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

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

Case reports: We report a few cases of a Portuguese family with Meretoja syndrome. Complete ophthalmological examination and tests such as pachymetry and Ocular Response Analyzer (ORA) were performed. The clinical spectrum of patients was variable. Visual acuity ranged from 20/20 to count fingers, depending on the degree of dystrophy and keratitis. They all had lattice corneal dystrophy type II and keratitis of varying severity. Discussion: Meretoja syndrome is a systemic amyloidosis and it is characterized by cranial neuropathy, corneal dystrophy and mild signs of polyneuropathy. This form of disease lacks specific treatment.

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

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

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.

The tear film consists of three layers: an outer thin lipid layer that is composed in part of lipid-rich excreta called meibum, secreted by the meibomian glands; a middle aqueous-mucin layer that nourishes the cornea and conjunctiva; and an inner mucin layer that helps to spread the aqueous layer over the ocular surface. Changes in the quality or quantity of any of the tear film components affect its normal protective function and promote the development of dry eye disease. Currently, a study in the U.S estimated that 3.25 million women and 1.68 million men 50 years and older are affected, and is expected to grow even more. Previous studies have identified some risk factors for dry eye disease such as older age, female sex, reduced androgen levels, and imbalanced diet. Dry eye disease has been divided into two groups: 1) aqueous tear-deficient dry eye, and 2) evaporative dry eye (also known as lipid tear deficiency dry eye). Previous publications have postulated that an abnormal tear film lipid layer would facilitate the evaporation from the tear film and lead to the development of dry eye disease. In our study, using two relatives humidities (25-35% and 35-45%) we have reported an increase in the evaporation rate by 42.1% and 40% in dry eye patients, compared to normal group. These results indicate that the dry eye patients have a higher rate of evaporation from the aqueous tear layer as compared to normal subjects. The development of new technologies to reduce the evaporation from the aqueous tear has been the aim of many pharmaceutical companies. Newer lipid emulsion eye drops are becoming more effective and popular. Recent data suggest that after the instillation of these lipid-containing eye drops the lipid layer thickness and ocular symptoms improved in dry eye patients, compared to other commercially available eye drops. RESUMEN La superficie ocular está cubierta por una delgada película, llamada película lagrimal, compuesta por 3 capas: la externa o capa lipídica, integrada principalmente por los lípidos provenientes de las glándulas de meibomio; la capa intermedia, acuosa, compuesta por proteínas y electrólitos; y la capa interna, compuesta en su mayor parte de mucina. Cambios cuantitativos o cualitativos de cualquiera de los componentes de la película lagrimal conllevan a situaciones patológicas como el ojo seco. Actualmente, en Estados Unidos 3,25 millones de mujeres y 1,68 millones de hombres mayores de 50 anos se encuentran afectados, y esta cifra va en aumento. Estudios previos han identificado factores de riesgo para la enfermedad entre los que se encuentran el envejecimiento, sexo femenino, disminución de los niveles de andrógenos y dietas desbalanceadas. La enfermedad del ojo seco se divide en dos grupos: 1) ojo seco con deficiencia del componente acuoso, y 2) ojo seco de tipo evaporativo (también conocido como ojo seco con deficiencia del componente lipídico). Publicaciones previas han señalado el aumento de la evaporación de la película lagrimal en presencia de una capa lipídica disfuncional. Nuestras investigaciones (usando humedades relativas de 25-35% y 35-45%) han reportado un aumento en la evaporación de un 42.1% y 40% aproximadamente en pacientes con ojo seco, en comparación con el grupo control. Estos resultados indican que los pacientes con ojo seco tienen una tasa de evaporación de la película lagrimal mucho más alta a la de personas sanas. Cada día más laboratorios invierten en el desarrollo de tecnología para reducir la evaporación de la película lagrimal. Gotas con emulsión lipídica son cada vez más comunes y efectivas, estas gotas restauran parcialmente la capa lipídica y han demostrado ser eficaces en el tratamiento del ojo seco de tipo evaporativo en comparación con las gotas sin contenido lipídico.

