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1.
Medicine (Baltimore) ; 98(51): e18077, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860958

RESUMO

RATIONALE: Angelman syndrome (AS) is an uncommon genetic disease characterized as serious retarded mental development and ocular abnormality. PATIENT CONCERNS: This report aims to present the ophthalmological features, and identify the diagnosis and outcomes of strabismus surgery in AS patients. DIAGNOSIS: Three children with exotropia were diagnosed with AS based on their typical clinical features. INTERVENTIONS: All patients underwent multiplex ligation-dependent probe amplification (MLPA) analysis and accepted lateral rectus recession surgery with the assistance of intravenous combined inhalation anesthesia. OUTCOMES: The maternal heritage deletion of chromosome 15q11.2-q13 was verified in all patients by MLPA. All patients with strabismus could not cooperate during the vision test, and had astigmatism. The strabismus type of AS patients was horizontal exotropia, and no vertical strabismus was found. One of these patients was combined with high myopia. The hypopigmentation on the hair and iris was ubiquitous. However, retina pigmentation was normal. After different degrees of lateral rectus recession, the exotropia was significantly relieved, and the surgical effects were stable postoperatively. LESSONS: Horizontal exotropia is the major strabismus type. Severe intellectual disability, hyperactivity, and speech impairment are the common characteristics of AS children. Its examination and operation design remains challenging. Thus, repeated examinations and intelligence rehabilitation are essential.


Assuntos
Síndrome de Angelman/diagnóstico , Exotropia/diagnóstico , Exotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Síndrome de Angelman/complicações , Criança , Pré-Escolar , China , Exotropia/complicações , Feminino , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Prognóstico , Doenças Raras , Recuperação de Função Fisiológica , Estrabismo/complicações , Estrabismo/diagnóstico , Estrabismo/cirurgia , Resultado do Tratamento , Testes Visuais
2.
Clin Ter ; 170(5): e339-e344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612190

RESUMO

PURPOSE: Outcomes Research Study on patients suffering from anisometropia or isoametropia associated with amblyopia and microstrabismus to show the impact of late occlusion treatment on therapeutic prognosis. MATERIALS AND METHODS: Enrollment of all the eligible patients presenting to recruiting centers at the Department of Pediatric Ophthalmology and Strabismus - Ophthalmological Clinic - Policlinico Umberto I - Rome. At baseline, all patients will undergo an opthalmologic evaluation. Recruited patients will be followed for a 2-year period. Our test group was composed of 31 patients, 11 with bilateral and 20 with monolateral amblyopia, totalling 42 amblyopic eyes, and it was assessed - always by the same examiner - with the help of the following orthoptic examinations: Wirt test, Irvine-Jampolsky test (4 dioptre fixation task), Visuscope, Cover Test, Bagolini striated glasses, and Worth lights test. We assessed pre-post treatment variations observed in the overall group of amblyopic eyes, regardless of the differences between RE and LE. OUTCOMES: Of the 31 children, 58.1% were males and 41.9% female, average age between 6 and 14 years. Of the 42 amblyopic eyes, after daily occlusion of 8 hours ± 2.30 SD, we recorded an improvement of 71.4%, and visual acuity increased from an average of 0.4 LogMAR to 0.1 LogMAR. CONCLUSION: Late anti-amblyopic occlusion treatment proved effective in the long term for children 6 to 12 years, specifically regarding visual acuity, fixation, stereopsis, and binocular collaboration in patients suffering from anisometropia or isoametropia and microstrabismus.


Assuntos
Ambliopia/terapia , Anisometropia/terapia , Estrabismo/terapia , Adolescente , Ambliopia/complicações , Anisometropia/complicações , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Exame Físico , Estrabismo/complicações , Acuidade Visual/fisiologia
3.
Middle East Afr J Ophthalmol ; 26(2): 71-76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543663

