PAAO JAN MARCH 2016 Vol15(1)

Jan-March 2016, Vol. 15(1) 

ISSN 2219-4665 

God’s Eye (Helix Nebula in Outer Space (Copyright Bigstockphoto ® )

Mejorando la vista. Mejorando las vidas. 

LIDERANDO EN EL CUIDADO OCULAR 

Alcon es el líder mundial en el cuidado ocular porque nos apasiona ayudar 

a la gente a ver mejor. Nos dedicamos a mejorar las vidas mejorando 

la vista, uno de nuestros sentidos más preciados. Les proveemos a los 

pacientes productos innovadores con el objetivo de proporcionarles los 

mejores resultados. Con nuestros tres negocios - quirúrgico, farmacéutico 

y cuidado de la visión - ofrecemos el más amplio espectro de productos 

líderes en la industria que atienden el ciclo completo de necesidades para 

el cuidado ocular. Nos enorgullecemos de ser un socio de confianza de los 

profesionales en todo el mundo.

Indexed 

Membership, Associations 

and Membership, Editorial Guidelines Associations 

and Editorial Guidelines 

Aims 

Aims and 

and scope: 

scope: 

Vision 

Vision Pan-America 

Pan-America (printed 

(printed version 

version 

ISSN 

ISSN 2219-4665, 

2219-4665, electronic 

electronic version 

version 

ISSN 

ISSN 2219-4673), 

2219-4673), the 

the official 

official publication 

publication 

of of 

of the 

the Pan-American 

Pan-American Association 

Association 

of of 

of Ophthalmology, 

Ophthalmology, is is 

is a quarterly 

quarterly fully 

fully 

peer 

peer reviewed 

reviewed scientific 

scientific publication 

publication 

that 

that publishes 

publishes original 

original research 

research in in 

in Ophthalmology, 

Ophthalmology, 

including 

including review 

review articles 

articles 

on 

on ophthalmic 

ophthalmic diseases 

diseases and 

and surgical 

surgical 

techniques, 

techniques, clinical 

clinical scientific 

scientific studies, 

studies, 

basic 

basic investigation, 

investigation, case 

case reports, 

reports, brief 

brief 

communications 

communications and 

and letters 

letters to to 

to the 

the editor 

editor 

in in 

in four 

four languages: 

languages: Spanish, 

Spanish, English, 

English, 

Portuguese 

Portuguese and 

and French. 

French. In In 

In addition, 

addition, 

the 

the journal 

journal publishes 

publishes critical 

critical reviews 

reviews of of 

of 

new 

new texts 

texts in in 

in ophthalmology 

ophthalmology deemed 

deemed 

to to 

to be 

be of of 

of importance 

importance to to 

to the 

the Pan-American 

Pan-American 

practitioner. 

practitioner. 

Follow us on Facebook and Twitter 

Pan-American Association 

of of Ophthalmology 

@paao_vision 

Vision Pan-America is also listed 

at the collection of the National 

Library of Medicine Catalog 

under the serial #101553235 

Pan-American Association of of Ophthalmology (PAAO) 

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1301 1301 Pan-American S Bowen Road Road Ophthalmological 

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F 

Printed in Printer Colombiana – Colombia 

Printed in in Printer Colombiana S.A. – Colombia 

Jan - 

March 

March 

2016; 

2015, 

Vol 

Vol. 

15(1). 

14(1) 

Editor-in-Chief: 

Associate Editor-in-Chief: Administrative Editorial Council: 

Paulo Elias C. Dantas, MD Lihteh Wu, MD (San José, Ana Luisa Hofling-Lima,MD (PAAO 

Editor-in-Chief: 

Editor Associate Emeritus: Editor-in-Chief: 

Administrative Editorial Council: 

Prof. of Ophthalmology 

Costa Rica) 

President.), Mark Mannis, MD 

Paulo Elias C. C. Dantas, MD Mark Lihteh J. Wu, Mannis, MD (San MD José, Eduardo Ana Luisa Alfonso, Hofling-Lima,MD (PAAO (PAAO 

Department of Ophthalmology 

(PAAO Imediate Past-President, 

(São Prof. Paulo, of Ophthalmology 

Brasil) 

(Sacramento, Costa Rica) CA, USA) President, President.), Miami, Mark FL, Mannis, USA), MD 

Santa Casa of São Paulo, Brazil 

Sacramento, CA, USA.) and Ana 

Department of Ophthalmology 

Luisa (PAAO Hofling Imediate Lima Past-President, 

William De La Peña, (Imediate MD (PAOF Past- 

Santa Casa of São Paulo, Brazil Associate Editor-in-Chief: President, Sacramento, São CA, Paulo, USA.) Brasil) and 

Chairman, Montebello, CA, USA) and 

Section Editor 

Lihteh Wu, MD (San José, Liana William Ventura De La MD Peña, MD (PAOF 

Costa Rica) 

(PAOF Chairman, Chair, Montebello, Recife Brazil) CA, USA) 

Section Editor 

Section Editor, Cataracts: Section Editor, 

Section Editor, Prevention of 

Nestor Gullo, MD (La Plata, Neurophthalmology: 

Blindness: Fernando R. Barría 

Section Editor, Cataracts: 

Section Editor, 

Section Editor, Prevention of of 

Argentina) 

Karl Golnik, MD (Cincinnati, von Bischhoffshausen, MD 

Nestor Gullo, MD (La Plata, 

Neurophthalmology: 

Blindness: Fernando R. R. Barría 

OH, USA) 

(Concepción, Chile) 

Argentina) Section Editor, Cornea and 

Karl Golnik, MD (Cincinnati, 

von Bischhoffshausen, MD 

External Disease: Allan R. 

OH, Section USA) Editor, Oncology: 

(Concepción, Section Editor, Chile) Refractive 

Section Editor, Cornea and 

Slomovic, MD (Ontario, Rubens N. Belfort, MD (São Surgery: Luis Izquierdo Jr, MD 

External Disease: Allan R. R. 

Section Editor, Oncology: 

Section Editor, Refractive 

Canada) 

Paulo, Brazil) 

(Lima, Peru) 

Slomovic, MD (Ontario, 

Rubens N. N. Belfort, MD (São 

Surgery: Luis Izquierdo Jr, MD 

Canada) Section Editor, Eye Banking: 

Paulo, Section Brazil) Editor, Ophthalmic 

(Lima, Section Peru) Editor, Retina and 

Luciene Barbosa de Sousa, MD Plastics and Orbital Diseases: Vitreous: Mauricio Maia, MD 

Section Editor, Eye Banking: 

Section Editor, Ophthalmic 

Section Editor, Retina and 

(São Paulo, Brazil) 

Chun Cheng Lin Yang, MD (São Paulo, Brazil) 

Luciene Barbosa de Sousa, MD 

Plastics and Orbital Diseases: 

Vitreous: Mauricio Maia, MD 

MSc (San José, Costa Rica) 

(São Section Paulo, Editor, Brazil) Genetics: 

Chun Cheng Lin Yang, MD 

(São Section Paulo, Editor, Brazil) Statistics and 

Eduardo José Gil Duarte Silva, 

MSc Section (San Editor, José, Pathology: 

Costa Rica) Epidemiology: Niro Kasahara, 

Section Editor, Genetics: 

Section Editor, Statistics and 

MD (Figueira da Foz, Portugal) J. Oscar Croxatto, MD (Buenos MD (São Paulo, Brazil) 

Eduardo José Gil Duarte Silva, 

Section Editor, Pathology: 

Epidemiology: Niro Kasahara, 

Aires, Argentina) 

MD Section (Figueira Editor, da Glaucoma: 

Foz, Portugal) J. J. Oscar Croxatto, MD (Buenos 

MD Section (São Editor, Paulo, Uveitis Brazil) and 

James C. Tsai, MD (New 

Aires, Section Argentina) Editor, Pediatric Immunology: Lourdes 

Section Editor, Glaucoma: 

Section Editor, Uveitis and 

Haven, CT, USA) 

Ophthalmology and Strabismus: Arellanes-García, MD (Mexico 

James C. C. Tsai, MD (New 

Section Editor, Pediatric 

Immunology: Lourdes 

Maria Estela Arroyo Yllanes, City, Mexico) 

Haven, CT, USA) 

Ophthalmology and Strabismus: 

Arellanes-García, MD (Mexico 

MD (México City, México) 

Maria Estela Arroyo Yllanes, 

City, Mexico) 

Editorial Advisory Board 

MD 

Editorial (México 

Review City, México) 

Board 

Editorial Advisory Board 

Denise de Freitas, MD (São 

Editorial Review Board 

Alejandro Lichtinger, MD Maria Audina Berrocal, MD 


Denise de Freitas, MD (São 

(Toronto, Ontario, Canada) 

Alejandro Lichtinger, MD 

(Miami, FL, USA) 

Maria Audina Berrocal, MD 

Paulo, Eduardo Brazil) Alfonso, MD 

(Toronto, Ashley Behrens, Ontario, MD Canada) (Riyadh, 

(Miami, Daniel Weil, FL, USA) MD (Buenos 

(Miami, FL, USA) 

Eduardo Alfonso, MD 

Saudi Arabia) 

Ashley Behrens, MD (Riyadh, 

Aires, Argentina) 

Daniel Weil, MD (Buenos 

(Miami, Eduardo FL, Arenas, USA) MD (Bogotá, 

Saudi Ana Luisa Arabia) Höfling-Lima (São 

Aires, Marian Argentina) Macsai, MD (Chicago, 

Colombia) 

Eduardo Arenas, MD (Bogotá, 


Ana Luisa Höfling-Lima, (São MD 

IL, USA) 

Marian Macsai, MD (Chicago, 

Colombia) J. Fernando Arévalo, MD (São Paulo, Bruno Paulo, Brazil) Fontes, Brazil) MD (Rio de 

IL, Marie USA) Eve Legare, MD 

(Riyadh, Saudi Arabia) 

J. J. Fernando Arévalo, MD 

Janeiro, Brazil) 

Bruno Fontes, MD (Rio de 

(Quebec City, Canada) 

Marie Eve Legare, MD 

(Riyadh, Alfredo Sadun, Saudi Arabia) MD (Los 

Janeiro, Carol L. Brazil) Karp, MD (Miami, 

(Quebec Natalio Izquierdo, City, Canada) MD (San 

Angeles, CA, USA) 

Alfredo Sadun, MD (Los 

FL, USA) 

Carol L. L. Karp, MD (Miami, 

Juan, Puerto Rico) 

Natalio Izquierdo, MD (San 


FL, Enrique USA) Graue-Hernández, 

Juan, Peter Quiros, Puerto Rico) MD (Los 

MD (Mexico City, Mexico) 

Enrique Graue-Hernández, 


Peter Quiros, MD (Los 

MD Eugenio (Mexico Maul City, de La Mexico) Puente 

Angeles, Renato Ambrósio CA, USA) Jr. (Rio de 

(Santiago, Chile) 

Eugenio Maul de La Puente 

Janeiro, Brazil) 

Renato Ambrósio Jr., (Rio MD de 

Puente, (Santiago, Ivan Schwab, MD Chile) (Santiago, MD Chile) (Rio Janeiro, de Janeiro, Brazil) Brazil) 

(Sacramento, CA, USA) 

Ivan Schwab, MD 

Office Staff 

(Sacramento, CA, USA) 

Office Staff 

Managing Editor 

Production Editor 


Teresa Bradshaw 

Terri Grassi 

Mapy Padilla 

Managing Editor 



(Arlington, TX, USA) 


(Lima, Peru) 

Teresa Bradshaw 

Terri Grassi 

Mapy Padilla 



(Lima, Peru) 

PAOF INDUSTRY SPONSORS 

PAOF INDUSTRY SPONSORS 

• Abbott Medical Optics Inc. • Bausch+Lomb Inc. 

• Oculus GmbH / Oculus Surgical 

• Abbott Alcon Inc. Medical Optics Inc. • Johnson Bausch+Lomb & Johnson Inc. Vision Care •• Rayner Intraocular Lenses Ltd. 

• Alcon Allergan Inc. Inc. 

Latin America 

• Johnson & Johnson Vision •• Merck & Co Co Inc. 

• Allergan Inc. 

Care Latin America 

Producida / Editada / Diseñada / 

3 TouchMedia 

strategy marketing communication Distribuida por: 3 Touch Media S.A.S. 

Producida // Editada // Diseñada // 

strategy 

strategy 

marketing 

marketing 

communication 

communication 

Distribuida por: 3 Touch Media S.A.S. 

3 TouchMedia 

December 2014, Vol. 13(4) 

