Eurípedes da Mota Moura

Aspectos psicológicos em usuários de prótese ocular

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.

Chronic dacryocystitis in American mucocutaneous leishmaniasis.

Purpose This study describes lacrimal tract involvement and surgical outcome in patients with mucocutaneous leishmaniasis. Methods Four patients, ages 20 to 75 years, had nasal lesions resulting from mucocutaneous leishmaniasis and sought treatment for chronic dacryocystitis. Each patient had had lacrimal symptoms since childhood or early adulthood, concomitantly with the development of upper airway lesions. Dacryocystography showed nasolacrimal duct stenosis in all cases on the affected side. Three patients underwent dacryocystorhinostomy (one bilaterally), and one patient had bilateral dacryocystectomy. Results Two patients had surgical fistula closure soon after surgery. A sequential endoscopic operation for remotion of a synechia between the fistula and the middle turbinate was successful in one of these patients. Histopathologic analysis of lacrimal sacs and nasal mucous membranes close to the anastomotic site revealed chronic nonspecific inflammatory process and negative immunohistochemistry for Leishmania. Conclusions Dacryocystitis may result from nasal mucocutaneous leishmaniasis. The surgical outcome was unsatisfactory in one of the four patients.

Dacryocystectomy: indications and results

BACKGROUND After the advent of dacryocystorhinostomy (DCR), dacryocystectomy (DCT) was regarded as mutilant surgery and reserved for lacrimal sac tumors. PURPOSE To present current indications for dacryocystectomy. METHODS Eighteen eyes from 11 patients subjected to DCT were reviewed retrospectively. Nine patients had chronic dacryocystitis confirmed by dacryocystography and two patients had lacrimal sac tumors. RESULTS The indications for DCT were: three patients with systemic medical problems, three patients with dry eye, two cases of lacrimal sac tumors, two cases of traumatic dacryocystitis and one case of cutaneous leishmaniasis. Dacryocystitis was resolved in 17 of 18 eyes; the two cases of tumor evolved without epiphora. One patient (traumatic dacryocystitis) had recurrence of dacryocystitis. CONCLUSIONS DCT is mainly performed when a lacrimal sac tumor is suspected but, since it avoids the intra- and postoperative complications related to dacryocystorhinostomy, it can be indicated in cases of dacryocystitis with significant lacrimal discharge and an enlarged or altered lacrimal sac.

Intraorbital polyacrylamide gel injection for the treatment of anophthalmic enophthalmos

Purpose: To evaluate the use of orbital polyacrylamide gel injection for the correction of anophthalmic enophthalmos. Methods: Noncontrolled clinical trial of 21 patients (14 with ocular implants, 5 with phthisis bulbi, and 2 with dermis-fat graft). Orbital CT was performed to estimate the volume of polyacrylamide gel needed to restore orbital volume. Polyacrylamide gel was injected using a 22-gauge (30 × 0.7 mm) needle transcutaneously inserted in the lateral third of the lower eyelid, directed to the orbital muscle cone. A second injection was administered 15 days later, if necessary. CT was repeated 30 days after the last procedure. Exophthalmometry was performed before and 90 days after the procedure. Results: The mean total volume injected per orbit was 2.4 ± 0.7 ml (range, 1–3.5 ml). The volume of the enophthalmic orbit increased from 26.9 ± 5.0 ml to 29.3 ± 4.9 ml (p < 0.001). The mean difference in exophthalmometry readings was 3.3 ± 1.6 mm (range, 1.5–8.0 mm) before the procedure and 1.0 ± 0.9 mm (range, 0.0–3.0 mm) after 3 months (p < 0.001). Adjustment of the ocular prosthesis or fabrication of a new one was necessary in 11 patients (52.4%), and the mean volume of the ocular prosthesis was reduced from 2.0 ± 0.6 ml to 1.6 ± 0.6 ml (p = 0.003). All patients were satisfied with the aesthetic results. No serious adverse events were observed. The initial results were maintained 1 year after the procedure. Conclusions: Polyacrylamide gel injection in the orbital space effectively reduces enophthalmos in ocular prosthesis wearers.

Síndrome de Down e alterações de vias lacrimais

PURPOSE: To identify the alterations of the lacrimal system in patients with Down syndrome. METHODS: A descriptive and retrospective survey covering eleven eyes in eight patients, diagnosed as Down syndrome, attended in the period from 1995 to 2001. RESULTS: All patients had chronic dacryocystitis with obstruction of the nasolacrimal duct. One patient also presented canaliculitis by Streptococcus sp and congenital absence of the lower lacrimal punctum was observed in another patient. Five patients were submitted to dacryocystorhinostomy, probing and intubation was performed in three patients. The complaints of epiphora were solved in four eyes. CONCLUSIONS: There are few accounts about lacrimal system disorders in patients with Down syndrome. The identification and surgical resolution of lacrimal obstruction is important, since it interferes with the quality of life of these patients. In the present study, it was verified that the lacrimal obstruction occurred in the nasolacrimal duct, like that which occurs in adults. The surgical prognosis was bad in 83.4% of intubations and in 57.2% of dacryocystorhinostomies. The reasons for the unsuccessful surgery may be related to a greater postoperative fibrosis in these patients, and the difficulty of obtaining their collaboration after surgery. Further studies are necessary to support the present observation.

