[Epidemiological and clinical profile of ocular eviscerations in northern Algeria, about 136 cases]. / Profil épidémiologique et clinique des éviscérations oculaires au nord de l'Algérie, à propos de 136 cas.

Introduction: Despite the existence of well codified indications, the performance of mutilating surgery in ophthalmology is not an easy decision to take due to the aesthetic and moral damages that patients may suffer. This surgery should be considered as a last resort in the case of a non-functional, painful and unsightly eye or in the presence of an oncological involvement and after all conservative alternatives have been exhausted. This study aims to define the factors making it possible to favor ocular evisceration, which is the least mutilating of the above-mentioned surgeries, by determining the epidemiological and clinical aspects of the patients. In addition, the results of the study will serve as a starting point for epidemiological surveillance and will guide preventive activities and the fight against blindness. Material & method: We conducted an exhaustive retrospective study of medical records from the archives of the ophthalmology departments of the Dr. Tidjani Damardji University Hospital Center in Tlemcen, the Specialized Hospital Establishment in ophthalmology of Oran Hamou Boutlelis, the Specialized Hospital Establishment in ophthalmology of Oran Front de mer and the University Hospital Center of Bejaia (unit Franz Fanon), in order to specify the epidemiological-clinical profile of patients who have undergone an ocular evisceration in the north of Algeria from January 1, 2008 to December 31, 2014. Results & discussion: We have identified 136 patients, representing an admission rate of 0,13% in all these services. We noted a slight male predominance with an estimated sex-ratio of 1.4. Evisceration was carried out mainly following an ocular trauma in 39% of cases. The surgical technique performed in all patients is a classic non-conservative evisceration of "four quadrants" or "four squares" under general anesthesia in 55.9% of cases. Post-operative complications were found in 19.8% of patients in our series, the main one being exteriorization of the intra-scleral implant in 9.5% of cases. This rate corresponds to the data in the literature, with figures between 0 and 67%. This complication may be in relation with the experience or even the competence of the surgeon. Accessibility to ocularists and the quality of prosthetic equipment were also studied. All the data collected were compared with data from the international medical literature. Our study carried out in the north of Algeria on ocular eviscerations, allowed us to deduce that this surgery is rarely carried out in ophthalmology. Its main indications are post-traumatic and post-infectious. Conclusion: The prevention of mutilating surgeries requires early diagnosis and appropriate treatment of ophthalmological pathologies and trauma. Losing an eye is always experienced as a tragedy and can be devastating at any age, affecting self-image and self-esteem. Psychological support is therefore essential.

Surgical management of orbital implant exposures after evisceration or enucleation: Retrospective study - Limoges University Hospital.

INTRODUCTION: Implant exposure is the most frequent complication after evisceration or enucleation, and multiple surgical techniques for the management of orbital implant exposure. The goal of our study is to investigate the success rate and risk factors for failure of various surgical procedures. METHODS: This was a retrospective study performed at the University Hospital of Limoges. We collected data from the files of every patient operated on for implant exposure between January 2005 and December 2020. The main criterion was the percentage of success for each procedure. Secondary objectives were to identify risk factors for failure of Müller's muscle flaps and to determine the incidence of post-enucleation socket syndrome depending on whether the orbital implant was maintained. RESULTS: Fifty-one patients were included: 26 patients who underwent Müller's muscle flap, 16 dermis-fat graft, 3 conjunctival flap, 2 amniotic membrane graft, 1 temporalis fascia graft, 1 buccal mucosa graft, 1 implant rotation, and 1 implant exchange. The dermis-fat grafts were more successful (87.5%) than the Müller's muscle flaps (52.2%) (P=0.0213). The study highlighted the importance of good vascularization of the implant (OR=32.00, P-value=0.0245) for the success of Müller's muscle flaps, and we found no statistically significant difference between the patients who maintained their implants and those who did not (P=0.3865) with regard to the incidence of post-enucleation socket syndrome. CONCLUSION: Müller's muscle flap may remain a reasonable option in the management of medium-sized implant exposures of well-vascularized implants confirmed on MRI in patients with no systemic healing disorders. Dermis-fat graft remains the option of choice in other cases, especially in large exposures or complicated orbits.

Fulminant keratomycosis caused by Cylindrocarpon lichenicola- A case report.

PURPOSE: To report the clinical features, phylogenetic characteristics, microbiological characteristics, and the management of the rare emerging fungal species Cylindrocarpon lichenicola. METHODS: A 55-year-old male farmer presented with a history of pain, redness, and defective vision. The corneal scrapings revealed septate hyphae macroconidia and multi-celled chlamydospores with lactophenol cotton blue mount. In addition, the culture revealed velvety to floccose, white growth with a pinkish-brown rim on the Sabouraud's dextrose agar. The growth was suggestive of the rare fungus Cylindrocarpon lichenicola. RESULTS: The course of the infection was rapidly progressive, involving the entire cornea with descemetocele and impending perforation. Reinfection with the rapid spread of disease to the sclera was noted; finally, evisceration with scleral frill excision was done. CONCLUSION: To our knowledge, this is the first case report of Fulminant Sclero Keratomycosis caused by Cylindrocarpon lichenicola.

