RESUMO
PURPOSE: To investigate the relationship between the kinematics of spontaneous blinks and the anterior area of the levator palpebrae superioris muscle in patients with Graves orbitopathy (GO). METHODS: This is a case-control study. The authors measured the margin reflex distance of the upper eyelid (margin reflex distance 1), the kinematics of spontaneous blinks, and the anterior area of levator palpebrae superioris muscle in CT coronal scans of patients with Graves upper eyelid retraction (GO) and a control group. The eye with the greatest margin reflex distance 1 was selected for analysis in each group. RESULTS: A total of 68 participants were included, with 36 in the GO group and 32 in the control group. In the GO group, the mean margin reflex distance 1 measured 6.5 mm, while in the control group, it was 3.9 mm. Almost all parameters related to the closing phase of spontaneous blinking activity, including amplitude, velocity, blinking rate, and interblink time, did not differ between the two groups. However, the effectiveness of the blink's amplitude (ratio of blink amplitude to margin reflex distance 1) and the main sequence (relationship between amplitude and velocity) were significantly reduced in the GO group compared with the control group. The area of the levator palpebrae superioris muscle was significantly larger in GO than in controls, with 71.4% of patients' muscles outside of the maximum range of the controls. CONCLUSIONS: In patients with GO, there is a reduction in blinking effectiveness, also known as blink lagophthalmos, which is a factor in the common occurrence of ocular surface symptoms. The increase in velocity with amplitude is also reduced in GO.
Assuntos
Piscadela , Pálpebras , Oftalmopatia de Graves , Músculos Oculomotores , Humanos , Piscadela/fisiologia , Feminino , Oftalmopatia de Graves/fisiopatologia , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Adulto , Estudos de Casos e Controles , Pálpebras/fisiopatologia , Doenças Palpebrais/fisiopatologia , Doenças Palpebrais/diagnóstico , Idoso , Tomografia Computadorizada por Raios X , LagoftalmiaRESUMO
PURPOSE: To measure the spontaneous blinking metrics after blepharoptosis correction with frontalis muscle flap advancement. METHODS: A video system was employed to measure the amplitude and velocity of spontaneous blinking of 24 eyelids after the frontalis muscle flap surgery for blepharoptosis correction. A control group with no eyelid disorders was also measured. The data of 13 eyelids who had frontalis slings with autogenous fascia, which were previously collected with the same method in another study, were used for comparison. Digital images were used to measure the superior margin reflex distance and the presence of lagophthalmos during a gentle closure of the palpebral fissure. Superficial keratitis was assessed by corneal biomicroscopy. RESULTS: The mean amplitude of spontaneous blinking was 6.3 mm in controls, 2.6 mm in the frontalis flap patients, and 2.1 mm in the fascia sling group. The mean blink velocity was 133.8 mm/second in controls, 39.0 mm/second (3.7 standard error) after the frontalis flap, and 36.3 mm/second in patients with frontalis sling with fascia. For these 2 parameters, there was no statistical difference between the surgical groups, but a significant reduction when compared with the control group. No significant association was found between lagophthalmos and keratitis and the surgical procedure. CONCLUSIONS: There is no difference between the blinking metrics of eyelids operated using the frontalis muscle flap advancement technique or frontalis sling with autogenous fascia. The presence of lagophthalmos and keratitis also does not differ between the 2 procedures.
Assuntos
Blefaroplastia , Blefaroptose , Piscadela , Pálpebras , Músculos Oculomotores , Retalhos Cirúrgicos , Humanos , Piscadela/fisiologia , Blefaroptose/cirurgia , Blefaroptose/fisiopatologia , Masculino , Feminino , Músculos Oculomotores/cirurgia , Músculos Oculomotores/fisiopatologia , Pálpebras/cirurgia , Pálpebras/fisiopatologia , Pessoa de Meia-Idade , Blefaroplastia/métodos , Idoso , Adulto , Fenômenos BiomecânicosRESUMO
ABSTRACT Purpose: Inferior eyelid laxity is classically evaluated using "snap-back" and "distraction" tests. This study aimed to assess the reproducibility of the technique used to indirectly quantify the horizontal tension in the lower eyelids using digital image processing. Methods: This longitudinal study was conducted to assess the reproducibility of a new technique that quantifies the horizontal tension in the lower eyelid. The study was conducted at the Hospital das Clínicas of Porto Alegre. The protocol was established by two trained ophthalmologist examiners, allowing intra- and interobserver agreement analyses. Image acquisition was done in two stages: the first image was captured with the eyelid in primary gaze position and the second with the eyelid in traction position. All images and measurements were processed using Image J 1.33m software from the National Institute of Health. The Bland-Altman method, intraclass correlation coefficients, concordance correlation coefficients, and technical measurement error were used to evaluate reproducibility. Results: The study participants comprised healthy individuals with no ophthalmologic pathologies. The measurements obtained in the neutral position showed a slightly higher agreement than those obtained in the traction position. The mean difference between the measurements performed in the traction position was 0.028 ± 0.7 mm and 0.014 ± 0.9 mm in the intra- and interobserver analyses, respectively. The Bland-Altman method demonstrated adequate confidence limits for both measurements. Correlation coefficients for measurements varied between 0.87 [95% confidence interval (CI) 0.68-0.95] and 0.91 (95% CI 0.77-0.97) in the neutral position and between 0.72 (95% CI 0.37-0.89) and 0.76 (95% CI 0.4-0.91) in the traction position. Conclusion: A high intra- and interobserver concordance was observed in the studied method to quantify lower eyelid tension. The proposed method is simple and easily reproducible, and to the best our knowledge, this is the first method that quantifies lower eyelid horizontal tension on the basis of digital image processing. This modified distraction test might be useful in studies quantifying lower eyelid horizontal tension.
