[Effect of surgery on longstanding strabismus on binocular visual evoked potential]. / Efecto de la cirugía de estrabismo de larga evolución en los potenciales evocados visuales binoculares.

PURPOSE: To analyse the effect of surgery on binocular visual evoked potential (BVEP) in adults with longstanding strabismus. METHODS: A prospective study was performed on 40 patients with a history of longstanding strabismus. Visual evoked potentials to binocular and monocular pattern reversal stimulation were recorded before surgery and 3 months after surgery. Binocular visual function was analysed by Worth and TNO tests before and after surgery. RESULTS: We did not find any differences between deviation and BVEP postoperatively (P = 0.82). The mean of BVEP and the percentage of increment of the BVEP response (10.5 and 27.14%) were larger postoperatively, than preoperatively (9.87 and 16.6%), P = 0.32 and P = 0.17, respectively. There were differences in the TNO results after surgery (P = 0.03) and when compared with postoperative deviation (P = 0.02), but not between TNO and BVEP postoperatively (P = 0.29). There were differences in the Worth results after surgery, and comparing with deviation and BVEP (P = 0.00, P = 0.01 and P = 0.07). CONCLUSIONS: Surgery in adults with longstanding strabismus could improve the deviation and seemed to improve BVEP response, but this point could not be confirmed. The results are not enough to show that the BVEP would be an objective test for binocular function evaluation, although there could be a relationship between BVEP and the TNO response.

[Painful incomplete third-nerve palsy caused by an internal carotid-communicating posterior artery aneurysm]. / Parálisis dolorosa incompleta del III nervio causada por un aneurisma de la carótida interna-comunicante posterior.

CLINICAL CASE: A 38-year-old woman presented acute-onset, painful incomplete third-nerve palsy caused by an internal carotid-posterior communicating artery (IC-PC) aneurysm. We describe the differential diagnosis with Tolosa-Hunt syndrome and the results after endovascular treatment. DISCUSSION: The presence of pupil-sparing third-nerve palsy may not exclude the presence of an IC-PC aneurysm and orbital magnetic resonance imaging and/or computed tomography imaging must be performed in these cases. The prompt recovery after endovascular treatment is consistent with previous reports.

[Conjunctival inclusion cyst after strabismus surgery by hang-back recession]. / Quiste conjuntival de inclusión tras cirugía de estrabismo según técnica de retroinserción en asa.

CASE REPORT: A 24-year-old woman, with a history of infantile esotropia and DVD operated on in infancy, had strabismus surgery performed by us. Four months later she presented with a cystic lesion that recurred after drainage and medical treatment. Complete excision of the cystic lesion was therefore performed. DISCUSSION: The epithelial cells implanted on the sclera at the time of the most recent surgery may have been the origin of inclusion cyst which developed after the strabismus surgery. This suggests a possible relationship with the scleral suture as the mechanism of cyst formation, independent of the muscle position. Complete excision is the recommended treatment for large cysts.

[Acute concomitant esotropia and hysterical amblyopia]. / Endotropía comitante aguda y ambliopía histéricas.

CASE REPORT: The authors present the case of a 26-year-old woman, in her 29th week of pregnancy, who developed intermittent esotropia and diplopia. Six months later, the process was associated with visual loss and an accommodative spasm which did not improve with cycloplegia and refraction. The symptoms remained unchanged two years later. DISCUSSION: Acute concomitant esotropia may have no obvious underlying cause, but it has been associated with disruption of fusion, myopia, neurological problems and decompensation of a pre-existing phoria or monofixation syndrome. A physical or emotional debilitating illness may precede the onset of the problem. In our case, a neurologic origin was excluded and a diagnosis of hysterical neurosis and acute concomitant esotropia with hysterical amblyopia or functional visual loss was established.