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1.
Br J Ophthalmol ; 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35383050

RESUMO

AIMS: To investigate the longitudinal changes of peripapillary retinal nerve fibre layer (RNFL) and choroidal thickness during myopic axial elongation. METHODS: Peripapillary RNFL and choroidal thickness were prospectively evaluated by spectral-domain optical coherence tomography (SD-OCT) in 46 eyes of 23 myopic children over the course of 4 years. Using serial OCT images acquired based on a fixed scan circle in the glaucoma progression analysis mode, general and sectoral RNFL thicknesses were acquired at the same position and the angular location of the peak was measured. The peripapillary choroidal thickness likewise was measured at eight positions in serial OCT images. RESULTS: The mean age at the baseline was 9.6±1.7 years. The mean axial length increased from 24.80±1.28 mm to 25.64±1.35 mm. The global peripapillary RNFL thickness was 98.54±12.06 µm at baseline. The global and sectoral RNFL thicknesses did not change during the 4 years. The angular location of RNFL peaks was also stable and was located in the superotemporal (64.18±10.85°) and inferotemporal (293.98±11.62°) sectors. The global peripapillary choroidal thickness was 145.40±28.67 µm at the baseline. The global and sectoral choroidal thicknesses did not change during the 4 years. CONCLUSIONS: The peripapillary RNFL and choroidal thicknesses as well as the locations of the RNFL peaks had been preserved, during the 4-year follow-up on myopic children, when traced and measured from the same location.

2.
Eur J Ophthalmol ; 32(1): 108-114, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33579164

RESUMO

PURPOSE: To evaluate the various surgical modalities of congenital lacrimal fistula and assess the mutual effect of lacrimal fistula and lacrimal drainage abnormality on the individual surgical outcomes. METHODS: In this retrospective cohort and case-control study, 74 eyes from 63 patients with lacrimal fistula who underwent surgical management between 2000 and 2015 at three medical centers were enrolled. The data collected included sex, age, preoperative symptoms, presence of concurrent lacrimal drainage abnormality, surgical methods, and surgical outcomes. The main outcome measures were treatment outcomes based on lacrimal drainage patency and symptom improvement, surgical outcome of fistulectomy according to the presence of lacrimal drainage abnormality, and surgical outcome of lacrimal drainage abnormality according to the presence of fistula. RESULTS: The mean age at the time of surgery was 9.2 (SD, ±8.8) years and the mean follow-up duration was 14.4 (SD, ±19.5) months. All eyes (37/37) with fistula without lacrimal drainage abnormality demonstrated surgical success after simple fistulectomy. Patients with concurrent lacrimal drainage abnormalities showed more frequent surgical failure than those with fistula alone (p = 0.009). However, the presence of fistula did not affect the outcomes of surgery for lacrimal drainage abnormality (p = 0.179). CONCLUSION: Simple fistulectomy is sufficient for sole asymptomatic or pauci-symptomatic lacrimal fistula. Symptomatic fistula as well as those accompanied with lacrimal drainage abnormality underwent fistulectomy and lacrimal drainage system surgery. Patients with accompanying lacrimal drainage system abnormalities showed less favorable outcomes. Meticulous preoperative examination of the lacrimal drainage system is critical for surgical planning and prognosis prediction.


Assuntos
Dacriocistorinostomia , Fístula , Doenças do Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Estudos de Casos e Controles , Fístula/cirurgia , Humanos , Doenças do Aparelho Lacrimal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
3.
Eur J Ophthalmol ; : 11206721211051931, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34632836

