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- ItemAcesso aberto (Open Access)Astigmatismo induzido na cirurgia extracapsular da catarata: acompanhamento a longo prazo(Conselho Brasileiro de Oftalmologia, 2004-02-01) Ghiaroni, Almir [UNIFESP]; Moreira, José Belmiro de Castro [UNIFESP]; Universidade Federal do Rio de Janeiro; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To study the long-term behavior of induced astigmatism in a series of patients who underwent extracapsular extraction in which a superoposterior limbal incision sutured with interrupted 10-0 mononylon sutures was performed. METHODS: 38 eyes of 35 patients were studied, 21 females and 17 males, with ages varying from 47 to 85 year (average = 70.17 year). All cases were operated by the same surgeon. The postoperative follow-up ranged from 15 to 33 months (average = 22.07 months). None of the cases had any of the sutures sectioned or removed. All patients recovered a corrected visual acuity equal or superior to 0.5. To calculate the induced astigmatism in each case, the preoperative and postoperative keratometric readings were considered and a program developed by Jaffe was used. RESULTS: The induced astigmatism ranged from 0.13 diopters (D) to 2.74D (average = 1.19D). Regarding the axis, there was induction of with-the-rule astigmatism in the majority of cases (60.52%). A significant shift in the dioptric power of the induced astigmatism was observed when the preoperative keratometric readings were compared with the keratometric readings recorded at the second postoperative week, between the first and the third postoperative months, between the third and the sixth postoperative months and after the twelfth postoperative month. CONCLUSION: When mononylon 10-0 is used as suture material in extracapsular extraction, the initially observed values of with-the-rule induced astigmatism tend to decrease during the post operative period.
- 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)Avaliação da ceratoplastia lamelar anterior profunda em pacientes com ceratocone(Conselho Brasileiro de Oftalmologia, 2009-08-01) Macedo, Jarbas Pereira de [UNIFESP]; Forseto, Adriana dos Santos [UNIFESP]; Allemann, Norma [UNIFESP]; Sousa, Luciene Barbosa de; Universidade Federal de São Paulo (UNIFESP); Eye Clinic Day Hospital; Hospital Oftalmológico de SorocabaPURPOSE: To evaluate the efficacy, complications and confocal microscopy corneal features of deep anterior lamellar keratoplasty using the air dissection technique in keratoconus. METHODS: Seventeen eyes with advanced keratoconus were submitted to this technique. Postoperative visual acuity and complication rate were analyzed. The thicknesses of full cornea tissue, host bed and donor button were measured, donor-host interface was also evaluated using confocal microscopy. RESULTS: Best-spectacle corrected visual acuity was 0.5 or better in 50% of the eyes. Complications occurred in five of seventeen patients (29.41%). Confocal microscopy demonstrated in four eyes the presence of hiperreflective structures at the interface, suggesting deposits and striae. Average corneal pachymetry, donor button and host bed thicknesses were respectively 609.00 ± 77.55 µm, 516.55 ± 43.65 µm and 92.50 ± 60.10 µm. CONCLUSIONS: Although technically challenging with the risk of intraoperative Descemet's membrane perforation, deep anterior lamellar keratoplasty with air dissection technique presents as an option for keratoconus treatment. Confocal microscopy demonstrated to be a useful method not only for the pachymetry measurement but also for the evaluation of interface by observing the absence of opacities in most of the cases.
- ItemAcesso aberto (Open Access)Catarata congênita: aspectos diagnósticos, clínicos e cirúrgicos em pacientes submetidos a lensectomia(Conselho Brasileiro de Oftalmologia, 2004-12-01) Oliveira, Márcia Lima Santos [UNIFESP]; Di Giovanni, Maria Elizabeth [UNIFESP]; Porfírio Neto Jr, Francisco [UNIFESP]; Tartarella, Marcia Beatriz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To analyze the clinical and therapeutic profiles of children with congenital cataract submitted to lensectomy. METHODS: Retrospective study of 89 eyes of 62 children who underwent surgery at the Congenital Cataract Sector - Department of Ophthalmology - Federal University of São Paulo, Brazil. RESULTS: Among the 62 children, 30.64% showed infectious causes, 19.36% genetic causes and 50% idiopathic causes. Strabismus was found in 54.83% of the patients and 27.42% had systemic diseases. Concerning pregnancy conditions, 22.58% of the mothers had no adequate prenatal care. Consanguinity was observed in 17.74% of the cases and congenital cataracts in 6 (9.68%) relatives. The diagnostic suspicion was of the mothers in 72.58% of children. Leukocoria was the main feature. The suspicion age varied from immediately after birth to 15 months (mean = 1.34 months). Age on diagnosis in the department varied from 8 days to 20 months (mean = 5.84 months). Secondary opacification in the visual axis was the most frequent postoperative complication; it occurred in 19.11% of 89 eyes. It was observed that 45.16% of the patients had difficulties in following postoperative treatment. They did not use eyeglasses, eye drops or correct eye patching for amblyopia. CONCLUSION: Rubeola is still one of the most important causes of congenital cataract in our country. This condition shows the necessity of better prevention. The first diagnostic suspicion is mainly by the mothers and within the three first months of age in most children, but there is a considerable delay between suspicion and the patient's presence in a specialized service center. Despite satisfactory surgery results, delay of surgery and difficulties in postoperative treatment impair final visual results.
