Eficacia y seguridad de la sutura ajustable en estrabismos horizontales: estudio comparativo de niños frente a adultos / Efficacy and safety of adjustable suture in horizontal strabismus: Comparative study of children versus adults

Objetivo Los procedimientos con sutura ajustable permiten abordar la imprevisibilidad de algunos resultados postoperatorios en la cirugía de estrabismo. El propósito del estudio fue comparar la efectividad de la sutura ajustable y no ajustable en el tratamiento del estrabismo horizontal en niños y en adultos. Método Estudio prospectivo en el que se incluyeron pacientes sometidos a cirugía de estrabismo para la corrección de un estrabismo horizontal con sutura colgante fija (grupo de sutura no ajustable) y sutura ajustable. Se registraron la agudeza visual, la ambliopía, la desviación, la afectación de los músculos oblicuos, las cirugías previas, el nistagmo, la necesidad de ajuste y las complicaciones. Las variables se registraron en el postoperatorio inmediato, a la semana y a los 3 y 6meses. Resultados Se incluyeron 186 pacientes: 157 (84,4%) con sutura ajustable y 29 (15,6%) con sutura no ajustable, de los cuales 119 eran niños y 67 eran adultos. En el postoperatorio, 19 niños (16,0%) y 19 adultos (28,4%) requirieron un ajuste (p=0,044). De 157 pacientes con sutura ajustable, se ajustó al 20% (32/157). El éxito tras el ajuste fue superior para la sutura ajustable (91,72% vs 79,31%; p=0,043) y se mantuvo los 6meses (p<0,05). La cirugía previa (p=0,004) y la exotropía (p=0,018) se relacionaron con la necesidad de ajuste. Conclusiones Un 20% de pacientes con estrabismo horizontal se pueden beneficiar de un ajuste postoperatorio para mejorar el resultado quirúrgico. La sutura ajustable mostró ser superior frente a la sutura colgante fija y supone una excelente opción quirúrgica tanto en niños como en adultos (AU)

Objective Adjustable suture procedures allow addressing the unpredictability of some postoperative results in strabismus surgery. The purpose of the study was to compare the effectiveness of adjustable and non-adjustable suture in the treatment of horizontal strabismus in children and adults. Methods Prospective study including patients undergoing strabismus surgery to correct horizontal strabismus with fixed hanging suture (non-adjustable suture group) and adjustable suture. Visual acuity, amblyopia, deviation, oblique muscle involvement, previous surgeries, nystagmus, need for adjustment, and complications were recorded. The variables were recorded in the immediate postoperative period, at one week and at 3 and 6months. Results 186 patients were included: 157 (84.4%) with adjustable suture and 29 (15.6%) with non-adjustable suture, of which 119 were children and 67 were adults. Postoperatively, 19 children (16.0%) and 19 adults (28.4%) required adjustment (P=.044). Of 157 patients with adjustable suture, it was adjusted in 20% (32/157). Success after adjustment was higher for adjustable suture (91.72% vs 79.31%; P=.043) and remained for 6months (P<.05). Previous surgery (P=.004) and exotropia (P=.018) correlated with the need for adjustment. Conclusions 20% of patients with horizontal strabismus can benefit from a postoperative adjustment to improve the surgical result. The adjustable suture was shown to be superior to the fixed hanging suture and is an excellent surgical option, both in children and adults (AU)

Efficacy and safety of adjustable suture in horizontal strabismus: Comparative study of children versus adults.

OBJECTIVE: Adjustable suture procedures allow addressing the unpredictability of some postoperative results in strabismus surgery. The purpose of the study was to compare the effectiveness of adjustable and non-adjustable suture in the treatment of horizontal strabismus in children and adults. METHODS: Prospective study including patients undergoing strabismus surgery to correct horizontal strabismus with fixed hanging suture (non-adjustable suture group) and adjustable suture. Visual acuity, amblyopia, deviation, oblique muscle involvement, previous surgeries, nystagmus, need for adjustment, and complications were recorded. The variables were recorded in the immediate postoperative period, at one week and at 3 and 6 months. RESULTS: 186 patients were included: 157 (84.4%) with adjustable suture and 29 (15.6%) with non-adjustable suture, of which 119 were children and 67 were adults. Postoperatively, 19 children (16.0%) and 19 adults (28.4%) required adjustment (p = 0.044). Of 157 patients with adjustable suture, it was adjusted in 20% (32/157). Success after adjustment was higher for adjustable suture (91.72% vs 79.31%; p = 0.043) and remained for 6 months (p < 0.05). Previous surgery (p = 0.004) and exotropia (p = 0.018) correlated with the need for adjustment. CONCLUSIONS: 20% of patients with horizontal strabismus can benefit from a postoperative adjustment to improve the surgical result. The adjustable suture was shown to be superior to the fixed hanging suture and is an excellent surgical option, both in children and adults.

