Translation and transcultural adaptation of the AS-20 scale to measure quality of life in adults with strabismus in Colombia, a pilot study.

BACKGROUND: Strabismus generates a negative psychosocial impact on adult patients, affecting aspects such as self-perception and quality of life. There is no scale in Colombian Spanish that measures these impacts. OBJECTIVE: To carry out the translation and cross-cultural adaptation of the AS-20 instrument into Colombian Spanish. MATERIALS AND METHODS: Pilot test of a cross-sectional Study for the translation, reverse translation, and cross-cultural the AS-20 instrument from its original language, English, to Colombian Spanish, in adult patients with strabismus in Bogotá, Colombia. RESULTS: 16 patients were assessed. The age range was between 18 and 68 years with a mean age of 41 years. The scale was answered in an average time of 10.62min. Difficulty was reported in three individuals for understanding two items (questions 8 and 14), which were resolved. CONCLUSION: The translation and pilot test of AS-20 scale into Colombian Spanish was carried out, identifying and solving translational difficulties. Is the first step in the cross-cultural adaptation process. Based on the results, the validation and cross-cultural adaptation can be completed in a future study.

Esotropia, nystagmus and optic disk staphyloma in Donnai-Barrow syndrome / Esotropia, nistagmo e estafiloma de disco óptico na síndrome de Donnai-Barrow

ABSTRACT A 12-year-old boy with Donnai-Barrow syndrome diagnosed intra-uterus presented esotropia, high myopia, nystagmus, and optic disk staphyloma in an ophthalmologic examination. The patient had associated Fanconi syndrome and sensorineural hearing loss as well as facial manifestations as hypertelorism, downward slanting of palpebral fissures and low ear implantation. Magnetic resonance imaging revealed agenesis of the corpus callosum. To our knowledge, this is the first reported case associated with esotropia, nystagmus, and optic disk staphyloma.

RESUMO Paciente do sexo masculino, 12 anos, com diagnóstico intrauterino de síndrome de Donnai-Barrow, apresentava ao exame oftalmológico esotropia, alta miopia, nistagmo e estafiloma de disco óptico. Associado ao quadro, apresentava síndrome de Falconi e perda auditiva neurossensorial, além de alterações faciais, como hipertelorismo, inclinação inferior das fissuras palpebrais e implantação baixa das orelhas. Ressonância magnética revelou agenesia de corpo caloso. Ao nosso conhecimento, este é o primeiro caso relatado associando esotropia, nistagmo e estafiloma de disco óptico.

Is hypermetropia regressing in accommodative esotropia? / A hipermetropia regride na esotropia acomodativa?

ABSTRACT Purposes: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. Methods: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. Results: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). Conclusion: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error.(AU)

RESUMO Objetivo: Avaliar a relação entre alterações na hipermetropia e o alinhamento ocular em pacientes com esotropia acomodativa. Métodos: Foram analisados retrospectivamente prontuários médicos de pacientes consecutivos diagnosticados com esotropia acomodativa refrativa (com esotropia eliminada ou reduzida a menos de 10 D com correção completa da hipermetropia). As medidas de refração em cicloplegia obtidas dos prontuários foram convertidas em equivalentes esféricos. Avaliaram-se ainda a presença de ambliopia, alterações do erro refrativo e o alinhamento ocular à admissão e depois do período de acompanhamento. Resultados: Setenta pacientes (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A diminuição média anual no desvio para perto e para longe com o uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, respectivamente. Os desvios miópicos totais dos olhos direito e esquerdo foram de 1,08 ± 1,35 D e 1,20 ± 1,40 D, respectivamente. Os desvios miópicos anuais foram de 0,22 D/ano e 0,26 D/ano para os olhos direito e esquerdo, respectivamente. A correlação entre a taxa de desvio miópico e a taxa de alteração do desvio para perto corrigido foi fraca. A correlação da taxa de desvio miópico não foi alta para os olhos direito e esquerdo (r=0,18, p=0,15). Conclusão: A quantidade de desvio e a hipermetropia diminuem gradualmente na esotropia acomodativa durante o acompanhamento. Por outro lado, pode não ser apropriado garantir aos pacientes que o desvio diminuirá em paralelo ao erro refrativo.(AU)

Correção de estrabismo incomitante por cirurgia de recuo-ressecção combinadas do mesmo músculo reto / Incomitant strabismus correction through combined resection and recession of the same rectus muscle

Resumo O presente trabalho relata o caso de um paciente, masculino, 38 anos, com estrabismo incomitante e consequente diplopia, submetido à cirurgia debilitadora com recuo e fortalecimento com ressecção do músculo reto inferior direito. O objetivo desta técnica cirúrgica é a correção do desvio em sua posição de maior incomitância, sem prejudicar o alinhamento ocular na posição primária do olhar (PPO). O resultado satisfatório, em concordância com os dados da literatura atual, contribui para fazer desta técnica uma opção no tratamento de estrabismos incomitantes de difícil manejo.

Abstract The present study reports a case of a patient, 38-year-old man, with incomitant strabismus and consequent diplopia, submitted to debilitating surgery with recession and strengthening resection of the right inferior rectus muscle. This surgical technique aims to correct the deviation in its greater incomitence position, without impairing the ocular alignment in the primary position of the eye (PPO). The satisfactory result, in agreement with data of current literature, contributes to make this technique an option in the treatment of challenging incomitant strabismus.

Long-Term Follow-Up of Cyclic Esotropia.

