Prevalence and causes of visual impairment in a Brazilian population: the Botucatu Eye Study.

BACKGROUND: This paper reports population-based data on the prevalence and causes of visual impairment among children and adults in Botucatu, Brazil. METHODS: A population-based cross-sectional study was conducted involving a random start point and then systematic sampling of an urban Brazilian population in the city of Botucatu. There were approximately 3,300 individuals aged 1 to 91 years who were eligible to participate in the study. Of this sample, 2485 (75.3%) underwent ophthalmic examination. The ophthalmic examination included uncorrected (presenting) and best corrected distance visual acuity using standardized protocols. The primary cause of decreased visual acuity was identified for all patients with visual impairment. RESULTS: Presenting low vision and presenting blindness were found in 5.2% (95% CI: 4.3-6.1) and 2.2% (95% CI: 1.6-2.8) of the population, respectively. Unilateral presenting low vision and unilateral presenting blindness were found in 8.3% (95% CI: 7.2-9.5) and 3.7% (95% CI: 2.9-4.4) of the population respectively. Best corrected low vision was found in 1.3% of the population (95% CI: 0.9-1.7) and best corrected blindness was discovered in 0.4% of people (95% CI: 0.2-0.7). The main cause of presenting low vision was refractive error (72.3%) and cataract was the most prevalent cause of blindness (50%). CONCLUSION: The main causes of low vision and blindness in this Brazilian city were uncorrected refractive errors, cataract, and retinal diseases. Programs to further reduce the burden of visual impairment need to be targeted toward the correction of refractive error and surgery for cataracts.

Autologous orbicularis muscle for filling facial folds-an experimental and clinical study.

PURPOSE: To present a technique for filling facial folds by using autologous orbicularis oculi muscle, based on an experimental model. METHODS: two studies are presented: (1) an experimental study using 15 albino guinea-pigs from which a strip of the sural triceps muscle was removed and implanted in the subcutaneous tissue of the dorsal area. The animals were sacrificed 7, 30 and 60 days after the implantation, and the material was histologically evaluated. And (2) an interventional prospective clinical trial carried out on 20 patients referred to blepharoplasty surgery. They received autologous preseptal orbicularis muscle for filling facial folds. The results where evaluated by patients satisfaction and clinical exam. RESULTS: the sural tricep muscle, when implanted in the subcutaneous tissue, resulted in fibrosis. The patients whom received autologous orbicularis muscle implanted for filling facial folds showed that the procedure can be successfully carried out. CONCLUSIONS: autologous preseptal orbicularis muscle is a good material for filling facial folds. Cicatricial tissue will be formed on its implantation site, filling the tissue gap that forms the folds on the skin.

Polyethylene gel in the subcutaneous tissue of rats: histopathologic and systemic evaluation.

PURPOSE: To evaluate the histological and systemic response to subcutaneous injection of polyethylene gel in rats. METHODS: Twenty-one white male rats were divided into 3 groups (G): G1 and G2 received subcutaneous polyethylene gel injection in the dorsal midline and were sacrificed at 30 and 60 postoperative days, respectively. G3 was not exposed to the polyethylene gel and was sacrificed after 60 days. Blood levels of lactate dehydrogenase (LDH), creatine kinase (CK), and alkaline phosphatase (ALP) were evaluated. The heart, kidney, liver, adrenal gland, injection site, and adjacent tissues were histologically examined. The results were submitted to statistical analysis. RESULTS: There was no clinical evidence of extrusion, reduction of the injected volume, or abnormalities in the adjacent tissues. Blood levels of CK and LDH were normal and similar in all groups. ALP levels were significantly lower in G2 than in G1 and G3. The systemic organs were normal on histological examination in the 3 groups evaluated. Microscopically, the polyethylene gel was surrounded by a thin pseudocapsule formation and minimal inflammatory cell response, which decreased from G1 to G2. CONCLUSION: The subcutaneous injection of polyethylene gel in rats elicited minimal local inflammatory response and no systemic side effects.

Isolated low grade pilocytic astrocytoma of the optic nerve in the elderly: case report.

A 68-year-old man presented with a history of a right optic glioma. Eighteen months ago he underwent a lateral orbitotomy at another institution for removal of an optic nerve mass. At that time histology revealed that the tumor was an optic nerve glioma with a pilocytic pattern. No further treatment was instituted and one year after surgery he noticed that his right eye was proptotic again. Magnetic resonance imaging of the orbit showed that his right orbit was almost completely filled with a mass which extended through the optic canal to the chiasma. The tumor was excised by a combined neurosurgical and orbital approach. Histology proved that the neoplasm was a low grade pilocytic astrocytoma of the optic nerve.

Orbital and adnexal sarcoidosis.

