To report the surgical outcome and visual rehabilitation of a patient with Fuchs' dystrophy diagnosed with endothelial dysfunction associated with subepithelial and deep corneal scar and advanced cataract, treated with DMEK combined with phacoemulsification and intraocular lens (IOL) implantation, followed by phototherapeutic keratectomy (PTK).

Although the presence of central corneal opacities could limit the visual prognosis, Descemet Membrane Endothelial Keratoplasty (DMEK) was performed and completely resolved corneal edema and opacities on the visual axis. A rigid contact lens fitting was necessary to treat irregular astigmatism postoperatively.

A single case description of a novel surgical treatment using hard palate to correct an upper eyelid deformity after traumatic laceration. The surgical procedure is described with accompanying diagram to illustrate the technique. The eyelid margin was successfully restored with proper anatomical outcome, as seen up to at least eighteen months post-operatively in the presented case. Our technique can be applied to the correction of small eyelid defects in other patients.

A 71-year-old man diabetic and smoker was treated with brachytherapy for a choroidal melanoma. Two years later he developed a radiation optic neuropathy and a contralateral vein occlusion. He received subtenon triamcinolone and then, he underwent a phacoemulsification surgery and one intravitreal injection of antiangiogenic, with functional and anatomical improvement. The radiation optic neuropathy is a chronic progressive vasculopathy induced by supra-threshold doses of ionizing radiation. The risk occurs when the total dose is more than 50 Gy or the daily fraction size exceeds 1,8 Gy. The vein occlusion could be related to risk factors. Several treatments have been used for radation papillopathy. Resumén Varón 71 años diabético y fumador, tratado con braquiterapia por melanoma coroideo. A los dos años presenta una neuropatía óptica por radiación y trombosis venosa contralateral. Se trata con corticodes subtenonianos y posteriormente, se interviene de cataratas y se introduce antiangiogénico intravitreo, con buen resultado. La neuropatía óptica por radiación es una vasculopatía progresiva y crónica secundaria a una radiación ionizante supraumbral. Ocurre cuando la dosis total recibida excede de 50 Gy o la dosis diaria de 1,8 Gy .La trombosis venosa podría estar relaciona con los factores de riesgo existentes. Diferentes tratamientos han sido propuestos para la papilopatía por radiación.

Topiramate is a drug used in the treatment of epilepsy, migraine, bulimia and other pathologies. We report a case of a 40-yearsold woman, presented to the emergency department of ophthalmology with blurred vision in both eyes and bilateral acute angle closure. Her medications included topiramate started 6 days before. Secondary angle closure glaucoma due to topiramate was diagnosed. The medication was discontinued and she was treated with topical antiglaucoma medications, intravenous mannitol and cyclopegics. At the 5-days follow-up visit, vision, intraocular pressure, and angle anatomy had returned to normal. The acute angle-closure glaucoma occurs due to edema of the ciliary body and uveal effusion that produces an anterior motion of the iris-lens diaphragm, with ocular hypertension and acute myopia. Resumen El topiramato es un fármaco usado en epilepsia, migraña, bulimia y otras patologías. En el párrafo siguiente describimos un caso de una mujer de 40 años, que recibía tratamiento con topiramato, que acudió al servicio de urgencias oftalmológicas por disminución de agudeza visual brusca de ambos ojos con cierre angular bilateral. La paciente fue diagnosticada de glaucoma de ángulo cerrado secundario a topiramato. La medicación se suspendió y se trató con medicación antiglaucomatosa tópica, manitol intravenoso y ciclopléjico. A los 5 días, la visión, presión intraocular y anatomía angular habían vuelto a la normalidad. El cierre angular agudo por topiramato se produce debido al edema del cuerpo ciliar y efusión ciliocoroidea que producen un desplazamiento anterior del diafragma iridocristaliniano originando un cierre angular, hipertensión ocular y miopización aguda.

Purpose: To assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness, measured with Spectralis® OCT, in healthy and glaucomatous subjects, through of inter-examiner variability, intratest and inter-test with and without software of followup. Methods: Cross-sectional and prospective study with 37 controls (63 eyes) and 33 patients with glaucomatous optic neuropathy (55 eyes). Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated. Results: Low inter-examiner, intra-test and inter-test variability, with ICC>0,75 e CV<10%, in both control group and patients with glaucoma. Conclusions: The Spectralis® OCT shows excellent reproducibility of RNFL measurements, validating it as an useful tool for monitoring the progression of glaucoma. Resumo Objectivos: Avaliar a reprodutibilidade das medições da camada de fibrasnervosas peripapilar (CFN), obtidas com o Spectralis® OCT, em indivíduos saudáveis e com neuropatia óptica glaucomatosa, através da variabilidade inter-examinador, intra-exame e inter-exame com e sem o software de followup. Métodos: Estudo transversal e prospectivo, com 37 controlos (63 olhos) e 33 doentes com neuropatia óptica glaucomatosa (55 olhos). Calculou-se o coeficiente de correlação intraclasse (CCI) e o coeficiente de variação (CV) das medições da CFN. Resultados: Verificou-se baixa variabilidade inter-examinador, intra-exame e inter-exame, com valores de CCI>0,75 e CV<10%, tanto no grupo controlo como no grupo dos doentes com glaucoma. Conclusões: O Spectralis® OCT apresenta uma excelente reprodutibilidade nas medições da CFN, validando-se como uma ferramenta útil para a monitorização da progressão do glaucoma.

Purpose: To further characterize the clinical presentation, diagnosis, and current treatment strategies of IgG4-related ophthalmic disease. Methods: Review and analysis of seven cases orbital inflammatory syndrome found to be biopsy positive for IgG4. Results: We present seven cases of IgG4-related ophthalmic disease, a previously unknown entity that has only recently been identified as a treatable systemic disorder. Management included surgical excision, systemic steroids, steroid-sparing immunosuppression, and radiotherapy. Conclusions: These cases illustrate the importance of including IgG4-related ophthalmic disease in the differential diagnosis of periorbital or orbital masses. Prompt recognition of this entity by clinicians can allow for effective treatment with corticosteroids. Treatment with steroid-sparing immune suppressants and radiotherapy has shown promise in chronic or refractory disease, nonetheless tumor excision may ultimately be necessary.

Allogeneic hematopoietic stem cell transplantation is considered the standard of care for hematological and lymphoid malignancies. One of the complications associated to this therapy is an immunemediated reaction known as graft versus host disease with repercussions towards many organs and tissues. In this article, ocular complications of graft versus host disease will be reviewed.