RESUMO

PURPOSE: To evaluate the effects of the concomitant use of spacer grafts in lateral tarsal strip surgery in patients with facial nerve palsy-related lower-eyelid retraction. METHODS: Patients who underwent lateral tarsal strip surgery to correct facial nerve palsy-related lower-eyelid retraction were retrospectively reviewed. Postoperative decreases in marginal reflex distance-2 values at 1, 2 and 6 months were measured along with the effects of spacer grafts. RESULTS: Forty-five patients (28 males) were included (mean age: 59.56 years). Mean preoperative marginal reflex distance-2 was 6.87 ± 1.34 mm. Twenty patients underwent lateral tarsal strip surgery only (lateral tarsal strip-only); 25 patients underwent lateral tarsal strip surgery using spacer grafts (lateral tarsal strip + graft). Median (interquartile range) follow-up duration was 12.0 (6.0-23.0) months. Retraction was significantly improved and maintained at 1, 2 and 6 months postoperatively in all patients (mean marginal reflex distance-2: 3.78 ± 1.06 mm, 4.30 ± 1.23 mm and 4.72 ± 1.11 mm, respectively). Surgical outcomes were significantly better in the lateral tarsal strip + graft than in the lateral tarsal strip-only group (Δmarginal reflex distance-2: 3.92 vs. 2.05 mm at 1 month, p < 0.001; 3.38 vs. 1.61 mm at 2 months, p = 0.001; 2.88 vs. 1.69 at 6 months, p = 0.042). Subgroup analyses by spacer graft type revealed no significant differences. CONCLUSION: The concomitant use of spacer material in lateral tarsal strip surgery yielded better surgical outcomes than lateral tarsal strip surgery alone. The use of spacer grafts should be considered for correcting severe facial nerve palsy-related lower-eyelid retraction.

4.
PLoS One ; 16(7): e0254889, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34283884

RESUMO

PURPOSE: To investigate whether the position of the central retinal vascular trunk (CRVT), as a surrogate of lamina cribrosa (LC) offset, was associated with the presence of glaucoma in normal-tension glaucoma (NTG) patients. METHODS: The position of the CRVT was measured as the deviation from the center of the Bruch's membrane opening (BMO), as delineated by spectral-domain optical coherence tomography imaging. The offset index was calculated as the distance of the CRVT from the BMO center relative to that of the BMO margin. The angular deviation of CRVT was measured with the horizontal nasal midline as 0° and the superior location as a positive value. The offset index and angular deviation were compared between glaucoma and fellow control eyes within individuals. RESULTS: NTG eyes had higher baseline intraocular pressure (P = 0.001), a larger ß-zone parapapillary atrophy area (P = 0.013), and a larger offset index (P<0.001). In a generalized linear mixed-effects model, larger offset index was the only risk factor of NTG diagnosis (OR = 31.625, P<0.001). A generalized estimating equation regression model revealed that the offset index was larger in the NTG eyes than in the control eyes for all ranges of axial length, while it was the smallest for the axial length of 23.4 mm (all P<0.001). CONCLUSIONS: The offset index was larger in the unilateral NTG eyes, which fact is suggestive of the potential role of LC/BMO offset as a loco-regional susceptibility factor.


Assuntos
Glaucoma de Baixa Tensão/fisiopatologia , Retina/fisiopatologia , Veia Retiniana/fisiopatologia , Adulto , Idoso , Lâmina Basilar da Corioide/fisiologia , Feminino , Glaucoma/diagnóstico , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/fisiologia , Disco Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico , Retina/metabolismo , Células Ganglionares da Retina/fisiologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual/métodos , Campos Visuais/fisiologia
5.
Curr Eye Res ; 46(7): 954-960, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33249930