PAN-AMERICA 

PAN-AMERICA

PAAO EXECUTIVE COMMITTEE 2015-2017 

PAOF BOARD 

President 

Eduardo C. Alfonso, MD 

President-Elect 

J. Fernando Arévalo, MD 

Past President 

Ana Luisa Höfling-Lima, MD 

Vice President 

Lihteh Wu, MD 

Executive Vice President 

Paulo E.C. Dantas, MD 

Secretary, English Language 

Region 

Carol L. Karp, MD 

Associate Secretary, English 

Language Region 

R.V. Paul Chan, MD 

Secretary, Portuguese Language 

Region 

Mauricio Maia, MD 

Associate Secretary, 

Portuguese Language Region 

Rubens N. Belfort, MD 

Secretary, 

Spanish Language Region 

Jorge E. Valdez García, MD 

MA 

Associate Secretary, Spanish 

Language Region 

Angela M. Fernández 

Delgado, MD 

Executive Director 

Ms. Teresa J. Bradshaw 

Chairman of the Board 

Liana Ventura MD 

Past Chair 

William De La Peña MD 

Vice Chair 

Jorge E. Valdez García. MD 

Secretary-Treasurer 

William De La Peña MD 

Executive Director 

Teresa J. Bradshaw 

PAAO BOARD OF DIRECTORS 2015-2017 

ARGENTINA 

Daniel Fernando Dilascio MD 1 

Eduardo Rubin MD 4 

Emilio Dodds MD 4 

Enrique S. Malbrán Sr. MD 2 

J. Ignacio Manzitti MD 1 

Javier Fernando Casiraghi MD 1 

Joaquín Alfredo Bafalluy MD 1 

Juan Oscar Croxatto MD 4 

Leonardo Fernández Irigaray MD 4 

María Alejandra Llaya MD 1 

Martin Charles MD 4 

Pablo Luis Daponte MD 1,9 

BOLIVIA 

Gustavo Aguirre Urquizu MD 1 

Noel Pedro Mercado Martínez MD 3 

BRAZIL 

Ana Luisa Höfling-Lima MD 2 

Homero Gusmão de Almeida MD 3 

Luciene Barbosa de Sousa MD 4 

Michel Eid Farah MD 4 

Rubens Belfort Jr. MD PhD 2 

Rubens N. Belfort MD 4 

CANADA 

Allan R. Slomovic MD 3 

CHILE 

Alejandro Vázquez de Kartzow MD 4 

Cristián Luco MD 2 

Fernando R. Barría von B. MD 4 

Gonzalo Vargas Díaz MD 1 

Javier Corvalán Rinsche MD 3 

Juan Verdaguer Taradella MD 2 

Mauricio A. López Muñiz MD 1 

Raul Romero Soto MD 1 

Raul Terán Arias MD 1 

Rodrigo Vidal Sobarzo MD 1 

Verónica Fernández Salgado MD 4 

COLOMBIA 

Alvaro Rodríguez González MD 2 

Angela María Fernández Delgado MD 1,4 

Carlos Augusto Medina Siervo MD 1 

José Ramiro Prada Reyes MD 4 

Juan Manuel Sánchez Alvarez MD 1 

Roberto Baquero H. MD 1,3 

COSTA RICA 

Claudio Orlich Dundorf MD 3 

Mario Esteban Alpízar Roldán MD 1 

Teodoro Evans MD 1 

CUBA 

Juan Raul Hernández Silva MD 3 

Liamet Fernández Argones MD 1 

Marcelino Rio Torre MD 

Zucel Veitia Rovirosa MD 1 

DOMINICAN REPUBLIC 

Carlos Gómez Chávez MD 3 

Joaquin Lora Hernández MD 1 

Miguel Angel López Pimentel MD 1 

ECUADOR 

Diego Mauricio Carpio Gotuzzo MD 1 

F. Guillermo Yosa Almeida MD 3 

Graciela G. Ruiz Yépez MD 1 

Sandra Larco Moncayo MD 4 

EL SALVADOR 

Andrés Cárdenas Hormaza MD 1 

Carlos Andrés López Gutiérrez MD 1,3 

GUATEMALA 

Cristián Rolando Acevedo Campos MD 3 

HAITI 

Frantz Large MD 3 

HONDURAS 

Erwin Ochoa Alcántara M. MD 3 

MEXICO 

Alejandro A. Lichtinger Dondish MD 1 

Carla Rocio Pérez Montaño MD 1 

David Rivera De La Parra MD 1 

Eduardo Chávez Mondragón MD 4 

Enrique L. Graue Wiechers MD 2 

Jorge E. Valdez García MD MA 3 

José Alejandro Claros Bustamante MD 1 

NICARAGUA 

Ramiro Blanco Barquero MD 3 

PANAMA 

Benjamín F. Boyd MD 2 

Rita Yee Chan MD 3 

Samuel Boyd Lewis MD 1 

PARAGUAY 

Pablo Cibils Farrés MD 3 

Rainald Duerksen Braun MD 1 

PERU 

Carlos Daniel Siverio Llosa MD 1 

Carlos Sosa Jara MD 1 

Cecilia Contreras Calisto MD 1 

Felipe Torres Villanueva MD 1 

Francisco Contreras Campos MD 2 

José Miguel Risco MD 1,3 

Juan Fernando Mendiola Solari MD 1 

Karin Flory Arellano Caro MD 1 

Mario Danilo J. De La Torre Estremadoyro MD 1 

PORTUGAL 

Angela Maria Veloso Carneiro MD PhD 1 

Maria João Capelo Quadrado MD PhD 3 

PUERTO RICO 

Hector Mayol MD 3 

María Hortencia Berrocal MD 1 

SPAIN 

Alfonso Arias Puente MD 1 

José A. Cristóbal Bescos MD 1 

José Luis Encinas Martín MD PhD 3 

URUGUAY 

Andrea Fernández López MD 1 

Jaqueline Lourdes Elias Núñez MD 1 

Martín Sánchez Fernández MD 1,3 

USA 

Alice R. McPherson MD 2 

Bradley R. Straatsma MD JD 2 

Cynthia Bradford MD 1 

J. Bronwyn Bateman MD 2 

Lynn D. Anderson PhD 4 

Lynn K. Gordon MD PhD 1 

Mark J. Mannis MD 2 

Mildred M.G. Olivier MD 1 

Paul R. Lichter MD 2 

Peter A. Quiros MD 1 

Richard L. Abbott MD 2 

Robert C. Drews MD 2 

Robert Weinreb MD 4 

Victor L. Pérez MD 1,4 

William L. Rich III MD FACS 3 

Zélia Maria da Silva Correa MD PhD 1 

VENEZUELA 

Claudia Luz Pabón Bejarano MD 1 

Francisco Antonio Millán Moreno MD 1 

José Antonio Ciuffi Pacheco MD 1 

José Luis Rincón Rosales MD 1 

Luis Felipe Rivero Caret MD 1 

María Alejandra Benavides Bernabél MD 1 

Oscar V. Beaujón Balbi MD 3 

WEST INDIES 

Nigel H. Barker MB BS FRCOphth 1,3 

Sonja E. Johnston BSc MB BS FRCS 1 

1 

Delegate 

2 

PAAO Past President 

3 

President, Affiliate National Society 

4 

President, Affiliated Subspecialty Society

ÍNDICE 

EDITORIAL 

BURNING THE MIDNIGHT OIL: CHANGING. 

IMPROVING. WORKING 

PAULO ELIAS C. DANTAS 

VIS. PAN-AM. 2016; 15(1): 5 

MESSAGE FROM THE PRESIDENT 

EDUARDO ALFONSO 


ORIGINAL ARTICLE 

THIRD-GENERATION FORMULAS AND 

INTRAOCULAR LENS CALCULATION WITH 

IOLMASTER ® : REFRACTIVE RESULTS IN 101 

EYES AND RELATIONSHIP WITH 

AXIAL LENGTH 

MÁRIO RAMALHO, FERNANDO VAZ, CATARINA PEDROSA, 

MAFALDA MOTA, INÊS COUTINHO, ANA SOFIA LOPES, ANTÓNIO 

MELO AND ISABEL PRIETO 

VIS. PAN-AM. 2016; 15(1): 7-9 

EPIDEMIOLOGICAL PROFILE OF EYE DISEASES 

IN AN EMERGENCY CENTER 

COMPLEX IN CAMPINAS, BRAZIL 

MARCELO VICENTE DE ANDRADE SOBRINHO, ANA CARLA 

BRITO DE AGUIAR, LEONARDO DIAS ALENCAR, WILLIAM W. 

BINOTTI AND ORLANDO FARIA JR. 


AVALIAÇÃO DA DENSIDADE DE PIGMENTO 

MACULAR E A SUA RELAÇÃO COM FATORES 

DE RISCO PARA A DEGENERESCÊNCIA 

MACULAR LIGADA À IDADE (DMLI) 

NADINE MARQUES, ANA MIRANDA, SANDRA BARROS, JOÃO 

CARDOSO, SONIA PARREIRA, ANA CARDOSO, NELVIA DONAIRE 

AND NUNO CAMPOS 


OPHTHALMOLOGICAL SCREENING OF 

STUDENTS IN CAMPINAS, BRAZIL. 

MARCELO VICENTE DE ANDRADE SOBRINHO, MARCELA 

GALLATE JORGE, PAOLA NAPOLITANO MESSIAS, 

CAROLINA PERES BATALHA, LIVIA GARCIA BISELLI AND LIVIA 

MISKULIN PREARO 


CASE REPORT 

INTRAVITREAL RANIBIZUMAB FOR THE 

TREATMENT OF MACULAR EDEMA 

SECONDARY TO MALIGNANT HYPERTENSION 

RAQUEL C. BRITO, PEDRO NEVES, INÊS MATIAS, MÁRIO 

ORNELAS AND DAVID MARTINS 

VIS. PAN-AM. 2016; 15(1): 21-22. 

OFTALMÍA NEONATAL SECUNDARIA A 

NEISSERIA GONORRHOEAE: REPORTE DE UN 

CASO CLÍNICO Y REVISIÓN DE 

LA LITERATURA 

FELIPE PETOUR, CRISTIÁN ARANEDA, SYLVIA ARANEDA, 

FEDERICA SOLANES, NICOLÁS SELEME AND DIEGO OSSANDON 


INADVERTENT VITREOUS STAINING BY 

TRYPAN BLUE DURING 

PHACOEMULSIFICATION 

ROBERTO PINTO COELHO 


TUBERCULOSIS OF THE LACRIMAL SAC 

MAFALDA TRINDADE SOARES, INÊS COUTINHO, ANTÓNIO 

RIBEIRO DA SILVA, LUÍS OLIVEIRA, PEDRO MONTALVÃO AND 

MIGUEL MAGALHÃES 


MESSAGE FROM THE 

CHAIRMAN OF THE PAOF BOARD 

COLLABORATIVE LEADERSHIP: WE ALL CAN BE 

AN AGENT FOR SOCIAL CHANGE 

LIANA MARIA VIEIRA DE OLIVEIRA VENTURA 


INSTRUCTIONS TO AUTHORS 

GENERAL INSTRUCTIONS FOR 

ONLINE SUBMISSIONS 

VIS. PAN-AM. 2016; 15(1): 31-32

EDITORIAL 

Paulo E.C. Dantas 

Burning the midnight oil 

Changing. Improving. Working. 

Editor-in-Chief 

Past November, we had the great opportunity of meeting with our 

editorial Board in Las Vegas during the AAO annual meeting to discuss 

issues related to the present and future of our scientific journal. 

We reviewed some interesting points regarding promoting our 

journal, making it an important source of scientific information and 

also a preferential source for publication of Pan-American science. 

Summarizing: Improving VPA! 

During this brainstorm session, many ideas went up, were approved 

and will be applied during the current year of 2016. One of the major 

change suggested by the group was to make VPA more a scientific 

journal and less a magazine, leaving social and institutional information 

be transmitted by our eVision newsletter and through our institutional 

website www.paao.org. This would bring more room to accommodate 

more scientific submissions and scientific material to the journal. 

Beginning this first 2016 issue, you will also notice a substantial 

change in our design. In another exceptional and diligent job, 

the brilliant Brazilian Boston-based designer Mr. Felipe Marques 

felipe@felipeferrari.com, created a piece of art voted unanimously as 

the best choice by the whole Editorial Board. Hope you like it also. 

From the front page to the inside, the new look was provided with 

the purpose of facilitating the reader’s life with more color contrast, 

bigger letters and best quality photos. 

You, as our reader, are the focus of our attention. So, if you have any 

suggestion, criticism or proposal, please send me an email. Will be more 

than happy to hear from you! 

We will always be “burning the midnight oil” to make Vision Pan- 

America, The Pan-American Journal of Ophthalmology, a reference to all 

Pan-American scientific community. 

Enjoy the issue! 

Paulo E.C. Dantas 

Editor-in-Chief 

pauloecdantas@me.com 

Standing (left to right): Rubens Belfort Neto, 

Fernando Arevalo, Denise de Freitas, Jorge Valdez, 

Renato Ambrósio and Enrique Graue. 

Seated (left to right): Paulo E.C. Dantas, Eduardo 

Arenas, Eduardo Alfonso and Mauricio Maia. 

V I S I O N P A N - A M E R I C A N – T H E P A N - A M E R I C A N J O U R N A L O F O P H T H A L M O L O G Y

Vis. Pan-Am. 2016; 15(1): 6. 

MESSAGE FROM THE PRESIDENT 


President of the Pan- American 

Association of Ophthalmology 

2015-2017 

As we start the New Year, I am 

happy to report that the Pan-American 

Association continues to make great 

strides in providing the membership 

superb educational opportunities, 

great venues for academic meetings 

and programs to improve visual health 

throughout Latin America. I, as well as 

the Executive Committee, leaders of 

the national and sub specialty societies 

as well as the membership at large have 

been working very hard to make these 

program successful. 

In January, the “Pan American” 

Association along with the American 

Academy of Ophthalmology hosted the 

leadership course in San Francisco. We 

are eager to see these young leaders 

continue to be effective in moving our 

profession forward with projects that 

ultimately better the lives of patients. 

We have just finished a tremendous 

World Congress of Ophthalmology 

(WOC) in Guadalajara, Mexico. The 

Pan-American Association, as co-host 

of the WOC, prepared a number of 

courses and symposiums. We enjoyed a 

plethora of social events organized by 

the Mexican Society of Ophthalmology 

(MSO) and the International Council of 

Ophthalmology (ICO). The kick off for 

the Congress was a subspecialty day 

were many of the Pan-American sub 

specialty groups presented a superb 

lineup of academic events. Saturday 

though Monday were filled with 

symposia and courses that attracted 

7500 ophthalmologists to Guadalajara. 

The Gradle Lecture was delivered by 

Dr. Nicolas G. Bazan. The meeting 

concluded with the MSO hosting the 

best of the WOC in Spanish. Industry was 

well represented with one of the largest 

exhibit areas of all ophthalmology 

congresses. The opening ceremony 

and social events were superb, all with 

traditional Mexican flair, including 

a Mexican fiesta which had all the 

traditional Mexican cuisine, Mariachi 

bands and singers. 

The Pan-American Association also 

hosted during the WOC a meeting of 

NGOs that presented the work they are 

doing so that we can better integrate 

our common needs and resources. The 

result will be better eye care for all of 

the patients. 

As we kick off our next meeting 

which will be the Pan-American course 

in Asuncion, Paraguay in August 

2016, we invite all the membership 

to join in this great academic event. 

Following this event, we will gear up 

for the “Pan American” Congress, jointly 

sponsored with the Peruvian Society of 

Ophthalmology, which will be held in 

August 2017 in Lima, Peru. Please save 

the dates on your calendars and join 

your colleagues in Lima. 

Thank you very much for being a 

Pan-American and please let us know 

of any suggestions that you may 

have. both myself and the Executive 

Committee are ready to listen to you. 

Sincerely yours, 


President of the Pan- American 

Association of Ophthalmology 2015-2017 

WOC by the numbers: 

230 invited scientific sessions in 22 

subspecialties 

• 26 subspecialty day sessions 

• 71 contributing societies 

• 167 Coordinators + over 900 invited 

speakers from over 100 countries 

• 1,446 free papers and posters from 

over 1800 abstract submissions 

• 66 submitted instruction courses + 

59 submitted video presentations 

6

Ramalho M et al. Intraocular lens calculation. 

Third-generation formulas and 

intraocular lens calculation with 

IOLMaster ® : Refractive results in 101 

eyes and relationship with axial length 

Mário Ramalho, Fernando Vaz, Catarina Pedrosa, Mafalda Mota, Inês 

Coutinho, Ana Sofia Lopes, António Melo, Isabel Prieto. 

From Hospital Prof. Dr. Fernando Fonseca, Amadora, Lisboa, Portugal 

Corresponding author: Mario Ramalho 

Azinhaga das Galhardas, nº17, Bloco C, 6ºB, 

1600-097 Lisboa 

E-mail: mario.r.ramalho@gmail.com 

Phone: +351 965137013 

Funding: None 

Proprietary/financial interes: None 

Date of submission: 13/10/2015 Date of approval: 11/11/2015 

ABSTRACT 

Introduction: Intraocular 

lens calculation has become one 

of the main features of cataract 

surgery. Accurate lens calculation 

is an important factor in patient 

satisfaction and quality of life. The 

purpose of our study is to evaluate 

which formula (SRK II, HofferQ, 

Holladay 1 and SRK-T) was nearest 

to the final refraction after cataract 

surgery, using the IOLMaster®. 

Material and Methods: We 

evaluated 101 eyes of 78 cataract 

patients. The expected refraction 

with the intraocular lens used in 

each patient was calculated with 

the different formulas and compared 

to the patient refraction 

one month after surgery. We obtained 

data retrospectively from 

23 eyes with axial length inferior 

to 22 mm, 62 eyes with axial 

length between 22 and 26 mm 

and 16 eyes with axial length superior 

to 26 mm. 

Results: The mean refraction 

after cataract surgery for all patients 

was -0.277 diopters (D) ± 

0.94. Hoffer Q performed better 

for eyes with axial length inferior 

to 22 mm with a mean absolute 

error (difference between lens 

calculation and final refraction) 

of 0.4957 D ± 0.396. For eyes with 

axial length between 22 and 26 

mm SRK-T performed better with 

a mean absolute error of 0.4515 

D ± 0.323 and for eyes with axial 

length superior to 26 mm SRK-T 

performed better with a mean 

absolute error of 0.5538 D ± 0.333. 

We did not find any statistical 

difference in the comparison between 

third generation formulas; 

we found statistical significance 

when comparing HofferQ and 

SRKII in the “inferior to 22 mm” 

group and SRK-T and SRKII in the 

“between 22 and 26 mm” group. 

Conclusions: All third generation 

formulas can be used to 

calculate the intraocular lens. We 

recommend using HofferQ in axial 

length inferior to 22 mm and 

using SRK-T in axial length superior 

to 22 mm. 