Resumo Objetivo: Oferecer recomendações e orientação baseadas em evidências para o tratamento da retinopatia diabética (RD) e do edema macular diabético (EMD) conforme a evidência clínica publicada recentemente e a experiência clínica. Métodos: Foi realizada pesquisa bibliográfica nos bancos de dados PubMed e Cochrane utilizando os termos “edema macular diabético” ou “retinopatia diabética” para identificar os estudos publicados de janeiro de 2008 a novembro de 2013. Posteriormente, procedeu-se pesquisa manual das referências citadas em artigos selecionados, publicados em periódicos científicos especializados. As referências identificadas nessas pesquisas bibliográficas foram revistas e apresentadas pelos membros de uma comissão de peritos em EMD na América Latina a todo o grupo durante o encontro de consenso, de dois dias de duração. Durante a reunião, os especialistas formularam recomendações levando em conta as vantagens, os riscos e os efeitos adversos das intervenções para a saúde. Níveis de evidência foram atribuídos às referências utilizadas para apoiar as recomendações com base no sistema de classificação de evidências SORT (Strength of Recommendation Taxonomy) referente à força da recomendação. Resultados: Foram formuladas 31 recomendações de consenso. Entre elas, a recomendação do controle glicêmico precoce em pacientes diabéticos para reduzir o risco de evolução da doença ocular. O grupo de especialistas também recomendou a coleta de dados epidemiológicos para definir melhor a prevalência da RD e do EMD na América Latina e definir algoritmos para o manejo e tratamento nos vários estágios da doença. Foi destacada a necessidade da triagem precoce e o desenvolvimento da infraestrutura para garantir aos que precisam um acompanhamento e tratamento adequados. Para avaliar adequadamente a evolução da doença e a resposta ao tratamento faz-se necessário realizar uma angiografia de fluorescência (AF) e uma tomografia de coerência óptica (TCO). Com base em evidências de alto nível, recomendamos ranibizumabe como o padrão-ouro para o tratamento do EMD e a fotocoagulação panretiniana (FPR) com o padrão-ouro para a RD proliferativa. A vitrectomia deve ser considerada na presença de tração macular ou se o edema não responder à farmacoterapia. Como os esteroides intravítreos dão lugar a uma redução do edema, eles podem ser utilizados para melhorar os efeitos de outros tratamentos, bem como em olhos pseudofácicos. Finalmente, ao selecionar um tratamento para a RD ou o EMD, é de especial importância considerar o estado de saúde geral do paciente. Conclusão: Embora essas diretrizes não pretendam substituir a decisão clínica profissional individual, elas devem ajudar a otimizar o tratamento do EMD na América Latina e garantir que os pacientes recebam a melhor atenção disponível e de maneira oportuna.

Resumen Objetivo: Ofrecer recomendaciones y orientación basadas en la evidencia para el tratamiento de la retinopatía diabética (RD) y del edema macular diabético (EMD) según la evidencia clínica publicada recientemente y la experiencia clínica. Métodos: Se realizó una búsqueda bibliográfica en las bases de datos PubMed y Cochrane utilizando los términos “edema macular diabético” o “retinopatía diabética” para identificar los estudios publicados de enero de 2008 a noviembre de 2013. Después de esto se realizó una búsqueda manual de referencias citadas en artículos selectos publicados en revistas revisadas por expertos, y se realizó una búsqueda manual de referencias citadas en artículos selectos publicados en revistas científicas revisadas por expertos. Los miembros del panel de expertos en EMD de América Latina revisaron las referencias identificadas en estas búsquedas de bibliografía y las presentaron ante el grupo en pleno durante la reunión de consenso, de dos días de duración. Durante esta reunión, los expertos formularon recomendaciones teniendo en cuenta los beneficios, riesgos y efectos adversos de las intervenciones para la salud. Se asignó a las referencias utilizadas como respaldo de las recomendaciones un nivel de evidencia basado en el sistema de clasificación de evidencias SORT (Strength of Recommendation Taxonomy) referente a la fortaleza de la recomendación. Resultados: Se formularon 31 recomendaciones consensuadas. Entre ellas se incluyeron la recomendación del control glucémico precoz en pacientes diabéticos a fin de reducir el riesgo de avance de la enfermedad ocular. El panel de expertos recomendó también la recolección de datos epidemiológicos para definir mejor la prevalencia de la RD y el EMD en América Latina, y definir algoritmos para el manejo y tratamiento en varios estadios de la enfermedad. Se hace un mayor énfasis en la necesidad de evaluación precoz y del desarrollo de infraestructura para garantizar a quienes necesitan un seguimiento y tratamiento adecuados. Tanto la angiografía con fluoresceína (AF) y la tomografía de coherencia óptica (TCO) son necesarias para la evaluación adecuada de la evolución de la enfermedad y la respuesta a la terapia. Sobre la base de evidencias de alto nivel, recomendamos el ranibizumab como la regla de oro para el tratamiento del EMD y la fotocoagulación panretiniana (FPR) como la regla de oro para la RD. Debe tenerse en cuenta una vitrectomía ante la presencia de una tracción macular o si el edema no responde a la farmacoterapia. Como los esteroides intravítreos generan una reducción del edema, se pueden usar para mejorar los efectos de otros tratamientos y también en ojos pseudofáquicos. Finalmente, al seleccionar un tratamiento para la RD o el EMD, es particularmente importante tener en cuenta el estado de salud general del paciente. Conclusión: Si bien estas pautas no pretenden ser un reemplazo del criterio clínico, deben ayudar a optimizar el tratamiento del EMD en América Latina y garantizar que los pacientes reciban la mejor atención disponible en tiempo y forma.

Purpose: To provide evidence-based recommendations and guidance for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) based on recently published clinical evidence and clinical experience. Methods: A literature search using PubMed and the Cochrane Library was performed with the terms “diabetic macular edema” or “diabetic retinopathy” to identify studies published from January 2008 to November 2013. This was followed by a manual search of references cited in selected papers published in peer-reviewed journals. The references identified in these literature searches were reviewed and presented by members of the Latin America DME expert panel to the entire group during the 2-day consensus meeting. During this meeting, the experts formulated recommendations with consideration of the health benefits, risks, and adverse effects of interventions. References used to support recommendations were assigned a level of evidence based on the Strength of Recommendation Taxonomy (SORT) evidence rating system. Results: Thirty-one consensus recommendations were formulated. These include the recommendation for early glycemic control in diabetic patients in order to reduce the risk of progression of ocular disease. The expert panel also recommended the collection of epidemiological data to further define the prevalence of DR and DME in Latin America and to establish management and treatment algorithms for various stages of the disease. The need for early screening and development of infrastructure to ensure appropriate follow-up and treatment of those in need is further emphasized. Both fluorescein angiography (FA) and optical coherence tomography (OCT) are needed for proper assessment of disease progression and response to therapy. Based on available high-level evidence, we recommend ranibizumab as the gold standard for the treatment of DME and panretinal photocoagulation (PRP) as the gold standard for proliferative DR. Vitrectomy should be considered in the presence of macular traction or if edema is not responding to pharmacological therapy. As intravitreal steroids provide a reduction in edema, they can be used to ameliorate the effects of other therapies as well as in pseudophakic eyes. Finally, when selecting a therapy for DR and/or DME, it is of particular importance to consider the general health status of a patient. Conclusion: Although these guidelines are not intended to be a replacement for clinical judgment, they should help to streamline the management of DME across Latin America and ensure that patients receive the best available care in a timely manner.

An 8-year-old girl, who underwent pars plana lensectomy and vitrectomy for non-infectious uveitis, was treated with a dexamethasone intravitreal implant (Ozurdex^®, Allergan Inc., Irvine CA), because of the persistence of cystoid macular edema. The implant migrated into the anterior chamber; however, no cornea edema was detected and a complete resolution of macular edema was observed.

