Diss. (sammanfattning) Göteborg : Göteborgs universitet , 2007. / Härtill 4 uppsatser.

Orientador: Keila M. Monteiro de Carvalho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias / Made available in DSpace on 2018-08-14T10:35:39Z (GMT). No. of bitstreams: 1 Flores_VanessaGoncalvesCrespi_M.pdf: 1368832 bytes, checksum: 225067078cb9cab20e2bae13fce26d7f (MD5) Previous issue date: 2009 / Resumo: Objetivo: Verificar percepções do residente de Oftalmologia e do supervisor em relação ao método de ensino e ao aprendizado cirúrgico de estrabismo. Métodos: Estudo descritivo. Participantes: residentes do 1° (R1), 2° (R2) e 3° (R3) anos. Cada residente estudou a técnica cirúrgica padrão em CD-ROM, depois, realizou um retrocesso de músculo reto de coelho albino, e um retrocesso de músculo reto em paciente durante cirurgia de estrabismo no Centro Cirúrgico. Foi aplicado questionário estruturado aos residentes após a sequência de procedimentos, e registradas observações do aprendizado pelo supervisor, incluindo-se variáveis referentes à aplicação da técnica cirúrgica de estrabismo, auto-avaliação do domínio da técnica e do treinamento recebido. Resultados: Foram estudados 41 questionários. Todos os R1 relataram ter pouca ou média dificuldade em relação à lembrança da sequência de passos do procedimento, 70% dos R2 e nenhum dos R3 relataram dificuldade. No manuseio do instrumental 93% dos R1 relataram algum grau de dificuldade, 52% dos R2 e nenhum dos R3. Os residentes relatam que no momento cirúrgico lembram do que foi ensinado na fase experimental (46%), que este treinamento atende totalmente suas necessidades (46%) e em parte para 49%. Conclusão: O método de aplicação de questionário estruturado foi útil em revelar que o preparo com cirurgia experimental, associado à oportunidades práticas e supervisão dos residentes, pode aprimorar o ensinamento cirúrgico de estrabismo. / Abstract: Aims: To verify Ophthalmology residents' and supervisors' perceptions regarding teaching and learning strabismus surgery. Methods: Descriptive Study. Participants: residents of 1st(R1), 2nd(R2) and 3rd(R3) years. Each resident studied the standard strabismus surgery technique on CD-ROM. After, he performed a rabbit rectus muscle recession and did a strabismus surgery on a patient. The residents answered a structured questionnaire and the authors made observations including variables referring to the technical surgery applied, self-evaluation of this technique and if appropriate training was given. Results: Forty-one questionnaires were analyzed. All of the R1 had some difficulty remembering the surgery sequence, 70% of R2, and none of R3. Concerning the handling of the surgical material 93% of R1 and 52% of R2 and none of R3 had any difficulty. The residents reported that during the surgery in patients, 46% remembered the experimental stage and that this training completely fulfilled their needs for 46% and partially for other 49%. Conclusion: The method of structured questionnaire application disclosed that the preparation with experimental surgery, associated with practice opportunities and residents' supervision, may improve the teaching in strabismus surgery. / Mestrado / Oftalmologia / Mestre em Ciências Médicas

No / Amblyopia is the condition in which reduced visual function exists despite full optical correction and an absence of observable ocular pathology. Investigation of the underlying neurology of this condition began in earnest around 40 years ago with the pioneering studies conducted by Hubel and Wiesel. Their early work on the impact of monocular deprivation and strabismus initiated what is now a rapidly developing field of cortical plasticity research. Although the monocular deprivation paradigm originated by Hubel and Wiesel remains a key experimental manipulation in studies of cortical plasticity, somewhat ironically, the neurology underlying the human conditions of strabismus and amblyopia that motivated this early work remains elusive. In this review, the authors combine contemporary research on plasticity and development with data from human and animal investigations of amblyopic populations to assess what is known and to reexamine some of the key assumptions about human amblyopia.

