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2.
J. optom. (Internet) ; 16(3): 189-198, July - September 2023. tab, graf
Artigo em Inglês | IBECS | ID: ibc-222227

RESUMO

Purpose This study aimed to translate the Convergence Insufficiency Symptom Survey (CISS) into the Italian language and assess psychometric properties of the translated questionnaire (CISS_I). Methods The CISS_I was arranged according to guidelines for a comprehensive multistep methodologic process for translating, adapting, and validating psychometric instruments in health care research. The CISS_I questionnaire was administered to 103 volunteers (21.8 ± 2.2 years), students in higher education, at two different times. A complete optometric evaluation was performed including subjective refraction, best corrected visual acuity, near point of convergence, prism fusional ranges to blur, diplopia and recovery, TNO stereo test and prism cover test for measurement of heterophoria. Results The performance of the CISS_I in terms of validity showed some points of weakness. Sensitivity was 42%, specificity was 74%, positive predictive value was 27% and negative predictive value was 85%. The area under the ROC curve was 0.672. On the contrary, the results showed good internal consistency of the CISS_I (Cronbach's alpha - α=0.89) and good test-retest reliability (ICC = 0.92). Rasch analysis showed good model fit (all items, except one, with infit and outfit mean square between 0.7 and 1.3), good measurement precision (person separation = 2.66) and good targeting –0,81 logits but also some evidence of multidimensionality. Conclusions The CISS_I showed some point of weakness in terms of validity but also good psychometric properties and has been shown to be applicable to an Italian speaking population to quantify the visual discomfort associated with near vision in higher education students. The results show that high CISS_I score is not necessarily linked to convergence insufficiency, while low scores can exclude the presence of this anomaly...(AU)


Assuntos
Humanos , Adulto Jovem , Transtornos da Motilidade Ocular , Avaliação de Sintomas , Visão Ocular , Inquéritos e Questionários , Tradução
3.
Arch. Soc. Esp. Oftalmol ; 98(7): 391-396, jul. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-222985

RESUMO

Propósito Estudiar los resultados del mini plegamiento central del recto medial (RM) en las insuficiencias de convergencia de adultos con diplopía. Método Análisis retrospectivo de una muestra de 9 casos (7 mujeres). Se recogieron los datos de la dosis de plegamiento del RM, la hipercorrección inmediata posquirúrgica y al final del seguimiento, la desviación final de cerca y de lejos, la diplopía y el tiempo de seguimiento desde la cirugía. Se consideró buen resultado la desaparición de la diplopía, mejoría de los síntomas y una exotropía final de cerca ≤8dioptrías prismáticas (dp). Resultados Se realizó un mini-plegamiento central del RM en 9 pacientes (8 unilaterales). Edad media: 58,66 años (SD: 21,39). La media de la desviación preoperatoria de cerca fue de 16,22 (±2,99) dp y de lejos 6,88 (±4) dp. Se registró hipercorrección en visión lejana en 5 casos que se resolvió a los 3 meses después de la operación. No hubo hipercorrección en visión de cerca excepto en un caso. Ninguno de los casos operados presentó hipercorrección al final del seguimiento. La desviación horizontal final fue ≤8dp en visión cercana, excepto en 3 casos (media: 6,22). Los síntomas y la diplopía se resolvieron en 8 casos. El seguimiento medio fue de 10,33 meses. Conclusión El mini-plegamiento central de 1 o 2 músculos rectos mediales puede mejorar los síntomas y signos de exotropía asociados a la insuficiencia de convergencia cuando los ejercicios y los prismas son rechazados por los pacientes o cuando estos abordajes no han resuelto el problema (AU)


Objective To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia. Methods The study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. Results A central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (± SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (± 2.9) pd and distance preoperative deviation: 6.88 (± 4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months. Conclusion Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diplopia/etiologia , Diplopia/cirurgia , Exotropia/cirurgia , Miopia/cirurgia , Transtornos da Motilidade Ocular/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Oftalmológicos/métodos
4.
Galicia clin ; 83(4): 58-59, oct.-dic. 2022. ilus
Artigo em Inglês | IBECS | ID: ibc-214900

RESUMO

Wall-eyed bilateral internuclear ophthalmoplegia is a rare neuroophthalmological condition characterized by dissociated abducting nystagmus, a large angle exotropia in primary gaze and supranuclearvertical gaze palsy.The authors present the case of an 83-year-old man admitted to theinternal medicine ward with the diagnosis of cholangitis that suddenlystarts with complaints of diplopia. Based on the clinical findings andresults of the diagnostic workup, was established the diagnosis ofWall-eyed bilateral internuclear ophthalmoplegia syndrome. (AU)


La oftalmoplejía internuclear bilateral es una rara condición neuroftalmológica caracterizada por nistagmo en abducción disociado, unaexotropía de gran ángulo en la mirada primaria y parálisis supranuclear de la mirada vertical.Los autores presentan el caso de un hombre de 83 años que ingresaen el servicio de medicina interna con el diagnóstico de colangitisque se inicia repentinamente con quejas de diplopía. Con base en loshallazgos clínicos y los resultados del estudio diagnóstico, se estableció el diagnóstico de síndrome de oftalmoplejía internuclear bilateral(síndrome WEBINO). (AU)


