Are iris mammillations correlated with keratoconus?

PURPOSE: To describe the presence of iris mammillations (IM) in keratoconus. DESIGN: Retrospective case series and literature review. OBSERVATIONS: This is a retrospective case series of eight patients presenting with keratoconus and IM, who were examined between January 2016 and December 2017 in the ophthalmology outpatient clinic. They had a median age of 14 (11-30), and all had bilateral keratoconus and diffusely distributed IM. The IM had similar presentations and similar iris colors. None had relevant medical or family diseases associated with IM. Three eyes previously had penetrating keratoplasty. Four (31%) out of 13 eyes had mean keratometry (Km) > 55D, and 4 (31%) had the thinnest pachymetry between 300 and 400µm. CONCLUSIONS AND IMPORTANCE: To the best of our knowledge , this is the first time that IM was observed in association with keratoconus patients. The possibility that IM is an early finding in otherwise healthy patients may help to predict the future diagnosis of keratoconus. Future studies are needed to show the frequency and possible association between IM and a keratoconus prognosis. This may also demonstrate that there is a subgroup of patients with a distinct etiology of keratoconus.

Eccentric fixation patterns, clinical findings, and reading speed in patients with bilateral toxoplasmic macular retinochoroiditis / Padrões de fixação excêntrica, achados clínicos e velocidade de leitura em pacientes com retinocoroidite macular bilateral por toxoplasmose

ABSTRACT Purpose: To study visual acuity, refractive errors, eccentric fixation, and reading performance in patients with toxoplasmic macular retinochoroiditis. Methods: Twenty-three participants with bilateral toxoplasmic macular retinochoroiditis and 4 with toxoplasmic macular retinocho­roiditis in their unique eye were evaluated. Participants reported their eye dominance, confirmed by the Portus and Miles test. Best corrected visual acuity, spherical equivalent refraction, magnification need, and reading speed were measured. Microperimetry (MAIA, Centervue - Padova, Italy) recorded the preferred retinal locus and fixation stability by means of the bivariate contour ellipse area. Fourteen eyes from 14 normally sighted subjects served as controls. Results: Mean ± SD best corrected visual acuity was better in the dominant eye than in the nondominant eye: 0.9 ± 0.2 (logMAR 0.5 to 1.4) vs. 1.2 ± 0.3 (logMAR 0.6 to 1.7) (p<0.0001, paired t-test). Spherical equivalent myopia of -4.00 or higher was present in 42% of the eyes. Microperimetry was performed in 42 eyes. Eccentric fixation was observed in all examined eyes. In 14 eyes (33%), the preferred retinal locus was placed (in the retina) superior temporal to the macular lesion, in 10 (24%) superior nasal, in 6 (14%) inferior temporal, and in 12 (28%) inferior nasal. There was no significant difference in the distribution of the preferred retinal locus position between dominant and nondominant eyes (p=0.85, Pearson test). There was no correlation between reading speed and the distance between the preferred retinal locus and the estimated original foveal position (r=-0.09; p=0.73), the bivariate contour ellipse area (r=-0.19; p=0.44), or best corrected visual acuity (r=0.024; p=0.92). Conclusions: Myopia is more prevalent in patients with toxoplasmic macular retinochoroiditis. Reading speed is not dependent on preferred retinal locus position, stability, or visual acuity. Nevertheless, documentation of fixation provides new data on the impact of visual impairment in these patients and may be useful for rehabilitation efforts.

RESUMO Objetivo: Estudar a acuidade visual, erros de refração, fixação excêntrica e desempenho de leitura em pacientes com retinocoroidite macular por Toxoplasmose. Métodos: Vinte e três pacientes com retinocoroidite macular por Toxoplasmose bilateral e quatro com retinocoroidite macular por Toxoplasmose no seu único olho foram avaliados. Os participantes relataram sua dominância ocular, confirmada pelo teste de Portus e Miles. A acuidade visual melhor corrigida, refração em equivalente esférico, magnificação necessária e velocidade de leitura foram medidas. A microperimetria (MAIA, Centervue - Padova, Italy) registrou a estabilidade preferida do locus e da fixação da retina por meio da área da elipse de con­torno bivariada. Quatorze olhos de 14 pacientes com boa visão serviram como controles. Resultados: A média ± DP da acuidade visual melhor corrigida foi melhor no olho do­minante do que no não dominante: 0,9 ± 0,2 (logMAR 0,5 a 1,4) vs. 1,2 ± 0,3 (logMAR 0,6 a 1,7) (p<0,0001, teste t pareado). Miopia em equivalente esférico de -4,00 ou maior estava presente em 42% dos olhos. Microperimetria foi realizada em 42 olhos. Fixação excêntrica foi observada em todos os olhos examinados. Em 14 olhos (33%), o locus retiniano preferencial estava localizado, na retina, na região súpero-temporal à lesão macular, em 10 (24%) súpero-nasal, em 6 (14%) ínfero-temporal, e em 12 olhos (29%) ínfero-nasal. Não houve diferença significativa na distribuição da posição do locus retiniano preferencial entre olhos dominantes e não dominantes (p=0,85, teste de Pearson). Não houve correlação entre velocidade de leitura e distância entre o locus retiniano preferencial e a posição foveal original estimada (r=-0,09; p=0,73), a área bivariada de contorno elipsóide (r=-0,19; p=0,44) ou acuidade visual melhor corrigida (r=0,024; p=0,92). Conclusões: A miopia é mais prevalente em pacientes com retinocoroidite macular por Toxoplasmose. A velocidade de leitura não é dependente da posição do locus retiniano preferencial, da estabilidade ou da acuidade visual. A documentação do padrão de fixação excêntrica, entretanto, oferece novos dados no impacto da deficiência visual nesses pacientes e pode ser útil em estratégias de reabilitação.

