OBJECTIVE: To evaluate the relationship of biomechanical properties, corneal hysteresis and corneal resistance factor with age, sex and various corneal parameters measured with a Pentacam in normal subjects. METHODS: A total of 226 eyes from 113 patients were enrolled in this study. The subjects underwent Ocular Response Analyzer and Pentacam evaluations. A varying-intercept multilevel regression was implemented using Bayesian inference. The predictor variables were age, sex, central corneal thickness, corneal volume at a 7-mm diameter, anterior chamber angle and volume, anterior chamber depth, mean radius of the corneal curvature and corneal astigmatism. RESULTS: Corneal hysteresis ranged from 5.5 to 14.8 mmHg (mean 10.42±1.74 mmHg), and the corneal resistance factor ranged from 5.7 to 15.5 mmHg (mean 10.23±1.88 mmHg). No predictor variable other than gender and central corneal thickness had a significant correlation with either corneal hysteresis or corneal resistance factor. Corneal hysteresis was positively associated with female sex and with central corneal thickness, and corneal resistance factor was positively associated with central corneal thickness. CONCLUSION: Despite the associations found, only a small fraction of the variance in biomechanical measurements could be explained by the descriptors that were evaluated, indicating the influence of other corneal aspects on the biomechanical characteristics.

INTRODUCTION: Dermatological disorders are common in medical practice. In medical school, however, the time devoted to teaching dermatology is usually very limited. Therefore, online educational systems have increasingly been used in medical education settings to enhance exposure to dermatology. OBJECTIVE: The present study was designed to develop a e-learning program for medical students in dermatology and evaluate the impact of this program on learning. METHODS: This prospective study included second year medical students at the University of Technology and Science, Salvador, Brazil. All students attended discussion seminars and practical activities, and half of the students had adjunct online seminars (blended learning). Tests were given to all students before and after the courses, and test scores were evaluated. RESULTS: Students who participated in online discussions associated with face-to-face activities (blended learning) had significantly higher posttest scores (9.0 + 0.8) than those who only participated in classes (7.75+1.8, p <0.01). CONCLUSIONS: The results indicate that an associated online course might improve the learning of medical students in dermatology.

OBJETIVOS: Avaliar a eficácia e efeitos colaterais da terapia imunossupressora em pacientes com uveíte associada à doença de Behçet. MÉTODOS: Estudo retrospectivo não randomizado no qual são analisados dados de 22 pacientes com uveíte associada à doença de Behçet que utilizaram clorambucil e/ou ciclosporina A sistêmica por período mínimo de 6 meses, acompanhados pelo período mínimo de 1 ano, num único Serviço de Uveíte, São Paulo, Brasil (período 1978-2007). A eficácia do tratamento foi avaliada pela redução no número de recidivas da inflamação e pela redução na dose diária de prednisona. RESULTADOS: Vinte e dois pacientes (10 M/12 F), com idade média de 29 (variação 10-43) anos, apresentaram tempo mediano de acompanhamento de 11 (variação 1-29) anos. Clorambucil (2-6 mg/dia) foi utilizado em 13 pacientes e ciclosporina A (3-5 mg/kg/dia) em 9 pacientes como droga de primeira escolha. As drogas foram substituídas quando não eficazes ou não toleradas devido a efeitos colaterais. Clorambucil foi eficaz em 78,5% (11/14) e induziu remissão da doença em 43% (6/14) dos pacientes; ciclosporina foi eficaz em 57% (8/14) dos pacientes. Clorambucil e ciclosporina A foram suspensos devido a efeitos colaterais em 21% (leucopenia) e em 57% (nefrotoxicidade, 36% e complicações gastrointestinais, 21%) dos pacientes, respectivamente. Nenhum caso de malignidade foi observado. 36% (16/44) olhos tiveram acuidade visual final <0,1, sendo que 69% (11/16) já apresentavam esta acuidade na primeira consulta. CONCLUSÃO: Este estudo reforça dados de literatura que o clorambucil induz remissão da doença de Behçet enquanto a ciclosporina A é efetiva, porém efeitos colaterais limitam o seu uso. A terapia com clorambucil pode ser uma opção a ser considerada em pacientes com uveíte refratária associada à doença de Behçet.

