VOLUME 77 - ISSUE 1

Purpose: To analyze the corneal thickness and anterior chamber (AC) angle using anterior segment optical coherence tomography (AS-OCT) in patients with acute anterior uveitis (AAU). Methods: Twenty two patients (24 eyes) were included. All patients underwent complete ophthalmological examination, applanation tonometry and AS-OCT at diagnosis and fifteen days after treatment. Results: Average corneal thickness before treatment was 564.2 ± 44.2 µm, 580.0 ± 44.3 µm and 580.1 ± 2.9 µm, respectively in central, pericentral and paracentral cornea. Fifteen days after treatment a significant decrease of corneal thickness was observed, with 529.5 ± 33.1 µm (p=0.0091) and 542.6 ± 33.6 µm (p=0.0068), respectively in central and pericentral cornea; paracentral corneal thickness (557.8 ± 35.3 µm) thinning did not reach statistical significance (p=0.1253). There was no significant change in temporal AC angle between visits, 44.3 ± 14.4 degrees before treatment and 44.7 ± 14.7 degrees fifteen days after (p=0.9343), and mean intraocular pressure, 10.8 ± 4.5 mmHg before treatment and 12.3 ± 3.0 mmHg fifteen days after (p=0.1874). Conclusion: In the studied group, AS-OCT detected a decrease of corneal thickness after AAU treatment. Temporal AC angle and intraocular pressure did not change during the studied period.

Keywords: Uveitis, anterior/diagnosis; Tomography, optical coherence; Anterior eye segment; Inflammation; Corneal pachymetry

Purpose: To evaluate the clinical outcome(s) and complication(s) of subconjunctival bevacizumab treatment in patients with recurrent pterygium. Methods: This prospective case series included patients who had undergone pterygium surgery and were diagnosed with recurrent pterygium. All patients received one subconjunctival injection of 0.5 mL of bevacizumab (2.5 mg/0.1 mL). The main outcome was the change in size and clinical appearance. The clinical appearance of the pterygium was graded according to Tan and colleagues. The horizontal size of the pterygium (from limbus to apex) was recorded from baseline to 2 months after injection. Treatment-related complications and adverse events were reported. Results: We included 36 eyes of 36 patients (18 males) with a mean age of 58.75 ± 10.98 years. Totally, 30.6% patients developed recurrent pterygium in both eyes (only the worst eye was treated), with 47.2% developing it in the left eye and 22.2% in the right eye. More than half the patients (58.3%) had a family history of pterygium. There was a significant difference in the size of pterygium at different intervals (P<0.05). Approximately two-thirds (66.7%) of patients presented with hyposphagma on the 2nd day after subconjunctival application; this value decreased to 30.6% by day 7 and to 0% at 1 month. Most patients (69.4%) exhibited amelioration of irritative symptoms within 2 days, 88.9% after 7 days, and 97.2% after 1 month. Conclusions: Subconjunctival bevacizumab injection is useful for the management of patients with recurrent pterygium, with no significant local or systemic adverse effects.

Keywords: Pterygium; Recurrence; Antibodies, monoclonal/therapeutic use; Angiogenesis inhibitors/administration & dosage; Injections

Purpose: Evaluate the relationship between the postural alignment of the head and possible interference in the view of children. Methods: We evaluated 11 children between 2 and 7 years of age of both sexes, with the visually impaired, who had nystagmus and head lock position. The test Lea Grating Acuity Test® was used to collect measurements of visual acuity. This applied on two occasions: with and without postural alignment of the head. For reliability of the postural alignment of the head, the slopes were measured by Fisiologic® software. Results: The children had a poorer performance after physiological postural alignment. This poor performance is possible due to loss of position lock nystagmus to gain postural alignment, said to be ideal. Postural compensations were observed, and sharply increased eyestrain. Conclusion: The pursuit of traditional postural alignment affect the visual response of children with visual impairments.

Keywords: Posture; Head; Ocular motility disorders; Nystagmus, physiologic; Visual acuity

