This case series report aimed to describe lamellar macular holes associated with the use of normal fluence photodynamic therapy.

We describe the clinical features in a case series of 64 patients presenting with a primary basal cell carcinoma (BCC) involving the lower lid and/or adjacent inferior periocular area, and present simple surgical guidelines for reconstruction based on the location and size of the lesion.

Cataract and glaucoma patients represent a challenge for the anterior segment surgeon due to either perform a cataract or glaucoma surgery alone or a combined procedure. We present the results of combined cataract phacoemulsification, intraocular lens implant and MMC trabeculectomy with releasable sutures. Sixty eyes of 44 patients were included from January 2008 to December 2011, with a mean age of 67.02±10,41) years old. 80% were primary open angle glaucoma (POAG) and 20% primary closed angle glaucoma (PCAG). Preoperative intraocular pressure was 23.28±5.89 mmHg; 26.08±10.66 for GPAA and 26.08±10.66 for GPCA with a cup/disc ratio of 0.81 and 0.74, respectively. Best corrected visual acuity (in LogMar) was 0.581 preoperatively, improved to 0.28±0.40 postoperatively in both groups with 0.60±0.41 to 0.25±0.37) in GPAA and 0.53±0.44 to 0.39±0.40 in GPCA. The intraocular pressure was reduced in 48.24% with 48.86% in GPAA and 52.72% in GPCA. The survival curve analysis was 0.91 in GPAA and 0.90 in GPCA at 50 and 30 months. In conclusion, combined surgery was successful in treatment patients with glaucoma and cataract. RESUMEN La asociación de catarata y glaucoma representa un reto para el oftalmólogo que debe decidir si realiza una cirugía de glaucoma o catarata o combinada. Presentamos nuestros resultados de cirugías de facoemulsificación de catarata, implante intraocular y trabeculectomía con MMC y suturas retirables.Se incluyen 60 ojos de 44 pacientes operados de Enero 2008 a Diciembre de 2011 con una edad promedio de 67,02±10,41) años. El 80% eran glaucomas de ángulo abierto (GAA) y 20% por cierre angular (GPCA). La presión intraocular previa fue de 23,28± 5,89 mmHg en GPAA y 26,08±10,66 en GPCA con una relación excavación/disco fue de 0,81 y 0,74, respectivamente. La agudeza visual preoperatoria mejor corregida (LogMar) fue de 0,581±0,41 mejorando a 0,28±0,38) en general y 0,60±0,41 a 0,25 ±0,37 en GPAA y 0,53±0,44 a 0,39±0,40 en GPCA. La reducción de la presión intraocular fue de 48,24% en promedio siendo del 48,86% en GPAA y 52,72% en GPCA. La sobrevida de la cirugía fue de 0,91 en el glaucoma de ángulo abierto y de 0,90 en el glaucoma por cierre angular a los 50 y 30 meses de seguimiento respectivamente. En conclusión, la cirugía combinada por un solo puerto es efectiva en el control del paciente con glaucoma y catarata. Palabras clave: catarata; glaucoma; tratamiento quirúrgico.

Purpose: Strabismus (heterotropia) is one of several possible complications of ocular traumatic injury. This condition is associated with a decreased quality of life. The purpose of this study is to report the functional outcomes of a series of 35 patients presenting with strabismus secondary to eye trauma. Methodology: Retrospective study. Treatments for each type of post-traumatic ocular lesion were categorized, which included conservative management by clinical observation; use of a lens with prismatic addition; intramuscular injection of botulinum toxin; or surgery. Strabismus conditions were evaluated prior to the treatment and six months after the last treatment had been received. The rate of therapeutic success, defined as ±10 PD (prism diopters) was assessed. Results: The orbital injuries that most commonly caused strabismus were found to be orbital fracture, penetrating eye injury and direct muscle trauma. All cases of direct muscle trauma received surgical treatment; 54% of orbital fractures resolved spontaneously during clinical observation, whereas 38% required surgery. Three cases of penetrating eye injury were observed and three were treated surgically. The rate of therapeutic success was 88.57%. A single treatment was sufficient for 88.6% of all cases. Conclusions: Non-surgical therapeutic clinical observation is sufficient in a significant percentage of cases because a large number of patients tend to spontaneous recovery. Additional techniques, such as treatment with botulinum toxin, can have a useful complementary role. Surgical intervention, assessed on a case by case basis, also turned out to be highly effective in the minority of cases where it was required.

Purpose: To compare the fluctuation of the ocular perfusion pressure (OPP) between eyes treated with glaucoma medication and eyes with a functioning filtering bleb. Study Design: cross-sectional controlled paired-eye design. Methods: Fourteen patients with primary open angle glaucoma (POAG) with one eye operated on (trabeculectomy) and the fellow eye treated with medication enrolled the study. Blood pressure and intraocular pressure were measured at 7 a.m., 1 p.m., and 7 p.m. Systolic, diastolic and mean OPP were calculated for the three time points and the fluctuation (range between the highest and the lowest values) compared between the eyes. Results: Mean values of the mean OPP fluctuation were 7.2 ± 3.9 mmHg and 8.5 ± 4.0 mmHg, for operated eyes and medically treated eyes, respectively (P = 0.149); mean systolic OPP fluctuation was 20.7 ± 11.2 mmHg for operated eyes and 21.2 ± 11.7 mmHg for medically treated eyes (P = 0.478); the mean diastolic OPP fluctuation was 8.4 ± 4.4 mmHg for operated eyes and 10.5 ± 5.4 mmHg for medically treated eyes (P= 0.085). Conclusion: In this small cohort of patients with POAG, the mean, systolic and diastolic OPP fluctuation did not differ between the operated eyes and medically treated ones.

Purpose: To assess the visual outcome and refractive error following wavefront (WF)-optimized laser in situ keratomileusis (LASIK) retreatment after previous WF-guided LASIK in myopic patients. Methods: A retrospective analysis of 19 eyes (14 patients) following WF-optimized LASIK retreatment after previous WF-guided LASIK that did not give desired refractive results was conducted. The primary LASIK procedures were performed using the Visx CustomVue™ laser with WF-guided technology. All of the subsequent retreatment LASIK procedures were performed with the Wavelight Allegretto™ Eye-Q 400 excimer laser using WF-optimized. Ophthalmic evaluations including uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and manifest refraction spherical equivalent (MRSE) were performed at baseline and postoperatively at 1, 3, 6 months. Results: UCVA and BSCVA improved following retreatment from 0.27±0.18 and 0.0±0.05 to 0.01±0.05 and -0.03±0.05 respectively at 6 months (p<0.001 and p=0.38). The MRSE decreased from -0.5 D pre-retreatment to -0.2 D at 6 months postretreatment. The pre-retreatment total HOA was 0.48±0.21 (0.24 to 1.01μm) and did not show correlation with the visual outcomes postoperatively. No intra-operative or postoperative complications occurred. Conclusions: The results of this small case series with patients presenting low degrees of residual ametropia indicate that WF-optimized LASIK retreatment could be considered as an option after primary WFguided LASIK. Retreatment with WF-optimized LASIK is safe and the results are predictable.

Purpose: To report the 6-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after the combination of intravitreal adalimumab (Humira) and bevacizumab (Avastin) in patients with macular edema of various etiologies. Methods: Retrospective interventional case series. We reviewed the clinical records of 5 consecutive patients (7 eyes) with macular edema of various etiologies including pseudophakic macular edema, diabetic papillophlebitis, central retinal vein occlusion, branch retinal vein occlusion, and exudative age-related macular degeneration. All patients were treated with at least one intravitreal injection of 1.25 mg/0.05 mL of bevacizumab and 2 mg/0.08 mL of adalimumab. Results: The mean number of combined bevacizumab and adalimumab injections per eye was 2.14 (range: 1 to 4 injections) at 6 months. The baseline BCVA improved from 1.19 ± 0.6 logarithm of the minimum angle of resolution (logMAR) to 0.94 ± 0.59 logMAR at 6 months (P < 0.05). Four (57.1%) of seven eyes gained ≥ 3 ETDRS lines of BCVA. Central macular thickness (CMT) at baseline by optical coherence tomography (OCT) had a mean of 416 ± 150 µm which was reduced to a mean of 354 ± 205 µm at 6 months (P < 0.05). There were no ocular or systemic complications. Conclusions: Combined intravitreal bevacizumab at doses of 1.25 mg and adalimumab at doses of 2.0 mg seems to provide stability or improvement in BCVA, OCT, and fluorescein angiography in macular edema of various etiologies with no systemic complications at 6 months of follow up. Resumen Objetivo: Reportar la respuesta anatómica y de agudeza visual mejor corregida (AVMC) posterior a la combinación del adalimumab intravítreo (Humira) y bevacizumab (Avastin) en pacientes con edema macular de variadas etiologías. Métodos: Serie retrospectiva intervencional de casos. Se revisaron los registros médicos de cinco pacientes consecutivos (siete ojos) con edema macular de variadas etiologías, incluyendo edema macular pseudofáquico, papiloflebitis diabética, oclusión de la vena central de la retina, oclusión de rama venosa retiniana, y degeneración macular relacionada con la edad. Todos los pacientes fueron tratados con al menos una inyección intravítrea de 1,25 mg/0,05 mL de bevacizumab y 2 mg/0,08 mL de adalimumab. A los pacientes se les cuantificó su AVMC por cartilla del Estudio del Tratamiento Temprano de la Retinopatía Diabética (EDTRS), examen oftalmológico, tomografía de coherencia óptica (TCO) y angiografía fluoresceínica (AGF) al inicio, y a las visitas en el primer, tercer y sexto mes. Los resultados se basaron en las modificaciones de la AVMC y la TCO. Resultados: La edad media de los pacientes fue de 71,5 ± 9,4 años. La media de inyecciones combinadas de bevacizumab y adalimumab fue de 2,14 por ojo (rango: 1 a 4 inyecciones) a seis meses. La AVMC basal mejoró de 1,19 ± 0,6 logaritmo del mínimo ángulo de resolución (logMAR) a 0,94 ± 0,59 logMAR a sies meses (P < 0,05). Cuatro (57,1%) de los siete ojos ganaron ≥ 3 líneas ETDRS de AVMC. El espesor macular central (EMC) al inicio por TCO tuvo una media de 416 ± 150 µm, el cual se redujo a una media de 354 ± 205 µm a seis meses (P < 0,05). No hubo complicaciones oculares o sistémicas. Conclusiones: El tratamiento intravítreo combinado de bevacizumab y adalimumab a dosis de 1,25 mg y 2,0 mg respectivamente impresiona proporcionar mejoría o estabilidad en la AVMC, TCO y AGF en edema macular de variadas etiologías sin complicaciones sistémicas a los seis meses de seguimiento. A pesar de las limitaciones por el pequeño tamaño de la muestra, corto seguimiento, y la falta de un grupo control, los resultados sugieren una potencial bioactividad relacionada con los favorables resultados anatómicos y visuales.

