Pérdida de agudeza visual progresiva en paciente con proptosis. Caso clínico y revisión de la literatura / Progressive visual impairment in a patient with proptosis. Case report and review of the literature.

Introducción: a raíz del siguiente reporte de caso clínico se pretende repensar el diagnóstico diferencial de los tumores orbitales y revisar la literatura existente al respecto. Caso: paciente de 54 años, fumadora, acude a nuestro centro por una pérdida de agudeza visual progresiva de dos años de evolución en el ojo derecho, que se acompañaba de proptosis. Las pruebas de imagen basadas en resonancia magnética y tomografía por emisión de positrones ­ tomografía computarizada (PET-TC) realizadas describían una lesión intraconal derecha de morfología indefinida, que rodeaba el nervio óptico. El estudio inmunohistoquímico y molecular anatomopatológico confirmó la sospecha de síndrome linfoproliferativo extranodal de bajo grado. Discusión: el manejo endoscópico de estas lesiones puede resultar en una menor comorbilidad en comparación con el abordaje externo tradicional. El papel de la cirugía radica en la obtención de una muestra de la lesión que permita un correcto diagnóstico. Conclusiones: el abordaje multidisciplinar con oftalmólogos, hematólogos y expertos en radioterapia permite obtener buenos resultados quirúrgicos y clínicos en la inmensa mayoría de casos.

Introduction: as result of the following clinical case report, we intend to review the differential diagnosis of orbital tumors and review the existing literature in this regard. Case report: a 54-year-old smoking patient, consulted to our department due to a progressive visual impairment over the last two years in her right eye. She presented proptosis in her clinical examination. Imaging studies based on MRI and PET-CT described a right intraconal lesion with an undefined morphology surrounding the optic nerve. Orbital tumors differential diagnosis is delicate. Nevertheless, Non-Hodgkin lymphomas followed by metastasis are the two most common found in this location. The immunohistochemistry and molecular studies, confirmed the suspected diagnosis of extranodal low-grade lymphoproliferative syndrome. Discussion: endoscopic management of these lesions may result in a lower comorbidity compared to traditional external approaches. Role of surgery lays in obtainment of a quality sample which allows a proper diagnosis. Conclusions: multidisciplinary approach with ophthalmologists, hematologists and radiotherapy experts enhance good surgical and clinical results in the vast majority of cases.

Baja visión y envejecimiento de la población / Low vision and population aging

El envejecimiento poblacional constituye un tema de gran preocupación mundial por su asociación con diversas enfermedades del ser humano que limitan su calidad de vida; muchas de ellas degenerativas. Se realiza una revisión con el objetivo de obtener una información actualizada sobre las causas de la baja visión y el envejecimiento poblacional. Cuba se sitúa en el cuarto lugar dentro de los países más envejecidos de América Latina. Con el envejecimiento aumentan los cambios fisiológicos y el deterioro visual, por lo que los ancianos de más de 60 años tienen ocho veces más probabilidad de tener un daño visual que los jóvenes. De ahí la importancia de diagnosticar y tratar oportunamente las enfermedades para evitar su progresión y las discapacidades visuales. El glaucoma constituye la segunda causa de ceguera en el mundo y la primera de ceguera irreversible en América Latina. Se sitúa entre las primeras causas de baja visión en Cuba, por lo que se deben desarrollar programas de detección de este, para así continuar elevando la expectativa de vida y proporcionarle una longevidad satisfactoria a nuestra población(AU)

Population aging is a topic of world concern because of its link to several human diseases that hinder the quality of life and are mostly degenerative. A literature review was made to collect updated information about the causes of low vision and population aging. Cuba holds the 4th place among the most aged countries in Latin America. The physiological changes and the visual deterioration increase with the aging, so the over 60 years-old elderly are eight times more likely to suffer some visual damage than the young people. Therefore, it is important to timely diagnose and treat diseases to avoid their progression and visual disabilities. Glaucoma represents the second cause of blindness worldwide and the first cause of irreversible blindness in Latin America. Likewise, it is one of the first causes of low vision in Cuba, hence detection programs should be developed to continue raising the life expectancies and providing our population with satisfactory longevity. Infomed, particularly the Virtual Library of Health, was used for this review(AU)

Teller test with functional vision evaluation in children with low vision / Teste com Cartões de Teller e avaliação da visão funcional em crianças com baixa visão

ABSTRACT Objective: To know the effectiveness of Teller card test along with the functional vision evaluation in low vision preschool children presenting normal or delayed development. Methods: Transversal study comprising patients from the children visual stimulation Ambulatory Service of the Faculty of Medical Sciences, University of Campinas Teaching Hospital, Campinas (SP)(FCM/HC/ Unicamp). The best corrected visual acuity was obtained using Teller cards and functional vision evaluation, independent from the child development. Results: From a total of 143 evaluated children, 65% did not respond to the Teller card test, only to, the functional vision evaluation. Among 143 children, 99 (70%) presented development delay and 44 (30%), normal development. Conclusion: The Teller card test was not enough to evaluate the children visual acuity with development delays, since more than half of them were not responsive to it, making it necessary that they were submitted to a complementary functional visual evaluation.

