Lacrimal gland atrophy and dry eye related to isotretinoin, androgen, and prolactin: differential diagnosis for Sjögren's syndrome.

This report is of three cases of sicca syndrome, initially suspected to be Sjögren's syndrome, which was ruled out by clinical and laboratory investigations. The patients were a 24-year-old woman, a 32-year-old man, and a 77-year-old woman with chronic symptoms of sicca syndrome, including dry eye syndrome. The first case was associated with the use of isotretinoin, a retinoic acid. The second was associated with the use of anabolic androgenic steroids, and the third was related to a prolactin- secreting pituitary adenoma. All cases manifested sicca, including dry eye syndrome, after those events, and the manifestations persisted. Magnetic resonance imaging revealed bilateral atrophy of the lacrimal gland. The medical history, ocular examinations, laboratory exams, and magnetic resonance images confirmed dry eye syndrome; however, the exams were all negative for Sjögren's syndrome. The lacrimal gland was absent on magnetic resonance imaging in all three cases. The clinical history revealed that the signs and symptoms appeared after chronic exposure to retinoic acid, anabolic androgenic steroids, and a prolactin-secreting pituitary adenoma, respectively. Chronic isotretinoin, anabolic androgenic steroids, and prolactin-secreting pituitary adenoma or, in this last case, its inhibitory treatment, can cause lacrimal gland atrophy, sicca syndrome, and dry eye syndrome, and a differential diagnosis of Sjögren's syndrome. Further studies on doses, time, and other susceptibilities to the long-lasting adverse effects of retinoic acid, anabolic androgenic steroids, and the repercussions of prolactin-secreting pituitary adenoma are necessary to confirm and expand upon these associations.

Causes and risk factors for graft failure in surgeries performed by physicians in fellowship training.

PURPOSE: To determine the incidence, causes, and risk factors of penetrating keratoplasty failure. METHODS: A retrospective study was carried out in 213 penetrating keratoplasties (194 patients) between January 1995 and January 2001 at the Cornea Section of the Ophthalmology Service at the School of Medicine, Federal University of Uberlândia MG, Brazil. Follow-up time for 213 surgeries ranged from 2 to 68 months (mean 29.05 +/- 17.17 months). RESULTS: Two hundred thirteen surgeries were evaluated, and 54 (25.3%) failed. Risk factors for developing graft failure were regraft [relative risk (RR) = 2.9734], trauma (RR = 1.4602) and herpes (HSV) (RR = 1.3400). Patients with previous glaucoma (P < 0.00001), previous ocular surgery (P < 0.0008), combined procedures (P < 0.001), and glaucoma after penetrating keratoplasty (P < 0.00001) had an increased the rate of graft failure. The main causes of graft failure were irreversible rejection (50%), glaucoma (20.3%), primary graft failure (16.6%), and infection (3.8%). CONCLUSION: Graft failure is a common problem in cornea transplantation. Etiology and pre- and postsurgical risk factors are important in the prognosis of keratoplasties.

Trauma ocular em crianças: um estudo epidemiológico na universidade federal de Uberlândia nos últimos cinco anos / Open-globe injuries in children: an epidemiological study at the federal university of Uberlândia in the last five years

Relatar a frequência, as causas, as condições da ocorrência e as complicações dos traumas oculares em crianças admitidas ao Hospital de Clínicas da Faculdade de Medicina da Universidade Federal de Uberlândia (HC-UFU). Método: Análise retrospectiva dos prontuários de 38 crianças (com até 15 anos de idade) que sofreram trauma ocular e foram atendidas no setor de emergência do HC-UFU no período de janeiro de 1996 a dezembro 2000. Os dados foram analisados usando o teste t-Student e o teste Qui-quadrado. Resultados: Os meninos foram acometidos aproximadamente 2.5 vezes mais que as meninas. A idade média foi de 8,70 ± 4,56 anos entre meninos e 7,00 ± 3,74 anos nas meninas. A média de segmento foi de 22,63 ± 20,99 meses. Foram encontrados 34 ferimentos penetrantes (89,5%), um ferimento perfurante (2,6%), um ruptura (2,6%) e dois casos com corpo estranho intraocular (CEIO) associado (5,3%), com acometimento corneano em 71.1% dos casos. Os acidentes domésticos foram a causa a mais comum de trauma. A melhor acuidade visual final corrigida encontrada foi melhor de 0,5 em 13,1% dos pacientes com acometimento corneano e 5,3% com acometimento escleral. Seis pacientes (15,8%) perderam completamente a visão do olho afetado. Conclusões: Os traumas oculares nas crianças permanecem um grave problema e continuam sendo uma causa importante de perda da visão. O lugar mais comum de ocorrência é em casa.

