Objetivo: Avaliar a eficiência da Triancinolona Acetonida como agente modulador da resposta inflamatória e cicatricial em coelhos submetidos a cirurgia de músculo extra-ocular. Método: Foi realizado estudo prospectivo, mascarado, em dois estádios. No primeiro estádio, dez coelhos foram submetidos a retrocesso do músculo reto superior em ambos os olhos. Aplicouse, em um deles, 0,15 cc de Triancinolona Acetonida (40mg/cc) nos tecidos circunjacentes ao local de reinserção muscular e, como controle, 0,15cc de solução de cloreto de sódio a 0,9% no local equivalente no olho contra-lateral. Quinze dias após, cinco coelhos foram submetidos a exenteração das órbitas e os restantes dos animais tiveram o mesmo procedimento realizado após trinta dias. O material do sítio de reinserção muscular foi avaliado por meio de análise histopatológica qualitativa e quantitativa (morfometria). No segundo estádio, com incrementação da agressão cirúrgica, dezesseis coelhos foram submetidos aos mesmos procedimentos com exenteração das órbitas após quinze dias, e posterior análise histopatológica dos tecidos. Resultados: Houve efeito inibitório sobre a intensidade da resposta inflamatória nos olhos tratados em comparação com os olhos controle. Conclusão: Nas condições de realização do presente estudo o uso per-operatório da triancinolona acetonida foi efetivo no controle da resposta inflamatória em olhos de coelhos submetidos a cirurgia de músculo extra-ocular. / Purpose: To evaluate the efficiency of triamcinolone acetonide (TRI) in limiting the postoperative inflammatory response and scarring following strabismus surgery. Methods: A prospective, two-stage, masked, controlled trial was conducted. In the first stage, the inflammatory response at the extraocular reattachment site was analyzed following superior rectus recession in ten rabbits. One eye had 0,15 cc of triamcinolone acetonide (40mg/cc) applied around the new insertion site and, similarly, 0,15 cc of isotonic saline solution (0,9%) was applied to the fellow eye following the same procedure, thus serving as a control. Fifteen days later, orbital exenteration was performed in five rabbits and the remaining five were exenterated thirty days later. The reattachment site tissues were submitted to qualitative and quantitative histological examinations. In the second stage 16 rabbits were submitted to amplified surgical trauma, after which the aforementioned steps were also carried out. Granuloma total area at the extraocular muscle reattachment sites of control and treated eyes were compared. Results: There was an inhibitory effect of TRI on the inflammatory response of treated eyes as compared to control eyes. Conclusions: TRI was effective in controlling the postoperative inflammatory response in rabbit eyes submitted to traumatic recession of the superior rectus muscle.

As disturbed binocular functions in small children may lead to severe amblyopia it is of interest to detect it as early as possible. Most tests for binocular functions, however, demand active cooperation and may be unreliable in children up to 4-5 years of age. This study therefore aims to employ visual evoked potentials (VEP) to enable the examiner to evaluate the binocular function in a subject without need of active cooperation from the subject. Initially we studied the relation of suprathreshold contrast to the latency of the transient pattern VEP (tpVEP). Although suprathreshold contrast independently influenced the tpVEP latency, interindividual variation was too large to suggest tpVEP as a possible method for objectively measuring contrast sensitivity in a subject. The tpVEP latency in normal and microstrabismic adult subjects was examined. It was significantly shorter with binocular viewing in normals, but not in the microstrabismic group. Contrast sensitivity and tpVEP latency was examined in adults, both with normal binocularity and with microstrabismus, using both luminance (black-and-white) contrast and colour contrast patterns. The tpVEP latency to colour contrast, like that to luminance contrast, is shorter in normal subjects who view the stimulus binocularly. Interindividual variation or overlap between the normal and microstrabismic groups did not improve with colour contrast. The most significant features of the tpVEP are amplitude and latency. Depending on stimulus conditions, the response may show variations in configuration, amplitude and, to a lesser degree, latency. To decrease the influence of such variations steady-state VEP (ssVEP) can be used. The stimulus is presented in a fast repetitive