Aplicación orbitaria de productos de relleno para optimización de simetría en pacientes con microftalmia o cavidades anoftálmicas adquiridas: revisión de la literatura / Aplicación orbitaria de productos de relleno para optimización de simetría en pacientes con microftalmia o cavidades anoftálmicas adquiridas: revisión de la literatura Orbital administration of fillers for optimization of symmetry in patients with microphthalmos or acquired anophthalmic sockets: A review

El tratamiento de la asimetría facial en pacientes con microftalmos o cavidades anoftálmicas adquiridas suele requerir cirugías reconstructivas agresivas. En los últimos años se han publicado trabajos sobre el uso de rellenos para optimizar la simetría del tejido orbitario, como técnicas mínimamente invasivas.Por este motivo, hemos realizado una revisión sistemática de la literatura publicada hasta el momento sobre la administración orbitaria de rellenos para el tratamiento de la pérdida de volumen. Se identificaron 14 artículos que cumplían con los criterios de selección; en los que se analizó el material utilizado, la técnica de inyección, el estudio anatómico de los pacientes antes del procedimiento y la presencia de complicaciones asociadas. Los materiales utilizados como relleno son: la grasa autóloga, la hidroxiapatita cálcica, el colágeno, el ácido hialurónico o el gel de poliacrilamida. Se aplicaron técnicas estándar de inyección peribulbar y retrobulbar, con escasas complicaciones asociadas, siendo la má grave el desarrollo de cuadros vaso-vagales. El seguimiento de los pacientes suele limitarse en la mayoría de los estudios a 12 meses, con variaciones significativas en la exoftalmometría posprocedimiento. En conclusión, la utilización de rellenos parece una práctica segura y con buenos resultados, aunque se precisan estudios con tiempo de seguimiento más prolongado que los publicados hasta el momento. (AU)

The treatment of facial asymmetry in patients with microphthalmos or acquired anophthalmic cavities usually requires aggressive reconstructive surgeries. In recent years, studies have been published on the use of fillers to optimize orbital tissue symmetry, as minimally invasive techniques.For this reason, we performed a systematic review of the literature published to date on the use of fillers for the treatment of volume loss in acquired anophthalmic or microphthalmic cavities. Fourteen articles were reviewed in which the material used, the injection technique, the anatomical study of the patients before the procedure and the presence of associated complications were analyzed.Various materials have been used as fillers, including autologous fat, calcium hydroxyapatite, collagen, hyaluronic acid, or polyacrylamide gel. Standard peribulbar and retrobulbar injection techniques were applied, with few associated complications, the most serious being the development of vasovagal symptoms. Patient follow-up is usually limited in most studies to 12 months.In Conclusion, the use of fillers seems to be a safe practice, with good results and few complications, although studies with longer follow-up times than those published to date would be required. (AU)

Spontaneous Globe Rupture following Prolonged Uncontrolled Elevated Intraocular Pressure.

We report two glaucoma patients who experienced unusual instances of spontaneous globe rupture. The patients arrived at the Bowen University Teaching Hospital's emergency ophthalmology unit with a history of bleeding from one eye without any history of ocular trauma. They were known glaucoma patients with poor control of their intraocular pressures (IOP). They eventually underwent evisceration shortly after presentation. Spontaneous eyeball rupture in glaucomatous eyes is extremely unusual and has a very poor prognosis for vision. Proper management and appropriate follow-up of glaucoma patients are very important to avert this dreaded complication of uncontrolled IOP.

Rehabilitación protésica individualizada en un defecto ocular de origen traumático. Reporte de caso / Individualized prosthetic rehabilitation in an ocular defect of traumatic origin. Case report

El trauma ocular constituye la causa de pérdida ocular más frecuente a nivel mundial y puede presentarse en cualquier etapa de vida, con mayor incidencia en la niñez. El manejo puede ser quirúrgico, quirúrgico-protésico o protésico. A continuación, se presenta un caso clínico que describe la rehabilitación protésica individualizada posterior a una evisceración en una lesión ocular unilateral traumática de hace aproximadamente 56 años, que presenta ptosis del párpado superior, colapso y atrofia muscular debido a la falta de función. Se describe la técnica de confección de los conformadores oculares para corregir la ptosis del párpado superior y lograr la expansión gradual de la cavidad, así como la confección de la prótesis ocular individualizada, con el objetivo de alcanzar los requerimientos funcionales y estéticos esperados. (AU)

