Management of strabismus related to infantile glaucoma: Case series.

OBJECTIVE: To evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results. METHODS: The clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied. RESULTS: Four patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs. CONCLUSION: Strabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed.

Manejo del estrabismo asociado al glaucoma de la infancia: serie de casos / Management of strabismus related to infantile glaucoma: Case series

Objetivo Evaluar las diferentes estrategias de tratamiento del estrabismo, sus complicaciones y resultados quirúrgicos en pacientes con glaucoma de la infancia. Métodos Se analizaron las historias clínicas de 7 pacientes con glaucoma de la infancia que requirieron tratamiento quirúrgico de estrabismo. Se analizaron las variables edad en el momento de la cirugía de estrabismo, tipo de glaucoma, cirugías de glaucoma, tipo de estrabismo, su tratamiento y resultados posquirúrgicos. Resultados De los 7 pacientes incluidos en nuestro estudio, 4 fueron sometidos a cirugía de estrabismo, 2 recibieron tratamiento con toxina botulínica y uno requirió ambas técnicas. Un 71,42% de los pacientes tenía glaucoma congénito primario, un 14,28% una disgenesia de segmento anterior y un 14,28% glaucoma secundario. Fueron intervenidas 4 exotropías y 3 endotropías. La principal dificultad fue el manejo de la conjuntiva y las ampollas filtrantes. Conclusiones El estrabismo constituye una complicación frecuente asociada al glaucoma de la infancia. La estrategia de tratamiento del estrabismo en estos pacientes debe ser individualizada. En nuestra serie, el tratamiento del estrabismo mejoró el alineamiento ocular. La cirugía debe considerarse de elección, teniendo en cuenta la importancia de proteger la conjuntiva y no interferir en las cirugías de glaucoma. La toxina botulínica es una opción útil en niños cuando se requieren tratamientos conservadores (AU)

Objective To evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results. Methods The clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied. Results Four patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs. Conclusion Strabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed (AU)

Study of reliability and validity of VOG Perea® and GazeLab® and calculation of the variability of their measurements. / Estudio de la fiabilidad y la validez de los videooculógrafos VOG Perea® y GazeLab® y cálculo de los márgenes de variabilidad.

OBJECTIVE: To determine the reliability and validity of VOG Perea® (VP) and GazeLab® (GL), their correlation and concordance with cover test (CT), and define the margins of variability of the measurement of angle deviation in primary position. METHODS: Forty-four orthotropic patients were included. Alternating prism CT, an examination with VP, and GL were performed. Intraclass correlation coefficient (ICC) was calculated to determine the reliability, and mean comparison was used to study validity. Correlation coefficient (R) between CT and each video-oculographer was calculated. Bland-Altman diagrams were used to determine concordance. All measurements were expressed in prismatic dioptres (PD). RESULTS: The mean horizontal deviation was -0.571 PD with CT; 0.22 PD with VP and 0.4 PD with GL. ICC was 0.246 (95% CI: [-0.402]-0.595) in GL and 0.984 [95% CI: 0.970-0.992)] in VP. Mean comparison between CT and GL was -0.9286 (CI 95%: [-1.822]-[0.0355], P=.042) and -0.8423 (95% CI: [-1.7190]-0.03450, P=.0593) for CT-VP. Correlation coefficient for VP was R=0.5704 (95% CI: 0.319-0.747, P=.0001) and R=0.4539 (95% CI: 0.174-0.666, P=.0025) for GL. Margins of variability for a single horizontal measurement in primary position with VP were±5.22 PD and±2 DP for GL. CONCLUSION: Both VP and GL are reliable and valid devices. Margins of variability for a horizontal measurement are ±5.22 PD in VP and±2 PD in GL.

Multimodal imaging in optic nerve melanocytoma: Optical coherence tomography angiography and other findings.