RESUMO Objetivo: A frouxidão palpebral inferior é avaliada classicamente por meio de testes de "snap-back" e "distraction test". O objetivo deste estudo foi avaliar a reprodutibilidade da técnica utilizada para quantificar indiretamente a tensão horizontal nas pálpebras inferiores através do processamento digital de imagens. Métodos: Este estudo longitudinal foi realizado para avaliar a reprodutibilidade de uma nova técnica que quantifica a tensão horizontal na pálpebra inferior. O estudo foi realizado no Hospital das Clínicas de Porto Alegre. O protocolo foi estabelecido por dois examinadores oftalmologistas treinados, permitindo análises de concordância intra e interavaliador. A aquisição de imagens foi feita em duas etapas: a primeira imagem foi capturada com a pálpebra na posição primária do olhar e a segunda com pálpebra tracionada. Todas as imagens e medições foram processadas usando o software Image J 1.33m do National Institute of Health. O método de Bland-Altman, os coeficientes de correlação intraclasses, os coeficientes de correlação de concordância e o erro técnico da medida foram utilizados para avaliar a reprodutibilidade. Resultados: Os participantes do estudo foram indivíduos saudáveis e sem patologias oftalmológicas. As medidas obtidas na posição neutra mostraram concordância levemente maior do que as obtidas na posição tracionada. A diferença média entre as medidas realizadas na posição tracionada foi de 0,028 ± 0,7mm e 0,014 ± 0,9mm nas análises intra e interobservadores, respectivamente. O método de Bland-Altman demonstrou limites de confiança adequados para ambas as medidas. Os coeficientes de correlação para as medidas variaram entre 0,87 [intervalo de confiança de 95% (IC) 0,68-0,95) e 0,91 (IC 95% 0,77-0,97) na posição neutra e entre 0,72 (IC 95% 0,37-0,89) e 0,76 (IC 95% 0,46-0,91) na posição tracionada. Conclusão: Observou-se elevada concordância intra e interobservador no método estudado para quantificar a tensão palpebral inferior. O método proposto é simples e facilmente reproduzível, e, do melhor modo possível, este é o primeiro método que quantifica a tensão horizontal da pálpebra inferior com base no processamento digital de imagens. Este teste de distração modificado pode ser útil em estudos que quantifiquem a tensão horizontal da pálpebra inferior.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Interpretação de Imagem Assistida por Computador/métodos , Doenças Palpebrais/fisiopatologia , Doenças Palpebrais/diagnóstico por imagem , Valores de Referência , Software , Fotografação/métodos , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Pálpebras/fisiopatologia , Pálpebras/diagnóstico por imagemRESUMO
PURPOSE: Inferior eyelid laxity is classically evaluated using "snap-back" and "distraction" tests. This study aimed to assess the reproducibility of the technique used to indirectly quantify the horizontal tension in the lower eyelids using digital image processing. METHODS: This longitudinal study was conducted to assess the reproducibility of a new technique that quantifies the horizontal tension in the lower eyelid. The study was conducted at the Hospital das Clínicas of Porto Alegre. The protocol was established by two trained ophthalmologist examiners, allowing intra- and interobserver agreement analyses. Image acquisition was done in two stages: the first image was captured with the eyelid in primary gaze position and the second with the eyelid in traction position. All images and measurements were processed using Image J 1.33m software from the National Institute of Health. The Bland-Altman method, intraclass correlation coefficients, concordance correlation coefficients, and technical measurement error were used to evaluate reproducibility. RESULTS: The study participants comprised healthy individuals with no ophthalmologic pathologies. The measurements obtained in the neutral position showed a slightly higher agreement than those obtained in the traction position. The mean difference between the measurements performed in the traction position was 0.028 ± 0.7 mm and 0.014 ± 0.9 mm in the intra- and interobserver analyses, respectively. The Bland-Altman method demonstrated adequate confidence limits for both measurements. Correlation coefficients for measurements varied between 0.87 [95% confidence interval (CI) 0.68-0.95] and 0.91 (95% CI 0.77-0.97) in the neutral position and between 0.72 (95% CI 0.37-0.89) and 0.76 (95% CI 0.4-0.91) in the traction position. CONCLUSION: A high intra- and interobserver concordance was observed in the studied method to quantify lower eyelid tension. The proposed method is simple and easily reproducible, and to the best our knowledge, this is the first method that quantifies lower eyelid horizontal tension on the basis of digital image processing. This modified distraction test might be useful in studies quantifying lower eyelid horizontal tension.