Ocular trauma is the most frequent cause of eye loss worldwide. It can occur at any stage of life, with a higher incidence in childhood. Management can be surgical, surgical - prosthetic or prosthetic. We describe individualized prosthetic rehabilitation in a clinical case of upper eyelid ptosis, collapse and muscle atrophy due to lack of function following evisceration in a traumatic unilateral ocular injury approximately 56 years previously. We describe the technique for making ocular shapers to correct ptosis of the upper eyelid and achieve gradual expansion of the cavity, as well as the preparation of an ocular prosthesis to fulfill the expected functional and esthetic requirements. (AU)

An innovative proposal for anophthalmic cavity reconstruction surgery with bone cement: a case report / Proposta inovadora para reconstrução de cavidades anoftálmicas utilizando cimento ósseo: um relato de caso

ABSTRACT We present a patient who underwent evisceration surgery after spontaneous rupture of the ocular globe due to long-data uncontrolled glaucoma, with posterior placement of an orbital implant made of a bone cement compound based on polymethylmethacrylate as alternative materials were not available. Such a compound is characterized by excellent biocompatibility and low cost, which makes it an interesting alternative for treatment. The anophthalmic socket was successfully filled, providing proper esthetic results and favorable conditions for the posterior scleral prosthesis implantation. No complications were observed during 10 months of follow-up. We believe that, in the absence of alternative materials, low-cost materials may be used in emergency settings to repair anophthalmic cavities and provide satisfactory functional and esthetic outcomes.

RESUMO Apresentamos um paciente que foi submetido à cirurgia de evisceração após ruptura espontânea do globo ocular devido a glaucoma não controlado de longa data, com posterior colocação de implante orbital feito de cimento ósseo, composto à base de polimetilmetacrilato, diante da indisponibilidade de materiais alternativos. Tal composto se caracteriza pela excelente biocompatibilidade e baixo custo, o que o torna uma alternativa interessante para o tratamento. A cavidade anoftálmica foi preenchida com sucesso, fornecendo resultados estéticos adequados e condições favoráveis para o implante posterior de prótese escleral. Nenhuma complicação foi observada durante os 10 meses de seguimento. Acredi­tamos que, na ausência de materiais alternativos, materiais de baixo custo podem ser usados em situações emergenciais para preencher cavidades anoftálmicas e prover resultados funcionais e estéticos satisfatórios.

A three-dimensional printed photopolymer resin implant for orbital rehabilitation for evisceration / Implante de resina fotocurável para evisceração produzido por impressora tridimensional

ABSTRACT Purpose: To evaluate the biocompatibility of three-dimensional (3D) printed orbital spheres for evisceration. Materials: A total of 10 consecutive patients (eight females and two males; mean age, 46.8 ± 14.2 years) underwent evisceration of blind painful eyes. 3D spherical implants produced by a rapid prototype machine were used to restore orbital volume. The implants were produced from a commercially available photocurable resin (Fullcure®). Systemic toxicity was evaluated by comparing serum biochemical measurements (creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase, albumin, creatinine, urea, alkaline phosphatase, and C-reactive protein) before and at 12 months after surgery. Local toxicity was assessed by the evaluation of signs of socket inflammation at the first postoperative month. Changes in implant size were determined by computed tomography scans at 2 and 12 months after surgery. Results: The postoperative evaluations were uneventful. The biochemical evaluation showed no significant changes after surgery. None of the patients presented signs of orbital implant inflammation, infection, exposure, or extrusion. Computed tomography scan evaluations revealed no changes in implant size. Conclusion: To the best of our knowledge, this is the first phase-1 clinical study to certify the biocompatibility of the Fullcure resin for orbital implants in humans. The 3D printing technology permits fast and accurate production of implants for this purpose.

RESUMO Objetivos: Avaliar a biocompatibilidade das esferas produzidas por impressora tridimensional em evisceração. Pacientes e métodos: Evisceração por olho cego doloroso foi realizada em 10 pacientes consecutivos (8 mulheres, idade média: 46.8 ± 14.2 anos). Os implantes esféricos foram produzidos pelo sistema de prototipagem rápida utilizando dados tridimensionais computadorizados. O material utilizado para produção dos implantes foi a resina fotocurável Fullcure®. A avaliação da toxicidade sistêmica do material foi realizada por meio da dosagem de marcadores bioquímicos (creatina fosfoquinase, aspartato aminotransferase, alanina aminotransferase, albumina, creatinina, ureia, fosfatase alcalina, e proteína C-reactiva) antes da cirurgia e aos 12 meses de pós-operatorio. A avaliação da toxicidade local foi realizada por meio do registro qualitativo dos sinais inflamatórios no lado operado durante o primeiro mês de pós-operatório. O tamanho dos implantes foi medido em tomografias computadorizadas (CT) aos 2 e 12 meses de pós-operatório. Resultados: A avaliação bioquímica mostrou que os marcadores estudados não sofreram alterações significativas após a cirurgia. Nenhum paciente apresentou sinais de inflamação atípica, infecção, exposição ou extrusão. A avaliação tomográfica não demonstrou mudanças nos tamanhos dos implantes. Conclusão: O presente trabalho é o primeiro estudo clínico realizado para atestar a biocompatibilidade dos implantes orbitais de resina fotocurável Fullcure. A produção dos implantes pela técnica de impressão tridimensional, utilizando essa resina, permite a disponibilização rápida e acurada do produto final