Purpose: To study the quality of life, treatment outcomes, and satisfaction in patients who have undergone cataract surgery Methods: This comparative case series study was conducted at the Ophthalmology Service of the Bettina Ferro de Souza University Hospital, Belém, Pará, Brazil. Totally, 60 patients with cataract were included; 50% underwent conventional extracapsular cataract extraction (ECEE) and 50% underwent cataract extraction by phacoemulsification (PHACO). Patients were interviewed using the Visual Function 14 (VF-14) questionnaire to determine the quality of life before and 30 days after surgery. The results of ophthalmological examination were recorded in the patients' files and were available throughout this study. One-way ANOVA, Tukey's post-hoc comparison, and the sign test were used for statistical analyses. Results: The mean VF-14 satisfaction index was 38.0 and 89.4 before and after surgery, respectively, for the ECEE group and 47.0 and 94.1, respectively, for the PHACO group. The improvement in patient quality of life after surgery was significant in both groups (p<0.0001), with a similar amount of improvement in both groups. Conclusions: The observed improvement in quality of life was significant (p<0.0001) and directly related to patient satisfaction with surgical outcomes, which was also significant (p<0.0001) as assessed using the VF-14. Satisfaction and quality of life are individual factors; consequently, patient responses to questions regarding improvements in the ability to perform each activity are subjective and depend uniquely on individual perception.

Keywords: Cataract; Cataract extraction; Quality of life; VF-14 questionnaire; Eye surgery

Purpose: To assess the agreement between the elevation and curvature measurements of the anterior and posterior corneal surfaces obtained using the Galilei Dual Scheimpflug Analyzer and those obtained using the Pentacam single Scheimpflug system. Methods: This prospective, noninterventional, diagnostic study was conducted at the Department of Ophthalmology at the American University of Beirut (Medical Center) and included 60 eyes of 60 consecutive patients. Measurements were obtained using 2 different Scheimpflug analyzers (Galilei and Pentacam). The best-fit sphere was set at 8 mm in both machines. Pachymetry (CCT), anterior elevation (AE) and posterior elevation (PE), and curvature were assessed. Pearson's correlation coefficients, comparison of means, and Bland-Altman plots were used to evaluate agreement between the 2 systems. Results: The average CCT (at the corneal apex) was 533 ± 35 µm and 532 ± 37 µm (p=0.980), the average central AE was 1.25 ± 3.95 µm and 2.29 ± 5.28 µm (p=0.964), and the average central PE was 4.19 ± 8.18 µm and 5.42 ± 14.05 (p=0.956) µm with the Galilei and Pentacam, respectively. Conclusion: The Scheimpflug analyzers correlated well in the assessment of pachymetry, elevation, and curvature.

Keywords: Cornea/pathology; Cornea/anatomy & histology; Corneal topography; Corneal pachymetry; Photography/instrumentation

Purpose: Translate and adapt the Convergence Insuficiency Symptom Survey (CISS) questionnaire to the Portuguese language and culture and assess the psychometric properties of the translated questionnaire (CISSvp). Methods: The CISS questionnaire was adapted according to the methodology recommended by some authors. The process involved two translations and back-translations performed by independent evaluators, evaluation of these versions, preparation of a synthesis version and its pre-test. The final version (CISSvp) was applied in 70 patients (21.79 ± 2.42 years) students in higher education, and at two different times, by two observers, to assess its reliability. Results: The results showed good internal consistency of the CISSvp (Cronbach's alpha - α=0.893). The test re-test revealed an average of the differences between the first and second evaluation of 0.75 points (SD ± 3.53), which indicates a minimum bias between the two administrations. The interrater reliability assessed by intraclass correlation coefficient ranged from 0.880 to 0.952, revealing that the CISSvp represents an appropriate tool for measuring the visual discomfort associated with near vision tasks with a high level of reproducibility. Conclusions: The CISS Portuguese version, showed good psychometric properties and has been sown to be applicable to the Portuguese population, to quantify the visual discomfort associated with near vision, in higher education students.

Keywords: Translations; Questionnaires; Language; Convergence, ocular; Asthenopia; Psychometrics

Purpose: To compare the cataract surgical rate (CSR) in 2001 with that in 2008 in all Argentinean provinces using current reporting methods and verify the accuracy of CSRs by crosschecking these methods with the number of sold intraocular lenses (IOLs) within the country. Methods: A longitudinal study including public and private setups was conducted, and it included 40 ophthalmologists from 22 provinces who provided cataract surgery data for 2001 and 2008. Other data were obtained from the Ministry of Health. Estimates were crosschecked against the market data for sold intraocular lens (IOLs) in 2008 and 2010. Results: The number of cataract surgeries increased 2.7-fold, from 62,739 in 2001 to 169,762 in 2008, with increases in every province except Mendoza. Although the population also increased by 9.4% during the same time period, the apparent CSR jumped from 1,744 to 4,313 per million population. The number of IOLs sold in Argentina in 2008 was 186,652, suggesting that the number of cataract surgeries performed was slightly greater than anticipated. Crosschecks with other countries using IOL sales data did not show discrepancies when compared with previously reported CSRs. Conclusions: Although the CSR in Argentina increased considerably from 2001 to 2008 for several reasons, the main reason was that thorough crosschecking between the number of surgeries reported and the number of IOLs sold revealed that the number of surgeries performed annually were being underestimated as a result of incomplete reporting by private practitioners. Furthermore, the presence of multiple societies of ophthalmology in the country complicated the process of obtaining accurate data.

