Revisión sistemática de la literatura: efecto de los rellenos inyectables en la región periorbitaria

Introducción: El conocimiento actual de la fisiopatología del envejecimiento periorbitario justifica la aplicación de materiales de relleno inyectables, dado que se enfocan en la restauración del volumen perdido en esta zona, convirtiéndose en una excelente alternativa a procedimientos quirúrgicos que remueven el tejido excedente. Sin embargo los efectos y la seguridad de esta naciente tendencia terapéutica aún no se sustentan en una sólida base científica. El objetivo de esta revisión es identificar el material de relleno inyectable más adecuado para el manejo de los defectos volumétricos estéticos de la región periorbitaria. Metodología: Se realizó una búsqueda exhaustiva de los artículos indexados publicados del 1º de enero de 2.000 al 30 de septiembre de 2.013, en diversas bases de datos electrónicas, se seleccionaron catorce publicaciones, se extrajo la información referente a datos demográficos, la intervención, el seguimiento y los desenlaces y se realizó un análisis de 14 estudios que cumplieron los criterios. Resultados: Todos los artículos incluidos poseían un bajo nivel de evidencia y del grado de recomendación. Todos los materiales de relleno se asociaron a altos niveles de satisfacción para el paciente, adecuada mejoría de la apariencia estética y similares efectos colaterales, el ácido hialurónico fue el material de relleno inyectable más utilizado en la región periorbitaria. Discusión: Los materiales de relleno inyectable mejoran los defectos volumétricos estéticos de la región periorbitaria pero es necesaria mayor evidencia para determinar el tipo relleno más apropiado para esta condición.

Melanose da margem palpebral com suspeita de malignidade: relato de caso

Apresenta-se relato de caso de paciente parda, com 47 anos de idade, havendo lesão pigmentada na margem palpebral inferior do olho direito, de aspecto irregular e heterogêneo, suspeitando-se clinicamente de lesão maligna. A paciente foi tratada com base no resultado da citologia de impressão e diagnosticada pelo exame histológico. Demonstra-se a importância da citologia para o planejamento da ressecção de lesões suspeitas como um método seguro e efetivo para assim se evitar cirurgias em áreas extensas da superfície ocular e de anexos.

Carcinoma basocelular da pálpebra: fatores relacionados com a recidiva tumoral

FUNDAMENTOS: O carcinoma basocelular (CBC) palpebral é o tumor maligno mais freqüente das pálpebras, sendo possível observar casos em que existe recidiva após a exérese tumoral. OBJETIVO: O objetivo deste estudo foi procurar reconhecer fatores relacionados com a recidiva do CBC palpebral. MÉTODOS: No período de 1998 a 2001 foram detectados, na Faculdade de Medicina de Botucatu/Unesp, 23 pacientes que apresentaram recidiva clínica de CBC palpebral. Foi realizada análise retrospectiva dos pacientes, analisando-se idade, sexo, história de exposição solar, localização do tumor na pálpebra, diagnóstico clínico, diagnóstico histológico, acometimento de bordas cirúrgicas e tempo de seguimento. RESULTADOS: em meio aos 23 pacientes analisados, não houve predominância de sexo, e a média de idade foi de 72,9 anos. Dos tumores localizados exclusivamente na pálpebra inferior, sobretudo no canto interno (74,0%), 34,7% eram do tipo sólido ulcerado, e a maioria (66,6%) apresentava margens cirúrgicas livres, quando da ressecção tumoral. CONCLUSÃO: A maioria das recidivas de CBC palpebral foi de tumores do tipo sólido e localizados no canto interno. Margens cirúrgicas livres não representam garantia de que a lesão não vá recidivar ou surgir de novo.

Hidrocistoma écrino e apócrino na pálpebra - Casuística na Faculdade de Medicina de Botucatu- São Paulo

Background - Hidrocystomas ecrine and apocrine may be observed in the eyelids. Objective - The purpose of this study was to observe the occurrence of eyelid hidrocystoma (eccrine or apocrine), as well as the relation between clinical and histopathological diagnosis. Patients and Methods - 42 patients were selected, with a total of 52 lesions, attended between January 1990 to April 1999, at the Botucatu Medical School, with diagnosis of hidrocystoma confirmed by histopathology diagnosis. Result - Hidrocystoma occurred in 0.07% of patients undergoing lesion removal during this period. Eccrine and the apocrine hidrocystoma were frequently observed in female patients, aged over 40 years. The clinical picture ranged from about 1 to 5 years. The lesions were mainly located in the lower eyelid and presented as a single lesion. The clinical diagnosis agreed with the histopathological diagnosis in 67.31% of the apocrine hidrocystomas, and 9.62% of the eccrine hidrocystomas. Conclusions - Apocrine hidrocystoma was the most frequently observed eyelid hidrocystoma. The correlation between clinical and histopathological diagnosis was higher for apocrine hidrocystomas.

