RESUMO
Resumen: La morbimortalidad perioperatoria en cirugía oftalmológica es baja, considerando que la mayor parte de la población que requiere estos procedimientos son pacientes de edad avanzada con múltiples comorbilidades. Embriológicamente el nervio óptico y las capas meníngeas que lo recubren se derivan del ectodermo y están estrechamente relacionadas con las capas meníngeas que recubren al sistema nervioso central, de esta forma la punción inadvertida de las mismas durante los bloqueos orbitarios provocan diseminación del fármaco por medio del líquido cefalorraquídeo a través del espacio subaracnoideo hasta el tronco encefálico. Se reporta el caso de paciente femenino de 61 años de edad, programada para lavado de cámara vítrea en ojo izquierdo. La técnica anestésica fue sedación más bloqueo retrobulbar; posterior a dicho procedimiento, se observa deterioro neurológico, alteraciones cardiovasculares, disminución de la saturación de oxígeno manteniendo ventilación espontánea, pero con obstrucción de la vía aérea; se da apoyo ventilatorio y se administra antihipertensivo, respondiendo favorablemente 40 minutos después del bloqueo retrobulbar. La relación entre un bloqueo orbitario y la aparición de sintomatología neurológica, cardiovascular y/o respiratoria debe suscitar sospechas de anestesia del tronco encefálico. Lo más importante es el reconocimiento y atención temprana de esta complicación para evitar secuelas neurológicas, cardiovasculares o incluso la muerte.
Abstract: Perioperative morbidity and mortality in ophthalmic surgery is low, considering that most of the population that requires these procedures are elderly patients with multiple comorbidities. Embryologically, the optic nerve and the meningeal sheaths that cover it originate from the ectoderm, are closely related to the meningeal layers that cover the central nervous system, whereby their inadvertent puncture during orbital blocks causes drug spread by the cerebrospinal fluid through the subarachnoid space to the brainstem. The case of a 61-year-old female patient is reported, programmed for lavage of the left eye vitreous chamber. The anesthetic technique was sedation and retrobulbar block; after this procedure, neurological impairment, cardiovascular alterations, decreased oxygen saturation were observed, maintaining spontaneous ventilation but with airway obstruction; ventilatory support is given and antihypertensive is administered, responding favorably 40 minutes after retrobulbar block. The relationship between an orbital block and the appearance of neurological, cardiovascular or respiratory symptoms should raise suspicion of brainstem anesthesia. The most important thing is early recognition and attention to this complication, to avoid neurological and cardiovascular sequelae or even death.
RESUMO
Resumen Durante la cirugía endoscópica nasosinusal, la sección inadvertida y retracción hacia la órbita de la arteria etmoidal anterior (AEA) es el mecanismo habitual del hematoma orbitario (HO); éste se manifiesta con proptosis, dolor y déficit visual potencialmente irreversible. El déficit visual es secundario a isquemia del nervio óptico por aumento de la presión intraocular, siendo suficientes treinta minutos para que ocurra daño visual permanente. Por sus secuelas el tratamiento del HO debe ser rápido y agresivo. Presentamos el caso de un varón de 72 años con diagnóstico de rinosinusitis crónica con pólipos nasales refractaria a tratamiento médico que se sometió a cirugía endoscópica nasal y que desarrolló en el posoperatorio inmediato con un HO. Se manejó precozmente con cantotomía-cantolisis, descompresión orbitaria medial endoscópica y control vascular de la AEA. El paciente evoluciona favorablemente, sin déficit visual. En este artículo se discutirán el diagnóstico y manejo oportunos del hematoma orbitario iatrogénico.
Abstract During endoscopic sinonasal surgery, inadvertent section of the anterior ethmoidal artery (AEA) with retraction into the orbit is the usual mechanism of orbital hematoma (OH), leading to proptosis, pain, and potentially irreversible visual loss. Thirty minutes is sufficient for retinal ischemia and permanent visual loss. The explanation for blindness is due to increased intraorbital pressure. The treatment of iatrogenic HO must be quick and aggressive, because if it is not managed in time, it can cause a permanent visual deficit. We present the case of a 72-year-old man with a diagnosis of chronic rhinosinusitis with nasal polyps refractory to medical treatment who underwent nasal endoscopic surgery, evolving in the immediate postoperative period with an HO, requiring canthotomy - cantolysis and early surgical reintervention for endoscopic medial orbital decompression and vascular control of AEA. The patient evolves favorably, without visual deficit. This article will discuss the timely diagnosis and management of iatrogenic orbital hematoma.