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Transtornos da Motilidade Ocular/diagnóstico por imagem , Transtornos da Motilidade Ocular/etiologia , Aspartato Aminotransferases , Exotropia
5.
J. optom. (Internet) ; 15(4)October - December 2022. tab
Artigo em Inglês | IBECS | ID: ibc-210184

RESUMO

Convergence insufficiency (CI) is a common binocular vision (BV) disorder characterized by difficulty in maintaining motor fusion at near, which affects approximately 7.5 percent of the population. Diagnostic criteria for the disorder are inconsistent, ranging from one to many clinical signs. Methodology for clinical tests is inconsistent in measurement technique, visual targets, required repetitions, and normative values.This manuscript demonstrates the inconsistencies amongst published studies, and highlights the importance of consistent clinical diagnostic signs, measurement techniques, visual targets, and cut-off criteria. For each clinical sign, the recommended methodology for the procedure is described. Several studies do not take age into account when diagnosing CI in their cohorts. As such, the review emphasizes changes in diagnostic signs with age.This manuscript highlights the need for consistent and clear procedures and diagnostic criteria amongst clinicians and provides the basis for future studies in terms of diagnostic testing required for CI of varying age groups. (AU)


Assuntos
Humanos , Acomodação Ocular , Convergência Ocular , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/epidemiologia , Transtornos da Visão/diagnóstico , Visão Binocular
6.
J. optom. (Internet) ; 15(4)October - December 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-210185

RESUMO

Background: Several studies have suggested that accommodative and non-strabismic binocular dysfunctions are commonly encountered in optometric practice. This study aims to verify whether these findings apply to a Portuguese clinical population.MethodsThis study included consecutive nonpresbyopic subjects that came to two Portuguese optometric clinics over a period of six months. A complete visual exam was conducted and included the measurement of visual acuity (VA), refraction, near point of convergence (NPC), distance and near phoria, near and distance fusional vergences, amplitude of accommodation (AA), monocular accommodative facility (MAF), relative accommodation and lag of accommodation.Results156 subjects with a mean age of 24.9 ± 5.3 years (from 18 to 35 years old) participated in the study. Of all subjects, 32 % presented binocular vision and/or accommodative disorders accompanied or not by refractive errors. Moreover, 21.1 % had accommodative disorders, and 10.9 % had a binocular vision dysfunction. Accommodative insufficiency (11.5 %) was the most prevalent disorder, followed by convergence insufficiency (7.1 %) and accommodative infacility (5. 8 %).ConclusionsClinicians should be aware that about one third of the optometric clinical population could have accommodative and/or non-strabismic binocular disorders. Accommodative insufficiency was the most prevalent dysfunction presented in the studied population, followed by accommodative infacility and convergence insufficiency. (AU)


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Acomodação Ocular , Transtornos da Motilidade Ocular , Presbiopia , Transtornos da Visão/epidemiologia , Testes Visuais , Visão Binocular , Portugal
7.
J. optom. (Internet) ; 15(4)October - December 2022. tab
Artigo em Inglês | IBECS | ID: ibc-210186

RESUMO

Clinical relevanceConvergence insufficiency (CI) at an early age can lead to learning difficulties affecting school performance. The aim of this study was to examine the prevalence of CI in a non-clinical population of Spanish children using well defined clinical criteria and to determine whether sex is a risk factor.MethodsVisual acuity and binocular vision tests were performed in 628 children aged 6–14 years (mean age 9.6 ± 1.3 years) at three schools in the Madrid Community, Spain. To assess CI prevalence we used CITT (Convergence Insufficiency Treatment Trial) criteria. The three signs considered were: i) exophoria at least 4∆ greater at near than at far; ii) near break point of convergence (NPC) ≥ 6 cm; and iii) reduced positive fusional vergence (PFV) at near (≤ 15∆ base-out break or failed Sheard's criterion).ResultsThe CI prevalence detected was 5.30% (33 children). Proportions of children with one or two signs of CI were 23.76% (148 children) and 12.20% (76 children), respectively. No differences in these CI rates by sex were detected.ConclusionThe clinically significant CI prevalence observed here suggests the need for more binocular vision screening programmes in school settings. (AU)


Assuntos
Humanos , Criança , Acomodação Ocular , Convergência Ocular , Transtornos da Motilidade Ocular/diagnóstico , Prevalência , Espanha , Projeção
8.
Arch. Soc. Esp. Oftalmol ; 97(10): 565-571, Oct. 2022.
Artigo em Espanhol | IBECS | ID: ibc-209651