BACKGROUND AND PURPOSE: To describe the development and treatment of patients with cyclic esotropia. PATIENTS AND METHODS: The clinical course of seven patients with cyclic esotropia were retrospectively reviewed and described. All patients underwent bilateral medial rectus recession based on the deviation manifested on the day they were esotropic. Additionally, one patient had previously undergone surgery for intermittent exotropia. RESULTS: All patients developed excellent postoperative alignment. After strabismus surgery, normal eye alignment with some degree of binocularity was reached in five patients. Moreover, there was no recurrence of the cyclic deviation in any patient, and no patient experienced an overcorrection. CONCLUSIONS: Strabismus surgery aimed to correct the horizontal esotropic angle present on the day the esotropia is manifested provides a good outcome that is stable long-term, with minimal risk of overcorrection. Possible explanations for the origin of cyclic esotropia are discussed.

Monocular surgery to correct large-angle esotropia: a 10-year follow-up study / Cirurgia monocular para correção de esotropias de grande ângulo: seguimento de 10 anos

ABSTRACT Purpose: To conduct a 10-year follow-up on the surgical correction of large-angle esotropia using monocular surgery, verifying surgical stability over time in both adults and children, and investigating the presence of consecutive exotropia among reviewed patients. Methods: The angles of deviation in primary position were measured using prism cover testing in patients with good vision in both eyes and the Krimsky method in those with severe amblyopia. Among the 46 patients who underwent surgery, 40 were evaluated 10 years post-surgery. Student's t-test and McNemar's test were used for statistical analyses. Results: No significant differences in the angles of deviation in primary position were found between measurements taken 6 months and 10 years post-surgery (p=0.922), as well as between children and adults (p=0.767). Among the 40 reviewed patients, only five presented with exotropia, all of which were small (the largest being XT 15Δ). Therefore, large consecutive exotropia over time was not observed. Conclusion: Our results suggest that monocular surgery to correct large-angle esotropia using large medial rectus recessions and broad lateral rectus resections was viable and safe in both adults and children over short and long terms.

RESUMO Objetivo: Conduzir um acompanhamento de 10 anos de correção cirúrgica de esotropias de grande ângulo com cirurgia monocular, verificando a estabilidade cirúrgica ao longo do tempo em adultos e crianças, investigando a presença de exotropias consecutivas entre os pacientes revisados. Métodos: Os ângulos de desvio em posição primária foram medidos usando teste de cobertura prismática em pacientes com boa visão em ambos os olhos e o método de Krimsky naqueles com ambliopia severa. Entre os 46 pacientes operados, 40 foram avaliados 10 anos após a cirurgia. O teste t-Student e o de McNemar foram usados para análises estatísticas. Resultados: Não foram encontradas diferenças significativas nos ângulos de desvio em posição primária entre as medidas realizadas 6 meses e 10 anos pós-operatórios (p=0,922, assim como entre crianças e adultos (p=0,767). Entre os 40 pacientes revisados, apenas cinco apresentaram exotropias, todas pequenas (sendo o maior XT 15Δ). Portanto grandes exotropias consecutivas ao longo do tempo não foram observadas. Conclusão: Nossos resultados sugerem que a cirurgia monocular para corrigir a esotropias de grande ângulo usando amplos recuos do reto medial e grandes ressecções do reto lateral foi viável e segura tanto em adultos quanto em crianças em curto como a longo prazo.

Comportamiento quirúrgico del estrabismo en el Hospital Oftalmológico Amistad Argelia-Cuba / Surgical behavior of strabismus in the Ophthalmological Hospital Friendship Algeria-Cuba

Se realizó un estudio longitudinal, descriptivo y retrospectivo en el Hospital Oftalmológico Amistad Argelia-Cuba, el Oued, Argelia, en el período comprendido entre junio de 2015 a mayo de 2017, con el objetivo de caracterizar el comportamiento quirúrgico en pacientes con estrabismo atendidos en dicho hospital. El universo estuvo constituido por 80 pacientes intervenidos quirúrgicamente, coincidiendo con la muestra. Las variables estudiadas fueron: edad, sexo, diagnóstico preoperatorio, dioptrías prismáticas preoperatorias, proceder quirúrgico, ojo operado y complicaciones transoperatorias oculares. De las 139 cirugías practicadas hubo predominio del sexo femenino. El 38.8 por ciento de los casos presentó esotropía comitante adquirida. El proceder quirúrgico más realizado fue la recesión de ambos rectos horizontales, predominando la cirugía bilateral sobre la unilateral(AU)

A longitudinal, descriptive, retrospective study was carried out in the Ophthalmological Amistad Hospital Algeria-Cuba, El Oued, in the period from June 2015 to May 2017, with the aim of characterizing the surgical behavior in patients with strabismus attended in said hospital. The universe consisted of 80 patients surgically treated, coinciding with the sample. The variables studied were: age, sex, preoperative diagnosis, preoperative prismatic diopters, surgical procedure, operated eye and transoperative ocular complications. Of the 139 surgeries performed / operated eyes, 52.5 percent of the patients corresponded to the female sex. 38.8 percent of the cases presented comitant acquired esotropia. The most performed surgical procedure was the recession of both horizontal rectums, in 84.9 percent, bilateral surgery prevailing over the unilateral one(AU)

Esotropía comitante aguda del adulto. Presentación de un caso / Acute concomitant esotropia of adulthood