RESUMO

Objectives: To investigate the characteristics of margin reflex distance 1 (MRD1) asymmetry in congenital lower eyelid epiblepharon and its resolution after surgical correction of epiblepharon.Methods: Among patients who underwent lower eyelid epiblepharon surgery from November 2015 to September 2017, patients with a preoperative MRD1 difference of more than 1.0 mm between the two eyes according to medical photographs were defined as having MRD1 asymmetry. A postoperative MRD1 difference of less than 1.0 mm between the two eyes was regarded as MRD1 asymmetry resolution. The preoperative MRD1 difference was compared between subgroups with resolved or sustained MRD1 asymmetry. Astigmatism and amblyopia were also assessed.Results: Among 432 patients, MRD1 asymmetry was observed in 24 patients (5.6%). MRD1 was always lower in the side with more extensive epiblepharon. At 6 months after surgery, the mean MRD1 difference between the two eyes was significantly decreased (1.8 ± 0.7 mm to 0.5 ± 0.8 mm, p < .001, paired t-test) and MRD1 asymmetry resolution occurred in 19 patients (79%). In the resolved MRD1 asymmetry group, the preoperative MRD1 difference was 2.0 mm or less and was significantly smaller than that in the sustained MRD1 asymmetry group (p = .010, Mann-Whitney U test). Six patients had preoperative aniso-astigmatism ≥ 1.50 D. Unilateral amblyopia presented in nine patients (38%) and improved within 1 year postoperatively.Conclusions: MRD1 asymmetry can be resolved after epiblepharon surgery, especially when the preoperative MRD1 difference is 2.0 mm or less. Unilateral amblyopia was frequent, but the treatment outcome was good.


Assuntos
Blefaroplastia/efeitos adversos , Doenças Palpebrais/congênito , Doenças Palpebrais/etiologia , Pálpebras/anormalidades , Pálpebras/fisiopatologia , Reflexo Pupilar/fisiologia , Blefaroplastia/métodos , Criança , Pré-Escolar , Doenças Palpebrais/fisiopatologia , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Período Pós-Operatório , Refração Ocular/fisiologia , Estudos Retrospectivos , Acuidade Visual/fisiologia
6.
Int J Ophthalmol ; 13(8): 1231-1237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821676

RESUMO

AIM: To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease (IgG4-MALT lymphoma), a rare but clinically important complication of ocular adnexal IgG4-related disease. METHODS: We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three tertiary and one secondary referral centers, between February 2003 and December 2016. Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified. CT and MR images were analyzed by consensus of two experienced head and neck radiologists. RESULTS: Lacrimal glands were the main site of involvement in all seven patients. The lesions typically showed well-demarcated margins, iso- to hyperattenuation on precontrast CT, T2 hypo- to isointensity, T1 isointensity, and homogenous internal architecture with homogenous enhancement pattern. Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images, respectively. CONCLUSION: Unlike in typical ocular adnexal IgG4-related disease, T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases. Although the findings may be nonspecific, the possibility of accompanying MALT lymphoma may need to be considered, when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients. However, this is a case series of a very rare complication of ocular adnexal IgG4-related disease, and thus caution is warranted to generalize the conclusion.

7.
Eye (Lond) ; 34(4): 669-674, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31527764

RESUMO

PURPOSE: To evaluate long-term outcomes of maintenance of lacrimal silicone stent for the management of functional epiphora after anatomically patent external dacryocystorhinostomy (DCR). METHODS: We retrospectively reviewed the medical records of 101 eyes of 75 patients who were diagnosed to have functional epiphora after external DCR from 2005 to 2014. Functional epiphora was defined as epiphora that persisted or recurred even after patent DCR confirmed by a lacrimal irrigation test. Secondary silicone intubation was indicated when the patients wanted a further intervention. The stent was intended to be kept in situ unless there was a stent-related complication or the patient wanted removal. RESULTS: In total, 34 of 75 patients (45.3%, 52 eyes) who agreed to the intervention underwent secondary silicone intubation. The success rates at 1, 3, and 5 years after surgery were 96.2%, 75.5%, and 70.2%, respectively. At the final follow-up (mean 72.7 ± 26.4 months), 32 (61.5%) eyes chose to retain the silicone tube: silicone stent was well maintained without epiphora and complications once inserted in 18 eyes (34.6%), whereas tube replacement was needed in 14 eyes (26.9%) because of nasal crust or whitish plaque formation on the tube surface. In 13 cases (25.0%), silicone stent was removed because of tube-related complications, and the most common complication was canaliculitis (n = 8, 15.4%). CONCLUSIONS: Secondary intubation and maintenance of the stent is an effective and simple procedure for functional epiphora. The main obstacle to long-term maintenance is tube-associated canaliculitis.