In the past decade, considerable attention has been paid to examination of the impact of amblyopia, and strabismus, upon the lives of the individuals. Although an extensive amount of literature exists regarding amblyopia and its associated visual defects, little is known about the contribution of the amblyopic eye in the habitual viewing condition (i.e. both eyes viewing). The purpose of these studies was to determine whether amblyopes are disadvantaged in the performance of tasks under habitual viewing conditions, highlighting any functional differences which may exist as a consequence of amblyopia. Secondly, the work aimed to investigate whether the amblyopic eye contributes to the habitual performance of these tasks. A simple light detection task, in a dichoptic arrangement based upon blue/yellow stimuli viewed through yellow filters, was used to investigate the above two aims and investigate the degree of interocular suppression in amblyopic participants. Using a 3D motion analysis system performance was assessed for an obstacle crossing task (adaptive gait) and a task of reaching for and grasping of an isolated object and in a 'cluttered' environment. Fine motor skills were assessed in a threading a needle task. On the whole it was found that amblyopes are not disadvantaged under habitual viewing conditions, and in cases where differences were found to exist this appeared to be in tasks requiring speed and accuracy. Consistently across all studies it was found that the amblyopic eye contributed in a positive manner, thus, as in visual normals, two eyes are better than one.

If cosmetic surgery has become the cultural lens through which Americans look at issues of beauty and ugliness (Haiken 1997), then minor bodily stigma is the personal lens through which we scrutinize our bodies and self-diagnose our own flaws in the first place (Ellis 1998). In this dissertation, I interrogated the stories of eight women who struggled with two specific minor bodily stigmas--strabismus (crossed eyes) and micromastia (small breasts). Cosmetic surgery presents a potential "cure" for both of these conditions, however, as some of my interviewees could testify, the results are unpredictable. While some women reported being grateful that they could try to resculpt their bodies with surgery, others were too afraid to try, or annoyed that the option existed in the first place. Using a Grounded Theory approach, I combined autoethographic techniques with interactive interviewing to collect and interpret my data about how individuals cope with, and talk about, minor bodily stigma in an age of cosmetic surgery. The two flaws I chose to examine carry a great deal of cultural significance because in the West, eyes are revered as "windows to the soul," while breasts are regarded as powerful symbols of sexuality. Consequently, I looked at each woman's exposure to culture at three levels--the mass media, the local culture, and the circle of family and friends. First, I wanted to find out how these women identified themselves as flawed in the first place, and what impact their perceived stigma had upon their lives. I wanted to know if, and how, they communicated to others about their minor bodily stigmas. Next, I delineated the eight coping strategies outlined by my interviewees and examined the efficacy of each. Finally, I looked at how each woman made and communicated her decision regarding whether or not to pursue cosmetic surgery as a solution to her minor bodily stigma. I asked those who had surgery to elaborate on their decision and its outcome.

Chronic opioid exposure in utero places the infant at risk of Neonatal Abstinence Syndrome (NAS), a clinical diagnosis of neurological, autonomic, and/or gastrointestinal withdrawal symptoms from opioid abstinence at birth. The prevalence of NAS is rising concurrently with the recent epidemic of opioid misuse among the general population in the United States, including pregnant women. Opioid misusing women typically receive methadone or buprenorphine as a treatment throughout pregnancy. However, the opioid misuse during pregnancy is associated with higher obstetric complications and a higher incidence of NAS in infants, at times requiring pharmacological intervention. The exact consequences to the human development from opioid exposure in utero remain unclear. Animal studies suggest that the fetal impacts of opioid exposure may differ from the consequences for an adult who uses opioids. Furthermore, there may be neurodevelopmental alterations in myelin physiology, dendritic length in the brain, and neurotransmitter systems when a child is exposed to opioids in utero. Clinical studies highlight associations between perinatal opioid exposure and gene mutation variants, cranial abnormalities on imaging, and a high prevalence of ocular and visual comorbidities. Ocular and visual comorbidities are of particular interest, because they may be treatable when detected early. The current literature about NAS infants and ocular and visual comorbidities is limited by the retrospective and small case-control study designs employed by the majority of the research groups. The proposed study design is a prospective study comparing groups of opioid exposed and non-opioid exposed infants born at Boston Medical Center in Boston, Massachusetts. The ocular and visual comorbidities detected in each group will be quantified, while analyzing the relationship and the relative risk attributable to the infant’s and mother’s demographics. The social context of opioid misuse may complicate the interpretation of the data; however, the design anticipates sufficient recruitment and generalizability as it is conducted at a safety net hospital. Ultimately, the goal of this proposal is to reduce the risk to the fetus with perinatal opioid exposure and build the knowledge base about ocular comorbidities in NAS infants so that optimal and comprehensive care can be provided in the future.