La esotropía aguda del adulto es un estrabismo no frecuente, de aparición tardía, por encima de los 7 años de edad y puede verse en edades avanzadas, el comienzo es brusco; se caracteriza desde el punto de vista clínico por diplopía, comitancia y relación binocular normal. Objetivo: Ofrecer una enseñanza clínico-quirúrgica de esotropía comitante aguda del adulto, relacionada con el estrés físico, además de ser infrecuente. Presentación de caso: Paciente femenina de 29 años de edad ,que acudió a la consulta de Oftalmología en agosto del 2014, la que refirió que hace 13 años después de sumergirse en un río notó desviación del ojo derecho hacia adentro de forma súbita, acompañado esto de visión doble permanente. En el examen oftalmológico se le realizó de forma minuciosa exploración sensorial y se llegó al diagnóstico definitivo de esotropía comitante aguda del adulto. Conclusiones: La esotropía comitante aguda del adulto tipo Franceschetti, es una forma especial de estrabismo, es infrecuente. A la paciente se le realizó tratamiento quirúrgico, sin el cual no se hubiera logrado el alineamiento ocular y restauración de la visión binocular(AU)

Acute isotropy in the elderly is a non frequent strabismus of late appearance, after the age of seven and can be seen at advanced age. The starting is rough; it is characterized, from the clinical point of view, by diplopia, concomitance and normal binocular relationship. Objective: To offer a clinical and surgical teaching of acute concomitant diplopia in the elderly related to physical stress, out of been non frequent. Case presentation: a 29 year old female patient who came into the eye consultation on August, 2014 complaining of right eye sudden inner deviation after sinking in a river, it was accompanied by permanent double vision. On eye examination she was performed a detailed sensorial exploration and definitely diagnosed as having concomitant isotropy. Conclusion: Franceschetti´s concomitant isotropy in the elderly is a special non frequent form of strabismus. The patient was performed surgical treatment needed to fulfill an ocular lining and restoration of binocular vision(AU)

Esotropía comitante aguda del adulto. Presentación de un caso / Acute concomitant esotropia of adulthood

Fundamentación. La esotropía aguda del adulto es un estrabismo no frecuente, de aparición tardía, por encima de los 7 años de edad y puede verse en edades avanzadas, el comienzo es brusco; se caracteriza desde el punto de vista clínico por diplopía, comitancia y relación binocular normal. Objetivo: Ofrecer una enseñanza clínico-quirúrgica de esotropía comitante aguda del adulto, relacionada con el estrés físico, además de ser infrecuente. Presentación de caso: Paciente femenina de 29 años de edad ,que acudió a la consulta de Oftalmología en agosto del 2014, la que refirió que hace 13 años después de sumergirse en un río notó desviación del ojo derecho hacia adentro de forma súbita, acompañado esto de visión doble permanente. En el examen oftalmológico se le realizó de forma minuciosa exploración sensorial y se llegó al diagnóstico definitivo de esotropía comitante aguda del adulto. Conclusiones: La esotropía comitante aguda del adulto tipo Franceschetti, es una forma especial de estrabismo, es infrecuente. A la paciente se le realizó tratamiento quirúrgico, sin el cual no se hubiera logrado el alineamiento ocular y restauración de la visión binocular.(AU)

Epidemiology of strabismus surgery in a public hospital of the Brazilian Federal District / Epidemiologia da cirurgia de estrabismo em um hospital público de Brasília, Distrito Federal

Abstract Purpose: to determine the prevalence of different types of strabismus submitted to a surgical procedure in a public hospital in the Brazilian Federal District. Methods: Retrospective cross-sectional review of medical records of patients who underwent strabismus surgery performed by the same surgeon from 2004 to 2014. Incomplete records were excluded from the study. Variables included sex, age, type of strabismus, type of surgery, and re-surgeries. Strabismus was classified into three main types (esotropia, exotropia, and pure vertical deviation), and their subtypes. The type of surgery was determined by the number of muscles operated on (up to two, or more than two), the involvement of oblique and vertical rectus muscles, and muscle displacement. Results: 563 patients were reviewed and 531 were included in the study. The average age was 12.7 years, and females accounted for 54.4% of total patients. Esotropia was the most frequent type of strabismus (74%), followed by exotropia (23.7%) and pure vertical deviation (2.3%). The most frequent subtype of esotropia was infantile (49.1%), with 16.1% of these surgeries performed before the age of 2. Constant exotropia was the most frequent subtype of exotropia (27.8%). The prevalence of esotropia decreased with age, whereas that of exotropia increased. 52.3% of surgeries involved more than two muscles. An association between different types of deviation was found in 58.9% of patients. In cases of paralytic strabismus, the sixth nerve was the most affected (46%). Re-surgeries accounted for 10.7% of total surgeries. Conclusion s: Esotropias were the most common types of strabismus, especially infantile esotropia. Most cases were associated with other types of deviation, and needed more complex surgeries, involving more than two muscles. This study expects to contribute to the planning of health measures that may effectively improve the assistance provided to the population.

