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- ItemAcesso aberto (Open Access)Acurácia da medida da inserção dos músculos retos com tomografia de coerência óptica em adultos submetidos a cirurgias de estrabismo(Universidade Federal de São Paulo (UNIFESP), 2017-03-29) Rossetto, Julia Dutra [UNIFESP]; Allemann, Norma [UNIFESP]; Mattos Júnior, Rubens Belfort [UNIFESP]; http://lattes.cnpq.br/4270399167335564; http://lattes.cnpq.br/0956596522261307; http://lattes.cnpq.br/8314526091344602; Universidade Federal de São Paulo (UNIFESP)Purpose: To assess the accuracy of anterior segment optical coherence tomography (AS-OCT) in measuring the distance of extraocular muscle (EOM) insertion to the limbus to improve preoperative assessment of adult patients undergoing strabismus surgery. Methods: A reliability analysis at an institutional practice performed in adult patients scheduled for strabismus surgery on rectus muscles. The distance between the EOM insertion and the limbus was measured preoperatively with AS-OCT. The value was compared to intraoperative measurement obtained with calipers. Additional measurements included the limbus-anterior chamber angle distance with AS-OCT and the axial length with IOLMaster. The main outcome measure was the greement between preoperative AS-OCT and intraoperative measurements. A difference of ≤ 1 millimeter (mm) was "clinically acceptable". Results: 144 muscles were analyzed from 74 patients. 31 of 33 reoperated muscles were successfully imaged. AS-OCT measurements were within 1 mm of intraoperative measurements in 77% of all the muscles. The accuracy was higher for muscles with no prior surgery (83%), as compared to re-operated muscles (58%). Although the accuracy decreased when comparing reoperations to primary surgeries for the medial (79 to 63%; p=0.09; 95%CI, -1.38 to 0.11) and the lateral rectus (81 to 49%; p=0.11; 95%CI, -2.06 to 0.22), the difference was not significant. No correlation between limbus-anterior chamber angle distance and axial length was established. Conclusions: AS-OCT is valuable in identifying EOM insertions in primary strabismus surgeries, but the accuracy decreases in re-operations. The intraoperative measure performed before the detachment of the muscle's tendon and the use of limbus as a reference point in the OCT proved to be suitable for performing the measurements.
- ItemAcesso aberto (Open Access)Adesivo biológico de fibrina na mioescleropexia posterior em coelhos: estudo experimental(Conselho Brasileiro de Oftalmologia, 2004-04-01) Moreira, Ana Tereza Ramos [UNIFESP]; Bottós, Juliana Mantovani; Bottós, Kátia Mantovani; Buquera, Michele; Anjos, Adilson Dos; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná Departamento de Oftalmologia; Universidade Federal do Paraná; Hospital de Olhos do Paraná; Universidade Federal do Paraná Laboratório de EstatísticaPURPOSES: 1. To evaluate the adhesion capacity of the fibrin biological adhesive in surgery of posterior fixation of the superior rectus muscle, when it is used for the reduction of the arc of contact. 2. To compare the reduction of the superior rectus muscle's action of eyes in which the biological adhesive has been used with those used as a control group. METHODS: The sample consisted of 30 animals, 60 eyes. One of the eyes of each animal was treated with biological adhesive (30 eyes), while the other was used as a control (30 eyes). All animals were sacrificed on the 60th postoperative day. Muscle reduction was analyzed and the sizes of the adherences produced at surgery and after 60 days were measured. RESULTS: The fibrin clot was produced immediately after applying the biological adhesive and at the end of few seconds all muscle fibers were adhered to the sclera. All muscles treated with biological adhesive showed reduction in motor function on the 60th postoperative day when compared with the control group. The sizes of the initially produced adherence compared with those after 60 days was reduced 28.48%. There was an ascending and positive but weak correlation (r=0.367204). There must exist other variables affecting adherence reduction. There was no significant inflammatory reaction or any other complication related to the surgery. CONCLUSIONS: The clinical results of motor function demonstrated that the biological adhesive of fibrin produced muscle-scleral adhesion, reducing the arc of contact of the superior rectus muscle in rabbits.
