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Efeitos adversos associados à aplica??o de toxina botulínica na face: revis?o sistemática com meta-análise
Zagui, Roberta Melissa Benetti;Matayoshi, Suzana;Moura, Frederico Castelo;
Arquivos Brasileiros de Oftalmologia , 2008, DOI: 10.1590/S0004-27492008000600027
Abstract: purpose: to estimate the occurrence of adverse effects associated with the use of botulinum toxin by performing a systematic review and meta-analysis. methods: a systematic literature search of medline and cochrane library was conducted until september 2007. the occurrence of the adverse effects was estimated of the relative frequency for case report and of the relative risk for randomized trials. heterogeneity was evaluated with the q test and i2 index. egger's significance test was used to identify the publication bias. sensitivity analysis was performed to evaluate the effect of the publication biases. results: eight randomized trials and thirteen case reports filled the inclusion criteria. in the systematic review of case reports, 1,003 subjects were studied and 182 (18.14%) showed adverse effects. eyelid ptosis was the most frequent adverse effect, presenting in 34 (3.39%) patients of the case reports. in the meta-analysis of randomized trials, the overall relative risk for adverse effects as headache, eyelid ptosis, local reaction and infection was respectively: 1.07, 3.25, 0.99 and 0.94. for all comparisons, p values were greater than 0.05. conclusion: ptosis was the most frequent adverse effect and showed the higher relative risk associated with botulinum toxin. it is necessary to perform a pattern of adverse effects related for better understanding the relationship between adverse effects and use of botulinum toxin.
Meningioma do nervo óptico simulando progress?o de dano axonal glaucomatoso: relato de caso
Hokazono, Kenzo;Moura, Frederico Castelo;Monteiro, Mário Luiz Ribeiro;
Arquivos Brasileiros de Oftalmologia , 2008, DOI: 10.1590/S0004-27492008000500023
Abstract: to report a case of an optic nerve sheath meningioma located at the optic canal area mimicking the progression of a glaucomatous axonal damage. a 60-year-old female patient developed progressive visual field loss and enlargement of the optic disc cup in the left eye while in treatment for primary open-angle glaucoma. because of the rapid progression of axonal loss, the asymmetry of the visual field defect and the fact that intraocular pressure had been under control, a compressive optic neuropathy was suspected. a computerized tomography scan of the orbit was normal but a high-resolution magnetic resonance imaging demonstrated an optic nerve sheath meningioma located at the optic canal area. compressive lesions of the anterior visual pathways are uncommon causes of optic disc cupping but should be considered in patients suspected of or undergoing treatment for glaucoma that present with atypical progression of visual loss.
Aspectos oftalmológicos da síndrome da hipertens?o intracraniana idiopática (pseudotumor cerebral)
Monteiro, Mário Luiz Ribeiro;Moura, Frederico Castelo;
Revista Brasileira de Oftalmologia , 2008, DOI: 10.1590/S0034-72802008000400008
Abstract: pseudotumor cerebri is a syndrome of increased intra-cranial pressure without a space-occupying lesion or ventriculomegaly in a patient with normal level of conscience and normal cerebrospinal fluid constitution. the terminology for the disorder has changed over the years in accordance with advances in diagnostic technology and insights into the disease process. when no secondary cause is identified, the syndrome is termed idiopathic intracranial hypertension. patients are not uncommonly seen by ophthamologists since they present with papiledema, double vision and visual loss, a frequently severe and irreversible complication. in this paper we review the diagnostic criteria and the ophthalmic manifestations of this condition. we also emphasize the importance of the ophthalmlogist in the diagnosis and monitoring of visual function during the medical treatment of this condition as well as in the in the event of surgical treatment performed using optic nerve sheath decompression.
Síndrome ocular isquêmica simulando retinopatia diabética unilateral: relato de caso e revis o da literatura Ischemic ocular syndrome simulating unilateral diabetic retinopathy: case report and literature review
Frederico Castelo Moura,Vitor Kazuo Lotto Takahashi,Eduardo Minelli
Revista Brasileira de Oftalmologia , 2012, DOI: 10.1590/s0034-72802012000400009
Abstract: A síndrome ocular isquêmica (SOI) ocorre devido à hipoperfus o ocular cr nica secundária à obstru o da artéria carótida. O quadro clínico inclui, entre outros, retinopatia proliferativa similar a retinopatia diabética. A SOI deve ser considerada principalmente nas retinopatias proliferativas unilaterais ou muito assimétricas e nos casos refratários ao tratamento por fotocoagula o. A indica o da endarterectomia nos pacientes com SOI isolada n o é bem definida. Este trabalho relata uma paciente com SOI simulando retinopatia diabética proliferativa unilateral e tratada por endarterectomia. Ischemic ocular syndrome (IOS) is caused by stenosis of carotid artery. Proliferative retinopathy is one of the signs and can lead to misdiagnosis with diabetic retinopathy. IOS must be considered in case of proliferative retinopathy asymmetric and refractory to laser treatment. Carotid endarterectomy in patients with IOS with no neurologic manifestations remains controversy. This paper reported a patient with IOS simulating diabetic retinopathy and treated with endarterectomy.