manner, yielding a VEP response shaped as a continuous curve. The frequency components of this curve can be analysed using Fast Fourier Analysis. Fast Fourier analysis of ssVEP in children aged 8-15 years with normal binocularity and with microstrabismus showed that the power of the second harmonic (the double frequency of stimulus frequency) of the response with binocular viewing was larger than with monocular viewing, both in normals and microstrabismic subjects. For higher stimulus frequencies, microstrabismic subjects showed a significantly lower power of the second harmonic compared with subjects with normal binocularity, when the stimulus was presented binocularly. Finally, Fast Fourier analysed ssVEP in pre-school children aged 4-5 years was studied. A normal group was compared with a group with microstrabismus and a group with significant amblyopia. Amblyopic subjects had significant interocular differences in the first harmonic. We confirmed the significant difference found between microstrabismic subjects and subjects with normal binocularity regarding the second harmonic’s power with higher temporal frequency binocular stimulation, although at a slightly lower frequency than for older children. A low power of the second harmonic in the ssVEP to a binocular stimulus with high temporal frequency is a strong indicator of disturbed binocular function. / För att förhindra amblyopi (ensidig synsvaghet) hos barn är det viktigt att upptäcka störningar i samsynsfunktionerna så tidigt som möjligt. Samsynstester kräver dock aktiv medverkan och kan ge osäkra resultat hos barn upp till 4-5 års ålder. Den här avhandlingen studerar möjligheterna att utifrån tidsmässiga (temporala) egenskaper hos visual evoked potentials (VEP) undersöka samsynsfunktioner objektivt, utan att den undersökte behöver medverka aktivt. Första delstudien visar att ett synstimulus kontrastnivå i relation till kontrastkänslighetströskeln oberoende påverkar latensen i VEP, men variationer mellan individer gör metoden olämplig som objektiv kontrastkänslighetstest. Andra delstudien jämför latensen i VEP hos individer med normal samsyn med den hos personer med mikroskelning. Stimulering av båda ögonen gav signifikant kortare latens än stimulering av ett öga hos normala, men inte hos mikroskelare. I den tredje delstudien jämfördes känslighet för luminanskontrast och färgkontrast hos individer med normal samsyn och personer med mikroskelning. Både luminansmönster (svart-vita) och färgkontrastmönster upptäcktes vid lägre kontrast om båda ögonen stimulerades istället för ett i taget hos normalseende. Mikroskelare uppfattade mönstren sämre med båda ögonen än med ett öga (det dominanta). Latensen i VEP mättes i båda grupperna för både luminans- och färgkontrastmönster. Båda typerna av kontrast gav förkortning av latensen när båda ögonen stimulerades vid normal samsyn, men denna förkortning uteblev hos mikroskelare. Både luminans- och färgkontrast gav för varierande resultat för att utnyttja metoden för objektiv undersökning av samsynen. Fourier-analys innebär att en kurvform delas upp i sinuskurvor med olika frekvens, amplitud och fas. Om ett stimulus växlar hastigt får man ett steady-state VEP (ssVEP), dvs en kontinuerligt vågformad VEP-kurva, som kan delas upp i delsinuskurvor med Fourieranalys. Detta gör att man särskilt kan studera frekvenser som är relaterade till stimuleringsfrekvensen, till exempel grundton och övertoner (multipler av grundtonsfrekvensen). Barn 8-15 år gamla, med normal samsyn och med mikroskelning undersöktes med ssVEP i det fjärde delarbetet. Den första övertonen (= ”second harmonic”) var statistiskt signifikant svagare hos mikroskelare jämfört med normala individer, när stimuleringsfrekvensen var hög. Det femte och sista delarbetet undersökte ssVEP hos 4-5 år gamla förskolebarn på motsvarande sätt. I denna studie deltog också en grupp barn med amblyopi (synsvaghet) på ena ögat. På en något lägre stimuleringsfrekvens bekräftades den svagare första övertonen hos barnen med mikroskelning jämfört med barnen med normal samsyn. De amblyopa barnen visade tydligast förändringar vid lägre stimuleringsfrekvenser och i ssVEP:s grundtonsfrekvens (= ”first harmonic” eller ”fundamental harmonic”). Resultaten i de olika grupperna är så pass åtskilda att metoden verkar lämpa sig för objektiv undersökning av samsynsfunktioner, i det att en svag första överton i binokulärt ssVEP utlöst av hög stimuleringsfrekvens inger en stark misstanke om störd samsyn, medan en stor skillnad i grundtonens styrka i höger respektive vänster ögas ssVEP tyder på amblyopi.

