RESUMO
We present a case report detailing the successful phacoemulsification surgery with artificial iris implantation for two individuals with oculocutaneous albinism. These women suffered from cataracts, resulting in reduced visual acuity and heightened photophobia due to iris pigmentary epithelium deficiency. The patients underwent phacoemulsification along with prosthetic artificial iris implantation into the posterior chamber. This intervention resulted in improved visual acuity, reduced photophobia and glare, and an overall enhanced quality of life. Our report highlights two cases of successful phacoemulsification and artificial iris implantation in patients with oculocutaneous albinism and cataracts, leading to improved visual acuity, reduced photophobia, and enhanced quality of life. Notably, there are no prior records in South American literature of cataract surgery combined with artificial iris implantation for oculocutaneous albinism patients up to the time of this publication.
Assuntos
Albinismo Oculocutâneo , Iris , Facoemulsificação , Acuidade Visual , Humanos , Albinismo Oculocutâneo/cirurgia , Albinismo Oculocutâneo/complicações , Feminino , Iris/cirurgia , Facoemulsificação/métodos , Resultado do Tratamento , Catarata/complicações , Catarata/congênito , Qualidade de Vida , Adulto , Órgãos Artificiais , Implantação de Prótese/métodos , Pessoa de Meia-Idade , Fotofobia/cirurgia , Fotofobia/etiologiaRESUMO
ABSTRACT: We report herein a case of fitting with a photochromic silicone hydrogel contact lens under a rigid gas-permeable lens (piggyback system) for photophobia and low vision correction after traumatic aniridia and aphakia. A 40-year-old woman was referred to our practice for contact lens fitting in her right eye, which was left aphakic after an open globe injury. She also presented traumatic aniridia in the right eye, and her left eye had been previously eviscerated. A successful fitting was obtained with a photochromic silicone hydrogel (senofilcon A) contact lens, with a Dk/t of 121 × 10-9, under an aspheric design, +13.00 D rigid gas-permeable lens. The patient displayed visual acuity and contrast sensitivity improvement and reported decreased photophobia.
Assuntos
Afacia , Lentes de Contato , Traumatismos Oculares , Baixa Visão , Adulto , Feminino , Humanos , Fotofobia/etiologia , Fotofobia/terapiaRESUMO
BACKGROUND: People with migraine exhibit postural control impairments. These patients also have an increased light sensitivity due to the disease, and it remains during the headache-free period. It is currently unknown if increased lighting levels can alter the balance control, especially in individuals with visual hypersensitivity, such as migraineurs. This study aimed to assess the balance and photophobia of women with migraine and non-headache controls under different light conditions. METHODS: This cross-sectional study consisted of 14 women with migraine (mean ± SD 30.6 ± 8.1 years old) and 14 women without any kind of headache (mean ± SD 27.2 ± 2.8 years old) screened from a tertiary headache clinical hospital and the local community. Quiet standing balance was evaluated during bipodal and unipodal support, under 3 light conditions: ambient (AMB) - 270 lx, visual discomfort threshold (VDT) - 400 lx, and intense visual discomfort (IVD) - 2000 lx. Sway area of the center of pressure was processed and compared between groups. The association of migraine with the risk of presenting a greater imbalance in the discomfort lighting conditions was verified. RESULTS: Compared to the non-headache controls, the migraine group presented greater sway area in bipodal stance under the 3 light conditions (mean difference (95% CI)): AMB 0.81 cm2 (0.19 to 1.43), P = .011; VDT 3.17 cm2 (0.74 to 5.60), P = .001; IVD 5.56 cm2 (2.75 to 8.37), P < .0001. Within-subject analysis showed increased sway area in bipodal stance among all lighting conditions for the migraine group only (mean difference (95% CI)): VDT-AMB 2.20 cm2 (0.23 to 4.18), P = .024; IVD-AMB 4.50 cm2 (2.38 to 6.62), P < .0001, IVD-VDT 2.29 cm2 (0.57 to 4.01), P = .005. The Prevalence Ratio (PR) analysis showed that migraine was associated with the risk of presenting greater imbalance in both bipodal and unipodal standing conditions for both VDT (PR value (95% CI) - bipodal: PR = 4.00 (1.02 to 15.59), P = .045; unipodal: PR = 4.00 (1.43 to 11.15), P = .008), and the IVD (bipodal: PR = 3.33 (1.13 to 9.58), P = .025; unipodal: PR = 5.50 (1.48 to 20.42), P = .010) lighting conditions. CONCLUSION: Photophobia might be a disturbing factor that worsens the balance of patients with migraine during the quiet standing posture.