Resumo Objetivo: Determinar a prevalência dos diferentes tipos de estrabismo submetidos a intervenção cirúrgica em um hospital público de Brasília, Brasil. Métodos: Estudo retrospectivo de corte transversal de prontuários médicos dos pacientes submetidos a cirurgias de estrabismo por um mesmo cirurgião, de 2004 e 2014. Foram excluídos prontuários incompletos. Variáveis pesquisadas incluíram sexo, idade, classificação do estrabismo, tipo da cirurgia e reoperações. Os estrabismos foram classificados em três tipos principais (esotropia, exotropia e desvio vertical puro) e seus subtipos. Avaliação do tipo da cirurgia considerou o número de músculos operados (intervenção em até 2 ou em mais músculos), o envolvimento de músculos oblíquos, retos verticais e transposição muscular. Resultados: Foram avaliadas 563 pacientes e 531 foram incluídas na análise. A média de idade foi 12,7 anos e o sexo feminino respondeu por 54,4%. A esotropia foi o tipo de estrabismo mais frequente (74%), seguido pela exotropia (23,7%) e desvio vertical puro (2,3%). O subtipo de esotropia mais frequente foi o infantil (49,1%), com 16,1% destas cirurgias realizadas antes dos 2 anos de vida. A exotropia constante foi o subtipo mais observado (27,8%) de exotropia. A proporção de esotropia diminuiu com a idade, enquanto a de exotropia aumentou. 52,3% das cirurgias envolveram mais de dois músculos. Associação de diferentes tipos de desvio foi observada em 58,9% dos pacientes. Dentre os estrabismos paralíticos, o VI nervo foi o mais acometido (46%). Reoperações corresponderam a 10,7% do total. Conclusão: As esotropias foram os estrabismos cirúrgicos mais comuns, especialmente a esotropia infantil. A maioria dos casos estava associada a outras formas de desvio e necessitaram de cirurgias mais complexas, envolvendo mais de 2 músculos. Espera-se que dados do estudo possam contribuir no planejamento de ações de saúde efetivas para melhorar a assistência à população.

Toxina botulínica versus cirugía convencional en esotropía residual YZ / Botulinum toxin versus conventional surgery in treating residual esotropia

Objetivo: comparar los resultados motores y sensoriales de los pacientes con esotropía residual tratados con toxina botulínica A con el grupo que recibe cirugía convencional. Métodos: se realizó un estudio experimental (analítico), longitudinal y prospectivo en 27 pacientes que cumplieron con los criterios de inclusión: esotropía residual de 20 a 30 dioptrías independientemente de la edad. Se analizaron las siguientes variables: edad, sexo, diagnóstico previo, tipo de cirugía previa, número de inyección de toxina botulínica A empleada o cirugía realizada en la reintervención, efectos secundarios, complicaciones, ángulo de desviación, fusión y estereopsis preoperatorio y posoperatorio al año. Se consideró éxito quirúrgico la desviación postratamiento igual o menor de 10 dioptrías prismáticas. Resultados: el ángulo de desviación preoperatorio promedio del grupo toxina botulínica A fue de 24,0 ± 1,2 dioptrías y el de cirugía convencional de 25,8 ± 1,1, en oposición con el ángulo de desviación posoperatorio promedio, donde hallamos diferencias significativas (p= 0,003) entre ambos grupos (10,3 ± 1,1 versus 6,0 ± 0,80). El 64,3 por ciento, del grupo de toxina botulínica A y el 92,3 por ciento de cirugía convencional obtuvieron éxito quirúrgico. No se encontraron diferencias significativas ( p= 0,165). Se encontró ptosis palpebral como efecto secundario en el grupo toxina botulínica A y ninguna complicación en ningún grupo. El 44,4 por ciento de los pacientes obtuvo fusión postratamiento pero ninguno alcanzó estereopsis(AU) Conclusiones: en las esotropías residuales de 20 a 30 dioptrías prismáticas tratadas con toxina botulínica se obtienen resultados motores y sensoriales similares al del grupo de cirugía convencional

Objective: to compare the motor and sensory results of patients with residual esotropia, who were treated with botulinum toxin A, and of a group undergoing conventional surgery. Methods: a prospective, longitudinal and experimental (analytical) study was conducted in 27 patients who fulfilled the inclusion criteria: residual esotropia from 20 to 30 dioptries independently of the age. The following variables were analyzed: age, sex, previous diagnosis, type of previous surgery, number of injection of botulinum toxin A applied or type of surgery performed in the reintervención, secondary effects, complications, deviation angle, coalition and preoperative and postoperative estereopsis to the year. It was considered surgical success the deviation same post-treatment or smaller than 10 prismatic dioptries. Results: the angle of preoperative deviation average of the group toxin botulínica A was of 24,0 ± 1,2 dioptres and the one of conventional surgery of 25,8 ± 1,1, in opposition with the angle of posoperative deviation average, where find significant differences ( p= 0,003) between both groups (10,3 ± 1,1 versus 6,0 ± 0,80). The 64,3 percent of the group of toxin botulínica A and the 92,3 percent of conventional surgery obtained surgical success. Significant differences were not find (p= 0,165). Palpebral ptosis was found as secondary effect in the group toxin botulínica A, and any complication in any group. The 44,4 percent of the patients obtained post-treatment fusion but any reached to estereopsis(AU) Conclusions: the residual esotropias of 20 to 30 prismatic dioptres treated with toxin botulínica shows resulted engines and sensory similar to the group of conventional surgery

Toxina botulínica versus cirugía convencional en esotropía residual YZ / Botulinum toxin versus conventional surgery in treating residual esotropia

