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- ItemAcesso aberto (Open Access)Artificial eye amplitudes and characteristics in enucleated socket with porous polyethylene spherical and quad-motility implant(Conselho Brasileiro de Oftalmologia, 2007-10-01) Lucci, Lucia Miriam Dumont; Hofling-Lima, Ana Luisa [UNIFESP]; Erwenne, Clélia Maria [UNIFESP]; Cassano, Emanuela Martins de Toledo; Faculdade de Medicina do ABC Departamento de Oftalmologia Setor de Plástica; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To compare artificial eye amplitudes in enucleated socket with porous polyethylene either spherical or quad-motility implant and study the characteristics of artificial eyes fit with the two orbital implants. METHODS: A total of 21 patients were prospectively studied who underwent enucleation because of an intraocular melanoma and the randomization defined a porous polyethylene either spherical or quad-motility orbital implant. Measurements of the amplitude of the artificial eye were obtained with prism and digital photos. The software Scion Image analyzed the digital photos (www.scioncorp.com) and the quantitative data were allocated to groups. The measurements (height, length, thickness) and weight of the 21 artificial eyes were analyzed. Student's t-test was performed to determine the significance of difference between groups (p<0.05). RESULTS: There was no statistically significant difference of the artificial eye amplitude analyzed by means of prisms between both orbital implants (p>0.05 for all directions). On analyzing the digital photos, the artificial eye with spherical implant showed higher artificial eye amplitude downward (p=0.009) among patients older than 55 years old, rightward (p=0.036) and downward (p=0.008) among the 9 patients with enucleated right eye. Height and length were similar in the 21 artificial eyes but those artificial eyes fit with quad-motility orbital implants were statistically significant thicker (p<0.001) and heavier (p=0.001). CONCLUSIONS: The similar amplitude of movement of artificial eyes was observed with both spherical and quad-motility orbital implants. Artificial eyes fit with quad-motility orbital implant are significantly thicker and heavier than those fit with spherical orbital implant.
- ItemAcesso aberto (Open Access)Aspectos psicológicos em usuários de prótese ocular(Conselho Brasileiro de Oftalmologia, 2003-10-01) Botelho, Nara Lucia Poli [UNIFESP]; Volpini, Marcos; Moura, Eurípedes Da Mota; Universidade Federal de São Paulo (UNIFESP); Hospital Sírio Libanês; Santa Casa de Misericórdia de Santo Amaro Setor de Plástica Ocular; Universidade de São Paulo (USP)PURPOSE: To evaluate psychological disturbances caused by acquired unilateral anophthalmia, the struggle for aesthetic recuperation on use of the ocular prosthesis, as well as involved interpersonal factors and psychosocial reintegration of these patients. METHOD: Thirty (30) patients with acquired unilateral anophthalmia without any other deformities in the orbital region and users of ocular prosthesis (16 males, 14 females) aged between 12 and 66 years, mean age 31.6 years, were submitted to an ophthalmic examination and psychological evaluation through a standardized questionnaire focusing on 66 questions lasting two hours in the period from January, 2000 to March, 2001. RESULT: The highest incidence of acquired anophthalmia (47%) was in the age ranging from 0 to 6 years old. Seventy (70)% of the patients are in the process of elaboration of their loss (n=21). The most used mechanisms of defense in the current situation were rationalization, repression, denial and displacement. Thirty (30)% accept the present situation. After the triggering event (TE) 36% manifested a depressive state 64% of whom got over the symptoms of depression. Sixty percent (60%) adapted the ocular prosthesis right after the surgical treatment while 40% adapted it two or more years after the TE. Aesthetically 70% are satisfied while 30% are unsatisfied. Fifty-three (53)% show low self-steem, 37% distorted self-image. CONCLUSION: An integration among various elements of the multidisciplinary team made up of surgeons, ocularists, psychologists and support from family and friends is fundamental during the whole process of mourning due to the loss. A positive attitude towards the person dealing with the issue minimizes the loss in all of its aspects, offering recovery of interpersonal aspects and psychosocial reintegration as he/she is given adequate resources to become more secure. The prosthesis has two functions: on the one hand it returns to the patient self-image and self-steem allowing his/her exposure without discrimination, which allows his psychosocial reintegration. On the other hand it becomes an instrument, which removes the possibility of the loss to be lived in its totality, which contributes to behavior of repression of the patients instead of acceptance of the new reality - mainly when the prosthesis is adapted after the TE. There is no direct relationship between the obtained aesthetic result and the degree of satisfaction of the patients. Prejudice is another important factor because it may interfere or not in the rehabilitation.
