Brazilian guidelines for the monitoring and treatment of pediatric allergic conjunctivitis / Diretrizes brasileiras sobre o monitoramento e tratamento da conjuntivite alérgica pediátrica

ABSTRACT Allergic conjunctivitis is an increasingly frequent condition with a higher prevalence in children. It can be debilitating and is responsible for a great economic burden. These guidelines were developed on the basis of the medical literature (PubMed/Medline database) and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology, the Brazilian Council of Ophthalmology, the Brazilian Society of Pediatrics, and the Brazilian Association of Allergy and Immunology. Allergic conjunctivitis is considered to be controlled when the ocular symptoms are not uncomfortable or are present, at most, on 2 days a week; the visual analog scale score is below 5; and the degree of conjunctival hyperemia is graded 0 or 1 on the Efron scale. Allergic conjunctivitis should be classified as mild, moderate, severe, and vision-threatening for adequate treatment and monitoring of frequency. The present document is a guideline for diagnosing, treating, and monitoring pediatric allergic conjunctivitis considering the clinical and demographic aspects of allergic conditions in Brazil.

RESUMO A conjuntivite alérgica (CA) é uma condição frequente, debilitante e responsável por grande impacto econômico, proporcionalmente maior quando acomete crianças. Essas diretrizes foram desenvolvidas com base na literatura científica (PubMed/Medline) e na experiência de um Comitê de Especialistas composto por membros da Sociedade Brasileira de Oftalmologia Pediátrica, do Conselho Brasileiro de Oftalmologia, da Sociedade Brasileira de Pediatria e da Associação Brasileira de Alergia e Imunologia. A conjuntivite alérgica é considerada controlada quando os sintomas não são desconfortáveis ou estão presentes por dois dias na semana; o escore visual pela escala analógica é inferior a 5 e o grau de hiperemia conjuntival é de 0-1 pela escala de Efron. A conjuntivite alérgica deve ser classificada em leve, moderada, grave e com risco de perda visual para tratamento e frequência de monitoramento adequados. Esta diretriz orienta o diagnóstico, tratamento e monitoramento da conjuntivite alérgica pediátrica, considerando aspectos clínicos e demográficos das condições alérgicas no Brasil.

Ocular Manifestations in Patients with Fanconi Anemia: A Single-Center Experience Including 106 Patients.

OBJECTIVES: To describe the prevalence of acquired ocular manifestations in patients with Fanconi anemia (FA) and to describe and correlate the congenital ocular malformations with the genetic subtypes of the disease. STUDY DESIGN: This is a cross-sectional observational study of 106 consecutive patients with confirmed diagnosis of FA who were followed at the Hematopoietic Stem Cell Transplantation (HSCT) Service at the Federal University of Paraná, Curitiba, Parana, Brazil. Participants underwent a complete ophthalmologic evaluation and 84 patients underwent ocular ultrasound examination. This study was conducted between November 2014 and August 2017. RESULTS: The patients ranged in age from 6 months to 43 years of age. Microphthalmia was the most common congenital ocular abnormality (95.2%). A decrease in anthropometric measurements was observed, including palpebral fissure length (78/103 patients [76.5%]), microcornea (48/103 patients [46.6%]), and ptosis (31/103 patients [30.1%]). We identified a new ophthalmic condition in 15 patients with FA, that is, epiretinal tissue on the optic disc. The genetic subtype was identified in 78 patients (79.6%), the FA-A subtype was most prevalent (50%). The most common acquired ocular manifestation (non-graft-versus-host disease [GVHD] related) in patients who did not undergo HSCT (n = 44) was limbal neovascularization (13.6%), whereas in patients who underwent HSCT (n = 62), the GVHD-related manifestation was ocular GVHD (51.6%). The most frequent symptom of ocular GVHD was keratoconjunctivitis sicca (29%). CONCLUSIONS: Several ocular manifestations were identified in patients with FA.

