Laceração de canalículo lacrimal em centro de referência do centro-oeste paulista / Lacrimal canaliculus laceration in a reference center in the Center-West of the state of São Paulo

RESUMO Objetivo: Descrever as características clínico-epidemiológicas, técnicas cirúrgicas e resultado do tratamento das lacerações canaliculares operadas em nosso serviço. Métodos: Estudo retrospectivo, realizado de janeiro de 2012 a junho de 2020, considerando-se as lesões de canalículo lacrimal operadas em um serviço de referência. Dados demográficos, características das lesões, detalhes das cirurgias e resultado do tratamento foram obtidos de prontuários eletrônicos e analisados estatisticamente. Resultados: Foram incluídos 26 portadores de lesões canaliculares, com idade entre 2 e 71 anos, sendo 73,1% homens. A lesão acometia o canalículo superior em 53,9%; 80,8% pacientes procuraram pelo serviço nas primeiras 24 horas, e 46,2% tiveram a cirurgia realizada entre 24 e 72 horas após o traumatismo. Todos os pacientes tiveram intubação mono ou bicanalicular, e o tempo transcorrido entre a cirurgia e a retirada do silicone, variou de zero a 183 dias. Após a cirurgia, 21 pacientes (80,8%; p<0,05) não apresentaram complicações, 2 (7,7%) evoluíram com obstrução canalicular, 2 (7,7%) com granuloma e 1 (3,8%) com ectrópio de ponto lacrimal. Conclusão: As lesões de canalículo encontradas em nossa prática são mais comuns em crianças ou homens jovens, acometem mais o canalículo superior e as nossas condutas levam a sucesso no tratamento na maior parte dos casos. As grandes controvérsias no assunto persistem, como o tipo e o tempo de permanência do tubo de silicone na via lacrimal. Somente estudos com grandes amostras podem consolidar esses conceitos.

ABSTRACT Objective: To describe the clinical and epidemiological characteristics, surgical techniques, and results of the canalicular laceration treatment at our service. Methods: A retrospective study was carried out from January 2012 to June 2020, considering canalicular injuries operated at a reference center. Demographic data, lesion characteristics, surgical details, and treatment outcomes were obtained from electronic medical records and were statistically analyzed. Results: Twenty-six cases of people with canalicular lesions aged between 2 to 71 years old were included, of whom 73.1% were men. The superior canaliculus was affected in 53.9%; 80.8% of patients searched for care within the first 24 hours, and 46.2% had the surgery performed between 24-72 hours after trauma. All patients had mono or bicanalicular intubation and the time elapsed between surgery and silicone removal ranged from 0 to 183 days. After surgery, 21 patients (80.8%, p<0.05) did not present any complications, two (7.7%) evolved with canalicular obstruction, two (7.7%) with granuloma, and one (3.8 %) with lacrimal puncta ectropion. Conclusion: In our practice, canalicular injuries are more common in children or young men, affecting mainly the superior canaliculus, and treatment success using our approach can be achieved in most of the cases. However, great controversies remain on the subject, such as type of intubation and when to remove the silicone tube from the lacrimal pathway. Larger series are required to consolidate controversial concepts.

Topical cyclosporine A 0. 05% before and after surgery to prevent pterygium recurrence / Ciclosporina A 0, 05% antes e após a cirurgia do pterígio para a prevenção da recorrência

ABSTRACT Purpose: We evaluated the role of the conjunctival flap rotation technique using 5-fluorouracil and adjuvant therapy with topical cyclosporine A at 0.05% during short pre- and postoperative periods for the prevention of primary pterygium recurrence. Methods: In this prospective study, 76 patients with primary pterygium (76 eyes) were categorized into two groups: the control group with 31 patients who did not receive cyclosporine treatment, and the cyclosporine group with 45 patients who received topical cyclosporine A (0.05%) twice a day, for 10 days before and 10 days after the pterygium excision operations. Patients were examined for disease recurrence, side effects, and complications at 10 and 21 days, and at 2 and 6 months after the operation. Data on demography, systemic diseases, and ophthalmologic histories were obtained from all patients, and these data were analyzed using descriptive statistics involving the absolute and relative percentages of frequency distribution. Goodman test was used for contrasts among multinomial populations to study the association between cyclosporine A and recurrence. Results: Most patients were between 30 and 60 years of age, and 67.1% were women. We confirmed a higher recurrence in patients with occupational sunlight exposure. The cyclosporine A used topically 10 days before and 10 days after the pterygium removal did not significantly reduce the recurrence of the pterygium. Conclusion: Topical 0.05% cyclosporine A when used for 10 days before and 10 days after the pterygium removal does not prevent or reduce the recurrence of primary pterygium.

