VOLUME 64 - ISSUE 1

Purpose: To determine the fiber layer analyzer GDx's specificity in a group of normal subjects, and the most altered parameters for this group. Methods: Normal patients were examined (complete ophthalmologic examination) and then we performed the fiber layer analysis with NFA- GDx (LDT). Total: 34 randomly selected eyes. Results and Conclusion: The specificity was 58.8%, and the corrected specificity 70.5%. The most altered parameter was symmetry (85.71%), and the less altered, the inferior and superior ratio (0%). When we have an isolated altered symmetry in a patient with normal IOP and normal optic disc, the false-positive diagnosis must be remembered; when a suspected glaucoma patient has an altered inferior ratio, glaucoma diagnosis must be remembered.

Keywords: Nerve fibers; Sensitivity and specificity; Diagnostic techniques ophthalmological; Laser

Purpose: To use digital image processing analysis techniques as a clinical tool for measuring the normal palpebral fissure. Methods: 70 palpebral fissure images of 23 males and 47 females with ages ranging from 10 to 60 years were analyzed. The images were captured with a CCD camera and transferred to a Macintosh computer. Using the NIH software, the following variables were measured: 1) area, 2) length, 3) height and angle between the medial and lateral canthi, 4) upper and lower eyelid curvatures 5) position of the highest point of the upper contour and the lowest point of the lower contour relative to the palpebral fissure midline. Results: The mean values obtained for the length, height and vertical position of the lateral canthus relative to medial canthus agree well with normative values found in the literature. Variables that have never been quantified as the upper and lower eyelid contour and palpebral fissure area were easily measured. Conclusions: The digital image processing is a simple method for the 2-dimensional analysis of the palpebral fissure and allows refined measurements of the fissure morphology.

Keywords: Eyelid diseases; Eyelids; Image processing, computer-assisted

Purpose: To examine the efficacy, predictability and safety of posterior chamber phakic intraocular lens implantation in patients with moderate and high myopia. Methods: We analyzed the results of 93 eyes of 54 patients who were submitted to the implantation of a posterior chamber phakic lens for the correction of their myopia. The target postoperative spherical equivalent refraction was emmetropia. Mean follow-up was 9 months (ranging from 1 to 38 months) Results: The mean preoperative spherical equivalent refraction was -13.56 D (ranging from -5.75 to-20.38 D) and the mean postoperative spherical equivalent at the last visit was -0.92 D (ranging from -3.38 to +1.00 D) with 39 eyes (41.9%) within ± 0.50 D, 64 eyes (68.8%) within ±1.00 D of emmetropia and 88 eyes (94.6%) within ± 2.00 D. A gain of more than two lines of visual acuity was seen in 45.17% (42 eyes) at last examination. Complications occurred in 15 eyes (16.1%): loss of endothelial cells in 2 eyes (2.2%), pupillary block in 2 eyes (2.2%) and loss of crystalline lens transparency in 11 eyes (11.8%) which caused visual symptoms in 6 eyes (6.5%) only. Conclusion: Posterior chamber phakic lens is an effective, predictable and safe method for reducing or correcting moderate and high myopia. Gains in visual acuity were significant. Longer follow-up in a larger number of eyes will help to better address long-term stability of the results.

Keywords: Intraocular lens implantation; Myopia; Ocular refraction

Purpose: To verify, in myopic individuals who are candidates for refractive surgery, the prevalence of different types of peripheral degenerative lesions of the retina, according to the type of myopia. Methods: Prospectively, during a one-year interval, we examined the eyes of patients in the Refractive Surgery Sector of the Department of Ophthalmology of the Federal University of São Paulo - Paulista School of Medicine, who presented at the initial visit a refraction with spherical equivalent above or equal to -1.00 spherical diopter, and did not have a personal background of ocular disease or surgery in that period. We investigated the existence of lesions and/or peripheral degeneration, which predispose to rhegmatogenous detachment of the retina. Results: The group was mostly composed of young adults (average age 31). We observed eyes with low myopia (263 eyes, 31%), moderate myopia (300 eyes, 36%) and high myopia (277 eyes, 33%). In 35.4% of the patients (27% of the eyes) we found peripheral degeneration, and the white with or without pressure was the most frequent finding (23.4% of the patients or 17.5% of the eyes). Among the lesions that predispose to rhegmatogenous detachment of the retina, the most frequently found was the lattice degeneration (8.6% of the patients or 6% of the eyes). Conclusions: The peripheral alterations which predispose or not to rhegmatogenous detachment of the retina presented an increase in prevalence according to the increase in the myopia grade, with the exception of tears. All patients with high myopia and candidates for refractive surgery should have the retinal periphery of both eyes examined.

