Evaluation of the agreement and reliability of Transpalpebral Tonometers compared with Goldmann Applanation Tonometer – A systematic Review and Meta-Analysis Protocol

In 2020, the global prevalence of glaucoma was estimated to be 76 million and it was projected to increase to 111.8 million by 2040. Accurate intraocular pressure (IOP) measurement is imperative in glaucoma management since it is the only modifiable risk factor. Numerous studies have compared the reliability of IOP measured using transpalpebral tonometers and Goldmann applanation tonometry (GAT). This systematic review and meta-analysis aims to update the existing literature with a reliability and agreement comparison of transpalpebral tonometers against the gold standard GAT for IOP measurement among individuals presenting for ophthalmic examinations. The data collection will be performed using a predefined search strategy through electronic databases. Prospective methods-comparison studies published between January 2000 and September 2022 will be included. Studies will be deemed eligible if they report empirical findings on the agreement between transpalpebral tonometry and Goldmann applanation tonometry. The standard deviation and limits of agreement between each study and their pooled estimate along with weights and percentage of error will be reported using a forest plot. Cochrane’s Q test and the I2 statistic will be used to assess heterogeneity, and the publication bias will be investigated using a funnel plot, Begg’s and Egger’s tests. The review results will provide additional evidence on the reliability of transpalpebral tonometers that, in turn, could possibly assist practitioners to make informed decision about using it as a screening or diagnostic device for clinical practice, outreach camps, or home-based screening. Institutional Ethics Committee registration number: RET202200390. PROSPERO Registration Number: CRD42022321693.

Rinosinusitis micótica alérgica con destrucción de base de cráneo / Allergic fungal rhinosinusitis with skull base destruction

La sinusitis micótica alérgica es una enfermedad inflamatoria de la mucosa rinosinusal producida por hongos que pueden aislarse de la cavidad de nasal de individuos sanos. Se produce indirectamente por los hongos que actúan como antígeno y desencadenan una reacción inmunológica mediada por IgE que origina pólipos y una secreción mucosa espesa con detritus e hifas denominada mucina. Su presentación clínica más frecuente es una sinusitis crónica unilateral o bilateral con pólipos. Con menos frecuencia, las sustancias originadas por la desgranulación de los eosinófilos producen remodelación o destrucción ósea y la sinusitis puede simular una neoplasia. Se describe el caso clínico de un paciente que padeció una sinusitis micótica alérgica con destrucción ósea masiva de la base del cráneo y que tuvo extensión intracraneal extradural e intraorbitaria de la enfermedad. Fue tratado con éxito mediante cirugía y corticoides. (AU)

Allergic fungal sinusitis is an inflammatory disease of the rhinosinusal mucosa caused by fungi that can be isolated from the nasal cavity of healthy individuals. The pathology is produced indirectly by the fungus that acts as an antigen and triggers an IgE-mediated allergic reaction that causes polyps and a thick mucous discharge with detritus and hyphae called mucin. Its most common clinical presentation is unilateral or bilateral chronic sinusitis with polyps. Less commonly, substances originated by the degranulation of eosinophils cause bone remodeling or destruction, and sinusitis can simulate a neoplasia. We describe the clinical case of a patient who suffered from allergic fungal sinusitis with massive bone destruction of the skull base and who had intracranial, extradural and intraorbital extension of the disease. He was successfully treated with surgery and corticosteroids.Key words: allergic fungal sinusitis, intracranial extension, endoscopic surgery, transorbital transpalpebral approach. (AU)

Resultados quirúrgicos de la técnica de elevación de la ceja transblefaroplastia / Clinical outcomes of the eyebrow lift technique of transblepharoplasty

RESUMEN Objetivo: Evaluar los resultados quirúrgicos de la técnica de elevación de la ceja transblefaroplastia y las complicaciones presentadas. Métodos: Se realizó un estudio descriptivo, retrospectivo, de corte longitudinal, de 12 pacientes (24 párpados) con ptosis de la ceja asociada a dermatochalasis del párpado superior desde mayo a septiembre del año 2018, en la consulta de Cirugía Plástica Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Fueron excluidos los que ya tenían una cirugía anterior del tercio facial superior. Resultados: El 83,3 por ciento de los pacientes fueron del sexo femenino. En cuanto a los grupos de edades resultó más frecuente el grupo de mayores de 62 años de edad. Hubo un predominio de la raza blanca, para un 58,3 por ciento. En el 60 por ciento de los casos del sexo femenino (6 pacientes), la dermatochalasis del párpado superior, asociada a la ptosis de la ceja, fue moderada. La ptosis de la ceja resultó corregida en 18 párpados, para el 75 por ciento. Se presentó el 25 por ciento de complicaciones (3 pacientes). Conclusiones: La técnica de elevación de la ceja transblefaroplastia logra la corrección de la ceja en el mayor número de pacientes con un bajo porcentaje de complicaciones, y constituye una buena opción quirúrgica para este tipo de afección palpebral(AU)