Resumen Objetivo: Determinar las modificaciones de la curvatura posterior de la córnea en pacientes a los que se realizó queratomileusis subepitelial asistida por laser miópico en el período de abril a noviembre 2011. Método: Fueron estudiados 15 pacientes (29 ojos), a los que se realizó queratomileusis subepitelial asistida por laser miópico. Se analizaron variables como edad, sexo, equivalente esférico, paquimetría preoperatoria, cantidad de ablación, estroma residual y diferencia de elevación posterior corneal, esta última obtenida del mapa de diferencia del tomógrafo Pentacam HR con medición preoperatoria, al mes y tres meses de la cirugía. Se realizó análisis de regresión múltiple. Resultados: El equivalente esferico, la paquimetria, cantidad de ablacion y el estroma residual se encontraron dentro de los parametros de seguridad establecidos. La diferencia promedio de la elevacion posterior corneal fue de 3,3 μm al mes, disminuyendo a 2,4 μm a los tres meses. Se observo relacion con la cantidad de ablacion y el estroma residual. Conclusiones: La queratomileusis subepitelial asistida por laser determinó modificaciones en la superficie corneal posterior, las cuales fueron más evidentes en el primer mes del posoperatorio. El estroma residual fue el factor más relacionado con estas modificaciones. Palabras clave: LASEK, elevación corneal posterior, paquimetría, estroma residual, total de ablación. Abstract Purpose: To determine the posterior corneal surface forward shift in myopic patients after laser-assisted subepithelial keratectomy from April to November 2011. Material and methods: Fifteen patients (29 eyes) were submitted to laserassisted subepithelial keratectomy surgery. Age, sex, spherical equivalent, preoperative corneal thickness, total ablation, residual bed thickness and variations in the posterior corneal surface elevation were evaluated. Posterior corneal surface elevation maps were assessed by Pentacam HR tomography and compared with the data of maps obtained prior to the surgery, one and 3 months after the procedure. Results: The spherical equivalent, pachymetry, microns of ablation and residual bed thickness were within the established parameters. The posterior corneal surface displayed a forward shift of 3,3 μm after a month and 2,4 μm three months later. A relation was found between total ablation, and residual bed thickness. Stepwise lineal multiple regression was used. Conclusions: The use of the laserassisted subepithelial keratectomy determined a forward shift of the posterior corneal surface in the early postoperative that gradually decreased. Residual bed thickness was a relevant factor associated to this change.

Age-related macular degeneration (AMD) is a chronic disease affecting the retina and is the most common cause of blindness in the ageing population in the developed world. Correct and timely diagnosis and classification allows physicians to estimate which patients are at high risk of progressing to more advanced stages of the disease In February 2012, 23 Latin American experts met in Cartagena, Colombia, to develop a Consensus on AMD. This paper summarizes the main points of the discussions including definitions, diagnosis, antiangiogenic treatments, and hopes for the future. Dry AMD remains untreatable but results from promising Phase II trials are awaited eagerly. Antiangiogenics, such as the licensed vascular endothelial growth factor (VEGF) inhibitors, aflibercept and ranibizumab, have revolutionized the treatment of wet AMD in recent years. These drugs work by inhibiting the choroidal neovascularization that causes the rapid vision loss in wet AMD. Another antiangiogenic, bevacizumab, is also commonly used off-label, but is not approved currently for intraocular use. However, barriers to treatment compliance, due to the frequency of monthly injections, can also affect the efficacy of these antiangiogenic therapies. Aflibercept has a longer duration of action compared with other treatments and thereby offers reduced injection frequency. By relieving patients of the need for monthly visits, it can help reduce the growing burden of AMD patients on healthcare resources.

We report a case of adult-onset foveomacular vitelliform dystrophy complicated with atrophic involution and subsequent choroidal neovascularization and treated with intravitreal ranibizumab. A 71-year-old woman diagnosed with adult-onset foveomacular vitelliform dystrophy experienced a progression of the vitelliform lesion to the atrophic stage in her left eye immediately after cataract surgery. Best-corrected visual acuity decreased from 0.5 to 0.16. Ten months later, the patient was referred with new worsening of her visual acuity (0.05) and metamorphopsia. The spectral-domain optical coherence tomography confirmed the presence of type 2 choroidal neovascularization next to the atrophic area. The patient was treated with 2 monthly injections of ranibizumab. Spectral-domain optical coherence tomography images improved significantly and her best-corrected visual acuity increased to 0.20 associated with subjective improvement of metamorphopsia. Ranibizumab may be effective for choroidal neovascularization in patients with adult-onset foveomacular vitelliform dystrophy.

Purpose: To present six cases of macular suberetinal hemorrhage who underwent intravitreal treatment with rtPA, ranibizumab and SF₆. Methods: Size and location of the hemorrhage and visual acuity were evaluated prior and after treatment. Results: Mean pretreatment visual acuity was hand movements at one meter, and three months later, 0.18 (decimal notation) (p>0.05). A partial displacement of de suberetinal hemorrhage from the fovea was achieved in all patients. Discussion: This triple procedure is an useful option for the treatment of suberetinal hemorrhage. However, the tissular damage associated to the subjacent disease in some cases does not allow significant functional improvement.

Purpose: To analyze the prevalence and morphometric characteristics of macular hole development in patients with neovascular age-related macular degeneration treated with ranibizumab. Methods: Patients diagnosed of neovascular age-related macular degeneration from January 2009 to December 2010 have been analyzed. Measurement of visual acuity and optical coherence tomography were scheduled. Results: Two hundred and thirteen eyes (patients) with exudative age-related macular degeneration were analyzed. Development of macular hole was evidenced in 4 eyes (1,9%) Discussion: Macular hole formation is a severe complication in patients with choroidal neovascularization treated with ranibizumab, frequently undervalued, which interferes with final outcome.

This article reviews the Bayesian statistical approach to diagnostic test analysis and application in the management of glaucoma patients. The central idea of the Bayesian method is the use of study data to update the state of knowledge about a quantity of interest. In diagnostic test analysis, the Bayesian approach explicitly elicits a clear interpretation of chances of a particular eye disease given a positive test result. The Bayesian method also provides a reasonable rationale for deciding whether to perform a laser iridotomy in a patient with occludable angles. We present several literature examples of Bayesian methods in practice, especially as it relates to glaucoma evaluation and progression.

Purpose: To review two cases of open angle glaucoma(OAG) refractory to medical and surgical treatment that underwent a novel surgical technique. Methods: Case reports of a novel surgical technique which consists in a trabeculectomy with Mitomycin C and aqueous diversion to the suprachoroidal space. Results: The target intraocular pressure remains stable after surgery without using any medical treatment. No severe complications were observed during follow-up. Conclusion: Managing intraocular pressure in refractory glaucoma has always been a challenge, and the need of both surgical and medical approaches is common. This novel surgical technique has the advantage of using 2 filtering pathways, which allows an adequate aqueous humor drainage even if one of the pathways fails.

We report the occurrence and management of a massive serous detachment of the macula, which followed trabeculectomy and lowering of the intraocular pressure (IOP) in a patient with central retinal vein occlusion (CRVO) and a previously undiagnosed complex coagulopathy with elevated plasma fibrinogen and homocysteine levels, as well as prothrombin 20210 and factor V Leiden mutations. Our case illustrates prompt resolution of the serous detachment with elevation of the IOP, and acute recurrence of the detachment following subsequent recurrence of hypotony after aqueous tube shunt surgery. Residual cystoid macular edema (CME) in the right eye, as well as hemiretinal vein occlusion with serous macular detachment and CME in the fellow left eye responded to bevacizumab. The occurrence of severe macular edema following lowering of intraocular pressure may warrant further evaluation for possible underlying venous occlusive disease or systemic coagulopathy.

