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PURPOSE: To assess the repeatability of central corneal thickness measurement at the geometrical center (Central Corneal Thickness - CCT) given by the Pentacam High Resolution (HR) Comprehensive Eye Scanner (Oculus, Wetzlar, Germany) over time. METHODS: Prospective, single center, observational study. Two separate CCT measurements were taken by the Pentacam corneal tomography exam (CTm) 3 to 12 months apart, and compared. RESULTS: One hundred and sixteen eyes (n=116) of 62 health patients were included in this study. Average CCT in first and last visits was 541.6±37 µm and 543.6±36.9 µm respectively. Mean difference between both measurements was 9.2±6.4 µm, and there was no statistically significant difference in CCT measurement between visits, with good correlation between them (P = 0.057, r² = 0,9209). CONCLUSION: Pentacam (HR) CTm gives repeatable CCT measurements over time. OBJETIVO: Avaliar a reprodutibilidade da medida da espessura corneana central, no seu centro geométrico, com medidas obtidas pelo sistema Pentacam de Alta Resolução (HR) com o decorrer do tempo. MÉTODOS: Realizado estudo observacional prospectivo em Centro Oftalmológico. Duas medidas isoladas da espessura central da córnea (ECC) foram realizadas com exame de tomografia do segmento anterior Pentacam HR em períodos com intervalos maiores que 3 e em até 12 meses, sendo então comparadas os resultados. RESULTADOS: Cento e dezesseis olhos (n = 116) de 62 pacientes saudáveis foram incluídos neste estudo. A média das medidas da ECC na primeira e na última avaliação foi de 541,6 ± 37 µm e 543,6 ± 36,9 µm, respectivamente. A diferença média entre as duas medições foi de 9,2 ± 6,4 µm, e não houve diferença estatisticamente significativa das medida da ECC entre as visitas, com boa correlação entre si (P = 0,057, r2 = 0,9209). CONCLUSÃO: O Tomógrafo de Segmento Anterior Pentacam HR apresentou medidas de ECC reprodutíveis ao longo do tempo.

In clinical settings, static ocular torsion is assessed by taking a fundus photograph and measuring the angle between a horizontal line and the line connecting the fovea to the head of the optic nerve (centro-cecal axis rotation; CCAR). We developed and tested a system specifically aimed at CCAR measurements, based on low-cost commercial hardware, and that implements an adaptive research algorithm that selects and presents bright dots on a monitor to outline the borders of the blind spot, locate its center, and measure CCAR. We examined 10 healthy subjects who underwent four CCAR measurements to evaluate the reliability of the system and compared our results with those of fundus photographic examination. Our data showed an excyclophoria, with mean ocular torsion of 6.4° in the right and 6.7° in the left eye. These values are in keeping with those in the literature. Moreover, the values of the intraclass correlation coefficients suggest excellent reliability of the technique.

Migraine in childhood and adolescence has been associated with the presence of behavioural and emotional difficulties, but only few data are available with respect to unusual types of headache syndromes such as Benign Paroxysmal Vertigo of Childhood (BPVC). Aim of the present study was to evaluate the behavioural and emotional profiles of clinically referred children and adolescents suffering from BPVC and migraine, as compared to normal controls. According to the revised International Classification of Headache Disorders (ICHD-2) the BPVC belongs to the category of "primary headache", as a migraine equivalent, in a subset that is called "periodic syndromes of childhood". A total of 60 clinically referred children and adolescents (4-15 years) 21 suffering from BPVC and 20 from migraine, according to the diagnostic criteria of the ICHD-2, and 19 normal control (NC) were recruited in this study. Psychological assessment were performed using the Child Behaviour Checklist (CBCL), the Children's Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC). Although most of the patients suffering from headache had scores within the normative non-pathological range, both BPVC and migraine patients had significantly higher CBCL total, internalizing, and externalizing scores, as compared to NC. Furthermore, both BPVC and migraine groups displayed significantly higher CDI and MASC scores than NC group. No differences were found between the two types of headache. In conclusion, clinically referred children and adolescents with BPVC and migraine showed higher indices of behavioural and emotional symptoms, both internalizing and externalizing, as compared to normal peers.

Aims It is well established that glaucoma results in a thinning of the inner retina. To investigate whether the outer retina is also involved, ultrahigh-resolution retinal imaging techniques were utilised. Methods Eyes from 10 glaucoma patients (25–78 years old), were imaged using three research-grade instruments: (1) ultrahigh-resolution Fourier-domain optical coherence tomography (UHR-FD-OCT), (2) adaptive optics (AO) UHR-FD-OCT and (3) AO-flood illuminated fundus camera (AO-FC). UHR-FD-OCT and AO-UHR-FD-OCT B-scans were examined for any abnormalities in the retinal layers. On some patients, cone density measurements were made from the AO-FC en face images. Correlations between retinal structure and visual sensitivity were measured by Humphrey visual-field (VF) testing made at the corresponding retinal locations. Results All three in vivo imaging modalities revealed evidence of outer retinal changes along with the expected thinning of the inner retina in glaucomatous eyes with VF loss. AO-UHR-FD-OCT images identified the exact location of structural changes within the cone photoreceptor layer with the AO-FC en face images showing dark areas in the cone mosaic at the same retinal locations with reduced visual sensitivity. Conclusion Losses in cone density along with expected inner retinal changes were demonstrated in well-characterised glaucoma patients with VF loss.

PURPOSE To evaluate the diagnostic assessment of optic nerve heads (ONH) by stereophotography (SP) and Heidelberg retina tomograph (HRT) in patients with retinitis pigmentosa (RP). METHODS This study involved 53 consecutive patients with RP and 24 controls who underwent ONH examination by SP and HRT. On the basis of the appearance at SP, RP ONH were divided in normal-colored (24/53) and pale (29/53). The measurements of vertical ONH diameter and vertical cup/disc ratio (VCDR) by SP and HRT were compared between the groups by means of t test and Bland-Altman plots. Diagnosis, ONH pallor and size, HRT image quality (image standard deviation, SD) were also inspected as sources of differences in the results by means of a multivariate analysis. RESULTS Vertical diameter measurements were similar using SP and HRT, respectively (1.93±0.50 and 1.80±0.62 for normal-colored ONH, P=0.43; 2.02±0.65 and 1.90±0.40 for pale ONH, P=0.27; and 1.98±0.55 and 1.84±0.52 for controls, P=0.33). In normal-colored ONH, VCDR was 0.30±0.11 at SP and 0.31±0.21 at HRT (P=0.90); in controls, it was 0.29±0.13 at SP and 0.30±0.18 at HRT (P=0.77). In the group with pale ONH, VCDR was 0.34±0.14 at SP and 0.53±0.24 at HRT (P

