RESUMO
BACKGROUND: Immunoglobulin (Ig)G4-related disease is classified as an immune-mediated disease. The etiology of this condition has not been explained to date. Manifestations of the disease are diverse, and simultaneous involvement of multiple organs is not unusual. CASE REPORT: We report the case of a patient referred to us after multiple unsuccessful paranasal sinus operations who presented with enophthalmos and a resultant migratory keratitis with a suspected diagnosis of silent sinus syndrome. Preservation of the orbit was no longer feasible. After five years without a definitive diagnosis, we ascertained that this was a case of IgG4-related disease. DISCUSSION: IgG4-related disease represents an important element in the differential diagnosis of chronic advanced diseases of the orbit and paranasal sinuses. The diagnosis should be considered in the case of unclear disease presentations. Typical histological findings include a storiform pattern of fibrosis, vasculopathy, and tissue infiltration by IgG4 plasma cells.
Assuntos
Oftalmopatia de Graves , Doença Relacionada a Imunoglobulina G4 , Doenças dos Seios Paranasais , Diagnóstico Diferencial , Humanos , Imunoglobulina G , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doenças dos Seios Paranasais/diagnósticoRESUMO
BACKGROUND: Immunoglobulin (Ig)G4-related disease is classified as an immune-mediated disease. The etiology of this condition has not been explained to date. Manifestations of the disease are diverse, and simultaneous involvement of multiple organs is not unusual. CASE REPORT: We report the case of a patient referred to us after multiple unsuccessful paranasal sinus operations who presented with enophthalmos and a resultant migratory keratitis with a suspected diagnosis of silent sinus syndrome. Preservation of the orbit was no longer feasible. After five years without a definitive diagnosis, we ascertained that this was a case of IgG4-related disease. DISCUSSION: IgG4-related disease represents an important element in the differential diagnosis of chronic advanced diseases of the orbit and paranasal sinuses. The diagnosis should be considered in the case of unclear disease presentations. Typical histological findings include a storiform pattern of fibrosis, vasculopathy, and tissue infiltration by IgG4 plasma cells.
Assuntos
Oftalmopatia de Graves , Doenças dos Seios Paranasais , Idoso , Diagnóstico Diferencial , Oftalmopatia de Graves/diagnóstico , Humanos , Imunoglobulina G , Doença Relacionada a Imunoglobulina G4 , Masculino , Doenças dos Seios Paranasais/diagnóstico , SíndromeRESUMO
BACKGROUND: To evaluate the long-term outcome and complication rate after surgical posterior capsule polishing as an alternative to Ndâ:âYAG-Laser posterior capsulotomy in the treatment of posterior capsule opacity after cataract extraction in eyes with high risk of developing pseudophakic retinal detachment. PATIENTS AND METHODS: This retrospective study comprised 265 eyes in 234 patients (134 women, 100 men, mean age: 61 years) with posterior capsule opacity who underwent surgical posterior capsule polishing between 1997 and 2010, with a follow-up of at least 12 months. RESULTS: Surgical posterior capsule polishing was performed in 220 myopic eyes (axial length > 25 mm), in 28 eyes after retinal detachment surgery and in 17 eyes with traumatic cataract. The mean follow-up was 73 months (range: 12 to 202 months); in 206 eyes (77.8â%), follow-up was more than 3 years. The final best-corrected visual acuity (BCVA) in logMAR (mean 0.56 ± 0.63) improved significantly (p < 0.001) compared to the preoperative BCVA (mean 0.93 ± 0.72). Recurrent posterior capsule opacity occurred in 74 eyes (27.9â%) and was treated by one or more surgical posterior capsule polishing procedures. Ndâ:âYAG-Laser posterior capsulotomy was performed in 28 eyes (10.6â%) and surgical capsulectomy in 8 eyes (3.0â%). Complications after surgical posterior capsule polishing included intraoperative capsule rupture in 9 eyes (3.5â%). No postoperative endophthalmitis was observed. However, retinal detachment occurred in 6 eyes (2.3â%) 62 months after surgical posterior capsule polishing. All eyes were myopic (axial length > 25 mm) and initially vitrectomised during first retinal detachment surgery. CONCLUSIONS: Long-term outcome and complication rate indicate that surgical posterior capsule polishing is not only a more complex procedure but is also associated with a higher relapse risk than Ndâ:âYAG-Laser posterior capsulotomy in the treatment of regenerative secondary cataract. Furthermore, conserving the posterior lens capsule does not always seem to minimise the cumulative risk of developing pseudophakic retinal detachment in high risk patients.