Assuntos
Transtornos de Enxaqueca/fisiopatologia , Fotofobia/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Transtornos de Enxaqueca/complicações , Fotofobia/etiologia , Adulto JovemRESUMO
OBJECTIVE: To report the finding of infrared meibography in a Mexican patient with EEC syndrome (Ectrodactyly-ectodermal dysplasia-cleft syndrome) confirmed by molecular analysis of the p63 gene. CLINICAL CASE: A 31 year-old male patient was seen due to a history of progressive visual loss in both eyes associated with long-term photophobia. The patient was born with cleft lip and palate, ectrodactyly of right hand, and afterwards, displayed nail dysplasia, anodontia and alopecia, with which ectodermal dysplasia was diagnosed. The ophthalmological findings were limited to the adnexa and the ocular surface. In vivo infrared meibography showed total absence of Meibomian glands in the lower eyelids and severe deficiency in the upper eyelids. In addition, it was shown that the patient was a heterozygous carrier of a missense mutation R304W (C â T) in exon 8 of the p63 gene. DISCUSSION: The R304W mutation in the p63 gene region is definitely related to characteristics such as the absence of Meibomian glands.
Assuntos
Fenda Labial/genética , Fissura Palatina/genética , Displasia Ectodérmica/genética , Glândulas Tarsais/diagnóstico por imagem , Mutação de Sentido Incorreto , Mutação Puntual , Fatores de Transcrição/genética , Transiluminação , Proteínas Supressoras de Tumor/genética , Adulto , Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Displasia Ectodérmica/diagnóstico por imagem , Éxons/genética , Heterozigoto , Humanos , Raios Infravermelhos , Masculino , Glândulas Tarsais/anormalidades , Glândulas Tarsais/patologia , Fotofobia/etiologia , Transtornos da Visão/etiologiaRESUMO
CASE REPORT: Posterior Polymorphous Dystrophy (DPP) is a rare posterior corneal dystrophy that is genetically transmitted as autosomal dominant. Corneal structures affected in this dystrophy are Descemet membrane and the endothelium. A case is presented on a 47 years old woman with no relevant history, with typical findings of DPP (vesicular and band lesions at the endothelium and posterior Descemet). DISCUSSION: To our knowledge there are no reported cases of DPP in Latin-American patients in the literature. The clinical manifestations in our patient were found to be very similar to the cases reported in other populations.
Assuntos
Distrofias Hereditárias da Córnea/diagnóstico , Distrofias Hereditárias da Córnea/complicações , Distrofias Hereditárias da Córnea/epidemiologia , Distrofias Hereditárias da Córnea/genética , Distrofias Hereditárias da Córnea/patologia , Lâmina Limitante Posterior/patologia , Diagnóstico Diferencial , Endotélio Corneano/patologia , Feminino , Distrofia Endotelial de Fuchs/diagnóstico , Genes Dominantes , Humanos , México/epidemiologia , Microscopia/métodos , Pessoa de Meia-Idade , Fotofobia/etiologia , Transtornos da Visão/etiologiaRESUMO
Moyamoya disease is a progressive, occlusive pathology involving the cerebral vasculature with particular involvement of the circle of Willis and its tributaries. The cause of moyamoya disease is unknown, but is believed to be hereditary. Females 20 to 39 years old with moyamoya represent 0.5% of all acute cerebral ischemia and infarcts with risk factors including smoking, estrogen-containing birth control use, coagulopathy, neoplasm, and congenital malformation. This case reports on a 20-year-old Puerto Rican female U.S. soldier with a 1-year history of migraine headaches with worsening right retro-orbital pain, blurred vision, and photophobia. The patient had minimal unilateral neurological deficits despite evidence of significant cerebral infarction on non-contrast computed tomography. Other neuroimaging findings were consistent with moyamoya disease with confirmation via cerebral angiography. This case details the process of diagnosis and treatment as well as discussing its incidence, identification, and treatment options.
Assuntos
Militares , Doença de Moyamoya/diagnóstico , Angiografia Cerebral , Infarto Cerebral/etiologia , Revascularização Cerebral , Anticoncepcionais Orais Hormonais , Feminino , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Transtornos de Enxaqueca/etiologia , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/cirurgia , Imagem Multimodal , Neuroimagem , Fotofobia/etiologia , Recidiva , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia , Adulto JovemRESUMO
Bilateral acute depigmentation of the iris (BADI) is a recently described entity characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris, and heavy pigment deposition in the anterior chamber angle. Involvement is always bilateral, simultaneous, and symmetrical. We report the case of a 61-year-old man who presented with bilateral ocular pain, red eyes, and severe photophobia. Examination revealed a dense Krukenberg spindle, heavy pigment dispersion in the anterior chamber, extensive transillumination iris defects, and a heavy pigment deposition in the trabecular meshwork bilaterally. Intraocular pressure increased to 48 mmHg in both eyes. The patient received topical steroids, maximum hypotensive treatment and oral valacyclovir. Intraocular pressure gradually decreased throughout the second and third months, and medications were gradually tapered. The time to complete resolution of pigment dispersion was 18 weeks. Visual acuity and visual fields remained normal, but the photophobia was permanent.
