Implante de la válvula de Baerveldt en un caso con glaucoma refractario / Baerveldt valve implantation in a case of refractory glaucoma

Se presenta una paciente femenina, de 52 años de edad, con antecedentes de asma bronquial, miopía y glaucoma juvenil diagnosticado a los 22 años de edad. Le fueron realizadas dos trabeculectomías en el ojo izquierdo y una en el ojo derecho. En el año 2008 se le realizó cirugía de facoemulsificación más implante de lente intraocular en ambos ojos. La paciente acudió a nuestro Servicio hace un año, y refirió disminución progresiva de la visión. El examen oftalmológico reveló agudeza visual mejor corregida de 0,4 y presión intraocular de 30 y 23,5 mm/Hg para los respectivos ojos, con terapia hipotensora máxima tolerable. Al fondo de ojo se observó daño glaucomatoso avanzado, mayor en ojo izquierdo. Como opción de tratamiento se realizó ciclofotocoagulación transescleral en 2 cuadrantes del ojo derecho. A los 6 meses se constató presión intraocular de 30 y 18 mm/Hg, y se decidió el implante de la válvula de Baervelt en el temporal superior del ojo derecho. En el posoperatorio a los 7 días el examen oftalmológico arrojó presión intraocular de 5 mm/Hg, atalamia grado III y agudeza visual mejor corregida de 0,2. Se prescribió tratamiento con midriático ciclopléjico y antinflamatorios tópicos y sistémicos, y se logró a los 15 días mejoría del cuadro ocular. Se obtuvo buena agudeza visual y presión intraocular de 12 mmHg a los 3 meses del posoperatorio. El dispositivo del drenaje de Baerveldt es eficaz para lograr la reducción de la presión intraocular en el glaucoma refractario(AU)

A case is presented of a female 52-year-old patient with a history of bronchial asthma, myopia and juvenile glaucoma diagnosed at age 22. Two trabeculectomies were performed on the left eye and one on the right eye. In the year 2008 the patient underwent phacoemulsification surgery plus intraocular lens implantation in both eyes. She attended our service a year ago, reporting progressive vision reduction. Ophthalmological examination revealed best corrected visual acuity of 0.4 and intraocular pressure of 30 and 23.5 mm/Hg for either eye, with maximum tolerated hypotensive therapy. Funduscopy showed advanced glaucomatous damage, greater in the left eye. The treatment option selected was transcleral cyclophotocoagulation in two quadrants of the right eye. At 6 months intraocular pressure was 30 and 18 mm/Hg, and it was decided to implant a Baerveldt valve in the upper temporal quadrant of the right eye. Ophthalmological examination results at 7 days postoperative were intraocular pressure 5 mm/Hg, grade III athalamia and best corrected visual acuity 0.2. The treatment indicated was a cycloplegic mydriatic and topical and systemic anti-inflammatories. Ocular status improvement was achieved at 15 days. Satisfactory visual acuity and an intraocular pressure of 12 mm/Hg were obtained at 3 months postoperative. The Baerveldt drainage device is effective to achieve intraocular pressure reduction in refractory glaucoma(AU)

Queratoplastia penetrante con fines ópticos. Presentación de cuatro casos / Penetrating keratoplasty with optical aims. Presentation of four cases

RESUMEN La queratoplastia penetrante ha sido el procedimiento empleado, de forma casi universal, para el tratamiento de las patologías corneales que afectan de forma irreversible a la visión. Se reportaron 4 casos clínicos de pacientes con afecciones corneales con compromiso visual severo, dado por visión de cuenta dedos y percepción luminosa. Luego de la evaluación completa en cada caso, se decidió realizar la queratoplastia penetrante con fines ópticos, con el objetivo de recuperar la transparencia de la córnea y la calidad visual. No existieron complicaciones transquirúrgicas y fueron seguidos según protocolo de evaluación postoperatoria de trasplante corneal. Los resultados y evaluación fueron satisfactorios, al año mantenían la transparencia del injerto y se logró mejoría considerable de la agudeza visual (AU).

ABSTRACT Penetrating keratoplasty has been a procedure used, almost universally, to treat corneal diseases affecting vision in an irreversible way. Four clinical cases are reported of patients with corneal affections severely compromising vision, given by short vision and luminous perception. After completely evaluating each case, the authors decided to perform the penetrant keratoplasty with optical aims, to recover cornea transparency and the vision quality. There were not transurgical complications and the patients were followed up according to the protocols of post-surgery evaluation of corneal graft. The results and evaluation were satisfactory; after a year, the transparency of the graft was maintained and visual acuity substantially improved (AU).

