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BACKGROUND: To evaluate the clinical findings of patients with SOP who underwent surgery. METHODS: This historical cohort study was performed on 1057 SOP patients managed with surgery in Farabi Hospital, Iran, from 2011 to 2022. RESULTS: There were 990 (93.7%) patients with unilateral SOP with the mean age of 21.8 ± 14.8 years. Of these, 715 patients (72.2%) were diagnosed with congenital SOP, and 275 patients (27.8%) had acquired SOP (P < 0.001). In contrast, 67 (6.3%) patients were diagnosed with bilateral SOP, with the mean age of 19.4 ± 15.6 years. Among these, 18 cases exhibited the masked type. The mean angle of vertical deviation in primary position at far in unilateral and bilateral cases was 15.6 ± 8.3 and 13.3 ± 9.1 â³, respectively (P < 0.001). In unilateral cases, abnormal head posture (AHP) was detected in 847 (85.5%) patients and 12 (1.2%) had paradoxical AHP. Amblyopia was found in 89 (9.9%) unilateral and 7 (10.3%) bilateral cases. Solitary inferior oblique myectomy, was the most common surgery in both unilateral (n = 756, 77.1%) and bilateral (n = 35, 52.2%) patients. The second surgery was performed for 84 (8.6%) unilateral and 33 (49.3%) bilateral cases (P < 0.001). The prevalence of amblyopia and the mean angle of horizontal deviation were significantly higher in patients who needed more than one surgery (all P < 0.05). CONCLUSION: Congenital SOP was more than twice as frequent as acquired SOP and about 90% of unilateral and 50% of bilateral cases were managed with one surgery. Amblyopia and significant horizontal deviation were the most important factors for reoperation. TRIAL REGISTRATION: The Institutional Review Board approval was obtained from the Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1400.012) and this study adhered to the tenets of the Declaration of Helsinki and HIPAA.
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Músculos Oculomotores , Procedimentos Cirúrgicos Oftalmológicos , Humanos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Músculos Oculomotores/cirurgia , Músculos Oculomotores/fisiopatologia , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Criança , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pré-Escolar , Doenças do Nervo Troclear/cirurgia , Doenças do Nervo Troclear/fisiopatologia , Doenças do Nervo Troclear/congênito , Irã (Geográfico)/epidemiologia , Idoso , Estrabismo/cirurgia , Estrabismo/fisiopatologia , Visão Binocular/fisiologia , Resultado do Tratamento , LactenteRESUMO
PURPOSE: To report the result of strabismus surgery in eye-salvaged retinoblastoma (Rb) patients. METHODS: A retrospective case series including 18 patients with Rb and strabismus who underwent strabismus surgery after completing tumor treatment by a single pediatric ophthalmologist. RESULTS: A total of 18 patients (10 females and 8 males) were included with a mean age of 13.3 ± 3.0 (range, 2-39) months at the time tumor presentation and 6.0 ± 1.5 (range, 4-9) years at the time of strabismus surgery. Ten (56%) patients had unilateral and 8(44%) had bilateral involvement and the most common worse eye tumor's group was D (n = 11), C (n = 4), B (n = 2) and E (n = 1). Macula was involved by the tumors in 12 (67%) patients. The tumors were managed by intravenous chemotherapy (n = 8, 47%), intra-arterial chemotherapy (n = 7, 41%) and both (n = 3, 17%). After complete treatment, the average time to strabismus surgery was 29.9 ± 20.5 (range, 12-84) months. Except for one, visual acuity was equal or less than 1.0 logMAR (≤ 20/200) in the affected eye. Seven (39%) patients had exotropia, 11(61%) had esotropia (P = 0.346) and vertical deviation was found in 8 (48%) cases. The angle of deviation was 42.0 ± 10.4 (range, 30-60) prism diopter (PD) for esotropic and 35.7 ± 7.9 (range, 25-50) PD for exotropic patients (P = 0.32) that after surgery significantly decreased to 8.5 ± 5.3 PD in esotropic cases and 5.9 ± 6.7 PD in exotropic cases (P < 0.001). The mean follow-up after surgery was 15.2 ± 2.0 (range, 10-24) months, in which, 3 (17%) patients needed a second surgery. CONCLUSION: Strabismus surgery in treated Rb is safe and results of the surgeries are acceptable and close to the general population. There was not associated with tumor recurrence or metastasis.