Cryptococcus gattii and Cryptococcus albidus in captive domestic Pigeon (Columba livia)

Cryptococcosis in animals is an important fungal disease caused by the encapsulated yeast Cryptococcus neoformans. This report describes the occurrence of Cryptococcus gattii and Cryptococcus albidus in domestic pigeon (Columba livia), living together with other birds in a breeding center. The animal presented a pinkish, vascularized mass with gelatinous aspect localized subcutaneously under the right lower eyelid, with approximately 2cm in diameter. At microbiological exam it was isolated Cryptococcus gatti from the eyelid mass, lungs and liver, C. albidus from the trachea and both Cryptococcus species from muscle and kidney.

Photodynamic therapy in periocular basal cell carcinoma: Case report

The authors report the use of photodynamic therapy with methyl aminolevulinate (Metvix (R)) in a patient with nodular and infiltrative basal cell carcinoma in the right lower eyelid. Side effects on the eye were evaluated weekly. After 12 weeks of treatment, to confirm cure the patient was submitted to a 2-mm punch biopsy, the anatomopathological findings of which were negative for neoplasia. Photodynamic therapy with methyl aminolevulinate was shown to be an attractive alternative to surgical excision(-)the current gold standard treatment worldwide.

Keratoconus:a review

Keratoconus is the most common primary ectasia. It usually occurs in the second decade of life and affects both genders and all ethnicities. The estimated prevalence in the general population is 54 per 100,000. Ocular signs and symptoms vary depending on disease severity. Early forms normally go unnoticed unless corneal topography is performed. Disease progression is manifested with a loss of visual acuity which cannot be compensated for with spectacles. Corneal thinning frequently precedes ectasia. In moderate and advance cases, a hemosiderin arc or circle line, known as Fleischer's ring, is frequently seen around the cone base. Vogt's striaes, which are fine vertical lines produced by Descemet's membrane compression, is another characteristic sign. Most patients eventually develop corneal scarring. Munson's sign, a V-shape deformation of the lower eyelid in downward position; Rizzuti's sign, a bright reflection from the nasal area of the limbus when light is directed to the limbus temporal area; and breakages in Descemet's membrane causing acute stromal oedema, known as hydrops, are observed in advanced stages. Classifications based on morphology, disease evolution, ocular signs and index-based systems of keratoconus have been proposed. Theories into the genetic, biomechanical and biochemical causes of keratoconus have been suggested. Management varies depending on disease severity. Incipient cases are managed with spectacles, mild to moderate cases with contact lenses and severe cases can be treated with keratoplasty. This article provides a review on the definition, epidemiology, clinical features, classification, histopathology, aetiology and pathogenesis, and management and treatment strategies for keratoconus.

The relationship between two types of upper eyelid movements: Saccades and pursuit

PURPOSE. To establish the relationship between upper eyelid saccades and upper eyelid pursuit movements. METHODS. Upper eyelid saccades and periodic sinusoidal upper eyelid pursuit movements were recorded in a sample of controls and patients with Graves upper eyelid retraction. A video-computerized system was used to register both types of movements that accompanied 60 of eye rotation across the upper and lower hemifields. The forced harmonic oscillator model was used to fit saccadic and pursuit movements. RESULTS. Mean mid-pupil eyelid distance for the Graves patients (6.6 +/- 1.1 mm) was significantly higher than for the controls (4.6 +/- 0.8 mm; t = 7.18; P < 0.00001). Despite the difference in the upper eyelid resting position, saccades and pursuit eyelid movements of both groups were extremely well fitted by underdamped solutions and steady forced solutions of the harmonic oscillator model, respectively. For the controls, the amplitude of the pursuit movements was well correlated with the upward and downward saccades. The amplitude of the eyelid movements of the Graves patients (saccades and pursuit) was significantly reduced compared with that of the controls. CONCLUSIONS. Saccadic and pursuit movements of the upper eyelid can be described by the harmonic oscillator model. In healthy subjects and Graves patients, the amplitude of pursuit lid movements is correlated to the saccade amplitude. Pursuit eyelid movements are more difficult to register than saccades, and their measurements do not allow clear separation of the relaxation and contraction properties of the upper eyelid retractors.