Visual development in children aged 0 to 6 years / Desenvolvimento visual infantil em crianças de 0 a 6 anos de idade

ABSTRACT Purposes: This study aimed to present the characteristics of visual development from a clinical viewpoint in infants and preschool children aged 0-6 years who were born at term with no pregnancy or childbirth complications. Methods: We conducted a bibliographic review on visual development in infants and preschool children. Results: We described visual development in children according to age groups: 0-1 month, 1-3 months, 3-6 months, 6-10 months, 10 months-1 year and 4 months, 1 year and 4 months-2 years, 2-4 years, and 4-6 years. Conclusion: Visual responses in infants and preschool children born at term and with normal development were observed to occur in an integrated manner with neuromotor functions in addition to cognitive and psycho-emotional sensory, behavioral, and visual capacity.

RESUMO Objetivos: Este estudo teve como objetivo apresentar as características do desenvolvimento visual do ponto de vista clínico em bebês e pré-escolares de 0 a 6 anos que nasceram a termo sem complicações na gravidez ou no parto. Métodos: Foi realizada uma revisão bibliográfica sobre o desenvolvimento visual em lactentes e pré-escolares. Resultados: Descrevemos o desenvolvimento visual em crianças de acordo com as faixas etárias: 0-1 mês, 1 a 3 meses, 3 a 6 meses, 6 a 10 meses, 10 meses a 1 ano e 4 meses, 1 ano e 4 meses a 2 anos, 2 a 4 anos e 4 a 6 anos. Conclusão: Observou-se que as respostas visuais em lactentes e pré-escolares nascidos a termo e com desenvolvimento normal ocorrem de forma integrada às funções neuromotoras, além da capacidade sensorial, comportamental e visual cognitiva e psicoemocional.

The impact of ocular tuberculosis on vision after two months of intensive therapy

ABSTRACT Tuberculosis is an infectious disease of global importance with major economic and social burden accounting for 25% of all avoidable deaths in developing countries. Extrapulmonary involvement may occur either in association with clinically apparent pulmonary tuberculosis or in isolation. This cross-sectional descriptive study aimed to evaluate the impact of ocular tuberculosis in visual acuity at baseline and after two months of intensive anti-tuberculous therapy. A sample of 133 pulmonary tuberculosis patients, seven disseminated tuberculosis, and three pleural tuberculosis patients was evaluated. All patients underwent routine ophthalmic evaluation, including assessment of visual acuity, biomicroscopy, applanation tonometry, indirect ophthalmoscopy, and fluorescent angiography as appropriate. None of the patients had impaired visual acuity due to tuberculosis. A rate of 4.2% (6/143) of ocular involvement was found. None of the patients with ocular involvement were HIV-infected. Of the six patients with ocular involvement, five met the diagnostic criteria for probable and one for possible ocular lesions. As for the type of ocular lesions, two patients had bilateral findings: one had sclerouveitis and the second had choroidal nodules. The other four patients presented with unilateral lesions: peripheral retinal artery occlusion in the right eye (one case), choroidal nodules in the left eye (one case), and choroidal nodules in the right eye (two cases). Patients progressed favorably after two month of intensive therapy, with no significant reduction in vision.

Vision and the Nobel Prize / A visão e Prêmio Nobel

ABSTRACT The Nobel Prize is the world's foremost honor for scientific advances in medicine and other areas. Founded by Alfred Nobel, the prizes have been awarded annually since 1901. We reviewed the literature on persons who have won or competed for this prize in subjects related to vision and ophthalmology. The topics were divided into vision physiology, diagnostic and therapeutic methods, disease mechanism, and miscellaneous categories. Allvar Gullstrand is the only ophthalmologist to win a Nobel Prize; he is also the only one to receive it for work in ophthalmology. Other ophthalmologists that have been nominated were Hjalmar Schiötz (tonometer), Karl Koller (topical anesthesia), and Jules Gonin (retinal detachment). Other scientists have won the prize for eye-related research: Ragnar Granit, Haldan Hartline and George Wald (chemistry and physiology of vision), and David Hubel and Torsten Wiesel (processing in the visual system). Peter Medawar is the only person born in Brazil to have won the Nobel Prize.

RESUMO O Prêmio Nobel é a principal honraria do mundo para avanços científicos em medicina e outras áreas. Fundada por Alfred Nobel, os prêmios são concedidos anualmente desde 1901. Revisamos a literatura sobre pessoas que ganharam ou competiram por esse prêmio em assuntos relacionados à visão e oftalmologia. Os tópicos foram divididos em fisiologia da visão, métodos diagnósticos e terapêuticos, mecanismo de doenças e variados. Allvar Gullstrand não é o único oftalmologista a ganhar um Nobel, porém é o único a recebê-lo por contribuições na oftalmologia. Outros oftalmologistas foram nomeados: Hjalmar Schiötz (tonometro), Karl Koller (anestesia tópica) e Jules Gonin (descolamento da retina). Outros cientistas ganharam o prêmio com pesquisas relacionadas à visão: Ragnar Granit, Haldan Hartline e George Wald (química e fisiologia da visão); David Hubel e Torsten Wiesel (processamento no sistema visual). Peter Medawar é a única pessoa que nasceu no Brasil a ganhar o prêmio.