Objetivo: Conhecer a eficácia do teste com Cartões de Teller em complemento a avaliação da visão funcional em crianças préescolares com baixa visão e desenvolvimento normal ou atrasado. Métodos: Estudo transversal em pacientes do ambulatório de estimulação visual infantil do Hospital de Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (HC/ FCM/Unicamp). A acuidade visual com a melhor correção óptica foi medida com Cartões de Teller e avaliação da visão funcional, independente do desenvolvimento da criança. Resultados: De um total de 143 crianças avaliadas 65% não responderam ao teste de Teller, porém, em complemento à avaliação da visão funcional pôde ser conhecida a acuidade visual das mesmas. Dentre as 143 crianças, 99 (70%) apresentaram atraso no desenvolvimento e 44 (30%) desenvolvimento normal. Conclusão: O Teste com Cartões de Teller para se conhecer a acuidade visual de crianças com atraso em seu desenvolvimento não se apresentou suficiente, pois mais da metade das crianças avaliadas não foi responsiva ao mesmo, necessitando de complementação de avaliação da visão funcional para a medida da acuidade visual.

Capacidad funcional y calidad de vida en los ancianos con degeneración macular y baja visión / Functional capacity and quality of life in elderly patients with macular degeneration and low vision

OBJETIVO: caracterizar la capacidad funcional y la calidad de vida en los ancianos con degeneración macular y baja visión, atendidos en el Instituto Cubano de Oftalmología “Ramón Pando Ferrer” en el período comprendido de enero a junio de 2013. MÉTODOS: se realizó un estudio descriptivo, de corte transversal. Fueron estudiadas las siguientes variables: edad, sexo, color de la piel, agudeza visual mejor corregida de cerca con cartilla Zeiss, antes y después de la rehabilitación visual, discapacidad visual, capacidad funcional para las actividades de la vida diaria, tipo clínico de degeneración macular, factores de riesgo de la enfermedad, motivación para la rehabilitación visual y ayudas ópticas y no ópticas prescritas. RESULTADOS: existió un predominio de la enfermedad en las mujeres (55,2 %), entre los 75-79 años de edad y en el color de la piel blanca. La discapacidad visual que prevaleció fue la baja visión ligera a moderada; la capacidad funcional mayormente encontrada fue la independencia con alguna limitación. La degeneración macular seca se presentó en el 82,7 % de los casos; el factor de riesgo más frecuente fue el tabaquismo (82,7 %); la lectoescritura fue la motivación principal y el mayor número de pacientes mejoró la agudeza visual después de la rehabilitación visual. Las ayudas ópticas y no ópticas que más se prescribieron fueron los microscopios y la iluminación. CONCLUSIONES: el grupo de edades entre 75 y 79 años, el sexo femenino y la piel blanca o caucasiana son los factores que aportan un mayor número de casos de degeneración macular y baja visión. La discapacidad visual que prevalece es la de los clasificados como baja visión ligera a moderada. La degeneración macular seca se presenta en casi la totalidad de los casos. Los factores de riesgo más frecuentes son el tabaquismo, la herencia y las enfermedades cardiovasculares. El mayor número de pacientes mejora después de la rehabilitación visual.

OBJECTIVE: to characterize the functional capacity and the quality of life of the elderly people with macular degeneration and low vision who were seen at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology from January to June 2013. METHODS: cross-sectional and descriptive study that included the following variables: age, sex, race, best corrected near visual acuity using Zeiss chart before and after visual rehabilitation, visual disability, functional capacity for daily life activities, clinical type of macular degeneration, risk factors for the disease, reason for visual rehabilitation and prescribed optical and non-optical aids. RESULTS: the disease prevailed in females (55,2 %), 75-79 years-old age group and Caucasians. Predominant visual disability was mild to moderate low vision; the mostly found functional capacity was independence with some limitations. Dry macular degeneration was present in 82,7 % of cases; the most frequent risk factor was smoking (82,7 %); reading and writing was the main motivation and a large number of patients improved their visual acuity after rehabilitation. The optical and non-optical aids that were mostly prescribed included microscopes and lighting. CONCLUSIONS: females, 75-79 years-old age group and Caucasians are the risk factors that cause the highest number of cases with macular degeneration and low vision. Visual disability prevailed among those classified as mild to moderate low vision patients. Dry macular degeneration was present in almost all the cases. The most frequent risk factors were smoking, heredity and cardiovascular diseases. Most of the patients improved their condition after visual rehabilitation.

