RESUMO
Proptosis and double vision were the presenting signs in a case of chronic orbital inflammation generated by osteolytic destruction of the sinuorbital barriers due to intranasal abuse of cocaine. The pathophysiologic background and reports from the literature dealing with orbital involvement in this condition are discussed.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Doenças Orbitárias/etiologia , Osteólise/etiologia , Doenças dos Seios Paranasais/etiologia , Administração Intranasal , Diplopia/etiologia , Exoftalmia/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Acuidade Visual , Testes de Campo Visual , Campos VisuaisRESUMO
PURPOSE: To develop a general setting-independent decision-analytical model that determines the costs, effectiveness, and cost-effectiveness of four screening strategies to detect amblyopia or amblyogenic factors in pre-school children and to apply the model in a German setting. METHODS: The general setting-independent decision-analytical model was developed from the perspective of society and the statutory health insurance was developed. Outcomes were the total number of newly detected true positive cases of amblyopia and the costs per newly detected true positive case of amblyopia. Strategies were screening of high-risk children up to the age of 1 year (ophthalmologists), screening of all children up to the age of 1 year (ophthalmologists), screening of all children aged 3 to 4 years (pediatricians or general practitioners), and screening of children aged 3 to 4 years visiting kindergarten (orthoptists). For the application example in a German setting, data from the published medical literature were used. RESULTS: In the base-case analysis of the application example, screening high-risk children by ophthalmologists had the lowest average cost per case detected but became dominated (less effective and more costly than an alternative) if a low (5.3%) probability of familial clustering of strabismus was assumed. Considering the various assumptions tested in the sensitivity analysis, screening of all children up to the age of 1 year by ophthalmologists was the only strategy not dominated by others. Detection rates, including cases detected before screening, were between 72% and 78% for the strategies that screen for all children. CONCLUSIONS: The model suggests that in Germany, both from a cost-effectiveness and a pure effectiveness point of view, screening all children up to the age of 1 year by ophthalmologists is the preferred strategy to detect amblyopia or amblyogenic factors. All strategies left a significant portion of children undetected.
Assuntos
Ambliopia/diagnóstico , Ambliopia/economia , Modelos Econômicos , Seleção Visual/economia , Criança , Análise Custo-Benefício , Alemanha , Custos de Cuidados de Saúde , Humanos , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
Ocular neuromyotonia is a rare motility disorder occurring after tumor irradiation near the skull base or as a consequence of vascular abnormalities. Ocular myasthenia, convergence spasm and a cyclic third nerve palsy must be considered as differential diagnoses. The case of a 32-year-old woman suffering from intermittent diplopia six months after radiation therapy of a recurrent pituary gland adenoma is presented.