PURPOSE To summarize the original literature on ab interno trabeculectomy with the Trabectome system and to review its efficacy and safety in the treatment of glaucoma. METHOD A literature search in PubMed was performed on ab interno trabeculectomy with the Trabectome system, and clinical relevant information was reviewed and summarized. RESULTS Ab interno trabeculectomy with the Trabectome system on average lowered intraocular pressure (IOP) to the mid-teens, and decreased the number of required glaucoma medications. Greater preoperative IOP correlated to a greater percent reduction in IOP. The success rates varied among studies, and the definition of success differed by authors. Intraoperative blood reflux was found in nearly all cases. Incidences of early hypotony and IOP spikes were low. No cases of endophthalmitis, wound leak, aqueous misdirection, choroidal hemorrhage or effusions, and irreversible visual acuity decrease (≥2 Snellen lines) have been reported. Available studies had a significant amount of data overlap. Only limited data on long-term results was available. There was no randomized controlled trial to date. CONCLUSIONS Ab interno trabeculectomy with the Trabectome system is an effective and safe surgical approach for patients with various types of open angle glaucoma. On average, the procedure at least in the short term lowers IOP to the mid teens regardless of preoperative IOP with or without the aid of topical medications.

Purpose: To report the results of a Latin American (LA) consensus panel regarding the diagnosis and management of primary open angle glaucoma, and to compare these results with those from a similar panel in the United States (US). Design: A RAND-like appropriateness methodology was used to assess glaucoma practice in LA. Methods: The 148 polling statements created for the RAND- like analysis in the US and 10 additional statements specific to glaucoma care in LA were presented to a panel of LA glaucoma experts. Panelists were polled in private using the RAND- like methodology prior to and after a panel meeting. Results: Consensus agreement or disagreement amongst LA experts was reached for 51.3% of statements prior to the meeting and increased to 66.5% in the private, anonymous post meeting polling (79.0% agreement, 21.0% disagreement). While there was a high degree of concordance (111 of 148 statements, 75%) between the results of this LA panel and the US panel, there were some notable exceptions relating to diagnostic and therapeutic decision-making. Conclusions: This RAND-like consensus methodology provides a perspective of how LA glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the US. These findings may be helpful to ophthalmologists providing glaucoma care in LA and in other regions of the world.

This report is about a 10 year old patient who was diagnosed with congenital glaucoma of both eyes. He underwent cataract surgery, filtering surgery, and diode laser ciclophotocoagulation before the insertion of Ahmed valve with mytomicine C in both eyes. The postoperative control of intraocular pressure was achieved in the right eye with topic timolol 0.5% twice a day. In the left eye encapsulated bleb, tube obstruction and endophthalmitis occurred. Authors described and discuss the management of surgical complications in the left eye. The implant of two Ahmed valve with mytomicine C, one of them at the inferior quadrant, predisposes to severe postoperative complications in refractory congenital glaucoma associated to aphaquia. To guarantee the success of IOP control and the preservation of visual functions, it is necessary a careful postoperative follow-up. Resumen El presente reporte es de un paciente masculino de 10 años de edad con diagnóstico de glaucoma congénito ambos ojos y antecedentes de afaquia bilateral, trabeculotomía asociada a trabeculectomía y ciclofotocoagulación transescleral fallidas; al que se le realizó implante valvular de Ahmed con mitomicina C en ambos ojos. Se logró control postoperatorio de la presión intraocular en ojo derecho con colirio timolol 0.5% dos veces al día. En el ojo izquierdo se presentó ampolla encapsulada, obstrucción del tubo de drenaje y endoftalmitis. Se describe y discute el manejo de estas complicaciones quirúrgicas. La colocación de dos válvulas de Ahmed con mitomicina C, una de ellas en el cuadrante inferior, predispone al desarrollo de severas complicaciones oculares en el glaucoma congénito refractario asociado a afaquia. El seguimiento postoperatorio estrecho garantiza el diagnóstico y tratamiento oportuno de las mismas.

Introduction: Congenital Ocular Melanocytosis (COM) is an infrequent disease (0,038% in Caucasian population), characterized by increase in number, size and pigmentation of melanocytes. It has been associated with ophthalmological diseases like uveal melanoma and glaucoma, and also with systemic pathologies, as Idiopathic Intracranial Hypertension, and delayed psycho-intellectual development. Clinical case: a 7-year-old female, who shows, as casual finding, iris hyperchromia in left eye, and grayish- blue multifocal pigmentation in episclera, which does not move with exploration, compatible with diagnosis of COM. The patient complains of repetitive urinary infections, so she is referred to Nephrology department, and a CUMS (Retrograde cistouretrography) is performed, establishing the diagnostic of severe vesicoureteral reflux (VUR). Discussion: There are several reports in literature related to the association between dermal hipo or hyperpigmentation and renal pathology. VUR has also been described in relation to hypomelanosis of Ito, pseudomelanosis duodeni and retinal pigment epithelium alterations. However, this is the first report in literature of Congenital Ocular Melanocytosis associated with severe Vesico-Ureteral Reflux.

Floppy eyelid syndrome is an uncommon condition characterized by rubbery and loose upper eyelid that may evert spontaneously during sleep and result in a chronic papillary conjunctivitis. Neurofibromatosis type 1 is an autosomal phacomatosis that may affect the eyelid causing mechanical blepharoptosis and lid deformation. The authors describe a case of a 58-year-old man with no previous history of neurofibromatosis who presented a plexiform neurofibroma in the eyelid simulating floppy eyelid syndrome Resumo Síndrome da frouxidão palpebral é uma condição rara caracterizada pela presença de pálpebras superiores mais elásticas que podem everter espontaneamente durante o sono e resultar em uma conjuntivite papilar crônica. A neurofibromatose tipo 1 é uma facomatose autossômica que pode afetar a pálpebra causando blefaroptose mecânica e deformações. Os autores descrevem um caso de um homem de 58 anos de idade sem historia previa de neurofibromatose que apresenta-se com neurofibroma plexiforme da pálpebra simulando a síndrome da frouxidão palpebral.

