Fractured Orbital Wall Reconstruction With an Auricular Cartilage Graft or Absorbable Polyacid Copolymer

Objective: The objective of the study was to compare the functional and aesthetic results of fractured orbital wall reconstruction with an auricular cartilage graft or absorbable polyacid copolymer. Materials and Methods: Twenty patients with blow-out orbital fracture/orbital floor associated or not with the medial wall were assessed by the same craniofacial surgical group. All were evaluated preoperatively and postoperatively by an ophthalmologist for diplopia, enophthalmos, exophthalmos, sensitivity, ophthalmic reflexes, intraocular pressure, and visual field. The patients were subjected to a preoperative facial multislice computed tomographic scan, repeated 6 months after surgery. Eight patients underwent reconstruction with an auricular cartilage graft, and 12 patients, with blade absorbable polyacid copolymer. Subtarsal access was used for all patients. Results: Two patients showed temporary ectropion, 1 in each group. All patients presented satisfactory ocular function, and all tests revealed good orbital delineation, orbital symmetry, periorbital sinus individualization, and reduction of blow-out. Conclusions: The blow-out orbital wall reconstruction can be performed with the use of an auricular cartilage or with a blade absorbable copolymer without differences regarding functional or aesthetic complications and sequelae.

Periorbital changes associated with topical bimatoprost

Purpose: To describe periorbital changes induced by chronic topical therapy with daily bimatoprost 0.03% (Lumigan, Allergan Inc., Irvine, CA, U.S.A.). Methods: A clinical investigation of 5 nonconsecutive patients with unilateral glaucoma treated daily with topical bimatoprost 0.03% for up to 4 years prior to presentation. Results: In eyes treated with bimatoprost 0.03% the authors noted periorbital fat atrophy, deepening of the upper eyelid sulcus, relative enophthalmos, loss of the lower eyelid fullness, and involution of dermatochalasis compared with the fellow untreated eye. By inspecting old photographs the authors confirmed that these unilateral changes were not present prior to starting bimatoprost. In addition, these changes were partially reversible after discontinuation of the medication, whenever that was possible. In 2 cases imaging studies confirmed the clinical impression that these findings were not related to primary orbital pathology. Conclusions: Physicians and patients should be aware of the potential of bimatoprost 0.03% to produce periorbital changes.

Intravitreal triamcinolone versus bevacizumab for treatment of refractory diabetic macular oedema (IBEME study)

Background/aims: The aim of this study was to compare the morphological and visual acuity outcomes associated with a single intravitreal injection of triamcinolone acetonide versus bevacizumab for the treatment of refractory diffuse diabetic macular oedema. Methods: Twenty-eight patients were randomly assigned to receive a single intravitreal injection of either 4 mg/0.1 ml triamcinolone acetonide or 1.5 mg/0.06 ml bevacizumab. Comprehensive ophthalmic evaluation was performed at baseline and at weeks 1, 4, 8 (+/- 1), 12 (+/- 2) and 24 (+/- 2) after treatment. Main outcome measures included central macular thickness measured with optical coherence tomography (OCT) and best corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity. Results: Twenty-six patients (26 eyes) completed all study visits (two patients missed two consecutive study visits). Central macular thickness was significantly reduced in the intravitreal triamcinolone group compared with the bevacizumab group at weeks 4, 8, 12 and 24 (p<0.05). Logarithm of the minimum angle of resolution (LogMAR) best-corrected visual acuity was significantly higher at weeks 8 (0.69; similar to 20/100(+1)) and 12 (0.74; 20/100(-2)) in the intravitreal triamcinolone group compared with the bevacizumab group (weeks 8 (0.83; similar to 20/125(-1)) and 12 (0.86; 20/ 160(+2))) (p<0.05). Significant change from baseline in mean intraocular pressure (mmHg) was seen at week 4 (+2.25) only in the intravitreal triamcinolone group (p<0.0001). No patient had observed cataract progression during the study. Conclusions: One single intravitreal injection of triamcinolone may offer certain advantages over bevacizumab in the short-term management of refractory diabetic macular oedema, specifically with regard to changes in central macular thickness. The actual clinical relevance of our preliminary findings, however, remains to be determined in future larger studies.

