Rmo-08-04-14-intercambio academico.pmd

Rev Mex Oftalmol; Julio-Agosto 2008; 82(4):269-276
tibody test for histoplasmosis and negative medical and la-boratory evaluation of toxoplasmosis, syphilis, and tuber- Arquivos Brasileiros
culosis. All patients were submitted to a complete ocularexamination including fluorescein angiography. One patient de Oftalmologia
was submitted to indocyanine green angiography. RESUL-
Vol. 70, Nº.4, 2007
TS: Five patients presented the classical triad of clinical
features that include peripapillary scarring, histo spots, cho-
roidal neovascularization, one patient presentd enlargement
of atrophic chorioretina scar, one patient presented multi-
SIQUEIRA, Rubens Camargo, JORGE, Rodrigo and SCO- ple retinal pigment epithelial detachment, one, neovascula- TT, Ingrid Ursula. Transconjunctival retinopexy with ac-
rized retinal pigment epithelial detachment. Another pa- tive external drainage of subretinal fluid: a prospective
tient presented only histo spots. CONCLUSIONS: These
pilot study of eight consecutive cases. Arq. Bras. Oftal-
findings of ocular histoplasmosis-like syndrome in patients mol., July/Aug. 2007, vol.70, no.4, p.573-576. ISSN 0004- with negative antibody serum test from a nonendemica area suggest that other agents could cause these similar fundus PURPOSE: To describe an alternative surgical technique
for the management of retinal detachment with no or mini- Key words: Histoplasmosis; Histoplasma [isolatin]; Histo-
mal proliferative vitreoretinopathy (grade B) using trans- plasma [purification]; Eye infections, fungal; Choroiditis; conjunctival retinopexy with active external drainage of Fluorescein angiography; Fundus oculi; Choroidal neovas- subretinal fluid. METHODS: In a prospective, interven-
cularization; Observational studies.
tional study, eight consecutive patients with retinal detach-ment with no or minimal proliferative vitreoretinopathy ESPINDOLA, Rodrigo França de, RODRIGUES, Beatriz (grade B) underwent transconjunctival retinopexy with ac- Alessi, PENTEADO, Lívia Tribst et al. The knowledge of
tive external drainage of subretinal fluid. Transconjuncti- medical students about cornea donation. Arq. Bras. Of-
val external drainage of subretinal fluid was achieved by talmol., July/Aug. 2007, vol.70, no.4, p.581-584. ISSN 0004- using a 29 gauge needle placed in the subretinal space un- der indirect ophthalmoscopic monitoring. Active suction was PURPOSE: To compare knowledge of medical students
performed (500 mmHg vacuum) using a vitrectomy line about the cornea donation process among those who alrea- coupled to the needle. After retinal reattachment, cryothe- dy studied Ophthalmology and the others. METHODS: A
rapy was applied to the scleral region corresponding to the questionnaire containing data as: age, sex, graduation year, area of the retinal break(s). RESULTS: In all cases there
and 10 multiple-choice questions about the subject was was retinal attachment at the end of surgery. Retinal redeta- applied to medical students from the interior of São Paulo chment occurred in four pseudophakic patients who then state, Brazil. The questions were: age for donation, contra- underwent pars plana vitrectomy. The four phakic patients indication for transplants, the time limit to remove the cor- maintained retinal attachment during follow-up (13-20 nea, among others. The knowledge regarding cornea dona- months). CONCLUSIONS: Transconjunctival retinopexy
tion was compared between the two groups: students who with active external drainage of subretinal fluid represents already studied Ophthalmology (Group A) and the others a useful, faster, and cheaper alternative to scleral buckling (Group B). RESULTS: The study group was composed of
for retinal detachments with no or minimal proliferative 402 students, of whom 140 were of group A and 262 of group retinopathy in phakic patients and, unlike scleral buckling, B. Knowledge between the two groups was different, but not is not associated with induced myopia.
statistically significant (p=0.8328). CONCLUSIONS:
Key words: Retina; Retinal detachment [surgey]; Draina-
Knowledge about the cornea donation process among the interviewed seemed to be insufficient, even those who hadstudied Ophthalmology. Information and education about AMARO, Miguel Hage, MUCCIOLI, Cristina and ABREU, transplants in Medical Schools should be improved.
Mariza Toledo. Ocular histoplasmosis-like syndrome: a
Key words: Cornea transplantation; Health education; Ques-
report from a nonendemic area. Arq. Bras. Oftalmol., July/
tionnaire; Tissue and organ procurement; Students, medical.
Aug. 2007, vol.70, no.4, p.577-580. ISSN 0004-2749.
PURPOSE: To report some cases of ocular histoplasmosis-
CAMARGO, Gustavo Bueno de, HIDA, Wilson Takashi, like syndrome from a nonendemica area. DESIGN: Obser-
GOLDCHMIT, Mauro et al. Paralytic strabismus: review
vational case series. METHODS: This is a prospective stu-
of 24 years at «Santa Casa de São Paulo». Arq. Bras. Of-
dy of 16 eyes from 8 immunocompetent patients evaluated talmol., July/Aug. 2007, vol.70, no.4, p.585-587. ISSN 0004- between January 2001 to September 2005. Six patients were female and 2 male aged between 20 to 44 years, average 28 PURPOSE: To describe the incidence, etiologies and fo-
years. All patients presented clinical features that resem- llow-up of patients with paralytic strabismus. METHODS:
bled ocular histoplasmosis. All patients had a negative an- Retrospective study of 519 strabismic patients with isolated Julio-Agosto 2008; 82(4)
Intercambio académico
III, IV or VI cranial nerve palsy of 11,000 charts of the
METHODS: Melan-A and tyrosinase were the two mar-
Ocular Motility Section of the Department of Ophthalmo- kers used for the detection of CMCs, using reverse trans- logy of «Faculdade de Ciências Médicas Santa Casa de São criptase nested polymerase chain reaction (RT-nested-PCR) Paulo», Brazil, between January 1980 and October 2004.