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Esotropia , Exotropia , Neoplasias da Retina , Retinoblastoma , Estrabismo , Masculino , Feminino , Humanos , Criança , Adolescente , Retinoblastoma/cirurgia , Retinoblastoma/complicações , Estudos Retrospectivos , Seguimentos , Recidiva Local de Neoplasia , Estrabismo/cirurgia , Esotropia/cirurgia , Músculos Oculomotores/cirurgia , Exotropia/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Neoplasias da Retina/cirurgia , Neoplasias da Retina/complicações , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the efficacy and toxicity of intravitreal carboplatin plus melphalan for the treatment of vitreous seeds in eyes with retinoblastoma (RB). METHODS: This retrospective series at a tertiary referral center included 22 consecutive RB patients who had received intravitreal carboplatin (16 µg per 0.05 ml) combined with melphalan (30 µg in 0.03 ml) [IVi (Ca-Me)] for treatment of vitreous seeds. Tumor control and drug toxicities were recorded. RESULTS: There were 22 eyes of 22 patients, divided into primary group (n = 13) without history of previous intravitreal chemotherapy (IViC) and refractory group (n = 9) with history of previous IViC using melphalan and/or topotecan. The demographics and clinical findings of the primary and refractory groups did not differ significantly. The 6-month follow-up revealed complete vitreous seed control (77% vs. 89%, p = 0.47). Vitreous seed recurrence was detected in 1 eye of each group at 6 months. During the next 18-month follow-up period, no recurrence of seed was observed. The response to IVi (Ca-Me) was not significantly influenced by previous IViC (p = 0.70), primary systemic or intra-arterial chemotherapy (p = 0.45), or the type of regression (p = 0.35). The most common tumor treatment complications were retinal detachment (RD) (n = 2), early hypotony (n = 2) and late hypotony (n = 4, unrelated), cataract (n = 2), and severe pigment dispersion (n = 1). Enucleation was performed in 8 eyes, for total RD (n = 1), phthisis bulbi (n = 5), and extensive solid tumor recurrence (n = 2). There was no case of orbital invasion, systemic metastasis, or death. CONCLUSION: Based on this interventional case series for primary and refractory vitreous RB seeds, carboplatin plus melphalan therapy may be effective with few toxic side effects.
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Neoplasias da Retina , Retinoblastoma , Humanos , Lactente , Retinoblastoma/diagnóstico , Retinoblastoma/tratamento farmacológico , Melfalan/efeitos adversos , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/tratamento farmacológico , Carboplatina/uso terapêutico , Estudos Retrospectivos , Antineoplásicos Alquilantes/efeitos adversos , Recidiva Local de Neoplasia/patologia , Corpo Vítreo/patologia , Inoculação de Neoplasia , Injeções IntravítreasRESUMO
BACKGROUND: To assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomography angiography (OCTA) in treated choroidal melanoma. METHODS: In this retrospective observational case series, we reviewed the recorded data of the patients with unilateral extramacular choroidal melanoma treated with ruthenium - 106 (106Ru) plaque radiotherapy with a follow-up period of more than 6 months. Automatically measured OCTA retinal parameters were analysed after image processing. RESULTS: Thirty-one eyes of 31 patients with the mean age of 51.1 years were recruited. Six eyes had no radiation maculopathy (RM). From 25 eyes with RM, nine eyes (36%) revealed a burnout macular microvasculature with imperceptible vascular details. Twenty-one non-irradiated fellow eyes from the enrolled patients were considered as the control group. Foveal and optic disc radiation dose had the highest value to predict the burnout pattern (ROC, AUC: 0.763, 0.727). Superficial and deep foveal avascular zone (FAZ) were larger in irradiated eyes in comparison to non-irradiated fellow eyes (1629 µm2 vs. 428 µm2, P = 0.005; 1837 µm2 vs 268 µm2, P = 0.021; respectively). Foveal and parafoveal vascular area density (VAD) and vascular skeleton density (VSD) in both superficial and deep capillary plexus (SCP and DCP) were decreased in all irradiated eyes in comparison with non-irradiated fellow eyes (P < 0.001). Compared with non-irradiated fellow eyes, irradiated eyes without RM had significantly lower VAD and VSD at foveal and parafoveal DCP (all P < 0.02). However, these differences at SCP were not statistically significant. CONCLUSION: The OCTA is a valuable tool for evaluating RM. Initial subclinical microvascular insult after 106Ru brachytherapy is more likely to occur in DCP. The deep FAZ area was identified as a more critical biomarker of BCVA than superficial FAZ in these patients.