PURPOSE: To evaluate optical coherence tomography (OCT), fundus autofluorescence (FAF) imaging and optical coherence tomography angiography (OCTA) as diagnostic tools in optic disc melanocytoma (ODM) and study the differences in peripapillary and macular vascular density in eyes with ODM using OCTA. METHODS: Patients with ODM were enrolled in this case series. Each patient underwent evaluation of best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, fundus photography, standard visual field testing, spectral domain OCT, ultrasound B-scan examination, FAF, fluorescein angiography and OCTA. RESULTS: Eight patients (three males and five females) with ODM (9 eyes) were enrolled. The largest ODM presented a nodular appearance with a hyper-reflective tumor surface and a posterior optical shadow on OCT. FAF images showed hypoautofluorescence of the tumor with well-defined outlines. Analysis of optic nerve vascular area showed decreased values in the radial peripapillary capillary plexus (3 of 5) and the outer retinal plexus (4 of 5) in the eyes with ODM. In contrast, the ODM eyes had a higher macular vascular area in the deep capillary plexus in 4 of 6 patients. CONCLUSIONS: ODM may be associated with changes in peripapillary and macular perfusion, with an increase in peripapillary vascularization being a possible risk factor for growth. OCTA might be a helpful objective method in the analysis of changes in flow in patients with ODM.

Cuerpos extraños intraoculares tras cirugía de catarata / Intraocular foreign bodies after cataract surgery

La presencia de cuerpos extraños intraoculares tras la cirugía de catarata es relativamente frecuente y son muchos los casos publicados en la literatura sobre este tema. Nos podemos encontrar con varios tipos de cuerpos extraños, de diversos materiales y algunos de ellos con capacidad de producir graves efectos secundarios. Se recomienda su extracción cuando es posible, siempre individualizando cada caso, así como extremar las medidas preventivas en todas las cirugías. En este trabajo hacemos una revisión del tema que consideramos de importancia por las posibles complicaciones oculares que pueden generarse

Intraocular foreign bodies after cataract surgery are relatively frequent, and there are many cases published in the literature on this topic. Different kinds of foreign bodies of various materials can be found, and some of them with the ability to produce side effects. Their extraction is recommended whenever possible, always individualising each case. It also recommended to carry out preventive measures in all surgeries for their prevention. In this work a review is presented on the topic, considered important due to the possible ocular complications that can occur

Intraocular foreign bodies after cataract surgery. / Cuerpos extraños intraoculares tras cirugía de catarata.

Intraocular foreign bodies after cataract surgery are relatively frequent, and there are many cases published in the literature on this topic. Different kinds of foreign bodies of various materials can be found, and some of them with the ability to produce side effects. Their extraction is recommended whenever possible, always individualising each case. It also recommended to carry out preventive measures in all surgeries for their prevention. In this work a review is presented on the topic, considered important due to the possible ocular complications that can occur.

Evaluación del grosor de los músculos extraoculares y estudio de correlación mediante tomografía de coherencia óptica / Assessment of extraocular muscle thickness and correlation study using optical coherence tomography

OBJETIVO: Describir los valores de normalidad del grosor de los músculos rectos horizontales mediante tomografía de coherencia óptica de dominio espectral (SD-OCT) y valorar si existe correlación entre el grosor muscular y el sexo, la edad o la longitud axial (LA). MATERIAL Y MÉTODOS: Estudio transversal de 131 ojos derechos de pacientes sin enfermedad oftalmológica. Se recogieron el sexo y la edad y se midió la LA utilizando un biómetro óptico Lenstar LS 900 (Haag-Streit AG, Koeniz, Suiza). El grosor del recto medio (RM) se midió a 7,2 y 9,2mm desde el limbo y el recto lateral (RL) a 8,5 y 10,5 mm utilizando la OCT. Se ajustó un modelo multivariable para analizar si el sexo, la edad y la LA podrían influir sobre el grosor muscular. RESULTADOS: La edad media fue 43,3 ± 20,9 años (rango 6-86), siendo 59% mujeres. La LA media fue 24,9 ± 2,7mm (rango: 20,4-33,8). El grosor medio del RL a 8,5mm fue 188,5 ± 51,2 μm (rango 69-342) y 186,5 ± 45,9 μm (rango 75 - 269) a 10,5 mm. El grosor del RM fue 158,1 ± 39,1μm (rango 69 - 273) a 7,2 mm y 193,7 ± 55,9 μm (rango 105-386) a 9,2 mm. Se observó correlación entre el grosor del RM y la LA (R = -0,255; p = 0,023), no hallándose correlación para el RL (p ≥ 0,203). Tampoco se encontró asociación entre el grosor y el sexo o la edad (p ≥ 0,125). CONCLUSIONES: La OCT permite medir el grosor de los músculos rectos horizontales, observándose una asociación entre el grosor del RM y la LA