in 6 patients with uveal melanoma. The expression of β- This study analyzed: the injured cranial nerve, affected eye, actin and GAPDH were used to assess the quality of the sex distribution, etiology and follow-up. RESULTS: It was
material. RESULTS: Five patients (83.33%) tested positi-
found that 17.1% of the cases were congenital and 82.9% ve for the presence of CMCs. The RT-nested-PCR was posi- acquired. The VI cranial nerve was the most frequently affec- tive for melan-A in 4 patients (66.7%) and positive for tyro- ted (49.7%). The incidence was higher in males (58.1%).
sinase in 4 (66.7%) of the 6 patients. Three (50%) patients Traumatism was the most common cause of III (43.0%), IV were positive for both markers. One (16.7%) patient was (52.4%) and VI (48.8%) nerve palsy. Surgery was perfor- negative for both markers. All negative controls were nega- med in the three groups: third nerve (42.9%), fourth nerve tive. CONCLUSIONS: The quality of the blood samples
(73.2%) and sixth nerve (43.2%). CONCLUSIONS:The
shipped overseas, from patients with uveal melanoma, was sixth cranial nerve was the most frequently affected and the preserved. The detection of CMCs using RT-nested-PCR was most common cause was traumatism, the same as observed positive in the majority of the patients.
Key words: Melanoma; Choroid neoplasms; Monophenol
Key words: Strabismus [epidemiology]; Strabismus [etio-
monooxygenase; Reverse transcriptase polymerase chain reac- logy]; Cranial nerves [physiopathology].
tion; Sequence analysis; DNA; Neoplasm circulating cells.
CUNHA, Leonardo Provetti, PRIMIANO JUNIOR, Hélio NUNES, Tânia Pereira, SARDINHA, Mariluze, PEREIRA, Paulo, NAKASHIMA, Augusto et al. Subconjunctival de-
Ivana Cardoso et al. Gold weight implantation: prematu-
posit of silicone oil after vitreoretinal surgery. Arq. Bras.
re and late complications. Arq. Bras. Oftalmol., July/Aug.
Oftalmol., July/Aug. 2007, vol.70, no.4, p.589-592. ISSN 2007, vol.70, no.4, p.599-602. ISSN 0004-2749.
PURPOSE: To evaluate the indications, the results and the
PURPOSE: To assess the histopathological findings of con-
complications seen in the patients submitted to gold weight junctival specimens from patients submitted to vitreoreti- implantation to correct paralytic lagophthalmos. ME-
nal surgery with intraocular silicone oil injection. ME-
THODS: Charts of 20 patients with lagophthalmos secon-
THODS: Prospective analyses of 30 eyes of 30 patients were
dary to facial nerve palsy of diverse etiologies, which were evaluated. Before the patients underwent removal of the in- submitted to gold weight implantation in the upper eyelid traocular silicone oil, conjunctival excision was performed of the affected side, were retrospectively examined. RESUL-
and submitted to histopathologic examination. RESULTS:
TS: The most frequent cause of paralytic lagophthalmos
The presence of empty spaces corresponding to silicone oil was acoustic neurinoma after surgery (40%). Early and late location was positive in 10 (33%) specimens. The presence complications occurred in 40% of the implants. Four pa- of inflammatory cells, vascular congestion, leukostases, lym- tients (20%) presented a local inflammatory reaction in the phocyte and monocyte infiltrates were positive in 27 (90%) first 3 months after surgery. Two patients (10%) presented specimens. The presence of silicone oil was positive in 10 skin and orbicular muscle thinness over the gold weight 4 (33%) specimens. Therefore, in those patients who undergo and 7 years after the implant, respectively. One patient (5%) vitreoretinal surgery, silicone oil may be present in the con- presented gold weight displacement after 3 years and ano- junctiva or subconjunctival space, even if biomicroscopic ther patient (5%) had late gold weight extrusion after 10 examination seems to be normal. According to our knowled- years. CONCLUSIONS: In this series, the complication rate
ge, this is the first study with the purpose to assess the histo- of gold weight implantation was high (40%). The complica- pathological findings of conjunctival specimens from pa- tions were divided into early, possibly related to the material tients submitted to vitreoretinal surgery with intraocular si- impurity and the late, due to the evolution of the facial nerve licone oil injection. CONCLUSIONS: Ophthalmologists
palsy that presented a decrease in muscle tonus.
should be aware of this possible complication after intrao- Key words: Gold; Prosthesis and implants; Facial paraly-
cular use of silicone oil after vitreoretinal surgery.
sis; Eyelid diseases; Postoperative complications; Human; Key words: Silicone oils [adverse effects]; Retina [surgery];
Vitreous body [surgery]; Biopsy; Postoperative care.
FERRAZ, Caroline Amaral, ALLEMANN, Norma and FERNANDES, Bruno F., ANTECKA, Emilia, PASSOS, Gil- CHAMON, Wallace. Phakic intraocular lens for presb-
berto dos et al. Detection of circulating malignant cells in
yopia correction. Arq. Bras. Oftalmol., July/Aug. 2007,
patients with uveal melanoma. Arq. Bras. Oftalmol., July/
vol.70, no.4, p.603-608. ISSN 0004-2749.
Aug. 2007, vol.70, no.4, p.593-598. ISSN 0004-2749.