In the past decade, considerable attention has been paid to examination of the impact of amblyopia, and strabismus, upon the lives of the individuals. Although an extensive amount of literature exists regarding amblyopia and its associated visual defects, little is known about the contribution of the amblyopic eye in the habitual viewing condition (i.e. both eyes viewing). The purpose of these studies was to determine whether amblyopes are disadvantaged in the performance of tasks under habitual viewing conditions, highlighting any functional differences which may exist as a consequence of amblyopia. Secondly, the work aimed to investigate whether the amblyopic eye contributes to the habitual performance of these tasks. A simple light detection task, in a dichoptic arrangement based upon blue/yellow stimuli viewed through yellow filters, was used to investigate the above two aims and investigate the degree of interocular suppression in amblyopic participants. Using a 3D motion analysis system performance was assessed for an obstacle crossing task (adaptive gait) and a task of reaching for and grasping of an isolated object and in a ¿cluttered¿ environment. Fine motor skills were assessed in a threading a needle task. On the whole it was found that amblyopes are not disadvantaged under habitual viewing conditions, and in cases where differences were found to exist this appeared to be in tasks requiring speed and accuracy. Consistently across all studies it was found that the amblyopic eye contributed in a positive manner, thus, as in visual normals, two eyes are better than one.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-08-14T20:25:49Z No. of bitstreams: 1 JoaoDallyson.pdf: 6621483 bytes, checksum: 19e928fa3d5789994cc1db5d829e0575 (MD5) / Made available in DSpace on 2017-08-14T20:25:49Z (GMT). No. of bitstreams: 1 JoaoDallyson.pdf: 6621483 bytes, checksum: 19e928fa3d5789994cc1db5d829e0575 (MD5) Previous issue date: 2013-07-05 / Strabismus is a condition that affects approximately 4% of the population causing aesthetic problems, reversible at any age, and irreversible sensory changes that modify the mechanism of vision. The Hirschberg test is one of the types of existing tests to detect such a condition. Detection Systems and computeraided diagnosis are being used with some success in helping health professionals. However, in spite of the increasing routine use of high-tech technologies, the diagnosis and therapy in ophthalmology is not a reality within the strabismus subspecialty. Thus, this thesis aims to present a methodology to detect and automatically diagnose and propose the plan of strabismus surgery through digital images. To do this, the study is organized in seven steps: (1) face segmentation; (2) eye region detection; (3) eyes location; (4) limbus and brilliance location; (5) detection, (6) diagnosis and (7) surgical planning of strabismus. The effectiveness of the study in the indication of the diagnosis and surgical plan was evaluated by the mean diference between the results provided by the methodology and the original indication of the expert. Patients were evaluated for eye positions: PPO, INFRA, SUPRA, DEXTRO and LEVO. The method was 88% accurate in identifying esotropias (ET), 100% in exotropias (XT), 80.33% in hipertropias (HT) and 83.33% in hipotropias (HoT). The overall average error in diagnosis was 5:6 and 3:83 for horizontal and vertical desviations, respectivelly. In planning surgeries of medial rectus muscles the average error was 0.6 mm for recession, and 0.9 mm for ressection. For lateral rectus muscles, the average error was 0.8 mm for recession, and 1 mm for resection. / O estrabismo é uma patologia que afeta cerca de 4% da população, provocando problemas estéticos (reversíveis a qualquer idade) e alterações sensoriais irreversíveis, modi cando o mecanismo da visão. O teste de Hirschberg é um dos tipos de exames existentes para detectar tal patologia. Sistemas de Detecção e Diagnóstico auxiliados por computador estão sendo usados com relativo sucesso no auxílio aos pro fissionais de saúde. No entanto, o emprego rotineiro de recursos de alta tecnologia no auxílio diagnóstico e terapêutico em oftalmologia não é uma realidade dentro da subespecialidade estrabismo. Sendo assim, o presente trabalho tem como objetivo apresentar uma metodologia para detectar e diagnosticar automaticamente, além de propor o plano cirúrgico do estrabismo por meio de imagens digitais. Para tanto, o estudo está organizado em sete estágios: (1) segmentação da face; (2) detecção da região dos olhos; (3) localização dos olhos; (4) localização do limbo e do brilho; (5) detecção; (6) diagnóstico e (7) planejamento cirúrgico