Ophthalmological findings in patients suspected with COVID-19 at a tertiary hospital in Pernambuco, Brazil / Achados oftalmológicos em pacientes com suspeita de COVID-19 atendidos na triagem do HC-UFPE

ABSTRACT Purpose: This study evaluated the frequency of the most common ophthalmological, neurological, and systemic findings in symptomatic patients seen at a COVID-19 screening service at Hospital das Clínicas - Universidade Federal de Pernambuco. Methods: A total of 104 patients under clinical suspicion of SARS-CoV-2 infection underwent medical evaluation through an ophthalmological and systemic symptoms survey. All participants selected for the study underwent COVID-19 RT-PCR testing. Results: The mean age was 38.8 years, with 44.23% between 31 and 40 years old, 68.27% female, and 31.73% male. The most common symptoms in patients with a positive RT-PCR test were cough (69.23%), fever (42.3%), hyposmia (38.46%), myalgia (38.46%), and ageusia (30.77%). In the positive group, 34.61% presented with ophthalmological symptoms: burning (19.23%), eye pain (11.54%), foreign body sensation (7.7%), hyperemia (7.7%), and tearing (3.84%). Conclusions: Systemic clinical features were characteristic of upper respiratory infection, but neurological findings of hyposmia and anosmia proved to be important markers for suspicion of SARS-CoV-2 infection. Ophthalmic symptoms in patients with COVID-19 were similar to those observed in other viral conditions and may precede systemic conditions. A high rate of self-medication was observed for general symptoms compared with ophthalmological conditions.

RESUMO Objetivo: Avaliar a frequência dos sintomas oftalmológicos, neurológicos e sistêmicos mais comuns em pacientes sintomáticos atendidos no serviço de triagem de COVID-19 do Hospital das Clínicas da UFPE. Métodos: Cento e quatro pacientes com suspeita clínica de infecção por Sars-Cov-2 foram submetidos a avaliação médica e aplicação de questionário sobre a sintomatologia oftalmológica, neurológica e sistêmica. Todos os participantes do estudo tiveram exame de RT-PCR para COVID-19 solicitado. Resultados: A média de idade foi de 38,8 anos, com 44,23% entre 31 e 40 anos. Mulheres corresponderam a 68,27% dos atendimentos e homens a 31,73%. Os sintomas mais frequentes nos pacientes com RT-PCR positivo foram: tosse (69,23%), febre (42,3%), mialgia (38,46%), hiposmia (38,46%), e ageusia (30,77%). Neste grupo, os sintomas oftalmológicos estiveram presentes em 34,61%, sendo: ardor (19,23%), dor ocular (11,54%), sensação de corpo estranho (7,7%), hiperemia (7,7%) e lacrimejamento (3,84%) os mais encontrados. Conclusões: O quadro clínico sistêmico foi característico de infecção respiratória alta, porém os achados neurológicos de hiposmia e anosmia mostraram-se importantes marcadores para a suspeição dos casos de infecção por COVID-19. Os sintomas oftalmológicos dos pacientes com COVID-19 foram semelhantes aos presentes em outros quadros virais, podendo preceder o quadro sistêmico. Houve uma alta taxa de automedicação para os sintomas gerais quando comparado ao quadro oftalmológico.

Fiabilidad y validez de un instrumento de medición del desempeño competitivo de las instituciones de salud mediante las tecnologías de la información y la comunicación / Reliability and validity of an instrument for measuring the competitive performance of health institutions through the use of Information and Communication Technologies