PURPOSE: To evaluate clinical and refractive results of
PURPOSE: The purpose of our study was to detect circula-
anterior chamber multifocal phakic intraocular lens Newli- ting malignant cells (CMCs) in oversea-shipped blood sam- fe® for presbyopia correction considering uncorrected far ples of patients with uveal melanoma diagnosed in Brazil.
and near visual acuity and refraction data and also to eva- Rev Mex Oftalmol
Intercambio académico
luate safety of this intraocular lens considering distance and a prospective study. Arq. Bras. Oftalmol., July/Aug. 2007,
near corrected visual acuity, endothelial cell count and com- vol.70, no.4, p.615-618. ISSN 0004-2749.
plications. METHODS: Retrospective analysis of a clini-
PURPOSE: To determine both the incidence of adverse reac-
cal database of 30 patients (51 eyes) who had received a tions in patients who underwent fluorescein angiography foldable anterior chamber multifocal intraocular lens for for the first time and to determine whether systemic arterial presbyopia correction. Data were collected before surgery hypertension, diabetes or allergy history increases the chance and at 1, 3, 6, 12 months after the procedure. Statistical of reaction to intravenous fluorescein. METHODS: Data
variance analysis and multiple comparisons were used to collection was carried out between January 2001 and Octo- verify possible associations. All complications were descri- ber 2002 in Recife, Brazil. Patients with prior fluorescein bed. RESULTS: After surgery the mean spherical equiva-
angiography history, pregnant patients or patients in use of lent was -0.046 D (+/-0.48) and 87.5% of the eyes could corticosteroids, immunosuppressive or antihistamine drugs read Parinaud 3 or better (equivalent to J2 or better) without were excluded. RESULTS: Out of 1,500 enrolled patients,
the need of near glasses. Endothelial cell loss was 7.57%.
1,039 (69.3%) underwent the test for the first time. The The intraocular lens was explanted in 6 (11.5%) eyes for mean age was 58 ± 16 years and the median age was 60 different reasons. Cataracts were the major cause of lens years. Of these, 628 (60.4%) were women. Nausea occurred removal. CONCLUSIONS: Improvement of mean unco-
in 71 (6.83%) patients, vomiting in 14 (1.35%), urticaria in rrected visual acuity and refraction data after multifocal 11 (1.06%), bronchospasm in 4 (0.38%) and laryngeal ede- phakic intraocular lens Newlife® implantation for presbyo- ma in 1 (0.01%). Five patients presented more than one pia correction was observed. Established safety criteria (dis- adverse reaction. Higher incidences of adverse reactions were tance and near corrected visual acuity, endothelial cell count observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24- and complications) did not confirm the safety of the proce- 2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history Key words: Presbyopia [surgery]; Lens implantation, in-
[p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS: A
traocular; Postoperative complications; Retrospective studies.
cumulative incidence of 9.72% adverse reactions was ob-served in patients who had undergone this test for the first SILVA, Edison Ferreira e and TRINDADE, Fernando Cança- time. The presence of the allergy history, diabetes or syste- do. Surgical correction of astigmatism during cataract
mic arterial hypertension increased the incidence of adver- surgery. Arq. Bras. Oftalmol., July/Aug. 2007, vol.70, no.4,
Key words: Fluorescein angiography; Anaphylaxis; Drug
PURPOSE: To evaluate the effect of peripheral limbar re-
hypersensitivity; Adverse reactions.
laxing incisions (PLRI) in the reduction of the astigmatism
during cataract surgery. METHODS: We studied prospec-
MURATA, Celina, MALLMANN, Felipe, YAMAZAKI, Es- tively 103 eyes of 103 patients submitted to PLRI, using the ter et al. Anterior ocular segment study with the Scheim-
Nichamim nomogram during cataract surgery by phacoe- pflug rotational camera in refractive surgery candida-
mulsification. After the first and sixth month we analized tes. Arq. Bras. Oftalmol., July/Aug. 2007, vol.70, no.4,
the changes in astigmatism topography, induction of astig- matism and sucess rate. The patients were divided into two PURPOSE: To analyze the anterior segment of refractive
groups according to the astigmatism (with-the-rule and surgery candidates and establish the variability pattern in against-the-rule), and studied separately. RESULTS: The-
this population regarding corneal volume, anterior cham- re was a statistically significant change in the mean astig- ber volume and depth and corneal thickness, using the non- matism topography in the preoperative and postoperative contact three dimensional analyzer Pentacam®. ME-
periods in both groups. There was an induction of 1.10 ± THODS: A retrospective study of 297 eyes of 149 patients
0.9 D and 37% of sucess rate in the with-the-rule group and was conducted using Pentacam®. According to the spheri- 1.70 ± 0.80 D and 51% of sucess rate in the against-the-rule cal equivalent value two groups were created, myopia (n=242 group after six months of follow-up. CONCLUSIONS: The
eyes) and hyperopia (n=55 eyes), to analyze the variables of peripherical relaxing limbal incisions (PLRI) are effective corneal volume, anterior chamber volume and depth and in reducing the preoperative astigmatism during cataract corneal thickness. RESULTS: The mean values of the myo-
surgery. The procedure is safe and easy. The Nichamin no- pia group were: corneal total volume 59.37 ± 3.51mm3, cor- mogram caused hypocorrection in both types of preoperati- neal volume at 3 mm 3.87 ± 0.23 mm3, at 5 mm 11.31 ± 0.67 mm3, and at 7 mm 24.30 ± 1.43 mm3, anterior cham- Key words: Astigmatism; Astigmatism [surgery]; Phacoe-
ber volume 198.74 ± 32.40 mm3, anterior chamber depth 3.19 ± 0.28 mm and corneal thickness 533.33 ± 33.47 mm.