Assuntos
Dor Ocular/diagnóstico , Doenças da Íris/diagnóstico , Transtornos da Pigmentação/diagnóstico , Doença Aguda , Humanos , Iris , Masculino , Pessoa de Meia-Idade , Fotofobia/etiologia , Acuidade VisualRESUMO
Bilateral acute depigmentation of the iris (BADI) is a recently described entity characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris, and heavy pigment deposition in the anterior chamber angle. Involvement is always bilateral, simultaneous, and symmetrical. We report the case of a 61-year-old man who presented with bilateral ocular pain, red eyes, and severe photophobia. Examination revealed a dense Krukenberg spindle, heavy pigment dispersion in the anterior chamber, extensive transillumination iris defects, and a heavy pigment deposition in the trabecular meshwork bilaterally. Intraocular pressure increased to 48 mmHg in both eyes. The patient received topical steroids, maximum hypotensive treatment and oral valacyclovir. Intraocular pressure gradually decreased throughout the second and third months, and medications were gradually tapered. The time to complete resolution of pigment dispersion was 18 weeks. Visual acuity and visual fields remained normal, but the photophobia was permanent.
Despigmentação aguda bilateral da íris (BADI) é uma nova doença caracterizada pela despigmentação aguda da íris, dispersão de pigmentos na câmara anterior e intensa deposição de pigmentos no seio camerular. O acometimento é sempre bilateral, simultâneo e simétrico. Relatamos o caso de um paciente de 61 anos, com dor ocular bilateral aguda, hiperemia e intensa fotofobia. Ao exame, apresentava denso fuso de Krukenberg, importante dispersão de pigmentos na câmara anterior, extensos defeitos à transiluminação iriana e densa deposição de pigmentos no seio camerular em ambos os olhos. O paciente recebeu corticoide tópico, terapia hipotensora máxima e valacyclovir oral. A pressão intraocular chegou a 48 mmHg em ambos os olhos mas foi reduzindo gradativamente ao longo do segundo e terceiro meses, permitindo a suspensão gradativa da medicação. A resolução completa da dispersão pigmentar demorou 18 semanas. A acuidade e os campos visuais permaneceram normais, mas o paciente manteve a fotofobia.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Dor Ocular/diagnóstico , Doenças da Íris/diagnóstico , Transtornos da Pigmentação/diagnóstico , Doença Aguda , Iris , Fotofobia/etiologia , Acuidade VisualRESUMO
PURPOSE: Postoperative adjuvant treatment using ß-radiotherapy (RT) is a proven technique for reducing the recurrence of pterygium. A randomized trial was conducted to determine whether a low fractionation dose of 2 Gy within 10 fractions would provide local control similar to that after a high fractionation dose of 5 Gy within 7 fractions for surgically resected pterygium. METHODS: A randomized trial was conducted in 200 patients (216 pterygia) between February 2006 and July 2007. Only patients with fresh pterygium resected using a bare sclera method and given RT within 3 days were included. Postoperative RT was delivered using a strontium-90 eye applicator. The pterygia were randomly treated using either 5 Gy within 7 fractions (Group 1) or 2 Gy within 10 fractions (Group 2). The local control rate was calculated from the date of surgery. RESULTS: Of the 216 pterygia included, 112 were allocated to Group 1 and 104 to Group 2. The 3-year local control rate for Groups 1 and 2 was 93.8% and 92.3%, respectively (p = .616). A statistically significant difference for cosmetic effect (p = .034), photophobia (p = .02), irritation (p = .001), and scleromalacia (p = .017) was noted in favor of Group 2. CONCLUSIONS: No better local control rate for postoperative pterygium was obtained using high-dose fractionation vs. low-dose fractionation. However, a low-dose fractionation schedule produced better cosmetic effects and resulted in fewer symptoms than high-dose fractionation. Moreover, pterygia can be safely treated in terms of local recurrence using RT schedules with a biologic effective dose of 24-52.5 Gy(10.).
Assuntos
Pterígio/radioterapia , Radioisótopos de Estrôncio/uso terapêutico , Adulto , Idoso de 80 Anos ou mais , Algoritmos , Partículas beta/efeitos adversos , Partículas beta/uso terapêutico , Fracionamento da Dose de Radiação , Oftalmopatias/etiologia , Feminino , Granuloma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fotofobia/etiologia , Estudos Prospectivos , Pterígio/patologia , Pterígio/cirurgia , Radioterapia/efeitos adversos , Recidiva , Esclera/efeitos da radiação , Esclera/cirurgia , Radioisótopos de Estrôncio/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
The short lasting primary headaches are classified as those without autonomic activation and those with important activation, which includes the cluster headache. This study focuses on the pathophysiology of cluster headache mainly in its autonomic phenomenon (conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, partial ptosis and eyelid oedema) showing the involvement of superior salivatory nucleus with the pain stimulus propagation, which begins in the trigeminal nerve. The autonomic alterations were studied in 28 patients being lacrimation and conjunctival injection, the main features.