Comparative Analysis of the Influence of Perichondrium on Conjunctival Epithelialization on Conchal Cartilage Grafts in Eyelid Reconstruction: Experimental Study in Rabbits

Background: Although the role of cartilage grafts in reconstruction of the posterior eyelid lamella is well established, spontaneous conjunctival epithelialization on such grafts has yet to be fully proven. The aim of this study was to perform a comparative analysis of the influence of perichondrium on conjunctival epithelialization over conchal cartilage grafts used in eyelid reconstruction in rabbits. Methods: The posterior lamellae of 100 lower eyelids from 50 rabbits were reconstructed with autogenous grafts of conchal ear cartilage. In the right eyelids, cartilage was grafted with the perichondrium in direct contact with the eyeball, and the left eyelids were reconstructed in a similar manner but using cartilage grafts without perichondrium. The animals were killed after 1, 2, 3, 4, and 5 weeks, and their lower eyelids were analyzed macroscopically and histologically. Results: The percentage difference in conjunctival epithelialization on the cartilage with perichondrium and that without perichondrium was 11.41 percent in the first week of the experiment, 13.64 percent in the second week, 18.69 percent in the third week, 10.38 percent in the fourth week, and 6.17 percent in the fifth week. The average percentage conjunctival epithelialization in the eyelids reconstructed with a cartilage graft with perichondrium was significantly higher throughout the 5 weeks of the experiment than in the eyelids reconstructed with cartilage without perichondrium (p < 0.0002). Conclusion: It was found that the perichondrium had an important role in conjunctival epithelialization in eyelids reconstructed with a cartilage graft in the present study. (Plast. Reconstr. Surg. 123: 55, 2009.)

Spontaneous Blinking in Patients With Graves` Upper Eyelid Retraction

Purpose: To describe spontaneous blink kinematics in Graves` upper eyelid retraction (UER). Methods: The magnetic search coil technique was used to record spontaneous blinks of 15 healthy subjects (aged 23-56 years, 15 eyelids) and 15 patients with Graves` UER (aged 22-62 years, 15 eyelids) during a 5-min period of video observation, and the signals were digitized at 200 Hz (12 bits). Overall, a total of 2,798 blinks were recorded for the controls and 1,860 for the patients. The distance between pupil center and upper eyelid margin in the primary position of gaze (MRD) was measured with the Image J software. Results: The blinking rate of patients was lower than that of control subjects, with a mean (+/-SEM) blinking rate (blinks/min) of 13.0 +/- 1.7 for patients and of 20.0 +/- 2.1 for the controls (t = 2.58, P = 0.016). There were no statistically significant differences in blink amplitude between controls (22.7 +/- 3.1 degrees) and Graves` patients (24.7 +/- 3.3 degrees). However, while only 22% of the blinks performed by controls were smaller than MRD, this rate was 78% for patients. In addition, in blinks larger than 25, patients showed lower down-phase velocity than controls. Conclusions: Patients with Graves` UER show reduced blinks rates and abnormal blink kinematics, which might be related to the development of exposure keratitis in this disease.

Traitement chirurgical des tumeurs palpebrales. [Surgical treatment of eyelid tumors]

After reviewing the general principles of eyelid reconstruction, the authors present reconstruction techniques with regard to the location and size of the eyelid defect. When the defect is less than one-quarter of lid length, direct suture is possible. When the defect is larger, reconstruction techniques differ for the upper and lower lid.

The influence of a certain volume of fluid in the lower tear meniscus on intraocular pressure measurements using the non-contact tonometer

Background: Intraocular pressure (IOP) is the pressure inside the eye that helps to maintain the integrity and the suitable form of the ocular globe. Precise and accurate measures of IOP are needed for the diagnosis as well as follow-up of glaucoma. In daily clinical practice, Goldmann applanation tonometer (GAT) and Non-contact tonometer (NCT) are the most common devices for measuring IOP. A close agreement between these methods has been showed, particularly in normotensive patients and a poor agreement, especially when IOP levels are above the normal range. Ophthalmologists have noticed a poor agreement between NCT and GAT, observing that by using NCT and after comparing with GAT, there is an overestimation of IOP readings, and particularly it occurs when the eyes are tearful. Previous studies investigate the effect of tears in Non-contact tonometer readings by the instillation of artificial tears, concluding in one of the studies that the variation was less than 1mmHg and not clinically significant, in contrast with another study which the increases were sadistically significant. Tear menisci are a thin strip of tear fluid located between the bulbar conjunctiva and the eyelid margins. We think that the overestimation of IOP readings using NCT could be due to the presence of a higher volume of tear in the lower tear meniscus which might cause an optical interference in the optoelectronic applanation monitoring system of this deviceObjectives: To research the influence of a certain volume of fluid in the lower tear meniscus on IOP measurements using the NCT in healthy eyes. Moreover, to investigate the agreement between IOP readings obtained by NCT and GAT in the presence and absence of this volume of fluidMethods: The study design will be transversal for diagnostic tests of repeated measures. We will study patients with no ocular pathology and IOP<21mmHg. It will consist in the measurement of IOP using NCT before and after the instillation of COLIRCUSÍ FLUOTEST, used as a volume of fluid in the lower tear meniscus, to observe if there will be differences using the paired t-test. Moreover, we will take IOP measures by GAT in order to know the agreement between these methods after and before the application of these eyedrops, using the ICC (intraclass correlation coefficient) and the Bland-Altmann method