Keywords: Retinal detachment; Radial keratotomy; Photorefractive keratectomy excimer laser; Myopia

Purpose: This study was designed to determine if lens prescription can be based solely on automated objective refraction. Methods: All patients were interviewed and underwent an ophthalmologic examination including clinical refraction with classical non-automated objective and subjective procedures (gold standard). Afterwards the automated objective refraction was performed using the automatic keratorefractor TOPCON 3000. Results: 1,001 eyes of 504 patients were studied. 45.2% were male patients and the mean age was 36.6 years. There was an overall concordance between clinical refraction and the automated objective refraction in 66.7% of the patients. The concordance of a spherical value, not considering variations of -0.50 to +0.50 SD was, approximately 90%. In simple hyperopic/myopic astigmatic eyes the concordance was 27.6%, in eyes with compound hyperopic/myopic astigmatism the concordance was 97.7%. Cycloplegia did not significantly affect this concordance. There was no significant difference regarding the axis of astigmatic eyes when using both techniques. Conclusion: Automated objective refraction is an useful tool in clinical refraction but clinical data should also be considered and the final lens prescription should never be based solely on the automated examination.

Keywords: Contact lenses; Refractive errors; Ocular refraction; Refractometry

Purpose: A survey was carried out on one hundred patients of the Emergency Service of the Ophthalmology Department of the Hospital das Clinicas of the University of Campinas (UNICAMP), in order to analyze the personal characteristics and the barriers against getting resolving ophthalmologic assistance. Variables, were the following: sex, age, home town, average distance between the place of initial symptoms and first visit to the hospital, time spent between the first examination (if performed in any other service) and the examination performed at the Hospital das Clinicas of University of Campinas, diagnosis, veracity of emergency, need to refer patients previously seen in other services to our Service and possibility of assistance and treatment at a secondary level. Methods: The sample showed the following characteristics: distances between 20 and 100 kilometers covered by 50.0% of the patients to be seen at University of Campinas. 75.0% of those patients needed someone to stay with them and 67.0% came from other municipalities. The long distances covered meant additional expenses for the treatment of diseases which should be treated locally. Results: Among the patients referred to University of Campinas by ophthalmologists of other services, 87.5% could have their diseases treated at a secondary level of assistance and 66.7% of real emergencies and 60% of false emergencies took longer than 7 days to reach the emergency room of University of Campinas. This shows the poor infrastructure of secondary services regarding excellence of emergency care and education of patients. Conclusions: We recommend education of general physicians and ophthalmologists for emergency eye care and also the supply of both secondary and tertiary public services or medicare, strategically setup in the whole state of Sao Paulo.

Keywords: Emergencies; Eye diseases; Health services accessibility

Purpose:1) To check self-knowledge and needs for orientation among regular class teachers working with low vision students; 2) To gather information to assist the training on visual deficiency of regular class teachers. Methods: A survey was conducted for the academic year of 1999 among those teachers working in public schools, Campinas/SP/Brazil, of which 11 were municipal and 9 state schools, respectively 79.0% and 90.0% of these schools. A self-administered questionnaire was used as data collection instrument. Results: The sample was composed of 50 teachers with a regular class experience averaging 20 years. Most of them, 94.0%, said that they had no specific preparation in the area of low vision. Only 18 teachers declared to have received some kind of information/orientation in order to work with their low vision students and of those only 15 teachers mentioned the kind of orientation received. The whole group of 50 declared interest in receiving information. From the information/orientation requested 66.0% mentioned extended working class materials, 50.0% visual performance and eye disease of their students and 46.0% visual acuity/visual field. Conclusion: It was detected that teachers of regular classes received none or little information about their low vision students but demonstrated interest in its obtention. It was also shown that those teachers are not prepared to work with visually impaired children.

Keywords: Low vision; Low vision; School health services; Interpersonal relations; Underachievement school health; Teacher

Purpose: To determine the growth of P. aeruginosa and S. aureus in liquid perfluoroctane perfluoroctane. Methods: Three culture media were used: perfluoroctane, soy and casein digestion broth and 0.9% saline. Five ml perfluoroctane were distributed among 1 ml flasks. Flasks 1 and 2 were inoculated with 1 entire colony of P. aeruginosa and flasks 3 and 4 were inoculated with the same amount of S. aureus. Flask 5 served as control without any contamination. One colony of each bacterium was also inoculated in 1 ml of the remaining culture media. Entire colonies were used because perfluoroctane is immiscible with water. All solutions were kept in an incubator at 37(0)C for 10 days. The cultures were replated under a laminar flow hood using a calibrated 1:1000 loop at times zero, 72 h, 168 h and 240 h after contamination. Bacterial growth was determined by counting the colonies on blood agar plates 24 hours after each replating. Results: Time zero demonstrated bacterial growth in all media, confirming inoculation. During the subsequent hours no further growth of these microorganisms was observed in perfluoroctane. Both bacteria developed abundantly in the remaining culture media at all times studied. The control flask did not show any bacterial growth. Conclusions: The "in vitro" results show that PFO does not seem to represent a favorable medium for bacterial growth.

