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1.
Am J Ophthalmol ; 209: 55-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31526795

RESUMO

PURPOSE: Sagging eye syndrome (SES), horizontal and/or vertical strabismus caused by orbital connective tissue degeneration, was first defined 10 years ago. This study investigated SES and other causes of acquired binocular diplopia in adults presenting to a single institution since the description of SES. DESIGN: Retrospective observational case series. METHODS: Medical records were reviewed of all new patients over the age of 40 who presented to the Stein Eye Institute with binocular diplopia between January 2015 and December 2018. Clinical causes of diplopia were tabulated in patients grouped by age and sex. In patients with SES, we tabulated binocular alignment, types of treatment, and surgical outcomes. RESULTS: There were 945 patients of mean age 66.5 years, of whom 514 (54.4%) were female. The most common cause of diplopia was SES (31.4%). The 297 patients with SES were older at 71.2 years (P < 0.0001) and more predominantly female at 59.9% than other patients (52.0%; P = 0.023). The relative proportion of SES patients among all diplopic patients increased with age from 4.7% under age 50 years to 60.9% over the age of 90. Age-related distance esotropia was present in 35% and cyclovertical strabismus in 65% of cases of SES. Strabismus surgery was performed in 50% of cases of SES. Mean esotropia at distance decreased from 6.9 ± 0.7Δ preoperatively to 0.3 ± 0.3Δ postoperatively. Preoperative hypertropia decreased from 3.0 ± 0.3Δ to 0.7 ± 0.2Δ postoperatively. Surgery resolved diplopia in all cases. CONCLUSIONS: It is important to recognize that SES is a very common cause of adult binocular diplopia.


Assuntos
Doenças do Tecido Conjuntivo/epidemiologia , Diplopia/epidemiologia , Doenças Orbitárias/epidemiologia , Estrabismo/epidemiologia , Visão Binocular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Doenças do Tecido Conjuntivo/fisiopatologia , Doenças do Tecido Conjuntivo/cirurgia , Diplopia/fisiopatologia , Diplopia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Doenças Orbitárias/fisiopatologia , Doenças Orbitárias/cirurgia , Prevalência , Estudos Retrospectivos , Estrabismo/fisiopatologia , Estrabismo/cirurgia , Síndrome
2.
Strabismus ; 28(1): 29-33, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31847669

RESUMO

Purpose: Monocular transposition of the inferior oblique muscle belly (IOMBT) effectively weakened mild to moderate inferior oblique overaction and corrected small primary position hypertropia. Now we aim to evaluate the efficacy of inferior oblique muscle belly transposition (IOMBT) in treating V pattern strabismus with upshoot in adduction.Methods: This is a retrospective review of 13 patients with V pattern who underwent IOMBT procedure from January 2017 to December 2018. The inclusion criteria were: the amount of V pattern from 15 to 25 pd; the degree of upshoot in adduction from +1 to +3; no or trace vertical deviation in primary gaze position. Bilateral IOMBT was performed to reduce the V pattern. Horizontal rectus muscle surgery was performed at the same stage to correct the horizontal deviation. The angle of deviation in upgaze and downgaze was measured pre- and postoperatively. The degree of elevation in adduction was graded. The amount of V pattern was the difference in horizontal angle between up- and downgaze. The change in the amount of V pattern was assessed postoperatively.Results: All 13 patients had complete resolution of the V pattern. The amount of V pattern changed from 18.92 ± 4.310 prism diopters to 3.462 ± 1.854 prism diopters postoperatively. The mean grade of upshoot in adduction changed from 1.92 to 0.12 postoperatively. No depression in adduction or consecutive A pattern were found after surgery.Conclusions: IOMBT can successfully eliminate the V pattern in patients with mild V pattern esotropia or exotropia with mild to moderate upshoot in adduction. This procedure appears to be a useful addition to our inferior oblique surgical armamentarium.