- ItemAcesso aberto (Open Access)Análise do duplo retrocesso de retos mediais em pacientes esotrópicos portadores de incomitância longe/perto(Conselho Brasileiro de Oftalmologia, 2001-06-01) Barcellos, Ronaldo Boaventura; Andrade, Eric Pinheiro De; Carvalho, Luiz Eduardo M. Rebouças De [UNIFESP]; Souza-dias, Carlos Ramos [UNIFESP]; Universidade de São Paulo (USP); Santa Casa de São Paulo Departamento de Oftalmologia; Universidade de Santo Amaro Faculdade de Medicina; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade de Ciências MédicasIntroduction: Accommodative convergence (AC) is the convergence induced by a determined amount of accommodation (A). Besides the many techniques described to correct esotropias, great distance/near incomitance is still a challenge in avoiding secondary exotropias and esotropias. Objective: To compare the surgical results obtained with double medial rectus recession and its relationship to distance/near incomitance and high hyperopias. Methods: 33 patients with esotropia and distance/near incomitance who where submitted to double medial rectus recession at Santa Casa de São Paulo, between 1980 and 1990 were retrospectively analyzed. There were two groups: those with more than 3.50 D of hyperopias (Group I) and those with less than 3.50 D (Group II). Results: Group I had a mean of 18.18 PD correction (72.72% of correction) for distance and 27.64 PD (63.36%) for near. Group II had a mean of 20.20 PD correction for distance (87.83%) and 34.60 PD (82.78%) for near. Conclusion: There was no statistical difference regarding the amount of distance/near incomitance reduction, between Groups I and II. The total amount of correction was greater for near but, in percentage, it was similar.
- ItemAcesso aberto (Open Access)Autologous grafting of extraocular muscles: experimental study in rabbits(Conselho Brasileiro de Oftalmologia, 2005-06-01) Meireles-teixeira, Jorge [UNIFESP]; Bicas, Harley E. A.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)PURPOSE: To evaluate the feasibility of autologous extraocular muscle grafting as a type of muscle expansion surgery. METHODS: The left superior rectus muscle of twenty-nine rabbits was resected and this fragment was attached to the endpoint of the respective right superior rectus (test group). Thereafter, the superior rectus of the left eye was reattached to the sclera (control group). Both groups were examined during different postoperative periods in order to assess their outcomes. RESULTS: The presence of hyperemia was slightly more frequent in the grafted group. Secretion and muscle atrophy were negligible in both groups. Fibrosis was greater in grafted animals. These muscles were weaker than the control muscles, although the force required to split muscular parts was always greater than the physiological one. CONCLUSIONS: This surgical technique was reliable and useful if one intends to achieve muscle expansion without the intrinsic risks of dealing with heterologous/artificial materials.
- ItemAcesso aberto (Open Access)Bupivacaine and botulinum toxin to treat comitant strabismus(Conselho Brasileiro de Oftalmologia, 2012-04-01) Hopker, Luisa Moreira [UNIFESP]; Zaupa, Priscila Fernandes [UNIFESP]; Lima Filho, Acácio Alves de Souza [UNIFESP]; Cronemberger, Monica Fialho [UNIFESP]; Tabuse, Marcia Keiko Uyeno [UNIFESP]; Nakanami, Célia Regina [UNIFESP]; Allemann, Norma [UNIFESP]; Mendonça, Tomás Scalamandré [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. METHODS: Eight patients (five female) were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique). RESULTS: Mean change in alignment was 10 prism diopters after 180 days (n=6). An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. CONCLUSION: In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxinum A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.