Two novel personal calibration procedures that do not require active user participation are presented. These procedures, in conjunction with a state-of-the-art remote eye-gaze tracking (REGT) technology, allow estimation of the angle between the optical and visual axes (angle kappa) automatically without explicit/active user involvement. The first algorithm for the binocular estimation of angle kappa (BEAK) is based on the assumption that at each time instant both eyes look at the same point on a surface with a known geometry (e.g., a computer monitor). The sensitivity of the BEAK procedure to the geometry of the observation surface and to the noise in the estimates of the optical axis is studied both analytically and in computer simulations. Experimental results with 4 adult subjects suggest that with the current REGT technology angle kappa can be estimated with an RMS error of 0.5°. The second personal calibration algorithm (‘calibrate and validate’, CaVa) adopts a probabilistic approach to the estimation of angle kappa in infants. Even though the presentation of visual stimuli at known positions is part of the procedure, the CaVa algorithm does not require/assume continuous fixation on the presented targets. If an infant attends to roughly half of the presented targets, angle kappa can be estimated accurately and with high confidence. In experiments with five babies, the average difference between repeated measurements of angle kappa was 0.04 ± 0.31°. The second part of the thesis describes two methods for automated measurement of eye misalignment in adults and infants. These methods are based on the user-calibration-free (UCF) technology presented in the first part of the thesis. The first method is based on the clinical Hirschberg test. It is shown that the UCF-REGT technology can improve significantly the accuracy of the Hirschberg test by enabling the estimation of subject-specific parameters (the Hirschberg ratio and angle kappa) in infants. The maximum error in the estimation of the horizontal and vertical components of eye misalignment in five orthotropic infants was shown to be less than 1°, which is significantly better than the accuracy of a standard clinical Hirschberg test. Finally, a novel Eye-Tracker Based Test (ETBT) for the estimation of the maximum (manifest + latent) angle of deviation is presented. ETBT is based on the UCF-REGT system. ETBT allows free head movements and does not require continuous fixation on specific targets. Experiments with 22 adult subjects demonstrated a good agreement of 0.7 ± 1.7° between ETBT and the gold-standard clinical procedure—the altenate prism and cover test. A pilot study with 5 orthotropic infants and one infant with strabismus demonstrated that the ETBT can be used in infants.

Two novel personal calibration procedures that do not require active user participation are presented. These procedures, in conjunction with a state-of-the-art remote eye-gaze tracking (REGT) technology, allow estimation of the angle between the optical and visual axes (angle kappa) automatically without explicit/active user involvement. The first algorithm for the binocular estimation of angle kappa (BEAK) is based on the assumption that at each time instant both eyes look at the same point on a surface with a known geometry (e.g., a computer monitor). The sensitivity of the BEAK procedure to the geometry of the observation surface and to the noise in the estimates of the optical axis is studied both analytically and in computer simulations. Experimental results with 4 adult subjects suggest that with the current REGT technology angle kappa can be estimated with an RMS error of 0.5°. The second personal calibration algorithm (‘calibrate and validate’, CaVa) adopts a probabilistic approach to the estimation of angle kappa in infants. Even though the presentation of visual stimuli at known positions is part of the procedure, the CaVa algorithm does not require/assume continuous fixation on the presented targets. If an infant attends to roughly half of the presented targets, angle kappa can be estimated accurately and with high confidence. In experiments with five babies, the average difference between repeated measurements of angle kappa was 0.04 ± 0.31°. The second part of the thesis describes two methods for automated measurement of eye misalignment in adults and infants. These methods are based on the user-calibration-free (UCF) technology presented in the first part of the thesis. The first method is based on the clinical Hirschberg test. It is shown that the UCF-REGT technology can improve significantly the accuracy of the Hirschberg test by enabling the estimation of subject-specific parameters (the Hirschberg ratio and angle kappa) in infants. The maximum error in the estimation of the horizontal and vertical components of eye misalignment in five orthotropic infants was shown to be less than 1°, which is significantly better than the accuracy of a standard clinical Hirschberg test. Finally, a novel Eye-Tracker Based Test (ETBT) for the estimation of the maximum (manifest + latent) angle of deviation is presented. ETBT is based on the UCF-REGT system. ETBT allows free head movements and does not require continuous fixation on specific targets. Experiments with 22 adult subjects demonstrated a good agreement of 0.7 ± 1.7° between ETBT and the gold-standard clinical procedure—the altenate prism and cover test. A pilot study with 5 orthotropic infants and one infant with strabismus demonstrated that the ETBT can be used in infants.

