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BACKGROUND: Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. OBJECTIVE: To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. METHODS: A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017â2022. MMS details were recorded. RESULTS: One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. STUDY LIMITATIONS: Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. CONCLUSION: The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.
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Carcinoma Basocelular , Neoplasias de los Párpados , Neoplasias Cutáneas , Humanos , Femenino , Persona de Mediana Edad , Anciano , Masculino , Estudios Retrospectivos , Carcinoma Basocelular/cirugía , Carcinoma Basocelular/patología , Neoplasias de los Párpados/cirugía , Neoplasias de los Párpados/patología , Cirugía de Mohs/métodos , Recurrencia Local de Neoplasia/patología , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Queratinocitos/patologíaRESUMEN
Abstract Background Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. Objective To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. Methods A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. Results One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. Study limitations Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. Conclusion The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.
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ABSTRACT Purpose: The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue. Methods: A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups. Results: Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%. Conclusions: The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>
RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados a longo prazo da técnica cirúrgica modificada de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase. Métodos: Um estudo prospectivo foi realizado no Departamento de Óculo-plástica do Complexo Hospital Ouro Verde. Pacientes com triquíase recorrente sem entrópio, que não responderam à terapia convencional, foram submetidos à cirurgia com separação intermarginal das lamelas das pálpebras e inserção de enxerto de mucosa oral usando cola de fibrina, substituindo a sutura. Pacientes foram avaliados 1 dia, 7 dias, 1 mês, 6 meses e 4 anos após a cirurgia. A aderência do enxerto, resolução dos sintomas, satisfação estética, satisfação geral do paciente e recorrência de triquíase foram avaliados aos 6 meses e aos 4 anos. Resultados: Quinze pacientes (total de 19 olhos) foram incluídos, dos quais 10 (66.7%) eram do sexo feminino e 5 (33.3%) do sexo masculino. A média de idade foi 75.4 ± 10.5 anos (intervalo 54-98 anos). Triquíase adquirida foi a principal causa, da qual 12 pacientes apresentaram blefarite crônica (86.7%), 2 pacientes com causa indeterminada (13.3%) e 1 paciente com triquíase tracomatosa (6.7%). A maioria dos casos envolveu apenas um segmento da pálpebra (89.4%) e com =5 cílios (84.2%; triquíase menor). Nenhuma reação adversa foi reportada com o uso da cola de fibrina e nenhum caso necessitou de sutura após inserção do enxerto. Aos 6 meses, não houve nenhuma falha de enxerto, 17 olhos de 13 pacientes (89.4%) apresentaram boa aderência de enxerto, 2 olhos de 2 pacientes (10.5%) mostraram aderência parcial do enxerto e 2 olhos de 1 paciente (10.5%) apresentaram recorrência da triquíase. Aos 4 anos, não houve nenhuma falha de enxerto, 3 olhos de 3 pacientes tiveram perda de seguimento e 2 olhos de 2 pacientes (14.2%) apresentaram recorrência da triquíase. A taxa de sucesso acumulativa após 4 anos foi de 78.9%. Conclusão: A cirurgia modificada de enxerto interlamelar de mucosa oral usando cola de fibrina mostrou uma boa taxa de sucesso a longo prazo. Esta técnica reduz o tempo cirúrgico, facilita a inserção de enxertos menores e, portanto, deve ser considerada em triquíase menor sem entrópio resistente ao tratamento convencional.
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Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adhesivo de Tejido de Fibrina , Mucosa Bucal , Adhesivo de Tejido de Fibrina/uso terapéutico , Estudios ProspectivosRESUMEN
PURPOSE: The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue. METHODS: A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups. RESULTS: Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%. CONCLUSIONS: The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>.
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Adhesivo de Tejido de Fibrina , Mucosa Bucal , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adhesivo de Tejido de Fibrina/uso terapéutico , Estudios ProspectivosRESUMEN
OBJECTIVE: We assessed the utility of apparent diffusion coefficients (ADCs) derived from diffusion-weighted imaging to differentiate benign and malignant orbital tumours by oculoplastic surgeons in the clinical setting and sought to validate observed ADC cut-off values. DESIGN AND PARTICIPANTS: Retrospective review of patients with benign or malignant biopsy-confirmed orbital tumours. METHODS: Blinded graders including 2 oculoplastic surgeons, 1 neuroradiologist, and 1 medical student located and measured orbital tumour ADCs (10-6 mm2/s) using the Region of Interest tool. OUTCOME MEASURES: Nonradiologist measurements were compared with each other to assess reliability and with an expert neuroradiologist measurement and final pathology to assess accuracy. RESULTS: Twenty-nine orbital tumours met inclusion criteria, consisting of 6 benign tumours and 23 malignant tumours. Mean ADC values for benign orbital tumours were 1430.59 ± 254.81 and 798.68 ± 309.12 mm2/s for malignant tumours. Our calculated optimized ADC cut-off to differentiate benign from malignant orbital tumours was 1120.84â¯×â¯10-6 mm2/s (sensitivity 1, specificity 0.9). Inter-rater reliability was excellent (intraclass correlation coefficientâ¯=â¯0.92; 95% CI, 0.86-0.96). Our 3 graders had a combined accuracy of 84.5% (92.3%, 92.3%, and 65.4%). CONCLUSIONS: Our ADC cut-off of 1120.84â¯×â¯10-6 mm2/s for benign and malignant orbital tumours agrees with previously established values in literature. Without priming with instructions, training, or access to patient characteristics, most tumours were correctly classified using rapid ADC measurements. Surgeons without radiologic expertise can use the ADC tool to quickly risk stratify orbital tumours during clinic visits to guide patient expectations and further work-up.
