Keila Monteiro de Carvalho

Characteristics of a pediatric low-vision population.

BACKGROUND Assessment of the causes of childhood blindness is important to develop preventive and therapeutic strategies that can reduce the incidence of visual impairment. METHODS A retrospective survey of the clinical records of 395 consecutive children younger than 14 years of age who were attended by the Low Vision Service of State University of Campinas (UNICAMP) was conducted. Data on the age distribution, the causes of low vision, the types of low vision aids prescribed, the follow up of their use, and improvement in visual acuity were obtained. RESULTS Congenital bilateral toxoplasmic macular scars, optic atrophy, and congenital cataracts were the major causes of low vision in this population. The optical aid most frequently prescribed was a telescope. The improvement of visual acuity with the use of aids was highly significant.

Results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus

OBJECTIVE: To evaluate the results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus. INTRODUCTION: Monocular surgery may preserve some muscles if a repeat operation is required, may help to avoid the exposure of the dominant eye to the inherent risks of a surgical procedure and may reduce surgical time. METHODS: We evaluated ninety-two consecutive patients who underwent monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus (angle of 40 prism diopters or greater). Patients were divided into group 1- esotropia and group 2 –exotropia. The postoperative follow-up was at 6 months, when the residual deviation was evaluated. In cases of residual deviations of over 15 PD (prism diopter), a second procedure was indicated. RESULTS: In all patients with preoperative deviations up to 60 PD, residual deviations were under 15 PD. Some patients with preoperative deviations of 65 PD (two in group 1 and four in group 2) and all patients with deviations over 65 PD had residual deviations over 15 PD. The 13 patients who underwent a second procedure experienced successful outcomes. Our ROC curve analysis showed that the cutoff point for obtaining a successful surgical result was 62.5 PD. No patient presented with a major limitation in respect of ocular movement. CONCLUSIONS: Monocular surgery under peribulbar anesthesia can be an alternative for horizontal large-angle strabismus given deviations of up to 60 PD. Monocular surgery did not result in successful outcomes for deviations of over 65 PD.

Causes of low vision and use of optical aids in the elderly

PURPOSE To determine the causes of low vision in an elderly population attended by a university visual rehabilitation service and to check for the use of prescribed optical aids. METHOD A cross-sectional study was carried out on patients aged 60 years or over attending for the first time a university low vision service in 2001. Ophthalmic reevaluation and interview were performed by means of a structured questionnaire in 2002. RESULTS The sample comprised 50 subjects aged between 60 and 90 years. Severe low vision (< or =20/200) was present in 68.0% of patients. The main cause of low vision was age-related macular degeneration (44.0%). Regarding literacy, 16.0% were illiterate and 72.0% had completed fundamental schooling. Thirty-one patients (62.0%) had been prescribed optical aids; 54.8% of these patients stated that they use them. A majority (70.6%) held a favorable opinion of these aids. CONCLUSIONS The main cause of low vision was age-related macular degeneration. Approximately half of those receiving prescriptions reported actually using the aids in their daily activities. Making best use of residual vision in the elderly population with visual impairment is a priority, given the social context, if the independence necessary for enhanced quality of life is to be achieved.

Satisfaction with ophthalmology residency training from the perspective of recent graduates: a cross-sectional study

BackgroundFew studies have evaluated satisfaction with medical residency programs from the perspective of residents or recent graduates. Knowledge of current conditions of teaching might help to identify deficiencies and to provide adequate training. So, the aim of this study was to assess the satisfaction with residency training and to identify deficiencies in this training from the perspective of recent graduates in ophthalmology residency.MethodsFor this purpose, we developed a questionnaire and gaved it to recent graduates in ophthalmology residency in São Paulo, Brazil, from January to December 2010. The questions contained demographic information (age, sex and time of practice in ophthalmology), a Likert scale to evaluate the level of satisfaction with medical residency concerning clinical knowledge, surgical skills and doctor-patient relationship and questions about deficiency in clinical and surgical areas.ResultsThe areas in which recent residency graduates were very or extremely satisfied were: acquisition of clinical knowledge (89.1%), acquisition of surgical skills (93.4%) and the development of doctor-patient relationship (74.9%). Specific areas of clinical knowledge in which they perceived more deficiency were orbit (48.3%) and ophthalmic pathology (47.9%), and in surgical skills were refractive surgery (65.9%) and orbit (59.2%)ConclusionsThe assessment of the satisfaction with residency training in ophthalmology from the perspective of recent graduates showed high level of satisfaction and identified specific deficiencies in ophthalmic pathology, refractive surgery and orbit.