Hemianopsia por les?o no corpo geniculado lateral. Importancia diagnóstica da análise da camada de fibras nervosas pela tomografia por coerência óptica: relato de caso
Moura, Frederico Castelo;Lunardelli, Patrícia;Leite, Cláudia Costa;Monteiro, Mário Luiz Ribeiro;
Arquivos Brasileiros de Oftalmologia , 2005, DOI: 10.1590/S0004-27492005000600029
Abstract: lesions of the lateral geniculate body (lgb) are the most unusual lesions of the visual pathways. imaging studies are very important in establishing the correct diagnosis. however, due to its small size and particular location, the lateral geniculate body and its lesions are sometimes difficult to detect in imaging studies possibly causing diagnostic confusion. the purpose of this paper is to document an unusual case of a lesion of the lateral geniculate body for which an optical coherence tomography study was very important in confirming the anatomic diagnosis of a lateral geniculate body lesion. a 39-year-old woman with a previous diagnosis of uveitis and central nervous system vasculitis was referred for investigation of a right temporal quadrantanopia. she had already been submitted to a magnetic resonance imaging (mri) that did not show any lesion along the visual pathway. ophthalmoscopy revealed retinal nerve fiber layer (rnfl) loss that was confirmed by optical coherence tomography. such finding associated with the observations on the neurological examination strongly suggested a lateral geniculate body lesion. the patient was submitted to another new magnetic resonance imaging obtained with especially oriented thin sections and an ischemic lesion of the lateral geniculate body was observed establishing the correct diagnosis. this case serves to confirm the importance of optical coherence tomography in determining the pattern of retinal nerve fiber layer loss in neuro-ophthalmic diseases and therefore to help in locating a lesion along the visual pathway.
Linfoma n?o-Hodgkin bilateral do seio cavernoso como manifesta??o inicial da síndrome de imunodeficiência adquirida: relato de caso
Barreira Junior, Alan Kardec;Moura, Frederico Castelo;Monteiro, Mario Luiz Ribeiro;
Arquivos Brasileiros de Oftalmologia , 2011, DOI: 10.1590/S0004-27492011000200013
Abstract: case report of bilateral cavernous sinus syndrome due to primary non-hodgkin lymphoma of the central nervous system in a patient infected by the human immunodeficiency virus. a 51-year-old male patient infected by the human immunodeficiency virus but without antiretroviral treatment developed paralysis of the v and vi cranial nerves. imaging studies were obtained to investigate an orbital apex and a cavernous sinus syndrome. a computerized tomography scan of the orbit was normal but a high-resolution magnetic resonance imaging demonstrated bilateral enlargement of the cavernous sinus. although primary lymphoma of the central nervous system is a rare condition, it should be considered in the differential diagnosis in immunocompromised patients who develop ocular motility abnormalities and imaging signs suggestive of infiltrative cavernous sinus lesions.
Frequency doubling perimetry in patients with mild and moderate pituitary tumor-associated visual field defects detected by conventional perimetry
Monteiro, Mário Luiz Ribeiro;Moura, Frederico Castelo;Cunha, Leonardo Provetti;
Arquivos Brasileiros de Oftalmologia , 2007, DOI: 10.1590/S0004-27492007000200024
Abstract: purpose: to test the ability of frequency doubling technology (fdt) perimetry to identify pituitary tumor-associated visual field defects. methods: twenty-three eyes from patients with pituitary tumor (pt) and 28 normal eyes were studied. subjects were eligible when presenting with normal visual acuity and mild or moderate temporal field loss in at least one eye on goldmann and standard automated perimetry (sap). fdt testing was performed using the c-20-5 screening and the c-20 full-threshold test. the sensitivity and specificity for identification of the field defect were determined and the groups were compared with regard to several parameters. finally, we compared the ability of fdt and sap to detect the characteristic pattern of temporal hemianopia/quadrantanopia. results: in the screening test, sensitivity ranged from 21.74% to 43.48% while specificity was 100%. in the threshold test, sensitivity ranged from 52.17% to 82.61% (specificities of 85.71% and 60.71%, respectively), according to total deviation analysis, and from 30.43% to 73.91% (specificities of 96.42% and 64.28%, respectively), according to the pattern deviation analysis. patients with pt presented a significantly higher number of abnormal points in the temporal hemifield. in 12 eyes fdt and sap were both able to identify the characteristic pattern of visual field defect; in 4 eyes fdt performed better than sap; in 4 eyes, sap performed better than fdt, while in 3 neither test was able to determine the pattern of visual field defect correctly. conclusions: threshold fdt perimetry seems to be a sensitive instrument for identifying abnormality in eyes with chiasmal compression-induced field defects detected on conventional perimetry.
