Keratoacanthoma (KA) and Squamous Cell Carcinoma (SCC) are entities that often have been difficult to differentiate. Current thought establishes that Keratoacanthoma behaves similarly to a lowgrade squamous cell carcinoma. We present a case of an 80 year old female which history of present illness as well as clinical impression mimics Keratoacathoma (KA), but on histopathological examination resulted in Squamous Cell Carcinoma (SCC). We posit the use of novel histopathological and cytological advances, such as TGF-β sequencing and TGF-Alpha staining in assessing the specimen. Subtle differences should guide treatment for patients that need further resection and that might have orbital involvement.

Resumen Introducción: La arteritis de células gigantes (ACG) es una inflamación granulomatosa y necrotizante de arterias de mediano y gran calibre de etiología desconocida. La pérdida de visión rápidamente progresiva es una de sus complicaciones más graves dada su potencial bilateralidad e irreversibilidad. La enfermedad de Crohn (EC) es debida a la inflamación transmural y segmentaria del tracto gastrointestinal. Ambas entidades poseen una baja incidencia en nuestro medio, siendo excepcional la coexistencia de éstas simultáneamente en el mismo paciente. Caso clínico: Mujer de 77 años de edad con antecedentes personales de EC en tratamiento activo con Infliximab que acudió por disminución súbita de agudeza visual (AV) por su ojo izquierdo (OI). A la exploración oftalmológica la AV por su OI era de cuenta dedos a 30 cm y mostraba un defecto pupilar aferente relativo izquierdo muy manifiesto. Funduscópicamente el OI mostró un edema de papila pálido con hemorragias peripapilares. La paciente refería síntomas de ACG y alteraciones analíticas compatibles, por lo que tras ser diagnosticada de neuritis óptica isquémica anterior arterítica se procedió a la administración de dosis altas de glucocorticoides experimentando una mejoría analítica y clínica, aunque la pérdida de función visual fue permanente. Conclusiones: El Infliximab es un farmaco anti-TNFα empleado en la EC activa en casos refractarios al tratamiento corticoideo. Existen datos que sugieren que puede ejercer un efecto beneficioso en la inhibicion de la ACG al estar implicado el TNFα en la etiopatogenia de ambos cuadros. Sin embargo, en nuestra paciente no fue suficiente como medicacion previa y preciso dosis altas de corticoides, previniendo asi la bilateralidad del cuadro de ACG. Palabras clave: Neuropatia óptica isquémica anterior; arteritis células gigantes; enfermedad de Crohn;, Infliximab. Abstract Introduction: Giant Cell Arteritis (GCA) is a granulomatous and necrotizing inflammation of medium and large calibre arteries due to unknown etiology. Rapidly progressive loss of vision is one of the most serious complications given its irreversibility. Crohn's disease (CD) is a segmental and transmural inflammation of the gastrointestinal tract. Both entities have a low impact in our environment and it is exceptional the coexistence of these conditions in the same patient. Clinical case: We present a 77 year old woman with a personal history of CD in active treatment with Infliximab who showed a sudden visual loss in her left eye (LE). In the ophthalmological examination, the visual acuity was counting fingers at 30 cm and we observed a very clear left relative afferent papillary defect. Fundus showed a papiledema with peripapillary haemorrhages. The patient reported symptoms and laboratory abnormalities compatibles with GCA, so after being diagnosed of arteritic anterior ischemic optic neuritis we proceeded to the administration of high doses of glucocorticoids leading to analytical and clinical improvement, although the visual loss was permanent. Conclusion: Infliximab is an anti-TNFα drug used in active CD in cases refractory to corticosteroid treatment, data suggest that may have a beneficial effect on GCA inhibition because TNFα participate in the pathogenesis of both diseases. However, in our patient, it was not enough and she needed high doses of corticosteroids to avoid the bilateralism of the disease.