Caracterización clinicoepidemiológica de la baja visión en el adulto mayor y su rehabilitación visual / Clinical and epidemiolotical characterization of the low vision in the older adult and their visual rehabilitation

OBJETIVO: caracterizar clínica y epidemiológicamente a los pacientes con diagnóstico de baja visión, así como su rehabilitación. MÉTODOS: se realizó un estudio descriptivo, prospectivo, en 628 pacientes atendidos en el Servicio de Baja Visión en el período de 2011 a 2012 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Se recogieron los datos generales, los antecedentes generales y oculares, el defecto refractivo, la causa de la baja visión, la motivación, la ayuda óptica y la evaluación de la rehabilitación visual. La información obtenida se plasmó en una base de datos; posteriormente se procesaron y analizaron para dar salida a los objetivos del estudio. RESULTADOS: predominaron el sexo femenino, la raza blanca y el grupo de edad entre 70 y 79 años. La mayor parte de los pacientes no presentaron enfermedad sistémica y sí estuvo presente en la mayoría de los pacientes con predominio del glaucoma, lo que constituyó la primera causa ocular de discapacidad visual en estos. La ayuda óptica estuvo en correspondencia con la motivación expresada por ellos, donde la principal fue la lectoescritura. En la mayoría de los casos se logró una adecuada rehabilitación. CONCLUSIONES: en los casos de baja visión, la rehabilitación presenta relación estadística con el sexo, los antecedentes patológicos generales, la motivación y la ayuda óptica, algunas sin explicación clínica.

OBJECTIVE: with the objective of characterizing clinical epidemically to the patients with diagnostic of low vision as well as its rehabilitation. METHODS: was carried out a descriptive study, prospective in 628 patients assisted in the service of Low Vision in the period from the 2011 to the 2012 in the ICO "Ramón Pando Ferrer". the general data were picked up, the general and ocular antecedents, refractive defect, causes of the drop vision, motivation, helps optics and evaluation of the visual rehabilitation. The obtained Information was captured in a database, later on they were processed and they analyzed to give exit to the objectives of the study. RESULTS: it prevailed the feminine sex, the white race and the age group between 70 and 79 years. Most of the patients didn't present systemic illness. I didn't seize in the ocular pathological antecedents that it was present in most of the patients with prevalence of the glaucoma, constituting the first ocular cause of visual discapacidad in these. The optic help was in correspondence with the motivationexpressed by the same ones, where the lecture-write was the main one, in most of the cases an appropriate rehabilitation was achieved. CONCLUSIONS: the rehabilitation was evaluated meeting statistical relationship with the sex, the general pathological antecedents, the motivation and the optic help, some without clinical explanation.

Discapacidad visual; otra forma de verla / Visual impairment; another way of see it

La discapacidad visual es un problema de salud pública que afecta a más de doscientos ochenta y cinco millones de personas alrededor del mundo, dentro de los cuales doscientos cuarenta y seis millones sufren baja visión y treinta y nueve millones ceguera primaria. Es una entidad altamente relacionada con las condiciones socioeconómicas y las posibilidades de acceder a los servicios de salud, esto explica que entre el 80 y el 90 por ciento de las personas con alteraciones visuales sean de países en vía de desarrollo, principalmente en zonas rurales. Una infinidad de casos de ceguera y baja visión son consecuencia de eventos prevenibles, entre los cuales sobresalen los defectos refractivos no corregidos tales como astigmatismo, miopía, hipermetropía y presbicia. Es por esto que la discapacidad visual se ha convertido en una prioridad para múltiples entidades a nivel mundial, que buscan disminuir la presentación de ceguera prevenible a través de una simple corrección visual bien diagnosticada...

Visual impairment is a public health problem that affects more than two hundred eighty-five million people around the world, among them two hundred forty-six million suffer low vision and thirty-nine million primary blindness. It is highly related to socio-economic conditions and the possibilities to access to health services, explained that between 80 and 90 percent of persons with visual impairments from countries developing, mainly in rural areas. An infinite number of cases of blindness and low vision are the result of events preventable, among which stand out the uncorrected refractive errors such as myopia, hyperopia, astigmatism and presbyopia. It is for this reason that visual impairment has become a priority for many organizations around the world, seeking to reduce the presentation of preventable blindness through a simple visual correction well diagnosed...

