Quality of life in children with strabismus / Qualidade de vida em crianças com estrabismo

ABSTRACT Purpose: To evaluate the quality of life of children with strabismus and understand their consequences in the functional and psychosocial aspects of the childhood. Methods: A semi-structured interview adapted of Adult Strabismus-20 questionnaire was conducted with parents or the legal responsible person of children aged between 3 and 13 years old attended at the public health care. A likert-scale of five points was used to measure the impact of strabismus in childhood, from psychosocial and functional aspects. Results: 97 children were included in the study. 61,4% of the children had esotropia (ET), while 35.9% had exotropia (XT). In each group, the magnitude of deviation was classified in smaller (<) or equal/greater (≥) then 30 prismatic diopters. When analyzing the functional and the psychosocial scores of the groups separated by the type of strabismus and magnitude of deviation, the average score of the group with esotropia and the patients with larger deviations were worse. The correlation value between the psychosocial and functional scores was 200.656 (p <0.01). Conclusion: Strabismus in childhood is associated with many negative effects. These consequences should be considered when deciding for surgical treatment on early ages. The strabismus treatment may change positively how these children perceive themselves, resulting in benefits on quality of life from both the functional and psychosocial perspectives.

RESUMO Objetivo: Avaliar a qualidade de vida de crianças com estrabismo e entender suas consequências em aspectos funcionais e psicossociais da infância. Métodos: Uma entrevista semiestruturada adaptada do questionário Adult Strabismus-20 foi realizada com os pais ou responsáveis legais das crianças entre 3 e 13 anos atendidas na rede pública de saúde. Uma escala do tipo Likert de cinco pontos foi usada para mensurar o impacto do estrabismo na infância, do ponto de vista funcional e psicossocial. Resultados: Foram incluídas no estudo 97 crianças, sendo 61,4% com esotropia e 35,9% com exotropia. Em cada grupo, a magnitude do desvio foi classificada em menor ou maior que 30 dioptrias prismáticas. Quando analisados os escores funcionais e psicossociais de cada grupo separados por tipo e magnitude do desvio, a média do escore do grupo com esotropia e dos pacientes com maior desvio foi pior. O valor de correlação entre os escores funcionais e psicossociais foi de 0,656 (p<0,01). Conclusão: Estrabismo na infância está associado a muitos efeitos negativos. As consequências devem ser levadas em consideração quando da decisão por tratamento cirúrgico em idades precoces. O tratamento do estrabismo pode alterar de forma positiva a percepção que a criança tem de si mesma, resultando em benefícios na qualidade de vida, tanto em aspectos funcionais quanto psicossociais.

Plication versus Resection in Horizontal Strabismus Surgery: A Systematic Review with Meta-Analysis.

PURPOSE: The purpose of this review was to compare the efficacy of rectus muscle plication versus resection on the treatment of horizontal strabismus and to evaluate the exodrift after each technique. METHODS: A research was performed in Latin American and Caribbean Literature on Health Sciences (LILACS); MEDLINE; and Cochrane Central Register of Controlled Trial (CENTRAL). The database was searched by 30 June 2019. The selection was restricted to articles published in English, Spanish, or Portuguese. There were no date restrictions in the search. A minimum mean follow-up of six months was required to access the primary outcomes. Motor alignment success was defined as postprocedure deviation within 10 prism diopters (PD) of orthotropia. RESULTS: Seven studies were eligible for inclusion. The grouped success rate after plication was 66% (95% CI = [43%-89%]), and the grouped success rate after resection was 68% (95% CI = [43%-89%]). High heterogeneity was observed between the estimations. There was no difference between the mean amount of deviation corrected in prism diopters, when using the mixed-model approach (SMD = 0.12; 95% CI = -0.2-0.44; p=0.45). The undercorrection rates were also analyzed. The combined odds ratio was 1.37 (95% CI = 0.59-3.16; p=0.462), and there was no statistical significance. CONCLUSION: Plication of horizontal extraocular muscles reveals to be an alternative to resection in strabismus surgery, with similar results. Exodrift is observed after plication and after resection in the treatment of exotropia, but randomized clinical trials are necessary to analyze and compare the follow-up.

Intermittent exotropia surgery: results in different age groups.

