Filipe José Pereira

Fístula liquórica traumática com luxação de globo ocular: relato de caso

This report describes the only case in the literature of globe luxation due to traumatic cerebrospinal fluid fistula to the orbit caused by fire gun with ocular globe maintenance. E.N., female, white, 7 months, admitted with left orbitocranial injury by fire gun. Ocular globe luxation was detected with complete ocular motility restriction and absence of pupillary reflex in the left orbit. Computed tomography showed fracture of the medial orbital wall; bone fragments near the apex of the orbit and a stretched optic nerve. Surgical exploration was performed, showing liquor fistula through the ethmoid-sphenoid wall that was blocked with sponge (Gelfoam®) plus organic glue in the left orbit posterior wall, with immediate resolution of the proptosis and ocular integrity maintenance. Although controversial, maintenance of the ocular globe instead of enucleation was performed due to the integrity of the globe in this case. Despite the blindness, we considered the result to the proposed treatment excellent, once the maintenance of the ocular globe provides a good appearance and will contribute to an adequate facial bone development.

Ophthalmic considerations in the management of Tessier cleft 5/9.

Purpose: To describe a patient with Tessier cleft number 5 and 9 and review the literature on the ocular impairment and management of this extremely rare anomaly. Methods: Interventional case report and literature review. Results: The literature review showed that the present patient is the second case with clefts 5/9. The ophthalmic consequences of this rare association are virtually unreported. Our case demonstrates that the presence of cleft number 9 adds a cicatricial component on the upper eyelid that severely impairs the dynamics of this lid. The corneal status of the patient was successfully managed with simultaneous upper eyelid lengthening and facial reconstruction. Conclusion: In order to avoid corneal perforation, simultaneous upper and lower eyelid reconstruction is mandatory in cases of cleft 5/9. The affected patients should be continuously followed in order to prevent amblyopia.

Congenital ectropion: three case reports and literature review

To report 3 cases of congenital ectropion because of their rarity and confusing classification. Case 1: JPT, 2 days old, male, negro. Left upper eyelid eversion with chemosis was present, passive to mechanic reduction. Compressive occlusion was done with ectropion regression in 48 hours. Case 2: AJL, 6 years old, female, Caucasian, with Down syndrome. The left eye had hyperemia, lagophthalmos and inferior leucoma. She received horizontal shortening (superior and inferior tarsal strip) and skin grafts, and after 2 months the patient did not return. Case 3: GSD, 4 years old, male, Caucasian, with Down syndrome. His signs and treatment were the same as in case 2. According to Picós classification the first case is classified as grade II due to eyelid eversion during the passage through the birth canal, more frequent in black people. Cases 2 and 3 represent grade III that is due to eyelid skin alteration, and the association with Down syndrome is observed. Treatment for ectropion grade III is always surgical, as it was done in these cases. We do not agree with Picós classification, the only one found in medline, because there are no articles confirming the existence of grade I (absent tarsus), grade II should be called congenital upper eyelid eversion, grade IV (microphthalmos and orbital cyst) is a disease of the orbit. Grade III refers to true ectropion, because horizontal enlargement of superior and inferior eyelids (megaloblepharon).

Complications and Management of Polymethylmethacrylate (PMMA) Injections to the Midface.

BACKGROUND Polymethylmethacrylate (PMMA) has been used as an injectable filler to treat hollows and reduce rhytids. PMMA injections have been associated with several side effects, however, the literature is scarce on periorbital complications and their treatments. OBJECTIVES The purpose of this study is to report a series of complications after periorbital PMMA injections to the midface and to describe their management. METHODS Retrospective chart review, including photography and histopathology when available. RESULTS The authors identified 11 cases of complications of PMMA injections to the midface. Patient ages ranged from 36 to 62 years (mean, 47 years; median, 44 years). Two (18%) were males and 9 (82%) were females. Adverse effects began between 2 to 24 months after injection (mean, 7.2 months; median, 6 months). All patients had edema, erythema, and contour irregularity. Seven (64%) patients had nodules, 4 (36%) had yellow, xanthomatous skin changes, and 2 (18%) had eyelid malposition. Histopathology demonstrated a giant cell inflammation in 5 of 6 cases. Corticosteroid injection was tried in 6 cases but was associated with minimal clinical improvement. Surgical debulking of the implanted material was performed in 9 (82%) cases and was effective in improving edema, erythema, and nodularity. CONCLUSIONS PMMA injection to the midface may be associated with chronic inflammation, fibrotic nodules, yellowing of the skin, and eyelid malposition. Intralesional corticosteroid injections yielded minimal or no improvement; surgical debulking achieved favorable results. LEVEL OF EVIDENCE 4: Therapeutic.