Purpose: To establish the correlation between morphometric corneal changes and the magnitude of the ametropia treated by excimer laser (LASIK) until the year of the surgery. Design: Observational, descriptive, longitudinal and prospective investigation Method: The studied group was comprised of 78 patients (151 eyes) operated with LASIK with a pendular microkeratome at the Abel Santamaría Hospital of November from November 2010 to June of 2011. Confocal microscopy with ConfoScan 4 (NIDEK) was performed for obtaining and studying the live corneal tissue images. Automatic scans were programmed with central fixation, speed of acquisition of the image to 25 images per second, magnification of 500x, lateral resolution of 0.6 µm/pix, with 350 images for scan, and distances of work of 1,98 mm. Statistical analysis of the variables was done by descriptive statistic, Pearson's correlation test and linear regression. Results: After LASIK, a significant statistic correlation was found on the magnitude of the treated ametropia with the following variables: epithelial thickness, pachymetry, stromal residual bed and keratocyte density in the posterior flap or in the retroablation zone. Conclusions: The higher the magnitude of the ametropia treated with LASIK, the greater the increase in the epithelial thickness in the first half of the postoperative period and, the lower the values of pachymetry, and residual stromal bed, keratocytes density on both sides of the lamellar flap, after one year of treatment. Resumen Objetivo: Establecer la correlación entre los cambios morfométricos corneales y la magnitud de la ametropía tratada hasta el año de cirugía corneal con láser de excímeros por la técnica LASIK. Diseño: Investigación observacional, descriptiva, longitudinal y prospectiva. Método: La muestra quedó constituida por 78 pacientes (151 ojos) operados con LASIK con microque-rátomo pendular en el Hospital Abel Santamaría Cuadrado en Pinar del Río de noviembre de 2010 a junio de 2011. Se utilizó el microscopio confocal ConfoScan 4 de NIDEK para la obtención y estudio de las imágenes in vivo del tejido corneal. Se programó en modo escaneo automático, con fijación central, velocidad de adquisición de la imagen a 25 imágenes por segundo, magnificación de 500x, resolución lateral de 0.6 µm/píxel, con 350 imágenes por escaneo, distancia de trabajo de 1,98 mm. Se utilizaron métodos de estadística descriptiva, correlación de Pearson y regresión lineal. Resultados: Se obtuvo posterior a LASIK correlación estadísticamente significativa entre la magnitud de la ametropía tratada y las variables grosor epitelial, paquimetría, lecho estromal residual y densidad de queratocitos en subcapas flap posterior y retroablación anterior. Conclusiones: Mientras mayor es la magnitud de la ametropía tratada con LASIK, mayor es el aumento del grosor epitelial en el primer semestre de postope-ratorio y menores los valores de paquimetría, lecho estromal residual y densidad queratocitaria a ambos lados del corte lamelar, al año de tratamiento. Key words: LASIK, Morfometría, cornea, microscopy confocal.

Introduction The present study intended to analyze the presence of refractive errors and strabismus at 3 years of age in a Portuguese population of ex-preterm infants with gestational age (GA) less than or equal to 32 weeks, as well as research potential risk factors for its occurrence. Material and methods Retrospective analysis of clinical charts from ex-preterm infants with GA less than or equal to 32 weeks, who were born in Centro Hospitalar de Entre Douro e Vouga – Unidade de São Sebastião (CHEDV-USS), Santa Maria da Feira, Portugal, between 2001 and 2007, and who were observed by the Ophthalmology Department. Data on neonatal history (GA, birth weight, duration of hospitalisation, duration of oxygen supplementation and a history of retinopathy of prematurity - ROP) as well as on the presence of refractive errors and strabismus at 3 years of age was collected. Results The study included 58 ex-preterm infants with a mean GA of 29 weeks. At 3 years of age, the prevalence of refractive errors was 5,17% for significant myopia, 10,34% for significant astigmatism and 5,17% for anisometropia. Strabismus was found in 18,97% of children. Almost one quarter (24.14%) of these ex-preterm infants were known to have significant ametropia and/ or strabismus. The duration of oxygen supplementation was found to be statistically significant in the development of myopia (p=0.0033) and anisometropia (p=0.0033) at 3 years of age. Discussion The results showed a high prevalence of ambliogenic risk factors in former premature infants at 3 years of age. Ophthalmic surveillance protocols of this group of children should assess the presence of ambliogenic risk factors in a systematic and periodic fashion, in order to address these changes as early as possible and prevent/ treat a potential amblyopia. Resumo Introdução Pretende-se estudar a presença de ametropias e estrabismo aos 3 anos de idade numa população portuguesa de ex-prematuros com idade gestacional (IG) igual ou inferior a 32 semanas, assim como pesquisar possíveis factores de risco para a sua ocorrência. Material e Métodos Estudo retrospectivo dos processos clínicos de ex-prematuros com IG igual ou inferior a 32 semanas nascidos no Centro Hospitalar de Entre Douro e Vouga – Unidade de São Sebastião (CHEDV-USS), Santa Maria da Feira, Portugal, entre 2001 e 2007, e que foram observados pelo Serviço de Oftalmologia. Foram recolhidos dados relativos aos antecedentes neo-natais (IG, peso ao nascer, número de dias de internamento, número de dias de oxigénio suplementar e antecedentes de retinopatia da prematuridade - ROP) e presença de ametropias e estrabismo aos 3 anos de idade.

We performed a prospective study in 137 patients between the ages of 1 and 19 first seen in our department of ophthalmology, which were referred to as carriers or be in the study of rheumatic disease. All patients underwent complete eye examination, 78 were female and 59 were men. 106 patients had active lesions, 101 of them anterior uveitis, 67 of them uveitis was bilateral in 34 was unilateral; cataract was found in 2 patients (1 unilateral and 1 bilateral), adhesions in 3 patients (1 unilateral and 2 bilateral ), 31 active patients showed alterations. The youngest patient who presented active lesions was a girl one year, which was found anterior uveitis.

Objective: To determine the effectiveness of treatment of myopic anisometropia with the Artisan^TM or Artiflex^TM phakic intraocular lens and refractive surgery in the Ophthalmological Cuban Institute Ramón Pando Ferrer between June 2008 and June 2010. Methods: The cohort consisted of 50 patients with myopic anisometropia in whom an Artisan^TM or Artiflex^TM phakic intraocular lens was implanted in the more myopic eye with and in whom the other eye was treated with LASEK. The sphere and refractive cylinder, uncorrected visual acuity and best corrected visual acuity, endothelial cell density, contrast sensitivity testing, and the binocular vision testing were analyzed as variables prior to surgery and 12 months later. Results: Sphere and refractive cylinder were corrected significantly. Uncorrected visual acuity was increased to 0.7 in the eye with phakic intraocular lens and to 0.9 in the eye treated with LASEK. Best corrected visual acuity increased to 0.9 and 1.0 respectively. Contrast sensitivity was recorded at 3 months of postoperative. 70% of cases before the surgery were had stereopsis, and of the 30% remaining, 16% achieved stereopsis in the post-operative period. Conclusions: The combined use of Artisan^TM or Artiflex^TM phakic intraocular lens and treatment with excimer laser were effective in the treatment of myopic anisometropia. Both sphere and refractive cylinder were reduced, and the majority of patients achieved stereopsis. Resumen Objetivo: Determinar la efectividad del tratamiento de la anisometropía miópica con el implante del lente fáquico Artisan^TM o Artiflex^TM y la cirugía refractiva láser en el Instituto Cubano de Oftalmología “Ramón Pando Ferrer” en el período de junio del 2008 a junio del 2010. Método: El universo estuvo constituido por un total de pacientes (50) con anisometropía miópica a los cuales se les implantó el lente fáquico de soporte iridiano en el ojo de mayor miopía y se corrigió el ojo contralateral utilizando la técnica de LASEK. Se analizaron como variables la esfera y cilindro refractivo, la mejor agudeza visual sin corrección y corregida, la densidad celular tomada por microscopía endotelial, la sensibilidad al contraste y estudios de visión binocular en el preoperatorio y a los 12 meses de las cirugías. Resultados: En el postoperatorio se obtuvo una corrección significativa de la esfera y el cilindro refractivo, la agudeza visual sin corrección se elevó en el ojo del lente fáquico y el ojo con LASEK a 0.7 y 0.9 respectivamente y la corregida a 0.9 y a 1.0. La sensibilidad al contraste se recuperó a partir de los tres meses del postoperatorio. El 70% de los casos en el preoperatorio tenían estereopsia. Del 30% restante, un 16% logró estereopsia en el postoperatorio. Conclusiones: La combinación del lente fáquico Artisan^TM o Artiflex^TM y el tratamiento con Excimer Láser para tratar la anisometropía miópica, resultó efectiva al reducir la esfera y el cilindro refractivo en ambos ojos y lograr estereopsia en la mayoría de los pacientes.

Resumen La infestación de la superficie ocular por larvas de mosca se denomina oftalmomiasis externa. Estas larvas se alimentan del tejido huésped causando diferentes manifestaciones clínicas. En general, los síntomas oculares se limitan a irritación conjuntival, lo cual puede conllevar al diagnóstico erróneo de conjuntivitis alérgica. La mosca nasal ovina Oestrus ovis es la causa más común de miasis en humanos, siendo el ganado caprino y ovino los hospederos habituales. El humano es un hospedero ocasional, especialmente donde la crianza de éste ganado es prevalente, las larvas no penetran el globo ocular debido a que no poseen mecanismos de penetración tisular. A pesar de que la oftalmomiasis externa por larvas de Oestrus ovis ocurre usualmente en pastores y granjeros, existen algunos casos aislados en areas urbanas. Nosotros presentamos un caso de oftalmomiasis externa por larvas de Oestrus ovis en el área urbana de la Ciudad de México. Abstract External ocular myiasis is an infestation of the eye with Dipterous larvae, which feed on the host tissue and subsequently may cause different clinical pictures. In general, ocular symptoms are limited to conjunctival irritation, which is often misdiagnosed as acute allergic conjunctivitis. Oestrus ovis (sheep nasal botfly) is the most common causes of myiasis in humans, with sheep and goats being the normal hosts for the larvae. Man can be an occasional host, especially where live stock herding is prevalent, although the larvae rarely enter the ocular tissues since they do not posses the ability to penetrate tissues. Although Oestrus ovis ophthalmomyiasis typically occurs in shepherds and farmers, isolated cases have also been reported in urban areas. We report a case of external ocular myiais caused by O. ovis in the urban area of Mexico City.

Objective: The aim of this work is to consider the most frequent causes of proptosis in newborns and to describe its different diagnosis. Methods: Proptosis newborn babies were evaluated. A complete ocular examination, which included neuro images, was made during a period of 18 months. Results: Nine proptosic newborn babies, with 100% positive neuro images, get into our institution. The most common pathology was found the vascular malformation capilary. This fact made possible to apply the immediate and adequate therapeutic. Conclusion: Proptosis in newborn babies is a relevant and important sign, and a oftalmologic emergency. Fast diagnosis and treatment avoid important visual consequences. Resumen Objetivo: Considerar las causas más frecuentes de proptosis en el neonato y sus diagnósticos diferenciales. Métodos: Se evaluaron los recién nacidos ingresados con proptosis, se realizó examen ocular completo que incluyó neuro-imágenes, durante el período de 18 meses. Resultados: Ingresaron 9 neonatos con proptosis, con neuro-imágenes positivas en el 100%, posibilitando la terapéutica inmediata y adecuada. Conclusión: La proptosis en el neonato es un signo de relevante importancia y una urgencia oftalmológica. El rápido diagnóstico y tratamiento evita importantes secuelas visuales.