Purpose: To document the prevalence of vision impairment among children in a resource-poor community in Peru. Methods: Cross-sectional study of children 5 to 18 years old in Puente Piedra, Peru from March to April, 2011. Participants underwent standard vision screening exam, consisting of distance visual acuity (VA), stereopsis, external eye exam, and color vision testing and completed a socio-demographic and health risk factor questionnaire. Results: 380 children were examined. The mean uncorrected VA was 0.07 ± 0.13 Log Mar. Children wearing eyeglasses were 3.7%. Visual impairment was found in both eyes in 8.9% and in one eye in 26.3%. Severe visual impairment (<20/200) was found in both eyes in one child (0.3%) and in the worse eye of 3 (0.7%) children. Thirteen (3.5%) children failed the stereopsis exam and 20 (5.5%) boys and 7 (1.9%) girls failed the color vision exam. Overall, 37.3% of children met the criteria for referral to an ophthalmologist. Major factors for referral included the history of eyeglasses use, previous eye exam, or parental concern about the child's vision. Factors for untreated vision impairment included not having seen a physician regularly, no previous eye exam, and having a blind family member. Conclusion: There is a high prevalence of vision impairment in children living in Puente Piedra, Peru. Few children wore glasses or have ever been examined before. Basic eye care is needed for this underprivileged population.

Purpose: Determine if anterior stromal puncture (ASP) has a more effective decrease in symptomatology (pain, photophobia, and foreign body sensation) than annular keratotomy (AK) in patients with painful bullous keratopathy (PBK) and poor visual prognosis. Methods: Patients with PBK, refractory to combined medical treatment and poor visual prognosis were randomly assigned to one of two surgical procedures. Symptomatology, central corneal thickness (CCT), visual acuity (VA), and best corrected (BCVA) were evaluated with a 12-month follow up. Results: From 78 patients with PBK, 13 met inclusion criteria; ASP was performed to 7 and AK to 6 of them. There was improvement in the magnitude of symptoms in both groups; however, there was no difference when groups were compared. CCT showed in the 7-month follow-up a significant reduction of 10.4% in the ASP group compared with a 9.6% increase in the AQ group (p=0.05). Twelve-month-follow up CCT presented a non-significant reduction of 9.3% in the ASP group compared with a 3.3% increase in the AQ group. VA and BCVA in both groups were not modified. None of the groups presented complications related to the surgical procedures. Conclusion: In this clinical trial, we documented that ASP and AQ produce a similar improvement in the symptomatology of patients with PBK refractory to combined medical treatment and poor VA potential. The ASP group additionally presented a significant decrease in CCT at 7 months of follow up, which looses statistical significance at 12 months of follow up, but maintains a clinical reduction of 9.3%. A longer follow-up period would be required to evaluate if this CCT reduction is able to modify the frequency of bullae development and symptoms relapse. Furthermore, the material used for ASP has a lower cost than the one used for AQ, which could represent an economic advantage for patients that attend our Hospital.

Purpose: To compare the prevalence of angle closure disease (ACD) diagnoses in a glaucoma department of an ophthalmology teaching hospital at two cut points, before and after encouragement of a supervised, mandatory gonioscopy for all patients, during all visits as well as to profile patients with angle closure disease in terms of age, gender, intraocular pressure, visual acuity, cup-to-disc ratio and refractive error parameters when divided by Foster's classification. Study design: Retrospective, two cut-point observational study. Material and methods: A 1-month sample of electronic medical records from 2010 and from 2013 was analyzed. Between those two cut points, gonioscopy was encouraged as a mandatory procedure and execution was supervised systematically. The prevalence of angle closure disease was obtained from the diagnosis of electronic medical records and patients with ACD were divided according to Foster's ACD classification in order to profile them. Results: A total of 2112 medical records from 2010 and 2549 medical records from 2013 were included. Angle closure disease prevalence went from 7.29% (n=154) in 2010 to 20.36% (n=519) in 2013. Prevalence of primary open angle glaucoma (POAG) decreased from 23.20% to 10.84% in the same time period. Conclusions: A comparison between the prevalence of angle closure disease between these two cut points showed a considerable increase. Angle closure disease was diagnosed 1.79 times more as opposed to when gonioscopy was not previously encouraged or supervised. ACD patients are generally women, with decreasing low hyperopia and intraocular pressure within normal ranges.