RESUMO Objetivo: Avaliamos os resultados da técnica de rotação de retalho conjuntival com uso de 5-fluorouracil e terapia adjuvante com ciclosporina A tópica a 0,05%, usada no pré e pós-operatório por curto período, quanto à prevenção da recidiva do pterígio primário Métodos: Estudo prospectivo, com 76 pacientes portadores de pterígio primário (76 olhos), divididos em dois grupos: controle com 31 pacientes que não receberam tratamento com ciclosporina e grupo ciclosporina com 45 pacientes que receberam ciclosporina tópica A (0,05%) duas vezes ao dia, por 10 dias antes e 10 dias após a cirurgia de excisão do pterígio. Os pacientes foram avaliados quanto à recorrência, efeitos colaterais e complicações com 10, 21 dias, 2 e 6 meses de pós-operatório. Dados demográficos, doenças sistêmicas e histórico oftalmológico foram coletados de todos os pacientes e esses dados foram analisados por meio de estatística descritiva envolvendo o percentual absoluto e relativo de distribuição de frequência. O teste de Goodman para contrastes entre populações multinomiais foi utilizado para o estudo da associação entre a ciclosporina A e a recorrência Resultados: A maioria dos pacientes tinha entre 30 e 60 anos e 67,1% eram mulheres. Confirmamos uma maior recorrência em pacientes com exposição ocupacional ao sol. A ciclosporina A tópica utilizada 10 dias antes e 10 dias após a remoção do pterígio não reduziu significativamente a sua recorrência Conclusão: A ciclosporina A tópica a 0,05% quando utilizada por 10 dias no pré e 10 dias no pós-operatório, não previne ou reduz a recidiva do pterígio primário significativamente.

Barriers between community screening for visual problems and treatments in a tertiary center

ABSTRACT OBJECTIVE To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.

"Transorbitario" foreign body after ATV accident / Corpo estranho "transorbitário" após acidente com quadriciclo

Abstract This report aims to show an unusual case of "transorbitário" wooden foreign body causing visual loss due to optic nerve damage on the side contralateral penetration of foreign matter.

Resumo O presente relato tem o objetivo de mostrar um caso incomum de corpo estranho de madeira "transorbitário" que causou perda visual por lesão do nervo óptico do lado contralateral a penetração do corpo estranho.

Exenteração orbitária: série de casos / Orbital Exenteration: a series of cases

RESUMO Objetivo: Descrever os casos de exenteração orbitária de um hospital terciário brasileiro. Métodos: Estudo retrospectivo, envolvendo pacientes submetidos à exenteração orbitária no Hospital das Clínicas da Faculdade de Medicina de Botucatu, entre os anos de 1993 a 2016. As cirurgias foram realizadas sob anestesia geral, por equipe multidisciplinar composta por oftalmologistas, otorrinolaringologistas e cirurgiões de cabeça e pescoço. Resultados: Foram estudados 14 casos de exenteração orbitária, com média de idade de 63,36 ± 13,18 anos e nove homens (64,3%). Todas cirurgias foram realizadas para tratamento de tumores malignos, sendo mais frequente o carcinoma espinocelular (7 casos - 50,0%). Os sítios primários mais frequentes foram as pálpebras (50,0%), seguida pela conjuntiva (28,6%). A maioria das cirurgias foram do tipo exenteração estendida (57,1%), com cicatrização por granulação espontânea (64,3%). A sobrevida em 1 ano foi de 78,6% e em 5 anos de 71,4%. Conclusão: O carcinoma espinocelular foi a principal causa de indicação de exenteração orbitaria, sendo as pálpebras o sítio primário mais frequente. O procedimento mais realizado foi a exenteração estendida, com a grande maioria alcançando margens livres.