Assuntos
Dacriocistorinostomia , Doenças do Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Intubação , Doenças do Aparelho Lacrimal/etiologia , Doenças do Aparelho Lacrimal/cirurgia , Obstrução dos Ductos Lacrimais/etiologia , Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal/cirurgia , Estudos Retrospectivos , Silicones , Stents , Resultado do Tratamento
9.
BMC Cancer ; 19(1): 774, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387552

RESUMO

BACKGROUND: Trastuzumab emtansine (Kadcyla®, T-DM1) is an antibody-drug conjugate used to treat HER2 (human epidermal growth factor receptor 2) overexpressing metastatic breast cancer. In this report, we present the first case of lacrimal drainage system stenosis identified after T-DM1 administration, and its successful treatment with a topical steroid. CASE PRESENTATION: A 36-year-old female with metastatic breast cancer was referred for excessive tearing of both eyes. She previously underwent mastectomy and was treated with multiple anti-cancer regimens. However, metastases to liver and bone were identified and T-DM1 was administered. After 2 months, epiphora developed in both eyes and the patient was referred for ophthalmologic examination. The height of the tear meniscus was increased. The fluorescein dye disappearance test (FDDT) showed a delayed clearance in both eyes. Diagnostic lacrimal probing demonstrated a lower distal canalicular stenosis in both eyes. Dacryocystography indicated multiple focal narrowing of nasolacrimal duct in the right eye and diffused narrowing of nasolacrimal duct in the left eye. Topical eyedrop of tobramycin 0.3% and dexamethasone 0.1% were prescribed four times a day. After 2 months of treatment, the patient reported relief from epiphora, and the height of tear meniscus was normalized in both eyes. CONCLUSION: T-DM1 administration in breast cancer treatment can induce lacrimal drainage system stenosis, which can be treated effectively with a topical steroid.


Assuntos
Ado-Trastuzumab Emtansina/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias da Mama/complicações , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/etiologia , Ado-Trastuzumab Emtansina/administração & dosagem , Adulto , Antineoplásicos Imunológicos/administração & dosagem , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Constrição Patológica , Diagnóstico por Imagem , Feminino , Humanos , Tomografia de Coerência Óptica
10.
Can J Ophthalmol ; 54(4): 421-425, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31358138

RESUMO

OBJECTIVE: To investigate the clinical outcomes of initial conservative management in infants with congenital dacryocystocele. DESIGN: Retrospective case series. PARTICIPANTS: A total of 30 congenital dacryocystoceles of 28 Korean infants treated between January 2006 and December 2015. METHODS: All patients were managed conservatively with lacrimal sac massage. Clinical courses and outcomes of the patients were retrospectively reviewed, and rates of resolution of dacryocystoceles and development of dacryocystitis were analyzed. RESULTS: In 27 cases of dacryocystoceles without infection, spontaneous resolution was achieved without any complication in 20 of 27 (74.1%) cases after conservative treatment. The mean duration of treatment was 27.5 days. Lacrimal probing was needed in 5 (18.5%) dacryocystoceles that persisted despite lacrimal sac massage for more than 1 month. Infectious dacryocystitis developed in 2 of 27 (7.4%) cases. Three dacryocystoceles were infected at presentation. Overall, 5 dacryocystoceles were complicated with infection and those cases received prompt systemic antibiotics treatment. External incision and drainage of the lacrimal sac was needed in 3 dacryocystoceles, and all cases were finally resolved without any additional procedures. CONCLUSIONS: In this case series, most of the uninfected dacryocystoceles could be successfully managed with conservative treatment alone. In cases with infection, systemic antibiotics were essential and external drainage was sometimes required, but these cases could be conservatively managed after the remission of infection.