OBJECTIVE: To present the clinical features and management in a series of patients with orbital and adnexal sarcoidosis. METHODS: This multicenter retrospective study included patients with biopsy-proven noncaseating granuloma involving the orbit or adnexa and evidence of systemic sarcoidosis. Clinical records were reviewed for initial examination findings, radiological findings, treatment modalities, and outcome. RESULTS: The study included 26 patients (19 female, 7 male; mean age, 52 years). The most common feature at the first examination was a palpable periocular mass followed by discomfort, proptosis, ptosis, dry eye, diplopia, and decreased vision. The disease affected the lacrimal gland (42.3%), orbit (38.5%), eyelid (11.5%), and lacrimal sac (7.7%). Among orbital lesions, the antero-inferior quadrant was preferentially involved. Treatment modalities included steroids, surgical debulking, and methotrexate. During a mean follow-up of 18.75 months, 84.6% of patients showed a complete response to the treatment, but 19.2% of patients developed further signs of sarcoidosis. CONCLUSIONS: Orbital soft tissue involvement is more common in patients older than 50 years and in women. The anterior inferior quadrants of the orbits appear to be preferentially affected. Although a good response to treatment with oral steroids is seen, long-term follow-up is recommended because active systemic disease can develop months to years later.

Tarsomarginal graft in upper eyelid coloboma repair.

Eyelid colobomas are congenital defects caused by failure of fusion of the mesodermal lid folds. The timing and approach to surgical repair depend on the severity of the defect and exposure keratopathy. Tarsomarginal grafts have been well described in eyelid reconstructions following tumor excision. Descriptions of lid coloboma repair using this approach are limited. We describe a series of upper lid colobomas repaired with the tarsomarginal graft.

Novel technique to control hypersecretion from a transplanted autologous submandibular salivary gland for keratoconjunctivitis sicca.

PURPOSE: To present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca. METHODS: A 65-year-old man presented with corneal epithelial edema and suspicious ocular surface dysplasia secondary to hypersecretion from a transplanted autologous SMG. The location and function of the gland were evaluated perioperatively using technetium-99m-pertechnetate scintigraphy. The course of the duct was marked with a radiation probe, surgically exposed, and partially ligated with titanium clips. RESULTS: Marked reduction in salivary flow and resolution of corneal edema and ocular surface changes were noted. Conjunctival biopsy showed no evidence of malignancy. Symptoms were stable during a 1-year follow-up period. CONCLUSION: Partial ligation of the transplanted SMG duct may be a simple and reversible technique to control hypersecreting glands with secondary corneal edema and ocular surface changes.

Lacrimal excretory system sequelae in patients treated for leishmaniasis.

UNLABELLED: Leishmaniasis infection may involve destruction of nasal tissues resulting in lacrimal drainage system alteration. PURPOSE: To evaluate the frequency of lacrimal excretory system sequelae in patients treated for leishmaniasis. METHODS: Forty-five leishmaniasis-treated patients (90 nasolacrimal ducts) were submitted to lacrimal excretory system evaluation. All were evaluated by Jones I test and when it was abnormal, dacryocystography and nasal endoscopy were performed. This situation occurred in 13 patients (26 nasolacrimal ducts). RESULTS: The majority of evaluated patients had the cutaneous form (64.4%) of leishmaniasis, however, 69.23% of the patients with lacrimal excretory system alterations had the mucocutaneous form of infection before treatment. In these, the most common alteration detected was bilateral permeable and dilated nasolacrimal ducts (92.30%). Only 3.84% (1/26) of the evaluated nasolacrimal ducts were obstructed. Nasal endoscopy showed turbinate hypertrophy (53.84%), septum deviation (53.84%) and nasal septum perforation (23.07%). CONCLUSION: Permeable and dilated lacrimal excretory system were the most common sequelae related to leishmaniasis infection.

Matrix metalloproteinase-9 expression in pterygium.

PURPOSE: To assess matrix metalloproteinase (MMP)-9 expression in pterygium lesion. METHODS: A prospective randomized clinical trial was done to evaluate the expression of matrix metalloproteinase in normal and in primary or recurrent pterygia in Tenon's capsule by immunohistochemical analysis and a computerized image analysis system. The data were submitted to statistical analysis. RESULTS: Matrix metalloproteinase expression showed no difference in normal Tenon's capsule and in primary or recurrent pterygia. CONCLUSION: The similar expression of the matrix metalloproteinase in normal Tenon's capsule and in primary or recurrent pterygia allowed us to conclude that matrix metalloproteinase is not implicated in the genesis or the recurrence of pterygium lesion.

Lack of papillomavirus (HPV) in pterygia of a Brazilian sample.

