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A case of a perfluoro-n-octane leakage into the orbital cavity after corneoscleral suture, scleral buckling and pars plana vitrectomy in an eye with perforating injury after trauma is reported for the first time. A previously healthy 39-year-old man was sent for ophthalmic evaluation one day after suffering a penetrating ocular trauma in his right eye while hammering a nail. On the initial evaluation, the patient presented sudden reduction of visual acuity on his right eye with a perforating corneoscleral injury, intraocular foreign body and retinal detachment. The patient was submitted to corneoscleral suture, pars plana vitrectomy with perfluoro-n-octane administration to flatten the retina and scleral buckling, when it was found transfixation of the globe by the intraocular foreign body. Postoperatively, computed tomography scans of the orbit were ordered due to proptosis, which showed the presence of hyperdense images, suggesting leakage of perfluoro-n-octane into the orbital cavity. Thus, in cases of perforating eye injury, one should be suspicious about the possibility of intraocular foreign body, as well as possible occurrence of transfixation of the globe when scheduling the surgery.

The purpose of this study was to compare the in vitro effects of triamcinolone acetonide (TA) and dexamethasone sodium phosphate (DEX) on human lens epithelial cells (HLE B-3).HLE B-3 cells were exposed for 24 h to commercially available TA (c-TA) and dimethylsulfoxide-solubilized TA (s-TA). The cells were treated with 1,000 (clinical dose), 750, 500, 200, and 100 μg/mL concentrations of c-TA, s-TA, and supernatant for 24 h. The cells were also treated with DEX at 2, 1, 0.5, 0.2, 0.1 (clinical dose), and 0.05 mg/mL. Cell viability, caspase-3/7 activity, and DNA fragmentation analyses were performed.The mean cell viabilities of HLE B-3 after exposure to c-TA at 1,000, 750, 500, 200, and 100 μg/mL were significantly reduced compared with control untreated cells. The s-TA also significantly reduced cell viability at 1,000, 750, and 500 μg/mL compared with dimethylsulfoxide control. The supernatant did not reduce cell viability. Caspase-3/7 activity significantly increased after treatment with c-TA and s-TA. DNA laddering revealed bands at 200 bp intervals with both c-TA at≥100 μg/mL and s-TA at ≥500 μg/mL. The cell viabilities of HLE B-3 after 24 h exposure to DEX were significantly reduced at 2 and 1 mg/mL but not at lower concentrations tested. Caspase-3/7 activities in HLE B-3 cells were not increased significantly after treatment with DEX at any dose tested. DNA laddering did not reveal any band at any dose tested.This study showed that TA at its clinical dose (1,000 μg/mL) in both commercial preparation and solubilized forms decrease HLE B-3 cell viability through an apoptotic pathway. DEX at its clinical dose (0.1 mg/mL) does not decrease cell viability or cause any increase of caspase-3/7 activity. This study suggests that for long-term sustained-release devices, DEX may be less damaging to human lens cells than TA.

Essential blepharospasm is a facial dystonia characterized by spontaneous, spasmodic and involuntary contractions of the eyelid muscles. In advanced cases, blepharospasm patients develop severe eyelid spasms that render them functionally blind, socially reclusive, and unable to work or care for themselves. Oculoplastic surgeons frequently have to deal with patients with blepharospasm. The decrease in quality of life caused by this pathology drives all the attention to the resolution of the spasms. However, other conditions may be associated with them and must be kept in mind during the ophthalmological examination. Four patients with essential blepharospasm were diagnosed as glaucomatous during their follow-up at the Oculoplastic Service. All of them showed glaucomatous optic neuropathy and corresponding visual field defect and no clinically apparent secondary cause for their glaucoma. Forced eyelid closure may lead to intraocular pressure peaks. These patients with blepharospasm present repetitive and spasmodic eyelid contractions and the intraocular pressure rise observed during eyelid squeezing could be an additional risk factor for glaucomatous damage. Our case series suggest that patients with blepharospasm should be seriously evaluated for glaucoma.

Essential blepharospasm is a facial dystonia characterized by spontaneous, spasmodic and involuntary contractions of the eyelid muscles. In advanced cases, blepharospasm patients develop severe eyelid spasms that render them functionally blind, socially reclusive, and unable to work or care for themselves. Oculoplastic surgeons frequently have to deal with patients with blepharospasm. The decrease in quality of life caused by this pathology drives all the attention to the resolution of the spasms. However, other conditions may be associated with them and must be kept in mind during the ophthalmological examination. Four patients with essential blepharospasm were diagnosed as glaucomatous during their follow-up at the Oculoplastic Service. All of them showed glaucomatous optic neuropathy and corresponding visual field defect and no clinically apparent secondary cause for their glaucoma. Forced eyelid closure may lead to intraocular pressure peaks. These patients with blepharospasm present repetitive and spasmodic eyelid contractions and the intraocular pressure rise observed during eyelid squeezing could be an additional risk factor for glaucomatous damage. Our case series suggest that patients with blepharospasm should be seriously evaluated for glaucoma.Blefaroespasmo essencial é uma distonia facial caracterizada por contrações espontâneas, espasmódicas e involuntárias dos músculos palpebrais, podendo tornar os pacientes funcionalmente cegos. Tais pacientes são geralmente referidos aos médicos oculoplásticos para avaliação e tratamento. Devido à intensidade dos espasmos e ao comprometimento da qualidade de vida, toda a atenção é dirigida à sua resolução e outras condições oculares associadas podem passar despercebidas. Neste estudo, quatro pacientes com blefaroespasmo foram diagnosticados como glaucomatosos durante o seu seguimento no Departamento de Plástica Ocular. As quatro pacientes apresentavam neuropatia óptica glaucomatosa e defeito no campo visual compatível, sem que houvesse nenhuma causa secundária para o glaucoma. O fechamento palpebral forçado causa importante aumento da pressão intra-ocular e estes pacientes com blefaroespasmo, por apresentar contrações espasmódicas e repetitivas das pálpebras, poderiam estar sob risco aumentado de desenvolver glaucoma.

Wegener granulomatosis (WG) is characterized by a classic triad of granulomatous inflammation of the respiratory tract, necrotizing vasculitis and nephritis. The absence of renal disease defines a subset of " limited WG" . Approximately 50% of WG patients develop ophthalmic disease. The histopatological study and +c-ANCA were essential to make a definite diagnosis in these cases.

A granulomatose de Wegener é descrita como uma tríade de lesões: granuloma necrosante do trato respiratório, vasculite disseminada e glomerulonefrite. Pode ocorrer de maneira sistêmica ou localizada. O envolvimento ocular e orbitário é comum em ambas as formas da doença, estando presente em 50% dos casos. O exame anatomopatológico e o c-ANCA+ foram fundamentais no diagnóstico efetivo da granulomatose de Wegener a despeito do envolvimento sistêmico nos casos apresentados.Wegener granulomatosis (WG) is characterized by a classic triad of granulomatous inflammation of the respiratory tract, necrotizing vasculitis and nephritis. The absence of renal disease defines a subset of " limited WG" . Approximately 50% of WG patients develop ophthalmic disease. The histopatological study and +c-ANCA were essential to make a definite diagnosis in these cases.

We report a case of a 66-year-old man with a history of high myopia and who was referred for acute decreased visual acuity of the right eye. Fundus examination and optical coherence tomography (OCT) showed a mild epiretinal membrane (ERM) and splitting of retinal layers. Pars plana vitrectomy was performed with intravitreous triamcinolone injection, posterior hyaloid and ERM peeling, and 12% perfluoropropane (C3F8) gas tamponade. After remaining asymptomatic for 17 months, the patient reported a new episode of sudden decreased visual acuity in his right eye, and OCT showed recurrent myopic foveoschisis (MF). He underwent vitrectomy and internal limiting membrane (ILM) peeling. Six months later, the patient's best corrected visual acuity had improved to 20/25. Optical coherence tomography showed a remarkably improved macular anatomy, with residual traction along the inferotemporal arcade, which was attributed to the vessel stiffness itself. We conclude that removing the internal limiting membrane is a challenging maneuver in myopic foveoschisis, even with staining approaches. Although myopic foveoschisis may be resolved without peeling the internal limiting membrane, its removal should be considered if the condition recurs.

Retinoschisis is an abnormal separation of the retinal layers and is asymptomatic in most cases. Enlargement of the area of retinoschisis and retinal tear and detachment are possible complications of the disease, and the treatment of retinoschisis is controversial. In this case report, we present a case of retinal detachment associated with senile retinoschisis in which pneumatic retinopexy was chosen as the treatment of choice and was performed successfully in one of the eyes. After a literature review on retinoschisis and pneumatic retinopexy for the treatment of associated retinal detachment, we found only one case that was successfully treated without drainage of subretinal fluid, using air as the filler. However, no previous reports have been found in the literature on the effectiveness of pneumatic retinopexy using C3F8 as the sole treatment for progressive retinal detachment in senile retinoschisis.