In the hyperopia group, the mean total corneal volume was LIRA, Rodrigo Pessoa Cavalcanti, OLIVEIRA, Cleriston 60.77 ± 3.31 mm3, corneal volume at 3 mm from the apex Lucena de Andrade, MARQUES, Marta Virgínia Ribeiro was 4.01 ± 0.20 mm3, at 5 mm was 11.73 ± 0.58 mm3, and Brito et al. Adverse reactions of fluorescein angiography:
at 7 mm was 25.09 ± 1.21 mm3, the anterior chamber volu- Julio-Agosto 2008; 82(4)
Intercambio académico
me was 146.61 ± 32.86 mm3, the anterior chamber depth was This factor, nevertheless, did not show any relation to the 2.76 ± 0.38 mm and the corneal thickness was 550.52 ± 29.49 adverse clinical event (p=0.334). CONCLUSIONS: Con-
mm. The difference between the groups was significant for cerning the studied series, the altered laboratory tests, elec- all variables (p<0.05). CONCLUSIONS: We observed in this
trocardiogram and/or thorax x-ray has no correlation with study that patients with myopia had lesser mean corneal vo- the adverse clinical events related to the anesthesia/surgical lume and pachymetry, and greater anterior chamber depth and volume compared with hyperopic patients.
Key words: Cataract extraction; Attitude of health person-
Key words: Corneal topography; Myopia [surgery]; Hype-
nel; Preoperative care; Diagnostic tests; routine.
ropia [surgery]; Anterior eye segment.
FERNANDES, José Byron Vicente Dias, MATAYOSHI, OLIVEIRA, Flávia Chaves de, DANTAS, Paulo Elias Co- Suzana, OSAKA, Junko Takano et al. Comparative analy-
rrea, MARCO, Erlan Stephan de et al. Long-term follow-
sis between sclera treated with glycerin and sclera trea-
up of a case series of therapeutic corneal transplant. Arq.
ted with gamma irradiation, alkali and glycerin in the
Bras. Oftalmol., July/Aug. 2007, vol.70, no.4, p.625-631.
reconstruction of anophthalmic socket: experimental stu-
dy in rabbits. Arq. Bras. Oftalmol., July/Aug. 2007, vol.70,
PURPOSE: To describe the results of therapeutic penetra-
ting keratoplasty in patients with impending perforation or PURPOSE: To compare two sclera decontamination me-
perforated infectious keratitis. METHODS: Fifty-nine char-
thods: treatment with glycerin versus treatment with gam- ts of patients with infectious keratitis who were submitted ma irradiation, alkali and glycerin, aiming to detect the cli- to therapeutic penetrating keratoplasty were retrospectively nical and histological alterations in rabbit anophthalmic reviewed at the Department of Ophthalmology of the Santa sockets reconstructed with sclera-involved polymethylme- Casa of São Paulo from January 2000 to December 2004.
thacrylate spheres. METHODS: Thirty-nine New Zealand-
Pre- and post operative visual acuity, biomicroscopy, echo- breed rabbits were divided into two groups: group I, whose graphy, culture and bacterioscopy were analyzed. Patients animals were submitted to enucleation of one eye and re- with a minimum 9-month follow-up were included and were construction with a polymethylmethacrylate sphere invol- divided into 5 groups: herpetic, bacterial, fungal, bacterial- ved in glycerin-treated sclera; group II, where there was fungal keratitis and keratitis with negative culture bacte- enucleation, and reconstruction performed with a polyme- rioscopy. RESULTS: Erradication of infection and restora-
thylmethacrylate sphere involved in sclera treated with ga- tion of ocular integrity were obtained in 95.2% of all bacte- mma irradiation, alkali and glycerin. The two groups were rial keratitis; 100% fungal; 25.0% bacterial-fungal; 95.2% observed at four moments, at 7, 21, 42 and 84 days after negative culture and 100% of all herpetic keratitis. Compli- surgery. Preset times elapsed, the rabbits were euthanized, cations included: 2 rejections, 6 recurrences, 13 glaucomas sockets were exenterated, the material was processed for and 1 perforation. CONCLUSIONS: In infectious keratitis
embedment in paraffin, cut into 5 µm sections thick and with perforation or impending perforation that did not res- stained with hematoxylin-eosin and Masson’s trichrome pond to conservative clinical therapy, therapeutic penetra- techniques. The scleras were submitted to morphometric and ting keratoplasty must be considered an alternative to erra- semiquantitative analysis. Results were compared by Mann- dicate infection and restore the ocular integrity.
Whitney’s non-parametric test. RESULTS: Comparative
Key words: Corneal transplantation; Keratoplasty; pene-
analysis of vascularization of the surgical interface pointed trating; Keratitis [surgery]; Keratitis [microbiology]; Visual out a significative difference in the evaluation done 21 days after the implant (P<0.001), with group II showing greaterneovascularization. Comparison of the fibrous capsule thic- TALLO, Fernando Sabia, SORIANO, Eduardo Sone and kness displayed a significative difference at moments co- ALVARENGA, Lênio Souza. Preoperative evaluation and
rresponding to 21 days (P<0.001) and 42 days (P<0.001).
cataract surgery. Arq. Bras. Oftalmol., July/Aug. 2007,
At both moments, group II presented a thicker fibrous cap- vol.70, no.4, p.633-637. ISSN 0004-2749.