Leber's Hereditary Optic Neuropathy (LHON) is a mitochondrially inherited disorder characterized by rapid, subacute vision loss. LHON has historically been a difficult disease to study due to its low incidence. Many questions concerning its pathophysiology have remained unanswered. A significant enigma concerns LHON's gender bias as represented by the male-to-female ratio of about 4:1. Another source of confusion includes the variable penetrance, since the mitochondrial mutation is necessary, but not sufficient, to cause conversion. A third challenge involves the tissue specificity, since typically only the optic nerve is involved with a specific pattern of optic atrophy due to primary loss of the papillomacular bundle (PMB) in affected individuals. The fourth remaining complexity is the pattern of rapid, subacute vision loss observed in nearly all affected individuals. Several clinical genetic studies, cybrid experiments, and histochemical studies have been conducted to address the three enigmas of gender bias, variable penetrance, and tissue specificity. Despite elucidation of these three aspects of the pathophysiology, the mechanism behind the rapid, significant vision loss remains a mystery.

A 25-year-old woman presented with blurry vision, headache, nausea, and syncope. Humphrey visual field testing revealed bitemporal defects, but magnetic resonance imaging was negative for chiasmal pathology. Macular optical coherence tomography showed focal parafoveal disruption of the photoreceptor inner segment/outer segment junction and infrared imaging showed hyporeflective macular lesions in both eyes. Our case demonstrates a diagnosis of acute macular neuroretinopathy that presented with bitemporal visual field defects. To our knowledge, bitemporal visual field loss, mimicking chiasmal pathology, has not been reported previously in association with acute macular neuroretinopathy.

Resumen La enfermedad de Best es una distrofia macular que se caracteriza por un acúmulo de lipofuscina sobre el epitelio pigmentario de la retina. Existen cinco estadios diferentes basados en el examen del fondo de ojo incluyendo la neovascularización coroidea. Describimos el caso de un varón de 59 años que acude al servicio de oftalmología por disminución de agudeza visual en ambos ojos. El examen del fondo de ojo reveló lesiones viteliformes en ambas máculas. La angiofluorescinografía mostró una membrana neovascular coroidea en el ojo izquierdo. Confirmando el electrooculograma la enfermedad de Best. La aparición de neovascularización coroidea en la enfermedad de Best es una complicación infrecuente que puede ocurrir en etapas tardías. Las opciones terapéuticas más efectivas son la terapia antiangiogénica y la terapia fotodinámica con veteporfirina. Palabras clave: Enfermedad de Best; neovascularización coroidea; Ranibizumab inyección intravítrea. Abstract Best's Disease is a macular dystrophy characterized by a lipofuscin accumulation on the retinal pigment epithelium. Five stages have been described based on fundus examination, including choroidal neovascularization. We report a case of a 59-years-old male, presented to the Department of Opthalmology with visual loss in both eyes. Fundus examination revealed vitelliform lesions in both maculas. Fluorescein angiography showed a choroidal neovascularization in the left eye. The electrooculogram confirmed the diagnosis of Best's disease. Choroidal neovascularization is a rare complication of Best's Disease in late stages. The most effective therapeutic options are photodynamic therapy with veteporfirin and antiangiogenic therapy

Relapsing Polychondritis (RP) is a rare, recurrent and autoimmune multisystem disorder affecting cartilaginous structures, such as auricles, joints, nasal septum, larynx and tracheobronchial tree. Ocular manifestations may be observed in 42,3-65% of cases. Episcleritis and scleritis are the most common findings. However, RP is frequently misdiagnosed, leading to potentially severe, debilitating and, sometimes, fatal disease. There is no established standardized therapeutic protocol for RP. Current medical therapy is largely empiric and based on case reports. The aim of this paper is to document one case of ocular involvement in RP disease, emphasizing clinical and imaging findings that can help to establish an early diagnosis.

Secondary injuries caused by lightning strikes are not frequent; however, survivors have important sequel in organs and tissues. We describe two cases. The first one with lightning-induced maculopathy and the other case involving lens damage. This paper discusses factors that determine the extent of injuries and review the management for each one. The study and data collection complained with local legislation and with the principles of the Declaration of Helsinki.