Objetivo: comparar los resultados motores y sensoriales de los pacientes con esotropía residual tratados con toxina botulínica A con el grupo que recibe cirugía convencional. Métodos: se realizó un estudio experimental (analítico), longitudinal y prospectivo en 27 pacientes que cumplieron con los criterios de inclusión: esotropía residual de 20 a 30 dioptrías independientemente de la edad. Se analizaron las siguientes variables: edad, sexo, diagnóstico previo, tipo de cirugía previa, número de inyección de toxina botulínica A empleada o cirugía realizada en la reintervención, efectos secundarios, complicaciones, ángulo de desviación, fusión y estereopsis preoperatorio y posoperatorio al año. Se consideró éxito quirúrgico la desviación postratamiento igual o menor de 10 dioptrías prismáticas. Resultados: el ángulo de desviación preoperatorio promedio del grupo toxina botulínica A fue de 24,0 ± 1,2 dioptrías y el de cirugía convencional de 25,8 ± 1,1, en oposición con el ángulo de desviación posoperatorio promedio, donde hallamos diferencias significativas (p= 0,003) entre ambos grupos (10,3 ± 1,1 versus 6,0 ± 0,80). El 64,3 por ciento, del grupo de toxina botulínica A y el 92,3 por ciento de cirugía convencional obtuvieron éxito quirúrgico. No se encontraron diferencias significativas ( p= 0,165). Se encontró ptosis palpebral como efecto secundario en el grupo toxina botulínica A y ninguna complicación en ningún grupo. El 44,4 por ciento de los pacientes obtuvo fusión postratamiento pero ninguno alcanzó estereopsis(AU) Conclusiones: en las esotropías residuales de 20 a 30 dioptrías prismáticas tratadas con toxina botulínica se obtienen resultados motores y sensoriales similares al del grupo de cirugía convencional

Objective: to compare the motor and sensory results of patients with residual esotropia, who were treated with botulinum toxin A, and of a group undergoing conventional surgery. Methods: a prospective, longitudinal and experimental (analytical) study was conducted in 27 patients who fulfilled the inclusion criteria: residual esotropia from 20 to 30 dioptries independently of the age. The following variables were analyzed: age, sex, previous diagnosis, type of previous surgery, number of injection of botulinum toxin A applied or type of surgery performed in the reintervención, secondary effects, complications, deviation angle, coalition and preoperative and postoperative estereopsis to the year. It was considered surgical success the deviation same post-treatment or smaller than 10 prismatic dioptries. Results: the angle of preoperative deviation average of the group toxin botulínica A was of 24,0 ± 1,2 dioptres and the one of conventional surgery of 25,8 ± 1,1, in opposition with the angle of posoperative deviation average, where find significant differences ( p= 0,003) between both groups (10,3 ± 1,1 versus 6,0 ± 0,80). The 64,3 percent of the group of toxin botulínica A and the 92,3 percent of conventional surgery obtained surgical success. Significant differences were not find (p= 0,165). Palpebral ptosis was found as secondary effect in the group toxin botulínica A, and any complication in any group. The 44,4 percent of the patients obtained post-treatment fusion but any reached to estereopsis(AU) Conclusions: the residual esotropias of 20 to 30 prismatic dioptres treated with toxin botulínica shows resulted engines and sensory similar to the group of conventional surgery

Visión binocular en pacientes operados de esotropía congénita con cuatro años de evolución / Binocular vision in patients operated of congenital esotropia with four years of follow-up

Objetivo: describir los resultados quirúrgicos y la obtención de fusión y estereopsia en operados de esotropía congénita, después de cuatro años de seguimiento y su relación con el ángulo de desviación preoperatorio y la edad al momento de la primera cirugía. Métodos: estudio descriptivo, longitudinal y prospectivo de una serie de casos, operados de esotropía congénita desde el año 2007 al 2010, seguidos durante cuatro años por consulta en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se analizaron las variables edad al diagnóstico, ángulo de desviación preoperatorio y posoperatorio, edad al momento de la primera cirugía, presencia de fusión, estereopsia y desarrollo de ambliopía. Resultados: el ángulo de desviación preoperatorio promedio de los pacientes estudiados fue de 39,8 dioptrías y la media de la edad al momento de la primera cirugía fue 22,5 meses (DE 9,2). La media de supervivencia del alineamiento ocular fue de 39,3 meses, y fue superior en los pacientes con un ángulo de desviación preoperatorio menor de 40 dioptrías y con menos de 24 meses de edad al momento de la primera cirugía (p= 0,001). Presentaban fusión y estereopsia a los 4 años el 57,7 y el 26,9 por ciento de los pacientes. La media del número de cirugía fue de 1,42 (DE ± 0,504) a los 4 años. La causa más frecuente de segunda cirugía fue la hiperfunción del oblicuo inferior (19,2 por ciento). Conclusiones: la presencia de fusión y de estereopsia a los 4 años de evolución es mayor en aquellos pacientes con menor ángulo de desviación preoperatoria y con menos de 2 años de edad a la primera cirugía(AU)

Objective: to describe the surgical results and the fusion and stereopsis obtained in patients operated of congenital esotropia, after 4 years of follow-up and their relationship with the pre-operative deviation angle and the age at the time of the first surgery. Methods: prospective, longitudinal and descriptive case series study, which was conducted in patients operated of congenital esotropia from 2007 to 2010; followed up for four years at the outpatient service of Ramón Pando Ferrer Cuban Institute of Ophthalmology. The analyzed variables were age at diagnosis, pre and postoperative deviation angle, age at the time of the first surgery, presence of fusion, stereopsis and development of amblyopia. Results: preoperative average deviation angle of the studied patients was 39. 8 dioptries, and the age mean at the time of the first surgery was 22,5 months (SD 9,2). The survival mean of the ocular alignment was 39,3 months, being higher in those patients with an preoperative deviation angle smaller than 40 dioptries and under 24 months-old at the time of the first surgery (p= 0,001). Fusion and estereopsia were present after 4 years in 57, 7 percent and 26 9 percent of the patients, respectively. The mean number of surgeries was 1,42 (SD ± 0,504) at 4 years of age whereas the most frequent cause for a second surgery was the inferior oblique muscle overaction (19, 2 percent).Conclusions: stereopsis, and fusion were more significant after four years in those patients with smaller preoperative deviation angle and under 2 years-old at the time of the first surgery(AU)