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Neoplasias Orbitales , Humanos , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/patología , Sensibilidad y Especificidad , Reproducibilidad de los Resultados , Diagnóstico Diferencial , Imagen de Difusión por Resonancia Magnética/métodosRESUMEN
ABSTRACT Purpose: This study aimed to evaluate the current practice patterns for assessing and managing upper lid ptosis among members of the Latin American and Spanish societies of Ophthalmic Plastic and Reconstructive Surgery. Methods: An e-mail was sent to invite members of both societies to participate in this anonymous web-based survey. The survey collected data on surgeons' demographics and four other sections: upper lid ptosis preoperative evaluation, surgical preferences, postoperative management, and complications. The frequency and proportions of the responses were then statistically analyzed. Results: The survey was responded by 354 experienced oculoplastic surgeons, 47.7% of whom generally performed more than 20 upper lid ptosis surgeries annually. Of those respondents, 244 (68.9%) routinely check for dry eye preoperatively. Less than half of the respondents (47.4%) perform the phenylephrine test for congenital or acquired ptosis. Mild upper lid ptosis was reported to be usually corrected with conjunctival mullerectomy (43.6%). Severe upper lid ptosis was reported to be usually corrected with frontalis surgery (57%), followed by anterior levator resection, mainly supramaximal resection (17.5%). In cases of severe congenital ptosis, the main reason for surgery was to alleviate the risk of amblyopia (37.3%). An anterior approach was reported to be usually (63.3%) used to manage involutional ptosis associated with dermatochalasis. Common complications comprised undercorrection after levator resection (40%) or frontalis suspension (27.5%). Conclusions: This study reports the current practice patterns among Spanish and Latin American oculoplastic surgeons in upper lid ptosis diagnosis and treatment. Surgeons can use this study data to compare disease management with their colleagues.
RESUMO Objetivo: Avaliar a prática e tratamento da ptose da pálpebra superior por membros das sociedades latino-americanas e espanhola de Cirurgia Plástica Ocular. Métodos: Os membros das referidas sociedades foram convidados por e-mail para responder a um questionário eletrônico garantindo o anonimato. O questionário constou de dados demográficos do cirurgião e outras quatro seções: avaliação pré-operatória da ptose da pálpebra superior, preferências cirúrgicas, conduta pós-operatória e complicações. Estatística descritiva foi utilizada para análise da frequência e proporções percentuais. Resultados: Trezentos e cinquenta e quatro experientes cirurgiões oculoplásticos dos quais 47,7% realizam mais de 20 cirurgias de ptose da pálpebra superior por ano responderam ao questionário. Na avaliação pré-operatória, 68,9% realizam testes para olho seco, mas o teste da fenilefrina é feito por menos da metade dos entrevistados (47,4%). A ptose da pálpebra superior leve geralmente é corrigida por conjuntivo-mullerectomia (43,6%), a ptose da pálpebra superior grave por cirurgia do músculo frontal (57%) ou ressecção da aponeurose do levantador via anterior, principalmente usando a supramáxima (17,5%). O principal motivo para operar a ptose congênita grave é o risco de ambliopia (37,3%). A ptose involucional associada à dermatocálase costuma ser corrigida pela via anterior (63,3%). Hipocorreção é complicação comum após a ressecção da aponeurose do levantador (40%) ou suspensão ao frontal (27,5%). Conclusões: As práticas atuais dos cirurgiões oculoplásticos espanhóis e latino-americanos para diagnóstico e tratamento de ptose da pálpebra superior foram relatadas. Os dados apresentados podem ser usados para comparar a abordagem dos cirurgiões com a de seus pares.