Oftalmomiasis intraocular postraumática por Phormia sp / Post-traumatic intraocular ophthalmomyasis due to Phormia sp

Paciente varón de 18 años el cual presentaba lesión en el ojo izquierdo por arma de fuego. Permaneció inconsciente 2 días en una zona agrícola, luego fue llevado a un hospital local donde se le extrajeron larvas. En el ojo izquierdo presentó una agudeza visual de no percepción de luz, heridas con pérdida de sustancia en los párpados superior e inferior, atalamia, hipotonía, edema corneal, herida con exposición uveal y salida de larvas en zona II. Se le practicó evisceración del ojo izquierdo

An 18 year-old male patient presented with an injury to the left eye caused by a firearm. He remained unconscious for 2 days in an agricultural area, had a visual acuity of non-perception of light, wounds with loss of substance in upper and lower eyelid, atalamia, hypotonia, corneal oedema, wound with uveal exposure and exit of larvae in zone II. He was subjected to evisceration of the left eye

Oftalmia simpática / Sympathetic ophthalmia

Resumo Relatar um caso de um paciente portador de Oftalmia Simpática (OS), com descolamento seroso da retina documentado através de tomografia de coerência óptica de domínio spectral (SD OCT), indocianina verde (ICG) e angiofluoreceinografia (AGF), que o diagnóstico foi realizado em uma consulta de rotina e iniciado tratamento clínico .

Abstract To report the case of a patient with sympathetic ophthalmia (OS), with serous detachment of retinal documented by spectral domain optical coherence tomography (OCT), indocyanine green (ICG) and angiofluorecephography (AGF). The diagnosis was made in a routine consultation and clinical treatment was initiated.

Historia breve de la cirugía de la cavidad anoftálmica y los implantes orbitarios / A brief history of the anophthalmic socket surgical technique and orbital implants

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Reabilitação de paciente eviscerado por meio de prótese ocular: relato de caso / Rehabilitation of patient eviscerated with eye prosthesis: case report / Rehabilitación de paciente eviscerado por medio de prótesis ocular: reporte de caso

O objetivo do presente estudo é relatar um caso clínico de reabilitação de paciente eviscerado unilateral por meio de prótese ocular. Para tal, o paciente teve o remanescente de sua esclera moldado. Este molde foi incluído em mufla para a posterior obtenção da esclera artificial em Resina Acrílica Ocular Termicamente Ativada (RAOTA) incolor. A esclera obtida foi provada no paciente e recebeu os ajustes necessários. Em seguida, foi realizada a centralização da pupila, feito o platô e pintada a íris artificial, que foi colada sobre o platô. Toda a superfície da esclera recebeu caracterização e o conjunto foi recoberto com uma nova camada de RAOTA incolor. Por fim, a prótese recebeu acabamento, polimento, e foi instalada. O paciente foi instruído quanto ao uso e higienização. Foi observado que após a instalação da prótese, a estética facial do indivíduo foi restaurada, o suporte palpebral restabelecido e o indivíduo foi reinserido ao convívio social. A partir do exposto, conclui-se que o tratamento reabilitador atingiu seu objetivo de restaurar a estética facial e foi de grande importância para o paciente, pois o mesmo resgatou a autoestima perdida e pode retornar ao convívio social sem constrangimentos(AU)

The objective was to report a clinical case of rehabilitation of unilateral eviscerated patient through ocular prosthesis. To do this, the patient had his sclera molded with alginate. This mold was included in muffle for the posterior obtaining of the artificial sclera in Thermally Activated Ocular Acrylic Resin (TAOAR) colorless. The sclera obtained was proven in the patient and received the necessary adjustments. Then the pupil's centralization was conducted, made the plateau and painted the artificial iris, which was glued on the plateau. The entire surface of the sclera received characterization and the set was covered with colorless TAOAR. Finally, the prosthesis received finishing, polishing, and was installed. The patient was instructed as to use and sanitize. It was observed that after installing the prosthesis, the facial aesthetics of the individual was restored, the eyelid support restored and the obtaining of the reinsertion of the individual to social conviviality. From the foregoing, it is concluded that the rehabilitation treatment has reached its objective of restoring the facial aesthetic and was of great importance to the patient, as the same rescued the lost self-esteem and could return to social conviviality without constraints(AU)

