Purpose Assess prevalence and causes of vision impairment among low–middle income school children in São Paulo. Methods Cluster sampling was used to obtain a random sample of children ages 11 to 14 years from public schools (grades 5–8) in three districts from June to November 2005. The examination included visual acuity testing, ocular motility, and examination of the external eye, anterior segment, and media. Cycloplegic refraction and fundus examination were performed in children with uncorrected visual acuity 20/40 or worse in either eye. A principal cause of visual impairment was determined for eyes with uncorrected visual acuity of 20/40 or worse. Results A total of 2825 children were enumerated and 2441 (86.4%) were examined. The prevalence of uncorrected, presenting, and best-corrected visual acuity 20/40 or worse in the better eye was 4.82%, 2.67%, and 0.41%, respectively. Spectacles were used by 144 (5.9%) children. Refractive error was a cause in 76.8% of children with visual impairment in one or both eyes; amblyopia, 11.4%; retinal disorders, 5.9%; other causes, 2.7%; and unexplained causes, 7.7%. Myopic visual impairment (spherical equivalent −0.50 D in one or both eyes) was not associated with age or grade level, but female sex was marginally significant (P = 0.070). Hyperopic visual impairment (+2.00 D or more) was not associated with age, grade level, or sex. Conclusions The prevalence of reduced vision in low–middle income urban São Paulo school children was low, most of it because of uncorrected refractive error. Cost-effective strategies are needed to address this easily treated cause of vision impairment.

Retinopathy of prematurity is one of the main causes of childhood blindness. Worldwide, there are more than 50,000 children blind due to retinopathy of prematurity. Visual impairment is a consequence of retinal detachment. It can be detected by serial ophthalmologic examination of infants at risk, and those identified with the severe form of the disease can be treated by laser or cryotherapy, which can decrease significantly the blindness due to ROP. The Brazilian Society of Pediatrics, Brazilian Council of Ophthalmology and Brazilian Society of Pediatric Ophthalmology suggest a guideline for the detection and treatment of retinopathy of prematurity in Brazil. This document was based on the results of the I Workshop of Retinopathy of Prematurity and presents the attributes for the implementation of an efficient diagnostic and treatment program.

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No statistically significant difference was shown between the two groups. Mendonça's forceps can be a safe alternative to electromyography to locate an extraocular muscle for botulinum toxin A injection.

Purpose: To identify the frequency and causes of uveitis leading to visual impair ment in patients referred to the Low Vision Service Department of Ophthalmology UNIFESP, over a twenty years period. Methods: In a retrospective study, medical records of 5,461 patients were re viewed. Data from the first clinical evaluation at the Low Vision Service were collected, patient's age, gender and cause of visual impairment were analyzed. Patients with uveitis had their chart reviewed for anatomical classification and clinical diagnosis. Results: The mean age of the patients referred to the Low Vision Service was 42.86 years and the mean age of patients with uveitis diagnosis was 25.51 years. Retinal disorders were the most common cause of visual impairment (N=2,835 patients; 51.9%) followed by uveitis (862 patients, 15.7%). Uveitis was posterior in 792 patients (91.9% of uveitis) and toxoplasmosis was the most common diagnosis (765 patients, 88.7%). Conclusions: In our study, uveitis represents the second cause of visual impairment in patients referred for visual rehabilitation and toxoplasmic retinochoroiditis was the most common clinical diagnosis. It affects a young working age population with a relevant social and economic impact, but the early diagnosis and treatment can improve the quality of life of these patients. Keywords

Twenty-two patients with Graves' ophthalmopathy underwent biopsy, and two patients had both eyes biopsied. The samples for the control group (n = 4) were obtained during routine non-thyroid-related corrective strabismus surgery. Ophthalmological evaluation with clinical activity score (CAS), endocrinological evaluation, and ultrasound were used in our study. Correlation between clinical and histological analyses in connective tissues and extraocular muscles from patients with Graves' ophthalmopathy was done. The echography results disclosed an enlargement in all extraocular recti muscles with the exception of one patient. Periodic acid-Schiff and Giemsa stains revealed a moderate number of mast cells in the endomysial connective tissue, none of which displayed significant degranulation. There were no signs of muscle cell damage. Fifteen of the biopsies showed weak cellular reactions with only scattered inflammatory cells. Furthermore, the inflammatory process may be localized and not equally distributed throughout the muscle. Thus, the biopsies might not be representative for the whole muscle. Statistical significance analysis was found when sex and CAS were compared (p = 0.001683) using the Fisher Test. In conclusion, our investigation indicates a pleomorphic pattern of histologic findings in connective tissue and extraocular muscles in Graves' ophthalmopathy.

RESUMO ABSTRACTPurpose: Evaluate the relationship between the postural alignment of the head and possible interference in the view of children. Methods: We evaluated 11 children between 2 and 7 years of age of both sexes, with the visually impaired, who had nystagmus and head lock position. The test Lea Grating Acuity Test® was used to collect measurements of visual acuity. This applied on two occasions: with and without postural alignment of the head. For reliability of the postural alignment of the head, the slopes were measured by Fisiologic® software. Results: The children had a poorer performance after physiological postural alignment. This poor performance is possible due to loss of position lock nystagmus to gain postural alignment, said to be ideal. Postural compensations were observed, and sharply increased eyestrain. Conclusion:The pursuit of traditional postural alignment affect the visual response of children with visual impairments.

IOAT can provide acceptable binocular visual function without the risk of anterior segment ischemia in cases of torn inferior rectus muscle.