Browsing by Author "Melo, A"
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- Anestesia em oftalmologiaPublication . Ramalho, M; Laranjo, J; Vaz, F; Pina, S; Santos, C; Pedrosa, C; Coutinho, I; Mota, M; Melo, ADescrevem-se as várias técnicas anestésicas usadas em oftalmologia. História, indicações e diferentes tipos de anestesia.
- Dacryocystorhinostomy: drill techniquePublication . Ramalho, M; Coutinho, I; Pedrosa, C; Pina, S; Vaz, F; Ferreira, M; Melo, AIntroduction: Dacryocystorhinostomy or DCR is a bypass procedure with an anastomosis between the lacrimal sac and the nasal mucosa via a bony ostium. It may be performed through an external skin incision or intranasally with or without endoscopic visualization. The success rates for endoscopic and external dacryocystorhinostomy vary widely (external 70-95%; endonasal 59-99%). Video: In the “classic” Dupuy-Dutemps-Brouget technique a scalpel blade is used to perform the skin incision and a Citelli’s punch is used to perform an osteotomy. In our procedure we use an electric scalpel to perform the skin incision which is an arciform incision at the orbital rim and a high speed rotary drill to perform the osteotomy. This technique is the procedure of choice in our Hospital. In 54 consecutive procedures with at least 1 year of follow-up there were only 2 recurrences, with an overall success rate of 96.3%. Conclusion: DCR is today a surgery which is carried out with excellent results by the ophthalmologist as well as by the otorhinolaryngologist. Our procedure has some differences from the common approach which may help to raise the success rate.
- Doença de Lyme – queratite resistente na infânciaPublication . Alves, S; Pina, S; Azevedo, R; Chang, N; Bernardo, M; Melo, AIntrodução: A Doença de Lyme (D. Lyme) resulta da infecção pela espiroqueta Borrelia Burgdorferi, cujo vector é o artópode Ixodes que pode parasitar o ser humano. Esta doença multissistémica evolui em 3 estadios sendo que diferentes manifestações oculares podem ser encontradas em cada um deles. Material e Métodos: Descrição de um caso clínico. Criança do sexo feminino, 9 anos, com queixas de diminuição da acuidade visual (A.V. 6/10) e fotofobia com 2 meses de evolução. Ao exame oftalmológico apresentava queratite filamentosa bilateral, sem outros achados. Concomitantemente referia queixas álgicas nos joelhos e anca esquerda com 6 meses de evolução. Analiticamente apresentava Ac Anti Borrelia Burgdorferi (Ig G / M – ELISA) positivo, TPHA negativo e posteriormente PCR para DNA de Borrelia negativo. Resultados: Perante o diagnóstico de D. Lyme sistémica crónica e devido à má adesão terapêutica decidiu-se internar a criança para realizar antibioterapia sistémica (ceftriaxone e.v.) e terapêutica tópica ocular. Após uma semana, observou-se melhoria significativa das queixas oftálmicas e articulares. Completou 4 semanas de tratamento observando-se remissão do quadro clínico. Discussão: Apesar do quadro atípico de queratite isolada, esta é a manisfestação ocular mais frequente no estadio 3. A não existência de uveíte é um factor de bom prognóstico. A opção terapêutica de monoterapia com ceftriaxone é reservada para casos graves da doença, justificando- -se neste caso pela cronicidade do caso e má adesão terapêutica. A utilização de corticoterapia sistémica é controversa pelo que não foi preconizada.
- Macular OCT findings in ROP patients treated with both laser and bevacizumabPublication . Santos, C; Azevedo, R; Pina, S; Teixeira, S; Melo, AObjective: To describe macular optical coherence tomography (OCT) findings in children with history of retinopathy of prematurity (ROP) treated with both laser and bevacizumab. Methods: Clinical records and OCT (Stratus OCTTM Carl Zeiss Meditec) findings of the first 3 patients treated with both laser and bevacizumab at our hospital were reviewed. Control group were patients who only had laser treatment. One eye from each patient was randomly chosen. The main outcome measure was foveal and parafoveal retinal thickness. Results: 7 eyes of 7 patients with type 1 (stage 3+) disease were studied. All eyes were submited to laser ablation of peripheral retina. The bevacizumab group (3 patients) recieved secondary intravitreal injection (0.03mL 25mg/mL). On the bevacizumab group, at three years of age, mean parafoveal retinal thickness was 219μm, mean foveal thickness was 208μm, with mean foveal depression of 11μm. On the control group (4 patients), aged between five and six years of age, mean parafoveal retinal thickness was 256μm, mean foveal thickness was 243μm, with mean foveal depression of 13μm. The Wilcoxon rank-sum test showed no statistical difference between both groups. Conclusions: recent studies in the literature have shown a reduced foveal depression in premature infants with or whithout ROP comparing with normal full-term children. We report the same findings in this series of children treated with both laser and bevacizumab.