RESUMO: Atualmente, os gases intraoculares são utilizados de rotina para o tratamento de várias doenças do segmento anterior e posterior, propiciando resultados melhores e mais rápidos. Os gases intravítreos são frequentemente usados para a terapia de descolamento de retina, buraco macular, hemorragia intravítrea e submacular e como coadjuvante em cirurgia vítrea. A aplicação de gases na câmara anterior é principalmente empregada no tratamento de hidrópsia corneana aguda, descolamento da membrana de Descemet e como adjuvante em ceratoplastia lamelar. Este artigo de revisão discute aspectos relacionados às atuais aplicações clínicas de gases para o tratamento de diferentes doenças oculares e também os possíveis efeitos adversos associados à injeção de gases na cavidade vítrea ou na câmara anterior. ABSTRACT: Intraocular gases in present day use are routinely implemented for therapy of several diseases of the anterior and posterior segment, leading to better and faster outcomes. Intravitreous gases are frequently used for therapy of retinal detachment, macular hole, intravitreous and submacular hemorrhage and as a coadjuvant during vitreous surgery. Intracameral gases are mainly employed for treatment of acute corneal hydrops, Descemet's membrane detachment and as adjuvant for lamellar keratoplasty. This review article discusses details concerning the current clinical applications of gases for treatment of different ocular diseases as well as the potential adverse events associated with gas injection in the vitreous cavity or in the anterior chamber.

Granulocytic Sarcoma is an uncommon manifestation of AML that can affect the orbit. A 10 year-old girl presented with a history of 1 day old proptosis (OS). The patient also presented with diplopia in the inferior quadrants OS. No other significant alterations were seen during her ophthalmological exam, with the exception of proptosis (OS). A CT scan displayed an extraconal mass to the left orbit. The mass had a molding contour with minimal bone destruction. A lateral orbitotomy was later performed. Subsequent histopathological examination and immunohistochemistry confirmed the diagnosis of granulocytic sarcoma. The systemic work-up was normal. The patient later underwent chemotherapy plus radiotherapy, and is now free of systemic disease after a 18-month follow-up. Resumo Sarcoma Granulocítico é uma forma incomum da Leucemia Mielóide Aguda e pode acometer a órbita. Apresentamos uma criança de 10 anos, feminina, que apresentou uma história de proptose no olho esquerdo há 1 dia. A paciente também apresentava diplopia on quadrante inferior do olho esquerdo. Não havia outras alterações ao exame clínico. Tomografia Computadorizada da órbita mostrou uma massa extraconal na órbita esquerda, com contornos em “moldura” sem destruição óssea. Foi realizada uma orbitotomia lateral com biópsia do tumor. O exame histopatológico confirmou o diagnóstico de Sarcoma Granulocítico. Exame clínicoradiológico não mostrou doença sistêmica. A paciente foi submetida a tratamento com quimioterapia e radioterapia e está livre de doença sistêmica após 1 ano e meio de seguimento.

Because eyelid ophthalmomyiasis externa is uncommon, it can be confused easily with a hordeolum or chalazion. We report a case of a 28-year-old patient with lower eyelid myiasis simulating a hordeolum. The patient underwent extraction using a simple surgical technique. The extracted worm was a Dermatobia hominis larva. Resumen Porque la oftalmomiasis externa es inusual, esta entidad puede ser confundida fácilmente con un orzuelo ó chalazión. Reportamos un caso de un paciente de 28 años con una miasis del párpado inferior simulando un orzuelo. Utilizando una simple técnica quirúrgica, una larva de Dermatobia hominis fue extraída en este paciente.

Purpose: We report a case of reversible amantadine-induced corneal edema in a patient with Parkinson's disease and early Fuchs' endothelial dystrophy. Methods: Case report of patient managed by the Cornea & External Disease service at Texas Tech University Health Sciences Center. Results: Clinical findings during the course of treatment including visual acuity, slit lamp examination, specular microscopy, and pachymetry are described. Conclusion: Amantadine is known to cause the onset of endothelial dysfunction and visual impairment even after years of treatment. Fortunately, its effects on the cornea have been shown to be mostly reversible in patients with a near normal endothelial count and function. However, more recent evidence suggests the possibility of irreversible edema despite discontinuation of the drug. Therefore, amantadine-induced endothelial dysfunction in a patient with a significantly reduced endothelial count and/or functionality may also lead to irreversible corneal edema and vision loss. For this reason, we suggest a screening examination for endothelial disease prior to initiating amantadine therapy.

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.