Purpose: To described the incidence of retinal detachment (RD) in patients with preoperative high myopic value after five year of phakic intraocular lens (pIOL) was implant Artisan/Artiflex. Setting: Instituto de Ojos Oftalmosalud, Lima, Peru. Methods: This retrospective study included a review of 203 medical records (271 eyes) of patients with myopic refraction that underwent pIOL implantation by the same experimented surgeon between January 2004 to 2009, with a minimum postoperative follow-up of 1 year. The inclusion criteria were patients over 18 years old, a spherical equivalent (SE) over -6.00 Diopter (D) or with an axial length greater than 26mm, stable refraction for at least 2 years with best visual acuity (BVA) better than 20/100, without abnormalities in the anterior segment, and minimum endothelial cell count of 2,000 cells/mm³. Results: The average age of patients was 28.5 years (21-39 years). The women/men ratio was 1.7: 1 (36% men, 64% women). The average preoperative SE was -12.39 D (-8.00 to -23.00). In 69.74% (203 patients) we implant pIOL in both eyes. 189 eyes (69.74%) and 82 eyes (30.26%) had Artisan and Artiflex implanted respectively. The incidence of RD after pIOL implantation was 1.1% (3/271 eyes) of them was after artisan lens implant. Conclusion: The pIOL implant is a safe and effective option of correction high myopia. The incidence of RD was not different from the natural history of RD in myopic patients or high myopic patients with anterior segment surgery. Likewise, the prompt surgical management of this complication led to a satisfactory visual resolution in these patients. Resumen Propósito: Describir la incidencia del desprendimiento de retina (DR) en pacientes altos miopes evaluados a un año de seguimiento posterior al implante del lente intraocular fáquico (pIOL) Artisan/Artiflex. Lugar: Instituto de Ojos Oftalmosalud, Lima, Perú. Métodos: Estudio retrospectivo en el que se incluyeron 203 historias clínicas (271 ojos) de pacientes con alta miopía a los que se les implanto pIOL entre enero de 2004 a 2009, por un solo cirujano experto, con un año de seguimiento post operatorio. Los criterios de inclusión fueron pacientes mayores de 18 años, con equivalente esférico (EE) superior a -6.00 dioptrías (D) o longitud axial mayor de 26 mm, con una refracción estable de 2 años previos, agudeza visual mejor corregida (AVCC) mejor de 20/100, sin anormalidades en el segmento anterior y con un contaje de células endoteliales mínimo de 2,000 cel/mm³. Resultados: La media de edad de los pacientes fue de 28.5 años (21 – 39 años). La relación mujer/hombre fue de 1.7:1 (36% hombres, 64% mujeres). La media de Equivalente esférico preoperatorio fue de -12.39 D (-8.00 a -23.00). En el 74.90% (203 pacientes) fue implantado pIOL en ambos ojos. A 189 ojos (69.74%) y 82 ojos (30.26%) les fue implantado el pIOL Artisan y Artiflex respectivamente. La incidencia de DR posterior a la implantación de pIOL fue 1.1% (3/271 ojos). Todos ellos presentados en pacientes a los que se les implantó el pIOL Artisan. (3 ojos). Conclusión: El implante de pIOL es una opción segura y efectiva para la corrección de alta miopía. La incidencia de DR no fue diferente frente a la historia natural del DR en pacientes miopes o en cirugías del segmento anterior. No obstante, el manejo precoz de dicha complicación lleva a una recuperación satisfactoria de su AV en estos pacientes.

Resumen El tratamiento efectivo del edema macular representa un desafío principalmente debido a la limitada accesibilidad de fármaco vítreo para establecer y mantener niveles terapéuticos a largo plazo. El implante intravítreo de dexametasona (implante DEX; Ozurdex^®) es actualmente el único sistema de aplicación de fármaco ocular biodegradable aprobado por la Administración de Alimentos y Medicamentos de EE.UU. que proporciona liberación del fármaco a una tasa estable por hasta 6 meses en el vítreo. Estudios clínicos recientes indican que el implante DEX emerge como una opción terapéutica efectiva y segura para el tratamiento de edema macular secundario a diversas enfermedades subyacentes. Abstract Effective treatment of macular edema is challenging primarily because of the limited vitreous drug accessibility to establish and maintain long-term therapeutic levels. Dexamethasone intravitreal implant (DEX implant; Ozurdex®) is currently the only biodegradable ocular drug delivery system approved by the US Food and Drug Administration that provides sustained drug release at a stable rate for up to 6 months in the vitreous. Recent clinical studies indicate that DEX implant is emerging as an effective and safe therapeutic option for treatment of macular edema secondary to a variety of underlying diseases.

RESUMO Objetivo Descrever a inclusão da asfericidade corneana (Q) como um novo parâmetro para seleção do anel no nomograma do anel de Ferrara. Local Clínica de Olhos Dr. Paulo Ferrara Materiais e Métodos Cinquenta olhos de 42 pacientes portadores de ceratocone foram submetidos ao implante do anel de Ferrara, em maio e junho de 2009. O tempo médio de seguimento pós-operatorio foi de 5,48 ± 0,97 [DP] meses). A tomografia corneana foi realizada pelo Pentacam (Oculus Pentacam®, USA) no pré e pós-operatório. Avaliou-se os dados pré e pós-operatórios relativos a asfericidade (Q), acuidade visual com correção (AVCC) e ceratometria (K). Resultados O implante do anel de Ferrara reduziu a asfericidade média, de – 0,86 para -0,42 (p=0,000). Observou-se uma redução significativa nos valores de Q em todos os casos. A ceratometria média reduziu de 49,10 para 45,90 (p = 0,000). A AVCC média aumentou de 20/77 para 20/47 (p = 0,001). Conclusão A consideração da asfericidade (Q) para seleção do anel de Ferrara pode melhorar os resultados visuais após o implante do anel. ABSTRACT Purpose To report the inclusion of the corneal asphericity (Q) as a new parameter for ring selection in the Ferrara Ring nomogram. Setting Dr. Paulo Ferrara Eye Clinic Material and Methods Intrastromal Ferrara ring segments were placed in 50 eyes of 42 patients with keratoconus, operated in May and June 2009. The mean follow-up time was 5.48 ± 0.97 [SD] months). Corneal topography was obtained from Pentacam (Oculus Pentacam®, USA). Statistical analysis included preoperative and postoperative asphericity (Q), best-corrected visual acuity (BCVA) and keratometry (K). Results The Ferrara intrastromal ring implantation significantly reduced the mean corneal asphericity from – 0.86 to -0.42 (p=0.000). It was observed a significant reduction in Q values in all cases. The mean K decreased from 49.10 to 45.90 (p = 0.000). The BCVA improved from 20/77 to 20/47 (p = 0.001). Conclusion The consideration of the asphericity (Q) for Ferrara intrastromal ring selection can improve the visual results after ring implantation.

Purpose To evaluate the outcome and complications of corneal transplant in a hospital school. Methods Retrospective study of medical records in cases of corneal transplantation due to infectious cause occurred in the Hospital de Clinicas, UFPR between 2002 and 2008. We included all cases with clinical or laboratory diagnosis of eye infection with active 6 months minimum follow up. Results Of the 146 transplants performed in the period, 16 (10, 95%) had infectious keratitis as an indication. Regarding the etiology were found: 9 cases of bacteria (56.25%), 3 fungal (18.75%), 2 herpetic (12.25%), 1 Acanthamoeba and 1 case unknown (6.25%). Visual acuity after the surgery had no change in 7 cases, 5 cases had a decrease in visual acuity and there was an improvement on 4. Evaluating the predisposing factors, 8 (50%) had a history of eye surgery, and in 5 (31.25%) there was a history of prior transplant, 2 (12.5%) cases occurred after trauma, 1 (6, 25%) case had a contact lens related infection and in 5 (31.25%) was not found any predisposing factor. Among the complications were: recurrence of infection, synechiae, cataract, glaucoma, OACR and need of re-suture. The corneal transparency was found in 68.75% of cases. The result after the first surgery was satisfactory in 13 cases, and achieved eye integrity. 2 progressed to evisceration / phthisis. Conclusions There was a rate of anatomical cure of 81.25% after the first transplant and 87.5% at the end of treatment. These data show undoubted success and improvement in quality of life. RESUMO Objetivo Avaliar as intercorrências e os resultados dos transplantes de córnea terapêuticos em um hospital escola. Métodos Estudo retrospectivo em prontuários de pacientes submetidos a transplante de córnea devido à causa infecciosa, ocorridos no Hospital de Clínicas da UFPR entre 2002 a 2008. Foram incluídos todos os casos com diagnóstico clínico ou laboratorial de infecção ocular ativa com seguimento mínimo de 6 meses. Resultados Dos 146 transplantes realizados no período, 16 (10,95%) tiveram como indicação ceratite infecciosa. Em relação a etiologia foram encontrados: 9 de causa bacteriana (56,25%), 3 fúngicas (18,75%), 2 herpéticas (12,25%) 1 caso Acanthamoeba e 1 caso não identificado (6,25%). A acuidade visual no pós-operatório não se alterou em 7 casos, em 5 casos houve piora de visão e em 4 houve melhora. Avaliando-se os fatores predisponentes, 8 (50%) apresentavam história de cirurgia ocular, sendo que em 5 (31,25%) havia história de transplante prévio, 2 (12,5%) ocorreram após trauma, 1 (6,25%) houve uso de lente de contato e em 5 (31,25%) não foi encontrado nenhum fator predisponente. Entre as complicações encontrou-se: recidiva de infecção, sinéquias, catarata, glaucoma, oclusão de artéria central de retina e necessidade de ressutura. A transparência corneana foi obtida em 68,75% dos casos. O resultado após a primeira cirurgia foi satisfatório em 13 casos, sendo conseguidaa cura anatômica, com 2 evoluindo para evisceração/phthisis. Conclusões O resultado final foi de cura anatômica de 81,25% após o primeiro transplante e 87,5% ao final do tratamento. Esses dados apresentados mostram sucesso e melhora indubitável na qualidade de vida. Conclusões O resultado final foi de cura anatômica de 81,25% após o primeiro transplante e 87,5% ao final do tratamento. Esses dados apresentados mostram sucesso e melhora indubitável na qualidade de vida.

Purpose To evaluate the effects of topic amniotic fluid on the treatment of keratoconjunctivitis sicca. Material and methods We studied 13 patients with moderate to severe dry eye, on which other therapies have failed. The patients applied topic amniotic fluid during four weeks. Weekly evaluations were made, recording: symptoms (OSDI score), staining with fluorescein and lissamine green (Oxford score), break-up time (BUT) and Schirmer test. Results We found a significant difference on the symptoms on the first (p = 0,01), third (p = 0,028) and fourth weeks (p = 0,024) of treatment, compared to the media before it. Also there was significant difference on the BUT at first week of treatment (p = 0,022). On lissamine green staining, there was a statistically significant difference with the media before treatment and the values of the first and fourth weeks after it (p = 0,001). We did not find difference on fluorescein staining or visual acuity. Conclusions On this study, the amniotic fluid demonstrated an improvement not only on the symptoms but also on the clinical signs of dry eye on the patients. The present study reflects the need of larger clinical trials in order to have more conclusive and applicable results. Resumen Objetivo Evaluar los efectos del líquido amniótico tópico en el tratamiento de la queratoconjuntivitis sicca. Materiales y métodos Se estudiaron 13 pacientes con queratoconjuntivitis sicca moderada a severa y en los cuales fracasaron otras terapias. Los pacientes utilizaron líquido amniótico estéril siguiendo indicaciones preestablecidas; se aplicó el tratamiento por vía tópica durante 4 semanas, evaluando agudeza visual, sintomatología (escala de OSDI), tinción con fluoresceína y verde lisamina (escala de Oxford), tiempo de ruptura lagrimal (BUT) y test de Schirmer antes y después del tratamiento. Durante el estudio los pacientes utilizaron lágrimas artificiales según necesidad. Resultados Se encontró una diferencia estadísticamente significativa en la sintomatología entre el promedio pre-terapia y el promedio a la primera (p = 0,01), tercera (p = 0,028) y cuarta semanas (p = 0,024) de tratamiento. En el BUT, hubo diferencia estadística a la primera semana (p = 0,022). En cuanto a la tinción con verde lisamina, existió diferencia significativa entre el promedio previo y la media a la primera y cuarta semanas de tratamiento (p = 0,001). No se encontró significancia al comparar los promedios en la tinción con fluoresceína. Se comparó el uso de lágrimas artificiales antes de iniciar el tratamiento con líquido amniótico y a las cuatro semanas del mismo y se encontró una frecuencia de uso diario significativamente menor al final del tratamiento (p = 0,041). Conclusión El líquido amniótico tópico mostró una mejoría tanto de la sintomatología como de las características clínicas en los pacientes estudiados. El presente estudio muestra resultados esperanzadores en cuanto al uso de esta nueva terapia. Sin embargo, son necesarios estudios con una mayor muestra y que incluyan un grupo control, para poder llegar a resultados concluyentes con el fin de aplicar este tratamiento en la práctica clínica. Palabras clave: Queratoconjuntivitis sicca, líquido amniótico, ojo seco.

