RESUMO
PURPOSE: To study the hypothesis that in normal patients, changes in eyelid elasticity may occur asymmetrically and in relation to the side on which the individual sleeps. DESIGN: Prospective, consecutive, single-center study within a large, tertiary-referral ophthalmology department within a university hospital. METHODS: This prospective study was carried out consecutively on 262 normal patients. The 3 inclusion criteria were 1) age≥55 years, 2) absence of facial nerve palsy, and 3) absence of eyelid trauma or surgery. Immediately before the ocular plastic surgeon assessed the patient, each patient was questioned in a separate consulting room by the attending orthoptist as to his or her customary side of sleeping. After detailed explanation, the "history-masked" ocular plastic surgeon then assessed the patient's upper eyelid laxity, the main outcome measurement. This was performed by asking the seated patient to look down and then gently grasping the upper eyelids close to the eyelid margin, just medial to the lateral commissure. The ocular plastic surgeon, with thumbs pronated, simultaneously distracted both upper eyelids superiorly, laterally, and anteriorly. The measured separation of the upper eyelid from the globe conjunctiva was obtained using calipers. Eyelid laxity grading was designated as grade 1: 0 to 1.9 mm; grade 2: 2.0 to 3.9 mm; grade 3: 4 to 9 mm; and grade 4: floppy. RESULTS: Two hundred sixty-two patients (58% females) who consecutively satisfied the selection criteria were evaluated, of which 70.22% (183/262) patients had significantly greater laxity of the upper eyelid that corresponded to the side on which they customarily slept. An unpaired t test used to compare the eyelid laxity between the sleeping side and nonsleeping side was statistically significant (p<0.001). CONCLUSION: Normal patients demonstrate a correlation between the side on which they historically or customarily sleep and the laxity of their ipsilateral upper eyelid.
Assuntos
Pálpebras/fisiopatologia , Lateralidade Funcional/fisiologia , Hipotonia Muscular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Sono/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
PURPOSE: To report 2 patients with apocrine adenocarcinoma of the eyelid and review the literature. DESIGN: Noncomparative, retrospective case series and review. PARTICIPANTS: Clinical data of 2 patients with histopathologic diagnoses of apocrine adenocarcinoma of the eyelid were obtained from medical records. The histopathology and immunohistochemistry data for the 2 cases were studied. A retrospective review was performed on all reported cases of eyelid apocrine carcinoma. MAIN OUTCOME MEASURES: Clinical features, histopathology, immunohistochemistry, and clinical course following treatment are reported. The results of a retrospective review of clinical presentations, local and systemic spread, treatment method, and prognosis from published case reports on eyelid apocrine adenocarcinoma are discussed. RESULTS: One patient had orbital invasion at presentation. This patient had radiotherapy alone and had no systemic or local recurrence at 2 years. One patient underwent a 4-mm margin wide surgical excision. This patient had no local or systemic recurrences at 1 year. A review of the literature suggests that the prognosis of adnexal apocrine tumors is indeterminate and variable. Most patients have successful outcomes following local surgical excision. Radiotherapy has been used as an adjunctive treatment for local metastatic disease. CONCLUSIONS: Apocrine adenocarcinoma is a rare adnexal tumor of the eyelid, which may present with orbital invasion.