- Manifestações oftalmológicas de doenças sistémicasPublication . Pina, S; Coutinho, I; Amaral, N; Bernardo, M; Melo, A; Paula, F; Batista, F; Amaral, M; Alves, JD
- Neuropatía óptica isquémica secundaria al uso de interferonPublication . Ramalho, M; Vaz, F; Santos, C; Gonçalves, A; Feijóo, B; Ferreira, M; Melo, AIntroducción:La neuropatía óptica isquémica anterior (NOIA) es una disfunción visual provocada por la reducción temporal o permanente de perfusión sanguínea del segmento anterior del nervio óptico. Se manifiesta como una pérdida indolor de la visión evolucionando en horas o días, con característicos cambios altitudinales del campo visual. Oftalmoscopicamente se caracteriza por edema del disco óptico por veces con hemorragias en llama peripapilar y estrechamiento peripapilar de las arteriolas. Caso Clínico: Varón de 48 años, seguido en consulta de gastroenterología para la hepatitis C crónica, con início de terapia de combinación con interferón-peg α2b y ribavirina hace 24 semanas. Referenciado por su Gastroenterólogo por aparición de "escotoma" en el ojo derecho con 3 días de evolución. Apresentava una agudeza visual (AV) de 9/10 en el ojo drecho e 10/10 en el ojo izquierdo, en el fondo de ojo derecho se observava edema del disco óptico con hemorragia peripapilar. En la perimetría .de Goldmann se denota la presencia de un defecto altidunal del campo visual. Se optó por suspender la terapia, manteniendo vigilancia. En la reevaluación a los 3 meses, ocurrió una desaparición del defecto altitudinal, AV ODE 10/10, y mejora de los resultados del fondo de ojo con desaparición de la hemorragia en la OE. Conclusiones: Aunque poco frecuente, se describen en la literatura casos de NOIA con el uso terapéutico de interferón-peg α2b. Los efectos secundarios oftálmicos, aunque raros, requieren que todos los pacientes tratados con IFN sean observados cuando hay quejas oculares.
- Neuropatia óptica isquemica secundária ao uso de interferãoPublication . Gonçalves, A; Feijóo, B; Ferreira, M; Vaz, F; Melo, AA neuropatia óptica isquémica anterior é uma disfunção visual aguda que pode ser idiopática ou secundária. Os autores descrevem um caso de neuropatia óptica isquémica anterior não arterítica de provável causa iatrogénica devido ao uso de interferão. Descreve-se o modo de acção dos interferões, os seus efeitos secundários oftalmológicas mais frequentes e, através de revisão de literatura analisa-se a eventual necessidade de seguimento destes doentes.
- Orbital lymphangioma: a surgical challengePublication . Ramalho, M; Santos, C; Pina, S; Coutinho, I; Vaz, F; Ferreira, M; Melo, ALymphangioma is an uncommon venolymphatic lesion with dead-end lymphatic channels, also defined as vascular hamartoma of lymphatic origin. Orbital lymphangiomas present management challenges to the ophthalmologist due to the tendency to recur locally unless it is completely excised, this is often difficult, because lymphangiomas tend to be infiltrative. The recurrence of hemorrhage and expansion can lead to vision loss and disfigurement. Case report: A 22-year-old woman who had a right orbital lesion excised when she was 18 months, with the confirmation of the clinical suspicion of lymphangioma, had also undergone surgery for another 3 times with a different surgeon. The patient presented with conjunctival chemosis, proptosis, exotropia, and no vision in the right eye, this symptoms had been present for several years. On ophthalmic examination, visual acuity was light perception in the right eye and 10/10 in the left eye. The biomicroscopy of the right eye revealed a punctate keratitis and an exuberant chemosis. The patient had proptosis and a limitation on the adduction of the right eye. Extensive orbital excision of the lymphangioma was performed with symptomatic improvement. After 13 years of follow-up the symptoms recurred progressively associated with recurrent corneal ulcers and pain, an evisceration was performed. The patient presented with adherences and fibrosis in the anophtalmic socket with the need for 2 surgerys for the excision of adherences and 1 surgery for correction of ectropion. Functional as well as aesthetic outcome was obtained. Conclusion: Orbital lymphangiomas represent unique treatment challenges. These infiltrative lesions are prone to recurrence with bleeding, disfigurement, vision loss, and diplopia and can result in disfigurement. Complete surgical excision, as in this case, is typically unattainable without
- Postenucleation socket syndrome: surgical repairPublication . Ramalho, M; Pina, S; Pedrosa, C; Santos, C; Vaz, F; Ferreira, M; Melo, AIntroduction: A contracted eye socket is a functional and cosmetic misfortune to the patient. It makes impossible to the patient to wear an eye prosthesis, but also becomes a source of chronic infection, discharge and irritation. There are several surgical techniques to deal with the postenucleation socket syndrome. Methods: Six consecutive patients with postenucleation socket syndrome underwent reconstruction of the anophthalmic socket. The cause for enucleation in 5 cases was related to trauma and a retinoblastoma in 1 case, all the cases presented to us several years after the enucleation and all the patients had difficulty or impossibility to wear the prosthesis. Results: All patients underwent surgery, which entailed scar tissue release, oral mucous membrane grafting and socket reconstruction. All patients who had surgery experienced significant improvement of socket contracture that enabled patients to wear a prosthesis again, improving significantly the quality of life. Conclusions: Surgical repair of the contracted socket using oral mucous membrane grafting can allow resumption of prosthesis wear. We describe 6 patients in which functional as well as aesthetic outcome was obtained.
- Projecto saúde para todos: programa integrado: projecto de cuidados especializados: oftalmologiaPublication . Ramalho, M; Teixeira, S; Pereira, L; Raposo, A; Silva, I; Picoto, M; Melo, AO Instituto Marquês de Valle Flor é uma Organização Não Governamental (ONG) fundada em 1951, que atua em São Tomé e Príncipe desde 1988. Está presente em todos os países da Comunidade dos Países de Língua Portuguesa e gere mais de quarenta projetos de cooperação na área da saúde, segurança alimentar, infraestruturas e educação.