OBJETIVO: Determinar a frequência de glaucoma e avaliar o comportamento da pressão intraocular (PIO) de 24 horas em pacientes portadores da síndrome da apnéia obstrutiva do sono (SAOS). MÉTODOS: Foi realizado estudo transversal em 11 pacientes consecutivos portadores de SAOS diagnosticados por polissonografia. Foram analisados dados demográficos: idade, sexo, raça/cor, peso, altura e doenças associadas. Os pacientes foram submetidos à avaliação oftalmológica completa que incluiu campo visual e também avaliação da pressão intraocular (PIO) de 24 horas com tonômetro de aplanação às 9h, 12h, 15h, 18h, 24h e 6h deitado e sentado. O critério para diagnóstico de glaucoma foi alteração de campo visual (CV) compatível com glaucoma e uma ou mais das seguintes alterações: relação escavação disco ³ 0,7, hemorragia, defeito em cunha, vaso em baioneta, sinal de Hoyt, assimetria > que 0,2 entre as escavações dos dois olhos. O ângulo devia ser aberto sem alterações. RESULTADOS: 9 (82%) de 11 pacientes apresentaram glaucoma ou suspeita de glaucoma, sendo 9% glaucoma de pressão normal e 73% suspeita de glaucoma por apresentarem alterações do nervo óptico ou hipertensão ocular. A média dos valores de PIO dos 11 pacientes apresentou-se mais elevada às 6 horas quando os pacientes estavam deitados. Ocorreram flutuações de PIO ³ 5 mmHg em 7 (64%) dos pacientes sendo que ocorreram flutuações de até 14 mmHg e picos de PIO de até 32 mmHg. CONCLUSÃO: A SAOS pode ser um fator de risco importante para o esenvolvimento de glaucoma principalmente de pressão normal. Pacientes com SAOS devem ser referidos para o oftalmologista e os oftalmologistas devem estar atentos para a associação de distúrbios do sono em pacientes com glaucoma de ângulo aberto. PURPOSE: To determine the frequency of glaucoma and evaluate the behavior of 24-hour intraocular pressure in patients with the obstructive sleep apnea syndrome (OSAS). METHODS: Eleven consecutive patients with OSAS, diagnosed by polysonography, were avaliated in a cross sectional study. Demographic data were analyzed: age, sex, race/color, weight, height and associated diseases. The patients were submitted to complete ophthalmologic examination, including the visual field, as well as to 24-hour intra-ocular pressure (IOP) evaluation by an applanation tonometer at 9h, 12h, 15h, 18h, 24h and 6h in the lying and sitting positions. The diagnostic criterion for glaucoma was alteration of the visual field (VF) compatible with glaucoma and one or more of the following alterations: cup-disc ratio ³ 0.7, hemorrhage, wedge-shaped defect, bayonet-shaped vessels, Hoyt's sign, asymmetry > than 0.2 between cup/disc ratio of the eyes. The angle should be opened without alterations. RESULTS: 9 (82%) of 11 patients showed glaucoma or were suspected to have glaucoma, 9% of which exhibited normal tension glaucoma and 73% were suspected to have glaucoma for presenting alterations in the optic nerve or ocular hypertension. The mean for the IOP values of the 11 patients was observed to be the highest at 6 o'clock, when they were lying down. Variations of IOP ³ 5 mmHg occurred in 7 (64%) of the patients, and variations of up to 14 mmHg and IOP peaks of up to 32 mmHg were observed. CONCLUSION: OSAS may be an important risk factor for the development of glaucoma, particularly that of normal tension glaucoma. Patients with OSAS must be referred to an ophthalmologist and those professionals must be attentive to the association of sleep disorders in patients with open-angle glaucoma.

Made available in DSpace on 2022-04-28T21:01:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-01-01 Purpose: To determine the frequency of glaucoma and evaluate the behavior of 24-hour intraocular pressure in patients with the obstructive sleep apnea syndrome (OSAS). Methods: Eleven consecutive patients with OSAS, diagnosed by polysonography, were avaliated in a cross -sectional study. Demographic data were analyzed: age, sex, race/color, weight, height and associated diseases. The patients were submitted to complete ophthalmologic examination, including the visual field, as well as to 24- hour intra-ocular pressure (IOP) evaluation by an applanation tonometer at 9h, 12h, 15h, 18h, 24h and 6h in the lying and sitting positions. The diagnostic criterion for glaucoma was alteration of the visual field (VF) compatible with glaucoma and one or more of the following alterations: cup-disc ratio ≥ 0.7, hemorrhage, wedge-shaped defect, bayonet-shaped vessels, Hoyt's sign, asymmetry > than 0.2 between cup/disc ratio of the eyes. The angle should be opened without alterations. Results: 9 (82%) of 11 patients showed glaucoma or were suspected to have glaucoma, 9% of which exhibited normal tension glaucoma and 73% were suspected to have glaucoma for presenting alterations in the optic nerve or ocular hypertension. The mean for the IOP values of the 11 patients was observed to be the highest at 6 o'clock, when they were lying down. Variations of IOP ≥ 5 mmHg occurred in 7 (64%) of the patients, and variations of up to 14 mmHg and IOP peaks of up to 32 mmHg were observed. Conclusion: OSAS may be an important risk factor for the development of glaucoma, particularly that of normal tension glaucoma. Patients with OSAS must be referred to an ophthalmologist and those professionals must be attentive to the association of sleep disorders in patients with open-angle glaucoma. Departamento de Oftalmologia Otorrinolaringologia e Cirurgia de Cabeça Pescoço da Faculdade de Medicina de Botucatu da Universidade Estadual Julio de Mesquita Filho - UNESP, Botucatu (SP) Departamento de Oftalmologia Pescoço da Faculdade de Medicina de Botucatu da Universidade Estadual Julio de Mesquita Filho - UNESP Otorrinolaringologia e Cirurgia de Cabeça, Botucatu (SP) Departamento de Oftalmologia Otorrinolaringologia e Cirurgia de Cabeça Pescoço da Faculdade de Medicina de Botucatu da Universidade Estadual Julio de Mesquita Filho - UNESP, Botucatu (SP) Departamento de Oftalmologia Pescoço da Faculdade de Medicina de Botucatu da Universidade Estadual Julio de Mesquita Filho - UNESP Otorrinolaringologia e Cirurgia de Cabeça, Botucatu (SP)