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Degeneração Macular , Melanoma , Angiofluoresceinografia , Humanos , Melanoma/radioterapia , Pessoa de Meia-Idade , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Radioisótopos de Rutênio , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To assess risk factors for ophthalmic vascular events after intra-arterial chemotherapy (IAC) for retinoblastoma. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients who received unilateral IAC as primary treatment for retinoblastoma from January 1, 2009, to November 30, 2017, at a single center. METHODS: Records were reviewed for patient demographics, tumor features, IAC parameters, and treatment-related vascular events in the early IAC era (2009-2011) compared with the recent era (2012-2017) using the t test and Fisher exact test. Change in event rates over time was assessed using Poisson regression analysis, with Spearman's rho used to test correlation. MAIN OUTCOME MEASURES: Rate of IAC-induced ophthalmic vascular events. RESULTS: There were 243 chemotherapy infusions in 76 eyes of 76 patients, divided into early (22 eyes, 57 infusions) and recent (54 eyes, 186 infusions) eras. Intra-arterial chemotherapy consisted of melphalan (243 infusions), topotecan (124 infusions), and carboplatin (9 infusions). A comparison (early vs. recent era) revealed fewer mean number of infusions (2.6 vs. 3.4, P = 0.02) with similar mean patient age and presenting tumor features. Event rates decreased over time (P < 0.01), with fewer ophthalmic vascular events (early era vs. recent era) in the recent era (59% vs. 9% per eye, 23% vs. 3% per infusion, P < 0.01), including peripheral retinal nonperfusion (5% vs. 2% per eye, P = 0.50), vitreous hemorrhage (9% vs. 2%, P = 0.20), subretinal hemorrhage (0% vs. 2%, P = 0.99), branch retinal vein occlusion (5% vs. 0%, P = 0.29), choroidal ischemia (14% vs. 4%, P = 0.14), and ophthalmic artery spasm/occlusion (27% vs. 0%, P < 0.01). Events did not correlate to patient age (P = 0.75), tumor diameter (P = 0.32), tumor thickness (P = 0.59), or cumulative dosage of melphalan (P = 0.13) or topotecan (P = 0.59). There were no IAC-induced vascular events in 72 infusions of 21 consecutively treated eyes in 2016 to 2017. CONCLUSIONS: Ophthalmic vascular events after IAC have decreased from the early era (2009-2011) through the current era (2012-2017) at this center. Experience performing this highly specialized procedure could be an important factor predicting IAC-related vascular events.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Infusões Intra-Arteriais/efeitos adversos , Doenças Retinianas/epidemiologia , Neoplasias da Retina/tratamento farmacológico , Vasos Retinianos/patologia , Retinoblastoma/tratamento farmacológico , Adolescente , Carboplatina/administração & dosagem , Criança , Pré-Escolar , Feminino , Angiofluoresceinografia , Humanos , Lactente , Masculino , Melfalan/administração & dosagem , Oftalmoscopia , Doenças Retinianas/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Topotecan/administração & dosagem , Ultrassonografia , Adulto JovemRESUMO
PURPOSE: To evaluate the results of conjunctival culture in patients with nasolacrimal duct obstruction (NLDO) and its changes after successful dacryocystorhinostomy surgery. METHODS: In this prospective study, 71 adult patients with NLDO and 41 age- and sex-matched controls without NLDO were evaluated. The patients were divided in 2 groups based on clinical examination; group A with purulent regurgitation and group B without purulent regurgitation. Dacryocystorhinostomy surgery was performed, and the silicon tube was inserted in patients with upper lacrimal drainage system stenosis and when the lacrimal sac or nasal mucosal flap was inadequate for suitable anastomosis. Before surgery, microbiologic specimens were taken from the conjunctiva. Postoperative conjunctival sampling was continued weekly until the culture became negative or the colony count reached to the range of the control group. RESULTS: There were 38 and 33 patients in groups A and B, respectively. Silicone tube was inserted for 17 patients (23.9%). The culture was positive for bacterial growth in all cases. The conjunctival culture in the control group was positive in 17 eyes (41.4%). The mean count of colonies in a sample unit was 5274 ± 6300, 1167 ± 1504, and 9.5 ± 1.5 for group A, group B, and controls, respectively. The mean time of normalization of specimens was 3.3 ± 1.3 weeks (range 1-7). Pathogenic bacterial growth, higher colony counts, the presence of silicone tube, and purulent regurgitation were significantly associated with longer normalization time (p = 0.007, p = 0.0001, p = 0.0001, and p = 0.01, respectively). CONCLUSIONS: This study suggests that after successful dacryocystorhinostomy surgery, a waiting period of 7 weeks is enough for conjunctival bacterial cultures to become negative or reach the level of the normal eyes.