Key-words: biometry, formula, 

cataract, refraction 

INTRODUCTION 

The first intraocular lens implantation 

after cataract surgery 

was performed by Harold Ridley 

in 1950. The dioptric power of 

this lens was 24 diopters, without 

previous lens calculation. 1 A 

single lens value was not satisfactory 

and pre-operative lens 

calculation began. Before 1975, 

intraocular lens power was calculated 

on the basis of clinical history 

with the formula P = 18 + (1.25 

x Ref), P being the power of the 

lens for emmetropia and ”Ref” the 

pre-operative refraction in diopters.2 

Afterwards, theoretical and 

regression formulas appeared, of 

which SRK was the best known 

and most popular (P = A - 2.5L - 

0.9K), where P is the power of the 

lens to emmetropia, A the lens 

constant, L the axial length in mm 

and K the corneal curvature in diopters, 

SRKII emerged as a variation 

of SRK, adding one to three 

diopters to the value of P depending 

on the axial length. 2 

Modern theoretical formulas 

also called third-generation formulas 

are the result of the union of 

linear regression methods with the 

theoretical model of the eye. The best 

known are the Holladay 1 (1988), the 

SRK-T (1990) and HofferQ (1993). They 

are widely popular by virtue of good 

results and ease of obtainment. 3 

The fourth-generation formulas 

are more complex. The 

Haigis (1991) uses three constants 

(surgeon factor, anterior chamber 

depth factor, axial length factor) 

and requires 100 to 300 patients 

to obtain the constants by 

a regression analysis, Holladay 2 

uses seven variables (axial length, 

mean K, age, horizontal corneal 

diameter, preoperative refrac- 


Vis. Pan-Am. 2016; 15(1): 7-9. 

All eyes (n=101) 

♂ / ♀ 35 / 66 

OD / OS 55 / 46 

Axial Length 23,84 ± 2,5 

Mean K 44,60 ± 1,66 

Pre-Op Visual Acuity 0,40 ± 0,19 

Sph. Eq. Pre-Op - 1,74 ± 6,48 

Sph. Eq. Post-Op - 0,28 ± 0,94 

Lens Power 20,3 ± 6,03 

Table 1 – Patients characteristics. OD – Right Eye; OE – Left Eye; Axial Length 

in mm; Mean K – Mean corneal curvature in diopters; Visual Acuity in decimals; 

Sph. Eq. – Spherical Equivalent in diopters. Lens Power in diopters. 

All Eyes (n=101) 

Mean Error 

SRK-T 0,4896 ± 0,35002 

Holladay 1 0,5238 ± 0,41657 p = 0,529v 

HofferQ 0,5386 ± 0,40018 p = 0,355 

SRK II 0,9366 ± 0,57870 p = 0,000 

Table 2 – Mean absolut error for all eyes in all formulas ordered from the formula with least 

error to the most. p refers to the comparison of means with t test. 

All Eyes (n=101) ≤ 0.25 D ≤ 0.5 D ≤ 1.0 D 

SRK-T 32% 58% 93% 

Holladay 1 35% 54% 89% 

HofferQ 33% 53% 91% 

SRK II 13% 32% 56% 

Table 3 – Percentage of eyes with mean error inferior or equal to 0.25 D, 0.5 D and 1.0 D with 

the different formulas. 

AL < 22 (n=23) 

Mean Error 

HofferQ 0,4957 ± 0,39598 

Holladay 1 0,5243 ± 0,42638 p = 0,814 

SRK-T 0,5478 ± 0,42573 p = 0,669 

SRK II 1,0565 ± 0,69859 p = 0,002 

Table 4 – Mean absolut error for eyes with axial length inferior to 22 mm, with all formulas, 

ordered from the formula with least error to the most. p refers to the comparison 

of means with t test. 

tion, anterior chamber depth and 

lens thickness). 

It is common practice to use 

the formulas adjusted to the axial 

length; HofferQ is used in small 

eyes and SRK-T in long eyes. 4,5 

The aim of our study is to evaluate 

which formula (SRK II, HofferQ, 

Holladay 1 and SRK-T) is closest 

to the final refraction by using 

IOLMaster®. 

METHODS 

In this retrospective study, 101 

eyes of 78 cataract patients were 

evaluated. The expected refraction 

with the intraocular lens used 

in each patient was calculated 

with the different formulas and 

compared with the patient refraction 

one month after surgery. We 

obtained data from 23 eyes with 

axial length inferior to 22 mm, 62 

eyes with axial length between 22 

and 26 mm and 16 eyes with axial 

length superior to 26 mm. 

The statistical analysis was 

performed with IBM SPSS Statistics 

Version 21® software. Descriptive 

statistics are described 

as mean (± standard deviation). 

Comparison of means was performed 

through independent 

sample T test. A P value

Ramalho M et al. Intraocular lens calculation. 

Aristodemou et al 5 conducted 

a study with 8108 eyes comparing 

HofferQ, Holladay 1 and 

SRK-T concluding that HofferQ 

performed best in axial length between 

20 and 20.99 mm, HofferQ 

and Holladay 1 between 21 and 

21.49 mm and SRK-T in axial length 

superior to 27 mm; in the remaining 

axial length values there was 

no statistical significance. 

Some studies showed better 

results with Haigis in eyes with 

extreme hyperopia 6 , as well as 

in long eyes 4 compared with the 

third-generation formulas but 

without statistical significance. 

Another study compared Holladay 

2 with the third-generation 

formulas stratified by axial 

length and found no statistically 

significant difference. 4 Overall, 

HofferQ seems to perform well 

in short axial length 7 and SRK-T 

in long eyes. 8-10 

Limitations of our study were 

the small sample and the fact that 

surgeries were performed by different 

surgeons. Nevertheless, in 

the light of our findings and the 

literature we recommend using 

HofferQ in axial length inferior to 

22 mm and using SRK-T in axial 

length superior to 22 mm. 

References 

1. Ridley H. Intra-Ocular Acrylic Lenses 

After Cataract Extraction. The Lancet. 

Jan-June 1952;Vol No CCLXII:758-61. 

2. Shamas HJ. Atlas of Ophthalmic 

Ultrassonography and Biometry. St. 

Louis, MO: CV Mosby Co.; 1984. 

3. Shamas HJ. Intraocular Lens Power 

Calculations. SLACK Incorporated.; 

2004. 

4. Wang JK, Hu CY, Chang SW. Intraocular 

Lens Power Calculation Using The 

Iolmaster And Various Formulas In 

Eyes With Long Axial Length. J Cataract 

Refract Surg. 2008;34(2):262-7. 

5. Aristodemou P, Knox Cartwright 

NE, Sparrow JM, Johnston RL. 

Formula Choice: Hoffer Q, Holladay 1, 

Or SRK/T And Refractive Outcomes 

In 8108 Eyes After Cataract Surgery 

With Biometry By Partial Coherence 

Interferometry. J Cataract Refract 

Surg. 2011; 37(1):63-71. 

6. Maclaren RE, Natkunarajah M, Riaz 

Y, Bourne RRA, Restori M, Allan BDS. 

Biometry And Formula Accuracy With 

Intraocular Lenses Used For Cataract 

Surgery In Extreme Hyperopia. Am J 

Ophthalmol. 2007;143(6):920-31. 

7. Gavin EA, Hammond CJ. Intraocular 

lens power calculation in short eyes. 

Eye 2008;22:935–38. 

8. Petermeier K, Gekeler F, Messias A, 

Spitzer MS, Haigis W, Szurman P. 

Intraocular lens power calculation 

and optimized constants for highly 

myopic eyes. J Cataract Refract Surg. 

2009;35:1575–81. 

9. Narvaez J, Zimmerman G, Stulting RD, 

Chang DH. Accuracy of intraocular 

lens power prediction using the Hoffer 

Q, Holladay 1, Holladay 2, and SRK/T 

formulas. J Cataract Refract Surg. 

2006; ;32(12):2050-3. 

10. Haigis W. Intraocular lens calculation 

in extreme myopia. J Cataract Refract 

Surg. 2009;35:906–11. 

AL 22-26 (n=62) 

Mean Error 

SRK-T 0,4515 ± 0,32293 

Holladay 1 0,4694 ± 0,36268 p = 0,772 

HofferQ 0,5121 ± 0,36324 p = 0,328 

SRK II 0,9024 ± 0,50937 p = 0,000 

Table 5 – Mean absolut error for eyes with axial length between 22 and 26 mm, with 

all formulas, ordered from the formula with least error to the most. p refers to the 

comparison of means with t test. 

AL > 26 (n=16) 

Mean Error 

SRK-T 0,5538 ± 0,33352 

HofferQ 0,7031 ± 0,51623 p = 0,339 

Holladay 1 0,7338 ± 0,54409 p = 0,268 

SRK II 0,8969 ± 0,65815 p = 0,073 

Table 6 – Mean absolut error for eyes with axial length superior to 26 mm, with all formulas, 

ordered from the formula with least error to the most. p refers to the comparison of means 

with t test. 

AL < 22 (n=23) ≤ 0.25 D ≤ 0.5 D ≤ 1.0 D 

HofferQ 39% 57% 91% 


the formula with least error in axial length inferior to 22 mm. 

AL 22-26 (n=62) ≤ 0.25 D ≤ 0.5 D ≤ 1.0 D 

SRK-T 35% 58% 98% 


the formula with least error in axial length between 22 and 26 mm. 

AL > 26 (n=16) ≤ 0.25 D ≤ 0.5 D ≤ 1.0 D 

SRK-T 19% 63% 94% 


the formula with least error in axial length superior to 26 mm. 



Epidemiological profile of eye 

diseases in an emergency center 

complex in Campinas, Brazil 

Marcelo Vicente de Andrade Sobrinho, MD 1 , Ana Carla Brito de Aguiar, MD 2 , 

Leonardo Dias Alencar, MD 2 , William W. Binotti, MD 2 , Orlando Faria Jr, MD 1 

1 

. Ophthalmologist, Complexo Hospitalar Ouro Verde, Campinas, São Paulo State, 

Brazil. 

2 

. Resident in Ophthalmology, Complexo Hospitalar Ouro Verde - Campinas - Sao 

Paulo State - Brazil. 

Corresponding author: Marcelo Vicente de Andrade Sobrinho, MD 

Rua Benjamin Constant, 1991 Cambuí – Campinas – SP CEP 13025 005 

Email: marcelosobrinho@terra.com.br 

Funding: None 



ABSTRACT 

Purpose: To trace the epidemiology 

of eye diseases seen in 

the emergency eye care center in 

Campinas, Brasil. 

Methods: A cross-sectional, 

observational, retrospective 

survey was conducted involving 

patient records assisted in the 

emergency room in January of 

2014. The factors analyzed were 

age, gender, origin of patient and 

nosological entities. 

Results: A total of 1063 patients 

were attended. 55.9% were 

male and 44.1% female. Mean age 

was 37 years old. Of this sample, 

18.2% were ocular trauma, 16.9% 

infectious conjunctivitis, 7.8% 

keratitis, 7.6% hordeolum, 7.5% 

ocular allergies, 4.7% subconjuntival 

hemorrhage, 3.9% blepharitis 

and meibomitis, 3.6% pterygium, 

3.4% corneal ulcer and 26% other 

diagnosis. 73.5% were from emergency 

eye care admittance of our 

service and 26.5% were referrals 

from other services. 

Conclusion: The most frequent 

etiology was ocular trauma. 

The majority of patients were 

male in economically active age 

and their main origin was from 

admittance of emergency eye 

care center. 

Key words: Epidemiology; Eye 

diseases; Urgencies; Ocular trauma. 

INTRODUCTION 

Ophthalmological emergencies 

are important causes 

of worker absenteeism due to 

incapacity or disability. According 

to the World Health Organization 

(WHO), approximately 55 million 

ocular traumas per year cause loss 

of working days. 1-3 

Thus, the knowledge of the 

prevalence of the ophthalmological 

urgencies provides information 

to plan preventive strategies, 

to establish health policies, to analyze 

and direct the service where 

the research is being conducted. 3 

The Emergency Department of 

Ophthalmology of the Complexo 

Hospitalar Ouro Verde (Hospital 

Complex Ouro Verde) in Campinas, 

São Paulo State, Brazil, attends the 

free demand of patients with ocular 

complaints, and also referrals 

from primary and secondary units 

of Campinas city and nearby cities. 

Therefore, it is an important source 

of data that reflects the regional 

epidemiology, since there is little 

information available. 

This study aimed to delineate 

the epidemiology of eye 

diseases seen at this Emergency 

Eye Care Center. 

METHODS 

A cross-sectional, observational, 

retrospective survey was conducted. 

We reviewed the charts of 

the patients seen during the month 

of January, 2014 at the emergency 

eye care center of the Ouro Verde 

Hospital Complex and studied 

how many patients were attended 

at the general emergency room 

of the Hospital, and, of these, how 

many were referred to the ophthalmology 

emergency room. 

Data collected included age, 

which were divided in 3 groups 

to be comparable to other studies 

analyzed (under 16 years old; 

between 16 and 45 years; and 

over 45 years), gender; origin of 

referral and diagnosis (divided 

in ocular trauma, infectious conjunctivitis, 

keratitis, hordeolum, 

ocular allergies, subconjunctival 

hemorrhage, blepharitis and 

meibomitis, pterygium and corneal 

ulcer). We included foreign 

body in the ocular trauma category 

and did not separate open 

from close ocular trauma. The 

lower prevalence etiologies were 

classified as other diagnosis. 

This study was approved by 

the Research Ethics Committee 

from the Municipal Hospital Dr. 

Mário Gatti, Campinas, São Paulo 

State, Brazil. 

10

Sobrinho MVA et al. Epidemiological profile in an emergency room. 

The Microsoft program Excel 

7, was used for processing and 

analyzing the data. 

RESULTS 

Patients attended in the 

emergency room represented 

5.1% of the 20.957 patients attended 

the general emergency 

room. Of these, 194 had ocular 

trauma (18.2%) with 132 foreign 

bodies (12,4%) and 62 other ocular 

traumas (5,8%); 180 infectious 

conjunctivitis (16.9%); 83 keratitis 

(7.8%); 81 hordeolum (7.6%); 80 

ocular allergies (7.5%); 50 subconjunctival 

hemorrhage (4.7%); 

42 blepharitis and meibomitis 

(3.9%); 39 pterygium (3.6%); 37 

corneal ulcers (39.4%) and 277 

were classified as other diagnosis 

(26%) (Table 1). There were 592 

male patients (55.9%) and 466 

females (44.1%). 

The first group (under 16 years 

old) had a total of 158 patients 

(15.1%). The second group (from 

16 to 45 years old) had 520 (49.7%) 

and the third group (above 45 

years old) had 367 (35.2%). The 

lowest age in the study was one 

year-old and the highest was 

84 years-old. The mean age was 

37±20 years-old. 

Regarding the referral origin of 

the patients, 766 (73.5%) were from 

the emergency eye care center 

admittance of our service and 276 

(26.5%) were referrals from other 

locations (other hospitals in Campinas 

and nearby cities). 

DISCUSSION 

In general, the majority of 

appointments at the emergency 

department of ophthalmology are 

1, 2, 4, 5 

ocular traumas and infections. 

According to the bibliographic 

research data, the incidence 

of ocular trauma varied 

from 21.6% to 65% worldwide. 1-3, 

6-9 

Similarly, ocular trauma (18.2%) 

was the most prevalent cause 

of attendance at our emergency 

eye care center followed by 

infectious conjunctivitis (16.9%). 

Previous studies have demonstrated 

that the most prevalent 

cases happened in young male 

patients (35.4% - 43%). 8-11 

The high prevalence of infectious 

conjunctivitis found in this 

study reflects the inappropriate 

use of the Hospital’s Emergency 

Department, since conjunctivitis 

and eyelid inflammations are 

conditions that can be treated in 

a primary and secondary level, 

which are responsible for resolving 

87.5% of the 

4, 12 

cases. 

Since the creation of the public 

health system in this country, 

the emergency services were 

always concentrated in hospitals. 

The flow of these patients 

remains guided by self choice, 

which results in crowded emergency 

rooms and, consequently, 

poor quality in assistance. 12,13 This 

study confirms the conjecture 

that the lack of hierarchy and the 

misuse of the public health system 

still persist today. 

In one of the studies, it was 

noted that the prevailing age of 

patients seeking ophthalmology 

service was between 20 and 30 

years. 3 In other, was noted similar 

age prevalence between 15 and 

29 years. 6 In this study, the prevailing 

age was between 16 and 

45 years, confirming that the economically 

active population is the 

most prevalent (49.6%). 

In all the studies that were 

analyzed, male patients prevailed. 

