Carlos Alberto Rodrigues Alves

Surgical treatment of endocrine exophthalmos by removal of orbital fat: clinical experience

PURPOSE To report a series of 73 patients with endocrine exophthalmos treated by removal of orbital fat using the transpalpebral approach during the period 1989 to 1999. METHODS The operation was performed according to the technique described by Olivari. Aesthetic analysis was done preoperatively and postoperatively (more than 6 months after surgery). The number of complications was also observed. RESULTS The average volume of resected fat was approximately 7.6 mL per orbit. No major complication was observed. In 9 patients with epiphora, all improved. One patient developed postoperative diplopia and 5 complained of temporary diplopia. Appearance improved in 62 patients (85%). CONCLUSION Surgical removal of orbital fat associated with endocrine exophthalmos provides consistent improvement in appearance with a low rate of complications. Additional procedures may be indicated to improve the cosmetic outcome.

Eficácia da técnica de sutura ajustável per-operatória simplificada para a correção de desvios horizontais: estudo prospectivo de 49 pacientes

PURPOSE: To evaluate the efficacy of a simplified intraoperative adjustable suture technique, under general anesthesia (GA) proposed by the authors. METHODS: A prospective study of 49 patients with horizontal strabismus, 22 esotropes and 27 exotropes. The same surgeon (MP) operated on all of the patients. The corneal light reflection was measured in millimeters (mm) from the limbus preoperatively and under GA: the esotropes from the temporal border and the exotropes from the nasal border. The adjustment was made or not based on these two measures if there was or not a difference between them. The authors calculated the adjustment on the measures in mm, not converting them in to prism diopters (PD) or taking the pupil as a reference point. RESULTS: 28 patients (57.1%) had the eye position modified under GA. In 25 of all of them (51.0%) surgery was adjusted. Surgical success was defined as orthotropia, eso- or exodeviation up to 10 PD, in a follow-up period of at least 6 months. The overall success rate was 75.6%. CONCLUSION: Results suggested this simplified procedure is effective. As an adjustable technique can conduct to more predictable outcomes, and being a simplified technique it can be employed in more cases, specially because it can be carried out by surgeons not used to the adjustable suture techniques.

Metodologia inédita para medida da torção ocular reflexa

Purpose: To develop a methodology to evaluate ocular torsion reflex. Methods: Modifications of a Helmholtz keratometer were made in order to perform keratometry in the primary position and during head tilt (30 degrees to the right, 30 degrees to the left). A total of 16 patients (32 eyes) were examined. There was a mean astigmatism of 0.50 to 3.50 (mean 1.18 ± 0.61). Results: The mean recorded intortions (right eye 5.31 ± 4.23, left eye 5.22 ± 3.91) were slightly lower than the extortions (right eye 7.84 ± 4.79, left eye 7.78 ± 4.09) with no significant difference between both eyes. Conclusions: The modified Helmholtz keratometer allows new and simple method to quantify ocular counterrolling.