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.