Paulo de Tarso Ponte Pierre Filho

Bilateral acute angle closure glaucoma in a patient with dengue fever: case report

Ocular complications in dengue fever are uncommon but may result in visual loss. The authors report the first documented case of a patient with dengue fever who presented with simultaneous bilateral acute angle closure glaucoma. The disease was confirmed by specific serological tests. Despite the treatment, severe visual impairment occurred in this case.

Intralenticular metal foreign body: case report

Intralenticular foreign bodies comprise about 5% to 10% of all intraocular foreign bodies and can result in serious complications. The management depends on some factors like size, location, material type and the risk of infection. We present a patient with an intralenticular metal foreign body in the left eye that, following initial treatment with topical steroid and antibiotic, underwent lens aspiration with removal of the intralenticular foreign body and insertion of a posterior chamber intraocular lens with good visual outcome.

Profile of ocular emergencies in a tertiary hospital from Northeast of Brazil

PURPOSE: To evaluate the profile of all the visits to the ophthalmic emergency service at a tertiary hospital in the city of Sobral, Ceara, northeast of Brazil. METHODS: A survey was carried out of all patients attended at ophthalmology emergency service of the department of ophthalmology of Santa Casa of Sobral, during the period between may and october 2008. Data on patients age, sex, level of education, residential address, health insurance status, average distance to our service, time between the initial symptoms and first visit to the hospital, site of medical evaluation indication, diagnosis, and veracity of emergency indication. All these data were collected during interview and ophthalmological examination. RESULTS: A total number of 1,024 patients were analyzed in the study. Mean and standard deviation to age was 31.5 ± 17.1 years (ranging from zero to 81). Sixty-five per cent of the patients were male and 35% female. Twenty-one per cent of the patients lived at least 50 kilometers away from the Santa Casa of Sobral. Ocular traumas (40.9%) of any nature were the most frequent occurrence, followed by infections (29%). About 45 % of cases were not considered as a true emergency and could be managed in primary or secondary health care centers. About the initial symptoms and first visit to the hospital, only 24% of the patients went to the ophthalmology emergency room on the same day in which their symptoms started. CONCLUSION: A great number of patients attended or treated at the ophthalmology emergency service of Santa Casa of Sobral presented with common ocular disorders of simple resolution. Therefore there is a failure in the primary and secondary health care to manage it. Certainly a considerable proportion of these patients had conditions which could have been diagnosed and treated in an ophthalmic outpatient clinic or by general practitioners.

Reproducibility of water drinking test performed at different times of the day

PURPOSE To evaluate the reproducibility of water drinking test (WDT) performed at different times of the day, in primary open angle glaucoma (POAG) patients and normal individuals. METHODS Fifteen patients with POAG and 30 normal individuals underwent three WDTs at different times of the day (7 AM, 12 PM, and 5 PM) on 3 different days. Test results in POAG patients and normal individuals were compared. Agreement and correlation of intraocular pressure (IOP) baseline levels, peak levels, and IOP change (peak IOP--baseline IOP) on tests performed at different times were evaluated. Only right eye measurements were analyzed. RESULTS Mean baseline IOP, peak IOP and IOP change were significantly higher in POAG patients than in normal individuals, at all time intervals (p<0.05). The Bland-Altman analysis demonstrated limits of agreement for IOP peak levels and IOP changes larger than the clinically acceptable (>3 mmHg), even though Pearsons test revealed good correlation among the results. CONCLUSION The mean IOP peak and mean IOP change observed during WDT are significantly higher in POAG patients than in control individuals. Low levels of agreement among WDTs performed at different times of the day suggest a poor reproducibility of WDT, which may limit its applicability for the diagnosis and follow-up of glaucoma.

Central retinal artery occlusion associated with traumatic carotid cavernous fistula: case report

Carotid cavernous fistulas are a rare entity occurring as result of head trauma and also spontaneously. The authors report a rare case of central retinal artery occlusion complicating traumatic carotid-cavernous fistula, resulting in severe visual acuity loss. Spontaneous closure of the fistula was observed. The possible mechanisms responsible for this complication are discussed.

Choroidal metastasis of gastric adenocarcinoma as a first sign of systemic disease recurrence: case report

To describe a patient with unilateral metastatic choroidal gastric adenocarcinoma as a first sign of systemic dissemination. A 54-year-old woman presented with a 7-month history of progressive pain and decrease in vision in her left eye. She had undergone total gastrectomy due to gastric adenocarcinoma two years previously. Examination of the left eye revealed an elevated creamy yellow choroidal tumor infiltrating the macular area and extending around the optic nerve head, suggesting metastasis. Treatment was enucleation of the affected eye. There was orbital recurrence of the tumor, leading to exenteration. Orbital and intraocular metastasis are generally associated with a bad prognosis. This patient represents a rare occurrence of metastatic gastric adenocarcinoma to the choroid, developing as a first sign of systemic recurrence.

Blindness after cosmetic blepharoplasty: case report

Blepharoplasty is one of the most commonly performed surgeries for rejuvenation of the periorbital region. We present a case of unilateral permanent visual loss following a bilateral lower lid cosmetic blepharoplasty with fat removal. The etiology of retrobulbar hemorrhage following blepharoplasty, treatment, and recommendations to reduce the chance of this rare but serious complication are discussed.

Septo-optic dysplasia: case report

A triade clinica da displasia septo-optica (DSO) compreende a ausencia de septo pelucido, displasia congenita do nervo optico e multiplos defeitos endocrinos. Uma forma incompleta de DSO tem sido reconhecida com dois dos tres elementos. Os autores relatam um caso de displasia septo-optica na forma incompleta em um garoto de 9 anos com baixa visao e nistagmo presentes desde o nascimento. O exame oftalmoscopico revelou papila pequena com imagem em duplo contorno bilateralmente. Ressonância magnetica mostrou hipoplasia dos nervos opticos, quiasma e ausencia do septo pelucido.

Análise da correlação entre síndrome de pseudo-exfoliação e aneurisma de aorta abdominal

PURPOSE: To investigate the suggested association between pseudoexfoliation syndrome and aneurysm of the abdominal aorta. METHODS: 65 patients recently operated for abdominal aortic aneurysm and 51 controls with peripheral atherosclerosis, without aneurysm, underwent an ophthalmologic examination under pupillary dilatation to detect the presence of pseudoexfoliation syndrome. RESULTS: There were no significant differences regarding mean age and distribution by gender and race between the groups (p > 0.05). Two of 65 patients with aortic aneurysm and one of 51 controls presented pseudoexfoliation syndrome (p = 1.00). CONCLUSION: The prevalence of pseudoexfoliation syndrome in patients operated for abdominal aortic aneurysm and in patients with peripheral atherosclerosis were similar. This finding does not support the proposed association between pseudoexfoliation syndrome and abdominal aortic aneurysm.