[Comparison of the modified fixation preference test with the conventional test in strabismic patients]. / Comparação do teste modificado de fixação preferencial com o convencional em pacientes com estrabismo.

PURPOSE: To compare the accuracy of the fixation preference test performed with the patient touching and looking at the fixation target, to the conventional method test done with the patient only looking at it. METHODS: A pilot transversal and prospective study was done with 40 strabismic patients with deviations greater than 10 prism diopters, from 7 to 30 years old. RESULTS: The modified test had a sensitivity of 93% (IC 95%=68.53 - 98.73%) and specificity of 77% (IC 95%=57.95 - 88.97%); while the conventional test had a sensitivity of 93% (IC 95%=68.53 - 98.73%) and a specificity of 46% (IC 95%=28.76 - 64.54%). CONCLUSIONS: Our results suggest that the modification of the fixation preference test by asking the patient to touch the fixation target might reduce the number of false positive results of the test.

Comparação do teste modificado de fixação preferencial com o convencional em pacientes com estrabismo / Comparison of the modified fixation preference test with the conventional test in strabismic patients

OBJETIVO: Comparar a acurácia do teste de fixação preferencial quando o paciente olha e toca o objeto alvo ao invés de apenas olhá-lo, como convencionalmente descrito. MÉTODOS: Estudo piloto transversal e prospectivo, incluindo 40 pacientes estrábicos, com desvios maiores que 10 dioptrias prismáticas entre 7 e 30 anos. RESULTADOS: O teste modificado mostrou sensibilidade de 93% (IC 95%=68,53 -98,73%) e especificidade de 77% (IC 95%=57,95 - 88,97%). O teste convencional apresentou sensibilidade de 93% (IC 95%=68,53 - 98,73%) e especificidade 46% (IC 95%= 28,76 - 64,54%). CONCLUSÕES: Estes resultados sugerem que a modificação no teste de fixação preferencial, solicitando que o paciente toque o objeto alvo, possa reduzir os resultados falsos positivos do teste.

PURPOSE: To compare the accuracy of the fixation preference test performed with the patient touching and looking at the fixation target, to the conventional method test done with the patient only looking at it. METHODS: A pilot transversal and prospective study was done with 40 strabismic patients with deviations greater than 10 prism diopters, from 7 to 30 years old. RESULTS: The modified test had a sensitivity of 93% (IC 95%=68.53 - 98.73%) and specificity of 77% (IC 95%=57.95 - 88.97%); while the conventional test had a sensitivity of 93% (IC 95%=68.53 - 98.73%) and a specificity of 46% (IC 95%=28.76 - 64.54%). CONCLUSIONS: Our results suggest that the modification of the fixation preference test by asking the patient to touch the fixation target might reduce the number of false positive results of the test.

The accuracy of binocular fixation preference for the diagnosis of strabismic amblyopia.

PURPOSE: To determine the accuracy of different scales of the binocular fixation preference test and 10(Delta) fixation test in diagnosing amblyopia in patients with strabismus. METHODS: A prospective and masked diagnostic study was undertaken. We compared 3 binocular fixation preference test scales with interocular Early Treatment Diabetic Retinopathy Study (ETDRS) acuity differences. The 10(Delta) fixation test was used for patients with strabismus <10(Delta). Sensitivity, specificity, and likelihood ratios for amblyopia with an interocular difference of >or=2 lines were determined. Intra- and interexaminer agreements were measured. RESULTS: The study included 221 literate strabismic patients. The accuracy of the binocular fixation preference test was similar for all scales, with no advantage in combining them (Cronbach's alpha = 0.99). The sensitivity and specificity of binocular fixation preference among patients with strabismus >or=10(Delta) were 72.8% (95% CI, 59.7%-83.6%) and 77.6% (95% CI, 66.6%-86.3%), respectively; among patients with deviations <10(Delta), these were 89.6% (95% CI, 72.6%-97.8%) and 64.2% (95% CI, 44.0%-81.3%), respectively. The 10(Delta) fixation test did not alter this accuracy. Likelihood ratios were stronger for extreme grades of the binocular fixation preference test; however, in intermediate grades, they only changed by approximately 15% of the pretest probability of amblyopia. Intra- and interexaminer agreements were 76% (95% CI, 51%-100%) and 73% (95% CI, 48%-97%), respectively. CONCLUSIONS: The binocular fixation preference test is more useful for diagnosing amblyopia when the results indicate either a very strong preference or no fixation preference. The intermediate grades of the test were less accurate in our study, accounting for most of the false positives and negatives results.

Resultados do tratamento da ambliopia com levodopa combinada à oclusão / Results of amblyopia treatment with levodopa associated with occlusion therapy

OBJETIVO: Verificar a melhora da acuidade visual com levodopa/benzerazida combinada à oclusão parcial e seguida por oclusão total, em pacientes com ambliopia considerada irreversível. MÉTODOS: Realizou-se estudo experimental aberto, envolvendo 37 pacientes entre 7 e 40 anos de idade, com ambliopia por estrabismo ou anisometropia, durante 9 semanas. Todos os pacientes foram tratados com levodopa (0,70 mg/kg/dia) e benzerazida 25 por cento associada à oclusão de 4 horas/dia do olho dominante por 5 semanas e, nas 4 semanas seguintes foi realizada somente a oclusão total (24 h) do olho dominante. A acuidade visual foi medida na tabela do ETDR (Early Treatment Diabetic Retinopathy) com escala logMAR (logaritmo do mínimo ângulo de resolução) antes de iniciar o tratamento e após 1, 3, 5 e 9 semanas de tratamento. As adesões ao tratamento de oclusão e a ingesta do me-dicamento foram verificadas por meio de questionário e pela contagem das cápsulas. Os efeitos adversos foram avaliados por exame clínico e questionário. RESULTADOS: Após 9 semanas de tratamento, a acuidade visual média melhorou em logMAR de 0,58 ± 0,16 para 0,23 ± 0,16 (melhora de 4 linhas na tabela ETDR). CONCLUSAO: Levodopa, na dose de 0,70 mg/kg/dia, é bem tolerada e associada à oclusão produz melhora significativa na acuidade visual de pacientes com ambliopia considerada irreversível.

Tratamento da ambliopia / Treatment of amblyopia

As diferentes técnicas para se obter uma oclusäo satisfatória e adequada no tratamento da ambliopia säo discutidas. O Autor aponta a freqüência com que a oclusäo deve ser mantida e o período até o qual o risco das recidivas já näo existe mais