Assuntos
Músculos Oculomotores/transplante , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento , Visão Binocular/fisiologia
3.
BMC Ophthalmol ; 19(1): 254, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842812

RESUMO

BACKGROUND: To investigate the surgical outcomes of strabismus related to iatrogenic occlusion of the ophthalmic artery and its branches from cosmetic facial filler injection. METHODS: A retrospective study was performed on 6 patients who underwent strabismus surgery among 23 patients who had suffered occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection. Initial, preoperative and final ocular motility examinations, the type of surgery and surgical outcomes were evaluated. RESULTS: At initial presentation, visual acuity was no light perception in 5 patients and hand motion in one patient. Five out of 6 patients showed initial ophthalmoplegia. Among these 5 patients, eye motility fully recovered in 3 patients although sensory strabismus developed during follow-up, while the remaining 2 patients had persistent ocular motility limitations. Strabismus surgery was performed at 2.2 ± 1.5 years after iatrogenic ophthalmic artery occlusion. Preoperatively, 5 of the 6 patients showed exotropia, and one patient had esotropia. Vertical deviation was found in 3 out of 6 patients in addition to the horizontal deviation. Successful outcome was achieved only in the 4 patients without persistent ophthalmoplegia after 1.4 ± 1.0 years from surgery. The other two patients with persistent ocular motility limitations failed to achieve successful alignment after surgery, and one patient eventually underwent evisceration due to phthisis bulbi. CONCLUSIONS: In our study, surgical outcomes of strabismus caused by cosmetic facial filler injection were successful only in patients without persistent ophthalmoplegia at the time of surgery.


Assuntos
Arteriopatias Oclusivas/induzido quimicamente , Preenchedores Dérmicos/efeitos adversos , Músculos Oculomotores/cirurgia , Artéria Oftálmica/efeitos dos fármacos , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adulto , Arteriopatias Oclusivas/diagnóstico , Humanos , Doença Iatrogênica , Oftalmoplegia/induzido quimicamente , Estudos Retrospectivos , Ritidoplastia , Estrabismo/induzido quimicamente , Estrabismo/fisiopatologia , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto Jovem
4.
Middle East Afr J Ophthalmol ; 26(3): 158-162, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31619904

RESUMO

OBJECTIVE: The aim of this study is to assess the incidence of retinopathy of prematurity (ROP) in preterm infants and to compare the visual outcomes in babies with and without ROP. MATERIALS AND METHODS: A consecutive cohort of 812 preterm babies were recruited with gestational age ≤32 weeks and or birth weight ≤1500 g. The outcome was assessed at the end of 15 months by determining fixation behavior, cycloplegic refraction, and vision by Cardiff cards. Incidence of visual outcomes with 95% confidence limits and relative risks were estimated. Chi-squared test and t-test were used as tests of significance. RESULTS: The incidence of ROP was 25%. The incidence of myopia, hypermetropia, astigmatism, and strabismus were 15.8% (14.3-17.3), 6% (5.1-7.1), 55.6% (53.6-57.7), and 1.8% (1.4%-2.5%), respectively, in the cohort. The most common refractive error in terms of spherical equivalence was myopia (19.8% in ROP and 14.4% in non-ROP group). The mean visual acuity measured by Cardiff Acuity cards was 0.282 and 0.27 logarithm of the minimum angle of resolution units (right eye) and 0.293 and 0.277 (left eye) in patients with and without ROP, respectively. Strabismus was present in 5% of ROP group and 0.8% of non-ROP group babies. Babies with ROP had six times (risk ratio-6.02; 95% confidence interval 2.8-12.8) higher chance of developing strabismus than those without ROP. CONCLUSIONS: Ophthalmological morbidities in premature infants such as refractive errors and strabismus are high in addition to complications like ROP. The incidence of these conditions is more in infants with ROP when compared to non-ROP group.


