RESUMO
PURPOSE: To describe the demography, clinical settings and outcomes in 2071 patients undergoing evisceration across a multi-tier ophthalmology hospital network and comparison of results with the global scenario of clinical settings for evisceration. METHODS: An analysis of 2071 patients undergoing evisceration and implant between 2013 and 2019. RESULTS: The mean age at surgery was 39 ± 22 years. Children constituted 303(15%) of the cases. The four leading indications for surgery included painful blind eye in 760(37%), phthisis bulbi in 552(27%), staphyloma in 215(10%) and open globe injury in 195(9%) patients. The clinical settings encountered were trauma in 852(41%), ocular infection in 714(34%), glaucoma in 198(10%), post ocular surgery in 146(7%), congenital in 95(5%) and uveitis in 21(1%). Trauma and infection remained the commonest clinical settings in the urban (843,75%), rural (622,77%) and metropolitan (101,71%) areas. Decade wise distribution suggested trauma to be the commonest clinical setting in the first 4 decades and infection in the next 6 decades. The mean follow-up period was 351 ± 386 days (median 194). While trauma remained one of the commonest clinical setting in both the developed and the developing economies, painful blind eye and intractable glaucoma were other common clinical settings in the developed economies and infection was one of the leading clinical setting in the developing economies. CONCLUSION: Most patients undergoing evisceration are young. The commonest indications for surgery include painful blind eye and phthisis bulbi. Trauma and infection remain the commonest clinical settings for evisceration in developed and developing economies.
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Glaucoma , Implantes Orbitários , Criança , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Evisceração do Olho/métodos , Registros Eletrônicos de Saúde , Glaucoma/epidemiologia , Glaucoma/cirurgia , Cegueira , Estudos Retrospectivos , Demografia , Enucleação OcularRESUMO
PURPOSE: To describe the clinical features, histopathology, treatment, and outcomes of patients with ocular surface squamous neoplasia (OSSN) presenting to a referral centre in India. METHODS: Retrospective interventional study. RESULTS: Of 438 patients, the mean age at presentation was 49 years. Human immunodeficiency virus infection was noted in 72 (16%), xeroderma pigmentosum in 22 (5%), hepatitis B virus infection in 14 (3%), and systemic cancer in 8 (2%) patients. Tumor pigmentation was noted in 243 (54%) tumors with a mean percentage of tumor pigmentation of 44% (median, 40%; range, 1 to 100%). Intraocular tumor extension was noted in 12 (3%), and orbital tumor extension in 16 (4%) eyes. Of the 381 treated lesions, excisional biopsy (n = 247; 65%) was the most common treatment modality. Of the 311 lesions with histopathology diagnosis of OSSN, invasive squamous cell carcinoma (n = 92; 30%) was the most common. Over a mean follow-up period of 11 months (median, 5 months; range, 1 to 108 months) in 368 patients, tumor recurrence was noted in 16 (4%) eyes, globe salvage was achieved in 341 (90%) eyes, vision salvage in 338 (89%) eyes, regional lymph node metastasis occurred in 9 (2%), and metastasis-related death in 9 (2%) patients. CONCLUSION: Pigmented OSSN is common in Asian Indian population. Appropriate management of OSSN is associated with good vision, globe, and life salvage rates in India.