Keywords: Cataract/epidemiology; Argentina; Health services research/statistics & numerical data

Purpose: To analyze the clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center. Methods: We conducted a prospective, observational study of patients with active uveitis admitted between May 2012 and July 2012 to an emergency eye care center. Results: The majority of patients were male (63.2%), with a mean age of 43.2 years; 66.2% patients were of mixed ethnicity, 22.5% were Caucasian, and 11.3% were black. Anterior uveitis was observed in 70.1% patients, posterior uveitis in 26.5%, and panuveitis in 3.4%; no patient was diagnosed with intermediate uveitis. All patients had a sudden and acute presentation. The most frequent symptoms were ocular pain (76.9%), redness (59.8%), and visual blurring (46.2%). The majority of patients had unilateral disease (94.9%) with a mean symptom duration of 6.2 days. Diffuse and anterior uveitis were associated with ocular pain (p<0.001). Scotomata and floaters were more frequent in patients with posterior uveitis (p=0.003 and p=0.016, respectively). Patients with anterior uveitis presented with better visual acuity (p=0.025). Granulomatous keratotic precipitates were more frequent in patients with posterior uveitis (p=0.038). An etiological diagnosis based on the evaluation at the emergency center was made in 45 patients (38.5%). Conclusions: Acute anterior uveitis was the most frequent form of uveitis. Initial patient evaluation provided sufficient information for deciding primary therapy and aided in arriving at an etiological diagnosis in a considerable number of patients.

Keywords: Uveitis/etiology; Uveitis/epidemiology; Uveitis/diagnosis; Uveitis/classification; Emergencies

Purpose: Observe whether there are differences in visual functions among premature infants with treated retinopathy of prematurity (ROP) in relation to preterm infants with ROP and spontaneous regression; and among these two groups with ROP and the control group without ROP. Methods: Crosssectional observational no blind study. Premature infants were born between 06/199206/2006 and were exam between 06/200912/2010; registered in data of Hospital de Olhos Sandalla Amin Ghanem; with gestational age less than or equal to 32 weeks and 1,599 g born weigh; without ROP and ROP stages II or III, in one of the eyes, with spontaneous regression or with treatment; at least three visits during the selection period at maximum 6 months in the first exam and minimum 4 years of age in reassessment (chronological age) were include. Premature that did not respond or were not located for reassessment and those that did not have conditions to do the exams were exclude. Study's groups: G1 ROP posttreatment; G2ROP postspontaneous regression; G3 without ROP (control). Visual function evaluated with visual acuity (VA), contrast sensitivity test (CST), color test (CT), eye movement, stereopsis. Results: Overall, there were 24 premature infants and 48 eyes. Normal VA: 64.28% (G1), 87.5% (G2) and 100% (G3); Normal CST: 66.67% (G1), 100% (G2) and 55.56% (G3); Normal Ishihara CT: 100% (G1 and G2) and 86% (G3); Normal Farnsworth CT: 20% (G1), 75% (G2) and 50% (G3). Normal stereoacuity: 0.00% (G1); 25% (G2) and 3.5% (G3). Strabismus: 37% (G2), 0.00% (G1 and G3). The prevalent tendency for lower response in CST and CT between the premature children in group G3 and Farnsworth color test in G1 is a curious result of this work and more study is necessary about these visual functions in older premature children. Conclusion: The visual functions showed no statistically significant difference among the groups studied.

Keywords: Infant, premature; Infant, premature, diseases; Retinopathy of prematurity; Visual acuity; Child, preschool