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PURPOSE: This study aimed to evaluate the current practice patterns for assessing and managing upper lid ptosis among members of the Latin American and Spanish societies of Ophthalmic Plastic and Reconstructive Surgery. METHODS: An e-mail was sent to invite members of both societies to participate in this anonymous web-based survey. The survey collected data on surgeons' demographics and four other sections: upper lid ptosis preoperative evaluation, surgical preferences, postoperative management, and complications. The frequency and proportions of the responses were then statistically analyzed. RESULTS: The survey was responded by 354 experienced oculoplastic surgeons, 47.7% of whom generally performed more than 20 upper lid ptosis surgeries annually. Of those respondents, 244 (68.9%) routinely check for dry eye preoperatively. Less than half of the respondents (47.4%) perform the phenylephrine test for congenital or acquired ptosis. Mild upper lid ptosis was reported to be usually corrected with conjunctival mullerectomy (43.6%). Severe upper lid ptosis was reported to be usually corrected with frontalis surgery (57%), followed by anterior levator resection, mainly supramaximal resection (17.5%). In cases of severe congenital ptosis, the main reason for surgery was to alleviate the risk of amblyopia (37.3%). An anterior approach was reported to be usually (63.3%) used to manage involutional ptosis associated with dermatochalasis. Common complications comprised undercorrection after levator resection (40%) or frontalis suspension (27.5%). CONCLUSIONS: This study reports the current practice patterns among Spanish and Latin American oculoplastic surgeons in upper lid ptosis diagnosis and treatment. Surgeons can use this study data to compare disease management with their colleagues.
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RESUMO Objetivo Analisar o perfil clínico de pacientes portadores de neoplasias escamosas da superfície ocular. Métodos Foram avaliados os principais fatores de risco envolvidos na gênese das neoplasias escamosas da superfície ocular, as características clínicas dos pacientes e os hábitos comportamentais associados. Foram incluídos neste trabalho de coorte histórica 80 pacientes com diagnóstico anatomopatológico de neoplasia escamosa da superfície ocular atendidos entre os anos de 2010 e 2020 em um hospital referência em oculoplástica e segmento anterior de Santa Catarina. Os dados clínicos e desfechos foram avaliados por meio da análise de prontuário e entrevista, sendo posteriormente tabulados no Excel e submetidos à analise estatística por meio do software Statistical Pakage for the Social Sciences, versão 16. Resultados Foi observado que 73,8% (n=59) eram do sexo masculino. A média de idade da amostra foi de 62 anos. Quanto ao fototipo de pele, de acordo com a escala de Fitzpatrick, constatou-se que a maioria apresentou os fototipos 1 e 2 (22; 27,5% e 44; 55%, respectivamente). Em relação à exposição ocupacional ao sol/radiação, 48% (n=60) apresentaram história de exposição ocupacional, sendo que, destes, 28 pacientes trabalhavam no setor de agricultura. Dos pacientes da amostra, 33 (41,2%) apresentavam histórico pessoal de neoplasias de pele, sendo que, destes, três apresentavam diagnóstico de xeroderma pigmentoso. Quanto ao hábito de uso de fatores de proteção solar, 61% (n=49) da amostra negou o hábito. Foi evidenciada associação estatisticamente significativa entre o hábito de usar fatores de proteção solar e histórico pessoal de neoplasias de pele. Em relação ao tipo de neoplasia escamosa, a maioria dos pacientes (72; 90%) apresentou diagnóstico anatomopatológico de carcinoma espinocelular ocular. Conclusão O perfil clínico epidemiológico dos pacientes portadores de neoplasias escamosas da superfície ocular neste estudo, predominantemente de carcinoma espinoceular ocular, foi de homens, idosos, de pele clara (fototipo 2) e com histórico importante de exposição aos raios solares ultravioleta A e B. Comorbidades imunodepressoras (HIV e transplante de órgão sólido) e doenças dermatológicas (albinismo e xeroderma pigmentoso) associaram-se ao aparecimento das neoplasias escamosas da superfície ocular em idade mais precoce. Em pacientes com histórico pessoal prévio de neoplasias de pele, foi evidenciado o hábito de uso de fatores de protetor solar mais presente em relação aos demais.
