Célia Regina Nakanami

Proposta de diretrizes brasileiras do exame e tratamento de retinopatia da prematuridade (ROP)

Retinopathy of prematurity is one of the main causes of childhood blindness. Worldwide, there are more than 50,000 children blind due to retinopathy of prematurity. Visual impairment is a consequence of retinal detachment. It can be detected by serial ophthalmologic examination of infants at risk, and those identified with the severe form of the disease can be treated by laser or cryotherapy, which can decrease significantly the blindness due to ROP. The Brazilian Society of Pediatrics, Brazilian Council of Ophthalmology and Brazilian Society of Pediatric Ophthalmology suggest a guideline for the detection and treatment of retinopathy of prematurity in Brazil. This document was based on the results of the I Workshop of Retinopathy of Prematurity and presents the attributes for the implementation of an efficient diagnostic and treatment program.

Prevalence and causes of visual impairment in low-middle income school children in Sao Paulo, Brazil.

PURPOSE Assess prevalence and causes of vision impairment among low-middle income school children in São Paulo. METHODS Cluster sampling was used to obtain a random sample of children ages 11 to 14 years from public schools (grades 5-8) in three districts from June to November 2005. The examination included visual acuity testing, ocular motility, and examination of the external eye, anterior segment, and media. Cycloplegic refraction and fundus examination were performed in children with uncorrected visual acuity 20/40 or worse in either eye. A principal cause of visual impairment was determined for eyes with uncorrected visual acuity of 20/40 or worse. RESULTS A total of 2825 children were enumerated and 2441 (86.4%) were examined. The prevalence of uncorrected, presenting, and best-corrected visual acuity 20/40 or worse in the better eye was 4.82%, 2.67%, and 0.41%, respectively. Spectacles were used by 144 (5.9%) children. Refractive error was a cause in 76.8% of children with visual impairment in one or both eyes; amblyopia, 11.4%; retinal disorders, 5.9%; other causes, 2.7%; and unexplained causes, 7.7%. Myopic visual impairment (spherical equivalent -0.50 D in one or both eyes) was not associated with age or grade level, but female sex was marginally significant (P = 0.070). Hyperopic visual impairment (+2.00 D or more) was not associated with age, grade level, or sex. CONCLUSIONS The prevalence of reduced vision in low-middle income urban São Paulo school children was low, most of it because of uncorrected refractive error. Cost-effective strategies are needed to address this easily treated cause of vision impairment.

Comparação entre os métodos de injeção de toxina botulínica em músculo ocular externo com o uso do eletromiógrafo e com o uso da pinça de Mendonça

PURPOSE: To compare two methods of botulinum toxin A (BTA) injection into the extraocular muscle (EOM): the electromyographically (EMG) guided injection and the injection using Mendoncas forceps. METHODS: Twenty-nine (29) patients with strabismus and low visual acuity in one eye were examined at the Department of Ophthalmology of UNIFESP. They were divided into 2 groups - group I with 17 patients receiving the botulinum toxin A injection using Mendoncas forceps, and group II with 12 patients receiving the toxin with electromyographical guidance. The patients of both groups were examined on the 7th and 14th day after intervention and the outcome of both methods of botulinum toxin A injection were compared. Friedman and Mann-Whitney correlation tests were used in the statistical analysis of the data. RESULTS: Although the follow-up examinations on the 7th and 14th days showed a different behavior between both methods, there was no statistically significant difference between the mean values of the correction attained in both groups at the end of this study. CONCLUSION: No statistically significant difference was shown between the two groups. Mendoncas forceps can be a safe alternative to electromyography to locate an extraocular muscle for botulinum toxin A injection.

Visual impairment from uveitis in a reference hospital of Southeast Brazil: a retrospective review over a twenty years period

PURPOSE To identify the frequency and causes of uveitis leading to visual impairment in patients referred to the Low Vision Service - Department of Ophthalmology - UNIFESP, over a twenty years period. METHODS In a retrospective study, medical records of 5,461 patients were reviewed. Data from the first clinical evaluation at the Low Vision Service were collected, patients age, gender and cause of visual impairment were analyzed. Patients with uveitis had their chart reviewed for anatomical classification and clinical diagnosis. RESULTS The mean age of the patients referred to the Low Vision Service was 42.86 years and the mean age of patients with uveitis diagnosis was 25.51 years. Retinal disorders were the most common cause of visual impairment (N=2,835 patients; 51.9%) followed by uveitis (862 patients, 15.7%). Uveitis was posterior in 792 patients (91.9% of uveitis) and toxoplasmosis was the most common diagnosis (765 patients, 88.7%). CONCLUSIONS In our study, uveitis represents the second cause of visual impairment in patients referred for visual rehabilitation and toxoplasmic retinochoroiditis was the most common clinical diagnosis. It affects a young working age population with a relevant social and economic impact, but the early diagnosis and treatment can improve the quality of life of these patients.