To report the frequency, causes, occurrence conditions and complications of eye injuries in children admitted in the Clinic Hospital of the Medical College of the Federal University of Uberlândia (HC-UFU). Method: Retrospective review of the records of 38 children (15 years of age or younger) that suffered penetrating injuries and were assisted at the HC-UFU emergency room from January 1996 through December 2000. Results: the male to female ratio was approximately 2.5:1. The mean age was 8.70 ± 4.56 years between boys and 7.00 ± 3.74 years in girls. We found 34 penetrating injuries (89.5%). Domestic accidents were the most common cause of injury. Six patients (15.8%) lost the vision of the injured eye completely. Conclusions: Serious eye injuries in children remain n a problem and the most common place for it occurs is the home and ocular trauma continues being an important cause of vision impairment.

A study of glaucoma after penetrating keratoplasty.

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

Ocular lesions arising after stings by hymenopteran insects.

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

Bilateral endogenous endophthalmitis associated with infective endocarditis: case report

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

Descompensação corneana por toque entre alça de lente intra-ocular e endotélio: relato de um caso / Corneal descompensation by touch between intraocular lens haptic and endothelium: case report

Os autores descrevem o caso de uma paciente submetida a extração extracapsular da catarata com implante de lente intra-ocular (LIO) no sulco ciliar e que apresentou descompensação corneana pelo toque da alça da LIO no endotélio quatro anos após cirurgia

Retinoblastoma: encaminhamento ao Hospital A. C. Camargo/Fundaçäo Antonio Prudente durante 15 anos sequenciais / Retinoblastoma: a fifteen year on line income to A. C. Camargo/Antonio Prudente Foundation - Säo Paulo

Foram avaliados os prontuários de 249 pacientes portadores de retinoblastoma vistos no Hospital A. C. Camargo da Fundaçäo Antonio Prudente no período de janeiro de 1975 a dezembro de 1989; desses, 164 (65,9//) eram unilaterais e 85 (34,1//) eram bilaterais. A idade de aparecimento dos primeiros sinais variou do nascimento aos 113 meses; a idade de encaminhamento ao serviço variou de 0 a 115 meses, a idade de encaminhamento ao Serviço variou de 0 a 115 meses, podendo-se constatar uma demora no encaminhamento principalmente nas faixas de menor idade. O tumor era intra-ocular ao dignóstico em 156 (63,9//) e extra-oculares em 88 (36,1//). Verificamos uma tendência à diminuiçäo de encaminhamentos nos estádios extra-oculares nos últimos anos. A frequência total de óbitos foi de 26,6//; observou-se diminuiçäo dessa taxa a partir de 1982, tanto nos tumores intra como nos extra-oculares. Acreditamos que o diagnóstico e o encaminhamento precoce a centros especializados de tratamento säo fatores essenciais para o progresso na cura desta doença

Cultura de material provindo de úlceras de córnea em laboratório de referência / Corneal ulcers cultures in refering laboratory

Análise dos resultados das culturas obtidas de material de úlceras de córnea em 263 pacientes no período de setembro de 1989. Confirma estudos anteriores de que o isolamento de bactérias (41,8%) mais frequente que o de fungos (3,8%). Neste período pela primeira vez foram isoladas 2 cepas de Acanthamoeba sp. como agente etiológico de úlcera de córnea. Entre as bactérias Gram positivas, Staphylococcus aureus foi a mais frequentemente isolada (22,1%), e entre as Gram negativas, Pseudomonas sp. foi a mais encontrada (7,6%). Entre as ceratites micóticas, os fungos mais frequentemente isolados foram Aspergillous sp. e Fusarium sp. Foram demonstradas alteraçöes nos perfis de sensibilidade das bactérias aos antibióticos testados em relaçäo ao estudo realizado neste mesmo Laboratório de Microbiologia Ocular da Escola Paulista de Medicina. Houve aumento de resistência bacteriana, cefalotina, atobromicina e amicacina, enquanto a gentamicina apresentou níveis de sensibilidade semelhantes em relaçäo ao estudo anterior

Prevalencia da infeccao chagasica em criancas de 5 municipios da regiao sudoeste de Minas Gerais, Brasil / Chagas' disease prevalence in children from five municipalities of south-west region of Minas Gerais, Brazil

Foi realizado um estudo soroepidemiologico em criancas de 1 a 14 anos para se avaliar a evolucao da doenca de Chagas nos ultimos anos em 5 municipios da regiao sudoeste de Minas Gerais. Foram colhidas 343 amostras de sangue em papel de filtro e realizada a reacao de imunofluorescencia indireta para a deteccao de anticorpos anti - T. cruzi. Os resultados foram comparados com aqueles obtidos pelo Inquerito Sorologico Nacional de Prevalencia da Doenca de Chagas realizado entre 1975 e 1980. Observou-se uma permanencia da transmissao natural nos municipios de Abadia dos Dourados, Campina Verde e Pedrinopolis e uma interrupcao da transmissao natural da doenca de Chagas no municipio de Gurinhata. No entanto, verificou-se uma reativacao da transmissao no municipio de Ipiacu, ja que pelo Inquerito Sorologico Nacional nenhuma amostra foi positiva nas faixas etarias de 1 a 6 anos e de 7 a 14 anos e a presente investigacao detectou 7 amostras da faixa de 1 a 6 anos apresentando anticorpos anti - T. cruzi