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PURPOSE: To examine subbasal corneal nerve changes in patients with bacterial infectious keratitis using in vivo confocal microscopy. METHODS: Thirteen patients (13 eyes) with unilateral bacterial keratitis and 12 healthy controls were prospectively enrolled in the study. In vivo confocal microscopy was performed in all the patients at 2 time points, in the acute phase of infectious keratitis and at 28 ± 0.6 months after resolution of the infection. RESULTS: The subbasal nerve length was 5.15 ± 1.03 mm/mm2 during the acute phase of bacterial keratitis (compared with that of the controls: 19.02 ± 1.78 mm/mm2, p<0.05). Despite the significant corneal nerve regeneration over the interval of 28 months after the resolution of the infection, the nerve density was still significantly reduced as compared with that of the controls (9.73 ± 0.93 mm/mm2, p<0.05). Moreover, in vivo confocal microscopy images showed diffuse high-reflecting areas referring to the scar tissue areas with thin and tortuous nerve branches regenerating toward these areas. CONCLUSIONS: A partial corneal nerve regeneration of subbasal nerve plexus during the first 28 months after the acute phase of infectious keratitis was observed. Moreover, the regenerated nerves of the patients remained morphologically altered as compared with those of the healthy controls. These results may be relevant to the clinical follow-up and surgical planning for these patients.

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El síndrome de Frey descrito inicialmente en 1923, es también conocido como Síndrome de la sudoración gustativa o Síndrome del Nervio aurículotemporal (N.auriculotemporalis), ya que las lesiones cutáneas asociadas a éste aparecen en la zona inervada por esta rama del nervio maxilar inferior (N. Mandibulares). Se caracteriza por sudoración gustativa y eritema en la región cervico-facial como respuesta a estímulos gustativos y excepcionalmente táctiles, pudiendo surgir como una complicación tras cirugía de la glándula parótida (parotidectomía), traumatismos o infección supurativa de esta glándula, como consecuencia de un daño ocasionado en las fibras parasimpáticas del nervio aurículotempora (N.auriculotemporalis). Los síntomas de sudoración y enrojecimiento de la piel suelen desarrollarse lentamente y resultan muy molestos. El tratamiento consiste en la colocación de anticolinérgicos locales o sistémicos, interposición de diversos materiales como colgajos regionales, tal como el músculo esternocleidomastoideo o la fascia temporoparietal

Frey's syndrome described initially in 1923, is also known as gustatory sweating syndrome or Auriculotemporal nerve Syndrome, since the cutaneous injuries associated with this one appear in the area supplied by this branch of the mandibularis nerve. It is characterized by gustatory perspiration and erythema in the cervico-facial region as response to gustatory and exceptionally tactile stimulation, being able to arise as a complication after surgery of the parotid gland (parotidectomy), traumatism or supurative infection of this gland, as consequence of a damage caused in the parasympathetic fibers from the auriculotemporal nerve. The symptoms of perspiration and reddening of the skin use to develop slowly and turn out to be very troublesome. The treatment consists of the placement of local or systemic anticolinergics, interposition of diverse materials as regional muscle flaps, such as the esternocleidomastoid muscle or the fascia temporoparietal

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OBJETIVO: Avaliar as alterações que ocorrem na sensibilidade corneanas após as cirurgias de LASIK e PRK MÉTODOS: Estudo prospectivo onde foram avaliados 60 olhos de 30 pacientes submetidos a LASIK bilateral simultaneamente e mais 30 olhos de 15 pacientes submetidos a PRK bilateral simultaneamente. De acordo com a quantidade de ablação intra-operatórias, os olhos foram divididos em dois grupos: Grupo 1 (menor que 40 µm) e Grupo 2 (Maior que 40 µm). A sensibilidade corneana foi medida na região central da córnea pelo estesiometro Cochet Bonnet® no pré operatório e após 30, 90 e 180 dias da cirurgias. RESULTADOS: A sensibilidade corneana na LASIK apresentou-se diminuída durante os três primeiros meses retornando as valores pré operatórios aos 6 meses; E de acordo com a quantidade de ablação o Grupo 1 apresentou diferença estatisticamente significante em relação ao Grupo 2 durante os três primeiros meses; No entanto a PRK recuperou seus valores pré operatório aos três meses e de acordo com a quantidade de ablação o Grupo 1 apresentou diferença estatisticamente significante somente no primeiro mês de pós operatório. CONCLUSÃO: A LASIK apresentou sensibilidade menor em relação ao PRK durante os 3 primeiros meses e somente aos 6 meses os valores da sensibilidade corneana foram similares; Os resultados também sugerem que a quantidade de ablação está relacionada com a diminuição da sensibilidade corneana durante os primeiros meses em ambas as técnicas cirúrgicas, principalmente na LASIK.

