Blefarospasmo essencial e espasmo hemifacial: Características dos pacientes, tratamento com toxina botulínica A e revisão da literatura

Purpose: To evaluate the characteristics of the essential blepharospasm and hemifacial spasm patients and the feasible treatment with botulinum toxin. A. Methods: Thirty-four essential blepharospasm or hemifacial spasm patients were evaluated according to gender, ocular complaint, time of disease, treatment outcome and complications. Results: Age median was 63 years and the mean was 61 years, with no difference regarding sex; 66.66% of the patients had hemifacial spasm and 33.33%, essential blepharospasm. Many patients complained of dry eye associated with involuntary spasm. Botulinum toxin A showed a positive outcome in 91.30% of the treated patients and complications observed after treatment were eyelid ptosis (8.33%) and buccal angle deviation (8.33%). Conclusion: Essential blepharospasm and hemifacial spasm occurred in the elderly, of both sexes. Treatment with botulinum toxin A was useful, with very low complication rates.

Formulário do perfil psicossocial do paciente anoftálmico com indicação de prótese ocular

The patient with anophthalmia may present feelings of inferiority and rejection. Knowing his/her needs and expectations contribute to a better technical intervention. Purpose: To elaborate a questionnaire of the psychosocial profile of the patient with anophthalmia with indication of ocular prosthesis. Methods: An exploratory research was used to elaborate the questionnaire, by means of a guided interview followed by writing down what was said by the interviewees, who were adult patients of the Bucco-Maxillo-Facial Prosthesis Center of FOSJC - UNESP. The guided interview was made up of 14 items directly related to the future outline of the profile. Each item of the interview resulted in questions of the questionnaire, which was pretested twice before reaching its final version. Results: The patients reported, in the exploratory research, unpleasant feelings with the loss of the eye; relationship shyness; expectations regarding surgery and prosthesis use; a wish to receive explanations and to hold their opinion about the treatment. The questionnaire of the psychosocial profile of the patient with anophthalmia with indication of ocular prosthesis is, therefore, made of 43 questions divided into 5 blocks in order to aid the comprehension of the inquired aspects and to facilitate both the computation of data and discussion, and also to improve the selection of questions according to the objective of the researcher or professional. Conclusions: It was concluded that the questionnaire was viable, can be used in full or by selecting blocks and provide a panorama of the patient's history related to the problem he/she faces, from the loss of the ocular globe to the confection of the prosthesis.

Efeito da mitomicina c no epitélio ciliar estudo experimental em coelhos com microscopia eletrônica de varredura e de transmissão

Purpose: To evaluate and correlate in the rabbit the possible changes caused by mitomycin C under the scleral flap in the ciliary epithelium with transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Methods: The eyes of 32 albino rabbits were studied and divided in 4 experimental groups. The right eye (RE) was intended for the experimental groups and the left eye (LE) for the controls. Group I (G1) was formed by 8 eyes that received 0,5 mg/ml of mitomycin C under the scleral flap and were examined after 15 days. Group II (G2) differed from G1 only in the time of the exam, after 30 days. Group III (G3) was formed by 8 eyes that received 0,2 mg/ml of mitomycin C under the scleral flap and were examined after 15 days. Group IV (G4) differed from group 3 just in the time of the exam, after 30 days. In each eye the internal ciliary epithelium were examined with TEM. Results: The following changes in the internal ciliary epithelium were observed in groups G2, G3, and G4 with TEM: discontinuous and irregular basement membrane, more irregular and electron-dense nucleous, enlargement among interdigitation, edematous mitochondria and myelin figures. These alterations were not found in all the animals of the groups. Group G 1 did not present alterations. Roughness in groups G 1, G2, G3 and G4 were observed with SEM. In groups G 1 and G2 continuity solutions were also observed. Conclusion: Mitomycin C in 0,2 mg/ml and 0,5 mg/ml concentrations caused changes in the internal ciliary epithelium 15 and 30 days after, with TEM and SEM. There was no correlation between dosage, time and with TEM and SEM.

Melanoma de coróide: Relato de caso insuspeito

The choroidal melanoma is the most frequent intraocular tumor in elderly, occurring mainly in the 60th. This paper shows a misdiagnosis tumor affecting a female aging 36 years-old, misdiagnosed and initially treated as a toxoplasmic uveitis. The tumor had orbit and neck metastasis. The authors call attention to the necessity of early diagnosis to improve the outcome.