RESUMO

Propósito Analizar la eficacia y la seguridad de la transposición del oblicuo inferior con miopexia en pacientes con hiperfunción primaria o secundaria del oblicuo inferior leve-moderada, con o sin diplopía. Método Estudio observacional retrospectivo de 12 pacientes tratados con dicha técnica entre octubre de 2018 y septiembre de 2021. Se suturó el oblicuo inferior a esclera a 5mm posterior a la inserción temporal del recto inferior. Todos tenían desviación vertical de pequeño ángulo (media ±DE: 4,42±1,62) en posición primaria (≤6 dioptrías prismáticas [dp]), hipertropia en aducción leve-moderada y 10 tenían diplopía. Los diagnósticos fueron: paresia del IVnervio (9), DVD (1) e hipertropia en aducción unilateral (2). De los 12 casos, 7 presentaban tortícolis, 2 torsión subjetiva y 2 torsión objetiva. Resultados La edad media de la muestra fue 46,86±25,1 años (50% hombres). De los 10 casos con diplopía, en 9 se resolvió. La desviación vertical media final en mirada al frente fue: 1,5dp ±2,93 (p=0,001). De 7 casos con hipertropia en aducción leve, en 3 desapareció y 4 quedaron igual. De 5 casos con hipertropia en aducción moderada, 2 mejoraron a leves y en 3 desapareció. El tortícolis se resolvió en 5 casos, y en otros 2 mejoró. El tiempo de seguimiento medio fue de 14,08±8,05 meses. No se registraron hipercorrecciones. Conclusiones La transposición del oblicuo inferior con miopexia es una nueva técnica eficaz y segura en pacientes con leve-moderada hipertropia en aducción e hipertropia de pequeño ángulo, con o sin diplopía (AU)


Purpose To evaluate the efficacy and safety of inferior oblique muscle transposition and myopexy in patients with mild/moderate inferior oblique muscle overaction, with or without diplopia. Method We retrospectively analysed data for the 12 patients who underwent the technique. Data were collected from October 2018 to September 2021. Surgery was performed by suturing the inferior oblique belly to the sclera at 5mm posterior to the temporal end of the inferior rectus. All 12 patients had mild hypertropia (≤6 prism diopters [pd]) in primary position and mild/moderate inferior oblique overaction. Mean preoperative hypertropia was 4.42pd ±1.62. Diplopia was recorded in 10 cases. The diagnoses were fourth nerve paresis (9), unilateral primary inferior oblique overaction (2) and dissociated vertical deviation (1). Torticollis was observed in 7 cases, 2 had subjective torsion and 2 objective torsion. Results Mean age was 46.86±25.1 years (50%: men). Diplopia resolved in 9 of the 10 cases. The mean final vertical deviation was 1.5±2.93 (P=.001) pd in straight gaze. Of 7 mild overshoot in adduction, it disappeared in 3 and 4 remained the same. Of 5 moderate overshoot in adduction, 2 improved to mild and 3 disappeared. Torticollis was eliminated in 5 patients and improved in another 2. Mean time from surgery was 14.08±8.05 months. There were no overcorrections Conclusions Inferior oblique muscle transposition with myopexy is a safe and effective procedure in patients with mild-to-moderate inferior oblique muscle overaction and small-angle hypertropia, with or without diplopia (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estrabismo/cirurgia , Transtornos da Motilidade Ocular , Músculos Oculomotores/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Diplopia/etiologia , Diplopia/cirurgia
9.
J. optom. (Internet) ; 15(3)Jul-Sep.2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-204707

RESUMO

Purpose: This study aimed to investigate the correlation between convergence insufficiency symptom survey (CISS) score and the signs of convergence insufficiency (CI) and to evaluate the sensitivity and specificity of the CISS to predict CI and ametropia among young adult university students.Method: This prospective cross-sectional clinic-based study included 300 first year university students (mean age = 21.58 (SD ± 2.2) years) who consecutively reported for eye examination. Participants were administered the CISS questionnaire and investigated for the signs of CI. Diagnosis of CI was based on presence of three or four signs. The correlation between the CISS score and the signs of CI were determined and Receiver Operation Characteristics (ROC) curves were used to evaluate sensitivity and specificity.Results: There were significant correlations between CISS score and the clinical signs of CI namely NPC break (rs = 0.622, p = 0.0001), NPC recovery (rs = 0.620, p = 0.0001), near exophoria (rs = 0.434, p = 0.0001), near PFV blur (rs = -0.359, p = 0.0001), near PFV break (-0.306, p = 0.0001), near PFV recovery (rs = -0.326, p = 0.0001) and gradient AC/A ratio (rs = -0.290, p = 0.0001). There was a significant positive correlation between CISS score and the number of clinical signs of CI (rs = 0.575, p-value = 0.0001). The CISS had good sensitivity (AOC = 0.882) to predict CI and poor sensitivity (AOC = 0.642) to predict ametropia.Conclusion: The CISS score is correlated with the severity and number of signs of CI in young adult Ghanaian university students. Its use in addition to clinical investigative testing may give a definitive diagnosis of symptomatic CI. (AU)