Subconjunctival adalimumab for treatment of dry eye disease in Sjögren's syndrome / Tratamento de olho seco com adalimumabe subconjuntival em pacientes portadores da síndrome de Sjögren

ABSTRACT Objective To describe the use of subconjuctival administration of the anti-tumor necrosis factor agent adalimumab for treatment of dry eye in patients with Sjögren's syndrome, and to investigate conjunctival healing. Methods Prospective, nonrandomized, noncomparative interventional case series including consecutive patients with Sjögren's syndrome and dry eye disease treated with subconjunctival adalimumab, who were refractory to conventional treatment. Patients with infectious ocular surface involvement or structural changes in the tear pathway or eyelids were excluded. Data recorded included age, sex, lissamine green staining pattern, Schirmer test results, intraocular pressure, conjunctival mobility, tear break up time and findings of biomicroscopic evaluation, following fluorescein dye instillation. The Ocular Surface Disease Index questionnaire validated for the Portuguese language was used for subjective assessment of patients. Results Eleven eyes of eight patients were studied. Mean patient age was 53±13.4 years. Patients were treated with subconjunctival injection of 0.03 mL of adalimumab and followed for 90 days thereafter. There were no statistically significant objective improvement (objective tests results; p>0.05) and no statistically significant changes in intraocular pressure (p=0.11). Questionnaire responses revealed a significant improvement in ocular symptoms (p=0.002). Conclusion Based on the Ocular Surface Disease Index questionnaire, subconjunctival administration of adalimumab improved dry eye symptoms. However, objective assessments failed to reveal statistically significant improvements.

RESUMO Objetivo Descrever o uso subconjuntival do antifator de necrose tumoral adalimumabe para o tratamento do olho seco em pacientes com síndrome de Sjögren e avaliar a cicatrização conjuntival. Métodos Série de casos intervencionista com desenho prospectivo, não randomizado, não comparativo. O medicamento adalimumabe foi aplicado em região subconjuntival em pacientes com síndrome de Sjögren e olho seco que eram resistentes a outras terapias convencionais. Pacientes com patologias oculares de origem infecciosa ou com alterações estruturais nas vias lacrimais e pálpebras foram excluídos do estudo. Os dados coletados incluíram idade, sexo, teste com lisamina verde, teste de Schirmer, pressão intraocular, mobilidade conjuntival, teste de ruptura do filme lacrimal, e avaliação biomicroscópica com colírio de fluoresceína. Além disso, o questionário Ocular Surface Disease Index validado para a língua portuguesa foi aplicado com objetivo de avaliar subjetivamente a resposta dos pacientes ao tratamento. Resultados Onze olhos de oito pacientes foram estudados. A idade média dos pacientes foi de 53±13,4 anos. A dose aplicada de adalimumabe subconjuntival foi de 0,03mL, e a duração do seguimento foi de 90 dias após a injeção. Não houve melhora estatisticamente significativa nos testes objetivos (todos apresentaram p>0,05). A pressão intraocular também não sofreu variações estatisticamente significativas (p=0,11). Entretanto, por meio do questionário, foi registrada melhora significativa dos sintomas oculares (p=0,002). Conclusão O uso do adalimumabe subconjuntival melhorou os sintomas de olho seco, avaliados por meio do questionário Ocular Surface Disease Index, mas não houve melhora estatisticamente significativa na avaliação objetiva.

Brazilian guidelines for the monitoring and treatment of pediatric allergic conjunctivitis.

Allergic conjunctivitis is an increasingly frequent condition with a higher prevalence in children. It can be debilitating and is responsible for a great economic burden. These guidelines were developed on the basis of the medical literature (PubMed/Medline database) and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology, the Brazilian Council of Ophthalmology, the Brazilian Society of Pediatrics, and the Brazilian Association of Allergy and Immunology. Allergic conjunctivitis is considered to be controlled when the ocular symptoms are not uncomfortable or are present, at most, on 2 days a week; the visual analog scale score is below 5; and the degree of conjunctival hyperemia is graded 0 or 1 on the Efron scale. Allergic conjunctivitis should be classified as mild, moderate, severe, and vision-threatening for adequate treatment and monitoring of frequency. The present document is a guideline for diagnosing, treating, and monitoring pediatric allergic conjunctivitis considering the clinical and demographic aspects of allergic conditions in Brazil.

Corneal Posterior Curvature Changes After Phacoemulsification Cataract Surgery with 2.75 mm Corneal Incision.

The aim of this study was to evaluate the corneal posterior curvature changes after phacoemulsification cataract surgery, with intraocular lens implantation, with a temporal limbal self-sealing 2.75 millimeters (mm) corneal incision, using a Placido-dual rotating Scheimpflug device. In this prospective intervention study, corneal posterior curvature changes were evaluated in fifty-six patients (56 eyes). All patients underwent corneal tomography using the Galilei G2 (Ziemer Ophthalmic System AG, Port, Switzerland) preoperatively (PRE) and with two weeks (RP15), one month (RP30), and three months (RP90) after phacoemulsification cataract surgery with a temporal limbal self-sealing 2.75 mm incision. Tomographic parameters analyzed in the posterior cornea were the steep curvature (K2), flat curvature (K1), mean curvature (average K), and posterior corneal astigmatism. We did not observe any statistically significant change in the K2, K1, average K, and posterior corneal astigmatism in any postoperative follow-up measurements (RP15, RP30, RP90), showing that the postoperative values tend to be the same as the preoperative ones when measured with the Galilei G2 tomography. In conclusion, the 2.75 mm temporal limbal self-sealing corneal incision in phacoemulsification cataract surgery does not induce significant changes in the posterior corneal curvature parameters of K2, K1, average K, and astigmatism.