Prevalência de tracoma cicatricial em Botucatu - Estado de São Paulo

Purpose: To evaluate the prevalence of cicatricial trachoma in a population-based sample at Botucatu city-Sao Paulo State, Brazil. Methods: A population-based cross-sectional study with randomized clustered sampling of households was conducted in the urban area of the city of Botucatu, São Paulo State, Brazil. The sample was estimated in 3000 person having been appraised 2554 patient (85,1% of the intended sample) from which 2339 had more than 10 year old at the research time. All the participants were submitted to ophthalmologic examination and the data were statistical analyzed. Results: Three cicatricial trachoma carriers were detected. So, the prevalence of this affection is Botucatu city is 0,13%, affecting mainly over 40'th and having trichiasis. Conclusion: Nevertheless the low prevalence rate of cicatricial trachoma in our region, to prevent trachoma blindness is the cicatrical form of the disease is very important to treat the trichiasis.

Ectrópio palpebral: Características e relação com alterações óculo-palpebrais

Objective: To evaluate the gender and the characteristics of the ectropion carriers in our region. Methods: A retrospective study was done evolving 112 ectropion carriers. The sex, race, eyelashes alterations (trichiasis and distichiasis), anterior and posterior blepharitis, conjunctival redness, íris color and pterygium presence were evaluated. Gender data were correlated to ectropion classification (involutional, cicatricial, mechanic or paralytic) and submitted to statiscal analysis. Results: The eyelid ectropion occurred more between 71 and 80 years old.The involutional ectropion was the most frequently observed (66,07%), followed by the cicatricial, mechanic, associated types and paralytic. The majority of the patients were male (70,53%), with White skin. Trichiasis (21,42%) and distichiasis (4,46%) were associated to the ectropion eyelid and mainly in the involutional ectropion carriers. Half of the sample had blepharitis and the majority of the patients had red eye (60%) and brown iris (63,39%). Perygium was absent in the majority of the patients. Conclusion: The involutional ectropium is the most frequently observed in our region, mainly in elderly, male, White skin, brown iris and associated to trichiasis, blepharitis and red eyes.

Causas de ambliopia e resultados do tratamento

Objective: to evaluate the causes and the results of occlusion amblyopia treatment. Methods: a retrospective study was done including children under 12 years old. Sex, age of starting treatment, etiology, ocular deviation affection, visual acuity and time for the occlusion treatment were evaluated. Results: 158 children had all the requirements to compose the sample. 50.6% were males. 70.2% had esotropia, 13.2% exotropia, 0.7% hypertropia and 4.4% presented horizontal and vertical strabismus. 11.4% had no ocular deviation. 6.6% presented anisometropia, 0.7% congenital cataract and 6.6% other diagnoses. Visual acuity improved in 85.5%, faster in the ortophoric children. The occlusion treatment time was long in all the deviation types. Conclusion: the treatment was beneficial in improving amblyopia in the majority of the children evaluated.

Exposição de culturas de fibroblastos de pterígios primários e recidivados à mitomicina c e ao 5-fluorouracil

Purpose: To evaluate the proliferation of the fibroblasts from primary and recurrent pterygium in culture of cells, after the exposure to mitomycin C and to 5-fluorouracil. Methods: Cultures of fibroblasts from primary and recurrent pterygiuns had been carried through. The cells of the third passage were exposed to mitomycin C 0.4% during 3 minutes and to 5-fluorouracil 25mg/ml that was kept in the nutritional medium. After 3, 6, 12 and 18 days of the exposure, cell countings were made in hemocytometer, in triplicate, with a control not treated with the drugs for each day. The data were submitted to statistical analysis.Results: Mitomicyn C had homogeneous behavior in the primary and recurrent groups, which inhibited the cellular proliferation since the first counting day. However, with 5-fluorouracil, the proliferation inhibition was verified only after the third day of evaluation (in the second counting day) in the recurrent group, and since the first counting day in the primary group. At the end of the experimental period, 5-fluorouracil and mitomycin C were equally efficient in the inhibition of the fibroblasts from primary and recurrent pterygium proliferation. In the controls not exposed, the cell's numbers were increasing during the experimental time.Conclusion: Mitomycin and 5-fluorouracil are equally able to inhibit fibroblasts proliferation from primary and recurrent pterygium Tenon's capsule in cell culture.

Comportamento do implante contendo bone morphogenetic protein (bmp) associado ao plasma rico em plaquetas na reparação de fraturas orbitárias

Purpose: This study intends to evaluate BMP (Bone Morphogenetic Protein) implant and BMP implant plus PRP (Platelet Rich Plasma) in rabbit orbital fractures, searching for tissue reaction, by radiological and morfometrical analysis. Methods:Third six white rabbits were submitted to orbital floor fracture and distributed in three groups: G1, with rabbits receiving a plate containing decalcified bone matrix and BMP; G2, with rabbits receiving the implant with BMP wrapped by PRP; G3, the control group where it was made the fracture only. The animals were evaluated radiologically after surgery and at sacrifice time in 7, 30, 90 and 180th day after surgery. After sacrifice, a block containing the right orbital tissue was extracted and prepared to morphological and morphometrical analysis. Results: An intensive linfomononuclear inflammatory reaction was observed at 7th day in G1 e G2, witch decreased after the 30th day; mesenchimal cells, osteoblasts, new bone and progressive cavitation of the implant were also observed, besides signs of calcium deposition by radiological study. In the control group fibrosis at the site of fracture was identified only. Conclusion: BMP seemed a good orbital implant producing new bone at the implant site and correcting bone defect.There was not observed acceleration of osteoinduction when the implant was associated with PRP.