This case report describes peripheral idiopathic polypoidal choroidal vasculopathy (IPCV) with a collection of small aneurysmal dilations that masqueraded as choroidal tumors in an elderly patient. A 68-year-old African American woman was referred to us with a suspected diagnosis of asymptomatic vascular choroidal tumor and choroidal capillary hemangioma, affecting the temporal peripheral fundus. Upon examination, optical coherence tomography (OCT) revealed two large hemorrhagic pigment epithelium detachments (PED), and indocyanine green angiography (ICG) confirmed the diagnosis of IPCV. One year later, there was reduction in the hemorrhagic pigment epithelium detachments and the lesion took on a different appearance, resembling a choroidal osteoma. No treatment was necessary despite the presence of multiple polyps. IPCV is a rare condition that can resemble other choroidal diseases depending on the stage of presentation. OCT is the best tool to determine the characteristics of the lesions, and indocyanine green angiography should be used to confirm the diagnosis. Not all cases require treatment.

Interferon and ribavirin are medications widely used in the treatment of some systemic diseases, mainly hepatitis C. Ribavirin when associated with interferon increases the rate of success of this treatment. There are about 170 million patients with chronic hepatitis C in the world, many in use of these medications. The classic associated retinopathy is described as cotton wool exudates and hemorrhages. Since the first reports, several different ocular disturbances were described in association with interferon. The present case shows a patient whose right eye presented with central retinal vein occlusion and whose left eye presented the typical findings of hemorrhages; prompt resolution after the medications were discontinued.

Relatar o caso de uma paciente com retinopatia por Valsalva que evoluiu com hemorragia submembrana limitante interna e foi submetida à vitrectomia via pars plana, tendo tido melhora da acuidade visual. Paciente hígida de 35 anos evoluiu com redução súbita e indolor da acuidade visual do olho direito, após crise de tosse. Ao exame oftalmológico, apresentava hemorragia pré-macular, sem outras alterações. Inicialmente, optou-se pela conduta expectante, porém não houve regressão completa da hemorragia. Então, foi indicada a vitrectomia via pars plana associada à remoção da membrana limitante interna, havendo melhora considerável da acuidade visual, sem complicações peri-operatórias e sem alterações significativas à tomografia de coerência óptica, autofluorescência ou eletrorretinograma multifocal. Neste caso, o tratamento da hemorragia sub-membrana limitante interna com a cirurgia vitreorretiniana resultou em melhora da acuidade visual e regressão da hemorragia.To report a case of a patient with Valsalva retinopathy that developed sub-internal limiting membrane hemorrhage, underwent pars plana vitrectomy and had visual acuity improvement after that. A 35-year-old healthy patient presented with sudden and painless vision loss of her right eye, after coughing. During the ophthalmologic evaluation, she had a pre-macular hemorrhage and no other abnormalities. Initially, we chose for expectant management, but the hemorrhage did not clear totally. Thus, pars plana vitrectomy associated with internal limiting membrane peeling was indicated, with considerable improvement of her visual acuity, without perioperative complications or significant findings in the optical coherence tomography, autofluorescence and multifocal electroretinogram. In this case, sub-internal limiting membrane hemorrhage treatment with vitreoretinal surgery was relatively useful, with visual acuity improvement and resolution of sub-internal limiting membrane hemorrhage.

A Sindrome de Aicardi e afeccao neurorretiniana de etiologia desconhecida. Seu diagnostico baseia-se no achado de convulsoes infantis e lacunas coriorretinianas associadas a alteracoes radiologicas caracteristicas (agenesia do corpo caloso). Todos os casos relatados ate o momento pertencem ao sexo feminino, com excecao de um que apresentava cariotipo 47XXY; a sobrevida ate a adolescencia e rara. Objetivo do presente trabalho e descrever um caso de sindrome de Aicardi, sendo provavelmente o primeiro registro desta doenca em nosso meio. As lacunas coriorretinianas sao elemento essencial ao diagnostico desta sindrome, sendo consideradas patognomonicas em crianca do sexo feminino apresentando convulsoes. Por este motivo, cabe ao oftalmologista papel de destaque no diagnostico desta sindrome.

Objetivo: Avaliar qual o tipo de assistência médica utilizada pelo paciente que procura as "Campanhas da Catarata". Métodos: Foram realizadas 299 entrevistas com pacientes que participaram da "Campanha da Catarata" do dia 15 de abril de 2000, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Resultados: Dos entrevistados 58,9% eram do sexo masculino e 41,1 % do sexo feminino; a idade média foi de 69,9 anos. A população estudada é composta principalmente por pessoas de baixa escolaridade (89,5% eram analfabetas ou com escolaridade até primeiro grau) e economicamente inativos em 70,9% (aposentados, 50,2%; desempregados, 8,3% e donas de casa, 12,5%). Os meios de assistência médica mais utilizados são serviço público em 87,0%, convênio médico em 8,0% e médico particular em 4,9%. Os principais motivos alegados pelos pacientes que dispunham de convênio e não o utilizaram, foram: não cobria a cirurgia em 25%, não dava cobertura para a lente intra-ocular em 33%. Conclusão: O público alvo da "Campanha da Catarata" atendido no HC-FMUSP é constituído por indivíduos de baixa escolaridade, a maioria não integrada no mercado de trabalho, e que utilizam como recurso de saúde o SUS ou convênios médicos que não cobrem os gastos da cirurgia de catarata. Projetos catarata dentro das condições realizadas por este estudo não atraem pacientes que possam pagar os custos da cirurgia de catarata.Purpose: To evaluate which kind of medical care cataract patients have. Methods: The authors of the survey conducted 299 interviews with patients who took part in the "Cataract Campaign" on April 15, 2000. Results: Among the interviewees, 58.9% were males, and 41.1% were females, with an average age of 69.9 years. Our population consisted largely of low educational level people (89.5% between illiteracy and elementary school level), and 70.9% are economically inactive (retired, 50.2%; unemployed, 8.3%; housewives 12.5%). The kind of medical care most frequently used was public health service (87.0%); followed by health insurance companies (8.0%) and private care (4.9%). The main reasons reported by patients who had health insurance but had not used it for the surgery were: the companies would not pay for the surgery (25.0%), would not provide the intraocular lens (33.0%). Conclusion: We conclude that the target public in the "Cataract Campaign" comprises low educational level individuals, most of them economically inactive. Even those who have health insurance seek for help in the campaign due to the lack of economical conditions. In the conditions of this study, the "Cataract Campaign" does not attract people who can pay for the surgery.

Objetivo: Avaliar qual o tipo de assistência médica utilizada pelo paciente que procura as "Campanhas da Catarata". Métodos: Foram realizadas 299 entrevistas com pacientes que participaram da "Campanha da Catarata" do dia 15 de abril de 2000, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Resultados: Dos entrevistados 58,9% eram do sexo masculino e 41,1 % do sexo feminino; a idade média foi de 69,9 anos. A população estudada é composta principalmente por pessoas de baixa escolaridade (89,5% eram analfabetas ou com escolaridade até primeiro grau) e economicamente inativos em 70,9% (aposentados, 50,2%; desempregados, 8,3% e donas de casa, 12,5%). Os meios de assistência médica mais utilizados são serviço público em 87,0%, convênio médico em 8,0% e médico particular em 4,9%. Os principais motivos alegados pelos pacientes que dispunham de convênio e não o utilizaram, foram: não cobria a cirurgia em 25%, não dava cobertura para a lente intra-ocular em 33%. Conclusão: O público alvo da "Campanha da Catarata" atendido no HC-FMUSP é constituído por indivíduos de baixa escolaridade, a maioria não integrada no mercado de trabalho, e que utilizam como recurso de saúde o SUS ou convênios médicos que não cobrem os gastos da cirurgia de catarata. Projetos catarata dentro das condições realizadas por este estudo não atraem pacientes que possam pagar os custos da cirurgia de catarata. Purpose: To evaluate which kind of medical care cataract patients have. Methods: The authors of the survey conducted 299 interviews with patients who took part in the "Cataract Campaign" on April 15, 2000. Results: Among the interviewees, 58.9% were males, and 41.1% were females, with an average age of 69.9 years. Our population consisted largely of low educational level people (89.5% between illiteracy and elementary school level), and 70.9% are economically inactive (retired, 50.2%; unemployed, 8.3%; housewives 12.5%). The kind of medical care most frequently used was public health service (87.0%); followed by health insurance companies (8.0%) and private care (4.9%). The main reasons reported by patients who had health insurance but had not used it for the surgery were: the companies would not pay for the surgery (25.0%), would not provide the intraocular lens (33.0%). Conclusion: We conclude that the target public in the "Cataract Campaign" comprises low educational level individuals, most of them economically inactive. Even those who have health insurance seek for help in the campaign due to the lack of economical conditions. In the conditions of this study, the "Cataract Campaign" does not attract people who can pay for the surgery.