The Middle Turbinate Resection and Its Repercussion in Olfaction with the University of Pennsylvania Smell Identification Test (UPSIT).

Introduction Nasal obstruction is a common complaint, and, for some, the middle turbinate resection is still a controversial issue among the surgical options due to the possibility of deleterious effects on olfaction. The University of Pennsylvania smell identification test (UPSIT) is considered the gold standard of smell identification tests, but data about it is still incipient in Brazil. Objective To evaluate if the middle turbinectomy has any repercussion on the sense of olfaction by using the UPSIT as an assessment tool. Methods A prospective study performed between 2013 and 2015 with 27 patients who were treated with middle turbinectomy by the same surgeon and tested with the UPSIT pre- and post-surgery, with a minimum interval of 3 months. Results Twenty-five patients completed the study. The mean age was 27.9 years. There was no statistical correlation between middle turbinectomy and the UPSIT score, or between gender and the UPSIT score. Conclusion There was no clinical repercussion on olfaction from partial middle turbinectomy.

The Middle Turbinate Resection and Its Repercussion in Olfaction with the University of Pennsylvania Smell Identification Test (UPSIT)

Abstract Introduction Nasal obstruction is a common complaint, and, for some, the middle turbinate resection is still a controversial issue among the surgical options due to the possibility of deleterious effects on olfaction. The University of Pennsylvania smell identification test (UPSIT) is considered the gold standard of smell identification tests, but data about it is still incipient in Brazil. Objective To evaluate if the middle turbinectomy has any repercussion on the sense of olfaction by using the UPSIT as an assessment tool. Methods A prospective study performed between 2013 and 2015 with 27 patients who were treated with middle turbinectomy by the same surgeon and tested with the UPSIT pre- and post-surgery, with a minimum interval of 3 months. Results Twenty-five patients completed the study. The mean age was 27.9 years. There was no statistical correlation betweenmiddle turbinectomy and the UPSIT score, or between gender and the UPSIT score. Conclusion There was no clinical repercussion on olfaction from partial middle turbinectomy.

Multiprofissional electronic protocol in ophtalmology with enfasis in strabismus.

OBJECTIVE: to create and validate an electronic database in ophthalmology focused on strabismus, to computerize this database in the form of a systematic data collection software named Electronic Protocol, and to incorporate this protocol into the Integrated System of Electronic Protocols (SINPE(c)). METHODS: this is a descriptive study, with the methodology divided into three phases: (1) development of a theoretical ophthalmologic database with emphasis on strabismus; (2) computerization of this theoretical ophthalmologic database using SINPE(c) and (3) interpretation of the information with demonstration of results to validate the protocol. We inputed data from the charts of fifty patients with known strabismus through the Electronic Protocol for testing and validation. RESULTS: the new electronic protocol was able to store information regarding patient history, physical examination, laboratory exams, imaging results, diagnosis and treatment of patients with ophthalmologic diseases, with emphasis on strabismus. We included 2,141 items in this master protocol and created 20 new specific electronic protocols for strabismus, each with its own specifics. Validation was achieved through correlation and corroboration of the symptoms and confirmed diagnoses of the fifty included patients with the diagnostic criteria for the twenty new strabismus protocols. CONCLUSION: a new, validated electronic database focusing on ophthalmology, with emphasis on strabismus, was successfully created through the standardized collection of information, and computerization of the database using proprietary software. This protocol is ready for deployment to facilitate data collection, sorting and application for practitioners and researchers in numerous specialties. OBJETIVO: criar uma base eletrônica de dados em oftalmologia com ênfase em estrabismo através da coleta padronizada de informações. Informatizar esta base sob a forma de software para a coleta sistemática de dados chamado "Protocolo Eletrônico" e incorporar este "Protocolo Eletrônico" da Oftalmologia ao Sistema Integrado de Protocolos Eletrônicos (SINPE(c)). MÉTODOS: este é um estudo descritivo e a metodologia aplicada em seu desenvolvimento está didaticamente dividida em três fases: 1) criação da base teórica de dados clínicos de oftalmologia com ênfase em estrabismo; 2) informatização da base teórica dos dados utilizando o SINPE(c); e 3) interpretação das informações com demonstração dos resultados. A informatização da base de dados foi realizada pela utilização da concessão de uso do SINPE(c). Foram incluídos neste protocolo 50 pacientes com estrabismo para validação do protocolo. RESULTADOS: o protocolo eletrônico desenvolvido permitiu armazenar informações relacionadas à anamnese, exame físico, exames complementares, diagnóstico e tratamento de pacientes com doenças oftalmológicas, com ênfase em estrabismo. Foram incluídos neste trabalho 2141 itens no protocolo mestre e foram criados 20 protocolos específicos de estrabismo, cada um com suas particularidades. Os 50 pacientes que foram incluídos nos protocolos específicos demonstraram a eficácia do método empregado. CONCLUSÃO: foi criada uma base eletrônica de dados em oftalmologia com ênfase em estrabismo através da coleta padronizada de informações. Esta base de dados foi informatizada sob a forma de software onde os futuros usuários poderão utilizar o protocolo eletrônico multiprofissional de doenças oftalmológicas com ênfase em estrabismo para a coleta de seus dados.