Resumo Proliferação melanocítica uveal difusa bilateral (BDUMP) é uma síndrome paraneoplásica ocular rara, cujo diagnóstico diferencial inclui melanoma uveal difuso, carcinoma ou melanoma metastático, linfoma intra-ocular de grandes células, síndrome da efusão uveal idiopática e síndrome de Vogt-Koyanagi-Harada. BDUMP está relacionada a perda visual importante e irreversível. O reconhecimento desta condição ajuda ao clínico diagnosticar uma doença maligna sistêmica subclínica. Nós apresentamos um caso de BDUMP, associado a melanoma uveal com documentação histológica, em um paciente sem o diagnóstico clínico de doença maligna. Abstract Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare ocular paraneoplastic syndrome whose differential diagnosis includes diffuse uveal melanoma, uveal metastatic carcinoma or melanoma, intra ocular large-cell lymphoma, idiophatic uveal effusion syndrome, and Vogt-Koyanagi-Harada syndrome. BDUMP is a vision-threatening disease and always represents a diagnostic challenge. Early recognition of this condition can help the clinician to identify an underlying malignancy. We report a case of BDUMP with histopathologically documented uveal melanoma in one eye in a patient without a detectable systemic malignancy.

Our studies published in 2008 and 2009 found: Phaco/IOL alone provides an effective treatment for patients with cataract coexistent with ocular hypertension or glaucoma when glaucoma drops are no longer adequate. Phaco/IOL alone may provide an effective treatment for patients with ocular hypertension or glaucoma who do not have cataracts when glaucoma drops are no longer adequate. We postulate as to why phaco/ IOL alone lowers IOP in eyes with elevated IOP: The natural lens, as it ages, compresses the trabecular meshwork and canal of Schlemm, and becomes a major cause of ocular hypertension, a precursor to adult glaucoma. Replacing the enlarged natural lens with a thin artificial lens expands the compressed trabecular meshwork and canal of Schlemm, improves their function, and thereby lowers the once elevated IOP.

Purpose: To evaluate visual results and optical coherence tomography (OCT) findings after treatment with a single subretinal dose of bevacizumab in patients with subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Methods: Four eyes of 4 patients with unilateral advanced subfoveal CNV due to AMD, who refused multiple doses of intravitreal bevacizumab, were recluted. All patients had 20/400 or worse visual acuity (VA) in the affected eye and 20/30 or better in the fellow eye. Each patient underwent vitrectomy with a single subretinal injection of bevacizumab (750μg / 0.3ml) and was followed up for one year with complete eye examinations, including fluorescein angiography (FA) and OCT. Results: At the one year follow-up, VA was stable or improved in 100% of eyes. The central macular thickness (CMT) also decreased significantly, with FA demonstrating a considerable reduction in the size of the subretinal neovascular membranes. Conclusions: Our results suggest that a single dose of subretinal bevacizumab is safe, effective and well tolerated, and significantly improved VA and CMT in patients with neovascular AMD. However, further evaluation with longer follow-up and a bigger population is desirable. Resumen Propósito: Evaluar los resultados visuales y de tomografía de coherencia óptica (OCT) luego de tratamiento con una única dosis de bevacizumab subretinal en pacientes con neovascularización coroidea (CNV) secundaria a degeneración macular relacionada con la edad (AMD). Métodos: Se trataron 4 ojos de cuatro pacientes con CNV subfoveal unilateral avanzada secundaria a AMD, que rechazaron dosis múltiples de bevacizumab intravítreo. Todos los pacientes presentaban una agudeza visual (VA) de 20/400 o peor en el ojo afectado y 20/30 o más en el ojo contralateral. Cada paciente fue sometido a vitrectomía con una única inyección subretinal de bevacizumab (750μg / 0.3ml) y fueron seguidos por un año con exámenes oftalmológicos completos, incluyendo retinofluoresceinografía (FA) y OCT. Resultados: Luego de un año de seguimiento, la VA se mantuvo estable o mejoró en el 100% de los ojos. El grosor macular central (CMT) también disminuyó significativamente y la FA demostró una reducción considerable en el tamaño de las membranas neovasculares subretinales. Conclusiones: Nuestros resultados sugieren que una única dosis de bevacizumab subretinal es segura, efectiva y bien tolerada, y mejora significativamente la VA y el CMT en pacientes con AMD neovascular. Sin embargo, una evaluación a más largo plazo con un seguimiento más extenso y una población mayor es deseable.

Purpose: To determine whether limbal cells have a role In the prevention of recurrence after primary pterygium surgery. Design: Case report series. Participants: 36 eyes with primary pterygium undergoing excision with conjunctival or limbal-conjunctival autograft. Methods: 18 eyes underwent excision with conjunctival autograft, whereas the rest underwent excision with limbal-conjuntival autograft. All of them were followed up for one year. Main Outcome Measure: Recurrence. Results: Two patients in the conjunctival graft group (11%) presented recurrence after 12 months, while none of the patients in the other group had recurrence. However, no statistical difference was found between the two types of autograft. (P = 0.2). Conclusion: The results suggest that the barrier effect of the graft, and not the limbal cells themselves, plays a role in reducing recurrences after primary pterygium surgery. Resumen Objetivo: Determinar si las células límbicas tienen un papel en la prevención de las recidivas tras cirugía del pterigio primario. Diseño: Serie de casos clínicos. Participantes: 36 ojos con pterigio primario sometidos a exéresis asociada a autoinjerto conjuntival o limboconjuntival. Métodos: 18 ojos se sometieron a exéresis con plastia conjuntival, mientras que los restantes se sometieron a exéresis con autoinjerto limboconjuntival. Todos ellos fueron seguidos durante un año. Principal Resultado Medido: Recidiva. Resultados: 2 pacientes en el grupo de plastia conjuntival (11%) presentaban recidiva a los 12 meses, por el contrario ninguno de los pacientes en el otro grupo presentó recidivas. A pesar de esto, no se encontraron diferencias estadísticamente significativas entre ambos tipos de injerto. (P=0.2). Conclusión: Los resultados sugieren que es el efecto barrera del injerto, y no las propias células límbicas, las que tienen un papel en la reducción de las recidivas tras la cirugía del pterigio primario.

Purpose: To assess factors that may influence central corneal thickness (CCT) and its effect on tonometry. Methods: This observational cross-sectional study includes 200 eyes (100 patients). Influence of age, sex, color of skin, topic drugs, ocular and systemic diseases in CCT were evaluated. Intraocular pressure (IOP) measurements by air tonometer, Goldmann and Pascal dynamic contour tonometry (DCT) were compared, and effects of CCT were analyzed. Results: There was significant association between CCT and age (p=0.012), color of skin (p=0.0004), primary open angle glaucoma (p=0.001), cataract surgery (p=0.004), topic use of dorzolamide (p=0.000), latanoprost (p=0.023) and prednisolone (p=0.015). IOP measurements showed statistically significant differences between thinnest and thickest corneas in applanation tonometry (p=0.002 y p=0.018). DCT readings were not significantly affected by CCT (p=0.274). Conclusions: Age, non-white color of skin and primary open angle glaucoma are significantly associated with lower CCT. Cataract surgery and topic drugs seem to influence CCT. DCT readings are not significantly affected by CCT, while applanation readings are. Resumen Objetivo: Determinar factores que pueden influir en el espesor corneal central (ECC) y evaluar la repercusión del mismo en los valores de tonometría.Metodología: Se estudiaron 200 ojos (100 pacientes). Se analizó la influencia de edad, sexo, color de piel, medicación tópica, antecedentes oculares y sistémicos en el ECC. La medida de la presión intraocular (PIO) con neumotonómetro, Goldmann y tonometría de contorno dinámico de Pascal (TCD) fue comparada y se evaluó el efecto del ECC. Resultados: Hubo asociación significativa entre ECC y edad (p=0.012), color de piel (p=0.0004), antecedente de glaucoma primario de ángulo abierto (p=0.001), cirugía de catarata (p=0.004) y uso tópico de dorzolamida (p=0.000), latanoprost (p=0.023) y prednisolona (p=0.015). Para la tonometría de aplanación (neumotonómetro y Goldmann) existieron diferencias significativas entre las PIO promedios para córneas delgadas y gruesas (p=0.002 y p=0.018), para la TCD no hubo diferencias significativas entre los tres grupos de ECC (p=0.274). Conclusiones: El envejecimiento, el color de piel no blanca y el antecedente personal de glaucoma primario de ángulo abierto se asocian significativamente a menor ECC. La medicación tópica y la cirugía previa de catarata parecen influir en el ECC. Las mediciones de PIO por TCD, a diferencia de las de aplanación, no se afectan significativamente por el ECC.

Impression cytology (IC) technique is non-invasive and painless, useful in the diagnosis of many disorders of the ocular surface, but dry eye disease is by far the most benefited from this technique. With a high sensitivity (78-87%), it allows to document sequential changes in the corneal, limbal and conjunctival surface over time in dry eye disease without biopsy. Squamous metaplasia and keratinisation are histological changes that can be observed in keratoconjunctivitis sicca. IC gives information about the diagnosis, severity, monitoring effects of treatment and orienting the ethiology. During the past decade, IC has contributed to significant advances in dry eye disease and actually its application has been used increasingly to assist in diagnosis of ocular surface disorders, including, among others limbal stem-cell deficiency, specific viral infections, vitamin A deficiency, allergic disorders and squamous neoplasia. Resumen La citología de impresión (CI) es una técnica no invasiva e indolora, útil en el diagnóstico de múltiples desórdenes de la superficie ocular, pero el ojo seco es con diferencia la patología que más se ha beneficiado de esta técnica. Con una sensibilidad alta (78-87%), permite documentar la secuencia de cambios que sufren córnea, limbo y conjuntiva, en el síndrome de ojo seco sin necesidad de recurrir a la biopsia. La metaplasia escamosa y la queratinización son los cambios histológicos que se observan en la queratoconjuntivitis sicca. La CI aporta información diagnóstica y permite valorar la severidad del cuadro, la respuesta al tratamiento e incluso orientar su etiología. Durante la década pasada el uso de la CI ha contribuido a importantes avances en el estudio del ojo seco y se han ampliado sus aplicaciones a otras enfermedades de la superficie ocular incluyendo la deficiencia de células madre limbales, infecciones de la superficie ocular, deficiencia de vitamina A, desórdenes alérgicos y la neoplasia escamosa, entre otros.