RESUMO

PURPOSE: The purpose is to study the clinical profile of amblyopia by age at diagnosis. SUBJECTS AND METHODS: A retrospective chart review of 327 amblyopic patients over 7 years (September 2009-December 2016) was performed, divided by age at diagnosis into four groups: <3, 3-7, 8-15, and >15 years. Demographics, eye conditions and eye examination parameters including visual acuity (VA), refractive errors, and motility measurements were collected. RESULTS: Mean age at diagnosis and follow-up time was 6.2 ± 6.1 years standard deviation (SD) and 12.4 months ± 20.6 SD, respectively. The most common overall cause of amblyopia was strabismus (37%) followed by anisometropia (36%). The main causes by age at diagnosis were: strabismus at <3 years, anisometropia at 3-7 years, anisometropia at 8-15 years, and mixed at >15 years. Significant improvement in VA with treatment was noted with age between 3 and 15 years (3-7 years, P = 0.001 and 8-15 years, P = 0.03). CONCLUSIONS: Strabismus was the main cause of amblyopia at <3 years of age; anisometropia was more prevalent in older children (3-15 years). The fact that more than a quarter of our amblyopic patients were detected late (after the age of 8 years) underscores the need for expanded vision screening measures in young children.


Assuntos
Ambliopia/terapia , Oclusão Terapêutica/métodos , Adolescente , Ambliopia/diagnóstico , Ambliopia/etiologia , Anisometropia/complicações , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Prevalência , Erros de Refração/complicações , Estudos Retrospectivos , Privação Sensorial , Estrabismo/complicações , Resultado do Tratamento , Seleção Visual , Acuidade Visual/fisiologia
4.
J Pediatr Ophthalmol Strabismus ; 56(5): 297-304, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545863

RESUMO

PURPOSE: To detect eye tracking abnormalities in children with strabismus in the absence or presence of amblyopia. METHODS: A total of 100 patients aged 7 to 17 years were enrolled prospectively for 2 years from the pediatric ophthalmology clinic of the American University of Beirut Medical Center: 50 children with strabismus (including 24 with amblyopia) and 50 age- and gender-matched controls. Eye tracking with different paradigms was performed. RESULTS: Mean age was 10.66 ± 2.90 years in the strabismus group and 10.02 ± 2.75 years in the control group. Demographic characteristics were similar with respect to vision, gender, and refraction. Four paradigms were tested using the eye tracker: (1) distance/near paradigm: patients with strabismus showed a lower fixation count and longer fixation at both distances and a tendency for decreased latency and percentage of fixation in distant elements; (2) reading paradigm: the strabismus group had a higher fixation count and duration, especially those without amblyopia; (3) location identification paradigm: strabismus group without amblyopia fixated less and with shorter duration on the most flagrant element; and (4) video paradigm: no differences in eye movements were noted. CONCLUSIONS: Significant eye movement deficits were demonstrated in patients with strabismus compared to controls while reading text and identifying prominent elements in a crowded photograph. This was significant in the non-amblyopic subgroup. [J Pediatr Ophthalmol Strabismus. 2019;56(5):297-304.].


Assuntos
Ambliopia/fisiopatologia , Movimentos Oculares/fisiologia , Estrabismo/fisiopatologia , Acuidade Visual , Adolescente , Distribuição por Idade , Ambliopia/complicações , Ambliopia/epidemiologia , Criança , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Prospectivos , Estrabismo/complicações , Estrabismo/epidemiologia , Estados Unidos/epidemiologia , Visão Binocular/fisiologia
5.
Indian J Ophthalmol ; 67(7): 1155-1157, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238434

RESUMO

Myopic strabismus fixus causes inability of the eye to elevate and abduct in the setting of a myopic superotemporally herniated globe. We report a novel surgical technique to manage an 18-year-old male with myopic strabismus fixus. Radiological imaging demonstrated a nasally deviated superior rectus (SR) and inferiorly displaced lateral rectus (LR). Silicone band assisted myopexy of SR and LR was done along with anchoring them to the sclera with a dacron suture. The patient had satisfactory alignment postoperatively and did not require any intervention over 1-year follow-up.