Multiprofissional electronic protocol in ophtalmology with enfasis in strabismus / Protocolo eletrônico multiprofissional em oftalmologia com ênfase em estrabismo

ABSTRACT Objective: to create and validate an electronic database in ophthalmology focused on strabismus, to computerize this database in the form of a systematic data collection software named Electronic Protocol, and to incorporate this protocol into the Integrated System of Electronic Protocols (SINPE(c)). Methods: this is a descriptive study, with the methodology divided into three phases: (1) development of a theoretical ophthalmologic database with emphasis on strabismus; (2) computerization of this theoretical ophthalmologic database using SINPE(c) and (3) interpretation of the information with demonstration of results to validate the protocol. We inputed data from the charts of fifty patients with known strabismus through the Electronic Protocol for testing and validation. Results: the new electronic protocol was able to store information regarding patient history, physical examination, laboratory exams, imaging results, diagnosis and treatment of patients with ophthalmologic diseases, with emphasis on strabismus. We included 2,141 items in this master protocol and created 20 new specific electronic protocols for strabismus, each with its own specifics. Validation was achieved through correlation and corroboration of the symptoms and confirmed diagnoses of the fifty included patients with the diagnostic criteria for the twenty new strabismus protocols. Conclusion: a new, validated electronic database focusing on ophthalmology, with emphasis on strabismus, was successfully created through the standardized collection of information, and computerization of the database using proprietary software. This protocol is ready for deployment to facilitate data collection, sorting and application for practitioners and researchers in numerous specialties.

RESUMO Objetivo: criar uma base eletrônica de dados em oftalmologia com ênfase em estrabismo através da coleta padronizada de informações. Informatizar esta base sob a forma de software para a coleta sistemática de dados chamado "Protocolo Eletrônico" e incorporar este "Protocolo Eletrônico" da Oftalmologia ao Sistema Integrado de Protocolos Eletrônicos (SINPE(c)). Métodos: este é um estudo descritivo e a metodologia aplicada em seu desenvolvimento está didaticamente dividida em três fases: 1) criação da base teórica de dados clínicos de oftalmologia com ênfase em estrabismo; 2) informatização da base teórica dos dados utilizando o SINPE(c); e 3) interpretação das informações com demonstração dos resultados. A informatização da base de dados foi realizada pela utilização da concessão de uso do SINPE(c). Foram incluídos neste protocolo 50 pacientes com estrabismo para validação do protocolo. Resultados: o protocolo eletrônico desenvolvido permitiu armazenar informações relacionadas à anamnese, exame físico, exames complementares, diagnóstico e tratamento de pacientes com doenças oftalmológicas, com ênfase em estrabismo. Foram incluídos neste trabalho 2141 itens no protocolo mestre e foram criados 20 protocolos específicos de estrabismo, cada um com suas particularidades. Os 50 pacientes que foram incluídos nos protocolos específicos demonstraram a eficácia do método empregado. Conclusão: foi criada uma base eletrônica de dados em oftalmologia com ênfase em estrabismo através da coleta padronizada de informações. Esta base de dados foi informatizada sob a forma de software onde os futuros usuários poderão utilizar o protocolo eletrônico multiprofissional de doenças oftalmológicas com ênfase em estrabismo para a coleta de seus dados.