The Shaken Baby Syndrome (SBS) is characterized by subdural hematomas (SH), retinal hemorrhages (RH), and multiple fractures of long bones without external evidence of head trauma. Subinternal limiting membrane (ILM) hemorrhage, also known as macular schisis, is a characteristic finding of this entity. There is no guideline on the right time to indicate surgical treatment. This report describes an abused child with massive sub-ILM hemorrhage, which showed spontaneous absorption after less than two months of follow-up. Due to the possible spontaneous resolution, we suggest an initial conservative treatment in cases of sub-ILM hemorrhage related to SBS.

O fechamento espontâneo de buraco de macula de espessura total e um fenomeno raro, especialmente em olhos vitrectomizados. Descrevemos nesse relato dois casos com essa apresentacao. No primeiro caso, notou-se o buraco de macula 1 mes apos vitrectomia por membrana epirretiniana e, no segundo, 3 semanas apos vitrectomia por descolamento de retina regmatogenico. O fechamento desses buracos ocorreu espontaneamente 2 meses e 1 mes apos sua documentacao, respectivamente. Feita a revisao bibliografica e propostas teorias para explicar esta evolucao atipica, o entendimento deste fenomeno pode nos ajudar a refinar a indicacao cirurgica desta patologia.

Purpose. To verify access barriers patients with retinal detachment face to arrive at a reference center and to evaluate patients’ knowledge about the disease.Methods. Transversal study that applied a questioner to 65 patients of the Clinical Hospital of the University of Sao Paulo with retinal detachment between February and August of 2010.Results. Reasons for not performing the surgery in other services were as follows: 47% were referred because there was not vitreoretinal surgeon at original service; 27% could not afford the surgery, had no health insurance, or had no coverage at health insurance plan for the procedure. Time between the first symptom and the arrival at our service was as follows: 18 patients arrived in up to 7 days; 35 between 8 and 30 days; 8 between 31 and 90 days; 5 in more than 90 days. Reasons for delay were as follows: 70% did not know how serious the pathology was; 56% thought that it had spontaneous cure; 16% did not have money to pay for ophthalmic evaluation, 10% did not know where to go and 24% for other reasons.Conclusion. Educational programs about disease and measures to optimize the referral to specialized services are needed to accelerate the treatment of patients with rhegmatogenous retinal detachment.

A retinopatia esclopetária é uma manifestação rara de trauma ocular que pode ou não penetrar a órbita. O objetivo desse trabalho é relatar um caso de retinopatia esclopetária após trauma orbitário por bala de arma de fogo com amaurose total inicial no olho acometido, que evoluiu ao longo de semanas com recuperação visual parcial. Relatamos um caso de um paciente com 12 anos, sexo masculino, vítima de ferimento por arma de fogo, que apresentava ao exame oftalmológico inicial do olho direito pupila não reagente com acuidade visual (AV) de sem percepção luminosa (SPL) e diagnóstico de retinopatia esclopetária nesse olho. O olho esquerdo apresentava-se normal. O paciente foi submetido à exérese do projétil alojado na cavidade orbitária. No 14° pós-operatório, o paciente referiu enxergar claridade, apresentava AV de conta dedos a 30 cm. Ao longo dos primeiros meses, o paciente apresentou melhora constante da AV e com oito meses de seguimento, apresentava AV de 0,15. Na retinopatia esclopetária, a AV geralmente é baixa. Ainda não é claro atualmente se a perda visual é ocasionada por lesão à retina, ao nervo óptico, ou um misto dos dois componentes. Casos de amaurose total após trauma geralmente não apresentam prognóstico visual. Porém, alguns pacientes podem apresentar melhora da AV, como no caso aqui descrito. Conclui-se assim que em casos traumáticos contusos em pacientes com baixa AV inclusive SPL, deve-se acompanhar esses pacientes e tratar, se necessário, pela possibilidade de recuperação visual. Corioretinitis sclopetaria is a rare manifestation of ocular trauma which may or may not penetrate the orbit. The aim of this study is to report a case of Corioretinitis sclopetaria after orbital trauma by a firearm bullet that had initial total blindness in the affected eye, and evolved over weeks with partial visual recovery. We report a 12 years old boy, victim of firegun injury, who presented a diagnosis of corioretinitis sclopetaria in his right eye. Initial ophthalmologic examination of this eye showed nonreactive pupil and visual acuity of no light perception. The left eye was normal. The patient underwent excision of the firearm bullet located in the orbit. On the early postoperative, the patient reported seeing light and presented visual acuity of counting fingers at 30 cm. The patient showed steady improvement and after eight months his visual acuity was of 0.15 on the affected eye. In corioretinitis sclopetaria, presented visual acuity is generally low. It is still unclear whether visual loss is caused by damage to retina, optic nerve or both components. Patients with total blindness after trauma usually have no visual prognosis. However, some patients may show visual acuity improvement, such as the case described here. Therefore, in patients victims of blunt ocular trauma with low visual acuity, including no light perception, it is important to monitor these patients and treat, if necessary, due to the possibility of visual recovery.

Descrevemos uma paciente de 9 anos, sexo feminino, com perda visual bilateral grave tratada com corticóide por via oral apresentando melhora em apenas um olho. Nove anos depois apresentou recidiva que inicialmente respondeu à pulsoterapia corticóide mas foi seguida de perda progressiva e completa da visão após a redução do tratamento. Novas tentativas terapêuticas não melhoraram a visão. Avaliação clínico-laboratorial não revelou doença sistêmica, mas apresentava anticorpos antinucleares (1/640), anti-Ro e anti-La positivos. Neuropatia óptica auto-imune é uma afecção rara, que simula neurite óptica idiopática e se caracteriza por perda visual aguda, sem doença sistêmica, mas com evidências laboratoriais de doença auto-imune, em especial o FAN positivo. Biópsia de pele freqüentemente mostra evidências de vasculite. Esta condição deve ser tratada agressivamente, com corticóide e imunossupressores, uma vez que o acometimento visual geralmente é mais grave do que o da neurite óptica idiopática/desmielinizante e pode ser irreversível.We report on a 9-year-old female patient who had bilateral severe visual loss and was treated with oral corticosteroids. Visual improvement occurred in one eye. Nine years later she presented relapse of visual loss in her only seeing eye. Pulse corticosteroid therapy resulted in dramatic visual improvement followed, however, by progressive and complete visual loss as soon as the corticosteroid was tapered. Repeat treatment did not result in visual improvement. Clinical and laboratory investigation failed to find a systemic disease but the patient had positive antinuclear (1/640), anti-Ro and anti-La antibodies. Autoimmune optic neuropathy is a rare condition that may mimic an idiopathic optic neuritis and is characterized by acute visual loss, without systemic disease but with laboratory evidence of an autoimmune disorder, usually a positive ANA. A skin biopsy usually shows evidence of vasculitis. This condition should be treated aggressively, with corticosteroids and immunosuppressant, since the visual involvement is usually worse than that of idiopathic/desmyelinating optic neuritis.

We report on a 9-year-old female patient who had bilateral severe visual loss and was treated with oral corticosteroids. Visual improvement occurred in one eye. Nine years later she presented relapse of visual loss in her only seeing eye. Pulse corticosteroid therapy resulted in dramatic visual improvement followed, however, by progressive and complete visual loss as soon as the corticosteroid was tapered. Repeat treatment did not result in visual improvement. Clinical and laboratory investigation failed to find a systemic disease but the patient had positive antinuclear (1/640), anti-Ro and anti-La antibodies. Autoimmune optic neuropathy is a rare condition that may mimic an idiopathic optic neuritis and is characterized by acute visual loss, without systemic disease but with laboratory evidence of an autoimmune disorder, usually a positive ANA. A skin biopsy usually shows evidence of vasculitis. This condition should be treated aggressively, with corticosteroids and immunosuppressant, since the visual involvement is usually worse than that of idiopathic/desmyelinating optic neuritis.

To report a case of a patient with Valsalva retinopathy that developed sub-internal limiting membrane hemorrhage, underwent pars plana vitrectomy and had visual acuity improvement after that. A 35-year-old healthy patient presented with sudden and painless vision loss of her right eye, after coughing. During the ophthalmologic evaluation, she had a pre-macular hemorrhage and no other abnormalities. Initially, we chose for expectant management, but the hemorrhage did not clear totally. Thus, pars plana vitrectomy associated with internal limiting membrane peeling was indicated, with considerable improvement of her visual acuity, without perioperative complications or significant findings in the optical coherence tomography, autofluorescence and multifocal electroretinogram. In this case, sub-internal limiting membrane hemorrhage treatment with vitreoretinal surgery was relatively useful, with visual acuity improvement and resolution of sub-internal limiting membrane hemorrhage.