PURPOSE: To assess the efficacy and side effects of immunosuppressive therapy in patients with Behçet's disease uveitis. METHODS: A nonrandomized retrospective case-series study analyzed data from 22 patients with Behçet's disease uveitis, from a single Uveitis Service, São Paulo, Brazil (period 1978-2007), under systemic chlorambucil and/or cyclosporine A, for at least 6 months with a minimum one-year follow-up. Drug efficacy was measured by reduction in relapse rate and reduction of prednisone dose. RESULTS: Patients (10M/12F) mean age was 29 (range 10-43) years-old at the onset of uveitis. The median duration of followup was 11 (range 1-29) years-old. Chlorambucil (2-6 mg/day) was used in 13 patients and cyclosporine A (3-5 mg/kg/day) in 9 patients at initiation. Drugs were switched because of no effectiveness or side-effects. Chlorambucil was effective in 78.5% (11/14) and induced disease remission in 43% (6/14) of patients, whereas cyclosporine A was effective in 57% (8/14) of patients. Chlorambucil and cyclosporine A were discontinued due to side effects in 21% (leucopenia) and in 57% of patients (nephrotoxicity, 36% and gastrointestinal complications, 21%), respectively. No case of late malignancy was observed. 36% (16/44) of eyes had final visual acuity <0.1, among which 69% (11/16) had already this visual acuity at the first visit. CONCLUSION: This study reiterates previous data that chlorambucil can induce long-term remission of Behçet's disease uveitis, whereas cyclosporine is effective but side effects limit its use. Chlorambucil therapy may still be a reasonable option in patients with intractable, sight-threatening Behçet's disease uveitis.

PURPOSE: To evaluate the performance of support vector machine, multi-layer perceptron and radial basis function neural network as auxiliary tools to identify keratoconus from Orbscan II maps. METHODS: A total of 318 maps were selected and classified into four categories: normal (n = 172), astigmatism (n = 89), keratoconus (n = 46) and photorefractive keratectomy (n = 11). For each map, 11 attributes were obtained or calculated from data provided by the Orbscan II. Ten-fold cross-validation was used to train and test the classifiers. Besides accuracy, sensitivity and specificity, receiver operating characteristic (ROC) curves for each classifier were generated, and the areas under the curves were calculated. RESULTS: The three selected classifiers provided a good performance, and there were no differences between their performances. The area under the ROC curve of the support vector machine, multi-layer perceptron and radial basis function neural network were significantly larger than those for all individual Orbscan II attributes evaluated (p<0.05). CONCLUSION: Overall, the results suggest that using a support vector machine, multi-layer perceptron classifiers and radial basis function neural network, these classifiers, trained on Orbscan II data, could represent useful techniques for keratoconus detection.

FUNDAMENTOS: O termo telemedicina faz referência ao uso de tecnologias de comunicação para a transmissão a distância de informações relacionadas à saúde. Esse recurso é utilizado em várias especialidades médicas, principalmente naquelas em que a interpretação de imagens representa uma etapa fundamental na formulação diagnóstica. OBJETIVO: Avaliar a concordância entre o diagnóstico presencial e o diagnóstico a distância de lesões cutâneas, utilizando a teledermatologia, em pacientes atendidos em uma unidade básica de saúde. MÉTODOS: Foi realizado um estudo prospectivo envolvendo pacientes atendidos no serviço de dermatologia da clínica FTC em Salvador - BA. Participaram do estudo um dermatologista responsável pela consulta presencial e dois dermatologistas responsáveis pela consulta a distância. Os diagnósticos obtidos através da teleconsulta foram avaliados quanto à concordância e comparados com os diagnósticos da consulta presencial. RESULTADOS: Foram incluídos neste estudo 60 pacientes. Observou-se um grau de concordância total variando de 86,6% a 91,6% com índice Kappa de 0,62. CONCLUSÃO: A teledermatologia é uma forma de assistência com um grande potencial de uso na dermatologia, podendo representar uma ferramenta útil principalmente em casos clínicos de baixa complexidade, oriundos de unidades básicas de saúde.

BACKGROUND: Telemedicine can be defined as the use of telecommunication technologies for the transmission of health data. It has been described in different medical specialties, especially those in which interpretation of images represents a fundamental key in formulating diagnosis. OBJECTIVE: To evaluate the role of teledermatology in primary care system. METHODS: A prospective analysis included 60 patients seen in a primary care unit. All patients were seen by a dermatologist as regular outpatient dermatology consultation. A medical student obtained digital images and a brief clinical history of all patients. Using a Telemedicine system these data were reviewed by two dermatologists for distance diagnosis. Agreement between the diagnoses was assessed. RESULTS: Good agreement, ranging from 86.6% to 91.6%, was achieved between direct observation and teleconsultation. Good agreement was also achieved between two telemedicine diagnosis (Kappa = 0.62). CONCLUSION: Teledermatology is a form of care with great potential for use in dermatology, and could represent a useful tool in cases of low complexity from primary health units.