Assuntos
Humanos , Masculino , Idoso , Doenças Orbitárias/etiologia , Pólipos Nasais/cirurgia , Endoscopia/efeitos adversos , Hematoma/etiologia , Endoscopia/métodos , Hemorragia/etiologiaRESUMO
A 4-mo-old northern red-shouldered macaw (Diopsittaca nobilis) was admitted to the veterinary hospital of the Arruda Câmara Zoo, in the State of Paraiba, Brazil, for investigation of an orbital mass. Given rapid progression and lack of response to treatment, the bird was euthanized, and an autopsy was performed. Histologically, the mass consisted of a retrobulbar invasive tumor characterized by tubular and rosette-like structures, with interspersed heteroplastic tissues, such as aggregates of neuroglial cells and islands of hyaline cartilage. The tumor was immunopositive for pancytokeratin, GFAP, NSE, and S100. These findings were compatible with an ocular teratoid medulloepithelioma, a neoplasm best described in humans but also reported rarely in young cockatiels and African Grey parrots.
Assuntos
Doenças das Aves/diagnóstico , Neoplasias Oculares/veterinária , Tumores Neuroectodérmicos Primitivos/veterinária , Papagaios , Animais , Doenças das Aves/patologia , Brasil , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/patologia , Tumores Neuroectodérmicos Primitivos/diagnóstico , Tumores Neuroectodérmicos Primitivos/patologiaRESUMO
Abstract Objective: To compare the use of 2 different local anesthetic solution (LAS) volumes of 1.5 mL and 3 mL in retrobulbar block in patients undergoing cataract surgery in terms of anesthesia, akinesia, and pain levels. Methods: 80 patients between 18-90 years old, ASA I-II-III, were included in the study. For retrobulbar anesthesia, 1.5 mL LAS was applied to one group (Group LV), and 3 mL LAS to the other group (Group HV). The patients' ocular and eyelid motion scores were evaluated and recorded in the first, third, fifth, and tenth minutes after the block, and at 30-minute intervals for 4 hours post-operatively. One day later, the first hour of analgesic need and the number of times they took analgesic agents were asked and recorded. In addition, side effects were questioned and recorded. Results: The 39 (48.75%) patients were male and 41 (51.25%) patients were female. The criteria determined in terms of ocular motor score after the retrobulbar block (ocular motor score≤4) were met in 92.5% of patients in Group LV in all patients in Group HV, and the time to fulfill the determined criteria in Group HV was found to be significantly lower compared to Group LV (p=0.004). The movements of the eye in all direction except the inward movement recovered in Group LV in a significantly shorter time than Group HV (p=0.004). There was no significant difference in pain levels and side effects between the groups (p=0.34). Conclusions: After 1.5 mL LAS administration in retrobulbar block, adequate akinesia was not achieved in about one tenth of patients, but no significant difference was found between 1.5 mL and 3 mL LAS volumes in analgesic efficacy and side effects.
Resumo Objetivo: Comparar o uso de 2 volumes diferentes de solução anestésica local (LAS) de 1,5 mL e 3 mL no bloqueio retrobulbar em pacientes submetidos à cirurgia de catarata em termos de anestesia, acinesia e níveis de dor. Métodos: 80 pacientes entre 18 e 90 anos, ASA I-II-III, foram incluídos no estudo. Para anestesia retrobulbar, 1,5 mL de LAS foi aplicado em um grupo (Grupo LV) e 3 mL de LAS no outro grupo (Grupo HV). Os escores de movimento ocular e palpebral dos pacientes foram avaliados e registrados no primeiro, terceiro, quinto e décimo minutos após o bloqueio e em intervalos de 30 minutos por 4 horas no pós-operatório. Um dia depois, a primeira hora de necessidade de analgésico e o número de vezes que eles tomaram analgésicos foram solicitados e registrados. Além disso, os efeitos colaterais foram questionados e registrados. Resultados: 39 (48,75%) pacientes eram do sexo masculino e 41 (51,25%) do sexo feminino. Os critérios determinados em termos de escore motor ocular após o bloqueio retrobulbar (escore motor ocular≤4) foram atendidos em 92,5% dos pacientes do Grupo LV em todos os pacientes do Grupo HV, e foi encontrado o tempo para atender aos critérios determinados no Grupo HV ser significativamente menor em comparação ao grupo LV (p = 0,004). Os movimentos do olho em todas as direções, exceto o movimento interior, se recuperaram no Grupo LV em um tempo significativamente menor que o Grupo HV (p = 0,004). Não houve diferença significativa nos níveis de dor e efeitos colaterais entre os grupos (p = 0,34). Conclusões: Após administração de 1,5 mL de LAS no bloqueio retrobulbar, não foi alcançada acinesia adequada em cerca de um décimo dos pacientes, mas não foi encontrada diferença significativa entre os volumes de 1,5 mL e 3 mL de LAS na eficácia analgésica e efeitos colaterais.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Dor , Extração de Catarata , Bloqueio Neuromuscular , Movimentos Oculares , Anestesia Local , Anestésicos Locais , Estudo ComparativoRESUMO
Resumo Objetivo: Verificar a presença das células-tronco mesenquimais (MSC) na área próxima ao nervo óptico de coelhos previamente lesado com álcool absoluto. Métodos: Os 12 coelhos da raça Nova Zelândia foram distribuídos em 2 lotes. Após sedação, cada olho do animal recebeu uma injeção retrobulbar de 1 ml de álcool absoluto em um dos olhos e de 1 ml de solução fisiológica 0,9% (SF) no olho contralateral. Após 15 dias deste procedimento inicial todos os olhos dos animais pertencentes ao lote A, receberam via retrobulbar, uma solução contendo MSC de tecido adiposo humano e previamente marcadas com Qdots,. Todos os olhos dos animais do lote B receberam solução PBS. Resultados: Após 15 dias desta última aplicação os animais foram sacrificados e as lâminas foram analisadas. A presença das MSC foi observada em 100% dos olhos dos animais do lote A. Conclusão: Os resultados sugerem que a marcação prévia das MSC com Qdots permitiu o acompanhamento das mesmas na região aplicada e em áreas mais internas do nervo óptico. A permanência de MSC após 15 dias de aplicação ao redor do nervo óptico sugere a viabilidade e possível participação das mesmas no processo de regeneração do tecido lesado. Nas condições deste estudo, a via de aplicação retrobulbar permitiu a mobilização das células tronco do local de aplicação até áreas centrais dos nervos ópticos nos animais do lote A, sugerindo que esta poderá ser uma via de acesso eficaz para as MSC no processo de regeneração de neuropatias ópticas.
