The importance of cyclotorsional changes in refractive surgery.

PURPOSE: To provide evidence of the importance of a precise record of torsional alterations in all patients about to undergo refractive surgery and particularly in patients with latent strabismus that may become decompensated due to the dissociation phenomenon produced during different surgical procedures that result in fixation loss. METHODS: Using 3D-VOG video-oculography, the authors analyzed the horizontal, vertical, and torsional movements of each eye after inducing fixation loss in one and both eyes in a patient with well-compensated dissociated vertical deviation (DVD). As the dissociated techniques, Posner maneuver and the placing of Bagolini filters with increasing densities by means of the Bielschowsky phenomenon, both pathognomonic of DVD. RESULTS: The authors observed not only horizontal and vertical alterations, but also cyclotorsional alterations which may even exceed 15 degrees depending on the resulting dissociation component. CONCLUSIONS: In view of the obtained results, the authors consider it important to conduct a meticulous study of ocular motility in all patients about to undergo refractive surgery, especially in the case of high astigmatism to rule out possible latent strabismus that may condition cyclotorsional alterations important in refractive surgery.

[Optic neuritis after meningococcal vaccination]. / Neuritis óptica tras vacunación de meningitis.

CASE REPORT: We report the case of a 13 year-old male with bilateral optic neuritis after meningococcal C vaccination. He was treated with intravenous corticosteroids, but only showed visual recovery in one eye. A significant limitation of his sharp vision remained in his other eye. DISCUSSION: There have been no previously reported cases of optic neuritis after meningococcal C vaccination and for this reason we have reported this case. It is not possible, however, to exclude some other factor in the etiology of the optic neuritis, but the temporal relationship between the neuritis and the vaccination suggests this was the cause.

Newborn hearing screening in the Campania region (Italy): early language and perceptual outcomes of infants with permanent hearing loss.

Hearing loss in children causes a deficit in early perceptive and language skills. The objective of this study was to evaluate early receptive and expressive language outcomes in children with hearing loss, identified by hearing screening, compared to the time of diagnosis. We studied 18 severely hearing impaired children who were divided into two groups according to the time of diagnosis. Evaluation of communicative language ability was carried out at 18 month of age using the "MacArthur Child Development Inventory" questionnaire, while evaluation of acoustic-perceptual abilities was assessed with the Genovese-Arslan protocol every three months following diagnosis. The linguistic communicative and acoustic-perceptual outcomes of hearing impaired children diagnosed before 6 months of age followed those expected for normally hearing children, with a trend of temporal progression of skills that were faster than those of children diagnosed after 6 months of age.

New diplopic restrictive strabismus as a sequela after conjunctival surgery for conjunctival lesions: a series of 3 cases, management and outcome.

OBJECTIVE: To present three clinical cases of diplopia secondary to conjunctival surgery (for tumor of caruncle and recurrent pterygium surgery). PATIENTS AND METHODS: Clinical data of three patients with binocular diplopia and incomitant esotropia associated with compensatory torticollis and duction limitation are shown and discussed. In all cases, a complete ophthalmological examination was performed including ocular motility study, duction test and preoperative evaluation under general anesthesia. RESULTS: The forced duction test was positive in all cases, confirming the diagnosis of restrictive strabismus. Uneventful surgery was performed in all cases in which conjunctival adherences to eye orbit bones were eliminated and the involved extraocular muscle was isolated and freed. Furthermore, some additional treatments were applied to avoid recurrency (subconjunctival and topical corticosteroids, amniotic membrane and therapeutic contact lens). One case presented postoperatively a new conjunctival adherence in spite of such anti-recurrency treatment although with no significant motility alterations associated. CONCLUSIONS: Conjunctival surgery can cause fibrosis and conjunctival adherences leading to restrictive strabismus. The surgical procedure for solving this problem must be performed with special care to avoid complications and recurrencies. The use of antimetabolites or amniotic membrane seems to be recommendable to ensure a satisfactory postoperative outcome.

Combined non-steroidal therapy in experimental corneal injury.

PURPOSE: The effects of anti-inflammatory non-steroidal therapy combined with free-radical scavengers were studied and compared to corticosteroid use in the treatment of experimental corneal injury. METHOD: Eighty New Zealand albino rabbits were used in this study. A corneal alkali burn was induced by applying 1-N NaOH filter paper on the central axis of the right cornea for 30 s. Animals were distributed into five treatment groups: group 1 (control group) was only given gentamicin; group 2 was treated with 0.5% dimethylthiourea (DMU); group 3 received 1% dexamethasone; group 4 was given combined 0.5% DMU and 1% indomethacin; group 5 was treated with 0.5% DMU and 0.1% diclofenac sodium. One 50-microliter drop of gentamicin was instilled every 12 h, whereas the other drugs were instilled every 6 h (50 microliters). All groups received the same antibiotic treatment as the control group. The animals were killed on the 5th day. Inflammatory index, area and perimeter of the wounded corneal zone, and corneal transparency were evaluated. RESULTS: No significant differences in the inflammatory index were found between the treatment groups and the control group after 72 h. Significant differences (p < 0.001) were observed at 24 h in groups 3-5 when compared with the control group. Planimetry showed significant differences in group 4 when compared with the other groups (p < 0.05). Corneal transparency study showed statistically significantly better values in groups 4 and 5, when compared with the other groups, including group 3 (p < 0.05). CONCLUSIONS: The use of 0.5% DMU combined with 1% indomethacin can be considered an alternative to corticosteroid treatment in our experimental chemical corneal injury.