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This study analyzed the quality of life of individuals with leprosy and compared quality of life indexes of patients in two different socioeconomic scenarios. The study was conducted at the leprosy clinic of the ABC School of Medicine, São Paulo, Brazil and during visits to the populations living along the Purus River in the Brazilian state of Amazonas. The Dermatology Life Quality Index (DLQI) was used to evaluate the patients. Quality of life was found to be impaired in 76.9% of the patients evaluated in the Amazon compared to 19% of the patients in Santo André. In the group of patients in the Amazon who had sequelae of the disease, quality of life was impaired.

Purpose: To demonstrate the sensitivity and the specificity of the ice test in the differential diagnosis of ptosis in myasthenia gravis., Methods: Prospective trial with a control group. The patients were instructed to hold a frozen ice pack on the closed ptotic eyelid. They were divided into 2 groups, with group I consisting of patients with myasthenia gravis and group II (control) consisting of patients with congenital, non-myasthenic myogenic or aponeurotic ptosis., Results: All patients in group I had increased palpebral fissure for at least 3 mm after the application of ice pack. No patient in group II showed increased palpebral fissure after the ice test., Conclusion: Ice test proved to be specific for the detection of myasthenic ptosis.

Metastasis confined to eyelids are rare, representing less than 1% of malignant eyelid lesions. More than 50% of all eyelid metastasis are reported to have the breast as the most common primary origin. Two cases of metastatic eyelid disease associated with primary breast carcinoma are described. These lesions were the first sign of metastatic systemic disease. Case 1: An 80-year old woman with no significant ophthalmological history complaining of a discrete painless lesion in the left upper eyelid. She had been diagnosed 10 years before as infiltrated ductal carcinoma of right mammary gland with no reference of metastatic disease. Case 2: A 77-year old woman who attends our ophthalmology service came complaining of a four-month history of a painless swelling and erythema of right lower eyelid. The past medical history was significant for infiltrated ductal carcinoma on right mammary gland 2 years before the ocular manifestation. Breast carcinoma is notorious for its presentation diversity. Metastatic disease should be considered as differential diagnosis of eyelid lesions. Although rare, these lesions can be an initial sign of systemic malignancy.

Purpose: To compare pain on injection of two modified anesthetic lidocaine solutions for use in upper blepharoplasty: 2% lidocaine with 1:100,000 epinephrine, and 2% lidocaine with 1:100,000 epinephrine buffered 9:1 with 8.4% sodium bicarbonate., Methods: In this prospective, double-masked study, 25 consecutive patients undergoing upper blepharoplasty were submitted to the anesthesic procedure. Each eyelid received one of two modified lidocaine solutions. Heart rate, systemic arterial pressure and oxygen saturation level were obtained before, during and after injection of two different anesthetic solutions. Patients used a 4-point scale to rate the perceived pain on injection., Results: All parameters were statistically analyzed and there was a significant difference in heart rate and oxygen saturation level., Conclusion: Pain on injection of eyelid anesthesia does not differ significantly with either buffered or unmodified lidocaine solutions.

Purpose: To evaluate the functional results and complications of the use of expanded polytetrafluoroethylene in frontalis suspension surgery for the treatment of blepharoptosis., Methods: Frontalis suspension procedure with polytetrafluoroethylene was performed between 2003 and 2007 on 23 patients (36 eyes) with blepharoptosis. An average follow-up time was 15.8 months (range, 3 to 36). Surgical technique used was described by Fox., Results: The causes of blepharoptosis found were: congenital in 20 patients (86.95%), blepharophimosis in 2 (8.69%) and traumatic in 1 (4.35%). At the first week of postoperatory 6 (26.08%) patients related palpebral asymmetry, 4 (17.39%) noticed local edema, 3 (13.04%) presented granulomas and 1 (4.35%) presented facial cellulitis on the ipsilateral frontal region. After 3 months of follow-up 3 (13.04%) patients related palpebral asymmetry and 1 (4.35%) persisted the granuloma., Conclusion: Polytetrafluoroethylene - Model CV3, 6.0 (Gore-tex(R), W.L. Gore & Associates Inc, Flagstaff, AZ, EUA) is an adequate material with good functional results (86.9%), relatively few complications (4.35%) and insatisfaction (13.4%) that could be an alternative for fascia lata in the surgery of frontalis suspension for the treatment of blepharoptosis.