2, 3, 7, 14 Similarly, our study 

showed male patients as more 

predominant (56%), although 

in a very close proportion to female 

patients. 

This may be associated with 

a lower prevalence of trauma 

compared to other studies, since 

there is a relation between ocular 

trauma with foreign body and 

male gender. 7 

Etiologies that cause red eye 

forces the person in a work environment 

to look for an emergency 

service, whether it is because 

of work security policies or by his 

own will, in order to discard an infectious-contagious 

or epidemic 

etiology and have a medical-legal 

note certifying his condition. 

Based on that, and on the 

social-economic changes in the 

country, we can presume that 

with greater inclusion of women 

in the labor market, there was an 

increase of female patients attended 

at the ophthalmological 

emergency rooms. 

The study of prevalence in 

this hospital reflects the profile of 

emergency eye care in the city of 

Campinas, since this emergency 

room caters its own free demand 

and referrals from other primary 

and secondary units in Campinas 

and nearby cities. 

Similar to other studies, ocular 

trauma (18.2%) was the most 

frequent etiology, followed by a 

close number of infectious conjunctivitis 

(16.9%). The patients 

that were most prevalent in this 

hospital were males in an economically 

active age. 

Considering that our institution 

is the main venue for 

ophthalmology urgencies in 

Campinas, this study reflects the 

epidemiological profile of urgencies 

in our city. 

References 

1. Filho PTPP, Gomes PRP, Pierre 

ETL, Neto FBP. Profile of ocular 

emergencies in a tertiary hospital 

from Northeast of Brazil. Rev Bras 

Oftalmol. 2010; 69(1):12-7. 

2. Cecchetti DFA, Cecchetti SAP, Nardy 

ACT, Carvalho SC, Rodrigues MLV, 

Rocha EM. Perfil clínico e epidemiológico 

das urgências oculares em 

pronto-socorro de referência. Arq 

Bras Oftalmol. 2008; 71(5): 635-8. 

3. Rocha MNMR, Ávila M, Isaac 

DLC, Oliveira LL, Mendonça LSM. 

Análise das causas de atendimento 

e prevalência das doenças oculares 

no serviço de urgência. Rev Bras 

Oftalmol. 2012; 71(6):380-4. 

4. Kara Junior N, Zanatto MC, Villaça 

VTN, Nagamati LT, Carvalho SC, 

Kara-Jose N. Aspectos médicos e sociais 

no atendimento oftalmológico 

de urgência. Arq Bras Oftalmol. 

2001; 64(1):39-43. 

5. Goiato MC, Mancuso DN, Fernandes 

AUR, Dekon SFC. Estudo sobre as 

causas mais freqüentes de perdas 

oculares. Arq Odontol. 2004; 

40(3):271-6. 

6. Edwards RS. Ophthalmic emergencies 

in a district general hospital casualty 

department. Br J Ophthalmol. 

1987; 71: 938-42. 

7. Araújo AAS, Almeida DV, Araújo VM, 

Góes MR. Urgência Oftalmológica: 

Corpo estranho ocular ainda como 

principal causa. Arq Bras Oftalmol. 

2002; 65:223-7. 

8. El-Mekawey HE, El Einen KGA, Abdelmaboud 

M, Khafagy A, Eltahawy 

EM. Epidemiology of ocular emergencies 

in the Egyptian population: 

a five-year retrospective study. Clin 

Ophthalmol 2011; 5 955-60. 

9. Girard B, Boucier F, Agdabed I, Laroche 

L. Activity and Epidemiology 

in an ophthalmological emergency 

Center. J Fr Ophthalmol. 2002; 25(7): 

701-11. 

10. Sánchez TH, Galindo FA, Iglesias CD, 

Galindo AJ, Fernández MM. Epidemiologic 

study of ocular emergencies 

in a general hospital. Arch Soc Esp 

Oftalmol. 2004; 79(9): 425-31. 

11. Cillino S, Casuccio A, Di Pace F, Pillitteri 

F, Cillino G. A Five-year retrospective 

study of the epidemiological 

characteristics and visual outcomes 

of patients hospitalized for ocular 

trauma in a Mediterranean área. 

BMC Ophthalmol. 2008; 8:6. 

12. Carvalho RS, Kara Jose N. Ophthalmology 

emergency room at 

the university of São Paulo general 

hospital: a tertiary hospital providing 

primary and secondary level care. 

Clinics. 2007; 62 (3):301-8. 

13. Machado MC, Kara-Jose N, Arieta 

CEL, Lourenço JLG, Carvalho RS. 

A study of pent-up demand in ophthalmology: 

Divinolândia Hospital/ 

Unicamp. Rev Bras Oftalmol. 2012; 

71(6):390-3. 

14. Weyll M, Silveira RC, Júnior NLF. 

Trauma ocular aberto: características 

de casos atendidos no 

complexo Hospitalar Padre Bento de 

Guarulhos. Arq Bras Oftalmol. 2005; 

68(4): 505-10. 



Avaliação da densidade de pigmento 

macular e a sua relação com fatores de 

risco para a Degenerescência Macular 

ligada à Idade (DMLI) 

Nadine Marques MD¹, Ana Miranda MD¹, Sandra Barros MD¹, João Cardoso MD¹, 

Sónia Parreira MD¹, Ana Cardoso MD², Nelvia Donaire ², Nuno Campos ³ 

¹ Residente de Oftalmologia 

² Assistente Hospitalar 

³ Diretor de Serviço Centro de Responsabilidade de Oftalmologia do Hospital Garcia 

de Orta 

Autor correspondente: Nadine Sousa Marques 

Avenida Torrado da Silva, 2805-267 Almada, Portugal 

Contato telefónico: (+351)212940294 

Fax: (+351)212940004 

Email: marques.nadine@gmail.com 

Funding: None 



Resumo 

Objetivo: Correlacionar a 

densidade de pigmento macular 

em indivíduos sem doença ocular 

com fatores de risco para a DMLI. 

Desenho do estudo: Estudo 

transversal. 

Métodos: 119 olhos de 60 

pacientes (34 mulheres e 26 homens) 

sem doença ocular e com 

fatores de risco para DMLI identificados 

em primeira consulta no 

Serviço de Oftalmologia do Hospital 

Garcia de Orta entre Junho 

e Agosto de 2013. Avaliou-se a 

densidade de pigmento macular 

com fotometria heterocromática 

de Flicker (QuantifEYE®) de ambos 

os olhos. Realizou-se exame 

oftalmológico completo e foi 

elaborado um questionário sobre 

o estado de saúde, estilo de vida 

e demografia. 

Resultados: A média de densidade 

de pigmento macular foi 

de 0,4450±0,09932. Detetou-se 

correlações negativas e estatisticamente 

significativas entre a 

densidade de pigmento e os seguintes 

fatores: idade, HbA1c dos 

diabéticos, colesterolémia, pressão 

arterial sistólica, unidade de 

maços de tabaco/ano nos fumadores 

e ex-fumadores (p

Marques NS et al. Densidade de pigmento macular e DMLI. 

regulação dos coriocapilares às 

necessidades metabólicas aumentadas, 

a diminuição do fluxo 

sanguíneo coroideu devido às 

alterações vasculares relacionadas 

com a idade, condicionam 

a formação de radicais livres de 

oxigénio. Estes, por sua vez, contribuem 

para uma resposta inflamatória 

e alterações degenerativas 

a nível macular. 3 

Outro mecanismo fisiopatológico 

da DMLI relaciona-se 

com o dano retiniano provocado 

pela exposição da retina 

à radiação do comprimento de 

onda (λ) da luz azul. 4 

O pigmento macular é formado 

por três componentes: a 

luteína, a zeaxantina e meso-zeaxantina. 

Este atinge maiores concentrações 

no nível das camadas 

mais externas da área macular 

da retina. O pigmento macular 

tem origem exclusiva na dieta e 

é considerado um fator protetor 

contra o desenvolvimento e progressão 

da DMLI por absorver a 

radiação no λ do azul e por propriedades 

antioxidants. 4 

O desenvolvimento da DMLI 

poderá resultar de uma vulnerabilidade 

genética associada a fatores 

de risco, que aumentam o stress 

oxidativo e, que são maioritariamente 

modificáveis. Destes fatores 

de risco, destacam-se o índice de 

massa corporal (IMC) elevado, baixa 

ingestão de carotenóides, hábitos 

alcoólicos e tabágicos, estilo 

de vida sedentário e existência de 

doenças cardiovasculares. 

Dos fatores de risco não modificáveis 

associados ao desenvolvimento 

de DMLI destacam-se a 

idade avançada e antecedentes 

familiares positivos. 

Este estudo tem como objetivo 

correlacionar a densidade de 

pigmento macular em indivíduos 

sem patologia ocular com fatores 

de risco para a DMLI. 

MATERIAL E MÉTODOS 

Estudo transversal de 119 

olhos de 60 pacientes (34 mulheres 

e 26 homens) sem doença 

ocular e com fatores de risco para 

DMLI identificados em consulta 

de primeira vez do Serviço de Oftalmologia 

do Hospital Garcia de 

Orta entre Junho e Agosto de 2013. 

Todos os doentes foram sujeitos 

a uma avaliação oftalmológica, 

que incluiu: Acuidade visual (avaliada 

com escala de Snellen), erro refrativo 

objetivo e subjetivo, pressão 

intra-ocular (utilizando-se o NIDEK 

NT-4000), biomicroscopia e fundoscopia 

sob dilatação farmacológica. 

Todos os participantes responderam 

a um questionário, 

através do qual foram obtidas 

informações sobre as características 

demográficas, estilo de vida, 

hábitos tabágicos, antecedentes 

médicos, ingestão atual ou passada 

de complementos vitamínicos. 

Foram ainda sujeitos à avaliação 

do peso corporal, altura, pressão 

arterial sistólica e diastólica e frequência 

cardíaca. 

O Índice de massa corporal 

(IMC) foi calculado segundo a 

seguinte fórmula: Peso em Kg/ 

(altura em metros).² Foi considerado 

um IMC baixo para valores 

30kg/m². 

Considerou-se hipertesão arterial, 

valores acima de 140mmHg 

de PAS e de 90mmHg de PAD 

no momento de colheita da história 

e valores abaixo dos mencionados 

em doentes a realizar 

antihipertensores. 

A dislipidémia foi considerada 

positiva para doentes com valores 

de colesterolémia> 220 mg/ 

dL e para doentes com valores 

inferiores a 220mg/dL a realizar 

estatinas. Estes valores foram obtidos 

por meio de um questionário 

realizado ao doente. Caso não 

houvesse resposta, obtivemos 

este valor por meio de análises 

recentes facultadas pelo doente 

ou através de consulta do seu 

processo hospitalar. 

Os doentes foram ainda questionados 

sobre a frequência de realização 

de exercício físico semanal, 

sendo divididos em 3 grupos, de 

acordo com este fator: 0x/semana, 

de 1 a 3x/semana e> 3x/semana. 

Quanto à ingestão de carotenóides, 

considerou-se os seguintes 

frutos, legumes e vegetais 

como fontes ricas de carotenóides: 

tomate, pêssego, manga, laranja, 

papaia, ameixa, batata doce, 

abóbora, couve galega, cenoura, 

nabo, espinafres, alface, feijão 

verde, bróculos e ervilhas. Os doentes 

foram questionados sobre 

a frequência de ingestão destes 

mesmos alimentos, considerando-se 

5 grupos: Grupo 1 -nunca 

(0x/semana), grupo 2- pouco (1- 

2x/semana), grupo 3- às vezes (3- 

4x/semana), grupo 4 – frequentemente 

(5-6x/semana) e grupo 

5- sempre (7x ou mais /semana). 

Neste estudo, avaliou-se ainda 

os hábitos tabágicos dos doentes, 

tendo sido divididos em 3 

grupos: Grupo 1- não fumadores, 

grupo 2- ex-fumadores (com um 

tempo mínimo de abstinência 

de 1 mês) e grupo 3- fumadores. 

Em todos estes grupos foi quantificado 

o peso tabágico de cada 

doente através do cálculo maços/ 

ano (nº de maços diários x nº de 

anos que fumou/fuma). 

No grupo dos diabéticos, é 

utilizado frequentemente a medição 

de hemoglobina glicosilada 

(HbA1c) para avaliar o controlo 

da patologia nos últimos 3 

meses. Este valor é considerado 

normal abaixo de 6,5%. O valor 

de HbA1c dos doentes diabéticos 

deste estudo foi obtido através do 

questionário. Caso o doente não 

soubesse este mesmo valor, consultávamos 

análises recentes ou o 

processo hospitalar do doente. 

Deste estudo, foram excluídos 

todos os pacientes com 

doença ocular atual ou recente, 

(nomeadamente catarata com 

AV


Tabela 1 

parados utilizando T-test para 

duas amostras independentes. 

Múltiplas comparações (nomeadamente, 

entre não-fumadores, 

fumadores vs. ex-fumadores, doentes 

com diferentes colorações 

da íris) foram realizadas, utilizando-se 

ANOVA, seguido de Tukey’s 

test para amostra com distribuição 

normal ou Kruskal-Wallis test 

para amostras sem distribuição 

dentro da normalidade. Correlações 

entra variáveis contínuas 

foram avaliadas com coeficiente 

de correlação de Pearson (r). Relações 

entre DPM e idade, IMC, 

sexo, hábitos tabágicos e outros 

fatores de risco para a DMLI foram 

analizados com regressões múltiplas 

lineares. Valores com p


de ingestão de alimentos contendo 

carotenóides: nunca, poucas 

vezes, às vezes, frequentemente e 

sempre. O grupo de ausência de 

ingestão de carotenóides é formado 

por 0 elementos e mostrou 

diferenca estatistica. (p 3x/ 

semana. A média de pigmento foi 

de 0,4299±0,0923, 0,4825±0,1025, 

0,3925±0,0945, respetivamente. A 

diferença de médias de DPM entre 

grupos foi estatisticamente significativo 

(p> 0,05), sendo a diferença 

do grupo 0x/semana vs 1-3x/semana 

de -0,0526. Além disso, a diferença 

entre o grupo de 1-3x/semana 

e> 3x/semana é de 0,09 e também 

estatisticamente significativa. 

Índice de massa corporal 

A amostra foi dividida em 4 

grupos: participantes com IMC 


Tabela 2- Correlações entre DPM e fatores de risco de DMLI. 

Variável dependente: 

Tukey HSD 

pigmento 

Comparações múltiplas 

Intervalo de Confiança 95% 

(I) 1=nunca, 2=pouco, 3=às vezes, 4=frequentemente, Diferença 

5=sempre 

média (I-J) Erro Padrão Sig. Limite inferior Limite superior 

pouco 

às vezes -,04064 ,02430 ,343 -,1040 ,0227 

frequentemente -,14375 * ,02609 ,000 -,2118 -,0757 

sempre -,11264 * ,02927 ,001 -,1890 -,0363 

às vezes 

pouco ,04064 ,02430 ,343 -,0227 ,1040 

frequentemente -,10311 * ,01907 ,000 -,1528 -,0534 

sempre -,07200 * ,02324 ,013 -,1326 -,0114 

frequentemente 

pouco ,14375 * ,02609 ,000 ,0757 ,2118 

às vezes ,10311 * ,01907 ,000 ,0534 ,1528 

sempre ,03111 ,02510 ,603 -,0343 ,0966 

sempre 

pouco ,11264 * ,02927 ,001 ,0363 ,1890 

às vezes ,07200 * ,02324 ,013 ,0114 ,1326 

frequentemente -,03111 ,02510 ,603 -,0966 ,0343 

Comparações múltiplas 

Tabela 3- DPM e a ingestão de carotenoides. 

Gráfico 4- Valores de DPM consoante hábitos 

tabágicos 

DPM 

,80 

,70 

,60 

,50 

,40 

,30 

,20 

57 

56 

24 

23 

nunca fomou exfumador actual fumador 

1=nunca fumou, 2=exfumador, 3=actual fumador 

ceder a DMLI e que esta está relacionada 

com a sua dose cumulativa 11 , tal como os 

valores baixos de DPM. 12 No nosso estudo, 

também verificámos que a DPM era inferior 

no grupo dos fumadores e superior nos 

não-fumadores; embora esta diferença não 

seja estatisticamente significativa. Também 

verificámos que existe uma correlação estatisticamente 

significativa e negativa entre 

a DPM e a unidade de maços/ano de todos 

os participantes. 