Assuntos
Recém-Nascido Prematuro , Erros de Refração/epidemiologia , Retinopatia da Prematuridade/epidemiologia , Estrabismo/epidemiologia , Acuidade Visual/fisiologia , Peso ao Nascer , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Incidência , Índia/epidemiologia , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Triagem Neonatal , Erros de Refração/diagnóstico , Erros de Refração/fisiopatologia , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/fisiopatologia , Estrabismo/diagnóstico , Estrabismo/fisiopatologia , Centros de Atenção Terciária
5.
Invest Ophthalmol Vis Sci ; 60(12): 3970-3979, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31560371

RESUMO

Purpose: Pattern strabismus is characterized by a cross-axis pattern of horizontal and vertical misalignments. In A-pattern strabismus, for example, a divergent change in the horizontal misalignment occurs on downgaze. Work with nonhuman primate models has provided evidence that this disorder is associated with abnormal cross-talk between brainstem pathways that normally encode horizontal and vertical eye position and velocity. Neurons in the interstitial nucleus of Cajal (INC) are normally sensitive to vertical eye position; in the present study, we test the hypothesis that, in monkeys with pattern strabismus, some INC neurons will show an abnormal sensitivity to horizontal eye position. Methods: Monkeys were rewarded for fixating a visual target that stepped to various locations on a tangent screen. Single neurons were recorded from INC in one normal monkey, and two with A-pattern strabismus. Multiple linear regression analysis was used to estimate the preferred direction for each neuron. Results: In the normal monkey, all INC neurons had preferred directions within 20° of pure vertical (either up or down). The preferred directions were significantly more variable in the monkeys with pattern strabismus, with a minority being more sensitive to horizontal eye position than vertical eye position. In addition, the vertical eye position sensitivity was significantly less in the monkeys with strabismus. Conclusions: In pattern strabismus, neurons in INC show neurophysiological abnormalities consistent with a failure to develop normal tuning properties. Results were consistent with the hypothesis that, in pattern strabismus, INC receives an abnormally strong signal related to horizontal eye position.


Assuntos
Neurônios Motores/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Estrabismo/fisiopatologia , Tegmento Mesencefálico/fisiopatologia , Animais , Movimentos Oculares/fisiologia , Fixação Ocular/fisiologia , Macaca mulatta , Macaca nemestrina
6.
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
7.
J. optom. (Internet) ; 12(3): 186-191, jul.-sept. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-185369

RESUMO

Purpose: To report long-term outcomes of strabismus surgery for treatment of third nerve palsy. Methods: We performed a 15-year retrospective study of patients who had undergone surgery. We analyzed preoperative mean deviation (at 6 months, 1 year after surgery, and at the end of follow-up), type of surgery, and factors predicting outcomes. A final deviation < 10 prism diopters (pd) was considered a good esthetic outcome, and no diplopia in the primary position at the end of follow-up was considered a good functional outcome. Results: Surgery was performed in 31 cases. Mean age was 36.27 years (women, 51.6%). Total and complete third nerve palsy was recorded in 22.6% and acquired palsy in 80.6%. Mean preoperative horizontal deviation (HD) in primary position was 40.24 pd (near) and 44.29 (distance) and 14.33 pd in vertical deviation (VD). Mean final HD was 8.94pd (near) and 11.35pd (distance), and mean final VD was 6.13. One surgery was performed in 68.9%. A favorable esthetic outcome was obtained in 64.5% and a successful functional outcome in 72.2%. Statistically significant differences were found between near HD (p = 0.019) and distance HD (p = 0.035) at 1 year compared with the end of follow-up and between VD at 6 months and 1 year after surgery (p = 0.03). Mean follow-up was 6.05 years. No specific factors predicted a successful outcome. Conclusions: Esthetic and functional results were similar. No predictors of successful outcome were identified. HD was better 1 year after surgery, and VD improved during follow-up