Auditory Nerve Recovery Function in Cochlear Implant Surgery with Local Anesthesia and Sedation versus General Anesthesia.

OBJECTIVE: To analyze auditory nerve recovery function (REC), comparing the results after local anesthesia and sedation with those after general anesthesia. METHODS: This was a prospective, cross-sectional and descriptive study in a tertiary referral center hospital. We included all patients (37 ears) who underwent surgery for cochlear implant under either general anesthesia or local anesthesia and sedation during 3 years. REC was measured according to the function of 3 components, 'T0', 'A' and 'tau', and was taken for 3 cochlear electrodes (apical, medial and basal). RESULTS: There were no significant differences in 'tau' and in the current level used, but there were significant differences in the parameters 'T0' apical and 'A' basal. CONCLUSIONS: There were no significant differences in REC between the 2 types of anesthesia, except for the parameters 'T0' apical and 'A' basal.

Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis / Comparação da eficácia da turbinoplastia em pacientes com e sem rinite alérgica

ABSTRACT INTRODUCTION: Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. OBJECTIVE: To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. METHODS: Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. RESULTS: Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. CONCLUSION: The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis.

RESUMO INTRODUÇÃO: A turbinoplastia é procedimento que visa a redução da concha inferior, à custa da remoção óssea exuberante e maior preservação da mucosa. É indicada para pacientes com e sem rinite alérgica, com hipertrofia irreversível das conchas inferiores. OBJETIVO: Avaliar a eficácia da cirurgia de turbinoplastia inferior nos sintomas obstrutivos e não obstrutivos em pacientes com e sem rinite alérgica. MÉTODO: Estudo prospectivo com 57 pacientes submetidos a turbinoplastia inferior. Foram avaliados quanto à obstrução nasal, roncos, pressão facial, alterações no olfato, espirros, prurido nasal e coriza, tempo de cirurgia e sangramento intraoperatório. A última avaliação foi com 3 meses de operação. RESULTADOS: 39 pacientes com rinite alérgica e 18 sem. Com 90 dias de operação, 94,7% dos pacientes apresentaram graus IV e V de melhora na respiração; 89,5% apresentaram melhora moderada ou total dos roncos; todos os pacientes tiveram melhora no olfato (apenas 1 moderada, os demais melhora total); 95,5% obtiveram melhora total da pressão facial e 89,7% obtiveram melhora moderada ou total em prurido nasal, espirros e coriza. CONCLUSÃO: Comprovou-se a eficácia da cirurgia de turbinoplastia inferior não só nos sintomas obstrutivos, mas também nos sintomas não obstrutivos tanto em pacientes com ou sem rinite alérgica.

Subjective and Objective Analyses of Voice Improvement After Phonosurgery in Professional Voice Users.

OBJECTIVES: To evaluate voice improvement after phonosurgery by subjective and objective voice analysis. DESIGN: Prospective observational analytic group study. METHODS: This study was conducted from January 2012 to December 2013. Two hundred forty professional voice users (patients), classified as Koufman level I or II with benign vocal fold lesions, were divided in two groups. Patients in group 1 had a diagnosis of superficial vocal fold lesions, and patients in group 2 had deep lesions on the vocal folds. All patients completed the Vocal Performance Questionnaire (VPQ) and underwent acoustic voice tests using the Praat program. Subjective and objective voice analyses were performed before phonosurgery and at 1, 2, and 3 months after phonosurgery. A control group of 100 volunteers was created and underwent the same voice metrics that were applied to the patients. RESULTS: Jitter, shimmer, harmonic-to-noise ratio, and VPQ scores significantly differentiated patients with vocal fold lesions from individuals in the control group. All of the analyzed parameters improved significantly after phonosurgery. Additionally, patients with superficial vocal fold lesions achieved normal voice parameters 1 month after surgery, and patients with deep lesions achieved normal voice parameters 3 months after surgery. CONCLUSIONS: Analysis of vocal parameters using the VPQ and acoustic tests revealed voice improvement after phonosurgery for both patient groups.

Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis.

INTRODUCTION: Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. OBJECTIVE: To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. METHODS: Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. RESULTS: Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. CONCLUSION: The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis.

