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
15 resultados
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article 5 Citação(ões) na Scopus Primary localized amyloidosis presenting as diffuse amorphous calcified mass in both orbits: case report(2011) GONCALVES, Allan Christian Pieroni; MORITZ, Rodrigo Bernal da Costa; MONTEIRO, Mario Luiz RibeiroPrimary localized amyloidosis is rare in the orbit. We report the case of a 63-year-old woman that presented with bilateral proptosis and ophthalmoplegia. A computed tomography scan revealed an infiltrative amorphous and markedly calcified mass in both orbits while a magnetic resonance scan showed a heterogeneous hypointense signal on T2-weighted images. A biopsy was performed through an anterior orbitotomy. Microscopy revealed extracellular amorphous and eosinophilic hyaline material which stained pink with Congo red and displayed green birefringence on polarized microscopy, leading to a diagnosis of amyloidosis. The results of the systemic workup were completely normal. A two-year follow-up period without any treatment disclosed no worsening of the condition. While calcification of nonvascular orbital lesions has often been regarded as suggestive of malignant disease, our case is a reminder that it can also be a characteristic presenting sign of orbital amyloidosis.- Evaluation of Ocular Versions in Graves' Orbitopathy: Correlation between the Qualitative Clinical Method and the Quantitative Photographic Method(2020) LEITE, Cristiane de Almeida; PEREIRA, Thais de Sousa; CHIANG, Jeane; GONCALVES, Allan C. Pieroni; MONTEIRO, Mario L. R.Purpose. To assess the agreement between the qualitative clinical method and the quantitative photographic method of evaluating normal and abnormal ocular versions in patients with inactive Graves' orbitopathy (GO).Methods. Forty-two patients with inactive GO had their ocular versions evaluated clinically according to three categories: normal, moderate alterations (-1 or -2 hypofunction), and severe alterations (-3 or -4 hypofunction). The subjects were photographed in the 9 positions of gaze, and the extent (mm) of eye movement in each position was estimated using Photoshop(R)and ImageJ and converted into degrees with a well-established method. The agreement between the two methods (qualitative vs. quantitative) for classifying ocular versions as normal or abnormal was assessed.Results. The mean quantitative measurements of versions were significantly different for each clinical category (normal, moderate alterations, and severe alterations) in the following five positions: abduction, adduction, elevation in abduction, elevation, and elevation in adduction (p<0.001). No such pattern was observed for the three infraversion positions (depression in abduction,p=0.573; depression,p=0.468; depression in adduction,p=0.268).Conclusion. The agreement was strong between the quantitative photographic method and the qualitative clinical method of classifying ocular versions, especially in lateral and supraversions, which are typically affected in GO. Digital photography is recommended for the assessment of ocular versions due to its practicality, suitability for telemedicine applications, and ease of monitoring during follow-up. This trial is registered with.
conferenceObject A comparative study of full-thickness blepharotomy vs. transconjunctival eyelid lengthening in the correction of upper eyelid retraction in Graves' Orbitopathy(2017) GONCALVES, Allan Christian Pieroni; NOGUEIRA, Thiago; MONTEIRO, Mario R.- A randomized comparative study of inferomedial vs. balanced orbital decompression. Analysis of changes in orbital volume, eyelid parameters, and eyeball position(2022) PEREIRA, Thais de Sousa; LEITE, Cristiane de Almeida; KUNIYOSHI, Cristina Hiromi; GEBRIM, Eloisa M. M. S.; MONTEIRO, Mario L. R.; GONCALVES, Allan C. PieroniBackground/objectives The objective of this study is to investigate and compare changes in orbital volume, eyelid parameters, and eyeball position after inferomedial and balanced (medial + deep lateral walls) orbital decompression (OD) in patients with Graves' orbitopathy (GO). Subjects/methods Prospective interventional trial. Forty-two patients with inactive GO and clinical indication for OD were randomly assigned to inferomedial or balanced OD. Preoperative and postoperative Hertel exophthalmometry, standardized photography, and computed tomography were used to evaluate upper and lower eyelid margin reflex distances (MRD1 and MRD2), orbital expansion, and changes in eyeball position. Results Clinical and radiological exophthalmometry improved significantly after OD with both surgical techniques (p < 0.001), but more so with balanced OD (p = 0.02). Concurrent eyeball descent (p = 0.01) and orbital volume expansion (p < 0.001) were observed with both techniques. The mean decompression volume was similar for the medial wall and the lateral wall but significantly smaller for the inferior wall (p < 0.05). Significant correlation coefficients were found for Hertel reduction vs. total decompression volume (p < 0.05). In the multivariate linear analysis, lateral wall decompression volume (LWDV) was predictive of exophthalmos reduction (p < 0.05). The two techniques produced a similar reduction in MRD1 and MRD2. A significant correlation was also found between Hertel reduction and lower lid elevation (p < 0.05). Conclusions Both inferomedial and balanced OD successfully expanded orbit capacity, but the latter was more efficient at reducing exophthalmos probably due to the inclusion of the lateral wall. Upper and lower eyelid retraction improved after OD, but only lower eyelid elevation was correlated with exophthalmos reduction.