Assuntos
Opacificação da Cápsula/cirurgia , Miopia/epidemiologia , Cápsula Posterior do Cristalino/cirurgia , Complicações Pós-Operatórias/epidemiologia , Descolamento Retiniano/epidemiologia , Opacificação da Cápsula/epidemiologia , Opacificação da Cápsula/patologia , Causalidade , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Terapia a Laser/estatística & dados numéricos , Lasers de Estado Sólido/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cápsula Posterior do Cristalino/patologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: To assess the outcome of routine trabectomy surgery in the treatment of primary (POAG) and secondary open angle glaucoma. PATIENTS/METHODS: 296 eyes of 296 patients with diagnosed open angle glaucoma and exfoliative glaucoma were analysed from June 2012 until June 2014. IOP readings (intraocular pressure) and the number of antiglaucoma medications was evaluated at every follow-up visit. For statistical analysis, 4 study cohorts were built (cohort 1 = trabectomy in POAG, cohort 2 = trabectomy in exfoliative glaucoma (PEX), cohort 3 = trabectomy + IOL in POAG, cohort 4 = trabectomy + IOL in PEX glaucoma). RESULTS: Mean IOP before trabectomy surgery was 19.8 ± 5.9 mmHg and 23.7 ± 9.5 mmHg in cohorts 1 and 2, respectively. At 1 year follow-up, IOP was reduced to normal level for cohorts 1 and 2 (14.8 ± 3.2 mmHg (p = 0.001) and 14.0 ± 3.3 mmHg (p = 0.046), respectively). The number of topical antiglaucoma medications changed to 2.1 ± 1.2 (p = 0.004) and 2.4 ± 1.2, respectively (p = 0.593) at one year follow-up, respectively, for POAG and exfoliative glaucoma. In study cohort 3 and 4, mean IOP before trabectomy surgery was 19.2 ± 4.0 mmHg and 23.2 ± 9.2 mmHg, respectively. At 1 year follow-up, IOP was reduced to normal levels in cohorts 3 and 4 (11.8 ± 3.1 mmHg (p < 0.01) and 12.6 ± 1.1 mmHg, respectively (p = 0.043)); the number of topical antiglaucoma medications changed to 2.3 ± 1.4 (p = 0.469) and 1.4 ± 0.8, respectively, (p = 0.102) at 1 year follow-up. A significant difference in IOP reduction could be demonstrated in POAG between the trabectomy + IOL group and the trabectomy cohort 1 year postoperative (p = 0.017); in the PEX trabectomy + IOL versus PEX trabectomy cohort no statistically significant difference (p = 0.678) could be demonstrated. No serious postoperative complications were recorded. CONCLUSION: Trabectomy surgery seemed to be a reliable and effective tool for the management of mild and moderate primary and secondary open angle glaucoma with uncontrolled IOP in daily routine. One year follow-up showed a significant reduction in intraocular pressure in all cohorts.
Assuntos
Síndrome de Exfoliação/diagnóstico , Síndrome de Exfoliação/cirurgia , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/cirurgia , Trabeculectomia/instrumentação , Trabeculectomia/métodos , Idoso , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
INTRODUCTION: The aim of this study was to compare the dynamic contour tonometry PASCAL® (DCT) versus the Goldmann applanation tonometry (GAT) in a glaucoma population and to analyse the correlation with the central corneal thickness (CCT). PATIENTS/METHODS: 191 eyes of 107 Caucasian glaucoma patients (62 female, 45 male) were included: 3 repeated GAT and dynamic contour tonometry (DCT) measurements (quality factor 1-2) were analysed. CCT was measured by ultrasound pachymetry. Criteria of ISO 8612 were fulfilled: 3 groups of IOP measurements were formed: group 1: 7-16 mmHg, group 2: 16-23 mmHg and group 3: > 23 mmHg, each including at least 40 eyes. Only 5.0â% outliers per area of intraocular pressure were permitted in a tolerance of ± 5.0 mmHg. RESULTS: Data of 191 eyes (mean CCT 553 µm) were analysed. GAT (19.68 mmHg ± 7.56 mmHg) showed good correlation to DCT (20.54 ± 8.21 mmHg) (r = 0.770, p < 0.001). Mean difference DCT-GAT was 0.86 ± 2.45 mmHg. In regard to the criteria of ISO 8612, the number of outliers were: group 1: (n = 68) 29.4â%, group 2: (n = 62) 41.9â%, and group 3: (n = 61) 31.2â%. No correlation was shown between CCT vs. GAT (r = 0.184, p = 0.057) and CCT vs. DCT (r = 0.177, p = 0.09), respectively. DISCUSSION: In conclusion, despite good correlation to GAT measurements DCT does not fulfil the ISO 8612 reference criteria in glaucoma patients. DCT and GAT did not show correlation to CCT.