do estrabismo. A e ficácia do estudo na indicação do diagnóstico e do plano cirúrgico foi avaliada pela m édia da diferença entre os resultados fornecidos pela metodologia e as indicações originais do especialista. Os pacientes foram avaliados nas posições do olhar: PPO, INFRA, SUPRA, DEXTRO e LEVO. O método obteve acuracia de 88% na identi cação de esotropias (ET), 100% nas exotropias (XT), 80,33% nas hipertropias (HT) e 83,33% nas hipotropias (HoT). O erro médio global na realização do diagnóstico foi de 5:6 e 3:83 para desvios horizontais e verticais, respectivamente. No planejamento de cirurgias de músculos retos mediais obteve-se erro médio de 0,6 mm para recuo, e 0,9 mm para ressecção. Para os músculos retos laterais, o erro médio foi de 0,8 mm para recuo e 1 mm para ressecção.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2016-09-20T21:40:36Z No. of bitstreams: 2 Tese - Maria Nice Araújo Moraes Rocha - 2016.pdf: 4334909 bytes, checksum: 0422cbf81db864afe284617eb3dca3e8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-21T13:57:20Z (GMT) No. of bitstreams: 2 Tese - Maria Nice Araújo Moraes Rocha - 2016.pdf: 4334909 bytes, checksum: 0422cbf81db864afe284617eb3dca3e8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-21T13:57:20Z (GMT). No. of bitstreams: 2 Tese - Maria Nice Araújo Moraes Rocha - 2016.pdf: 4334909 bytes, checksum: 0422cbf81db864afe284617eb3dca3e8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-01-19 / The objective of this study was to propose the planning of surgery for correction of horizontal strabismus, esotropia and exotropias through algorithms and formulas that convert the measure of the deviation angle prism diopters to millimeters, which is used in surgical practice. Demonstrated the preparing of the formulas and flowcharts according to the theoretical foundations presented. Was make retrospective analysis of 136 patients operated in accordance with the algorithms and formulas proposed. Two algorithms were constructed on the basis of anatomy, physiology and oculomotricity, instrumental in planning and semiotics of strabismus surgery. The preparation of the formulations was done using mathematical calculations associated with knowledge of the mechanics of eye movements. It was completed two formulas for esotropias correction: ET1 and ET2 = = 0,33D 0,30D and two for exotropias correction: XT1 and XT2 = = 0,40D 0,43D, dependent on the number of eyes to be operated and magnitude of the deviation. For this work was adopted as individual success criteria to orthotropia ± 10Δ, in agreement with several studies in the literature. The result of successful group in the immediate post operative period (7days after surgery) was equal to 92.9% in the correction of esotropia and 82.3% in exotropias. In the late postoperative period (3-6 months after surgery) there was the result of success were 75.3% and 62.8% for esotropias to exotropias. The results were compared to studies conducted in similar conditions and concluded that the proposed method is effective for surgical planning in correcting esotropias and exotropias. / O objetivo deste trabalho foi propor o planejamento da cirurgia para correção de estrabismos horizontais- esotropias e exotropias- através de algoritmos e fórmulas que convertem a medida do ângulo do desvio de dioptrias prismáticas para milímetros, que é usada na prática cirúrgica. Demonstrou-se a elaboração das fórmulas e fluxogramas de acordo com os fundamentos teóricos apresentados. Foi feita análise retrospectiva de 136 pacientes operados de acordo com os algoritmos e fórmulas propostas. Dois algoritmos foram construídos com base na anatomia, fisiologia e oculomotricidade, fundamentais na semiologia do estrabismo e planejamento da cirurgia. A elaboração das fórmulas foi feita utilizando cálculos matemáticos associados ao conhecimento da mecânica dos movimentos oculares. Construimos duas fórmulas para correção de esotropias:ET1= 0,33D e ET2= 0,30D e outras duas para correção de exotropias: XT1= 0,40D e XT2= 0,43D, dependentes do número de olhos a serem operados e magnitude do desvio. Para este trabalho foi adotado como critério de sucesso individual ortotropia± 10Δ, em consenso com vários estudos na literatura. O resultado de sucesso em grupo no pósoperatório imediato (7 dias após a cirurgia) foi igual a 92,9% nas correções de esotropias e 82,3% nas exotropias. No pós-operatório tardio (3-6 meses após a cirurgia) observou-se o resultado de sucesso em 75,3% para esotropias e 62,8% para exotropias. Os resultados foram comparados com estudos feitos em condições similares. Concluímos que o método proposto é eficaz para o planejamento cirúrgico na correção de esotropias e exotropias.