Abstract Obtective: To verify the presence of mesenchymal stem cells (MSC) in the area close to the optic nerve of previously injured with absolute alcohol. Methods: Twelve New Zealand breed rabbits were divided into two groups, and after sedation, each eye of the animal received a retrobulbar injection of 1 ml of absolute ethanol in one eye, and 1 ml of physiological solution 0.9 % (PS) in the contralateral eye. After 15 days all eyes of animals belonging to group A, received via retrobulbar a solution containing MSCs from human adipose tissue (AT) and previously marked with Qdots, while all eyes of animals from group B received solution containing PBS. Results: The presence of MSC was observed in 100% of the eyes of the animals of group A and the more central areas near and into the optic nerve. Conclusion: The results suggest that the appointment of MSC with Qdots allowed their follow-up applied in the region and in the inner areas of the optic nerve. The MSC permanence after 15 days of application around the optic nerve suggests the feasibility and possible involvement of the same during the damaged tissue regeneration process. Under the conditions of this study, the route of retrobulbar application and the presence of the stem cells to the central areas of the optic nerves in animals of group A, suggests that this might be an effective approach for MSCs in regeneration process of optic neuropathies.
Assuntos
Animais , Feminino , Coelhos , Doenças do Nervo Óptico/terapia , Tecido Adiposo/citologia , Adipócitos , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/citologia , Regeneração Nervosa , Nervo Óptico/citologia , Semicondutores , Diferenciação Celular , Células Cultivadas , Doenças do Nervo Óptico/induzido quimicamente , Método Duplo-Cego , Pontos Quânticos , Injeções IntraocularesRESUMO
Background: Deep fungal infections of the orbit and nasal passages causing rhinitis and ulcerative keratomycosis areuncommonly reported in cats. Hyalohyphomycetes and phaeohyphomycetes have rarely been associated with this disorder.Sino-orbital fungal diseases are emerging and more invasive than sino-nasal fungal diseases with poor response to therapyand a worse prognosis. Brachycephalic feline breeds seem to be at increased risk for development of upper respiratoryfungal diseases. Diagnosis is based on the demonstration of fungal hyphae by cytology or histology and definitive confirmation by fungal culture and molecular methods. This is the first case report of a cat with clinical mixed fungal ball withAspergillus and Scopulariopsis in Brazil.Case: A 3-year-old male Persian cat, in São José city, Santa Catarina, Brazil, was presented with exophthalmos and corneal ulcer of the left eye and protrusion, hyperemia, quemosis and fibroses of the left third eyelid. The retropulsion of theglobe was negative in this eyeball and a presumptive diagnosis of a retrobulbar mass was made. The patient underwenta surgical procedure for inspection and collection of samples for bacterial and mycological culture. Culture revealed nobacterial growth, however, unique and abundant growth of Aspergillus spp. was present. A subconjunctival enucleation ofthe left eye was made and the mass was sent for histopathology examination. Histology showed inflammatory proliferativenecrotizing pyogranulomatous reaction; with the presence of severe fungal infection evidenced by large number of hyalineseptated regular and irregular mold hyphae. Molecular identification was performed using panfungal primers (ITS3-F /ITS4-R). Patient was treated with systemic itraconazole associated with amphotericin B and topical clotrimazole. A massstarted to grow rapidly in the left pterygopalatine fossa and was surgically removed, but recurrence occurred seven daysafter...(AU)
Assuntos
Animais , Gatos , Aspergillus , Scopulariopsis , Micoses/veterinária , Órbita/patologia , Bulbo Olfatório/patologia , Doenças Respiratórias/veterináriaRESUMO
Background: Deep fungal infections of the orbit and nasal passages causing rhinitis and ulcerative keratomycosis areuncommonly reported in cats. Hyalohyphomycetes and phaeohyphomycetes have rarely been associated with this disorder.Sino-orbital fungal diseases are emerging and more invasive than sino-nasal fungal diseases with poor response to therapyand a worse prognosis. Brachycephalic feline breeds seem to be at increased risk for development of upper respiratoryfungal diseases. Diagnosis is based on the demonstration of fungal hyphae by cytology or histology and definitive confirmation by fungal culture and molecular methods. This is the first case report of a cat with clinical mixed fungal ball withAspergillus and Scopulariopsis in Brazil.Case: A 3-year-old male Persian cat, in São José city, Santa