Assuntos
Humanos , Adulto , Correlação de Dados , Convergência Ocular , Acomodação Ocular , Gana , Erros de Refração , Transtornos da Motilidade Ocular , Visão Binocular , Estudos Transversais , Estudos Prospectivos , Inquéritos e Questionários
10.
J. optom. (Internet) ; 14(2): 142-155, April-June 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-208526

RESUMO

Aim: The aim of this study was to explore associations among clinical measures of accommodation and vergences with symptoms, which could facilitate the validation of the Convergence Insufficiency Symptoms Survey to screen for deficient clinical measures.MethodsUsing a multi-stage random cluster sampling, 1211 high school students (481 males and 730 females) between 13 and 18 years of age were selected and examined. Visual acuity, stereoacuity and suppression, refractive errors, near point of convergence, heterophoria and fusional vergences, as well as, amplitude of accommodation, accommodative response, facility and relative accommodation were evaluated. The validity of the Convergence Insufficiency Symptoms Survey to distinguish between children with and those without anomalies in the clinical measures were characterized using the Receiver Operation Curve, sensitivity and specificity of the tests.ResultsThe overall mean and standard deviation for symptoms score was 27.38 ± 11.04. Deficient accommodative measures revealed worse symptoms scores than did deficient vergence measures and children with deficient clinical measures had significantly higher mean symptoms scores. (p = 0.001) However, the correlations between defective clinical measures and symptoms were significant but relatively weak. The Receiver Operation Curve showed that the clinical measures with the highest sensitivities using the CISS (≥16) were: reduced amplitude of accommodation 0.63, 95% Confidence interval, 0.59−0.68%) accommodative facility 0.62 (95% Confidence interval, 0.58−0.67) and near point of convergence 0.60 (95% Confidence interval, 0.53−0.67).ConclusionDeficient clinical measures and symptoms of asthenopia are prevalent and correlated in the sample of school children studied. Overall, findings suggest that high school children with deficient clinical measures may be symptomatic when they perform intense near task compared to those without deficiencies. (AU)


Assuntos
Humanos , Adolescente , Medições dos Movimentos Oculares , Acomodação Ocular , Convergência Ocular , Transtornos da Motilidade Ocular/diagnóstico , Erros de Refração , Visão Binocular , Acuidade Visual , Amostragem Aleatória e Sistemática , Amostragem por Conglomerados
12.
J. optom. (Internet) ; 13(3): 185-190, jul.-sept. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-196816

RESUMO

PURPOSE: The use of ophthalmic instruments requires increased effort on the accommodation and vergence system. This study aimed to understand the prevalence of binocular vision anomalies among ophthalmology trainees attending a surgical training program at a tertiary eye care center. METHODS: This prospective cohort study was carried out between April and November 2017 at a tertiary eye care center in South India. All the ophthalmology trainees inducted for the training programs at the institution underwent a comprehensive ophthalmic and binocular vision assessment. Subjects with previous diagnosis of binocular vision dysfunction and vision therapy were excluded. RESULTS: The mean (SD) age of the subjects was 29 (3) among which 48 were females. Out of the total 75 subjects, 66 had prior surgical experience [range: 1 to 17 years]. Thirty-eight subjects were asymptomatic and 37 were symptomatic. The most common asthenopic symptom was the presence of headache. Forty-one (55%) out of the 75 had a diagnosis of a non-strabismic binocular vision dysfunction. The range of phoria at distance was orthophoria to 14 Prism Diopter (PD) exophoria (mean +/− SD: −1 +/− 3), and at near 4PD esophoria to 25PD exophoria (mean +/− SD: −4 +/− 5). Based on standard diagnostic criteria, 15 subjects (20%) had convergence insufficiency, 14 (19%) had accommodative infacility, 9 (12%) had intermittent divergent squint (IDS), while 3 subjects (4%) had convergence excess. CONCLUSIONS: This study shows the high frequency of binocular vision dysfunctions among ophthalmology trainees joining a tertiary eye care center


OBJETIVO: El uso de instrumentos oftálmicos requiere un esfuerzo incrementado de los sistemas de acomodación y vergencia. El objetivo de este estudio fue comprender la prevalencia de anomalías de visión binocular entre los alumnos de oftalmología que asistían a un programa de formación quirúrgica en un centro terciario de cuidados oculares. MÉTODOS: Este estudio de cohorte prospectivo fue realizado entre abril y noviembre de 2017 en un centro terciario de cuidados oculares en el sur de India. Todos los estudiantes de oftalmología inscritos en los programas de formación en el centro fueron sometidos a un amplio examen oftálmico y binocular. Se excluyó a los sujetos con diagnóstico previo de disfunción de visión binocular y terapia ocular. RESULTADOS: La edad media (DE) de los sujetos fue de 29 años (3), de los cuales 48 eran mujeres. Del total de 75 sujetos, 66 tenían experiencia quirúrgica previa [rango: de 1 a 17 años]. Treinta y ocho sujetos eran asintomáticos y 37 sintomáticos. El síntoma de astenopía más común fue la presencia de cefalea. Cuarenta y uno (55%) de los 75 sujetos fueron diagnosticados de disfunción visual binocular no estrábica. El rango de foria de lejos fue de ortoforia a 14 dioptrías prismáticas (DP) a exoforia (media +/− DE: −1 +/− 3) y, de cerca, de esoforia a 4DP a esoforia a 25DP (media +/− DE: −4 +/− 5). Basándonos en criterios diagnósticos estándar, 15 sujetos (20%) tenían insuficiencia de convergencia, 14 (19%) falta de facilidad acomodativa, 9 (12%) tenían estrabismo divergente intermitente (EDI), y 3 sujetos (4%) tenían exceso de convergencia. CONCLUSIONES: Este estudio muestra la alta frecuencia de disfunciones de visión binocular entre los estudiantes de oftalmología que acudierona un centro terciario de cuidados oculares