Myopia progression and axial elongation in Spanish children: Efficacy of atropine 0.01% eye-drops.

PURPOSE: To assess myopia progression in Spanish children and whether treatment with low-dose atropine eye drops delays myopia progression and axial elongation. METHODS: 339 eyes of 339 Caucasian patients with myopia, aged 5 to 11 years, were examined. Participants were randomized to a treatment arm, receiving one atropine (0.01%) eye drop/day for two, and an untreated control arm. At the baseline and 2-year follow-up visits, we recorded: spherical equivalent (SE), axial length (AL), mean keratometry (Mean-K) and anterior chamber depth (ACD). We also examined the rate of children with higher myopia progression (change in SE >1 D/2 years) and identified risk factors for progression. RESULTS: In 339 eyes of the 339 children (age=7.61; SD 1.70; range 5-11 years), the mean baseline SE was-2.15 (SD 0.62) D, and AL was 24.24 (SD 0.79) mm. After 2 years, higher increases occurred in all variables except ACD in the untreated group vs. the atropine group, respectively: SE (-0.51 (SD 0.39) D vs. -0.76 (SD 0.37) D, P<0.001), AL (0.20 (SD 0.20) mm vs. 0.37 (SD 0.27) mm, P<0.001) and Mean-K (0.01 (0.28) D vs. 0.09 (0.32) D, P=0.018). Myopia progression was reduced by 32% in the treatment group. There were more progressors >1D/2y in the control group: 62/168 (36.9%) vs. 35/171 (20.5%) (P<0.001). Atropine was identified as a protective factor against myopia progression (B=1.12; 95% CI= 0.98-1.27; P=<0.001). CONCLUSION: Spanish children showed a low rate of myopia progression. Atropine 0.01% showed a significant effect in slowing the progression of both refractive error and axial elongation.

Satisfacción de la cirugía de estrabismo basada en la opinión de cirujanos expertos / Satisfaction with strabismus surgery based on the opinion of expert surgeons

OBJETIVO: El objetivo es valorar la percepción de los cirujanos de estrabismo en España sobre la satisfacción de los pacientes tras la cirugía, analizando cuáles consideran que son los tipos de estrabismo con pacientes más satisfechos y las causas de insatisfacción. MÉTODO: Se realizó una encuesta a los miembros de la Sociedad Española de Estrabología mayores de 50 años, que estuvieran en activo y cuya principal actividad quirúrgica fuera la cirugía de estrabismo, con ejercicio de su profesión en España y más de 20 años de experiencia quirúrgica. La encuesta constaba de 18 preguntas acerca de la percepción de la satisfacción de los pacientes según el tipo de estrabismo, la edad del paciente y la causa de insatisfacción más frecuente tras la cirugía. RESULTADOS: Se incluyeron 29 encuestas de cirujanos con una experiencia quirúrgica media de 31 años. La causa de insatisfacción percibida más frecuente fue el estrabismo residual. No se encontraron diferencias en el índice de satisfacción entre niños y adultos. La cirugía que consideran que produce mayor satisfacción es la endotropía, seguida de la parálisis del IV par descompensada y la exotropía, mientras que la parálisis del III par craneal es la que más descontento causa. CONCLUSIONES: Según la opinión de los cirujanos, la cirugía de la endotropía es la más satisfactoria para el paciente seguida de la exotropía, los estrabismos verticales y la parálisis traumática del IV par craneal

PURPOSE: To assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the causes of dissatisfaction. METHODS: A survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery. RESULTS: The questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4th nerve palsy, and exotropia, while 3rd nerve palsy was the cause of the most dissatisfaction. CONCLUSIONS: According to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4th cranial nerve

Satisfaction with strabismus surgery based on the opinion of expert surgeons. / Satisfacción de la cirugía de estrabismo basada en la opinión de cirujanos expertos.