To investigate the ability of sectorial analysis using the Heidelberg Retinal Tomograph 3 (HRT3) to discriminate between healthy and glaucomatous eyes and to determine whether this is affected by disc size and glaucoma severity.Multicenter, cross-sectional evaluation of diagnostic tests.Two hundred thirty-three eyes from 137 normal subjects and 96 glaucoma patients classified by the presence of a repeatable visual field defect.Participants underwent imaging with the HRT3, and the diagnostic accuracy of stereometric parameters, Moorfields regression analysis (MRA), and glaucoma probability score (GPS) were analyzed sectorially by glaucoma stage and optic disc size.Sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristics curve (AUC).Of stereometric parameters, the cup-to-disc area ratio of the inferotemporal sector had the largest AUC (AUC, 0.74). Both MRA and GPS algorithms showed the best diagnostic accuracy in the inferotemporal sector, with a sensitivity and specificity of 63% and 88% for MRA and 80% and 62% for GPS, respectively. In small discs, sectorial MRA analysis had higher diagnostic accuracy than the global optic nerve head (ONH) analysis (sensitivity of 70% and specificity of 82% in the inferonasal sector), and these findings were confirmed in very large discs (sensitivity of 74% and specificity of 85% in the inferotemporal sector). Similarly, stereometric parameters discriminated better sectorially rather than globally, with different parameters giving the best results in different optic disc size subgroups. MRA sensitivity was weak in the early-glaucoma stage, with slightly higher figures if considered sectorially rather than globally. GPS diagnostic accuracy was very consistent across ONH sectors in each disc size and glaucoma stage subgroup, with no single sector demonstrating better diagnostic accuracy than the global analysis.Heidelberg Retinal Tomograph 3 sectorial analysis showed moderate diagnostic performance and may offer potential advantages over global analysis in the clinical diagnostic process. Small discs are classified more accurately by examining the inferonasal sector, whereas larger discs are classified more accurately by examining the inferotemporal sector. Neither HRT parameters nor classification algorithms seem to be good at the earlier stage of the disease.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Aim: The aim of the study was to investigate the role of Humphrey Matrix threshold testing in the detection of early functional retinal impairment in subjects with type 1 diabetes mellitus (DM1) without any signs of retinal vasculopathy, and to investigate the relationship between both functional and structural retinal parameters and metabolic control. Methods: Thirty eyes of 30 subjects with DM1, with no sign of retinal vasculopathy, and 30 eyes of 30 age- and sex-matched healthy subjects were enrolled in this cross-sectional clinical study. Functional testing included Humphrey Matrix perimetry and white-on-white Humphrey visual field perimetry (HFA), while retinal nerve fibre layer (RNFL) thickness was measured by scanning laser polarimetry with variable corneal birefringence compensator (GDx VCC). Results: Matrix mean deviation (MD) was found to be significantly reduced in subjects with DM1 compared with controls (−1.10 (SD 2.98; 95% CI −2.21 to 0.01) vs 1.37 (SD 2.11; 95% CI 0.58 to 2.16), p = 0.0005). HFA MD and pattern standard deviation (PSD) were significantly worse in subjects with DM1 compared with controls (p = 0.010 and p = 0.013 respectively). Among structural parameters, average peripapillary RNFL thickness was reduced in DM1 subjects (p = 0.006). Matrix MD and HFA MD and PSD, and average peripapillary and superior RNFL, were significantly reduced in subjects with DM1 with HbA 1c ⩾7% compared with controls. Conclusions: Functional and structural retinal testing by Humphrey Matrix and GDx VCC could be useful for the identification of early retinal impairment in people with DM1 with no sign of retinal vasculopathy.

Author(s): Choi, Stacey S; Zawadzki, Robert J; Keltner, John L; Werner, John S | Abstract: PurposeTo study the integrity of inner and outer retinal layers in patients with various types of optic neuropathy by using high-resolution imaging modalities.MethodsThree high-resolution imaging systems constructed at the University of California Davis were used to acquire retinal images from patients with optic neuropathy: (1) adaptive optics (AO)-flood-illuminated fundus camera, (2) high-resolution Fourier domain optical coherence tomography (FDOCT), and (3) adaptive optics-Fourier domain optical coherence tomography (AO-FDOCT). The AO fundus camera provides en face images of photoreceptors whereas cross-sectional images (B-scans) of the retina are obtained with both FDOCT and AO-FDOCT. From the volumetric FDOCT data sets, detailed thickness maps of a three-layer complex consisting of the nerve fiber (NF), ganglion cell (GC), and inner plexiform (IP) layers were created. The number of visible cones in the en face images of photoreceptors was then compared with visual sensitivity maps from Humphrey visual field (HVF; Carl Zeiss Meditec, Inc., Dublin, CA) testing, as well as FDOCT and AO-FDOCT images, including the thickness maps of the NF-GC-IP layer complex. Five types of optic neuropathy were studied: (1) optic neuritis with multiple sclerosis (MS), (2) idiopathic intracranial hypertension (pseudotumor cerebri), (3) nonarteritic anterior ischemic optic neuropathy (NAION), (4) optic nerve head drusen with NAION, and (5) systemic lupus erythematosus with MS and arthritis.ResultsWith permanent visual field loss and thinning of the NF-GC-IP layer complex, cone photoreceptors showed structural changes, making them less reflective, which caused the appearance of dark spaces in the en face images (hence, reduced number of visible cones) and indistinct outer retinal layers in OCT images. However, when the visual field loss was only transient, with a normal NF-GC-IP layer complex, there were no detectable abnormalities in cone photoreceptors (i.e., they were densely packed and had distinct photoreceptor layering in the OCT images).ConclusionsCone photoreceptors show structural changes when there is permanent damage to overlying inner retinal layers. There was a positive relation between the thickness of the three-layer inner retinal complex, visual sensitivity, and integrity of the cone mosaic.

OBJETIVO: Avaliar se a opacificação de cápsula posterior (OCP) influenciaria na análise da camada de fibras nervosas pela polarimetria "scanning laser" (GDx). MÉTODOS: Trinta e sete pacientes pseudofácicos não glaucomatosos foram submetidos a análise da camada de fibras nervosas pelo GDx antes e após a realização de capsulotomia com Nd:YAG laser. RESULTADOS: Em cinco olhos, o GDx não conseguiu imagens aceitáveis pelos parâmetros de aquisição do aparelho. Em todos os outros, não foi observada diferença significante entre os valores médios das variáveis antes e após a realização da capsulotomia posterior. CONCLUSÃO: A presença de OCP em graus moderados e/ou quando há imagens aceitáveis em pacientes pseudofácicos não influencia o resultado da análise das imagens das fibras do nervo óptico pelo GDx. Apenas intensos graus de OCP que impeçam a obtenção de imagem analisável pelo aparelho inviabilizam o exame. PURPOSE: To evaluate if posterior capsule opacification (PCO) would alter the analysis of nerve fiber layer using the scanning laser polarimetry (GDx). METHODS: Pseudophakic non-glaucomatosous eyes (37 patients) underwent nerve fiber layer analysis using GDx before and after posterior capsulotomy with Nd:YAG Laser. RESULTS: In five eyes, GDx did not obtain acceptable images using the device's parameters of acquisition. In the others, mean variable values did not reach significant difference before and after posterior capsulotomy. CONCLUSION: Moderate degrees of PCO and/or acceptable images in pseudophakic patients do not alter the analysis of nerve fiber layer by GDx. Only intense degrees of PCO that hinder analyzable images make the examination impracticable.