PURPOSE: Because the influence of papillomavirus (HPV) in pterygium pathogenesis is controversial, the aim of this study was to identify whether it is present in the pterygia lesions in our region. METHODS: Thirty-six patients with unilateral primary pterygia were submitted to excision of pterygia and a sample of normal conjunctiva. Tissues were submitted to polymerase chain reaction (PCR) evaluation for papillomavirus DNA detection. RESULTS: We were unable to detect any HPV DNA in all studied specimens. CONCLUSION: According to our results papillomarivus is not important for pterygium formation.

[Eyelid alterations associated with palpebral ectropion]. / Alterações da margem palpebral associadas ao ectrópio.

PURPOSE: To evaluate eyelid margin alterations in ectropion carriers. METHODS: An observational study was done involving 53 eyelid ectropion patients and 25 individuals with dermochalasis (control group). Eyelash position and margin inflammation were observed using digital images. The data were submitted to statistical analysis. RESULTS: Patients with ectropion showed a decreased number of eyelashes, loose convexity, trichiasis and distichiasis as compared with the control group. CONCLUSION: Patients with eyelid ectropion have eyelid margin alterations probably due to the chronic inflammatory process in this region.

Expression of vascular endothelial growth factor (VEGF) in macrophages, fibroblasts, and endothelial cells in pterygium treated with 5-Fluorouracil.

PURPOSE: To evaluate the VEGF expression in macrophages, fibroblasts, and endothelial cells from pterygium before and after 5-fluorouracil (5-FU) exposure. METHODS: 68 excised pterygia (42 primary and 26 recurrent) were studied by immunohistochemistry, to analyze its expression in cells from pterygium and normal conjunctiva. VEGF expression was evaluated before and after a 5-FU subconjunctival injection 15 days prior to surgery. RESULTS: Expression in macrophages was moderate in normal conjunctiva and low to moderate in pterygium tissues. In fibroblasts, it was negative or low in both tissues. Pterygium had a higher proportion of high VEGF expression in endothelial cells compared to normal tissue (p < 0.05). 5-FU did not have any influence on expression. CONCLUSION: VEGF expression in pterygium macrophages, fibroblasts, and endothelial cells was low and similar to that normal in conjunctival tissue. High VEGF expression was found in pterygium endothelial cells compared to normal conjunctiva. 5-FU does not impact VEGF expression.

Orbital solitary fibrous tumor: report of two cases and literature review.

BACKGROUND: Solitary fibrous tumor (SFT) is a rare, benign, and very uncommon lesion in the orbit. Because of its complex and variable clinical and histological appearance the SFT is often misdiagnosed. CASES: Two new cases of orbital SFT are reported, one in a man and the other in a woman, both unilateral and in the superomedial orbit. OBSERVATIONS: Clinical and tomographical evaluations were conducted and the lesions were excised. The histological evaluation showed the tumors were composed of spindle-shaped cells within collagen bundles and vascular channels. Immunohistochemical staining was positive for CD 34 and negative for S-100 protein. CONCLUSION: Immunohistochemical study is an important adjuvant in determining the SFT diagnosis. Long-term follow-up is necessary because of the possibility of SFT recurrence after excision.

Evaluation of lacrimal system outflow in the newborn by dye tests.

PURPOSE: The aim of this study was to evaluate the outflow from the lacrimal excretory system (LES) at birth. METHOD: Two-hundred LES were evaluated by the Milder Test (DDT) and the modified Jones I Test (JIT) in 100 newborns (NBs) from 31 (T1) until 42 (T3) weeks of gestational age. The occurrence of obstruction was related to sex, weight at birth, presence of ocular discharge and the degree of maturity. RESULTS: Both tests were in agreement and showed LES obstruction in 61.5% (DDT) and 78.5% (JIT), respectively, while the LES outflow increased with increasing maturity. CONCLUSION: Evaluation of LES outflow at birth reveals obstruction rates that are much higher than those clinically observed in children with complaints of epiphora.

Prevalence of refractive errors in a Brazilian population: the Botucatu eye study.

PURPOSE: To determine the prevalence and demographic associations of refractive error in Botucatu, Brazil. METHODS: A population-based, cross-sectional prevalence study was conducted, which involved random, household cluster sampling of an urban Brazilian population in Botucatu. There were 3000 individuals aged 1 to 91 years (mean 38.3) who were eligible to participate in the study. Refractive error measurements were obtained by objective refraction. RESULTS: Objective refractive error examinations were performed on 2454 residents within this sample (81.8% of eligible participants). The mean age was 38 years (standard deviation (SD) 20.8 years, Range 1 to 91) and females comprised 57.5% of the study population. Myopia (spherical equivalent (SE) < -0.5 dropters (D)) was most prevalent among those aged 30-39 years (29.7%; 95% confidence interval (CI) 24.8-35.1) and least prevalent among children under 10 years (3.8%; 95% confidence interval (CI) 1.6-7.3). Conversely hypermetropia (SE > 0.5D) was most prevalent among participants under 10 years (86.9%; 95% CI 81.6-91.1) and least prevalent in the fourth decade (32.5%; 95% CI 28.2-37.0). Participants aged 70 years or older bore the largest burden of astigmatism (cylinder at least -0.5D) and anisometropia (difference in SE of > 0.5D) with a prevalence of 71.7% (95% CI 64.8-78.0) 55.0% (95% CI 47.6-62.2) respectively. Myopia and hypermetropia were significantly associated with age in a bimodal manner (P < 0.001), whereas anisometropia and astigmatism increased in line with age (P < 0.001). Multivariate modeling confirmed age-related risk factors for refractive error and revealed several gender, occupation and ethnic-related risk factors. CONCLUSIONS: These results represent previously unreported data on refractive error within this Brazilian population. They signal a need to continue to screen for refractive error within this population and to ensure that people have adequate access to optical correction.