PURPOSE: To assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the causes of dissatisfaction. METHODS: A survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery. RESULTS: The questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4th nerve palsy, and exotropia, while 3rd nerve palsy was the cause of the most dissatisfaction. CONCLUSIONS: According to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4th cranial nerve.

Parálisis oculomotoras en el contexto de una reactivación del virus varicela-zóster: a propósito de 4 casos / Oculomotor nerve palsy in herpes zoster ophthalmicus: Presentation of 4 cases

La infección por el virus varicela-zóster (VVZ) tiene una alta prevalencia a nivel mundial. De las muchas manifestaciones oftalmológicas que puede manifestar, la diplopía de aparición brusca es una de ellas. Revisamos 4 casos clínicos de mononeuritis del III y VI par craneales en el contexto de vesículas herpéticas por el VVZ y revisamos la fisiopatología y las manifestaciones clínicas más importantes. Es obligado para el oftalmólogo descartar complicaciones mediante pruebas de imagen y el correcto tratamiento con antivirales sistémicos

Varicella zoster virus (VZV) infection has a high prevalence worldwide. Within the multiple ophthalmologic manifestations that VZV can cause, sudden diplopia is among them. A review is presented of four clinical cases of 3rd and 4th oculomotor nerve palsies in herpes zoster ophthalmicus. A review is also presented of the physiopathology and most important clinical manifestations. Imaging tests are essential in order to rule out complications. Systemic antiviral administration is the correct treatment

Oculomotor nerve palsy in herpes zoster ophthalmicus: Presentation of 4 cases. / Parálisis oculomotoras en el contexto de una reactivación del virus varicela-zóster: a propósito de 4 casos.

Varicella zoster virus (VZV) infection has a high prevalence worldwide. Within the multiple ophthalmologic manifestations that VZV can cause, sudden diplopia is among them. A review is presented of four clinical cases of 3rd and 4th oculomotor nerve palsies in herpes zoster ophthalmicus. A review is also presented of the physiopathology and most important clinical manifestations. Imaging tests are essential in order to rule out complications. Systemic antiviral administration is the correct treatment.

Manifestaciones neuroftalmológicas como complicación de una infección por Mycoplasma pneumoniae y desarrollo posterior de una encefalitis aguda diseminada / Neuro-ophthalmological manifestations as complication of an infection with Mycoplasma pneumoniae and subsequent development of disseminated acute encephalitis

El objetivo es describir dos cuadros clínicos neuroftalmológicos en niños por infección sistémica por Mycoplasma pneumoniae (M. pneumoniae). Se presentan los casos de dos niñas de 14 y 12 años que acudieron a urgencias: la primera con oftalmoplejía internuclear y la segunda con pérdida de visión y cefalea. No presentaban otra focalidad neurológica. En la imagen de resonancia magnética se evidenciaron placas hiperintensas en ambas, sugerentes de cuadro desmielinizante. Al mes, los síntomas neuroftalmológicos se resolvieron y las resonancias magnéticas de control fueron normales. El diagnóstico fue encefalitis diseminada aguda secundaria a M. pneumoniae. El diagnóstico se hace por PCR (gold standard) y/o IgM en serología. Es importante pensar en esta posible etiología ante casos sugerentes de enfermedad desmielinizante. Existe controversia sobre el papel de los antibióticos y si se contemplan los corticoides. Como conclusión, M. pneumoniae debe ser diagnóstico diferencial en afectaciones neuroftalmológicas agudas en niños

The purpose of this article is to describe two paediatric neuro-ophthalmological clinical cases caused by a systemic infection due to Mycoplasma pneumoniae (M. pneumoniae). The cases are two girls aged 14 and 12 seen in the Emergency Department: The first one had internuclear ophthalmoplegia and second with loss of vision and headache. They had no other neurological foci. Magnetic resonance imaging showed hyperintense plaques in both, suggestive of a demyelinating disease. One month later, the neuro-ophthalmological symptoms resolved, with normal follow-up magnetic resonance imagings. The diagnosis was acute disseminated encephalitis secondary to M. pneumoniae. The diagnosis was made using PCR (gold standard) and/or IgM in serology. It is important to think about this possible aetiology in cases of suggestive demyelinating disease. There is controversy about the role of antibiotics and on whether corticosteroids are contemplated. In conclusion, M. pneumoniae must be a differential diagnosis in acute neuro-ophthalmological disorders in children

Neuro-ophthalmological manifestations as complication of an infection with Mycoplasma pneumoniae and subsequent development of disseminated acute encephalitis. / Manifestaciones neuroftalmológicas como complicación de una infección por Mycoplasma pneumoniae y desarrollo posterior de una encefalitis aguda diseminada.