- ItemAcesso aberto (Open Access)Comparação entre os métodos de injeção de toxina botulínica em músculo ocular externo com o uso do eletromiógrafo e com o uso da pinça de Mendonça(Conselho Brasileiro de Oftalmologia, 2005-04-01) Mendonça, Tomás Fernando Scalamandré [UNIFESP]; Cronemberger, Monica Fialho [UNIFESP]; Lopes, Márcia Cordeiro Emery [UNIFESP]; Nakanami, Célia Regina [UNIFESP]; Bicas, Harley Edson Amaral; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)PURPOSE: To compare two methods of botulinum toxin A (BTA) injection into the extraocular muscle (EOM): the electromyographically (EMG) guided injection and the injection using Mendonça's forceps. METHODS: Twenty-nine (29) patients with strabismus and low visual acuity in one eye were examined at the Department of Ophthalmology of UNIFESP. They were divided into 2 groups - group I with 17 patients receiving the botulinum toxin A injection using Mendonça's forceps, and group II with 12 patients receiving the toxin with electromyographical guidance. The patients of both groups were examined on the 7th and 14th day after intervention and the outcome of both methods of botulinum toxin A injection were compared. Friedman and Mann-Whitney correlation tests were used in the statistical analysis of the data. RESULTS: Although the follow-up examinations on the 7th and 14th days showed a different behavior between both methods, there was no statistically significant difference between the mean values of the correction attained in both groups at the end of this study. CONCLUSION: 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.
- ItemAcesso aberto (Open Access)Diminuição da função do músculo levantador da pálpebra superior em pacientes submetidos à cirurgia de ptose palpebral involucional e dermatocálase(Conselho Brasileiro de Oftalmologia, 2008-12-01) Forno, Eliana; Moura, Eurípedes Da Mota; Matayoshi, Suzana; Paes, Ângela Tavares; Paranhos Junior, Augusto [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the differences between upper eyelid levator muscle function (UELMF), margin reflex distance (MDR1), and eyelid crease height (ECH) before and after ptosis and dermatochalasis surgery. METHODS: Forty-four patients with blepharoptosis and dermatochalasis were enrolled. Intervention: An exploration of the levator tendon (LT) during a blepharoplasty procedure in patients with blepharoptosis and dermatochalasis and in case of its disinsertion, the tendon was reattached to the tarsus. Measured outcome: The differences between UELMF, MDR1, ECH before and after surgery were evaluated bilaterally. Dependency between both eyes was corrected by generalized estimating equations. Pearson correlation was used to evaluate the dependency of the two eyes regarding UELMF, MDR1 and ECH. RESULTS: There was a statistical significant difference between the measures of UELMF before and after surgery with excursion decreasing by a mean value of 1.1 mm after the procedure (P<0.001). Measures of MDR1 showed an increase by a mean of 1.6 mm and ECH decreased by a mean of 3.97 mm (P<0.001). We found a significant correlation between both eyes for all analyzed eyelid variables, both before and after surgery. Correlation before surgery was stronger for the group without previous surgery. The same results for correlation were found for the amount of disinsertion (P>0.001). CONCLUSIONS: Upper eyelid levator muscle function decreases after ptosis surgery.
- ItemAcesso aberto (Open Access)Recuo assimétrico dos músculos retos horizontais para correção de incomitância alfabética: relato de caso(Conselho Brasileiro de Oftalmologia, 2013-06-01) Corrêa, Alyne Borges [UNIFESP]; Mendonça, Tomás Fernando Scalamandré [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The authors report a case of 21-year-old man with divergent noncomitant strabismus, V pattern anisotropy, right inferior oblique muscle overaction and right superior oblique muscle hypofunction, which was performed under topical anesthesia an asymmetrical recession of the horizontal rectus muscles fibers to correct alphabetical incomitance. The immediate surgical outcome was considered very good (orthotropic, no V or A pattern), since the success was not obtained through conventional surgical technique.