Objetivo: Reportar los resultados a largo plazo de la cirugía de estrabismo para tratar la parálisis del III par. Métodos: Realizamos un estudio retrospectivo a 15 años, de pacientes sometidos a cirugía. Analizamos la desviación media preoperatoria (a 6 meses, 1 año tras la cirugía, y al final del seguimiento), el tipo de cirugía, y los factores predictivos de los resultados. Se consideró un buen resultado estético una desviación final < 10 dioptrías prismáticas (pd), y un buen resultado funcional la ausencia de diplopía en la posición primaria al final del seguimiento. Resultados: Se practicó cirugía en 31 casos. La edad media fue de 36,27 años (mujeres, 51,6%). Se registró parálisis total y completa del III par en el 22,6% de los casos, y parálisis adquirida en el 80,6%. La desviación horizontal preoperatoria media (DH) en posición primaria fue de 40,24 pd (de cerca) y 44,29 (de lejos), y 14,33pd en desviación vertical (DV). La DH final media fue de 8,94 pd (de cerca) y 11,35 pd (de lejos), y la DV final media fue de 6,13. Se practicó cirugía en el 68,9% de los casos. Se obtuvo un resultado estético favorable en el 64,5% de los casos, y un resultado funcional exitoso en el 72,2%. Se encontraron diferencias estadísticamente significativas entre DH de cerca (p = 0,019) y de lejos (p = 0,035) a 1 año, en comparación con el final del seguimiento, y entre DV a 6 meses y 1 año tras la cirugía (p = 0,03). El seguimiento medio fue de 6,05 años. Ningún factor específico predijo un resultado exitoso. Conclusiones: Los resultados estético y funcional fueron similares. No se identificaron factores predictivos de un resultado exitoso. DH fue mejor 1 año tras la cirugía, y DV mejoró durante el seguimiento


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Estrabismo/fisiopatologia , Visão Binocular/fisiologia , Estudos Retrospectivos , Estrabismo/etiologia , Estrabismo/cirurgia
8.
Invest Ophthalmol Vis Sci ; 60(10): 3374-3380, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31387113

RESUMO

Purpose: Binocular discordance due to strabismus, anisometropia, or both may result in not only monocular visual acuity deficits, but also in motion perception deficits. We determined the prevalence of fellow-eye deficits in motion-defined form (MDF) perception, the ability to identify a two-dimensional (2D) shape defined by motion rather than luminance contrast. We also examined the following: the causative role of reduced visual acuity and binocularity, associations with clinical and sensory factors, and effectiveness of binocular amblyopia treatment in alleviating deficits. Methods: Participants included 91 children with residual amblyopia (strabismic, anisometropic, or both; age, 9.0 ± 1.7 years), 79 nonamblyopic children with treated strabismus or anisometropia (age, 8.5 ± 2.1 years), and 20 controls (age, 8.6 ± 1.5 years). MDF coherence thresholds, visual acuity, stereoacuity, and interocular suppression were measured. Results: MDF deficits, relative to controls, were present in the fellow eye of 23% of children with residual amblyopia and 20% of nonamblyopic children. Stereoacuity and age first patched were correlated with MDF threshold (r = 0.29, 95% CI: 0.09-0.47; r = -0.33, 95% CI: -0.13 to -0.50, respectively). MDF deficits were more common in children treated with patching alone than in those receiving contrast-rebalanced binocular treatment with games or movies (t89 = 3.46; P = 0.0008). The latter was associated with a reduction in mean fellow eye MDF threshold (t26 = 6.32, P < 0.0001). Conclusions: Fellow eye MDF deficits are common and likely reflect abnormalities in binocular cortical mechanisms that result from early discordant visual experience. Binocular amblyopia treatment, which is effective in improving amblyopic eye visual acuity, appears to provide a benefit for the fellow eye.


Assuntos
Ambliopia/fisiopatologia , Percepção de Movimento/fisiologia , Transtornos da Percepção/fisiopatologia , Visão Binocular/fisiologia , Ambliopia/terapia , Anisometropia/fisiopatologia , Bandagens , Criança , Feminino , Percepção de Forma/fisiologia , Humanos , Masculino , Estrabismo/fisiopatologia , Jogos de Vídeo , Acuidade Visual
9.
Strabismus ; 27(3): 143-148, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31407938