The purpose of this article is to describe two paediatric neuro-ophthalmological clinical cases caused by a systemic infection due to Mycoplasma pneumoniae (M. pneumoniae). The cases are two girls aged 14 and 12 seen in the Emergency Department: The first one had internuclear ophthalmoplegia and second with loss of vision and headache. They had no other neurological foci. Magnetic resonance imaging showed hyperintense plaques in both, suggestive of a demyelinating disease. One month later, the neuro-ophthalmological symptoms resolved, with normal follow-up magnetic resonance imagings. The diagnosis was acute disseminated encephalitis secondary to M. pneumoniae. The diagnosis was made using PCR (gold standard) and/or IgM in serology. It is important to think about this possible aetiology in cases of suggestive demyelinating disease. There is controversy about the role of antibiotics and on whether corticosteroids are contemplated. In conclusion, M. pneumoniae must be a differential diagnosis in acute neuro-ophthalmological disorders in children.

Estudio de la calidad de vida y la función visual en niños con glaucoma en España / Quality of life and visual function in children with glaucoma in Spain

Objetivo: Evaluar el efecto del glaucoma en la función visual, la calidad de vida en los niños y la calidad de vida percibida por los cuidadores en niños de hasta 16 años. Material y métodos: Se diseñó un estudio observacional y prospectivo. Se aplicó el cuestionario GQL-15 (Glaucoma Quality of Life) a los niños y a los cuidadores, y el cuestionario VFQ-25 (Visual Functioning Questionnarie) a los niños. Se registraron diferentes variables de la historia clínica que podrían influir en la calidad de vida y la función visual. Resultados: Se incluyó a un total de 24 pacientes con una edad media de 9,13 ± 3,08 años, de los cuales 3 tenían afectación unilateral y 20 presentaban glaucoma congénito primario. Los padres reportaron una peor calidad de vida que los niños: el resultado de la encuesta GQL-15 fue de 32,30 ± 11,56 puntos en los niños y de 37,5 2 ± 14,59 puntos en los cuidadores (p = 0,001). El parámetro que más se relacionó con la calidad de vida y la función visual fue el defecto medio del campo visual en el mejor ojo. Se encontró una correlación estadísticamente significativa entre el resultado de GQL-15 y el defecto medio del campo visual (niños: R = 0,63; p < 0,01 y cuidadores: R = 0,81; p < 0,001). Conclusiones: El daño funcional visual producido por el glaucoma tiene un impacto importante en la calidad de vida y en la función visual de los niños con glaucoma, si bien la calidad de vida percibida por los cuidadores es peor que la percibida por el niño

Objective: To evaluate the effect of glaucoma on visual function, as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age. Material and methods: An observational and prospective study was designed using the questionnaire GQL-15 (Glaucoma Quality of Life) and conducted on children and caregivers. The questionnaire VFQ-25 (Visual Functioning Questionnaire) was conducted on children. Different variables of the clinical history that could influence the quality of life and visual function were recorded. Results: The study included 24 patients with a mean age of 9.13 ± 3.08 years, and included 3 with unilateral involvement, and 20 diagnosed with primary congenital glaucoma. Parents reported a worse quality of life than children. The result of the GQL-15 survey was 32.3 ± 11.56 points in children and 37.52 ± 14.59 points in caregivers (P = .001). The parameter most related to quality of life and visual function was the mean deviation (MD) of the visual field in the best eye. A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field (children: R = 0.63, P < .01, caregivers: R= 0.81, P < .001). Conclusions: Functional loss has an impact on the quality of life and visual function in children with glaucoma, although the quality of life perceived by the caregivers is worse than that perceived by the child

Quality of life and visual function in children with glaucoma in Spain. / Estudio de la calidad de vida y la función visual en niños con glaucoma en España.

