Flávio Jaime Rocha

A study of glaucoma after penetrating keratoplasty.

Purpose. To identify the incidence and risk factors associated with the development of glaucoma after penetrating keratoplasty. Methods. A retrospective study was carried out in 228 patients who underwent penetrating keratoplasty from January 1995 to January 2000 at the Cornea Section of the Ophthalmology Service at the School of Medicine, Federal University of Uberlândia MG, Brazil. Follow-up time ranged from 4 to 60 months (mean, 17.14 ± 13.65). Results. Two hundred twenty-eight patients undergoing penetrating keratoplasty were evaluated and 49 (21.5%) developed glaucoma. Risk factors for developing glaucoma were bullous keratopathy [relative risk (RR) = 2.1774), herpesvirus (RR = 1.8979), and trauma (RR = 1.0575). Mean intraocular pressure before transplantation was 15.26 ± 5.37 mm Hg. Intraocular pressure after transplantation ranged from 22 to 58 mm Hg, with a mean value of 30.04 ± 7.06 mm Hg. Thirty-six (73.5%) patients had medical treatment, 10 (20.4%) had medical and surgical treatment, and three (6.1%) had surgical treatment. Final intraocular pressure ranged from 4 to 34 mm Hg (mean, 16.79 ± 5.36). Conclusion. The incidence of glaucoma after penetrating keratoplasty is high, and the risk factors include aphakic/pseudophakic bullous keratopathy, herpes simplex virus, and trauma.

Ocular Lesions Arising After Stings by Hymenopteran Insects

Purpose. To describe the ocular lesions that occur after stings from hymenopteran insects. Methods. We examined the ocular alterations in five patients who suffered ocular trauma from hymenopteran insect stings. Results. In 4 cases where the insect was identified as a wasp, all the patients presented with persistent corneal decompensation and two presented with total cataract, requiring surgical treatment. In the case of trauma by a bee sting, the patient presented with corneal edema and an inflammatory reaction of the anterior chamber with total regression of these alterations after clinical treatment. Conclusion. Although a rare occurrence, ocular trauma caused by hymenopteran insects can result in severe ocular alterations in humans.

Epidemiology and etiologic diagnosis of infectious keratitis in Uberlandia, Brazil.

Purpose. To study risk factors, microbiological characteristics, and clinical course of nonviral infectious keratitis diagnosed in a referral service of ophthalmology. Methods. A total of 65 charts of patients with microbial keratitis were retrospectively reviewed at the Clinical Hospital of Federal University of Uberlandia, Brazil, from July 2001 through August 2004. All cases were submitted to microbiological tests and treated according to local protocol. Risk factors, clinical course, therapeutic keratoplasty, and visual outcomes were analyzed. Results. The mean age of patients was 45.9 years (2–83 years) and male to female ratio 2.6:1. Symptoms at presentation ranged from 1–3 days in 16 patients out of 65 (24.61%), 4–7 days in 19 cases (19/65; 29.23%), and more than 7 days in 27 patients (27/65; 41.53%). The major risk factor was trauma (28/65; 40%), predominantly by organic material. A total of 32 eyes out of 65 (49.23%) were culture positive. Fungi were the most common isolates (18/32; 56.25%), being headed by Fusarium sp (11/65; 16.92%), and the most common bacteria was Streptococcus pneumoniae (7/65; 10.77%). Final visual acuity was equal to or better than 20/60 in 20 patients out of 65 (30.77%), between 20/60 and 20/400 in 7 patients (7/65; 10.77%), and worse than 20/400 in 35 patients out of 65 (53.85%). A total of 48 eyes out of 65 (73.84%) presented corneal scar, 12 eyes (12/65; 18.46%) needed therapeutic penetrating keratoplasty, and 2 eyes (2/65; 3.08%) were eviscerated. Conclusions. The high incidence of fungal keratitis in the studied population shows their vulnerability to such infections, which may result in devastating visual outcomes.

Bilateral endogenous endophthalmitis associated with infective endocarditis: case report

Bilateral endogenous endophthalmitis is a rare condition initiated by infection by microbes in the bloodstream, such as those arising from a foci of infective endocarditis. We report a case and discuss the diagnostic aspects and the clinical outcome of a patient with characteristic findings of the disease. The patient was a 49 year old white male who had a metallic aortic valve implanted 7 months previously, and who presented to the hospital with 10 days of fever, cough and dyspnea, then diarrhea and mental confusion. On the second day of hospitalization, he experienced sudden loss of vision in both eyes. A Gram-positive coccobacillus was isolated from the bloodstream, he was treated with fluoroquinolone with disappearance of fever, decreased ocular inflammation, and improvement in his vision to light perception. He later underwent valve replacement surgery but died during the procedure. We review the occurrence of ocular signs and symptoms and their importance in patients with endocarditis.

Infectious Keratitis Secondary to Histoplasma capsulatum: The First Case Reports in Humans

The authors report an unusual case of fungal keratitis caused by Histoplasma capsulatum in a male immunocompetent patient. PCR confirmed the presence of the fungus DNA in the material studied. To our knowledge this is the first reported case in humans described all over the world.

Retinoblastoma : encaminhamento ao hospital A.C. Camargo/fundação Antônio Prudente durante 15 anos seqüenciais

Foram avaliados os prontuarios de 249 pacientes portadores de retinoblastoma vistos no Hospital A. C. Camargo da Fundacao Antonio Prudente no periodo de janeiro de 1975 a dezembro de 1989; desses, 164 (65,9//) eram unilaterais e 85 (34,1//) eram bilaterais. A idade de aparecimento dos primeiros sinais variou do nascimento aos 113 meses; a idade de encaminhamento ao servico variou de 0 a 115 meses, a idade de encaminhamento ao Servico variou de 0 a 115 meses, podendo-se constatar uma demora no encaminhamento principalmente nas faixas de menor idade. O tumor era intra-ocular ao dignostico em 156 (63,9//) e extra-oculares em 88 (36,1//). Verificamos uma tendencia a diminuicao de encaminhamentos nos estadios extra-oculares nos ultimos anos. A frequencia total de obitos foi de 26,6//; observou-se diminuicao dessa taxa a partir de 1982, tanto nos tumores intra como nos extra-oculares. Acreditamos que o diagnostico e o encaminhamento precoce a centros especializados de tratamento sao fatores essenciais para o progresso na cura desta doenca