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Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment183DISCUSSIONMalignant eyelid tumors constitute an importantpart of clinical ophthalmology. At our institution, surgeryis still the treatment of choice, except in patients withhigh surgical risk, multiple lesions or refusal to submit tosurgery for aesthetic or psychological reasons. Suchpatients may opt for immunotherapy with 5% imiquimodcream. Knowledge of treatment costs is an essentialsubsidy to the financial planning of health careinstitutions.Aguilar et al. evaluated the cost of treatment forsuperficial BCC in the lower limbs. Surgery was found tobe more costly, but also more efficacious, than clinicaltreatment. (11)Vanaclocha et al. evaluated the cost-effectivenessof treatment of superficial BCC using surgical excision or5% imiquimod cream at dermatological and nondermatologicalservices and found that clinical treatmentreduced patient cost compared to surgery. (12) In addition,the cost was higher at non-dermatological services due tomore expensive surgical procedures and postoperative care.Surgical treatment was less costly in our study thanin the literature. However, the duration of surgery andneed of supplies may have been underestimated by thefact that estimates were based on image analysis.Nevertheless, we believe that even if corrected for thisdifference, surgery would still be significantly lessexpensive than immunotherapy, especially in view ofthe low fixed labor costs of Brazilian public institutions.The cost of clinical treatment was similar to whathas been reported from other countries, but prolongedtreatment would be financially unfeasible in the contextof Brazilian public health care. The possibility of reducingclinical cost to the level of surgical cost through bulkpurchase of less expensive but equivalent brands ofmedication might be explored in future studies.5. Gupta AK, Browne M, Bluhm R. Imiquimod: a review. J CutanMed Surg. 2002;6(6):554-60.6. Peris K, Campione E, Micantonio T, Marulli GC, Fargnoli MC,Chimenti S. Imiquimod treatment of superficial and nodularbasal cell carcinoma: 12-week open-label trial. Dermatol Surg.2005;31(3):318-23.7. Schön MP, Schön M. Immune modulation and apoptosis induction:two sides of the antitumoral activity of imiquimod.Apoptosis. 2004;9(3):291-88. Macedo EM , Carneiro RC, Matayoshi S. Imunoterapia tópicano tratamento do carcinoma basocelular periocular. Rev BrasOftalmol. 2009;68(6):355-8.9. Kara-Junior N, de Santhiago MR, Kawakami A, CarricondoP, Hida WT. Mini-rhexis for white intumescent cataracts. Clinics(Sao Paulo). 2009;64(4):309-12.10. Kara-José Junior N, Avakian A, Lower LMT, Rocha AM,Cursino M, Alves MR. Facoemulsificação versus extração extracapsularmanual do cristalino: análise de custos. Arq BrasOftalmol. 2004;67(3):481-9.11. Aguilar M, de Troya M, Martin L, Benítez N, González M. Acost analysis of photodynamic therapy with methylaminolevulinate and imiquimod compared with conventionalsurgery for the treatment of superficial basal cell carcinomaand Bowen’s disease of the lower extremities. J Eur AcadDermatol Venereol. 2010;24(12):1431-6.12. Vanaclocha F, Daudén E, Badía X, Guillén C, Conejo-Mir JS,Sainz de Los Terreros M, Hamel L, Llorens MA; HEIS StudyGroup. Cost-effectiveness of treatment of superficial basalcell carcinoma: surgical excision vs. imiquimod 5% cream. BrJ Dermatol. 2007;156(4):769-71.Corresponding author:Erick Marcet Santiago de MacedoRua Dr. Veiga Filho, n° 207, apto. 59, CEP 01229-001- São Paulo, (SP), Brazile-mail: erickmarcet@yahoo.com.brREFERENCES1. Wong CS, Strange RC, Lear JT. Basal cell carcinoma. BMJ.2003;327(7418):794-8. Review.2. Allali J, D’Hermies F, Renard G. Basal cell carcinomas of theeyelids. Ophthalmologica. 2005;219(2):57-71. Review.3. Cook BE Jr, Bartley GB. Treatment options and future prospectsfor the management of eyelid malignancies: an evidence-basedupdate. Ophthalmology. 2001;108(11):2088-98;quiz 2099-100, 2121.4. Hamada S, Kersey T, Thaller VT. Eyelid basal cell carcinoma:non-Mohs excision, repair, and outcome. Br J Ophthalmol.2005;89(8):992-4. Comment in Br J Ophthalmol.2006;90(5):660-1. Br J Ophthalmol. 2006;90(7):926; authorreply 926-7.Rev Bras Oftalmol. 2012; 71 (3): 180-3