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Carcinoma de Células Escamosas , Neoplasias da Túnica Conjuntiva , Neoplasias Oculares , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/terapia , Neoplasias da Túnica Conjuntiva/diagnóstico , Neoplasias da Túnica Conjuntiva/epidemiologia , Neoplasias da Túnica Conjuntiva/terapia , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/epidemiologia , Neoplasias Oculares/terapia , Humanos , Índia/epidemiologia , Recidiva Local de Neoplasia , Estudos RetrospectivosRESUMO
PURPOSE: To describe the surgical outcomes and implant complications in 1,800 patients undergoing evisceration with primary implant. METHODS: An Electronic Medical Record-driven analysis of 1,800 patients undergoing evisceration with primary implant between 2013 and 2019. Implant sizing was performed intra-operatively to place the largest implant without tension on the wound closure. Outcome measures included implant complications, prosthesis measurements, and incidence of a good aesthetic outcome. Good outcome was defined as <2 mm enophthalmos and grade 1 or less superior sulcus deformity with a custom ocular prosthesis. RESULTS: Eighteen hundred eyes of 1800 patients were included. The mean age at surgery was 36 ± 21 years (median 32 years). Implants used were poly(methyl methacrylate) (PMMA) in 1737 (97%) and porous polyethylene in 63 (3%) patients. Two-petal sclerotomy was performed in 1512 (88%) and four-petal sclerotomy in 165 (10%) patients. The mean diameter of the implant used was 19.35 ± 1.18 mm (median 20, range 10-22 mm). The implant extrusion rate was 3% (56) and implant displacement was seen in none. The mean prosthesis volume and thickness were 2.22 ± 0.67 ml (median 2, range 1-6.5 ml) and 6 ± 1 mm (median 6, range 2-9 mm). The mean difference in prosthesis projection on Hertel's exophthalmometer was 0.28 ± 1 mm (median 0, range 0-1 mm). Good outcome was observed in 93%. The mean follow-up period was 351 ± 386 days (median 194). CONCLUSION: Evisceration with empirically selected primary orbital implant placement is associated with minimal implant complications and gives a good aesthetic outcome in 93% of the patients.
Assuntos
Evisceração do Olho , Implantes Orbitários , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Registros Eletrônicos de Saúde , Estudos Retrospectivos , Implantação de Prótese/efeitos adversos , Polietileno , Complicações Pós-Operatórias/etiologia , Polimetil Metacrilato , Enucleação OcularRESUMO
Purpose: To describe the clinical features and management of post-keratoplasty ocular surface squamous neoplasia (pk-OSSN) in patients with xeroderma pigmentosum (XP).Methods: Retrospective case series of seven patients with XP.Results: The mean age at diagnosis of pk-OSSN was 22 years (median, 21 years; range, 12 to 37 years). There were four males and three females. Full-thickness keratoplasty (n = 5) and Descemet stripping endothelial keratoplasty (n = 2) were performed for optical (n = 6) and therapeutic indications (n = 1). None of the patients had evidence of OSSN before or at the time of keratoplasty. The mean interval between keratoplasty and pk-OSSN was 44 months (median, 14 months; range, 3 to 109 months). The tumor epicenter was located at the limbus (n = 4), bulbar conjunctiva (n = 1) or cornea (n = 2). The mean dimension of the lesions was 12 mm (median, 11 mm; range, 6 to 18 mm). Treatment details included conjunctival/corneal tumor excision (n = 6), plaque brachytherapy (n = 3; 1 primary, 2 adjuvant) and extended enucleation (n = 1). One patient had tumor recurrence 18 months after OSSN treatment, which was treated with wide excisional biopsy. All patients are alive and free of disease over a mean follow-up period of 37 months (median, 37 months; range, 4 to 65 months).Conclusion: XP patients undergoing keratoplasty can develop OSSN several months to years after keratoplasty and require close follow-up for the same. Wide excisional biopsy with/without plaque radiotherapy is effective in the management of pk-OSSN.
Assuntos
Carcinoma de Células Escamosas/etiologia , Neoplasias da Túnica Conjuntiva/etiologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Ceratoplastia Penetrante/efeitos adversos , Complicações Pós-Operatórias , Xeroderma Pigmentoso/complicações , Adolescente , Adulto , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Criança , Neoplasias da Túnica Conjuntiva/diagnóstico , Neoplasias da Túnica Conjuntiva/cirurgia , Doenças da Córnea/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
Purpose: To evaluate the current practice patterns in the treatment of thyroid eye disease (TED) in Indian subcontinent through a web-based survey of members of Oculoplastics Association of India (OPAI). Methods: This was an online web-based questionnaire survey disseminated via monkeysurvey.com to all ratified active members of OPAI between May 1, 2016 and June 30, 2016. Questions encompassed the background, training, region, and experience of oculoplastic surgeons along with the management protocol of TED. Results: Of the 435 emails sent to OPAI members, 9 bounced and 180 (42.3%) responded within the study period. A large majority (96%) of respondents were oculoplastic surgeons practicing in India and the remaining practiced within South-East Asia. Two-thirds of respondents were oculoplastic surgeons with less than 10 years of clinical experience; 82% were fellowship trained in Oculoplasty. Almost all (99%) favored a multidisciplinary management of TED. A large majority routinely grade the severity (89%) and activity (87%) of disease before management. While corticosteroid remained the treatment of choice, 54% preferred immune-modulators as the second-line of therapy for recalcitrant TED. Three-quarters did not use orbital radiotherapy as a management modality in active TED owing to concerns over its efficacy and/or safety. Conclusion: The survey gives useful insights to the practice patterns of TED management in Indian subcontinent. Multidisciplinary approach and grading of disease severity and activity were the rule rather than exception among OPAI members. Immune modulation was the preferred steroid-sparing agent in recalcitrant disease. Orbital radiotherapy was an uncommon treatment choice.