Diabetic macular edema is a leading cause of visual disability in patients with diabetes mellitus.Purpose of this study is to compare two main diagnostic methods fluorescein angiography and optical coherence tomography (OCT) in early detection of diabetic macular edeme.It is prospective study. Consecutive 74 eyes of 74 patients with early diabetic macular edema from Ludvig Maximillian University Eye Clinic, Munich, Germany is enrolled in this study. There is statistical significant correlation between focal leakage and central macular thickness measured with OCT. Average central foveolar thickness measured with OCT in our sample were 328+/-85 um. Common type of macular edema anlysed on fluorescein angiography is diffuse diabetic macular edema. Central macular thickness measured with OCT in eyes with focal edema is 252+/-23.34 um, diffuse edema 305+/-41.4 um and cystoid macular edema 376+/-80.5 um. Difference between macular thickness in eyes measured OCT in eyes with proliferative and non proliferative diabetic retinopathy is not statisticaly significant (t=0.69). Central macular OCT thickness is higher in patients with insulin dependent diabetes mellitus compared to insulin dependent diabetes mellitus and it is statistically significant (t=2.12). Risk factors (levelof hemoglobin Alc, blood pressure, duration of diabetes mellitus) have significant influence on macular thickness measured with OCT. Optical coherence tomography has important advance compared to recently used diagnostic methods in early detection and evaluation of diabetic macular edema. It is non invasive, non contact and safe diagnostic method with capability to differentiate pathological changes smaller than 10 microns. Average central macular thickness in our sample is 328+/-85 um.

To investigate and compare the diagnostic accuracy of the Heidelberg Retinal Tomograph 3 (HRT3) diagnostic algorithms and establish whether they are affected by optic disc size and glaucoma severity.Multicenter cross-sectional evaluation of diagnostic tests.Two hundred forty-two eyes from 139 normal subjects and 103 glaucomatous patients classified by the presence of a repeatable visual field (VF) defect.Eyes were imaged by the HRT3. The diagnostic accuracies of Moorfields regression analysis (MRA) and the glaucoma probability score (GPS) was explored by sensitivity and specificity and area under the receiver operating characteristics curves (AUC). The analysis was performed globally and by optic disc size quartiles and by 3 VF severity groups.Sensitivity, specificity, and AUC.The GPS showed a sensitivity (80% vs. 77%) similar to and a specificity (57% vs. 67%) lower than that of MRA Result. It showed a higher specificity in small discs than MRA Result (77% vs. 68%) but a low to very low specificity in medium to very large discs (medium, 61%; large, 50%; very large, 26%). Moorfields regression analysis Global showed the highest sensitivity and specificity (68% and 78%) in very large discs. R. Burke linear discriminant function (RB-LDF) and cup shape measure (CSM) showed the best and least variable AUC across optic nerve head sizes and glaucoma stages. The sensitivity of both MRA and the GPS decreased at the earlier glaucoma stages. The MRA and GPS agreement was moderate throughout the entire population and in small discs and early stage, whereas it was weaker among the other disc size and glaucoma stage subgroups.HRT3 diagnostic algorithms' accuracy is moderate. The GPS is less specific and more influenced by disc size than MRA. Cup shape measure and the RB-LDF offer the best and less variable performances across different disc sizes and glaucoma stages.

PURPOSE: To compare an ultrasound pachymeter with an optical low coherence reflectometry (OLCR) pachymeter for measuring pre- and postoperative central corneal thickness of patients undergoing photorefractive keratectomy (PRK). METHODS: In a prospective, noncomparative, interventional study, 48 myopic eyes (mean manifest refractive spherical equivalent: -4.93±2.93 diopters [D]) of 30 healthy patients underwent PRK. Pre- and postoperative central corneal thickness was measured by two examiners (E1, E2) with an ultrasound pachymeter and an OLCR pachymeter. Agreement and inter-rater repeatability were determined using the comparison method described by Bland and Altman. RESULTS: The limits of agreement between the two devices ranged from 17.8 µm (E1) to 20.5 µm (E2) preoperatively and from 22.4 µm (E1) to 16.9 µm (E2) postoperatively. The coefficient of inter-rater repeatability ranged from 9.1 µm (ultrasound pachymeter) to 5.4 µm (OLCR pachymeter) preoperatively and from 7.1 µm (ultrasound pachymeter) to 4.7 µm (OLCR pachymeter) postoperatively. CONCLUSIONS: The OLCR pachymeter seems to show better pre- and postoperative repeatability compared to the ultrasound pachymeter. The agreement between the two devices should be considered acceptable for clinical practice. Photorefractive keratectomy did not affect the postoperative agreement and repeatability of the pachymeters. [J Refract Surg. 2007;23:661-666.]

Local anesthesia is commonly used to perform cataract surgery. We present a case in which local anesthesia systemic toxicity, which occurred after peribulbar block. It is a life-threatening complication if it is not recognized early and appropriately resuscitated can be fatal. This case report attempts to highlight the need for trained personnel, with suitable monitoring and recent guidelines in the management of local anesthesia systemic toxicity surgery under a regional technique.

OBJETIVO: Avaliar o efeito da redução da pressão intra-ocular (PIO) obtido com o uso de terapia medicamentosa na espessura da camada de fibras nervosas da retina medida pela polarimetria de varredura a laser (PVL) em pacientes glaucomatosos ou hipertensos oculares. MÉTODOS: Trinta e sete olhos de 37 pacientes foram prospectivamente incluídos no estudo e avaliados com a PVL sem uso de medicação ocular hipotensora e num período entre 15 e 30 dias após a instituição de medicação ocular hipotensora, que resultou em redução da PIO de pelo menos 25%. Os parâmetros medidos pela PVL antes e após a redução da PIO foram comparados com o teste t de Student pareado. RESULTADOS: A PIO média dos 37 pacientes diminuiu significativamente de 26,57±4,23 mmHg para 16,54±2,92 mmHg (p0,05). CONCLUSÃO: A redução da PIO com o uso de medicação ocular hipotensora não altera a medida da espessura da camada de fibras nervosas da retina pela PVL em pacientes com glaucoma ou hipertensão ocular. PURPOSE: To evaluate changes in retinal nerve fiber layer thickness as measured by scanning laser polarimetry (SLP) after the use of medication to reduce intraocular pressure (IOP) in glaucomatous or ocular hypertensive patients. METHODS: The authors prospectively enrolled 37 eyes of 37 patients in whom IOP was reduced by more than 25% after the use of medication. The images were obtained before and 15 to 30 days after the introduction of medication. The SLP parameters measured before and after the use of medication were compared using paired Student's t Test. RESULTS: The mean IOP was significantly reduced from 26.57±4.23 mmHg to 16.54 ±2.92 mmHg after the use of medication (p0.05). CONCLUSION: The retinal nerve fiber layer thickness, as measured by SLP, is not affected by the reduction of IOP with medication in patients with glaucoma or ocular hypertension.