sule than group I. Likewise, there was variation in sclera PURPOSE: Analysis of the relevance of preoperative eva-
thickness, being thicker in group II, at the 21-day post-im- luation to prevent adverse clinical events, pre- and postope- plant (P=0.003) moment, and at the 42-day moment rative, on cataract surgery. METHODS: The study inclu-
(P=0.024), as well. Along the experimental period, when des 1254 patients submitted to cataract surgery at the Insti- groups were analyzed we could observe statistically signifi- tuto da Catarata do Departamento de Oftalmologia da UNI- cative diminution of vascularization in the surgical interfa- FESP - EPM, in the period of Jan - Dec 2004. Data refe- ce, in group I, as well as in group II, at the moment of 7, 21, rring to the preoperative evaluation and adverse clinical 42 and 84 days. CONCLUSIONS: When used as coating
events related to anesthesia/surgical procedure were re- on the polymethylmethacrylate implant for the reconstruc- trospectively collected. RESULTS: Sixteen patients (1.2%)
tion of rabbit anophthalmic socket, the sclera treated with showed an adverse clinical event. Nine hundred thirty-six gamma irradiation, alkali and glycerin reacted similarly to patients (74.6%) showed at least one altered examination.
the traditionally used glycerin-treated sclera. The two treat- Rev Mex Oftalmol
Intercambio académico
ments induced a similar inflammatory response. The for- PURPOSE: To evaluate the effects of mitomycin C (MMC)
mation of neovessels, thickness of fibrous capsule and of on the internal ciliary epithelium (ICE) of the ciliary body sclera developed differently in the two groups. Neverthe- of animals treated with two differents aqueous humor su- less, they presented similar results at the end of the 84-day pressants. METHODS: The eyes of sixteen Norfolk albino
observation period. There was no significant difference bet- rabbits divided into four experimental groups were studied.
ween the two groups, with regard to sclera preservation.
The right eyes (RE) of the four groups received 0.1 ml of Key words: Sclera; Sclera [radiation effects]; Decontami-
MMC (0.5 mg/ml) under the scleral flap. The left eyes (LE) nation; Eye enucleation; Orbital implants; Glycerol; Poly- was the control group. Group 1 (G1) did not have any other metylmethacrylate; Comparative study; Rabbits.
treatment. To Group 2 (G2) and Group 4 (G4) acetazolami-de was administered. To Group (G3) and Group 4 (G4) ti- PINHEIRO JR., Manuel Neuzimar, SANTOS, Procópio Mi- molol maleate was administered. ICE was examined by guel dos, SANTOS, Regina Cândido Ribeiro dos et al. Oral
transmission electron microscopy (TEM). RESULTS: The
flaxseed oil (Linum usitatissimum) in the treatment for
following aspects were observed in all groups, except in G1 dry-eye Sjögren’s syndrome patients. Arq. Bras. Oftalmol.,
LE: cell shrinkage and/or enlargement of intercellular spa- July/Aug. 2007, vol.70, no.4, p.649-655. ISSN 0004-2749.
ces, rarefied mitochondria, clear vesicular structures and PURPOSE: To evaluate if oral flaxseed oil (Linum usitatis-
electron-dense bodies. The internal limitant membrane simum), which reduces the inflammation in rheumatoid ar- showed to be thickened, discontinued and separeted in all thritis, may help keratoconjunctivitis sicca’s treatment in groups, except in G1 LE and G2 LE. Discharge of cytoplas- Sjögren’s syndrome patients. METHODS: In a randomi-
matic material was observed only in the groups treated with zed clinical trial, 38 female patients with rheumatoid ar- aqueous humor supressants. CONCLUSIONS: 1) MMC,
thritis or systemic lupus erithematosus associated with ke- acetazolamide and timolol maleate caused morphological ratoconjunctivitis sicca and Sjögren’s syndrome were con- alterations in the ciliary epithelium even when used alone.
secutively selected from patients of the Departament of Reu- 2) The combination of MMC and acetazolamide caused more matology of the Amazonas University Hospital. Keratocon- alterations than did isolated acetazolamide, but not more junctivitis sicca diagnosis was based on a dry-eye symptom than MMC alone. 3) For the other combinations the altera- survey score (Ocular Surface Disease Index - OSDI®), Schir- mer-I test, fluorescein break-up time, 1% Rose Bengal stai- Key words : Ciliary body [drug effects]; Ciliary body [ul-
ning of ocular surface measured by the van Bijsterveld sca- trastructure]; Epithelium [drug effects Mitomycin]; Epithe- le. All patients had ocular surface inflammation evaluated lium [toxity]; Microscopy, electron, transmission; Acetazo- and quantified by conjunctival impression cytology, before lamide [therapeutic use]; Acetazolamide [therapeutic use]; and after the study. The subjects were divided into three groups with 13 (Group I), 12 (Group II) and 13 (Group III)patients. Group I received flaxseed oil capsules with a final OLIVEIRA, Adália Dias Dourado, D’AZEVEDO, Pedro 1 g/day dosis, Group II flaxseed oil capsules with a final 2 Alves, SOUSA, Luciene Barbosa de et al. Laboratory de-
g/day dosis and Group III - controls - placebo, for 180 days.
tection methods for methicillin resistance in coagulase
RESULTS: Comparing the results at the beginning and at
negative Staphylococcus isolated from ophthalmic infec-
the end of the treatment, statistically significant changes tions. Arq. Bras. Oftalmol., July/Aug. 2007, vol.70, no.4,
(p<0.05) in symptoms (OSDI®), ocular surface inflamma- tion quantified by conjunctival impression cytology, Schir- PURPOSE: To evaluate different methods of oxacillin sus-
mer-I test and fluorescein break-up time occurred in Groups ceptibility testing of ocular isolates, considering polymera- I e II when compared to controls. CONCLUSIONS: The-
se chain reaction (PCR) as the ‘gold standard’, and to com- rapy with oral flaxseed oil capsules 1 or 2 g/day reduces ocu- pare the in vitro susceptibility to oxacillin with that of other lar surface inflammation and ameliorates the symptoms of antimicrobials used in ophthalmologic practice. ME-
keratoconjunctivitis sicca in Sjögren’s syndrome patients.