Visión binocular en pacientes operados de esotropía congénita con cuatro años de evolución / Binocular vision in patients operated of congenital esotropia with four years of follow-up

Objetivo: describir los resultados quirúrgicos y la obtención de fusión y estereopsia en operados de esotropía congénita, después de cuatro años de seguimiento y su relación con el ángulo de desviación preoperatorio y la edad al momento de la primera cirugía. Métodos: estudio descriptivo, longitudinal y prospectivo de una serie de casos, operados de esotropía congénita desde el año 2007 al 2010, seguidos durante cuatro años por consulta en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se analizaron las variables edad al diagnóstico, ángulo de desviación preoperatorio y posoperatorio, edad al momento de la primera cirugía, presencia de fusión, estereopsia y desarrollo de ambliopía. Resultados: el ángulo de desviación preoperatorio promedio de los pacientes estudiados fue de 39,8 dioptrías y la media de la edad al momento de la primera cirugía fue 22,5 meses (DE 9,2). La media de supervivencia del alineamiento ocular fue de 39,3 meses, y fue superior en los pacientes con un ángulo de desviación preoperatorio menor de 40 dioptrías y con menos de 24 meses de edad al momento de la primera cirugía (p= 0,001). Presentaban fusión y estereopsia a los 4 años el 57,7 y el 26,9 por ciento de los pacientes. La media del número de cirugía fue de 1,42 (DE ± 0,504) a los 4 años. La causa más frecuente de segunda cirugía fue la hiperfunción del oblicuo inferior (19,2 por ciento). Conclusiones: la presencia de fusión y de estereopsia a los 4 años de evolución es mayor en aquellos pacientes con menor ángulo de desviación preoperatoria y con menos de 2 años de edad a la primera cirugía(AU)

Forma clínica e fatores de risco associados ao estrabismo na binocularidade visual / Clinical forms and risk factors associated with strabismus in visual binocularity

RESUMO Objetivo: Identificar e analisar fatores de risco associados ao estrabismo, dados oftalmológicos e antecedentes pessoais e familiares. Métodos: Estudo prospectivo, descritivo e analítico realizado com 240 pacientes que consultaram pela primeira vez nos ambulatórios de estrabismo. Foram avaliadas a frequência e associação entre estrabismo, dados de exames oftalmológicos e antecedentes pessoais e familiares para identificação dos fatores de risco. Resultados: Observou-se maior prevalência de estrabismo em mulheres (56,96%) em relação aos homens (43,02%). A faixa etária mais atendida no ambulatório de estrabismo foi composta de crianças até 15 anos de idade (83,54%). Encontrou-se mais esotropia (55,27%) que exotropia (42,20%) e parcela menor de estrabismo vertical isolado (2,53%). A prematuridade foi associada ao estrabismo convergente (p=0,023) e não ao divergente (p=0,086). O diabetes mellitus materno foi associado à esotropia (p=0,024) e exotropia (p=0,036) no filho, mas a hipertensão arterial materna, uso de medicamentos para hipertensão e diabetes durante a gravidez e drogas ilícitas não foram estatisticamente significativos. Pacientes com paralisia cerebral tiveram mais associação com exotropia (p=0,008) que esotropia (p=0,019). Malformações congênitas, consanguinidade entre os pais e traumas oculares não apresentaram associação estatisticamente significativa para o estrabismo. A maioria dos pacientes com estrabismo apresentou boa acuidade visual corrigida e fundoscopia normal. Na análise de proporções a hipermetropia foi mais frequente na esotropia (68,7%). Conclusão: Os fatores de riscos internos e externos podem interferir na formação e desenvolvimento do olho na fase de plasticidade ocular, com prejuízo da binocularidade visual, podendo resultar em estrabismo. Há divergências com relação aos fatores de risco realmente associados e mais estudos são necessários para a identificação.

ABSTRACT Objective: To identify and analyze risk factors associated with strabismus, the eye data and personal and family history. Methods: A prospective, descriptive and analytical study, with 240 patients who consulted for the first time in strabismus clinics. We evaluated the frequency and association between strabismus and data eye examination and personal and family history to identify risk factors. Results: There was a higher prevalence of strabismus in women (56.96%) compared to men (43.02%). The age group most satisfied in strabismus clinic are children up to 15 years of age (83.54%). Met more esotropia (55.27%) than exotropia (42.20%) and lower portion of isolated vertical strabismus (2.53%). Preterm birth was associated with convergent strabismus (p = 0.023) but not the diverging (p = 0.086). Maternal diabetes mellitus was associated with esotropia (p = 0.024) and exotropia (p = 0.036) on the child, but the mother’s high blood pressure, medications for hypertension and diabetes during pregnancy and illicit drugs was not statistically significant. Patients with cerebral palsy association with exotropes had more (p = 0.008) which esotropia (p = 0.019). Congenital malformations, consanguinity between parents and ocular trauma showed no statistically significant association for strabismus. Most patients with strabismus showed good visual acuity, normal fundus. In the analysis of proportions farsightedness was more common in esotropia (68.7%). Conclusions: Internal and external risk factors can interfere in the formation and development of the eye in eye plasticity phase with impaired visual binocularity and may result in strabismus. There are differences with respect to risk factors associated truly and more studies are needed to identify.