ABSTRACT Objective: To describe causes of orbital exenteration in a Brazilian tertiary hospital. Methods: A retrospective study was done, involving patients submitted to orbital exenteration at the Clinical Hospital of Botucatu Medical School, between the years of 1993 to 2016. The surgeries have been performed under general anesthesia, by a multidisciplinary team, composed by ophthalmologists, otolaryngologists and head and neck surgeons. Results: Fourteen cases of orbital exenteration occurred in the period of the study, with a mean age of 63.36 ± 13.18 years and nine were men (64.3%). All exenteration were due to malignant tumors, being more frequent the squamous cell carcinoma (7 cases - 50.0%). The most common primary sites were the eyelids (50.0%) followed by the conjunctiva (28.6%). The majority of the surgeries was extended exenteration type (57.1%) and most of the reconstructions was made by spontaneous granulation (64.3%). The survivor rate in 1 year was 78,6% and in 5 years was 71.4%. Conclusion: The main cause of orbital exenteration was squamous cell carcinoma and the most frequent primary site was the eyelids. Extended exenteration was necessary for the majority of cases, most of them with free margins.

O tracoma em escolares do município de Botucatu, São Paulo, Brasil: detecção e promoção de saúde em uma doença negligenciada / Trachoma in schoolchildren of the city of Botucatu, Sao Paulo, Brazil: detection and health promotion of a neglected disease

RESUMO Objetivo: O objetivo do presente trabalho foi promover o ensino do tracoma, assim como atuar no combate esta desta importante causa de cegueira evitável. Métodos: Esta proposta foi aprovada pelo Ministério da Saúde (Programa PET - Saúde/Vigilância em Saúde), prevendo o treinamento em serviço de alunos de graduação em Medicina e Enfermagem e agentes de saúde, no município de Botucatu, São Paulo - Brasil, no ano de 2010. O treinamento abrangeu parte teórica e prática, a qual constou de estudo transversal, por amostragem aleatorizada, para estudo da prevalência do tracoma inflamatório em escolares de 1a a 4a séries do ensino público fundamental, seguindo os critérios da Organização Mundial de Saúde (OMS) e com supervisão de dois oftalmologistas com certificação para o diagnóstico clínico. Os dados obtidos foram analisados estatisticamente. A equipe foi avaliada quanto ao aprendizado. Resultados: O trabalho de campo mostrou que a prevalência de tracoma em crianças do município de Botucatu no ano de 2010 foi de 3,42%. A notificação compulsória, a pesquisa dos comunicantes, aplicação do tratamento para os afetados e o seguimento conforme padronizado aconteceu com a participação ativa da equipe. Conclusão: A prevalência do tracoma inflamatório em Botucatu no ano de 2010 foi de 3,42%. As atividades desenvolvidas pelos participantes do Programa PET - Saúde/Vigilância em Saúde - Tracoma permitiu treinamento em serviço efetivo, resultando na formação de multiplicadores, uma força adicional na luta pela eliminação do tracoma como causa de cegueira.

ABSTRACT Objective: The purpose of this study was to promote the teaching of trachoma and to act in the combat of this leading cause of preventable blindness. Methods: This proposal was approved by the Ministry of Health (PET Program - Health/Health Surveillance), predicting the service training of medicine and nursing graduate students and health workers, in Botucatu, Sao Paulo - Brazil, in 2010. The training covered theory and practice, which consisted of cross-sectional study, with a randomized sampling to study the prevalence of inflammatory trachoma in schoolchildren from first to 4th grades of public elementary schools, following the World Health Organization criteria (WHO) and the supervision of two certified ophthalmologists for clinical diagnosis.The data were statistically analyzed. The staff was evaluated for learning. Results: The fieldwork showed that the prevalence of trachoma in children of Botucatu in 2010 was 3.42%. Compulsory notification, the communicants search, the treatment application to the affected and the follow-up as standardized happened with the active participation of staff. Conclusion: The prevalence of inflammatory trachoma in Botucatu in 2010 was 3.42%.The activities developed by the participants of PET Program - Health/Health Surveillance - Trachoma allowed effective training in service, resulting in the formation of multipliers, an additional force in the fight for the elimination of trachoma as a blindness cause.