Palpebral dimensions in Brazilian children: assessment based on digital images.

PURPOSE: To determine palpebral dimensions and development in Brazilian children using digital images. METHODS: An observational study was performed measuring eyelid angles, palpebral fissure area and interpupillary distance in 220 children aged from 4 to 72 months. Digital images were obtained with a Sony Lithium movie camera (Sony DCR-TRV110, Brazil) in frontal view from awake children in primary ocular position; the object of observation was located at pupil height. The images were saved to tape, transferred to a Macintosh G4 (Apple Computer Inc., USA) computer and processed using NIH 1.58 software (NTIS, 5285 Port Royal Rd., Springfield, VA 22161, USA). Data were submitted to statistical analysis. RESULTS: All parameters studied increased with age. The outer palpebral angle was greater than the inner, and palpebral fissure and angles showed greater changes between 4 and 5 months old and at around 24 to 36 months. CONCLUSION: There are significant variations in palpebral dimensions in children under 72 months old, especially around 24 to 36 months.

Blinding orbital cellulitis: a complication of strabismus surgery.

A 56-year-old healthy man underwent left medial rectus recession and lateral rectus resection for esotropia. The next day he developed severe left periocular pain with decreased vision, an afferent pupillary defect, periorbital edema, limited ocular motility, and proptosis. Computed tomography showed fat stranding and less than 90 degrees of posterior globe tenting. Despite intravenous antibiotics to treat orbital cellulitis, and a lateral canthotomy and cantholysis to decompress the orbit, visual acuity worsened to no light perception. The patient underwent emergent orbital decompression including release of the superior and inferior septum and outfracturing of the orbital floor and medial wall; however, there was no recovery of vision. Blinding orbital cellulitis is a rare complication after strabismus surgery. Despite poor prognosis, prompt diagnosis and aggressive treatment may maximize visual potential.

Spontaneous eye blink analysis in the normal individual.

PURPOSE: Spontaneous eye blink activity in the primary eye position and its relationship to age and gender were assessed using digital image processing techniques to quantify blink opening and closing time. METHODS: One hundred-and-eighty healthy volunteers (90 males and 90 females), divided into the age groups 0-3, 4-12, 13-20, 21-40, 41-60 and > or = 60 years old, were evaluated prospectively. They were videotaped digitally in a standard setting and the images were transferred to a personal computer (Macintosh 400) and processed with the iMovie software. Blink opening and closing time were measured at 30 frames/second. The data were then subjected to statistical analysis. RESULTS: The closing time was significantly longer than the opening time for all ages and both genders. Elderly individuals (> or = 41 years old) and women had significantly longer closing times. CONCLUSION: Image processing techniques made possible the observation of differences in spontaneous eye blink opening and closing time in relation to age and gender.

A comparison of human and porcine acellular dermal tissues in the subcutaneous space of a rat model.

The study compared the host response to a human and a porcine acellular dermal tissue implanted in the subcutaneous space of a rat model. The human and porcine acellular grafts were surgically implanted in the subcutaneous tissue of rats (5 rats/group) and the materials were evaluated at 7, 15, 30, 60 and 180 postoperative days (PO). The histological immune response was quantified using a digital image analysis system, which evaluated the number of vessels present in the implants and in the surrounding soft tissue, the area of inflammatory cell infiltration in the grafts, the width of the capsular formation present around the tissues and the area of implants absorbed. The data were submitted to statistical analysis. Light microscopy showed mononuclear cellular infiltration, the presence of a capsular formation surrounding the grafts and the presence of vacuolar structures (optically "empty spaces") inside the implants. The image analysis comparing both materials showed significant inflammatory cells in the human graft at 15 and 30 PO, thicker capsular formation in the porcine tissue at 60 PO, increased number of vessels inside the implants and in the surrounding tissues in the porcine graft and a similar absorption pattern in both materials at 180 PO. The histological findings showed that both tissues were well-tolerated when implanted in the subcutaneous tissue of rats, allowing us to consider the porcine acellular dermal graft as a provisional alternative material for reconstructive plastic surgery.