Secuencia Moebius. Análisis retrospectivo de 30 pacientes / Moebius syndrome. A retrospective analysis of 30 patients.

Introducción: La secuencia Moebius se caracteriza por el compromiso congénito de los nervios motor ocular externo y facial, y se puede asociar al compromiso de otros pares craneales y a otros defectos congénitos. Su etiología es multifactorial y no bien definida, actualmente la teoría más aceptada es la disrupción vascular durante el desarrollo del romboencéfalo. Su incidencia exacta se desconoce, pero impresiona estar en aumento y asociada a la exposición prenatal a teratógenos. Objetivos: Analizar las historias clínicas de 30 pacientes con secuencia Moebius y las características de su compromiso ocular. Materiales y métodos: Estudio retrospectivo, transversal, observacional y descriptivo. Se analizaron 30 historias clínicas de pacientes con secuencia Moebius atendidos por vez primera entre el mes de Julio de 1999 y Junio de 2012 por el servicio de Oftalmología del Hospital Garrahan. Resultados: Se estudiaron 30 pacientes 15 de sexo femenino y 15 de sexo masculino, dentro de los antecedentes maternos 7 madres refirieron ingesta de misoprostol y 4 tuvieron metrorragias durante el primer trimestre de embarazo. Todos los pacientes tuvieron compromiso del VII nervio; en 20 pacientes fue bilateral y simétrico; y en los restantes asimétrico. Todos los pacientes tuvieron compromiso del VI nervio bilateral, a algunos de los cuáles se les efectuó cirugía de estrabismo otros están en plan de cirugía y unos pocos no la requirieron por presentar fijación de ambos ojos en posición primaria de la mirada. Conclusión: la secuencia Moebius es una rara patología genética y congénita multifactorial y de compromiso multisistémico que ha visto incrementada su frecuencia desde el uso de ciertos fármacos teratógenos y que obliga a una intervención quirúrgica precoz de neuroortopedistas, oftalmólogos, cirujanos plásticos y control clínico multidisciplinario para brindarles a estos niños las mejores posibilidades de desarrollo funcional y estético reparador (AU)

Introduction: Moebius syndrome is characterized by congenital palsy of the external and facial oculomotpr nerves, and may be associated with involvement of other cranial nerves and congenital defects. The etiology is multifactorial and not well defined. Currently, the most widely accepted theory is a rhombencephalic maldevelopment. The true incidence of Moebius syndrome is unknown, but it seems to be increasing associated with prenatal exposure to teratogenic factors. Objectives: To analyze the clinical charts of 30 patients with Moebius syndrome assessing ocular involvement. Material and methods: A retrospective, cross-sectional, observational study. Thirty clinical charts of patients with Moebius syndrome that were first seen at the Department of Ophthalmology of Hospital Garrahan between July 1999 and June 2012 were assessed. Results: Of the 30 patients 15 were female and 15 male. Maternal history showed seven mothers that received misoprostol and four that had metrorrhagia in the first trimester of pregnancy. All patients had VII cranial nerve involvement; the involvement was bilateral and symmetric in 20 and asymmetric in the remaining patients. All patients had bilateral VI nerve involvement, some of whom underwent surgery for strabismus, others are on the list for surgery, and a few do not require surgery because of fixation of both eyes in primary gaze position. Conclusion: Moebius syndrome is a rare multifactorial genetic and congenital pathology with multisystemic involvement and increased incidence because of the use of teratogenic drugs requiring early surgical intervention by neuroorthopedic and plastic surgeons, and ophthalmologists, and a multidisciplinary follow-up to provide these children with the best possibilities for functional development and aesthetic repair (AU)

Factores de riesgo que influyen en la no obtención de visión binocular en operados de esotropía congénita / Risk factors present in failed binocular vision of patients operated on from congenital esotropia

Objetivo: determinar los factores de riesgos que influyen en la no obtención de visión binocular en los pacientes operados de esotropía congénita. Métodos: estudio de serie de casos en pacientes operados de esotropía congénita en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido de enero de 2007 a mayo de 2010. Se analizaron las variables siguientes: fusión, estereopsis, edad quirúrgica, estabilidad del alineamiento ocular, número de cirugías, ambliopía y defecto refractivo.Resultados: el 57,7 por ciento de los pacientes alcanzó fusión y el 30,8 por ciento logró estereopsia, en un rango de 3 000 a 400 segundos de arco. Los niños operados tuvieron después de los 18 meses un riesgo cinco veces mayor de no desarrollar fusión y cuatro veces mayor de no desarrollar estereopsis que los operados antes de esa edad. Los pacientes que perdieron el alineamiento ocular tuvieron al año de la cirugía casi tres veces mayor probabilidad de no alcanzar fusión que aquellos que mantuvieron la ortotropía. La probabilidad de no desarrollar estereopsis fue casi dos veces mayor en los niños ambliopes. Conclusiones: la cirugía temprana resulta importante para mejorar los resultados funcionales visuales en los operados de esotropía congénita. La pérdida del paralelismo ocular y la ambliopía estuvieron asociadas al no desarrollo de fusión y estereopsis(AU)