Title from PDF of title page. / Document formatted into pages; contains 317 pages. / Thesis (Ph.D.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: 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. / ABSTRACT: 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. / ABSTRACT: 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. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

Background/Aims: In an investigation of the functional impact of amblyopia on children, the fine motor skills, perceived self-esteem and eye movements of amblyopic children were compared with that of age-matched controls. The influence of amblyogenic condition or treatment factors that might predict any decrement in outcome measures was investigated. The relationship between indirect measures of eye movements that are used clinically and eye movement characteristics recorded during reading was examined and the relevance of proficiency in fine motor skills to performance on standardised educational tests was explored in a sub-group of the control children. Methods: Children with amblyopia (n=82; age 8.2 ± 1.3 years) from differing causes (infantile esotropia n=17, acquired strabismus n=28, anisometropia n=15, mixed n=13 and deprivation n=9), and a control group of children (n=106; age 9.5 ± 1.2 years) participated in this study. Measures of visual function included monocular logMAR visual acuity (VA) and stereopsis assessed with the Randot Preschool Stereoacuity test, while fine motor skills were measured using the Visual-Motor Control (VMC) and Upper Limb Speed and Dexterity (ULSD) subtests of the Brunicks-Oseretsky Test of Motor Proficiency. Perceived self esteem was assessed for those children from grade 3 school level with the Harter Self Perception Profile for Children and for those in younger grades (preschool to grade 2) with the Pictorial Scale of Perceived Competence and Acceptance for Young Children. A clinical measure of eye movements was made with the Developmental Eye Movement (DEM) test for those children aged eight years and above. For appropriate case-control comparison of data, the results from amblyopic children were compared with age-matched sub-samples drawn from the group of children with normal vision who completed the tests. Eye movements during reading for comprehension were recorded by the Visagraph infra-red recording system and results of standardised tests of educational performance were also obtained for a sub-set of the control group. Results Amblyopic children (n=82; age 8.2 ± 1.7 years) performed significantly poorer than age-matched control children (n=37; age 8.3 ± 1.3 years) on 9 of 16 fine motor skills sub-items and for the overall age-standardised scores for both VMC and ULSD items (p<0.05); differences were most evident on timed manual dexterity tasks. The underlying aetiology of amblyopia and level of stereoacuity significantly affected fine motor skill performance on both items. However, when examined in a multiple regression model that took into account the inter-correlation between visual characteristics, poorer fine motor skills performance was only associated with strabismus (F1,75 = 5.428; p =0. 022), and not with the level of stereoacuity, refractive error or visual acuity in either eye. Amblyopic children from grade 3 school level and above (n=47; age 9.2 ± 1.3 years), particularly those with acquired strabismus, had significantly lower social acceptance scores than age-matched control children (n=52; age 9.4 ± 0.5 years) (F(5,93) = 3.14; p = 0.012). However, the scores of the amblyopic children were not significantly different to controls for other areas related to self-esteem, including scholastic competence, physical appearance, athletic competence, behavioural conduct and global self worth. A lower social acceptance score was independently associated with a history of treatment with patching but not with a history of strabismus or wearing glasses. Amblyopic children from pre-school to grade 2 school level (n=29; age = 6.6 ± 0.6 years) had similar self-perception scores to their age-matched peers (n=20; age = 6.4 ± 0.5 years). There were no significant differences between the amblyopic (n=39; age 9.1 ± 0.9 years) and age-matched control (n = 42; age = 9.3 ± 0.38 years) groups for any of the DEM outcome measures (Vertical Time, Horizontal Time, Number of Errors and Ratio (Horizontal time/Vertical time)). Performance on the DEM did not significantly relate to measures of VA in either eye, level of binocular function, history of strabismus or refractive error. Developmental Eye Movement test outcome measures Horizontal Time and Vertical Time were significantly correlated with reading rates measured by the Visagraph for both reading for comprehension and naming numbers (r>0.5). Some moderate correlations were also seen between the DEM Ratio and word reading rates as recorded by Visagraph (r=0.37). In children with normal vision, academic scores in mathematics, spelling and reading were associated with measures of fine motor skills. Strongest effect sizes were seen with the timed manual dexterity domain, Upper Limb Speed and Dexterity. Conclusions Amblyopia may have a negative impact on a child’s fine motor skills and an older child’s sense of acceptance by their peers may be influenced by treatment that includes eye patching. Clinical measures of eye movements were not affected in amblyopic children. A number of the outcome measures of the DEM are associated with objective recordings of reading rates, supporting its clinical use for identification of children with slower reading rates. In children with normal vision, proficiency on clinical measures of fine motor skill are associated with outcomes on standardised measures of educational performance. Scores on timed manual dexterity tasks had the strongest association with educational performance. Collectively, the results of this study indicate that, in addition to the reduction in visual acuity and binocular function that define the condition, amblyopes have functional impairment in childhood development skills that underlie proficiency in everyday activities. The study provides support for strategies aimed at early identification and remediation of amblyopia and the co-morbidities that arise from abnormal visual neurodevelopment.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser.