Avaliação da visão funcional infantil em serviço oftalmológico universitário / Functional vision evaluation for children in university ophthalmological service

Objetivo: Avaliar a Visão Funcional de crianças de zero a 5 anos e 11 meses de idade, após diagnóstico oftalmológico de Baixa Visão, para identificar a necessidade de Estimulação Visual no grupo estudado do Serviço de Estimulação Visual/VSN/OFTALMOLOGIA/HC/FCM/UNICAMP. Materiais e Métodos: Trata-se de estudo transversal analítico, aprovado pelo Comitê de Ética em Pesquisa, nº 1025/2010. Foi utilizado instrumento de Avaliação da Visão Funcional Infantil, organizado após estudos na literatura de autores nacionais e internacionais, na busca por avaliações da visão funcional que contemplassem a necessidade do serviço. Considerando-se as diferentes faixas etárias infantis propostas neste estudo, com n = 143, ponderou-se sobre a efetividade de algumas avaliações pesquisadas, organizando-se instrumento avaliatório, com tópicos, desenvolvidos de maneira a se obter respostas visuais eficientes para determinar condutas em Estimulação Visual. O Instrumento de Avaliação da Visão Funcional Infantil foi aplicado em grupo controle, com mesmo n (n=143) para sua validação. Resultados: As afecções oftalmológicas, responsáveis pelas deficiências visuais do grupo estudado foram: Retinopatia da Prematuridade, Afecções de Nervo Óptico, Deficiência Visual Cortical, Coriorretinite Macular Infecciosa, Malformações Oculares, Catarata Infantil, Degenerações Primárias da Retina, Glaucoma Congênito, Ceratopatias e Trauma Ocular ou Orbitário. A distribuição por idades foi determinada pela proximidade de respostas visuais esperadas para cada faixa etária deste estudo. Em relação ao Desenvolvimento Neuro Psico Motor (DNPM), 44 (30%) crianças apresentavam Bom desenvolvimento Neuro Psico Motor (BDNPM) e 99 (70%) Retardo no Desenvolvimento Neuro Psico Motor (RDNPM). No grupo controle, 2 crianças (1,4%) apresentaram RDNPM.

Objective: To evaluate the Functional Vision in children between zero and 5 years and 11 months old, after ophthalmological diagnosis of Low Vision, in order to identify the necessity of Visual Stimulation in the studied group from the Visual Stimulation Service/VSN/OPHTHALMOLOGY/HC/FCM/UNICAMP. Materials and Methods: This is a transversal analytical study, approved by the Research Ethics Committee, nº 1025/2010. It was used an Instrument for Functional Vision Evaluation for Children, organized after studies in the literature of national and international authors, in the search for functional vision evaluations which addressed the need for the service. Considering the different infant ages proposed on this study, with n = 143, the effectiveness of some evaluations surveyed were pondered, resulting in the organization of an evaluation instrument, with topics, developed in order to obtain efficient visual answers to determine Visual Stimulation conducts. The Instrument for Functional Vision Evaluation was applied in the Control Group, with similar n (n=143) for its validation. Results: The ophthalmologic diseases, responsible for the visual deficiencies of the studied group were: Retinopathy of Prematurity, Optical Nerve Disorder, Cortical Visual Deficiency, Infectious Macular Chorioretinitis, Ocular Malformations, Child Cataract, Retinal Primary Degenerations, Congenital Glaucoma, Ceratopatias and Ocular or Orbital Trauma. The age distribution was determined by the proximity of visual responses expected for each group age on this study. Regarding to the Psycho Neuro Motor Development (PNMD), 44 (30%) of the children presented Good Psycho Neuro Motor Development (GPNMD) and 99 (70%) presented Retardation of Psycho Neuro Motor Development (RPNMD).

Qualidade de vida de crianças com deficiência visual atendidas em Ambulatório de Estimulação Visual Precoce / Quality of life in visual impaired children treated for Early Visual Stimulation

