Roberto Sebastiá

Treatment of paralytic lagophthalmos with gold weight implants covered by levator aponeurosis.

Purpose: To describe a technique to treat paralytic lagophthalmos and exposure keratitis with gold weight implants covered by levator aponeurosis. Methods: The authors studied a case series of 29 patients who underwent surgical treatment for paralytic lagophthalmos using the technique of gold weight implantation covered by the aponeurosis of the levator palpebrae superioris muscle between June 1997 and December 2006. None had undergone previous surgical treatment. Results: All patients sustained their implants; there were no cases of extrusion, dislocation, or infection. Patients had significant improvement of symptoms, especially exposure keratopathy, with lagophthalmos dimensions decreased from 4 to 5 mm preoperatively to 0.5 mm after surgery. Conclusions: Excellent results were obtained by recessing the levator palpebrae superioris muscle aponeurosis with relaxing incisions and advancing it to overly the gold weight implant completely. Visibility of the implant in the pretarsal upper eyelid surface was minimized, extrusion was avoided, and good eyelid position was obtained.

Immunohistochemical detection of Hsp90 and Ki-67 in pterygium

BackgroundTo examine the immunohistochemical expression of heat shock protein 90 (Hsp90) and Ki-67 protein in human pterygium.Materials and methodsTissues obtained during pterygium surgery of 15 patients who underwent the bare-sclera procedure and 10 normal conjunctivae were studied. All of these pterygia were primary ones. Recurrent pterygia were excluded. Normal bulbar conjunctivas (2 x 2 mm) were obtained from the nasal region close to the limbus from patients during their cataract and retina surgeries. Immunohistochemical detection of Hsp90 and Ki67 was done using the streptavidin–biotin method in paraffin embedded tissue sections.ResultsThe percentage of cells stained for Hsp90 was greater for pterygium epithelium (76 ± 10.8) than for normal conjunctiva (1.4 ± 0.8). In each pterigyum sample more than 60% of cells were positive. The differences in positive cells between normal and pterigyum epithelium were highly significant for Hsp90 (P < 0,001).Pterygium epithelium also showed a higher percentage of cells that stained for Ki67 (10.1 ± 9.5) than for normal conjunctiva (2.1 ± 1.9). The differences in positive cells were also statistically significant for Ki67 (P < 0.01). Although there were significant differences in the majority of samples observed. It was noted that in some samples there was no difference between normal and pterygium epithelium for Ki67.ConclusionOur results indicate an abnormal expression of Hsp90 and ki-67 in pterygium samples when compared to normal conjunctiva.The finding of abnormal expression of levels of Hsp90 in pterygium samples can stimulate new research into pterygium and its recurrence.Virtual SlidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1128478792898812

Two-stage reconstruction for eyelid deformities in partial cryptophthalmos.

Purpose: Cryptophthalmos was first described in 1872 as a rare syndrome consisting of congenital upper eyelid and eyebrow coloboma and a rudimentary ocular bulb. Later, Fraser described it as being part of a complex syndrome with multiple anomalies. Many cases have been described since then, but very few surgical techniques have been proposed for its correction. In this paper, the authors present a surgical procedure for correction of the upper eyelid and ocular bulb anomalies in cryptophthalmos. Methods: Five patients with Fraser syndrome were seen from 1993 to 2008. They were in the age group of 18 months to 24 years. Of these, 4 patients underwent reconstruction of the upper eyelid. Results: The large upper eyelid coloboma and the cutaneous pterygium were treated with a 2-stage procedure, with good results obtained with the adoption of Mustardés technique. Conclusions: The complexity of the surgical treatment increases when there is no possibility of rudimentary eye bulb preservation. In upper eyelid reconstruction, the authors adopted Mustardés technique with fixation of the lower eyelid transposed flap to the levator muscle, leading this way to relatively good upper eyelid motility. The authors consider imperative that the upper fornix be reconstructed with adequate depth to allow perfect positioning of an aesthetic prosthesis, in this way improving the final aesthetic and functional results.

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.

Tratamento do lagoftalmo paralítico com a utilização do implante de peso de ouro recoberto pela aponeurose do músculo levantador palpebral

POURPOSE: To demonstrate an improvement in paralytic lagophthalmos surgical treatment complications and aesthetic results by covering the gold weight implants with the levator palpebrae muscle aponeurosis. METHODS:We studied a case series of twenty nine patients presenting idiopatic facial palsy with more than 4 years of clinical evolution, submitted to paralytic lagophthalmos surgical treatment using a modification of the technique of gold weight implantation covered by the aponeurosis of the levator palpebrae superioris muscle (Gladstone, 1996) between June 1997 and December 2006. None had undergone previous surgical treatment. RESULTS:All patients sustained their implants. There were no cases of extrusion, dislocation or infection, with clinical symptoms improvement and lagophthalmos reduction. CONCLUSION:By widely dissecting the levator palpebrae superioris muscle aponeurosis, exceeding it and recovering the implant completely, we obtained excellent results. The pretarsal upper eyelid surface became regular, extrusion was avoided and, comparatively to Gladstones technique that performs an aponeurotic plication over the gold weight implant, we managed to obtain a better adjustment of the superior eyelid final positioning after implant coverage.

Manifestações órbito-palpebrais da neurofibromatose tipo 1: revisão de 16 casos

OBJETIVO: Caracterizar os achados orbito-palpebrais na neurofibromatose tipo 1 e relatar a abordagem cirurgica realizada. METODOS: Foram estudados retrospectivamente os pacientes portadores de NF1 com envolvimento orbito-palpebral atendidos no Ambulatorio de Cirurgia Plastica Ocular do Departamento de Oftalmologia da Universidade Federal Fluminense e 38a Enfermaria da Santa Casa de Misericordia do Rio de Janeiro. RESULTADOS: Dos 16 pacientes estudados, 12 apresentavam neurofibromas orbito-palpebrais, 3 apresentavam glioma do nervo optico e 3 algum tipo de displasia ossea levando a exoftalmia ou enoftalmia. Dez pacientes foram submetidos a algum tipo de cirurgia plastica reconstrutora. CONCLUSAO: Os achados clinicos encontrados estao de acordo com o descrito na literatura, tratando-se de doenca com expressividade variavel. Geralmente os pacientes necessitam ser submetidos a multiplas cirurgias.