The current study illustrates the evolution of the active uveitis found in 15 children two years after initiating treatment; the number of patients in whom the uveitis was treated and controlled; and the duration and the manner of treatment The evolution of other alterations found is also shown including synechiae, capsular opacities, band keratopathy and pathologic cataract, in the same time period. Resumen: En el presente trabajo se muestra la evolución de las uveítis en actividad hallada en estos 15 niños dos años después de iniciado el tratamiento; en cuántos pacientes se logró controlar y hacer desaparecer, en cuánto tiempo y cómo. Se muestra también la evolución de las otras alteraciones que se hallaron tales como sinequias, opacidades capsulares, queratopatía en banda y catarata patológica, en el mismo lapso.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can cause significant damage to the ocular surface and eyelids. The intense inflammation during the acute phase may lead to scarring sequelae and vision loss. Treatment of the chronic manifestations is challenging and only partially effective in many cases. Ophthalmologic evaluation and management during the acute phase is crucial in avoiding these problems. The evaluation and management of patients with SJS and TEN is described, with an emphasis on amniotic membrane transplantation as an effective means of limiting the acute phase damage.

Purpose: To describe the management and outcome of a patient who presented pseudophakic high myopia treated with a collagen polymer (collamer) implantable contact lens (iCL). Methods: A 51-year old man with a traumatic cataract since childhood had a phacoemulsification with an intraocular lens (IOL) implantation in another center on his left eye nine months before our evaluation. The uncorrected visual acuity (UCVA) was 20/800 in the left eye with a best-corrected visual acuity (BCVA) of 20/30. The manifested refraction was -10.00 (-2.00 × 130). We decided to perform an ICL implantation as an alternative to correct his refractive defect. Results: After an uneventful ICL implantation the patient's UCVA in his left eye was 20/30, and the manifested refraction was +1.00 (-1.00 × 130). No complications were experienced. Conclusions: Implantable collamer lenses offer a safe and effective alternative for patients with pseudophakic ametropia. Resumen Objetivo: Describir el manejo y resultado de un paciente con alta miopía pseudofáquica tratado con un lente intraocular de colámero (colágeno polímero), ICL (implantable collamer lens). Métodos: Masculino de 51 años de edad con antecedente de catarata traumática desde la infancia realizándose facoemulsificación con implante de lente intraocular en el ojo izquierdo en otro centro nueve meses previos a nuestra evaluación. La agudeza visual sin corrección era de 20/800 en el ojo izquierdo, con una agudeza visual mejor corregida de 20/30. La refracción manifiesta era de -10.00 (-2.00 × 120). Decidimos implantar un ICL como una alternativa para corregir el defecto refractivo. Resultados: Después de la colocación del ICL la agudeza visual sin corrección en el ojo izquierdo fue de 20/30 con una refracción manifiesta de +1.00 (-1.00 × 130). No se presentaron complicaciones. Conclusiones: Los lentes implantables de colámero (ICL) ofrecen una alternativa segura y eficaz en pacientes con ametropía pseudofáquica.

Case Report: A 43 year old male patient, with no history of previous disease was examined in the Medico Legal service of Santiago, one year after a mandibular tooth extraction (tooth #17). The patient developed an infection: an abscess of mouth floor, cervical abscess, temporal subperiosteal abscess and ophthalmoplegia resulting in optic atrophy. Discussion: The anatomical access through the orbit is demonstrated to be between the third mandibular molar and the inferior ophthalmic vein, through the facial spaces to the orbit. The authors alert the specialist of the rare but potentially severe consequences of dental extraction. Communication between professionals involved can avoid both severe sequelae as well as medical-legal complications. Resumen Reporte del Caso: Masculino, 43 años sin antecedentes mórbidos examinado en el servicio Médico Legal de Santiago un año después del suceso, posterior a exodoncia dentaria mandibular (pieza 17) presentó cuadro infeccioso: absceso piso boca, absceso cervical, absceso temporal subperiostico y oftalmoplejía culminando con atrofia óptica. Discusión: Por lo infrecuente del caso considerando que la infección comenzó en la mandíbula, a juicio de los autores explicamos la vía de acceso anatómica entre el tercer molar mandibular y la vena oftálmica inferior y como los gérmenes a través de de los espacios faciales alcanzaron la órbita, se alerta a los especialistas sobre las consecuencias de una exodoncia dental. La comunicación efectiva inter disciplinaria entre los profesionales involucrados evita complicaciones de tipo médico- legales y secuelas definitivas al paciente.

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.