Visual pathway abnormalities were found in most multiple sclerosis patients despite history of previous optic neuritis

OBJECTIVE It was to investigate visual field (VF) abnormalities in a group of multiple sclerosis (MS) patients in the remission phase and the presence of magnetic resonance imaging (MRI) lesions in the optic radiations. METHODS VF was assessed in 60 participants (age range 20-51 years): 35 relapsing-remitting MS patients [20 optic neuritis (+), 15 optic neuritis (-)] and 25 controls. MRI (3-Tesla) was obtained in all patients. RESULTS Visual parameters were abnormal in MS patients as compared to controls. The majority of VF defects were diffuse. All patients except one had posterior visual pathways lesions. No significant difference in lesion number, length and distribution was noted between patients with and without history of optic neuritis. One patient presented homonymous hemianopsia. CONCLUSION Posterior visual pathway abnormalities were found in most MS patients despite history of previous optic neuritis.

Peribulbar versus general anesthesia for horizontal strabismus surgery

PURPOSE To compare the results of strabismus surgery under peribulbar and general anesthesia in cases of small and moderate angle of horizontal strabismus. METHODS Medical records of eighty-four patients with small and moderate angle horizontal strabismus who underwent strabismus surgery were reviewed. Forty-two patients were submitted to the surgery under peribulbar anesthesia and forty-two under general anesthesia. The surgery was considered satisfactory when postoperative angle was 10 prism diopters or less. RESULTS Surgery was satisfactory in all patients. Mann-Whitney test showed no difference in the preoperative angle of deviation (p=0.366) and in the postoperative results (p=0.800) between the two groups. Adjusting for the variables age and type of strabismus (esotropia and exotropia), ANCOVA (analysis of covariance) results showed no statistical difference (p=0.368). There were no complications due to surgery or anesthesia in either group. CONCLUSIONS This study suggested that there was no difference between the postoperative results of strabismus surgery under peribulbar and general anesthesia in small and moderate angle of horizontal strabismus.

Strabismus surgery learning for Ophthalmology residents of university service

PURPOSE To verify Ophthalmology residents and supervisors perceptions regarding learning and teaching strabismus surgery. DESIGN Descriptive Study. METHODS SUBJECTS 1(st) and 2(nd) year residents. Each resident studied the standard strabismus surgery technique on a CD-ROM, then performed a rabbit rectus muscle recession and a strabismus surgery on a patient. A structured questionnaire was handed to the residents, and the authors made observations including variables referring to the surgical technique applied, self-evaluation of this technique and if appropriate training was given. RESULTS Thirty-eight questionnaires were analysed. All 1(st) year residents (R1) had had some difficulty remembering the surgery sequence and 69.6% of 2(nd) year residents (R2). Concerning the surgical material handling, 93.3% of R1 and 52.2% of R2 had had any difficulty. The residents reported that during the surgery in humans, 50% remembered the experimental stage and that this training completely fulfilled their needs for 47% and partially for other 47%. CONCLUSION Experimental surgery, more practice opportunities and residents supervision may improve the teaching of strabismus surgery.

Intracranial and orbital aspergillosis in immunocompetent patient

Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil (HC-UNICAMP): Post-Graduation Student of the Department of Ophthalmo-Otolaryngology of the Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil; Professor of the Department of Radiology of the Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil; Professor of the Department of Pathology of the Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil; Associate Professor and Chief of the Department of Ophthalmo-Otolaryngology of the Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil. A 32-year old woman presented with headache and diplopia for two years. She does not have immunologicic and rheumathic diseases, neither hypertension, diabetes and HIV. Neurological examination showed absence of abduction of the right eye. This is a pseudotumoral lesion due to aspergillosis, with a solid intraconal lesion

Anterior transposition compared to graded recession of the inferior oblique muscle for V-pattern strabismus

objective To compare the efficacy of anterior transposition (AT) and graded recession (GR) in the treatment of V- pattern strabismus caused by overaction of the inferior oblique muscle. methods The charts of surgically treated cases of V-pattern strabismus were analyzed retrospectively and the patients classified as AT or GR. Age, initial horizontal deviation, initial V-pattern and the amount of V-pattern correction were compared between the two groups. results There was no significant difference in age (p = 0.066), initial horizontal deviation (p = 0.59), initial V-pattern (p = 0.15) or the amount of V-pattern correction (p = 0.78) between the two groups. conclusion AT is at least as effective as GR in the treatment of V-pattern strabismus caused by overaction of the inferior oblique muscle.

Tumor de células granulares acometendo a órbita em uma criança

The authors report a rare case of granular cell tumor in the left medial rectus muscle of a seven-year-old boy. Clinical, pathologic and radiologic findings of the present case are described and a brief literature review is undertaken.