PURPOSE: To report the outcomes in patients undergoing surgical correction of intermittent exotropia and to compare the age at surgery to motor and sensory success. METHODS: This was a retrospective cohort study. The results of patients with intermittent exotropia treated with surgery over a 4-year period were reviewed. Patients were divided into two groups based on age at first surgery (<4 years vs. ≥4 years), and motor and sensory outcomes were compared between the two groups. RESULTS: One hundred thirty-six patients were evaluated, with 67 and 51 patients undergoing surgery before and after the age of 4 years, respectively. The mean age at surgery was 6.8 ± 2.6 years. The reoperation rate for the patients who underwent surgery before 4 years of age was 48% versus 42% for the ones who underwent surgery after this age (p=0.93). Postoperative stereopsis showed an inverse linear association with age at surgery (p<0.001). For each month younger at the time of surgery, there was 0.69 s of arc worsening in the Titmus test. Conversely, when we separately analyzed the patients in whom the first postoperative alignment was esotropic vs. orthophoric/exotropic, we found no correlation between the immediate postoperative alignment in the first week and sensory outcome at the last visit. CONCLUSIONS: When indicated, patients with intermittent exotropia can be operated upon safely under 4 years of age, and may even present better motor results than older patients. Postoperative stereoacuity in younger children revealed to be worse than in older children; however, this result is unlikely to be due to inadequate age for surgery, but rather, immaturity for performing the stereopsis test.

Intermittent exotropia surgery: results in different age groups / Cirurgia para correção de exotropia intermitente: resultados em diferentes grupos etários

ABSTRACT Purpose: To report the outcomes in patients undergoing surgical correction of intermittent exotropia and to compare the age at surgery to motor and sensory success. Methods: This was a retrospective cohort study. The results of patients with intermittent exotropia treated with surgery over a 4-year period were reviewed. Patients were divided into two groups based on age at first surgery (<4 years vs. ≥4 years), and motor and sensory outcomes were compared between the two groups. Results: One hundred thirty-six patients were evaluated, with 67 and 51 patients undergoing surgery before and after the age of 4 years, respectively. The mean age at surgery was 6.8 ± 2.6 years. The reoperation rate for the patients who underwent surgery before 4 years of age was 48% versus 42% for the ones who underwent surgery after this age (p=0.93). Postoperative stereopsis showed an inverse linear association with age at surgery (p<0.001). For each month younger at the time of surgery, there was 0.69 s of arc worsening in the Titmus test. Conversely, when we separately analyzed the patients in whom the first postoperative alignment was esotropic vs. orthophoric/exotropic, we found no correlation between the immediate postoperative alignment in the first week and sensory outcome at the last visit. Conclusions: When indicated, patients with intermittent exotropia can be operated upon safely under 4 years of age, and may even present better motor results than older patients. Postoperative stereoacuity in younger children revealed to be worse than in older children; however, this result is unlikely to be due to inadequate age for surgery, but rather, immaturity for performing the stereopsis test.

RESUMO Objetivo: Descrever os resultados em pacientes submetidos à correção cirúrgica de exotropia intermitente e comparar o sucesso motor e sensorial em relação à idade na cirurgia. Métodos: Estudo tipo coorte retrospectivo. Os resultados cirúrgicos de pacientes com exotropia intermitente foram avaliados em um período de 4 anos. Os pacientes foram divididos em 2 grupos de acordo com a idade na primeira cirurgia (antes ou após os 4 anos de idade) e foram comparados quanto aos resultados motores e sensoriais. Results: 136 pacientes foram avaliados, 67 operados antes dos 4 anos e 51 operados após esta idade. A idade média na cirurgia foi de 6,8 ± 2,6 anos. A taxa de reoperação em pacientes operados antes dos 4 anos foi de 48% versus 42% naqueles operados mais tarde (p=0,93). A estereopsia pós-operatória mostrou uma associação linear inversa com a idade na cirurgia (p<0,001). Para cada mês mais jovem na idade da cirurgia, houve uma piora de 0,69 segundos de arco no teste de Titmus. Por outro lado, não foi encontrada correlação entre o alinhamento pós-operatório na primeira semana e o resultado sensorial na última visita, quando avaliamos separadamente os pacientes que se apresentaram com esotropia ou orto/exotropia na primeira semana pós-cirúrgica. Conclusão: Havendo critério para cirurgia, os pacientes com exotropia intermitente podem ser operados com segurança antes dos 4 anos de idade, e podem muitas vezes apresentar um melhor resultado motor do que os pacientes operados mais tarde. A estereopsia pós-operatória em crianças mais jovens foi pior, mais provavelmente por imaturidade ao realizar o teste do que por idade inadequada na cirurgia.

The Use of Botulinum Toxin to Treat Infantile Esotropia: A Systematic Review With Meta-Analysis.