Objective assessment of surgical technique in rotation and nasal projection variation / Avaliação objetiva da técnica cirúrgica na variação da rotação e projeção nasal

ABSTRACT INTRODUCTION: In rhinoplasty, facial esthetic analysis is critical for proper surgical planning. Parameters such as rotation and nasal projection should be routinely evaluated. Few studies have objectively assessed changes in facial angles postoperatively. OBJECTIVE: To evaluate the effectiveness of medial intercrural sutures and of rotation of the nasal tip on the increase of rotation and nasal projection in Caucasian patients undergoing primary rhinoplasty. METHODS: A prospective study carried out between 2011 and 2013, with 27 patients treated with primary rhinoplasty with a basic technique by the same surgeon, with medial intercrural sutures and rotation of the nasal tip. Rotation and nasal projection were measured from photographs obtained preoperatively and after 12 months. RESULTS: All 27 patients completed the study. The mean age was 27.1 years. There was a mean increase of 8.4° in the rotation - a statistically significant value. There was no significant change in the projection. CONCLUSION: The medial intercrural and nasal tip rotation sutures are effective in increasing nasal rotation in Caucasian patients undergoing rhinoplasty.

RESUMO INTRODUÇÃO: Na rinoplastia, a análise estética facial é essencial para um planejamento cirúrgico adequado. Parâmetros como rotação e projeção nasal devem ser rotineiramente avaliados. Há poucos estudos que avaliem objetivamente as mudanças nos ângulos faciais no pós-operatório. OBJETIVO: Avaliar a eficácia das suturas intercrura mediais e de rotação da ponta nasal no aumento da rotação e projeção nasal em pacientes caucasianos submetidos à rinoplastia primária. MÉTODO: Estudo prospectivo realizado entre 2011 e 2013, com 27 pacientes submetidos à rinoplastia primária técnica básica, pelo mesmo cirurgião, com suturas intercrura mediais e de rotação da ponta nasal. Mediu-se a rotação e a projeção nasal a partir de fotografias no pré-operatório e 12 meses após. RESULTADOS: Todos os 27 pacientes completaram o estudo. A idade média foi de 27,1 anos. Houve aumento médio de 8,4° na rotação, com significância estatística. Não houve alteração significativa na projeção. CONCLUSÃO: As suturas intercrura mediais e de rotação da ponta nasal são eficazes no aumento da rotação nasal em pacientes caucasianos submetidos à rinoplastia.

Objective assessment of surgical technique in rotation and nasal projection variation.

INTRODUCTION: In rhinoplasty, facial esthetic analysis is critical for proper surgical planning. Parameters such as rotation and nasal projection should be routinely evaluated. Few studies have objectively assessed changes in facial angles postoperatively. OBJECTIVE: To evaluate the effectiveness of medial intercrural sutures and of rotation of the nasal tip on the increase of rotation and nasal projection in Caucasian patients undergoing primary rhinoplasty. METHODS: A prospective study carried out between 2011 and 2013, with 27 patients treated with primary rhinoplasty with a basic technique by the same surgeon, with medial intercrural sutures and rotation of the nasal tip. Rotation and nasal projection were measured from photographs obtained preoperatively and after 12 months. RESULTS: All 27 patients completed the study. The mean age was 27.1 years. There was a mean increase of 8.4° in the rotation - a statistically significant value. There was no significant change in the projection. CONCLUSION: The medial intercrural and nasal tip rotation sutures are effective in increasing nasal rotation in Caucasian patients undergoing rhinoplasty.

A comparison study of corneal topographic changes following 20-, 23-, and 25-G pars plana vitrectomy.

PURPOSE: To evaluate and compare corneal topographic changes following pars plana vitrectomy with the 23-gauge (G) and 25-G transconjuntival sutureless vitrectomy system as well as the standard 20-G vitrectomy system. METHODS: We prospectively evaluated corneal topographic changes in 45 eyes of 45 patients divided into three groups according to vitrectomy system used (20-, 23-, and 25-G). All patients underwent computer-assisted videokeratography using an EyeSys System 3000 topographer preoperatively and at one week, one month, and three months postoperatively. RESULTS: In the 20-G vitrectomy group, we found statistically significant postoperative changes in corneal curvature parameters with an average steepening of 0.98 ± 0.18 D (P<0.001) and 0.93 ± 0.21 D (P<0.001) at one week and one month, respectively. No statistically significant difference was observed at the three-month follow-up visit. In the 23- and 25-G groups, no statistically significant changes in corneal curvature parameters were observed at any postoperative follow-up visit. CONCLUSION: Twenty-three-gauge and 25-gauge transconjunctival sutureless vitrectomy did not induce topographic corneal changes following surgery, whereas 20-G vitrectomy was found to induce transient topographic corneal changes that had returned to preoperative levels at three months postoperatively.