Introdução: Ambliopia é uma alteração neurológica cortical causada por experiência visual anormal durante o período crítico do desenvolvimento visual. Trabalhos recentes vêm demonstrando que além das conhecidas alterações visuais classicamente descritas na ambliopia, como a acuidade visual, inúmeras funções perceptuais da visão (locais e globais) estão afetadas. Objetivo: Analisar e comparar o impacto de diferentes tipos de ambliopia no processamento visual de cor e sensibilidade ao contraste (SC). Material e métodos: Foram estudados 42 indivíduos amblíopes de 7-40 anos (estrabismo n=16, anisometropia n=18 e de causa mista n=8) e 33 controles pareados por idade. Testou-se a visão de cores pela medida de limiar de cromaticidade para os eixos protan, deutan e tritan com o Cambridge Color Test (CCT-v.02), a sensibilidade ao contraste (SC) espacial de luminância de primeira ordem para as frequências espaciais 0,4; 1,6; 3,2; 6,4; 12,8 cpg, segunda ordem para as frequências 0,4; 1,6; 3,2; 6,4 cpg e contraste radial para as frequências espaciais 0,4; 1,6; 3,2; 6,4; 12,8 cpg com o sistema Psyknematix (v.1.4.3. Kybervision Consulting R&D). Resultados: Não houve alteração na discriminação de cores em amblíopes; mas redução de sensibilidade ao contraste para estímulo linear de primeira ordem para a frequência espacial 0,4 cpg (F= 3,24, p= 0,027) nos olhos dominantes dos amblíopes estrábicos e 12,8 cpg (F= 6,71, p= 0,002) nos olhos não dominantes de indivíduos amblíopes por anisometropia e de causa mista; redução da SC de segunda ordem para a frequência espacial 6,4 cpg (F =5,30, p= 0,002) nos olhos não dominantes dos amblíopes anisométropes e mista e redução de SC radial para a frequência espacial 1,6cpg (F= 3,79; p= 0,014), 3,2cpg (F= 2,84; p= 0,044), 6,4cpg (F= 5,19; p= 0,003) e 12,8 cpg (F= 9,80; p< 0,001) nos olhos não dominantes do grupo de ambliopia mista e para a frequência espacial 12,8cpg para todos os grupos de ambliopia em relação aos controles. Conclusão: Não há impacto na discriminação de cores para nenhum tipo de ambliopia. Existem diferentes impactos para a sensibilidade ao contraste de distintos níveis de complexidade entre diferentes tipos de ambliopia, e o tipo mista apresenta pior desempenho para todas as funções, desde as mais elementares às mais complexas / Introduction: Amblyopia is a cortical neural disfunction caused by abnormal visual experience during critical period of visual development. Recent work has shown that beyond deficits on visual acuity many other perceptual visual functions (local and global) are affected. Purpose: To analyze and compare the impact of different types of amblyopia on visual processing of color vision and contrast sensitivity. Methods: We studied 42 amblyopes aged 7-40 years (strabismus n=16, anisometropia n=18 and mixed n=8 ) and 33 age-matched controls. We tested color vision by chromaticity threshold measurement for protan, deutan and tritan axes with Cambridge Color Test (CCT-v.2.0) and spatial contrast sensitivity of luminance (SC) of first order for spatial frequencies (sf) 0.4; 1.6; 3.2; 6.4; 12.8 cpd; second order for frequencies 0.4; 1.6; 3.2; 6.4 cpd and radial contrast for frequencies 0.4; 1.6; 3.2; 6.4; 12.8 cpd with Psyknematix System (v.1.4.3. Kybervision Consulting R&D). Results: Our results demonstrate no alterations on colour discrimination in amblyopes. Decrease of contrast sensitivity for first order stimuli for frequency 0.4 cpd (F = 3.24, p = 0.027) in dominant eyes of strabismic amblyopia and for 12.8 cpd (F = 6.71, p = 0.002) in nondominant eyes of amblyopic individuals with anisometropia and mixed cause; decrease of CS for second order stimuli for 12,8 cpd (F = 5.30, p = 0.002) in nondominant eyes of anisomotropic and mixed amblyopia and decrease of radial SC for frequency 1.6cpd (F = 3.79 , p = 0.014), 3.2cpd (F = 2.84, p = 0.044), 6.4cpd (F = 5.19, p = 0.003) and 12.8 cpd (F = 9.80, p <0.001 ) in non-dominant eyes of mixed amblyopia and for frequency 12.8 cpd for all amblyopia groups compared to control. Conclusion: There is no impact in color discrimination of any group of amblyopia. There are different impacts between types of amblyopia on contrast sensitivity of different levels of complexity. Mixed type presents the worst performance for all functions from the most elementary to the most complex stimuli