El objetivo del presente estudio es relatar un caso clínico de rehabilitación de paciente eviscerado unilateral por medio de prótesis oculares. Para ello, el paciente tuvo el remanente de su esclera moldeada. Este molde fue incluido en mufla para la posterior obtención de la esclera artificial en Resina Acrílica Ocular Termalmente Activada (RAOTA) incolora. La esclera obtenida fue probada en el paciente y recibió los ajustes necesarios. A continuación, se realizó la centralización de la pupila, hecha la meseta y pintada el iris artificial, que fue pegada sobre la meseta. Toda la superficie de la esclera recibió caracterización y el conjunto fue recubierto con una nueva capa de RAOTA incoloro. Por último, la prótesis recibió el acabado, pulido, y se instaló. El paciente fue instruido en cuanto al uso e higienización. Se observó que después de la instalación de la prótesis, la estética facial del individuo fue restaurada, el soporte palpebral restablecido y el individuo fue reinsertado a la convivencia social. A partir de lo expuesto, se concluye que el tratamiento rehabilitador alcanzó su objetivo de restaurar la estética facial y fue de gran importancia para el paciente, pues el mismo rescató la autoestima perdida y puede retornar a la convivencia social sin limitaciones(AU)

Peripapillary choroidal thickness in contralateral eyes after evisceration of diseased eyes / Espessura coroide peripapilar de olhos contralaterais após evisceração do olho doente

ABSTRACT Purpose: To evaluate peripapillary choroidal thickness changes in contralateral eyes of patients who had undergone evisceration of their diseased eyes. Methods: In this retrospective study, peripapillary choroidal thickness parameters in 34 eyes of 34 patients who had undergone diseased-eye evisceration between March 2014 and May 2016 were evaluated using spectral domain optical coherence tomography. The scans were manually delineated to identify the principal surfaces of Bruch's membrane, the Bruch's membrane opening, and the anterior sclera. Peripapillary choroidal thickness was measured between the Bruch's membrane and the anterior sclera at increasing distance away from the Bruch's membrane opening. The mean peripapillary choroidal thickness values in the contralateral eyes of the patients and those of the control group were compared. Results: The mean peripapillary choroidal thickness was higher in the contralateral eyes of the patients compared with that of normal eyes at all distances from the Bruch's membrane opening. Conclusion: Increased peripapillary choroidal thickness was noted in the contralateral eyes of the patients, potentially resulting in a thicker choroid. Although further investigation is required to determine the cause, these findings indicate the presence of a compensatory factor in the contralateral eyes.

RESUMO Objetivo: Avaliar as alterações da espessura coroide peripapilar em olhos contralaterais de pacientes submetidos à evisceração do olho doente. Métodos: Neste estudo retrospectivo, parâmetros da espessura coróide peripapilar de 34 olhos de 34 pacientes submetidos à evisceração, entre março de 2014 e maio de 2016, foram avaliados com tomografia de coerência óptica de domínio espectral. As varreduras foram manualmente delineadas para identificar as principais superfícies da membrana de Bruch, a abertura da membrana de Bruch e a esclera anterior. A espessura coroide peripapilar foi medida entre a membrana de Bruch e a esclera anterior a uma distância crescente da abertura da membrana de Bruch. Compararam-se os valores médios da espessura coroide peripapilar dos olhos contralaterais dos pacientes e do grupo controle. Resultados: A espessura coroide peripapilar média foi mais espessa nos olhos contralaterais dos pacientes, quando comparada com os olhos normais, em todas as distâncias da abertura da membrana de Bruch. Conclusão: O aumento da espessura coroide peripapilar foi notado nos olhos contralaterais dos pacientes. O espessamento da coroide pode ser resultante do distúrbio. Embora seja necessária uma investigação mais aprofundada para determinar a causalidade, esses achados podem apontar para um fator compensatório dos olhos contralaterais.

Pseudomonas aeruginosa-induced bilateral endophthalmitis after bilateral simultaneous cataract surgery: case report / Endoftalmite bilateral induzida por Pseudomonas aeruginosa após cirurgia bilateral simultânea de catarata: relato de caso

ABSTRACT Bilateral simultaneous cataract surgery (BSCS) has gained popularity among eye surgeons in many countries. This study examines the case of a 77-year-old patient who developed bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery. Immediate bilateral vitrectomy and intravitreal antibiotics injection were performed. Ultimately, both eyes were eviscerated due to pain refractory to treatment and no light perception.

RESUMO A cirurgia bilateral simultânea de catarata ganhou popularidade entre cirurgiões oftalmológicos em muitos países. Este estudo examina o caso de um paciente de 77 anos que desenvolveu endoftalmite bilateral por Pseudomonas aeruginosa após uma cirurgia bilateral simultânea de catarata. Vitrectomia bilateral imediata e injeção de antibióticos intravítreos foram realizadas. Em última análise, ambos os olhos foram eviscerados devido à dor refratária ao tratamento e sem percepção de luz.