- ItemAcesso aberto (Open Access)Complicações intra e pós-operatória da dacriocistorrinostomia externa(Sociedade Brasileira de Oftalmologia, 2011-12-01) Lorena, Silvia Helena Tavares [UNIFESP]; Silva, João Amaro Ferrari [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: The research project goal is to determine the incidence of complications during the external dacryocystorhinostomy and post surgery done by the author, in São Paulo Hospital, from april 10th , 2009 to january 15th, 2010. METHODS: This is a retrospective study of the records of the patients submitted to external dacryocystorhinostomy in São Paulo Hospital, from april 10th 2009 to january 15th, 2010.The patient were submitted to the ophtahalmologic evaluation: Ocular inspection, biomicroscopiy, Milder Test, Test of Jones I and II and dacryocystograph exam. It is important point out, that the included patients in this study, the patients were examined by the author of this work. RESULTS: This study was verified that out of 15 external dacryocystorhinostomy done, the complications were: bleeding (46,66%), oddment loss of the nasal mucosa (26,66%,utilização) of the hammer in the osteotomy (6,66%).The pos-operatory complications: cutaneous fistula (6,66%), hypertrophic (6,66%). Among the 15 surgeries there was only 1 failure corresponding to the 6,66%. The average time of surgery follow-up was of 4 months. CONCLUSION: The external dacryocystorhinostomy offers great results,according this study.
- ItemAcesso aberto (Open Access)Dacriocistite aguda: relato de 2 casos(Sociedade Brasileira de Oftalmologia, 2011-02-01) Lorena, Silvia Helena Tavares [UNIFESP]; Silva, João Amaro Ferrari [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The adult lacrimal obstruction can be congenital or acquired. In the case of the acquired form, the etiology classifies in not-specific (it involves the coating epithelium and/or the vascular plexus submucosae of the lacrimal duct) and specific (infections, inflammations, tumours and iatrogenies). The diagnosis is established by means of the anamnesis and clinical evaluation based on semiology of the lacrimal sack. The patients with lacrimal obstruction present epiphora, acute pains and swelling, mostly in the region of the lacrimal sack causing ectasye of various degrees whichn culminate with cutaneous fistulization. The image exams routinely proposed for dacryocysto-graphy, which represent a great help in showing the best surgical technique for dacryocystorhinostomy, will be indicated as soon as the acute inflammatory state is treated.
- ItemAcesso aberto (Open Access)Novel use of trypan blue in ocular surface staining: redefining implications for this vital dye(Sociedade Brasileira de Oftalmologia, 2011-12-01) Ambrósio Junior, Renato [UNIFESP]; Ahmad, Habeeb; Caldas, Diogo; Canedo, Ana Laura Caiado; Valbon, Bruno; Guerra, Frederico Procopio; Lima Filho, Acácio Alves de Souza [UNIFESP]; Instituto de Olhos Renato Ambrósio; Corneal Tomography and Biomechanics Study Group; Doheny Eye Institute; Price Vision Group; Universidade Federal de São Paulo (UNIFESP)Different applications of trypan blue (TB) for intraocular surgery have been reported, with very high levels of safety and efficacy. We describe the use of TB as an alternative vital dye for staining the ocular surface to assess the integrity of superficial cell layers of the cornea and the surface environment. This facilitates the diagnosis of various ocular surface disorders, including screening for dry eye disease (DED) among refractive and cataract patients. TB staining properties are different from fluorescein and both are stable in a solution, so that a double staining technique is introduced.
- ItemAcesso aberto (Open Access)Persistent fetal vasculature: ocular features, management of cataract and outcomes(Conselho Brasileiro de Oftalmologia, 2013-06-01) Tartarella, Marcia Beatriz [UNIFESP]; Takahagi, Rodrigo Ueno [UNIFESP]; Braga, Ana Paula [UNIFESP]; Fortes Filho, João Borges [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio Grande do Sul School of Medicine Department of OphthalmologyPURPOSES: To describe ocular features, management of cataract and functional outcomes in patients with persistent fetal vasculature. METHODS: Retrospective, descriptive case series of patients with persistent fetal vasculature. Data were recorded from the Congenital Cataract Section of Federal University of São Paulo, Brazil from 2001 to 2012. All patients were evaluated for sex, age at diagnosis, systemic findings, laterality, age at surgery, and initial and final follow-up visual acuities. Follow-up and complications after cataract surgery were recorded. Ultrasound was performed in all cases and ocular eco-Doppler was performed in most. RESULTS: The study comprised 53 eyes from 46 patients. Age at diagnosis ranged from 5 days of life to 10 years-old (mean 22.7 months). Twenty-seven patients were male (58.7%). Persistent fetal vasculature was bilateral in 7 patients (15.2%). Forty-two eyes (79.2%) had combined (anterior and posterior forms) PFV presentation, 5 eyes (9.4%) had only anterior persistent fetal vasculature presentation and 6 eyes (11.3%) had posterior persistent fetal vasculature presentation. Thirty-eight eyes (71.7%) were submitted to cataract surgery. Lensectomy combined with anterior vitrectomy was performed in 18 eyes (47.4%). Phacoaspiration with intraocular lens implantation was performed in 15 eyes (39.5%), and without lens implantation in 5 eyes (13.2%). Mean follow-up after surgery was 44 months. Postoperative complications were posterior synechiae (3 cases), retinal detachment (2 cases), phthisis (3 cases), posterior capsular opacification (8 cases), inflammatory pupillary membrane (5 cases), glaucoma (4 cases), intraocular lens implantation displacement (1 case) and vitreous hemorrhage (2 cases). Complications were identified in 19 (50%) of the 38 operated eyes. Visual acuity improved after cataract surgery in 83% of the eyes. CONCLUSIONS: Patients with persistent fetal vasculature have variable clinical presentation. There is an association of persistent fetal vasculature with congenital cataract. Severe complications are related to cataract surgery in patients with persistent fetal vasculature, but 83% of the operated eyes improved visual acuity.
- 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)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.