Assuntos
Movimentos Oculares/fisiologia , Miopia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Elastômeros de Silicone , Estrabismo/cirurgia , Técnicas de Sutura/instrumentação , Adolescente , Humanos , Masculino , Miopia/complicações , Miopia/fisiopatologia , Músculos Oculomotores/fisiopatologia , Estrabismo/complicações , Estrabismo/fisiopatologia
6.
Mol Med Rep ; 19(6): 4832-4840, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31059016

RESUMO

Previous studies have demonstrated that strabismus or amblyopia can result in marked brain function and anatomical alterations. However, differences in spontaneous brain activity in strabismus and amblyopia (SA) patients as compared with control individuals remain unclear. The present study aimed to analyze the potential brain activity changes in SA patients and their association with behavioral performance. In total, 16 patients with SA (10 women and 6 men) and 16 healthy controls (HCs; 6 men and 10 women) with matched age and sex were recruited. All subjects were examined with resting­state functional magnetic resonance imaging (rs­fMRI), and changes in the spontaneous brain activity of SA patients were evaluated by the regional homogeneity (ReHo) method. The diagnostic ability of the ReHo method was assessed using receiver operating characteristic (ROC) curve analysis. In addition, the association between the mean ReHo value in different brain regions and the behavioral performance was explored by correlation analysis. It was observed that the ReHo value was significantly increased in SA patients compared with HCs in the following brain regions: left lingual gyrus, right middle occipital gyrus/precuneus, bilateral anterior cingulate, left middle occipital gyrus and bilateral precentral gyrus. By contrast, the ReHo value of the left inferior frontal gyrus was significantly lower than that in HCs. ROC curve analysis indicated that the ReHo method has certain credibility for the diagnosis of SA patients. In addition, no similar changes were detected in other brain regions. These results revealed abnormal spontaneous brain activity in certain parts of the brain in adult patients with SA, which suggests the involvement of the neuropathological or compensatory mechanism in these patients, and may be beneficial for clinical treatment.


Assuntos
Ambliopia/complicações , Encéfalo/fisiopatologia , Imagem por Ressonância Magnética/métodos , Estrabismo/complicações , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/fisiopatologia , Feminino , Lobo Frontal , Humanos , Masculino , Curva ROC , Adulto Jovem
7.
Health Qual Life Outcomes ; 17(1): 81, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064363

RESUMO

BACKGROUND: To estimate the effect of strabismus (squinting) on mental health and health-related quality of life aspects in children and adolescents. METHODS: Data from the German Health Interview and Examination Survey for Children and Adolescents KiGGS (2003-2006 baseline survey; N = 14,835, aged 3 to 17 years, 49% girls) were examined. The presence of strabismus was derived by parental questionnaire, and health-related quality of life and mental health were investigated with the KINDL-R and Strengths and Difficulties Questionnaire. Associations between strabismus and outcomes were analyzed using multivariable linear and logistic regression models. RESULTS: Of 12,989 children without missing data, 579 children (4.5% of the sample) were reported to have strabismus. Children with strabismus had lower scores in the parent-reported KINDL-R total scale (adjusted beta = - 1.02; 95%CI: -1.86 to - 0.18; p = 0.018) and sub-scale 'friends' (adjusted beta = - 2.18; 95%CI: -3.56 to -0.80; p = 0.002) compared to children without strabismus. The presence of strabismus was also associated with more mental health problems like 'hyperactivity/inattention' (adjusted OR = 1.50; 95%CI: 1.14 to 1.98; p = 0.005), and 'peer problems' (adjusted OR = 1.35; 95%-CI: 1.05 to 1.74; p = 0.018) as reported by parents. CONCLUSIONS: Strabismus in children and adolescents is associated with lower health-related quality of life.


Assuntos
Qualidade de Vida , Estrabismo/psicologia , Adolescente , Estudos de Casos e Controles , Criança , Transtornos do Comportamento Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Modelos Logísticos , Masculino , Pais/psicologia , Estrabismo/complicações , Inquéritos e Questionários
10.
Indian J Ophthalmol ; 67(4): 520-521, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30900586