THODS: The Vitek gram-positive identification card was
Long-term studies are needed to confirm the role of this the- used to identify ocular coagulase negative Staphylococcus rapy for keratoconjunctivitis sicca in Sjögren’s syndrome.
species. The presence of the mecA gene was determined by Key words: Dry eye syndromes; Keratoconjunctivitis sicca
the polymerase chain reaction assay with a combination of [drug therapy]; Flaxseed oil [therapeutic use]; Keratitis; two primer sets (mecA and 16S rRNA) in a single region.
Sjögren’s syndrome; Tears [metabolism].
Results were analyzed and compared with other oxacillinsusceptibility methods: PBP2a detection by rapid slide la- HAMADA, André, SILVA, Maria Rosa Bet de Moraes and tex agglutination test (SLA); oxacillin E-test; the Vitek au- GREGORIO, Elisa Aparecida. Ultrastructural evaluation
tomated gram-positive susceptibility card (GPS-105); the of mitomycin C toxic effects on the ciliary epithelium of
oxacillin salt agar screening test (OSAS) at a concentration normal rabbits eyes with and without aqueous humor
of 6.0, 1.0 and 0.75 µg oxacillin per ml and the cefoxitin suppressant treatment. Arq. Bras. Oftalmol., July/Aug.
disk diffusion test (CDD). Automated susceptibility was also 2007, vol.70, no.4, p.657-666. ISSN 0004-2749.
determined to other antimicrobial agents (fluoroquinolones, Julio-Agosto 2008; 82(4)
Intercambio académico
penicillin G, amoxicillin-ampicillin, cefazolin, ampicillin- from refraction were decomposed in power vectors for sta- sulbactam, erythromycin, clindamycin, gentamicin, tetra- tistical analyses. Data were first analyzed in one eye and cycline, trimethoprim-sulfamethoxazole, vancomycin and then in both eyes. RESULTS: The mean difference between
rifampin. RESULTS: Of the 69 CoNS isolates tested, 71%
clinical subjective refraction and automatized wavefront re- were mecA-positive and 29% mecA-negative. All methods fraction on cycloplegic eyes was of -0.19 SD combined with - tested had a statistically significant agreement with poly- 0.06 CD in the 15º axis for data in one eye, and -0.17 SD merase chain reaction. There was a tendency of positive combined with -0.05 CD in the 3º axis for data in both eyes polymerase chain reaction predomination among the S. epi- of the same patient. CONCLUSIONS: In the present study
dermidis isolates in comparison to non-epidermidis isola- clinical subjective refraction and automatized wavefront re- tes, although this was not statistically significant (78.3% fraction under cycloplegia had similar numerical values.
vs. 56.5%; χ2= 2.54; P= 0.11). The oxacillin salt agar scree- Key words: Refractive errors [surgery]; Refraction, ocular;
ning test (0.75 µg oxacillin/ml) showed the best performan- Optometry; Diagnostic techniques, ophthalmological; Com- ce, with 100% sensitivity and negative predictive value; 95% specificity and 98% positive predictive value. Using the E-test, the mecA-positive isolates were statistically significantly YAMANE, Cláudio de Lima, VIANNA, Raul N. G., CAR- more resistant to ciprofloxacin, ofloxacin, gatifloxacin and DOSO, Gilberto Perez et al. Cataract extraction using the
moxifloxacin (P= 0.002; P= 0.008; P= 0.002 and P= 0.003, phacoemulsification technique in patients with uveitis.
respectively). There was a statistically significant higher pro- Arq. Bras. Oftalmol., July/Aug. 2007, vol.70, no.4, p.683- portion of resistance of the coagulase negative Staphylo- coccus mecA-positives for: penicillin G, amoxicillin-ampi- PURPOSE: To report outcomes of cataract extraction by
cillin, cefazolin, ampicillin-sulbactam, erythromycin, clin- phacoemulsification in patients with uveitis. METHODS:
damycin, gentamicin and tetracycline (P<0.05). All coagu- We retrospectively reviewed the charts of 189 patients (242 lase negative Staphylococcus species were susceptible to eyes) with uveitis who underwent cataract extraction by pha- vancomycin and there was no statistically significant corre- coemulsification at the Uveitis and Ocular Immunology Unit lation between the mecA-positive isolates and resistance to of McGill University Health Centre, Montreal, Quebec, Ca- trimethoprim-sulfamethoxazole or to rifampin. CONCLU-
nada. RESULTS: Average follow-up was 46 ± 31.2 mon-
SIONS: In the present study, we found that the E-test and
ths. Average preoperative visual acuity was 20/100 and ave- the oxacillin salt agar screening test S (0.75 µg oxacillin rage postoperative visual acuity was 20/40. Hundred and per ml), when compared with polymerase chain reaction, forty-six eyes (59.9%) attained visual acuity better than 20/ were the most accurate currently available methods to phe- 40. Visual loss occurred in 26 eyes. The most common pe- notypically detect oxacillin resistance of coagulase negati- roperative complication was posterior capsule rupture with ve Staphylococcus species. This study demonstrated that a vitreous loss seen in 7 eyes (3%). Recurrence of uveitis was good option for screening of ocular isolates for oxacillin the most common postoperative complication seen in 73 resistance in the microbiology laboratory is the cefoxitin eyes (30.16%). Other postoperative complications included disk diffusion test and the automated Vitek system. We be- iris atrophy (28.51%), ocular hypertension (28.09%), epi- lieve it is important to have available methods that accura- retinal membrane (26.44%), posterior capsule opacification tely detect methicillin resistance of the less commonly en- (19%), cystoid macular edema (13.63%), ocular hypotony countered species, chiefly because of their increasing im- (12.80%), optic disc atrophy (8.67%) and posterior syne- portance as opportunistic pathogens.
chiae (6.61%). CONCLUSIONS: Cataract extraction by
Key words: Methicillin resistance; Sensitivity and specifici-
phacoemulsification is safe in patients with uveitis. Succes- ty; Latex fixation tests; Oxacillin; Microbial sensitivity tests; sful visual results are observed in long-term follow-up des- Staphylococcus [isolation]; Staphylococcus [purification]; pite the prevalence of recurrence of uveitis, posterior capsu- Coagulase; Eye infections; bacterial; Comparative study.
le opacification and macular abnormalities. To the best ofour knowledge this is the largest series presented to date.