A comparison study of corneal topographic changes following 20-, 23-, and 25-G pars plana vitrectomy / Um estudo comparativo das alterações topográficas da cornea após a vitrectomia via pars plana com 20, 23 e 25 gauge

ABSTRACTPurpose:To evaluate and compare corneal topographic changes following pars plana vitrectomy with the 23-gauge (G) and 25-G transconjuntival sutureless vitrectomy system as well as the standard 20-G vitrectomy system.Methods:We prospectively evaluated corneal topographic changes in 45 eyes of 45 patients divided into three groups according to vitrectomy system used (20-, 23-, and 25-G). All patients underwent computer-assisted videokeratography using an EyeSys System 3000 topographer preoperatively and at one week, one month, and three months postoperatively.Results:In the 20-G vitrectomy group, we found statistically significant postoperative changes in corneal curvature parameters with an average steepening of 0.98 ± 0.18 D (P<0.001) and 0.93 ± 0.21 D (P<0.001) at one week and one month, respectively. No statistically significant difference was observed at the three-month follow-up visit. In the 23- and 25-G groups, no statistically significant changes in corneal curvature parameters were observed at any postoperative follow-up visit.Conclusion:Twenty-three-gauge and 25-gauge transconjunctival sutureless vitrectomy did not induce topographic corneal changes following surgery, whereas 20-G vitrectomy was found to induce transient topographic corneal changes that had returned to preoperative levels at three months postoperatively.

RESUMOObjetivos:Avaliar e comparar as alterações topográficas da córnea após a vitrectomia via pars plana com o sistema transconjuntival sem suturas de 23 gauge (g) e 25 g e com o sistema tradicional de vitrectomia via pars plana 20 g.Método:Neste estudo prospectivo, as alterações topográficas da córnea foram avaliadas em 45 olhos de 45 pacientes, divididos em 3 grupos de acordo com o sistema de vitrectomia utilizado (20, 23 e 25 g). Todos os pacientes foram submetidos a topografia corneana computadorizada utilizando-se o topógrafo EyeSys System 3000 antes da cirurgia, e com 1 semana, 1 mês e 3 meses após a cirurgia.Resultados:No período pós-operatório, no grupo de vitrectomia 20 g, foram encontradas alterações estatisticamente significativas nos parâmetros da curvatura corneana estudados, com um aumento médio da curvatura de 0,98 ± 0,18 D (p<0,001) e 0,93 ± 0,21D (p<0,001) após uma semana, e um mês, respectivamente. Não se observou diferença estatisticamente significativa na visita realizada 3 meses após a cirurgia. Nos grupos 23 g e 25 g, não se observaram alterações estatisticamente significativas nos parâmetros da curvatura corneana em nenhum dos momentos analisados no pós-operatório.Conclusão:A vitrectomia transconjuntival sem suturas 23 g e 25 g não induziu alterações topográficas da córnea após a cirurgia, enquanto que a vitrectomia 20 g induziu alterações topográficas da córnea transitórias que retornaram aos níveis pré-operatórios três meses após a cirurgia.

Optical coherence tomography in patients undergoing cataract surgery.

PURPOSE: To assess the ability of spectral domain optical coherence tomography (SD-OCT) to diagnose macular changes pre- and post-cataract surgery and to identify changes in central foveal thickness (CFT) relative to age, sex, and presence of concomitant ophthalmic pathologies, for a period of 6 months post-surgery. METHODS: A prospective study of patients evaluated by SD-OCT within 5 h before surgery at 7, 30, 60, 90, and 180 days post-op, with respect to CFT and presence of maculopathy. RESULTS: Ninety-eight eyes of 98 patients were evaluated, with the following mean results: age = 71.4 years, pre-op VA = 0.27 logMAR, and final VA = 0.73 logMAR. There were 21 eyes in patients with diabetes mellitus (DM) and 10 eyes with age-related macular degeneration (AMD), three with epiretinal membrane, and four with glaucoma. Sixty eyes had no other ophthalmic-related pathologies (NOO), and had a mean pre-op CFT of 222 µm, which progressively increased up to the 60th day post-op, reaching a mean of 227.2 µm. No pseudophakic cystoid macular edema was observed. The mean CFT was statistically significantly different (p<0.001) between NOO and diabetic patients from 30 days post-op. Four eyes presented with preoperative diagnosis of AMD as measured by ophthalmoscopy. After completion of the OCT, which was performed within 5 h before surgery, six additional patients were found to have AMD. Of the 98 total eyes, 10 were diagnosed with maculopathy only by OCT exam. Binocular indirect ophthalmoscopy (BIO) was unable to detect such changes. CONCLUSION: OCT diagnosed preoperative maculopathies in 21.4% of the patients, and was more effective than BIO (11.2%). OCT showed a progressive increase in CFT in diabetics up to 180 days post-operatively, as well as greater CFT in male patients and patients older than 70 years.