A disponibilidade de lentes de contato cada vez mais confortáveis e toleráveis favoreceu não só a ampliação das indicações, mas também o aumento do número de seus usuários. Como conseqüência deste fato as complicações associadas ao uso de lentes de contato são cada vez mais comuns, e representam um problema de grande prevalência na prática clínica. O objetivo deste estudo é revisar as principais doenças e alterações do segmento anterior e superfície ocular associadas ao uso de lentes de contato.

Nowadays, contact lenses have shown a larger variety of options in order to meet the needs of different patients. They have become more frequent in the clinical practice and, consequently, the complications related to contact lenses have been more common. This review attempted to describe the main alterations and diseases of the cornea and anterior segment associated with contact lens wearers.

OBJETIVO: Desenvolver uma rede neural artificial para classificar em normal ou portador de ceratocone os pacientes submetidos ao exame do Orbscan II TM. MÉTODOS: Foi realizado um estudo retrospectivo envolvendo 98 exames de 59 pacientes. Utilizando o programa Java Neural Network 1.1 foi criada uma rede neural artificial para classificar os exames entre os dois grupos (normais e portadores de ceratocone). Foram utilizados 73 exames para treinamento e validação da rede, e 25 para testar o seu funcionamento. RESULTADOS: Dos 73 exames utilizados no treinamento da rede, 59 eram normais e 14 mostravam alterações relacionadas ao ceratocone. O método utilizado para treinamento da rede foi o "backpropagation". A taxa de aprendizado utilizada foi de 0,2, e a taxa de tolerância de erro 0,05. Dos 25 exames utilizados para a avaliação da eficácia da rede, 19 eram normais, e 6 apresentavam ceratocone. Após o treinamento a rede apresentou sensibilidade e especificidade de 83 e 100%, respectivamente. CONCLUSÃO: A rede neural artificial representa uma opção útil e viável para auxiliar na classificação de exames realizados com o Orbscan II TM.

PURPOSE: To evaluate an artificial neural network in order to correctly identify Orbscan II TM tests of patients with normal and keratoconus corneas. METHODS: A retrospective analysis included 98 Orbscan II TM tests of 59 subjects and an artificial neural network was created and trained based on the Java Neural Network 1.1 software. Seventy-three tests (59 normal tests and 14 keratoconus examinations) were applied to train the neural network and 25 eyes were used to test the method (19 normal eyes and 6 cases of keratoconus corneas). RESULTS: Backpropagation method was performed to train the neural network to 5% error and 0.2 learning rate. The trained neural network presented sensibility and specificity of 83 and 100% respectively. CONCLUSION: Artificial neural network can accurately help clinicians to classify keratoconus in Orbscan II TM tests.

Relata-se o caso de uma paciente portadora de síndrome da imunodeficiência adquirida empiricamente tratada com esquema tríplice para tuberculose miliar. Durante a evolução clínica a paciente cursou com lesões comprometendo a pálpebra e conjuntiva tarsal à direita. A hipótese diagnóstica inicial foi de tuberculose ocular com comprometimento conjuntival e palpebral. A biópsia da lesão conjuntival mostrou presença do Criptococcus neoformans. Após o início do tratamento específico com anfotericina B, a paciente apresentou melhora das lesões cutâneas.

This paper is about a patient with acquired immunodeficiency syndrome empirically treated for miliary tuberculosis. During the clinical evolution the patient presented lesions compromising the right eyelid and tarsal conjunctiva. The initial diagnostic hypothesis was ocular tuberculosis with conjunctival and eyelid involvement. The biopsy of the conjuctival lesion identified an encapsulated yeast-like fungus: Criptococcus neoformans. After starting treatment with B anfotericin, the cutaneus lesions cleared.

OBJETIVO: Avaliar os prontuários dos pacientes com estrabismo sensorial em aspectos variados, como etiologia, tipo e medida do desvio, correlação do tipo do desvio com a idade de aparecimento da doença de base, e resultado cirúrgico dos casos operados. MÉTODOS: Avaliação dos prontuários médicos dos pacientes com estrabismo sensorial atendidos no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP - no setor de Motilidade Ocular Extrínseca, no período de setembro de 1990 a julho de 2002. RESULTADOS: Foram avaliados 84 pacientes masculinos e 107 femininos; o diagnóstico mais freqüente para baixa visual foi coriorretinite atrófica em 49 casos. Oitenta e sete pacientes tinham exotropia e 97 tinham esotropia. Oitenta e dois pacientes tiveram cirurgia indicada, e 50 foram operados. Em 42 deles, foi constatado sucesso cirúrgico de 90,5% (desvio longe e perto menor ou igual a 15 dioptrias prismáticas). CONCLUSÕES: O bom resultado cirúrgico observado neste e em outros estudos reforça a necessidade da correção cirúrgica nesses casos.