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Túnica Conjuntiva/microbiologia , Infecções Oculares Bacterianas/microbiologia , Obstrução dos Ductos Lacrimais/microbiologia , Ducto Nasolacrimal/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus saprophyticus/isolamento & purificação , Estudos de Casos e Controles , Contagem de Colônia Microbiana , Dacriocistorinostomia , Infecções Oculares Bacterianas/cirurgia , Feminino , Humanos , Intubação , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/cirurgia , Estudos Prospectivos , Elastômeros de Silicone , Infecções Estafilocócicas/cirurgia , Fatores de TempoRESUMO
Introduction: Amblyopia, or lazy eye, is a type of visual impairment in which the eyesight is not complete, even with the use of glasses. For the treatment of this disease, accurate and continuous examinations are needed. Nowadays, patient-centered care, by relying on web-based electronic records for amblyopia, has the potential to reduce treatment costs, increase the quality of care, and improve the safety and effectiveness of treatment. Therefore, the purpose of this study is to design and evaluate an Electronic Health Record (EHR) for patients with amblyopia. Methods: The present study is applied developmental research. Using a Morgan table as a sampling tool, a straightforward random sampling technique selected 150 records from 1,500 records that were free of flaws. The design of the electronic version proceeded in a cascading manner so that after the design of each part, it was presented to the amblyopia experts, and if approved, the next part was designed. To design this EHR, the C# programming language and MySQL database were used. A system evaluation was performed by entering and recording patient information. For this purpose, the standard Questionnaire of User Interaction Satisfaction (QUIS), consisting of 18 questions, was used. Results: According to the amblyopia EHR data elements, the data of physician and patient, examinations, website members, and members' roles were determined. After defining the fields and classes that explain the tables, the EHR was designed. The usability evaluation of the system showed that the mean selection of very good and good options by the users of EHRs was over 90%, indicating the patients' acceptance of web-based EHRs. Conclusion: The design of an EHR for amblyopia is an effective step toward integrating and improving the information management of these patients. It will also enable the storage and retrieval of patients' information to reduce and facilitate the control of amblyopia complications.
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Persistent unilateral or bilateral visual deprivation at any age, particularly in children, can compromise sensory fusion and result in a type of strabismus known as sensory or secondary strabismus. There are several pathologies that can induce visual impairment, such as severe anisometropia, congenital unilateral cataract, corneal opacity, retinal diseases, and optic nerve anomalies. Sensory strabismus may be horizontal or vertical or a combination of them; however, most reports indicate the development of horizontal deviation as sensory strabismus. Regardless of the direction of the sensory strabismus, early diagnosis and management of the underlying pathology are important before strabismus treatment. The primary treatment approach for patients with sensory strabismus is surgery to correct ocular misalignment and straighten the eyes. This can help to improve the patients' symptoms and diminish the negative psychosocial impacts. In this article, we review the underlying etiologies and background pathologies associated with sensory strabismus. In addition, we investigate the determinant factors of the direction of sensory strabismus and its management strategies.