Spontaneous Blinking in Patients With Graves' Upper Eyelid Retraction

Purpose: To describe spontaneous blink kinematics in Graves' upper eyelid retraction (UER).Methods: The magnetic search coil technique was used to record spontaneous blinks of 15 healthy subjects (aged 23-56 years, 15 eyelids) and 15 patients with Graves' UER (aged 22-62 years, 15 eyelids) during a 5-min period of video observation, and the signals were digitized at 200 Hz (12 bits). Overall, a total of 2,798 blinks were recorded for the controls and 1,860 for the patients. The distance between pupil center and upper eyelid margin in the primary position of gaze (MRD) was measured with the Image J software.Results: The blinking rate of patients was lower than that of control subjects, with a mean (+/-SEM) blinking rate (blinks/min) of 13.0 +/- 1.7 for patients and of 20.0 +/- 2.1 for the controls (t = 2.58, P = 0.016). There were no statistically significant differences in blink amplitude between controls (22.7 +/- 3.1 degrees) and Graves' patients (24.7 +/- 3.3 degrees). However, while only 22% of the blinks performed by controls were smaller than MRD, this rate was 78% for patients. In addition, in blinks larger than 25, patients showed lower down-phase velocity than controls.Conclusions: Patients with Graves' UER show reduced blinks rates and abnormal blink kinematics, which might be related to the development of exposure keratitis in this disease.

Reduced Insulin Clearance And Lower Insulin-degrading Enzyme Expression In The Liver Might Contribute To The Thrifty Phenotype Of Protein-restricted Mice.

Nutrient restriction during the early stages of life usually leads to alterations in glucose homeostasis, mainly insulin secretion and sensitivity, increasing the risk of metabolic disorders in adulthood. Despite growing evidence regarding the importance of insulin clearance during glucose homeostasis in health and disease, no information exists about this process in malnourished animals. Thus, in the present study, we aimed to determine the effect of a nutrient-restricted diet on insulin clearance using a model in which 30-d-old C57BL/6 mice were exposed to a protein-restricted diet for 14 weeks. After this period, we evaluated many metabolic variables and extracted pancreatic islet, liver, gastrocnemius muscle (GCK) and white adipose tissue samples from the control (normal-protein diet) and restricted (low-protein diet, LP) mice. Insulin concentrations were determined using RIA and protein expression and phosphorylation by Western blot analysis. The LP mice exhibited lower body weight, glycaemia, and insulinaemia, increased glucose tolerance and altered insulin dynamics after the glucose challenge. The improved glucose tolerance could partially be explained by an increase in insulin sensitivity through the phosphorylation of the insulin receptor/protein kinase B and AMP-activated protein kinase/acetyl-CoA carboxylase in the liver, whereas the changes in insulin dynamics could be attributed to reduced insulin secretion coupled with reduced insulin clearance and lower insulin-degrading enzyme (IDE) expression in the liver and GCK. In summary, protein-restricted mice not only produce and secrete less insulin, but also remove and degrade less insulin. This phenomenon has the double benefit of sparing insulin while prolonging and potentiating its effects, probably due to the lower expression of IDE in the liver, possibly with long-term consequences.

Relationship Between Lower-limb Muscle Strength And Functional Independence Among Elderly People According To Frailty Criteria: A Cross-sectional Study.

Muscle strength and functional independence are considered to be determinants of frailty levels among elderly people. The aim here was to compare lower-limb muscle strength (LLMS) with functional independence in relation to sex, age and number of frailty criteria, and to ascertain the influence of these variables on elderly outpatients' independence. Quantitative cross-sectional study, in a tertiary hospital. The study was conducted on 150 elderly outpatients of both sexes who were in a cognitive condition allowing oral communication, between October 2005 and October 2007. The following instruments were used: five-times sit-to-stand test (FTSST), Functional Independence Measurement (FIM) and Lawton's Instrumental Activities of Daily Living Scale (IADL). Descriptive, comparative, multivariate, univariate and Cronbach alpha analyses were performed. The mean time taken in the FTSST was 21.7 seconds; the mean score for FIM was 82.2 and for IADL was 21.2; 44.7% of the subjects presented 1-2 frailty criteria and 55.3% > 3 criteria. There was a significant association between LLMS and functional independence in relation to the number of frailty criteria, without homogeneity regarding sex and age. Functional independence showed significant influence from sex and LLMS. Elderly individuals with 1 or 2 frailty criteria presented greater independence in all FTSST scores. The subjects with higher LLMS presented better functional independence.