Retinal nerve fiber layer loss documented by Stratus OCT TM in patients with pituitary adenoma: case report
Leal, Bruno Campelo;Moura, Frederico Castelo;Monteiro, Mário Luiz Ribeiro;
Arquivos Brasileiros de Oftalmologia , 2006, DOI: 10.1590/S0004-27492006000200021
Abstract: purpose: to report abnormalities of retinal nerve fiber layer (rnfl) thickness using optical coherence tomography (stratus octtm) in patients with pituitary adenoma. methods: two patients with long-standing bitemporal visual field defects and optic nerve band atrophy were submitted to optical coherence tomography examination (stratus octtm). results: both patients with band atrophy revealed diffuse loss of the retinal nerve fiber layer on stratus octtm, with severe reduction in the nasal and temporal areas of the optic disc. retinal nerve fiber layer loss correlated well with visual field loss and with previous histological studies of band atrophy of the optic nerve. conclusions: stratus optical coherence tomography can provide useful information in the diagnosis of band atrophy from chiasmal lesions such as pituitary adenomas.
Compara??o entre o polarímetro de varredura a laser, a tomografia de coerência óptica 1 e o Stratus-oct na detec??o da perda axonal da atrofia em banda do nervo óptico
Leal, Bruno Campelo;Moura, Frederico Castelo;Monteiro, Mário Luiz Ribeiro;
Arquivos Brasileiros de Oftalmologia , 2006, DOI: 10.1590/S0004-27492006000400014
Abstract: purpose: to compare the abilitiy of scanning laser polarimetry (gdx), optical coherence tomography (oct) 1 and stratus- optical coherence tomography to discriminate between healthy eyes and eyes with band atrophy of the optic nerve and temporal hemianopsia. methods: twenty-three eyes with band atrophy of the optic nerve and 23 eyes from healthy subjects were included in this observational prospective case-control study. all eyes underwent retinal nerve fiber layer (rnfl) thickness analysis using gdx, optical coherence tomography-1 and stratus-optical coherence tomography. mean values obtained with each equipment were compared between band atrophy and normal eyes. receiver operating characteristic (roc) curves and sensitivities at fixed specificities (80% e 95%) were calculated for each parameter calculated with each equipment and compared. results: when compared with healthy subjects, the parameters corresponding to the global average as well as each of the four quadrant retinal nerve fiber layer thickness in eyes with band atrophy were significantly smaller (p<0.05), than in normal eyes, with the exception of gdx's temporal thickness parameter. comparison of the areas under roc curves (aucs) of the parameters from the three equipments revealed significantly greater values for the stratus-oct when compared to the oct-1 in the global average and in the temporal quadrant thickness measurement. stratus-oct was significantly more sensitive than gdx in the global average as well as in the temporal, nasal and inferior quadrant. oct-1 was superior to gdx only in the temporal quadrant. all three equipments revealed a similar ability to identify retinal nerve fiber layer reduction in the superior quadrant. conclusions: the stratus oct showed the best ability to discriminate between eyes with band atrophy of the optic nerve and healthy eyes although all three equipments were able do identify most of the abnormal eyes. oct-1 was inferior to stratus-oct and superior do gdx in t
Perda visual bilateral grave como sinal de apresenta??o de trombose de seio venoso cerebral: relato de caso
Cunha, Leonardo Provetti;Gon?alves, Allan Christian P.;Moura, Frederico Castelo;Monteiro, Mário Luiz Ribeiro;
Arquivos Brasileiros de Oftalmologia , 2005, DOI: 10.1590/S0004-27492005000400020
Abstract: our purpose is to report a case of cranial venous thrombosis causing pseudotumor syndrome, where the principal clinical manifestation was severe bilateral vision loss. a 24-year-old man presented with severe bilateral vision loss, transient obscuration of vision, headache, bilateral papilledema and constricted visual fields. computed tomography as well as neurologic examination was unrevealing. a lumbar puncture disclosed an increased cerebrospinal fluid opening pressure and complete blood count (cbc) showed increased numbers of platelets. a brain magnetic resonance imaging disclosed characteristic sings of chronic papilledema and suggestive signs of superior sagital sinus thrombosis. a cranial magnetic resonance venography disclosed thrombosis of superior sagital, transvers and sigmoid sinuses. the patient was treated with an optic nerve sheath decompression in the left eye, acetazolamide and anticoagulation. his ocular evaluation showed reduction of the papilledema, but severe vision loss remained. pseudotumor cerebri with severe vision loss can be the presenting sign of cranial venous thrombosis secondary to a potentially life-threatening hematologic disorder.
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