Assuntos
Glaucoma/diagnóstico , Manometria/métodos , Manometria/normas , Hipertensão Ocular/diagnóstico , Oftalmologia/normas , Feminino , Glaucoma/complicações , Humanos , Internacionalidade , Masculino , Manometria/instrumentação , Hipertensão Ocular/etiologia , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The aim of this study was to evaluate the indication, visual and refractive outcome, endothelial cell loss and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL). PATIENTS AND METHODS: This retrospective study comprised 62 eyes of 56 patients without adequate capsular support undergoing posterior iris-claw aphakic IOL implantation (Verisyse™/Artisan®) between 2006 and 2012. Mean follow-up was 34 months (range from 13 to 78 months). RESULTS: The IOLs were inserted during primary lens surgery in 11 phakic eyes (17.8â%), during an IOL exchange procedure for dislocated posterior chamber IOLs in 34 eyes (54.8â%), and as a secondary procedure in 17 aphakic eyes (27.4â%). The final best spectacle-corrected visual acuity (BSCVA) in logMAR (mean 0.24 ± 0.45) improved significantly (p < 0.001) compared to the preoperative BSCVA (mean 0.61 ± 0.65). The mean spherical equivalent improved from preoperative 7,25 ± 5,04 diopters (D) (range -â10.25 to +â16.0 D) to -â0.21 ± 1.01 D (range - 4.0 to 3.0 D) postoperatively. Mean central endothelial cell density was 1844 ± 690 cells/mm(2) preoperatively. After surgery mean endothelial cell density decreased statistically not significant with a loss of 5.5â% to 1743 ± 721 cells/mm(2) (p > 0.05) at last follow-up visit. Complications included cystoid macular oedema in 4 eyes (6.4â%), early postoperative hypotony in 2 eyes (3.2â%), pupil ovalisation in 2 eyes (3.2â%), traumatic iris-claw IOL disenclavation in 2 eyes (3.2â%) and spontaneous IOL disenclavation in one eye (1.6â%). CONCLUSIONS: Retropupillar iris-claw IOL provides good visual and refractive outcomes with a low endothelial cell loss and can be used for a wide range of indications in eyes without adequate capsular support.
Assuntos
Perda de Células Endoteliais da Córnea/etiologia , Implante de Lente Intraocular/efeitos adversos , Lentes Intraoculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Afacia Pós-Catarata/diagnóstico , Afacia Pós-Catarata/etiologia , Afacia Pós-Catarata/cirurgia , Contagem de Células , Perda de Células Endoteliais da Córnea/diagnóstico , Endotélio Corneano/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Desenho de Prótese , Refração Ocular , Estudos Retrospectivos , Acuidade Visual , Adulto JovemRESUMO
Today MMF can be considered as standard treatment besides cyclosporin A for immunosuppression after high-risk perforating keratoplasty. The efficacy of systemic MMF for this indication has been documented in several clinical studies including multicentre designs. Whether or not MPA therapy offers further advantages is currently under discussion. Sirolimus and tacrolimus are effective but could not achieve clinical importance due to higher rates of side effects. An additional benefit of combination therapies is not proven by clinical studies up to date. Everolimus shows pre-clinically a promising immunosuppressive and antiproliferative effect. Topical preparations of immunosuppressants as monotherapy are obviously insufficient as alternatives for systemic immunosuppressive therapy. Whether or not topical combination therapies will become established as alternatives to systemic treatment has to be demonstrated in the following years.