Purpose: Normal-tension glaucoma has been associated with systemic vascular diseases such as peripheral vasospasm. This study aims to evaluate the influence of peripheral vasospasm on the thickness of the retinal nerve fiber layer (RNFL) in Raynaud's disease (RD), and the correlation between global RNFL and peripheral microcirculation features in RD patients. Methods: Observational cross-sectional study of 18 patients (35 eyes) with a diagnosis of RD followed in our clinic, and 20 healthy controls (39 eyes). RNFL parameters were obtained using spectral domain optical coherence tomography (SD-OCT Spectralis®, Heidelberg). Global and sectorial peripapillary RNFL thickness were registered. Age, gender, refractive error, best-corrected visual acuity and intraocular pressure were determined, and slit-lamp biomicroscopy and fundus examination were performed. Nailfold videocapillaroscopy (NC) was performed in the RD group to characterize capillary morphology and blood flow. Mann-Whitney and Fisher's exact tests were used for statistical analysis. Statistical significance level was set at p<0.05 (two-sided). Results: There was no significant difference in the global RNFL between RD patients and the control group (p=0.35). The presence of avascular areas in NC was associated with a lower global RNFL thickness (p=0.026). Conclusion: The association between avascular areas in NC and the lower global RNFL thickness in RD patients suggests that systemic vasospasm severity may be related to optic nerve damage propensity. Therefore, its presence in NC may identify RD patients at risk for optic nerve head damage. A larger sample with a long-term study is needed to support the clinical and therapeutic implications of our findings.

Purpose: To compare biometrical measurements performed with the new IOLMaster-700 (Carl Zeiss Meditec AG, Jena, Germany) from those obtained with the Aladdin (Topcon, Tokyo, Japan). Methods: A prospective, cross-sectional, observational, comparative study was proposed. Twenty-four eyes were assessed using two biometry devices. Measurements of axial length (AL), anterior chamber depth (ACD), mean keratometry (KM), flattest (Kf) and steepest keratometry (Ks) and white-to-white (WTW) were done with both devices in a random order. Results: No statistically significant differences (p>0.05) between the two biometry were found for AL (24.22±0.92mm [range 22.66 to 26.09 mm] with IOL Master and 24.22±0.91mm [range 22.65 to 26.09 mm] with the Aladdin), ACD (3.59±0.26mm [range 3.05 to 4.11 mm] with IOL Master and 3.42±0.60mm [range 3.05 to 4.02 mm] with the Aladdin) and Kf (42.43±1.21 D [range 40.55 to 45.15 D] with IOL Master and 42.41±1.25 D [range 40.66 to 45.36 D] with the Aladdin). In Km (42.99±1.23 D [range 41.07 to 45.31 D] with IOL Master and 42.90±1.27 D [range 41.06 to 45.55 D] with the Aladdin), Ks (43.55±1.38 D [range 41.20 to 46.57 D] with IOL Master and 43.40±1.42 D [range 41.21 to 46.62 D] with the Aladdin) and WTW (12.32±0.40mm [range 11.6 to 13.1 mm] with IOL Master and 12.03±0.36 mm [range 11.46 to 12.87 mm] with the Aladdin), there was a statistical difference. Conclusions: Measurements with the new IOLMaster-700 correlated well with those obtained with the Aladdin in patients with clear lens; although a statistical difference was found in KM, Ks and WTW. This difference was not clinically significant.

Introduction: Trabeculectomies are amongst the most common surgical procedures to lower intraocular pressure (IOP). Scleral flap dimensions are a key factor in influencing aqueous outflow and subsequent IOP reduction, especially in the early postoperative period. Despite the substantial diversity of scleral flap shapes that is used in practice, there is little information comparing outcomes between them. In this study, we review the literature on the uses and outcomes of various scleral flap shapes. Methods: A literature review was performed using the databases: MEDLINE, SCOPUS, and Web of Science. Search terms for relevant studies included the following: trabeculectomy AND (square OR triang* OR rectang* OR polygon* OR arc OR shape) AND flap. Results: Our initial literature search revealed 71 unique articles, six of which met our inclusion and exclusion criteria and were reviewed. Four articles reported the use of triangular flaps, one rectangular flap, one square flap, and two arc-shaped flaps. The data from each article were reviewed for the following:

1. Surgical technique;
2. Early postoperative intraocular pressure reduction;
3. Final postoperative intraocular pressure reduction;
4. Postoperative complications.

Conclusions: A myriad of scleral flap shapes is utilized in surgical practice. Essentially all of the trabeculectomy procedures, regardless of scleral flap shape, achieved substantial reductions in IOP with similar success rates. However, due to the variability in surgical technique and lack of direct comparison, we cannot definitively conclude or deny that one flap shape is superior to another. We believe our review provides the most comprehensive analysis of scleral flap shape to date and highlights its importance in regulating aqueous flow, especially in the early postoperative period.