Assuntos
Tratamento Conservador/métodos , Cistos/terapia , Doenças do Aparelho Lacrimal/terapia , Antibacterianos/uso terapêutico , Cistos/congênito , Cistos/diagnóstico , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Doenças do Aparelho Lacrimal/congênito , Doenças do Aparelho Lacrimal/diagnóstico , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2315-2322, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342147

RESUMO

PURPOSE: To evaluate the effect of a topical steroid instillation on recently developed incomplete nasolacrimal duct obstruction (NLDO) evaluated by using anterior segment optical coherence tomography (ASOCT). METHODS: Forty-nine eyes of 31 patients with incomplete NLDO who developed epiphora within 3 months were recruited and treated with a topical steroid for 3 months. Tear meniscus height (TMH) and area (TMA) were measured by ASOCT. The treatment was considered to be effective when there was improvement of subjective epiphora, normal tear meniscus on slit lamp examination, a fluorescein dye disappearance test with grade 0 or 1, and TMH < 250 µm on ASOCT. The treatment effectiveness and associated factors were analyzed. RESULTS: Treatment was effective in 24 eyes (49.0%) after 6 months of follow-up. TMH and TMA at 3 months were significantly decreased in the effective group on ASOCT (TMH: from 385 to 268 µm, p = 0.002, TMA: from 0.0564 to 0.0266 mm2, p = 0.001, Wilcoxon test). In the effective group, the eyes with normal tear meniscus at 1 month were significantly more frequent than those in the ineffective group (p < 0.001, Fisher's exact test). No patient in the effective group required further invasive management during 3 years of follow-up. CONCLUSIONS: Topical steroid instillation has a significant therapeutic effect on recently developed incomplete NLDO. Additional invasive procedures were avoided in half of the subjects.


Assuntos
Dexametasona/administração & dosagem , Obstrução dos Ductos Lacrimais/tratamento farmacológico , Ducto Nasolacrimal/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Administração Tópica , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Microscopia com Lâmpada de Fenda , Fatores de Tempo , Resultado do Tratamento
14.
Can J Ophthalmol ; 54(1): 111-115, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30851763

RESUMO

OBJECTIVE: To analyze the relationship among the presence of lacrimal sac mucus retention, the vertical size of the lacrimal sac, and the duration of tearing symptom in patients with nasolacrimal duct obstruction (NLDO). DESIGN: Retrospective case series. PARTICIPANTS: We reviewed the medical records of 473 patients (664 eyes) who underwent external dacryocystorhinostomy for primary NLDO. METHODS: The information about the presence of lacrimal sac mucus retention and vertical size of the lacrimal sac lumen was collected intraoperatively. The vertical size of the lacrimal sac was classified into 3 groups: small (<5 mm), medium (5-10 mm), and large (>10 mm). The relationship between the lacrimal sac size, presence of mucus retention, and duration of tearing was analyzed. RESULTS: Of the 664 eyes, 138 had a small lacrimal sac, 199 had a medium lacrimal sac, and 327 had a large lacrimal sac. The distribution of the lacrimal sac size groups differed significantly between the eyes with (n = 245) and without (n = 419) mucus retention (p < 0.001). Among all the subjects of each lacrimal sac size group, there was no significant difference in the duration of symptoms (p = 0.176). However, in patients without mucus retention, the symptom duration in the small lacrimal sac group was significantly longer than that in the large lacrimal sac group (p = 0.017). CONCLUSIONS: In cases with mucus retention, a small lacrimal sac is rare. In cases without mucus retention, the duration of tearing symptom was significantly longer in small lacrimal sac group.