PURPOSE. To relate in vivo microscopic retinal changes to visual function in patients who have various forms of retinal dystrophy. METHODS. The UC Davis Adaptive Optics (AO) fundus camera was used to acquire in vivo retinal images at the cellular level. Visual function tests consisting of visual fields, multifocal electroretinography (mfERG), and contrast sensitivity were measured in all subjects by using stimuli that were coincident with areas imaged. Five patients with different forms of retinal dystrophy and three control subjects were recruited. Cone densities were quantified for all retinal images. RESULTS. In all images of diseased retinas, there were extensive areas of dark space between groups of photoreceptors, where no cone photoreceptors were evident. These irregular features were not seen in healthy retinas, but were apparent in patients with retinal dystrophy. There were significant correlations between functional vision losses and the extent to which these irregularities, quantified by cone density, occurred in retinal images. CONCLUSIONS. AO fundus imaging is a reliable technique for assessing and quantifying the changes in the photoreceptor layer as disease progresses. Furthermore, this technique can be useful in cases where visual function tests provide borderline or ambiguous results, as it allows visualization of individual photoreceptors. Copyright © Association for Research in Vision and Ophthalmology.

OBJETIVO: Estudar, ao perímetro de Goldmann, um grupo de pacientes com hemianopsia completa ao perímetro Humphrey (24-2 full threshold test), e verificar em quantos casos a perimetria computadorizada deixou de identificar a presença de campo visual periférico residual. MÉTODOS: Dezenove pacientes com defeitos campimétricos por compressão quiasmática foram estudados prospectivamente por meio das perimetrias manual e computadorizada. Vinte e cinco olhos com hemianopsia temporal completa pelo programa 24-2 do Humphrey Field Analyzer foram selecionados e estudados pela perimetria manual de Goldmann para avaliar a presença de campo visual periférico residual. De acordo com os resultados ao perímetro de Goldmann, os olhos foram divididos em 2 grupos: grupo 1, os portadores de hemianopsia temporal completa ao Goldmann e grupo 2, os portadores de campo visual temporal periférico residual. Foi calculada a média do "mean deviation" fornecido pelo aparelho nos dois grupos e o resultado foi comparado pelo teste t de Student. RESULTADOS: A perimetria computadorizada deixou de identificar a presença de campo visual periférico residual em 17 dos 25 olhos (68%). Os valores médios do "mean deviation" no grupo 1 e grupo 2 foram respectivamente -15,43 e -15,93. O estudo estatístico não mostrou diferença significativa entre os dois valores. CONCLUSÕES: A perimetria computadorizada Humphrey com o programa 24-2 threshold test deixa de identificar remanescentes temporais de campo visual em grande porcentagem de pacientes com compressão quiasmática grave. A análise do "mean deviation" fornecido pelo aparelho não permite identificar estes casos. Pacientes estudados ao perímetro automático e apresentando hemianopsia temporal completa, devem complementar sua avaliação perimétrica com a pesquisa por áreas remanescentes no campo visual temporal. PURPOSE: To study, on Goldmann perimetry, a group of patients with complete temporal hemianopia on Humphrey perimetry (24-2 full threshold test) and to evaluate the percentage of eyes in which computerized perimetry failed to identify a temporal visual field remnants. METHODS: Nineteen patients with visual field defect by chiasmal compression were prospectively studied with manual and automated perimetry. Twenty-five eyes with complete temporal hemianopia on Humphrey Field Analyzer, 24-2 threshold test were selected and studied with Goldmann perimeter, in order to evaluate the presence of a temporal visual field remnants. According to the result of Goldmann perimetry the eyes were divided into two groups: group 1, with complete temporal hemianopia; group 2, with residual temporal visual field remnants in the periphery. The mean number of mean deviation in the 2 groups was calculated and compared using Student's t test. RESULTS: Automated perimetry failed to identify a temporal residual visual field in 17 of 25 eyes studied (68%). Mean values of the mean deviation in groups 1 and 2 were respectively -15.43 and -15.93. Statistical analysis did not indicate a significant difference between them. CONCLUSIONS: Computerized automated Humphrey perimetry using 24-2 threshold test fails to identify temporal visual field remnants in a great percentage of patients with severe chiasmal compression. Analysis of the mean deviation is not helpful in identifying such cases. Patients evaluated on automated perimetry and presenting with a complete temporal hemianopia should be checked for temporal visual field remnants.

To investigate the diagnostic occlusion test (OT) according to Marlow in strabismus sursoadductorius (StS; also known as 'unilateral superior oblique palsy') and its implications for surgical treatment.In 67 cases of StS, angles of strabismus were measured before and after patching the affected eye for three days. Horizontal, vertical and torsional deviations were measured in front of the tangent screen of Harms in nine directions of gaze.After OT, most cases of StS showed the following distribution of vertical deviation (VD) on horizontal versions: setting the VD in 30 degrees adduction to 100%, VD in primary position (PP) was 50%, VD in abduction 14%, excyclotropia in PP about 40% of the amount of VD. Those StS-cases showing the same distribution of VD on horizontal versions before and after OT were called 'typical' ones (27% of the patients). However, 73% of the patients showed a different distribution before OT: 68% VD in PP, 36% VD in abduction, excyclotropia of 20% in PP. After OT these cases converted to the normal pattern described above: VD in PP was 53 % and VD in 30 degrees abduction was 19%, excyclotropia in PP was 36%.In 'typical' StS-cases, OT is not necessary. 'Atypical' cases, however, can be converted into 'typical' ones: they get more incomitant VD on horizontal versions and greater excyclotropia in PP. As VD in adduction remains almost the same in both groups after OT, surgery can be based on the angle in adduction. In individual 'atypical' patients the amount of oblique muscle surgery has to be modified after OT.

The introduction of the laser scanning tomograph raises the possibility of the estimation of optic disc morphology in a less subjective and less time-consuming way than the conventional planimetry of fundus photography. The aim of the present study was to estimate the efficiency of the HRT method in a comparison of data collected in a glaucomatous patient group to planimetric data obtained in young normal volunteers.Repeated rim/disc area measurements were done in 10 glaucoma patients with a Heidelberg Retina Tomograph and in a group of five young volunteers with good vision. The intra-photographic, intra-observer examination of the planimetric method was compared to the inter-photographic assessment of the HRT technique.The variability of the mean normalised area ratio quotient was nearly 50% less using laser scanning tomography techniques (mean rim/disc area ratio = 0.17).The results show the superiority of HRT over the conventional planimetric technique. Furthermore, the much shorter processing time and the advantages of a computer-based databank in follow-up examination with HRT provides the hope that it could replace the rather time-consuming and subjective manual planimetric technique in the examination of glaucomatous optic nerve conditions.