We conducted an epidemiological, descriptive and transverse study in 75 patients with primary open angle glaucoma, with the objective of measuring the function of the vascular endothelium with the hypothesis that endothelial dysfunction may occur in the physiopathology of the disease which may interfere with the level of perfusion of the optic nerve head. In the group of patients studied, women (61.3%) as well as non-Caucasians (78.6%). were most common. More than half of the cases were from 50 to 59 years of age (53.3%). More than half of the patients showed moderate decrease of endothelium-dependent vasodilatation, and only 22.6% demonstrated a normal response. These results suggest that in patients with primary open angle glaucoma, there is clinical evidence of endothelial dysfunction that could influence the appearance and progression of the disease. Our results suggest the need for larger studies and evidence of clinical correlation. Resumen Se realizó un estudio epidemiológico descriptivo y transversal en 75 pacientes con de Glaucoma Primario de Ángulo Abierto, con el objetivo de medir clínicamente la función del endotelio vascular partiendo de la hipótesis que la Disfunción Endotelial puede intervenir en la fisiopatología de la enfermedad al interferir el nivel de perfusión en la cabeza del nervio óptico. En el grupo de pacientes estudiados predominaron las mujeres (61,3%) y los no blancos (78,6%). Más de la mitad de los casos estuvo en el rango de 50 a 59 años (53,3%), con diferencia significativa en cuanto al sexo. Más de la mitad de los pacientes mostraron disminución moderada de la vasodilatación endotelio-dependiente y sólo en el 22,6% se obtuvo una respuesta normal. Estos resultados nos permiten concluir que en los pacientes portadores de Glaucoma Primario de Ángulo Abierto existe evidencia clínica de Disfunción Endotelial que pudiera influir en la aparición y progresión de la enfermedad, por lo esta variable requiere mayor investigación y correlación clínica.

There is a considerable overlap between eye and skin disease. Embryologically both organs arise from the ectoderm. Their origin and contiguity explain their unique relationship. Many dermatologic conditions affect the eye, and it is essential to understand this important relationship for the proper diagnosis and treatment. The patient may present with dermatological complaints, while on further investigation, an ocular ailment may be the primary pathology. We have attempted to review the most common dermatological conditions and their ocular manifestations.

Purpose: To introduce a new route for delivering medications throughout the intrastromal space, injecting depot cortisone mixed with different anti microbial agents, acting not only in the cornea but also in the anterior segment for the treatment of uveitis. Material and methods: We studied 44 consecutive cases with acute or chronic inflammatory processes of the cornea and anterior segment treated with injections of Depot Bethametasone (Diprospan®) mixed with different anti infectious substances, placed in the intrastromal space with the aid of a tuberculine syringe. All the data were processed according to the clinical diagnosis, type of anti infectious agent, number of doses required, and best visual acuity obtained before and after the end of the treatment. Results: Of a total of 44 cases mean age 43 years, the main diagnosis was infectious keratitis (31.8%), followed by corneal abscess (18,1%). The most antimicrobial agent utilized was amikacine (69.1%), followed by acyclovir (6.61%). Only two cases received more than 9 doses and the great majority only need between 1 and 4 applications to finish the treatment. A total of 86.3% of the cases showed a complete improvement of its initial conditions. Conclusions: We think that the application of intrastromal injections of depot cortisone (Bethametasone) is an ideal and safe route to treat acute or chronic diseases of the cornea and anterior segment without complications, with excellent clinical response and without the need or any other type of medications. Resumen Objetivo: Demostrar que inyecciones intraestromales con mezclas de medicamentos antiinfecciosos y corticoides de depósito, son un método viable y seguro para el tratamiento de patologías infecciosas no solo de la cornea sino del segmento anterior. Materiales y métodos: Se estudiaron 44 casos, con alteraciones inflamatorias agudas o crónicas de la córnea y del segmento anterior que fueron tratadas con una mezcla de betametasona de depósito (Diprospan™) y un agente antiinfeccioso, colocados a través de una jeringa con aguja de tuberculina dentro del estroma corneano. Se tabularon patologías a tratar, medicamentos antiinfecciosos utilizados, número de dosis requeridas, y agudeza visual mejor corregida (AVMC) antes y después del tratamiento. Resultados: El promedio de edad fue de 43,09 años. La patología tratada más frecuente fue la queratitis infecciosa (31,8%), seguida de absceso corneal (18,1%). El agente antiinfeccioso más utilizado fue la amikacina (69,1%), seguido por aciclovir (6,61%). Solo 2 pacientes recibieron más de 9 aplicaciones de la mezcla, pero el mayor porcentaje (88,6%) solo necesitó de 1 a 4 aplicaciones para mejorar. El 86,3% de los ojos mejoraron de su patología. Conclusiones: Consideramos que la aplicación de una mezcla de agentes antiinfecciosos y betametasona de depósito (Diprospan™) a nivel intracorneano, para el tratamiento de patología infecciosa corneal y de segmento anterior, es una opción viable, segura y que mantiene niveles de antiinfecciosos y antiinflamatorios permanentes a nivel intracorneano y en el segmento anterior, con resultados clínicos comprobados.

Objective: To report different histopathological types of basal cell carcinoma (BCC) involving the periocular region correlating with location and age. Methods: A retrospective analysis was performed on eyelid specimens obtained from the Henry C. Witelson Ophthalmic Pathology Registry, Canada over a 15-year period. The lesions were classified according the histopathological subtypes in nodular, nodular with sebaceous differentiation, nodular with squamous (Basosquamous) differentiation and sclerosing or morphea type. The mean age was evaluated for each subtype and correlation with location was made, whereas the lesions presented on the lower or upper eyelid, medial or lateral canthus. The statistical analysis was made using the unpaired t-test. Results: There were 4313 eyelid lesions analyzed over a 15-year period. Of those, 323 (7.48%) were BCCs. Two hundred and eighty two (87.30%) were nodular, 15 (4.64%) were nodular with squamous differentiation, 3 (0.92%) were nodular with sebaceous differentiation and 23 (7.12%) were of the sclerosing type. The overall most common location was the lower lid in 236 (73.06%) cases, followed by upper lid in 44 (13.75%), medial canthus in 32 (9.9%) and lateral canthus in 2 (0.61%) lesions. Nine BCCs (2.78%) had uncertain location. When the histopathological subtypes were evaluated individually the following results were obtained: In the nodular group, 207 (73.4%) lesions were located on the lower lid, 37 (13.12%) in the upper lid, 28 (9.92%) in the medial canthus and 2 (0.7%) in the lateral canthus. In the basosquamous group, 9 (60%) were in the lower lid, 5 (33.33%) in the upper lid, 1 (6.66%) in the medial canthus and no lesions were found in the lateral canthus. In the nodular with sebaceous differentiation group, 2 (66.66%) lower lid and 1 (33.33%) medial canthal lesions were found. In the sclerosing type group, 18 (78.26%) were in the lower lid, 2 (8.69%) in both the upper lid and medial canthus, with no lesions located on the lateral canthal region. Comparing the mean age of each histopathological type, the group of patients with basosquamous carcinoma was the youngest (62.53 years +/- 16.8 years), followed by the group with nodular BCC (65.28 years +/- 15.9 years), and patients with BCC with sebaceous differentiation (67 years +/- 13.14 years), and for the oldest group composed by patients with sclerosing BCC (75.65 years +/- 11.72 years). There were statistically significant values comparing sclerosing BCC with, nodular BCC (p value= 0.0018) and basosquamous carcinoma (p value= 0.0092) using the unpaired t-test Conclusions: In this single center study the incidence and anatomic location of the different histopathological subtypes of basal cell carcinoma were clearly identified. The data presented is of importance when approaching a patient with a suspect periocular lesion. Nodular BCC was the most common histopathological subtype and the preferred location was the lower lid followed by the upper lid. An older age on presentation was associated with the sclerosing subtype, indicating a more aggressive disease with worse prognosis. Furthermore, all suspect lesions should be excised with careful examination of the histopathological subtype. Resumo Objetivo: Reportar diferentes subtipos histopatológicos de carcinoma basocelular (CBC) acometendo a região periocular correlacionando-os com suas localizações e idades. Materiais/Métodos: Análise retrospectiva foi realizada a partir das lesões palpebrais obtidas do Henry C. Witelson Ophthalmic Pathology Registry, Canada, em um período de 15 anos. Os espécimes estudados foram classificados de acordo com o subtipo histopatológico em nodular, nodular com diferenciação escamosa, nodular com diferenciação sebácea e esclerosante ou morfeaforme. A determinação da localização em pálpebra inferior, pálpebra superior, canto medial e canto lateral foi realizada, correlacionando a idade média com cada subtipo histopatológico. A análise estatística foi realizada utilizando o teste t não-pareado. Resultados: Foram analisadas 4.313 lesões palpebrais em um período de 15 anos. O CBC da região periocular foi encontrado em 323 (7,48%) das lesões estudadas. Dos 323 casos, 282 (87.30%) eram do subtipo nodular, 15 (4.64%) nodular com diferenciação escamosa, 3 (0.92%) nodular com diferenciação sebácea e 23 (7.12%) esclerosante. A pálpebra inferior foi o local mais frequentemente acometido em 236 (73.06%) dos casos, seguido pela pálpebra superior em 44 (13.75%), canto medial em 32 (9.9%) e canto lateral em 2 (0.61%) dos casos. Cinco (1,54%) casos tiveram localização incerta e 4 (1,23%) foram casos de exenteração. Avaliando cada subtipo histopatológico os resultados foram: Nos casos de CBC nodular, 207 (73.4%) foram localizados na pálpebra inferior, 37 (13.12%) na pálpebra superior, 28 (9.92%) no canto medial e 2 (0.7%) no canto lateral. Nos casos de CBC nodular com diferenciação escamosa, 9 (60%) foram localizados na pálpebra inferior, 5 (33.33%) na pálpebra superior, 1 (6.66%) no canto medial e nenhuma lesão foi encontrada no canto lateral. Nos casos de CBC nodular com diferenciação sebácea, 2 (66.66%) foram localizados na pálpebra inferior e 1 (33.33%) no canto medial. Nos casos de CBC esclerosante, 18 (78.26%) foram localizados na pálpebra inferior, 2 (8.69%) na pálpebra superior e canto medial e nenhum caso foi encontrada no canto lateral. Comparando a idade média de cada subtipo histopatológico, os pacientes apresentando CBC nodular com diferenciação escamosa foram os mais jovens (62.53 anos +/- 16.8 anos), seguidos pelo grupo com CBC nodular (65.28 anos +/- 15.9 anos), CBC nodular com diferenciação sebácea (67 anos +/- 13.14 anos), e com o tipo esclerosante apresentando idade média mais elevada (75.65 anos +/- 11.72 anos). Foi observada diferença estatisticamente significativa comparando as idades médias entre os pacientes com CBC esclerosante e nodular (p = 0.0018) e entre CBC esclerosante e nodular com diferenciação escamosa (p= 0.0092). Conclusão: No presente estudo realizado em centro único, a incidência e localização anatômica dos diferentes subtipos histopatológicos de carcinoma basocelular foi claramente identificada. Os dados encontrados são importantes na avaliação de pacientes com lesões perioculares suspeitas. O CBC nodular foi o subtipo histopatológico mais encontrado e sua localização preferencial foi a pálpebra inferior, seguida pela pálpebra superior. A idade mais elevada foi associada com o subtipo esclerosante, indicando doença mais agressiva com pior prognóstico. Por conseguinte, todas as lesões suspeitas devem ser excisadas e análise histopatológica cuidadosa realizada para caracterização do subtipo histopatológico.