ABSTRACT Objective: To assess the surgical outcomes of the eyebrow lift technique of transblepharoplasty and the complications presented. Methods: A descriptive, retrospective, longitudinal study was carried out with 12 patients (24 eyelids) with eyebrow ptosis associated with upper eyelid dermatochalasis, from May to September 2018, in the Ocular Plastic Surgery office of Ramón Pando Ferrer Cuban Institute of Ophthalmology. Those who already had a previous surgery of the upper facial third were excluded. Results: 83.3 percent of the patients were female. Regarding the age groups, the group of people over 62 years of age was more frequent. There was a predominance of the white race, accounting for 58.3 percent. In 60 percent of female cases (6 patients), dermatochalasis of the upper eyelid, associated with eyebrow ptosis, was moderate. Eyebrow ptosis was corrected in 18 eyelids, for 75 percent. 25 percent of complications were presented (3 patients). Conclusions: The eyebrow lift technique of transblepharoplasty achieves eyebrow correction in the greatest number of patients with a low percentage of complications, and constitutes a good surgical option for this type of eyelid condition(AU)

Hemangiossarcoma ocular em um equino: relato de caso / Equine ocular hemangiosarcoma: case report

O hemangiossarcoma ocular na espécie equina é um tumor maligno, raro e agressivo, de origem vascular endotelial. No presente trabalho, descreve-se um caso de hemangiossarcoma ocular em uma égua de 10 anos que apresentava secreção serossanguinolenta advinda de uma massa, acometendo a conjuntiva bulbar e a terceira pálpebra do olho direito. O diagnóstico foi realizado com base na avaliação histopatológica e na imuno-histoquímica. Foi realizada a enucleação, assim como a completa excisão cirúrgica do tecido acometido, não sendo observada, após seis meses da terapia, a recidiva ou a metástase da lesão.

Equine ocular hemangiosarcoma is a rare and aggressive malignant tumor of vascular endothelial origin. We describe a case of ocular hemangiosarcoma in a 10-year-old mare with serosanguineous secretion arising from a mass involving the bulbar conjunctiva and third eyelid of the right eye. The diagnosis was based on histopathological evaluation and immunohistochemistry. Enucleation was performed as complete surgical excision of the affected tissue, with no recurrence or metastasis of the lesion being observed after six months of.

Blefaroplastia: elevação transpalpebral das sobrancelhas / Blepharoplasty: transpalpebral brow elevation

Introdução: A descida das sobrancelhas faz parte do processo natural de envelhecimento do terço superior da face. A ação da musculatura glabelar é uma das causas desta ptose e de outros sinais de envelhecimento. Estes sinais devem ser diagnosticados e tratados de maneira adequada durante os procedimentos de blefaroplastia sob pena de piora da ptose e de resultado não satisfatório. Métodos: Ao longo dos últimos 17 anos, um total de 246 pacientes, portadores de alterações do terço superior da face e com indicação de blefaroplastia, foram submetidos à elevação transpalpebral das sobrancelhas pela técnica de McCord modificada, mediante ampla dissecção, maior número de pontos de fixação e miomectomias dos músculos corrugadores e prócerus. Os pacientes foram acompanhados com avaliações ambulatoriais e com registros fotográficos nos 6 e 12 meses de pós-operatório. Resultados: A intercorrência mais comum foi a parestesia temporária da região frontal e do couro cabeludo. Não ocorreram casos de hematomas pós-operatórios. Ao longo do tempo foram observados resultados consistentes, com manutenção da elevação das sobrancelhas e diminuição efetiva da ação da musculatura glabelar, sem cicatrizes no couro cabeludo. Conclusões: A elevação transpalpebral de sobrancelhas, associada à miomectomia glabelar, mostra-se uma alternativa adequada, segura e efetiva para tratamento dos sinais de envelhecimento do terço superior da face.

Introduction: The brows lowdown naturally occur as an aspect of the aging upper face process. The glabelar muscular action is one cause of this ptosis and also of others aging signs. These signs must be adequately treated during the blepharoplasty, to avoid the penalty of a limited final result. Methods: Along of the last 17 years, a total of 246 patients with aesthetic problems of the upper face and with blepharoplasty indication, were submitted to a transpalpebral browlift by modified McCord technique, based in a extended dissection, more fixation stitches and prócerus and corrugators muscles miomectomy. Out patients follow-up were in ambulatory conditions with photographic records after 6 and 12 months. Results: The most common intercurrence was a transient parestesia of the frontal region and of the scalp. No postoperative hematomas were registered. The results were consistent with maintenance of the eyebrows elevation and the effective reduction of the glabelar muscles action, without the necessity of any type of coronal incision. Conclusions: The transpalpebral brow elevation associated with glabellar myomectomy shows to be an adequate option, by its safe and effective procedures for the treatment of the upper face aging signs.

Orbital Reconstruction via Extended Transconjuctival and Transpalpebral Approach

In case of blow-out fracture involving floor or inferomedial wall, the fracture site can be accessed by methods such as subcilliary incision, mid-lower eyelid incision, infra-orbital incision and transconjunctival incision. Meanwhile, in case of orbital fracture involving supero-medial wall or roof, above-mentioned methods have the limitation of fracture site exposure, and bicoronal incision is required to overcome the difficult approach. The authors exposed fracture site widely and executed accurate reduction through extended transconjunctival approach and transpalpebral approach, instead of the approach by bicoronal incision. We executed 118 cases of orbital reconstruction by above method among 96 patients who consulted doctors to reconstruct blow-out fracture and enophthalmos from September 1997 to May 2001. Among the 118 cases were 50 cases of orbital floor fracture, 4 cases of orbital roof fracture, 48 cases of orbital medial wall fracture, 13 cases of complex type and 3 cases of enophthalmos. The authors made wide dissection of antero-superial medial wall of orbit and roof fracture of orbit enabled by above methods, which allowed enough exposure and approach to orbital fracture site and prevented side effects such as post operative lower eyelid scar or ectropion and scleral show.