VOLUME 63 - ISSUE 6

Purpose: To analyze long-term results of modified Schocket implant. Methods: The records of 45 patients (45 surgeries) with at least one year follow-up who received a modified Schocket implant were analyzed. Comparisons were made regarding success rates (final IOP< 22 mmHg), survival time, diag- nosis, initial and final IOP, percentual postoperative intraocular pressure (IOP) reduction and complications. Results: After a mean follow-up of 31.9 ± 19.9 months 28 cases (62.2%) were considered successful. Mean survival time was 38.9 months and success probability around 30 months 0.74. Initial IOP was 37.2 ± 11.3 mmHg and final IOP was 16.3 ± 9.3 mmHg and postoperative IOP reduction was 49.6 ± 32.6%. Survival analysis in the different diagnosis groups (neovascular, congenital, aphakic, postkeratoplasty) did not reveal statistical significance. Conclusion: The results suggest that the modified Schocket implant provides satisfactory long-term control of refrac- tory glaucomas.

Keywords: Glaucoma; Drainage devices

Purpose: To prove, also at Água Comprida (MG), the higher incidence of anisocoria and lower IOP levels in chagasic patients formerly detected at Mambai (GO), both endemic Chagas' areas. Material and methods: In a prospective, masked and paired study, 190 patients were evaluated. Pairing was according to age, sex and race. Pupil diameter was determined in 84 pairs using photography. Anisocoria was considered when a difference > 0.3 mm was observed. IOP was analyzed in 95 pairs. Results: 25 chagasic patients (29.8%) and 10 controls (11.9%) had anisocoria. This difference was statistically significant (p = 0.007). There were no differences in pupil diameter between chagasic patients and controls for OD or OS. Chagasic patients had a mean IOP of 11.3±2.5 mmHg (OD) and 11.3±2.4 mmHg (OS) and controls showed mean IOPs of 13.1±2.6 and 13.1±2.5 mmHg respectively. The differences between chagasic patients and controls were statistically significant for OD and OS (pOD=pOE <0.0001). The comparison of IOP levels according to sex was also statistically significant (females p =0.002, males p= 0.003). Conclusion: The results demonstrate a higher frequency of anisocoria and lower IOP levels in chronic chagasic patients.

Keywords: Anisocoria; Intraocular pressure alterations; Chagas' disease

Purpose: To evaluate the clinical results of LASIK for moderate and high degrees of myopia, with and without drying the stroma during photoablation. Patient and Methods: Retrospective analysis of 39 eyes of 30 patients submitted to LASIK, without drying the stroma during photoablation, in the period from April 1996 to April 1997 (Group I) and analysis of 42 eyes of 28 patients with drying of the stromal bed at each 80 pulses during photoablation in the period of April of 1997 to September of 1997 (Group II). After lamellar keratotomy with an automated microkeratome (Chiron Corneal Shaper ®), photoablation with fluoride-argon excimer laser, 193 nm, Summit model Apex Plus ® was carried out. In 2 eyes of the Group I, the photoablation was not possible due to compli- cations during the lamellar keratotomy. Results: The average follow-up was 8.7 months in Group I and 7.7 months in Group II. The mean treatment was -10.81D (±2.38) in Group I and -8.73D (±2.82) in Group II. The average variations of the achieved spherical equivalent in relation to the attempted treatment in months 1, 3, 6 and 12 were respectively, -0.96D (±1.19), -1.19D (±1.37), -1.06D (±1.41) and -1.10D (±0.66) in Group I and -0.23D (±1.02), -0.41D (±1.34), -0.75D (±1.16) and -1.03D (±1.31) in Group II. On the last visit 17 eyes (45.9%) of Group I and 31 eyes (73.8%) of Group II showed uncorrected VA of 20/40 or better. Four intraoperative complications occurred in Group I, in 2 of them the photoablations were not performed and one intraoperative complication occurred in Group II. There was a loss of 2 or more lines in 3 eyes (3.7%) ot Group I. Conclusion: Drying of the stroma led to a faster visual recovery due to smaller hypocorrection. No significant differences were observed in the long-term follow-up.