Objective: To present the outcomes of 4 patients with Acanthamoeba keratitis (AK) who underwent combined penetrating keratoplasty and cataract extraction (PKP/CE) after medical treatment of their infection. Method: Retrospective case series. 4 patients with AK underwent PKP/CE after medical control of infection was achieved. Results: The mean time from control of infection to surgery was 4 months. Three patients maintained a clear graft after a mean follow up of one year. One patient with bilateral sclerokeratitis who underwent bilateral PKP had recurrent infection in the right eye and required a repeat transplant 7 months after her initial transplant for visual rehabilitation. Conclusion: PK with lens extraction is a good approach for visual rehabilitation in patients with a history of AK after complete control of infection with medical treatment. Resumen Objetivo: Presentar 4 casos de queratitis por acanthamoeba (QA) y su manejo médico-quirúrgico en el proceso de rehabilitación visual. Método: Se realizó un estudio retrospectivo. Se incluyeron 4 pacientes con diagnóstico de QA que fueron sometidos a queratoplastia penetrante con extracción del cristalino (QP/EC) luego de obtenida la estabilidad clínica con un tratamiento médico agresivo. Resultados: El tiempo medio en lograr estabilidad clínica fue de 4 meses. 3 casos presentaron injerto corneal transparente con más de una año de seguimiento. 1 paciente con escleroqueratitis bilateral, sometido a QP bilateral, presentó un cuadro de recurrencia amebiana. Dicho paciente requirió una segunda QP en ojo derecho luego de 7 meses de la primera para su correcta rehabilitación visual. Conclusión: La QP/EC es una muy buena opción para la rehabilitación visual en pacientes con antecedentes de QA posterior al control completo de la infección mediante tratamiento médico.

Introduction: Corneal hysteresis quantifies the biomechanical properties of corneal tissue, both static and dynamic, that influence the quantification of ocular pathology such as in corneal ectasia and after surgical procedures. It may also be important for the diagnosis and treatment of corneal disease. Objective: To determine corneal hysteresis and the corneal resistance factor in patients with the diagnosis of corneal ectasia pre-and post-surgical implantation of intracorneal rings. Method: This is a prospective, comparative and longitudinal study. The statistical analysis was performed using a Student t- test for paired samples. We studied a series of 14 patients (16 eyes) with the diagnosis of corneal ectasia, fourteen with the diagnosis of keratoconus, one with the diagnosis of pellucid marginal degeneration, and one with the diagnosis of post-LASIK ectasia. The mean age was 25 years (range 16-39), 50% were female and 50% were male. This study was performed in the Cornea and Refractive Surgery Department of the Instituto de Oftalmología, Fundación Conde de Valenciana I.A.P., Mexico City. In this series, the quantification of the biomechanics was made with the ORA (Ocular Response Analyzer) by Reichert's, pre- and post-surgical implantation of intra-corneal rings one month after surgery. Other variables that were included were visual acuity, visual capacity, refraction error by spherical equivalent and keratometry average. Results: The visual acuity prior to surgery varied from count fingers at one foot to 20/50 on the Snellen chart or its equivalence of 3.00 to .40 in LogMAR. After surgical implantation of the rings, the visual acuity was better by an average of four lines with a decrease in refractive error by a spherical equivalent of three diopters and an average keratometric flattening of four diopters. With regard to the corneal biomechanics, hysteresis and corneal resistance factor did not vary, (pre = 6.5 mmHg and post = 6.4 mmHg). Discussion: Despite our hypothesis that corneal hysteresis and the corneal resistance factor should be greater after surgical implantation of intracorneal rings, our study demonstrated no change in the viscoelastic properties of the cornea. Nonetheless, the results of the biomechanics were better as reflected in visual acuity, a decreased refractive error, flatter keratometric curvature and the promise of long range corneal stability as suggested in the literature. Conclusion: The expected biomechanical property changes of the cornea were not statistically significantly different in terms of quantification of hysteresis and corneal resistance factor using the ORA. Resumen Introducción: La histéresis corneal es la cuantificación de las propiedades biomecánicas del tejido corneal, estas características son estáticas y dinámicas, las cuales influyen en los estados patológicos como en las ectasias corneales y procedimientos oculares, actualmente importantes para el diagnóstico y manejo de las enfermedades del tejido corneal. Objetivo: Determinar la histéresis corneal y factor de resistencia corneal en pacientes con el diagnóstico de ectasia corneal pre y post-quirúrgico a la implantación de anillos. Método: Es un estudio prospectivo, comparativo y longitudinal, del análisis estadístico de una serie de muestras pareadas a través de una prueba t de student. Se estudiaron una serie de 14 pacientes, un total de 16 ojos de pacientes con el diagnóstico de ectasia corneal, catorce con el diagnostico de queratocono, uno con el diagnóstico de degeneración marginal pelucida, y otro con el diagnóstico de ectasia post-LASIK. Este estudio se realizó en el Departamento de Cornea del Instituto de Oftalmología, Fundación Conde de Valenciana, I.A.P., México D.F. De esta serie de casos se les realizó la cuantificación de su biomecánica a través ORA (ocular response analyzer) de Reichert's, pre y post implante de anillos intracorneales a los 30 días. Otras variables que se incluyeron son; agudeza visual, capacidad visual, error refractivo en equivalente esférico y promedio queratométrico. Resultados: Un total de 16 ojos, el promedio de edad fue de 25 años (rango de 16-39), 50% del sexo femenino y 50% del sexo masculino. La agudeza visual previa la cirugía fue de cuenta dedos a 20/50 según cartilla de Snellen o su equivalencia de 3.00 a .40 en LogMAR, después de la implantación de los anillos, la agudeza visual mejoró en un promedio de 4 líneas, menor error refractivo en equivalente esférico de tres dioptrías, aplanamiento de la queratometría promedio de cuatro dioptrías, y en lo que respecta a las características de la biomecánica corneal, la histéresis corneal y el factor de resistencia corneal no presentaron diferencias significativas, pre 6.5 mmHg y post 6.4 mmHg. Discusión: A pesar de inferir que la histéresis y el factor de resistencia corneal debieran de aumentar con la implantación quirúrgica de los anillos intracorneales, este estudio demuestra que no hay cambios en las propiedades viscoelásticas de la cornea, sin embargo los resultados biomecánicos fueron mejores en el aspecto de la agudeza visual, menor error refractivo, menor curvatura corneal y prometen estabilidad corneal a lo largo del tiempo de acuerdo con la literatura mundial. Conclusión: Los cambios esperados en las propiedades de la biomecánica corneal no mostraron diferencia estadísticamente significativa en la cuantificación de histéresis corneal y factor de resistencia corneal utilizando el ORA.

Purpose: To summarize the findings of an international team of volunteer researchers, scientists and physicians, from Brazil, United States of America and Italy, who have made eight yearly field investigations in rural Brazil to study a giant pedigree of LHON. Methods: The world's largest pedigree of LHON, a family of 328-members, was found in Colatina, Espirito Santo state, Brazil. All subjects underwent a detailed questionnaire and neuro-ophthalmologic investigation. Results: 2001-3: The researchers found, organized and defined the pedigree of LHON that was founded by an Italian immigrant born in 1861. The mitochondrial mutation was 11778, homoplasmic, Jhaplogroup. Epidemiological studies and gene linkage analysis were performed on this pedigree. Sophisticated equipment was brought for psychophysical and electrophysiological testing to complement the comprehensive neuro-ophthalmological examinations. 2004-5: Subclinical and serological measurements were found to be useful in following the progression of LHON in carriers. 2006-8: OCT findings (nerve fiber layer (NFL) thickness), complemented psychophysics and was demonstrated to be an excellent the best objective preclinical diagnostic tool to determine changing seen in most LHON carriers. Conclusions: We were able to establish incidence and penetrance data on a giant pedigree of 11778 LHON. Smoking and drinking alcohol were identified as risk factors. Psychophysical and OCT findings were frequent amongst asymptomatic carriers. Objetivo: Resumir achados de um time de pesquisadores voluntários internacionais, cientistas e médicos, do Brasil, Estados Unidos e Itália, que realizaram oito expedições a uma área rural do Brasil para estudar um pedigree muito grande de NOHL. Métodos: O pedigree mais extenso do mundo de NOHL, uma família com 328 membros, foi descoberto em Colatina, estado do Espírito Santo, Brasil. Todos os indivíduos foram submetidos a extenso questionário e investigação neuro-oftalmologica. Resultados: 2001-3: Os pesquisadores localizaram, organizaram e definiram o pedigree de NOHL que foi iniciado por uma imigrante italiana nascida em 1861. A mutação mitocondrial era 11778, haplogrupo J homoplasmico. Estudos epidemiológicos e analise genética foram realizados. Sofisticados equipamentos foram trazidos para realização de testes eletrofisiologicos e psicofísicos, complementares a extenso e completo exame neuro-oftalmologico. 2004-5: Medidas subclínicas e sorológicas se mostraram úteis no acompanhamento da progressão de portadores de LHON. 2006-8: Achados de OCT (espessura da camada de fibras nervosas da retina), complementaram achados psicofísicos e demonstraram ser uma ferramenta boa e objetiva na determinação de alterações pré clinicas observada na maioria dos portadores de NOHL. Conclusões: Estabelecemos dados de incidência e num pedigree gigante de NOHL 11778. Tabaco e álcool foram considerados fatores de risco. Alterações psicofísicas e de OCt foram freqüentes em portadores assintomáticos de NOHL. Resumen Objetivo: Resumir los hallazgos encontrados por un grupo internacional de investigadores, científicos y médicos voluntarios de Brasil, Estados Unidos e Italia que han realizado ocho viajes anuales para estudiar un pedigrí gigante de LHON en una comunidad rural de Brasil. Método: El pedigrí de LHON más grande del mundo, una familia de 328 miembros localizada en la comunidad de Colatina, en el estado de Espirito Santo, Brasil. Todos los sujetos recibieron un cuestionario detallado y fueron investigados desde el punto de vista neuro-oftalmológico. Resultados: 2001-3: Los investigadores encontraron, organizaron y definieron el pedigrí de LHON que fue fundado por un inmigrante italiano nacido en 1861. La mutación mitocondrial fue 11778, homoplásmica y de haplogrupo-J. Se realizaron estudios epidemiológicos y de ligamiento genético. Para complementar el examen neuro-oftalmológico integral, equipo sofisticado fue trasladado para realizar los estudios psicofísicos. 2004-5 Se encontro que las mediciones subclínicas y serológicas son útiles en el monitoreo de la progresión en portadores de LHON. 2006-8: Hallazgos de OCT (grosor de CFN) complementaron los estudios psicofísicos y se demostró que éste es el cambio preclínico más objetivo hallado en la mayoría de los portadores. Conclusión: Fuimos capaces de generar información con respecto a la incidencia y penetrancia de un pedigrí gigante de LHON 11778. Como factores de riesgo fueron identificados el consumo de tabaco y alcohol . Es común que entre los portadores asintomáticos se encuentren hallazgos psicofísicos y en la OCT.