OBJETIVO: Analisar a qualidade de vida em crianças com deficiência visual atendidas em Ambulatório de Estimulação Visual Precoce da Unifesp em duas situações, antes e após intervenções reabilitacionais pela equipe multiprofissional. MÉTODOS: Aplicou-se o questionário de qualidade de vida QFVI. O instrumento possui uma versão para crianças menores de três anos e outra para crianças maiores de três anos (três a sete anos) e é dividido em seis domínios: Saúde geral; Saúde geral da visão; Competência; Personalidade; Impacto familiar e Tratamento. RESULTADOS: A correlação entre as subescalas nos dois momentos mostrou-se significativa. Houve diferença estatisticamente significativa em saúde geral da visão (p=0,029) e outras diferenças importantes foram obtidas em saúde geral, impacto familiar e qualidade de vida geral. DISCUSSÃO: Este instrumento mostrou-se eficiente na aferição da qualidade de vida relacionada à visão nas famílias que frequentam esse ambulatório. As intervenções multidisciplinares promoveram melhora da visão funcional da criança e qualidade de vida da família como um todo. CONCLUSÃO: A qualidade de vida relacionada à visão de crianças atendidas no Ambulatório de Estimulação Visual Precoce da Unifesp apresentou melhora significativa na saúde geral da visão.

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.

Screening for visual impairment: Outcome among schoolchildren in a rural area of Delhi.

Background: Uncorrected refractive errors are the main cause of vision impairment in school-aged children. The current study focuses on the effectiveness of school eye screening in correcting refractive errors. Objectives: 1. To study the magnitude of visual impairment among school children. 2. To assess the compliance of students for refraction testing, procurement and use of spectacles. Materials and Methods: An intervention study was conducted in schools of the north- west district of Delhi, in the rural field practice area of a medical college. Students studying in five government schools in the field practice area were chosen as the study subjects. Results: Out of 1123 students enrolled, 1075 (95.7%) students were screened for refractive errors. Low vision (visual acuity < 20/60) in the better eye was observed in 31 (2.9%) children and blindness (visual acuity <20/200) in 10 (0.9%) children. Compliance with referral for refraction was very low as only 51 (41.5%) out of 123 students could be tested for refraction. Out of 48 students, 34 (70.8%) procured spectacles from family resources but its regular use was found among only 10 (29.4%) students. The poor compliance among students stems out of various myths and perceptions regarding use of spectacles prevalent in the community. Conclusion: Refractive error is an important cause of avoidable blindness among rural school children. Behavior change communication among rural masses by spreading awareness about eye health and conducting operational research at school and community level to involve parent's teachers associations and senior students to motivate students for use of spectacles may improve utilization of existing eye health services in rural areas.

Serviço de visão subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC): análise dos pacientes atendidos no 1º ano do departamento (2004) / Low vision service at the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC): analysis of the patients examined on the first year of the department (2004)

Objetivo: Traçar o perfil dos pacientes portadores de baixa visão atendidos no serviço de visão subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC). Métodos: Realizou-se um estudo transversal no qual foram revisados 82 prontuários de pacientes com baixa visão, atendidos pelo Serviço Único de Saúde (SUS) no primeiro ano do departamento de Visão Subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira em 2004. Os dados analisados foram: sexo, faixa etária, etiologia, acuidade visual inicial e final (pós-refração) para longe e perto, com e sem auxílio óptico e recurso óptico indicado. Resultados: Dos 82 pacientes avaliados, 11 (13,4 por cento) foram excluídos do trabalho por não apresentarem visão subnormal. Dos 71 pacientes restantes, 32 (45 por cento) eram menores de 20 anos. Quanto ao sexo, não houve diferença estatisticamente significante (51 por cento eram mulheres e 49 por cento eram homens). A etiologia mais frequente em crianças e adolescentes foi o glaucoma congênito (15,6 por cento). Em pacientes de 20 a 39 anos prevaleceu a toxoplasmose ocular (21,1 por cento). Entre os pacientes de 40 a 59 anos, a retinose pigmentar foi a patologia mais frequente (19 por cento). Nos idosos, o glaucoma foi a patologia mais encontrada (40 por cento). Trinta e três pacientes (40,2 por cento) tinham acuidade visual entre 20/60 e 20/160. O sistema telescópico foi o único auxílio óptico indicado para longe (44 por cento) e os óculos foram os mais indicados para perto (54,5 por cento). Conclusão: Existe uma alta prevalência de baixa visão em crianças e adolescentes em países em desenvolvimento como o Brasil. Desta forma o oftalmologista precisa criar programas preventivos, melhorar as condições de atendimento e atentar para o diagnóstico precoce e o tratamento destes pacientes.