Purpose: The purpose of this review was to examine the efficacy of botulinum toxin in the treatment of infantile esotropia and to evaluate the average response of BT and its complication rates. Methods: A research was performed in the Latin American and Caribbean Literature on Health Sciences (LILACS), MEDLINE, and Cochrane Central Register of Controlled Trial (CENTRAL). The database was searched between December 28, 2016 and January 30, 2017. The selection was restricted to articles published in English, Spanish, or Portuguese. There were no date restrictions in the search. Results: Nine studies were eligible for inclusion. The grouped success rate of BT treatment in infantile esotropia was 76% (95% confidence interval [CI]: 61%-89%). For the success rate, I2 of 94.25% was observed, indicating a high heterogeneity (P < 0.001). The complication rates were also analyzed. The grouped consecutive exotropia (XT) rate was 1% (95% CI: 0%-2%). The grouped ptosis rate was 27% (95% CI: 21%-33%). The grouped vertical deviation rate was 12% (95% CI: 4%-22%). The mean change of the deviation after BT injection was -30.7 (95% CI: -37.7, -23.8), demonstrating a significant improvement in alignment. Conclusions: Botulinum toxin injection into medial recti muscles reveals to be a safe procedure and a valuable alternative to strabismus surgery in congenital esotropia, especially in moderate deviations.

Variability in Response to Bilateral Medial Rectus Recessions in Infantile Esotropia.

PURPOSE: To evaluate factors associated with surgical success in bilateral medial rectus recessions in infantile esotropia. METHODS: The results of 97 patients with infantile esotropia undergoing surgical correction from January 2010 through December 2013 at Children's Medical Center of Dallas were reviewed. Multivariate logistic regression analysis of risk factors for success and evaluation of the relationship of surgical responses to baseline characteristics were performed. RESULTS: The authors achieved an overall success rate of 59% (57 of 97 patients) with one surgery. At the time of surgery, preoperative angle, refraction, amblyopia, and simultaneous inferior oblique surgery were not significantly related to success or failure. The mean dose response was 3.61 ± 1.45 prism diopters per millimeter of surgery and was modestly correlated only with the preoperative deviation (r(2) = 0.32). Failure was associated with variability in dose-response, not inadequate or inconsistent with surgical dosing. CONCLUSIONS: Surgical success with bilateral medial rectus recessions in infantile esotropia is limited by the high variability in surgical dose-response. [J Pediatr Ophthalmol Strabismus. 2016;53(5):305-310.].

Revesz syndrome

Revesz syndrome is a rare variant of dyskeratosis congenita and is characterized by bilateral exudative retinopathy, alterations in the anterior ocular segment, intrauterine growth retardation, fine sparse hair, reticulate skin pigmentation, bone marrow failure, cerebral calcification, cerebellar hypoplasia and psychomotor retardation. Few patients with this syndrome have been reported, and significant clinical variations exist among patients. This report describes the first Brazilian case of Revesz syndrome and its ocular and clinical features.

A síndrome de Revesz é uma rara variante de disceratose congênita caracterizada por retinopatia exsudativa bilateral, alterações no segmento anterior ocular, retardo do crescimento intrauterino, pilificação fina e escassa, pigmentação cutânea reticular, falência da medula óssea, calcificações cerebrais, hipoplasia cerebelar e retardo neuropsicomotor. Há variações clínicas significativas entre os poucos relatos desta patologia existentes na literatura. Descrevemos o primeiro caso brasileiro de síndrome Revesz e suas características clínicas e oculares.

Surgical results of strabismus correction in patients with myelomeningocele.

PURPOSE: Myelomeningocele is one of the most common birth defects. It is associated with severe neurological deficiencies, and ocular changes, such as strabismus, are very common. The purpose of this study was to describe indications for strabismus surgery in patients with myelomeningocele and to evaluate the results achieved with surgical correction. METHODS: We retrospectively reviewed records of all patients with myelomeningocele who underwent surgery for strabismus correction in a 5-year period in an institution for disabled children. RESULTS: The main indications for strabismus surgery were esotropia and A-pattern anisotropia. Excellent surgical results were achieved in 60.9% of patients, satisfactory in 12.2%, and unsatisfactory in 26.9%. CONCLUSION: Patients with myelomeningocele and strabismus had a high incidence of esotropia and A-pattern anisotropia. Strabismus surgery in these patients had an elevated percentage of excellent and satisfactory results, not only for the ocular deviation, but also for improvement of head posture.

