Guilherme Herzog Neto

Eye disease related to onchocerciasis: A clinical study in the Aratha-ú, Yanomami Tribe, Roraima State, Brazil

The prevalence of ocular lesions due to onchocerciasis was evaluated among residents of the Yanomami Tribe, in the northern Amazon, Brazil, an endemic area for onchocerciasis. 83 natives were submitted to an ocular examination including an external examination, biomicroscopy, intraocular pressure measurement, and a fundus examination. Clinical, parasitological and serological tests were carried out simultaneously. The population demonstrated a high prevalence of eosinophilia, skin microfilaria (55%) and onchocercal subcutaneous nodules (35%). A high prevalence of probable onchocerciasis related eye lesions was detected. Punctate keratitis (41%) and microfilaria in the anterior chamber (39%) were found as well as other probable onchocercotic lesions-chorioretinitis (7.2%) and anterior uveitis (6.0%). Other anterior eye lesions (corneal leucomas, conjunctival injection, lid nodules) occurred in 51% of the individuals. The anterior eye lesions were more prevalent than the posterior lesions. We did not find an association of glaucoma with onchocerciasis. The prevalence of these suggestive ocular lesions strongly correlates with the cutaneous nodules and eosinophilia, suggesting that skin nodules may be an indication for an eye examination. The present study provides evidence that significant infection and eye disease due to onchocerciasis persists in certain regions of Northern South America.

The effect of horizontal strabismus surgery on the vertical palpebral fissure width

PURPOSE To compare vertical lid fissure width before and after medial or lateral rectus muscle recessions for horizontal strabismus. METHODS In this prospective, noninterventional case series, vertical eyelid fissure width measurements were compared before and after treatment in consecutive patients undergoing extraocular muscle recessions for esotropia or exotropia. Digital imaging analysis was used to measure vertical lid fissure width. Each measurement was an average of three separate images. RESULTS A total of 59 subjects were enrolled, including 42 for esotropia and 17 for exotropia. Mean postoperative vertical palpebral fissure width increased by 0.96 mm (11.9%; range, 0.64-2.5 mm) in esotropia patients and 1.00 mm (11.8%; range, 0.19-3.23 mm) in exotropia patients (P < 0.0001 in both groups.) CONCLUSIONS Recession of a rectus muscle for comitant horizontal strabismus may result in vertical widening of the palpebral fissure.

Bilateral lid/brow elevation procedure for severe ptosis in Kearns-Sayre syndrome, a mitochondrial cytopathy

Background The purpose of this work was to determine the effectiveness and possible complications encountered with bilateral fascia lata lid suspension used to correct blepharoptosis in patients with Kearns-Sayre syndrome. Methods This was a retrospective study of seven patients with Kearns-Sayre syndrome who had a minimum of 1 year of follow-up. A bilateral fascia lata sling was used to correct the ptosis. Preoperative and postoperative measurements of the vertical lid fissure width (VFW) and marginal reflex distance (MRD) were performed. The Student’s t-test was used to analyze the results. Results The mean preoperative VFW and MRD measurements were 4±2.45 mm and 0.14±0.92 mm, respectively. The mean postoperative VFW and MRD measurements were 7.71±1.85 mm, and 2.86±1.69 mm, respectively. All preoperative and postoperative values were considered to be statistically significant (P<0.01). Adequate elevation of the lids was obtained in all patients, both functionally and aesthetically. All of the patients showed a mild symmetric postoperative inferior version lagophthalmos, and one patient developed corneal ulceration and scarring due to corneal exposure and a weak Bell’s phenomenon. Conclusion The surgical technique described to correct the blepharoptosis found in patients with Kearns-Sayre syndrome was found to be efficient and relatively safe. The correction should be conservative to decrease the risk of postoperative corneal damage that occurred in one patient.

Reconstrução palpebral com retalho de Fricke: relato de dois casos

O câncer de pele e o tumor mais comum na especie humana, sendo o carcinoma basocelular o de maior prevalencia. Este trabalho relata dois casos recentes deste tipo de tumor, envolvendo tanto a palpebra superior quanto a inferior em duas mulheres. O primeiro caso e de uma mulher de 72 anos de idade, amaurotica do olho direito, com comprometimento de aproximadamente 80% da palpebra superior esquerda, 70% da palpebra inferior esquerda e comprometimento da parede lateral da orbita, comprovado pela tomografia computadorizada. O exame anatomopatologico da peca cirurgica revelou a presenca de carcinoma basocelular invasivo, com margens livres. Foi feita reconstrucao imediata com retalho de Fricke. O segundo caso e de senhora de 68 anos de idade, com historia previa de trauma na regiao periorbitaria esquerda, apresentando edema e hiperemia palpebral, com aspecto brilhante, com perda dos cilios e pequena ulceracao central, envolvendo aproximadamente 90% da palpebra superior e 65% da palpebra inferior esquerda, com comprometimento da parede lateral da orbita evidenciado na tomografia. O exame anatomopatologico da peca cirurgica revelou a presenca de carcinoma basocelular invasivo, com margens livres. Foi optado pela reconstrucao imediata com retalho de Fricke. Os autores acreditam que apesar deste tipo de retalho nao ser a primeira escolha na maioria das reconstrucoes palpebrais, nao deveria ser negligenciado, pois em certos casos, tornar-se-ia a unica opcao viavel.