Assuntos
Dacriocistorinostomia/métodos , Obstrução dos Ductos Lacrimais/diagnóstico , Ducto Nasolacrimal/diagnóstico por imagem , Lágrimas/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Obstrução dos Ductos Lacrimais/metabolismo , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/metabolismo , Ducto Nasolacrimal/cirurgia , Tamanho do Órgão , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
17.
Invest Ophthalmol Vis Sci ; 59(10): 4020-4030, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30098190

RESUMO

Purpose: To investigate changes of ß-zone parapapillary atrophy (PPA) during axial elongation. Methods: Change of ß-zone PPA was evaluated by spectral-domain optical coherence tomography (SD-OCT) in myopic children for 2 years, prospectively. Using the infrared images acquired by a fixed scan circle in the glaucoma progression analysis (GPA) mode, the retinal pigment epithelial opening (RPEO) and the clinical disc margin (CDM) were manually delineated. The area and position of ß-zone PPA was calculated as the differences from those of the RPEO and CDM, respectively. The ß-zone PPA was further differentiated into ßBM PPA (ß-zone PPA with Bruch's membrane [BM]) and γ-zone PPA (ß-zone PPA without BM). The change of ß-zone PPA was compared between the first and final visits. Results: The area of ß-zone PPA increased in 35 eyes (76%). This increase was associated with RPEO area increase and CDM area decrease. The center of ß-zone PPA moved along the direction of vascular trunk dragging, but to a lesser extent. The ß-zone PPA enlargement was correlated with the extent of vascular trunk dragging (P = 0.014). In all eyes with ß-zone PPA increase, the γ-zone portion had increased. Even in childhood, ßBM PPA existed next to their γ-zone PPA in 11 eyes (24%), including 4 eyes that showed increase of both γ-zone and ßBM portion during axial elongation. Conclusions: Enlargement of ß-zone PPA during axial elongation was affected by the extent and direction of vascular trunk dragging, thus implicating disproportionate growth between the retina and sclera.


Assuntos
Miopia/diagnóstico por imagem , Atrofia Óptica/diagnóstico por imagem , Disco Óptico/diagnóstico por imagem , Lâmina Basilar da Corioide/diagnóstico por imagem , Lâmina Basilar da Corioide/patologia , Criança , Feminino , Humanos , Masculino , Miopia/patologia , Atrofia Óptica/patologia , Disco Óptico/patologia , Estudos Prospectivos , Epitélio Pigmentado da Retina/diagnóstico por imagem , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica
18.
Korean J Ophthalmol ; 32(2): 134-139, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29560617

RESUMO

PURPOSE: To analyze stereopsis change before and after inferior oblique weakening surgery. METHODS: We retrospectively reviewed the medical records of 31 patients who had undergone inferior oblique weakening surgery. The factors analyzed included sex, age at surgery, preoperative and postoperative visual acuity (VA), time from first detection to surgery, degree of inferior oblique overaction (IOOA), primary/secondary IOOA, exotropia/hypertropia, bilaterality, and type of surgery. RESULTS: Eighteen patients with a mean age 7.3 ± 3.1 years exhibited stereopsis of 60 arc seconds or better before surgery and 17 had stereopsis better than 60 arc seconds after surgery. Postoperatively, stereopsis improved in 13 patients and deteriorated in 9. Better preoperative VA and the absence of superior oblique underaction were associated with better preoperative stereopsis. Better preoperative VA, postoperative VA, and the presence of head tilt were associated with better postoperative stereopsis. Unilateral inferior oblique weakening surgery and accompanying hypertropia were associated with improved stereopsis, while the absence of hypertropia was associated with deteriorated stereopsis. CONCLUSIONS: In this retrospective study, 58.1% of patients tended to have bifoveal fixation. When a vertical deviation is present in the primary position due to unilateral IOOA, IO weakening surgery can be expected to improve binocular function.


Assuntos
Percepção de Profundidade/fisiologia , Exotropia/cirurgia , Miotomia , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adolescente , Criança , Pré-Escolar , Exotropia/fisiopatologia , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Acuidade Visual/fisiologia
19.
Optom Vis Sci ; 95(4): 405-410, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29554007