Submitted by Liliane Ferreira (ljuvencia30@gmail.com) on 2018-09-04T15:33:47Z No. of bitstreams: 2 Dissertação - Márcia Cartaxo Barbosa - 2018.pdf: 6346404 bytes, checksum: 5342b20d9e2221bdf24236df500045eb (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-09-05T11:10:42Z (GMT) No. of bitstreams: 2 Dissertação - Márcia Cartaxo Barbosa - 2018.pdf: 6346404 bytes, checksum: 5342b20d9e2221bdf24236df500045eb (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-09-05T11:10:42Z (GMT). No. of bitstreams: 2 Dissertação - Márcia Cartaxo Barbosa - 2018.pdf: 6346404 bytes, checksum: 5342b20d9e2221bdf24236df500045eb (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-08-07 / This study was conducted to investigate visual results and compliance with occlusion therapy in strabismic amblyopia in a population sample. Data were selected from medical records of patients examinated at the Department of Strabismus of the Reference Center for Ophthalmology – CEROF, Federal University of Goias, Brazil, during the period from January 1st 2011 to January 1st 2017. Statistical analysis was performed using descriptive analysis, frequency of occurrence and association tests (p=0.05). We found a significantly higher number of esotropia associated with vertical deviation in the study population. A total resolution of amblyopia with equal visual acuity between the eyes was obtained in 123 patients and an 8.6-fold higher relative risk of obtaining this outcome in the compliance group compared to the non-compliance group. The compliance was 87.5% (253 patients), with 50.9% (147 patients) of the total compliance subgroup (when the occlusion dose was between 80% and 100% of that prescribed). Poor compliance was related to higter final treatment age, higher evasion rate, higher rate of suspension of treatment due to inefficacy, less recurrence and lower rate of maintenance of prophylactic occlusion after treatment. They did not interfere with compliance: initial age of treatment, frequency of revision, origin, prophylactic occlusion prior to treatment, exchange of health care staff team, change of conduct during treatment and follow up of treatment by the parents or other persons. / Estudo retrospectivo para avaliar os resultados visuais e a adesão ao tratamento oclusivo da ambliopia estrabísmica e o perfil destes pacientes em uma amostra populacional. Foram analisados 289 casos do total de 2974 pacientes atendidos nos ambulatórios de estrabismo do Centro de Referência em Oftalmologia (CEROF) entre 01 de janeiro de 2011 e 01 de janeiro de 2017. Avaliou-se a acuidade visual inicial, medida aos 6 meses de tratamento e ao final do tratamento e a adesão a cada retorno dos pacientes ao longo do tratamento oclusivo. Foram feitas análises estatísticas nas formas descritiva, de frequência de ocorrência e de testes de associação (p=0,05). Encontrou-se um número significativamente maior de esotropia associada ao desvio vertical na população de estudo. Obteve-se a resolução total da ambliopia, com acuidade visual final igual entre os olhos, em 123 pacientes e um risco relativo 8,6 vezes maior de se obter este desfecho no grupo adesão em relação ao grupo não-adesão. Registrou- se adesão em 253 pacientes (87,5%), sendo 147 (50,9%) do subgrupo adesão total (quando a dose de oclusão ministrada se encontra entre 80% a 100% da prescrita). A não-adesão relacionou-se e a idade final de tratamento maior, maior taxa de evasão, maior taxa de alta por ineficácia, menor recidiva e menor taxa de manutenção de oclusão profilática após o tratamento. Não interferiram na adesão: idade inicial do tratamento, frequência de retornos, procedência, realização de oclusão profilática anterior ao tratamento, troca de equipe médica, mudança de conduta durante o tratamento e acompanhamento do tratamento pelos genitores ou outras pessoas.