Resumen Desde su surgimiento, la utilización de las tecnologías de la información y la comunicación ha logrado mayores ventajas competitivas en las empresas y organismos públicos, incluyendo el sector salud, aunque sobre este hay poca evidencia científica. El objetivo de la investigación fue validar un cuestionario para la medición del desempeño competitivo de las instituciones de salud del estado de Baja California, mediante el uso de las tecnologías de la información y la comunicación. El enfoque del estudio es cuantitativo, con alcance descriptivo de tipo retrospectivo y diseño no experimental de corte transversal. El cuestionario elaborado con base en la revisión de literatura se aplicó entre septiembre de 2020 y mayo de 2021 a una muestra de profesionales de la salud (n = 203). Constó de 59 ítems, como resultado de la medición de 9 dimensiones, en donde su índice de validez de contenido para n = 13 expertos fue catalogado como adecuado (0.79). La fiabilidad obtenida en la prueba piloto fue alta (alfa de Cronbach = 0.86). Para evaluar la validez de constructo se llevó a cabo un análisis factorial exploratorio, que determinó 9 factores que explican el 84.5 % de la varianza total y una fuerte correlación entre las variables. El instrumento obtenido presentó adecuadas propiedades psicométricas de confiabilidad y validez, que a su vez permitieron medir el impacto que tienen las tecnologías de la información y comunicación sobre el desempeño competitivo de las instituciones de salud.

Abstract Since their emergence, the use of information and communication technologies has achieved greater competitive advantages in companies and public organizations, including the health sector, although there is little scientific evidence about it. The objective of the research was to validate a questionnaire to measure the competitive performance of health institutions in the state of Baja California, through the use of information and communication technologies. The study approach is quantitative, with a retrospective descriptive scope and a non-experimental cross-sectional design. The questionnaire developed based on the literature review was administered between September 2020 and May 2021 to a sample of health professionals (n = 203). It consisted of 59 items, as a result of measuring 9 dimensions, where its content validity index for n = 13 experts was classified as adequate (0.79). The reliability obtained in the pilot test was high (Cronbach's Alpha = 0.86). To evaluate the construct validity, an exploratory factor analysis was carried out, which determined 9 factors that explain 84.5 % of the total variance and a strong correlation between the variables. The obtained instrument presented adequate psychometric properties of reliability and validity, which in turn made it possible to measure the impact of information and communication technologies on the competitive performance of health institutions.

Ophthalmological findings in patients suspected with COVID-19 at a tertiary hospital in Pernambuco, Brazil.

PURPOSE: This study evaluated the frequency of the most common ophthalmological, neurological, and systemic findings in symptomatic patients seen at a COVID-19 screening service at Hospital das Clínicas - Universidade Federal de Pernambuco. METHODS: A total of 104 patients under clinical suspicion of SARS-CoV-2 infection underwent medical evaluation through an ophthalmological and systemic symptoms survey. All participants selected for the study underwent COVID-19 RT-PCR testing. RESULTS: The mean age was 38.8 years, with 44.23% between 31 and 40 years old, 68.27% female, and 31.73% male. The most common symptoms in patients with a positive RT-PCR test were cough (69.23%), fever (42.3%), hyposmia (38.46%), myalgia (38.46%), and ageusia (30.77%). In the positive group, 34.61% presented with ophthalmological symptoms: burning (19.23%), eye pain (11.54%), foreign body sensation (7.7%), hyperemia (7.7%), and tearing (3.84%). CONCLUSIONS: Systemic clinical features were characteristic of upper respiratory infection, but neurological findings of hyposmia and anosmia proved to be important markers for suspicion of SARS-CoV-2 infection. Ophthalmic symptoms in patients with COVID-19 were similar to those observed in other viral conditions and may precede systemic conditions. A high rate of self-medication was observed for general symptoms compared with ophthalmological conditions.

Las tecnologías de la información y la comunicación como factor de desempeño competitivo en instituciones de salud / Information and Communication Technologies as a competitive performance factor in health