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudantes de Medicina/estatística & dados numéricos , Oftalmologia , Exotropia/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Estudos Prospectivos , Estudos de Coortes
13.
Arch. Soc. Esp. Oftalmol ; 95(8): 367-372, ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-201735

RESUMO

OBJETIVO: Describir una alternativa quirúrgica para tratar la hiperacción del oblicuo inferior y presentar los primeros resultados con dicha técnica. MATERIAL Y MÉTODOS: Un total de 6ojos consecutivos de 6 pacientes con hiperacción primaria o secundaria del oblicuo inferior se sometieron a una operación de miopexia retroecuatorial del oblicuo inferior bajo anestesia general. Los resultados primarios medidos fueron la desviación vertical postoperatoria en el campo de acción del músculo oblicuo inferior y las complicaciones quirúrgicas intraoperatorias y postoperatorias. Los resultados finales se evaluaron después de 6 meses de cirugía. RESULTADOS: La muestra de pacientes consistió en 3 niñas y 3 niños de entre 3 y 7 años. La media de la hiperacción del oblicuo inferior preoperatoria fue 34 ± 4,6°, equivalente a 3+. La hiperacción del oblicuo inferior se redujo en todos los pacientes, siendo la media de reducción de 28 ± 1,98° y la desviación postoperatoria media de 6 ± 2,84°. Cuatro de 6ojos obtuvieron un éxito total, y solo un caso quedó sin corregir. No se produjeron complicaciones intraoperatorias o postoperatorias. CONCLUSIÓN: La miopexia retroecuatorial del músculo oblicuo inferior es un enfoque quirúrgico alternativo para la hiperacción del oblicuo inferior. Es una técnica eficiente, segura y reversible que podría usarse en casos de hiperacción del oblicuo inferior entre 2+ y 3+


PURPOSE: To describe an alternative surgical approach to treat inferior oblique overaction and report the first results of this technique. MATERIALS AND METHODS: A total of 6 consecutive eyes of 6patients with primary or secondary inferior oblique overaction underwent inferior oblique retro-equatorial myopexy under general anaesthesia. The primary outcomes measured were the postoperative vertical deviation in the field of action of the inferior oblique muscle, and the intra- and postoperative surgical complications. Final results were evaluated at six-months after surgery. RESULTS: The patient population consisted of 3 girls and 3 boys aged between 4 and 7 years old. The mean preoperative inferior oblique overaction was 34° ± 4.6°, equivalent to 3+. Inferior oblique overaction was reduced in all patients with a mean reduction of 28° ± 1.98°, and the mean postoperative deviation was 6° ± 2.84°. Total success was achieved in four out of six eyes, and only one case remained under-corrected. No intra- or postoperative complications were reported. CONCLUSION: Inferior oblique retro-equatorial myopexy is an alternative surgical approach for inferior oblique overaction. It is an efficient, safe, and reversible technique that could be used in cases of inferior oblique overaction between 2+ to 3+


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Músculos Oculomotores/cirurgia , Transtornos da Motilidade Ocular/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Prospectivos , Período Pré-Operatório , Período Pós-Operatório , Acuidade Visual
14.
Arch. Soc. Esp. Oftalmol ; 95(5): 0-0, mayo 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-186850

RESUMO

El objetivo es describir dos cuadros clínicos neuroftalmológicos en niños por infección sistémica por Mycoplasma pneumoniae (M. pneumoniae). Se presentan los casos de dos niñas de 14 y 12 años que acudieron a urgencias: la primera con oftalmoplejía internuclear y la segunda con pérdida de visión y cefalea. No presentaban otra focalidad neurológica. En la imagen de resonancia magnética se evidenciaron placas hiperintensas en ambas, sugerentes de cuadro desmielinizante. Al mes, los síntomas neuroftalmológicos se resolvieron y las resonancias magnéticas de control fueron normales. El diagnóstico fue encefalitis diseminada aguda secundaria a M. pneumoniae. El diagnóstico se hace por PCR (gold standard) y/o IgM en serología. Es importante pensar en esta posible etiología ante casos sugerentes de enfermedad desmielinizante. Existe controversia sobre el papel de los antibióticos y si se contemplan los corticoides. Como conclusión, M. pneumoniae debe ser diagnóstico diferencial en afectaciones neuroftalmológicas agudas en niños