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Anisometropia , Doenças Retinianas , Estrabismo , Baixa Visão , Criança , Humanos , Estrabismo/diagnósticoRESUMO
PURPOSE: This study aimed to compare the preoperative clinical features of patients with sensory esotropia (ET) and sensory exotropia (XT). METHODS: In a retrospective study, the medical records of 13,252 patients who underwent strabismus surgery were reviewed at the Farabi Eye Hospital, Iran, from 2012 to March 2022. There were 1017 patients with sensory horizontal strabismus whose, in their worse eye, had corrected distance visual acuity (CDVA) equal to or <20/160 tested with the Snellen chart. RESULTS: The mean age of patients was 29.0 ± 12.4 years [574 (56.4%) males and 443 (43.6%) females]. Sensory XT and ET were observed in 717 (70.5%) and 300 (29.5%) patients, respectively (P<.001). The mean CDVA in the strabismic and non-strabismic eyes was 1.40 ± 0.75 and 0.05 ± 0.13, respectively (P<.001). Also, the CDVA in the strabismic eyes was significantly worse in the patients with sensory XT than in the patients with sensory ET (P<.001). Sphere and spherical equivalent (SE) components were more hyperopic in both eyes of patients with sensory ET than sensory XT (P<.001). In sensory ET group, the mean horizontal deviation at far and near was significantly higher than the sensory XT group (both P<.001). The prevalence of moderate and severe amblyopia among all patients with sensory strabismus was 274 (26.9%) and 727 (71.5%), respectively (P<.001). There were 398 (39.1%) patients who needed more than one surgery. CONCLUSION: The frequency of sensory XT was about 2.5 times more than the sensory ET. Most patients with sensory ET were operated at a younger age, had better CDVA, more hyperopic spherical and SE, and higher angle of deviation compared with patients with sensory XT. The chance of reoperation in patients with sensory strabismus was about 40%.
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Esotropia , Exotropia , Acuidade Visual , Humanos , Feminino , Masculino , Estudos Retrospectivos , Adulto , Esotropia/fisiopatologia , Esotropia/cirurgia , Acuidade Visual/fisiologia , Adulto Jovem , Exotropia/fisiopatologia , Exotropia/cirurgia , Adolescente , Pessoa de Meia-Idade , Criança , Músculos Oculomotores/cirurgia , Músculos Oculomotores/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos , Pré-Escolar , Irã (Geográfico)/epidemiologia , Visão Binocular/fisiologia , IdosoRESUMO
Scleritis is a rare complication of strabismus surgery. We present the case of an 11-year-old girl with Down syndrome who underwent strabismus surgery and developed bilateral symmetric nodular scleritis 3 weeks after surgery. Anterior segment optical coherence tomography revealed localized hyporeflective thickening of the sclera at the primary site of muscle insertion in both eyes. Treatment with topical and oral corticosteroids led to resolution of her condition.
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Purpose: To report a 3-month-old boy with rapid progressive orbital intraosseous hemangioma which was treated with excisional biopsy and orbital rim reconstruction. Observation: A 3-month-old boy was referred with the aggressive growth of a mass on the right orbital region. The mass was noted to develop over 4 weeks. On presentation this firm nontender orbital mass measuring 5 × 5cm mimicked a more ominous malignancy. The spiral computed tomography scan showed a destructive mass with protrusion superiorly and inferiorly toward the orbital cavity and anterior cranial fossa. The patient underwent gross tumor resection and reconstruction of the orbital rim. Histology findings revealed an intraosseous hemangioma. There was no evidence of recurrence after 1-year follow-up. Conclusion and Importance: Due to rapid progression, the patient's age, and lesion size, this case is unique. There were additional challenges regarding complete resection, intra-cranial extension, and significant blood loss in an infant. Therefore, in the face of rapidly progressing orbital tumors in infants, despite the very low prevalence of intraosseous hemangioma, this diagnosis should be considered.
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PURPOSE: To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS). METHOD: This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022. RESULTS: The mean age of patients was 19.4 ± 11.9 (range, 3-70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia. CONCLUSION: This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.