Keywords: Myopia surgery; Laser surgery; LASIK

Purpose: Alport's Syndrome is characterized by hereditary nephritis, usually associated with neurosensitve deafness (Alport, 1927) and ocular disease (Sohar, 1954). Thus we intended to analize manifestations of the syndrome in a family, regarding clinical and genetical aspects. Patients and method: Fifteen patients of the same family of which four had Alport´s syndrome were submitted to ophthalmologic examination. The examinations were performed at the Ophthalmologic Clinic of HGV/UFPI. Results: Four patients with Alport´s syndrome were revealed, of which three had moderate deafness, anterior lenticonus and chronic nephropathy, and one of them had renal disease alone. All the patients were white, male aged 12 to 25 years. The visual acuity of eyes with lenticonus varied between 20/50 and 20/100. Conclusions: The family analysis identified three confirmed cases and a suspected one, sugesting a pattern of X-linked recessive inheritance, and it was not possible to exclude autosomal dominant inheritance with incomplete penetrance.

Keywords: Alport's syndrome; Lenticonus

Purpose: To compare efficacy, safety and toxicity of indinavir and zidovudine, when administered either alone or concomitantly. Methods: This is a prospective study which has been carried out since April 1995, on 300 seropositive HIV-1 patients (599 eyes) without any opportunistic infection, and with CD4 between 50 to 250 cells/mm ³, who participated in a rando- mized double blind study. The determined efficacy parameter was the appearance of opportunistic infections. In July 1996, the patients who received only zidovudine started to receive also lamivudine. In February 1997, the study was opened and all the patients started to receive the three drugs. Results: In this study we report the ocular findings observed in the beginning of the study and the alterations which have been prospectively observed during 4 years. Three patients (4 eyes, 1.33%), who belonged to the group that received only zidovudine, developed CMV retinopathy. Conclusion: The results suggest an incidence reduction of CMV retinopathy in patients treated with protease inhibitor.

Keywords: HIV-1 seropositive patients; Indinavir; Zidovudine; Lamivudine; Ocular findings in AIDS; Opportunistic infection

Purpose: In order to verify the prevalence of ocular abnormalities in patients who are deaf due to genetic causes, this paper presents the visual assessment of 97 deaf patients. Methods: 97 patients with definite or suspected diagno- sis of congenital and genetic deafness underwent a complete ophthalmologic evaluation; 10 patients were excluded. Results: 42 (48.28%) patients presented one or more ocular abnormalities, 22 (25.29%) patients presented several abnormalities and clinical manifestations of established genetic diseases. Conclusions: The ocular abnormalities may be the only clinical manifestations associated with deafness. Therefore the ophthalmological examination is a helpful tool for the etiological diagnosis of deafness.

Keywords: Ocular abnormalities; Genetical deafness

Purpose: To determine average anatomical measurements in oriental offspring (both parents Japanese) aiming to help oculoplastic surgeons to deal with these patients. Methods: The palpebral crease height, eyebrow height and visible pretarsal skin were measured in 56 oriental offs-pring, totalizing 112 lids. 16 (28.5%) patients were male and 40 (71.5%) female. The mean age was 25.2 years. There were no statistically significant differences between right and left lids of both genders. Results: The average measure of the eyebrow height was 13.6 mm (2.5 SD) in males and 14.5mm (2.2 SD) in females. (T= 1.7) (P= 0.083), not statistically significant. The average of visible pretarsal skin in males was 1.2 (1.2 SD) and 1.7 (1.6 SD) in female. (T= 1.84) (P= 0.070), not statistically significant. The average palpebral crease height was 3.9 mm (2.5 SD) in males and 4.9 mm (2.9 SD) in females. (T= 1.95) (P= 0.060), not statistically significant. Conclusions: Due to equivalence of means between both lids and between both genders, the average measure- ments may be used as good anatomical marks in surgical procedures in Oriental lids.

Keywords: Oriental eyelid; Eyelid fold

Purpose: To reevaluate the residual accomodation after instillation of two different cycloplegic drugs; 1% cyclo- pentolate, 1% tropicamide and their association. Material and Method: We selected 46 patients aged bet- ween 15 and 25 years, with iris graded 4 and 5 according to the Seddon classification and without any type of eye disease. Those patients came spontaneously to the Depart- ment of Ophthalmology Outpatient Clinic of the Santa Casa-São Paulo, within the period of October 1997 to September 1988. The 46 patients were submitted to three complete ophthalmologic examinations. The potential of accommodation of each eye was tested as follows: 20 minutes after instillation of 1% tropicamide; 40 minutes after 1% cyclopentolate instiIlation and 30 minutes after 1% tropicamide plus 1% cyclopentolate, with an interval of 5 minutes between both drugs. Examination were performed with an interval of at least seven days between the tests. Results: There were no differences between the emmetropia, the hyperopia and the short myopia groups regarding all drugs (p > 0.005). 1% cyclopentolate and the association at the drugs caused statistically significant less residual accomodation, compared to 1% tropicamide in the hype- ropia and myopia groups. Conclusion: 1% cyclopentolate 1% and the association of the drugs are safe for the static refractometric examination in young patients with dark iris and without any type of eye disease, since they promote an average residual accomodation of 1.21 +/- 0.7 spherical diopters (SD) in all studied groups.