Eccentric fixation patterns, clinical findings, and reading speed in patients with bilateral toxoplasmic macular retinochoroiditis.

PURPOSE: To study visual acuity, refractive errors, eccentric fixation, and reading performance in patients with toxoplasmic macular retinochoroiditis. METHODS: Twenty-three participants with bilateral toxoplasmic macular retinochoroiditis and 4 with toxoplasmic macular retinocho-roiditis in their unique eye were evaluated. Participants reported their eye dominance, confirmed by the Portus and Miles test. Best corrected visual acuity, spherical equivalent refraction, magnification need, and reading speed were measured. Microperimetry (MAIA, Centervue - Padova, Italy) recorded the preferred retinal locus and fixation stability by means of the bivariate contour ellipse area. Fourteen eyes from 14 normally sighted subjects served as controls. RESULTS: Mean ± SD best corrected visual acuity was better in the dominant eye than in the nondominant eye: 0.9 ± 0.2 (logMAR 0.5 to 1.4) vs. 1.2 ± 0.3 (logMAR 0.6 to 1.7) (p<0.0001, paired t-test). Spherical equivalent myopia of -4.00 or higher was present in 42% of the eyes. Microperimetry was performed in 42 eyes. Eccentric fixation was observed in all examined eyes. In 14 eyes (33%), the preferred retinal locus was placed (in the retina) superior temporal to the macular lesion, in 10 (24%) superior nasal, in 6 (14%) inferior temporal, and in 12 (28%) inferior nasal. There was no significant difference in the distribution of the preferred retinal locus position between dominant and nondominant eyes (p=0.85, Pearson test). There was no correlation between reading speed and the distance between the preferred retinal locus and the estimated original foveal position (r=-0.09; p=0.73), the bivariate contour ellipse area (r=-0.19; p=0.44), or best corrected visual acuity (r=0.024; p=0.92). CONCLUSIONS: Myopia is more prevalent in patients with toxoplasmic macular retinochoroiditis. Reading speed is not dependent on preferred retinal locus position, stability, or visual acuity. Nevertheless, documentation of fixation provides new data on the impact of visual impairment in these patients and may be useful for rehabilitation efforts.

Oculomotor Status, Binocular Vision, and Stereoacuity in a Series of Keratoconus Subjects.

Purpose: A group of keratoconus subjects (KG) and a control group (CG) were evaluated for sensory and motor status. We tried to clarify the factors (best-corrected visual acuity [BCVA]), heterophorias, fusional amplitude, anisometropia, astigmatism) that may be associated with a binocular disturbance. Methods: BCVA (logMAR) was measured. Binocular vision was checked using cover tests, striate Maddox, and a 6Δ base-down prism (simultaneous perception), a prism bar (fusion and fusional convergence break point), and Titmus Fly Test (stereopsis). Results: Fifty-four subjects of the KG, 27 men (median 16 years), and 29 of the CG, 15 men (median 20 years), were evaluated. In the KG, 8 (15%) subjects had strabismus. Those whose BCVA in the worse eye was logMAR ≥0.7 had a significantly higher frequency of strabismus and absence of simultaneous perception. Spherical equivalent anisometropia ≥ 1.0 diopter (D) was significantly different in both groups as was the frequency of gross stereopsis. In comparing fine and gross stereopsis in both the KG and the CG, there was a significant difference in the frontal astigmatism between eyes in the KG (P = 0.03) and CG (P = 0.01). Conclusions: In our study, the KG presented a higher frequency of strabismus and impaired binocular vision. Frontal astigmatism was different between groups with gross and fine stereopsis, in both the CG and KG. Future studies are needed to elucidate or reinforce the factors associated with the loss of binocularity in keratoconus. Testing for stereopsis may be helpful to consider in the treatment guidelines for keratoconus.