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Ambliopia , Síndrome da Retração Ocular , Acuidade Visual , Humanos , Ambliopia/fisiopatologia , Ambliopia/epidemiologia , Masculino , Feminino , Estudos Retrospectivos , Adulto , Acuidade Visual/fisiologia , Criança , Pré-Escolar , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Idoso , Irã (Geográfico)/epidemiologia , Síndrome da Retração Ocular/fisiopatologia , Síndrome da Retração Ocular/epidemiologia , Síndrome da Retração Ocular/complicações , Prevalência , Refração Ocular/fisiologia , Erros de Refração/fisiopatologia , Erros de Refração/epidemiologia , Anisometropia/fisiopatologia , Anisometropia/epidemiologiaRESUMO
BACKGROUND: To assess the characteristics and outcomes of uveal melanoma management at a tertiary center in the Middle East. METHODS: A study on 164 patients with uveal melanoma was conducted by reviewing the available medical records, ultrasound, and pathology report results. Age at diagnosis, tumor location and size, treatment mode, visual outcome, metastasis, mortality, and survival were studied. RESULTS: The mean age of patients was 52.0 ± 15.0 years, and 52.5% were male. Choroidal melanoma was the most common uveal melanoma, followed by the ciliary body and iris melanoma. The mean thickness of tumors was 8.29 ± 3.29. The majority of patients (n = 111, 67.9%) were managed by brachytherapy with ruthenium-106 plaques. Enucleation was performed primarily in 46 (28%) patients and secondarily in nine (5.5%) patients. The sexual disparity was detected as the proximity of uveal melanoma to the fovea in males. For a 61-month mean follow-up period, mortality occurred in eight of our cases, six of which were due to metastasis. The most common site for distance metastasis was the liver (5/6), followed by the lung (1/6). The five-year and eight-year overall survival (OS) rate was 0.947%± 0.019. The 5-year survival rate reached zero in metastatic patients. OS was not statistically different depending on the age, tumor diameters, the primary treatment received, or the histopathologic findings (p > 0.50 for all). CONCLUSION: In this study, individuals diagnosed with UM exhibited an OS rate of around 94% at the five-year mark, which remained consistent up to eight years. Notably, the presence of distance metastasis emerged as the sole statistically significant factor influencing overall survival.
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Testes Genéticos/métodos , Melanoma , Proteínas Supressoras de Tumor/genética , Ubiquitina Tiolesterase/genética , Neoplasias Uveais , Adulto , Idoso , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Feminino , Saúde Global , Humanos , Incidência , Masculino , Melanoma/diagnóstico , Melanoma/epidemiologia , Melanoma/genética , Pessoa de Meia-Idade , Proteínas Supressoras de Tumor/metabolismo , Ubiquitina Tiolesterase/metabolismo , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/epidemiologia , Neoplasias Uveais/genética , Adulto JovemRESUMO
PURPOSE: To evaluate the outcomes of no-split, no-tenotomy transposition of only the superior rectus muscle combined with medial rectus recession in patients with complete abducens nerve palsy. METHODS: In this procedure, the temporal margin of the superior rectus muscle, 10 mm posterior to the insertion, was secured with a nonabsorbable suture and sutured to the sclera at a distance of 12 mm from the limbus in the superotemporal quadrant, halfway between the superior rectus and lateral rectus. Success was defined as distance and near alignment of ≤8Δ and no diplopia in primary position 6 months after surgery. RESULTS: A total of 8 patients with abducens nerve palsy underwent the procedure. At the last follow-up, the mean postoperative change in primary position deviation was 42.6Δ ± 8.1Δ (range, 34Δ-57Δ) for distance and 42.1Δ ± 7.5Δ (35Δ -57Δ) for near, a significant reduction (P = 0.012). Abduction deficit also improved significantly (P = 0.010). Postoperatively, no vertical deviation or torsional diplopia was induced. At the 6 months' follow-up, compared with the first postoperative visit, an esodrift at near developed in 1 patient. Of the 8 cases, 6 fulfilled the criteria for success. CONCLUSIONS: In our small study cohort, no-split, no-tenotomy superior rectus transposition and medial rectus recession improved esotropia and abduction limitation without inducing significant vertical deviations or torsional diplopia.