Assuntos
Doenças Palpebrais/diagnóstico por imagem , Doenças Palpebrais/fisiopatologia , Interpretação de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Adulto , Pálpebras/diagnóstico por imagem , Pálpebras/fisiopatologia , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fotografação/métodos , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , SoftwareRESUMO
BACKGROUND: Although the nonaffected side appears to be clinically normal in hemifacial spasm (HFS), it is not known whether this side can be considered normal regarding histopathological findings. The purpose of this study was to objectively evaluate and compare orbicularis oculi samples of patients with HFS (not previously treated with botulinum toxin) and control patients undergoing cosmetic upper eyelid blepharoplasty. METHODS: Orbicularis oculi samples from 22 eyelids were evaluated. There were 7 samples from the affected and 7 samples from the nonaffected sides of patients with HFS who had not been previously treated with botulinum toxin, and 8 samples from normal control patients. Muscle samples were prepared using hematoxylin and eosin staining, and a digital image analysis software was used for objective analyses. RESULTS: When compared with normal controls, endomysial and perimysial connective tissue areas were significantly increased (P = 0.015) on the affected side in HFS, suggesting that this disorder is associated with chronic alterations that lead to muscle degeneration. Cell density was significantly reduced on the affected (P = 0.028) and also on the nonaffected sides in HFS (P = 0.003) compared with normal controls. This was observed, although, clinically, there were no signs or symptoms of increased muscular contraction on the nonaffected sides in any of the patients with HFS studied. CONCLUSIONS: Significant morphological differences in the orbicularis oculi muscle in patients with HFS were observed on both the affected and nonaffected sides. Our findings suggest a potential role for muscle homeostasis disturbances on both sides for patients with HFS. Affected sides in patients with HFS did, however, demonstrate muscle degeneration that was not present on the nonaffected sides.
Assuntos
Pálpebras/fisiopatologia , Músculos Faciais/fisiopatologia , Espasmo Hemifacial/fisiopatologia , Músculos Oculomotores/fisiopatologia , Idoso , Blefaroplastia/métodos , Pálpebras/cirurgia , Feminino , Espasmo Hemifacial/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
To assess spontaneous blinking and anomalous eyelid movements in patients with hemifacial spasm with an emphasis on interocular differences. Spontaneous eyelid movements were registered bilaterally for 3 min using a high-speed video camera in 28 patients with hemifacial spasm (HFS) who had not been treated with botulinum toxin injections for at least 5 months. The degree of blink conjugacy, maximum velocity, and amplitude of the closing phase of the blinks were determined for the affected and non-affected sides. Out of the 28 subjects, 23 (82%) presented with abnormal nonconjugate spasms that were similar to blinks, and in 17 (61%), high-frequency eyelid twitches were detected between blinks on the affected eye. The rate of nonconjugate blink-like spasms ranged from 0.3 to 24.7 movements/min. With regard for conjugate blinks, there was no significant interocular difference in amplitudes or eyelid closure velocities. The amplitude and velocity were significantly lower for nonconjugate movements than for spontaneous blinks. HFS is a unique condition in which complex patterns of eyelid movements, including both conjugate and nonconjugate movements, are present. Conjugate movements correspond to spontaneous blinking, and the same metrics were observed in affected and non-affected eyes. Nonconjugate movements correspond to anomalous nonconjugate blink-like spasms and high-frequency eyelid twitches in the affected eye, both of which were characterized by lower amplitudes and velocities than were observed in conjugate movements.
Assuntos
Piscadela/fisiologia , Movimentos Oculares/fisiologia , Pálpebras/fisiopatologia , Espasmo Hemifacial/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravação em VídeoRESUMO
Workers in the dry-cleaning industry are exposed to organic solvents that may cause eye irritation and tear film changes. Objective To quantify changes in the ocular surface and tear film in dry cleaners exposed to organic solvents and associate these changes with ocular irritation as reported in a symptom questionnaire for dry eye diagnosis. Methods This was a case and control study in which the characteristics and eye-irritation symptoms were compared between two groups of 62 participants that were either exposed or not exposed to organic solvents. A general optometric examination and the following test were performed: lipid interferometry, Lissamine Green Stain, tear breakup time, Schirmer I, conjunctival impression cytology and the Donate dry eye symptoms questionnaire. Results Sixty-five percent of exposed workers obtained a higher score than 13 on the Donate dry eye symptoms questionnaire which indicated the presence of more irritation symptoms than those in the non- exposed group. A Chi-square analysis indicated the exposed group reported significantly higher incidences (P <0.005) for eye irritation symptoms of sandy sensation; tearing eyes sensation; foreign body sensation; tearing; dry eye; dryness; eyestrain and heavy eyelids. A Mann Whitney-U indicated greater severity only for symptoms relating to dry eye; sandy sensation; foreign body sensation, tearing; tearing eyes and dryness. There was a statistically significant difference (P <0.05) for Schirmer I; tear break up time; and the ocular surface assessed with Lissamine green staining and conjunctival impression cytology between groups. A reduction in the thickness of the lipid layer in the exposed group compared to the non-exposed group was observed. Surprisingly, clinical test outcomes were not significantly correlated with dry eye symptoms nor years of exposure. Conclusion Workers in the dry-cleaning industry exposed to organic solvents are associated with changes in ocular surface and tear film generating irritation symptoms commonly present in evaporative dry eye.