RESUMO

Purpose: To evaluate the superficial retinal vascular plexus density using optical coherence tomography angiography (OCTA) in cases of strabismic amblyopia. Methods: Ten eyes of 10 patients with purely strabismic amblyopia underwent detailed ocular evaluation followed by the assessment of the superficial retinal plexus vascular density using OCTA (Topcon DRI OCT Triton, Swept Source OCT, Topcon, Japan). Ten contralateral normal eyes of the same patients were considered as control. All these 20 eyes underwent a 4.5 × 4.5 mm cube scan OCTA centered at the fovea. Using the Topcon propriety software all 20 eyes were assessed for the capillary plexus density of the superficial retinal vascular plexus along the superior, inferior, nasal, and temporal quadrants centered at the fovea. The numerical values were statistically assessed using a paired t-test with respect to each quadrant between the normal and the pathological eyes. Results: The average age of patients was 16 years and eight patients were males. The mean superficial retinal vascular plexus density along the superior, inferior, nasal, and temporal quadrants in normal and pathological eyes were 49.25 ± 30.34 and 48.93 ± 2.85, 47.22 ± 4.11 and 47.37 ± 4.8, 45.54 ± 1.55 and 43.81 ± 4.21, and 46.26 ± 4.63 and 46.38 ± 5.40, respectively. Similarly, the capillary densities along the central were 17.84 ± 3.49 and 17.24 ± 2.44 in normal and pathological eyes. The differences among all these four quadrants and central area were not statistically significant (P-values > 0.05 for all four quadrants and central area) as compared with the normal eyes. Conclusion: The superficial retinal vascular plexus density of a 4.5 × 4.5 mm cube centered at the fovea of eyes of cases of strabismic amblyopia is similar to that of normal eyes.


Assuntos
Ambliopia/diagnóstico , Angiofluoresceinografia/métodos , Macula Lutea/irrigação sanguínea , Vasos Retinianos/diagnóstico por imagem , Estrabismo/diagnóstico , Tomografia de Coerência Óptica/métodos , Adolescente , Ambliopia/etiologia , Capilares/patologia , Feminino , Fundo de Olho , Humanos , Macula Lutea/diagnóstico por imagem , Masculino , Estrabismo/complicações
11.
Arch. Soc. Esp. Oftalmol ; 94(3): 107-113, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-178310

RESUMO

Objetivo: Describir las alteraciones de la motilidad ocular, tratamiento y resultados en la miastenia gravis (MG). Material y método: Se analizaron retrospectivamente datos de pacientes con MG. Se evaluaron la edad media, el sexo, el diagnóstico inicial, la desviación ocular, la evolución de los síntomas, el tratamiento realizado y los resultados. Se consideró buen resultado la resolución de la desviación o diplopía al final del seguimiento en posición primaria de mirada y lectura. Resultados: Se incluyeron 14 casos (9: mujeres; bilaterales: 10) de edad media: 55,64 años. En 4 el diagnóstico fue realizado en oftalmología. El diagnóstico inicial fue en 3 casos parálisis del iii par bilateral, en uno parálisis del iii par unilateral, en 3 paresia de recto superior o inferior, en 2 casos parálisis del vi par, en uno paresia del iv par, en 3 de exotropía y en uno de endotropía. La diplopía se presentó en los 14 casos y 9 asociaron ptosis. La desviación ocular fue horizontal en 11 (8: exotropía) y vertical en 4. Se realizó cirugía de estrabismo con buen resultado final en 4 casos que no respondieron al tratamiento farmacológico. Seis pacientes resolvieron la diplopía con el tratamiento farmacológico y un caso con prismas. La ptosis requirió tratamiento quirúrgico en un paciente. Se consiguieron buenos resultados en un 78,57%. Conclusión: La diplopía de comienzo agudo secundaria a un estrabismo de ángulo variable o parálisis oculomotora, con o sin ptosis, puede ser diagnóstico de MG. La cirugía de estrabismo consiguió buenos resultados. El tratamiento farmacológico no consiguió resolver la diplopía en todos los casos