Purpose: To evaluate anatomical and visual outcomes after silicone oil removal in patients operated on retinal detachment and proliferative vitreoretinopathy in a referential eye-care centre in Joinville, southern Brazil. Methods: Retrospective, non-comparative, consecutive case series. Cases included all patients with retinal detachment and grade C posterior proliferative vitreoretinopathy examined and operated on by the same physician (MJN) from January 1997 to August 2006. Cases of retinal detachment associated with trauma, giant tears, viral retinitis or diabetic retinopathy were excluded. The initial surgery, performed in all the eyes, included pars plana vitrectomy, 360-degree scleral buckling, laser endophotocoagulation around the retinal tears and silicone oil infusion in the vitreous cavity. A prophylactic 360-degree peripheral laser photocoagulation was applied one to three months before silicone oil removal. Results: Twenty-seven patients underwent silicone oil extraction. Nineteen (70,4%) were men and the mean age was 54,1 years-old (range 24-79 yo). The median follow-up was 284 days (73-988 days). Twenty-six eyes (96,3%) had the retina attached at the last examination. After silicone oil extraction, visual acuity improved in 13 patients (48,2%), stabilized in 9 patients (33,3%) and decreased in 5 patients (18,5%). There was a case of severe visual loss after silicone oil extraction (from 20/40 to 20/400), with an indetermined optic disc atrophy. Conclusions: Silicone oil removal provided good anatomical and visual results in most of the patients. Nevertheless, 5 cases had unfavorable outcomes, particularly one with a severe and unexplained vision loss. Surgeons must be aware of adverse results associated with silicone oil removal and its benefits must be outweighed against its extended duration in the eye and the possibility of complications with a new surgical procedure. Resumo Objetivo: Avaliar os resultados anatômicos e visuais após a retirada do óleo de silicone em pacientes operados de descolamento de retina e vitreorretinopatia proliferativa num centro oftalmológico de referência em Joinville, sul do Brasil. Métodos: Estudo retrospectivo e não-comparativo de casos consecutivos de descolamento de retina com vitreorretinopatia proliferativa posterior grau C examinados e operados pelo mesmo médico (MJN) de Janeiro de 1997 a Agosto de 2006. Foram excluídos os casos de descolamento de retina associados a trauma, ruptura gigante, retinite viral ou retinopatia diabética. A cirurgia inicial, realizada em todos os olhos, consistiu de vitrectomia via pars plana, introflexão escleral em 360 graus, endofotocoagulação retiniana ao redor das rupturas retinianas e colocação de óleo de silicone na cavidade vítrea. A fotocoagulação profilática em 360 graus na periferia retiniana também foi realizada um a três meses antes da remoção do óleo de silicone. Resultados: Vinte e sete pacientes foram submetidos à extração do óleo de silicone. Dezenove (70,4%) eram homens e a idade média foi 54,1 anos (variação de 24 a 79 anos). O tempo de seguimento médio foi 284 dias (73-988 dias). Vinte e seis olhos (96,3%) tinham a retina colada no último exame oftalmológico. Após a extração do óleo de silicone, a acuidade visual melhorou em 13 pacientes (48,2%), manteve-se estável em 9 pacientes (33,3%) e diminuiu em 5 pacientes (18,5%). Houve um caso de perda visual grave após a remoção do óleo de silicone (de 20/40 a 20/400), com atrofia óptica de causa indeterminada. Conclusões: A retirada do óleo de silicone propiciou bons resultados anatômicos e visuais na maioria dos pacientes. Entretanto, 5 casos tiveram evolução desfavorável, principalmente um com perda visual grave e inexplicável. Os cirurgiões precisam estar cientes dos resultados adversos associados à extração do óleo de silicone e os seus benefícios devem ser analisados perante os riscos de sua duração prolongada no interior do olho e da possibilidade de complicações com um novo procedimento cirúrgico.

Purpose: To evaluate the long term efficacy and safety of intravitreal bevacizumab (Avastin, Genentech) for treatment of age-related macular degeneration (AMD) in two eye clinics in southern Brazil. Methods: Retrospective chart review of 36 consecutive patients with neovascular AMD who received one or more intravitreal injections of bevacizumab and completed at least one year of follow-up. At each visit, visual acuity (VA) and ophthalmic examination was assessed; optical coherence tomography and fluorescein angiography were performed at first visit and then as needed basis. Cases with prior verteporfirin photodynamic therapy, photocoagulation and intravitreal or periocular injections of triamcinolone or other anti-angiogenic drugs were excluded. After written informed consent was obtained, patients were treated with an intravitreal bevacizumab dose of 0.05ml (1.25mg) to 0.1ml (2.50mg). Rein-jections were performed if necessary. Results: Thirty-nine eyes of 36 patients were included in this study (38.9% male, 61.1% female) with a mean age of 75.2 years-old (5988 years). In the mean period of 17.3 months (range 12-27), they received an average of 3.3 injections (range 1-8). Twenty-eight eyes (71.8%) had improved (38.5%) or stabilized (33.3%) VA with a mean variation from 0.80 logMAR before treatment to 0.82 logMAR at last follow-up visit. No significant ocular or systemic side effects were noted. Conclusions: This study suggests that bevacizumab appears to be a safe and effective treatment for neovascular AMD after one year of initial therapy as it has been shown recently by Bashur et al.^[5] Further studies are necessary to validate these preliminary findings. Resumen Objetivos: Avaliar em longo prazo a eficácia e segurança do bevacizumab intravítreo (Avastin, Genentech) para o tratamento da degeneração macular relacionada à idade (DMRI) exsudativa em dois serviços oftalmológicos de referência do sul do Brasil: Hospital de Olhos Sadalla Amin Ghanem (Joinville/SC) e Oftalmoclínica (Curitiba/PR). Métodos: Estudo retrospectivo de 36 pacientes com DMRI neovascular que receberam uma ou mais injeções intravítreas de bevacizumab e completaram pelo menos um ano de seguimento. Em cada consulta, a acuidade visual (AV) e exame oftalmológico eram realizados; tomografia de coerência óptica e angiografia fluoresceínica foram efetuadas na primeira visita e quando necessário. Foram excluídos os casos previamente submetidos à terapia fotodinâmica com verteporfirina, fotocoagulação e aplicações intravítreas de triancinolona ou outras drogas anti-angiogênicas. Após preenchimento do consentimento informado, os pacientes foram tratados com bevacizumab intravítreo com doses de 0,05ml (1,25mg) a 0,1ml (2,50mg). Reinjeções eram aplicadas caso houvesse indicação. Resultados: Trinta e nove olhos de 36 pacientes foram tratados, sendo 61,1% do sexo feminino; a média de idade foi de 75,2 anos (59-88 anos). No período médio de 17,3 meses (12-27) os pacientes receberam média de 3,3 injeções (1-8). Vinte e oito olhos (71,8%) tiveram melhora (38,5%) ou estabilização (33,3%) da AV, com variação média de 0,80 logMAR antes do tratamento para 0,82 logMAR na última consulta. Não se notou efeito colateral ocular ou sistêmico durante o acompanhamento. Conclusões: Os resultados observados sugerem que o bevacizumab intravítreo seja eficaz e seguro no tratamento da DMRI neo-vascular após um ano do início do tratamento

A study of 114 cases operated due to upper eyerlid ptosis in the months of October 2004 to August 2006 was carried out in the Southern Children Hospital from Santiago de Cuba where the folding of the aponeu-rosis of the elevator muscle of the upper lid (musculus levator palpebrae superioris) was applied as surgical technique. The most frequent age was from 6 to 10 years and the male sex was the most affected. The postoperative clinical course was satisfactory in most of the cases. Resumen Se realizó un estudio de 114 casos operados por ptosis palpebral en los meses de octubre del año 2004 hasta agosto del año 2006 en el Hospital Infantil Sur de Santiago de Cuba donde se aplicó como técnica quirúrgica el plegamiento de la aponeurosis del músculo elevador del párpado superior. La edad más frecuente fue de 6 a 10 años y el sexo masculino fue el más afectado. La evolución postoperatoria fue satisfactoria en la mayoría de los casos.

We describe the clinical and histopathologic characteristics of a variant form of the Vernal Keratoconjunctivitis, called "Exuberant pigmented conjunctivitis" and demonstrate the allergic response to environmental particles combined with high altitude, dust, concentrated ultraviolet rays and dryness. Resumen Describimos las características clinicas e histopatológicas de una variante de la Queratoconjuntivitis vernal, llamada “Conjuntivitis Exuberante pigmentada” y demostramos su respuesta alérgica a partículas del medio ambiente combinadas con un clima seco, polvo y gran altitud.

Exenteration is a radical and disfiguring surgical procedure, indicated in cases where malign and benign processes cannot be treated with more conservative treatment techniques. The most common indication for exenteration is malignant neoplasms. The objective of this study is to describe, in detail, the histopathological analysis of the six ex-enteration specimens received between 2000 and 2005 in a reference center for ocular pathology, in Montreal, Canada. Resumo A cirurgia de exenteração é um procedimento radical, indicado em casos de pro-cessos malignos e benignos quando técnicas mais conservadoras são insuficientes para o tratamento. A maior parte das indicações de exenteração é atribuída a neoplasias malignas. Este estudo tem como objetivo relatar em detalhe a análise histopatológica dos seis espécimes de exenteração recebidos entre 2000 e 2005 em um serviço de referência de patologia ocular, localizado em Montreal, Canadá.

Purpose: To evaluate the prevalence of trachoma in school children in Botucatu city, state of São Paulo, Brazil and to verify the local spatial distribution of detected cases. Methods: Cross-sectional studies investigating trachoma cases among school-age children in the city of Botucatu in 2005. A sample size of 2,092 was estimated based on a previous prevalence of 11.2% in the same city, with an estimation error of 10% and a confidence level of 95%. Children were selected by probable cluster sampling. Spatial data were evaluated by CartaLinx (v1.2) and Geoda softwares and data referring to locations of the schools were converted into Thiessen polygons. Results: The prevalence of trachoma in Botu-catu school children in 2005 was 3.0%. The spacial distribution of detected cases did not show areas with higher concentration. Conclusion: The prevalence of trachoma among schoolchildren in Botucatu city - São Paulo State, was 3.0% and the spatial distribution analysis did not show areas of higher concentration of cases in this particular city. Resumo Objetivo: Avaliar a prevalência de trachoma em escolares da cidade de Botucatu, São Paulo-Brasil, verificando a distribuição espacial dos casos detectados. Métodos: Estudo transversal, realizado no ano de 2005, com amostra por conglomerado (escolas) de todas as escolas da cidade de Botucatu. A amostra foi constituída de 2.092 crianças, estimada pela prevalência histórica de 11,2% de tracoma em escolares da mesma cidade. Adotou-se erro de estimação de 10% e interval de confiança de 95%. A distribuição espacial foi feita usando a CartaLinx (v1.2) e o software Geoda, segundo a localização das escolas, convertida pelos polígonos de Thiessen. Conclusão: A prevalência de trachoma em escolares de Botucatu, no ano de 2005, foi de 3,0%. A distribuição espacial dos casos detectados não revelou áreas de maior con-centração da doença.

Resumen En este trabajo se evalúo la eficacia de la utilización de la AGUJA EN PATÍN DE NIEVE que es utilizada de forma tradicional en la cirugía general y ortopédica y fue usada por primera vez en la cirugía oftalmológica en la corrección quirúrgica de ptosis palpebral congénita severa. Fueron intervenidos quirúrgicamente 112 ojos de 89 niños entre 2 y 14 años de edad. Durante la cirugía y en el postoperatorio se evalúo el tiempo quirúrgico empleado, el sangrado, el edema y el riesgo de infección. Durante nuestro trabajo no se identificaron complicaciones importantes que comprometieran el resultado final estético deseado.