ABSTRACT Objective To analyze the clinical profile of patients with ocular surface squamous neoplasms (OSSN). Methods The main risk factors involved in the genesis of the ocular surface squamous neoplasms, the clinical features, and the behavioral habits associated were evaluated. This historical cohort study included 80 patients with anatomopathological diagnosis of OSSN who were treated between 2010-2020 at a reference hospital in oculoplastic and anterior segment in Santa Catarina. The clinical data and outcomes were evalated through the analysis of medical records and interviews, being later tabulated in Excel and analyzed using the SPSS 16 software. Results Regarding the clinical profile of the patients in the sample, 73.8% (n = 59) were male. The mean age of the sample was 62 years old. As for the skin phototype, according to the Fitzpatrick scale, most of the sample presented the phototype 1 and 2 (27.5% n = 22; and 55% n = 44 respectively). Regarding occupational exposure to the sun / radiation, 48% (n = 60) had history of occupational exposure, and of these, 28 patients worked in the agricultural area. Of the patients of the sample, 33 (41.2%) had a personal history of skin neoplasms, and of these, 3 had diagnosis of xeroderma pigmentosum. As for the habit of using sun protection factors, 61% (n = 49) of the sample denied the habit. A statistically significant association was evidenced between the habit of using sun protection factors and people's history of skin cancer. Regarding the type of squamous neoplasia, most patients in the 90% sample (n = 72) had an anatomopathological diagnosis of ocular squamous cell carcinoma. Conclusion The clinical epidemiological profile of patients with OSSN in this study, predominantly ocular squamous cell carcinoma, was men, elderly, fair-skinned (phototype 2) and with an important history of exposure to UVA and UVB rays. Immunosuppressive comorbidities (HIV, solid organ transplant) and dermatological diseases (albinism, xeroderma pigmentosum) are associated with the appearance of OSSN at an early age. In patients with a previous personal history of skin neoplasms, the habit of using sunscreen factors was more present than in the other patients.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Cutáneas/epidemiología , Carcinoma de Células Escamosas/epidemiología , Neoplasias de la Conjuntiva/epidemiología , Neoplasias del Ojo/epidemiología , Neoplasias Cutáneas/patología , Luz Solar/efectos adversos , Protectores Solares , Rayos Ultravioleta/efectos adversos , Carcinoma de Células Escamosas/patología , Comorbilidad , Encuestas y Cuestionarios , Factores de Riesgo , Estudios de Cohortes , Exposición Profesional , Neoplasias de la Conjuntiva/patología , Radiación Solar , Exposición a Riesgos Ambientales , Neoplasias del Ojo/patología , Factor de Protección Solar/estadística & datos numéricosRESUMEN
Objetivo: Describir las características clínicas y patológicas del carcinoma basocelular. Métodos: Se realizó un estudio descriptivo y retrospectivo de serie de casos en el Servicio de Cirugía Plástica Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde enero del año 2016 a diciembre de 2018. Se incluyeron todos los pacientes con diagnóstico histopatológico posoperatorio de carcinoma basocelular en el período de estudio. La muestra quedó conformada por 54 pacientes y se caracterizó según el año del diagnóstico, la edad, el sexo, el color de la piel, la procedencia, el grado de diferenciación celular, el párpado afectado, la localización palpebral, el diagnóstico preoperatorio y el diagnóstico histopatológico posquirúrgico. Resultados: El 57,4 por ciento de los pacientes fueron del sexo femenino. El grupo más afectado fue el de 60-79 años con el 53,7 por ciento de los casos, con una edad media de presentación de 54,57 años. El 88,9 por ciento de la muestra fueron de piel blanca. En el 79,6 por ciento se afectó el párpado inferior y en el 64,8 por ciento el tercio interno. El 64,8 por ciento fueron carcinoma basocelular poco diferenciados y la concordancia entre el diagnóstico clínico y el histopatológico fue del 85,2 por ciento. Conclusiones: El carcinoma basocelular es más frecuente en el sexo femenino, en los adultos mayores y en los pacientes de piel blanca. En cuanto al grado de diferenciación celular, es poco diferenciado, y se localiza fundamentalmente en el tercio interno del párpado inferior. Existe concordancia entre el diagnóstico clínico y el histopatológico en la mayoría de los pacientes(AU)
Objective: Describe the clinical and pathological characteristics of basal cell carcinoma. Methods: A retrospective descriptive study was conducted of a case series from the Oculoplastic Surgery Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2016 to December 2018. The study universe was all the patients with a postoperative histopathological diagnosis of basal cell carcinoma in the period analyzed, from whom a sample 54 patients was selected. The variables analyzed were year of diagnosis, age, sex, skin color, place of residence, degree of cell differentiation, eyelid affected, eyelid location, preoperative diagnosis and postsurgical histopathological diagnosis. Results: Of the patients studied, 57.4 percent were female. The most affected age group was 60-79 years with 53.7 percent of the cases and a mean presentation age of 54.57 years. 88.9 percent of the sample had white skin. The lower eyelid was affected in 79.6 percent and the inner third in 64.8 percent. 64.8 percent were poorly differentiated basal cell carcinomas, whereas agreement between clinical and histopathological diagnosis was 85.2 percent. Conclusions: Basal cell carcinoma is more common in the female sex, elderly people and white skin patients. In terms of degree of cell differentiation, it is poorly differentiated, and its main location is the inner third of the lower eyelid. In most patients there is agreement between the clinical and histopathological diagnosis(AU)
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Humanos , Femenino , Anciano , Neoplasias Cutáneas/epidemiología , Carcinoma Basocelular/diagnóstico , Neoplasias de los Párpados/diagnóstico , Carcinoma Basocelular/patología , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
PURPOSE: To assess the sensitivity and specificity of lateral midpupil lid distances for the detection of upper lid lateral flare. METHODS: Lateral lid flare was determined by unanimous agreement among six experienced oculoplastic surgeons in the grading of photographs obtained for patients with Graves orbitopathy (GO). Bézier lines were employed to extract the upper eyelid contours of the patients and a control group of age and sex matched subjects. Custom software was employed to determine 5 lateral midpupil eyelid distances. The sensitivity and specificity of each measurement in detecting lateral flare were estimated from receiver operating characteristic curves. The non-parametric Kruskal-Wallis one-way analysis of variance (ANOVA) with Dunn's posthoc test was used to compare the median values of the contour parameters between groups. RESULTS: The degree of agreement between judges evaluated with the Fleiss' Kappa test was relatively high (K = 0.69, z = 16.6, p < .0001). The raters classified 12 lids with lateral lid flare (LLF) and 7 without LLF in patients with GO. There was no agreement on the presence or absence of LLF in 11 lids. In all eyes, lateral midpupil lid distances diminished from the center of the eyelid towards the lateral canthus. Receiver operating characteristic analysis for the midpupil distances revealed that the fourth distance from the center demonstrated high sensitivity and specificity in detecting flare. At this location (2.5 mm medial to the lateral canthus) a midpupil distance equal to or greater than 60% of the margin reflex distance (MRD1) indicated the presence of flare. CONCLUSIONS: - A single measurement of a lateral midpupil eyelid distance 2.5 mm medial to the lateral canthus is a sensitive and specific measurement for the diagnosis of the LLF.