Introduction: Cockayne syndrome is an autosomal recessive disorder, with two fundamental characteristics: profound postnatal changes in physical and intellectual development and premature aging with progressive multi-organ degeneration. Retinal dystrophy, enophthalmos, optic nerve atrophy, nystagmus, dry eye, corneal infiltrates and band keratopathy are typical ophthalmological findings. Clinical cases: We describe two cases of the same family, with emphasis on ocular manifestations and their management. In the first, there was macular pigment dispersion, coroidosis, retinal vasculature attenuation, optic atrophy, and band keratopathy. The second case had cataracts, miosis, pigmentary retinopathy, retinal vascular attenuation and band keratopathy. Conclusion: The ophthalmological approach to these patients is difficult since any surgical procedure is hampered by enophthalmos, poor pupil dilation and systemic manifestations that complicate the anesthetic procedures. The intention of these cases is to alert clinicians to this rare, inherited and fatal disorder, which leads to ocular and systemic manifestations that are difficult to manage. Resumo Introdução: Síndrome de Cockayne é uma doença autossómica recessiva rara, com duas características: alterações profundas no desenvolvimento físico e intelectual pós-natal e envelhecimento prematuro com degeneração multi-orgânica progressiva. São achados oculares característicos: distrofia retiniana, enoftalmia, atrofia óptica, nistagmo, olho seco, infiltrados corneanos, queratopatia em banda, entre outros. Casos clínicos: Descrevem-se dois casos da mesma família, dando especial ênfase às manifestações oculares e sua abordagem. No primeiro, observou-se dispersão pigmentar macular, coroidose, vasculatura retiniana atenuada, atrofia óptica, miose e queratite em banda. O segundo caso apresenta cataratas, miose, retinopatia pigmentar, vasculatura retiniana atenuada e queratopatia em banda. Conclusões: A abordagem oftalmológica destes doentes é difícil uma vez que qualquer procedimento cirúrgico é dificultado pela enoftalmia, má dilatação pupilar e pelas manifestações sistémicas que complicam a anestesia. Pretende-se alertar para esta entidade rara, hereditária, que cursa com alterações oculares e sistémicas múltiplas de difícil resolução e que evoluem progressivamente para a morte.

Resumen Paciente de 79 años de edad, con antecedentes desde 2002 de carcinoma pulmonar a células pequeñas. Tratada con quimioterapia estándar y de rescate. En 2005 presentó disminución de la visión en OD .En el fondo de ojo reveló dos masas coroideas con líquido subretinal. Por la ausencia de progresión del tumor, duda en el diagnóstico inicial, se indicó biopsia aspirativa con aguja fina (PAAF). La PAAF mostró características celulares de un carcinoma neuroendocrino de bajo grado. El paciente fue tratado con placa de rutenio 106. En el último seguimiento, la agudeza visual mejoró y se redujeron los tumores coroideas. Abstract A 79 year old female patient with a history of a small cell lung carcinoma since 2002. Treated with standard and rescue chemotherapy. In 2005 showed decreased of acuity vision in RE. The fundus examination revealed two choroidal mass with subretinal fluid. Because the absence of tumor progression and doubt on the original diagnosis, was indicating fine needle aspiration biopsy (FNAB). The FNAB showed cellular characteristics of a low-grade neuroendocrine carcinoma. The patient was treated with a plaque of ruthenium 106. At the last follow-up, improved acuity vision and reduced the choroidal tumors.

Introduction: Topiramate is an anticonvulsant drug used to treat epilepsy. It is also approved for, and now most frequently prescribed for, the prevention of migraines. A serious but not often discussed side effect of the drug is the development of acute myopia and acute angle-closure glaucoma in the early stage of therapy. Case report: A 45-year-old woman presented at the emergency department with bilateral blurred vision two weeks after beginning topiramate therapy for the prevention of migraines. Ophthalmological evaluation revealed a BCVA of 20/25 OU with -3,75 D OD and -4,50 D OS. Intraocular pressures were 30 mmHg OD and 42 mmHg OS. Biomicroscopy showed shallow anterior chambers and gonioscopy revealed closed angles bilaterally. She also performed an anterior segment exam with Pentacam® that showed anterior displacement of the lens-iris diaphragm with consequent narrow angles OU. The symptoms and clinical findings resolved completely upon cessation of topiramate and treatment with topic antiglaucoma drugs. Anterior chamber parameters and central corneal thickness were documented by Pentacam®. Conclusions: Topiramate use may cause acute angle-closure glaucoma and myopia, which are reversible upon discontinuation of the drug. Visual outcome is usually good and the episode resolves within a few weeks. Physicians should recognize this condition educating patients about these serious adverse effects and promoting ophthalmological screening prior to prescribing topiramate. RESUMO Introdução: O topiramato é um anticonvulsivante destinado a tratar a epilepsia. Também está aprovado na prevenção da enxaqueca, sendo muitas vezes prescrito com este objectivo. Um efeito adverso grave e nem sempre discutido é o desenvolvimento de miopia aguda e glaucoma de ângulo fechado nas fases iniciais do tratamento. Caso clínico: Mulher de 45 anos, recorreu ao serviço de urgência por visão turva bilateral, 2 semanas após o início de terapêutica com topiramato para a prevenção de enxaqueca. O exame oftalmológico revelou acuidades visuais de 20/25 OU com correcção de -3,75 D no OD e -4,50 D no OE. As pressões intra-oculares eram de 30 mmHg no OD e 42 mmHg no OE. A biomicroscopia mostrou câmaras anteriores baixas (rasas) e a gonioscopia revelou ângulos fechados bilateralmente. Foi também realizado estudo do segmento anterior com o Pentacam® que mostrou um deslocamento anterior do diafragma íris-cristalino com consequentes ângulos fechados em ODE. Os sintomas e achados clínicos reverteram-se completamente após cessação do medicamento topiramato e tratamento com anti-glaucomatosos tópicos. Os parâmetros da câmara anterior e a espessura central da córnea foram documentados pelo Pentacam®. Conclusões: O uso de topiramato pode causar glaucoma de ângulo fechado e miopia que são reversíveis com a suspensão do fármaco. O prognóstico visual é geralmente bom e o episódio resolve-se em algumas semanas quando o diagnóstico é feito prontamente. Porém, a administração de topiramato deveria ser seguida de informação aos pacientes quanto aos efeitos adversos além de completo exame oftalmológico prévio. Palavras-chave: Glaucoma de ângulo fechado; Miopia aguda; Pentacam; Pressão intra-ocular; Topiramato.

Objectives: To describe Jones tube surgery with a technique employing an endocanalicular Diode laser and endoscopic control, and to evaluate the results obtained. Method: Retrospective study of 22 patients with a maximum follow-up of 30 months. Results: Only two tubes did not function correctly and were removed with time. The remainder were succesful using this alternative technique. Conclusión: Jones tube surgery with the endocanalicular laser is a minimally invasive technique that achieves successful results in more than 90% of cases and presents advantages relative to the conventional technique. Resumen Objetivos: Describir la cirugía de Jones mediante una técnica que emplea Diodo Láser por vía endocanalicular y control endoscópico. Evaluar los resultados obtenidos. Método: Estudio retrospectivo de 22 pacientes con seguimiento máximo de 30 meses. Resultados: Sólo dos tubos no funcionaron correctamente y fueron extraídos al cabo de un tiempo. El resto, con distintas alternativas fueron exitosos. Conclusión: La cirugía de Jones con láser endocanalicular es una técnica mínimamente invasiva que logra más de un 90% de resultados exitosos y presenta ventajas respecto a la técnica convencional.