Objetivo: Avaliar a eficiência da Triancinolona Acetonida como agente modulador da resposta inflamatória e cicatricial em coelhos submetidos a cirurgia de músculo extra-ocular. Método: Foi realizado estudo prospectivo, mascarado, em dois estádios. No primeiro estádio, dez coelhos foram submetidos a retrocesso do músculo reto superior em ambos os olhos. Aplicouse, em um deles, 0,15 cc de Triancinolona Acetonida (40mg/cc) nos tecidos circunjacentes ao local de reinserção muscular e, como controle, 0,15cc de solução de cloreto de sódio a 0,9% no local equivalente no olho contra-lateral. Quinze dias após, cinco coelhos foram submetidos a exenteração das órbitas e os restantes dos animais tiveram o mesmo procedimento realizado após trinta dias. O material do sítio de reinserção muscular foi avaliado por meio de análise histopatológica qualitativa e quantitativa (morfometria). No segundo estádio, com incrementação da agressão cirúrgica, dezesseis coelhos foram submetidos aos mesmos procedimentos com exenteração das órbitas após quinze dias, e posterior análise histopatológica dos tecidos. Resultados: Houve efeito inibitório sobre a intensidade da resposta inflamatória nos olhos tratados em comparação com os olhos controle. Conclusão: Nas condições de realização do presente estudo o uso per-operatório da triancinolona acetonida foi efetivo no controle da resposta inflamatória em olhos de coelhos submetidos a cirurgia de músculo extra-ocular. / Purpose: To evaluate the efficiency of triamcinolone acetonide (TRI) in limiting the postoperative inflammatory response and scarring following strabismus surgery. Methods: A prospective, two-stage, masked, controlled trial was conducted. In the first stage, the inflammatory response at the extraocular reattachment site was analyzed following superior rectus recession in ten rabbits. One eye had 0,15 cc of triamcinolone acetonide (40mg/cc) applied around the new insertion site and, similarly, 0,15 cc of isotonic saline solution (0,9%) was applied to the fellow eye following the same procedure, thus serving as a control. Fifteen days later, orbital exenteration was performed in five rabbits and the remaining five were exenterated thirty days later. The reattachment site tissues were submitted to qualitative and quantitative histological examinations. In the second stage 16 rabbits were submitted to amplified surgical trauma, after which the aforementioned steps were also carried out. Granuloma total area at the extraocular muscle reattachment sites of control and treated eyes were compared. Results: There was an inhibitory effect of TRI on the inflammatory response of treated eyes as compared to control eyes. Conclusions: TRI was effective in controlling the postoperative inflammatory response in rabbit eyes submitted to traumatic recession of the superior rectus muscle.

Orientador: Keila Miriam Monteiro de Carvalho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T17:43:27Z (GMT). No. of bitstreams: 1 Iyeyasu_JosieNaomi_M.pdf: 2865326 bytes, checksum: 018dc8b97aceb196f37b41ab8738a88b (MD5) Previous issue date: 2011 / Resumo: Introdução: A educação à distância é uma ferramenta de ensino cada vez mais utilizada nas escolas médicas e em diversas especialidades, incluindo a oftalmologia. Apesar disso, programas online de simulações clínicas ainda têm sido pouco utilizados no Brasil. Objetivos: desenvolver um site de casos clínicos de estrabismo e verificar a efetividade do aprendizado baseado em educação à distância para médicos residentes de oftalmologia. Método: estudo de intervenção prospectivo randomizado. O site de 15 casos clínicos reais de estrabismo, extraídos da prática clínica de oftalmologia do Hospital de Clínicas da UNICAMP foi construído usando a plataforma online de apoio ao ensino e aprendizado Moodle e disponibilizado na web com acesso por login e senha. Dezesseis médicos residentes do primeiro ano de oftalmologia foram divididos em dois grupos aleatórios: um que foi submetido à intervenção (acesso ao site) e outro que não foi submetido à intervenção. Foram apresentados, em momentos distintos (antes do acesso do grupo da intervenção ao site e após o acesso), dois casos clínicos adicionais impressos com perguntas referentes à semiologia, hipótese diagnóstica e conduta. Foram comparadas as médias globais das notas e as médias das notas de cada questão isoladamente contida nos casos clínicos antes e após o acesso ao site entre os grupos de acesso e de não acesso, bem como as médias da notas dos casos clínicos pré e pós acesso com as médias das notas da prova escrita regular. Foi feita também a análise estatística das notas do questionário de avaliação do site respondido pelos residentes do grupo de acesso. Resultados: não houve diferença