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Enfermedades de los Párpados/diagnóstico , Párpados/diagnóstico por imagen , Oftalmopatía de Graves/diagnóstico , Aparato Lagrimal/diagnóstico por imagen , Estudios Transversales , Enfermedades de los Párpados/etiología , Oftalmopatía de Graves/complicaciones , HumanosRESUMEN
PURPOSE: The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. METHODS: The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. RESULTS: We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. CONCLUSION: The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.
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Extracción de Catarata , Catarata , Ceguera , Brasil/epidemiología , Femenino , Humanos , Lactante , Masculino , Agudeza VisualRESUMEN
ABSTRACT Purpose: The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. Methods: The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. Results: We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. Conclusion: The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.
RESUMO Objetivo: Determinar o impacto do uso de unidade móvel no acesso à saúde ocular e avaliar o perfil da população que necessita de cuidados oftalmológicos, as doenças oculares mais frequentes e o tratamento. Métodos: Estudo transversal realizado em 14 municípios da região sudoeste do Estado de São Paulo utilizando uma unidade móvel oftalmológica. Os participantes eram usuários do Sistema Único de Saúde que procuraram atendimento oftalmológico, sem restrição quanto a idade, gênero ou condição socioeconômica. Os dados foram transferidos para a tabela Excel para análise estatística. Resultados: Participaram do estudo 6.878 pessoas, com média de idade de 44 anos (variação de 4 meses a 96 anos) e 65,5% eram mulheres. Erros refrativos estavam presentes em 78,6% dos participantes, catarata em 9,6% e pterígio em 8,3%. Para 60% foram prescritos óculos, para 10% foi mantida a correção óptica em uso e para 28% foram necessárias apenas orientações. Exames especializados ou procedimentos cirúrgicos foram indicados para 18,1% dos casos que foram encaminhados para tratamento em serviço terciário. Dentre os pacientes referenciados, 36,4% necessitavam de cirurgia oculoplástica ou para tratar afecções externas do olho e 31,8%, de cirurgia de catarata. Conclusão: A grande maioria dos pacientes que procurou atendimento na unidade móvel necessitava de prescrição de óculos. A unidade móvel oftalmológica possui alto grau de resolutividade para os problemas oculares, com oportunidade de tratar os erros refrativos e referenciar os pacientes que necessitam de atendimento especializado, geralmente relacionado a condições cirúrgicas. Unidades móveis podem ser uma alternativa aos cuidados oftalmológicos básicos, melhorando o acesso, atuando na promoção da saúde ocular e prevenindo a cegueira.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Catarata/patología , Extracción de Catarata , Ceguera , Brasil/epidemiología , Agudeza VisualRESUMEN
RESUMEN Introducción: la dacriocistorrinostomía externa es la técnica más empleada por la mayoría de los cirujanos oculoplásticos para tratar a los pacientes con obstrucción del canal nasolagrimal. Es posible que los galenos cometan algunos errores en este tipo de cirugía, a pesar de los grandes avances en las tecnologías ópticas, las técnicas quirúrgicas y el uso de modernos materiales de intubación. La principal causa de los errores es el cierre de la osteotomía por tejido cicatrizal o de granulación, con la formación de sinequias en la cavidad nasal. La mitomicina C es el antibiótico alquilante más estudiado en la prevención del exceso de cicatrización en el área de la osteotomía; sin embargo, existen acuerdos y desacuerdos entre estudiosos del tema sobre la eficacia, dosis y tiempo de exposición de este medicamento. El papel de cada una de estas variables en el resultado final de la cirugía es controversial. Objetivo: brindar evidencias sobre el papel de la aplicación transoperatoria de la mitomicina C en la dacriocistorrinostomía externa. Métodos: se realizó una revisión de la bibliografía actualizada disponible en idioma español e inglés. Se consultaron los textos completos y resúmenes en las bases de datos: PubMed, Ebsco, Google Académico y Scielo. También se revisaron novedosos artículos en prestigiosas revistas especializadas. Conclusiones: la mayoría de los autores coinciden en que este medicamento contribuye a elevar la tasa de éxito de la dacriocistorrinostomía externa; aunque su aplicación es segura, todavía se estudian algunas variables que mejorarían su eficacia.