Visual function and macular architecture in patients with inactive zone 2 and 3 toxoplasmic retinochoroiditis / Função visual e arquitetura macular em pacientes com retinocoroidite toxoplásmica inativa nas zonas 2 e 3

ABSTRACTPurpose:To evaluate the visual function and architecture of the central and peripapillary retina in patients with inactive toxoplasmic retinochoroiditis outside the macular and peripapillary regions (zones 2 and 3).Methods:Cross-sectional study of 20 eyes (18 patients) with zone 2 and 3 toxoplasmic scars and visual acuity ≥20/25. Patients underwent Humphrey 10-2 perimetry, contrast sensitivity (Mars test), and color vision testing (L'Anthony desaturated D-15). The retinal nerve fiber layer (RNFL) and macular thicknesses were determined by optical coherence tomography.Results:The patients' mean age was 27.4 ± 10.3 years, and the mean duration of remission was 6.15 ± 5.19 months. Abnormal contrast sensitivity and color vision were observed in three (15.0%) and four eyes (20.0%), respectively. Mean deviation (MD) and pattern standard deviation (PSD) fell outside the 95% normal confidence limits of the perimeter's database in 14 (70.0%) and seven eyes (35.0%), respectively. Foveal and mean RNFL thicknesses were within the normal limits in all eyes. Eyes with zone 2 retinochoroiditis had lower foveal sensitivity than eyes with zone 3 lesions (p=0.041). Eyes with a longer duration of remission had a higher MD (r=0.575; p=0.013) and a lower PSD (r=-0.593; p=0.010).Conclusions:Despite normal central and peripapillary retinal architecture, eyes with inactive zone 2 and 3 toxoplasmic retinochoroiditis can present with abnormal color, contrast, and macular perimetric sensitivity. Zone 2 retinochoroiditis was associated with lower foveal sensitivity, and a longer duration of retinochoroiditis remission was associated with better perimetric parameters (MD and PSD).

RESUMOObjetivo:Avaliar a função visual e arquitetura da retina central e peripapilar em pacientes com retinocoroidite toxoplásmica inativa fora da região macular e peripapilar (zonas 2 e 3).Métodos:Estudo transversal de 20 olhos (18 pacientes) com cicatrizes toxoplásmicas nas zonas 2 e 3 com acuidade visual ≥20/25. Os pacientes foram submetidos à perimetria Humphrey 10-2, teste de sensibilidade ao contraste (Teste Mars) e teste de visão de cores (L'Anthony D-15 dessaturado). As espessuras da camada de fibras nervosas da retina (CFNR) e da mácula foram determinadas pela tomografia de coerência óptica.Resultados:A média de idade dos pacientes foi 27,4 ± 10,3 anos, e a duração média da remissão da retinocoroidite foi de 6,15 ± 5,19 meses. Alterações na sensibilidade ao contraste e cores foram observada em, respectivamente, 3 olhos (15,0%) e 4 olhos (20,0%). Os índices perimétricos mean deviation (MD) e pattern standard deviation (PSD) estiveram fora do intervalo de confiança de 95% do perímetro em 14 olhos (70,0%) e 7 olhos (35,0%), respectivamente. A espessura foveal e da CFNR média estiveram dentro do limite da normalidade em todos os olhos. Olhos com retinocoroidite na zona 2 tiveram menor sensibilidade foveal que olhos com lesões na zona 3 (p=0,041). Olhos com remissão de longa duração tiveram um MD mais alto (r=0,575; p=0,013) e um PSD mais baixo (r=-0,593; p=0,010).Conclusão:Apesar da arquitetura normal da retina central e peripapilar, olhos com retinocoroidite inativa nas zonas 2 e 3 podem apresentar anormalidades da visão de cores, sensibilidade ao contras e perimetria macular. A retinocoroidite na zona 2 está associada a uma menor sensibilidade foveal. Longos intervalos de remissão da retinocoroidite estiveram associados a melhores parâmetros perimétricos (MD e PSD).

Quality of vision in refractive and cataract surgery, indirect measurers: review article / Qualidade visual em cirurgia refrativa e catarata, medidores indiretos: artigo de revisão

Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.