Assuntos
Túnica Conjuntiva/efeitos dos fármacos , Síndromes do Olho Seco/diagnóstico , Compostos Orgânicos/toxicidade , Solventes/química , Lágrimas/efeitos dos fármacos , Adolescente , Adulto , Astenopia/etiologia , Estudos de Casos e Controles , Túnica Conjuntiva/patologia , Túnica Conjuntiva/fisiologia , Síndromes do Olho Seco/etiologia , Pálpebras/efeitos dos fármacos , Pálpebras/fisiopatologia , Feminino , Humanos , Lavanderia , Lipídeos/química , Masculino , Exposição Ocupacional , Compostos Orgânicos/química , Lágrimas/química , Lágrimas/fisiologia , Adulto JovemRESUMO
PURPOSE: Eye closure sensitivity (ECS) has been described as a reflex trait in juvenile myoclonic epilepsy (JME). However, there is no consensus regarding its significance on prognosis. The aim of this study is to clarify the long-term impact of ECS documented by a clinical interview and a video-EEG neuropsychological protocol (VNPP) in a series of 133 JME patients. METHODS: Data from 22 JME patients with ECS confirmed by a VNPP (Group 1) were compared with those of 20 JME patients without any reflex traits (Group 2). They were followed for a mean of 8.21 years (SD=±5.044). The frequency of seizures was assessed using a diary. Except for photosensitivity (PS), any other reflex traits occurrence, drugs/alcohol abuse intake, noncompliance, and Jeavons syndrome, were considered exclusion criteria. RESULTS: Group 1 had a lower age at epilepsy onset (p = 0.028), higher incidence of febrile seizures (13.6%), and familial history of epilepsy (p = 0.023). Only 18.2% had self-perception of eyelid myoclonia (EM) (kappa coefficient = 0.193), which persisted in 77.3% of patients. Limb myoclonia, tonic-clonic seizures (TCS) and/or myoclonic-tonic-clonic seizures (MTCS), as well as absences were more frequent (p = 0.015; p = 0.013; p = 0.011, respectively) in Group 1. PS did not influenced frequency of EM (p = 1.0), absences (p = 0.648), or TCS/MTCS (p = 0.934). Psychiatric comorbidities were not different between groups. CONCLUSIONS: ECS is related to a worse outcome regarding control of all seizure types, persistence of EM, and higher frequency of limb myoclonia, as well as the total number of TCS and/or MTCS.
Assuntos
Pálpebras/fisiopatologia , Epilepsia Mioclônica Juvenil/diagnóstico , Epilepsia Mioclônica Juvenil/fisiopatologia , Reflexo/fisiologia , Adulto , Fatores Etários , Anticonvulsivantes/uso terapêutico , Eletroencefalografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Epilepsia Mioclônica Juvenil/tratamento farmacológico , Prognóstico , Estatísticas não Paramétricas , Adulto JovemRESUMO
PURPOSE: To measure the long-term effects of frontalis slings with fascial tissues on the downward eyelid saccadic movements Methods: Downward lid saccades for 10, 20, 30, 40, and 50 degrees of downgaze were measured in a sample of 19 patients with congenital ptosis who underwent frontalis slings with fascia lata (autogenous and banked) and temporalis fascia. Mean postoperative time was 10.7 years ± 3.8 SD. Seventeen age-matched normal subjects comprised the control group. Lid movements as well as the magnitude of brow motion were quantified in all participants with an opto-electronic device that automatically corrected any head movement. RESULTS: Most patients (77.4%) displayed lagophthalmos on eyelid closure. The lid saccades of the patients were severely restricted and did not increase beyond 30 degrees of downgaze. The maximum velocity of lid saccades was also abnormally low. Although the pre- and postoperative lid positions did not differ between eyes operated with the three types of slings, interocular analysis of patients who had bilateral surgery showed that the restrictive effect on the saccadic movements was more asymmetrical with banked fascia than with autogenous tissue. Overall, there was a significant negative correlation between the surgical effect with frontalis contraction and maximum saccadic amplitude. While in controls brow motion accounted for about 3.3-9.3% of the lid saccades, it was responsible for more than 43.5-57.4% lid movements in the patients. CONCLUSION: Fascial slings have a permanent restrictive effect on the elastic properties of the lids. Postoperative lagophthalmos is a natural consequence of any type of fascial sling. Downward saccadic amplitude is negatively correlated with the surgical effect with frontalis contraction.
Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Piscadela/fisiologia , Pálpebras/fisiopatologia , Fáscia/transplante , Previsões , Movimentos Sacádicos/fisiologia , Adolescente , Adulto , Blefaroptose/congênito , Blefaroptose/fisiopatologia , Criança , Elasticidade , Pálpebras/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To analyze the upper eyelid contour of patients with unilateral congenital ptosis who underwent single-strip frontalis suspension. METHODS: The authors compared the upper eyelid shape of the right and left eyes of 10 patients who underwent unilateral frontalis suspension with a single strip of autogenous fascia. At a mean postoperative time of 10.1 ± 4.01 months, the image J software was used to measure the ratio between the nasal and temporal areas of the upper half of the palpebral fissure. The midpupil upper eyelid distance (MRD1) was also measured on the photos with the same software. The nonparametric Wilcoxon signed-rank test was used to compare the data. RESULTS: Postoperative MRD1 ranged from 2.5 to 4.7 mm (median = 3.8) on the affected side. The MRD1 for nonoperated eyelid ranged from 1.8 to 5.0 mm (median = 3.5). On the operated side, the temporal areas ranged from 50.3 to 85.7 mm (median 65.2) and nasal areas ranged from 41.5 to 72.3 (the median was 60.1). In the contralateral, nonoperated palpebral fissures, the temporal areas ranged from 42.7 to 94.3 mm (median = 54.5) and the nasal areas ranged from 36.8 to 86.1 mm (median 52.3). The T/N ratio distributions were almost identical between groups, ranging from 0.9 to 1.2 (median = 1.1) in the operated eyes and from 0.9 to 1.3 (median = 1.1) in the fellow eyes. CONCLUSIONS: In autogenous fascia frontalis suspension procedures, the upper eyelid contour of the ptotic eyelids can be adequately normalized with a single area of traction on the tarsal plate.
Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Fáscia/transplante , Músculos Oculomotores/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Pálpebras/fisiopatologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: The study was designed to compare the outcome of full-thickness blepharotomy and transconjunctival eyelid lengthening in the correction of upper eyelid retraction (UER) in patients with Graves' orbitopathy (GO). METHODS: This is a prospective randomized interventional study. Following ophthalmic examination, determination of the ocular surface disease index (OSDI) and photography, 27 patients with UER were randomly assigned to either graded full-thickness blepharotomy (G1) or transconjunctival Müller muscle recession and graded disinsertion of the levator palpebrae superioris muscle (G2). Six months later, patients were reevaluated. Digital images were analyzed with the assistance of customized software. A standardized "normal range" of upper eyelid height and contour was calculated based on healthy controls. The outcome of the two groups was compared. RESULTS: Forty-seven eyelids of 27 patients (19 female) with UER were included. Twenty-seven eyelids (15 patients) were allocated to G1 and 20 eyelids (12 patients) to G2. On average, surgery lasted 37.46 ± 5.73 min in G1 and 32.70 ± 8.39 min in G2. Based on the margin reflex distance, 93% of the eyelids in G1 and 85% in G2 were within the normal range after surgery. The corresponding figures for lid contour were 63 and 55%. Both groups displayed significant improvement in OSDI scores. No significant difference was observed in the overall comparison. CONCLUSIONS: The two surgical techniques were equally effective in the treatment of UER from GO. Postoperative contour outcomes were considerably worse in patients with severe UER than in patients with mild or moderate UER, regardless of group. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 . Study registered on ClinicalTrial.gov number: NCT01999790.
Assuntos
Blefaroplastia/métodos , Pálpebras/cirurgia , Oftalmopatia de Graves/cirurgia , Qualidade de Vida , Adulto , Pálpebras/fisiopatologia , Feminino , Seguimentos , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Prospectivos , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
El colágeno1 es una proteína que desempeña un papel crítico en la arquitectura de la piel. La cualidad que transmite es la fuerza y resistencia. La esencia de este trabajo es demostrar que con la estimulación del colágeno de la piel del párpado inferior se logra restablecer la piel necesaria para que tenga un aspecto agradable, sin necesidad de recurrir a la exéresis. Al conseguir el calentamiento del colágeno, la piel recobra propiedades como elasticidad, retracción y retención, cualidades propias de una piel joven. La idea que se quiere transmitir es que se puede mejorar la piel sin correr el riesgo6,7 de una asimetría o una desmesura que termine con ectropión o retracciones cicatrizales luego de extracción de piel. Este es un procedimiento rápido que no entorpece el normal desempeño quirúrgico, extremadamente seguro ya que se recurre a una estimulación proteica sin sacar piel y perdura el resultado en el tiempo o sea que es efi caz
Collagen1 is a protein plays a critical role in skin architecture. The quality that comes through is the strength and endurance. The essence of this paper is to demonstrate that collagen stimulation of the lower eyelid skin, manages to restore the skin necessary to have a nice look without resorting to excerecis. By getting the heating of collagen and recovers elasticity properties, shrinkage and retention qualities of youthful skin. The idea to be conveyed, is that you can improve the skin without running the risk6,7 of an asymmetry or disproportion to end scarring ectropion or retraction after removal of skin. This is a quick procedure that does not hinder the normal surgical performance, extremely safe because it uses a non-protein stimulation by removing skin and the result lasts over time or whether it is eff ective.