To evaluate the effects of Triesence® (TRI), a new preservative-free triamcinolone approved by the U.S. Food and Drug Administration (FDA) for intraocular use, on human retina pigment epithelial (ARPE-19) and rat neurosensory (R28) cells in culture.ARPE-19 and R28 cell cultures were treated 24 h with 1,000, 500, 200, or 100 μg/mL of crystalline (cTRI) or 1,000, 500, or 200 μg/mL of solubilized (sTRI). TRI was solubilized by centrifuging the drug, discarding the supernatant containing the vehicle and then resuspending the drug pellet in an equivalent amount of Dimethyl sulfoxide to achieve the same concentration as the commercial preparation. Percentage of cell viability (CV) was evaluated by a trypan blue dye-exclusion assay. The mitochondrial membrane potential (ΔΨm) was analyzed with the JC-1 assay. The caspase-3/7 activity was measured by a fluorochrome assay.In the ARPE-19 cultures, the cTRI caused a decrease in CV at 1,000 μg/mL (13.03±6.51; P0.001), 500 μg/mL (28.87±9.3; P0.001), 200 μg/mL (54.93±5.61; P0.001), and 100 μg/mL (82.53±0.65; P0.005) compared with the untreated controls (96.98±0.16). In R28 cultures, the cTRI treatment also reduced CV values significantly (P0.001) for the 1,000 μg/mL (22.73±2.44), 500 μg/mL (34.63±1.91), 200 μg/mL (58.70±1.39), and 100 μg/m (75.33±2.47) compared with the untreated controls (86.08±3.54). Once the TRI was solubilized (sTRI), the CV and ΔΨm remained similar to the untreated controls for both ARPE-19 and R28 cells. The sTRI treatment with 1,000, 500, and 200 μg/mL increased in caspase-3/7 activity in ARPE-19 cells (P0.01) and in R28 cells (P0.05) compared with dimethyl sulfoxide equivalent controls.The crystalline form of TRI (cTRI) can cause a significant decrease in CV to cultured retinal cells. Once the TRI is solubilized (sTRI), at the same concentrations, the cells remain viable with no decrease in CV or ΔΨm. The sTRI can, however, increase caspase-3/7 activity, thus suggesting some degree of apoptosis.

We report the case of a seven year-old male patient, born at term without any perinatal complications, referred to the Retina/Vitreous Service for diagnostic elucidation. He had a history of progressive visual acuity loss on his left eye that started four years ago. On examination, he had decreased corneal diameter and corectopia of the right eye (OD), without any noteworthy findings on the biomicroscopy of the left eye (OS). The fundus of the OD revealed total retinal detachment, and the OS initially showed peripheral retinal vascular abnormalities and retinal exudation, associated with retinal vitreous traction on the temporal sector. The CT and MRI of the brain/orbits showed no abnormalities, except for findings suggestive of an old retinal detachment on the OD, confirmed by ultrasonography, which also showed microphthalmia of the OD. The diagnosis of familial exudative vitreoretinopathy, a rare disease of autosomal dominant inheritance and related to consanguineous marriages, that can initially simulate Coats disease, was proposed. The patient was treated with diode laser photocoagulation in the temporal periphery of the OS, with improvement in the areas of vitreoretinal traction.

A case of a perfluoro-n-octane leakage into the orbital cavity after corneoscleral suture, scleral buckling and pars plana vitrectomy in an eye with perforating injury after trauma is reported for the first time. A previously healthy 39-year-old man was sent for ophthalmic evaluation one day after suffering a penetrating ocular trauma in his right eye while hammering a nail. On the initial evaluation, the patient presented sudden reduction of visual acuity on his right eye with a perforating corneoscleral injury, intraocular foreign body and retinal detachment. The patient was submitted to corneoscleral suture, pars plana vitrectomy with perfluoro-n-octane administration to flatten the retina and scleral buckling, when it was found transfixation of the globe by the intraocular foreign body. Postoperatively, computed tomography scans of the orbit were ordered due to proptosis, which showed the presence of hyperdense images, suggesting leakage of perfluoro-n-octane into the orbital cavity. Thus, in cases of perforating eye injury, one should be suspicious about the possibility of intraocular foreign body, as well as possible occurrence of transfixation of the globe when scheduling the surgery.

PURPOSE To assess oxysterol-induced mitochondrial DNA (mtDNA) damage and mitochondrial dysfunction in cultured human retinal pigment epithelial cells (ARPE- 19). METHODS ARPE-19 cultures were exposed for 6 and 24 hours to 40 microg/mL 7-ketocholesterol (7kCh), and total DNA was extracted. Long-extension polymerase chain reaction was performed to amplify the full-length mtDNA genome. The products were separated by electrophoresis on a 0.8% agarose gel stained with ethidium bromide. Superoxide and reactive oxygen/nitrogen species (ROS/RNS; hydrogen peroxide, peroxynitrite anions, and peroxyl radicals) were measured with an amine-reactive green-dye assay and 2',7'-dicholorodihydrofluorescein diacetate (H(2)DCFDA) dye assay, respectively. The changes in mitochondrial membrane potential (DeltaPsim) were measured with a cationic (green) dye assay. Western blot analysis was used to assess porins, a structural protein of the mitochondrial membranes. RESULTS The 7kCh-treated cultures showed significant increase in ROS/RNS production (P < 0.001) compared with untreated controls, but the superoxide levels were unchanged. The 7kCh-treated ARPE-19 cultures had diminished levels of the full-length 16.2-kb mtDNA band, a 2.2-fold decrease of the DeltaPsim compared with control cultures (P < 0.001), and decreased levels of porins. CONCLUSIONS 7kCh causes significant damage to the full-length intact mtDNA and mitochondrial dysfunction in ARPE-19 cells. These observations suggest that the mitochondria and its DNA may be targets for oxysterol-induced oxidative stress and may play a role in the pathogenesis of retinal diseases.

Wegener granulomatosis (WG) is characterized by a classic triad of granulomatous inflammation of the respiratory tract, necrotizing vasculitis and nephritis. The absence of renal disease defines a subset of " limited WG" . Approximately 50% of WG patients develop ophthalmic disease. The histopatological study and +c-ANCA were essential to make a definite diagnosis in these cases.

We report on a 9-year-old female patient who had bilateral severe visual loss and was treated with oral corticosteroids. Visual improvement occurred in one eye. Nine years later she presented relapse of visual loss in her only seeing eye. Pulse corticosteroid therapy resulted in dramatic visual improvement followed, however, by progressive and complete visual loss as soon as the corticosteroid was tapered. Repeat treatment did not result in visual improvement. Clinical and laboratory investigation failed to find a systemic disease but the patient had positive antinuclear (1/640), anti-Ro and anti-La antibodies. Autoimmune optic neuropathy is a rare condition that may mimic an idiopathic optic neuritis and is characterized by acute visual loss, without systemic disease but with laboratory evidence of an autoimmune disorder, usually a positive ANA. A skin biopsy usually shows evidence of vasculitis. This condition should be treated aggressively, with corticosteroids and immunosuppressant, since the visual involvement is usually worse than that of idiopathic/desmyelinating optic neuritis.

Purpose. Pars plana vitrectomy (PPV) has been reported to reduce macular thickness and improve visual acuity in patients with diabetic macular edema (ME). The hypothesis for the study was that after PPV, clearance is accelerated and VEGF concentrations are reduced. To test this hypothesis, hVEGF(165) injections were performed in rabbit eyes, with and without PPV, and vitreous VEGF levels were measured as a function of time. Methods. The PPV group rabbits had a bilateral 25-gauge PPV, and in the no-PPV group, rabbits had intact vitreous. Intravitreal injections of hVEGF(165) were performed, and the animals were euthanatized at time points up to 7 days. The vitreous was isolated and an enzyme-linked immunosorbent assay was used to measure the VEGF levels. Pharmacokinetic parameters were determined in a noncompartmental analysis approach. Results. Mean vitreous VEGF levels decreased more rapidly in eyes subjected to PPV than in no-PPV eyes. The vitreous VEGF half-life (t([)(1/2)(])) in PPV eyes was 10 times shorter than that in normal eyes. In addition, mean clearance and mean area under the curve (AUC) increased and decreased, respectively, in eyes that underwent PPV. Conclusions. VEGF clearance is increased after PPV. Reducing VEGF concentrations in the vitreous post-PPV may partially explain the improvement in macular thickness in some patients with ME. Unexpectedly, the half-life of VEGF in the vitreous, even in no-PPV eyes, was

A functional Fourier domain optical coherence tomography instrument offering spectral Doppler imaging of in vivo pulsatile human retinal blood flow was constructed. An improved phase-resolved algorithm was developed to correct bulk motion artifacts. Spectral Doppler imaging provides complementary temporal flow information to the spatially distributed flow information of the color Doppler image by providing direct visualization of the Doppler spectrum of the flow whose pattern can be further quantified with various velocity envelope curves and their corresponding flow indices. The coefficient of repeatability on resistance index measurement was assessed by analyzing 14 measurements on two vessels within two normal subjects. © 2008 Society of Photo-Optical Instrumentation Engineers.

