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Hidrocistoma , Neoplasias das Glândulas Sudoríparas , Humanos , México/epidemiologia , Hidrocistoma/patologia , Hidrocistoma/tratamento farmacológico , Hidrocistoma/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Neoplasias das Glândulas Sudoríparas/patologia , Neoplasias das Glândulas Sudoríparas/diagnóstico , Adulto , Encaminhamento e Consulta , Neoplasias Orbitárias/tratamento farmacológico , Neoplasias Orbitárias/diagnóstico , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas/administração & dosagemRESUMO
BACKGROUND: Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD), an autoimmune disorder arising from the activity of T lymphocytes against antigens that infiltrate thyroid tissue, orbital tissue and extraocular muscles. An increase in oxidative stress has been discovered in autoimmune thyroid disease, encouraging investigation into new forms of treatment. Selenium has been described as a treatment option given its antioxidant properties. The present study evaluates the decrease of progression and inflammatory signs in patients with mild GO with oral selenium supplementation. METHODS: Controlled, randomized, single center trial at an ophthalmology referral center in Mexico City. Patients at least 18years of age with mild GO according to the CAS classification were included; exclusion criteria in addition to corticosteroid treatment included smokers or selenium allergy. Each patient was randomized into one of two groups. Group A took placebo tablets which consisted of 100µg of starch twice a day for 6months, and group B took a 100µg selenium tablet twice a day for 6months. The patients from both groups were examined and evaluated using a CAS score before and after the first, third and sixth month of treatment. RESULTS: Thirty eyes of 30 patients were studied. The pretreatment values showed no statistically significant differences between groups (P>0.05). Intergroup analysis showed statistically significant differences in palpebral fissure and CAS score between the pretreatment values and six months after treatment in the selenium group (P<0.05). No differences were found in any variables in the placebo group during the study period (P>0.05). No adverse events were reported. CONCLUSIONS: This is the first study in a Mexican population demonstrating that oral selenium decreases clinical activity and stops progression in patients with mild GO.
Assuntos
Doença de Graves , Oftalmopatia de Graves , Selênio , Antioxidantes , Oftalmopatia de Graves/tratamento farmacológico , Humanos , Estresse OxidativoAssuntos
Amiloidose/diagnóstico , Doenças do Aparelho Lacrimal/diagnóstico , Amiloidose/cirurgia , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Exoftalmia/cirurgia , Humanos , Aparelho Lacrimal/diagnóstico por imagem , Aparelho Lacrimal/patologia , Doenças do Aparelho Lacrimal/cirurgia , Masculino , México , Pessoa de Meia-Idade , Encaminhamento e Consulta , Centros de Cuidados de Saúde Secundários , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To evaluate the efficacy of transconjunctival botulinum toxin type A (BTX-A) in the treatment of upper eyelid retraction in the active inflammatory phase of dysthyroid orbitopathy, establish the ideal dose, and evaluate side effects. METHODS: This is a comparative, prospective study in patients with thyroid orbitopathy, conducted at the Conde Ophthalmology Institute in Valenciana, Mexico. The patients included had dysthyroid orbitopathy in the inflammatory phase, and they were treated with subconjunctival injection of botulinum toxin type A (BTX-A) in the upper eyelid. Five units (group 1) and ten units (group 2) of BTX-A, in a single subconjunctival dose were applied to the non-dominant eye. We evaluated visual acuity, margin-to-reflex distance (RPM1), crease height, ocular motility, diplopia and keratitis, before and after administration of the toxin. The patients were followed at one, 4 and 16 weeks, with the Student t-test as a statistical analysis. RESULTS: At week 4, 15 patients (100%) showed a reduced margin to reflex distance. The mean result for group 1 was -1.75mm (range -1 to -2.5mm) and group 2 was -2mm (range -1 to -4mm). Statistically significant differences were seen between pre-treatment and week 4 in both groups, but no differences between doses. Complete improvement of keratitis and lagophthalmos was observed in 5 and 2 patients, respectively. Visual acuity, ocular motility and crease height did not change in 93% of the patients. One patient (group 1) exhibited complete ptosis and vertical diplopia, which resolved spontaneously at week 6. CONCLUSION: Transconjunctival BTX-A application is safe and effective for the treatment of eyelid retraction in dysthyroid orbitopathy. No difference was found between doses. No severe side effects were reported.
