Bilateral lid/brow elevation procedure for severe ptosis in Kearns-Sayre syndrome, a mitochondrial cytopathy.

BACKGROUND: The purpose of this work was to determine the effectiveness and possible complications encountered with bilateral fascia lata lid suspension used to correct blepharoptosis in patients with Kearns-Sayre syndrome. METHODS: This was a retrospective study of seven patients with Kearns-Sayre syndrome who had a minimum of 1 year of follow-up. A bilateral fascia lata sling was used to correct the ptosis. Preoperative and postoperative measurements of the vertical lid fissure width (VFW) and marginal reflex distance (MRD) were performed. The Student's t-test was used to analyze the results. RESULTS: The mean preoperative VFW and MRD measurements were 4±2.45 mm and 0.14±0.92 mm, respectively. The mean postoperative VFW and MRD measurements were 7.71±1.85 mm, and 2.86±1.69 mm, respectively. All preoperative and postoperative values were considered to be statistically significant (P<0.01). Adequate elevation of the lids was obtained in all patients, both functionally and aesthetically. All of the patients showed a mild symmetric postoperative inferior version lagophthalmos, and one patient developed corneal ulceration and scarring due to corneal exposure and a weak Bell's phenomenon. CONCLUSION: The surgical technique described to correct the blepharoptosis found in patients with Kearns-Sayre syndrome was found to be efficient and relatively safe. The correction should be conservative to decrease the risk of postoperative corneal damage that occurred in one patient.

Eye disease related to onchocerciasis: a clinical study in the Aratha-ú, Yanomami Tribe, Roraima State, Brazil.

The prevalence of ocular lesions due to onchocerciasis was evaluated among residents of the Yanomami Tribe, in the northern Amazon, Brazil, an endemic area for onchocerciasis. 83 natives were submitted to an ocular examination including an external examination, biomicroscopy, intraocular pressure measurement, and a fundus examination. Clinical, parasitological and serological tests were carried out simultaneously. The population demonstrated a high prevalence of eosinophilia, skin microfilaria (55%) and onchocercal subcutaneous nodules (35%). A high prevalence of probable onchocerciasis related eye lesions was detected. Punctate keratitis (41%) and microfilaria in the anterior chamber (39%) were found as well as other probable onchocercotic lesions-chorioretinitis (7.2%) and anterior uveitis (6.0%). Other anterior eye lesions (corneal leucomas, conjunctival injection, lid nodules) occurred in 51% of the individuals. The anterior eye lesions were more prevalent than the posterior lesions. We did not find an association of glaucoma with onchocerciasis. The prevalence of these suggestive ocular lesions strongly correlates with the cutaneous nodules and eosinophilia, suggesting that skin nodules may be an indication for an eye examination. The present study provides evidence that significant infection and eye disease due to onchocerciasis persists in certain regions of Northern South America.

Suspensão de supercíllo: via transpalpebral / Brow ptosis: trans palpebral approach

Objetivo: Analisar a suspensão de supercílio via trans-palpebral. Método: Foi realizado um estudo prospectivo, entre janeiro de 2003 e dezembro de 2004, incluindo todos os pacientes que procuraram o serviço com queixa de excesso de pele na pálpebra superior e/ou queixa de queda na posição do supercílio. No total, foram reali-zados 68 procedimentos cirúrgicos. Realizou-se registro fotográfico no pré-operatório e pós-operatório tardio, comparando-se o resultado obtido. Resultados: Quanto ao sexo, 88,9 per cent dos pacientes eram do sexo feminino e 11,1 per cent do sexo masculino. Observou-se que 22,3 per cent dos pacientes tinham assimetria. A suspensão foi bilateral em 94,1 per cent dos casos e unilateral em 5,9 per cent. Na maioria dos casos (88,9 per cent), a colocação de um ponto de sustentação foi suficiente. Em 94,7 per cent dos casos, a suspensão envolveu a região temporal do supercílio e, em 5,3 per cent, apenas a porção nasal. Não houve relato de alteração de sensibili-dade local nesta casuística. As complicações encontra-das foram: edema local (100 per cent); equimose (47,2 per cent); depressão discreta no local por onde se pas-sou o fio (100 per cent). Conclusão: As vantagens da técnica apresentada justificam, na opinião dos autores, o seu emprego, como mais uma opção para elevação do supercílio.