Assuntos
Doenças da Córnea/etiologia , Doenças da Córnea/prevenção & controle , Transplante de Córnea/efeitos adversos , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Imunossupressores/administração & dosagem , Pré-Medicação/métodos , Transplante de Córnea/métodos , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this study was to investigate the influence of the anterior chamber depth (ACD) on the measurement of the optic nerve head size with OCT and HRT 3. PATIENTS AND METHODS: 100 pseudophakic eyes of 100 patients were enrolled in this prospective study. The measurement of the optic nerve head was performed with the optical coherence tomography (Stratus OCT, Carl Zeiss Meditec Inc., Dublin, CA) and the confocal laser scanning tomography (Heidelberg retina tomograph, HRT 3, Heidelberg Engineering, GmbH, Dossenheim, Germany). Bland and Altman plots were used to examine the agreement between the parameters of the two techniques. The relationship between the optic nerve head size and the ACD was analysed by linear regression. RESULTS: Optic disc size measurement with the OCT and the HRT 3 showed no significant difference (p = 0.638). Measurement of the optic disc size with the OCT was significantly correlated with the ACD (- 0.234; p = 0.016). The optic disc size decreases with increasing values of the ACD. There was no influence of the ACD on the measurement of the optic disc size with the HRT 3 (r = 0.128; p = 0.193). CONCLUSION: While the optic disc size measured by OCT decreased with increasing ACD, the measurement with the HRT 3 turned out to be independent of the ACD. The OCT may underestimate the optic disc size in lower ACD. This may result in reduced agreement between the two devices.
Assuntos
Câmara Anterior/anatomia & histologia , Microscopia Confocal/instrumentação , Microscopia Confocal/métodos , Disco Óptico/anatomia & histologia , Tomografia de Coerência Óptica/instrumentação , Tomografia de Coerência Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Artefatos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The aim of this study was to evaluate the effect of central corneal thickness (CCT) of keratoconic corneas on intraocular pressure (IOP) measurements as measured by four different techniques. PATIENTS AND METHODS: Forty-one eyes of forty-one keratoconus patients (group 1) and fifty eyes of fifty healthy subjects (group 2) were enrolled. IOP was measured with iCare, IOPen, Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). CCT was measured by ultrasonic pachymetry. These data were used for statistical analysis. RESULTS: The mean IOPs measured by GAT, DCT, iCare and IOPen were 11.4, 14.7, 10.8, and 15.7 mmHg in group 1; and 14.2, 15.4, 15.4 and 14.3 mmHg in group 2, respectively. Between both groups, there was a statistically significant difference in iCare (p < 0.001), GAT (p < 0.001) and IOPen (p = 0.040) measurements; with no difference between DCT (p = 0.266) measurements. IOPen measurements were significantly associated with CCT (r = - 0.314; p = 0.046). CONCLUSION: IOPen seemed to be affected by CCT. IOP readings by iCare, GAT and DCT were found to be independent of CCT in keratoconic corneas.
Assuntos
Córnea/diagnóstico por imagem , Córnea/fisiopatologia , Pressão Intraocular , Ceratocone/diagnóstico , Ceratocone/fisiopatologia , Manometria/métodos , Ultrassonografia/métodos , Adulto , Topografia da Córnea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The main problem of the management of suspected pleomorphic adenoma of the lacrimal gland is the safety of the preoperative diagnosis without biopsy. The current clinical standard (en bloc resection if suspected) has been questioned in this regard in recent publications. In this context we have analysed all consecutive lesions of the lacrimal gland region in our department for 5 years and evaluated pre-and intraoperative clinical and histological findings in regard to the safety of the preoperative diagnosis pleomorphic adenoma. METHODS: Retrospective analyses were performed for 93 consecutive cases of lesions of the lacrimal gland, which were resected or biopsied in the Department of Ophthalmology Charité CVK 2005 - 2009, so that a histological assessment was available. Clinical symptoms, radiological signs, histological diagnosis, therapeutic approach and results were documented. RESULTS: 65 patients had a dacryoadenitis (70 %), 5 were diagnosed with sarcoidosis (5 %), in another 5a pseudotumour of the orbit was diagnosed (5 %). Pleomorphic adenomas were found in 4 patients (4 %), 10 patients had a lymphoma (11 %), 7 of these 10 had an extranodal marginal zone lymphoma (EMZL), an adenocarcinoma was diagnosed in one patient (1 %), two patients had adenocystic carcinoma of the lacrimal gland (2 %) and another patient had a malignant mixed tumour as a consequence of an incomplete resection of pleomorphic adenoma (1 %). 8 patients were treated by an en bloc resection following the preoperative diagnosis pleomorphic adenoma. CONCLUSIONS: The majority of lesions in the lacrimal gland are inflammatory processes. The preoperative evaluation of the diagnosis pleomorphic adenoma had a sensitivity of 100 % and a specificity of 50 %.