Objective: To present a report of the ocular motility disorders, treatment and outcomes of myasthenia gravis (MG). Material and method: A retrospective study was performed on the data of patients with MG. An evaluation was made using mean age, gender, initial diagnosis, ocular deviation, time of onset of clinical characteristics, treatment and results. Resolution of diplopia and/or ocular deviation in primary and reading gaze was considered a good outcome at the end of follow-up. Results: A total of 14 cases were included. The mean age of the sample was 55.64 years, of which 9 were women, and 10 cases were bilateral. The diagnosis was made by ophthalmologists in 4 cases. The initial diagnoses were diverse: bilateral cranial third nerve palsy in 3, unilateral third nerve palsy in 1, superior or inferior rectus palsy in 3, sixth nerve palsy in 2, fourth nerve palsy in 1, exotropia in 3 and esotropia in 1. Diplopia was presented in 14 cases and 9 associated ptosis. The different types of strabismus were horizontal ocular deviation in 11 cases: 8 with exotropia, and 4 with vertical deviation. Strabismus surgery was performed in 4 cases that did not respond to medical treatment, with a good final outcome. Pharmacological treatment resolved diplopia in 6 cases, and prisms in one. Ptosis surgery was only necessary in one patient. Outcome was favourable in 78.57% at the end of follow-up. Conclusion: Acute onset diplopia caused by strabismus with variable angle or oculomotor palsy, associated or not with a ptosis can indicate MG. There were favourable outcomes with strabismus surgery. Pharmacological treatment did not resolve the diplopia in all cases


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diplopia/etiologia , Diplopia/cirurgia , Estrabismo/complicações , Estrabismo/cirurgia , Miastenia Gravis/complicações , Transtornos da Motilidade Ocular/terapia , Estudos Retrospectivos , Blefaroptose/cirurgia
12.
Minerva Stomatol ; 68(1): 11-16, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30667200

RESUMO

BACKGROUND: The aim of this retrospective study was to evaluate the occlusion in adolescents with strabismus in comparison with healthy subjects without vision problems. METHODS: The test group included 50 subjects (23 males and 27 females) with a diagnosis of strabismus and the control group included 50 healthy patients (23 males and 27 females) without any past or present disturbance of vision. Dental cast analysis was performed to evaluate antero-posterior, transversal and vertical malocclusion and dental crowding. Furthermore, oral habits (mouth breathing, atypical swallowing, finger sucking) were recorded. Mann-Whitney test was performed in order to evaluate significant differences between the groups regarding overbite, overjet and dental crowding; Kruskal-Wallis non-parametric test was adopted to compare the samples. Chi square test and Fisher test were adopted for the analysis of cross-bite, Angle Class, and oral habits. RESULTS: No significant difference was found regarding the malocclusion and the unhealthy oral habits between the groups (P>0.05). The test group showed a slightly higher prevalence of cross-bite but the difference between the two groups was not significant (P>0.05). CONCLUSIONS: A possible relationship between the stomatognathic system and strabismus was not confirmed by the results of this study.


Assuntos
Má Oclusão/complicações , Estrabismo/complicações , Adolescente , Técnica de Fundição Odontológica , Feminino , Humanos , Masculino , Estudos Retrospectivos
13.
Int Ophthalmol ; 39(1): 213-217, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29582258

RESUMO

BACKGROUND: To report midterm outcomes of strabismus strategy for management of diplopia in chronic progressive external ophthalmoplegia and specific surgical planning rationale. DESIGN: Retrospective interventional case series. RESULTS: Two patients, a 26-year-old male and a 36-year-old female, diagnosed with chronic progressive external ophthalmoplegia presented with blepharoptosis and intermittent diplopia. Ocular motility examination was significant for bilateral profound impairment of adduction with relative preservation of abduction, infraduction and elevation. Control of intermittent exotropia gradually worsened over 3 and 1.5 years of follow-up, respectively, in the presence of documented stability of the angle of exodeviation. Strabismus surgery involving modest amounts of bilateral medial rectus resection and lateral rectus recessions was undertaken. Surgical intervention was successful in controlling alignment in primary position and alleviating diplopia and asthenopia after 9 and 8 years of follow-up time, respectively, despite slow progression of ophthalmoplegia. CONCLUSION: Bilateral selective impairment of adduction and intermittent exotropia may be the presenting ocular motility disturbance in chronic progressive external ophthalmoplegia. Properly designed strabismus surgery may provide sustainable, in the midterm, control of alignment and symptomatic relief in selected patients with CPEO.