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Oftalmopatia de Graves , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/epidemiologia , Oftalmopatia de Graves/terapia , Humanos , Índia/epidemiologia , Internet , Inquéritos e QuestionáriosRESUMO
Koebner phenomenon is the development of isomorphic pathologic lesions on a wound of a patient with preexisting cutaneous disease, most commonly psoriasis. An elderly male with palmoplantar psoriasis developed periocular psoriasis in the form of blepharitis and conjunctivitis following an external dacryocystorhinostomy as a manifestation of Koebner phenomenon. Immediate diagnosis and treatment with topical steroids led to complete recovery. Thus, the authors report the first case of Koebner phenomenon in ophthalmic literature, with a review of previously published postsurgical cases of Koebnerization in psoriasis patients. All surgeons should be aware of its existence and warn susceptible patients regarding its occurrence.
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Blefarite/etiologia , Cicatriz/complicações , Conjuntivite/etiologia , Dacriocistorinostomia/efeitos adversos , Psoríase/complicações , Idoso de 80 Anos ou mais , Humanos , MasculinoRESUMO
Canalicular papillomatosis is a rare disorder characterized by a mass lesion arising from the epithelium as a stalk from one of the canalicular walls. Traditionally, they have been treated with an open canaliculotomy and excision biopsy with or without additional cryotherapy. A patient with upper canalicular squamous papillomas treated with dacryoendoscopy-guided transcanalicular intralesional and topical interferon alpha 2b is presented, and the ineffectiveness of interferons in this case is discussed.
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Quimioterapia Assistida por Computador/métodos , Endoscopia/métodos , Neoplasias Oculares/tratamento farmacológico , Aumento da Imagem/métodos , Interferon-alfa/administração & dosagem , Aparelho Lacrimal/patologia , Papiloma/tratamento farmacológico , Neoplasias Oculares/diagnóstico , Seguimentos , Humanos , Injeções Intralesionais , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Papiloma/diagnóstico , Proteínas Recombinantes/administração & dosagemRESUMO
PURPOSE: The aim is to compare the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN DCR) with external DCR (EXT-DCR) in the treatment of nasolacrimal duct obstruction (NLDO) in children. METHODS: A retrospective, comparative chart analysis of all consecutive children <16 years after EXT-DCR or NEN-DCR between June 2012 and February 2016. RESULTS: Seventy-one children (79 eyes) underwent DCR in the study, of which 37 children (40 eyes) underwent EXT-DCR and 34 (39 eyes) NEN-DCR. Mean age of both groups (8.7 vs. 7.7 years) was comparable. Etiologically, persistent congenital NLDO was the most common indication (50% vs. 72%), followed by acquired and secondary NLDO. Mean duration was shorter for NEN-DCR (47 vs. 37 min; P = 0.0021). Mitomycin C 0.04% was used more often in NEN-DCR (10% vs. 56.41%). Success after primary EXT-DCR was 100% as compared to 75% for primary NEN-DCR at median follow-up of 12 and 16 months respectively. At revision, the main cause of failure was granuloma (60%). After revision, all eyes were symptom-free at a median follow-up of 9.5 months. CONCLUSION: Primary NEN-DCR has a poorer outcome than EXT-DCR in the treatment of NLDO in children and is more likely to need a revision procedure.