Assuntos
Adenoma Pleomorfo/patologia , Adenoma Pleomorfo/cirurgia , Neoplasias Oculares/patologia , Neoplasias Oculares/cirurgia , Doenças do Aparelho Lacrimal/patologia , Doenças do Aparelho Lacrimal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adenoma Pleomorfo/epidemiologia , Adulto , Biópsia , Neoplasias Oculares/epidemiologia , Alemanha/epidemiologia , Humanos , Doenças do Aparelho Lacrimal/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/estatística & dados numéricos , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Cavernous hemangiomas are the most common benign neoplasms of the orbit. Options for surgical therapy are transnasal, transcranial, transantral and ophthalmological approaches. In this study we present consecutively treated hemangiomas that were resected via ophthalmological approaches in our clinic between the years 2005 and 2010. METHOD: A retrospective analysis of all patients with orbital cavernous hemangiomas of the Eye Department of Charité Campus Virchow Klinikum from 2005 to 2010. We present the surgical approach, pre- and postoperative visual acuity, eye motility, globe position and operative complications. RESULTS: From 5 / 2005 to 5 / 2010 10 histologically confirmed intraorbital hemangiomas were resected in our department.7 hemangiomas were intraconal, 3 tumours were extraconal. 4 tumours were resected via a lateral orbitotomy, and in 6 patients tumour removal was carried out via a swinging eyelid approach. In all patients, visual acuity, visual field and motility remained unchanged pre- and postoperatively. Preoperative exophthalmos resolved completely after surgery. CONCLUSION: The swinging eyelid and lateral orbitotomy techniques are appropriate surgical approaches for resection of orbital cavernous hemangiomas. The resection via these approaches can be considered as a low-risk procedure.
Assuntos
Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Blefaroplastia/métodos , Anormalidades do Olho/cirurgia , Doenças Palpebrais/cirurgia , Pálpebras/anormalidades , Pálpebras/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Medicina Baseada em Evidências , Anormalidades do Olho/diagnóstico , Doenças Palpebrais/diagnóstico , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Everolimus is a novel proliferation signal inhibitor that has potent immunosuppressive activity. As previously shown, systemic administration of the drug could effectively enhance the mean survival time (MST) of corneal allografts. Commonly, the topical application of immunomodulatory agents is preferred over systemic use, in order to reduce the side effects. PURPOSE: To investigate the efficacy of topically applied everolimus to prevent corneal graft rejection in an experimental model. METHODS: A total of 45 female Lewis rats received 3.5-mm grafts of MHCI/II incompatible Dark Agouti donors. Recipients were randomly assigned to receive either: (1) 0.05% everolimus microemulsion, (2) 0.025% everolimus microemulsion or (3) a vehicle as the control. Treatment was started on the day of surgery and applied 5 times daily. Grafts were graded every day and a rejection score was generated based on cornea clarity and oedema. RESULTS: Local administration of 0.05 or 0.025% everolimus was effective in prolonging the mean survival time of corneal grafts (MST = 21 +/- 6.57 days and 16.4 +/- 2.3 days, respectively) as compared to vehicle control group (MST = 13.3 +/- 1.7 days; p < 0.001 and p < 0.001). Real-time PCR demonstrated that topical administration of everolimus increased the mRNA levels of CD25, IL-10 and IFN-gamma, but this was significant only for IL-10 (p = 0.015). CONCLUSIONS: These data indicate that topically applied everolimus is effective in prolonging corneal allograft survival in an experimental keratoplasty model.
Assuntos
Rejeição de Enxerto/tratamento farmacológico , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/administração & dosagem , Ceratoplastia Penetrante , Sirolimo/análogos & derivados , Administração Tópica , Animais , Citocinas/genética , Modelos Animais de Doenças , Everolimo , Feminino , RNA Mensageiro/metabolismo , Ratos , Ratos Endogâmicos Lew , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sirolimo/administração & dosagem , Transplante HomólogoRESUMO
Ocular toxocariasis represents an organ manifestation of the systemic infection with the Nematode larva Toxocara canis. The infection can provoke very different changes in the eye. Especially posterior uveitis, vitreous body infiltrates, epiretinal membranes and suberetinal granulomas can occur. The diagnosis of these changes can be difficult due to the variety of the symptoms and on the other side by the absence of characteristic specific changes. Moreover unclear findings can occur when only serological examinations are performed. In unclear cases the antibody-detection by means of ELISA from the vitreous body fluid can be useful. The examination of vitreous body material can prove toxocara infection when no systemic signs of infection are present and no antibodies are detectable in the serum. Besides the systemic anti-helminthic therapy with Albendazol the pars plana vitrectomy is a substantial therapeutic option in ocular toxocariasis when vitreo-retinal complications are present. A well timed adequate therapy can stabilize the visual acuity in many cases.