OBJECTIVE: To evaluate the effect of glaucoma on visual function, as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age. MATERIAL AND METHODS: An observational and prospective study was designed using the questionnaire GQL-15 (Glaucoma Quality of Life) and conducted on children and caregivers. The questionnaire VFQ-25 (Visual Functioning Questionnaire) was conducted on children. Different variables of the clinical history that could influence the quality of life and visual function were recorded. RESULTS: The study included 24 patients with a mean age of 9.13±3.08 years, and included 3 with unilateral involvement, and 20 diagnosed with primary congenital glaucoma. Parents reported a worse quality of life than children. The result of the GQL-15 survey was 32.3±11.56 points in children and 37.52±14.59 points in caregivers (P=.001). The parameter most related to quality of life and visual function was the mean deviation (MD) of the visual field in the best eye. A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field (children: R=0.63, P<.01, caregivers: R=0.81, P<.001). CONCLUSIONS: Functional loss has an impact on the quality of life and visual function in children with glaucoma, although the quality of life perceived by the caregivers is worse than that perceived by the child.

Evaluación del grosor de los músculos extraoculares y la quemosis tras tocilizumab en oftalmopatía de Graves mediante tomografía de coherencia óptica / Response to tocilizumab treatment in Graves' ophthalmopathy by measuring rectus muscle thickness and chemosis using optical coherence tomography

PROPÓSITO: Evaluar el grosor de los músculos extraoculares y la quemosis tras el tratamiento con tocilizumab en pacientes con oftalmopatía de Graves activa mediante tomografía de coherencia óptica. MÉTODOS: Serie de 5 casos con oftalmopatía de Graves activa (escala de actividad clínica ≥ 4/10) tratados mediante 4 dosis de tocilizumab. Estos pacientes habían sido tratados previamente con corticoides sin mejoría. Se empleó una tomografía de coherencia óptica de dominio espectral para determinar el grosor del recto lateral y del recto medial, y la quemosis antes y después de 4 dosis de tocilizumab administradas mensualmente. Se realizó el escaneado a las 3 y 9 h (nasal y temporal). RESULTADOS: Se estudiaron 4 mujeres y un hombre con una edad mediana de 52 años (rango: 38-73). La duración mediana de la actividad fue de 17 meses (rango: 12-18). El grosor muscular mediano del recto medial y del recto lateral pretratamiento fue 249 μm (174-366) y 337 μm (142-443) respectivamente, siendo la quemosis mediana 409 μm (290-610). Tras el tratamiento con tocilizumab el grosor muscular disminuyó a 157 μm (88-187) y 197 μm (99-290) respectivamente (p = 0,043; Wilcoxon), y la quemosis a 59 μm (0-78). La escala de actividad clínica disminuyó de 5 (4-8) a 1 (0-3). CONCLUSIONES: Se observó una reducción en el grosor muscular de los rectos horizontales y en la quemosis en pacientes con oftalmopatía de Graves tras el tratamiento con tocilizumab mediante tomografía de coherencia óptica, por lo que esta técnica podría ser útil para la valoración de la respuesta al tratamiento

PURPOSE: To assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves' ophthalmopathy by optical coherence tomography. METHODS: Case series of five patients with active Graves' ophthalmopathy (clinical activity score ≥ 4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o'clock (nasal and temporal). RESULTS: The study included four women and one man with a median age of 52 years (range: 38-73). Median Graves' ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249 μm (174-366) and 337 μm (142-443), respectively. Median chemosis was 409 μm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157 μm (88-187) and 197 μm (99-290), respectively (P = .043; Wilcoxon) and chemosis to 59 μm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). CONCLUSIONS: A reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves' ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses

Evaluación del grosor de los músculos extraoculares y estudio de correlación mediante tomografía de coherencia óptica / Assessment of extraocular muscle thickness and correlation study using optical coherence tomography

