Tânia Pereira Nunes

Implante de peso de ouro: complicações precoces e tardias

PURPOSE To evaluate the indications, the results and the complications seen in the patients submitted to gold weight implantation to correct paralytic lagophthalmos. METHODS Charts of 20 patients with lagophthalmos secondary to facial nerve palsy of diverse etiologies, which were submitted to gold weight implantation in the upper eyelid of the affected side, were retrospectively examined. RESULTS The most frequent cause of paralytic lagophthalmos was acoustic neurinoma after surgery (40%). Early and late complications occurred in 40% of the implants. Four patients (20%) presented a local inflammatory reaction in the first 3 months after surgery. Two patients (10%) presented skin and orbicular muscle thinness over the gold weight 4 and 7 years after the implant, respectively. One patient (5%) presented gold weight displacement after 3 years and another patient (5%) had late gold weight extrusion after 10 years. CONCLUSIONS In this series, the complication rate of gold weight implantation was high (40%). The complications were divided into early, possibly related to the material impurity and the late, due to the evolution of the facial nerve palsy that presented a decrease in muscle tonus.

Ação do colírio de fenilefrina 10% no posicionamento palpebral de indivíduos normais

OBJETIVOS: Determinar a acao de uma gota do colirio de fenilefrina 10% sobre as palpebras superior e inferior de individuos normais; verificar a ocorrencia de alteracoes no posicionamento das palpebras superior e inferior do olho contralateral, apos instilacao desta medicacao. METODOS: Estudo prospectivo observacional, do qual participaram 24 individuos normais, com idade entre 20 e 39 anos, submetidos a instilacao de uma gota do colirio de fenilefrina 10% no fundo de saco conjuntival superior, aleatoriamente em um dos olhos. Todos os individuos foram filmados antes e apos a instilacao do colirio (3, 10, 15, 30, 45 e 60 minutos). As imagens foram submetidas ao processamento digital e editadas para analise das medidas palpebrais. Foi tracada uma linha horizontal do canto medial ate o canto externo. Considerou-se a altura da palpebra superior a distância entre o ponto mais alto da margem palpebral superior e a linha horizontal tracada. A altura palpebral inferior foi avaliada como a distância entre o ponto mais baixo da margem palpebral inferior e a referida linha. RESULTADOS: Em relacao a palpebra superior, a medida antes da instilacao da fenilefrina 10% diferiu significativamente dos demais momentos (p<0,001) com elevacao media da palpebra superior de 0,79 mm e retracao de 0,37 mm na altura palpebral inferior. Em relacao ao olho contralateral, observou-se queda da palpebra superior em praticamente todos os momentos estudados, com o menor nivel aos 3 minutos (queda media de 0,68 mm). A palpebra inferior contralateral mostrou elevacao media de 0,37 mm. CONCLUSOES: A instilacao de uma gota do colirio de fenilefrina 10% em olhos de individuos normais altera a posicao da palpebra superior do olho testado, assim como a da palpebra inferior. O posicionamento da palpebra superior e inferior do olho contralateral tambem se alteram.

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.

Inflamação idiopática da órbita com extensão extra-orbital: relato de caso

The authors report a case of a patient with idiopathic orbital inflammation with extension beyond the orbit. Biopsy was performed to confirm the diagnosis of idiopathic orbital inflammation and computed tomography demonstrated the extraorbital extension. Treatment with methotrexate and radiotherapy was used.

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.

Avaliação dos resultados cirúrgicos com a técnica da ressecção do músculo de Müller-conjuntiva no tratamento da blefaroptose

OBJETIVE: To evaluate the results of Mullers muscle-conjunctival resection for correction of blepharoptosis and to discuss the advantages of this procedure. METHODS: 38 patients (39 eyelids) were submitted to Mullers muscle-conjunctival resection. Blepharoptosis varied from 1.0 mm to 3.0 mm (mean: 2.0 mm). The amount of eyelid elevation produced by phenylephrine guided the amount of tissue to be resected. RESULT: 33 eyelids (85%) treated with this procedure were cosmetically acceptable. CONCLUSIONS: Mullers muscle-conjunctival resection procedure is a relatively simple technique for blepharoptosis, with good levator function and positive 10% phenylephrine test. The advantages are: preservation of tarsus and predictable results.

Uso da fáscia temporal na suspensão frontal: descrição da técnica cirúrgica - Relato de caso

PURPOSE: To familiarize the ophthalmologist with the anatomy of the temporal region, to describe the surgical technique of temporal fascia harvest and frontalis suspension and to demonstrate advantages and disadvantages of temporal fascia in frontalis suspension. METHODS: Review of the clinical and surgical data of one case with severe blepharoptosis who underwent frontalis suspension using temporal fascia. Review of the anatomy of the temporal fossa and the surgical techniques. RESULTS: Good esthetic and functional results were obtained in this case. CONCLUSION: Temporal fascia is a good choice for frontalis suspension with some advantages: it is autogenous, it is easily harvested and it yields minimal post-operative morbidity.

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.

Microftalmia com cisto colobomatoso orbitário: relato de casos

Microphthalmos with colobomatous orbital cyst is a rare differential diagnosis of congenital orbital tumors. Early diagnosis and adequate treatment are important for orbital and eyelid growth. We present three cases of microphthalmos with colobomatous orbital cyst and demonstrate the importance of imaging techniques. Ultrasonography, computed tomography, magnetic resonance and histological study of the ablated mass established the correct diagnosis of colobomatous cyst.

Dacriocistite crônica secundária a sarcoidose: relato de caso

A case of chronic dacryocistitis secondary to sarcoidosis is described. Review of the clinical pathological findings and surgical technique used to treat the patient. Dacryocystorhinostomy with silicone intubation on the left side was performed. Biopsy specimens of lacrimal sac mucosa showed a histological findings compatible with sarcoidosis, an uncommon diagnosis.