Objective: To find the clinical–pathologic characteristics of three cases of melanocytic lesions of ocular adnexes. Methods: A retrospective study was done with three patients of the National Eye Institute of Perú. Results: The first case was an oculo-dermal melanocytosis o nevo of Ota, in a 36 year-old women, with congenital flat pigmentation of the inferior eyelid and melanosis oculi in the right eye. The second case was a 32 year-old female patient with Xeroderma pigmentosum, who had three nodular pigmented lesions in the right inferior lid. The histopathologic diagnosis was a pigmented basal cell carcinoma. The third case was a 54 year-old female patient who had a histopathologic diagnosis of melanoma in right inferior lid and basal cell carcinoma in left inferior lid. Surgical resection of the tumors in both eyes was done. One year later a palpebralorbital recurrence presented in the melanoma case. Conclusions: The first case of oculodermal melanocytosis didn't develop uveal melanoma. The patient had pigmented eyelid skin. The case 2 with typical Xeroderma pigmentosum developed a pigmented basal carcinoma in right eye and a squamous cell carcinoma in left eye, but it was atypical because the initial symptomathology developed when the patient was 14 years old. The case 3 of malignant melanoma of the eyelid of right eye and basal cell carcinoma of the eyelid of left eye had a melanoma recurrence one year after the resection of the tumor, due to a large neoplasia and to the epithelioid histopathologic type wich is very aggressive. Resumen Objetivos: Presentar 3 casos de lesiones melanocíticas en anexos oculares con el fin de examinar sus características clínicas e histopatológicas. Métodos: Se realizó un estudio retrospectivo. Se incluyeron 3 pacientes del Instituto Nacional de Oftalmología. Se analizaron sus características clínicas e histopatológicas. Resultados: El primer caso correspondió a melanocitosis oculodérmica, en una mujer de 36 años, que presentó pigmentación congénita plana del párpado inferior derecho y melanosis óculi. El segundo caso fue una mujer de 32 años de edad con xeroderma pigmentoso, que presentó lesiones nodulares pigmentadas en el párpado inferior del O.D, el cual se llegó al diagnosticó histopatológico de carcinoma basocelular pigmentado. Tuvo también un carcinoma escamoso conjuntival en O.I. El tercer caso correspondió a una mujer de 54 años que tuvo un diagnóstico histopatológico de melanoma del párpado inferior derecho y de carcinoma basocelular del párpado inferior izquierdo. Se hizo una resección quirúrgica de los tumores de ambos ojos. Un año después hubo una recurrencia pálpebro-orbitaria en el caso del melanoma. Conclusiones: El caso 1 de la melanosis oculodérmica no desarrolló melanoma de la uvea. Sólo tuvo problemas estéticos en la piel. El caso 2 de xeroderma pigmentosum fue típico en el sentido que desarrolló carcinoma basocelular pigmentado en el ojo derecho y carcinoma escamoso en el ojo izquierdo, pero fue atípico en el sentido que la sintomatología fue de inicio tardío es decir a los 14 años. El caso 3 de melanoma maligno de la piel del párpado del ojo derecho y de carcinoma basocelular del ojo izquierdo, tuvo una recurrencia del melanoma 1 año después de operada, por ser el tumor muy grande y por tener un tipo histopatológico epitelioide, que es muy agresivo.

Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels from the retina or optic nerve, is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab on DR including DME and PDR. The results indicate that intravitreal bevacizumab injections may have a beneficial effect on macular thickness and visual acuity (VA), independent of the type of macular edema that is present. Therefore, in the future this new treatment modality could replace or complement focal/grid laser photocoagulation in DME. In addition, in PDR, this new option could be an adjuvant agent to pan-retinal photocoagulation so that more selective therapy may be applied.

Vascular endothelial growth factor (VEGF) plays an important role in many diseases of the posterior segment of the eye that are characterized by macular edema and intraocular neovascularization. Recently, anti-VEGF agents such as pegaptanib sodium and ranibizumab have been shown to be of benefit in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). However, in many parts of the world both pegaptanib sodium and ranibizumab are not readily available. Bevacizumab is a humanized recombinant monoclonal antibody against all VEGF isoforms. It has been proposed as an alternate treatment since it is more readily available. Since October 2005, investigators from Pan-American Collaborative Retina Study Group (PACORES) have tretaed patients with different vitreo-retinal pathologies with intravitreal bevacizumab. In our retrospective studies of relatively short follow-up, we have observed both functional and anatomic improvements in an important group of patients with diseases such as CNV secondary to different etiologies such as myopia and AMD, diabetic macular edema, as an adjuvant in proliferative diabetic retinopathy, macular edema secondary to venous vascular occlusions and pseudo-phakic cystoid macular edema. We believe that our results are promising. However, further studies are needed to determine the dose, injection interval, the number of injections and the long term safely, among other issues. El factor de crecimiento vascular endotelial (VEGF por sus en inglés, Vascular Endothelial Growth Factor) juega un papel importante en muchas enfermedades del segmento posterior que se caracterizan por edema macular y neovascularización intraocular. Recientemente, se ha demostrado la eficacia de fármacos anti-VEGF como el ranibizumab y el pegaptabib sodio en la neovascularización coroidea (NVC) secundaria a la degeneración macular relacionada a la edad (DMRE). Sin embargo en muchas partes del mundo, tanto el pegaptanib sodio como el ranibizumab no se encuentran fácilmente disponibles. El bevacizumab es un anticuerpo monoclonal recombinado humanizado que se adhiere e inhibe todas las isoformas del VEGF. Este se ha propuesto como un tratamiento alternativo ya que es fácil de obtener. Desde octubre del 2005, los investigadores del grupo PACORES (Pan-American Collaborative Retina Study Group) hemos utilizado el bevacizumab intra-vítreo en diferentes patologías vitreoretinianas. En nuestros estudios retrospectivos de seguimiento relativamente corto, hemos observado mejoría anatómica y funcional en un grupo importante de pacientes con patologías como la NVC secundaria a diferentes etiologías incluyendo la DMRE y miopía, edema macular diabético, como adyuvante en la retinopatía diabética proliferativa (RDP), edemas maculares secundarios a oclusiones retinales venosas y edema macular cistoideo pseudofáquico. Creemos que los resultados son prometedores pero se requieren de más estudios para determinar la dosis, el intervalo entre tratamientos, el número de tratamientos y la seguridad a largo plazo entre otras consideraciones.

HSV stromal keratitis is a frequent cause of ocular and visual morbidity. There are three recognized clinical forms: interstitial, disciform (endotheliitis), and necrotizing stromal keratitis, which all differ clinically as well as pathophysiologically. Although treatment for epithelial HSV keratitis has been standardized, it still remains controversial for the stromal form. The goal and challenge in the treatment lies in the balance of the inflammation generated by the host's immune system, and the infection from the virus. Several studies, including the cornerstone HEDS studies, consolidated the benefit of combined corticosteroid and antiviral therapy in the treatment of all forms of HSV stromal keratitis. Most studies used topical trifluridine as antiviral of choice, however several studies have demonstrated that oral acyclovir (or valacyclovir) along with topical corticosteroids is an equivalent and effective therapy, and avoids the often underestimated epithelial toxicity of long-term topical trifluridine. Prophylaxis from recurrences with oral acyclovir (or valacyclovir) is essential in the management of these patients due to the frequent relapses and its consequence on visual prognosis.

