52%) and optic disk pallor (10.52%), perivascular damage (5.26%), and changes in the pigment epithelium of the retina (5.26%). Conclusion: There was a high prevalence of fundoscopic changes related to SLE, showing the importance of regular fundoscopic examinations even in asymptomatic lupus patients or in lupus patients with no associated diseases.

Keywords: Systemic lupus erythematosus; Fundoscopy

Purpose: To describe two patients who presented with severe campimetric constriction and to determine the source of visual symptoms caused by vigabatrin, an anticonvulsant medication that increases brain gamma-aminobutyric acid. Methods: Patients were submitted to a complete neuroophthalmologic evaluation as well as a careful retina examination, Goldmann perimetry, computerized tomography of the brain and orbits, electroretinograms (ERG), magnetic ressonance imaging (1 patient) and visual evoked potential (1 patient). Results: Visual acuity was normal; the first patient had the visual field restricted to the 20 to 30 degree central area and the second, a mild to moderate constriction. Neuroimaging examinations were normal as well as the visual evoked potential. Mild optic disc pallor (3 eyes) and very slight retinal arteriolar narrowing was observed. ERG showed reduction of the b wave (case 1) and oscillatory potential responses (case 2). Conclusions: Visual alterations caused by vigabatrin are due to a retina dysfunction presumably involving the amacrine, bipolar and ganglion cells but there are no significant pathologic findings on fundoscopic examination. Patients receiving this medication should be followed closely with periodic central and peripheral visual field testing.

Keywords: Vigabatrin; Visual fields; Electroretinogram

This article describes an unusual case of an obstruction of the tear ducts caused by Ascaris lumbricoides in an one-year-old child, and presents a brief report of some other cases in the medical literature, emphasizing the necessity of considering helminths as a cause of this obstruction in malnourished children who live in areas with a high prevalence of intestinal parasistes.

Keywords: Lacrimal obstruction; Ascaris; Epiphora

Purpose: The authors describe a rare case of malignant conjunctival melanoma with a long evolution. Methods: A case report. Results: Until this time the patient does not show any sign of relapse of this melanoma, after local excision. Conclusion: Without cryotherapy or more agressive methods we observe that there are some cases of conjunctival melanoma that might be cured with only a local excision. An important aspect of this case is the relevance of the histopathologic analysis of the removed surgical fragments.

Keywords: Melanoma; Conjunctiva

Purpose: To describe the unusual association of Charcot-Marie-Tooth disease (CMTD) and posterior scleritis. Methods: Case report of a 16-year-old female with decreased visual acuity and pain in both eyes. Results: Ophthalmologic examination showed a posterior scleritis, confirmed by ultrasound and angiofluoresceinography. Foot deformities and sensory dysfunction were identified in the patient and some of her relatives. The diagnosis of CMTD in this patient was confirmed by eletrophysiologic studies. Conclusions: The association of posterior scleritis in a patient with CMTD has never been reported. This is also the first description of an inflammatory ocular disease in these patients.

Keywords: Charcot-Marie-Tooth disease; Posterior scleritis