The purpose of this article is to describe two paediatric neuro-ophthalmological clinical cases caused by a systemic infection due to Mycoplasma pneumoniae (M. pneumoniae). The cases are two girls aged 14 and 12 seen in the Emergency Department: The first one had internuclear ophthalmoplegia and second with loss of vision and headache. They had no other neurological foci. Magnetic resonance imaging showed hyperintense plaques in both, suggestive of a demyelinating disease. One month later, the neuro-ophthalmological symptoms resolved, with normal follow-up magnetic resonance imagings. The diagnosis was acute disseminated encephalitis secondary to M. pneumoniae. The diagnosis was made using PCR (gold standard) and/or IgM in serology. It is important to think about this possible aetiology in cases of suggestive demyelinating disease. There is controversy about the role of antibiotics and on whether corticosteroids are contemplated. In conclusion, M. pneumoniae must be a differential diagnosis in acute neuro-ophthalmological disorders in children


Assuntos
Humanos , Feminino , Criança , Adolescente , Infecções por Mycoplasma/complicações , Encefalomielite Aguda Disseminada/complicações , Encefalomielite Aguda Disseminada/virologia , Transtornos da Motilidade Ocular/etiologia , Neurite Óptica/etiologia , Mycoplasma pneumoniae , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia de Coerência Óptica
15.
Arch. Soc. Esp. Oftalmol ; 95(1): 38-41, ene. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195316

RESUMO

El síndrome de Kabuki es una enfermedad genética rara debida a una mutación genética en los genes KMT2D y KDM6A, que afecta a múltiples órganos, entre ellos los ojos, en la mayoría de los pacientes. Las características clínicas más típicas son: facies peculiar, baja estatura, anormalidades esqueléticas y bajo coeficiente intelectual. Las manifestaciones oculares más frecuentes son el estrabismo, la ptosis y los defectos refractivos. Presentamos una serie de casos de 5 pacientes (3 mujeres), 4 de ellos con estrabismo en forma de esotropía, hiperacción de oblicuos inferiores e hipofunción de oblicuos superiores asociado a un síndrome V. Son pocos los casos publicados de síndrome de Kabuki que describan las afectaciones oftalmológicas y las estrabológicas. Podría ser conveniente la realización de resonancias magnéticas orbitarias para detectar cambios en los trayectos musculares que estén relacionados con la patología de los movimientos oculares encontrados


Kabuki syndrome is a rare genetic disorder, caused by mutation in the KMT2D or KDM6A genes, which affects several organs in the majority of patients, among which are the eyes. The most typical clinical characteristics are mental retardation, postnatal growth retardation, skeletal anomalies, and characteristic facial features. As the eyes are affected in most of the cases, ophthalmological examination is recommended for the early detection of ocular anomalies, in order to prevent visual impairment. The most frequent ocular signs are strabismus, ptosis, and refractive anomalies. A series of cases of Kabuki syndrome is described in five children, four of whom exhibited strabismus with esotropia, over action of inferior oblique muscles, and under action of superior oblique muscles associated with a V pattern. Most published papers do not report or might underestimate the ocular problems. It may be appropriate to perform orbital magnetic resonances in order to detect changes in the muscle paths that are related to the pathology of the eye movements found


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Anormalidades Múltiplas/fisiopatologia , Face/anormalidades , Doenças Hematológicas/fisiopatologia , Transtornos da Motilidade Ocular/genética , Doenças Vestibulares/fisiopatologia , Anormalidades Múltiplas/genética , Astigmatismo/genética , Blefaroptose/genética , Proteínas de Ligação a DNA/genética , Face/fisiopatologia , Mutação da Fase de Leitura , Doenças Hematológicas/genética , Hiperopia/genética , Proteínas de Neoplasias/genética , Estrabismo/genética , Estrabismo/cirurgia , Doenças Vestibulares/genética
16.
Arch. Soc. Esp. Oftalmol ; 94(6): 309-312, jun. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-185054

RESUMO

El síndrome del uno y medio de Fisher está producido por una lesión unilateral en la parte dorsal e inferior de la protuberancia localizada específicamente en el tegmento pontino, área que contiene el fascículo longitudinal medial (FLM), la formación reticular paramediana pontina (FRPP) y el núcleo del VI par craneal, responsables de los movimientos horizontales de la mirada. Clínicamente se manifiesta con una parálisis conjugada de la mirada con oftalmoplejía internuclear ipsilateral. Se presenta el caso de una paciente de 60 años de edad que, tras presentar diplopía binocular, oftalmoplejía y parálisis de la mirada conjugada a la izquierda se realizaron estudios de imagen observándose un hematoma hemiprotuberancial secundario a un cavernoma. Tras conducta expectante presentó varios episodios de resangrados con empeoramiento clínico: cefalea, diplopía, tetraparesia e hipoestesia en hemicara derecha, por lo que ante tal evolución se planteó exéresis microquirúrgica del cavernoma protuberancial