OBJETIVO: Describir los valores de normalidad del grosor de los músculos rectos horizontales mediante tomografía de coherencia óptica de dominio espectral (SD-OCT) y valorar si existe correlación entre el grosor muscular y el sexo, la edad o la longitud axial (LA). MATERIAL Y MÉTODOS: Estudio transversal de 131 ojos derechos de pacientes sin enfermedad oftalmológica. Se recogieron el sexo y la edad y se midió la LA utilizando un biómetro óptico Lenstar LS 900 (Haag-Streit AG, Koeniz, Suiza). El grosor del recto medio (RM) se midió a 7,2 y 9,2mm desde el limbo y el recto lateral (RL) a 8,5 y 10,5 mm utilizando la OCT. Se ajustó un modelo multivariable para analizar si el sexo, la edad y la LA podrían influir sobre el grosor muscular. RESULTADOS: La edad media fue 43,3 ± 20,9 años (rango 6-86), siendo 59% mujeres. La LA media fue 24,9 ± 2,7mm (rango: 20,4-33,8). El grosor medio del RL a 8,5mm fue 188,5 ± 51,2 μm (rango 69-342) y 186,5 ± 45,9 μm (rango 75 - 269) a 10,5 mm. El grosor del RM fue 158,1 ± 39,1μm (rango 69 - 273) a 7,2 mm y 193,7 ± 55,9 μm (rango 105-386) a 9,2 mm. Se observó correlación entre el grosor del RM y la LA (R = -0,255; p = 0,023), no hallándose correlación para el RL (p ≥ 0,203). Tampoco se encontró asociación entre el grosor y el sexo o la edad (p ≥ 0,125). CONCLUSIONES: La OCT permite medir el grosor de los músculos rectos horizontales, observándose una asociación entre el grosor del RM y la LA

OBJECTIVE: To report reference values for the horizontal rectus muscles thickness using Spectral Domain optical coherence tomography (SD-OCT), and to evaluate whether there are any correlations between the muscle thickness and gender, age, or axial length (AL). MATERIAL AND METHODS: A cross-sectional study was conducted on 131 right eyes of healthy subjects. The gender and age were recorded, and axial length was measured using an optical biometer. The medial rectus (MR) muscle thickness was measured at 7.2 and 9.2 mm from the limbus, and the lateral rectus (LR) at 8.5 and 10.5 mm from the limbus using OCT. A multivariate model was adjusted to determine whether gender, age, and axial length could have an impact on the muscle thickness. RESULTS: Mean age was 43.3 ± 20.9 years (range 6-86), and 59% were women. Mean AL was 24.9 ± 2.7 mm (range: 20.4 - 33.8). Mean thickness was 188.5 ± 51.2 μm (range 69-342) for the LR at 8.5 and 186.5 ± 45.9 μm (range 75-269) at 10.5 mm, and for the MR, 158.1 ± 39.1μm (range 69 - 273) at 7.2 mm and 193.7 ± 55.9μm (range 105-386) at 9.2 mm. A correlation was observed between the AL and MR thickness (R = -.255; P = .023) while no correlation was observed for the LR (P ≥ 0.203). No correlations were found between thickness and gender or thickness and age (P ≥ 0.125). CONCLUSIONS: The reference ranges of the horizontal rectus muscles thickness was described using SD-OCT, observing an association between the AL and the MR thickness

Response to tocilizumab treatment in Graves' ophthalmopathy by measuring rectus muscle thickness and chemosis using optical coherence tomography. / Evaluación del grosor de los músculos extraoculares y la quemosis tras tocilizumab en oftalmopatía de Graves mediante tomografía de coherencia óptica.

PURPOSE: To assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves' ophthalmopathy by optical coherence tomography. METHODS: Case series of five patients with active Graves' ophthalmopathy (clinical activity score ≥4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o'clock (nasal and temporal). RESULTS: The study included four women and one man with a median age of 52 years (range: 38-73). Median Graves' ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249µm (174-366) and 337µm (142-443), respectively. Median chemosis was 409µm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157µm (88-187) and 197µm (99-290), respectively (P=.043; Wilcoxon) and chemosis to 59µm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). CONCLUSIONS: A reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves' ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses.

Assessment of extraocular muscle thickness and correlation study using optical coherence tomography. / Evaluación del grosor de los músculos extraoculares y estudio de correlación mediante tomografía de coherencia óptica.

OBJECTIVE: To report reference values for the horizontal rectus muscles thickness using Spectral Domain optical coherence tomography (SD-OCT), and to evaluate whether there are any correlations between the muscle thickness and gender, age, or axial length (AL). MATERIAL AND METHODS: A cross-sectional study was conducted on 131 right eyes of healthy subjects. The gender and age were recorded, and axial length was measured using an optical biometer. The medial rectus (MR) muscle thickness was measured at 7.2 and 9.2mm from the limbus, and the lateral rectus (LR) at 8.5 and 10.5mm from the limbus using OCT. A multivariate model was adjusted to determine whether gender, age, and axial length could have an impact on the muscle thickness. RESULTS: Mean age was 43.3±20.9 years (range 6-86), and 59% were women. Mean AL was 24.9±2.7mm (range: 20.4-33.8). Mean thickness was 188.5±51.2µm (range 69-342) for the LR at 8.5 and 186.5±45.9µm (range 75-269) at 10.5mm, and for the MR, 158.1±39.1µm (range 69-273) at 7.2mm and 193.7±55.9µm (range 105-386) at 9.2mm. A correlation was observed between the AL and MR thickness (R=-.255; P=.023) while no correlation was observed for the LR (P≥0.203). No correlations were found between thickness and gender or thickness and age (P≥0.125). CONCLUSIONS: The reference ranges of the horizontal rectus muscles thickness was described using SD-OCT, observing an association between the AL and the MR thickness.