- Bilateral periorbital necrotizing fasciitis: case report(2018) LEONARDO, Fabio Henrique Luiz; ANABUKI, Mariana; GONCALVES, Allan Christian PieroniNecrotizing fasciitis is a severe infection of the subcutaneous tissue characterized by necrosis of the superficial fascia and overlying skin and is usually associated with previous trauma and comorbidities. Periorbital necrotizing fasciitis is rare and commonly causes visual loss and soft tissue defects. A better prognosis relies critically on early diagnosis, prompt medical treatment, and timely surgical intervention. We describe a rare case of periorbital necrotizing fasciitis in the absence of an inciting event. A 55-year-old female patient presented with acute painful swelling and redness of the right upper eyelid that spread to both eyelids bilaterally within 24 h. We swiftly started the patient on intravenous antibiotic therapy, and we surgically debrided the necrotic tissue the following day. We performed two further procedures to improve eyelid closure and appearance. Despite the severe presentation, timely antibiotic therapy and proper surgical interventions led to a successful outcome in this case.
- Fifteen years of experience with frontalis suspension using polytetrafluoroethylene (Gore-Tex (R)) suture in blepharoptosis repair(2020) LEONARDO, Fabio Henrique Luiz; GONCALVES, Allan C. PieroniPurpose: To review the outcomes of frontalis suspension surgeries with the use of polytetrafluoroethylene in patients with blepharoptosis. Methods: A retrospective observational study analyzed the outcomes of frontalis suspension surgeries performed in a single institution from 2003 to 2018. All procedures were performed with closed incision and single pentagon techniques. Outcomes were classified as satisfactory or unsatisfactory, with satisfactory defined as a margin reflex distance of >3 mm and <1 mm between eyelids and unsatisfactory as hypocorrection, surgical complications, and asymmetry. Results: We included a total of 76 eyelids from 52 patients in our study. Within a mean postoperative follow-up of 16.8 +/- 18.5 months (range, 3-95), 59 (77.6%) eyelids had a satisfactory outcome, and 17 (22.4%) were unsatisfactory (8 cases of asymmetry, 3 granulomas, 3 suture extrusions, 2 abscesses, and 1 case of cellulitis). Nine eyelids from the unsatisfactory group required reoperation. Among the patients with a follow-up of >= 12 months (38 surgeries), lasting results were observed in most eyelids, except for 2 late-onset suture extrusions. Conclusion: The use of polytetrafluoroethylene in frontalis suspension surgery was shown to be predictable, safe, and lasting. Our findings support previous studies that have shown adequate functional results and low complication rates.
conferenceObject A RANDOMIZED COMPARATIVE STUDY OF SURGICAL CORRECTION OF GRAVES UPPER EYELID RETRACTION THROUGH CONJUNCTIVAL OR BLEPHAROTOMY APPROACH(2014) GONCALVES, Allan Christian Pieroni; NOGUEIRA, Thiago Machado; GONCALVES, Ana Carolina A.; SILVA, Luzia D.; MONTEIRO, Mario L. R.- Bilateral extraocular muscles enlargement from Kimura's disease of the orbit(2016) GONCALVES, Allan Christian Pieroni; MORITZ, Rodrigo B.; ALDRED, Vera L.; MONTEIRO, Mario Luiz RibeiroKimura's disease (KD) is a rare chronic inflammatory disease of unclear etiology, characterized by subcutaneous nodules, mainly in the head and neck region, frequently associated with regional lymphadenopathy. Orbital involvement is infrequent and when it occurs, usually affects the eyelid or the lacrimal gland. We report a case of a 44-year-old man that presented with bilateral slowly progressive proptosis that was initially misdiagnosed as Graves' Ophthalmopathy. 15 months of worsening proptosis and the development of facial and temporal swelling led to further investigation. Computed tomography and magnetic resonance imaging showed enlargement of all recti muscles and diffuse orbital infiltration. An orbital biopsy was performed and was consistent with the diagnosis of KD. Long term oral corticosteroid showed marked improvement of proptosis and facial swelling. This case serves to emphasize that KD should be included in the differential diagnosis of inflammatory diseases of the orbit, even when characterized by predominant involvement of the extraocular muscles.