Quanto à ingestão de carotenóides, diversos 

estudos associam uma suplementação de 

carotenóides na dieta a uma aumento dos níveis 

plasmáticos de carotenóides, mas também 

aumento da DPM. Segundo Berendschot et 

al 13 ., um suplemento diário de 10 mg de luteína 

16


associa-se a um aumento de 0,19 

a 0,90 ᶙM de luteína plasmática e 

de 5,3% da DPM após 4 semanas. 

No nosso estudo, verificou-se que 

os participantes que ingeriam com 

maior frequência alimentos com 

carotenóides apresentavam DPM 

mais alta. A diferença entre os grupos 

apresentados foram estatisticamente 

significativas. 

A componente hereditária 

contribui ainda para o desenvolvimento 

de DMLI. Variantes em 

vários genes foram implicados 

no risco e proteção da DMLI, 

nomeadamente o cromossoma 

1q32 para o fator H do complemento 

(que protege as células do 

epitélio pigmentar contra o dano 

causado pelo complemento), o 

gene hemicentina em 1q24-25 

e o gene ABCR no cromossoma 

1p. Borel et al 14 , concluiu que 

os genes BCMO1 e CD36 estão 

implicados nas concentrações 

plasmática e retiniana de luteína 

e, que suas variantes podem modular 

estas mesmas concentrações. 

Este componente genético 

conjuntamente com os fatores 

de risco modificáveis podem ser 

dois desencadeadores de diminuição 

de DPM e de desenvolvimento 

de DMLI. No nosso estudo, 

verificou-se que havia uma 

média de DPM mais baixa nos 

pacientes com história familiar 

positiva, apesar de não ser estatisticamente 

significativa. 

No presente estudo, destaca-se 

ainda uma correlação negativa 

entre IMC e a DPM, como 

outros estudos realizados previamente. 

15,16 Cerca de 80% dos carotenóides 

são armazenados no 

tecido adiposo. 17 Como tal, esta 

correlação poderá dever-se a um 

aumento de tecido adiposo, que 

desencadeia uma maior retenção 

de carotenóides a este nível, levando 

a uma diminuição dos níveis 

de pigmento macular. Outro 

mecanismo fisiopatológico poderá 

também estar relacionado com 

a maior ingestão de lípidos, que 

desencadeiam acumulação de 

lípidos a nível da membrana de 

Bruch, aterosclerose, um aumento 

de ácidos gordos polinsaturados 

e depleção de ácidos gordos 

omega-3 (que aumentam o dano 

oxidativo da retina). 

Verificou-se que as íris de coloração 

mais clara (verde e azul) 

apresentavam valores de DPM 

estatisticamente inferiores às íris 

Tabela 4- Valores de DPM consoante coloração da íris. 

castanhas. Estes dados vêm também 

de encontro aos resultados 

apresentados noutros estudos. 18 

O mecanismo fisiopatológico 

será uma menor proteção das íris 

mais claras contra a radiação λ do 

azul e radiação ultravioleta, que 

desencadeia dano oxidativo fotoquímico 

e apoptose das células 

do epitélio pigmentar da retina 

induzida pela radiação. 19,20 

Podemos concluir que a DPM 

tem tendência a diminuir com a 

idade e a ser inferior em indivíduos 

com fatores de risco para a 

DMLI. Como tal, a colheita de uma 

boa história clínica e avaliação da 

densidade do pigmento macular 

poderão ser, em conjunto, um 

bom método para destacar os 

pacientes em maior risco de desenvolvimento 

de DMLI.A identificação 

destes mesmos fatores de 

risco e mudança de estilo de vida 

poderão ainda ser importantes 

para um melhor prognóstico visual 

nos doentes com DMLI. 

Como conclusão, a densidade 

de pigmento macular tem tendência 

a diminuir com a idade e 

a ser inferior em indivíduos com 

fatores de risco para a DMLI.. 

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Ophthalmological screening 

of students in Campinas, Brazil 

Marcelo Vicente de Andrade Sobrinho¹, Marcela Gallate Jorge ², Paola 

Napolitano Messias², Carolina Peres Batalha², Livia Garcia Biselli ³, 

Livia Miskulin Prearo³ 

From Department of Ophthalmology, Pontifícia Universidade de Campinas 

(PUC), Campinas, Brazil. 

¹ Professor of Ophthalmology. 

² Resident in Ophthalmology. 

³ Medical Undergraduate. 

Funding: None 


Corresponding author: Marcelo Vicente de Andrade Sobrinho, MD 

Rua Benjamin Constant, 1991 Cambuí – Campinas – SP CEP 13025 005 

Email: marcelosobrinho@terra.com.br 


ABSTRACT 

Purpose: To analyze eye 

health and visual acuity in children 

and teenagers to promote 

early detection and treatment of 

visual impairments. 

Methods: Public school 

students were pre-screened by 

teachers, and those who presented 

behavior, signs, or symptoms 

of decreased visual acuity (VA) or 

any other type of ophthalmological 

disorder, participated in a VA 

screening. The VA was registered 

for each eye, with or without optical 

correction. Children with VA 

less than or equal to 0.18 (logMAR) 

in the worst eye, and/or with 

complaints of asthenopia, eye 

irritation and itching, strabismus, 

conjunctival or corneal lesions 

were referred to the Ophthalmology 

Department of Celso Pierro 

Hospital for a complete ophthalmological 

evaluation. 

Results: Fifty (52.63%) patients 

were male and 45 (47.37%) 

were female. The average age 

of the participants was 10 years. 

Their eyes were evaluated and 114 

(77.03%) presented refractive errors; 

7 (9.45%) of the patients who 

were referred to the clinic already 

wore prescription eyeglasses, and 

all of them had inappropriate refractive 

correction. 

Conclusion: The most common refractive errors were: astigmatism 

in 94 (82.45%) children, myopia in 14 (9.72%) and hyperopia in 6 

(4.16%). The conclusion is that there are not enough visual campaign and 

screening exams in public schools. 

Keywords: eye health, health promotion, diagnosis, visual acuity, 

ocular refraction 

INTRODUCTION 

Visual impairment affects 7–25% preschool and school-aged children 

1,2 and is the third most common cause of health problems in 

school-aged children. 3 Refractive errors (nearsightedness, farsightedness, 

astigmatism), strabismus, and amblyopia are the leading causes of 

visual acuity reduction in this population. As claimed by the Brazilian 

Council of Ophthalmology (CBO), 20% of students have an ophthalmologic 

abnormality (refractive error, amblyopia, conjunctivitis, strabismus, 

ocular sequela accidents, congenital malformation, etc.). Ten percent of 

these students have refractive errors that need correction, with approximately 

5% having severe visual acuity (VA) reduction (less than 50% of 

normal vision). 4 According to the World Health Organization, about 7.5 

million school-age children are visually impaired, but only 25% present 

symptoms, hence a detailed ophthalmologic examination is necessary 

to diagnose the majority of the cases. 5 

Basic visual skills include the ability to use both eyes effectively and 

coordinate them to identify, recognize, and comprehend visual information. 

During their early school years, children perform recognition, association, 

and memory, exercises that require good visual discrimination 

ability. It has been estimated that as much as 85% of the learning a child 

does occurs through visual stimuli. 6 

Early development visual ability may change frequently during the 

first school years, 5 when the development of the visual apparatus occurs. 

Daily and prolonged contact between teachers and students allows 

for close observation of behavior, signs, and symptoms, of visual 

difficulties. 7 One of the first manifestations of reduced visual acuity may 

be the lack of interest in reading or writing, since the child will not properly 

assimilate the visual information. In consideration of the importance 

of vision in the education and socialization of children and the high 

18

Sobrinho MVA et al. Ophthalmological screening in students. 

prevalence of visual disorders affecting children, the CBO, in partnership 

with the Brazilian Ministry of Education, developed a broad national 

campaign for eye health promotion called “Olho no Olho/ Veja bem 

Brasil” (1998). The project screened every first grade child living in cities 

with at least 40,000 inhabitants, and the needed prescription eyeglasses 

were donated. 8 In 1999, the program reached 2.28 million children, and 

256,815 pairs of glasses were provided. In 2000, 450,000 medical examinations 

were performed, and 300,000 glasses were provided. 4 

Early visual impairment detection aims to increase treatment resolution 

and prevent the damage children may suffer during development. (9) 

Because multiple capabilities are mediated through vision, visual restriction 

will negatively interfere in the learning process and in the child’s 

overall development. In addition, the consequences of visual disturbances 

economically influence the nation owing to the occupational, 

social and psychological limitations of the affected individuals. 10 

The results of the Project “Olho no Olho/ Veja bem Brasil” motivated 

this research project, which aims to analyze the eye health and the visual 

acuity of children and adolescents in Campinas, SP, Brazil. 

SUBJECTS AND METHODS 

Public school students of Campinas were evaluated during the first 

semester of 2014. These children were pre-screened by teachers who 

then referred students presenting with behavior, signs, or symptoms of 

decreased visual acuity or any other type of ophthalmological disorder. 

In the first phase, screenings were performed to evaluate the children’s 

visual acuity. The VA was registered for each eye with or without 

optical correction. Children with VA less than or equal to 0.18 (logMAR) 

in the worst eye (with or without optical correction) were referred for a 

complete ophthalmological evaluation. Children who complained of asthenopia, 

eye irritation and itching, strabismus, conjuctival and corneal 

lesions, were also referred to the Ophthalmology Department of Celso 

Pierro Hospital and Maternity (Catholic University of Campinas). 

The following parameters were considered: sex; age; number of students 

who attended the pre-screening and also the following screening; 

number of students who were referred for the comprehensive evaluation; 

visual acuity with and without correction; number of students who were 

wearing glasses previously; number of students with asthenopia complaints 

who received eyeglasses prescription; prevalence of refractive errors; 

and other diagnose such as allergic conjunctivitis, ocular deviation, 

ptosis, stye, conjunctival nevus, keratoconus, and ocular trauma. 

RESULTS 

Two hundred and fifty nine (47.35%) out of 547 children referred 

by teachers attended the visual screening. The results of the following 

patients who had a complete ophthalmologic examination were: 58 

(61.05%) children had low visual acuity; 33 (34.73%) children had other 

eye disorders (asthenopia, frequent ocular irritation, ocular deviation, 

corneal injury, and conjuctival injury); and 4 (4.21%) children were unable 

to provide reliable responses during the screening test. Seventy-four 

(77.89%); 39 male [52.70%] patients and 35 female [47.30%]) attended 

the ophthalmologic appointment. The abstention rate was 22.11%. The 

average age of the participants was 10 years (6–15 years). The average 

visual acuity was 0.30 (LogMAR). 

One hundred and fourteen 

(77.03%) out of 148 eyes evaluated 

presented refractive errors. 

The average dynamic spherical 

equivalent refraction was +1,75 

(ranged from -26,00 to +6,00) and 

the average ecstatic spherical 

equivalent refraction was +5,54 

(ranged from -15,75 to +7,50). Table 

1 shows the frequency of the 

most common refractive errors in 

the examined population. Table 2 

shows the frequency of the most 

common eye diseases in the examined 

population. 

Strabismus was diagnosed 

in 2 (2.70%) children. Among the 

18 children referred to the Ophthalmologic 

Clinic of asthenopia 

symptoms, 12 (66.67%) were diagnosed 

with refractive errors: 2 

children presented myopia (prevalence 

of 16.67%), 8 compound 

myopic astigmatism (prevalence 

of 66.67%), and 2 had hyperopia 

(prevalence of 16.67%). All children 

who arrived at the clinic already 

using glasses, 7 (9.45%) had 

wrong prescriptions. 

DISCUSSION 

The evaluation of any potential 

eye ailment should be done 

early, as a greater delay in diagnosis 

leads to a lower chance 

of recovery. Furthermore, visual 

impairment contributes to low 

school performance and socialization. 

8,11 In the present study, 

58 students presented low visual 

acuity (VA), representing 

22.39% of the total sample (n 

= 259). The low AV frequency 

found is in agreement with the 

literature data, ranging between 

11.9% and 25.8 %. 

According to Granzoto et al 5 

15.1% of students have low VA. Similar 

research reported rates of 20%, 12 

11.9%, 13 22.5%, 14 and 25.8%. 15 

Among the 148 eyes examined 

during the complete ophthalmologic 

appointment, refrac- 



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Brasileiro de Prevenção da Cegueira 

e Reabilitação Visual; 2000 Set 06- 

09, Natal, Brasil. Arq Bras Oftalmol 

[periódico online] 2000 [citado 2001 

Mar 12 ];63(4). Disponível em URL: 

http://cbo.com.br/abo/s634_tl02. 

htm#OLHO. 

13. Figueiredo RM, Santos EC, 

Jesus IAA, Castilho RM, Santos EV. 

Proposição de procedimento de detecção 

sistemática de perturbações 

oftalmológicas em escolares. Rev 

SaúdePublica. 1993;27:204-9. 

14. Suzuki CK, Osawa A, Amino CJ, 

Yamashiba CH, Matuda E, Takei LM, 

et al. Saúde ocular de alunos de 1a. 

a 8a. séries do 1o. grau de escolas 

estaduais de São Paulo-SP. Arq Bras 

Oftalmol. 1994, 57(4):226. 

15. Castro LHP, Castro CCI, Nassaralla 

JR. JJ. Projeto Boa Visão: Revisão de 1 

ano de uma campanha de prevenção 

à cegueira em escolas municipais 

de Goiânia-GO. Arq Bras Oftalmol. 

1997; 60(4):355. 

16. Podhye AS, Khandekar R, Dharmadhikari 

S, Dole k, Gogate D, 

Deshpande M. Prevalence of uncorrected 

refractive error and other 

eye problems among urban and rural 

school children. Middle East Afr J 

Ophthalmol. 2009;16(2):69-74. 

17. Vitale S, Cotch MF, Sperduto RD. 

Prevalence of visual impairment 

in the United States. JAMA. 

2006;10;295(18):2158-63. 

18. Alves MR, Kara-José N, Temporini 

ER. Atendimento oftalmológico de 

escolares do sistema público de 

ensino no município de São Paulo – 

aspectos médico-sociais. Arq. Bras 

Oftalmol. 2000; 63(5):359-63. 

19. Moreira JBC. Projeto Osasco: exame 

de pré-escolares na cidade de 

Osasco em 1975. Arq Bras Oftalmol. 

1983;46:24-7. 

tive errors were observed in 114 (77.03%), with 

82.46% of the refractive errors corresponding 

to astigmatism. Refractive errors were the 

most prevalent problems, which corroborated 

previous reports. 

According to Podhye et al 16 and Vitale et al. 17 

refractive errors are the most prevalent causes 

of low VA in students. Data from the ‘Veja Bem 

Brasil’ Project shows that among 1000 elementary 

school students, 100 have refractive errors. 

The high absenteeism rates in screening 

(52.65%) and later in outpatient appointments 

(22.11%) should be considered. 

In a study from Alves et al, 18 227 parents 

of children with eye complaints participated, 

and the main reasons for not attending 

the appointments were insufficient means 

of transportation (41.6%), lack of appropriate 

orientation (31.0 %) and the possibility of lost 

wages (24.8 %). In a similar study conducted 

by Moreira et al, 19 among the 2,280 students 

expected for the screening, 2,238 participated. 

The very low 1.84% absenteeism rate was 

due to the detailed instructions given by the 

teachers who performed the pre-screening 

at school. 

Owing to socioeconomic and cultural 

conditions, a significant number of children 

are unable to attend health promotion strategies 

and/or cannot follow the prescribed 

treatment, e.g., when corrective lenses are 

required. In the present project held at the 

Ophthalmology Department of Celso Pierro 

Hospital, a partnership with the private sector 

was established to provide donated lenses for 

those patients who required this treatment. 