ABSTRACT Introduction: external dacryocystorhinostomy is the most used technique by oculoplastic surgeons to treat patient with nasolacrimal duct obstruction. Physicians may make some mistakes in this type of surgery despite great advances in optical technologies, surgical techniques and the use of modern materials for intubation, The main cause of errors is the closure of the osteotomy due to scar tissue or granulation with synechia formation in the nasal cavity. Mitomycin-C is the most studied alkylating antibiotic in the prevention of excessive scarring in the osteotomy area; however, there are some agreements and disagreements among scholars on the efficacy, dosage and time of exposure of this drug. The role of each of these variables in the final outcome of the surgery is controversial. Objective: to provide some evidences about the transoperative application of Mitomycin-C in external dacryocystorhinostomy. Methods: a review of the updated bibliography available in Spanish and English languages was carried out. Complete texts and abstracts were consulted in the databases: PubMed, Ebsco, Google Scholar and Scielo. Novel articles were also reviewed in prestigious specialized journals. Conclusions: must authors agree that this drug appears to improve the success rate of external dacryocystorhinostomy. Although its application is safe, some variables are still being studied that would improve its efficacy.
Asunto(s)
Cirugía General , Dacriocistorrinostomía , Mitomicina , Aparato Lagrimal , Obstrucción del Conducto LagrimalRESUMEN
ABSTRACT Purpose: To perform a long-term comparison of the quantitative efficacy of internal and external browpexy in combination with upper-lid blepharoplasty based on lateral and central eyebrow positions. Methods: This retrospective study evaluated internal and external browpexy with upper-lid blepharoplasty surgeries that were performed during the period between January 2012 and December 2017 in the oculoplastic surgery department of our hospital. Patients who had undergone periorbital and forehead surgery, who had ophthalmologic or neurological diseases, and who were Botox users were not included in the study. Preoperative and postoperative measurements were made on photographs taken in the same position. The distances from the pupil center and from the point of intersection between the horizontal line passing through the pupil and the vertical line passing through the lateral canthus to the upper eyebrow borders were measured. Photogrammetric analysis of eyebrow position was analyzed using Corel Draw software. Results: Preoperative and postoperative photographs of 70 eyelids were analyzed. Measurements were taken 24 months after surgery. Mean elevations of 2.10 and 3.19 mm were observed in the central region and lateral regions, respectively, in the internal browpexy group. These elevations were 2.66 and 3.03 mm in the external browpexy group and 0.48 and 0.55 mm in the control group. Eyebrow elevations in the central and lateral regions were not significantly different from baseline in the control group (p=0.126 and p=0.25). Internal and external browpexy showed statistically similar elevation values in the central and lateral regions (p=0.636 and p=0.342). Conclusions: External and internal browpexy surgery afforded adequate and similar elevations of the central and lateral brow, which were significantly different from those in the standard blepharoplasty group during long-term follow-up.
RESUMO Objetivo: Avaliar a comparação, a longo prazo, da eficácia quantitativa da sobrancelha interna e externa em combinação com a blefaroplastia da pálpebra superior com base nas posições lateral e central da sobrancelha. Métodos: Este estudo retrospectivo avaliou as cirurgias interna e externa da braquiterapia com blefaroplastia de pálpebra superior realizadas entre janeiro de 2012 e dezembro de 2017 no setor de cirurgia Oculoplástica de nosso hospital. Pacientes submetidos à cirurgia periorbitária e frontal, com doenças oftalmológicas ou neurológicas e usuários de Botox não foram incluídos no estudo. Medidas pré e pós-operatórias foram feitas em fotografias tiradas na mesma posição. Foram medidas as distâncias do centro da pupila e do ponto de intersecção entre a linha horizontal que passa pela pupila e a linha vertical que passa pelo canto lateral do olho até as bordas superiores da sobrancelha. A análise fotogramétrica da posição da sobrancelha foi analisada usando o software Corel Draw. Resultados: Foram analisadas fotografias pré e pós-operatórias de 70 pálpebras. As medidas foram feitas 24 meses após a cirurgia. Elevações médias de 2,10 e 3,19 mm foram observadas na região central e laterais, respectivamente, no grupo de sobrancelha interna. Essas elevações foram de 2,66 e 3,03 mm no grupo da sobrancelha externa e 0,48 e 0,55 mm no grupo controle (p=0,126, p=0,25). A sobrancelha interna e externa apresentou valores de elevação estatisticamente semelhantes nas regiões central e lateral (p=0,636, p=0,342). Conclusões: Cirurgia de sobrancelha externa e interna proporcionam elevações adequadas e semelhantes nas sobrancelhas central e lateral que foram significativamente diferentes daqueles no grupo de blefaroplastia padrão no acompanhamento a longo prazo.