Qualidade Visual é a medida da capacidade individual de reconhecer detalhes de um objeto no espaço. Medições de função visual na clínica oftalmológica são limitadas por vários fatores, tal como máximo contraste e assim podem não refletir adequadamente as condições visuais reais, bem como os aspectos subjetivos da percepção do mundo pelo paciente. O sucesso em uma cirurgia está não apenas em restaurar linhas de visão, mas sim qualidade visual. Portanto, as cirurgias refrativas e de catarata têm a responsabilidade de alcançar resultados de qualidade. É difícil definir qualidade visual por um único parâmetro, sendo os principais testes de função visual: sensibilidade ao contraste; glare; dispersão intraocular da luz e aberrometria. Nesta revisão os diferentes componentes da função visual são explicados e os diversos métodos disponíveis para se avaliar a qualidade de visão são descritos.

Static and dynamic postural control in low-vision and normal-vision adults

OBJECTIVE: This study aimed to evaluate the influence of reduced visual information on postural control by comparing low-vision and normal-vision adults in static and dynamic conditions. METHODS: Twenty-five low-vision subjects and twenty-five normal sighted adults were evaluated for static and dynamic balance using four protocols: 1) the Modified Clinical Test of Sensory Interaction on Balance on firm and foam surfaces with eyes opened and closed; 2) Unilateral Stance with eyes opened and closed; 3) Tandem Walk; and 4) Step Up/Over. RESULTS: The results showed that the low-vision group presented greater body sway compared with the normal vision during balance on a foam surface (p≤0.001), the Unilateral Stance test for both limbs (p≤0.001), and the Tandem Walk test. The low-vision group showed greater step width (p≤0.001) and slower gait speed (p≤0.004). In the Step Up/Over task, low-vision participants were more cautious in stepping up (right p≤0.005 and left p≤0.009) and in executing the movement (p≤0.001). CONCLUSION: These findings suggest that visual feedback is crucial for determining balance, especially for dynamic tasks and on foam surfaces. Low-vision individuals had worse postural stability than normal-vision adults in terms of dynamic tests and balance on foam surfaces. .

Evaluation of the correlation between dental occlusion and posture using a force platform

OBJECTIVES: Force platforms are widely used to evaluate the relationship between posture and dental occlusion. This study evaluated whether force platforms are able to detect eventual postural modifications resulting from dental occlusion. METHOD: A total of 44 healthy volunteers who were given no information on the aim of the study underwent six postural stabilometric exams under different mandibular and visual conditions. Four parameters were considered: sway area, sway velocity, X axis displacement of the center of the foot pressure and Y axis displacement of the center of the foot pressure. RESULTS: An analysis of variance (ANOVA) revealed the relative influence of each factor; specifically, the ocular afference significantly influenced the sway area and sway velocity parameters, and the mandibular position had only aweakinfluence on theswayareaparameter. CONCLUSIONS: Vision was shown to influence body posture, and a weak correlation was observed between mandibular position and body posture in healthy subjects. However, the force platform is most likely not able to clearly detect this relationship. Gnathologists must use caution when using force platform analysis to modify a therapeutic plan. The sway area seems to be the most sensitive parameter for evaluating the effect of occlusion on body posture.

Multifocal visual electrophysiology in visual function evaluation / 法医学杂志

Multifocal visual electrophysiology, consisting of multifocal electroretinography (mfERG) and multifocal visual evoked potential (mfVEP), can objectively evaluate retina function and retina-cortical conduction pathway status by stimulating many local retinal regions and obtaining each local response simultaneously. Having many advantages such as short testing time and high sensitivity, it has been widely used in clinical ophthalmology, especially in the diagnosis of retinal disease and glaucoma. It is a new objective technique in clinical forensic medicine involving visual function evaluation of ocular trauma in particular. This article summarizes the way of stimulation, the position of electrodes, the way of analysis, the visual function evaluation of mfERG and mfVEP, and discussed the value of multifocal visual electrophysiology in forensic medicine.

Condições visuais autorrelatadas e quedas em idosos institucionalizados / Self-reported visual conditions and falls in institutionalized elderly

OBJETIVO: Avaliar as condições visuais autorrelatadas por idosos institucionalizados e sua relação com acidentes por quedas. MÉTODOS: Estudo prospectivo em que foram entrevistados 59 idosos residentes em instituições de longa permanência para idosos, em Goiânia, GO, entre 2005 e 2007. Foram realizados dois inquéritos com intervalo de dois anos para realização das avaliações propostas. As condições visuais no primeiro inquérito e o relato de quedas no seguimento foram autorrelatadas. Os idosos foram classificados segundo a presença de déficit visual e comparados quanto à ocorrência de queda com o teste Exato de Fisher. RESULTADOS: Déficit visual foi relatado por 48 (81,4 por cento) dos idosos e os acidentes por quedas atingiram 32 (54,2 por cento) dos mesmos, sendo estes mais prevalentes entre idosos com déficit visual. Após o primeiro inquérito, no seguimento de dois anos, não foi encontrada diferença estatisticamente significativa (p=0,171) entre a variável déficit visual autorrelatado e quedas. CONCLUSÃO: Os dados encontrados sinalizam a necessidade de melhor investigação clínica oftalmológica dos idosos. O diagnóstico precoce de comprometimentos visuais e/ou a correção dos mesmos pode beneficiar os idosos e evitar prejuízos funcionais futuros advindos destes e de consequências como as quedas.