Qualidade de vida de crianças com deficiência visual atendidas em Ambulatório de Estimulação Visual Precoce

PURPOSE: To evaluate the quality of life in visually impaired children followed in the Early Visual Stimulation Ambulatory of Unifesp in two moments, before and after rehabilitational intervention of multiprofessional team. METHODS: A CVFQ quality of life questionnaire was used. This instrument has a version for less than three years old children and another one for children older than three years (three to seven years) divided in six subscales: General health, General vision health, Competence, Personality, Family impact and Treatment. RESULTS: The correlation between the subscales on two moments was significant. There was a statistically significant difference in general vision health (p=0,029) and other important differences obtained in general health, family impact and quality of life general score. DISCUSSION: The questionnaire showed to be effective in order to measure the quality of life related to vision on families followed on this ambulatory. The multidisciplinary interventions provided visual function and familiar quality of life improvement. CONCLUSION: The quality of life related to vision in children followed in Early Visual Stimulation Ambulatory of Unifesp showed a significant improvement on general vision health.

Bupivacaine and botulinum toxin to treat comitant strabismus

PURPOSE To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. METHODS Eight patients (five female) were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique). RESULTS Mean change in alignment was 10 prism diopters after 180 days (n=6). An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. CONCLUSION In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxin A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.

Influence of head posture on the visual acuity of children with nystagmus

PURPOSE Evaluate the relationship between the postural alignment of the head and possible interference in the view of children. METHODS We evaluated 11 children between 2 and 7 years of age of both sexes, with the visually impaired, who had nystagmus and head lock position. The test Lea Grating Acuity Test® was used to collect measurements of visual acuity. This applied on two occasions: with and without postural alignment of the head. For reliability of the postural alignment of the head, the slopes were measured by Fisiologic® software. RESULTS The children had a poorer performance after physiological postural alignment. This poor performance is possible due to loss of position lock nystagmus to gain postural alignment, said to be ideal. Postural compensations were observed, and sharply increased eyestrain. CONCLUSION The pursuit of traditional postural alignment affect the visual response of children with visual impairments.

Cistos primários do epitélio pigmentar da íris e corpo ciliar: aspectos de biomicroscopia ultra-sônica

Objetivo: Descrever as caracteristicas, incidencia e distribuicao dos cistos primarios de epitelio pigmentar de iris e corpo ciliar ao exame de biomicroscopia ultra-sonica, que devem ser diferenciados de lesoes solidas. Metodos: Foram estudados de modo retrospectivo os prontuarios de 73 pacientes, 82 olhos, com diagnostico ecografico de cisto primario de iris ou corpo ciliar durante o periodo de janeiro/97 a dezembro/99. Utilizou-se o biomicroscopio ultra-sonico, aplicando tecnicas padronizadas de imersao. Resultados: A biomicroscopia ultra-sonica os cistos caracterizaram-se por apresentarem paredes finas e regulares, e conteudo anecoico. Quarenta e oito pacientes (65,7%) eram do sexo feminino. A maior incidencia (28,8%) ocorreu para o grupo incluido no intervalo de 20 a 29 anos de idade. Observou-se uma caracteristica distribuicao, predominantemente nos quadrantes temporais inferiores. Conclusoes: A biomicroscopia ultra-sonica mostrou-se util no diagnostico de cistos primarios do epitelio pigmentar da iris e do corpo ciliar, auxiliando na diferenciacao de patologias tumorais e avaliando possiveis complicacoes. O conhecimento dos criterios ecograficos e da distribuicao epidemiologica facilitam o diagnostico destas lesoes.

Object distance scaling in real space is preserved in low vision subjects

Abstract Purpose: We investigate the ability of adults with and without visual impairment estimate distances between stimuli in real environment. Methods: We evaluated 12 subjects aged between

Prevalence of refractive errors in Möbius sequence

PURPOSE To assess the prevalence of refractive errors in Möbius sequence. METHODS This study was carried out during the Annual Meeting of the Brazilian Möbius Society in November 2008. Forty-four patients diagnosed with the Möbius sequence were submitted to a comprehensive assessment, on the following specialties: ophthalmology, neurology, genetics, psychiatry, psychology and dentistry. Forty-three patients were cooperative and able to undertake the ophthalmological examination. Twenty-two (51.2 %) were male and 21 (48.8%) were female. The average age was 8.3 years (from 2 to 17 years). The visual acuity was evaluated using a retro-illuminated logMAR chart in cooperative patients. All children were submitted to exams on ocular motility, cyclopegic refraction, and fundus examination. RESULTS From the total of 85 eyes, using the spherical equivalent, the major of the eyes (57.6%) were emmetropics (>-0.50 D and <+2.00 D). The prevalence of astigmatism greater than or equal to 0.75 D was 40%. CONCLUSION The prevalence of refractive errors, by the spherical equivalent, was 42.4% in this studied group.