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Dacriocistorinostomia/métodos , Obstrução dos Ductos Lacrimais/diagnóstico , Ducto Nasolacrimal/cirurgia , Adolescente , Criança , Endoscopia , Feminino , Seguimentos , Humanos , Masculino , Ducto Nasolacrimal/diagnóstico por imagem , Nariz , Estudos Retrospectivos , Resultado do TratamentoRESUMO
To determine the factors predictive of outcome in canalicular laceration repair at a tertiary eye care centre. A retrospective review of the medical records of all primary canalicular laceration repairs managed at a tertiary eye care centre between the years 2006 and 2014 was done. Thirty-nine patients were included and majority were male (79.5%) with a mean age of 30.05 + 16.2 years (range 2-65). Most (n = 34) had monocanalicular laceration and 5 had bicanalicular laceration. All surgeries were done in the operating room setting. Overall patency by irrigation was seen in 74.4% at a median follow-up of 19.89 weeks (range 21-910). Anatomical outcome was different among the stents and best after Mini-Monoka monocanalicular stent (17/19; 89.5%) followed by bicanalicular annular stents (n = 6; 60%) and 20G Silicone rod (8/14, 57%). The factors predictive of poor outcome were related to the mode of injury [road traffic accidents; Hazard ratio (HR)19.57; p = 0.048] and the type of stent [20G silicone rod (HR 35.7; C.I 3.04 - 419.14; p = 0.004)] by multivariate analysis. Skill of the surgeon was critical as the outcome for fellows-in-training showed a trend towards failure (HR 6.66, p = 0.07). Complications included stent extrusion (n = 28.2%), punctal granuloma (n = 5.1%) and stent exposure (n = 2.5%). The mode of injury - road traffic accidents and type of stent - 20 G silicone rod were risk factors predictive of poorer outcome after canalicular laceration repair. Individual skill of operating surgeon may be a critical factor suggesting a review of training protocols.
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Traumatismos Oculares/cirurgia , Lacerações/cirurgia , Doenças do Aparelho Lacrimal/cirurgia , Aparelho Lacrimal/lesões , Procedimentos Cirúrgicos Oftalmológicos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Traumatismos Oculares/diagnóstico , Feminino , Humanos , Lacerações/diagnóstico , Doenças do Aparelho Lacrimal/diagnóstico , Masculino , Pessoa de Meia-Idade , Oftalmologia , Estudos Retrospectivos , Stents , Centros de Atenção Terciária , Irrigação Terapêutica , Resultado do TratamentoRESUMO
Postoperative blindness after orbital surgery is an extremely rare and a disastrous complication. Ophthalmic artery occlusion as a cause of such unexpected vision loss has not been documented in literature. The authors report a case of a middle aged man who developed sudden vision loss due to ophthalmic artery occlusion following transconjunctival excision of orbital schwanomma. The possible mechanisms contributing to the loss of vision are discussed and preventive strategies are suggested to reduce the incidence of this complication.
Assuntos
Arteriopatias Oclusivas/etiologia , Túnica Conjuntiva/cirurgia , Artéria Oftálmica , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Órbita/cirurgia , Neoplasias Orbitárias/cirurgia , Complicações Pós-Operatórias , Adulto , Arteriopatias Oclusivas/diagnóstico , Humanos , Masculino , Procedimentos Cirúrgicos Oftalmológicos/métodos , Neoplasias Orbitárias/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Conventional treatment for acute dacryocystitis consists of medical management followed by elective delayed external dacryocystorhinostomy (EXT-DCR). The purpose of this study was to compare the outcome after primary nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR) versus conventional treatment in acute dacryocystitis. METHODS: Retrospective chart analysis of all consecutive patients of acute dacryocystitis presenting between 2011 and 2015 was performed. Group A had patients who underwent primary NEN-DCR within 2 weeks of presentation. Group B comprised age- and gender-matched patients who received conventional treatment. RESULTS: Forty-six patients were included with 23 patients in each group. Mean age (45.2 ± 14.7 vs. 47.5 ± 14 years) and gender distribution (women 17/23 in group A vs. 15/23 in group B) in both groups were comparable. Mean duration from presentation to surgery was 7.82 ± 4.65 days for group A versus 27.3 ± 12 days for group B (p = 0.00001, independent T test). Mean time for complete resolution of symptoms was 21.4 ± 6 days for group A versus 38.69 ± 15.8 for group B (p = 0.000014, independent T test). Mitomycin-C usage (0.04%; 17 vs. 14) and mean follow up of both groups (6.4 vs. 5.7 months) were comparable. While functional success was similar (20/23) in both, anatomical success was seen in 22/23 and 21/23 in groups A and B, respectively. Complications included disfiguring scar in 4, recurrent acute dacryocystitis in 3, and punctal ectropion in one patient in the EXT-DCR group. CONCLUSIONS: Primary NEN-DCR leads to faster resolution facilitating earlier rehabilitation with comparable anatomical and functional outcomes compared with conventional delayed EXT-DCR in acute dacryocystitis.