Ten years after Baerveldt™ implantation, a woman underwent immunosuppressive therapy for necrotizing scleritis. She subsequently developed symptoms suggestive of endophthalmitis in the setting of tube exposure. Cultures isolated fungal Paraconiothyrium. She underwent two vitrectomies with anterior chamber washouts, Baerveldt™ device removal, and intraocular and systemic antifungal therapy. The endophthalmitis has since resolved.

Purpose: To describe a rare bilateral corneal ring-shaped opacity, not categorized as corneal dystrophy or degeneration occurring without any associated ocular or systemic disease. Methods: Case report and review of the literature. Results: The authors describe the clinical history and examination of an 80 years old man, with an asymptomatic bilateral and symmetrical ring-shaped corneal opacity in the deep stroma of the corneal mid-periphery. The surrounding corneal stroma was clear, and the tear film, epithelium and its basement membrane, Descemet’s membrane and endothelium were normal. This rare corneal anomaly was discovered by chance and its etiology is unknown. Conclusions: These rings may result from deposits of unknown origin or possibly a rare corneal dystrophy.

Purpose: To determine choroidal thickness in preterm children with or without history of Retinopathy of Prematurity (ROP) with spectral domain optical coherence tomography (SD-OCT) system. Methods: In a cross-sectional study, 39 eyes of premature patients (Group 1) and 39 eyes of children with history of ROP (Group 2) between 9 and 17 years old were evaluated with Cirrus Zeiss 500 SD-OCT after cycloplegia. Choroidal thickness was measured from the fovea to 1500µm nasal and temporally with intervals of 500 µm using HD1 line raster program of SD-OCT. Clinical history of gestational age at birth, birth weight, time of oxygen exposure, stage of ROP in maximal severity of acute disease and ROP treatment were inquired. Results: Subfoveal thickness was lower in Group 2 (296,85±60,11µm) than in Group 1 (301,82±30,63µm). The mean choroidal thickness in all retinal tested points was not statistically different between groups. The time of oxygen exposure was the most relevant negative predictor considering choroidal thickness (β=-0,420; p= 0,032). Conclusions: Choroidal thickness can be measured using SD-OCT high definition raster scans in the majority of children. Comparing macular choroidal thickness in both groups, we found that it was thinner nasally, subfoveal and temporally in group 2, with no statistical significance. This can suggest a probable delayed choroidal development in preterm infant due to ROP, which can be attenuated with age.

Purpose: To evaluate the quality, readability and suitability of the information on glaucoma available in Portuguese in the Internet. Study design: Cross-sectional limited survey of internet resources. Methods: We used as keyword “GLAUCOMA” for research on four search engines in the internet. The first 30 sites that appeared on each search engine were recorded and those that appeared at least in two search engines were selected. The Sandvik score, Flesch-Kincaid formula and the Suitability Assessment of Materials (SAM) were used as tools to evaluate quality, readability and suitability, respectively. Results: The information provided on the websites presented moderate quality (mean Sandvik score 7.7 ± 1.4), readability of 16.0 ± 1.7 years of education and were unsuitable (mean SAM score 21.4 ± 6.4 %) for the target audience. Conclusion: Most websites about glaucoma had moderate quality. In order to understand the information, an average of 16 years of formal education was deemed necessary. All websites were unsuitable to the target population. RESUMO Objetivos: Avaliar a qualidade, a apreensibilidade e adequabilidade das informações sobre o glaucoma, em português, disponibilizadas na internet. Desenho do estudo: Estudo transversal sobre sítios na internet. Métodos: Utilizou-se a palavra chave “GLAUCOMA” em quatro buscadores para a pesquisa na internet. Os 30 primeiros sites que apareceram em cada buscador foram registrados e aqueles que apareceram em pelo menos dois buscadores foram incluídos no estudo. Como ferramentas para a avaliação da qualidade, apreensibilidade e adequabilidade foram utilizados o escore de Sandvik, o índice de Flesch-Kincaid e o Suitability Assessment of Materials (SAM), respectivamente. Resultados: A informação disponibilizada nos sites selecionados apresentou qualidade mediana (escore médio de Sandvik 7,7 ± 1,4), apreensibilidade média de 16,0 ± 1,7 anos de escolaridade e foi considerada inadequada para o público-alvo (SAM médio de 21,4 ± 6,4 %). Conclusão: A maioria dos sites na internet sobre glaucoma apresentou qualidade moderada. Para a leitura compreensível da matéria contida nos sites, era necessário que o leitor tivesse pelo menos concluído a terceira série do ensino médio. Todos os sites foram considerados inadequados para a compreensão da informação publicada. Palavras-chave: Glaucoma; informação; internet; Controle de Qualidade; Educação de Pacientes.