184RELATO DE CASODiplopia após injeção de toxina botulínicatipo A para rejuvenescimento facialDiplopia after injection of botulinictoxin type A for facial rejuvenationMárcia Melo de Oliveira Rassi 1 , Lucas Henrique Barbosa dos Santos 2RESUMORelato de 4 casos de pacientes encaminhadas ao serviço de Ortóptica deste Hospital, que apresentaramdiplopia após a injeção de toxina botulínica tipo A para rejuvenescimento facial. Nas medidas de ângulo do estrabismoem posições diagnósticas todas apresentaram microestrabismo paralítico, sendo duas por déficit da função domúsculo oblíquo inferior e duas por déficit de função de músculo reto lateral. Baseados nos casos descritos, aconselha-seaos profissionais que fazem uso desta toxina para fins de rejuvenescimento facial que estejam atentos para adiplopia como efeito colateral.Descritores: Diplopia/induzido quimicamente; Toxinas botulínicas tipo A/efeitos adversos; Relatos de casosABSTRACTReport of 4 patients referred to the Orthoptics Service of this Hospital, who presented diplopia after theinjection of botulinic toxin type A for facial rejuvenation.When measuring the angle of the strabismus in the diagnosticpositions, all of the patients presented paralitical micro strabismus, two of them due to inferior oblique paresisand theother two due to lateral rectus paresis. Based on the cases described, we advise the professionals that make use ofBTA for facial rejuvenation to be aware of diplopia as a complication.Keywords: Diplopia/chemically induced; Botulinic toxins, type A/adverse effects; Case reports1Hospital Ver-Excelência em Oftalmologia – Goiânia (GO), Brasil;2Departamento de Plastica Ocular e Vias Lacrimais do Hospital Ver-Excelência em Oftalmologia – Goiânia (GO), Brasil.Trabalho realizado no VER - Excelência em Oftalmologia, Goiânia(GO), Brasil.Os autores declaram inexistir conflitos de interesseRecebido para publicação em 18/11/2010 - Aceito para publicação em 27/6/2011Rev Bras Oftalmol. 2012; 71 (3): 184-7
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Page 5 and 6: 146173 Características e deficiên
Page 7 and 8: 148Rezende F, Bisol RAR, Tiago Biso
Page 9 and 10: 150Ventura BV, Ventura M, Lira W, V
Page 15 and 16: 156Moura EM, Volpini M, Moura GAGIN
Page 17 and 18: 158Moura EM, Volpini M, Moura GAGco
Page 19 and 20: 160ARTIGO ORIGINALEficácia da comb
Page 21 and 22: 162Almodin J, Buhler Junior C, Almo
Page 23 and 24: 164ARTIGO ORIGINALHipermetropia ap
Page 25 and 26: 166Ambrósio Jr R, Silva RS; Lopes
Page 33 and 34: 174Ventura CVOC, Gomes MLS, Ventura
Page 39 and 40: 180ARTIGO ORIGINALPeriocular basal
Page 41: 182Macedo EMS, Carneiro RC, Carrico
Page 45 and 46: 186Rassi MMO, Santos LHBTABELA 1Per
Page 47 and 48: 188RELATO DE CASOSíndrome de Down:
Page 49 and 50: 190Lorena SHTachados de blefarite e
Page 51 and 52: 192Passos AF, Borges DFINTRODUÇÃO
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Page 55 and 56: 196Veloso CER, Almeida LNF, De Marc
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Page 59 and 60: 200Schellini SA, Sousa RLFINTRODUÇ
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Page 65 and 66: 206Instruções aos autoresA Revist
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