OBJECTIVE: To evaluate the visual conditions self-reported by institutionalized elderly and their relation to accidental falls. METHODS: Prospective study in which we interviewed 59 elderly residents of long-stay institutions for elderly in Goiânia, between 2005 and 2007. Two surveys were conducted with an interval of two years to perform the assessments proposed. The visual conditions in the first survey and the report of falls in the wake were self-reported. The elderly were classified according to the presence of visual impairment and compared the occurrence of fall with the Fisher exact test. RESULTS: Visual deficit was reported by 48 (81.4 percent) of the elderly and accidents from falls reached 32 (54.2 percent) of them; which were more prevalent among older adults with visual impairment. After the first inquiry, in the following two years, found no statistically significant difference (p = 0.171) between the variable self-reported visual impairment and falls. CONCLUSION: The findings indicate the need for better research ophthalmology clinic for the elderly. Early diagnosis of visual impairment and / or correct it can benefit the elderly and to avoid future functional impairment arising from these and consequences such as falls.

Atención y conciencia visual / Attention and visual consciousness

Algunos filósofos y científicos cognitivos piensan que la atención es necesaria para la conciencia visual. Ellos normalmente aceptan este requerimiento sobre la base de estudios sistemáticos de patologías perceptuales, como el síndrome de negligencia unilateral, o respaldados en experimentos psicológicos de ceguera inatencional en los que individuos con sus capacidades perceptivas intactas supuestamente no experimentan conscientemente elementos presentes en su campo visual cuando estos son desatendidos. En este artículo sugeriré que la estrategia de la ceguera inatencional es insuficiente y no nos fuerza a aceptar que la atención es necesaria para la conciencia visual por dos razones. Primero, la evidencia empírica disponible es consistente con interpretaciones alternativas que no apelan a la necesidad atencional. Segundo, hay buenas razones para pensar que la atención es independiente de la conciencia. Si esto es así, entonces posiblemente existen modos de conciencia que no requieren de atención.

Some philosophers and cognitive scientists think that attention is necessary for visual consciousness. They normally accept this requirement on the basis of systematic studies of perceptual pathologies, such as unilateral neglect, or based on psychological experiments of intentional blindness in which individuals with intact perceptual capacities allegedly don´t experiment at the conscious level features which are present in their visual fields but not attended. In this paper I will suggest that the inattentional blindness strategy is insufficient and do not force us to accept that attention is necessary for visual consciousness for two reasons. First, the empirical evidence available is consistent with alternative interpretations that do not appeal to the necessity of attention. Second, there are good reasons to think that attention and visual consciousness are independent. If this is so, then possibly there are modes of consciousness that do not require attention.

Retinosquisis juvenil y su rehabilitación visual / Juvenile retinoschisis and its visual rehabilitation

La retinosquisis es una distrofia vitreorretiniana caracterizada por la separación de las capas de la retina y la formación de quistes intrarretinianos. En la retinosquisis juvenil se describen alteraciones oftalmológicas que la distinguen de la retinosquisis adquirida. Con el objetivo de describir las características clínicas de un caso atípico de retinosquisis juvenil se realizó el estudio de un paciente varón de 8 años de edad, quien acudió a consulta por disminución de la visión y la posibilidad de ayuda óptica. Al examen del fondo de ojo se visualizó una esquisis a nivel macular y periférica con edema de ambas máculas. El electrorretinograma presentó una disminución en la amplitud de la onda b. La tomografía de coherencia óptica reveló la separación de la retina interna a nivel de la capa de fibras nerviosas y el edema macular quístico. El tratamiento realizado fue la corrección y la ayuda ópticas para la visión cercana. Se concluye que se trata de una enfermedad infrecuente y, a su vez, de un caso atípico donde se imbricaron diversos signos que orientaban hacia las dos formas clínicas de la enfermedad, pero independientemente de que aparezcan características de retinosquisis adquirida en un paciente joven, el tratamiento de rehabilitación visual con ayuda óptica sigue siendo el más indicado para lograr una mayor calidad visual