- ItemAcesso aberto (Open Access)Estudo do raspado de conjuntiva de pacientes tratados de retinoblastoma: Etapa II -- citologia(Conselho Brasileiro de Oftalmologia, 2002-06-01) Santos, Maria Carmen Menezes; Santos, Gilda Da Cunha [UNIFESP]; Vozza, João Antônio; Medeiros, Nivaldo; Erwenne, Clélia Maria [UNIFESP]; Fundação Antônio Prudente Hospital A. C. Camargo; Universidade Federal de São Paulo (UNIFESP); Fundação Antônio Prudente Hospital A. C. Camargo Laboratório IPACE; Fundação Antônio Prudente Hospital A. C. Camargo Departamento de Patologia ClínicaPurpose: Human conjunctival cytology has been extensively studied. Lack of data about the characteristics of conjunctival smears in patients treated for retinoblastoma who underwent enucleation and radiotherapy motivated this study. Methods: A previously studied group of 114 orbits of 58 patients was examined. The authors present the results of conjunctival cytology in 4 different situations, with and without enucleation, with and without radiotherapy. Results: In the leukocytic infiltrate in orbits with ocular bulbi predominated the lymphocyte, while in the others predominated the polymorphonuclear neutrophil. In general, the majority of epithelial cell alterations seen in the conjunctival smears of irradiated orbits were: cell with large nuclei, prominent nucleoli, and cytoplasmatic hyalinization. Conclusion: The cytological findings of the conjunctival smears do not indicate a characteristic and distinct pattern for each group.
- ItemAcesso aberto (Open Access)Estudo do raspado de conjuntiva e margem palpebral de pacientes tratados de retinoblastoma: etapa I - Microflora aeróbica(Conselho Brasileiro de Oftalmologia, 2002-03-01) Santos, Maria Carmen Menezes; Santos, Gilda Da Cunha [UNIFESP]; Vozza, João Antônio; Medeiros, Nivaldo; Erwenne, Clélia Maria; Universidade Federal de São Paulo (UNIFESP); Fundação Antônio Prudente Hospital A. C. Camargo Laboratório IPACE; Fundação Antônio Prudente Hospital A. C. Camargo Departamento de Patologia Clínica; Fundação Antônio Prudente Hospital A. C. Camargo Serviço de OftalmologiaPurpose: Conjunctival discharge is a common complaint among patients treated for retinoblastoma who underwent enucleation and radiotherapy. Lack of data about the microflora in those patients motivated this study. Methods: One hundred and fourteen orbits of 58 patients were examined. The authors present the results of aerobic bacterial and fungal culture of conjunctival and eyelid margin smears, as well as conjunctival cytology, in 4 different conditions: with and without enucleation, with and without radiation. Microorganisms were identified according to the National Committee for Clinical Laboratory Standards, using Gram and Leishman staining. Results: Microorganisms were more frequent in irradiated anophthalmic sockets, both in the conjunctiva (54.5%) and eyelid margin (63.6%); however the difference was not statistically significant. On the other hand, in orbits with ocular bulbi, the radiation, in the late phase, represented a limiting factor for the presence of microorganims in the conjunctiva and eyelid margin, but without a statistically significant difference. The coagulase-negative Staphylococcus was the most frequent microorganism in the conjunctiva and eyelid margin in all groups. There was fungus growth, Candida tropicalis, in only one case. Conclusions: Topical antibiotics in patients treated for retinoblastoma who underwent enucleation, with or without radiotherapy, are suggested.