The one and a half Fisher syndrome is produced by an unilateral lesion in the dorsal and inferior part of the pons located specifically in the pontine tegmentum. This is an area that contains the medial longitudinal fasciculus (LMF), the paramedian pontine reticular formation (PPRF) and the nucleus of the sixth cranial nerve, responsible for the horizontal movements of the gaze. Clinically it manifests with conjugate gaze palsy with internuclear ophthalmoplegia. The case is reported on a 60 year-old patient, who presented with binocular diplopia, ophthalmoplegia and paralysis of the gaze conjugated to the left. Imaging studies were performed that showed a hemi-protuberant haematoma secondary to a cavernoma. As expected, he presented with several episodes of re-bleeding with clinical worsening: headache, diplopia, tetraparesis, and hypoaesthesia in the right side of the face, as such that the microsurgical exeresis of the protuberant cavernoma was considered


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Encefalopatias/etiologia , Neoplasias Encefálicas/complicações , Tronco Encefálico , Hemangioma Cavernoso/complicações , Transtornos da Motilidade Ocular/etiologia , Síndrome
18.
Arch. Soc. Esp. Oftalmol ; 94(3): 107-113, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-178310

RESUMO

Objetivo: Describir las alteraciones de la motilidad ocular, tratamiento y resultados en la miastenia gravis (MG). Material y método: Se analizaron retrospectivamente datos de pacientes con MG. Se evaluaron la edad media, el sexo, el diagnóstico inicial, la desviación ocular, la evolución de los síntomas, el tratamiento realizado y los resultados. Se consideró buen resultado la resolución de la desviación o diplopía al final del seguimiento en posición primaria de mirada y lectura. Resultados: Se incluyeron 14 casos (9: mujeres; bilaterales: 10) de edad media: 55,64 años. En 4 el diagnóstico fue realizado en oftalmología. El diagnóstico inicial fue en 3 casos parálisis del iii par bilateral, en uno parálisis del iii par unilateral, en 3 paresia de recto superior o inferior, en 2 casos parálisis del vi par, en uno paresia del iv par, en 3 de exotropía y en uno de endotropía. La diplopía se presentó en los 14 casos y 9 asociaron ptosis. La desviación ocular fue horizontal en 11 (8: exotropía) y vertical en 4. Se realizó cirugía de estrabismo con buen resultado final en 4 casos que no respondieron al tratamiento farmacológico. Seis pacientes resolvieron la diplopía con el tratamiento farmacológico y un caso con prismas. La ptosis requirió tratamiento quirúrgico en un paciente. Se consiguieron buenos resultados en un 78,57%. Conclusión: La diplopía de comienzo agudo secundaria a un estrabismo de ángulo variable o parálisis oculomotora, con o sin ptosis, puede ser diagnóstico de MG. La cirugía de estrabismo consiguió buenos resultados. El tratamiento farmacológico no consiguió resolver la diplopía en todos los casos


Objective: To present a report of the ocular motility disorders, treatment and outcomes of myasthenia gravis (MG). Material and method: A retrospective study was performed on the data of patients with MG. An evaluation was made using mean age, gender, initial diagnosis, ocular deviation, time of onset of clinical characteristics, treatment and results. Resolution of diplopia and/or ocular deviation in primary and reading gaze was considered a good outcome at the end of follow-up. Results: A total of 14 cases were included. The mean age of the sample was 55.64 years, of which 9 were women, and 10 cases were bilateral. The diagnosis was made by ophthalmologists in 4 cases. The initial diagnoses were diverse: bilateral cranial third nerve palsy in 3, unilateral third nerve palsy in 1, superior or inferior rectus palsy in 3, sixth nerve palsy in 2, fourth nerve palsy in 1, exotropia in 3 and esotropia in 1. Diplopia was presented in 14 cases and 9 associated ptosis. The different types of strabismus were horizontal ocular deviation in 11 cases: 8 with exotropia, and 4 with vertical deviation. Strabismus surgery was performed in 4 cases that did not respond to medical treatment, with a good final outcome. Pharmacological treatment resolved diplopia in 6 cases, and prisms in one. Ptosis surgery was only necessary in one patient. Outcome was favourable in 78.57% at the end of follow-up. Conclusion: Acute onset diplopia caused by strabismus with variable angle or oculomotor palsy, associated or not with a ptosis can indicate MG. There were favourable outcomes with strabismus surgery. Pharmacological treatment did not resolve the diplopia in all cases


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diplopia/etiologia , Diplopia/cirurgia , Estrabismo/complicações , Estrabismo/cirurgia , Miastenia Gravis/complicações , Transtornos da Motilidade Ocular/terapia , Estudos Retrospectivos , Blefaroptose/cirurgia
19.
J. optom. (Internet) ; 10(3): 169-175, jul.-sept. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-164146

