Oscillopsia After Isolated Lateral Wall Decompression Versus Balanced or 3-Wall Decompression.

PURPOSE: To assess the incidence of postoperative masticatory oscillopsia after orbital decompression, comparing results between isolated lateral wall and balanced or 3-wall orbital decompression. METHODS: An observational retrospective study was performed, involving 161 consecutive patients who underwent orbital decompression between 2008 and 2018. Patients' clinical data were registered, and archives were revised for data compilation. Patients were divided into 2 groups according to the type of surgery: "lateral" group included patients who underwent isolated lateral wall decompression and "lateral plus" group involved patients with balanced or 3-wall decompression. Exclusion criteria were secondary decompressions, those not including lateral wall and asymmetrical surgeries, so analysis was performed among 131 remaining patients. Oscillopsia was self-reported and was registered as present or not. Diplopia was evaluated according to Paridaens grading system. RESULTS: Statistical analysis among the 131 patients with lateral wall decompression (isolated or in combination) was performed. Seven patients referred oscillopsia, 5 among "lateral" group, while 2 reported oscillopsia on "lateral plus" group (p = 0.001). The authors found no differences on new-onset or worsening of diplopia between groups (p = 1). CONCLUSIONS: Oscillopsia was significantly higher after isolated lateral wall decompression than after balanced or 3-wall decompression, while no differences were found between groups according to diplopia status. Transmission of temporal muscle contraction to the orbit seems to be the cause of the oscillopsia. The authors postulate that the absence of orbital floor or medial wall may act as a dampener for the temporalis muscle contractions, allowing the orbital contents to be expanded through them, and avoiding oscillopsia.

Outcomes of Medial Rectus Recession With Adjustable Suture in Acute Concomitant Esotropia of Adulthood.

PURPOSE: To review and analyze the surgical outcomes of bilateral medial rectus recession with adjustable suture in acute concomitant esotropia of adulthood (ACEA). METHODS: The charts of all adults diagnosed as having ACEA between 2004 and 2017 were reviewed. Best corrected visual acuity, refractive error, ocular alignment measured in prism diopters (PD), and stereopsis were examined at presentation, 1 day postoperatively, and final follow-up visit (median: 10 months; range: 4 to 144 months). All patients underwent bilateral medial rectus recession using adjustable suture surgery and topical anesthesia. Statistical analysis was used to calculate surgical dose-responses and to study possible correlations with clinical parameters. RESULTS: Fifteen patients diagnosed as having ACEA were included. The mean age was 39.2 ± 10.7 years, and the mean refractive errors in the right and left eyes were -3.97 ± 2.87 and -3.60 ± 2.74 diopters (D), respectively. Average esotropia deviations at near and distance were 22.7 ± 7.2 and 23.0 ± 7.5 PD. All patients improved with medial rectus recession (mean: 12.0 ± 2.2 mm) with a final mean deviation of 0.7 ± 1.8 PD. The mean dose-responses at 1 day postoperatively and final visit were 1.86 ± 0.58 and 1.83 ± 0.43 PD/mm, respectively. There was a significant positive correlation between surgical dose-responses at 1 day postoperatively and final visit and preoperative deviation (R2 = 0.55; P < .001; R2 = 0.66; P < .001), whereas there were no significant correlations with age, sex, refractive error, BCVA, or stereopsis (all P > .05). CONCLUSIONS: Good postoperative and final outcomes are achieved with large medial rectus recessions in ACEA. A larger dose-response can be expected in large preoperative deviations, independent of other clinical and ocular parameters. [J Pediatr Ophthalmol Strabismus. 2019;56(2):101-106.].

Abnormal head position in infantile nystagmus syndrome.

Infantile nystagmus is an involuntary, bilateral, conjugate, and rhythmic oscillation of the eyes which is present at birth or develops within the first 6 months of life. It may be pendular or jerk-like and, its intensity usually increases in lateral gaze, decreasing with convergence. Up to 64% of all patients with nystagmus also present strabismus, and even more patients have an abnormal head position. The abnormal head positions are more often horizontal, but they may also be vertical or take the form of a tilt, even though the nystagmus itself is horizontal. The aim of this article is to review available information about the origin and treatment of the abnormal head position associated to nystagmus, and to describe our treatment strategies.

El tortícolis en la cirugía del nistagmus congénito y la videonistagmografía / The torticollis in congenital nystagmus surgery and videonystagmography

Se analizan 66 pacientes con nistagmus congénito manifiesto, 29 de ellos con estrabismo asociado. Se analizan variables como el tipo de tortícolis, registro videonistagmográfico horizontal y vertical, la disminución en la convergencia, tipo de cirugía. En la muestra de pacientes presenta patología sensorial asociada el 40,5 por ciento. Resultados: De la muestra de 66 pacientes con nistagmus congénito, el tortícolis que aparece con más frecuencia en los pacientes estudiados es el tortícolis horizontal (89 por ciento). La técnica quirúrgica más frecuentemente utilizada fue la retroinserción amplia retroecuatorial (12-15 mm) de los músculos recto medio y recto lateral contralateral (44 por ciento). La velocidad del nistagmus horizontal registrada en la videonistagmografía (VNG) es mayor en los que tienen tortícolis horizontal que en los que no lo presentan. Si se asocia un problema mayor de nistagmus en resorte, estrabismo, parálisis oculomotora, esto puede hacer aumentar o modificar el tortícolis.- El 100 por ciento de los pacientes con nistagmus y estrabismo asociado tiene tortícolis. Conclusiones: La causa principal del tortícolis en los pacientes con nistagmus es el nistagmus por delante del estrabismo. El tortícolis de presentación más frecuente es el horizontal en el 89 por ciento de los casos. El tortícolis torsional se presenta en el 36 por ciento de los pacientes de nuestra muestra y el vertical en el 34 por ciento. El estrabismo tiene un papel clave en la aparición de tortícolis vertical y torsional en el nistagmus. Sin embargo el estrabismo está menos presente en casos de tortícolis horizontales puros. Es necesario antes de tomar una determinada actitud terapéutica en un nistagmus contar con el mayor número de datos posibles para desenmascarar los componentes del nistagmus y la presencia o no de estrabismo, y la VNG aporta gran información a este respecto, como la presencia o no de bloqueo, la disminución de la intensidad en ciertas posiciones, etc.

We analyze 66 patients with congenital manifest nystagmus, 29 of them with associated strabismus. Parameters studied were head position, type of surgery, videonistagmography registration, ocular abnormalities, frequencies. Horizontal torticollis was the most frequent head position found (89 percent), followed by torsional (36 percent) and vertical (34 percent) torticollis. No sensory nystagmus blocked in convergence (18 percent). Although sensory nistagmus never block, they to reduce their intensity by more than half in 28.6 percent of cases. The type of surgery we used the most was over one horizontal muscle and contralateral muscle in the other eye. We concluded that nystagmus is the main cause of abnormal horizontal head position. However strabismus also participate. Torsional and vertical head position is mostly caused by strabismus. Although simple clinical study is the first step to any understanding of nystagmus, videonistagmography give us some useful information. We can study with much more precision some nystagmus movements (0,2 percent) that are undetectable by visual study. It is also useful in case of blocking convergence.