Catarina, Brazil, was presented with exophthalmos and corneal ulcer of the left eye and protrusion, hyperemia, quemosis and fibroses of the left third eyelid. The retropulsion of theglobe was negative in this eyeball and a presumptive diagnosis of a retrobulbar mass was made. The patient underwenta surgical procedure for inspection and collection of samples for bacterial and mycological culture. Culture revealed nobacterial growth, however, unique and abundant growth of Aspergillus spp. was present. A subconjunctival enucleation ofthe left eye was made and the mass was sent for histopathology examination. Histology showed inflammatory proliferativenecrotizing pyogranulomatous reaction; with the presence of severe fungal infection evidenced by large number of hyalineseptated regular and irregular mold hyphae. Molecular identification was performed using panfungal primers (ITS3-F /ITS4-R). Patient was treated with systemic itraconazole associated with amphotericin B and topical clotrimazole. A massstarted to grow rapidly in the left pterygopalatine fossa and was surgically removed, but recurrence occurred seven daysafter...
Assuntos
Animais , Gatos , Aspergillus , Bulbo Olfatório/patologia , Micoses/veterinária , Scopulariopsis , Órbita/patologia , Doenças Respiratórias/veterináriaRESUMO
Abstract Background and objectives: Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. Case report: Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. Conclusions: During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.
Resumo Justificativa e objetivos: A anestesia peribulbar surgiu como uma opção mais segura quando comparada com o bloqueio retrobulbar intraconal. Ainda assim, a anestesia peribulbar não pode ser considerada isenta de riscos. Inúmeras complicações foram descritas quando da aplicação dessa técnica. O presente relato tem como objetivo descrever um caso raro caracterizado por amaurose e paralisia contralaterais quando da tentativa de se fazer a anestesia peribulbar. Relato de caso: Paciente masculino, 75 anos, estado físico ASA II, submetido à facectomia por facoemulsificação com implante de lente intraocular. Sedado com fentanil e midazolam e submetido a APB. Não houve intercorrências durante a cirurgia. Após o término do procedimento o paciente relatou ausência de visão no olho contralateral. Foram observadas acinesia da musculatura inervada pelo III e VI pares cranianos, ptose palpebral e pupilas de tamanho médio, não responsivas ao estímulo luminoso. Após quatro horas da anestesia, houve recuperação completa da visão, da movimentação das pálpebras e do globo ocular não operado. Conclusões: Durante a APB, estruturas localizadas no espaço intraconal podem ser atingidas acidentalmente levando a complicações como a descrita no relato acima. O respeito às diretrizes técnicas e o uso de agulhas com o tamanho adequado podem reduzir o risco de tal complicação, mas não de forma completa.
Assuntos
Humanos , Masculino , Idoso , Doenças do Nervo Oculomotor/etiologia , Cegueira/etiologia , Anestesia Local/métodos , Midazolam/administração & dosagem , Fentanila/administração & dosagem , Facoemulsificação/métodosRESUMO
BACKGROUND AND OBJECTIVES: Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. CASE REPORT: Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. CONCLUSIONS: During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.
RESUMO
Retrobulbar tumors may arise from any orbital tissue. Some are primary and others may extend from adjacent structures or derived from metastases. Multilobular osteochondrosarcomas are regarded as slowly growing and potentially malignant neoplasms in dogs. This tumor is of rare occurrence on retrobulbar region. This paper aims to report a rare case of female dog, Shih Tzu, spayed, five-year-old, that was referred to the Hospital of Veterinary Medicine, Federal University of Bahia, Brazil, with an increased volume in the orbital space, after enucleation for exophthalmia of unknown etiology. This animal was evaluated clinic and the diagnosis image (radiography and computed tomography) demonstrated a large formation of bone predominantly in the region of the right orbit and zygomatic arch, with invasion and destruction of adjacent bones. Due to her poor quality of life, the dog was submitted to euthanasia and after necropsy. On gross examination, an encapsulated nodular mass with an irregular surface, measuring 5.6 x 4.6 x 3.9 cm, was located in the right lateral skull, occupying the orbit with displacement of the zygomatic arch. The tumor was identified by histopathology as a malignant mesenchymal neoplasm, multilobular osteochondrosarcoma. Thus, differential diagnoses for exophthalmos should include cancers, including the multilobular osteocondrossarcoma.