Purpose: To outline low vision (LV) patients profile of the low vision department of the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC). Methods: Transversal study of 82 medical charts from the low vision service at the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira of the first year of the department - 2004, considering age, gender, etiology, distance and near visual acuity with and without optical aids and prescription assistance. Results: Of the 82 available patients, 11 (13.4 percent) were excluded of the study because they did not present low vision. Of the 71 patients, 32 (45 percent) were younger than 20 years old. Regarding the gender, there was not a significant difference (51 percent female and 49 percent male). The most frequent etiology in infants and adolescents was congenital glaucoma and in patients aged between 20-39 years was ocular toxoplasmosis (21.1 percent). In patients with 40-59 years old, pigmentary retinosis was the most frequently pathology (19 percent). In elderly people it was glaucoma (49 percent). Thirty-three patients (40.2 percent) had visual acuity between 20/60 and 20/160. The telescopic system was the only optical aid indicated for distance (44 percent) and glasses were the most indicated for near (54.5 percent). Conclusion: There is a high prevalence of low vision in infants and adolescents that live in developing countries like Brazil. Therefore, ophthalmologists need to be aware to promote early diagnosis and treatment to these patients, creating preventive programs and better assistance conditions.

Síndrome isquémico ocular / Ocular ischemic syndrome

El síndrome isquémico ocular es caracterizado por síntomas y signos oculares secundarios a la estenosis severa y prolongada ipsilateral de la arteria carótida interna extracraneal o de la arteria carótida común, ocasionalmente, se ha asociado a la oclusión de la arteria oftálmica. En general, se considera un diagnóstico poco usual y constituye la tercera causa más común de glaucoma neovascular con pobre pronóstico visual. Hallazgos oculares incluyen disminución progresiva de la visión, inflamación del segmento anterior, neovascularización del iris y del ángulo iridocorneal, glaucoma neovascular y retinopatía por hipoperfusión periférica. Describimos un paciente con severa estenosis carotídea ipsilateral y disminución progresiva de la visión por la isquemia ocular. Se realiza una revisión sobre el manejo de esta condición tan controversial

Ocular ischemic syndrome is characterized by ocular symptoms and signs that are secondary to prolonged and severe ipsilateral stenosis of extracranial internal carotid artery or of the common carotid artery; occasionally, ipsilateral ophthalmic artery obstruction can also be responsible. It is generally considered as an unusual diagnosis, and the 3rd most common cause in neovascular glaucoma with poor visual prognosis. Ocular findings include gradual onset of decreased vision, inflammation of the anterior segment, iris and iridocorneal angle neovascularization, neovascular glaucoma and peripheral hypoperfusion retinopathy. Here is a patient with l severe ipsilateral carotid stenosis and progressive visual loss due to ocular ischemia. A literature review on the best management of this so controversial condition was made

Diagnóstico de baixa visão em crianças: sentimentos e compreensão de mães / Diagnosis of low vision in children: feelings and comprehension of mothers

OBJETIVOS: Identificar os sentimentos e reações de mães perante ao diagnóstico de baixa visão do filho e a sua compreensão do diagnóstico. MÉTODOS: Este estudo caracteriza-se como uma pesquisa qualitativa. Foram entrevistadas 11 mães de crianças com baixa visão atendidas pelo Serviço de Estimulação Visual do Setor de Oftalmologia Hospital de Clínicas da Unicamp. Para a coleta dos dados foram utilizadas entrevistas semiestruturadas. Os tópicos principais da entrevista foram: sentimentos diante do diagnóstico e a compreensão do diagnóstico da baixa visão. RESULTADOS: As mães apresentaram medo de que o filho fique cego e compreensão não clara da baixa visão, interpretando o diagnóstico médico de acordo com a sua subjetividade. CONCLUSÕES: A maneira como o diagnóstico é transmitido para as famílias é de extrema importância. As condições culturais, econômicas e emocionais dos pais, na maioria das vezes podem impedir a compreensão clara do diagnóstico.

PURPOSE: To identify mothers' feeling and reactions when facing the diagnosis of low vision and their comprehension of this diagnosis. METHODS: This study features a qualitative research. Eleven low vision children's mothers attended at the Visual Stimulation Service of Ophtalmology Sector of Unicamp Hospital were interviewed. Semi-strutured interviews were used to collect data. The main issues of the interview were: feelings when faced with the diagnosis and comprehension of this low vision diagnosis. RESULTS: The results revealed mothers' fear of blindness and a low comprehension of the meaning of low vision, and their interpretation of medical diagnosis according to their subjectivity. CONCLUSIONS: The way the diagnosis is transmitted to the families is extremely important. Parents cultural, economical and emocional background may often impair the diagnosis comprehension.

Evaluation of ‘vision screening’ program for three to six-year-old children in the Republic of Iran.