Surgical results of strabismus correction in patients with myelomeningocele / Resultados cirúrgicos da correção do estrabismo em pacientes com mielomeningocele

Purpose: Myelomeningocele is one of the most common birth defects. It is associated with severe neurological deficiencies, and ocular changes, such as strabismus, are very common. The purpose of this study was to describe indications for strabismus surgery in patients with myelomeningocele and to evaluate the results achieved with surgical correction. Methods: We retrospectively reviewed records of all patients with myelomeningocele who underwent surgery for strabismus correction in a 5-year period in an institution for disabled children. Results: The main indications for strabismus surgery were esotropia and A-pattern anisotropia. Excellent surgical results were achieved in 60.9% of patients, satisfactory in 12.2%, and unsatisfactory in 26.9%. Conclusion: Patients with myelomeningocele and strabismus had a high incidence of esotropia and A-pattern anisotropia. Strabismus surgery in these patients had an elevated percentage of excellent and satisfactory results, not only for the ocular deviation, but also for improvement of head posture. .

Objetivo: A mielomeningocele é um dos mais frequentes defeitos do nascimento e está associada a disfunções neurológicas severas. Alterações oculares como estrabismo são muito comuns nesses pacientes. O objetivo deste estudo foi descrever as principais indicações de cirurgia de estrabismo em pacientes com mielomeningocele e avaliar os resultados atingidos com a correção cirúrgica. Métodos: Foi realizado estudo restrospectivo com revisão de prontuários de todos os pacientes com mielomeningocele submetidos à cirurgia para correção de estrabismo em um período de 5 anos em uma instituição de assistência a crianças deficientes. Resultados: As principais indicações para cirurgia de estrabismo foram esotropia e anisotropia com padrão em A. Resultados cirúrgicos excelentes foram alcançados em 60,9% dos pacientes, satisfatórios em 12,2% e insatisfatórios em 26,9%. Conclusão: Pacientes com mielomeningocele e estrabismo têm uma alta incidência de esotropia e anisotropia com padrão em A. A cirurgia de estrabismo nesta população teve uma elevada porcentagem de resultados excelentes e satisfatórios, não somente em relação ao desvio ocular, mas também na melhora na posição viciosa de cabeça .

[The main factors related with cornea non-donation of potential donors in a university hospital of Curitiba]. / Principais variáveis envolvidas na não-doação de córneas de potenciais doadores em um hospital universitário de Curitiba.

PURPOSE: To define the main factors related with cornea non-donation of potential donors in a University Hospital of Curitiba. METHODS: The potential corneal donators who died at the I.C.U and at Emergency Section at Hospital Universitário Evangélico de Curitiba (HUEC) between November 2007 and February 2008 were selected. A close relative was interviewed by telephone, following a standard interview protocol. RESULTS: The most significant result was that from the 64 relatives interviewed, 60 (93.75%) had not been approached about the organ donation. From the same group, 32 (53.33%) would have consented the corneal donation if the approach had been performed. CONCLUSION: The low number of relatives approaches by physicians at the time of death was the main handicap in the process of corneal donation permission.

Principais variáveis envolvidas na não-doação de córneas de potenciais doadores em um hospital universitário de Curitiba / The main factors related with cornea non-donation of potential donors in a university hospital of Curitiba

OBJETIVO: Determinar as principais variáveis envolvidas na não-doação de córneas de potenciais doadores em um hospital universitário de Curitiba. MÉTODOS: Selecionaram-se os potenciais doadores de córnea que foram a óbito nas UTIs Geral e Cardiológica e no Pronto-socorro do Hospital Universitário Evangélico de Curitiba (HUEC) entre os meses de novembro de 2007 e fevereiro de 2008. Um questionário padronizado foi aplicado por telefone às pessoas com estreito grau de parentesco com o falecido. RESULTADOS: O resultado mais relevante foi que dentre 64 familiares entrevistados, 60 (93,75 por cento) afirmaram não terem sido abordados em relação à doação de órgãos no momento do óbito. Destes, 32 (53,33 por cento) teriam permitido a doação de córneas se tivessem sido abordados. CONCLUSÃO: A carência de abordagem dos familiares por parte dos profissionais da área da saúde no momento do óbito mostra-se como principal obstáculo no processo de permissão de doação de córneas.

PURPOSE: To define the main factors related with cornea non-donation of potential donors in a University Hospital of Curitiba. METHODS: The potential corneal donators who died at the I.C.U and at Emergency Section at Hospital Universitário Evangélico de Curitiba (HUEC) between November 2007 and February 2008 were selected. A close relative was interviewed by telephone, following a standard interview protocol. RESULTS: The most significant result was that from the 64 relatives interviewed, 60 (93.75 percent) had not been approached about the organ donation. From the same group, 32 (53.33 percent) would have consented the corneal donation if the approach had been performed. CONCLUSION: The low number of relatives approaches by physicians at the time of death was the main handicap in the process of corneal donation permission.