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Dacriocistite/cirurgia , Dacriocistorinostomia/métodos , Ducto Nasolacrimal/cirurgia , Doença Aguda , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to compare the characteristics of the ostium after external dacryocystorhinostomy and nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR). METHODS: This cross-sectional study included patients who underwent a successful external dacryocystorhinostomy or NEN-DCR and had ≥1 month follow up. Pictures of the ostium were captured with a nasal endoscope (4 mm, 30°) after inserting a lacrimal probe premarked at 2 mm. Image analyses were performed using Image J and Contour softwares. RESULTS: Of the 113 patients included, external dacryocystorhinostomy group had 53 patients and NEN-DCR group had 60 patients. The mean age of patients in the NEN-DCR group (38 years) was significantly (p < 0.05) lower than the external dacryocystorhinostomy group (50 years). There was no statistically significant difference (2 sample t test, p > 0.05) in mean follow up (6 vs. 4 months), maximum diameter of ostium (8 vs. 7 mm), perpendicular drawn to it (4 vs. 4 mm), area of ostium (43 vs. 36 mm), and the minimum distance between common internal punctum and edge of the ostium (1 vs. 1 mm) between the external and NEN-DCR groups. CONCLUSIONS: Image processing softwares offer simple and objective method to measure the ostium. While ostia are comparable in size, their relative position differs with posteriorly placed ostia in external compared with inferior in NEN-DCR.
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Dacriocistorinostomia/métodos , Processamento de Imagem Assistida por Computador/métodos , Obstrução dos Ductos Lacrimais/diagnóstico , Ducto Nasolacrimal/diagnóstico por imagem , Software , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/cirurgia , Nariz , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
Second primary tumor (SPT) is defined as a second tumor that presents either simultaneously or after the diagnosis of an index tumor. Second primary malignancies are the leading cause of death in patients with heritable retinoblastoma (RB). Acute lymphoblastic leukemia (ALL), as SPT in RB patients, is extremely rare. To the best of our knowledge, only five cases of ALL as SPT in patients with RB has been documented in the literature. Herein, we report a case of a 6-year-old girl with bilateral RB, who developed ALL during the course of treatment of RB. This case highlights the importance of reviewing blood investigations regularly to diagnose leukemia as SPT in RB and also the necessity for proper counseling and lifelong follow-up in these patients.
RESUMO
AIMS: To evaluate the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR) in patients with nasolacrimal duct obstruction (NLDO) in India. METHODS: Retrospective case series of NEN-DCR between July 2012 and October 2014. All patients had follow-up >3 months. Success was defined anatomically as patency on irrigation and functionally as relief from epiphora. STATISTICAL ANALYSIS USED: Fischer's exact test and Chi-square test. RESULTS: A total of 122 patients (134 eyes; 81 female; mean age 37 ± 18 years) were included. Indications were primary acquired NLDO in 92 (68%) eyes of adults (>18 years), NLDO in children (<18 years) in 22 eyes (16%), acute dacryocystitis in 13 eyes, failed prior DCR in six eyes, and secondary acquired NLDO in one eye. Mean duration of surgery was 36 min (range: 16-92). At a median follow-up of 6 months (range: 3-15), 86% eyes had functional success and 85% had anatomical success. Revision NEN-DCR was successful in 13/16 eyes. All patients with acute dacryocystitis were completely symptom-free at final visit. In children, (17/22) 77% achieved functional success after primary NEN-DCR which improved to 100% after one revision. Tube-related epiphora and granuloma in ten eyes resolved after removal. CONCLUSION: NEN-DCR gives good outcome in primary NLDO and is also effective in those with acute dacryocystitis and in children with NLDO. The technique obviates the need for an endoscope and has an acceptable safety profile and thus may be particularly suited for the developing nations.