Assuntos
Adenocarcinoma/patologia , Glândulas Apócrinas/patologia , Neoplasias Palpebrais/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adenocarcinoma/terapia , Idoso de 80 Anos ou mais , Neoplasias Palpebrais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias das Glândulas Sudoríparas/terapiaRESUMO
PURPOSE: The purpose of this study was to identify phenotypic markers of human limbal stem cells in fetal and adult corneas. METHODS: RNA from microscopically dissected superficial limbal and central fetal (18 weeks) corneas was amplified and used to generate P(32)-labeled, reverse-transcribed antisense RNA that was linearly amplified and hybridized to a focused stem cell cDNA microarray. Differential gene expression of fetal limbus was compared with the expression of central cornea. Microarray differential expression experiments were performed on P63-expressing primary cultured limbal epithelial cells (passage 1; Pa1) and primary cells passaged 5 times (Pa5). Semiquantitative RT-PCR assay and immunohistochemistry were performed on fetal and adult corneas and cultured primary limbal epithelial cells, to confirm the results of the microarray experiments. Slow-cycling (pulsed bromodeoxyuridine label-retaining) limbal epithelium in corneal organ culture was studied for the expression of four selected upregulated limbal genes. RESULTS: Of the 266 genes tested, 33 were differentially overexpressed (more than twofold) in the fetal limbus (compared with central cornea) and primary cultured limbal epithelium compared with primary cells after 5 passages. Cytokeratin 15 (CK15) and cytokeratin 14 (CK14) are expressed in limbal basal epithelium and P-cadherin (CDH3) and Wnt-4 expression was restricted to basal and immediate parabasal limbal epithelium of both the adult and fetal corneas). Bromodeoxyuridine label retaining epithelium in corneal organ culture (slow-cycling cells) expressed the four selected limbal upregulated genes. CONCLUSIONS: For the first time, a focused stem cell pathway microarray analysis has been performed on fetal cornea and cultured limbal explant epithelium. CK15, CK14, CDH3, and Wnt-4 are expressed in the basal limbal epithelial cells.
Assuntos
Células-Tronco Adultas/citologia , Biomarcadores/metabolismo , Células Epiteliais/citologia , Epitélio Corneano/embriologia , Células-Tronco Fetais/citologia , Limbo da Córnea/embriologia , Adulto , Células-Tronco Adultas/metabolismo , Técnicas de Cultura de Células , Células Epiteliais/metabolismo , Epitélio Corneano/metabolismo , Proteínas do Olho/genética , Proteínas do Olho/metabolismo , Células-Tronco Fetais/metabolismo , Perfilação da Expressão Gênica , Regulação da Expressão Gênica/fisiologia , Humanos , Técnicas Imunoenzimáticas , Técnicas de Amplificação de Ácido Nucleico , Análise de Sequência com Séries de Oligonucleotídeos , Técnicas de Cultura de Órgãos , Fenótipo , RNA/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase ReversaAssuntos
Cegueira Noturna/etiologia , Transtornos da Visão/etiologia , Campos Visuais , Deficiência de Vitamina A/diagnóstico , Comportamento Alimentar , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Cegueira Noturna/terapia , Equipe de Assistência ao Paciente , Deficiência de Vitamina A/terapia , Xeroftalmia/etiologia , Xeroftalmia/terapiaRESUMO
INTRODUCTION: Necrotising fasciitis (NF) is a severe infection of deep subcutaneous soft tissues with high morbidity and mortality. Periocular necrotising fasciitis (PONF) is a very rare condition with many unanswered questions about the presentation and management. We present a retrospective case series of patients with PONF from three centres in Australia and two in the UK to investigate the clinical and microbiological characteristics and outcomes and report on patients treated with antibiotics alone. RESULTS: Twenty-nine patients (20 men; 69%) with PONF were identified and followed up for between 2â months and 10â years (median 57, mean 52.6â months) between 1990 and 2013. Conditions associated with chronic immunocompromise were present in 16/29 (55%). Twenty-one (75%) recalled minor periocular trauma or an infected lesion, two having been assaulted by the same assailant. Systemic shock occurred in 6/29 (21%) patients and 1 died. Group A, ß-haemolytic Streptococcus was the most common bacterium identified (25/29, 86%). Intravenous antibiotics were used in all patients, and up to five tissue debridements were required to control the disease in 23/29 (74%); reconstructive surgery was required in 12/29 (41%) patients. One patient died from the disease and visual loss occurred in four eyes of four patients (14%). CONCLUSIONS: PONF has a better prognosis than disease elsewhere in the body, but is still associated with significant risk of visual loss and a small risk of death. Intravenous antibiotic treatment with cautious observation may be reasonable in selected patients with a low threshold for debridement.