Assuntos
Albendazol/administração & dosagem , Antinematódeos/administração & dosagem , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/terapia , Toxocaríase/diagnóstico , Toxocaríase/terapia , Vitrectomia/métodos , Terapia Combinada , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Uveíte/diagnóstico , Uveíte/terapiaRESUMO
PURPOSE: This report presents a procedure as an alternative to free skin grafts for reconstruction of rhomboid skin defects in the lid region. METHOD: Ten consecutively treated patients were included who had skin defects after resection of eyelid tumors such as basaliomas. The skin defects were rhomboid and had the same horizontal and vertical diameter (medium 1.5 cm) and were therefore too large for a horizontal advancement flap. The defects were closed by preparation of four triangular skin flaps that were sutured crosswise into the defect. RESULTS: The procedure was adequate for reconstruction of the defect in all ten cases. There were no lid malpositions and the cosmetic results were favorable in all cases. The medium operation time was significantly shorter in comparison to free skin grafts. CONCLUSIONS: Application of free skin grafts is a standard procedure for reconstruction of anterior lamellar lid defects. Triangular transposition flaps can be a timesaving alternative with good cosmetic results.
Assuntos
Pálpebras/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Procedimentos Cirúrgicos Oftalmológicos/métodos , Procedimentos de Cirurgia Plástica/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Anormalidades da Pele/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de PeleRESUMO
PurposeTo assess the anterior chamber (AC) characteristics and its correlation to laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption.Patients and methodsThe study included 97 cataract eyes (n=97, mean age 68.6 years) undergoing femtosecond laser-assisted cataract surgery (FLACS). Three cohorts were analysed relating to the flare photometry directly post femtosecond laser treatment (flare <100 n=28, 69.6±7 years; flare 100-249 n=47, 67.7±8 years; flare >249 photon counts per ms cohort n=22, 68.5±10 years). Flare photometry (KOWA FM-700), corneal topography (Oculus Pentacam, Germany: AC depth, volume, angle, pachymetry), axial length, pupil diameter, and endothelial cells were assessed before FLACS, immediately after femtosecond laser treatment and 1 day postoperative (LenSx Alcon, USA). Statistical data were analysed by SPSS v19.0, Inc.ResultsThe AC depth, AC volume, AC angle, central and thinnest corneal thickness showed a significant difference between flare <100 vs flare 100-249 10 min post femtosecond laser procedure (P=0.002, P=0.023, P=0.007, P=0.003, P=0.011, respectively). The AC depth, AC volume, and AC angle were significantly larger (P=0.001, P=0.007, P=0.003, respectively) in the flare <100 vs flare >249 cohort 10 min post femtosecond laser treatment.ConclusionsA flat AC, low AC volume, and a narrow AC angle were parameters associated with higher intraocular inflammation. These criteria could be used for patient selection in FLACS to reduce postoperative intraocular inflammation.
Assuntos
Câmara Anterior/patologia , Extração de Catarata/métodos , Terapia a Laser/métodos , Fotometria/métodos , Idoso , Câmara Anterior/metabolismo , Barreira Hematoaquosa/fisiologia , Capsulorrexe , Proteínas do Olho/metabolismo , Humanos , Fótons , Projetos Piloto , Estudos ProspectivosRESUMO
PURPOSE: To assess the outcome of trabectome surgery in the treatment of glaucomatocyclitic crisis (Posner-Schlossman syndrome) in patients with uncontrolled intraocular pressure (IOP). PATIENTS/METHODS: Trabectome surgery was performed in seven patients with diagnosed glaucomatocyclitic crisis and uncontrolled IOP where cytomegalovirus DNA was verified by polymerase chain reaction in aqueous humour samples. All patients were treated with oral valganciclovir. After surgery the patients were followed-up for 12 months. RESULTS: Mean IOP before trabectome surgery was 40±10 mm Hg (range 33-58 mm Hg). The mean number of antiglaucoma medication prior to surgery was 3.1±0.4. By the end of the 12 months, IOP in all patients was reduced to normal level (13±1 mm Hg) and their antiglaucoma medication was decreased to 0.8±1.1. No recurring attack of glaucomatocyclitic crisis occurred. DISCUSSION: In addition to oral valganciclovir therapy, trabectome surgery seems to be a reliable and effective tool for the management of glaucomatocyclitic crisis with uncontrolled IOP.