- ItemAcesso aberto (Open Access)Exenteração: estudo retrospectivo(Conselho Brasileiro de Oftalmologia, 2006-10-01) Atique-tacla, Milena [UNIFESP]; Paves, Luis [UNIFESP]; Pereira, Max Domingues [UNIFESP]; Manso, Paulo Gois [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Brasileiro de Controle do Câncer setor de tumores cutâneosPURPOSE: To review all cases of orbit exenteration performed at the Orbit Sector, Ophthalmology Department - Federal University of São Paulo, from 1998 to 2003. METHODS: We reviewed conditions leading to orbital exenteration in 21 patients at the Orbit Sector of UNIFESP-EPM from August 1998 to May 2003. Data regarding sex, age, race, primary lesion site, visual acuity at the moment of diagnosis, previous surgeries related to the exenteration, type of performed surgery, histopathologic diagnosis, postoperative complications and use of adjuvant treatment were collected. RESULTS: 21 patient charts were retrospectively analyzed. Ages ranged from 5 to 91 years (mean of 58.5 years). Of these, 12 were male and 9 were female, most of them Caucasian. All lesions that led to exenteration were malignant neoplasias; however, none were metastatic. Lesions originated from eyelids in twelve patients, from bulbar conjunctiva in six and from the orbit in three. Cases were also classified as squamous cell carcinoma (eleven cases), basal cell carcinoma (four cases), sebaceous gland carcinoma (two cases), rhabdomyosarcoma (two cases), mucoepidermoid carcinoma (one case) and adnexal microcistic carcinoma (one case). Visual acuity at the moment of diagnosis ranged from 20/40 to no light perception. Only six patients had been submitted to previous surgeries related to the exenteration. After surgery, three patients suffered graft necrosis, one presented ethmoidal sinus fistula to the orbit and one presented orbital socket shrinkage. Six patients needed postoperative radiotherapy and two had been previously submitted to chemotherapy. CONCLUSION: Most patients analyzed in our study presented lesions that are usually small in the beginning; however, they can disseminate to the orbit in the absence of adequate treatment.
- ItemAcesso aberto (Open Access)Indications for eye removal over a 13-year period at an ophthalmology referral center in Sao Paulo, Brazil(Consel Brasil Oftalmologia, 2017) Hime, Bernardo; Isenberg, Jordan; Rocha, Gustavo; Lowen, Marcia [UNIFESP]; Morales, Melina [UNIFESP]; Fernandes, Bruno Franco; Belfort, Rubens N. [UNIFESP]Purpose: To analyze the indications and types of eye removal at Latin America's highest-volume ophthalmic reference center in Sao Paulo, Brazil. Methods: A retrospective analysis was conducted of surgical pathological reports in the electronic database of the Ophthalmology Department of the Universidade Federal de Sao Paulo Hospital of patients who underwent eye-removal procedures between January 2000 and December 2012. Results: A total of 412 cases met the inclusion criteria for this study. The most common indications for eye removal were ocular melanoma and retinoblastoma, representing 35.4% and 31.1% of the total cases, respectively. Other frequent indications included endophthalmitis (6.3%), nonspecific inflammation (4.1%), squamous cell carcinoma (3.6%), panophthalmitis (3.4%), and phthisis bulbi (1.2%). The remaining indications accounted for 14.8% of all cases, with each accounting for <1% of the total cases. Enucleation was the most common eye-removal procedure seen in our study. Conclusions: The two most common indications for eye removal were ocular melanoma and retinoblastoma. Alternative treatment options are effective in limiting the need for eye removal but are constrained by our public center's socioeconomic context.
- ItemAcesso aberto (Open Access)Phacoemulsification and foldable acrylic IOL implantation in children with treated retinoblastoma(Conselho Brasileiro de Oftalmologia, 2012-10-01) Tartarella, Marcia Beatriz [UNIFESP]; Britez-Colombi, Gloria Fátima [UNIFESP]; Motono, Marcia; Chojniak, Martha Motono; Fortes Filho, João Borges [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital A C Camargo Ocular Oncology Department; Universidade Federal do Rio Grande do Sul Department of OphthalmologyPURPOSE: To study the results of cataract surgery in children with radiation-induced cataract after treatment for retinoblastoma. METHODS: Retrospective interventional case series. Six consecutive patients diagnosed with secondary cataracts due to radiation therapy for retinoblastoma. Intervention: Phacoemulsification and foldable acrylic intraocular lens implantation. Outcomes measu- red: Visual acuity, binocular indirect ophthalmoscopy and slit-lamp biomicroscopy. Aspirated lens material and aqueous humor samples were collected during surgery. RESULTS: Six uniocular children between 3 to 5 years of age at time of surgery were studied. The mean time interval between radiotherapy and cataract diagnosis was 22.3 months. The mean follow-up after surgery was 17.2 months (range: 12 to 23 months). All eyes achieved a clear visual axis after surgery allowing monitoring of the tumor status. None developed recurrence or retinoblastoma dissemination. Histopathological analysis of the aspired material showed no tumoral cells in all samples. All patients improved vision after cataract surgery. CONCLUSIONS: Phacoemulsification with acrylic intraocular lens implantation seems to be a safe, feasible, and effective method for the removal of radiation-induced cataracts in patients with treated retinoblastoma.