En la actualidad la elevación del desempeño competitivo constituye una prioridad en las instituciones de salud. Tal exigencia tiene el propósito de reducir los costos de atención y aumentar la productividad, en un contexto donde la demanda de servicios hospitalarios es cada vez mayor por el acelerado envejecimiento poblacional y el incremento de los costos de atención. Disímiles investigaciones han demostrado que con el empleo de las tecnologías de la información y la comunicación se puede elevar el desempeño competitivo en salud. Dentro de estas, la Minería de Procesos posibilita mejorar la ejecución de los procesos de negocio, con el impacto en el empleo de recursos, así como en los tiempos y en la satisfacción del proceso de atención. El objetivo de la investigación fue analizar el impacto que tienen las tecnologías de la información y la comunicación como factor de desempeño competitivo en las instituciones de salud, a partir de su evaluación en el Sistema de Información Hospitalaria XAVIA HIS, por medio de la aplicación de Minería de Procesos. La investigación presentó un enfoque cualitativo, con alcance explicativo y un diseño no experimental, donde se empleó el análisis documental y la modelación. Fue aplicada al Sistema de Información Hospitalaria XAVIA HIS en el año 2019. Para esto, fue utilizada la metodología computacional para la aplicación de la Minería de Procesos. Como resultado se obtuvo un modelo adecuado a la realidad y fácilmente analizable, que constató el impacto de las tecnologías de la información y la comunicación en la elevación del desempeño competitivo en las instituciones de salud(AU)

At present, it constitutes a priority the competitive performance elevation in health institutions. This exigence has a purpose to reduce the costs of healthcare and increase productivity, in a context where the demand for hospital services is increasing, due to the accelerated aging of the population and the increase in the costs of healthcare. Different researches have shown that with the use of Information and Communication Technologies, competitive performance in health can be increased. Within this, Process Mining allows to improve the execution of business processes, which it impacts the use of resources, as well as the times and satisfaction of the healthcare process. The objective is to analyze the impact that Information and Communication Technologies have, as a factor of competitive performance in health institutions, based on their evaluation in the XAVIA HIS Hospital Information System, through the application of Process Mining. The research has a qualitative approach, with explanatory scope and non-experimental design, where documentary analysis and modeling are used. It is applied to the Hospital Information System XAVIA HIS in 2019. For this, the Methodology was used for the application of process mining. As a result, a model adapted to reality and easily analyzed is obtained, which it is confirms the impact of Information and Communication Technologies in increasing competitive performance in health institutions(AU)

Juvenile xantogranuloma with íris involvement / Xantogranuloma juvenil com acometimento iriano

Abstract Herein we report a case of juvenile xantogranuloma, an inflammatory disease more commonly diagnosed during childhood and is characterized by cutaneous and ocular manifestations. Iris is the main target, presenting as local or diffuse yellowish lesions. Iris involvement may precipitate not only glaucoma but also amblyopia. Treatment is based on corticosteroids therapy, either local or systemic aiming disease control.

Resumo É relatado um caso raro de xantogranuloma juvenil, doença de natureza inflamatória diagnosticada mais frequentemente na infância, com manifestações cutâneas e oculares. A íris é o principal sítio extracutâneo da doença, apresentando-se como lesão amarelada, difusa ou localizada. O acometimento iriano pode acarretar surgimento de glaucoma, além de ambliopia. O manejo clínico da lesão ocular no presente caso foi baseado no necessidade no uso contínuo de corticoide tópico e sistêmico para estabilização da doença.

Surgical Reconstruction of Ocular Surface Tumors Using Fibrin Sealant Tissue Adhesive.

PURPOSE: To evaluate the surgical outcomes of ocular surface reconstruction in corneal-conjunctival tumors using fibrin tissue adhesive. METHODS: A prospective noncomparative study was performed between May 2013 and February 2015. Patients were submitted to routine surgical procedure for corneal-conjunctival tumor excision followed by amniotic membrane graft transplantation using fibrin tissue adhesive (Evicel®, Omrix Biopharmaceuticals Ltd., Israel). Results were assessed on the 1st, 7th, 15th and 30th postoperative days to analyze subjective complaints, adhesiveness and positioning of the graft, potential complications and recurrences. RESULTS: Twenty-five eyes were analyzed (male, 14). The diagnosis after the treatment was categorized as squamous cell neoplasia, dysplasia, actinic keratosis, squamous papilloma and compound melanocytic nevus. Few significant symptoms were reported, such as mild hyperemia and ocular dyscomfort. One case developed a conjunctival granuloma which regressed after topical treatment. All grafts were successful with no displacements or retraction postoperatively. There was no clinical recurrence of the tumor in a mean time of follow-up of 11 months. CONCLUSION: Fibrin tissue adhesive is safe and effective in the surgery of ocular surface tumor. In this series, sutureless amniotic membrane transplantation using fibrin glue has the potential to shorten the surgical time, mitigate inflammation postoperatively and improve patient discomfort.