OBJECTIVE: To report reference values for the horizontal rectus muscles thickness using Spectral Domain optical coherence tomography (SD-OCT), and to evaluate whether there are any correlations between the muscle thickness and gender, age, or axial length (AL). MATERIAL AND METHODS: A cross-sectional study was conducted on 131 right eyes of healthy subjects. The gender and age were recorded, and axial length was measured using an optical biometer. The medial rectus (MR) muscle thickness was measured at 7.2 and 9.2 mm from the limbus, and the lateral rectus (LR) at 8.5 and 10.5 mm from the limbus using OCT. A multivariate model was adjusted to determine whether gender, age, and axial length could have an impact on the muscle thickness. RESULTS: Mean age was 43.3 ± 20.9 years (range 6-86), and 59% were women. Mean AL was 24.9 ± 2.7 mm (range: 20.4 - 33.8). Mean thickness was 188.5 ± 51.2 μm (range 69-342) for the LR at 8.5 and 186.5 ± 45.9 μm (range 75-269) at 10.5 mm, and for the MR, 158.1 ± 39.1μm (range 69 - 273) at 7.2 mm and 193.7 ± 55.9μm (range 105-386) at 9.2 mm. A correlation was observed between the AL and MR thickness (R = -.255; P = .023) while no correlation was observed for the LR (P ≥ 0.203). No correlations were found between thickness and gender or thickness and age (P ≥ 0.125). CONCLUSIONS: The reference ranges of the horizontal rectus muscles thickness was described using SD-OCT, observing an association between the AL and the MR thickness

Assessment of extraocular muscle thickness and correlation study using optical coherence tomography. / Evaluación del grosor de los músculos extraoculares y estudio de correlación mediante tomografía de coherencia óptica.

OBJECTIVE: To report reference values for the horizontal rectus muscles thickness using Spectral Domain optical coherence tomography (SD-OCT), and to evaluate whether there are any correlations between the muscle thickness and gender, age, or axial length (AL). MATERIAL AND METHODS: A cross-sectional study was conducted on 131 right eyes of healthy subjects. The gender and age were recorded, and axial length was measured using an optical biometer. The medial rectus (MR) muscle thickness was measured at 7.2 and 9.2mm from the limbus, and the lateral rectus (LR) at 8.5 and 10.5mm from the limbus using OCT. A multivariate model was adjusted to determine whether gender, age, and axial length could have an impact on the muscle thickness. RESULTS: Mean age was 43.3±20.9 years (range 6-86), and 59% were women. Mean AL was 24.9±2.7mm (range: 20.4-33.8). Mean thickness was 188.5±51.2µm (range 69-342) for the LR at 8.5 and 186.5±45.9µm (range 75-269) at 10.5mm, and for the MR, 158.1±39.1µm (range 69-273) at 7.2mm and 193.7±55.9µm (range 105-386) at 9.2mm. A correlation was observed between the AL and MR thickness (R=-.255; P=.023) while no correlation was observed for the LR (P≥0.203). No correlations were found between thickness and gender or thickness and age (P≥0.125). CONCLUSIONS: The reference ranges of the horizontal rectus muscles thickness was described using SD-OCT, observing an association between the AL and the MR thickness.