Comparative electrophysiological responses in anisometropic and strabismic amblyopic children

Purpose To compare anisometropic hypermetropic amblyopic and strabismic amblyopic responses to pattern electroretinogram (PERG) and pattern visual evocated potential (PVEP). Materials and methods Fifty-six patients – 18 hypermetropic anisometropic amblyopic children (mean age 9.70±2.5 years), 19 strabismic amblyopic children (mean age 10.30±2.6 years) and 19 normal emetropic subjects (mean age 10.10±2.2 years) – were enrolled in this study. After routine ophthalmic examination, PERG and PVEP were recorded in response to checks reversed at the rate of two reversals/second stimulating macular area. Results The difference between hypermetropic anisometropic amblyopia and strabismus amblyopia with respect to P100/P50/N95 wave latencies (P=0.055/0.855/0.132) and P100/P50/N95 amplitudes (P=0.980/0.095/0.045) was not statistically significant. However, there was a significant statistical difference between strabismic amblyopia group and controls for P100/P50/N95 latencies (P=0.000/0.006/0.004). Conclusion Our findings indicated that despite clinical differences between anisometropic amblyopic and strabismic amblyopic patients, no differences were found in the responses of PVEP and PERG. The abnormal components of the PVEP and PERG in amblyopic subjects could reflect a retinal dysfunction in the visual pathway.

Fila cirúrgica digital como instrumento auxiliar de gestão hospitalar: Sugestões de adequações propostas por um serviço universitário de oftalmologia

Objetivo: Avaliar, atraves de busca na internet, quais os servicos publicos com atendimento oftalmologico no Brasil que possuem um pacote digital composto de pagina da instituicao na rede digital, prontuario eletronico, sistema de regulacao de atendimento e fila de espera cirurgica digital. Enfatizar a presenca destes elementos de pesquisa com a condicao de funcionamento de fila de espera cirurgica digital com possibilidade de consulta publica pelo paciente usuario. Metodos: Estudo transversal atraves de busca na internet de servicos de oftalmologia com este pacote digital completo ou parcial em carater nacional. Os dados foram pesquisados na internet no periodo de junho a julho de 2015. As instituicoes foram divididas em grupos de pesquisa, assim designados: hospitais multidisciplinares universitarios, hospitais multidisciplinares assistenciais, hospitais uni-disciplinares assistenciais (somente oftalmologia) e banco de olhos (como entidade de atendimento publico). Duas variaveis foram avaliadas: numero total e parcial de servicos publicos de oftalmologia que possuem este sistema digital e como foi desenvolvido este pacote digital por cada instituicao. Os dados foram avaliados atraves do teste Qui quadrado e prova exata de Fisher. O nivel de significância do estudo foi 0,05. Resultados: Foram encontradas 48 instituicoes publicas oftalmologicas detentoras deste pacote digital, sendo: 24 universitarias, 15 assistenciais, 3 hospitalares uni-disciplinares (somente oftalmologia), 6 bancos de olhos. Somente 10,4 % destas instituicoes apresentaram uma fila de espera cirurgica digital. Exclusivamente os bancos de olhos obtiveram dados significativos quanto a presenca de fila cirurgica digital, bem como a origem de seu desenvolvimento. Conclusao: Apenas algumas instituicoes apresentaram um pacote digital completo, porem a fila de espera cirurgica digital e o componente mais raro destas instituicoes. Razoes desta constatacao sao explanadas pelo estudo. Embora com pequena representacao, em todo territorio nacional somente dois bancos de olhos apresentaram fila cirurgica digital com possibilidade de consulta publica.

Enoftalmia causada por uso tópico unilateral de Bimatoprost

O autor descreve o caso de uma paciente que apresenta o olho direito com o sulco palpebral profundo e enoftalmia deste lado, tratado durante uma decada com Bimatoprost topica. Concluem que os achados clinicos sao provavelmente efeitos colaterais do medicamento.