Ultrasonographic aspects and biometry of Striped owl`s eyes (Rhinoptynx clamator)

Objective To report the biometric values and ultrasonographic aspects of the normal eye of the Striped owl (Rhinoptynx clamator). Sample population Twenty-seven healthy, free-living, adult Striped owls from the Ecological Park of Tiete Veterinary Ambulatory (Sao Paulo, Brazil). Procedures Both eyes of all owls underwent B-mode ultrasonographic examination and biometry was performed for lens axial length (WL), depth of the anterior (AC) and vitreous (VC) chambers, axial length of the globe (LB) and the pecten oculi (LP) of both eyes, using a 12 MHz probe. The owls were manually restrained without sedation and the eyes were topically anesthetized. Results Biometric and statistical findings were as follows: in the left eye, the means and standard deviations were: LB = 23.76 +/- 0.92 mm, WL = 7.79 +/- 0.27 mm, AC = 4.27 +/- 0.47 mm, VC = 11.36 +/- 0.29 mm and LP = 5.69 +/- 0.50 mm; in the right eye, the values were: LB = 24.25 +/- 0.79 mm, WL = 8.03 +/- 0.40 mm, AC = 4.56 +/- 0.52 mm, VC = 11.40 +/- 0.25 mm, and LP = 5.68 +/- 0.41 mm. No significant differences were found between left and right eyes measurements of LB, WL, AC, VC, and LP dimensions. Conclusions Ocular ultrasound aspects and biometric values of the Striped owl are reported. The study`s results provide means for various ocular measurements. The ultrasound is an easy and safe exam to be performed in the Striped owl`s eyes.

Hypertrophy and neuron loss: structural changes in sheep SCG induced by unilateral sympathectomy

Recently, superior cervical ganglionectomy has been performed to investigate a variety of scientific topics from regulation of intraocular pressure to suppression of lingual tumour growth. Despite these recent advances in our understanding of the functional mechanisms underlying superior cervical ganglion (SCG) growth and development after surgical ablation, there still exists a need for information concerning the quantitative nature of the relationships between the removed SCG and its remaining contralateral ganglion and between the remaining SCG and its modified innervation territory. To this end, using design-based stereological methods, we have investigated the structural changes induced by unilateral ganglionectomy in sheep at three distinct timepoints (2, 7 and 12 weeks) after surgery. The effects of time, and lateral (left-right) differences, were examined by two-way analyses of variance and paired t-tests. Following removal of the left SCG, the main findings were: (i) the remaining right SCG was bigger at shorter survival times, i.e. 74% at 2 weeks, 55% at 7 weeks and no increase by 12 weeks, (ii) by 7 weeks after surgery, the right SCG contained fewer neurons (no decrease at 2 weeks, 6% fewer by 7 weeks and 17% fewer by 12 weeks) and (iii) by 7 weeks, right SCG neurons were also larger and the magnitude of this increase grew substantially with time (no rise at 2 weeks, 77% by 7 weeks and 215% by 12 weeks). Interaction effects between time and ganglionectomy-induced changes were significant for SCG volume and mean perikaryal volume. These findings show that unilateral superior cervical ganglionectomy has profound effects on the contralateral ganglion. For future investigations, it would be interesting to examine the interaction between SCGs and their innervation targets after ganglionectomy. Is the ganglionectomy-induced imbalance between the sizes of innervation territories the milieu in which morphoquantitative changes, particularly changes in perikaryal volume and neuron number, occur? Mechanistically, how would those changes arise? Are there any grounds for believing in a ganglionectomy-triggered SCG cross-innervation and neuroplasticity? (C) 2011 ISDN. Published by Elsevier Ltd. All rights reserved.