- Customized Minimally Invasive Orbital Decompression Surgery Improves Lower Eyelid Retraction and Contour in Thyroid Eye Disease(2017) GONCALVES, Allan C. Pieroni; GUPTA, Shivani; MONTEIRO, Mario L. R.; DOUGLAS, Raymond S.Purpose: To investigate the outcome of a customized approach with targeted zygomatic basin bone removal orbital decompression in lower eyelid retraction and contour of patients with thyroid eye disease. Methods: In a comparative case series, clinical charts and photos of a consecutive sample of 92 patients with thyroid eye disease submitted to different types orbital decompression were studied. Exophthalmos, midpupil to lower eyelid margin distances (MRD2) at 11 meridians, and globe position were measured and compared according to the types of decompression. Each eyelid was also labeled as within or outside normal limits regarding both contour pattern analysis and MRD2 compared with a control normal range. Eyelid contour and globe position from patients with orbital decompression with zygomatic basin removal were compared with those without basin removal. Results: A total of 105 orbits from 57 patients met the study inclusion criteria. Ninety-eight orbits had lateral orbital wall decompression and in 53% of these cases, bone in the zygomatic basin was removed. Removal of the zygomatic basin did not significantly enhance decrease in proptosis, but significantly induced vertical globe descent and improved MRD2 (p < 0.05). Preoperatively, 37% of the eyelids were in the normal MRD2 range and 18% within the normal contour range. Preoperatively, 77% had normal MRD2 and 55% normal contour range. Conclusions: Our study findings support the practical utility of incorporating a customized approach to orbital decompression, and suggest that an individualized approach with targeted bone removal may obviate the need for additional surgeries such as lower eyelid retraction repair.
- A Comparative Study of Clinical vs. Digital Exophthalmometry Measurement Methods(2020) PEREIRA, Thais de Sous; KUNIYOSHI, Cristina Hiromi; LEITE, Cristiane de Almeida; GEBRIM, Eloisa M. M. S.; MONTEIRO, Mario L. R.; GONCALVES, Allan C. PieroniBackground. A number of orbital diseases may be evaluated based on the degree of exophthalmos, but there is still no gold standard method for the measurement of this parameter. In this study we compare two exophthalmometry measurement methods (digital photography and clinical) with regard to reproducibility and the level of correlation and agreement with measurements obtained with Computerized Tomography (CT) measurements. Methods. Seventeen patients with bilateral proptosis and 15 patients with normal orbits diseases were enrolled. Patients underwent orbital CT, Hertel exophthalmometry (HE) and standardized frontal and side facial photographs by a single trained photographer. Exophthalmometry measurements with HE, the digital photographs and axial CT scans were obtained twice by the same examiner and once by another examiner. Pearson correlation coefficient (PCC) was used to assess correlations between methods. Validity between methods was assessed by mean differences, interintraclass correlation coefficients (ICC's), and Bland-Altman plots. Results. Mean values were significantly higher in the proptosis group (34 orbits) than in the normal group (30 orbits), regardless of the method. Within each group, mean digital exophthalmometry measurements (24.32 +/- 5.17 mm and 18.62 +/- 3.87 mm) were significantly greater than HE measurements (20.87 +/- 2.53 mm and 17.52 +/- 2.67 mm) with broader range of standard deviation. Inter-/intraclass correlation coefficients were 0.95/0.93 for clinical, 0.92/0.74 for digital, and 0.91/0.95 for CT measurements. Correlation coefficients between HE and CT scan measurements in both groups of subjects (r = 0.84 and r = 0.91, p<0.05) were greater than those between digital and CT scan measurements (r = 0.61 and r = 0.75, p<0.05). On the Bland-Altman plots, HE showed better agreement to CT measurements compared to the digital photograph method in both groups studied. Conclusions. Although photographic digital exophthalmometry showed strong correlation and agreement with CT scan measurements, it still performs worse than and is not as accurate as clinical Hertel exophthalmometry. This trail is registered with NCT01999790.