RESUMO

Background: Recession and resection of rectus muscles for correction of strabismus in Thyroid Eye Disease (TED) is relatively unpopular as it is assumed to enhance the restriction of ocular ductions. Therefore, the purpose of this study was to compare ductions of recession only and recess/resect procedures. Methods: We retrospectively reviewed the charts of 119 patients who underwent strabismus surgery for TED from 1991 to 2015, of which 102 were included in the present study. Forty-six interventions were performed on horizontal, 56 on vertical rectus muscles; comprising 41 recess/resect surgeries for horizontal deviations, and 7 in patients with vertical strabismus. Ocular ductions and alignment were evaluated preoperatively and at 3 and 12 months postoperatively. Results: Both recessions as well as recess/resect procedures resulted in improved abduction and elevation, respectively. At the exam 3 months postoperatively, median abduction for the recession only group and the recess/resect group were 27.5° and 35°, respectively. The similar figures for elevation were 25° and 10°, respectively. Neither were statistically significant. No restricted adduction or depression was seen in the recess/resect surgeries groups with lateral or superior rectus resection. None of the patients showed unusual postoperative inflammation or conjunctival scarring. Conclusion: In this retrospective analysis, we found an equal effect on ocular ductions in patients with TED when comparing recess/resect eye muscle surgery to recess only procedures. In TED patients with large horizontal angle deviations and abduction deficit, medial rectus recession and lateral rectus resection surgery can be considered. Muscle resections in TED do not seem to have a clinically relevant risk to increase the restriction of ocular ductions but rather improve ductions in the restricted directions of gaze.


Assuntos
Movimentos Oculares/fisiologia , Oftalmopatia de Graves/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento
10.
BMC Ophthalmol ; 19(1): 196, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455265

RESUMO

BACKGROUND: To evaluate the results of unilateral inferior oblique anterior transposition (IOAT) for markedly asymmetric dissociated vertical deviation (DVD) combined with inferior oblique over-action (IOOA). METHODS: Retrospective chart review of the records of all patients with asymmetric DVD combined with unilateral IOOA in the non-dominant eye who received unilateral IOAT on the non-dominant eye. No other muscles were operated on simultaneously. The amount of DVD and IOOA were measured before and after the operation and statistically analysed. RESULTS: Seventeen patients were included. The mean age at surgery was 23.5 ± 8.4 (range 12-38) years old. The mean postoperative follow-up period was 15.7 ± 7.2 (range 6-32) months. The primary position DVD was 19.6 ± 5.4 (range 14-36) PD preoperatively and decreased significantly to 2.9 ± 2.0 (range 0-8) PD postoperatively (P < 0.01). Preoperatively, there were 2, 7, and 8 patients with + 1, + 2, and + 3 IOOA, respectively, and these were reduced from 2.4 ± 0.7 to 0.3 ± 0.4 postoperatively (P < 0.01). None of the patients were complicated obvious hypotropia, anti-elevation syndrome or IOOA in the contralateral eye. CONCLUSIONS: Unilateral IOAT was recommended in patients with asymmetric DVD coexists with unilateral IOOA.


Assuntos
Músculos Oculomotores/transplante , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Visão Binocular/fisiologia , Adolescente , Adulto , Criança , Movimentos Oculares/fisiologia , Feminino , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
11.
Semin Ophthalmol ; 34(6): 451-457, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31348729

RESUMO

Purpose: To determine the clinical manifestations and risk factors of developing strabismus in primary congenital glaucoma (PCG) patients who underwent glaucoma surgery. Methods: A retrospective case-series study of 54 PCG patients who were followed for at least 3 years after glaucoma surgery. The subjects were divided into 2 groups based on the occurrence of strabismus. Age at glaucoma diagnosis and surgery, visual acuity, intraocular pressure, amblyopia, cup-disc ratio, and orthoptic status were compared between the 2 groups. Results: Twenty of 54 patients (37.0%) developed strabismus after glaucoma surgery. The mean ages at the time of glaucoma diagnosis and surgery were 3.2 ± 2.7 months and 3.4 ± 2.8 months in the strabismus group and 24.3 ± 19.1 months and 26.4 ± 18.9 months in the non-strabismus group, respectively (p < .05). In addition, the mean logMAR visual acuities were 0.87 ± 0.38 in the strabismus group and 0.24 ± 0.21 in the non-strabismus group (p < .05). The proportion of patients experiencing amblyopia was 90.0% in the strabismus group. Low visual acuity and young age at glaucoma surgery were significant predictors of developing strabismus. Kaplan-Meier survival analysis demonstrated that the probability of developing strabismus after glaucoma surgery was 50.6% at 10 years post-surgery. Conclusions: PCG patients who developed strabismus after glaucoma surgery were diagnosed with glaucoma and underwent surgery at a younger age, exhibited a worse mean best corrected visual acuity, and exhibited a higher amblyopia incidence than did patients in the non-strabismus group.