FREITAS, Wilson de, MELO JUNIOR, Luiz Alberto Soares, Key words: Cataract extraction [methods]; Phacoemulsifi-
SCHOR, Paulo et al. Comparative analyses between cli-
cation; Lens implantation, intraocular; Uveitis.
nical refraction and automatic refraction obtained
through a wave front sensor. Arq. Bras. Oftalmol., July/
FONSECA, Ellen Carrara, DE FENDI, Lígia Issa, AN- Aug. 2007, vol.70, no.4, p.677-682. ISSN 0004-2749.
DRETTA, Paulo Sérgio et al. Urbach-Wiethe syndrome:
PURPOSE: To evaluate and compare refractive errors ob-
a case report. Arq. Bras. Oftalmol., July/Aug. 2007, vol.70,
tained through clinical subjective and automatized wave- front refraction analyses in eyes under cycloplegia. ME-
We present a case of Urbach-Wiethe syndrome with typical THODS: Prospective study of 147 patients, 279 eyes, un-
findings, including ocular lesions. A 15-year-old girl was re- dergoing preoperative examination for refractive surgery.
ferred to our department complaining of itchy eyelid lesions Clinical subjective refraction was performed first followed (moniliform blepharosis) associated with other systemic ma- by wavefront refraction. Results on astigmatism obtained nifestations. Diagnosis was confirmed by performing skin Rev Mex Oftalmol
Intercambio académico
biopsy. Artificial tears were prescribed, with partial relief of cluding 2 female patients and 3 male patients is reported.
the symptom. The objective of the present study is to describe The patients were submitted to complete medical history, a typical case of Urbach-Wiethe syndrome attended at the ophthalmological examination and alpha-galactosidase ac- Ophthalmologic Sector of the Medical School of Marília.
tivity test. Cornea verticillata was a constant finding in all Key words: Lipoid proteinosis of Urbach and Wiethe; Lipi-
patients. This demonstrates the important role of the ophtal- doses; Eyelids; Syndrome; Eye manifestations; Cases report.
mological examination for the diagnosis of Fabry’s diseasesince the eye findings are so characteristic of the disease.
CHAVES, Jacinto Barbosa Lay, BATISTA, Marcus Sabry Key words: Corneal opacity; Fabry disease; Lysosomal sto-
Azar, PISKE, Ronie Leo et al. Subperiosteal hematoma of
the orbit: case report. Arq. Bras. Oftalmol., July/Aug. 2007,
vol.70, no.4, p.693-697. ISSN 0004-2749.
SHIRATORI, Claudia Akemi, KOMATSU, Maria Claudia, We describe a sixteen years old male patient that suffered a SCHELLINI, Silvana Artioli et al. Eyelid ectropion in
craniocerebral trauma and presented at the emergency room, Down’s syndrome related to allergic conjunctivitis: case
with ocular pain, palpebral hematoma and left eye propto- report . Arq. Bras. Oftalmol., July/Aug. 2007, vol.70, no.4,
sis. Orbital computed tomography showed left subperios- teal orbital hematoma. A surgical drainage was performed.
This is a case report of a patient with Down’s syndrome Subperiosteal hematoma of the orbit is a rare cause of prop- with an important mechanical ectropion and elongation of tosis; its early diagnosis must be made in order to avoid the lower lid related to chronic allergic conjunctivitis, besi- des cataract and keratoconus. The tarsal strip technique and Key words: Hematoma [etiology]; Hemorrhage [etiology];
ressection of redundant and thick conjunctiva was the sur- Craniocerebral trauma [complications]; Exophthalmos; Or- gical approach chosen for this case. Functional and cosme- bital diseases [etiology]; Case reports.
tic outcomes were considered satisfactory.
Key words: Ectropion; Blepharoplasty; Conjunctiva [surgery];
VIANNA, Raul N. G., KASSUGA, Augusto, ONOFRE, Conjunctivitis, allergic; Down syndrome; Case reports.
Gabriela et al. Subretinal neovascularization following
ruptured retinal arterial macroaneurysm: case report.
CYPEL, Marcela, BELFORT JR., Rubens, MORAES, Nil- Arq. Bras. Oftalmol., July/Aug. 2007, vol.70, no.4, p.698- va et al. Primary intraocular B-cell lymphoma: case re-
port. Arq. Bras. Oftalmol., July/Aug. 2007, vol.70, no.4,
A 51-year-old black woman was referred to our Retina Cli- nic for evaluation of loss of vision in her left eye. She was Ocular non-Hodgkin’s lymphoma is a rare condition that previously diagnosed with a ruptured retinal arterial ma- can involve the retina, the vitreous and the optic nerve. It croaneurism (RAM) in the same eye. The ophthalmoscopic can occur alone or can be associated with lymphoma of the examination of the affected eye disclosed a subretinal le- central nervous system and a frequent manifestation is a sion with some hemorrhage and exudation in the same area posterior uveitis of difficult treatment. This kind of ocular previously diagnosed with ruptured RAM. Fluorescein an- tumor is difficult and a challenge to diagnosis. We describe giography revealed a gradually hyperfluorescent net of ves- a case of non-Hodgkin’s intraocular B-cell lymphoma in a sels located in the subfoveal region, consistent with the diag- 47-year-old woman who had a posterior uveitis as the first nosis of subretinal neovascular membrane. In this paper we manifestation. We emphasize the importance of a careful stress the possibility of subretinal neovascularization follo- investigation and of the general clinical examination since wing a ruptured RAM, even as a rare event.