Hemangiomas are the most common benign tumors of infancy. Capillary hemangioma generally is presented as a spot or well-defined purple lesion. The diagnosis of these tumors is based on physical examination. Giant hemangioma is a rare and extensive variation of capillary hemangioma, that generally occurs in newborns and suckling infants. There are several therapeutical modalities, as the intralesional injection of steroids, laser therapy, intralesional injection of sclerosing solutions, surgery, radiotherapy and embolization. New therapeutical modalities have been developed, with the objective of getting better results and to make possible the treatment of the lesions of difficult surgical access or refractory cases to the used therapeutical modalities. The best results have been observed with interferon-alpha. This is a case of a patient with three months of age, that presented since birth, a purplish tumor in the superior eyelid of the right eye, plain and purplish cutaneous lesions in the temporal and parietal right region. On computed tomography of the skull, an orbital expansive vascularized process with intracranial extension could be observed. Systemic therapy with steroids was the initial treatment, during forty days, with gradual reduction for four weeks. With the practically unchanged clinical findings, the treatment with interferon-alpha was indicated, in the dose of subcutaneous 3.000.000 U/m(2), three times a week. After 9 months of treatment, a small residual orbital lesion was observed. In this case, interferon-alpha is presented as a good option for the treatment of craniofacial giant hemangioma.

Purpose: To observe the role of senile enophthalmos in involutional entropion., Methods: Prospective clinical study comparing a population of 30 white patients above 65 years with involutional entropion (Group I) of an age- and race-matched control group (Group II). All age and exophthalmometric values were analyzed by a statistical study., Results: The average age was 77.7 years in Group I and 75.7 years in Group II. Eyes with involutional entropion are no more likely to have enophthalmos (15.22 mm) than is the involved contralateral eye (15.11 mm) or normal eyes of an age- and race-matched control group (15.13 mm)., Conclusion: There is no correlation between involutional entropion and senile enophthalmos.

Purpose: To evaluate the correction of lower eyelid cicatricial ectropion due to shrinking of anterior lamela with the surgical technique of bipedicle myocutaneous flap from the upper eyelid., Methods: Prospective study with eight eyelids of six patients. There were two patients with unilateral ectropion who had received external local radiotherapy., Results: There were three male and three female patients, with mean age of 72 years. One patient presented an incomplete blinking for one month that spontaneously resolved. Three eyelids of two patients maintained a residual ectropion; one of them had received local external radiotherapy. Follow-up ranged from 19 to 23 months (mean of 20 months) and all patients improved their ocular condition., Conclusion: The bipedicle myocutaneous flap is effective for correction of cicatricial ectropion due to shrinking of anterior lamella.

Report of a complication related to the use of 0.1% trypan blue during capsular staining of the anterior crystalline lens capsule in an extracapsular cataract extraction with intraocular lens implantation. The capsular dye was injected using an air-bubble technique, inadvertently, it was done using high pressure dispersing the dye through the zonules leading to a complete lost of red reflex, the following steps of the procedure becoming more difficult after the cataract extraction and causing a temporary disturbance of visual acuity in the postoperative period. In order to avoid this complication, the authors also describe the use of "Modified air-bubble technique" where dispersive viscoelastic is placed into the iridolenticular space 360 degrees to create a protection barrier.

Purpose: To verify the topographical alterations in enucleated pig eye cornea after radiofrequency application., Methods: A prototype radiofrequency modulator with 10 different energy possibilities was used. For each energy we used 10 enucleated pig eyes that were topographed before and after applying radiofrequency, following a nomogram with 8 spots in step one, 16 spots in step 2, and 24 spots in step 3, in a total of 3 steps for each eye, 300 applications and 400 topographies., Results: Corneal curvature variation occurred after radiofrequency applications for all utilized selections, demonstrated by the mean variation of initial KM (minimum dioptry) and final KM (35.78 and 37.37 respectively) with 1.59 dioptries of variation (p<0.001). The energy that demonstrated more stability was 0.625 W/s (65 degrees C)., Conclusion: The obtained topographic values demonstrated that the central corneal curvature increased after radiofrequency application, and the higher the energy and the more spots used, more curved became the cornea, despite homogeneity.