Objective: to determine the risk factors that have an impact on failing to achieve binocular vision in patients operated on from congenital esotropia. Methods: a case-series study conducted in patients operated on from congenital esotropia at the Pediatric Ophthalmology service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2007 through May 2010. The following variables were analyzed: fusion, stereopsis, stability of the ocular alignment, surgical age, number of surgeries, amblyopia, and refractive defect. Results: in this group, 57.7 percent of the patients reached fusion and 30.8 percent achieved stereopsis, in a range of 3000 to 400 arc seconds. The risk of not developing fusion and the risk of not developing stereopsis in operated children aged over 18 months were 5 times higher and 4 times higher, respectively, than in children operated on before that surgical age. Those patients who lose the ocular alignment after one year of surgery were 3 times more likely to fail to achieve fusion than those who kept orthotopia. The probabilities of not developing stereopsis were almost twice greater in amblyopic children. Conclusions: the early surgery is important to improve the visual functional results in those operated on from congenital esotropia. The loss of ocular parallelism and amblyopia were associated to unsuccessful development of fusion and stereopsis(AU)

Factores de riesgo que influyen en la no obtención de visión binocular en operados de esotropía congénita / Risk factors present in failed binocular vision of patients operated on from congenital esotropia

Objetivo: determinar los factores de riesgos que influyen en la no obtención de visión binocular en los pacientes operados de esotropía congénita. Métodos: estudio de serie de casos en pacientes operados de esotropía congénita en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido de enero de 2007 a mayo de 2010. Se analizaron las variables siguientes: fusión, estereopsis, edad quirúrgica, estabilidad del alineamiento ocular, número de cirugías, ambliopía y defecto refractivo.Resultados: el 57,7 por ciento de los pacientes alcanzó fusión y el 30,8 por ciento logró estereopsia, en un rango de 3 000 a 400 segundos de arco. Los niños operados tuvieron después de los 18 meses un riesgo cinco veces mayor de no desarrollar fusión y cuatro veces mayor de no desarrollar estereopsis que los operados antes de esa edad. Los pacientes que perdieron el alineamiento ocular tuvieron al año de la cirugía casi tres veces mayor probabilidad de no alcanzar fusión que aquellos que mantuvieron la ortotropía. La probabilidad de no desarrollar estereopsis fue casi dos veces mayor en los niños ambliopes. Conclusiones: la cirugía temprana resulta importante para mejorar los resultados funcionales visuales en los operados de esotropía congénita. La pérdida del paralelismo ocular y la ambliopía estuvieron asociadas al no desarrollo de fusión y estereopsis

Objective: to determine the risk factors that have an impact on failing to achieve binocular vision in patients operated on from congenital esotropia. Methods: a case-series study conducted in patients operated on from congenital esotropia at the Pediatric Ophthalmology service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2007 through May 2010. The following variables were analyzed: fusion, stereopsis, stability of the ocular alignment, surgical age, number of surgeries, amblyopia, and refractive defect. Results: in this group, 57.7 percent of the patients reached fusion and 30.8 percent achieved stereopsis, in a range of 3000 to 400 arc seconds. The risk of not developing fusion and the risk of not developing stereopsis in operated children aged over 18 months were 5 times higher and 4 times higher, respectively, than in children operated on before that surgical age. Those patients who lose the ocular alignment after one year of surgery were 3 times more likely to fail to achieve fusion than those who kept orthotopia. The probabilities of not developing stereopsis were almost twice greater in amblyopic children. Conclusions: the early surgery is important to improve the visual functional results in those operated on from congenital esotropia. The loss of ocular parallelism and amblyopia were associated to unsuccessful development of fusion and stereopsis

Bupivacaine and botulinum toxin to treat comitant strabismus / Bupivacaína e toxina botulínica para tratamento de estrabismo comitante

PURPOSE: To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. METHODS: Eight patients (five female) were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique). RESULTS: Mean change in alignment was 10 prism diopters after 180 days (n=6). An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. CONCLUSION: In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxinum A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.

OBJETIVO: Avaliar a mudança na motilidade ocular e espessura dos músculos medida por ultrassonografia após injeção intramuscular de bupivacaína e toxina botulínica tipo A. MÉTODOS: Oito pacientes (5 mulheres) foram incluidos para avaliar a mudança na motilidade ocular antes e após 1, 7, 30 e 180 dias da injeção de 2 ml de bupivacaína 1,5% e 2,5 U de toxina botulínica tipo A nos músculos agonista e antagonista, respectivamente, de 8 olhos amblíopes. A espessura muscular foi medida antes após 1, 7, 30 dias da injeção através de ultrassonografia ocular 10-MHz (técnica palpebral). RESULTADOS: A média de mudança no alinhamento ocular foi igual a 10 dioptrias prismáticas após 180 dias (n=6). Foi observado um aumento médio de 1,01 mm na espessura muscular após 30 dias da injeção de bupivacaína e 0,28 mm após a injeção de toxina botulínica A medido pela ultrassonografia. Os músculos reto laterais injetados com bupivacaína tiveram um aumento médio de 1,5 mm na sua espessura. CONCLUSÃO: Neste estudo, observou-se uma mudança no alinhamento ocular após 180 dias de injeção intramuscular de bupivacaína e toxina botulínica A. Em geral, houve um aumento da espessura muscular de ambos os grupos de músculos injetados com toxina botulínica A e com bupivacaína após 30 dias da injeção. Essa mudança foi mais pronunciada nos músculos retos laterais após a injeção de bupivacaína.