Brinzolamida tópica en el nistagmo congénito: Estudio retrospectivo / Topical brinzolamide in congenital nystagmus: A retrospective study

Objetivo: Evaluar los efectos del tratamiento con brinzolamida tópica en la agudeza visual y en la intensidad del nistagmo en pacientes con nistagmo congénito. Material y métodos: Se diseñó un estudio retrospectivo en el que se revisaron las historias clínicas de 11 pacientes con nistagmo congénito. A todos los pacientes se les realizó una exploración oftalmológica completa y una videooculografía mediante VOG-Perea, antes y a los 3 días de iniciar el tratamiento con brinzolamida tópica (Azopt) cada 8horas. Cinco investigadores expertos evaluaron la intensidad del nistagmo de forma enmascarada mediante un vídeo antes y después del tratamiento. Por último, se registró la mejoría subjetiva de los pacientes. Resultados: Se encontraron diferencias estadísticamente significativas en la agudeza visual binocular de cerca previa y posterior al tratamiento. Se encontró un leve aumento de la frecuencia del nistagmo, que fue estadísticamente significativa en la mirada horizontal hacia la izquierda y con la mirada hacia abajo (p = 0,04, p = 0,03 significativo). El índice Kappa de concordancia entre los investigadores evaluando la intensidad del nistagmo fue de 0,014. Solo 2 de los pacientes notaron mejoría en la agudeza visual y un paciente notó mejoría en el aspecto estético. Conclusiones: A pesar de producirse una mejoría en el nistagmo, esta es leve, no apreciable cosméticamente por los pacientes en la mayoría de los casos, y no se relacionó con una mejoría significativa en la agudeza visual ni en la calidad de vida de los pacientes. Son necesarios nuevos estudios para evaluar los efectos de la brinzolamida tópica y establecer las posibles indicaciones terapéuticas en el nistagmo (AU)

Objective: To evaluate the effect of treatment with topical brinzolamide on visual acuity and nystagmus intensity in patients with congenital nystagmus. Material and methods: A retrospective study was designed in which the clinical records of 14 patients with congenital nystagmus were reviewed. All patients underwent a complete ophthalmological examination and a Perea video-oculography (VOG) before, and three days after, initiation of treatment with topical brinzolamide (Azopt). Five expert researchers evaluated the intensity of nystagmus by video before and after treatment. Finally, the subjective improvement of the patients was recorded. Results: Statistically significant differences were found in pre- and post-treatment binocular near visual acuity. A slight increase in the frequency of nystagmus was found, which was statistically significant with the horizontal gaze to the left and with the gaze downwards (P = .04, P = .03, respectively). The kappa index concordance between the researchers evaluating the intensity of nystagmus was 0.014. Only two of the patients noticed improvement in visual acuity, and one patient noticed improvement in the aesthetic aspect. Conclusions: In spite of an improvement in nystagmus, it was slight, not cosmetically appreciable by patients in most cases, and was not related to a significant improvement in visual acuity or in patient quality of life. Further studies are needed to evaluate the effects of topical brinzolamide, and to establish potential therapeutic indications in nystagmus (AU)

Topical brinzolamide in congenital nystagmus: A retrospective study. / Brinzolamida tópica en el nistagmo congénito: Estudio retrospectivo.