The retinoschisis is a vitreoretinal dystrophy characterized by the separation of the retina layers and the formation of intraretinal cysts, In juvenile retinoschisis are described ophthalmologic alterations distinguished of the acquired retinoschisis. The objective of present paper was to conduct a study to describe the clinical features of an atypical case of juvenile retinoschisis of a male patient aged 8 who came to consultation due to a decrease of vision and the possibility of optical help. At eye examination it was visualized a schisis at macular level and peripheral with edema ob both maculae. The electroretinogram showed a decrease in the b-wave amplitude. The tomography of optical coherence demonstrated the separation of the internal retina at level of the nervous fibers and the cystic macular edema. Treatment consisted of correction and optical help to the close vision. We conclude that it is a uncommon disease and at the same time, of a atypical case where are overlapped different signs directed towards the two clinical ways of the disease, but independently that appear characteristics of acquired retinoschisis in a young patient, the treatment of visual rehabilitation with optical help remains the more prescribed to achieve a great visual quality

Comportamento visual e perfil socioeconômico e demográfico de recém-nascidos prematuros da Maternidade do Hospital das Clínicas de Pernambuco - UFPE / Visual behavior and socioeconomic and demographic profile of the premature newborns from Federal University of Pernambuco Maternity (UFPE)

OBJETIVO: Caracterizar o comportamento visual e perfil socioeconômico e demográfico de recém-nascidos prematuros no primeiro mês de idade cronológica. MÉTODOS: Estudo descritivo de corte transversal, aninhado a um estudo longitudinal intitulado: "Comparação do comportamento visual no primeiro trimestre de vida de lactentes nascidos pré-termo em duas maternidades da cidade do Recife/PE". A amostra foi composta por 52 recém-nascidos prematuros recrutados de junho de 2007 a junho de 2008, na Maternidade do Hospital das Clínicas da Universidade Federal de Pernambuco. Foram coletados dados biológicos, socioeconômicos e demográficos dos recém-nascidos e famílias, por meio de consulta aos prontuários e entrevista com as genitoras. Para caracterizar o comportamento visual dos recém-nascidos utilizou-se o Método de Avaliação do Comportamento Visual de Lactentes. RESULTADOS: Observou-se que a maioria dos recém-nascidos era do sexo masculino, com idade gestacional entre 33 semanas e 36 semanas e 6 dias, apresentaram comportamento visuomotor adequado para a faixa etária pesquisada e que a maioria das famílias apresentava boas condições socioeconômicas e demográficas. Ainda foi possível detectar em 19 por cento da amostra sinais oculares, os quais foram encaminhados para um Serviço de Oftalmologia. CONCLUSÕES: Os resultados apontam o método como um instrumento importante na triagem visual, possibilitando a detecção oportuna de alterações visuais em lactentes prematuros desde o 1º mês de vida. O olhar clínico da avaliação terapêutica ocupacional de lactentes deve voltar-se para a observação do comportamento considerando não apenas os riscos biológicos, mas também a influência que os fatores ambientais e sociais exercem sobre o desempenho funcional da criança.

OBJECTIVE: To characterize the behavior of premature newborns in the first year of chronological age. METHODS: This is a cross-sectional descriptive study, bound to a longitudinal study titled: "Comparison of visual behavior on the first quarter of year of life of premature nursling born at two maternities of Recife/PE." The sample was composed by 52 premature newborns selected from June, 2007 to June, 2008 from the Maternity of the Federal University of Pernambuco (UFPE). Biological, socioeconomic and demographic data was collected through medical records and interviews with progeny. Newborns were evaluated by the Assessment Guide of Visual Ability in Infants. RESULTS: Most of the newborns were male at a gestational period between 33 weeks and 36 weeks and 6 days, showed a good visual behavior development for the age researched, and most of the families showed good socioeconomical and demographic profile. Besides, it was possible to detect ocular signs in 19 percent of sample, that were referred to an Ophthalmology Service. CONCLUSION: This study results point out the method like an important key in the early detection and visual screening for premature nursling since the first month of life and it led us to believe that clinical view for occupational therapy intervention must be focused not only on biological risks but also at the influence environment in newborn performance.

Comportamento visual e desenvolvimento motor de recém-nascidos prematuros no primeiro mês de vida / Visual behavior and the motor development of premature newborns in the first month of life

OBJETIVO: Caracterizar o comportamento visual e o desenvolvimento motor de RNPT com um mês de idade corrigida, nascidos na maternidade de um hospital escola. MÉTODO: Estudo descritivo, seccional no primeiro mês de idade corrigida em uma coorte de recém-nascidos prematuros, utilizando-se como instrumentos de avaliação o Método de Avaliação da Conduta Visual de Lactentes e o Alberta Infant Movement Scale (AIMS). RESULTADOS: Observou-se que os recém-nascidos prematuros apresentaram respostas esperadas para as provas que avaliam o comportamento oculomotor e com frequências inferiores para a prova do sorriso, conforme o método de avaliação utilizado no estudo. Na avaliação motora, 25 por cento apresentaram percentil abaixo de 5; 8,3 por cento com percentil 5; 8,3 por cento com percentil 10; 25 por cento com percentil 25; 8,3 por cento com percentil 50 e 25 por cento com percentil 75. CONCLUSÕES: Os resultados deste estudo demonstraram que mesmo em pequena amostra é possível observar atraso típico no desenvolvimento motor de lactentes prematuros quando se utiliza instrumento de avaliação adequado. Evidenciou-se que a idade gestacional pode ter influenciado o desempenho dos lactentes e que os recém-nascidos prematuros, mesmo com a idade corrigida, ainda estão aquém dos bebês a termo no que se refere às aquisições do desenvolvimento motor, indicando a necessidade de alerta ao desenvolvimento no percentil 10 ou abaixo, mesmo apresentando desempenho satisfatório no comportamento visual. A correção da idade foi um importante fator que norteou a compreensão das aquisições visuais e motoras de lactentes prematuros

