Response to correction of refractive errors and hypoaccommodation in children with congenital Zika syndrome.

PURPOSE: To describe the immediate response to correction of refractive errors and hypoaccommodation in children with congenital Zika syndrome (CZS). METHODS: Children born between May and December 2015 with a confirmed diagnosis of CZS and enrolled in a multidisciplinary early intervention program were included in this study. All children received a comprehensive ophthalmic examination, including dynamic retinoscopy and cycloplegic refraction. Children were prescribed their full correction if they met the criteria for refractive error, and additional plus 3.00 overcorrection for strabismus, accommodative dysfunction, and/or low vision. Monocular and binocular visual responses to Lea Grating Test at 30 cm, with and without eyeglasses, were measured on day 1 of glasses wear. RESULTS: A total of 60 children were evaluated (mean age at evaluation, 11.5 ± 1.1 months; range, 9.0-16.0 months). Lea Grating Test responses were abnormal in all children prior to spectacle correction. Hypoaccommodation was present in 17 of 21 children (81%). Overcorrection was prescribed for all children. Visual responses were subnormal even with glasses use; however, immediate improvement in binocular vision was found in 37 children (62%) and in 74 of 119 eyes (62.2%). For the monocular visual improvement, 27 of 115 eyes (23.5%) had structural abnormalities, and 44 of 115 eyes (38.3%) were structurally normal. There was a statistical difference between the cycloplegic refraction of the children in August and in November, including emmetropia (P = 0.001), hyperopia (P = 0.000), myopia (P = 0.007), and astigmatism (P = 0.004). CONCLUSIONS: Eyeglasses can improve visual acuity in children with CZS. Significant changes in their refractive status over time requires periodic updates.

[Skew deviation. Strabismological diagnosis and treatment alternatives].

BACKGROUND: We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS: This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS: Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS: Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.

Desviación oblicua: diagnóstico estrabológico y alternativas de tratamiento / Skew deviation: strabismological diagnosis and treatment alternatives

Objetivo: Analizar las posibilidades de diagnóstico y tratamiento en pacientes con skew deviation (SD) o estrabismo con desviación oblicua. Material y métodos: Estudio prospectivo, observacional y longitudinal de pacientes con SD, de septiembre de 2007 a mayo de 2008. Se realizó exploración estrabológica, estudio multidisciplinario y se evaluaron alternativas terapéuticas. Resultados: Se estudiaron 10 pacientes con SD. Edad 11.5 + 13.6 años. Los diagnósticos neurológicos fueron esclerosis múltiple, malformación arteriovenosa, epilepsia, hidrocefalia, encefalopatía isquémica, atrofia cortical, hipoplasia de cuerpo calloso y hemorragia talámica. Se encontró retraso psicomotor en 80 %, además se asoció a apraxia de Cogan, síndrome de Parinaud, nistagmo en see-saw, síndrome de Foville y hemiplejía. Los estrabismos relacionados fueron exotropía en cinco, endotropía en tres, hipertropía en dos, desviación vertical disociada en uno. Se encontró lesión a II, III y VII nervios craneales. Conclusiones: El estudio estrabológico adecuado permite un mejor diagnóstico de la lesión en SD y con ello vigilar la evolución neurológica del paciente. El tratamiento debe incluir la rehabilitación óptica y el manejo del estrabismo, principalmente con toxina botulínica.

BACKGROUND: We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS: This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS: Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS: Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.

Síndrome de Brown bilateral / Bilateral Brown syndrome

Objetivo: El síndrome de Brown (SB) se caracteriza por restricción activa y pasiva de la elevación en adducción. Puede ser congénito o adquirido, intermitente o permanente, uni o bilateral; este último se presenta en el 10 por ciento de los casos. Nuestro objetivo es describir 9 casos de SB bilateral y revisar la literatura al respecto. Pacientes: se describen características clínicas de 9 casos y se revisa la literatura. Resultados: De los 9 casos, 2 eran de sexo masculino, y 7 de sexo femenino. Edad promedio: 5.7 años. 1 caso intermitente. Los casos publicados en diferentes series son: 13/126 (Brown), 3/8 (Clark y Noel), 7/36 (Waddell ) y 1/30 (Eustis). Entre los casos bilaterales hay alta incidencia de casos familiares. Conclusión: Se confirma que el cuadro es más común en mujeres. 7/9 tenía alineamiento en posición primaria. Todos tenían déficit bilateral de elevación y anisotropía en V. Frente a un caso de SB bilateral es conveniente examinar a los familiares en busca de casos asintomáticos.

Objective: The motility defect known as Brown´s síndrome is characterized by active and passive restriction of elevation in adduction. It may be either congenital or acquired, intermittent or permanent, uni or bilateral. It is bilateral in 10 percent of cases. Our purpose is to report 9 cases with bilateral Brown´s syndrome and review the cases previously published. Patients: 9 cases are described: 2 males and 7 females, average age 5,7 years who had bilateral Brown´s syndrome and review. Results: 9 cases are described: 2 males and 7 females, average age 5,7 years who had bilateral Brown´s syndrome, 1 of them was intermittent. Bilateral cases published are: 13/126 in Brown´s series, 3/28 in Clark and Noel´s, 7/36 in Waddell´s and 1/30 in that of Eustis. Among bilateral cases there is a striking incidence of familial cases. Conclusion: Brown´s statement that the disorder is more common in females than in males is confirmed in our series. It should be noted that 7 out of 9 of these patients had normal alignment in primary gaze. All cases had bilateral elevation deficit and V pattern. In bilateral cases examination of the relatives should be performed in order to detect asymptomatic familial cases.

Neuroblastoma-associated opsoclonus-myoclonus treated with intravenously administered immune globulin G.

An 18-month-old black girl had progressive truncal ataxia, opsoclonus, and multifocal myoclonus associated with a nonresectable abdominal ganglioneuroblastoma. Before chemotherapy, she received intravenously administered IgG, 1 gm/kg, for 2 days; within 48 hours of the first dose, there was significant improvement of the opsoclonus-myoclonus and ataxia. She required a 1 gm/kg maintenance dose every 4 to 6 weeks for a total of 12 doses, but is now free of symptomatic after 2 years with no therapy.

Tratamiento quirúrgico de los oblicuos: Hospital Regional "Honorio Delgado" / Surgical treatment of oblique: Honorio Delgado Hospital Regional

Presentamos nuestra experiencia en el tratamiento quirúrgico de 16 casos de estrabismo con compromiso de los oblicuos. Las conductas quirúrgicas adoptadas fueron: debilitamiento del OI homolateral por miectomía y del RI contralateral por reseción en los casos de estrabismo con parálisis del OS; el retroceso del OS en la hiperfunción de éste músculo; la miectomía, miotomía y zetoplastía en la hiperfunción del OI; y por último la retroposición del OS homolateral y la resección del RS contralateral en la parálisis del OI.

Our experience in the surgical treatment of 16 cases of strabismus due to involvement of the oblique muscules is presented. The surgical procedure carried out were: weakening of the ipsilateral lower oblique muscle by myectomy and resection of the contralateral right lower muscle in the cases of strabismus with upper oblique palsy. Backward displacement the upper oblique was performed in the hyperfuntion of this muscle. Myectomy, myotomy and zetoplasty were done in hiperfuntion of the lower oblique. Lasly retroposition of the ipsilateral upper oblique and resection of the lower oblique palsy was done in cases of lower oblique palsy.