Assuntos
Humanos , Masculino , Feminino , Terapia por Ultrassom , Blefaroptose/reabilitação , Colágeno/deficiência , Pálpebras/fisiopatologiaRESUMO
Introducción: La blefaroplastia produce resultados clínicos y estéticos favorables en los pacientes aquejados por dermatocalasis. Objetivo: Evaluar los resultados de los procedimientos quirúrgicos convencional y con láser de CO2 en estos afectados. Métodos: Se realizó un estudio descriptivo, prospectivo y trasversal de 300 pacientes con dermatocalasis, atendidos en el Servicio de Oculoplastia del Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero de 2015 hasta diciembre de 2016. Resultados: Predominaron el grupo etario de 40 a 59 años, el sexo femenino y la afectación en los párpados superiores, sin diferencias significativas en cuanto a las técnicas quirúrgicas empleadas; se observó un mayor número de complicaciones en los pacientes operados de manera convencional, con más frecuencia del sangrado. En general los pacientes evolucionaron satisfactoriamente y los que presentaron limitaciones del campo visual superior se recuperaron sin dificultad luego de la intervención quirúrgica. Conclusiones: La blefaroplastia con láser de CO2 constituye una mejor y más calificada opción terapéutica para la corrección de la dermatocalasis
Introduction: Blepharoplasty produces favorable clinical and cosmetic results in the patients that are suffering from dermatochalasis. Objective: To evaluate the results of the conventional and CO2 laser surgical procedures in these affected patients. Methods: A descriptive, prospective and cross-sectional study of 300 patients with dermatochalasis, assisted in the Oculoplasty Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital Ophthalmologic Center was carried out in Santiago de Cuba, from January, 2015 to December, 2016. Results: There was a prevalence of the 40 to 59 age group, female sex and upper lids disorder, without significant differences concerning the surgical techniques that were used; a higher number of complications in patients operated with a conventional way was observed, with more frequency of bleeding. In general the patients had a favorable clinical course and those that presented limitations of the upper visual field recovered without difficulty after the surgical intervention. Conclusions: Blepharoplasty with CO2 laser constitutes a better and more qualified therapeutic option for the correction of dermatochalasis
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Blefaroptose , Blefaroplastia , Pálpebras/fisiopatologia , Lasers de Gás/uso terapêutico , Epidemiologia Descritiva , Estudos Transversais , Estudos ProspectivosRESUMO
PURPOSE:: To evaluate whether reducing eyelid muscular force through the administration of botulinum toxin type A (BTX-A) to the orbicularis oculi muscles of patients with keratoconus affected corneal parameters indicative of disease progression. METHODS:: In this prospective parallel randomized clinical trial, 40 eyes of 40 patients with keratoconus were randomized into equally sized control and BTX-A groups. Patients in the BTX-A group received subcutaneous BTX-A injections into the orbicularis muscle. The control group received no intervention. Palpebral fissure height, best spectacle-corrected visual acuity (BSCVA), and corneal topographic parameters were evaluated at baseline and at 3-, 6-, 12-, and 18-month follow-ups. RESULTS:: The mean ± standard deviation vertical palpebral fissure heights were 9.74 ± 1.87 mm and 9.45 ± 1.47 mm at baseline in the control and BTX-A groups, respectively, and 10.0 ± 1.49 mm and 9.62 ± 1.73 mm at 18 months, with no significant difference between the groups (p=0.337). BSCVA values were 0.63 ± 0.56 and 0.60 ± 0.27 at baseline in the control and BTX-A groups (p=0.643), and 0.52 ± 0.59 and 0.45 ± 0.26 at 18 months, again with no significant difference between the groups (p=0.452). In addition, there were no statistical differences between the groups at 18 months for the three keratometry topographic parameters: flattest (K1), steepest (K2), and mean (Km) keratometry (p=0.562). CONCLUSION:: BTX-A inhibition of eyelid force generation did not result in detectable changes in corneal parameters in keratoconic patients during 18 months of follow-up.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Progressão da Doença , Pálpebras/fisiopatologia , Ceratocone/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Adolescente , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Protocolos Clínicos , Paquimetria Corneana , Topografia da Córnea , Pálpebras/efeitos dos fármacos , Músculos Faciais/efeitos dos fármacos , Feminino , Humanos , Injeções Subcutâneas , Ceratocone/fisiopatologia , Masculino , Fármacos Neuromusculares/administração & dosagem , Estudos Prospectivos , Acuidade Visual , Adulto JovemRESUMO
PURPOSE: To measure spontaneous blink metrics and brow motion in patients with congenital ptosis operated with frontalis slings with autogenous fascia lata. METHODS: An infrared three-dimensional video motion analyzer was employed to simultaneously measure brow motion and spontaneous blinks of 17 patients with congenital ptosis who underwent frontalis sling with autogenous fascia lata and a control group of equal number of healthy subjects. A customized software identified and quantified the amplitude and maximum velocity spontaneous blinks eyelid and brown motion during a 5-minute observation of a commercial movie. The corneal status of the patients with and without lagophthamos was evaluated with slit-lamp biomicroscopy with fluorescein staining. RESULTS: Lagophthalmos was detected on 13 (76.5%) patients. Out of these 3 (23%) showed signs of inferior superficial keratopathy despite the presence of normal (upwards) Bell's phenomenon in all of them. Blink rate was significantly diminished in the patients. The distribution of interblink time was similar in both groups. The mean amplitude of the down-phase of the patients' blinks was only 38% of the controls. The main sequence slope of the patients' blinks was abnormally low. In controls brow motion was a minute and random event no related to blinks. In the patients, the mean brow amplitude was five times higher than in controls reaching 45% of the blink amplitude. CONCLUSIONS: Spontaneous blink amplitude and velocity are severely impaired in patients with fascia lata autogenous slings. After surgery blinking amplitude is linearly related to the amplitude of brow motion.
Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Piscadela/fisiologia , Pálpebras/fisiopatologia , Fáscia/transplante , Previsões , Adolescente , Adulto , Fenômenos Biomecânicos , Blefaroptose/congênito , Blefaroptose/fisiopatologia , Criança , Pálpebras/cirurgia , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Gravação em Vídeo , Adulto JovemRESUMO
ABSTRACT Purpose: To evaluate whether reducing eyelid muscular force through the administration of botulinum toxin type A (BTX-A) to the orbicularis oculi muscles of patients with keratoconus affected corneal parameters indicative of disease progression. Methods: In this prospective parallel randomized clinical trial, 40 eyes of 40 patients with keratoconus were randomized into equally sized control and BTX-A groups. Patients in the BTX-A group received subcutaneous BTX-A injections into the orbicularis muscle. The control group received no intervention. Palpebral fissure height, best spectacle-corrected visual acuity (BSCVA), and corneal topographic parameters were evaluated at baseline and at 3-, 6-, 12-, and 18-month follow-ups. Results: The mean ± standard deviation vertical palpebral fissure heights were 9.74 ± 1.87 mm and 9.45 ± 1.47 mm at baseline in the control and BTX-A groups, respectively, and 10.0 ± 1.49 mm and 9.62 ± 1.73 mm at 18 months, with no significant difference between the groups (p=0.337). BSCVA values were 0.63 ± 0.56 and 0.60 ± 0.27 at baseline in the control and BTX-A groups (p=0.643), and 0.52 ± 0.59 and 0.45 ± 0.26 at 18 months, again with no significant difference between the groups (p=0.452). In addition, there were no statistical differences between the groups at 18 months for the three keratometry topographic parameters: flattest (K1), steepest (K2), and mean (Km) keratometry (p=0.562). Conclusion: BTX-A inhibition of eyelid force generation did not result in detectable changes in corneal parameters in keratoconic patients during 18 months of follow-up.
RESUMO Objetivo: Avaliar se a administração da toxina botulínica tipo A (BTX-A) no músculo orbicular de pacientes com ceratocone a fim de reduzir a força muscular palpebral pode alterar os parâmetros corneanos indicativos de progressão da doença. Métodos: Ensaio clínico randomizado paralelo prospectivo. Quarenta olhos de 40 pacientes, randomizados em grupo controle ou grupo BTX-A na razão de 1:1. Pacientes do grupo BTX-A foram submetidos à injeção subcutânea da toxina botulínica tipo A no músculo orbicular. Os pacientes do grupo controle não sofreram nenhuma intervenção. Foram avaliados a medida da fenda palpebral, melhor acuidade visual corrigida, e topografia corneana nos momentos pré-operatório, e aos 3-,6-,12-, e 18 meses de seguimento. Resultados: Média ± DP (desvio padrão) da fenda palpebral no pré-operatório nos grupos controle e BTX-A foram 9,74 ± 187 e 9,45 ± 1,47 mm, respectivamente; aos 18 meses, a média da altura da fenda palpebral vertical nos grupos controle e BTX-A foram 10,0 ± 1,49 mm e 9,62 ± 1,73 mm, respectivamente, sem diferença significante entre os grupos (p=0,337). A média pré-operatória da melhor acuidade visual corrigida nos grupos controle e BTX-A foram 0,63 ± 0,56 e 0,60 ± 0,27, respectivamente (p=0,643); aos 18 meses, a média nos grupos controle e BTX-A foram 0,52 ± 0,59 e 0,45 ± 0,26, respectivamente, sem diferença significante entre os grupos (p=0,452). Não houve diferença estatística entre os grupos aos 18 meses para todos os parâmetros topográficos ceratométricos avaliados, mais plano-(K1), mais curvo-(K2), e ceratometria média Km (p≥0,562). Conclusão: A inibição da força muscular palpebral pela toxina botulínica tipo A não causou alterações detectáveis nos parâmetros corneanos em pacientes com ceratocone, com 18 meses de seguimento.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Progressão da Doença , Toxinas Botulínicas Tipo A/uso terapêutico , Pálpebras/fisiopatologia , Ceratocone/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Acuidade Visual , Protocolos Clínicos , Estudos Prospectivos , Toxinas Botulínicas Tipo A/administração & dosagem , Topografia da Córnea , Pálpebras/efeitos dos fármacos , Músculos Faciais/efeitos dos fármacos , Paquimetria Corneana , Injeções Subcutâneas , Ceratocone/fisiopatologia , Fármacos Neuromusculares/administração & dosagemRESUMO
This article evaluates the effects of Muller's muscle-conjunctival resection (MMCR) on ocular surface scores and dry eye symptoms. Forty-six patients were enrolled in the study. Eighteen underwent bilateral upper eyelid skin excision with MMCR and 28 underwent bilateral upper eyelid skin-only excision (control group). The Salisbury Eye Evaluation Questionnaire and an ocular surface evaluation protocol consisting of Schirmer's test, tear break-up time (TBUT), fluorescein and rose bengal corneal staining were performed during the pre-operative consultation and on postoperative days 7, 30, and 90. Improvement in symptoms questionnaire scores from baseline was observed on postoperative day 90 in the blepharoplasty plus MMCR group. There was no change in questionnaire scores in patients who underwent blepharoplasty alone. No between-group difference in Schirmer's test, TBUT, or fluorescein and rose bengal staining was found at any time point. In the blepharoplasty-only (control group), the fluorescein staining score was reduced on postoperative day 30 as compared to baseline, but not on day 90. In this sample, addition of MMCR to upper eyelid blepharoplasty did not worsen ocular surface scores or dry eye symptoms.