Assuntos
Diplopia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Oftalmoplegia Externa Progressiva Crônica/cirurgia , Refração Ocular/fisiologia , Estrabismo/cirurgia , Acuidade Visual , Adulto , Diplopia/etiologia , Diplopia/fisiopatologia , Feminino , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Oftalmoplegia Externa Progressiva Crônica/complicações , Oftalmoplegia Externa Progressiva Crônica/fisiopatologia , Estudos Retrospectivos , Estrabismo/complicações , Estrabismo/fisiopatologia
14.
Ophthalmology ; 126(3): 456-466, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30352226

RESUMO

PURPOSE: To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad game plus continued spectacle correction vs. continued spectacle correction alone. DESIGN: Multicenter randomized clinical trial. PARTICIPANTS: One hundred thirty-eight participants aged 7 to 12 years with amblyopia (33-72 letters, i.e., approximately 20/200 to 20/40) resulting from strabismus, anisometropia, or both. Participants were required to have at least 16 weeks of optical treatment in spectacles if needed or demonstrate no improvement in amblyopic-eye visual acuity (VA) for at least 8 weeks prior to enrollment. METHODS: Eligible participants (mean age 9.6 years, mean baseline VA of 59.6 letters, history of prior amblyopia treatment other than spectacles in 96%) were randomly assigned to treatment for 8 weeks with the dichoptic binocular Dig Rush iPad game (prescribed for 1 hour per day 5 days per week) plus spectacle wear if needed (n = 69) or continued spectacle correction alone if needed (n = 69). MAIN OUTCOME MEASURES: Change in amblyopic-eye VA from baseline to 4 weeks, assessed by a masked examiner. RESULTS: At 4 weeks, mean amblyopic-eye VA letter score improved from baseline by 1.3 (2-sided 95% confidence interval [CI]: 0.1-2.6; 0.026 logMAR) with binocular treatment and by 1.7 (2-sided 95% CI: 0.4-3.0; 0.034 logMAR) with continued spectacle correction alone. After adjusment for baseline VA, the letter score difference between groups (binocular minus control) was -0.3 (95% CI: -2.2 to 1.5, P = 0.71, difference of -0.006 logMAR). No difference in letter scores was observed between groups when the analysis was repeated after 8 weeks of treatment (adjusted mean: -0.1, 98.3% CI: -2.4 to 2.1). For the binocular group, adherence data from the iPad indicated that slightly more than half of the participants (58% and 56%) completed >75% of prescribed treatment by the 4- and 8-week visits, respectively. CONCLUSIONS: In children aged 7 to 12 years who have received previous treatment for amblyopia other than spectacles, there was no benefit to VA or stereoacuity from 4 or 8 weeks of treatment with the dichoptic binocular Dig Rush iPad game.


Assuntos
Ambliopia/terapia , Jogos de Vídeo , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Ambliopia/etiologia , Ambliopia/fisiopatologia , Anisometropia/complicações , Criança , Computadores de Mão , Óculos , Feminino , Seguimentos , Humanos , Masculino , Estrabismo/complicações , Resultado do Tratamento
15.
J Craniomaxillofac Surg ; 47(2): 305-310, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30581083

RESUMO

OBJECTIVE: To determine the predictive value of vertical incomitance for diplopia outcome in orbital fracture patients. PATIENTS AND METHODS: A prospective cohort study composed of patients with orbital fractures was designed. The predictor variable was vertical incomitance, and the primary outcome variable was diplopia. Incomitance was calculated in prism diopters (Δ) as the difference of the maximum absolute deviation between the upper and lower three gaze directions. Standard statistics for patient characteristics, the Fisher exact test for categorical variables and the Wilcoxon rank sum test for continuous variables were computed. RESULTS: The sample was composed of 188 patients grouped as follows: non-operated (n = 124) and operated (n = 64). Fifty-one patients showed vertical incomitance of whom 10 (19.6%) had persistent diplopia at the 1-year follow-up. The mean incomitance was 9.6Δ in the diplopia group versus 2Δ in the non diplopia group (OR = 1.13; p < 0.001). There was a statistically significant association between vertical incomitance of >2Δ and persistent diplopia at 1 year after adjusting for the surgery variable (OR = 1.07; p < 0.04). CONCLUSION: The present study has demonstrated that in orbital fracture patients, vertical incomitance was associated with (1) persistence of long-term diplopia, (2) the decision to perform surgery, and (3) the severity of the fracture.