PURPOSE: To evaluate the alterations that occur on the cornea sensitivity after Lasik and PRK surgery. METHODS: Prospective studies have evaluated60 eyes from 30 patients subjected simultaneously to bilateral Lasik and 30 eyes from 15 patients subjected simultaneously to bilateral PRK. According to the amount of inner operatory ablation the eyes were divided into two groups: Group I (< 40 µm) and group II (> 40µm). The cornea sensitivity was measured in the central region of the cornea on the pre operatory and then again at 30, 90 and 180 days after the surgery with the esthesiometer. RESULTS: The cornea sensitivity in Lasik presented itself in a minor way during the first three months, returning to pre operatory values at six months; and according to the amount of ablation group I presented statistically significant difference in comparison to group II during the first three months; however PRK recovered its pre operatory values at three months and according to the amount of ablation group I presented statistically significant difference only on the first month of pre operatory. CONCLUSION: Lasik showed the least sensitivity in comparison to PRK during the first three months, only at six months the sensitivity values were similar to each other; the results suggest that the result of ablation endangers the cornea sensitivity during the first months on both surgical techniques especially Lasik.

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PURPOSE: To review the pathophysiology of LASIK-associated dry eye conditions and provide insights into prophylaxis to decrease the incidence of dry eye after LASIK and to treat the condition when it occurs. METHODS: A review of the literature was performed on LASIK-associated dry eye and the experience of the authors was summarized. RESULTS: LASIK has a neurotrophic effect on the cornea, along with other changes in corneal shape, that affect tear dynamics causing ocular surface desiccation. Dry eye is one of the most common complications of LASIK surgery. Symptoms of dryness may occur in more than 50% of patients, with other complications such as fluctuating vision, decreased best spectacle-corrected visiual acuity, and severe discomfort occurring in approximately 10% of patients. Preoperative dry eye condition is a major risk factor for more severe dry eye after surgery and should be identified prior to surgery. Optimization with artificial tears, nutrition supplementation, punctal occlusion, and topical cyclosporine A in patients with symptoms or signs of dry eye prior to LASIK decreases the incidence of more bothersome symptoms following surgery. Patients with LASIK-induced neurotrophic epitheliopathy often respond to topical cyclosporine A treatment, which treats the underlying inflammation and may benefit nerve regeneration. CONCLUSIONS: LASIK-induced dry eye and neurotrophic epitheliopathy are common complications of LASIK surgery. Optimization of the ocular surface prior to surgery decreases the incidence and severity of postoperative symptoms of the condition.

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El neuroblastoma olfatorio es una neoplasia neuroectodérmica maligna rara que afecta a la bóveda nasal y que tiende a invadir las estructuras vecinas, entre estas a la cavidad intracraneal. Su asociación con aneurismas intracraneales nunca ha sido descrita. Presentamos a una paciente con la coexistencia de un aneurisma del segmento oftálmico de la arteria carótida interna y un neuroblastoma olfatorio con invasión intracraneal. La coexistencia entre neoplasias del sistema nervioso central y aneurismas intracraneales es infrecuente. En este artículo analizamos las posibles causas de la asociación entre neoplasias y aneurismas intracraneales.

The olfactory neuroblastoma is a rare malignant neuroectodermal neoplasia of the nasal roof. It has a highly tendency of invades near structures including intracranial compartment. Associations between olfactory neuroblastoma with intracranial aneurysms have been never described. We show a case of a female with coexistence of an internal carotid artery aneurysm and olfactory neuroblastoma. The coexistence between nervous system tumors with intracranial aneurysms is not common. In this paper we analyze the association between intracranial neoplasia and aneurysms.