Risk Factors Associated With the Ophthalmoscopic Findings Identified in Infants With Presumed Zika Virus Congenital Infection.

IMPORTANCE: The Zika virus (ZIKV) might cause microcephaly and ophthalmoscopic findings in infants of mothers infected during pregnancy. OBJECTIVE: To assess and identify possible risk factors for ophthalmoscopic findings in infants born with microcephaly and a presumed clinical diagnosis of ZIKV intrauterine infection. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional study at the Altino Ventura Foundation in Recife, Brazil, that included 40 infants with microcephaly born in Pernambuco state, Brazil, between May and December 2015. Toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus were ruled out in all of them. Testing of cerebrospinal fluid for ZIKV using IgM antibody-capture enzyme-linked immunosorbent assay was performed in 24 of 40 infants (60.0%). The infants and mothers underwent ocular examinations. The infants were divided into 2 groups, those with and without ophthalmoscopic alterations, for comparison. MAIN OUTCOMES AND MEASURES: Identification of risk factors for ophthalmoscopic findings in infants born with microcephaly and ZIKV intrauterine infection. RESULTS: Among the 40 infants, the mean (SD) age was 2.2 (1.2) months (range, 0.1-7.3 months). Of the 24 infants tested, 100% had positive results for ZIKV infection: 14 of 22 infants (63.6%) from the group with ophthalmoscopic findings and 10 of 18 infants (55.6%) from the group without ophthalmoscopic findings. The major symptoms reported in both groups were rash by 26 mothers (65.0%), fever by 9 mothers (22.5%), headache by 9 mothers (22.5%), and arthralgia by 8 mothers (20.0%). No mothers reported conjunctivitis or other ocular symptoms during pregnancy or presented signs of uveitis at the time of examination. Thirty-seven eyes (46.3%) of 22 infants (55.0%) had ophthalmoscopic alterations. Ten mothers (71.4%) of infants with ocular findings reported symptoms during the first trimester (frequency, 0.48; 95% CI, 0.02-0.67; P = .04). A difference was also observed between the groups of infants with and without ocular findings regarding the cephalic perimeter: mean (SD) of 28.8 (1.7) and 30.3 (1.5), respectively (frequency, -1.50; 95% CI, -2.56 to -0.51; P = .004). CONCLUSIONS AND RELEVANCE: Ocular involvement in infants with presumed ZIKV congenital infection were more often seen in infants with smaller cephalic diameter at birth and in infants whose mothers reported symptoms during the first trimester.

Macular hole: 10 and 20-MHz ultrasound and spectral-domain optical coherence tomography / Buraco macular: ultrassonografia de 10 e 20 MHz e tomografia óptica de domínio espectral

PURPOSE: Optical coherence tomography (OCT) is valuable for macula evaluation. However, as this technique relies on light energy it cannot be performed in the presence of opaque media. In such cases, the ultrasound (US) may predict some macular features. The aim of this study was to characterize images obtained by ultrasound with 10 and 20-MHz transducers comparing to OCT, as well as to analyze the relationship between the vitreous and retina in eyes with macular hole (MH). METHODS: 29 eyes of 22 patients with biomicroscopic evidence of MH at different stages were included. All patients were evaluated using ultrasonography with 10 and 20-MHz transducers and OCT. RESULTS: OCT identified signs of MH in 25 of 29 eyes. The remaining 4 cases not identified by US were pseudoholes caused by epiretinal membranes. In MH stages I (2 eyes) and II (1 eye), both transducers were not useful to analyze the macular thickening, but suggestive findings as macular irregularity, operculum or partial posterior vitreous detachment (PVD) were highlighted. In stages III (14 eyes) and IV (5 eyes), both transducers identified the double hump irregularity and thickening. US could measure the macular thickness and other suggestive findings for MH: operculum, vitreomacular traction and partial or complete PVD. In cases of pseudoholes, US identified irregularities macular contour and a discrete depression. CONCLUSION: 10-MHz US was useful for an overall assessment of the vitreous body as well as its relationship to the retina. The 20-MHz transducer allowed valuable information on the vitreomacular interface and macular contour. OCT provides superior quality for fine morphological study of macular area, except in cases of opaque media. In these cases, and even if OCT is not available, the combined US study is able to provide a valid evaluation of the macular area improving therapeutic approach.