Objective: To evaluate the efficacy of topical anesthesia and topical + intracameral anesthesia in phacoemulsification of different opacity grade cataracts. Material and Methods: 128 patients underwent with phacoemulsification and foldable intraocular lens implantation. The patients were divided into two groups: topical anesthesia only (n=64) and topical + intracameral anesthesia (n=64) with preservative free 1% lidocaine added to the infusion solution. Cataract opacity grade, intra-operative and immediate post-operative pain as well as vital signs were recorded. Results: Mean age of 68.4 years ± 2.7 D (49-90), 67 females (52.34%) and 61 males (47.66%). Cataract opacity grades were as follows: II (18%), III (61.7%), IV and greater (20.3%). Thirteen patients experienced mild pain: 9 (7%) in the topical anesthesia group during nuclear rotation and 4 (3%) in the topical + intracameral anesthesia group during insertion of the phaco needle into the anterior chamber. (p= 0.14) Vital signs were stable. Conclusion: Topical anesthesia is both safe and effective in phacoemulsification. Topical + intracameral anesthesia is more appropriate for cases with cataracts of greater density. RESUMEN Objetivo: Evaluar la efectividad de la anestesia tópica sola y anestesia tópica e intracameral en diferentes grados de cataratas tratadas con facoemulsificación. Material y Método: Se revisaron 128 pacientes con catarata y sometidos a facoemulsificación e implante de lente intraocular plegable. Se dividieron en dos grupos: grupo de anestesia tópica (n=64) y grupo de anestesia tópica e intracameral (n=64) con lidocaína al 1% libre de conservadores administrada a la infusión de irrigación. Se registraron tipo de catarata, dolor trans y post operatorio inmediato y signos vitales. Resultados: La edad media fue de 68.4 ± 2.7 D (49-90), 67 mujeres (52.34%) y 61 hombres (47.66%). Las cataratas se distribuyeron en los siguientes grados: II (18%), III (61.7%), IV y mayor (20.3%). Trece pacientes presentaron leve dolor, 9 (7%) del grupo con anestesia tópica al rotar el núcleo en cataratas grado IV y 4 (3%) en el grupo de tópica e intracameral, durante la introducción de la pieza de mano a la cámara anterior. (p=0.14) Signos vitales eran estables. Conclusión: La anestesia tópica es segura y efectiva en facoemulsificación, la anestesia tópica e intracameral es mejor en casos de catarata de mayor densidad

Se realiza un estudio descriptivo prospectivo con un grupo de 45 pacientes remitidos por primera vez a nuestro servicio, portadores de algunas de las enfermedades reumáticas. De ellos 37 (82%), presentaban o habían presentado en algún momento uveítis anterior u otros tipos de alteraciones del segmento anterior. Se halla igual número de casos para ambos sexos y el 20% era menor de 5 años. Estos pacientes en su gran mayoría no presentaron, ni síntomas ni signos que hicieran sospechar que se estaba desarrollando una enfermedad ocular. La mayoría tenía diagnóstico de Artritis Idiopática Juvenil. Los hallazgos más relevantes en la lámpara de hendidura fueron la presencia de pigmentos y sinequias. Todos los casos recibieron tratamiento local, asociado o no a tratamiento sistémico (esteroide y/o inmunosupresor). La evolución fue satisfactoria en la mayoría de los pacientes.

PURPOSE: To determine the efficacy of isopropyl alcohol 70% versus sodium hypo-chlorite in the disinfection of Goldmann tonometer prism in a clinical setting. DESIGN: Prospective, randomized, comparative clinical study. METHODS: Isopropyl alcohol 70% and sodium hypochlorite were compared to a control group in a total of eighty-one tonometer prisms used in different patients. MAIN OUTCOME MEASURES: Efficacy of isopropyl alcohol 70% and sodium hypo-chlorite in the disinfection of Goldmann tonometer prism. RESULTS: No statistical difference was found between isopropyl alcohol 70% and sodium hypochlorite in bacterial elimination (100%) compared to the control group. CONCLUSION: Results suggest that tonometer prism disinfection might not be necessary unless infection susceptibility factors such as corneal deformities and conjunctivitis or systemic infections are present.

Acanthamoeba keratitis is a sight-threatening corneal infection, which is rare, but may be increasing in frequency. The spectrum of disease ranges from mild, with an excellent prognosis, to severe and complicated with significantmorbidity. Its diagnosis is frequently delayed and the index of suspicion needs to be high, particularly in cases of atypical keratitis in contact lens wearers. Prolonged medical therapy with multiple anti-amoebal agents is usually required and penetrating keratoplasty is sometimes necessary for visual rehabilitatio.

The results of preclinical and finished clinical trials revealed the efficacy of antivascular endothelial growth factor (anti-VEGF) therapy as antiangiogenic and antipermeability agents. The safety of single-dose intravitreal injections of different dosages has been established. Macugen has been the first approved anti-VEGF drug in the United States since December 2004 for the treatment of neo-vascular AMD. The results of the ongoing ranibizumab (Lucentis) trials that are currently running will need to compare to that observed with pegaptanib in similarly designed phase trials. In addition, the preliminary data from the bevacizumab SANA study and intravitreal bevacizumab (Avastin) are promising. We are looking forward to the results of the Phase III randomized trials. Probably, the combination of anti-VEGF compounds with photodynamic therapy or intravitreal steroids may be the future management of choroidal neovascularization. This article will review the current role of anti-VEGF therapy in the management of choroidal neovascularization.

Purpose: To report a case of unilateral Pneumocistis carinii (Pc) choroiditis as a primary presentation of disseminated pneumocystosis in immunocompetent patient. Materials and Methods: Clinical examination on of a 25-year-old caucasian female with cystic fibrosis and impaired left eye vision. Results: Polimerase Chain Reaction (PCR) of vitreous humor tested positive for Pc. Laboratory investigations proved her immunological competence and excluded other infeccious diseases. Choroiditis regressed after specific therapy with intravenous trimethoprim-sulfamethoxazole. Vitrectomy was performed for residual epiretinal membrane. Conclusions: Ophthalmologic examination is an important tool in the dianosis of disseminated pneumocystosis. In contrast to what is currently accepted, this case suggests that unilateral choroiditis may be caused by Pc, no matter the immunocompetence status of the patient. Resumo Objectivo: Apresentar a coroidite por Pneumocystis carinii (Pc) com as particularidades de contexto de imunocompetência, ausência de história prévia de pneumonia a Pc ou sua profilaxia, apresentação unilateral e o envolvimento do vítreo. Material e Métodos: Descreve-se o caso de um doente com fibrose quística que recorre à consulta de oftalmologia por diminuição da acuidade visual monocular esquerda. Resultados:: A investigação oftalmológica foi compatível com o diagnóstico de coroidite por Pc, identificando-se este parasita através da análise do humor vítreo por PCR do DNA. O estudo sistémico (analítico, bacteriológico, imunológico e imagiológico) não revelou patologia infecciosa concomitante e comprovou a competência imunológica. Instituiu-se terapêutica com trimetoprim-sulfametoxazol endovenoso, obtendo-se uma regressão quase completa das lesões. Procedeu-se a cirurgia vitreo-retiniana para remoção de membrana epi-retiniana residual. Conclusões: A coroidite por Pc pode ser o primeiro e único sinal de doença sistémica. O exame oftalmológico revelou-se um instrumento diagnóstico da pneumocistose disseminada, para a qual não existe teste serológico ou investigação clínica complementar específicos. Este caso sugere que o envolvimento oftalmológico pelo Pc não está limitado ao contexto da SIDA ou outras imunodeficiências. Num contexto de imunocompetência, uma coroidite unilateral com envolvimento do vítreo deverá incluir no seu diagnóstico diferencial o Pneumocystis carinii como agente etiológico responsável.