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Doenças do Nervo Abducente , Esotropia , Humanos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Músculos Oculomotores/cirurgia , Doenças do Nervo Abducente/cirurgia , Esotropia/cirurgia , Diplopia/cirurgia , Visão Binocular/fisiologiaRESUMO
Intermittent exotropia (IXT) causes photophobia, and photophobia has been studied by measurement of contrast sensitivity (CS). CS was reduced in children with IXT. We compared binocular CS (BCS) in patients with IXT and normal subjects in relation to the angle of strabismus and control of IXT. This case-control study was performed on 40 patients with IXT and 40 normal subjects who were examined with the CSV1000 CS device in mesopic (3 cd/m2) and photopic (85 cd/m2) conditions with and without a glare stimulus at 3, 6, 12, and 18 cycle/degree (cpd) spatial frequencies. The angle of strabismus and near stereoacuity were also measured. The patient's IXT compensation was graded based on the office control scale. The mean age for IXT and normal participants were 12.30 ± 0.60 (range, 6-18) and 11.00 ± 0.78 (range, 6-18) years, respectively (P = .34). The IXT patients had lower binocular CS than controls at all spatial frequencies (P < .001). The largest decrease in CS occurred at 6 cpd spatial frequency under mesopic condition (1.61 ± 0.07 vs 1.38 ± 0.15, P < .001) and photopic condition with glare (2.03 ± 0.06 vs 1.77 ± 0.13, P < .001). Patients with better control scores had higher levels of BCS; also, the score of BCS showed a significant decrease in patients with a deviation of 25 prism diopter or more, compared to those with less deviation. BCS correlated at 3 and 6 cpd with near stereoacuity (r = -0.652, P < .001 and r = -0.613, P < .001). Binocular CS in patients with IXT correlates with the angle of strabismus and level of compensation.
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Exotropia , Estrabismo , Criança , Humanos , Adolescente , Sensibilidades de Contraste , Estudos de Casos e Controles , Fotofobia , Visão BinocularRESUMO
PURPOSE: To use orbital computed tomography (CT) to explore the proportion of superior-compartment lateral rectus muscle atrophy in abducens nerve palsy and its relationship with clinical findings. METHODS: Twenty-two patients with isolated unilateral abducens nerve palsy were enrolled. Orbital CT scans of all patients were acquired. All measurements were performed in two ways for normal and paretic lateral rectus muscles: posterior volume (mm3) and maximal cross-section area (mm2). These variables were also measured separately in the superior and inferior 40% of the muscle. Primary position esotropia and amount of abduction limitation was also recorded. RESULTS: The mean deviation was 23.4Δ ± 12.1Δ (range, 0Δ-50Δ); the mean limitation of abduction, -2.7 ± 1.3 (range, -1 to -5). Seven cases (31.8%) showed the gross morphologic characteristics of superior-compartment atrophy. In these 7 cases, the mean percentage of atrophy in posterior volume and in maximal cross-section was significantly greater in the superior compartment than the inferior compartment (P = 0.02 for both). The mean limitation of abduction in these 7 cases (-1.7 ± 0.9; range, -1 to -3) was significantly lower than in other cases (-3.1 ± 1.3, range, -1 to -5 [P = 0.02]). CONCLUSIONS: In our study cohort, a subgroup of abducens nerve palsy cases demonstrated evidence of superior portion lateral rectus atrophy on orbital CT. The superior-compartment-atrophy group had both a smaller primary gaze esotropia and a smaller abduction deficit, providing evidence that compartmental atrophy should be considered in patients with partially retained lateral rectus function.
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Doenças do Nervo Abducente , Esotropia , Humanos , Esotropia/diagnóstico por imagem , Doenças do Nervo Abducente/diagnóstico por imagem , Músculos Oculomotores/patologia , Atrofia/patologia , Tomografia , Estudos Retrospectivos , Procedimentos Cirúrgicos Oftalmológicos/métodosRESUMO
We report the choroidal and ciliary body invasion by retinoblastoma (RB) in a salvaged eye after complete and successful primary treatment. Case 1: A 25-month-old boy was referred due to group B RB lesions based on the International Classification of RB (ICRB; groups A-E) in the right eye (OD). His left eye (OS) was enucleated because of advanced group E RB. After 47 months of uneventful follow-up (F/U), a new lesion recurred and was treated with transpupillary thermotherapy. Four months later, a fast-growing pigmented subretinal mass was detected that was treated by brachytherapy with the apical dose of 80 Gy. Three weeks later, the lesion regressed completely, and no recurrence happened after 6 years of F/U. Case 2: A 4-month-old girl with a deletion in chromosome 13 was referred for bilateral RB. OD was enucleated because of unresponsive RB and anterior segment involvement. In OS, group B lesions had multiple recurrences after systemic chemotherapy. After a while, a single mass appeared in the nasal periphery which was controlled well with brachytherapy. Four months later, AC involvement was controlled with IAC, intravitreal, and intracameral chemotherapy, but posterior synechia and cataract appeared later. One year after the last treatment, UBM showed a ring-shaped ciliary body mass. Her parents refused enucleation again, and she received intravenous chemotherapy. Two years later, magnetic resonance imaging showed orbital and optic canal involvement with a deformed globe. In conclusion, RB recurrence can appear as local choroidal and ciliary body involvement even after a time of complete remission. The role of B-scan and UBM in early diagnosis and successful treatment is valuable.