Assuntos
Blefaroplastia , Blefaroptose/cirurgia , Túnica Conjuntiva/cirurgia , Síndromes do Olho Seco/fisiopatologia , Pálpebras/cirurgia , Músculos Oculomotores/cirurgia , Idoso , Blefaroptose/fisiopatologia , Túnica Conjuntiva/fisiopatologia , Pálpebras/fisiopatologia , Feminino , Fluorofotometria , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Estudos Prospectivos , Inquéritos e Questionários , Lágrimas/fisiologiaRESUMO
PURPOSE: To investigate possible temporary differences in corneal topographic parameters between affected and normal eyes in patients with hemifacial spasm (HFS) treated with botulinum toxin-A (BTX-A), over the course of 1 treatment cycle. METHODS: This prospective study evaluated corneal topographic differences between affected and normal contralateral eyes during a 4-month period in patients with HFS treated with BTX-A (the duration of action of BTX-A for HFS ranges from 2 to 4 months). Corneal topographic analysis was performed using a conventional topographer (Atlas; Carl Zeiss Meditec, Dublin, CA). Steep K and astigmatism measurements were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. RESULTS: Twenty-four patients (16 women and 8 men) were evaluated. Steep K [46.9 ± 3.6 diopters (D)] and astigmatism values (2.6 ± 2.5 D) were significantly higher in affected eyes of HFS patients than in nonaffected eyes (45.0 ± 1.4 D and 0.9 ± 0.6 D) before treatment (P = 0.001 for steep K and P = 0.0003 for astigmatism). Astigmatism values also showed significant differences between the affected eye (1.4 ± 0.8 D) and nonaffected eye (0.9 ± 0.6 D) at 4 months (P = 0.006), whereas steep K showed significant differences between both eyes at 15 days (affected eye: 45.6 ± 1.5 D, nonaffected eye: 45.0 ± 1.4 D, P = 0.008), 3 months (affected eye: 45.6 ± 1.8 D, nonaffected eye: 45.1 ± 1.3 D, P = 0.03) and 4 months (affected eye: 45.8 ± 1.2 D, nonaffected eye: 45.1 ± 1.4 D, P = 0.003) after treatment. CONCLUSIONS: The differences in steep K, and especially in astigmatism values, between eyes tended to reduce during the period of action of BTX-A. At 4 months, when the BTX-A effect is considered to be over or very reduced, a significant difference between eyes for both parameters was noted again.
Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Astigmatismo/fisiopatologia , Toxinas Botulínicas Tipo A/uso terapêutico , Córnea/fisiopatologia , Pálpebras/fisiopatologia , Espasmo Hemifacial/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Topografia da Córnea , Feminino , Espasmo Hemifacial/fisiopatologia , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/efeitos dos fármacos , Estudos Prospectivos , Acuidade Visual/fisiologiaRESUMO
BACKGROUND/AIMS: In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the affected side, thus changes in corneal topography and eyelid morphometry may be observed after treatment. We aimed to evaluate these parameters during a 4-month period in patients with HFS treated with botulinum toxin A (BTX-A). METHODS: This prospective study evaluated eyelid morphometric and corneal topographic changes in patients with HFS before onabotulinum toxin A application, and after 15â days and 2, 3 and 4â months. RESULTS: 24 patients were treated with BTX-A. On the normal side, the mean palpebral fissure height (PF), interpalpebral surface area (ISA), steep K and astigmatism values were 8.7±1.98â mm, 122.09±39.37â mm2, 44.99±1.45â D and 0.9±0.64â D, respectively, before treatment. A statistically significant difference was not observed in these parameters after treatment (p>0.05). On the affected side, the mean PF, ISA, steep K and astigmatism were 5.5±1.77â mm, 67.68±28.49â mm2, 46.91±3.57â D and 2.63±2.46â D, respectively, before treatment. We observed a statistically significant (p<0.05) increase in the mean PF and ISA on the affected side 15â days (8.36±1.91â mm and 115.92±34.44â mm2, respectively), 2 months (8.18±1.80â mm and 112.22±33.57â mm2, respectively) and 3 months (7.27±1.65â mm and 95.48±27.80â mm2, respectively) after treatment. A statistically significant decrease in steep K and astigmatism was observed at 2 months (45.14±1.20â D and 1.01±0.58â D, respectively) and 3â months (45.64±1.77â D and 1.36±1.31â D, respectively) after treatment. CONCLUSIONS: The results suggest that treatment with BTX-A in patients with HFS leads to eyelid and corneal changes on the affected eye that are significant during the known period of action of the toxin. Thus, caution should be taken when performing ophthalmological examination in patients with HFS, since it may vary according to BTX-A period of action.