PURPOSE: To evaluate the charts of patients with sensorial strabismus regarding range of different aspects, such as etiology, the type and the amount of deviation, relationship between the type of deviation and the patient's age when the disease occurred and the surgical outcome. METHODS: A retrospective analysis of data charts of 191 patients seen at the section of Ophthalmology at the University of São Paulo, from September 1990 to July 2002. RESULTS: There were 84 male and 107 female patients. The most frequent diagnosis responsible for low vision in the squinted eye was atrophic chorioretinitis in 49 patients. Eighty-seven were exotropes and 97 were esotropes. Fifty patients were operated on, but 8 of them were lost to follow-up. In 90.5% the surgical outcome was successful: less than 15 prismatic diopters of hyper or undercorrection after surgery. CONCLUSIONS: The good surgical outcome seen in this and other studies enhances and justifies the need for surgical correction of this type of strabismus.

Ceratite intersticial não luética, surdez e vertigem caracterizam a síndrome de Cogan. Os achados oculares mais comuns no início da síndrome são opacidades corneanas numulares periféricas bilaterais. O tratamento desta rara doença utiliza imunossupressão sistêmica com agentes citotóxicos e corticosteróides. O relato de caso apresenta uma paciente com a evolução da forma clássica da síndrome de Cogan.

Non-luetic interstitial keratitis, deafness and vertigo characterize Cogan's syndrome. The most common ocular findings in early Cogan's syndrome are bilateral, peripheral, subepithelial numular corneal opacities. The report presents a patient with the evolution of the classic form of Cogan's syndrome.

OBJETIVO: Desenvolver uma rede neural artificial para planejar a estratégia cirúrgica em pacientes portadores de estrabismo sensorial, com desvio horizontal. MÉTODOS: Foi realizado estudo retrospectivo envolvendo 95 pacientes portadores de estrabismo sensorial, atendidos no Ambulatório de Motilidade Ocular Extrínseca do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foi construída uma rede neural artificial utilizando-se o Java Neural Network 1.1. Foram utilizados 68 pacientes para treinamento e validação da rede e 27 para testar o seu funcionamento. RESULTADOS: Dos 68 pacientes utilizados no treinamento da rede, 37 apresentavam exotropia e 31 esotropia. O método utilizado para treinamento da rede foi o "backpropagation". A taxa de aprendizado utilizada foi de 0,6, e a taxa de tolerância de erro 0,05. Dos 27 pacientes utilizados para avaliação da eficácia da rede, 18 apresentavam exotropia, e 9 esotropia. A eficácia da rede foi avaliada pela média da diferença entre os resultados fornecidos pela rede, e as indicações originais. Nos pacientes com exotropia o erro médio foi de 0,4 mm (±0,4), para o retrocesso do músculo reto lateral, e de 0,3 mm (±0,3), para a ressecção do músculo reto medial. Nas esotropias, o erro médio foi de 0,2 mm (±0,2), para o retrocesso do músculo reto medial e de 0,5 mm (±0,3), para ressecção do músculo reto lateral. CONCLUSÃO: A rede neural artificial, por sua característica de simular o sistema nervoso central biológico, e sua capacidade de realizar tarefas cognitivas, é opção viável para auxiliar no planejamento cirúrgico da cor-reção do estrabismo.

PURPOSE: To develop a neural network model for planning of the surgical strategy of patients with sensorial strabismus. METHODS: In this retrospective study, medical records of 95 patients with sensorial strabismus were reviewed. All patients were seen at the Strabismus Sector of the Hospital das Clínicas of the University of São Paulo. The neural network was designed containing 3 layers. Sixty-eight patients were used in the training and validation set, and 27 in the test set. RESULTS: In the 68 patients used in the training and validation set, 37 had exotropia, and 31 esotropia. The backpropagation approach was used for training the neural network. A learning rate of 0.6, and a tolerance error of 0.05 were used. In the 27 patients used in the test set, 18 had exotropia, and 9 had esotropia. The efficacy of the neural network was analyzed using the average of the difference between the indication supplied by the network and the original indication. In patients with exotropia, the average error was 0.4 mm (±0.4), for recession of the lateral rectus muscle, and 0.3 mm (±0.3), for the resection of the medial rectus muscle. In the esotropia group, the average error was 0.2 mm (±0.2) for the recession of the medial rectus muscle, and 0.5 mm (±0.3) for resection of the lateral rectus muscle. CONCLUSION: As the artificial neural network can simulate a biological central nervous system, and is able to carry out cognitive tasks, it can be a viable option to help the surgical planning for strabismus correction.