RESUMO

Purpose: To evaluate the changes in the stimulus and response Accommodative Convergence to Accommodation (AC/A) ratio following vision therapy (VT) in Convergence Insufficiency (CI). Methods: Stimulus and response AC/A ratio were measured on twenty five CI participants, pre and post 10 sessions of VT. Stimulus AC/A ratio was measured using the gradient method and response AC/A ratio was calculated using modified Thorington technique with accommodative responses measured using WAM-5500 open-field autorefractor. The gradient stimulus and response AC/A cross-link ratios were compared with thirty age matched controls. Results: Mean age of the CI and control participants were 23.3 ± 5.2 years and 22.7 ± 4.2 years, respectively. The mean stimulus and response AC/A ratio for CI pre therapy was 2.2 ± 0.72 and 6.3 ± 2.0 PD/D that changed to 4.2 ± 0.9 and 8.28 ± 3.31 PD/D respectively post vision therapy and these changes were statistically significant (paired t-test; p < 0.001). The mean stimulus and response AC/A ratio for controls was 3.1 ± 0.81 and 8.95 ± 2.5 PD/D respectively. Conclusions: Stimulus and response AC/A ratio increased following VT, accompanied by clinically significant changes in vergence and accommodation parameters in subjects with convergence insufficiency. This represents the plasticity of the AC/A crosslink ratios that could be achieved with vision therapy in CI (AU)


Objetivo: Evaluar los cambios de la relación convergencia acomodativa/acomodación (AC/A) estímulo y respuesta, tras terapia visual (TV) en casos de Insuficiencia de Convergencia (CI). Métodos: Se midieron las relaciones AC/A de estímulo y respuesta en veinticinco participantes, tras realizar sesiones previas y posteriores de TV. La relación AC/A de estímulo se midió utilizando el método gradiente, y la relación AC/A de respuesta se calculó utilizando la técnica modificada de Thorington, midiendo las respuestas acomodativas con un autorrefractómetro de campo abierto WAM-5500. Se compararon las relaciones cruzadas AC/A gradiente estímulo y respuesta con treinta controles emparejados por edad. Resultados: La edad media del grupo con CI y el grupo control fue de 23,3 ± 5,2 años y 22,7 ± 4,2 años, respectivamente. La relación media AC/A de estímulo y respuesta para CI previa a la terapia fue de 2,2 ± 0,72 y 6,3 ± 2 PD/D, cuyos valores fueron de 4,2 ± 0,9 y 8,28 ± 3,31 PD/D respectivamente tras la terapia visual. Dichos cambios fueron estadísticamente significativos (prueba de t pareada; p < 0,001). La relación media AC/A de estímulo y respuesta para los controles fue de 3,1 ± 0,81 y 8,95 ± 2,5 PD/D. Conclusiones: La relación AC/A de estímulo y respuesta se incrementó tras la TV, junto a cambios clínicamente significativos en lo que respecta a vergencia y parámetros de acomodación en los pacientes con insuficiencia de convergencia. Esto representa la plasticidad de las referencias cruzadas AC/A, que podría alcanzarse con terapia visual en los casos de CI (AU)


Assuntos
Humanos , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/terapia , Convergência Ocular/fisiologia , Acomodação Ocular/fisiologia , Optometria/métodos , Visão Binocular/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Refratometria/métodos , Ambliopia/complicações , Estrabismo/complicações
20.
Arch. Soc. Esp. Oftalmol ; 92(4): 175-177, abr. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-161825

RESUMO

CASO CLÍNICO: Paciente con síndrome de Duane, operado con transposición aumentada de recto superior (TRS) al recto lateral (RL), y recesión del recto medio (RM). En el postoperatorio se observó desviación vertical, torsional y diplopía. La retirada de la fijación escleral y la recesión del RS lo resolvieron. DISCUSIÓN: La TRS al RL está descrita en el tratamiento del síndrome de Duane con resultados controvertidos. Puede ser una alternativa a la transposición de los rectos verticales cuando asocia la recesión del RM en el mismo procedimiento, o en el postoperatorio inmediato para disminuir el riesgo de isquemia del segmento anterior


CLINICAL CASE: A patient diagnosed with Duane syndrome underwent an augmented superior rectus transposition (SRT) to lateral rectus (LR) and medial rectus (MR) recession. Vertical, torsional deviation and diplopia were observed post-operatively. Removal of the Foster suture and superior rectus recession resolved the symptoms. DISCUSSION: SRT to LR is proposed in Duane syndrome with a favorable outcome. The benefit of SRT is open to debate. It could be an alternative for the vertical rectus transposition when MR recession has to be operated on in the same procedure, or in the immediate post-operative period, in order to decrease the risk of anterior segment ischaemia


Assuntos
Humanos , Masculino , Idoso , Síndrome da Retração Ocular/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Complicações Pós-Operatórias , Segmento Anterior do Olho/irrigação sanguínea , Segmento Posterior do Olho/fisiopatologia , Transtornos da Motilidade Ocular/complicações
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