estatisticamente significativa entre os grupos, tanto em relação às notas globais (p=0,9677) como de cada questão isolada (p=0.4968 para a questão referente à semiologia, p=0.7386 para a questão referente às hipóteses diagnósticas e p=0.8407 para a questão referente à conduta). Para ambos os grupos o desempenho na prova escrita teórica foi superior ao nos casos clínicos impressos feitos (p= 0,0092 na comparação com as notas pré acesso e p= 0,0021 na comparação com as notas pós acesso). Em relação ao questionário de avaliação do site, o item que teve a menor mediana e a menor nota mínima foi a velocidade de carregamento do curso, enquanto o item que teve a maior mediana e a maior nota mínima foi referente à qualidade e relevância do conteúdo do curso. Conclusão: Obtivemos sucesso no desenvolvimento do sistema de aprendizado online por meio de casos clínicos de estrabismo. Com relação às avaliações dos alunos a respeito do mesmo, houve aprovação do método pela maioria dos participantes que tiveram acesso ao curso. Apesar de não ter sido verificada diferença de desempenho entre os grupos de acesso e de não acesso, o estudo foi pioneiro em nosso serviço, já que não havia sido desenvolvido nenhum tipo de programa de simulações clínicas anteriormente, tendo o estudo demonstrado que, pelo menos o método a distância não é inferior ao aprendizado não assistido por casos clínicos online / Abstract: Introduction: Web-based e-learning is a teaching tool which is being used with increased frequency in many medical schools and specialties such as ophthalmology. However, web-based clinical case simulation programs are still underused in Brazil. Aims: This study aimed to develop an Internet-based course by using a clinical case presentation scenario, geared towards residents at the Ophthalmo-Otolaryngology Department of the University of Campinas, and to evaluate the effectiveness of this method in graduate medical education. Methods: This was an interventional randomized study. First, a website was built using the distance learning platform called Moodle, and 15 real clinical cases of strabismus extracted from the clinical practice of the Department were developed in multimedia format and made available, with access by username and password. Sixteen first-year ophthalmology residents were divided into two randomized groups: one experimental group, which was submitted to intervention (access and use of the e-learning site) and another, control group, which was not submitted to intervention. In order to evaluate the extent of learning achieved by both groups, it was presented, in distinct moments (before the group intervention having access to the site and after that), two additional printed clinical cases with questions regarding semiology, diagnostic hypothesis and patient management. The global average achievement scores and the average scores for each question of these clinical cases were calculated for both sittings, before and after accessing the site, and were compared between both groups of students. The average scores for clinical cases before and after accessing the site were also compared by using the written regular test. A statistical analysis was carried out for the site evaluation questionnaire answered by the residents of the experimental group. Results: there was no statistically significant difference between the groups for both global scores (p=0.9677) and isolated question scores (p=0.4968 for the question about semiology, p=0.7386 for the question about the diagnostic hypothesis and p=0.8407 for the question about patient management). The written regular test scores were superior to the written clinical case scores for both groups (p= 0.0092 in comparison with the scores before access and p= 0.0021 in comparison with scores after access for the experimental group). Regarding the site evaluation questionnaire, which scores were generally high or very high, the course loading speed was the item presenting the lowest mean and the lowest minimal score; whereas the quality and relevance of the course content was the item presenting the highest mean and the highest minimal score. Conclusion: We were able to successfully develop the e-learning site and respective clinical cases. In relation to student evaluation results, the method was approved by most participants who had access to the on-line course. Despite the fact that there was no statistically significant difference between the access and the non-access groups, the study was pioneer at our service, since a clinical case on-line program had never been developed previously. Therefore, this study was able to demonstrate at least an equivalence relation between e-learning and traditional methods / Mestrado / Oftalmologia / Mestre em Ciências Médicas