OBJETIVO: A tomografia de coerência óptica (OCT) é um método diagnóstico valioso para estudo da mácula. Entretanto, por se basear na energia luminosa, não pode ser realizada quando existe opacidade de meios. Nesses casos, o ultrassom (US) pode predizer algumas características maculares. Este estudo teve como objetivos caracterizar imagens obtidas por US com transdutores de 10 e 20-MHz comparadas ao OCT, assim como analisar a relação vitreorretiniana em olhos com buraco macular (BM). MÉTODOS: Vinte e nove olhos de 22 pacientes com evidência biomicroscópica de BM em diferentes estágios foram incluídos. Todos os pacientes foram avaliados com ultrassonografia utilizando transdutores de 10 e 20-MHz e OCT de domínio espectral. RESULTADOS: OCT diagnosticou BM em 25 dentre 29 olhos estudados. Os 4 casos não identificados por US eram pseudoburacos decorrentes de membrana epirretiniana. Nos BM estágios I (2 olhos) e II (1 olho), ambos transdutores não foram úteis para analisar o espessamento macular, mas foram identificados sinais sugestivos como irregularidade macular, opérculo ou descolamento parcial do vítreo posterior (DVP). Nos estágios III (14 olhos) e IV (5 olhos), ambos transdutores identificaram irregularidade, dupla corcova e espessamento macular. O US foi capaz de medir a espessura macular e identificar outros indícios de BM, como opérculo, tração vitreorretiniana e DVP. Em pseudoburacos, o US identificou irregularidades no contorno macular e discreta depressão. CONCLUSÃO: US de 10-MHz foi útil para uma avaliação global do corpo vítreo e sua relação à retina. O US de 20-MHz forneceu informações importantes sobre a junção vitreorretiniana e contorno macular. OCT fornece qualidade superior para estudo morfológico da região macular, exceto em casos de opacidade de meios. Nesses casos, ou quando o exame tomográfico não for disponível, o estudo ultrassonográfico de 10 e 20-MHz é capaz de proporcionar análise válida da região macular e auxiliar na abordagem terapêutica.

Macular hole: 10 and 20-MHz ultrasound and spectral-domain optical coherence tomography.

PURPOSE: Optical coherence tomography (OCT) is valuable for macula evaluation. However, as this technique relies on light energy it cannot be performed in the presence of opaque media. In such cases, the ultrasound (US) may predict some macular features. The aim of this study was to characterize images obtained by ultrasound with 10 and 20-MHz transducers comparing to OCT, as well as to analyze the relationship between the vitreous and retina in eyes with macular hole (MH). METHODS: 29 eyes of 22 patients with biomicroscopic evidence of MH at different stages were included. All patients were evaluated using ultrasonography with 10 and 20-MHz transducers and OCT. RESULTS: OCT identified signs of MH in 25 of 29 eyes. The remaining 4 cases not identified by US were pseudoholes caused by epiretinal membranes. In MH stages I (2 eyes) and II (1 eye), both transducers were not useful to analyze the macular thickening, but suggestive findings as macular irregularity, operculum or partial posterior vitreous detachment (PVD) were highlighted. In stages III (14 eyes) and IV (5 eyes), both transducers identified the double hump irregularity and thickening. US could measure the macular thickness and other suggestive findings for MH: operculum, vitreomacular traction and partial or complete PVD. In cases of pseudoholes, US identified irregularities macular contour and a discrete depression. CONCLUSION: 10-MHz US was useful for an overall assessment of the vitreous body as well as its relationship to the retina. The 20-MHz transducer allowed valuable information on the vitreomacular interface and macular contour. OCT provides superior quality for fine morphological study of macular area, except in cases of opaque media. In these cases, and even if OCT is not available, the combined US study is able to provide a valid evaluation of the macular area improving therapeutic approach.