- ItemAcesso aberto (Open Access)Reoperação nas esotropias congênita e essencial adquirida não acomodativa(Conselho Brasileiro de Oftalmologia, 2011-06-01) Ejzenbaum, Fábio [UNIFESP]; Marques, Adele Christina Manso; Ferreira Pinto, Janine Radd; Souza-dias, Carlos Ramos; Goldchmit, Mauro; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade de Ciências Médicas Departamento de OftalmologiaPURPOSE: To analyze the results in patients reoperated from congenital and essential esotropia. METHODS: A retrospective chart review of 393 patients who underwent surgery from 2000-2004 was performed. Subjects were divided into two groups: Congenital esotropia (91patients) and essential esotropia (302 cases). RESULTS: Among congenital cases we had 9 reoperations (9.9%). There were undercorrections (3.3%), overcorrections (2.2%), anisotropia (V) (1.1%), hypotropia (1.1%) and dissociatd vertical divergences (2.2%). Among the essential cases, there were 31 (10.3%) reoperations due to undercorrections (n=6.6%), overcorrections (n=2%) and hypotropias (1.7%). CONCLUSIONS: Outcomes reoperations rates were 9.9% and 10.2% between congenital and essential esotropias with a higher rate of undercorrections. Amblyopia in both groups and deviations higher than 50∆ in essential esotropias seems to be the most important factors for poor results.
- ItemAcesso aberto (Open Access)Toxina botulínica no tratamento de estrabismo horizontal em crianças com paralisia cerebral(Conselho Brasileiro de Oftalmologia, 2006-08-01) Cronemberger, Monica Fialho [UNIFESP]; Mendonça, Tomás Scalamandré [UNIFESP]; Bicas, Harley Edison do Amaral [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)To evaluate the efficacy of botulinum toxin injection in the treatment of horizontal strabismus in children with cerebral palsy. METHODS: A group of 24 patients, age 6 - 156 months, with cerebral palsy and horizontal strabismus (17 esotropias ranging from 25 to 45 PD and 7 exotropias ranging from 20 to 45 PD) were treated with botulinum toxin (34 medial rectus and 14 lateral rectus muscles). The children underwent full ophthalmic examination. The injection treatment was performed after sedation using Mendonça's forceps. The follow-up was done after 7 days, 15 days and monthly. Deviation less or equal of 10 PD after 6 months of follow-up was considered successful. However, if patients did not achieve this result a second application could be performed. RESULTS: In the group of esotropia (n=17) 47.1% had successful results with only one application after two years of follow-up. All of these patients had previous deviation less than or equal to 35 PD. In the exotropia group a single injection was not sufficient to achieve successful result. The side effects included: subconjutival hemorrhage in 4 (16.7%) patients, transient vertical deviation in 4 (16.7%) and transient ptosis in 22 (91.7%). CONCLUSION: The use of botulinum toxin was a good alternative in the treatment of children with cerebral palsy and esotropia.
- ItemAcesso aberto (Open Access)Treatment outcomes in VI nerve palsy corrected by Carlson & Jampolsky technique(Conselho Brasileiro de Oftalmologia, 2007-12-01) Ejzenbaum, Fábio [UNIFESP]; Pinto, Janine Radd Ferreira; Souza-dias, Carlos Ramos; Goldchmit, Mauro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de São Paulo Faculdade de Ciências Médicas Department of OphthalmologyPURPOSE: To study the results of Carlson & Jampolsky technique in 31 patients with VI nerve palsy. METHODS: We had 23 unilateral and 8 bilateral cases. The mean unilateral preoperative esotropia was 56.8 PD ± 24 PD (30 PD to 100 PD) and they had a mean postoperative follow-up of 14 ± 17.9 months (3 to 72). The mean bilateral preoperative esotropia deviation angle in primary position was 74.5 PD ± 20.7 PD (45 PD to 100 PD) and the mean postoperative follow-up was 14.7 ± 15.7 months (4 to 47). RESULTS: In the unilateral group, 18 patients had good results and reoperation was not necessary. Out of 5 patients who were reoperated (2 undercorrections and 3 overcorrections), 2 had to use prismatic glasses. Among the bilateral patients, 2 cases were reoperated (1 undercorrection and 1 overcorrection), and the undercorrected patient remained with esotropia (ET13 PD), and also had to use prismatic glasses. CONCLUSIONS: Carlson & Jampolsky technique was useful to treat patients with VI nerve palsy. We had low reoperation rates and, among the 7 patients who needed a second intervention, only 3 did not achieve good results.