CONCLUSION 

The most common refractive errors in the 

examined population were: astigmatism in 94 

(82.45%) children, myopia in 14 (9.72%), and hyperopia 

in 6 (4.16%). The results demonstrate 

the relevance of visual health campaigns and 

screening exams to diagnose and treat ophthalmologic 

disorders early. The conclusion 

is that there are not enough visual campaign 

and screening exams in public schools. 

20

Brito RC et al. Intravitreal Ranibizumab in macular edema secondary to malignant hypertension. 

Intravitreal Ranibizumab for the 

treatment of macular edema secondary 

to malignant hypertension 

Raquel C. Brito, MD, Pedro Neves, MD, Inês Matias, MD, Mário Ornelas, MD, 

David Martins, MD 

From Department of Ophthalmology, São Bernardo Hospital, 

Setúbal, Portugal 

¹ Professor of Ophthalmology. 

² Resident in Ophthalmology. 

³ Medical Undergraduate. 

Funding: None 


Corresponding author: Raquel Claro Brito, MD 

Rua Direita de Massamá, nº125 – 7ºA. 2745-756 Massamá, Portugal 

Telephone: (+351) 215903433/ (+351) 969905827 

Email: raquel.claro.brito@gmail.com 


ABSTRACT 

Our purpose is to report a 

clinical case of bilateral macular 

edema caused by malignant hypertension 

in a 35-year old male. 

Patient presented with bilateral 

low visual acuity, massive macular 

edema, retinal hemorrhages and 

papilledema. Soon after he was 

diagnosed with other target-organ 

lesions, on heart and kidneys. 

After 6 months of controlled 

blood pressure, an increase in visual 

acuity and a small decrease 

of macular edema, we effectively 

treated the lower vision eye with 

two intravitreal ranibizumab injections, 

improving anatomy 

and function on both eyes. Even 

though we only treated one eye 

with ranibizumab, the contralateral 

eye also improved visual acuity 

and central macular thickness. 

This probably happened due to 

systemic absorption of ranibizumab. 

To the best of our knowledge, 

this is the first report of ranibizumab 

use in macular edema 

due to malignant hypertension. 

Keywords: Malignant hypertension; 

macular edema; ranibizumab. 

INTRODUCTION 

Malignant hypertension is a 

rare hypertensive emergency in 

which systolic blood pressure is 

higher than 200 mmHg and/or 

diastolic blood pressure is higher 

than 140 mmHg and target-organ 

lesions are present. 1,2 Its ocular 

manifestations are due to vascular 

constriction, arteriolar obstruction 

and blood-ocular barrier disruption, 

and retinopathy, choroidopathy 

and optic neuropathy. 3,4 Without 

treatment, the mortality rate is 

higher than 90% in one year. 1 

CASE REPORT 

A 35-year-old caucasian male 

patient, with no relevant medical 

history, came for urgent ophthalmologic 

evaluation because 

of bilateral progressive blurred 

vision and holocranial headache 

for the past two weeks. Best-corrected 

visual acuity (BCVA) on 

the right eye (OD) was counting 

fingers and on the left eye (OS) 

was 0,1. Pupillary reflexes were 

symmetric and slow, medium 

were clear and the average intraocular 

pressure was 14 mmHg 

on OD and 13 mmHg on OS. Fundoscopy 

of both eyes showed 

flame and dot hemorrhages in 

all quadrants, retinal edema with 

massive macular edema, hard 

exudates in the macula forming 

a macular star and disc edema 

(Figure 1). Macular optical coherence 

tomography (OCT) revealed 

a central macular thickness 

(CMT) of 984 µm and 968 µm on 

OD and OS, respectively (Figure 

2). Blood pressure was 241/146 

mmHg, and the patient was re- 

Figure 1. Fundoscopy of both eyes showed flame and dot hemorrhages in all quadrants, retinal edema 

with massive macular edema, hard exudates in the macula forming a macular star and disc edema. 

Figure 2. Macular OCT revealed massive macular edema on 

both eyes. 



Figure 3. Fluorescein angiography. 

Figure 4. Macular OCT, 4 months after diagnosis and blood 

pressure control. 

Figure 5. Retinography, 4 months after diagnosis, retinal hemorrhages were reabsorbed, disc 

edema resolved and a preretinal hemorrhage was seen on OS. 

Figure 6. Macular OCT showing normal CMT on both eyes after two injections of ranibizumab 

on OD. 

ferred for emergent blood pressure 

control. He was diagnosed 

with acute renal insufficiency 

requiring emergent hemodialysis 

and cardiac markers for ischemia 

were elevated. Two weeks 

later, fluorescein angiography 

showed delayed choroidal filling 

in the early phases, blocking of 

choroidal fluorescence by retinal 

hemorrhages, multiple microaneurysms 

in the peripapillary region, 

and fluorescein leakage in 

late phases related to the retinal 

edematous areas (Figure 3). 

After 4 months of ophthalmologic 

observation only, and normal 

blood pressure levels, BCVA 

increased to 0,1 on OD and 0,6 on 

OS, and CMT decreased to 644 µm 

on OD and 600 µm on OS (Figure 

4). Most of retinal hemorrhages 

were reabsorbed, disc edema 

resolved and a preretinal hemorrhage 

was seen on OS (Figure 5). 

After 6 months, BCVA remained 

stable but CMT lightly increased, 

so we decided to treat only the eye 

with lower visual acuity, the right 

eye, with intravitreal ranibizumab 

0,5 mg. CMT returned to normal 

on both eyes after two injections 

with one month interval (Figure 6), 

and BCVA improved to 0,3 and 0,8 

on OD and OS, respectively. After 

two years of follow-up, CMT and 

visual acuity are stable, as well as 

blood pressure levels. 

DISCUSSION 

In this clinical case, malignant 

hypertension was the first manifestation 

of systemic hypertension, 

which is rare, but must be 

kept on mind. The recognition of 

malignant hypertension has implications 

for the eye and general 

health of patients. 

Intravitreal ranibizumab 0,5 

mg was effective in the treatment 

of macular edema due to malignant 

hypertension, improving 

both visual function and anatomic 

retinal profile on macular OCT. Initially, 

in malignant hypertension, 

there is vascular constriction in 

choroidal and retinal vasculatures 

that cause ischemia, and these 

are followed by vasodilation and 

increased vascular permeability. 

Induced retinal edema, in turn, 

produces more ischemia and vascular 

endothelial growth factor 

release, which can be blocked by 

intravitreal ranibizumab. 

Even though we only treated 

the right eye with ranibizumab, 

the left eye also improved BCVA 

and CMT. We think this happened 

because of systemic absorption 

of ranibizumab, despite the fact 

that ranibizumab is a monoclonal 

antibody fragment, having a 

shorter systemic half-life without 

the Fc domain, of about 2 hours 

after entering systemic circulation 

from the eye. 5 And besides the 

fact that systemic absorption of 

ranibizumab given intravitreally 

seems to be minimal. 

Final OCT shows IS/OS line 

distortion and retinal pigment epithelium 

atrophy on OD, signs of 

irreversible damage of the retina, 

that can explain the low visual 

acuity of the treated eye, even after 

the achievement of a normal 

macular thickness. 

References 

1. Shantsila A, Shantsila E, Lip 

GY. Malignant hypertension: a 

rare problem or is it underdiagnosed? 

Curr Vasc Pharmacol. 

2010;8(6):775-9. 

2. Tajunisah I, Patel DK. Malignant 

hypertension with papilledema. J 

Emerg Med. 2013; 44(1):164-5. 

3. Hayreh SS, Servais GE. Retinal 

hemorrhages in malignant arterial 

hypertension. Int Ophthalmol. 

1988;12(2):137-45. 

4. Tajunisah I, Patel DK. Images in 

clinical medicine. Retinal detachment 

in malignant hypertension. N 

Engl J Med. 2009;27-361(9):899. 

5. Avery RL, Castellarin AA, Steinle 

NC et all. Systemic pharmacokinetics 

following intravitreal injections 

of ranibizumab, bevacizumab 

or aflibercept in patients with 

neovascular AMD. Br J Ophthalmol. 

2014;98(12):1636-41. 

22

Petour F et. al. Oftalmía neonatal secundaria a Neisseria gonorrhoeae. 

Oftalmía neonatal secundaria a 

Neisseria gonorrhoeae: Reporte de un 

caso clínico y revisión de la literatura 

Ophthalmia neonatorum secondary 

to Neisseria gonorrhoeae: Case report and literature review 

Felipe Petour 1 , Cristián Araneda 1 , Sylvia Araneda 2,3 , Federica Solanes 2,3 , 

Nicolás Seleme 4 , Diego Ossandon 2 

Corresponding author address: Felipe Petour Gazitúa 

Orinoco 65, Depto 405, Las condes, Santiago 

Telephone: 7-2180623 

Email: fapetour@miuandes.cl 

1. 

Facultad de Medicina, Universidad de los Andes, Santiago, Chile. 

2. 

Departamento de Oftalmología, Hospital Roberto del Río, Chile. 

3. 

Departamento de Oftalmología, Pontificia Universidad Católica de Chile, Chile. 

4. 

Departamento de Oftalmología, Hospital Clínico Universidad de Chile. 

Funding: None 


Date of submission: 07/06/2015 Date of approval: 25/09/2016 

RESUMEN 

Neisseria gonorrhoeae es una 

causa importante de oftalmía 

neonatal, pudiendo causar 

múltiples complicaciones en el 

recién nacido, incluyendo perforación 

corneal, panoftalmitis 

y ceguera. Se presenta caso de 

recién nacido de 1 mes de vida, 

con conjuntivitis infecciosa bilateral 

y compromiso corneal 

unilateral, además de cultivo 

positivo para gonococo. Tomografía 

axial computarizada 

de órbita mostró compromiso 

inflamatorio intraocular del 

ojo izquierdo. Se manejó con 

terapia antibiótica endovenosa, 

evolucionando con opacificación, 

vascularización, adelgazamiento 

progresivo de la 

córnea y atalamia del ojo izquierdo. 

Se sometió a cirugía para 

parche corneal y reformación 

de cámara anterior. Durante 

seguimiento, ecografía ocular 

mostró un examen normal del 

ojo derecho y una menor longitud 

axial y engrosamiento 

coroideo del ojo izquierdo. 

Palabras claves: Oftalmia 

neonatal, Conjuntivitis, Bacteriana, 

Neisseria gonorrhoeae. 

ABSTRACT 

Neisseria gonorrhoeae is a 

important cause of ophthalmia 

neonatorum, and it can cause 

multiple complications in the 

newborn, including corneal 

perforation, panophtalmitis and 

blindness. We report a case of 1 

month old newborn with bilateral 

infectious conjunctivitis and 

corneal unilateral commitment, 

with positive culture for gonococcus. 

ACT showed intraocular 

inflammatory involvement of 

the left eye. It is managed with 

intravenous antibiotic therapy, 

evolving with opacification 

, vascularization , progressive 

thinning of the cornea and athalamia 

of the left eye. It undergoes 

surgery for corneal patch 

and anterior chamber reshaping. 

During follow-up, eye ultrasound 

examination showed normal 

right eye and a smaller axial 

length and choroidal thickening 

of the left eye. 

Key words: Ophthalmia neonatorum, 

Conjunctivitis, Bacterial, 

Neisseria gonorrhoeae. 

INTRODUCCIÓN 

La conjuntivitis neonatal también 

llamada Oftalmía Neonatal 

(ON) es una infección aguda mucopurulenta 

de la conjuntiva. Se 

presenta dentro de las 4 primeras 

semanas de vida, afectando entre 

el 1.6% al 12% de los recién nacidos 

(RN). Dentro de las causas de 

ON se encuentran las conjuntivitis 

químicas asociadas a profilaxis 

ocular, e infecciones tanto virales 

como bacterianas 1 . 

Neisseria gonorrhoeae (NG) es 

un diplococo gram negativo, capaz 

de causar conjuntivitis, perforación 

corneal, panoftalmitis y 

ceguera en el RN. El compromiso 

ocular por NG generalmente se 

presenta entre las 24-48 horas de 

vida, aunque puede ocurrir hasta 

3 semanas post-parto. 2 El riesgo 

de transmisión vertical es de 30- 

42%, disminuyendo con el uso de 

profilaxis. 3 Los RN con antecedentes 

maternos de embarazo 

no controlado, abuso de drogas 

y enfermedades de transmisión 

sexual (ETS) tienen mayor riesgo 

de infección por NG. 4 El 2011 se 

notificaron 1426 casos de NG en 

Chile, siendo el 0.3% oculares. 5 

Se presenta el caso clínico de 

un paciente del Hospital Roberto 

del Río con compromiso ocular 

secundario a ON por NG. Consideramos 

de interés publicar dada 

la baja incidencia en la población 

pediátrica chilena y las dramáticas 

consecuencias que esta entidad 

puede producir. 

CASO CLíNICO 

RN de un 1 mes de vida, prematuro 

de 35 semanas, con antecedente 

materno de embarazo 

no controlado, abuso de drogas 

y parto en ambulancia, con múltiples 

consultas previas por secre- 



Figura 1. a) Secreción purulenta bilateral; b) 

Ojo derecho (OD): hiperemia conjuntival; c) 

Ojo izquierdo (OI): hiperemia conjuntival y 

úlcera e infiltrado corneal; d) TAC de cerebro 

que muestra intenso compromiso Inflamatorio 

intraocular en OI 

Figura 1 A 

Figura 1 B 

Figura 1 C 

Figura 1 D 

Figura 2 a) Ecografía OI: cavidad vítrea con 

muy escasos grumos vítreos, retina aplicada 

y grosor coroídeo de 1,67 mm; b) OI: Opacififación 

y vascularización corneal con adelgazamiento 

a temporal; c) OI: parche corneal 

Figura 2A 

ción ocular purulenta bilateral y 

cultivo positivo para NG. 

Al cuarto día de vida comienza 

con secreción mucopurulenta 

bilateral, tratada con cloranfenicol 

colirio, respondiendo parcialmente 

por lo que se cambia a 

tobramicina colirio. Consultó en 

varias oportunidades en atención 

primaria de salud (APS), por persistencia 

de secreción bilateral, 

manteniéndose siempre tratamiento 

tópico. 

Al mes de vida, consulta en 

urgencia del Hospital Roberto 

del Río, donde se toman cultivos, 

resultando positivos para 

gonococo, por lo que se indica 

hospitalización para tratamiento 

y manejo. 

Al examen físico presentaba 

edema palpebral, secreción mucopurulenta, 

quemosis e hiperemia 

conjuntival en ambos ojos 

(ODI). En ojo izquierdo además 

presentaba edema corneal, con 

adelgazamiento importante 

corneo escleral y contacto iridocorneal. 

Tomografía axial computarizada 

solicitada en extrasistema 

mostraba compromiso 

inflamatorio intraocular del OI 

(Figura 1). Se realizó punción lumbar 

para descartar compromiso 

meníngeo, con citológico normal 

y cultivos negativos. Se decidió 

terapia endovenosa con ceftriaxona 

50 mg/k/día, asociado a eritromicina 

oral hasta que se descartó 

Chlamydia trachomatis. PCR 

de muestra ocular positiva para 

gonococo, estudio negativo para 

Clamidia, VIH, sífilis, hepatitis B y C. 

Completó tratamiento endovenoso 

con ceftriaxona por 14 

días asociado a moxifloxacino en 

colirio cada 4 horas inicialmente. 

El ojo derecho (OD) mejoró 

completamente, sin secuelas. 

El OI presentó mejoría del compromiso 

intraocular en controles 

ecográficos posteriores, pero 

evolucionó con opacificación, 

vascularización y adelgazamiento 

progresivo de la córnea y 

atalamia, motivo por el cual se 

decidió parche corneal con objetivo 

tectónico y reformación de 

cámara anterior (Figura 2). 

A los dos meses de evolución 

se retiraron las suturas corneales y 

se repitió la ecografía ocular que 

mostró un examen normal del 

OD y una menor longitud axial y 

engrosamiento coroideo del OI 

(Figura 3). 