PRECLINICAL INVESTIGATION OF THE RETINAL BIOCOMPATIBILITY OF SIX NOVEL VITAL DYES FOR CHROMOVITRECTOMY

Purpose: To investigate the retinal biocompatibility of six novel vital dyes for chromovitrectomy. Methods: An amount of 0.05 mL of 0.5% and 0.05% light green (LG), fast green (FG), Evans blue (EB), brilliant blue (BriB), bromophenol blue (BroB), or indigo carmine (IC) was injected intravitreally in the right eye, whereas in the left eye balanced salt solution was applied for control in rabbits` eyes. Clinical examination, fluorescein angiography, histology with light microscopy, and transmission electron microscopy were performed after 1 and 7 days. Retinal cell layers were evaluated for morphologic alterations and number of cells. The electroretinographic changes were assessed at baseline, 24 hours and 7 days. Results: Fluorescein angiography disclosed hypofluorescent spots only in the 0.5% EB group. Light microscopy and transmission electron microscopy disclosed slight focal morphologic changes in eyes exposed to 0.05% IC, FG, BriB, similar to the control at 1 and 7 days. In the lower dose groups, EB, LG, and BroB caused substantial retinal alterations by light microscopy. At the higher dose, BroB and EB produced diffuse cellular edema and vacuolization within the ganglion cells, bipolar cells, and photoreceptors. FG and IC at 0.5% caused slight retinal alterations similar to balanced salt solution injection. LG at 0.5% caused diffuse vacuolization of bipolar cells after 1 and 7 days. Injection of 0.5% EB caused a significant decrease in neuroretinal cell counts in comparison to control eyes in the 7-day examination (P < 0.05). Electroretinography revealed intermittent prolonged latency and decreased amplitude in eyes injected with 0.5% EB, LG, BriB, and BroB, while at the lower dose, only LG and EB induced few functional changes. Conclusion: The progressive order of retinal biocompatibility, from safest to most toxic, was IC, FG, BriB, BroB, LG, EB.

The visual ecology of avian photoreceptors

The spectral sensitivities of avian retinal photoreceptors are examined with respect to microspectrophotometric measurements of single cells, spectrophotometric measurements of extracted or in vitro regenerated visual pigments, and molecular genetic analyses of visual pigment opsin protein sequences. Bird species from diverse orders are compared in relation to their evolution, their habitats and the multiplicity of visual tasks they must perform. Birds have five different types of visual pigment and seven different types of photo receptor-rods, double (uneven twin) cones and four types of single cone. The spectral locations of the wavelengths of maximum absorbance (lambda (max)) of the different visual pigments, and the spectral transmittance characteristics of the intraocular spectral filters (cone oil droplets) that also determine photoreceptor spectral sensitivity, vary according to both habitat and phylogenetic relatedness. The primary influence on avian retinal design appears to be the range of wavelengths available for vision, regardless of whether that range is determined by the spectral distribution of the natural illumination or the spectral transmittance of the ocular media (cornea, aqueous humour, lens, vitreous humour). Nevertheless, other variations in spectral sensitivity exist that reflect the variability and complexity of avian visual ecology. (C) 2001 Elsevier Science Ltd. All rights reserved.

Combined effect of cyclosporine and sirolimus on improving the longevity of recombinant adenovirus-mediated transgene expression in the retina

Objectives: To reevaluate the longevity and intraocular safety of recombinant adenovirus (rAd)-mediated gene delivery after subretinal injection, and to prolong transgene expression through the combination of 2 synergistic immunosuppressants. Methods: An rAd vector carrying green fluorescent protein (GFP) gene was delivered subretinally in the rat eye. The GFP expression was monitored in real time by fundus fluorescent photography. Intraocular safety was examined by observation of changes of retinal pigmentation, cell infiltration in virus-contacted area, immunophenotyping for CD4(+) and CD8(+) cytotoxic T lymphocytes, and CD68(+) macrophages, histologic findings, and dark-adapted electroretinography. Two synergistic immunosuppressants, cyclosporine and sirolimus, were used alone or in combination to prolong transgene expression by temporary immunosuppression. Results: The GFP expression peaked on day 4, dramatically decreased on day 10, and was not detectable on day 14. The decreased GFP expression was coincident with cell infiltration in virus-contacted area. Immunostaining showed that the infiltrating cells were CD4(+) and CD8(+) cytotoxic T lymphocytes and CD68(+) macrophages. Clumped retinal pigmentation and decreased b wave of dark-adapted electroretinogram were observed at 3 to 4 weeks after injection. Histologic examination confirmed rAd-induced retinal degeneration. Transient immunosuppression by cyclosporine and sirolimus, either alone or in combination, improved transgene expression, with the combination being the most efficient. The combined immunosuppression attenuated but did not retard the rAd-induced retinal damage. Conclusions: Transgene expression mediated by rAd after subretinal delivery is short-term and toxic to the retina. Combination of cyclosporine and sirolimus may act as an immunosuppressive adjunct to prolong rAd-mediated gene transfer. Clinical Relevance: The intraocular safety of rAd should be carefully considered before clinical trials are performed.