Trichoepithelioma is a benign skin tumor and is most commonly found on the face, however, there are few reports about its occurrence on the eyelids. It is not usually recognized because of its rarity, origin, biological potential, and controversial classification. The purpose of this paper is to report two cases of solitary trichoepithelioma on the eyelid, their histopathology and treatment. This lesion should be considered when a single solid nodule on the face appears, and can be differentiated from basal-cell carcinoma. Histopathologic confirmation is essential.

Relatively few investigations of anaerobic bacteria as ocular flora have been conducted, and their results have been contradictory. The conjunctival sacs of 22 normal subjects and of 14 patients with acquired immunodeficiency syndrome, and 22 anophthalmic sockets were cultured for anaerobic bacteria Thirty-four (77.3%) of the 44 eyes of normal subjects harbored anaerobic bacteria; Propionibacterium acnes was present in 28 eyes (63.6%), Lactobacillus species in 6 eyes (13.6%), and Veillonella species in 7 eyes (15.9%). The finding were very similar for anophthalmic sockets (p = 0.01), with 17 (77.3%) of the 22 sockets harboring anaerobes; Propionibacterium acnes was the organism identified in 16 (72.7%) of these sockets; Veillonella was identified in 4 (18.1%), Peptococcus niger in 3 (13.6%) and P. granulosum in 2 (9.0%) of these sockets. Acquired immunodeficiency syndrome patients had the highest incidence of anaerobic organisms, with positive cultures obtained from 24 (85.7%) of the 28 eyes. Propionibacterium species were isolated from 16 (57.1%) of these eyes. Clostridium species from 10 (35.7%) eyes and Actinomyces species from 8 (28.6%) eyes. It thus appears that anaerobic organisms are common flora in normal conjunctival sacs and in anophthalmic sockets, as well as in the sacs of acquired immunodeficiency syndrome patients, but the latter group had a higher incidence (x2 = 0.87) and a spectrum of organisms that was different from that of the other two groups.

The efficacy of topical 1% apraclonidine in controlling early postoperative IOP rise after cataract extraction was evaluated. Topical 1% apraclonidine was applied to 20 patients who underwent extracapsular cataract extraction with posterior intraocular lens implantation. On another 20 patients, who acted as control group a placebo (artificial tears) was given. The IOP was measured before preoperative medication and postoperatively at 6, 12 and 24 h, using the Perkins hand-held applanation tonometer. In the control group, 9 patients (45%) developed intraocular hypertension and in the treated group only 2 (10%) showed hypertension, but with short duration and a moderate IOP rise. The difference in frequency of intraocular hypertension between the groups was statistically significant (p less than 0.02). The statistical analysis showed that the postoperative IOP of operated treated eyes was significantly smaller than the IOP of operated control eyes. Furthermore, the postoperative IOP and the initial IOP did not differ statistically. The results of this study demonstrate the efficacy of topical apraclonidine 1% in controlling the early and transient intraocular hypertension following cataract extraction.

Sequence data from three previously-uncharacterized members of the snRNP E protein multigene family suggest that each is a non-transcribed processed pseudogene, even though one clone has the potential to code for a full-length protein with greater than 90% similarity to previously-characterized E protein cDNAs. Each of the newly-analyzed family members is without introns, contains a tract of polyadenylic acid residues, and is flanked by short direct repeats. In addition, the three sequences all contain point mutations that distinguish them from the E protein coding sequence. Seven point mutations are common to the three sequences described here and to two previously-described E protein pseudogenes. Although all of these mutations are transitions, only 5 of 7 could have been generated by deamination of methylated cytosines in inactive genes. Thus, the common mutations in the pseudogenes suggest an origin other than the expressed gene that we have described. Allelic variants for two of the pseudogenes were detected and repetitive elements are located near four of the five E protein pseudogenes that have been characterized.

The snRNP E protein is one of four "core" proteins associated with the snRNAs of the U family (U1,U2,U4,U5, and U6). Screening of a human teratoma cDNA library with a partial cDNA for a human autoimmune antigen resulted in the isolation of a cDNA clone containing the entire coding region of this snRNP core protein. Comparison of the 5' end of this cDNA with the sequences of two processed pseudogenes and primer extension data suggest that the cDNA is nearly full length. The longest open reading frame in this clone codes for a basic 92 amino acid protein which is in perfect agreement with amino acid sequence data obtained from purified E protein. The predicted sequence of this protein reveals no extensive similarity to other snRNP proteins, but contains regions of similarity to a eukaryotic ribosomal protein.