Purpose: To determine the incidence of intraretinal hemorrhage in newborns at the Hospital de San José, Bogotá, Colombia from September 2009 to September 2010. Design: Cohort study. Methodology: Live newborns were examined at the San José Hospital for a year (September 2009 to 2010), analyzing neonatal and maternal factors associated with the presence of intraretinal hemorrhages. A simple random cluster sampling was used, excluding newborns with a compromised general status, as well as those whose parents or legal guardians did not sign the informed consent form. Patients with the presence of intraretinal hemorrhages were examined every 2 weeks until resolution was observed. Results: A total of 190 newborns were examined, finding an incidence of intraretinal hemorrhages of 22.6% (95% CI 16.6 to 28.6). Most of the mothers were nulliparous (55.8%) and deliveries were eutocic (65.1%). From newborns with hemorrhages, 81.3% were born at term, and hemorrhages in most patients (93.0%) were resolved by the second week of monitoring. Associations between hemorrhages and cesarean section (RR 0.42, CI 0.22 to 0.79) and episiotomy (RR 1.73, CI 1.02 to 2.94) were observed. Conclusions: Newborns who presented intraretinal hemorrhages were children of nulliparous mothers on whom episiotomy was performed, and some with eutocic and instrumented deliveries. The first two variables had statistical significance for the development of intraretinal hemorrhages.

Prupose: To confirm the microbiological presence of C. trachomatis in indigenous communities of Colombia found to have cases of active trachoma. Method: An ophthalmic evaluation was performed in order to identify the active forms of the disease. Ocular swabs were taken from the conjunctiva and analyzed by real-time PCR “in house” for the detection of C. trachomatis. Positive samples were confirmed with a commercial real time PCR and DNA sequencing. Study Design: Descriptive study. Subjects: Children with active trachoma from different indigenous communities in Vaupés, Colombia. Main outcome measures: Presence of C. trachomatis in conjunctival swab samples. Results: Fifteen clinical cases of active trachoma were identified in children between one and 12 years old. A major proportion of TI was observed, compared with TF and greater bilateral commitment of the disease. Patients were from the indigenous communities of Santa Catalina (73.3%), Pacuativa (20%) and Piramirí (6.7%). The presence of C. trachomatis was confirmed in 3 (20%) patients, by real time PCR technique “in house” and confirmatory, and validated with sequencing. Conclusion: This study confirms the presence of C. trachomatis in cases of active trachoma in indigenous communities of the department of Vaupés, Colombia.

We aimed to summarize the applications, strengths and weaknesses of two anterior segment imaging modalities: the ultrasound biomicroscopy (UBM) and the anterior segment optical coherence tomography (AS-OCT) in the diagnosis and surgical management of glaucoma. This narrative review was based on our clinical experience with these technologies supported on scientific literature review through Medline via PubMed®. The syntax used in the search was “Glaucoma AND Anterior Chamber Angle AND Ultrasound Biomicroscopy OR UBM AND Anterior Segment Optical Coherence Tomography OR AS-OCT”. Publications were selected based on relevance and no redundancy, and authorship from 2007-2014. Additionally, UBM and AS-OCT images were selected from two of the authors’ personal archives to illustrate prevalent glaucoma findings and post-operatory using both technologies. AS-OCT and UBM share overlapping characteristics and are both useful in glaucoma diagnosis and post-operative assessment. However, particular technical features of each will direct the best application to clarify specific glaucoma etiologies, to guide in the most effective management and to explain glaucoma surgical outcomes.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that still remains a public health problem in many countries. Its incidence in industrialized countries has been increasing during recent years due to HIV infection and immigration. Tuberculosis affects primarily the lung and lymph nodes but has the potential to infect almost every organ system and unusual presentations raise difficulties in differential diagnosis. The authors report a rare case of tuberculosis affecting the nasolacrimal system.