Tumores retrobulbares podem originar-se de qualquer tecido orbital. Alguns são primários e outros podem estender-se a partir de estruturas adjacentes ou derivados de metástases. O osteocondrosarcoma multilobular é um tumor considerado de crescimento lento, potencialmente maligno e sua ocorrência é considerada rara em região orbital. Este trabalho objetiva descrever um caso de uma cadela, Shih Tzu, castrada, com cinco anos, atendida no Hospital de Medicina Veterinária da Universidade Federal da Bahia, Brasil, com apresentação de aumento de volume no espaço orbital, após enucleação devido a exoftalmia de etiologia desconhecida. O animal foi avaliado clinicamente e por exames de imagem (radiografia e tomografia computadorizada), os quais demonstraram uma grande formação óssea predominantemente na região da órbita direita e arco zigomático, com invasão e destruição dos ossos adjacentes. Devido às más condições de sobrevida apresentada pelo animal, foi indicado o procedimento de eutanásia e por fim, submetido à necropsia. No exame macroscópico, uma massa nodular encapsulada de superfície irregular, medindo 5,6 x 4,6 x 3,9 centímetros, foi localizada no crânio lateral direito, ocupando a órbita com deslocamento do arco zigomático. O tumor foi identificado por exame histopatológico como neoplasia mesenquimal maligna, osteocondrossarcoma multilobular. Desta forma, diagnósticos diferenciais para exoftalmia devem incluir neoplasias, dentre elas o osteocondrossarcoma multilobular.
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Neoplasias Orbitárias , Cães , Olho , NeoplasiasRESUMO
Background: The squamous cell carcinoma (SCC) is the second most common cancer in the oral epithelium of dogs and rarely involves the retrobulbar area. The diagnosis is confirmed with cytological and histopathological exam. Faced with the unusual occurrence of retrobulbar tumors in dogs, we report a case of SCC in the left maxilla, with ipsilateral retrobulbar metastasis, and also highlight clinical aspects of the neoplasia, exams, early diagnosis and therapeutic possibilities.Case: A male dog, 17 years old, with a history of visual loss, enlargement of left eye and prostration after 25 days of a dental treatment. The patient had exophthalmia of the left eye with mild lateral deviation, meibomitis, lagophthalmos, moderate conjunctival hyperemia and episcleral congestion, protrusion of the third eyelid, epiphora, moderate purulent discharge, paracentral corneal degeneration, absence of pupillary reflex to light (direct and consensual) and presence of immature cataract. The Schirmer test and intraocular pressure were normal, as well as complete blood count and biochemical profile. Due to the testy temperament of the animal, the intraoral examination was limited to two-thirds of the jaw in the first appointment. Ocular vitreous ultrasound was performed showing moderate amount of membranous and punctate echoes, as well as medium-high reflectivity were present in all meridians...
O carcinoma de células escamosas (CCE) é considerado a segunda neoplasia oral não odontogênica, maligna, mais frequente em cães [6] e raramente acomete a região retrobulbar nesta espécie [3,11]. Neoplasias retrobulbares têm representatividade de 4% quando comparadas as de outras estruturas oculares [2] e em 74% das vezes, representam metástases [8].Diante da ocorrência incomum de neoplasias na região retrobulbar em cães, objetivou-se relatar o caso de CCE na maxila esquerda, com metástase retrobulbar ipsilateral, não obstante, ressaltar importantes aspectos da neoplasia que auxiliem no rápido diagnóstico e na escolha terapêutica...
Assuntos
Animais , Cães , Carcinoma de Células Escamosas/veterinária , Exoftalmia/veterinária , Hiperemia/veterinária , Metástase Neoplásica , Neoplasias Maxilares/veterinária , Ética , Doenças do Aparelho Lacrimal/veterináriaRESUMO
Background: The squamous cell carcinoma (SCC) is the second most common cancer in the oral epithelium of dogs and rarely involves the retrobulbar area. The diagnosis is confirmed with cytological and histopathological exam. Faced with the unusual occurrence of retrobulbar tumors in dogs, we report a case of SCC in the left maxilla, with ipsilateral retrobulbar metastasis, and also highlight clinical aspects of the neoplasia, exams, early diagnosis and therapeutic possibilities.Case: A male dog, 17 years old, with a history of visual loss, enlargement of left eye and prostration after 25 days of a dental treatment. The patient had exophthalmia of the left eye with mild lateral deviation, meibomitis, lagophthalmos, moderate conjunctival hyperemia and episcleral congestion, protrusion of the third eyelid, epiphora, moderate purulent discharge, paracentral corneal degeneration, absence of pupillary reflex to light (direct and consensual) and presence of immature cataract. The Schirmer test and intraocular pressure were normal, as well as complete blood count and biochemical profile. Due to the testy temperament of the animal, the intraoral examination was limited to two-thirds of the jaw in the first appointment. Ocular vitreous ultrasound was performed showing moderate amount of membranous and punctate echoes, as well as medium-high reflectivity were present in all meridians...(AU)