Asunto(s)
Humanos , Periodo Posoperatorio , Blefaroplastia , Cejas , Párpados , Estudios RetrospectivosRESUMEN
Abstract Objective: The aim of this study is to compare scar appearance and the histopathological aspects of inflammatory response induced by the use of radiofrequency [RF] incision and a cold-blade scalpel incision in upper blepharoplasty surgery. Methods: This is a comparative, prospective, double-blind study that recruited 10 Caucasian patients from Oculoplastic Sector of Ophthalmological Center of Minas Gerais (Belo Horizonte, MG, Brazil) aged 60-70 years, Fitzpatrick skin types 3 and 4, with upper eyelid dermatochalasis and indication for upper blepharoplasty. These patients underwent upper blepharoplasty using RF incision in one eyelid (10 eyelids in total) and cold-blade incision in the contralateral eyelid (10 eyelids in total). The two techniques were compared for clinical scar appearance and histopathology of the excised tissue materials (i.e., upper eyelid skin). To evaluate clinical scar appearance, we employed two distinct methods: photo-documentation and statistical analysis of the assessment performed by two masked observers (oculoplastic specialists) that examined all patients during all the follow-up based on Vancouver scar scale criteria, which includes attributes related to scar's vascularization, thickness, pigmentation, and elasticity. Follow-up was performed on days 30, 60, and 180 after surgery. After the follow-up period, the collected data were statistically analyzed by using the Wilcoxon signed-rank test. Results: The eyelids incised with a scalpel displayed thicker scars (hypertrophic scars), which differed significantly only in the first month after surgery (p = 0.022). The two surgical techniques did not show statistically significant difference in vascularity, elasticity, or pigmentation of the scar during the follow up period (sixth postoperative month). Regarding the histopathological evaluation, the excised skin fragments exhibited the same patterns, except the cautery effect that was observed at the edges of the skin excised with RF, which showed 0.20-0.30-mm thick thermal damage. Conclusion: The two techniques did not show statistically significant difference in terms of scar appearance after the sixth postoperative month.
Resumo Objetivo: Este estudo comparou o aspecto da cicatriz e histopatologia da resposta inflamatória induzidas pelo uso de radiofrequência [RF] e incisão fria em blefaroplastia superior. Métodos: Trata-se de um estudo comparativo, prospectivo, duplo-cego, no qual foram selecionados dez pacientes da raça branca do Departamento de Plástica Ocular do Centro Oftalmológico de Minas Gerais, na faixa etária entre 60-70 anos, fototipos 3 e 4 pela classificação Fitzpatrick, que apresentavam dermatocalase com indicação de blefaroplastia superior. Estes pacientes foram submetidos à blefaroplastia superior com a utilização da RF em uma pálpebra (total de 10 pálpebras) e de incisão fria na pálpebra contralateral (total de 10 pálpebras). As duas técnicas foram comparadas quanto ao aspecto clínico da cicatriz e avaliação histopatológica do material excisado (pele de pálpebra superior). Para avaliação do aspecto clínico da cicatriz optamos por dois métodos: a fotodocumentação e análise estatística da avaliação de dois observadores oculoplásticos mascarados que examinaram os pacientes durante todo o período de follow-up baseado na escala de cicatrização de Vancouver que inclui atributos relacionados à vascularização, espessura, pigmentação e elasticidade. O seguimento foi feito com 30, 60 e 180 dias de pós operatório. Após o follow-up, foi realizada análise estatística dos dados através do Teste de Pontos com Sinais de Wilcoxon. Resultados: As pálpebras operadas com bisturi apresentaram tendência a cicatrizes mais grossas (hipertróficas) com diferença estatisticamente significativa apenas para o primeiro mês de cirurgia (p=0.022). Não houve diferença estatisticamente significativa entre vascularização, elasticidade e pigmentação entre as duas técnicas de cirurgia avaliadas. Em relação à avaliação histopatológica, os fragmentos de pele excisados apresentaram o mesmo padrão inflamatório com a exceção do efeito de cautério nas bordas das peles excisadas com RF, que variaram de 0,20-0,30mm de espessura de dano térmico. Conclusão: As duas técnicas não mostraram diferença estatisticamente significativa no aspecto clínico da cicatriz após o sexto mês pós-operatório.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Cicatriz , Blefaroplastia/métodos , Herida Quirúrgica/patología , Terapia por Radiofrecuencia/métodos , Estudio Comparativo , Método Doble Ciego , Estudios ProspectivosRESUMEN
PURPOSE: To perform a long-term comparison of the quantitative efficacy of internal and external browpexy in combination with upper-lid blepharoplasty based on lateral and central eyebrow positions. METHODS: This retrospective study evaluated internal and external browpexy with upper-lid blepharoplasty surgeries that were performed during the period between January 2012 and December 2017 in the oculoplastic surgery department of our hospital. Patients who had undergone periorbital and forehead surgery, who had ophthalmologic or neurological diseases, and who were Botox users were not included in the study. Preoperative and postoperative measurements were made on photographs taken in the same position. The distances from the pupil center and from the point of intersection between the horizontal line passing through the pupil and the vertical line passing through the lateral canthus to the upper eyebrow borders were measured. Photogrammetric analysis of eyebrow position was analyzed using Corel Draw software. RESULTS: Preoperative and postoperative photographs of 70 eyelids were analyzed. Measurements were taken 24 months after surgery. Mean elevations of 2.10 and 3.19 mm were observed in the central region and lateral regions, respectively, in the internal browpexy group. These elevations were 2.66 and 3.03 mm in the external browpexy group and 0.48 and 0.55 mm in the control group. Eyebrow elevations in the central and lateral regions were not significantly different from baseline in the control group (p=0.126 and p=0.25). Internal and external browpexy showed statistically similar elevation values in the central and lateral regions (p=0.636 and p=0.342). CONCLUSIONS: External and internal browpexy surgery afforded adequate and similar elevations of the central and lateral brow, which were significantly different from those in the standard blepharoplasty group during long-term follow-up.