this is the most common type in the eye. We expect to call Key words: Retinal neovascularization; Retinal artery [pa-
the attention to this disease that many times appears in an thology]; Aneurysm, ruptured [complications]; Aneurysm, unspecific form with unspecific symptoms.
ruptured [diagnosis]; Fluorescein angiography.
Key words: Uveitis; Central nervous system neoplasms
[complications]; Lymphoma, non-Hodgkin [surgery]; Para-
CORDEIRO, Cynthia Azeredo, OREFICE, Fernando, LAS- MAR, Euler Pace et al. Cornea verticillata - a clinical mar-
OYAMADA, Maria Kiyoko, DOTTO, Patrícia de Freitas ker of Fabry disease: case report. Arq. Bras. Oftalmol., July/
and ABDALLA, Milena. Technical factors that influence
Aug. 2007, vol.70, no.4, p.701-705. ISSN 0004-2749.
multifocal electroretinogram (mfERG) recording. Arq.
Fabry’s disease is a rare X-linked lisosomal storage disor- Bras. Oftalmol., July/Aug. 2007, vol.70, no.4, p.713-717.
der of glycosphingolipid (GL) metabolism, caused by a de- ficiency of að-galactosidase A activity. The progressive ac- PURPOSE: To describe the main intervening factors ob-
cumulation of GL in tissues results in the clinical manifes- served during the acquisition and analysis of multifocal elec- tations of the disease, that are more evident in hemizygous troretinogram (mfERG), that could affect the recorded sig- males, and include angiokeratomas, acroparesthesia, cor- nal, the obtained responses and their analysis. METHODS:
nea verticillata, cardiac and kidney involvement, cerebro- The error factors observed during the acquisition of 100 vascular manifestations. A family with Fabry’s disease in- sequential multifocal electroretinogram tests, in the period Julio-Agosto 2008; 82(4)
Intercambio académico
of May to July, 2005 were analyzed. The examinations of CHAVES, Alessandra Pinheiro, GOMES, José Álvaro Pe- multifocal electroretinogram were carried out in agreement reira and HOFLING-LIMA, Ana Luisa. Ocular changes
with international guideline recommendations, taking into induced by chemotherapy. Arq. Bras. Oftalmol., July/Aug.
account the established parameters of equipment, with 61 2007, vol.70, no.4, p.718-725. ISSN 0004-2749.
elements, and visual angle of 30º. All patients had been sub- Antineoplastic agents offer an increase in the patients’ sur- mitted to complete ophthalmologic examination, excluding vival rates, but may induce side effects in different organs those with inadequate transparency of ways, flat corneas and tissues. Mucositis is one of the most common side effects and those incapable to visualize a central fixation target.
during chemotherapy with certain agents. The ocular toxi- RESULTS: The intervening factors, that could cause arti-
city induced by these drugs may manifest as changes in the facts and errors in the interpretation of the obtained results, ocular surface and in the tear film. The purpose of this re- observed and corrected during the acquisition of multifocal search was to study the ocular surface changes induced by electroretinogram were: eccentric or poor fixation, eye mo- chemotherapy and to establish their clinical correlation with vements, orbicular contraction, cervical muscle contraction, the chemotherapy and mucositis. The 39 selected patients inadequate transparency of the corneal electrode, electrode underwent a full ophthalmological examination and supple- displacement, lens support decentralization, inadequate mentary tests. We compared 2 groups of patients: with (case) viewing distance in patients with high refractive errors, eye and without mucositis (control). Statistical analysis was per- height inadequacy in relation to the center of the screen, formed with the Statistical Package for Social Sciences soft- electrical noise in 60 HZ frequency and electromagnetic field ware. Mucositis was identified in 51.4% of the patients af- and high impedances. Excessive use of filters in wave pro- ter chemotherapy. The brakeup time showed a statistically cessing for noise and artifact removal can interfere with the significant decrease after chemotherapy (p<0.0001). Punc- analysis of the obtained results. CONCLUSIONS: Simple
tate epitheliopathy was seen in 78.4% of cases. Schirmer observational cares during signal acquisition are of signifi- test results did not show significant changes pre x post-che- cant importance to ensure accuracy of the topographical elec- motherapy. Chemotherapy may induce tear film changes, troretinogram information, good waveform morphology and as shown in this study by the brakeup time, Schirmer test low noise level register. Through their ready correction, the and biomicroscopy. Chemotherapy-induced mucositis invol- correct and adjusted analysis of the amplitude and of impli- ves also the conjunctival mucosa, which was subjectively cit time of peaks N1, P1 and N2 is reliable. Digital smooth characterized by the ocular symptoms and proved in our system with specific frequency peak removal supply waves study by impression cytology and microbiology.
with more defined morphology with lower amplitude re- Key words: Chemotherapy [adverse effects]; Drug therapy,
duction than other available resources.
mucositis [chemically induced]; Neoplasms [drug therapy]; Key words: Retinal diseases [diagnosis]; Electroretinogra-
phy [methods]; Retina [physiology]; Evoked potentials, vi-sual; Diagnostic errors.
Rev Mex Oftalmol

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