OBJECTIVE: To evaluate the effect of treatment with topical brinzolamide on visual acuity and nystagmus intensity in patients with congenital nystagmus. MATERIAL AND METHODS: A retrospective study was designed in which the clinical records of 14 patients with congenital nystagmus were reviewed. All patients underwent a complete ophthalmological examination and a Perea video-oculography (VOG) before, and three days after, initiation of treatment with topical brinzolamide (Azopt). Five expert researchers evaluated the intensity of nystagmus by video before and after treatment. Finally, the subjective improvement of the patients was recorded. RESULTS: Statistically significant differences were found in pre- and post-treatment binocular near visual acuity. A slight increase in the frequency of nystagmus was found, which was statistically significant with the horizontal gaze to the left and with the gaze downwards (P=.04, P=.03, respectively). The kappa index concordance between the researchers evaluating the intensity of nystagmus was 0.014. Only two of the patients noticed improvement in visual acuity, and one patient noticed improvement in the aesthetic aspect. CONCLUSIONS: In spite of an improvement in nystagmus, it was slight, not cosmetically appreciable by patients in most cases, and was not related to a significant improvement in visual acuity or in patient quality of life. Further studies are needed to evaluate the effects of topical brinzolamide, and to establish potential therapeutic indications in nystagmus.

Concordancia de la distancia desde la inserción hasta el limbo de los músculos rectos entre la medida intraoperatoria y con tomografía de coherencia óptica / Agreement between intraoperative measurements and optical coherence tomography of the limbus-insertion distance of the extraocular muscles

OBJETIVO: Valorar la concordancia entre la medida intraoperatoria y mediante tomografía de coherencia óptica de dominio espectral (SD-OCT) de la distancia desde la inserción muscular de los rectos horizontales hasta el limbo. MÉTODOS: Se analizaron 67 músculos de 21 pacientes con estrabismo. La distancia inserción-limbo de los músculos rectos horizontales fue medida mediante SD-OCT y de forma intraoperatoria de 2 maneras: 1) directa, tras la apertura de la conjuntiva en los pacientes en los que se realizó cirugía; 2) transconjuntival, en aquellos que fueron tratados con toxina o en músculos que no iban a ser intervenidos. Se calculó el coeficiente de correlación intraclase y se realizó un análisis de Bland-Altman para determinar la concordancia entre las medidas. RESULTADOS: La edad media fue 45,9 ± 20,9 años (rango 16-85), con el 52% de mujeres. El porcentaje de identificación de manera intraoperatoria directa fue el 95,6% (22/23), mientras que transconjuntival fue el 90,9% (40/44) y mediante OCT fue de 85% (57/67). Fueron finalmente analizados para el estudio de concordancia 22 músculos mediante medida intraoperatoria directa y OCT y 35 mediante medida transconjuntival y OCT. El coeficiente de correlación intraclase mostró buena fiabilidad de la medida con OCT tanto con la medida intraoperatoria directa (0,931; intervalo de confianza al 95% (IC 95%): 0,839-0,972; p < 0,001), como con la medida intraoperatoria transconjuntival (0,889; IC 95%: 0,790-0,942; p < 0,001). CONCLUSIONES: La OCT de dominio espectral permite medir de una forma eficaz la distancia desde la inserción de los músculos rectos horizontales hasta el limbo esclerocorneal, con una elevada concordancia con la medida intraoperatoria

OBJECTIVE:To assess the agreement between intraoperative measurements of the limbus-insertion distance of the extraocular muscles with those measured by spectral domain optical coherence tomography. METHODS: An analysis was made of a total of 67 muscles of 21 patients with strabismus. The limbus-insertion distance of the horizontal rectus muscles were measured using pre-operative SD-OCT and intra-operatively in 2 ways: 1) direct, after a conjunctival dissection in patients who underwent surgery, or 2) transconjunctival in patients who were treated with botulinum toxin, or in those who were not going to be operated. The intraclass correlation coefficient and Bland-Altman plots were calculated to determine the concordance between the 2 methods. RESULTS: The mean age was 45.9 ±20.9 years (range 16 to 85), with 52% being women. The percentage of identification by direct intraoperative measurement was 95.6% (22/23), by transconjunctival intraoperative measurement 90.9% (40/44), and by OCT 85% (57/67), with 22 muscles finally being analysed for the agreement study between direct intraoperative measurement and OCT measurements, and 35 muscles for the agreement between transconjuctival intraoperative measurement and OCT. The intraclass correlation coefficient showed good agreement with OCT and direct intraoperative measurements (0.931; 95% confidence interval (95% CI): 0.839-0.972; P<.001), and with transconjunctival intraoperative measurements (0.889; 95% CI: 0.790-0.942; P<.001). CONCLUSIONS: The SD-OCT is an effective technique to measure the distance from the insertion of the horizontal rectus muscles to the limbus, with a high agreement with intraoperative measurements being demonstrated