ALLAN CHRISTIAN PIERONI GONCALVES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
2 resultados
Resultados de Busca
Agora exibindo 1 - 2 de 2
- Y Ocular motility changes after inferomedial wall and balanced medial plus lateral wall orbital decompression in Graves' orbitopathy: a randomized prospective comparative study(2021) LEITE, Cristiane de Almeida; PEREIRA, Thais de Sousa; CHIANG, Jeane; MORITZ, Rodrigo Bernal; GONCALVES, Allan Christian Pieroni; MONTEIRO, Mario Luiz RibeiroOBJECTIVES: To compare the surgical outcomes of inferomedial wall orbital decompression (IM-OD) and balanced medial plus lateral wall orbital decompression (ML-OD) in patients with inactive Graves' orbitopathy (GO) with regard to exophthalmos reduction and ocular motility abnormalities. METHODS: Forty-two patients with inactive GO eligible for OD were randomly assigned to either the IM-OD or ML-OD groups. Pre and postoperative evaluations included Hertel exophthalmometry, sensory, and motor extraocular motility assessment, standardized photographs in the nine gaze positions, and computed tomography (CT) of the orbits. ClinicalTrials.gov: NCT03278964. RESULTS: Exophthalmometry reduction was statistically significant in both groups (p<0.001), but was greater in the ML-OD group (p=0.010). New-onset esotropia occurred in 11.1% and 23.5% of patients who underwent IM-OD and ML-OD, respectively, with no statistically significant difference in the frequency of pre and postoperative strabismus in either group. The mean increase in preoperative esotropia was 24 +/- 6.9 and 12 +/- 8.8 prism diopters in patients who underwent IM-OD and ML-OD, respectively. In the IM-OD group, abduction and elevation worsened at the first (p<0.05) and third (p<0.05) postoperative visits but were restored at 6 months. The versions did not change postoperatively with ML-OD. The preoperative CT-measured medial rectus muscle area predicted new-onset strabismus (p=0.023). Significant postoperative medial rectus muscle enlargement occurred in both groups (p<0.001). Restriction in elevation and abduction was significantly associated with enlarged inferior (p=0.007) and medial rectus muscle areas (p=0.002). CONCLUSIONS: IM-OD is as safe as ML-OD with regard to new-onset strabismus, and represents a good alternative for patients who do not require significant exophthalmos reduction. ML-OD offers greater exophthalmos reduction and smoother postoperative recovery. Patients with preoperative enlarged medial rectus muscle on CT are at risk for new-onset esotropia, and preoperative esotropia is likely to increase after OD.
- Chronic unilateral tearing as a sign of lacrimal sac squamous cell carcinoma(2021) MATOS, Aline Mota Freitas; BREGA, Danielle Ribeiro; CUNHA, Leonardo Provetti; GOLLNER, Angela Maria; GONCALVES, Allan Christian PieroniTearing is a very common symptom in ophthalmic practice; however, this issue is commonly overlooked. The authors describe the case of a patient with chronic unilateral epiphora that had been neglected for 8 y; lacrimal system workup was performed for this patient only because of dacryocystitis evolvement. Following the diagnosis of nasolacrimal duct blockage, dacryocystorhinostomy was indicated. Intraoperative abnormal mucosa was subjected to biopsy, and a diagnosis of squamous cell carcinoma in the lacrimal sac was established. Extended tumor excision was performed for the patient and adjuvant radiotherapy was administered, without any recurrence till the 2-year follow-up. The present report highlights the relevance of a detailed evaluation for determining the underlying causes of tearing, especially in chronic unilateral presentation. The consideration of potential malignancy in such cases could prevent delayed diagnosis of uncommon but potentially life-threatening malignancies of the lacrimal drainage system.