Assuntos
Movimentos Oculares/fisiologia , Cirurgia Filtrante/efeitos adversos , Glaucoma/congênito , Pressão Intraocular/fisiologia , Músculos Oculomotores/fisiopatologia , Complicações Pós-Operatórias/etiologia , Estrabismo/etiologia , Pré-Escolar , Feminino , Seguimentos , Glaucoma/fisiopatologia , Glaucoma/cirurgia , Humanos , Incidência , Lactente , Masculino , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estrabismo/epidemiologia , Estrabismo/fisiopatologia , Fatores de Tempo
12.
J Pediatr Ophthalmol Strabismus ; 56: e49-e52, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31282961

RESUMO

A 37-year-old man suffered a penetrating left orbital injury with rupture of the inferior rectus muscle and avulsion of the optic nerve. The orbit was explored and the inferior rectus muscle stump was identified 25 mm from the limbus. Despite this, the muscle was successfully reattached and the patient achieved satisfactory postoperative alignment. [J Pediatr Ophthalmol Strabismus. 2019;56:e49-e52.].


Assuntos
Ferimentos Oculares Penetrantes/complicações , Músculos Oculomotores/lesões , Procedimentos Cirúrgicos Oftalmológicos/métodos , Órbita/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estrabismo/cirurgia , Adulto , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/cirurgia , Movimentos Oculares , Humanos , Masculino , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/cirurgia , Órbita/diagnóstico por imagem , Estrabismo/etiologia , Estrabismo/fisiopatologia , Tomografia Computadorizada por Raios X
13.
Trials ; 20(1): 437, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311577

RESUMO

BACKGROUND: Amblyopia (lazy eye) affects the vision of approximately 2% of all children. Traditional treatment consists of wearing a patch over their 'good' eye for a number of hours daily, over several months. This treatment is unpopular and compliance is often low. Therefore, results can be poor. I-BiT is a system, based on stereo technology using shutter glasses, designed to treat amblyopia using dichoptic stimulation. This trial uses a redesigned system for home use and includes eye-tracking capability. METHODS/DESIGN: This is a randomised controlled trial involving three groups of 40 patients each, aged between 3.5 and 12 years, with a diagnosis of (1) anisometropic amblyopia, (2) mixed or strabismic amblyopia prior to strabismic surgery and (3) mixed or strabismic amblyopia who have just undergone strabismus surgery. They will be randomised in a 1:1 ratio between I-BiT and control and will receive treatment, at home over a 6-week period. Their visual acuity will be assessed independently at baseline, mid-treatment (week 3), at the end of treatment (week 6) and, for those receiving the active I-BiT treatment, 4 weeks after completing treatment (week 10). The primary endpoint will be the change in visual acuity from baseline to the end of treatment. Secondary endpoints will be additional visual acuity measures, patient acceptability, compliance and the incidence of adverse events. DISCUSSION: This is a randomised controlled trial using the redesigned I-BiT™ system to determine if this is a feasible treatment strategy for the management of anisometropic, strabismic and mixed amblyopia. TRIAL REGISTRATION: ISRCTN Number/Clinical trials.gov, ID: NCT02810847 . Registered on 23 June 2016.