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BACKGROUND: Post-herpetic neuralgia (PHN) is one complication after herpes zoster infection, which may affect the facial superficial sensitivity. METHODS: Eighteen patients with PHN were interviewed and evaluated according to a systematized sensitivity approach, including mechanical, thermal and pain. RESULTS: The pain location was V1 in 15 patients. All trigeminal branches from both facial sides were evaluated; we compared the affected with the opposite side. There was a significant difference at V1 with cold (P=0.038), vonFrey (P=0.008) and pinpricks (P=0.022); at V2, the statistical difference occurred with cold (P=0.034), heat (P=0.019) and pinpricks (P=0.037); at V3, differences occurred with cold (P=0.042) and heat (P=0.036). Only V1 and oral mucosa (V2-3) presented pain threshold differences between both sides (P=0.001, P=0.021). CONCLUSION: Age, predominance of trigeminal PHN in V1 and continuous burning pain was common and similar to literature. Sensation was hampered with evident deficits of all sensory modalities in the affected trigeminal areas, especially V1.

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PURPOSE: This study correlated confocal microscopic images obtained using the Nidek ConfoScan 2.0 System in corneas with clinical suspicion of Acanthamoeba keratitis, with diagnosis confirmed by either cytological and/or histological analysis. METHODS: Fifteen eyes of 14 patients with a clinical diagnosis of Acanthamoeba keratitis underwent confocal microscopy evaluation. RESULTS: Fifteen eyes of 14 patients (one bilateral case) showed Acanthamoeba keratitis alterations that ranged from massive infestation to cicatricial opacity in the stroma. Ten patients (71%) were females. Mean age was 26 years (range 19 to 37 yr). All patients were contact lens wearers. CONCLUSION: Confocal microscopy was a useful, noninvasive technique in the diagnosis and treatment of Acanthamoeba keratitis, especially in those cases in which corneal scraping, cytological analysis, and culture are negative. It also eliminated the necessity of tissue biopsy, considered an invasive procedure.

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Presentamos el manejo quirúrgico de los aneurismas paraclinoídeos. Discutimos los fundamentos microanatómicos, indicaciones, técnica quirúrgica empleada, complicaciones y resultados de una serie prospectiva de 10 pacientes operados por el equipo vascular del INC Asenjo entre noviembre de 1999 y julio de 2000. Las complicaciones correspondieron a una infección de herida operatoria y una colección extradural en la primera paciente de la serie, un hematoma cervical en otra enferma y un infarto de la arteria coroídea anterior en una paciente con aneurisma global de carótida. Se realizó control neurooftalmológico preoperatorio en todos los pacientes, registrandose en 3 compromisos de nervio óptico postquirúrgicos. No hubo mortalidad en la serie. Especial énfasis se aplica a la importancia del conocimiento microanatómico, al trabajo en equipo y a la planificación prequirúrgica para el manejo de esta compleja patología

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Säo discutidos os aspectos anatômicos da fossa ptérigo-maxilar e do nervo nasociliar, cujas infiltraçöes anestésicas säo atos simples, rápidos, eficazes e seguros em vários procedimentos odontológicos e otorrinolaringológicos, possibilitando a realizaçäo de cirurgias nasossinusais bem menos sangrantes com a utilizaçäo de doses bem menores de anestésicos gerais, em virtude da aboliçäo dos estímulos álgicos e consequente näo liberaçäo de catecolaminas

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El ganglio trigeminal también conocido como ganglio semilunar o ganglio de Gasser, contiene la mayoría de los cuerpos celulares de las neuronas sensitivas primarias, mientras que las restantes provienen del núcleo mesencefálico.

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Se describen las alteraciones de las ducciones en cuatro grupos: por parálisis: III par, IV par, VI par; por hipofunción: agenesia muscular, sección traumática del músculo, debilitamiento quirúrgico excesivo, músculo suelto; por alteraciones inervacionales: síndrome de Duane, parálisis monocular de elevadores, síndrome de Moebius; por restricción: síndrome de Brown, estrabismo fijo, fibrosis del recto inferior, estrabismo tiroideo, fractura blow-out de órbita, adhesión post-quirúrgica

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