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Blefaroptose/tratamento farmacológico , Toxinas Botulínicas Tipo A/administração & dosagem , Oftalmopatia de Graves/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Reação de Fase Aguda/tratamento farmacológico , Adulto , Idoso , Blefaroptose/etiologia , Toxinas Botulínicas Tipo A/efeitos adversos , Feminino , Oftalmopatia de Graves/complicações , Humanos , Injeções , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Evisceration is currently becoming the technique of choice in the treatment of certain eye diseases, including, among others, painful blind eye and endophthalmitis. The most widely used implants are currently the hydroxyapatite and porous polyethylene for the rehabilitation of the anophthalmic socket. OBJECTIVE: To describe the indications, type of implant material used, and complications in evisceration surgery. METHODS: A retrospective, observational, descriptive study based on clinical records of patients that underwent evisceration between 2008 and 2015 in the Instituto Fundación Conde de Valenciana, Mexico. RESULTS: A total of 186 evisceration surgeries were performed, of which 52.7% of the patients were men. The mean age was 54 years. The right eye was eviscerated in 53% of cases, and 79.2% had a vision of no light perception. Most patients had preoperative pain. The most common diagnosis for which evisceration was performed was endophthalmitis. Phthisis bulbi was reported in 20 eyes. A primary implant was inserted in 86.81% of the cases, with 34.81% of the implants being made of porous polyethylene. Four cases showed extrusion of the implant, with 2 cases of porous polyethylene. The ocular prosthesis was tolerated in 91% of cases. There were no cases of sympathetic ophthalmia. CONCLUSION: Evisceration is shown to be a good alternative to enucleation in cases where the sclera can be preserved, showing a low incidence of sympathetic ophthalmia.
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Evisceração do Olho/estatística & dados numéricos , Academias e Institutos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis , Criança , Pré-Escolar , Úlcera da Córnea/cirurgia , Durapatita , Endoftalmite/cirurgia , Traumatismos Oculares/cirurgia , Olho Artificial , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Implantes Orbitários , Polietileno , Implantação de Prótese , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Epiblepharon is characterized by a cutaneous horizontal fold adjacent to the lid margin. Some cases showed spontaneous resolution, others required surgical treatment. We propose a medical treatment with botulinum toxin type A (BTX-A). OBJECTIVE: To provide clinical evidence of the usefulness of botulinum toxin type A (BTX-A) in patients with lower eyelid epiblepharon. SUBJECTS AND METHODS: This was a prospective, non-randomized, nonmasked study. Patients with lower eyelid epiblepharon with corneal eyelash contact were included in the study. The scale proposed by Khwarg and Lee (1997) was used to assess the epiblepharon clinical evaluation. A single dose of 12.5 IU of BTX-A (Dysport ®) was directly injected into the medial pre-tarsal orbicularis muscle region in the lower eyelid. Patients were evaluated before the injection and at 1, 4, 12 and 24 weeks after the injection. We performed descriptive statistics and Wilcoxon Signed Rank Test, comparing prior injection measurements to post injection measurements at the 24th week. A p less than 0.05 was considered statistically significant. Each eye was separately analyzed. RESULTS: Fourteen eyes of seven Hispanic patients were treated, five female and two male. The mean age was 8.4 months (4 - 14 months). The height of the skin-fold, the area of the cornea touched by the cilia and the symptoms score improved after the first week of BTX-A injection and remained so until the end of study (p less than 0.05). No major complications were noted. CONCLUSION: The effect of a single 12.5 IU injection of BTX-A (Dysport ®) into the medial orbicularis muscle portion in the lower eyelid epiblepharon patients successfully improves the clinical signs and symptoms.