Assuntos
Ambliopia/terapia , Óculos , Privação Sensorial , Estrabismo/terapia , Jogos de Vídeo , Visão Binocular , Acuidade Visual , Fatores Etários , Ambliopia/diagnóstico , Ambliopia/fisiopatologia , Criança , Pré-Escolar , Inglaterra , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Estrabismo/diagnóstico , Estrabismo/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
15.
J Pediatr Ophthalmol Strabismus ; 56(4): 234-237, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322713

RESUMO

PURPOSE: To evaluate the ability of the PDI Check (PDI Check LLC, Anchorage, AK) near vision screening game to assess monocular acuity, stereopsis, suppression, and color. METHODS: Children and adults consented to perform the PDI Check Quick Screening game following conventional near testing of patched Rosenbaum acuity, Titmus Fly stereo, Worth 4-dot, and Ishihara color. Time to complete each test and preferred method were recorded. RESULTS: A total of 77 patients (5 to 63 years old) attempted all tests. There was a positive correlation between the PDI Check and conventional tests for all visual tasks. Using previously determined instrument referral criteria, sensitivity/specificity was determined for right acuity (67%/91%), left acuity (55%/94%), stereopsis (87%/95%), red-green color (80%/99%), and ocular suppression (58%/98%). Screening time was 202 ± 96 versus 99 ± 42 seconds for the PDI Check and the game was preferred by 87%. CONCLUSIONS: The PDI Check provided a valid assessment of near vision in less than half the time of conventional testing without patches or goggles. This Quick Screening version may help eye technicians and physicians with time efficiency in the frequent task of near visual assessment. [J Pediatr Ophthalmol Strabismus. 2019;56(4):234-237.].


Assuntos
Percepção de Profundidade/fisiologia , Estrabismo/diagnóstico , Jogos de Vídeo , Seleção Visual/instrumentação , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Privação Sensorial , Estrabismo/fisiopatologia , Adulto Jovem
17.
Rom J Ophthalmol ; 63(1): 35-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198896

RESUMO

Aim: To compare visual acuity using the LEA symbol chart with Snellen E test chart in preschool children of age 3-5 years. Patients and methods: Inclusion criteria: 50 emmetropic children aged 3 to 5 years. Exclusion criteria: Strabismus, amblyopia, ametropia, and any organic eye disease. A pseudo randomized protocol was used to test visual acuity (VA) in each subject monocularly on both eyes using Snellen E chart and LEA symbol chart. Visual acuity for both charts was scored as smallest optotype size which the child correctly identified 3 of maximum 4 optotypes. The strength of agreement on VA between two charts was tested using Interclass correlation coefficient (ICC). A Mann-Whitney U test was applied to compare both the groups. Results: Boys: Girls = 26:24 with a mean age and standard deviation of 4.12 + 0.79 years. ICC between Snellen's and LEA symbol chart was 0.256 and 0.213 for right and left eye respectively. Analysis of the two samples using Mann-Whitney test showed a significant difference between the two charts (p value <0.000). Conclusion: LEA symbol test showed only a fair agreement with Snellen E charts for visual acuity measurements. Visual acuity measurement with LEA symbol chart showed significantly higher scores as compared to Snellen's chart.


Assuntos
Ambliopia/diagnóstico , Erros de Refração/diagnóstico , Estrabismo/diagnóstico , Seleção Visual/instrumentação , Acuidade Visual , Ambliopia/fisiopatologia , Pré-Escolar , Feminino , Humanos , Masculino , Erros de Refração/fisiopatologia , Reprodutibilidade dos Testes , Estrabismo/fisiopatologia , Visão Binocular/fisiologia
18.
Strabismus ; 27(2): 47-53, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31184517

RESUMO

The purpose of this article is to compare alignment outcomes following pediatric strabismus surgery for simple horizontal strabismus in patients with state-based aid, used as a proxy for lower socioeconomic status (SES) with those with private insurance. Medical records of all children treated with horizontal strabismus surgery over a period from 2014-17 were retrospectively reviewed. Medical assistance was used as a proxy for lower SES. Patients were compared to a control population undergoing similar surgery by same surgeons in the same time period. Data points were collected at preoperative and postoperative month 6 visits. Improvement in alignment was the primary outcome variable.  Improvement in fusion, amblyopia, and stereopsis were also examined. Demographic information and compliance with treatment recommendations were recorded. 69 patients met inclusion criteria from a total population of 105 patients; 36 were excluded due to loss to follow-up. This was compared to a control group with private insurance; 34 patients were identified out of a total of 38, 4 patients were lost to follow-up. Overall rate of operative success was 71.0% at POM6. Overall rate of success for control group was 73.5%. The difference failed to be statistically significant (p = 0.37). Race, sex, age at time of surgery, and type of strabismus (esotropia, exotropia) failed to correlate with success rate of surgery. Poor compliance with prescribed treatments (glasses, patching/atropine) in both groups correlated with surgical failure. 68.1% of study patients and 70.6% of control reported good compliance with treatment. We present the first analysis of the impact of SES on strabismus surgery outcomes. Overall surgical success rate in our study population failed to differ significantly from a control population and were comparable to that reported in the literature. We found that compliance with treatment influenced surgical success rates in our study population. The high rate of lost to follow-up in the study population is an important factor influencing our conclusion that no difference exists between our groups.