Anoftalmia congênita clínica - alterações oculares e sistêmicas associadas

Purpose: To describe alterations observed in patients with congenital clinical anophthalmia and the occurrence of association with other ocular and extra ocular abnormalities. Methods: An observational retrospective study was conducted evaluating 12 patients with congenital clinical anophthalmia at Faculdade de Medicina de Botucatu-UNESP, between 1992 and 2005. In those patients it was observed the ocular abnormalities, severity, laterality, follow-up and to systemic abnormalities associated. The congenital clinical anophthalmia have been associated to major severity abnormalities extra-oculars, mainly when the anophthalmia was bilateral, such agenesis of corpus callosum, others craniofacial anomalies and cardiac defects. In the cases unilateral, the alteration associated more frequently was the facial asymmetry, showing the direct correlation between anophthalmos and development of orbit and face. Conclusion: There was relation between congenital clinical anophthalmia and ocular abnormally and extra-ocular abnormally. Patients with bilateral anophthalmos disease have more severe alterations. anophthalmia congenital attends a course with abnormalities of development of the face.

Conhecimento de estudantes de medicina sobre o processo de doacção de córneas

Purpose: To compare knowledge of medical students about the cornea donation process among those who already studied Ophthalmology and the others. Methods: A questionnaire containing data as: age, sex, graduation year, and 10 multiple-choice questions about the subject was applied to medical students from the interior of São Paulo state, Brazil. The questions were: age for donation, contraindication for transplants, the time limit to remove the cornea, among others. The knowledge regarding cornea donation was compared between the two groups: students who already studied Ophthalmology (Group A) and the others (Group B). Results: The study group was composed of 402 students, of whom 140 were of group A and 262 of group B. Knowledge between the two groups was different, but not statistically significant (p=0.8328). Conclusion: Knowledge about the cornea donation process among the interviewed seemed to be insufficient, even those who had studied Ophthalmology. Information and education about transplants in Medical Schools should be improved.

Ectrópio palpebral em portador da síndrome de Down e conjuntivite alérgica: Relato de caso

This is a case report of a patient with Down's syndrome with an important mechanical ectropion and elongation of the lower lid related to chronic allergic conjunctivitis, besides cataract and keratoconus. The tarsal strip technique and ressection of redundant and thick conjunctiva was the surgical approach chosen for this case. Functional and cosmetic outcomes were considered satisfactory.

Extrusão dos implantes em portadores de cavidade anoftálmica

Purpose: To evaluate the characteristics of patients with anophthalmic cavity who developed sphere extrusion. Methods: A retrospective observational study was done evaluating 37 patients with anophthalmic cavity and sphere extrusion at the Faculdade de Medicina de Botucatu-UNESP. Results: Extrusion was observed in enucleated and eviscerated cavities. The majority of the patients had the eye removed because of phthisis bulbi or trauma and the extrusion happened 1 or 2 years after the surgery. Extrusion was preceded by conjunctival dehiscence and exposure of the sphere and occurred with all used implants. Conclusion: Complications after orbital implant placement are a possibility. Dehiscence and sphere extrusion may happen and another surgery would be necessary. The patient and the ophthalmologist have to be prepared for this.

Utilização do AutoCAD 2004 para quantificação de pesquisas usando fotomicrografias eletrônicas

Objective: To determine if the AutoCAD 2004 program is available to be used in quantitative research on electron microscopy. Methods: A demonstrative of the AutoCAD2004 was done in an experimental model of diabetes induced in rats. The animals were divided by lot in control group animals (GC-10 animals) and diabetic group (GD - 10 animals), evaluated 1 month after the diabetes induction.The eyes were removed after sacrifice and prepared to electron microscopy. The retina was photographed and the AutoCAD2004 program was used to measure the basal membrane of retina vessels. The results were submitted to statistical analysis. Results:The AutoCAD2004 was effective to obtain quantitative measures from the basal membrane of retina vessels and there were no difference between the studied groups. Conclusion: The AutoCAD2004 was effective, safe and easy to apply to quantify biological parameters, which allowed suggest it to quantitative research.