O carcinoma de células escamosas (CCE) é considerado a segunda neoplasia oral não odontogênica, maligna, mais frequente em cães [6] e raramente acomete a região retrobulbar nesta espécie [3,11]. Neoplasias retrobulbares têm representatividade de 4% quando comparadas as de outras estruturas oculares [2] e em 74% das vezes, representam metástases [8].Diante da ocorrência incomum de neoplasias na região retrobulbar em cães, objetivou-se relatar o caso de CCE na maxila esquerda, com metástase retrobulbar ipsilateral, não obstante, ressaltar importantes aspectos da neoplasia que auxiliem no rápido diagnóstico e na escolha terapêutica...(AU)
Assuntos
Animais , Cães , Carcinoma de Células Escamosas/veterinária , Neoplasias Maxilares/veterinária , Exoftalmia/veterinária , Hiperemia/veterinária , Metástase Neoplásica , ética , Doenças do Aparelho Lacrimal/veterináriaRESUMO
The effects of sildenafil on retrobulbar and retinal circulation were studied in 18 adult male, albino, homozygous rabbits, of the New Zealand White breed, randomly divided into 3 groups of 6 animals, for drug treatment at a dose of 3.5mg kg-1 every 24 hours, for 7, 15 and 30 days. Nine animals used for control were treated with saline solution at 0.9%. It was evaluated intraocular pressure (IOP), mean arterial pressure (MAP), ocular perfusion pressure (PPO), B-mode ultrasonography and fluorescein angiography before and at the end of treatments. A slight decrease in results of IOP, MAP and PPO after treatment with sildenafil was evident, however, there was no statistical significance. It was observed significant increased diameter of the ophthalmic artery after 7 and 30 days of treatment and decreased mean arterial pressure after 7, 15 and 30 days of treatment, with no statistical difference. On fluorescein angiography, it was observed that the arterial, arteriovenous and venous stages initiated more rapidly in animals after treatment, with significant difference on the arteriovenous stage at the 7th and 15th days. It was possible to admit that the sildenafil citrate improves blood circulation in the retina of rabbits, by increasing the speed of blood flow and decreasing the perfusion pressure.(AU)
Os efeitos do sildenafil sobre a circulação retrobulbar e a retiniana foram estudados em 18 coelhos machos adultos, albinos, homozigotos, da raça Nova Zelândia Branco, distribuídos aleatoriamente em 3 grupos de 6 animais, para tratamento com o fármaco na dose de 3,5mg kg-1 a cada 24 horas, por 7, 15 e 30 dias. Nove animais foram utilizados para controle, tratados com solução fisiológica a 0.9%. Foram avaliadas a pressão intraocular (PIO), a pressão arterial média (PAM) e a pressão de perfusão ocular (PPO), ultrassonografia em modo-B e a angiografia fluoresceínica, antes e ao término dos tratamentos. Evidenciou-se discreta diminuição nos resultados da PIO, da PAM e da PPO após tratamento com sildenafil, entretanto não houve significância estatística. Observou-se aumento significativo do diâmetro da artéria oftálmica após 7 e 30 dias de tratamento e diminuição da pressão arterial média após 7, 15 e 30 dias de tratamento, sem diferença estatística. À angiografia fluoresceínica, observou-se que as fases arterial, artério-venosa e venosa iniciaram-se mais rapidamente nos animais após o tratamento, com diferença significativa na fase artério-venosa ao 7o e 15o dias. Foi possível admitir que o citrato de sildenafil melhora a circulação de sangue na retina de coelhos, através do aumento da velocidade do fluxo de sangue e diminuição da pressão de perfusão.(AU)
Assuntos
Animais , Masculino , Coelhos , Citrato de Sildenafila/administração & dosagem , Citrato de Sildenafila/uso terapêutico , Retina/efeitos dos fármacos , Circulação Sanguínea/efeitos dos fármacosRESUMO
The effects of sildenafil on retrobulbar and retinal circulation were studied in 18 adult male, albino, homozygous rabbits, of the New Zealand White breed, randomly divided into 3 groups of 6 animals, for drug treatment at a dose of 3.5mg kg-1 every 24 hours, for 7, 15 and 30 days. Nine animals used for control were treated with saline solution at 0.9%. It was evaluated intraocular pressure (IOP), mean arterial pressure (MAP), ocular perfusion pressure (PPO), B-mode ultrasonography and fluorescein angiography before and at the end of treatments. A slight decrease in results of IOP, MAP and PPO after treatment with sildenafil was evident, however, there was no statistical significance. It was observed significant increased diameter of the ophthalmic artery after 7 and 30 days of treatment and decreased mean arterial pressure after 7, 15 and 30 days of treatment, with no statistical difference. On fluorescein angiography, it was observed that the arterial, arteriovenous and venous stages initiated more rapidly in animals after treatment, with significant difference on the arteriovenous stage at the 7th and 15th days. It was possible to admit that the sildenafil citrate improves blood circulation in the retina of rabbits, by increasing the speed of blood flow and decreasing the perfusion pressure.