- ItemAcesso aberto (Open Access)Retinoblastoma bilateral de aparecimento tardio: relato de caso(Conselho Brasileiro de Oftalmologia, 2008-06-01) Melo, Maria Cecília Santos Cavalcanti; Ventura, Liana Maria Vieira De Oliveira; Erwenne, Clélia Maria [UNIFESP]; Arcoverde, Ana Lúcia Andrade Lima; Hospital de Olhos de Pernambuco; Fundação Altino Ventura; FAV; Universidade Federal de São Paulo (UNIFESP)A case of retinoblastoma with uncommon features is reported, aiming at improving follow-up. In 1993, SJMMF, 9-month-old white boy, presented a squint in the left eye. A retinal tumor was detected. The patient had a family history of retinoblastoma. Enucleation was performed and retinoblastoma was proved. The patient underwent examination for staging, all were normal. The fellow eye remained normal for 10 years. During routine examination the retina map revealed three retinoblastoma white lesions in the nasal retina. The patient underwent transpupillary thermotherapy with diode laser. After 30 days, the lesions became atrophic. After 60 days there was tumor recurrence on the border of the lesion. Sclera cryotherapy was performed. There was tumor regression for six months. During follow-up, condensations next to the atrophic tumor lesions were discovered, which were vitreous seeds. Brachitherapy with 125 iodine was done. The lesions disappeared after 30 days. New vitreous seeds appeared 3 months later, set on the retina surface. They were blocked with sclera cryotherapy and transpupillary thermotherapy. The patient presented with new vitreous seeds after six months, which adhered to the retina. They were blocked with transpupillary thermotherapy. Follow-up was for 38 months since the appearance of the bilateral tumor. The patient presents normal visual acuity and clinical examination. This case is important considering the low frequency of the disease at this age. It is essential to maintain alertness when cases of retinoblastoma are seen as cured.
- ItemAcesso aberto (Open Access)Single institutional retrospective analysis: treatment of choroidal melanomas with cobalt-60 brachytherapy(Conselho Brasileiro de Oftalmologia, 2004-06-01) Pellizzon, Antônio Cássio Assis; Salvajoli, João Victor; Novaes, Paulo Eduardo; Fogaroli, Ricardo; Ferrigno, Robson; Maia, Maria Aparecida Conte; Chojniak, Marta Motono; Erwene, Clélia Maria [UNIFESP]; Hospital do Câncer - AC Camargo Centro de Tratamento Pesquisa Department of Radiation Oncology; Instituto Arnaldo Vieira de Carvalho; Hospital do Câncer - AC Camargo Centro de Tratamento Pesquisa Department of Onco-opthalmology; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the outcome of patients with choroidal melanoma treated with conservative therapy with brachytherapy (episcleral Co-60 plaque therapy) at the Hospital do Cancer São Paulo, Brazil. METHODS: We evaluated 102 patients consecutively treated from January, 1999 to June, 1999. Median age, maximum tumor base diameter and apex size were 55.5 years, 9.75 mm and 5 mm, respectively. Doses at the base of the tumor, including 1 mm of sclera, ranged from 157 to 487 Gy (median 284.5 Gy) and to the apex from 37 to 220 Gy (median 106 Gy). RESULTS: The crude eye preservation rate with conservative therapy alone was 78.5%. Five-year overall actuarial survival rate was 92.2% and eye conservation rate was 78%. Side effects were mostly an uncomplicated retinopathy in 39/102 patients (38.2%); macular degeneration or scarring led to poor central vision in 31/102 patients (30.3%) of cases. CONCLUSION: Our experience with cobalt-60 plaque brachytherapy achieved a satisfactory rate of local tumor control, despite the oversized base diameters of treated tumors.