Keywords: Perfluorocarbons; Bacterial growth; Pseudomonas aeruginosa; Staphylococcus aureus; In vitro

Purpose: To describe the epidemiologic aspects of closed-globe injury with contusion and its alterations. Methods: Forty patients with closed-globe injury, were analyzed prospectively between January 1998 and February 1999. They were attended at the Ocular Trauma Outpatient Clinic of the Department of Ophthalmology of the Escola Paulista de Medicina-Federal University of São Paulo. A complete ophthalmologic examination was performed in all patients and they were classified according to the new classification proposed by Pieramici et al (1997). Results: Sixty-seven and a half percent (67.5%) of the studied patients were less than 30 years old. The main causes were: accidents at home and acts of violence with 32.5% each. In relation to visual acuity, with best correction, 60.0% of the patients did not achieve 20/100 visual acuity. Seventy-five per cent (75.0%) showed improvement in visual acuity during follow-up and most in less than 1 month. Fifty-two and a half percent (52.5%) were classified as zone III. Fifty percent (50%) of the patients developed hyphema and 67.5% had some grade of angle recession, higher than 180° in 30.0%. Conclusions: In relation the patients attended at the Ocular Trauma Outpatient Clinic of the Federal University of São Paulo Escola Paulista de Medicina, more than 13 years old, males, with closed-globe injury we may conclude: 1. it is more prevalent in adults; 2. the main causes were domestic accidents and violence (32.5% each); 3. it presents good visual acuity recovery, except for zone III patients; 4. fifty per cent developed hyphema; 5. more than a half had angle recession (67.5%) and 30.0% had angle recession over 180°.

Keywords: Eye injuries

Purpose: To evaluate bacterial contamination of autologous serum eyedroppers after topical use. Methods: Autologous serum eyedroppers used for ocular surface diseases were submitted to culture after topical use. A total of 127 eyedroppers was cultivated after the patients had used the drops and returned them to the laboratory. Results: We found that 76.03% of the eyedroppers were contaminated. Nine-two microorganisms were found: coagulase-negative Staphy-lococcus (35.86%), Alcaligenes sp (21.73%), Klebsiella sp (20.65%) and Bacillus sp (9.78%). Conclusion: The eye-dropper contamination can be caused by normal flora and by skin and environmental microorganisms. These results show the contamination risk at the moment of instillation. Further research will be done to evaluate fungal contamination and to correlate the patient's normal flora with microorganisms found in the eyedroppers.

Keywords: Ophthalmic solutions; Drug contamination; Bacterial eye infections; Staphylococcus; Alcaligenes; Klebsiella

Brain tissue in the orbit in continuation with intracranial contents is unusual. However, isolated brain tissue in orbit, is much rarer. In the present research, two cases of ectopic brain tissue in the orbit with ependymal cyst are reported. Similarities with and differences between other cases reported in the literature are analyzed, as well as the difficulties of the diagnosis of their malformation. There are not many many cases of ectopic brain tissue reported in the literature.

Keywords: Choristoma; Orbital diseases; Brain; Case report; Ependyma

Purpose: To report a case of bilateral Propionibacterium acnes endophthalmitis after extracapsular cataract extraction. Case Report: Male, 56 years old, underwent bilateral no- simultaneous extracapsular cataract extraction in 1998, followed by the second surgery 7 months after the first. Four months after each surgery, an unspecific inflamma- tory response was diagnosed. Almost 1 year after intense topical, peribulbar and systemic steroid treatment, he underwent anterior chamber paracentesis, vitreous and endocapsular puncture, when P. acnes was isolated. A vitrectomy was performed and vancomycin was injected into the vitreous chamber and the anterior chamber of his left eye, whose evolution was pthisis bulbi his right eye was submitted to vitrectomy, vancomycin injection and intraocular lens explantation, recovering a best corrected visual acuity of 20/70. Conclusion: Late bilateral non simultaneous endophthalmitis presentation after cataract extracapsular extraction with intraocular lens implant leads us to a complete clinical and laboratorial investigation facing an active inflammatory response after the first surgery, including microbiological conjunctival cul-de-sac evaluation in order to rule out the possibility of exogenous contamination before the fellow eye can undergo the same surgical procedure.

Keywords: Endophthalmitis; Propionibacterium acnes; Cataract extraction