Background: Since 1996, vision screening of three to six-year-old children is conducted every year in Iran. We present outcomes of project review held in August 2006. Materials and Methods: Kindergarten teachers examined vision by using Snellen's illiterate ‘E’ chart. They used torchlight to detect strabismus. On a repeat test, if either eye had vision <20/30, the child was referred to the optometrist. A pediatric ophthalmologist examined and managed children with strabismus or amblyopia. Provincial managers supervised the screening program. The evaluator team assessed the coverage, yield, quality and feasibility, and cost-effectiveness of vision screening, as well as magnitude of amblyopia, and its risk factors. Result: In 2005, 1.4 million (67%) children were examined in all provinces of Iran. Opticians examined 90,319 (61%) children with defective vision that were referred to them. The prevalence of uncorrected refractive error, strabismus and amblyopia was 3.82% (95% CI 3.79 – 3.85), 0.39% (95% CI 0.38 – 0.40) and 1.25% (95% CI 1.24 – 1.26) respectively. Validity test of 7,768 children had a sensitivity of 74.5% (95% CI 72.7 – 76.3) and specificity of 97.2% (95% CI 96.7 – 97.7). The cost of amblyopia screening was US $ 1.5 per child. While the cost of screening and treating one child with amblyopia was US $ 245. Conclusion: A review of the vision screening of children in Iran showed it with screening and useful exercise and had a yield of 1:21. The coverage of vision screening was low and the management of children with amblyopia, low vision and refractive error needed strengthening.

Electroretinographic assessment and diagnostic reappraisal of children with visual dysfunction: a prospective study.

PURPOSE: To assess the presence or absence of a retinal cause of visual impairment using electroretinography (ERG) in children with no obvious discernable cause on ocular examination. DESIGN: Prospective observational case series. MATERIALS AND METHODS: A prospective study was carried out involving 120 children with the mean age 4.4+/-3.2 years with visual dysfunction. All children underwent ERG under general anesthesia using a special handheld mini-Ganzfeld (Kurbisfeld) dome. RESULTS: Fifty-two (43.3%) children were male and 68 (56.7%) were female. The clinical diagnosis was as follows: Leber's congenital amaurosis (LCA) (n=47), achromatopsia (n=25), congenital stationary night blindness (CSNB) (n=9) and others (unclassifiable, n=39). The visual acuity ranged from perception of light (PL) to PL with projection in children with LCA. In the rest (n=73), some sort of visually guided behavior was discernable. Following ERG, a diagnostic reappraisal resulted as follows: LCA (n=49), achromatopsia (n=28), CSNB (n=4), cone-rod dystrophy (n=22), rod-cone degeneration (n=7), normal (n=8) and others (unclassifiable, n=2). Except for the two unclassifiable cases, ERG was successful in the diagnosis or exclusion of retinal dysfunction in the rest. By Pearson Chi-square test, there was a statistically significant association between the clinical and ERG diagnosis (P < 0.001). CONCLUSION: LCA was the commonest cause of visual dysfunction in our series. A statistically significant correlation between clinical and electrophysiological diagnosis was seen. ERG helped in firmly establishing the presence or absence of global retinal dysfunction in the majority (118/120) of pediatric patients with visual dysfunction.

Achados oftalmológicos em pacientes com múltiplas deficiências / Ophthalmologic findings in multiple handicapped patients

OBJETIVO: Relatar os achados oftalmológicos em portadores de múltiplas deficiências. MÉTODOS: Foram estudados 274 usuários do Sistema Unico de Saúde atendidos no Departamento de Oftalmologia Pediátrica e Estrabismo da Fundação Altino Ventura (FAV), no período de junho a setembro de 2004. RESULTADOS: A freqüência dos pacientes quanto ao gênero foi de 58,5 por cento para o masculino e 41,5 por cento para o feminino. A variação das idades foi de 0,1 a 20 anos com mediana de 5. A maioria (61,3 por cento) dos pacientes apresentava boa acuidade visual, contudo 38,7 por cento apresentava baixa de visão (< 20/80). As heterotropias foram vistas em 66 pacientes (24,0 por cento). Os transtornos refracionais mais freqüentes foram astigmatismo (53,2 por cento) e hipermetropia (29,0 por cento). CONCLUSÃO: Crianças com múltiplas deficiências necessitam de diagnóstico e tratamento oftalmológico precoce, possibilitando um melhor desenvolvimento global. A integração de uma equipe multidisciplinar constituída de pediatras, oftalmologistas pediátricos e profissionais de visão subnormal pode assegurar melhor qualidade na reabilitação visual.