Corticosteroid-induced glaucoma in a child after a scleral reinforcement procedure

Corticoteroid-induced glaucoma can result from either topical or systemic corticosteroid use. Compared with adults, the corticosteroid response in children is less well known. The case is reported of a child who developed glaucoma after receiving topical corticosteroids following a scleral re-inforcement procedure. The raised intraocular pressure was controlled after cessation of the corticosteroids and with the use of antiglaucoma therapy. As many forms of cortico-steroids are widely used, children on corticosteroids should have regular intraocular pressure measurements as part of their management.

Evaluation of polymethylmethacrylate as ocular implant in rabbits subjected to evisceration

Spheres of different types of material are used for the replacement of lost volume after removal of the eye bulb or its content to prevent contraction of the orbital cavity. The aim of this study was to evaluate the scope of polymethylmethacrylate (PMMA) used as intraocular implant in eviscerated rabbit eye. Twelve New Zealand rabbits underwent unilateral evisceration of the left eye, with subsequent implantation of PMMA sphere 12 mm in diameter. Clinical evaluation was performed daily during the first 15 days after surgery and every 15 days until the end of the study period (180 days). For the histopathological analysis, three animals per trial underwent enucleation at 15, 45, 90 and 180 days after evisceration. There was no wound dehiscence, signs of infection or implant extrusion in any animal throughout the study period. Histological examination revealed the formation of fibrovascular tissue around the implants. The PMMA behaved as inert and non-integrable.

Avaliação da tonopaquimetria como exame de rastreio de glaucoma primário de ângulo aberto

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Estudo comparativo entre o tonómetro de aplanação de Goldmann e o tonómetro de não contacto em pacientes com glaucoma primário de ângulo aberto

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

A implementação de prototerapia no contexto da radioterapia em Portugal

Mestrado em Radioterapia - Área de especialização: Dosimetria Clínica

O perfil dos pacientes observados no gabinete de rastreio da consulta de oftalmologia de um hospital central

No gabinete de rastreio de uma consulta de oftalmologia, realiza-se o primeiro contacto com o paciente e efectuam-se exames com o propósito de recolher indicadores e dados para a abordagem médica e facilitadores da consulta. Objectivos: Caracterizar os pacientes observados no gabinete de rastreio da consulta de oftalmologia, entre 30 de Setembro e 3 de Outubro de 2013, avaliando os seguintes parâmetros: pressão intraocular (PIO),ametropias por refracção automática.

Análise da acuidade visual no implante de LIO fáquica em miopias elevadas

Introdução – Na correção de miopias elevadas, a cirurgia por implante de lente intraocular fáquica tem tido progressivamente uma maior adesão em relação à cirurgia por laser. Compara-se a acuidade visual (AV) antes e após a cirurgia implanto-refrativa, verificando-se a efetividade deste método no incremento da visão em miopias elevadas. Metodologia – Foram analisados, retrospetivamente, 70 olhos de 41 pacientes, com miopia elevada, entre os 20 e 50 anos, submetidos a cirurgia implanto-refrativa entre 2009 e 2012. Resultados – Um dia após cirurgia, 42,86% da amostra melhorou a AV, 34,29% manteve e 22,85% diminuiu. Após 30 dias observou-se um aumento generalizado da quantidade de visão, sendo que: 64,29% atingiu os 10/10 de AV, 24,29% alcançou entre 9/10-7/10 e 11,42% entre 6/10-4/10. Conclusão – Comprovou-se a efetividade desta técnica cirúrgica, verificando-se o aumento da AV em 52,86% da amostra.