Actualmente, a los 11 meses 

del diágnostico, en la zona del 

parche corneal se observa un leucoma, 

que ha ido disminuyendo. 

El ojo no presenta potencial visual, 

pero sí ha permitido el desarrollo 

normal de la órbita. 

DISCUSSIÓN 

Durante el siglo XIX la ON 

era la principal causa de ceguera 

neonatal, debido principalmente 

a Chlamydia trachomatis y Neisseria 

gonorrhoeae. En 1881 el Dr. Carl 

Franz Credé, un obstetra alemán, 

introdujo como profilaxis solución 

de nitrato de plata al 2%, lo 

que llevó a una drástica reducción 

de la conjuntivitis neonatal por 

NG desde el 10% a un 0.3%. 5 

Actualmente, la incidencia 

de ON por NG es extremadamente 

baja en países desarrollados, 

oscilando entre 2-3 por cada 

10.000 recién nacidos vivos 7 , debido 

principalmente al screening 

de infecciones de transmisión 

sexual durante el embarazo, y el 

tratamiento oportuno de éstas. 

La ON por gonococo se presenta 

la mayoría de las veces en RN 

en que la vía de parto fue vaginal. 

Existe un reporte de caso 

de ON en cesárea 8 , siendo en 

ese caso la rotura prematura de 

membranas el principal factor 

de riesgo asociado. 

En cuanto al cuadro clínico, la 

oftalmía neonatal por gonococo 

se presenta típicamente como 

una conjuntivitis hiperaguda 

bilateral durante los primeros 

3-4 días de vida, a diferencia del 

compromiso por clamidia que 

típicamente se presenta a la semana 

de vida. Los RN presentan 

quemosis profunda, asociado a 

edema palpebral y abundante 

24

Petour F et. al. Oftalmía neonatal secundaria a Neisseria gonorrhoeae. 

secreción mucopurulenta bilateral. 

9 En caso de no recibir tratamiento 

oportuno, las consecuencias 

pueden ser devastadoras 

incluyendo úlcera y perforación 

ocular, panoftalmitis y secuelas 

como leucomas, ptisis bulbi. 10 

El diagnóstico se basa en la 

presunción clínica y el estudio 

microbiológico. Frente a todo 

RN con sospecha de ON por NG 

debe tomarse una muestra de 

secreción conjuntival y enviarse 

para estudio con Gram y Cultivo. 

El recuento de células polimorfonucleares 

elevadas o la presencia 

de diplococos Gram negativos intracelulares 

a la tinción de Gram, 

son considerados diagnóstico 

presuntivo, pero sólo el cultivo 

nos dará el diagnóstico definitivo. 7 

Todo RN con ON por NG debe 

ser hospitalizado, y evaluado 

con el fin de descartar infección 

gonocócica diseminada (artritis, 

sepsis, meningitis, neumonía). El 

tratamiento consiste en una sola 

dosis de ceftriaxona 25-50 mg/ 

kg (dosis máxima 125 mg) por vía 

intramuscular o endovenosa. 11 En 

casos como el de nuestro paciente, 

el cual se ve con muy poca 

frecuencia, no hay la suficiente 

evidencia para apoyar un tratamiento 

en particular. Algunos han 

usado antibióticos intravitreos, 

intramuscular y/o endovenoso. 

En nuestro paciente se decidió 

tratamiento endovenoso con ceftriaxona 

50 mg/kg/día por 14 días 

para asegurarnos una buena penetrancia 

intraocular y cubrir otros 

posibles focos, además de una 

quinolona de cuarta generación 

tópica. Se recomienda además el 

aseo frecuente con solución salina 

para promover la resolución 

de la inflamación conjuntival asociada. 

El uso de antibióticos tópicos 

no es necesario, pero podría 

ser efectivo en la reducción de 

la descarga mucopurulenta conjuntival. 

9 La madre, al igual que 

sus parejas sexuales, deben ser 

estudiados y recibir tratamiento 

para gonorrea. 12 

que una de las complicaciones en 

ellos es el barro biliar o pseudolitiasis, 

por lo que se sugiere usar 

cefotaximo 25-50 mg/kg/día. 

Es importante recalcar que 

hasta que no se descarte infección 

causada por Chlamydia, 

se debe asociar tratamiento 

empírico con un macrólido, ya 

que la coinfección es frecuente 

y hasta un 30-50% de los pacientes 

infectados con clamidia 

pueden presentar una complicación 

respiratoria. 

Existe bastante controversia 

con respecto al uso de profilaxis 

ocular en los RN. Por una parte, el 

grupo de trabajo de los servicios 

de prevención de Estados Unidos 

(USPSTF) recomienda que todos 

los RN dentro de las primeras 24 

horas de vida debieran recibir profilaxis 

ocular, ya sea con ungüento 

de eritromicina al 0.5% o tetraciclina 

al 1%. Esta medida es eficaz en 

prevenir la ON tanto por NG como 

por Chlamydia trachomatis, siendo 

además sencilla, sin riesgos para el 

RN y de bajo costo. 4 

Por otra parte, el diagnóstico 

y tratamiento de las madres 

constituye la mejor forma de prevención 

de la infección vertical 

por NG. Es por este motivo que 

en poblaciones con controles del 

embarazo y baja tasa de infección 

materna se cuestiona la profilaxis 

ocular rutinaria del RN. 13 

En nuestro país por muchos 

años se ha utilizado colirio de cloranfenicol 

o gentamicina como 

profilaxis gonocócica. En 2008 el 

Ministerio de Salud (MINSAL), al 

determinar que la incidencia de 

oftalmía gonocócica era baja, no 

justificó el uso de profilaxis ocular. 

Sin embargo, si la determinación 

local es mantener la profilaxis, 

recomiendan colirio oftálmico o 

ungüento de eritromicina al 0,5% 

o tetraciclina al 1% en cada ojo, 

siendo efectivas tanto para gonococo 

como para Chlamydia. 14 

CONCLUSIÓN 

El compromiso oftalmológico 

por NG puede ser devastador, 

pero prevenible y tratable. El diagnóstico 

y tratamiento oportunos 

de esta patología es relevante 

tanto para oftalmólogos, pediatras 

y médicos generales. 

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and prevention of ophthalmia 

neonatorum. Can Fam Physician. 

2013; 59:1187-90. 

2. Azari AA, Barney NP. Conjunctivitis: 

a systematic review of 

diagnosis and treatment. JAMA. 

2013; 310: 1721-9. 

3. Hammerschlag MR. Chlamydial 

and gonococcal infections in 

infants and children. Clin Infect 

Dis. 201; 53: 99-102. 

4. Force USPST. Ocular prophylaxis 

for gonococcal ophthalmia 

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statement. Am Fam 

Physician. 2012; 85:195-6. 

5. Recommendations for the prevention 

of neonatal ophthalmia. Paediatr 

Child Health. 2002; 7: 480-8. 

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Epidemiología DIPLAS/MINSAL, 

Informe anual 2011 Gonorrea (CIE 

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Abril de 2015]. 

7. Mayor MT, Roett MA, Uduhiri KA. 

Diagnosis and management of 

gonococcal infections. Am Fam 

Physician. 2012; 86: 931-8. 

8. Jacobsen T, Knudsen JD,Weis NM. 

Gonorrheal ophthalmia neonatorun 

in a premature infant delivered 

by caesarean section. Ugesk 

Laeger. 1991;153:2571. 

9. Richards A, Guzman-Cottrill JA. 

Conjunctivitis. Pediatr Rev. 2010; 

31: 196-208. 

10. Woods CR. Gonococcal infections 

in neonates and young children. 

Semin Pediatr Infect Dis. 2005; 

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11. Workowski KA, Berman S, Centers 

for Disease Control and Prevention 

(CDC). Sexually transmitted 

diseases treatment guidelines 

2010; 59: 1-110. 

12. Thanathanee O, O’Brien TP. Conjunctivitis: 

systematic approach to 

diagnosis and therapy. Curr Infect 

Dis Rep. 2011; 13: 141-8. 

13. Darling EK, McDonald H. A metaanalysis 

of the efficacy of ocular 

prophylactic agents used for the 

prevention of gonococcal and 

chlamydial ophthalmia neonatorum. 

J Midwifery Womens Health. 

2010; 55: 319-27. 

14. Manual de atención personalizada 

en el proceso reproductivo, capítulo 

XI - Atención inmediata del 

recién nacido/a, página 230-231, 

MINSAL 2008. 

Figura 2B 

Figura 2C 

Figura 3: A) Vista frontal. B) Ecografía OI: 

cavidad vítrea de aspecto normal con engrosamiento 

coroideo (OD: 1,67 mm, OI: 2,26 mm) y 

menor longitud axial respecto al ojo contralateral 

(OD:17,46 mm, OI:15,34 mm) 

Figura 3-A 

Figura 3-B 

En los menores de 1 mes se 

sugiere no usar ceftriaxona, ya 



Inadvertent vitreous staining by 

trypan blue during phacoemulsification 

Roberto Pinto Coelho, MD, PhD 

Department of Ophthalmology, School of Medicine of Ribeirão Preto, 

University of São Paulo, Brazil. 

Corresponding author: Roberto Pinto Coelho 

Av. Independência 2509, Alto da Boa Vista, 

Ribeirão Preto, SP, Brazil, ZIP code 14025-390 

Phone: (16)40092981, 

E-mail: robertopintocoelho@gmail.com 

Funding: None 

Proprietary/financial interes: None Date of submission: 20/09/2015 Date of approval: 05/11/2015 

ABSTRACT 

We report a case in which 

the vitreous was inadvertently 

stained with trypan blue during 

cataract surgery. 

INTRODUCTION 

Trypan blue is commonly 

used during cataract surgery 

to enhance visualization of the 

anterior capsule, especially in 

white cataracts and patients 

with corneal opacities. 1 It is also 

used in pediatric cataract surgery 

and staining of the internal 

limiting membrane during vitreoretinal 

surgery. 2 Although the 

safety profile of Trypan blue is 

good, many authors report adverse 

events, including inadvertent 

staining of the intraocular 

lens 3 , posterior capsule 4 , cornea 5 

and vitreous 6, 7 during attempts 

to stain the anterior capsule. We 

report a case in which the vitreous 

was inadvertently stained 

with Trypan blue during cataract 

surgery. 

CASE REPORT 

A 68-year-old man with no 

history of previous ocular trauma 

presented with dim vision in 

the right eye. The best-corrected 

visual acuity was 20/40. A mature 

(LOCSIII) cataract was observed 

on slit lamp examination. Further 

anterior segment examination 

with a dilated pupil did not show 

phacodonesis oriridodonesis. Angle 

recession was not observed 

on gonioscopy. 

Surgery was performed 

under topical anesthesia. The 

anterior chamber was entered 

with a 15-degree slit knife and 

Trypan blue (0.1 ml, 0.6 mg/ml) 

was injected to stain the anterior 

capsule. After 10 seconds, 

the anterior chamber was refilled 

with sodium hyaluronate 

1.4% (Healon GV, Abbot Medical 

Optics). A 2.75 mm clear cornea 

incision was made, and a continuous 

curvilinear capsulorhexis 

was performed. 

During cataract fragmentation, 

a dark blue glow was observed 

(Figure 1) instead of a red 

fundus reflex. This resulted in 

difficulty removing nucleus fragments 

and cortex and inserting 

the intraocular lens (IOL). The patient 

presented the next day for 

a postoperative examination and 

reported blue vision. 

Figure 1- Intraoperative view shows a blue fundus glow as a result of trypan staining of the vitreous 

26

Coelho RP. Inadvertent vitreous staining by trypan blue. 

Visual acuity was 20/40. Intraocular 

pressure was 20 mm Hg. 

Slit lamp examination showed 

particulate Trypan blue in the 

vitreous cavity. The IOL was well 

centered and the corneal incision 

was secure. The vitreous had a 

blue hue; there was no view of 

the fundus. B-scan ultrasonography 

showed no retinal neither 

choroidal detachment. 

A clinical diagnosis of retained 

Trypan blue was made. A 

postoperative course of topical 

ciprofloxacin and prednisolone 

four times a day was started. The 

patient returned on postoperative 

day 5, and visual acuity had 

improved to 20/20. 

DISCUSSION 

In ophthalmology, Trypan 

blue has been used to stain the 

endothelium of donor corneas. 8 

Trypan blue 0.06% effectively 

stains tissue during anterior and 

posterior segment surgery without 

significant toxicity to corneal 

endothelial and retinal pigment 

epithelial cells with short exposure 

times. 9 

Several methods of staining 

the anterior capsule have 

emerged, including Trypan blue 

under an air bubble 1 , Trypan blue 

in a balanced salt solution injected 

subcapsularly, a prepared mixture 

of Trypan blue with sodium 

hyaluronate under an air bubble, 

and Trypan blue under sodium 

hyaluronate 1% (Healon GV). 10 

Trypan blue has been reported 

to inadvertently stain the intraocular 

lens 3 , posterior capsule 4 , 

cornea 5 and vitreous. 6,7 These 

structures may also become 

stained if the dye gains access to 

the vitreous cavity in eyes with a 

history of trauma or vitrectomy 

in which there is some degree of 

zonular dehiscence and separation 

of the anterior hyaloid face 

from the posterior lens surface 

with liquid vitreous. 

The patient had no history of 

blunt trauma, and we assumed 

Figure 2. Chopper beneath nucleus fragment to avoid posterior capsule rupture and direct microscope light reflex on the IOL to visualization of the 

remaining cortex 

the Trypan blue dye gained access 

to the vitreous cavity through a 

compromised zonular apparatus 

as in the case cited, although preoperatively 

there were no signs to 

suggest zonular weakness. 

The surgery became very 

complicated, and to avoid complications, 

we positioned the 

chopper beneath nucleus fragments 

during phacoemulsification 

to separate the phaco tip 

from the posterior capsule and 

to avoid rupture (Figure 2). Before 

cortex aspiration, we inserted the 

IOL in the bag, and with the direct 

References 

microscope light reflex on the 

IOL, visualization of the remaining 

cortex improved and facilitated 

aspiration (Figure 2). 

Trypan blue dye requires 

careful use in cases with a history 

of trauma and possibly 

compromised zonular integrity. 

Limiting the duration in which 

the dye is placed over the capsule 

or premixing it with an ophthalmic 

viscosurgical device, as 

suggested by Chowdhury and 

coauthors10, can limit the access 

of the dye to the vitreous cavity 

and avoid complications. 

1. Melles GRJ, de Waard PWT, Pameyer 

JH, Beekhuis WH. Trypan blue capsule 

staining to visualize the capsulorhexis 

in cataract surgery. J Cataract Refract 

Surg. 1999;25:7–9. 

2. Beutel J, Dahmen G, Ziegler A, Hoerauf 

H. Internal limiting membrane 

peeling with indocyanine green or 

trypan blue in macular hole surgery; 

a randomized trial. Arch Ophthalmol. 

2007; 125:326–32. 

3. Werner L, Apple DJ, Crema AS, et 

al. Permanent blue discoloration 

of a hydrogel intraocular lens by 

intraoperative trypan blue. J Cataract 

Refract Surg. 2002; 28:1279–86. 

4. Birchall W, Raynor MK, Turner 

GS. Inadvertent staining of the 

posterior lens capsule with trypan 

blue dye during phacoemulsification 

[photo essay]. Arch Ophthalmol. 2001; 

119:1082–3. 

5. Jhanji V, Agarwal T, Titiyal JS. 

Inadvertent corneal stromal staining 

by trypan blue during cataract 

surgery. J Cataract Refract Surg. 

2008; 34: 161–2. 

6. Chowdhury PK, Raj SM, Vasavada AR. 

Inadvertent staining of the vitreous 

with trypan blue [letter]. J Cataract 

Refract Surg. 2004; 30:274–5. 

7. Gaur A, Kayarkar VV. Inadvertent 

vitreous staining [letter]. J Cataract 

Refract Surg. 2005; 31:649. 

8. Stocker FW, King EH, Lucas DO, 

Georgiade N. A comparison of two 

different staining methods for evaluating 

corneal endothelial viability. 