INTRODUÇÃO: O equilíbrio do sistema oculomotor depende de múltiplos fatores, para cujas correções os procedimentos são geralmente indiretos (modificação de respostas musculares, não das causas inervacionais) e, em muitos casos (correção de paralisias, dissinergias, nistagmos), insatisfatórios. Métodos para controle específico dos mecanismos de comando não têm sido possíveis, pelas peculiaridades próprias do sistema nervoso central, restando, pois, os de introdução de forças de movimentação ou de contenção sobre o próprio olho. ANÁLISES DE MÉTODOS ALTERNATIVOS: FORÇAS DE MOVIMENTAÇÃO: Entre os métodos com perspectivas de produção de rotações oculares, são revistos os de transposições musculares, com proposta para favorecer a ação abdutora de oblíquos. Referem-se ainda a métodos de aproveitamento de forças acumuladas em mecanismos distensíveis, ao de estimulação elétrica direta sobre músculos, e ao de geração de forças originadas por campos magnéticos (em modelos de construção experimental). FORÇAS DE CONTENÇÃO: Para se contrapor a ações musculares excessivas ou indesejáveis, propõe-se o uso de forças de contenção geradas por meio de fixações distensíveis (do olho à órbita), por campos magnéticos, ou pelo aumento da fricção no movimento ocular rotacional, por maior viscosidade. INTRODUCTION: The balance of the oculomotor system depends on multiple factors, whose corrections are usually based on indirect procedures (modifications of muscular responses but not of the innervational causes) and unsatisfactory in many cases (correction of paralysis, dyssynergic movements, nystagmus). Use of methods for the specific control of the innervational command has not been possible because of the peculiarities of the central nervous system. Therefore, the solution remains the application of forces for rotational movements or for their contention directly on the eye itself. ANALYSIS OF ALTERNATIVE METHODS: FORCES FOR ROTATIONS: Among the methods which may produce ocular rotations that of muscular transpositions is reviewed, with a proposition to favor the abducting action of the oblique muscles. References are also made about methods based on forces accumulated by distensible mechanisms; generated by electric stimulation of muscles or generated by magnetic fields (in experimental models). RESTRICTIVE FORCES: For restraining excessive or undesirable muscular actions, the propositions are of using forces generated by distensible fixations (of the eye to the orbit), by magnetic fields, or by increased friction during the rotational ocular movement, caused by increased viscosity.

Purpose To determine whether the increase in intraocular pressure (IOP) for 45 seconds during laser in situ keratomileusis (LASIK) suction can induce a decrease in retinal nerve fiber layer thickness (RNFLT) assessed by a confocal scanning laser polarimeter. Setting Jules Gonin Hospital, University of Lausanne, Lausanne, Switzerland. Methods Eleven normal volunteers were enrolled in the study. The optic disc of each eye was analyzed by the GDx® Nerve Fiber Analyzer (Laser Diagnostic Technologies, Inc.), version 1.0.14. Using the standard circle that appears as a 10-pixel green circle on the GDx display, the system assessed the RNFLT at 1.75 disc diameter from the outer edge of the optic nerve head. To further evaluate the possible retinal nerve fiber layer (RNFL) loss, the 360-degree circumference was divided into 36 segments measuring 10 degrees each and the RNFLT was calculated for each sector. All subjects had a GDx assessment before 100 mm Hg ocular compression of 1 eye for 45 seconds and then 2 minutes and 1 month after compression. Results Before compression, the mean RNFLT was 69.09 μm ± 10.96 (SD); it was 69.27 ± 10.98 μm after 2 minutes and 67.00 ± 10.58 μm after 1 month. No statistically significant difference was found between the before and after measurements. Conclusion A 45-second acute increase in IOP, such as during LASIK suction, did not decrease the RNFLT in normal eyes.

PURPOSE. To describe detailed phenotypic and genotypic analysis of a pleomorphic adenocarcinoma of the ciliary epithelium (CE). CASE REPORT. An 86-year-old white woman developed an enlarging mass protruding from her previously eviscerated left eye 2 months postoperatively. Based on light and ultrastructural microscopy, the final diagnosis was a pleomorphic adenocarcinoma of the ciliary epithelium (CE). DISCUSSION. Cell proliferation indices confirmed the unusually rapid growth rate of this tumor; the peridiploid DNA content might explain the relatively low incidence of distant metastases. An imbalance o the chromosome 6 was also found by Comparative Genomic Hybridization (CGH).

Objetivo: Analisar a validade diagnóstica do GDx™ Scanning Laser System em portadores de glaucoma primário de ângulo aberto, bem como, avaliar o seus resultados em pacientes suspeitos de glaucoma. Métodos: Foram submetidos ao exame com o GDx™ Scanning Laser System, 77 glaucomatosos (142 olhos) portadores de defeito característico do campo visual, 40 indivíduos normais (80 olhos) e 36 suspeitos de glaucoma com pressão intra-ocular (Po) acima de 20 e abaixo de 25 mmHg com campo visual normal. Analisou-se a sensibilidade, especificidade, razão de probabilidade e as probabilidades pré e pós-teste. Resultados: Considerando como exame anormal a presença de pelo menos um índice alterado, entre glaucomatosos e normais, observou-se uma especificidade de 82,5% e sensibilidade de 90,1%. A razão de probabilidade encontrada foi de 5,1 e as probabilidades pré e pós-teste de 63,9% e 90% respectivamente. Entre suspeitos e normais, observou-se uma especificidade de 82,5% e sensibilidade de 33,3%. A razão de probabilidade encontrada foi de 1,9 e as probabilidades pré e pós-teste de 8,5% e 15% respectivamente. Conclusão: O GDx™ Scanning Laser System apresenta validade diagnóstica significativa em diferenciar olhos glaucomatosos de normais. Em suspeitos de glaucoma o exame mostrou pouca capacidade na diferenciação dos normais. Purpose: to analyze the diagnostic power of the GDx™ Scanning Laser System in primary open angle glaucoma (POAG) and glaucoma suspects. Methods: 77 POAG patients (142 eyes) with characteristic visual field loss, 40 normal subjects and 36 glaucoma suspects (72 eyes) with intraocular pressure (IOP) above 20 and below 25 mmHg with normal visual fields were submitted to GDx™ Scanning Laser System examinations. Sensitivity, specificity, likelihood ratio and pre- and post-test probabilities were calculated. Results: Considering abnormal the presence of at least one parameter out of normal limits, 82.5% specificity and 90.1% of sensitivity between glaucomatous and normals were found. Likelihood ratio was 5.1 and pre-test and post-test probabilities were 63.9% and 90% respectively. Between suspects and normals specificity was 82.5% and sensitivity 33.3%. Likelihood ratio was 1.9 and pretest and post-test probabilities were 8.5% and 15% respectively. Conclusion: The GDx™ Scanning Laser System presented significant diagnostic power to differentiate glaucomatous from normal eyes. The examination showed low performance to differentiate glaucoma suspects from normals.