We report a case in which the vitreous was inadvertently stained with trypan blue during cataract surgery.

Neisseria gonorrhoeae is a important cause of ophthalmia neonatorum, and it can cause multiple complications in the newborn, including corneal perforation, panophtalmitis and blindness. We report a case of 1 month old newborn with bilateral infectious conjunctivitis and corneal unilateral commitment, with positive culture for gonococcus. ACT showed intraocular inflammatory involvement of the left eye. It is managed with intravenous antibiotic therapy, evolving with opacification , vascularization , progressive thinning of the cornea and athalamia of the left eye. It undergoes surgery for corneal patch and anterior chamber reshaping. During follow-up, eye ultrasound examination showed normal right eye and a smaller axial length and choroidal thickening of the left eye. RESUMEN Neisseria gonorrhoeae es una causa importante de oftalmía neonatal, pudiendo causar múltiples complicaciones en el recién nacido, incluyendo perforación corneal, panoftalmitis y ceguera. Se presenta caso de recién nacido de 1 mes de vida, con conjuntivitis infecciosa bilateral y compromiso corneal unilateral, además de cultivo positivo para gonococo. Tomografía axial computarizada de órbita mostró compromiso inflamatorio intraocular del ojo izquierdo. Se manejó con terapia antibiótica endovenosa, evolucionando con opacificación, vascularización, adelgazamiento progresivo de la córnea y atalamia del ojo izquierdo. Se sometió a cirugía para parche corneal y reformación de cámara anterior. Durante seguimiento, ecografía ocular mostró un examen normal del ojo derecho y una menor longitud axial y engrosamiento coroideo del ojo izquierdo.

Our purpose is to report a clinical case of bilateral macular edema caused by malignant hypertension in a 35-year old male. Patient presented with bilateral low visual acuity, massive macular edema, retinal hemorrhages and papilledema. Soon after he was diagnosed with other target-organ lesions, on heart and kidneys. After 6 months of controlled blood pressure, an increase in visual acuity and a small decrease of macular edema, we effectively treated the lower vision eye with two intravitreal ranibizumab injections, improving anatomy and function on both eyes. Even though we only treated one eye with ranibizumab, the contralateral eye also improved visual acuity and central macular thickness. This probably happened due to systemic absorption of ranibizumab. To the best of our knowledge, this is the first report of ranibizumab use in macular edema due to malignant hypertension.

Purpose: To analyze eye health and visual acuity in children and teenagers to promote early detection and treatment of visual impairments. Methods: Public school students were pre-screened by teachers, and those who presented behavior, signs, or symptoms of decreased visual acuity (VA) or any other type of ophthalmological disorder, participated in a VA screening. The VA was registered for each eye, with or without optical correction. Children with VA less than or equal to 0.18 (logMAR) in the worst eye, and/or with complaints of asthenopia, eye irritation and itching, strabismus, conjunctival or corneal lesions were referred to the Ophthalmology Department of Celso Pierro Hospital for a complete ophthalmological evaluation. Results: Fifty (52.63%) patients were male and 45 (47.37%) were female. The average age of the participants was 10 years. Their eyes were evaluated and 114 (77.03%) presented refractive errors; 7 (9.45%) of the patients who were referred to the clinic already wore prescription eyeglasses, and all of them had inappropriate refractive correction. Conclusion: The most common refractive errors were: astigmatism in 94 (82.45%) children, myopia in 14 (9.72%) and hyperopia in 6 (4.16%). The conclusion is that there are not enough visual campaign and screening exams in public schools.