Purpose: To describe the ophthalmic coherence tomography (OCT) findings of a case of Juvenile X-linked Retinoschisis. Methods: Case report Results: OCT of the posterior pole demonstrated a diffuse cystic degeneration in the outer plexiform layer of the retina. Conclusion: OCT findings in patients with X-linked Juvenile Retinoschisis consistently demonstrate an intraretinal splitting. OCT, therefore may be helpful in the diagnosis of this rare disease.

Rosacea is a skin disease that frequently involves the eye. Chronic inflammation can lead to corneal vascularization with decreased visual acuity. Treatment of ocular rosacea includes lubricants, lid hygiene, and the use of topical and systemic medications to control inflammation. Systemic tetracyclines are the mainstay of treatment.

AIM: To assess the long term effect of intravitreal triamcinolone acetonide (IVTA) on intraocular pressure (IOP) in patients with macular edema. METHODS: A retrospective case review was performed to identify all patients treated with IVTA at a university based retina practice between March 2003 and January 2004. Baseline IOP was calculated using the mean measurement from three previous visits and changes in IOP were followed after IVTA injection. RESULTS: A total of 35 eyes of 23 patients were identified. Each patient was injected with 0.1ml (4mg) of 40mg/ml triamcinolone acetonide. Responders were defined as mild (elevation 5-10mm Hg), moderate (11-15mm Hg), and severe (over 15mm Hg elevation) elevation in IOP from baseline. 23 of the 35 eyes (66%) were classified as IVTA responders. Mean time to IOP elevation was 42 days. Of those patients with elevated IOP, 15 (65%) required topical hypotensive treatment and one patient required trabeculectomy. Eleven (48%) patients remain on topical therapy and mean time of therapy for all IOP responders was 352 days at last follow up. Nine of ten central retina vein occlusion (CRVO) patients had an elevation in IOP classified as moderate or severe. Mean IOP elevation in the CRVO group was 12.3 mm Hg. CONCLUSIONS: Elevated intraocular pressure is a frequently observed sequela of IVTA treatment and may require long term hypotensive topical medication. Preoperative diagnosis of CRVO has a strong correlation with IOP spikes requiring treatment, an increased number of antiglaucoma medications once therapy is initiated, and in some cases, filtering surgery.

Purpose: to report a case of metastatic sclerochoroidal calcification is a rare ocular entity characterized by yellow-white irregular subretinal lesions. These lesions are caused by the deposition of calcium salts at the level of the sclera and choroid, in patients with abnormal calcium and phosphate metabolism. METHODS: CASE REPORT A 52 year-old asymptomatic woman underwent a routine ophthalmic examination. Past medical history was remarkable for end-stage renal insufficiency on haemodialysis associated with secondary hyperparathyroidism. Visual acuities, anterior segment examination and intraocular pressures were within normal limits. Fundoscopic examination revealed bilateral symmetric subretinal yellow white cluster-like lesions located above the superior vascular arcades. Fluorescein angiography, ultrasonographic and computerized tomography studies were obtained; their results confirmed our clinical diagnosis of metastatic sclerochoroidal calcification. CONCLUSION Sclerochoroidal calcification, a rare and poorly recognized disease with a characteristic pattern, should be included in the differential diagnosis of yellow-white lesions in the retina. A complete anamnesis to rule out possible calcium homeostasis abnormalities can be helpful. BACKGROUND Sclerochoroidal calcification is a rare and often misdiagnosed entity^1,2 characterized by yellow-white irregular subretinal lesions. These lesions are caused by the deposition of calcium salts at the level of the sclera and choroid, and can occur in three varieties according to its origin: metastatic, dystrophic and idiopathic. Even though several cases and series have been reported in the literature,^1-5 it remains poorly recognized and is often misdiagnosed.^2-5 Thus, increased awareness of this diagnosis is warranted.

Purpose: To report the clinical picture and outcome of Behçet’s Disease with hyperprolactinemia. Methods: We report a case of an 18-year-old female who presented with monocular decreased visual acuity two days before. Results: The fundus examination revealed papilitis and mild posterior vitritis OS. Serologic analysis revealed hyperprolactinemia, HLA B51 positive. Brain computed tomography and magnetic resonance imaging excluded intracraneal patology. Vitreous humor Polymerase-Chain-Reaction was negative for common pathogens. Conclusions: This case suggests the role of prolactin in immunoregulation and pathogenesis of Behçet’s Disease. We suggest serum prolactin measu-rement in atypical Behçet’s Disease suspect.

Interferons are glycoproteins that bind to cell-surface receptors and lead to anti-viral, anti-proliferative, and anti-angiogenic properties. Interferons have been used successfully in many different diseases throughout medicine, and recently success has been demonstrated for the treatment of ocular surface neoplasias. Traditional treatment for corneal and conjunctival intraepithelial neoplasia and squamous cell carcinoma includes surgical excision and adjunctive cryotherapy. The use of chemotherapeutic agents, including interferon alfa 2b (IFN a2b), mitomycin C (MMC) and 5-fluorouracil (5-FU), has limited the need for extensive surgical manipulation of the ocular surface and potentially decreases recurrence rates. This article will focus on the use of IFN in the treatment of corneal and conjunctival intraepi-thelial neoplasia and squamous cell carcinoma.

Pterygium is a common benign lesion in countries near the equator due to its association with extensive solar exposure. Other etiologic factors such as human papillomavirus infection are still controversial. Four cases of ocular surface squamous neoplasia initially diagnosed as pterygium are described. Improper specimen handling lead to inadequate therapy and enucleation in three cases. RESUMEN El pterigion, debido a su asociación con exposición solar severa, es una patología benigna frecuente en los países cercanos al ecuador. La presencia de otros factores causales como la infección por papilomavirus humano es aún controversial. Se presentan cuatro casos de neoplasias escamosas de la superficie ocular (NESO) confundidas clínicamente con pterigion, en las cuales el incorrecto manejo del especimen llevó al tratamiento inadecuado y en tres casos, a la pérdida del globo ocular.

Purpose: To demonstrate the use of fibrin glue as an alternative to sutures in the scleral fixation of conjunctival autografts during pterygium surgery. Methods: Review of the literature and description of the authors’ current technique. Conclusion: Fibrin glue appears to be a safe alternative to sutures as a means of fixating conjunctival autografts during pterygium surgery. A theoretical risk exists for the transmission of viral or prion-based diseases however no documented cases of transmission have been reported.

The frontal sling is a surgical technique to correct severe ptosis with minimal or absent elevador muscle function. Despite the development of new synthetic materials, the fascia is still the best alternative. We describe the most used procedures to obtein the fascia and to make the frontal sling. We emphasize the use of the materials and techniques that are available for all the ophthalmologist. RESÚMEN La suspensión al frontal es una técnica para corregir ptosis severas en las que la función del músculo elevador es mínima o nula. A pesar de la aparición de nuevos materiales sintéticos la fascia lata sigue siendo la mejor alternativa. Describimos los procedimientos más usados para extraer la fascia y para realizar la suspensión al frontal, haciendo hincapié en el uso de técnicas y materiales al alcance de todos los oftalmólogos.