Asunto(s)
Blefaroplastia , Cejas , Párpados , Humanos , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
ABSTRACT Purpose: Punctal stenosis can result in symptoms such as epiphora and can significantly reduce the quality of life of patients. Perforated punctal plug insertion is an easy procedure that is commonly used as the first step of treatment for punctal stenosis. Methods: Clinical, demographic, and outcome data were retrospectively collected for 54 eyes of 21 males and 11 females who consecutively presented to our Oculoplastic Clinic and underwent silicone Micro Flow perforated punctal plug insertion. All patients had epiphora with punctal stenosis. Results: Of the 54 plugs, 26 plugs (48.1%) were lost and 28 (51.8%) stayed in place. Of the latter, eight were explanted because of the occlusion of the plug with secretions and recurrent conjunctivitis; moreover, two plugs migrated deep into the vertical canaliculus. Of the 54 plugs, only 18 (33.3%) were well-tolerated with significant symptomatic improvement. Conclusion: Plug loss is a prominent problem in patients implanted with perforated punctal plugs. Silicone punctal plugs failed in 66.7% of our patients over a mean follow-up of 14.2 months.
RESUMO Objetivo: A estenose punctal pode resultar em sintomas como a epífora e diminuir significativamente a qualidade de vida dos pacientes. A inserção de um tampão perfurado é um procedimento fácil que é comumente usado como o primeiro passo do tratamento para a estenose punctal. Métodos: Dados clínicos, demográficos e de resultado foram coletados retrospectivamente de 54 olhos de 21 homens e 11 mulheres que consecutivamente se apresentaram em nossa Clínica de Oculoplástica e foram submetidos a inserção de um tampão de silicone perfurado Micro Flow. Todos os pacientes tinham epífora com estenose punctal. Resultados: Dos 54 tampões, 26 (48,1%) foram perdidos e 28 (51,8%) permaneceram no local. Destes últimos, 8 foram removidos devido a oclusão do tampão com secreção e conjuntivite recorrente, além disso, 2 migraram profundamente no canalículo vertical. Dos 54 tampões, apenas 18 (33,3%) foram bem tolerados com significativa melhora dos sintomas. Conclusão: A perda de tampões é um problema de destaque em pacientes implantados com tampões perfurados. Tampões de silicone falharam em 66,7% dos pacientes durante um seguimento médio de 14,2 meses.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Siliconas/administración & dosificación , Síndromes de Ojo Seco/cirugía , Tapones Lagrimales/efectos adversos , Aparato Lagrimal/cirugía , Obstrucción del Conducto Lagrimal/terapia , Prótesis e Implantes , Lágrimas , Síndromes de Ojo Seco/complicaciones , Implantación de Prótesis , Obstrucción del Conducto Lagrimal/etiologíaRESUMEN
PURPOSE: Punctal stenosis can result in symptoms such as epiphora and can significantly reduce the quality of life of patients. Perforated punctal plug insertion is an easy procedure that is commonly used as the first step of treatment for punctal stenosis. METHODS: Clinical, demographic, and outcome data were retrospectively collected for 54 eyes of 21 males and 11 females who consecutively presented to our Oculoplastic Clinic and underwent silicone Micro Flow perforated punctal plug insertion. All patients had epiphora with punctal stenosis. RESULTS: Of the 54 plugs, 26 plugs (48.1%) were lost and 28 (51.8%) stayed in place. Of the latter, eight were explanted because of the occlusion of the plug with secretions and recurrent conjunctivitis; moreover, two plugs migrated deep into the vertical canaliculus. Of the 54 plugs, only 18 (33.3%) were well-tolerated with significant symptomatic improvement. CONCLUSION: Plug loss is a prominent problem in patients implanted with perforated punctal plugs. Silicone punctal plugs failed in 66.7% of our patients over a mean follow-up of 14.2 months.