Dacriocistorrinostomia transnasal vídeo-endoscópica com Nd: YAG laser e diodo laser

PURPOSE: To evaluate the technique of dacryocysthorrinosthomy for the treatment of nasolacrimal duct obstruction, by transnasal endoscopic video-assisted approach with Nd:YAG laser and diode laser. METHODS: Fifty one surgeries dacryocysthorrinostomy transnasal endoscopic video assisted were performed in 42 patients, 36 females, 6 males, aged between 3 and 92 years, mean age 52.3 years, in the period of April 1997 to February 2003. RESULT: The surgery successfully relieved lacrimal duct obstruction in 92.15% of the patients. CONCLUSION: The technique was efficient for the treatment of nasolacrimal obstruction. In all patients bicanalicular silicone stents were inserted at the time of surgery and removed after six to eight weeks. There is no difference in the results between Nd:YAG and diode laser. The postoperative period in all cases was comfortable and there was no hemorrhage.

Enxerto de mucosa do palato duro: complicações na área doadora - Relato de casos

The graft of hard palate mucosa is a satisfactory substitute for posterior eyelid lamella (tarsus and conjunctiva) in eyelid reconstruction. The advantages of hard palate over other graft materials are: its mucosal surface, minimal contraction during healing, and easiness of harvesting. We present two palatal donor site complications and we discuss the probable pathophysiology of these complications.

Diminuição da função do músculo levantador da pálpebra superior em pacientes submetidos à cirurgia de ptose palpebral involucional e dermatocálase

OBJETIVO: Avaliar a diferenca da funcao do musculo levantador da palpebra superior (FMLPS), distância margem reflexo (DMR1) e altura do sulco palpebral (AS) antes e depois da cirurgia de blefaroplastia superior associada a correcao de ptose palpebral. METODOS: Quarenta e quatro pacientes com blefaroptose e dermatocalase foram incluidos. Intervencao: exploracao do tendao do musculo levantador da palpebra superior (MLPS) durante a blefaroplastia, em portadores de blefaroptose e dermatocalase. Nos casos de desinsercao, o tendao foi refixado ao tarso. Desfechos analisados: foram analisados de forma bilateral a diferenca entre FMLPS, DMR1 e AS antes e depois da intervencao. A dependencia entre os olhos foi corrigida por meio de equacoes de estimativa generalizada. Foi utilizada a correlacao de Pearson para quantificar a dependencia entre os olhos para FMLPS, DMR1 e AS. RESULTADOS: Houve diferenca significante entre as medidas de FMLPS antes e depois da cirurgia, havendo reducao da excursao do MLPS apos a cirurgia, diminuindo, em media, 1,1 mm (P 0,01). CONCLUSAO: A funcao do musculo levantador da palpebra superior diminui apos a cirurgia para a correcao da ptose.

Comparative analysis between sclera treated with glycerin and sclera treated with gamma irradiation, alkali and glycerin in the reconstruction of anophthalmic socket: experimental study in rabbits

PURPOSE To compare two sclera decontamination methods: treatment with glycerin versus treatment with gamma irradiation, alkali and glycerin, aiming to detect the clinical and histological alterations in rabbit anophthalmic sockets reconstructed with sclera-involved polymethylmethacrylate spheres. METHODS Thirty-nine New Zealand-breed rabbits were divided into two groups: group I, whose animals were submitted to enucleation of one eye and reconstruction with a polymethylmethacrylate sphere involved in glycerin-treated sclera; group II, where there was enucleation, and reconstruction performed with a polymethylmethacrylate sphere involved in sclera treated with gamma irradiation, alkali and glycerin. The two groups were observed at four moments, at 7, 21, 42 and 84 days after surgery. Preset times elapsed, the rabbits were euthanized, sockets were exenterated, the material was processed for embedment in paraffin, cut into 5 microm sections thick and stained with hematoxylin-eosin and Massons trichrome techniques. The scleras were submitted to morphometric and semiquantitative analysis. Results were compared by Mann-Whitneys non-parametric test. RESULTS Comparative analysis of vascularization of the surgical interface pointed out a significative difference in the evaluation done 21 days after the implant (P<0.001), with group II showing greater neovascularization. Comparison of the fibrous capsule thickness displayed a significative difference at moments corresponding to 21 days (P<0.001) and 42 days (P<0.001). At both moments, group II presented a thicker fibrous capsule than group I. Likewise, there was variation in sclera thickness, being thicker in group II, at the 21-day post-implant (P=0.003) moment, and at the 42-day moment (P=0.024), as well. Along the experimental period, when groups were analyzed we could observe statistically significative diminution of vascularization in the surgical interface, in group I, as well as in group II, at the moment of 7, 21, 42 and 84 days. CONCLUSION When used as coating on the polymethylmethacrylate implant for the reconstruction of rabbit anophthalmic socket, the sclera treated with gamma irradiation, alkali and glycerin reacted similarly to the traditionally used glycerin-treated sclera. The two treatments induced a similar inflammatory response. The formation of neovessels, thickness of fibrous capsule and of sclera developed differently in the two groups. Nevertheless, they presented similar results at the end of the 84-day observation period. There was no significant difference between the two groups, with regard to sclera preservation.

Triquíase pós blefaropigmentação: relato de caso

Blepharopigmentation is a procedure used to create a permanent eyeliner to replace the daily application of cosmetic lash line enhancement. Few studies show ocular and lid complications of blepharopigmentation. The present paper describes 3 cases of trichiasis related to this procedure. The authors discuss the probable pathophysiology and comment the treatment of the cases.