Assuntos
Diplopia/etiologia , Fraturas Orbitárias/complicações , Estrabismo/complicações , Adulto , Diplopia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/diagnóstico por imagem , Fraturas Orbitárias/patologia , Estudos Prospectivos , Estrabismo/diagnóstico por imagem , Estrabismo/etiologia , Tomografia Computadorizada por Raios X
17.
Gait Posture ; 65: 197-202, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30558930

RESUMO

BACKGROUND: Sensory feedback from the visual system along with the vestibular and somatosensory systems is essential for the regulation of normal postural control. Children with strabismus and, therefore, with abnormal binocular vision, may have an altered perception of space and use different sets of cues to determine depth perception when compared with children without strabismus. OBJECTIVE: To explore the postural control of children with and without strabismus, when the three sensory systems are challenged. METHOD: Forty-six children (21 with strabismus and 25 age-matched controls) aged between 5 and 10 years completed ophthalmic screening and then underwent assessment for postural control, which included Paediatric Balance Scale (PBS) and six conditions of the Sensory Organization Test (SOT). Four primary outcome measures were: PBS summary score, Equilibrium Score (ES), Strategy Score (SS) and Sensory Analysis Score of the SOT. RESULTS: A significant difference (P < 0.05) was observed between the strabismus and non-strabismus group in the PBS and, ES and SS of SOT condition 1. The Sensory Analysis scores were significantly different (P = 0.03) between the groups for 'Somatosensory'. Simple linear regression analysis suggested that the strabismus condition was significantly (P ≤ 0.02) associated with the PBS and, the ES and SS of condition 1, with a variance of 14.6%, 16.1% and 12.8%, respectively. Subgroup analysis suggested that age was a significant (P ≤ 0.001) correlate for balance scores in non-strabismus group (R2 ranged from 32% to 58.4%), but not for the strabismus group. SIGNIFICANCE: Postural control in children with strabismus is not equivalent to that of children without strabismus, when their somatosensory system is challenged. Additionally, the functional balance performance of children with strabismus is lower than their counterparts without strabismus. Collectively, the results suggest that the usual improvement in balance performance with increasing age is observed in children without strabismus but not in children with strabismus.


Assuntos
Retroalimentação Sensorial/fisiologia , Equilíbrio Postural/fisiologia , Distúrbios Somatossensoriais/etiologia , Estrabismo/fisiopatologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Exame Neurológico/métodos , Estrabismo/complicações , Vestíbulo do Labirinto/fisiopatologia
18.
J Binocul Vis Ocul Motil ; 68(4): 99-109, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30322349

RESUMO

Nystagmus has a profound impact on patients visual function and social life. Infantile nystagmus (IN) is much more common than neurological nystagmus, and establishing the correct diagnosis is key in guiding the appropriate treatment paradigm. This paper attempts to demonstrate a stepwise approach in investigation and clinical evaluation, that is (often) sufficient in differentiating IN from nystagmus of neurological origin, and to uncover underlying sensory etiologies of IN. Targeted and rational uses of paraclinical exams are emphasized when they deemed necessary to complement the clinical assessment. The author's preferred surgical and non-surgical strategies to optimize vision, and improve the head posture and strabismus that can accompany nystagmus, are discussed (although without the goal of writing a complete revision on the topic).


Assuntos
Nistagmo Congênito/diagnóstico , Nistagmo Congênito/terapia , Movimentos Oculares/fisiologia , Óculos , Cabeça/fisiopatologia , Humanos , Lactente , Nistagmo Congênito/etiologia , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Nistagmo Patológico/terapia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Postura/fisiologia , Estrabismo/complicações
19.
J Fr Ophtalmol ; 41(8): 687-695, 2018 Oct.
Artigo em Francês | MEDLINE | ID: mdl-30217607