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CLINICAL SIGNIFICANCE: Understanding the refractive profile, amblyopia prevalence, binocular status, and head position in patients with Brown syndrome help clinicians become more familiar with this syndrome. BACKGROUND: Brown syndrome is identified as an active and passive restricted elevation of the eye in adduction. There is little information on clinical features, including refractive status, amblyopia, abnormal head posture (AHP), and types of deviation in these patients. METHODS: This study retrospectively evaluated records of 100 Brown syndrome patients from 2015 to 2022 at Farabi Eye Hospital, Iran. RESULTS: The mean age was 6.99 ± 6.33 years, including 48 (48%) males. A congenital source was found in 74 (74%) and 96 (96%) patients had unilateral involvement. The mean CDVA for the affected and non-affected eyes were 0.05 ± 0.11 and 0.03 ± 0.06 logMAR, respectively (P = 0.31). In unilateral cases, hyperopia, myopia, and emmetropia were observed in 55 (57.29%), 2 (2.08%), and 39 (40.63%) affected eyes, respectively. The most common type of deviation was pure hypotropia, which was found in 53 (53%) cases, followed by 'combined exotropia and hypotropia' observed in 26 (26%) patients. The mean angle of hypotropia and horizontal deviation in the primary position at distance was 12.10 ± 8.50 and 8 ± 13.20 prism dioptre, respectively. A V-pattern was found in 76 (76%) patients. Amblyopia was observed in 13 (21.67%) of 60 cooperative patients, and AHP was noticed in 66 (66%) patients, in which "combined chin up and contralateral face turn" was the most common type. CONCLUSION: About 75% of cases were congenital, 50% had pure hypotropia, 75% showed V-pattern, 20% had amblyopia, and AHP was observed in 67% of patients. The remarkable prevalence of amblyopia alongside the high occurrence of AHP should alert clinicians to carefully assess patients with Brown syndrome for sensory fusion and amblyopia.
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Purpose: To evaluate the frequency of facial asymmetry parameters in patients with head tilt versus those with head turn. Methods: This cross-sectional comparative study was performed on 155 cases, including 58 patients with congenital pure head turn due to Duane retraction syndrome (DRS), 33 patients with congenital pure head tilt due to upshoot in adduction or DRS, and 64 orthotropic subjects as the control group. The facial appearance was evaluated by computerized analysis of digital photographs of patients' faces. Relative facial size (the ratio of the distance between the external canthus and the corner of the lips of both face sides) and facial angle (the angular difference between a line that connects two external canthi and another line that connects the two corners of the lips) measured as quantitative facial parameters. Qualitative parameters were evaluated by the presence of one-sided face, cheek, and nostril compression; and columella deviation. Results: The facial asymmetry frequency in patients with head tilt, head turn, and orthotropic subjects was observed in 32 (97%), 50 (86.2%), and 22 (34.3%), respectively (P < 0.001). In patients with head tilt and head turn, the mean facial angle was 1.78º ± 1.01º and 1.19º ± 0.84º, respectively (P = 0.004) and the mean relative facial size was 1.027 ± 0.018 and 1.018 ± 0.014, respectively (P = 0.018). The frequencies of one-sided nostril compression, cheek compression, face compression, and columella deviation in patients with pure head tilt were found in 19 (58%), 21 (64%), 19 (58%), and 19 (58%) patients, respectively, and in patients with pure head turn the frequencies were observed in 42 (72%), 37 (63%), 27 (47%), and 43 (74%), respectively. All quantitative and qualitative facial asymmetry parameters and facial asymmetry frequencies were significantly higher in head tilt and head turn patients as compared to the control group (P < 0.001). Conclusion: All facial asymmetry parameters in patients with head tilt and head turn were significantly higher than orthotropic subjects. The quantitative parameters such as relative facial size and facial angle were significantly higher in patients with pure head tilt than pure head turn. The results revealed that pure head tilt was associated with a higher prevalence of facial asymmetry than pure head turn.