Os efeitos do sildenafil sobre a circulação retrobulbar e a retiniana foram estudados em 18 coelhos machos adultos, albinos, homozigotos, da raça Nova Zelândia Branco, distribuídos aleatoriamente em 3 grupos de 6 animais, para tratamento com o fármaco na dose de 3,5mg kg-1 a cada 24 horas, por 7, 15 e 30 dias. Nove animais foram utilizados para controle, tratados com solução fisiológica a 0.9%. Foram avaliadas a pressão intraocular (PIO), a pressão arterial média (PAM) e a pressão de perfusão ocular (PPO), ultrassonografia em modo-B e a angiografia fluoresceínica, antes e ao término dos tratamentos. Evidenciou-se discreta diminuição nos resultados da PIO, da PAM e da PPO após tratamento com sildenafil, entretanto não houve significância estatística. Observou-se aumento significativo do diâmetro da artéria oftálmica após 7 e 30 dias de tratamento e diminuição da pressão arterial média após 7, 15 e 30 dias de tratamento, sem diferença estatística. À angiografia fluoresceínica, observou-se que as fases arterial, artério-venosa e venosa iniciaram-se mais rapidamente nos animais após o tratamento, com diferença significativa na fase artério-venosa ao 7o e 15o dias. Foi possível admitir que o citrato de sildenafil melhora a circulação de sangue na retina de coelhos, através do aumento da velocidade do fluxo de sangue e diminuição da pressão de perfusão.
RESUMO
Objetivo: describir y caracterizar los pacientes con neuritis óptica que asisten al servicio de oftalmología del Hospital de San José. Diseño: estudio observacional retrospectivo. Métodos: se revisaron historias clínicas de pacientes que asistieron a la consulta de oftalmología desde septiembre de 2007 hasta agosto de 2012 y se tomaron todos los pacientes con diagnóstico de neuritis óptica. Se revisaron en total 174 historias clínicas, de las cuales 78 cumplieron los criterios de inclusión y 96 fueron excluidas. Resultados: La mayoría de los pacientes con neuritis óptica en este estudio, tuvieron esclerosis múltiple (34%). Al inicio del episodio agudo, la mayoría de los pacientes tenían AV entre MM y CD, con recuperación visual significativa a 20/70 o mejor (55%). Los pacientes presentaron comúnmente defecto pupilar aferente relativo, saturación al rojo disminuida y alteraciones del campo visual. El tipo de neuritis más frecuente fue la neuritis óptica retrobulbar. Conclusiones: la neuritis óptica es una patología que presenta características clínicas variables y su etiología puede corresponder a gran variedad de patologías según su clasificación. De la realización de una buena historia clínica y un adecuado examen oftalmológico, la evaluación interdisciplinaria, se puede hacer un diagnóstico adecuado y rápido para el manejo y estudio de ésta patología; disminuyendo así las complicaciones que puedan afectar definitiva e irreversiblemente la calidad de vida de los pacientes que la presentan.
Objective: to describe and characterize patients with optic neuritis attending the ophthalmology department of the Hospital de San José. Design: retrospective observational study. Methods: review of medical records of patients attending the ophthalmology department from September 2007 until August 2012. All patients diagnosed with optic neuritis were reviewed. A total of 174 records; 78 of them met the inclusion criteria and 96 were excluded. Results: 34% of patients with optic neuritis in this study had multiple sclerosis. At the beginning of the episode, most patients had visual acuity between HM and CF, with significant visual recovery to 20/70 or better (55%). Patients frequently presented relative afferent pupillary defect, decreased in red saturation and visual field defects. The most common type of neuritis found was retrobulbar optic neuritis.