RESUMO

INTRODUCTION: Thyroid-related immune orbitopathy often results in a restrictive strabismus. We report our experience of surgical management in these cases. PATIENTS AND METHODS: We present a retrospective case series conducted on 32 patients, operated between 2008 and 2017. Strabismus surgery was proposed in the postinflammatory stage with stable clinical findings for at least 6 months. It was performed under general anesthesia by recessions of restrictive muscles using a fixed suture technique. Outcomes were graded as excellent, good or poor, according to the presence or absence of diplopia in primary or reading positions, and according to whether prism prescription was necessary. RESULTS: The study included 32 patients (21 women, 11 men) with a mean age of 53 years. Average follow-up was 9.6 months. Eight patients developed diplopia after orbital decompression. Fifteen patients had vertical surgery, 8 horizontal surgery, 9 mixed surgery. A mean of 1.31 surgeries (range 1-3) were performed. After all surgeries, 28 patients (87.5 %) had an excellent outcome, 4 (12.5 %) had a good outcome, and none had a poor outcome. There was a significant improvement in stereoscopic acuity (P<0.01), but not motility. Among the 8 patients who developed diplopia after orbital decompression, a clinically acceptable final outcome was achieved after only one surgery. CONCLUSION: Strabismus surgery using conventional non-adjustable sutures provides excellent ocular alignment and relief from diplopia in the majority of patients with dysthyroid strabismus. The reoperation rate is similar to other techniques, such adjustable suture and intraoperative relaxed muscle technique.


Assuntos
Oftalmopatia de Graves/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Estrabismo/complicações , Estrabismo/epidemiologia
20.
J Fr Ophtalmol ; 41(9): 814-822, 2018 Nov.
Artigo em Francês | MEDLINE | ID: mdl-30217613

RESUMO

PURPOSE: To evaluate the improvement in quality of life of patients operated within 6 months for strabismus in Graves' disease using a questionnaire. MATERIALS AND METHODS: A retrospective study was based on a cohort of patients undergoing strabismus surgery for Graves' disease at the Nancy university medical center between June 2015 and January 2017. A quality-of-life questionnaire composed of the functional GO QOL questionnaire plus 10 additional questions was given to patients. The questionnaires were completed by patients in consultation before surgery and then at six months postoperatively. A subgroup analysis was conducted to identify potential risk factors such as smoking, orbital decompression, duration of disease progression, number of surgeries, previous treatments or gender influences on the progression of the postoperative score. RESULTS: Thirty-three patients (15 men/18 women) underwent surgery, with mean age 56 years; 16 (48 %) were smokers, 24 (70 %) were operated for the first time for strabismus. 8 patients (24 %) had a history of surgical orbital decompression. The mean preoperative GO QOLf was 30 (±23.8), which increased to 72 (±29.6) postoperatively (P=0.004). All the answers to the questions proposed were improved by surgery. The most improved items were difficulty in extreme gaze+6.82 points (P=0.001) and going down stairs +6.81 (P=0.002). Smokers had a lower preoperative GO QOLf than non-smokers (25±22.84 vs. 34±24.55); the same was true for their postoperative improvement (35±34.5 points vs. 50±18.8, P=0.002). History of orbital decompression did not appear to influence quality of life (21±25.39 vs. 65±33.98); the same was true for previous corticosteroid or immunosuppressant treatment (28±23.52 vs. 67±28.24), respectively P=0.42; P=0.73. Gender did not appear to influence the results P=0.17. First-time strabismus surgery patients showed a tendency which was not significant toward better improvement after 2 or 3 surgeries (respectively 45 vs. 39 vs. 33) P=0.056. There was no correlation between the duration of the disease and the change in the GO QOLf (R=0.04). CONCLUSION: This study confirms that strabismus surgery significantly improves the quality of life of patients with Graves' ophthalmopathy. The GO QOLf demonstrates its effectiveness in highlighting this progression. Our ten additional questions proved to be very good tools for assessing this condition.


Assuntos
Oftalmopatia de Graves/cirurgia , Qualidade de Vida , Estrabismo/cirurgia , Inquéritos e Questionários , Descompressão Cirúrgica , Feminino , Doença de Graves/complicações , Doença de Graves/cirurgia , Oftalmopatia de Graves/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Estrabismo/complicações
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