Retinopatía por radiación secundaria a tratamiento de carcinoma de seno maxilar: un caso dramático / Radiation retinopathy secondary to treatment of maxillary sinus carcinoma: a dramatic case

Caso clínico: Un varón de 53 años consulta por pérdida de visión en ojo derecho tras irradiación de carcinoma de seno maxilar derecho. La exploración funduscópica muestra hemorragias, exudados, edema macular e isquemia retiniana periférica, compatibles con una retinopatía por radiación. La evolución es tórpida a pesar de tratamiento con láser e inyecciones intravítreas de bevacizumab, finalizando en evisceración del ojo afecto. Discusión: La retinopatía por radiación debe tenerse en cuenta ante cualquier pérdida de visión tras irradiación de cabeza y cuello. El seguimiento oftalmológico a largo plazo de estos pacientes es fundamental para conseguir un diagnóstico precoz (AU)

Clinical case: A 53-year old male presented with visual impairment in right eye after irradiation of right maxillary sinus carcinoma. Funduscopy shows radiation retinopathy: haemorrhages, exudates, macular oedema, and peripheral retinal ischaemia. A poor outcome was achieved despite laser treatment and intravitreal injections of bevacizumab, resulting in evisceration of the affected eye. Discussion: Radiation retinopathy must be considered in any loss of vision after head and neck irradiation. Ophthalmological long-term follow-up of these patients is essential for an early diagnosis (AU)

Indications for eye removal over a 13-year period at an ophthalmology referral center in São Paulo, Brazil / Indicações para remoção ocular ao longo de um período de 13 anos no centro de referência oftalmológica em São Paulo, Brazil

ABSTRACT Purpose: To analyze the indications and types of eye removal at Latin America's highest-volume ophthalmic reference center in São Paulo, Brazil. Methods: A retrospective analysis was conducted of surgical pathological reports in the electronic database of the Ophthalmology Department of the Universidade Federal de São Paulo Hospital of patients who underwent eye-removal procedures between January 2000 and December 2012. Results: A total of 412 cases met the inclusion criteria for this study. The most common indications for eye removal were ocular melanoma and retinoblastoma, representing 35.4% and 31.1% of the total cases, respectively. Other frequent indications included endophthalmitis (6.3%), nonspecific inflammation (4.1%), squamous cell carcinoma (3.6%), panophthalmitis (3.4%), and phthisis bulbi (1.2%). The remaining indications accounted for 14.8% of all cases, with each accounting for <1% of the total cases. Enucleation was the most common eye-removal procedure seen in our study. Conclusions: The two most common indications for eye removal were ocular melanoma and retinoblastoma. Alternative treatment options are effective in limiting the need for eye removal but are constrained by our public center's so cioeconomic context.

RESUMO Objetivo: Analisar os tipos e indicações para a remoção dos olhos no maior centro de referência oftalmológica da América Latina em São Paulo, Brasil. Métodos: Revisão retrospectiva de laudos cirúrgico patológico em uma base de dados eletrônica do Departamento de Oftalmologia do Hospital da Universidade Federal de São Paulo. Foram analisados pacientes submetidos ao procedimento de remoção oftálmica no período de janeiro de 2000 a dezembro de 2012. Resultados: Um total de 412 casos estiveram de acordo com os critérios de inclusão desse estudo. A indicação mais comum para remoção oftálmica foi Melanoma ocular e Retinoblastoma, representando, respectivamente, 35,4% e 31,1% do total de casos. Outras indicações frequentes incluíam Endoftalmite 6,3%, Inflamação inespecífica 4,1%, Carcinoma escamocelular 3,6%, Panoftalmite 3,4% e Phthisis Bulbi 1,2%. O restante das indicações totalizaram 14,8% de todos os casos, sendo que cada um correspondem com menos de 1% do total. Enucleação foi o procedimento de remoção oftálmica mais comum observado em nosso estudo. Conclusão: As duas indicações mais frequentes para remoção oftálmica no centro oftalmológico de referência do Brasil foi melanoma e retinoblastoma. Opções terapêuticas alternativas são efetivas para limitar a necessidade da remoção ocular, porém são restritos devido ao contexto socioeconômico de nossa população.

The reasons for evisceration after penetrating keratoplasty between 1995 and 2015 / As causas de evisceração após ceratoplastia penetrante entre 1995 e 2015

ABSTRACT Purpose: The purpose of this study was to determine the indications and frequency of evisceration after penetrating keratoplasty (PK). Methods: The medical records of all patients who underwent evisceration after PK between January 1, 1995 and December 31, 2015 at Ankara Training and Research Hospital were reviewed. Patient demographics and the surgical indications for PK, diagnosis for evisceration, frequency of evisceration, and the length of time between PK and evisceration were recorded. Results: The frequency of evisceration was 0.95% (16 of 1684), and the mean age of the patients who underwent evisceration was 56.31 ± 14.82 years. The most common indication for PK that resulted in evisceration was keratoconus (37.5%), and the most common underlying cause leading to evisceration was endophthalmitis (56.25%). The interval between PK and evisceration ranged from 9 to 78 months. Conclusions: Although keratoplasty is one of the most successful types of surgery among tissue transplantations, our findings show that it is associated with a possible risk of evisceration.