Assuntos
Neurite Óptica/epidemiologia , Doenças do Nervo Óptico/terapia , Oftalmopatias/epidemiologiaRESUMO
A 12-year-old male English Pointer was examined due to a soft-tissue swelling at the medial canthus of the right orbital region, which was causing facial deformity. The dog had epiphora, purulent nasal discharge, epistaxis, dyspnea, and progressive weight loss. An intraoral mass was observed near the right maxillary premolars. Neoplastic disease was diagnosed based on ancillary tests, which included blood work, skull and intraoral radiographs, ocular ultrasonography and computed tomography. Histopathology revealed transitional carcinoma involving the nasal and oral cavities, maxilla, bony orbit and retrobulbar space. Nasal tumors represent approximately 2% of all tumors diagnosed in this species. Transitional carcinoma is the second most common type of malignant epithelial tumor in the nasal sinuses. This case illustrates the extensive destruction of the soft and bony tissues of the face, including the bony orbit that this type of tumor can cause.(AU)
Um cão da raça Pointer Inglês, de 12 anos de idade, foi encaminhado para avaliação clínica por apresentar aumento de volume no canto temporal (medial) da órbita direita, o qual estava causando deformidade facial. O cão apresentava epífora, secreção nasal mucopurulenta, epistaxe, dispnésia e perda de peso progressiva. Uma massa foi observada na cavidade oral, próxima aos dentes pré-molares, do lado direito da face. Suspeitou-se de proliferação neoplásica baseando-se nos testes auxiliares, entre os quais: radiografia craniana e oral, ultrassonografia ocular e tomografia computadorizada. A análise histopatológica da massa revelou tratar-se de carcinoma transicional envolvendo as cavidades oral e nasal, os ossos da maxila e da órbita, além do espaço retrobulbar. Os tumores da cavidade nasal representam aproximadamente 2% de todos os tumores diagnosticados nessa espécie. O carcinoma transicional é o segundo tipo de neoplasia epitelial maligna mais comum nos seios nasais de cães. Este trabalho descreve a destruição extensiva dos tecidos moles e dos ossos da face e chama atenção para o fato de que esse tipo de neoplasia deve ser considerado nas doenças da órbita.(AU)
Assuntos
Animais , Carcinoma/patologia , Neoplasias , Doenças Respiratórias/patologia , Osso e Ossos/anatomia & histologia , Cães , TomografiaRESUMO
A 12-year-old male English Pointer was examined due to a soft-tissue swelling at the medial canthus of the right orbital region, which was causing facial deformity. The dog had epiphora, purulent nasal discharge, epistaxis, dyspnea, and progressive weight loss. An intraoral mass was observed near the right maxillary premolars. Neoplastic disease was diagnosed based on ancillary tests, which included blood work, skull and intraoral radiographs, ocular ultrasonography and computed tomography. Histopathology revealed transitional carcinoma involving the nasal and oral cavities, maxilla, bony orbit and retrobulbar space. Nasal tumors represent approximately 2% of all tumors diagnosed in this species. Transitional carcinoma is the second most common type of malignant epithelial tumor in the nasal sinuses. This case illustrates the extensive destruction of the soft and bony tissues of the face, including the bony orbit that this type of tumor can cause.
Um cão da raça Pointer Inglês, de 12 anos de idade, foi encaminhado para avaliação clínica por apresentar aumento de volume no canto temporal (medial) da órbita direita, o qual estava causando deformidade facial. O cão apresentava epífora, secreção nasal mucopurulenta, epistaxe, dispnésia e perda de peso progressiva. Uma massa foi observada na cavidade oral, próxima aos dentes pré-molares, do lado direito da face. Suspeitou-se de proliferação neoplásica baseando-se nos testes auxiliares, entre os quais: radiografia craniana e oral, ultrassonografia ocular e tomografia computadorizada. A análise histopatológica da massa revelou tratar-se de carcinoma transicional envolvendo as cavidades oral e nasal, os ossos da maxila e da órbita, além do espaço retrobulbar. Os tumores da cavidade nasal representam aproximadamente 2% de todos os tumores diagnosticados nessa espécie. O carcinoma transicional é o segundo tipo de neoplasia epitelial maligna mais comum nos seios nasais de cães. Este trabalho descreve a destruição extensiva dos tecidos moles e dos ossos da face e chama atenção para o fato de que esse tipo de neoplasia deve ser considerado nas doenças da órbita.
Assuntos
Animais , Carcinoma/patologia , Doenças Respiratórias/patologia , Neoplasias , Osso e Ossos/anatomia & histologia , Cães , TomografiaRESUMO
Introducción: La anestesia retrobulbar proporciona excelentes condiciones para la cirugía de cataratas, sin embargo conlleva riesgo de grave daño sobre estructuras nobles. La siguiente serie de casos tiene por objetivo describir el uso de ultrasonografía como guía imagenológica en el bloqueo retrobulbar, para facoeresis e implante de lente intraocular. Método: Se llevó a cabo una serie de 4 casos, en que se utilizó ultrasonido con un transductor lineal de alta frecuencia, para mapeo e inserción de aguja de bloqueo retrobulbar bajo visión ecográfica en tiempo real. Resultados: Se obtuvo visión de la aguja y posicionamiento de ella en el cono muscular retrobulbar e infi ltración con anestésico local en los cuatro pacientes, logrando anestesia total en todos los casos, aquinesia total en tres y parcial en uno. No hubocomplicaciones atribuibles al procedimiento. Conclusión: Creemos que la ultrasonografía no es sólo factible, sino que podría ser un verdadero aporte en la seguridad de la anestesia ocular.
Background: Retrobulbar anesthesia provides excellent surgical conditions for cataract surgery. However, it conveys the risk of serious damage to fragile structures. The aim of this study is to describe the use of ultrasonography as a guide for retrobulbar blockade in surgical cataract patients. Methods: A series offour cases was selected and a high frequency linear ultrasound transducer was used for initial scanning andperforming of a real-time ultrasound-guided retrobulbar blockade. Results: Ultrasound images were used for needle positioning in the muscular cone of the eye and local anesthetic infiltration was performed in four patients. Complete anesthesia was achieved in all cases and complete akinesia was obtained in three, with partial akinesia in the remaining case. There were no complications in this series. Conclusion: We believe that ultrasound guided retrobulbar blockade is a feasible technique and it could be a real improvement on the safety of ophthalmic anesthesia.