To report a case of a patient with Valsalva retinopathy that developed sub-internal limiting membrane hemorrhage, underwent pars plana vitrectomy and had visual acuity improvement after that. A 35-year-old healthy patient presented with sudden and painless vision loss of her right eye, after coughing. During the ophthalmologic evaluation, she had a pre-macular hemorrhage and no other abnormalities. Initially, we chose for expectant management, but the hemorrhage did not clear totally. Thus, pars plana vitrectomy associated with internal limiting membrane peeling was indicated, with considerable improvement of her visual acuity, without perioperative complications or significant findings in the optical coherence tomography, autofluorescence and multifocal electroretinogram. In this case, sub-internal limiting membrane hemorrhage treatment with vitreoretinal surgery was relatively useful, with visual acuity improvement and resolution of sub-internal limiting membrane hemorrhage.

Background Diabetic retinopathy is one of most common and threatening ocular diseases. Many of these patients need to be submitted to panretinal photocoagulation (PRP), experiencing a significant level of pain. The purpose of this study is to evaluate the effectiveness of oral metamizole in reducing pain during PRP in patients with proliferative diabetic retinopathy (PDR) and very severe non-proliferative diabetic retinopathy (VSNDR). Methods Patients from a single center with PDR or VSNDR and indication of bilateral PRP were recruited for a double-masked, controlled, prospective study. The treated eyes were randomly assigned in two groups, and each patient had one eye assigned per group. Group A received 1000 mg of metamizole and group B received a placebo pill 40 min before the laser treatment. The groups were switched for the treatment of the fellow eye. Each patient scored the pain sensation immediately after each PRP section using Scott’s visual analogue scale (VAS). The paired Student t test was used to measure the significance between the two groups VAS scores, with significance level adopted of p

Introdução: Foi demonstrado recentemente que as medidas de espessura da rima neurorretiniana através do parâmetro minimum rim width (MRW) da tomografia de coerência óptica (TCO) inclui componentes como a extensão da camada de fibras nervosas da retina (CFNR) e das camadas retinianas externas. Objetivo: Determinar se a subtração dos componentes de retina externa, denominados camadas retinianas protrusas (CRPs), das medidas de MRW está associada à melhora da capacidade diagnóstica de glaucoma pela TCO. Métodos: Estudo transversal com 123 pacientes diagnosticados com glaucoma de ângulo aberto e 123 controles normais, com idade semelhante, dos quais foram obtidas imagens de TCO da cabeça do nervo óptico (24 varreduras) na região peripapilar (varredura circular). Quando presentes, as CRPs foram segmentadas manualmente e as medidas de MRW ajustada (MRWa, gerada pela subtração da espessura das CRPs do total da medida de MRW) foram calculadas. Foi comparada a capacidade diagnóstica dos parâmetros MRW e MRWa e foi determinado se o parâmetro MRWa se correlaciona melhor com o parâmetro de espessura da CFNRp em comparação com a correlação de MRW com o parâmetro de espessura da CFNRp. Resultados: Nas 5.904 varreduras obtidas com TCO, as CRPs foram identificadas com menos frequência em pacientes com glaucoma (448, 7,6%) em comparação com os controles (728, 12,3%; P

OBJETIVOS: Identificar preditores pré-operatórios para a ocorrência de dor aguda pós-operatória precoce em pacientes submetidos à ceratectomia fotorrefrativa. MÉTODOS: Trata-se de uma pesquisa exploratória que incluiu pacientes submetidos à PRK. Antes da cirurgia, os indivíduos responderam ao questionário sociodemográfico, a Escala de Catastrofização da Dor (ECD) e o Inventário de Ansiedade Traço-Estado (IDATE) e foram submetidos a medições do equivalente esférico e sensibilidade corneana, além dos efeitos da Modulação condicionada da dor (MCD) nos dois tipos de estímulos condicionantes imersão na água e colírio de rosa bengala. Após a cirurgia, responderam a Escala Visual Analógica (EVA) e o Questionário de Dor McGill Reduzido (QDMR) nos períodos de uma, 24, 48 e 72 horas. As correlações de Spearman foram calculadas para escores de dor e preditores pré-operatórios. RESULTADOS: Esta pesquisa incluiu 34 olhos de 34 pacientes. Dados sociodemográficos, equivalente esférico, ECD e IDATE não foram preditores significativos de dor aguda pós-operatória (p > 0,05). Houve correlação direta estatisticamente significativa entre QDMR máximo e EVA máximo e estesiometria pré-operatória (r = 0,394 e r = 0,407, respectivamente; p < 0,05). Não foram encontradas correlações entre os escores de dor pós-operatória e os efeitos da MCD (p > 0,05). DISCUSSÃO: Vários fatores preditivos de dor pós-operatório encontrados na literatura foram avaliados, no entanto apenas um foi identificado neste estudo. Sugere-se que estesiometria pode ser considerada no manejo da dor pós-operatória e esse problema merece mais atenção e estudos. CONCLUSÕES: A MCD não foi preditivo de desenvolvimento de dor pós-operatória precoce. Este estudo mostrou que a sensibilidade da córnea diminuída pré-operatória foi um marcador protetor para dor intensa após PRK OBJECTIVES: To identify preoperative predictors for the occurrence of early acute postoperative pain in patients undergoing photorefractive keratectomy (PRK). METHODS: This exploratory research included patients who underwent PRK. Before surgery, subjects answered a sociodemographic questionnaire, the Pain Catastrophizing Scale (PCS) and the State-Trait Anxiety Inventory (STAI) and had their spherical equivalent and corneal sensitivity measured, in addition to the effects of conditioned pain modulation (CPM) in both types of conditioning stimuli. After surgery, they answered the Visual Analogue Scale (VAS) and the short-form McGill Pain Questionnaire (SF-MPQ) in the periods of 1, 24, 48 and 72 hours. Spearman\'s correlations were calculated for pain scores and preoperative predictors. RESULTS: This research included 34 eyes of 34 patients. Sociodemographic data, spherical equivalent, PCS and STAI were not significant predictors of acute postoperative pain (p > 0.05). There was a statistically significant direct correlation between the SF-MPQ and VAS pain scores and preoperative esthesiometry scores (r = 0.39 and r = 0.41, respectively; p < 0.05). No correlations were found between postoperative pain scores and the effects of CPM (p > 0.05). DISCUSSION: Preoperative abnormal lower corneal sensitivity was a protective marker for severe pain after PRK. We have not identified the type of CPM paradigm that most correlates with pain after PRK. CONCLUSIONS: The CPM was not predictive of the development of early postoperative pain. This study showed that corneal sensitivity has a correlation with postoperative pain after PRK