RESUMO Objetivo: O objetivo deste estudo foi determinar as indicações e a frequência de evisceração ocular após cirurgia de ceratoplastia penetrante ou transplante de córnea (PK). Métodos: Foram analisados os registros médicos de todos os pacientes submetidos à evisceração após PK entre 1º de janeiro de 1995 e 31 de dezembro de 2015 no Hospital de Treinamento e Pesquisa de Ankara. Foram registradas a demografia do paciente e as indicações cirúrgicas de PK, diagnóstico de evisceração, frequência de evisceração, tempo entre PK e evisceração. Resultados: A frequência de evisceração foi de 0,95% (16 de 1684) e a média de idade foi de 56,31 ± 14,82 anos. A indicação mais comum para PK que terminou na evis ceração foi o ceratocone (37,5%) e a causa subjacente à evisceração foi a endoftalmite (56,25%). O intervalo entre PK e evisceração variou de 9 a 78 meses. Conclusão: Embora a ceratoplastia seja uma das cirurgias mais bem sucedidas entre os transplantes de tecidos, pode-se deduzir do estudo que não é tão inócua, pois pode evoluir para a evisceração ocular.

Chirurgie mutilante du globe oculaire au Centre Hospitalo-Universitaire Joseph Ravoahangy Andrianavalona, Madagascar

Introduction : La chirurgie mutilante du globe oculaire se définit par l'ablation chirurgicale du globe oculaire ou bien de son contenu. Notre étude a pour but d'étudier le profil épidémio-clinique de la chirurgie mutilante du globe oculaire au CHU-JRA.Matériels et méthodes : Il s'agit d'une étude rétrospective, descriptive sur 4 ans et demi, allant de janvier 2009 à juillet 2013 incluant tous les patients ayant subi une amputation du globe oculaire avec un dossier complet et enregistrés dans le registre du bloc opératoire. Résultats : Nous avons retenu 38 cas, soit 1,65% des activités chirurgicales du service. L'âge moyen était de 17,50. Le sex-ratio était de 1,11. Les 68,42% de nos patients venaient d'un milieu rural. Le délai de consultation moyen est de 25 jours. Les indications chirurgicales étaient le rétinoblastome dans 28,95%. L'éviscération a été pratiquée chez 27 patients, l'énucléation chez 10 patients et l'exentération chez un patient. Discussion : Le choix de la technique chirurgicale est différent d'une étude à l'autre et est fonction des indications. Conclusion : Une éducation de la population et une bonne prise en charge des pathologies oculaires permettent de limiter la chirurgie mutilante du globe oculaire

Experimental acrylonitrile butadiene styrene and polyamide evisceration implant: a rabbit clinical and histopathology study / Estudo clínico e histopatológico em coelhos eviscerados com utilização de implantes de poliamida e acrilonitrila butadieno estireno

The purpose of this study was to evaluate acrylonitrile butadiene styrene (ABS) and polyamide implants in rabbits submitted to evisceration at the macroscopic and microstructure level and to assess clinical response and histopathological changes as well. For the experimental study implants of 12mm diameter were prepared by rapid prototyping, weighed and the outer and inner surfaces evaluated macroscopically and by electron microscopy. In addition, a compression test was performed and ultrastructural damage was then determined. After evisceration of the left eyeball, nine New Zealand rabbits received ABS implants and nine others received polyamide implants. The animals were assessed daily for 15 days after surgery and every seven days until the end of the study (90 days). Histopathological evaluation was performed at 15, 45 and 90 days after surgery. The ABS implants weighed approximately 0.44g, while the polyamide ones weighed 0.61g. Scanning electron microscopy demonstrated that the ABS implants had regular-sized, equidistant micropores, while the polyamide ones showed micropores of various sizes. The force required to fracture the ABS implant was 14.39 ±0.60 Mpa, while for the polyamide one, it was 16.80 ±1.05 Mpa. Fifteen days after surgery, we observed centripetal tissue infiltration and scarce inflammatory infiltrate. Implants may be used in the filling of anophthalmic cavities, because they are inert, biocompatible and allow tissue integration.(AU)

