Isolated abducens nerve palsy associated with coronavirus disease: an 8-month follow-up / Paresia isolada do nervo abducente associada ao COVID-19: 8 meses de seguimento

ABSTRACT We report the case of a previously healthy 48-year-old man who developed an isolated abducens nerve palsy 18 days after presenting with coronavirus disease (COVID-19) confirmed by reverse transcriptase polymerase chain reaction. His main complaint at arrival was double vision. Ocular examination revealed a sixth cranial nerve palsy in the left eye. The incomitant esotropia at arrival was 30 prism diopters. Abduction was markedly limited, while adduction was normal in the left eye. The patient underwent complete clinical, neurological, and neuroimaging investigations, including cerebrospinal fluid sample analysis to rule out infectious causes. A conservative approach with orthoptic therapy and Fresnel prism was opted. Eight months after the onset of COVID-19, regression of the strabismus was observed, and the patient reported complete recovery of the diplopia. This case suggests that isolated abducens nerve palsy caused by severe acute respiratory syndrome coronavirus 2 infection may improve with a conservative approach.

RESUMO Reportamos o caso de homem previamente hígido, 48 anos, com paralisia isolada do nervo abducente 18 dias após infecção pelo novo coronavírus (COVID-19) confirmada por reação cadeia polimerase de transcriptase reversa. A principal queixa do paciente na admissão era diplopia. O exame ocular revelou paralisia do sexto nervo craniano do olho esquerdo. Esotropia incomitante no exame inicial media 30 dioptrias prismáticas. Abdução estava limitada com adução completa no olho esquerdo. O paciente foi submetido a investigação clínica e neurológica com exame de neuroimagem, incluindo análise de amostra do líquido cefalorraquidiano para descartar causas infecciosas. Optou-se por abordagem conservadora com terapia ortóptica e prisma de Fresnel. Oito meses após a infecção pelo COVID-19, o paciente evoluiu com regressão do estrabismo e informou recuperação completa do quadro. Este relato sugere que paralisia isolada do nervo abducente causada por SARS-CoV-2 pode melhorar com abordagem conservadora.

Isolated abducens nerve palsy associated with coronavirus disease: an 8-month follow-up.

We report the case of a previously healthy 48-year-old man who developed an isolated abducens nerve palsy 18 days after presenting with coronavirus disease (COVID-19) confirmed by reverse transcriptase polymerase chain reaction. His main complaint at arrival was double vision. Ocular examination revealed a sixth cranial nerve palsy in the left eye. The incomitant esotropia at arrival was 30 prism diopters. Abduction was markedly limited, while adduction was normal in the left eye. The patient underwent complete clinical, neurological, and neuroimaging investigations, including cerebrospinal fluid sample analysis to rule out infectious causes. A conservative approach with orthoptic therapy and Fresnel prism was opted. Eight months after the onset of COVID-19, regression of the strabismus was observed, and the patient reported complete recovery of the diplopia. This case suggests that isolated abducens nerve palsy caused by severe acute respiratory syndrome coronavirus 2 infection may improve with a conservative approach.

Pattern-Reversal Visual Evoked Potential in Children With Congenital Zika Syndrome.

PURPOSE: To objectively evaluate the visual function in children with congenital Zika syndrome using pattern-reversal visual evoked potential (PR-VEP). METHODS: This was a cross-sectional study composed of two patient groups: children aged between 18 and 24 months who were positive for the Zika virus (congenital Zika syndrome group) and age-matched healthy children (control group). All patients underwent a comprehensive ophthalmologic examination and PR-VEP was performed binocularly in a room with constant dim illumination. The P100 peak time in the 60' arc stimuli was used, and the results were correlated with visual acuity, cephalic perimeter at birth, and funduscopic findings. RESULTS: Thirty-seven children were included in the congenital Zika syndrome group and 15 in the control group. The mean age was 18.5 ± 0.9 months (range: 17 to 20 months) in the congenital Zika syndrome group and 24.3 ± 1.6 months (range: 21 to 28 months) in the control group. The P100 response was normal in 7 patients (18.9%) with congenital Zika syndrome, borderline in 2 (5.4%), abnormal with prolonged latency in 18 (48.6%), and abnormal with no response in 10 (27.0%). A significant correlation between the visual acuity and P100 peak time was observed (P < .001). The P100 values were not correlated significantly with the cephalic perimeter at birth (P = .412) or the funduscopic findings (P = .510). PR-VEP in children with congenital Zika syndrome and no funduscopic findings was significantly worse than in the control group (P = .001). CONCLUSIONS: Children with congenital Zika syndrome have characteristically abnormal PR-VEPs regardless of the funduscopic findings and severe microcephaly. The PR-VEP findings supported the diagnosis of cortical visual impairment in these children. [J Pediatr Ophthalmol Strabismus. 2021;58(2):78-83.].

Relato de uma série de 30 casos presumíveis de neurorretinite subaguda unilateral difusa (DUSN) / Report of a serial of 30 cases of presumed diffuse unilateral subacute neuroretinitis (DUSN)

Objetivo: Relatar uma série de 30 casos com características de neurorretinite subaguda unilateral difusa em Pemambuco e descrever os "aspectos clínicos e epidemiológicos". Métodos :Análise retrospectiva de 30 pacientes com neurorretinite subaguda unilateral difusa, atendidos no ambulatório de uveítes da Fundaçäo Altino Ventura e do Hospital de Olhos de Pemambuco, de janeiro de 1998 a abril de 2000. Resultados: Em relaçäo ao sexo, 20 pacientes (66,7 por cento) eram do sexo masculino. A idade variou de 7 a 40 anos com média de idade de 18,1 anos (s = 6,9). O olho esquerdo foi acometido em 15 casos (50,0 por cento). A acuidade visual para longe com a melhor correçäo era igual ou pior do que 20/400 em 29 casos (96,7 por cento). Os achados fundoscópicos foram considerados graves em mais da metade dos casos. Palidez do disco óptico grave em 20 casos (66,6 por cento), estreitamento vascular retiniano grave em 16 casos (53,3 por cento) e atrofia do epitélio pigmentar retiniano grave em 15 casos (50,0 por cento). Conclusäo: Devido ao fato de, em nenhum dos pacientes, haver sido encontrada larva no espaço subretiniano e consequente realizaçäo de tratamento idequado, os casos relatados neste estudo apresentaram avançado grau de acometimento ocular e importante baixa da acuidade visual.

Síndrome de Best - Relato de um caso / Best's Syndrome - A case report

Objetivos: Relatar um caso raro de distrofia macular viteliforme do adulto num paciente de 57 anos, com queixa visual para perto, atendido em uma consulta ambulatorial de rotina. Local: Fundação Altino Ventura, Recife, Pernambuco. Métodos: É descrito um caso mencionado atendido na Fundação Altino Ventura. Resultados: Examinamos um paciente em sua quinta década de vida, com quadro compatível com distrofia viteliforme do tipo adulto. Testes aletrofisiológicos confirmaram o diagnóstico. Conclusões: São discutidos os aspectos clínicos desta entidade e sua apresentação na literatura mundial.