(1) To determine the agreement between optical and ultrasound pachometry for central corneal thickness measurements used to "correct" applanation intraocular pressure (IOP) readings. (2) To determine the inter- and intra-observer variability of optical and ultrasound pachometry.Central corneal thickness (CCT) was measured in a masked manner using optical and ultrasound pachometry in 50 normal eyes. To assess intra- and inter-observer variability, multiple masked measurements were obtained in 51 eyes (optical pachometry) and 34 eyes (ultrasound pachometry). Agreement was determined by a published technique that uses the mean of the differences, standard error (SE) and standard deviation (SD).The mean difference in CCT between optical and ultrasound pachometry was 0.001 mm (SD 0.031 mm; SE 0.00439 mm). The mean inter-observer difference for the optical pachometer was 0.019 mm (SD 0.049 mm; SE 0.0069); the mean intra-observer difference was 0.003 mm (SD 0.017; SE 0.0.0024). The mean inter-observer difference for ultrasound pachometry was 0.001 mm (SD 0.009; SE 0.0015) and the mean intra-observer difference was 0.002 mm (SD 0.011; SE 0.0019).Ultrasound pachometry is the more reliable method for the measurement of central corneal thickness used to correct applanation IOP values. Optical pachometry had good intra-observer variability. The range of error in IOP correction for corneal thickness (inter-observer) that can occur using the ultrasound pachometer is -1.2 mmHg to +1.4 mmHg as compared to -5.6 mmHg to +8.5 mmHg with the optical pachometer.

Among the possible variables responsible for systemic errors in the acquisition of pachometric measurements, the corneal hydration condition plays a determinant role. In the present study, the authors have investigated the importance of this condition with two different pachometers (Storz Corneoscan II and Allergan Humphrey), reproducing an experimental dehydrated condition. The main datum arising from the comparison of the measurements obtained is represented by the different time course of the value of the measurement in the two groups. In fact, confronting the medium initial superimposed thickness value in the two tables (521 vs. 520 µm) there is a substantial difference in the final examination. For the first group of 60 corneas, the thickness values appear almost identical in the different intervals of time (medium initial thickness 521 vs. 512 µm final thickness). For the group examined with the solid-point machine, a decreasing thickness equal to 7% was evidenced (520 vs. 482 µm) with a significant decrease in the corneal thickness after only 45 s.

Retinal photoreceptors use the heterotrimeric G protein transducin to couple rhodopsin to a biochemical cascade that underlies the electrical photoresponse. Several isoforms of each transducin subunit are present in the retina. Although rods and cones seem to contain distinct transducin subunits, it is not known whether phototransduction in a given cell type depends strictly on a single form of each subunit. To approach this question, we have deleted the gene for the rod transducin α-subunit in mice. In hemizygous knockout mice, there was a small reduction in retinal transducin α-subunit content but retinal morphology and the physiology of single rods were largely normal. In homozygous knockout mice, a mild retinal degeneration occurred with age. Rod-driven components were absent from the electroretinogram, whereas cone-driven components were retained. Every photoreceptor examined by single-cell recording failed to respond to flashes, with one exception. The solitary responsive cell was insensitive, as expected for a cone, but had a rod-like spectral sensitivity and flash response kinetics that were slow, even for rods. These results indicate that most if not all rods use a single transducin type in phototransduction.

PURPOSE: A method to measure the tear film beneath a soft contact lens, referred to as post-lens tear thickness (PLTT), would have many applications to contact lens research. In this study a noninvasive technique for measuring the PLTT is presented. METHODS: The feasibility of measuring the tear layer by optical pachometry was first assessed using a model eye. The baseline corneal thickness (B) of both eyes of 21 subjects was measured, etafilcon-A ionic disposable soft contact lenses (58% water) were inserted, and the total thickness (T) of the cornea, contact lens, and PLTT were measured. After the pachometry readings the lenses were removed and their center thickness (C) determined. The PLTT was calculated using the equation: PLTT = T-(B+C). Two sets of measurements of T were performed at 15 and 25 minutes after lens insertion. The entire procedure was repeated at a second visit. RESULTS: The pachometry measurements of the small aqueous reservoir between the model eye and the lens closely matched those obtained by direct microscopic measurement. For human PLTT, the mean values (and 95% confidence intervals) for right eyes on visits 1 and 2 were 11 (8, 13) and 12 (10, 15) microm, respectively, and for left eyes were 12 (10, 15) and 11 microm (8, 14) microm, respectively. CONCLUSIONS: It is possible to measure the post-lens tear thickness using optical pachometry. The variability between repeated measurements suggests that with careful sample size planning, the technique is sufficiently precise to be useful in group assessments of PLTT.

PURPOSE To describe clinically occult choroidal vascular abnormalities that can be revealed by indocyanine green (ICG) angiography. METHODS Out of approximately 2,700 patients who underwent ICG angiography, a lesion was incidentally observed in eight eyes of eight patients. In five patients, the ICG study included a second examination taken during artificially induced intraocular hypertension. Examinations were repeated in six patients over a follow-up period ranging from 4 months to 3 years. RESULTS On ICG angiogram, the choroidal vasculopathy appeared as a round-oval hyperfluorescent area 2-4 disk diameters in size that was located at the temporal vascular arcades in six eyes, at the inferomacular region in one eye, and above the optic disk in one eye. The lesions were not identifiable with funduscopic, fluorescein angiographic, or ultrasonographic examination. The lesions filled at the same time as the choroidal arteries and lost fluorescence in mid-late phase of the ICG angiogram. The ICG series taken during induced intraocular hypertension showed the hyperfluorescent areas originated from choroidal arterial abnormalities giving rise to confluent hyperfluorescent patches. Draining vessels connecting the choroidal vasculopathy with a vortex vein were evidenced in three eyes. A sector of apparent choroidal hypoperfusion downstream from the lesion was present in three eyes. During the follow-up period, the lesions remained occult and with an unchanged ICG angiographic pattern in all patients. CONCLUSION Some silent occult choroidal vascular abnormalities may be incidentally revealed by ICG angiography. These must be distinguished from ICG imaging of concomitant chorioretinal disorders.

Three different herpes simplex virus (HSV) mutants, designated hrR3, MGH-1 and R3616, were used to infect Y79 retinoblastoma cells grown in suspension. Two parameters were assayed: (a) vector-mediated gene expression, measured by histochemical staining of a transferred LacZ transgene, and (b) virus-mediated oncolysis, determined by the inability of infected cells to exclude trypan blue dye. The tested HSV mutants were found to infect cells grown in suspension at a relatively low multiplicity of infection (MOI = 0.01) and were capable of transferring the LacZ gene as early as 2 days after infection. Furthermore, differences in oncolytic activity were observed amongst the tested viruses: MGH-1 and R3616 exhibited 50% cell kill at a MOI of 0.1 over a period of 6 days, whereas hrR3-mediated oncolysis appeared less efficient. These studies provide a rationale for further exploitation of oncolytic herpes viruses as a potential treatment of intraocular tumors.

Diffuse correlation spectroscopy (DCS) measurements in vivo recorded from rabbits' ocular fundus are presented. Despite the complexity of these ocular tissues, we provide a clear and simple demonstration of the DCS abilities to analyze variations in physiological quantities of clinical interest. Indeed, the reported experimental activities demonstrate that DCS can reveal both choroidal-flow and temperature variations and detect nano- and micro-aggregates in ocular fundus circulation. Such abilities can be of great interest both in fundamental research and practical clinical applications. The proposed measuring system can be useful in: (a) monitoring choroidal blood flow variations, (b) determining the end-point for photo-dynamic therapy and transpupillary thermo therapy and, (c) managing the dye injection and determining an end-point for dye-enhanced photothrombosis. Moreover, it could allow both diagnoses when the presence of nano- and micro-aggregates is related to specific diseases and verifying the effects of nanoparticle injection in nanomedicine. Even though the reported results demonstrate the applicability of DCS to investigate ocular fundus, a detailed and accurate investigation of the limits of detection is beyond the scope of this article.