Avaliou-se a macroscopia, a microestrutura, a resposta clínica e histopatológica de implantes de acrilonitrila butadieno estireno (ABS) e poliamida em coelhos submetidos à evisceração. Para o estudo experimental, os implantes foram elaborados por meio de prototipagem rápida, com 12mm de diâmetro, pesados e tiveram suas superfícies avaliadas macroscopicamente e por microscopia eletrônica de varredura. Adicionalmente, foi realizado ensaio de compressão para determinar a força necessária para fraturar os implantes. Após a evisceração do olho esquerdo, nove coelhos da raça Nova Zelândia receberam implantes de poliamida e nove outros receberam implantes de ABS. Os animais foram avaliados diariamente nos primeiros 15 dias após a cirurgia e a cada sete dias até o fim do período experimental (90 dias). Avaliação histopatológica foi realizada aos 15, 45 e 90 dias após a cirurgia. Os implantes de ABS pesaram 0,44g, e os de poliamida 0,61g. A microscopia eletrônica de varredura demonstrou que os implantes de ABS eram formados por microporos equidistantes, enquanto os de poliamida apresentavam microporos de vários tamanhos. A força necessária para fraturar os implantes de ABS foi de 14.39±0.60 Mpa, enquanto para os de poliamida foi de 16.80±1.05Mpa. Quinze dias após a cirurgia, foi observada infiltração fibrovascular centrípeta. Os implantes podem ser utilizados para correção de cavidades anoftálmicas por se mostrarem inertes, biocompatíveis e permitirem a infiltração tecidual.(AU)

Nanoskin: uso para reposição de volume na cavidade anoftálmica / Use of Nanoskin for volume replacement of the eye socket

RESUMO Objetivo: Avaliar a biocompatibilidade da Nanoskin para reposição de volume em cavidades enucleadas ou evisceradas de coelhos. Métodos: Estudo experimental, utilizando implantes de Nanoskin (Innovatecs®, São Carlos, Brasil), celulose bacteriana produzida pela bactéria Acetobacter xylinum tendo como substrato o chá-verde. Implantes de 10mm de diâmetro/5mm de espessura foram colocados em cavidades enucleadas (G1) ou evisceradas (G2) de 21 coelhos, avaliados clinicamente todos os dias, sacrificados aos 7, 30 e 90 dias após a cirurgia. O material foi removido e preparado para exame de microscopia óptica. Resultados: Sinais flogísticos discretos no pósoperatório imediato, não tendo sido evidenciados sinais infecciosos ou extrusão de nenhum implante. Houve aparente redução do volume ao longo do período experimental. Histologicamente ambos os grupos foram muito semelhantes, apresentando aos 7 dias células inflamatórias (predominantemente monócitos e neutrófilos), rede de fibrina e hemácias. A Nanoskin apresentava-se como pequenas esferas, de cor rósea, com pequenos espaços entre elas, permeados por escassas células inflamatórias. As células inflamatórias se modificaram ao longo de período experimental, sendo possível observar aos 30 dias células gigantes multinucleadas e fibroblastos maduros permeando o implante. Aos 90 dias, a estrutura do implante apresentava-se desorganizada, amorfa, com restos necróticos e com áreas ovoides, revestidas por fina membrana rósea, que pareciam se agrupar, vazias ou preenchidas por material acelular, róseo ou acinzentado. Conclusão: A Nanoskin provocou reação inflamatória que levou à reabsorção e redução do volume do implante. Novas formulações devem ser estudadas a fim de ter um produto que seja permanente para reparo da cavidade anoftálmica.

ABSTRACT Objective: The aim of this study was to evaluate the biocompatibility of Nanoskin for replacing volume in enucleated or eviscerated anophthalmic sockets of rabbits. Methods: An experimental study was carried out using enucleated or eviscerated rabbits, which received Nanoskin implants (Innovatecs®, São Carlos, Brazil), a cellulose produced by a bacteria (Acetobacter xylinum) using green tea as substrate. Implants of 10mm diameter/5mm of thickness were used placed in enucleated (G1) or eviscerated (G2) anophthalmic sockets of 21 rabbits.They were clinically examined daily, sacrificed at 7, 30 and 90 days after surgery and the material was removed and prepared for histological examination. Results: There were discrete signs of inflammation in the immediate postoperative period, with no evidence of infection or extrusion in any animal. However apparent reduction of volume during the trial period occurred. Histologically both groups were similar, with inflammatory cells (mainly monocytes and neutrophils), fibrin and hemaceas at 7 days postoperatively.The Nanoskin was presented as small pink spheres, with small gaps between them and permeated by few inflammatory cells. These cells have changed over the study, at 30 days multinucleated giant cells and mature fibroblasts that permeate the implant were observed. At 90 days, the structure of the implant was disorganized, amorphous, with necrotic debris and ovoid areas covered with thin pink membrane that seemed to cluster, empty or filled with no cellular pink or gray material. Conclusion: Nanoskin caused an inflammatory reaction leading to reabsorption and reduction of implant volume. New formulations should be studied in order to have a permanent product to repair the anophthalmic socket.