OBJECTIVES: Analyze the characteristics and results in the Retinopathies of the Prematurity (ROP) Blindness Prevention Program in the given period. METHOD: Retrospective study of Series screening babies to present ROP risk factors, among 1998-2005 included. RESULTS: In total was screening 4396 children, the incidence annual average was of 16/100 cases included in the screening protocol and the calculated prevalence was 0.3/10,000 infants The age average and weight in the series were of 30.1 weeks and 1702 grams of weight. The 11.2% of screening babies (493) develops ROP and 2% (79) received treatment with cryotherapy (69%) while the remaining 31% with photocoagulation with laser diode and green-blue by means of indirect binocular ophthalmoscope, 15% of the treaties by means of cryotherapy and 4% of the photocoagulates developed derived complications of proceeding. CONCLUSIONS: The positive results as for the identification and treatment of the ROP by means of our program suggests their continuation and extension or application in environments with socioeconomic similarity to ours. RESUMEN OBJETIVOS: Analizar las características y los resultado del programa Prevención de la Ceguera por Retinopatía de la Prematuridad (ROP) en el periodo dado. METODO: Estudio Retrospectivo de Serie de Casos pesquisados por presentar factores de riesgo para la ROP, en el periodo comprendido entre los años 1998-2005 incluidos. RESULTADOS: En total se pesquisaron 4396 niños, La incidencia anual promedio fue de 16/100 pesquisados y la prevalencia calculada del 0.3/10,000 infantes. Las medias de edad y peso en la serie fueron de 30.1 semanas y 1702 gramos de peso. El 11.2% de los pesquisados (493) desarrollo ROP y el 2% (79) recibió tratamiento. De estos, el 69% se trató con crioterapia, mientras el restante 31% con fotocoagulación con láser diodo y verde-azul mediante oftalmoscopio binocular indirecto. El 15% de los tratados mediante crioterapia y el 4% de los fotocoagulados desarrollaron complicaciones derivadas del proceder. CONCLUSIONES: Los resultados positivos en cuanto a la identificación y tratamiento precoces de la ROP mediante nuestro programa sugiere su continuación y extensión de su aplicación en entornos con similitud socioeconómica al nuestro.

INTRODUCTION: Because of long time morbility and the incrising number of premature newborn that survive, rethinophathy of prematurity still is a special disease to study. Nowadays more than oxigenotherapy or lasertherapy some new treatments using growth factors that normally promote the normal vascularization are arising. PURPOSE: the authors make a review of published articles about the growth factors that promote and downregulate retinal vascularization. MATERIAL AND METHODS: the authors have made a search of publishe articles on Medline and Pubmed since Janu ary 2000 in English, Portuguese and Spanis using these keywords: prematurity, retino pathy, oxigenotherapy, neovascularizatio growth factor. They also make manual searc on books of ophthalmology, paediatrics an embryology. RESULTS: They selected tw review articles and sixteen investigation a ticles over hundred and ten that were found CONCLUSION: The advance in the unders tanding of neovascularization seams to have practical application in a near future not only on prematurity but also in others disease lik diabetic retinopathy or DMLI. Resumo INTRODUÇÃO: A retinopatia do prematuro continua a ter especial atenção dada a morbilidade que apresenta a longo prazo e também a quantidade de recém-nascidos cada vez mais prematuros que os avanços científicos conseguem fazer sobreviver. Hoje em dia além do controlo da oxigenoterapia e laserterapia começam a querer-se incluir novos tratamentos usando os próprios factores promotores da normal vascularização retiniana. OBJECTIVO: fazer uma breve revisão do que foi publicado sobre os vários factores promotores e inibidores da vascularização. MÉTODOS: Foi efectuada uma pesquisa de artigos publicados na base de dados Medline/Pubmed desde Janeiro de 2000, em língua inglesa, portuguesa ou espanhola, usando as palavras chave: prematurity, retinopathy, oxigenotherapy, neovascularization, growth factor. Foi também realizada pesquisa manual em livros de Oftalmologia, Pediatria e Embriologia. RESULTADOS: Dos cento e dez artigos encontrados foram seleccionados 2 artigos de revisão e dezasseis artigos de investigação que serviram de base a este artigo. CONCLUSÕES: Os avanços do conhecimento nesta área da vascularização tem aplicação prática num futuro próximo, não só nesta patologia como em outras em que há neovascularização, nomeadamente retinopatia diabética ou DMLI.

SUMMARY We present a prospective study analyzing a series of patients with ophthalmic cephalgia, probably induced by an erroneous position of the screen more than five degrees above the level of the sight in VDT users. All patients included in the analysis used the VDT more than 4 hours every day, complained of cephalgia and asthenopia as one of their symptoms and were using the screen computer 15 degrees above eye level. Patients with other causes of cephalgia such as inappropriate refraction, general disorders and use of laptops were excluded. After several weeks and proper positioning of the screen, patients were questioned about their symptoms, and 70% reported a clear improvement. The pathophysiology of this finding called "screen VDT cephalgia" are discussed along with its importance and relevance in the workplace from and ophthalmologic and ergonomic standpoint. RESUMEN Se presenta un estudio prospectivo en el que se analizan una serie de pacientes en los que se les sospechó una cefalea oftálmica inducida por la mala posición de uso de los monitores de computador, de acuerdo a un protocolo en el que se recomienda que la altura del mismo este al menos 15 grados por debajo del eje visual. Todos los pacientes incluídos usaban el computador tipo personal por un lapso mayor de 4 horas diarias, tenían cefalea y utilizaban el monitor por encima del eje visual. A todos se les descartó cualquier otra causa oftalmológica o sistémica responsable de la cefalea. Se excluyeron aquellos pacientes usuarios de laptop. La mejoría de los síntomas astenópicos fue del 70% tres semanas o más después de haber corregido la altura de uso del monitor. Se insiste en la importancia desde el punto de vista ocular, laboral y ergológico y se explican las posibles causas fisiológicas responsables de este nuevo síndrome del Monitor.

Animal studies have brought new expectations in the development of local chemotherapy for the treatment of patients with ocular cancer. To know the intermediate and mediate adverse reactions of some of the citostatics will open the breach in the treatment of malignant tumours with no need of radical surgery. At the National Institute of Oncology (INOR), a study performed on rabbits to determine the complications related to the administration of cisplatinum by subconjunctival location as an cistostatic agent for the treatment of epithelial tumours. As results of this, some oedema was observed and the moderated congestion of blood vessels in those eyes which received the trial product. RESUMEN Estudios en animales han abierto expectativas en el desarrollo de la quimioterapia local para el tratamiento de los pacientes con cáncer de presentación ocular. Conocer las reacciones adversas inmediatas y mediatas de algunos citostaticos, abre una brecha en el tratamiento de los tumores malignos sin tener que llegar a la realización de cirugías mutilantes. En el INOR realizamos un estudio en conejos para determinar las complicaciones inherentes a la administración de cisplatino por vía subconjuntival como agente citostático de primera línea para el tratamiento de los tumores epiteliales. Como resultado observamos algo de edema y congestión moderada de vasos sanguíneos en los ojos que le fueron administrados el producto prueba a las dosis referidas.

OBJECTIVE To compare the results with publications of other authors on the subject. METHOD All the diagnosed cases of Osteoma of coroides in this center from their inauguration in 1941 to II of 2002 are reviewed that altogether add 17, but of 8, 1 because finally it was arrived at the diagnosis of Melanoma, 1 by coroiditis, 1 by Haemangioma and 5 doubtful ones are discarded there to consider that they did not have all the tests necessary to be considered like such; therefore the studied cases are 9, such that were diagnosed by oftalmoscopía and confirmed by ECHO, TAC or RMN and AGF. RESULTS In our study was the following thing: - 67% go by visual alterations. - The diagnosis between 2° and 3° is more frequent decades of life 67%. - More frequent in women 67%. - More frequent in an eye 78% (OI = 56%). - 89% are of location to peripapilar. - Only in 10% a diminution of the size is reported. - Diminution of AV. In 40% with respect to the first visit, 56% stay equal. - Average time of pursuit 3.30 years. RESUMEN El Osteoma coroideo es una tumoración benigna en la que el Tejido óseo sustituye a la coroides. OBJETIVO Comparar los resultados con las publicaciones de otros autores sobre el tema. MÉTODO Son revisados todos los casos diagnosticados de Osteoma de coroides en este centro desde su inauguración en el año 1941 hasta II de 2002 que en total suman 17, pero de ahí son descartados 8, 1 porque finalmente se llegó al diagnóstico de Melanoma, 1 por coroiditis, 1 por Haemangioma y 5 dudosos por considerar que no tenían todas las pruebas necesarias para ser considerados como tales; por lo tanto los casos estudiados son 9, los mismos que fueron diagnosticados por oftalmoscopía y confirmados por ECO, TAC o RMN y AGF. RESULTADOS En nuestro estudio se encontró lo siguiente: - El 67% acude por alteraciones visuales. - Es más frecuente el diagnóstico entre la 2° y 3° décadas de la vida 67%. - Más frecuente en mujeres 67%. - Más frecuente en un ojo 78% (OI= 56%). - El 89% es de localización peripapilar. - Sólo en el 10% se reporta una disminución del tamaño. - Disminución de AV. En el 40% respecto a la primera visita, el 56% se mantiene igual. - Tiempo medio de seguimiento 3,30 años. THEY SUMMARIZE The coroideo Osteoma is a benign tumoración in which the bony Weave replaces the coroides.

Purpose: To report the epidemiology of retinoblastoma (RB) in Guatemala. Design: Retrospective case series. Methods: All medical files of patients from the pediatric division of our center who were diagnosed with retinoblastoma (RB) in the past ten years (1995-2005) were reviewed. From each file, the gender, age of diagnosis, clinical manifestations, staging based on the Reese-Ellseworth classification, and the geographical origin of the patients were recorded in a data sheet. Main Outcome Measures: Incidence of retinoblastoma in Guatemala. Results: From January 1997 to March of 2005, sixty-eight (68) patients were diagnosed with RB. Thirty-five (52%) were male and thirty-three (48%) female. Mean age of diagnosis was 31 months. Forty-nine (72%) cases were unilateral and 19 (28%) had bilateral involvement. Sixty-seven percent of the cases were at advanced stages at the diagnosis. Conclusion: RB in Guatemala is diagnosed at advanced stages and the mean age of diagnosis is greater than the developed countries.

Purpose. To evaluate the safety and efficacy of goniotomy as a first-line surgery in cases of open angle pe-diatric glaucoma, other than primary congenital, in which medical therapy had failed or had been judged to be not advisable. Methods. A non-comparative retrospective chart review of a series of gonio-tomies performed in children with refractory secondary glaucoma. Success was defined as an intraocular pressure (IOP) less or equal to 22 mmHg, without need for further surgical intervention with or without additional medical therapy. Results. 12 patients (16 eyes) with underlying diagnoses of Sturge Weber Syndrome, uveitis, infantile and traumatic glaucoma were included. The mean age at the first goniotomy was 5.2-year-old, with a mean follow-up of 35 months. Surgical success was achieved in 9 eyes (56%) with a mean IOP of 16.3 + 4.61mmHg (reduction of 16 mmHg, p<0.001). Complications included different degrees of hyphema and a small iris prolapse. Discussion. Although traditionally limited to management of congenital glaucoma, goniotomy is a relatively gentle and potentially useful first-line surgical procedure for children with refractory glaucoma different than congenital.