Purpose: To compare the effectiveness of limbal relaxing incisions (LRI) with that of toric intraocular lens (IOL) implantation for the treatment of astigmatism during phacoemulsification using nonvectorial (predictability, safety, and efficacy) and vectorial analyses. Methods: This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism of 0.75-2.50 diopters (D) in both eyes. Patients were randomly assigned to 2 groups: a toric IOL group, which received toric IOLs in both eyes, and an LRI group, which received spherical IOLs associated with LRI placement in both eyes. All patients were evaluated at 1, 3, and 6 months after surgery, when refractive astigmatism analysis was performed using both nonvectorial and Alpins vectorial methods. Outcomes were assessed within each group and compared between groups. Results: The proportion of eyes within ±0.50 D of the intended correction at 3 and 6 months after surgery was 75% and 71.88%, respectively, in the LRI group and 40% and 66.67%, respectively, in the toric IOL group. In the remaining period, the proportion was greater in the toric IOL group. The safety index showed no difference at any time point. The efficacy index at 1 and 3 months after surgery was significantly higher in the toric IOL group (0.43 and 0.44, respectively) than in the LRI group (0.31 and 0.36, respectively). At 6 months after surgery, the status of eyes in the LRI group was as follows: 53.13% were undercorrected, 43.74% achieved the intended correction, and 3.13% were overcorrected. In the toric IOL group, 16.76% eyes were undercorrected, 76.67% achieved the intended correction, and 6.67% were overcorrected. The success rates for astigmatic surgery, astigmatism reduction at the intended axis, and astigmatism corrected were 43%, 62%, and 64%, respectively, in the LRI group and 57%, 81%, and 94%, respectively, in the toric IOL group. Conclusions: Our results suggest that the use of toric IOLs may be advantageous over the use of LRIs for the treatment of astigmatism during phacoemulsification. Although such advantages seem subtle in nonvectorial analyses, they are highlighted in vectorial analyses.

Keywords: Astigmatism/physiopathology; Lens implantation, intraocular; phacoemulsification/methods; Limbus cornea/surgery; Evaluation of the efficacy/effectiveness of interventions

Incontinentia pigmenti (IP) is an X-linked dominant disorder affecting the skin, teeth, eyes, and central nervous system. Ocular changes are common and may lead to severe vision loss. We report on the ocular manifestations in two young girls with IP, with emphasis on the asymmetry of this condition in both eyes and associated retinal problems. The outcomes of laser treatment of the ischemic peripheral retina were good and resulted in stability of vision.

Keywords: Incontinentia pigmenti/diagnosis; Incontinentia pigmenti/therapy; Laser therapy; Case reports

Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.

Keywords: Refractive errors/surgery; Eye injuries/complications; Eye injuries/ultrasonography; Ocular hypotension/etiology; Ciliary body/injuries; Gonioscopy; Tomography, optical coherence/methods; Microscopy/methods; Visual acuity; Case reports; Humans; Male; Adul

Here we report the case of a 73-year-old man who was diagnosed with metachronous, multiple primary tumors with non-Hodgkin B-cell mantle cell lymphoma involving the orbit on the basis of biopsy and immunohistochemistry in 2012. The patient had been diagnosed with non-Hodgkin small cell lymphoma and basal cell skin carcinoma in 2010 and intestinal adenocarcinoma with metastasis to the regional lymph nodes in 2011, thus representing a typical case of metachronous, multiple primary tumors. Mantle cell lymphoma is a rare disease and its prognosis is quite poor, particularly when it is associated with other metachronous malignancies. Therefore, physicians should consider mantle cell lymphoma as a differential diagnosis for neoplasms of the orbit.

Keywords: Lymphoma, mantle cell/diagnosis; Orbital neoplasms/diagnosis; Lymphoma, non-Hodgkin; Case report

Here we describe the case of a 65-year-old Caucasian female who presented with an amelanotic malignant conjunctival melanoma and highlight the clinical and pathological features of this rare entity that displayed exclusive corneal invasive growth without evidence of conjunctival tumors other than primary acquired melanosis. Impression cytology aided in the initial diagnosis. The patient underwent surgical treatment. Histopathology and immunohistochemistry revealed an invasive amelanotic melanoma limited to the cornea and exhibiting S-100, Melan A, and HMB-45 positivity. The absence of pigmentation delayed early clinical detection and treatment. Awareness of this nonpigmented melanoma is important for early recognition and appropriate management.

Keywords: Melanoma/pathology; Conjunctival neoplasms; Eye neoplasms; Cytological techniques; Diagnostic techniques, Ophthalmological; Humans; Female; Aged; Case report

The cornea is a transparent tissue in front of the eye that refracts light and facilitates vision. A slight change in the geometry of the cornea remarkably affects the optical power. Because of this sensitivity, biomechanical study of the cornea can reveal much about its performance and function. In vivo and in vitro studies have been conducted to investigate the mechanics of the cornea and determine its characteristics. Numerical techniques such as the finite element method (FEM) have been extensively implemented as effective and noninvasive methods for analyzing corneal mechanics and possible disorders. This article reviews the use of FEM for assessing the mechanical behavior of the cornea. Different applications of FEM in corneal disease studies, surgical predictions, impact simulations, and clinical applications have been reviewed. Some suggestions for the future of this type of modeling in the area of corneal mechanics are also discussed.

Keywords: Finite element analysis; Cornea/physiology; Cornea/ultrastructure; Cornea/surgery; Biomechanics/methods; Models, biological