Optical coherence tomography in patients undergoing cataract surgery / Tomografia de coerência óptica em pacientes submetidos a cirurgia de catarata

ABSTRACTPurpose:To assess the ability of spectral domain optical coherence tomography (SD-OCT) to diagnose macular changes pre- and post-cataract surgery and to identify changes in central foveal thickness (CFT) relative to age, sex, and presence of concomitant ophthalmic pathologies, for a period of 6 months post-surgery.Methods:A prospective study of patients evaluated by SD-OCT within 5 h before surgery at 7, 30, 60, 90, and 180 days post-op, with respect to CFT and presence of maculopathy.Results:Ninety-eight eyes of 98 patients were evaluated, with the following mean results: age = 71.4 years, pre-op VA = 0.27 logMAR, and final VA = 0.73 logMAR. There were 21 eyes in patients with diabetes mellitus (DM) and 10 eyes with age-related macular degeneration (AMD), three with epiretinal membrane, and four with glaucoma. Sixty eyes had no other ophthalmic-related pathologies (NOO), and had a mean pre-op CFT of 222 μm, which progressively increased up to the 60thday post-op, reaching a mean of 227.2 μm. No pseudophakic cystoid macular edema was observed. The mean CFT was statistically significantly different (p<0.001) between NOO and diabetic patients from 30 days post-op. Four eyes presented with preoperative diagnosis of AMD as measured by ophthalmoscopy. After completion of the OCT, which was performed within 5 h before surgery, six additional patients were found to have AMD. Of the 98 total eyes, 10 were diagnosed with maculopathy only by OCT exam. Binocular indirect ophthalmoscopy (BIO) was unable to detect such changes.Conclusion:OCT diagnosed preoperative maculopathies in 21.4% of the patients, and was more effective than BIO (11.2%). OCT showed a progressive increase in CFT in diabetics up to 180 days post-operatively, as well as greater CFT in male patients and patients older than 70 years.

RESUMOObjetivos:Avaliar a capacidade da tomografia ocular de coerência de domínio espectral Spectral Domain-Optical Coherence Tomography (SD-OCT) diagnosticar alterações maculares no pré e pós-operatório da cirurgia de catarata e a variação da espessura foveal central (CFT) de acordo com a idade, sexo, presença ou não de oftalmopatias associadas, pelo período de 6 meses após a cirurgia.Método:Estudo prospectivo com pacientes avaliados pela SD/FD-OCT no pré-operatório (dia da cirurgia) e 7, 30, 60, 90 e 180 dias após, no que se refere à EFC e presença de maculopatia.Resultados:Foram avaliados 98 olhos de 98 pacientes, 35 homens e 63 mulheres. O estudo mostrou a seguintes médias: idade = 71,4 anos, AV pré-operatória = 0,27, AV final = 0,73. Vinte-um olhos eram de pacientes com diabetes mellitus (DM), 10 apresentavam degeneração macular relacionada à idade (AMD), 3 com membrana epirretiniana e 4 tinham glaucoma. Sessenta olhos apresentavam-se normais, ou seja, sem outras oftalmopatias (NOO). Avaliando a EFC do grupo NOO observou-se uma CFT média no pré-operatório de 222 μm, que mostrou um aumento progressivo até o 60o dia de pós-operatório, quando atingiu média de 227,2 μm. Não foi observado edema macular cistóide do pseudofácicos. Ao comparar a diferença entre a CFT média de pacientes NOO e pacientes diabéticos, observou-se que os valores são significativos (p<0,001) a partir do 30º dia de pós-operatório. Quatro olhos apresentaram, pela oftalmoscopia, diagnóstico pré-operatório de DMRI. Após a realização do exame de OCT, horas antes da cirurgia, observou-se que mais 6 pacientes apresentavam AMD. Do total de 98 olhos, 10 tiveram o diagnóstico de maculopatia somente pelo exame de OCT. A oftalmoscopia binocular indireta (BIO) não foi capaz de detectar tais alterações.Conclusão:O OCT diagnosticou doenças maculares pré-operatórias em 21,4% dos pacientes, sendo mais efetivo que a BIO (11,2%). Mostrou um aumento progressivo da CFT em diabéticos até 180 dias de pós-operatório. Detectou que a CFT é maior em pacientes do sexo masculino, e que a CFT dos pacientes com mais de 70 anos é maior que em pacientes mais jovens.