Blefaroplastia associada a enxertia de pele autóloga para xantelasmas extensos: relato de caso

Xanthelasma can be treated with acids, laser or primary suture, all presenting frequent relapses besides being inefficacious in extensive cases. The authors present the functional and esthetic result of a female patients case with extensive xanthelasmas on the upper and lower eyelids which were removed combined with upper and lower blepharoplasty, using the skin removed from the upper eyelids to cover the defect in the lower, and vice-versa.

Contour Symmetry of the Upper Eyelid Following Bilateral Conjunctival-Müller’s Muscle Resection

Background Conjunctiva-Müller muscle resection (CMMR) is a simple, effective, and predictable procedure for internal treatment of ptosis. Objectives The authors determined contour symmetry of the upper eyelid following bilateral CMMR. Methods Thirty control participants (ie, without ptosis) and 44 patients with acquired bilateral blepharoptosis who underwent CMMR were evaluated in a prospective study. To assess symmetry of lid contour, distances from midpupil to the upper eyelid (ie, MPLDs) were determined radially at intervals of 15° (total, 180°) along the palpebral fissure, and MPLDs at each angle were compared for right and left eyes. Results For control participants, the mean marginal reflex distance (MRD1; ie, MPLD at 90°) ± standard error (SE) was 4.05 mm ± 0.75 mm, and small contour asymmetries (<10%) were measured for all angles. Medial (9.4% ± 4.7%) and lateral (8.1% ± 4.9 %) asymmetries were not significantly different for these participants. For patients with ptosis, the mean preoperative MRD1 was 2.56 ± 0.1 mm, and mean medial and lateral lid asymmetries (14.3% ± 8.4% and 16.7% ± 9.7%, respectively) were significantly higher than those of controls. Medial and lateral asymmetries correlated significantly with the extent of ptosis and were more pronounced laterally than medially. One month after CMMR, the lateral-medial discrepancy in lid asymmetry was resolved, and mean medial and lateral MPLDs (9.9% ± 7.5% and 8.5% ± 5.3%, respectively) were similar to those of controls. Conclusions For patients with involutional ptosis, CMMR enables elevation of the lid margin and correction of contour anomalies.

Acesso posterior para implante de peso de ouro

PURPOSE To demonstrate an innovative technique of gold weight implantation through a posterior approach and evaluate its effectiveness and possible complications. The results will be compared to the other existing technique through anterior approach which has been unchanged for a long time, according to the literature. METHODS A prospective study (sequence of cases) was undertaken with patients who presented paralytic lagophthalmos for over 6 months. These patients presented many different etiologies and were assisted at the Department of Ophthalmology of Governador Celso Ramos Hospital-SC from February 2006 to February 2007. The implantation through posterior approach was performed by only 2 surgeons. RESULTS Thirteen patients with paralytic lagophthalmos, 9 men and 4 women, with an average age of 53.07 (range from 17 to 73) were submitted to a gold weight implantation through posterior approach. The follow-up period of those patients varied from 2 months to 1 year, with an average of 6.3 months. In 3 of the patients, the implanted weight caused asymmetry to the margin-reflex distance (MRD) on the primary look position with ptosis of 2 mm in 2 patients and 4 mm in 1 patient. CONCLUSIONS Although such technique has shown a satisfactory result, the authors believe that it is essential to extend the follow-up a little longer, so that the sustainability of its efficacy can be proved.