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Toxinas Botulínicas Tipo A/administração & dosagem , Doenças da Córnea/prevenção & controle , Doenças Palpebrais/congênito , Pálpebras/anormalidades , Músculos Oculomotores/efeitos dos fármacos , Doenças da Córnea/patologia , Pestanas/patologia , Doenças Palpebrais/tratamento farmacológico , Doenças Palpebrais/patologia , Pálpebras/patologia , Feminino , Humanos , Lactente , Masculino , México , Neurotoxinas/administração & dosagem , Músculos Oculomotores/patologia , Estudos Prospectivos , Remissão Espontânea , Resultado do TratamentoRESUMO
BACKGROUND: Oculopharyngeal muscular dystrophy (OPMD) is a late onset hereditary myopathy of autosomal dominant transmission characterised by ptosis, dysphagia and limb weakness. The disease is caused by short heterozygous expansions of a (GCN)(10) triplet located in the first exon of the PABPN1 gene at chromosome 14q11.1. Most affected individuals from North America and Europe carry a mutant (GCN)(13) allele. Although evidence for a founder mutation effect has been shown in several populations with OPMD, analysis of large groups of patients from different ethnic backgrounds will help to identify the relative contribution of each allele to the disease and a possible genotype-phenotype correlation. METHODS: 22 unrelated patients with OPMD from Mexico, a previously uncharacterised population, were clinically and molecularly analysed. Detailed ophthalmological and clinical examinations were performed in each proband and molecular analysis of the PABPN1 gene was carried out by PCR amplification and allele-specific cloning/sequencing. Two single nucleotide polymorphisms (SNPs) linked to PABPN1 were determined in each individual and in a number of affected first-degree relatives. RESULTS: 15 subjects (68%) carried a mutant (GCN)(15) or (GCG)(11)(GCA)(3)(GCG) PABPN1 allele; the remaining 7 (32%) exhibited an abnormal (GCN)(13) or (GCG)(9)(GCA)(3)(GCG) allele. Analysis of two SNPs linked to PABPN1 strongly suggests that both expanded alleles originate from two independent founder effects. In addition, in this particular population the (GCN)(15) allele was associated with an earlier onset of the disease (mean 46.5 years) compared with the (GCN)(13) allele (mean 54.7 years). CONCLUSION: The results of this study suggest that OPMD in the Mexican population is mostly due to (GCG)(11) or (GCG)(9) PABPN1 expanded alleles arising from two independent founder effect mutations. These findings add to the definition of the genetic features of the disease and to the establishment of a probable genotype-phenotype correlation.
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Efeito Fundador , Distrofia Muscular Oculofaríngea/genética , Proteína I de Ligação a Poli(A)/genética , Adulto , Idoso , Alelos , Sequência de Bases , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Dados de Sequência Molecular , Polimorfismo de Nucleotídeo Único , Repetições de TrinucleotídeosRESUMO
OBJECTIVE: To describe the results of amniotic membrane (AM) transplantation, using the simultaneous application of 0.02% Mitomycin C (MMC), in conjunctival fornix reconstruction. MATERIAL: We compared two groups of patients: group A, who were treated only with AM and group B, in whom MMC (0.02%) was also applied. Operative technique used: In group A, the surgical procedure involved a careful removal of the cicatricial tissue, followed by AM transplantation. In group B, following the careful removal of the cicatricial tissue, 0.02% MMC was then applied to the surgical field for 60 seconds, and this was followed by extensive irrigation with saline solution. AM transplantation was then performed. We ultimately evaluated the depth of the conjunctival fornix and ocular motility. RESULTS: Group A: eleven eyes of eleven patients were evaluated. Seven had chemical injuries, three had traumatic symblepharon and one had Stevens-Johnson syndrome. In two cases a 7 mm or greater conjunctival fornix depth was observed. In four cases the ocular motility was better than -1. Group B: Twelve eyes of twelve patients were evaluated. Seven had chemical injuries, 2 had traumatic symblepharon and 3 had Stevens-Johnson syndrome. In nine cases a 7 mm or greater conjunctival fornix depth was obtained. In 9 cases the ocular motility restriction was resolved. Poor results of fornix reconstruction, as well as ocular motility, were observed in those patients with autoimmune diseases, irrespective of the treatment used. CONCLUSIONS: The simultaneous combination of AM and MMC results in better conjunctival fornix reconstruction than with the use of AM alone.