Increased frequency of activated satellite cells in overacting inferior oblique muscles from humans.

PURPOSE: Strabismus is an oculomotor disorder in which there is a misalignment of the visual axes of the eyes. Inferior oblique muscle (IOM) overaction is a common finding in comitant horizontal strabismus, but its origin is unclear. Recent studies have demonstrated that myogenic satellite cells (SCs) are still activated in adult extraocular muscles, with continuous myonuclear addition in normal uninjured muscles. The objective of this study was to determine whether there are differences in the processes of activation and proliferation of SCs in IOMs of patients with strabismus and IOM overaction and in patients with no history of strabismus. METHODS: Cross sections of IOMs from strabismic and control groups were analyzed immunohistochemically for the presence of MyoD1 and myogenin, specific markers of activated SCs, and for c-Met, which is expressed in quiescent, activated, and proliferating SCs. RESULTS: In overacting IOMs of 26 patients in the strabismic group and 10 patients in the control group, 28.8% and 3.0% of the myofibers, respectively, were associated with MyoD1-positive SC. The frequency of myogenin-positive SC was 30.8% in the strabismic group and 3.6% in the control group, and the frequency of presumptive SCs immunostained for c-Met was 33.6% in the strabismic group and 34.1% in the control group. CONCLUSIONS: The presence of an increased number of activated SCs in overacting IOMs of the strabismic group in contrast to the frequency in the control group resembles the findings detected in developing, regenerating, or hypertrophic muscle tissue. High levels of MyoD1- and myogenin-positive SC in overacting IOMs support the hypothesis that these cells may be involved in alterations in IOM structure correlated with the overaction observed clinically.

Fratura isolada de parede medial da órbita associada á redução importante de movimentação ocular: relato de caso / Orbital medial wall issolated fracture associated with important reduction of ocular movements: case report

Homem de 25 anos apresentou diplopia em todas as posições do olhar, associada à movimentação ocular dolorosa, após sofrer traumatismo contuso em região orbitária direita. Tomografia computadorizada revelou fratura isolada indireta de parede medial de órbita direita. A correção cirúrgica da fratura levou ao desaparecimento da queixa de diplopia e melhorou o campo de visão binocular.

Correção de estrabismo restritivo por técnica cirúrgica não-convencional / New approach in restrictive strabismus surgery

Os autores relatam caso de pacientes de 56 anos com lata miopia e estrabismo (eso e hipotropia) muito grande, desenvolvido progressivamente. O acesso operatório para secçäo completo do reto medial foi facilmente conseguido por uma orbitotomia transcaruncular, näo apenas pela impossibilidade de uso de técnicas convencionais, como pelo alto risco de rutura escleral em casos assim. O reto lateral foi ressecado e reinserido acima de seu trajeto original, após ter sido achado no quadrante ínfero-temporal do olho. O resultado cirúrgico imediato (uma exotropia de cerac de 12 graus) foi considerado muito bom, já que tais desvios tendem á recidiva.

Síndrome de Opitz - relato de caso / Opitz syndrome - a case report

Descriçäo de quadro clínico de criança com síndrome de Opitz, estrabismo e outros distúrbios oculomotores. Relato de caso: Pacientes de três anos com hipospádia peno-escrotal, escroto bífido, ânus anteriorizado, micrognatia, pálato alto, fronte ampla, raiz nasal baixa, hipertelorismo e epicanto, implantaçäo baixa de orelhas, clinodactilia, espinha bífida e retardo do desenvolvimento neuromotor, interpretadas como manifestaçöes da síndrome de Opitz (OMIM *145410). Apresentava um ET alternante com fixaçäo cruzada (síndrome de Ciancia), associada a manifestaçöes da síndrome de Duane bilateral e desvio vertical (E/D), possivelmente devido a uma dissociaçäo motora entre o RSD e músculos palpebrais do OD. A criança faleceu após cirurgia de reconstruçäo anorretal. Discussäo: Apesar de comprometimentos oculares, näo há publicaçöes referentes á síndrome de Opitz em periódicos oftalmológicos. As com mençöes sobre estrabismo näo säo acompanhadas por relatos mais pormenorizados da motilidade ocular. O caso apresentava dissociaçöes oculomotoras importantes, mas seus esclarecimentos näo foram possíveis pelo falecimento prematuro da criança.