Assuntos
Dacriocistorinostomia/métodos , Ducto Nasolacrimal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Nariz , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
AIM: To study the incidence of nasolacrimal duct probing-induced bacteremia using the metabolic colorimetric sensor technique of blood culture. METHODS: Prospective, interventional study of all consecutive patients who underwent endoscopic-guided probing for congenital nasolacrimal duct obstruction (CNLDO). All patients were operated by a single surgeon (MJA). Blood was drawn under strict aseptic conditions before and after probing. Blood culture was performed using the BacT/ALERT microbial detection system and the protocols were followed as per the manufacturer and Clinical and Laboratory Standard Institute guidelines. Probing induced bacteremia was defined as a negative pre-probing culture and a positive post-probing culture. RESULTS: Thirty-one eyes of 25 consecutive patients with CNLDO who underwent probing were studied. The mean age at probing was 27 months. All patients presented with epiphora and occasional discharge. One patient presented with unilateral dacryocele along with an acute dacryocystitis. All the pre and post-probing cultures were negative except for the one with acute dacryocystitis. The subsequent subcultures and identification by VITEK 2 system revealed the bacteremia to be caused by Haemophilus influenzae. CONCLUSION: Nasolacrimal duct probing does not induce bacteremia in routine CNLDO cases unless there is an associated acute dacryocystitis. Preoperative antibiotic prophylaxis is perhaps not needed for systemically healthy CNLDO patients without an acute dacryocystitis. However, with regards to infantile acute dacryocystitis, further evidence is needed to formulate guidelines on additional preoperative antibiotic prophylaxis other than the routine treatment of infection.
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Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Bacteriemia/microbiologia , Dacriocistorinostomia/efeitos adversos , Infecções Oculares Bacterianas/microbiologia , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/isolamento & purificação , Bacteriemia/epidemiologia , Bacteriemia/prevenção & controle , Técnicas Bacteriológicas , Criança , Pré-Escolar , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/prevenção & controle , Feminino , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/prevenção & controle , Humanos , Incidência , Lactente , Aparelho Lacrimal , Obstrução dos Ductos Lacrimais/congênito , Obstrução dos Ductos Lacrimais/terapia , Masculino , Cuidados Pré-Operatórios , Estudos ProspectivosRESUMO
PURPOSE: To report the anatomical and cosmetic outcome of transconjunctival dacryocystorhinostomy (TDCR) in an Asian Indian population. METHODS: TDCR was initially performed in cadaver eyes followed by patients with primary acquired nasolacrimal duct obstruction (NLDO). This was a prospective noncomparative case series of all consecutive TDCRs performed between April 2013 and June 2015. Outcome measures were anatomical patency, epiphora, presence of diplopia, aesthetic outcome, and health status. RESULTS: A total of 17 (18 eyes) patients with a mean age 43.9 ± 11.8 years (range, 32-75) were included in the study. Eight were males, and one patient underwent TDCR in both eyes. TDCR was successfully performed in 15/18 (82%) eyes under local anesthesia. Procedure converted to transcutaneous external DCR in two and dacryocystectomy in one patient each. Mean duration of surgery was 52.6 (range, 29-110) min. Anatomical patency and relief from epiphora was achieved in all (15/15) eyes after TDCR at a median follow-up of 15.5 months. At final follow-up, objective assessment of the cosmetic outcome graded the surgical scar at the lateral canthus as invisible in all except one and conjunctival fornix as visible only after eyelid eversion in all patients. Disturbance of the medial fat pad was not seen in any patient. A questionnaire-based health status evaluation showed marked improvement in anxiety/depression before and after TDCR with an overall well-being score of 88 on a scale of 0-100 (worst-best) after TDCR. CONCLUSIONS: TDCR offers a promising aesthetic approach in patients with primary acquired NLDO and gives excellent functional and cosmetic outcome.