Keywords: Accommodation residual; Cycloplegics; Cyclo- plegia

Purpose: Retrospective uncontrolled series of consecutive patients with retinoblastoma considering: 1-tumor features on computed tomography, 2-proportion of patients with optic nerve invasion in pathology studies of enucleated eyes and 3-results after chemotherapy. Methods: The authors revised the charts of 11 consecutive patients diagnosed with retinoblastoma betweenFebuary/98 and September/99, treated at the Departments of Pediatric Oncology and Ophthalmology. Seven cases who received chemotherapy with vincristine sulfate, etoposide and carboplatin (VEC) were selected for this study to evaluate tumor presentation (response to chemotherapy and patient survival). Results: The seven studied patients were diagnosed between the ages of 15 and 38 months (mean =25.7 months), 3 being unilateral, 3 bilateral and 1 trilateral (with pinealo- blastoma). All patients were treated with VEC protocol administered in 2 to 5 cycles, and divided in to 2 groups: Group1- Patients treated with primary chemotherapy to obtain tumor reduction and preservation of one of the eyes (5 patients); Group2- Patients treated with aggressive chemotherapy for extraocular disease (2 patients). Of the 5 patients treated with primary chemotherapy (4 subsequently enucleated due to eye filling tumor), 4 achieved some tumor reduction, however 2 of them had only an initial tumor response and died on average 10 months later, one was chemoresistant. Patients with bilateral tumor were also treated with external beam radiation treatment (EBRT) of the eye containing the smaller tumor. The average follow-up period after primary chemotherapy was 12.4 months. The two patients submitted to primary enucleation and adjuvant chemotherapy (Group 2) had brain metastasis and died on average 4.5 months later regardless of treatment. Conclusion: This study revealed that: 1-retinoblastoma is a disease of late diagnosis and advanced clinical presentation in our area. 2-The percentage of enucleations with free optic nerve margins was only 50% of the cases. 3-The chemo- therapy protocol using VEC associated either with radiothe- rapy or enucleation provided satisfactory tumor reduction and increased survival in patients with advanced disease but did not change the lethal outcome when brain metastasis and optic nerve invasion were present. Randomized studies will be necessary to determine efficacy and complications of these new chemotherapy protocols. Abbreviations: VEC- vincristine sulfate 1.5mg/m², etoposide 100 mg/m², carboplatin 360mg/ m².

Keywords: Retinoblastoma; Therapy

Presbyopia is one of the earliest universal signs of aging and the basic pathophysiology involved in its development has been a matter of controversy for centuries. This article discusses many aspects of presbyopia by reviewing the literature on the multitude of age-related changes that occur in the eye.

Keywords: Accommodation; Presbyopia

Purpose: To review and discuss the available treatments for choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) emphasizing to photodynamic therapy (PDT). Methods: Published papers from 1974 until 1999 related to AMD, its available treatments and PDT were reviewed. Results: The most used effective treatment for CNV is laser photocoagulation which does not have a major impact on the blindness due to AMD. Alternative techniques of prevention and treatment are under investigation including surgery, pharmacological antiangiogenic treatment and prevention with photocoagulation. PDT using verteporfin demonstrated effectiveness in closing CNV membranes in an experimental model. A clinical trial showed that a single course treatment could stabilize the area and extent of leakage from subfoveal CNV with classic component in the majority of patients for up to 3 months (Phase I/II). A 12-month data for quaterly treatments was recently reported and showed that vision stabilization, meaning vision improvement, no change, or loss of < 3 lines, occurred in 61.4% of the verteporfin-treated eyes and verteporfin-treated eyes are more likely to avoid a six-line or greater loss (85%) compared to placebo (76%). Another clinical trial (Phase III B) is under way to analyze the role of PDT in the occult type of CNV. Conclusion: Treatment for this devastating condition remains a challenge. These clinical studies have shown an early closure of the CNV following PDT with exciting results in terms of visual acuity, although on a long-term basis these results are yet to be proven. Photodynamic therapy is one of the most promising new technologies to treat CNV.

Keywords: Photodynamic therapy; Age-related macular degeneration; Choroidal neovascularization