Arch Ophthalmol. 1966;76(6):833-5. 

9. Van Dooren BTH, Beekhuis WH, 

Pels E. Biocompatibility of trypan 

blue with human corneal cells. Arch 

Ophthalmol. 2004; 122:736–42. 

10. Kayikic¸iog˘luO¨ , Erakgu¨nT, Gu¨ler 

C. Trypan blue mixed with sodium 

hyaluronate for capsulorhexis [letter]. 

J Cataract Refract Surg. 2001; 27:970. 



Tuberculosis of the lacrimal sac 

Mafalda Trindade Soares 1 , Inês Coutinho 2 , António Ribeiro da Silva 3 , 

Luís Oliveira 4 , Pedro Montalvão 4 , Miguel Magalhães 5 

1. 

Resident of Otorhinolaryngology Head and Neck Surgery Department –Professor 

Doutor Fernando da Fonseca Hospital, Amadora, Portugal 

2. 

Resident of Ophthalmology Department - Professor Doutor Fernando da Fonseca 

Hospital, Amadora, Portugal 

3. 

Attending Doctor of Otorhinolaryngology Department - Santarém Districtal 

Hospial, Portugal 

4. 

Attending Doctor of Otorhinolaryngology Department - Instituto Português de 

Oncologia de Lisboa Francisco Gentil, Portugal 

5. 

Director of Otorhinolaryngology Department - Instituto Português de Oncologia de 

Lisboa Francisco Gentil, Portugal 

Corresponding address: Mafalda Trindade Soares 

Otorhinolaryngology Head and Neck Surgery Department –Professor 

Doutor Fernando da Fonseca Hospital, Amadora, Portugal 

Estrada IC 19 2720-276 Amadora 919990458 

Email: mafaldamctsoares@gmail.com 

Acknowledgements: 

Dr. Maria Graça Evaristo and Dr Pedro Henriques for support and 

availability 

Funding: None 

Proprietary/financial interes: None Date of submission: 21/10/2015 Date of approval: 30/10/2015 

Figure 1: Right medial canthal swelling 

Figure 2: Orbital CT: Enlargement of the right lacrimal sac (10x8x5mm) 

ABSTRACT 

Tuberculosis is an infectious 

disease caused by Mycobacterium 

tuberculosis that still remains 

a public health problem in many 

countries. Its incidence in industrialized 

countries has been increasing 

during recent years due 

to HIV infection and immigration. 

Tuberculosis affects primarily the 

lung and lymph nodes but has 

the potential to infect almost 

every organ system and unusual 

presentations raise difficulties in 

differential diagnosis. The authors 

report a rare case of tuberculosis 

affecting the nasolacrimal system. 

Keywords: tuberculosis, dacryocystitis, 

lacrimal sac 

INTRODUCTION 

Tuberculosis is an infectious 

disease caused by Mycobacterium 

tuberculosis (M. tuberculosis) 

that still remains a public health 

problem in many countries. 1,2 Its 

incidence in industrialized countries 

has been increasing during 

recent years due to HIV infection 

and immigration. 1,2 Tuberculosis 

affects primarily the lung and 

lymph nodes but has the potential 

to infect almost every organ 

system and unusual presentations 

raise difficulties in differential diagnosis. 

3 Ocular tuberculosis may 

be the first or unique manifestation 

of disease. In this location it 

may involve eyeball appendages 

of the eye like lacrimal apparatus 

or orbit . Very few cases of tuberculous 

dacryocystitis have been 

reported in the literature. Culture 

of M. tuberculosis is required for 

the definitive diagnosis. 

The purpose of this paper 

is to call attention to an unusual 

diagnosis of a lacrimal apparatus 

infectious condition. 

CASE REPORT 

A 60-year-old woman, with 

type 1 diabetes, presented to the 

emergency department complaining 

of tearing and a right 

medial canthal mass that was 

growing for 2 months (Figure 

1). She had a history of recurrent 

conjunctivitis and blepharitis on 

the right eye without response 

to conventional treatment. Ophthalmologic 

exam revealed in the 

right eye ephifora, blepharitis and 

a palpable and painless medial 

canthal mass, without purulent 

discharge, displacement of the 

globe or other alterations. Nasal 

examination was unremarkable. 

Laboratory tests were normal, 

without eosinophilia. C-Anca and 

p-anca were negative as well 

as VDRL and HIV screening. Or- 

28

Soares MT et. al. Tuberculosis of the lacrimal sac. 

bit Computed tomography (CT) 

demonstrated a medial canthal 

swelling with enlargement of the 

lacrimal sac (10x8x5mm) (Figure 

2). CT scan of the thorax showed 

no abnormality. Fine-needle aspiration 

cytology was performed 

(Figure 3). The BD MGIT TBc Identification 

Test was positive and 

culture confirmed the presence 

of M.tuberculosis (Figure 4,5). 

She was treated with anti-tubercular 

agents. She started with 

2 months of rifampicin (600mg), 

isoniazid (300mg), ethambutol 

(400mg) and pyrazinamide 

(1500mg) followed by a second 

phase of isoniazid and ethambutol 

for 4 months. Substantial improvement 

was achieved and the patient 

is asymptomatic for 2 years. 

DISCUSSION 

Dacryocystitis is an infection 

of the lacrimal sac, secondary 

to obstruction of the nasolacrimal 

duct. Chronic inflammation 

results in fibrosis, stenosis, and 

ultimately complete obstruction 

of the nasolacrimal duct, with 

insidious epiphora 4,5 The lacrimal 

excretory system is prone to 

infection and inflammation for 

various reasons. Tuberculous dacryocystitis 

is a very rare cause. 3 

The spread of mycobacterium 

tuberculosis to the lacrimal sac 

may be by incidental contamination 

of the conjunctiva which 

could be carried by the normal 

flow of tears into the lacrimal sac 

or it can be haematogenous. 6 In 

this patient the cause is not well 

known. Immunosuppression is a 

major risk factor to develop tuberculosis 

and the patient had a 

history of diabetes, which could 

contribute to lower her immunity. 

Risk factors such as HIV infection, 

past history of pulmonary tuberculosis 

or recent contact with a 

person infected with tuberculosis 

were absent. Regarding its rarity 

and lack of specified symptoms, 

diagnosis is often delayed. 3 

Other systemic diseases can 

affect the lacrimal system and 

differential diagnosis includes 

other granulomatous diseases 

such as sarcoidosis, granulomatosis 

with polyangiitis, eosinophilic 

granulomatosis with polyangiitis, 

chronic infections like syphilis, 

leprosy, shistosomiasis and also 

neoplasms. 3 If a granulomatous disease 

is thought to be the cause, nasal symptoms 

and findings may be present but it 

doesn’t always happen, like in our case. 3 

Computed Tomography findings may 

contribute to the diagnosis but they are 

not specific for nasolacrimal tuberculosis. 

6 Microbiological culture is therefore 

mandatory for the diagnosis. The BD 

MGIT TBc identification test is a immunochromatographic 

assay that can confirm 

the presence of M. tuberculosis complex 

from liquid culture, by detecting MPT64, a 

protein that is specifically secreted during 

growth by the M. tuberculosis complex 

cells. 7,8 It is a rapid, sensitive (95-100%) and 

specific (100%) tool. 8 

In our case, a high index of suspicion 

was crucial to ensure a quick and 

proper treatment. 

CONCLUSION 

Tuberculous dacryocistitis is extremely 

rare. In order to perform early and adequate 

treatment a high index of suspicion 

is required for the diagnosis, as unusual 

presentations of the disease still occur. In 

this case the main treatment is anti-tuberculous 

therapy. 

Acknowledgements 

Dr. Maria Graça Evaristo for support 

and availability. 

References 

1. Assen S, Lutterman J.A. Tuberculous dacryoadenitis: 

a rare manifestation of tuberculosis. 

Neth J Med. 2002;60(8):327-9. 

2. Jablenska L, Lo S, Uddin J, Toma A. Nasolacrimal 

tuberculosis: case report highlighting the 

need for imaging in identifying and managing 

it effectively. Orbit. 2010;29(2):126-8. 

3. Tosun F, Tozkoparan E, Erdurman C, Ors F, 

Deniz O. Primary nasolacrymal tuberculosis 

diagnosed after dacryocytorhinostomy. Auris 

Nasus Larynx. 2007;34(2):233-5. 

4. SC Wong, V Healy, JM Olver. An unusual 

case of tuberculous dacryocystitis. Eye. 

2004;18(9):940-2. 

5. Mills DM, Bodman MG, Meyer DR, Morton 

AD 3rd. The microbiologic spectrum of dacryocystitis: 

a national study of acute versus 

chronic infection. Ophthal Plast Reconstr 

Surg. 2007;23(4):302-6. 

6. Sigelman SC, Muller P. Primary Tuberculosis 

of the Lacrimal Sac. Arch Ophthalmol. 

1961;65(3):450-2. 

7. Brent AJ, Mugo D, Musyimi R, et al. Performance 

of the MGIT TBc Identification Test 

and Meta-Analysis of MPT64 Assays for 

Identification of the Mycobacterium tuberculosis 

Complex in Liquid Culture. Journal of 

Clinical Microbiology. 2011;49(12):4343-46. 

8. Machado D, Ramos J, Couto I, Cadir N, et al. 

“Assessment of the BD MGIT TBc Identification 

Test for the Detection of Mycobacterium 

tuberculosis Complex in a Network of 

Mycobacteriology Laboratories. Biomed Res 

Int. 2014:1-6. 

Figure 3: Fine-needle aspiration cytology 

Figure 4: Microbiological culture: Mycobacterium Tuberculosis 

Figure 5: BD MGIT TBc Identification Test: positive 


Vis. Pan-Am. 2016; 15(1): 30. 

MESSAGE FROM THE CHAIRMAN 

OF THE PAOF BOARD 

Liana Maria Vieira de 

Oliveira Ventura, MD, PhD 

President, Pan-American Ophthalmological 

Foundation 

Collaborative Leadership: 

We all can be an agent for 

social change 

Proud to be PAN-AMERICAN 

February 2016 

As we all look ahead to this upcoming 

year, we have the opportunity to 

reflect on lessons learned from the past 

and to imagine how we can collaborate 

to deliver better services in our profession 

through our ophthalmological societies. 

The world now requires each ophthalmologist 

to act as an agent for social 

change, committed to collaborative leadership, 

with motivation and innovation for 

local and international entrepreneurship. 

The Pan-American Association of 

Ophthalmology (PAAO) offers its membership 

very high-level educational 

activities, resources and opportunities 

such as the Pan American Congress, 

Pan-American Regional Courses, Resources 

for Educators, Webinars, PAAO 

Leadership Course, Training Programs 

for Ophthalmologists (Scholarships), and 

the opportunity of publishing scientific 

papers in the Journal Vision Pan-America. 

All these activities have been very 

successful and clearly demonstrate the 

PAAO’s commitment to help ophthalmologists 

to assume responsibilities that 

result in a high local and global positive 

impact, in the public and private health 

system, collaborating for the present and 

future of our society. 

PAAO’s cooperation with the supranational 

institutions reflects accurately 

the Pan-American values and mission. 

There are 26 National Ophthalmological 

Societies and 20 Subspecialty Societies 

affiliated to the PAAO and we have collaborative 

projects with the Lions Club 

International Foundation. As we can 

see, the PAAO provides numerous services 

to benefit the community. 

Through the Pan-American Ophthalmological 

Foundation (PAOF), we 

dream to do more with regard to supporting 

PAAO’s noble mission. This can 

be made possible by changing paradigms 

and breaking down barriers that 

divide and building bridges between 

organizations, promoting intersectorial 

cooperation networks and combining 

efforts and knowledge among colleagues. 

Everyone can be agents for 

social change, contributing with leadership 

skills and innovation to improve 

patient care and the social and economic 

reality of our society. 

We need to be encouraged in our 

capabilities, to learn how to avoid apathy 

and indifference, and to act in an 

exemplary way to improve our environment 

and to offer answers to our most 

urgent social problems. We need to extend 

our reach to our fellow colleagues 

to benefit other communities of the 

globe, and when feasible, to include 

them in our services. 

With this perspective, PAAO and 

PAOF recently organized the Pan-American, 

NGOs and Service Clubs workshop 

“Collaborating For A Better Vision” 

during the World Congress of Ophthalmology 

(WOC 2016) in Guadalajara, 

Mexico. The participants were important 

supranational organizations such as 

Lions Clubs International Foundation, 

Rotary International, International Eye 

Foundation, ORBIS International, Helen 

Keller International and the Pan-American 

Health Organization (PAHO). Each 

presented their regional plans for Latin 

America and global action plans for the 

elimination of preventable blindness. 

These supranational institutions suggested 

how they could collaborate with 

PAAO’s mission in education and prevention 

of blindness. 

During the WOC2016 meeting, 

the PAOF Executive Committee conducted 

a meeting with the purpose of 

discussing its development highlights 

and to identify potential Pan-American 

leaders to be Ambassadors, representing 

the countries that need to be supported 

by the Pan-American’s mission. 

Please let us know how you would 

like to be collaborate supporting the 

Pan-American projects through donations 

to the PAOF. 

What can we do better? Please send 

us suggestions of projects that you 

would support or that the Foundation 

could do in collaboration with supranational 

organizations. We welcome you to 

also recommend Pan-American Leaders 

to be an Ambassador of PAOF. Please 

write to Teresa Bradshaw at teresa.bradshaw@paao.org 

with your suggestions. 

I would like to thank you because, as 

an Active Member of the PAAO, you are 

supportive of our mission and together 

we can all be agents for social change, 

providing a better vision worldwide for 

improved patient care and the elimination 

of preventable blindness. 

Warm regards, 

Liana Maria Vieira de Oliveira 

Ventura, MD, PhD 

President, Pan-American Ophthalmological 

Foundation 

30

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TIONS TO AUTHORS, PLEASE SCAN THE FO- 

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EQUATOR Network at http://www.equator-network.org 

32

{ 

} 

TORIC Aspheric IOL 

T 

toric

Preserva la visión alcanzando las menores 

presiones-objetivo en más pacientes 

Investigadores de diversos estudios, (AGIS, Shirakashi, Shields) 

han comprobado que alcanzar y mantener la PIO entre 14 y 15 mmHg 

reduce la progresión de pérdida del campo visual 1,2,3. 

Lumigan ® alcanza la PIO-objetivo de 14/15 mmHg en un mayor número 

de pacientes: 

® 

vs. timolol 4 ® dorzolamida/ 

® 

vs. 

vs. latanoprost 6 

timolol 5 

Porcentaje de Pacientes que 

alcanzaron la PIO-Objetivo ≤14 21% 9% 17% 2% 19% 9% 

Porcentaje de Pacientes que 

alcanzaron la PIO-Objetivo ≤15 31% 16% 24% 9% 29% 14% 

Lumigan 

® (bimatoprost) Forma farmacéutica y presentación. 

esentación.Frascos cuenta-gotas conteniendo 5 ml de solución oftalmológica estéril de bimatoprost a 0,03%. USO ADULTO.Composición. 

Cada ml contiene: 0,3 mg de bimatoprost. Vehículo: cloreto de sódio, fosfato de sódio 

hepta-hidratado, ácido cítrico mono-hidratado, ácido clorídrico y/o hidróxido de sódio, cloruro de benzalconio y agua purificada qsp. Indicaciones. LUMIGAN ® (bimatoprost) es indicado para la reducción de la presión intra-ocular elevada en pacientes con glaucona o hipertensión 

ocular.Contraindicaciones. 

LUMIGAN ® (bimatoprost) está contraindicado en pacientes con hipersensibilidad al bimatoprost o cualquier otro componente de la fórmula del producto. Precauciones y Advertencias. 

Advertencias. Fueron relatados aumento gradual del crescimiento 

de las pestañas en el largo y espesura, y oscurecimiento de las pestañas (en 22% de los pacientes después 3 meses, y 36% después 6 meses de tratamiento), y, oscurecimiento de los párpados (en 1 a

PAAO JAN MARCH 2016 Vol15(1)

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