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Túnica Conjuntiva/cirurgia , Dacriocistorinostomia/métodos , Endoscopia/métodos , Obstrução dos Ductos Lacrimais/psicologia , Ducto Nasolacrimal/cirurgia , Satisfação do Paciente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: The purpose of this study is to report the time taken for superior osteotomy and complications during this step in primary powered endoscopic dacryocystorhinostomy (PEnDCR) using the piezoelectric system and mechanical burr. METHODS: This prospective interventional comparative series was performed on all consecutive patients who underwent a primary PEnDCR over a 4-month period. The surgery was performed as per standard protocols and all patients were operated on by a single surgeon (M.J.A.). Parameters documented were demographic data, type of powered instrument used, time taken for superior osteotomy, exposure of the agger nasi, exposure of entire sac, and complications such as excess bleeding, soft tissue injury, or mucosal burns. Statistical analyses were performed using the linear mixed-effect model and 2-sample t tests. RESULTS: A total of 55 PEnDCRs were studied, 29 in the mechanical burr group and 26 in the piezoelectric or ultrasonic group. The mean time for superior osteotomy in the mechanical burr group was 3.71 minutes (range, 1.75 to 6.58 minutes); in the ultrasonic group it was 4.12 minutes (range, 1.33 to 6.25 minutes). There was no significant difference (p = 0.17) between the 2 groups. Subcategory analyses of time taken by age (p = 0.057) and sex (p = 0.56) did not show any difference between the groups. Two patients in the mechanical burr group had an insignificant superficial sac injury and 1 patient in the ultrasonic group suffered epithelial burns away from the site of osteotomy, which resolved spontaneously without any sequelae. There was no excess bleeding in any of the groups. CONCLUSION: The time taken by mechanical burr and piezoelectric system are comparable for superior osteotomy in PEnDCR. If anatomical boundaries are respected, their use appears to be safe without major complications.
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Dacriocistorinostomia/métodos , Endoscopia/métodos , Obstrução Nasal/cirurgia , Osteotomia/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/cirurgia , Duração da Cirurgia , Estudos Prospectivos , Terapia por Ultrassom/métodos , Adulto JovemRESUMO
Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery.
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Falha de Equipamento , Complicações Intraoperatórias , Facoemulsificação/instrumentação , Análise de Falha de Equipamento , Feminino , Humanos , Microscopia Eletrônica , Pessoa de Meia-Idade , Facoemulsificação/métodos , TitânioRESUMO
Hemorrhage into the crystalline lens is exceedingly rare but has been described following ocular trauma [1, 2], glaucoma surgery [3-5], laser iridotomy [6], pediatric cataract surgery [7], and also in the absence of an obvious pathology [8]. We describe a case of intra- and retro-lenticular organised bleed which presented 9 years following repair of open globe injury and which was treated using fugo blade-assisted lens aspiration. The fugo blade provided adequate endocoagulation of retrolenticular blood during posterior capsulotomy and prevented undue anterior segment hemorrhage.
Assuntos
Capsulorrexe/instrumentação , Hemorragia Ocular/cirurgia , Ferimentos Oculares Penetrantes/cirurgia , Cápsula do Cristalino/cirurgia , Cristalino/irrigação sanguínea , Adolescente , Hemorragia Ocular/diagnóstico , Hemorragia Ocular/etiologia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/patologia , Humanos , Cápsula do Cristalino/lesões , Cristalino/lesões , Cristalino/cirurgia , MasculinoRESUMO
Recent studies document that the zona pellucida matrix of human oocytes is composed of four glycoproteins designated as ZP1, ZP2, ZP3, and ZP4 instead of three as proposed in mouse model. In the present study, investigations were carried out to find the presence of the fourth ZP glycoprotein in the ovaries of non-human primates namely bonnet monkey (Macaca radiata). Employing total RNA isolated from bonnet monkey ovaries, the complementary deoxyribonucleic acid (cDNA) encoding bonnet monkey ZP1 (up to furin cleavage site) was successfully amplified by reverse transcribed polymerase chain reaction (RT-PCR). The deduced amino acid (aa) sequence of bonnet monkey ZP1 revealed 96.0% identity with human ZP1. The 21 cysteine residues present in bonnet monkey ZP1 were conserved in human, mouse, rat, quail, and chicken. Simultaneously, polyclonal antibodies were generated in mice against synthetic peptides corresponding to human ZP1 (P1, 137-150 aa; P2, 223-235 aa; P3, 237-251 aa; P4, 413-432 aa; and P5, 433-451 aa). Employing anti-peptide antibodies that were devoid of cross-reactivity as determined by ELISA with human/bonnet monkey recombinant ZP2, ZP3, and ZP4, the presence of ZP1 in the ovaries of bonnet monkey and human oocytes was demonstrated by indirect immunofluorescence. The antibodies against peptides P3 and P4 reacted only with the ZP of bonnet monkey ovaries and not other ovarian associated cells. The data presented in this manuscript provide evidence, for the first time, that the bonnet monkey ZP matrix is composed of four glycoproteins.