INTRODUÇÃO: Existe controvérsia em relação à espessura da coroide em pacientes com Diabetes mellitus (DM). Neste estudo, comparou-se a espessura de coroide em pacientes sem diabetes (controle) e diabéticos com e sem presença de retinopatia diabética (RD) em seus diferentes estágios. Avaliou-se também a correlação da espessura da coroide com variáveis sistêmicas e oculares. MÉTODO: Este estudo transversal incluiu pacientes com e sem diabetes do ambulatório de Oftalmologia. Mediu-se a espessura da coroide por meio da tomografia de coerência óptica de domínio espectral (SD-OCT), e foram avaliadas as variáveis sistêmicas como: medida da hemoglobina glicada (HbA1c), glicemia plasmática de jejum (GPJ), glicemia plasmática capilar (GPC), taxa de filtração glomerular estimada (TFGe), índice de massa corpórea (IMC) e pressão arterial média (PAM). Também foram avaliadas as variáveis oculares como: acuidade visual corrigida (AVCC) e espessura macular pela SD-OCT. RESULTADOS: O estudo incluiu 275 pacientes (275 olhos), dos quais 42 (15,27%) apresentaram-se com diabetes e sem RD, 43 (15,63 %), com RD leve, 46 (16,72 %), com RD moderada, 39 (14,18 %), com RD grave, 24 (8,72 %), com RD proliferativa, 40 (14,54 %), RD proliferativa status pós-panfotocoagulação, e 41 (14,90 %) indivíduos sem diabetes. A coorte diabética consistiu em 234 participantes, dos quais 50,0% eram homens e 85,9% tinham DM tipo 2. Em média, esses pacientes tinham 59,6 (± 13,0) anos e tinham diabetes há 15,9 (±8,68) anos. O grupo controle apresentou a coroide mais espessa (327,09 µm ± 48,77) comparado ao grupo de pacientes diabéticos (280,47 µm ± 83,40) com significância estatística (p < 0,001). Houve uma redução progressiva da média da espessura da coroide entre os grupos. O grupo sem RD apresentou a espessura da coroide maior (306,97 µm ± 77,84), seguido do grupo RDNP leve (301,83 µm ± 91,33), grupo RDNP moderada (300,36 µm ± 70,36), grupo RDNP grave (283,20 µm ± 86,80), RDP (250,08 µm ± 58,75) e RD pós laser (222,40 µm ± 73,15), com significância estatística (p < 0,001). As variáveis idade, tempo de duração do DM, estágio da RD, TFGe, IMC, GPC e AVCC foram as únicas que apresentaram uma correlação estatisticamente significativa (P < 0,001). Após o ajuste para a idade, apenas a GPC foi a variável que apresentou correlação estatisticamente significante (p < 0,001). Em subanálise entre os grupos de pacientes com DM, a influência da GPC sobre a espessura da coroide manteve-se estatisticamente significativa (p < 0,001) apenas nos pacientes diabéticos sem RD, RDNP leve, RDNP moderada.CONCLUSÃO: A espessura da coroide reduz à medida que a RD progride e sofre influência da GPC no momento do exame em pacientes com sem RD, RDNP leve, RDNP moderada. A espessura da coroide deve, portanto, ser ajustada, de acordo com esta variável em pacientes diabéticos BACKGROUND: There is controversy regarding choroidal thickness in patients with diabetes mellitus (DM). In this study, we compared choroidal thickness in patients without diabetes (control) and diabetics with and without diabetic retinopathy (DR) in its different stages. We also evaluated the correlation of choroidal thickness with systemic and ocular variables. METHODS: This cross-sectional study included patients with and without diabetes from the Ophthalmology outpatient clinic. We measured choroidal thickness by spectral domain optical coherence tomography (SD-OCT) and evaluated systemic variables such as glycated hemoglobin (HbA1c) measurement, fasting plasma glucose (FPG), capillary plasma glucose (CPG), estimated glomerular filtration rate (eGTR), body mass index (BMI), and mean arterial pressure (MAP). We also evaluated ocular variables such as corrected visual acuity and macular thickness by SD-OCT. RESULTS: The study included 275 patients (275 eyes), of whom 42 (15.27%) presented with diabetes and no DR; 43 (15.63%) with mild DR; 46 (16.72%), with moderate DR; 39 (14.18%), with severe DR; 24 (8.72%), with proliferative DR; 40 (14.54%), DR proliferative after panphotocoagulation; and 41 (14.90%) individuals without diabetes. The diabetic cohort consisted of 234 participants, of whom 50.0% were men and 85.9% had type 2 diabetes mellitus. On average, these patients were 59.6 (± 13.0) years old and had diabetes for 15.9 years. (± 8.68) years. The control group had the thickest choroid (327.09 µm ± 48.77) compared to the group of diabetic patients (280.47 µm ± 83.40 ) with statistical significance (p < 0,001). There was a progressive reduction in the average choroidal thickness among groups. The group without DR had the largest choroidal thickness (306.97 µm ± 77.84), followed by the mild NPDR group (301.83 µm ± 91.33), moderate NPDR group (300.36 µm ± 70.36) , severe NPDR group (283.20 µm ± 86.80), PDR (250.08 µm ± 58.75) and post laser DR (222.40 µm ± 73.15), with statistical significance (p < 0,001). The variables age, duration of DM, DR stage, eGFR, BMI, CPG and visual acuity were the only ones that showed a statistically significant correlation (p < 0.001). After adjusting for age, only CPG was the variable that showed a statistically significant correlation (p < 0.001). In subanalysis among the DM patient groups, the influence of CPG on choroidal thickness remained statistically significant (p < 0.001) only in the diabetic patients without DR, mild NPDR, moderate NPDR. CONCLUSION: Choroidal thickness decreases as DR progresses and is influenced by CPG at the time of examination in patients with no DR, mild NPDR, moderate NPDR. Choroidal thickness should therefore be adjusted according to this variable in diabetic patients

OBJETIVO: Descrever as manifestações clínicas e fenotípicas e o prognóstico visual de uma família com aniridia congênita (AC) no Nordeste do Brasil. MÉTODOS: Trata-se de um estudo transversal envolvendo 31 indivíduos (56 olhos), de uma mesma família que apresentava fenótipo de AC. A população do estudo residia no município de Água Branca, no sertão do estado de Alagoas, região nordeste do Brasil. Foram analisadas variáveis clínicas e fenotípicas. Para a análise, foi utilizada a estatística descritiva (frequência absoluta e relativa e medidas de tendência central e de dispersão) e inferencial (testes de Shapiro-Wilk e t Student). Considerou-se o intervalo de confiança de 95% e a significância de 5%. RESULTADOS: Dos 31 indivíduos, 18 (58,1%) eram do sexo masculino, com média de idade de 27,45±17,49, sem diferença entre os sexos. Dos 56 olhos avaliados, 26 eram olhos direitos e 30 olhos esquerdos: 61,3% (n=19) dos indivíduos apresentavam aniridia bilateral total; 25,8% (n=8) referiam perda total de percepção da luz em ambos os olhos. As anormalidades oculares mais prevalentes foram o nistagmo (n=27; 87,09%), catarata (n=20; 64,5%), estrabismo 14 (45,2%), alterações corneanas, como opacidades e/ou vascularização (n=13; 41,93%) e ectopia lentis (n=6; 19,4%). Treze indivíduos foram submetidos ao exame de tomografia de coerência óptica (OCT) retiniana, cinco homens e sete mulheres, com idade entre 9 e 48 anos (Média 30,15±15,9). Todos os pacientes apresentavam perda da depressão foveal, redução da espessura macular e redução da acuidade visual. Nove indivíduos foram submetidos a cirurgia de facoemulsificação. CONCLUSÃO: O estudo mostrou ampla variação fenotípica entre os indivíduos estudados, com pobre prognóstico visual. O estudo destaca a necessidade de estabelecer mecanismos de cuidado integral para as famílias com a doença. OBJECTIVE: We aimed to describe the clinical and phenotypic manifestations as well as the visual prognosis of a family with congenital aniridia (CA) in Northeastern Brazil. METHODS: This was a cross-sectional study involving 31 individuals (56 eyes) from the same family presenting CA phenotypes. The study population resided in the municipality of Água Branca, in the backlands of the state of Alagoas, Northeastern Brazil. The clinical and phenotypic variables were analyzed. For the analysis, descriptive statistics (absolute and relative frequency and measures of central tendency and dispersion) and inferential statistics (Shapiro-Wilk and Student\'s t tests) were used, with 95% confidence intervals and significance set at 5%. RESULTS: Of the 31 individuals, 18 (58.1%) were male, with a mean age of 27.45 ± 17.49 years, with no difference between sexes. Of the 56 eyes evaluated, 26 and 30 were right and left eyes, respectively; 61.3% (n = 19) individuals had complete bilateral aniridia and 25.8% (n = 8) reported a total loss of light perception in both the eyes. The most prevalent ocular abnormalities were nystagmus (n = 27; 87.09%), cataract (n = 20; 64.5%), strabismus (n = 14; 45.2%), corneal changes such as opacities and/or vascularization (n = 13; 41.93%), and ectopia lentis (n = 6; 19.4%). Further, 13 individuals underwent retinal optical coherence tomography, six man and seven women aged 9-48 (mean, 30.15 ± 15.9) years. All patients presented absence of foveal depression as well as reduced macular thickness and visual acuity. Nine subjects underwent phacoemulsification. CONCLUSION: The study showed wide phenotypic variation among the studied individuals, with poor visual prognosis. The study highlights the need to establish comprehensive care mechanisms for families with the disease.