PURPOSE: To report the visual findings in patients with multiple handicaps. METHODS: Two hundred and seventy-four patients cared for at the Pediatric and Strabismus Ophthalmology Department of the "Fundação Altino Ventura" - Brazilian National Health System, were examined from June to September 2004. Age varied from 0.1 to 20 years with a median of 5. RESULTS: The majority of the patients (61.3 percent) presented good visual acuity; however low visual acuity (< 20/80) was observed in 38.7 percent of the patients. Heterotropias were observed in 66 patients (24.0 percent); astigmatism (53.2 percent) and hyperopia (29.0 percent) were more frequent. CONCLUSION: Children with multiple handicaps need an early ophthalmologic diagnosis and treatment for better global development. The integration of a multidisciplinary team with pediatricians, pediatric ophthalmologists and specialists in low vision, may assure a better visual rehabilitation.

Freshwater sponge spicules: a new agent of ocular pathology

In a recent outbreak of human ocular injuries that occurred in the town of Araguatins, at the right bank of Araguaia river, state of Tocantins, Brazil, along the low water period of 2005, two patients (8 and 12-year-old boys) presented inferior adherent leukoma in the left eye (OS), and peripherical uveites, with snowbanking in the inferior pars plana. The third one (13-year-old girl) showed posterior uveites in OS, also with snowbanking. Histopathological analysis of lensectomy material from the three patients and vitrectomy from the last one revealed several silicious spicules (gemmoscleres) of the freshwater sponges Drulia uruguayensis and D. ctenosclera. This work brings material evidences, for the first time in the literature, that freshwater sponge spicules may be a surprising new etiological agent of ocular pathology.

Reabilitação visual em pacientes com retinose pigmentária / Visual rehabilitation in patients with retinitis pigmentosa

OBJETIVOS: Determinar quais auxílios de visão subnormal podem ser úteis na reabilitação de pacientes com retinose pigmentária e os benefícios adquiridos com o programa de reabilitação visual baseado em medidas de acuidade visual nas tarefas da vida diária. MÉTODOS: Participaram deste estudo 30 pacientes com retinose pigmentária com idade variando de 7 a 73 anos. Foram realizados testes de acuidade visual e de função visual (perimetria manual, eletrorretinograma de campo total) e testes de adaptação de auxílios de visão subnormal. Um histórico visual foi pesquisado e perguntas específicas da utilização da visão foram feitas. Foi efetuado programa de treinamento do auxílio óptico a ser adaptado e de manuseio do mesmo antes de sua prescrição final. RESULTADOS: A acuidade visual no melhor olho variou de MM (movimentos de mão) a 20/40 para longe e visão melhor que 16M a 0,5M para perto. Do total de pacientes, 90 por cento receberam prescrição de auxílio óptico ou eletrônico: treze para perto, nove para longe, dois auxílios eletrônicos e três lentes filtrantes. Três pacientes com grave constrição de campo visual e profunda baixa de acuidade visual foram encaminhados para orientação e mobilidade. CONCLUSÕES: Os auxílios ópticos: os telescópios, as lupas manuais e de apoio, as lentes esferoprismáticas, os auxílios não ópticos, os auxílios eletrônicos e iluminação adequada foram úteis na reabilitação visual de pacientes com retinose pigmentária, podendo trazer benefícios como a melhora da acuidade visual e da eficiência visual. A prescrição dos auxílios ópticos possibilitou a realização de atividades da vida diária, antes prejudicada pela deficiência visual, sendo relatado alto nível de satisfação por parte dos pacientes, com o programa de reabilitação visual implementado.

PURPOSE: To determine which low-vision aids could be useful to patients with retinitis pigmentosa and also the benefits that the rehabilitation program could provide based on visual acuity and/or daily visual tasks. METHODS: A group of 30 patients with retinitis pigmentosa aged from 7 to 73 years were enrolled in this study. Visual acuity and visual function tests (visual field, full-field electroretinogram) was performed and low-vision aids tested. Information about the use of the remaining vision was obtained. After choosing the best optical or electronic devices and before their prescription, a low-vision training program was carried out. RESULTS: The best corrected visual acuity varied from HM (hand movements) to 20/40 for distance and visual acuity better than 16M to 0.5M for near. 90 percent of the patients had optical devices prescribed: 13 for near, 9 for distance, 2 electronic devices and 3 filters. Three patients with extremely narrow visual field and very low visual acuity were referred to orientation and mobility. CONCLUSIONS: The low-vision aids were useful for the retinitis pigmentosa patients: telescopes, hand-held magnifiers, stand magnifiers, half-eye base-in prism lenses, electronic devices and illumination control were beneficial to enhance visual acuity and visual efficiency. The prescription of low-vision aids was helpful in daily-life activities and a high level of satisfaction with the implemented visual rehabilitation program was reported.