Single spectrometer-based complex conjugate artifact removal methods are evaluated for in vivo imaging with complementary metal-oxide semiconductor line scan camera based high-speed Fourier-domain optical coherence tomography (FD-OCT) at 100,000 axial scans per second. Performance of three different phase-shifting methods with the same OCT engine is evaluated using modified data acquisition schemes, depending on the requirements of each phase-shifting technique. The suppression ratio of complex conjugate artifact images using a paperboard is assessed for all tested methods. Several other characteristics, including a list of additional hardware requirements (beyond standard FD-OCT components) and data acquisition schemes for each of the methods is presented. In vivo full-range images of human fingerpad and nail are shown and compared with standard FD-OCT images. Additionally, a complex-conjugate-free human retinal volume acquired at the speed of 100,000 A-scans/s is presented. © 2010 Society of Photo-Optical Instrumentation Engineers.

· Background: Follicular large cell lymphoma of the orbit is a very rare and aggressive lymphoproliferative disease of the ocular adnexa. In this study we analyzed the clinicopathologic characteristics of one patient, including the immunoglobulin gene rearrangement assay by means of polymerase chain reaction. · Case report: A 71-year-old female underwent an incisional biopsy in the superior nasal quadrant of the left orbit following the occurrence of bilateral eyelid edema and ptosis. Histology and immunohistochemistry revealed a follicular large cell lymphoma of the orbit. Computerized tomography aimed at staging the disease revealed a supraclavicular lymphoadenopathy approximately 0.5 cm in diameter. Bone marrow biopsy was negative for lymphoma. The patient was classified as stage IV. She underwent a 10-week cycle of polychemotherapy (VP16, adriamycin, cyclophosphamide, vincristine, prednisone, bleomycin). Ten months after therapy, disease recurred at the cervical lymph nodes and the patient underwent a radiotherapy cycle of 4320 cGy with disease remission. At the time of writing, the patient presents a left axillary adenopathy on computerized tomography follow-up. · Conclusion: Ophthalmologists should be aware of possible rare occurrences of follicular large cell lymphomas of the orbit. In this case the clinical outcome is always more aggressive than the more common MALT-type lymphoma, which usually exhibits benign behavior.

Purpose: To measure the central-to-peripheral corneal thickness and its volume according to age and gender in 10-30-year-old patients with Down syndrome (DS) and in matched individuals without DS. Methods: In the report, 202 normal pattern right eyes of patients with Down syndrome and 190 right eyes of individuals without Down syndrome and compared averages using independent sample t-tests and multiple linear regression models. The measured variables included the apical corneal thickness; the minimum corneal thickness; the average thickness on rings at 2 mm (R2), 3 mm (R3), and 4 mm (R4); the corneal volume in the central zones at 2-, 3-, 4-, and 10-mm diameters; Ambrosio’s relational thickness; and the pachymetric progression indices. Results: The mean age of the participants was 16.99 ± 4.70 and 17.22 ± 4.54 years (p=0.636). The means ± SD were 516.7 ± 33.0 and 555.7 ± 33.1 µm for apical corneal thicknesses, 508.0 ± 33.5 and 549.0 ± 40.6 µm for minimum corneal thicknesses, 543.0 ± and 588.4 ± 33.8 µm for R2s, 584.9 ± 35.6 and 637.0 ± µm for R3s, 646.9 ± 38.5 and 707.6 ± 37.1 µm for R4s, 396.4 ± 102.3 and 462.7 ± 96.2 µm for Ambrosio’s relational thicknesses, 1.36 ± 0.37 and 1.22 ± 0.18 for pachymetric progression index maximums, 1.62 ± 0.11 and 1.74 ± 0.11 mm3 for corneal volume at 2 mm, 3.73 ± 0.24 and 4.01 ± 0.24 mm3 for corneal volume at 3 mm, 6.76 ± 0.44 and 7.30 ± 0.43 mm3 for corneal volume at 4 mm, and 57.03 ± 3.44 and 61.51 ± 3.40 mm3 for total corneal volume in the Down syndrome and control groups, respectively (all p

· Background: In pathologic myopia, choroidal neovascularization (CNV) usually occurs in macular region and at the center of the macular staphyloma. CNV has been reported to occur at the borders of an inferior posterior staphyloma in the tilted disc syndrome. We present a case of multiple simultaneous CNVs located at the borders of a myopic macular staphyloma. · Methods: The clinical and angiographic records of a myopic patient who presented several areas of choroidal neovascularization were reviewed. · Results: On fundus examination, four gray lesions surrounded by subretinal hemorrhages and covered by a large serous retinal detachment were observed at the borders of a posterior staphyloma. Fluorescein angiography revealed that these four lesions were CNVs extending from the borders of the staphyloma to the macular region. As measured by B-scan ultrasonography, the staphyloma was 4 mm deep. · Conclusion: This case supports the hypothesis that the borders of staphylomas are sites at risk for the development of CNV in pathologic myopia.

Background Due to the unique characteristics of the eye, ophthalmologic diagnostic techniques often rely on the photons interaction with the retina to infer its internal structure. Although these techniques are widely used, the interpretation of the generated images is not always fully understood, as in scanning laser ophthalmoscopy dark field imaging. This limits the exploitation of its full potential as a diagnostic tool for deep abnormalities in the retina, as in the situation of drusen. Methods With the aim of better understanding the retinal diagnostic images, we have carried out computer simulations of incident laser beams interacting with different structures of the human eye, including a retina with and without drusen. We have used the Geant4 simulation toolkit, applying the optical package of the electromagnetic (EM) physics working group, to simulate the physical processes of reflection, refraction, absorption, and scattering of low energy photons (2 eV) in biological tissues. For each simulation it was used a single beam of orange light, with a Gaussian profile, that travels through all optical elements of the eye. The reflected beam characteristics were analyzed by virtual detectors in different locations, which collected information about the number and position of photons. The geometry and optical properties of all components of the eye were considered according to the published data. Results Simulation results put in evidence that the presence of drusen influences the profile of the reflected beams. It changes the mean free path of the photons, modifying its reflection pattern, which depends on the area illuminated by the incident beam. This result is also visible when the reflected beam is analyzed outside of the eye, when the profile has no longer a symmetrical Gaussian distribution. These results will support the retinal diagnostic images that will be obtained in a near future with a new developed ophthalmic apparatus. Conclusions The shape analysis of the reflected beams in retinal laser scanning techniques could increase its potential as a diagnostic examination tool for the deeper structures of the retina.