Introdução: O implante de lente intraocular (LIO) na cirurgia de catarata pediátrica é recente e, apesar de ser progressivamente mais realizado, há ainda controvérsias em relação à técnica cirúrgica empregada e em relação ao momento ideal para se implantar a LIO. Existem evidências na literatura de que a idade ideal para realizar o implante primário seja após os dois anos de idade e para o implante secundário após os três anos de idade. Contudo, são poucas as publicações de implante de LIO em crianças antes dessa faixa etária, o que pode enviesar as conclusões. Existem também novas plataformas de LIOs que ainda não foram avaliadas em crianças. Objetivos: Avaliar os resultados de implante de LIO em crianças submetidas a cirurgia de catarata. Métodos: Os principais desfechos avaliados foram complicações pós-operatórias, cirurgias adicionais e mudança refracional. Foram realizados três estudos retrospectivos e um estudo prospectivo. No primeiro estudo retrospectivo, comparou-se duas técnicas cirúrgicas de capsulotomia posterior (via corneal e via pars plana) com vitrectomia anterior no implante primário de LIO no saco capsular em 46 crianças (56 olhos) entre três meses e nove anos de idade. No segundo estudo retrospectivo, avaliou-se o implante primário de LIO no saco capsular em 68 crianças (93 olhos) entre cinco e 24 meses de idade. No terceiro estudo retrospectivo, foi avaliado o implante secundário de LIO no sulco ciliar em 50 crianças (75 olhos) entre 11 e 30 meses de vida. Prospectivamente, no quarto estudo, comparouse duas LIOs acrílicas, uma hidrofóbica (AcrySof SA60AT) e outra hidrofílica (Akreos Adapt AO) com bordas quadradas implantadas em 17 crianças (26 olhos) entre cinco e 12 anos. Resultados: No primeiro estudo houve mais complicações na modalidade cirúrgica via corneal (p

Objetivos: Determinar o efeito da panfotocoagulação retiniana (PFC) nos parâmetros topográficos do disco óptico e na camada de fibras nervosas da retina (CFNR) peripapilar em pacientes com retinopatia diabética proliferativa (RDP). Métodos: Este é um estudo observacional prospectivo, de centro único. Trinta e oito olhos de 26 pacientes diabéticos foram submetidos a PFC para retinopatia diabética proliferativa. As estereofotografias (EFs) e os parâmetros do disco óptico foram avaliados usando o retinógrafo Visucam da Zeiss e a Tomografia de varredura a laser (TVL), respectivamente. A espessura da CFNR peripapilar foi medida por tomografia de coerência óptica (OCT) e polarimetria de varredura a laser (PVL). Todas as medições foram realizadas no início e 12 meses após a conclusão da PFC. Resultados: Trinta e oito olhos de 26 pacientes (15 mulheres) com média de idade de 53,7 anos (faixa etária de 26 a 74 anos) foram recrutados. Nenhuma diferença significativa foi encontrada entre a média horizontal e vertical para relação escavação/disco óptico (E/D) determinadas pelas EFs antes e após o tratamento com PFC (P = 0,461 e 0,839, respectivamente). Os valores globais dos parâmetros do disco óptico analisados com a TVL não mostraram nenhuma mudança significativa entre o baseline e 12 meses após o tratamento (área do disco, área da escavação, área da rima, volume da escavação, volume da rima, relação área da escavação/área do disco, relação linear do tamanho da escavação/disco, profundidade média da escavação, profundidade máxima da escavação, medida do formato da escavação, variação na altura do contorno, espessura média da CFNR e área transversal da CFNR). O OCT e o PVL não encontraram diferença significativa entre a CFNR peripapilar antes e após a PFC (P = 0,114 e P = 0,813, respectivamente). Conclusões: Nossos resultados sugerem que a PFC nos padrões realizados no presente estudo não causa significantes alterações morfológicas no disco óptico em pacientes diabéticos com RDP após um ano de acompanhamento Purpose: To determine the effect of panretinal photocoagulation (PRP) on optic disc topographic parameters and peripapillary retinal nerve fiber layer (RNFL) in nonglaucomatous patients with proliferative diabetic retinopathy (PDR). Methods: This is a prospective, single center, observational study. Thirty-eight eyes of 26 diabetic patients underwent PRP for proliferative diabetic retinopathy. Stereoscopic disc photographs and optic nerve head (ONH) parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscopy (CSLO), respectively. The peripapillary RNFL thickness was measured by optical coherence tomography (OCT) and scanning laser polarimetry (SLP). All measurements were performed at baseline and 12 months after completion of PRP. Results: Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 years (range 26 to 74 years) were recruited. No significant difference was found between mean horizontal and vertical cup to disc (C/D) ratio determined by stereoscopic disc photographs before and after PRP treatment (P=0.461 and 0.839, respectively). The global values of ONH parameters analyzed with the CSLO showed no significant change from baseline to 12 months (disc area, cup area, rim area, cup volume, rim volume, C/D area ratio, linear C/D ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness and cross-sectional area). The OCT and SLP did not find significant difference between peripapillary RNFL before and after PRP (P=0.114 and P=0.813, respectively). Conclusion: Our results suggest that PRP as performed in this study does not cause significant morphological optic disk changes in diabetic PDR patients after one year of follow-up

Objetivo: Estudar e comparar a acuidade visual, metamorfopsia, espessura foveal, camada limitante externa e zona elipsoide por meio da Tomografia de Coerência Óptica (OCT), e a taxa de recorrência dos pacientes operados de remoção de membrana epirretiniana, com e sem a retirada da membrana limitante interna. Métodos: Pacientes com MER operados por um único cirurgião e randomizados, aleatoriamente, em dois grupos. Todos os pacientes tiveram a retirada da membrana epirretiniana: 35 pacientes do Grupo 01, sem a adicional retirada de membrana limitante interna, e 28 pacientes do Grupo 02, com a retirada dessa membrana. Os pacientes foram seguidos e avaliados no primeiro, terceiro e sexto mês. Resultados: Setenta pacientes operados no total, sendo sete excluídos por perda de seguimento. Os pacientes de ambos os grupos evoluíram com melhora gradativa da visão ao longo do tempo. No Grupo 01, a média de acuidade visual inicial foi 0,60 logMAR (±0,3 desvio padrão - DP), no primeiro mês foi 0,49 logMAR (±0,26 DP), no terceiro mês, 0,39 logMAR (±0,30 DP) e no sexto mês, 0,27 logMAR (±0,25 DP). No Grupo 02, a média de acuidade visual inicial foi 0,63 logMAR (±0,25 DP), no primeiro mês foi 0,44 logMAR (±0,26 DP), no terceiro mês, 0,41 logMAR (±0,35 DP), e no sexto mês, 0,43 logMAR (0,44 DP). Não houve diferença estatisticamente significante quanto à melhora da acuidade visual entre os dois grupos. Não foi encontrada diferença estatisticamente significante em relação às alterações na OCT entre os grupos. O Grupo 02 apresentou maior taxa de recidiva (17%) quando comparada com o Grupo 01 (3,6%), embora esta diferença não foi estatisticamente significante (p=0,09). Conclusão: Ambos os grupos apresentaram melhora funcional e anatômica semelhantes, mas o grupo no qual não se removeu a membrana limitante interna mostrou uma possível tendência à maior taxa de recidiva Objective: To study and compare the visual acuity, metamorphosis, foveal thickness, the outer limiting layer and the ellipsoid zone, studied by Optic Coherence Tomography (OCT), and the recurrence rate of patients undergoing removal of epiretinal membrane with and without the removal of the internal limiting membrane. Methods: Seventy patients undergoing removal of epiretinal membrane, by a single surgeon and randomly assigned into two groups. Group 1, without additional removal of internal limiting membrane, 35 patients, and group 2 with the removal of the internal limiting membrane, 28 patients. Both groups were followed and evaluated in the first, third and sixth month. Results: Patients of both groups developed with a gradual improvement of vision over time. In group 1, the mean initial visual acuity was 0.60 logMAR (±0.3 standard deviation - SD), the average visual acuity of the first month was 0.49 logMAR (±0.26 SD), in the third month 0.39 logMAR (±0.30 DP), and in the sixth month logMAR 0.27 (±0.25 SD). In group 2, the mean initial visual acuity was 0.63 logMAR (±0.25 SD), average visual acuity of the first month was 0.44 (±0.26 DP) logMAR, in the third month 0.41 logMAR (±0.35 DP), and in the sixth month 0.43 logMAR (±0.44 DP). There was no statistical difference in improvement in visual acuity between the two groups, there was no statistically significant differences related to tomographic alterations between the groups, but the group 2 showed a higher relapse rate (17%) compared to the group 1 (3.6%). Although the difference is not statistically significant (p=0.09). Conclusion: Both groups showed similar functional and anatomical improvement, but the group which the internal limiting membrane was not removed showed a higher recurrence rate