Purpose: To correlate macular pigment density in patients without ocular pathology and risk factors for development of DMLI. Study design: Transversal study. Methods: 119 eyes from 60 patients (34 women and 26 men) without ocular pathology and with risk factors for DMLI seen at Garcia de Orta Hospital between June and August 2013. Macular pigment density was evaluated with heterochromatic flicker photometry (QuantifEYE®). All participants received a complete ophthalmological examination and respond a questionary about their actual health status, lifestyle and demographic information. Results: The macular pigment density average was 0,4450 ± 0,09932. We noticed a negative and statistical significant correlation between macular pigment density and the following risk factors: age, HbA1c in diabetics, hypercholesterolemia, systolic arterial pressure, tobacco exposure and ex-smokers (p<0,05). It was observed a positive and statistical significant correlation between the ingestion frequency of food containing carotenoids and macular pigment density (p<0,05). Conclusions: Macular pigment density was lower according to age and risk factors for the development of ARMD Resumo Objetivo: Correlacionar a densidade de pigmento macular em indivíduos sem doença ocular com fatores de risco para a DMLI. Desenho do estudo: Estudo transversal. Métodos: 119 olhos de 60 pacientes (34 mulheres e 26 homens) sem doença ocular e com fatores de risco para DMLI identificados em primeira consulta no Serviço de Oftalmologia do Hospital Garcia de Orta entre Junho e Agosto de 2013. Avaliou-se a densidade de pigmento macular com fotometria heterocromática de Flicker (QuantifEYE®) de ambos os olhos. Realizou-se exame oftalmológico completo e foi elaborado um questionário sobre o estado de saúde, estilo de vida e demografia. Resultados: A média de densidade de pigmento macular foi de 0,4450±0,09932. Detetouse correlações negativas e estatisticamente significativas entre a densidade de pigmento e os seguintes fatores: idade, HbA1c dos diabéticos, colesterolémia, pressão arterial sistólica, unidade de maços de tabaco/ano nos fumadores e ex-fumadores (p<0,05). Existiu uma correlação positiva e significativa entre a frequência de ingestão de alimentos contendo carotenóides e a densidade de pigmento macular (p<0,05). Conclusões: Neste estudo, a densidade de pigmento macular apresentou tendência a diminuir com a idade e a ser inferior em indivíduos com fatores de risco para a DMLI.

Purpose: To trace the epidemiology of eye diseases seen in the emergency eye care center in Campinas, Brasil. Methods: A cross-sectional, observational, retrospective survey was conducted involving patient records assisted in the emergency room in January of 2014. The factors analyzed were age, gender, origin of patient and nosological entities. Results: A total of 1063 patients were attended. 55.9% were male and 44.1% female. Mean age was 37 years old. Of this sample, 18.2% were ocular trauma, 16.9% infectious conjunctivitis, 7.8% keratitis, 7.6% hordeolum, 7.5% ocular allergies, 4.7% subconjuntival hemorrhage, 3.9% blepharitis and meibomitis, 3.6% pterygium, 3.4% corneal ulcer and 26% other diagnosis. 73.5% were from emergency eye care admittance of our service and 26.5% were referrals from other services. Conclusion: The most frequent etiology was ocular trauma. The majority of patients were male in economically active age and their main origin was from admittance of emergency eye care center.

Introduction: Intraocular lens calculation has become one of the main features of cataract surgery. Accurate lens calculation is an important factor in patient satisfaction and quality of life. The purpose of our study is to evaluate which formula (SRK II, HofferQ, Holladay 1 and SRK-T) was nearest to the final refraction after cataract surgery, using the IOLMaster®. Material and Methods: We evaluated 101 eyes of 78 cataract patients. The expected refraction with the intraocular lens used in each patient was calculated with the different formulas and compared to the patient refraction one month after surgery. We obtained data retrospectively from 23 eyes with axial length inferior to 22 mm, 62 eyes with axial length between 22 and 26 mm and 16 eyes with axial length superior to 26 mm. Results: The mean refraction after cataract surgery for all patients was -0.277 diopters (D) ± 0.94. Hoffer Q performed better for eyes with axial length inferior to 22 mm with a mean absolute error (difference between lens calculation and final refraction) of 0.4957 D ± 0.396. For eyes with axial length between 22 and 26 mm SRK-T performed better with a mean absolute error of 0.4515 D ± 0.323 and for eyes with axial length superior to 26 mm SRK-T performed better with a mean absolute error of 0.5538 D ± 0.333. We did not find any statistical difference in the comparison between third generation formulas; we found statistical significance when comparing HofferQ and SRKII in the“inferior to 22 mm” group and SRK-T and SRKII in the“between 22 and 26 mm” group. Conclusions: All third generation formulas can be used to calculate the intraocular lens. We recommend using HofferQ in axial length inferior to 22 mm and using SRK-T in axial length superior to 22 mm.