Assuntos
Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Classe Social , Estrabismo/cirurgia , Adolescente , Criança , Pré-Escolar , Percepção de Profundidade/fisiologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento
19.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 2043-2047, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203518

RESUMO

PURPOSE: To investigate clinical findings of the pseudo inferior oblique overaction (IOOA) syndrome and the outcomes of strabismus surgery and to discuss the mechanisms proposed for this disease. METHODS: This syndrome is defined by Y pattern strabismus with exotropia in upgaze. There is marked abduction and hypertropia of the adducting eye when elevation is carried out in side gaze, but there is no hypertropia of the adducting eye in horizontal side gaze. Sixteen patients were included and surgery was performed in 14 patients. Success of the surgical intervention was defined as correction of the Y pattern, orthotropia in primary position, upgaze, and downgaze. RESULTS: Thirteen of the sixteen patients were female. The mean age was 9.6 ± 6.1 years. The mean follow-up time was 14.7 ± 16.9 months. Pre-operatively, 12 patients were orthophoric, and four patients were exophoric (4 to 8 PD) in primary position. In downgaze, all patients were orthophoric. Mean exotropic deviation in upgaze was 25.06 ± 5.9 (18 to 40 PD). Fourteen patients underwent surgery with 2-mm bilateral lateral rectus recession and full tendon supraplacement in seven cases, and 2/3 tendon supraplacement in the other seven patients. The success rate of surgery was 92.8% after the first operation, which reached 100% after a second surgical procedure was performed on one of the patients. CONCLUSIONS: Strabismus surgery is effective in correcting the Y pattern in patients with pseudo IOOA. A 2/3 tendon supraplacement combined with 2-mm recession of the lateral rectus muscles is the preferred treatment.


Assuntos
Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Visão Binocular/fisiologia , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento , Adulto Jovem
20.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 2005-2014, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172264

RESUMO

PURPOSE: The lateralis splitting technique has been an interesting option for treating large-angle exotropia due to complete 3rd nerve paralysis since its inception in the early 1990s. The purpose of this study is to report on our experience regarding the effectiveness and complications of this method. METHODS: Retrospective analysis of a consecutive series of 29 patients operated by one single experienced surgeon and examined according to a specific operative and perioperative protocol. Patients were examined preoperatively, on the 2nd day and 3rd month after surgery. Outcome measures include strabismus angle, horizontal motility, head turn, binocular function, and incidence and resolution of postoperative serous retinal detachment as seen with infrared imaging and spectral domain optical coherence tomography (SD-OCT). RESULTS: Surgery brought about a large and stable reduction of strabismus angle and head turn. It reduced horizontal motility, but moved the range of monocular excursion much closer to center. Eighty percent of patients with constant diplopia acquired some fields of single binocular vision. A significant number of cases (33.3%) developed transitory serous retinal detachment with varying onset and extent. CONCLUSION: This is by far the largest published study regarding the outcome of lateralis splitting in NIII palsy. The procedure is difficult, yet a very useful option. Serous detachment is a serious complication, but usually transitory. Its cause and mechanisms are not fully understood and warrant further investigation.


Assuntos
Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Visão Binocular/fisiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/fisiopatologia , Estudos Retrospectivos , Estrabismo/etiologia , Estrabismo/fisiopatologia , Resultado do Tratamento , Adulto Jovem
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