OBJETIVO: Avaliar a capacidade do potencial visual evocado multifocal (PEV-mf) em diferenciar pacientes portadores de hemianopsia temporal de controles normais e avaliar a correlação entre o PEV-mf, o campo visual (CV) realizado com a perimetria automatizada e a tomografia de coerência óptica de domínio fourier (TCO-dF). MÉTODOS: Vinte sete olhos de 21 pacientes com defeito de campo visual temporal secundário a compressão quiasmática e 43 olhos de 23 controles normais foram submetidos aos exames PEV-mf, CV e TCO-dF (3D OCT-1000®, Topcon) da mácula e da camada de fibras nervosas da retina (CFNR). Foi calculada a média das respostas do PEV-mf global, do PEV-mf central e a média de espessura do TCO-dF da mácula para cada quadrante e para cada hemicampo, enquanto a espessura da CFNR foi dividida em 12 setores ao redor do nervo óptico. A perda de CV foi calculada para os quatro quadrantes e para os hemicampos temporal e nasal no CV 24-2 e CV 10-2. Os dois grupos foram comparados utilizando equações de estimativas generalizadas (GEE) e as correlações entre o PEV-mf, CV e o TCO-dF foram calculadas. RESULTADOS: As médias das amplitude P1 e N2 do PEV-mf global e central para os hemicampos e os quadrantes temporais foram significativamente menores nos pacientes que nos controles (p < 0.004). Não houve diferença estatística entre os grupos para os parâmetros de amplitudes do PEV-mf nos setores nasais. Não houve diferença estatística nas médias das latências do PEV-mf global e central entre os pacientes e os controles normais. Foi encontrada correlação moderada, estatisticamente significativa, entre os parâmetros de amplitudes temporais do PEV-mf - global e central com a perda de CV 24-2 e 10-2 temporal, assim como com as medidas de espessura macular e da espessura CFNR na TCO-dF. CONCLUSÕES: As médias das amplitudes do PEV-mf foram capazes de diferenciar olhos de pacientes com hemianopsia dos controles normais e apresentaram correlação significativa com os dados obtidos pela perimetria automatizada e pelo TCO-dF. Estes dados sugerem que o PEV-mf global e central podem ser utilizados na detecção de anormalidades do campo visual em pacientes portadores de compressão quiasmática PURPOSE: To evaluate the ability of multifocal visual evoked potential (mfVEP) to differentiate patients with temporal hemianopia due to chiasmal compression from normal controls. To assess the relationship between mfVEP, standard automated perimetry (SAP) and fourier domain-optical coherence tomography (fd-OCT). METHODS: Twenty-seven eyes of 21 patients with permanent temporal visual field (VF) defects from chiasmal compression and 43 eyes of 23 healthy controls underwent mfVEP, SAP and fd-OCT (3D OCT-1000®, Topcon) macular and peripapillary retinal nerve fiber layer (RNFL) measurements. It was averaged the responses for global mfVEP, central mfVEP and fd-OCT macular measurements were averaged in quadrants and halves, while peripapillary RNFL thickness was averaged in 12 sectors around the disc. VF loss was estimated in four quadrants and each half of 24-2 and 10-2 strategy test points. The two groups were compared using generalized estimated equations (GEE). Correlations between mfVEP, VF and fd-OCT findings were verified. RESULTS: Global and central mfVEP P1 and N2 amplitude parameters of temporal measurements were significantly smaller in patients than controls (p < 0.004). No significant differences were observed between the groups with respect to mfVEP amplitude parameters from the nasal measurements. No significant differences were observed in global and central mfVEP latency parameters for all averaged measurements between patients and healthy controls. A significant moderate correlation was found between global and central mfVEP amplitude parameters of temporal measurements and temporal VF 24-2 and 10-2 loss as well as with corresponding fd-OCT macular and RNFL thickness measurements. CONCLUSIONS: mfVEP amplitude parameters were able to differentiate eyes with temporal hemianopia from controls and were significant correlated with VF and fd-OCT findings. These data suggest that it is a useful technology for detecting visual abnormalities in patients with chiasmal compression

O albinismo e uma alteracao genetica rara que compromete a producao de melanina. As alteracoes clinicas consistem na falta de pigmentacao da pele, cabelo e pelos. Apresenta alteracoes oftalmologicas importantes, que comprometem a acuidade visual de forma severa, na grande maioria dos casos. As alteracoes oftalmologicas sao, ametropias, nistagmo, rarefacao do epitelio pigmentado da iris e da retina, hipoplasia foveal e decussacao anomala do nervo optico. Este estudo foi dividido em tres diferentes partes com os seguintes objetivos principais: Parte 1: Analise comparativa entre o grau de transparencia da iris (GTI), o grau de transparencia da retina (GTR) e a espessura da regiao macular com a acuidade visual nos pacientes com albinismo. Parte 2: Teste de sensibilidade ao contraste espacial de luminancia e ofuscamento com lentes de contato filtrantes em ambientes claros e escuros. Parte 3: Avaliacao da visao de cores, utilizando\\se o teste de Pranchas de Ishihara e o Cambridge Color Test (CCT). Material\' e\' Métodos: Participaram do estudo 121 individuos albinos, com idade media de 31,18 (} 15,47) anos, o que totalizou 242 olhos. Os participantes foram divididos em diferentes grupos nas tres partes do estudo, alguns participaram de uma ou mais partes. Na primeira parte os participantes foram submetidos a consulta oftalmologica, classificacao do grau de transparencia da iris e da retina em uma nova classificacao baseada em quatro diferentes graus de transparencia, alem de avaliacao foveal pelo exame de Tomografia de Coerencia Optica (OCT). Na segunda parte, os participantes foram submetidos ao teste de contraste computadorizado, utilizando lentes de contato filtrante e transparentes, em ambientes claros e escuros. Nesta etapa foi avaliada a influencia da lente filtrante na sensibilidade de contraste visual dos individuos com albinismo. Na terceira parte, os participantes foram submetidos aos testes de Pranchas de Ishihara e de Cambridge Colour Test (CCT), para avaliacao da visao de cores nos pacientes albinos. Resultados: Os resultados foram os seguintes: Parte\'1: A correlacao entre AV logMAR e GTI foi positiva (+0,569) e significativa (p

Objetivos: Avaliar a capacidade do eletrorretinograma de padrão reverso (PERG) macular e multifocal (mf) de diferenciar pacientes com suspeita de glaucoma (SG) e glaucoma com defeito de campo hemianópico (GH) de controles, comparar a capacidade de discriminação do PERG e tomografia de coerência óptica (TCO) fourrier domain, e avaliar a relação entre as medidas do PERG e TCO. Métodos: Medidas do campo visual (CV) computadorizado, respostas do PERG transiente e modo estacionário e PERGmf foram obtidos dos SG (n=14, 24 olhos), GH (n=5, 7 olhos) e controles (n=19, 22 olhos). Os seguintes parâmetros de TCO foram investigados: camada de fibras nervosas da retina peripapilar (CFNRpp), espessura total da mácula e espessuras das camadas segmentadas da mácula. As medidas foram analizadas utilizando-se modelos lineares de efeito misto. Também foi avaliada a relação entre as medidas e a performance diagnóstica de cada tecnologia. Resultados: Comparado aos controles, a média do tempo de pico de P50 da resposta do PERG transiente estava reduzida nos SG e GH, enquanto que a fase, a amplitude do modo estacionário e respostas do PERGmf estavam anormais apenas no GH. A média das medidas da TCO de espessura macular e da CFNRpp nos SG e GH diferiram significativamente dos controles. Uma significativa relação foi observada entre o PERG e a maior parte dos dos parâmetros do CV central e TCO. A análise por regressão e componentes principais revelou que a TCO de nervo óptico e mácula, assim como o PERG transiente e PERGmf tiveram estatisticamente capacidade similar em discriminar os SG dos controles. Conclusões: Os parâmetros do PERG e da TCO podem estar anormais, com significativa relação entre as medidas, em uma porcentagem alta de olhos com SG com CV normal. Nossos achados sugerem que as duas tecnologias podem ser úteis e complementares na detecção precoce de glaucoma Purpose: To evaluate the ability of macular and multifocal (mf) pattern electroretinogram (PERG) to differentiate glaucoma suspects (GS) and glaucoma with hemifield loss (GHL) from controls, to compare the discrimination ability of PERG and fourier-domain optical coherence tomography (fdOCT), and to assess the relationship between PERG and fdOCT measurements. Methods: Standard automated perimetry (SAP), steady-state and transient PERG responses and mfPERG measurements were obtained from GS (n=14, 24 eyes), GHL (n=5, 7 eyes) and controls (n=19, 22 eyes). The following fdOCT parameters were investigated: circumpapillary retinal nerve fiber layer (cpRNFL), full-thickness macula, and segmented macular layer thicknesses. Measurements were compared using mixed effects linear models. The relationships between measurements and the diagnostic performance of each technology were also assessed. Results: Compared to controls, average P50 peak time transient PERG responses were reduced in GS and GHL, whereas average phase and amplitude steady-state and mfPERG responses were abnormal only in GHL. The average fdOCT-measured cpRNFL and macular thickness measurements in GS and GHL differed significantly from controls. A significant relationship was found between PERG and most fdOCT or central SAP sensitivity parameters. Principal component regression analysis revealed that optic disc and macular OCT parameters, along with mfPERG and transient PERG parameters had statistically similar ability to discriminate GS from controls. Conclusions: PERG and OCT parameters may be abnormal, with significant correlations between measurements, in a high percentage of GS eyes with normal SAP. Our findings suggest that both technologies may be helpful and complementary in early glaucoma detection