- ItemAcesso aberto (Open Access)Tratamento conservador em retinoblastoma intra-ocular(Conselho Brasileiro de Oftalmologia, 2003-12-01) Erwenne, Clélia Maria [UNIFESP]; Antonelli, Célia Beatriz Gianotti; Marback, Uardo Ferrari; Novaes, Paulo Eduardo; Universidade Federal de São Paulo (UNIFESP); Fundação Antonio Prudente Hospital AC Camargo Departamento de Pediatria; Fundação Antonio Prudente Hospital AC Camargo Departamento de RadioterapiaPURPOSE: To report the results of conservation of the ocular globe after treatment with carboplatin and laser; with or without the use of other forms of local treatment or radiotherapy, if necessary. METHODS: All eyes, initially untreated, were evaluated using indirect ophthalmology under inhalation anesthesia in an outpatient clinic treatment setting. They were categorized according to the Reese-Ellsworth system; thereafter, the patients were evaluated clinically by a pediatric oncologist. The patients received the first cycle of chemotherapy consisting of intravenous carboplatin 200 mg/m², vincristine 1.5 mg/m² and etoposide 150 mg/m², for three days. This was followed by other cycles with intervals of between 21 and 28 days. From 7 to 15 days after the end of the chemotherapy cycle, another indirect ophthalmoscopy under inhalation anesthesia was performed, with documentation of the findings and laser hyperthermia application, using a Diode laser, 810 nm, continuous pulse with a large spot size. The procedure (chemotherapy and laser) was repeated until complete cicatrization of all lesions was observed, or until the need for another treatment modality such as radiotherapy or enucleation became apparent. Follow-up examinations every two months during the first year and three months thereafter were done for review and for treatment of recurrent or new lesions. Pediatric oncology follow-up was also done throughout the entire initial assessment and follow-up period. RESULTS: We treated a total of 62 patients with retinoblastoma, of whom 32 were male and 30 female. Fifteen were unilateral and 47 were bilateral with a total of 107 eyes. The mean age was 16.9 months (2.6 - 71.4). In 5 patients we administered 4 cycles of chemotherapy; but in most cases we found it necessary to use between 4 - 8 chemotherapy cycles. In 34 eyes we could not avoid the use of radiotherapy. The mean follow-up time was 26.8 months (5 - 60). In the bilateral cases, we were able to conserve the globe as follows (Reese & Ellsworth): I 10/11 (90.9%); II 8/9 (88.8%); III 10/10 (100.0%); IV 3/8 (37.5%); V 14/54 (25.9%). Considering all those bilateral cases we reached conservation of 48.9% of the treated eyes. In the unilateral group, we were able to conserve the globe as follows: I 0/0 (0%); II 2/2 (100%); III 1/3 (33.3%); IV 1/3 (33.3%); V 0/0 (0%). Considering the total we conserved 26.6% of the unilateral cases. There was no case of nephrotoxicity or ototoxicity among our patients.
- ItemAcesso aberto (Open Access)O uso da biópsia aspirativa com agulha fina (BAAF) no diagnóstico de lesão iriana suspeita: relato de caso(Conselho Brasileiro de Oftalmologia, 2001-08-01) Corrêa, Zélia Maria da Silva [UNIFESP]; Marcon, Ítalo Mundialino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Faculdade Federal de Ciências Médicas de Porto AlegreTo report the case of a patient who presented with a solid anterior segment intraocular mass in his right eye, and the diagnostic investigation chosen by the authors. Diagnostic uncertainty and patient's refusal to agree with the treatment caused the authors to perform a fine needle aspiration biopsy of the lesion. Biopsy was performed by corneal puncture, through the aqueous and the tumor. Cytology of the specimen obtained by the biopsy determined the therapeutic strategy for this case. Cytology diagnosis was consistent with primary malignant melanoma of the choroid of mixed cell type. Enucleation of the eye was suggested due to the position of the tumor and its potential to spread distant metastases. After enucleation, anatomopathological examination of the eye presented a similar result to cytology. The patient is currently been followed, with no signs of metastasis 2 years after enucleation.