Intentos suicidas en el área de salud del Policlínico Universitario José Martí Pérez / Suicidal attempts in the health area of José Martí Pérez University Polyclinic

Se efectuó un estudio descriptivo y transversal de 19 pacientes con intento suicida, pertenecientes al área de salud del Policlínico Universitario José Martí Pérez de Santiago de Cuba, desde julio del 2008 hasta igual mes del 2009, con vistas a determinar la conducta de estos y trazar estrategias de trabajo ante dicha situación. En la serie, ese acto predominó en las personas de 10-20 años, sexo masculino, raza mestiza, nivel de escolaridad universitario y desocupación laboral. Entre los métodos para suicidarse, los más empleados fueron la ingestión de psicofármacos y la autoagresión.

A descriptive and cross-sectional study of 19 patients with suicide attempt, belonging to the health area of José Martí Pérez University Polyclinic from Santiago de Cuba was carried out from July, 2008 to the same month of 2009, aimed at determining their behaviour and to establish work strategies in this situation. People in the age group from 10-20, male sex, mestiza race, university school level and unemployment prevailed in the series. Among the methods of suicide, those mostly used were psycho-drugs ingestion and the self-aggression.

Optical coherence tomography enhanced depth imaging of choroidal tumors.

PURPOSE: To describe the spectral-domain optical coherence tomography (SD-OCT) features of choroidal tumors imaged using enhanced depth imaging (EDI) technique. DESIGN: Prospective observational case series. METHODS: One tumor each from 23 eyes of 23 patients was included. All the patients underwent clinical fundus photography, ultrasonography, and EDI SD-OCT. Qualitative characteristics (tumor outline, reflectivity and/or shadowing of choroidal layers, and detection of inner sclera) and quantitative characteristics (measurement of maximum tumor thickness and the largest tumor diameter) were assessed. RESULTS: Patients (male=12) were categorized as: amelanotic choroidal nevus (4), melanotic choroidal nevus (9), choroidal melanoma (3), circumscribed choroidal hemangioma (3), and choroidal metastasis (4). In all cases, EDI SD-OCT was able to identify the tumor distinctly from the surrounding normal choroid. Qualitative analysis revealed: amelanotic nevi, homogenous and medium reflective band with visible choroidal vessels; melanotic nevi and choroidal melanomas, high reflective band in the anterior choroid with shadowing, and nonvisualization of choroidal vessels and inner sclera; choroidal hemangiomas, medium/low reflective band without shadowing; and choroidal metastasis, low reflective band in the deep choroid with enlargement of the suprachoroidal space. Maximum tumor diameter and thickness was measurable by EDI SD-OCT only in 10 cases that were <9.0 mm in diameter and <1.0 mm in thickness (undetectable by ultrasonography). CONCLUSIONS: It is possible to obtain cross-sectional views of a variety of choroidal tumors using EDI SD-OCT. Small choroidal tumors nondetectable by ultrasonography can be objectively measured by this technique.

Circulating tumor cells in uveal melanoma.