Assuntos
Antibacterianos/uso terapêutico , Desbridamento/métodos , Fasciite Necrosante/terapia , Doenças Orbitárias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fasciite Necrosante/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/diagnóstico , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemAssuntos
Segmento Anterior do Olho/irrigação sanguínea , Calázio/tratamento farmacológico , Corioide/irrigação sanguínea , Isquemia/induzido quimicamente , Oclusão da Veia Retiniana/induzido quimicamente , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Humanos , Injeções Intralesionais , Doenças Vasculares/induzido quimicamenteAssuntos
Glaucoma de Ângulo Aberto/epidemiologia , Oftalmopatia de Graves/epidemiologia , Pressão Intraocular , Glaucoma de Ângulo Aberto/diagnóstico , Oftalmopatia de Graves/diagnóstico , Humanos , Irã (Geográfico)/epidemiologia , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/epidemiologia , PrevalênciaAssuntos
Calázio/terapia , Glucocorticoides/administração & dosagem , Temperatura Alta/uso terapêutico , Procedimentos Cirúrgicos Oftalmológicos , Triancinolona Acetonida/administração & dosagem , Curetagem , Glucocorticoides/uso terapêutico , Humanos , Injeções , Ensaios Clínicos Controlados Aleatórios como Assunto , Triancinolona Acetonida/uso terapêuticoAssuntos
Encefalopatias/diagnóstico , Hemianopsia/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais , Encefalopatias/complicações , Hemianopsia/etiologia , Humanos , Imageamento por Ressonância Magnética , Lobo Occipital/patologia , Estudos Retrospectivos , Testes de Campo Visual , Vias Visuais/patologiaAssuntos
Antagonistas Adrenérgicos alfa/efeitos adversos , Complicações Intraoperatórias , Doenças da Íris/induzido quimicamente , Iris/efeitos dos fármacos , Facoemulsificação/métodos , Sulfonamidas/efeitos adversos , Antagonistas de Receptores Adrenérgicos alfa 1 , Antineoplásicos/efeitos adversos , Humanos , Doenças da Íris/prevenção & controle , Masculino , Hiperplasia Prostática/tratamento farmacológico , Síndrome , TansulosinaAssuntos
Abscesso/microbiologia , Doenças Palpebrais/patologia , Transtornos Psicóticos/psicologia , Ferimentos e Lesões/complicações , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Antibacterianos/uso terapêutico , Cisto Epidérmico/patologia , Doenças Palpebrais/etiologia , Doenças Palpebrais/microbiologia , Humanos , Masculino , Órbita/diagnóstico por imagem , Ruptura/complicações , Tomógrafos Computadorizados , Resultado do Tratamento , Ferimentos e Lesões/microbiologiaRESUMO
Eye involvement in inherited epidermolysis bullosa (EB) can occur as a spectrum of symptoms and signs. This article describes these signs and symptoms. It also offers options for treatment.
Assuntos
Ambliopia/etiologia , Doenças da Córnea/etiologia , Epidermólise Bolhosa/complicações , Ambliopia/patologia , Ambliopia/terapia , Doenças da Córnea/patologia , Doenças da Córnea/terapia , Epidermólise Bolhosa/patologia , Epidermólise Bolhosa/terapia , HumanosRESUMO
We describe a technique of irrigating and thereby rapidly and effectively clearing the cornea of relatively large amounts of surface contaminants that reduce surgical visibility and may contribute to endophthalmitis. This technique is referred to as "macrowash." If the technique is required, it is usually at the commencement of cataract surgery, immediately after placement of the surgical drape. The technique not only saves time, but also reduces the volume of irrigating solution required by the "microwash" technique, which is traditionally carried out by the scrub nurse/surgical assistant using a Rycroft cannula attached to a 15 mL container of irrigating solution.