RESUMO

SIGNIFICANCE: Herpes zoster ophthalmicus (HZO) has variable initial manifestations, and acute orbital inflammation may be the first sign without apparent zoster rash. This case series is significant for presenting diverse clinical features and treatment options of HZO with acute orbital inflammation. PURPOSE: To report a case series of patients diagnosed as HZO with acute orbital inflammation including two cases with unique presentations. CASE REPORTS: Medical records of four patients of HZO with acute orbital inflammation were reviewed. Two men and two women with a median age of 57 years (range, 32 to 69 years) were diagnosed as having HZO with acute orbital inflammation. Initial presentations included two cases of zoster rash and two cases of orbital pain preceding vesicles. Clinical orbital findings included proptosis, ptosis, ophthalmoplegia, and decreased visual acuity. Orbital magnetic resonance image showed enlarged extraocular muscle with enhancement and optic nerve sheath enhancement in all four patients, and unilateral dacryoadenitis in one patient. All four patients were administered with systemic steroid, three patients received intravenous acyclovir, and one patient received oral acyclovir. Orbital signs improved in all patients over several months. CONCLUSIONS: Herpes zoster ophthalmicus may initially present with orbital inflammatory signs, such as acute orbital myositis, perioptic neuritis, or dacryoadenitis, without zoster rash. Physicians should be aware of acute orbital inflammation as a presenting sign of HZO.


Assuntos
Infecções Oculares Virais/diagnóstico , Herpes Zoster Oftálmico/diagnóstico , Miosite Orbital/diagnóstico , Doença Aguda , Aciclovir/uso terapêutico , Adulto , Idoso , Antivirais/uso terapêutico , Combinação de Medicamentos , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Feminino , Glucocorticoides/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/virologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miosite Orbital/tratamento farmacológico , Miosite Orbital/virologia
20.
Ophthalmology ; 125(8): 1224-1233, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29544962

RESUMO

PURPOSE: To investigate the positional change of central retinal vasculature and vascular trunk to deduce the change in the lamina cribrosa (LC) during axial elongation. DESIGN: Prospective cohort study. PARTICIPANTS: Twenty-three healthy myopic children (46 eyes). METHODS: Participants had undergone a full ophthalmologic examination and axial length measurement every 6 months for 2 years. Using spectral-domain OCT, circle scans centered around the optic disc in the glaucoma progression analysis mode, which enabled capturing of the same positions throughout the entire study period, and enhanced depth imaging of the deep optic nerve head complex were performed. Infrared imaging of the circle scans was used to measure the changes in the angles between the first and final visits. The angle between the major superior and inferior retinal arteries was measured along the circle scan twice: from the center of the circle scan and from the central retinal vascular trunk, respectively. The positional change of the retinal vascular trunk also was measured. MAIN OUTCOME MEASURES: Change in vascular angle and position of vascular trunk with axial elongation and associated factors. RESULTS: The vascular angle measured from the center of the circle scan did not change (P = 0.247), whereas the angle measured from the central retinal arterial trunk decreased with axial elongation (P < 0.001). A generalized estimating equation analysis revealed that the factors associated with angle decrease were axial elongation (P = 0.004) and vascular trunk dragging (P < 0.001). The extent of vascular trunk dragging was associated with axial elongation (P < 0.001) and increased border length with marginal significance (P = 0.053), but the extent of dragging could not be explained fully by their combination. The major directionality of dragging was mostly to the nasal side of the optic disc, with large variations among participants. CONCLUSIONS: During axial elongation, the retinal vasculature at the posterior pole was unchanged, whereas the position of the central vascular trunk was dragged nasally. Because the central retinal vascular trunk is embedded in the LC, its dragging indicates nasal shifting of the LC, which could explain the vulnerability of myopic eyes to glaucomatous optic neuropathy.


Assuntos
Pressão Intraocular/fisiologia , Miopia/diagnóstico , Disco Óptico/irrigação sanguínea , Postura/fisiologia , Vasos Retinianos/diagnóstico por imagem , Criança , Progressão da Doença , Feminino , Seguimentos , Glaucoma/diagnóstico , Glaucoma/etiologia , Humanos , Masculino , Miopia/complicações , Miopia/fisiopatologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/etiologia , Prognóstico , Estudos Prospectivos , Tomografia de Coerência Óptica
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