Despite advances in the diagnosis and local tumor control, the overall mortality rate for uveal melanoma remains high because of the development of metastatic disease. The clinical and histopathological systems currently being used to classify patients are not sufficiently accurate to predict metastasis. Tumor genotyping has demonstrated significant promise but obtaining tumor tissue can be problematic. Furthermore, assessment of tumor tissue does not indicate whether tumor cells have actually been shed and cannot indicate whether treatment is reducing metastasis. The detection of circulating tumor cells in blood has been shown to be a prognostic biomarker that can be used to monitor the effectiveness of therapy in patients with metastatic carcinoma. Uveal melanoma disseminates hematogenously, and the detection of circulating melanoma cells may potentially be useful for diagnosis, risk stratification, and the monitoring of disease progression and treatment efficacy. PCR-based and immunomagnetic cell isolation techniques, derived from studies in patients with cutaneous melanoma, have been tested. For various biological and technical reasons, they have not demonstrated the accuracy and reproducibility required for an effective prognostic assay in patients with uveal melanoma. Assessments have been confounded by false positives and negatives and thus, correlations between circulating melanoma cells and survival have not yet been established. Circulating melanoma cell detection is a valuable tool for investigating metastasis in uveal melanoma and also has the potential to become a standard part of uveal melanoma management. However, more research on the biology of uveal melanoma as well as improvements upon the current technologies are needed.

A new device for ocular globe enucleation.

It is important to perfect the enucleation technique, especially in cases of intraocular malignancy, to obtain an adequate amount of tissue for histologic analysis and to cause a minimum amount of trauma to the remaining orbital structures. This study describes the use of a new device for ocular globe enucleation. The new instrument has been employed in 16 consecutive enucleation procedures with no complications. The new device has promoted good division of the optic nerve and allowed severing of the optic nerve stump at a length of more than 10 mm.

Fundus autofluorescence of choroidal nevus and melanoma.

BACKGROUND: To describe autofluorescence patterns of choroidal melanocytic lesions using the Heidelberg Retinal Angiograph 2 system (HRA2). METHODS: 20 patients with choroidal melanocytic lesions in the ocular fundus underwent ophthalmologic examination, fundus photography, autofluorescence and optical coherence tomography (OCT). Pathologic examination was performed on one enucleated eye with a large choroidal melanoma. RESULTS: 15 patients had choroidal nevi and 5 had malignant choroidal melanoma (1 small, 1 medium and 3 large tumours). Choroidal nevi did not show any characteristic autofluorescence pattern, although secondary retinal pigment epithelium (RPE) changes, such as drusen and pigment epithelium detachment, appeared faintly hyperautofluorescent in 2 patients. Only the small malignant choroidal melanomas had prominent orange pigmentation, although all melanomas had an intense confluent hyperautofluorescent signal over the lesions. Pathology of one large malignant melanoma revealed lipofuscin underlying RPE. CONCLUSION: Most nevi did not have characteristic hyperautofluorescent features, but choroidal melanomas seemed to have a pattern of confluent hyperautofluorescence. Therefore, autofluorescence may be a useful non-invasive tool to assess lipofuscin in pigmented choroidal lesions, which may contribute to the diagnosis of malignancy. This hypothesis, however, remains to be confirmed in large prospective studies.

[Histopathologic findings in retinoblastoma]. / Achados histopatológicos em retinoblastoma.

OBJECTIVE: To study histopathological findings of enucleated eyes with retinoblastoma. METHODS: Twenty-eight cases of retinoblastoma treated by enucleation at the Federal University of São Paulo from December 2000 to October 2002 were histopathologically reviewed. Clinical data included age, gender, race, unilateral or bilateral involvement and previous treatment. The histopathological review evaluated the presence of iris and/or angle neovascularization, tumor differentiation and optic nerve and choroidal invasion according to Khelfaoui's classification. RESULTS: Of 27 patients, 13 (48.5%) were boys and 14 (59.3%) were girls, 16 were white, 6 were black and 5 were asiatic, age ranging from 2 to 96 months (mean, 22.7 months). 13 cases were bilateral and 14 cases were unilateral. All tumors were histologically characterized by a proliferation of small cells with high nuclear-to-cytoplasmic ratios and 20 (71.4%) of them were well differentiated. Choroidal involvement was observed in 18 (64.2%) cases (degree II, III) and optic nerve invasion in 8 (28.5%) cases (degree III, IV, V). CONCLUSION: Neovascularization, necrosis and calcification were the most commonly observed feature. The invasion into the optic nerve and choroid, which are the two most important predictors of patient outcome were found in 28.5% and 64.2% of the cases, respectively.