Controle postural de escolares com respiração oral em relação ao gênero / Postural control of mouth breathing school aged children regarding gender

TEMA: controle postural de escolares com respiração oral. OBJETIVO: comparar postura e equilíbrio corporal entre os grupos de escolares com e sem respiração oral considerando a variável gênero. MÉTODO: o estudo foi realizado em uma escola municipal da cidade de Santa Maria; foi aprovado pelo Comitê de Ética da Universidade Federal de Santa Maria. O grupo estudo (com respiração oral) e o grupo controle (sem respiração oral) foram selecionados, baseados na anamnese, na idade (entre 8 a 12 anos), na avaliação do sistema estomatognático e na avaliação auditiva. A amostra final ficou composta por 51 escolares no grupo estudo (20 gênero feminino e 31 gênero masculino) e 58 escolares no grupo controle (34 gênero feminino e 24 gênero masculino). Ambos os grupos foram submetidos à posturografia dinâmica (teste de organização sensorial -TOS - e análise sensorial) e à avaliação postural em vista lateral direita e esquerda. RESULTADO: no gênero feminino encontrou-se diferença estatisticamente significante nos valores obtidos no ângulo que analisa o alinhamento horizontal da cabeça, nos valores do TOS III e no valor médio de todos os TOS. No gênero masculino verificou-se diferença numericamente significante nos valores obtidos no ângulo do joelho, no ângulo do tornozelo, no TOS III, TOS IV e no valor médio de todos os TOS. CONCLUSÃO: escolares com respiração oral apresentam alterações posturais; no gênero feminino no posicionamento cefálico e no masculino em membros inferiores. O equilíbrio corporal dos escolares com respiração oral, em ambos os gêneros, mostrou estar mais prejudicada em relação aos escolares sem respiração oral, principalmente na presença de conflito sensorial.

BACKGROUND: postural control of mouth breathing school aged children. AIM: to compare the posture and body balance of school aged children groups, with and without oral breathing considering the variable gender. METHOD: the study was developed at a municipal school in the city of Santa Maria (Brazil) and received prior approval of the ethics committee of the University of Santa Maria. The study group (with oral breathing) and the control group (without oral breathing) were selected based on an anamnesis, age (between 8 and 12 years), assessment of the stomatognathic system and auditory evaluation. The final sample was composed by 51 children in the study group (20 female and 31 male) and 58 in the control group (34 female and 24 male). Both groups were submitted to a dynamic posturography (sensory organization test - SOT) and to a postural assessment in right and left lateral view. RESULTS: regarding the female gender, a statistically significant difference was observed for the angle that evaluates head horizontal alignment; for the SOT III value and for all SOT mean values. As for the male gender, a significant numerical difference was observed for the knee angle, for the ankle angle, for the SOT III value, for the SOT IV value and for all SOT mean values. CONCLUSION: school aged children with oral breathing present postural alterations; females present head positing alterations and males present alterations in the position of the inferior limbs. The body balance of school aged children with oral breathing, of both genders, demonstrated to be altered when compared to children without oral breathing, especially in the presence of sensorial conflict.

Blow-in fracture of the orbital roof presenting as a case of non-resolving choroidal effusion.

A 34-year-old male patient was referred to us as a case of non-resolving suprachoroidal hemorrhage. History revealed decrease in right eye vision following trauma to forehead. B scan ultrasonography (USG) of the right eye showed a high-reflective structure indenting the globe. It turned out to be an inferiorly displaced fracture fragment from the orbital roof on computerized tomography (CT) scan. The choroidal elevation disappeared after open reduction of the fracture fragment and patient had good recovery of vision. USG and CT scan were helpful in the diagnosis and management of this case.

Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries.

A prospective observational study was done to assess ocular survival, visual outcome and prognostic factors of open globe injury. Eighty eyes of penetrating trauma between 2004 and 2006 were categorized according to the ocular trauma classification system. Primary repair was done and outcomes were assessed at one, three and six months. The final vision was categorized as per World Health Organization classification of visual impairment. Factors at presentation were evaluated for prognostic value towards visual outcome. Sixty-nine eyes with minimum one month follow-up were included for analysis. Statistical analysis was done using Univariate and Multivariate analysis. We found Grade IV visual acuity (<5/200) at presentation (64%) as the most important factor contributing to poor visual outcome. Statistically insignificant factors were time since injury, cataract, and presence of intraocular foreign body. Ocular survival was 97%. We concluded that initial visual acuity, hyphema, zone and length of injury, retinal detachment and vitreous hemorrhage are statistically significant factors affecting outcome in open globe injuries.

Visual prognosis, intraocular pressure control and complications in phacomorphic glaucoma following manual small incision cataract surgery.

Aims: To evaluate intraocular pressure (IOP) control, visual prognosis and complications following manual small incision cataract surgery among eyes with phacomorphic glaucoma. Materials and Methods: This prospective, non-randomized interventional consecutive case series included all patients with phacomorphic glaucoma who presented to a tertiary eye care referral center in South India between March 2006 and April 2007. All patients underwent slit-lamp bio-microscopy, applanation tonometry and gonioscopy of the other eye to rule out angle closure. Small incision cataract surgery with intraocular lens implantation was performed in all affected eyes. Complete ophthalmic examination was done at each follow-up visit. Results: A total of 74 eyes with phacomorphic glaucoma were included in this study. The preoperative mean IOP was 38.4±14.3 mmHg and mean IOP at last follow-up was 12.7±2.4 mmHg. There was a statistically significant difference between IOP at presentation and IOP at last follow-up (P< 0.001). None of the eyes required long-term antiglaucoma medication. No significant intraoperative complications were noted. The final postoperative best corrected visual acuity was 20/40 or better in 51 patients. Eighteen eyes had corneal edema and 36 eyes had anterior chamber inflammation. Both conditions resolved with standard medical therapy. Conclusion: Manual small incision cataract surgery is safe and effective in controlling IOP and achieving good functional visual acuity with minimal complications in the management of phacomorphic glaucoma in developing countries.

Síndrome de visión de la computadora en estudiantes preuniversitarios / Computer vision syndrome observed in high school students

OBJETIVO: Describir el comportamiento clínico-epidemiológico del síndrome de visión de la computadora en estudiantes de décimo grado del preuniversitario Rafael María de Mendive desde septiembre del 2007 a junio del 2008. MÉTODOS: Se realizó un estudio descriptivo y transversal. El universo estuvo constituido por todos los alumnos del grado con manifestaciones clínicas relacionadas con el uso de la computadora (183 pacientes) y la muestra fue de 45, tomada mediante un muestreo aleatorio simple (1 de cada 4). Se tuvo en cuenta las siguientes variables: grupos de edad, sexo, manifestaciones clínicas, uso de cristales, tiempo de trabajo con la computadora, intervalo de reposo visual por hora de trabajo y evolución visual después de 3 meses del tratamiento. RESULTADOS: Predominó el sexo femenino (68,9 por ciento) con una edad media de 16,5 y los síntomas relevantes fueron la cefalea (82,2 por ciento) y fatiga ocular (75,5 por ciento). Los pacientes que usaban cristales y que el tiempo de trabajo con el ordenador fue superior a 4 horas originó los síntomas visuales antes mencionado; así como la miopía dentro de las ametropías (70 por ciento) y los descansos visuales de 15-20 minutos mejoraron el complejo de síntomas (51,2 por ciento). CONCLUSIONES: El síndrome de visión de la computadora constituye un problema de salud en este centro educacional, por lo que es importante realizar siempre un diagnóstico precoz debido a los efectos negativos que trae consigo en el adolescente, la escuela y la familia

OBJECTIVE: To characterize the clinical and epidemiological behavior of the computer vision syndrome in 10th grade students from Rafael María de Mendive high school in the period of September 2007 to June 2008 METHODS: A cross-sectional and descriptive study was conducted in which the universe of study was made up of all students of this educational level, who presented with clinical features derived from the computer use (183 patients).The final sample comprised 45 students selected on the basis of simple randomized sampling (1 out of 4). There were taken into consideration some variables: age groups, sex, clinical features, use of glasses, length of time spent in computer work, visual rest period per working hour and visual evolution after 3 months of treatment. RESULTS: Females predominated (68,9 percent) aged 16.5 years as average and the most relevant symptoms were headache (82,2 percent) and eyestrain (75.5 percent). Patients who wore glasses and worked over 4 hours at computer showed the above-mentioned visual symptoms; additionally, myopia within the ametropies (70 percent) and the visual resting lasting 15-20 minutes improved this set of symptoms (51,2 percent). CONCLUSIONS: Computer vision syndrome is a real health problem in our environment; therefore, it is important to making an early diagnosis of this entity due to its negative effects in teenagers, the school and the family