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1.
Arch. Soc. Esp. Oftalmol ; 96(1): 10-18, ene. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200180

RESUMO

OBJETIVO: Comparar el control postural de niños estrábicos frente a niños sin estrabismo. MATERIAL Y MÉTODOS: Cohortes transversales. Se incluyeron un total de 171 niños: 73 niños con endotropia, 24 con exotropia y 74 controles. El control postural fue explorado mediante una plataforma dinamométrica en bipedestación, en varias condiciones: ojos abiertos y cerrados, fijación de mirada cercana y lejana; y sobre suelo duro y gomaespuma. Se estudiaron como variables: el área, la velocidad media, las longitudes en el eje X e Y del desplazamiento del centro de presión. RESULTADOS: Los niños con endotropia y exotropia presentaron valores de velocidad media, longitud X e Y significativamente mayores frente a los controles en el examen de ojos abiertos, distancia de fijación lejana y sobre suelo de gomaespuma; con ojos abiertos, sobre suelo duro y distancia lejana, los valores de las exotropias fueron mayores que los de endotropias y controles. Con ojos cerrados, no hubo diferencias entre los 3 grupos en todas condiciones de exploración descritas, pero sus valores empeoraban frente a sus respectivos con ojos abiertos. CONCLUSIONES: Los niños estrábicos presentaron un peor control postural que los niños no estrábicos. Todos los niños se mostraron más inestables con ojos cerrados frente a con ojos abiertos lo que demuestra que, tanto para estrábicos como no estrábicos, la visión tiene un papel relevante en la estabilidad postural


OBJECTIVE: To compare the postural control of children with strabismus versus non-strabismus children. MATERIAL AND METHODS: Cross-sectional cohort study with a total of 171 children, including 73 children with esotropia, 24 with exotropia, and 74 controls. Postural control was determined using a dynamometric platform in a standing position in various conditions: eyes open and eyes closed, near and gaze fixation, and with and without foam pad. The studied variables were the area, the mean speed, and the lengths in the X and Y axis of the centre of pressure displacement. RESULTS: Children with esotropia and exotropia had significantly higher mean values (speed, lengths of X and Y) compared to controls. In the open-eye, far distance fixation, and on foam pad, as well as under exam conditions; with eyes open, without foam pad, and far distance fixation, the exotropia values were higher than those of endotropia and controls. With eyes closed, there were no differences between the 3 groups under the described examination conditions, but their values were worse compared to their respective ones with eyes open. CONCLUSIONS: The children with strabismus had a worse postural control than the non-strabismus ones. All of the them appeared to be more unstable with eyes closed than with eyes open, which demonstrates that vision plays an important relevant role in postural stability in both strabismus and non-strabismus children


Assuntos
Humanos , Masculino , Feminino , Criança , Estudos de Coortes , Postura/fisiologia , Estrabismo/fisiopatologia , Percepção Visual , Equilíbrio Postural , Estudos Transversais , Acuidade Visual , Exotropia/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Dinamômetro de Força Muscular , Análise de Variância
2.
Medicine (Baltimore) ; 99(46): e23111, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181679

RESUMO

To compare distant visual acuity (DVA) and near visual acuity (NVA) in amblyopia and evaluate if NVA can be used to diagnose amblyopia.A retrospective study was performed on 73 patients diagnosed with amblyopia based on DVA, by measuring their NVA and comparing the DVA and NVA. The NVA was measured by Snellen chart at 30 cm and the DVA was measured by Dr Hahn vision test chart at 5m. The patients' age, type of amblyopia, spherical equivalent, the difference between spherical equivalent and the fellow eye spherical equivalent spherical, and prism diopter (PD) were evaluated and their relationship with the difference between the DVA and NVA was analyzed.The NVA was significantly better than the DVA in amblyopia (P = .000). The difference between the DVA and NVA was not significantly related to the type of amblyopia (P = .600) or the patients' age(P = .351). Also, the difference between the DVA and NVA was not significantly affected by the spherical equivalent (P = .425) or the difference between spherical equivalent and the fellow eye spherical equivalent (P = .212) in anisometropia amblyopia, and also not by the PD (P = .882) in strabismus amblyopia.In amblyopes, the NVA was better than the DVA before amblyopia treatment. The difference between the DVA and NVA was not affected by age, type of amblyopia, spherical equivalent, the difference between spherical equivalent and the fellow eye spherical equivalent spherical, or PD. Therefore, it should be taken into consideration that NVA could underestimate the severity of amblyopia and affect the accuracy at diagnosing amblyopia.


Assuntos
Ambliopia , Anisometropia/complicações , Estrabismo/complicações , Acuidade Visual , Ambliopia/diagnóstico , Ambliopia/etiologia , Anisometropia/fisiopatologia , Criança , Técnicas de Diagnóstico Oftalmológico/classificação , Técnicas de Diagnóstico Oftalmológico/normas , Precisão da Medição Dimensional , Diagnóstico Precoce , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Estrabismo/fisiopatologia
3.
PLoS One ; 15(10): e0240019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002097

RESUMO

Since the inferior rectus muscle (IRM) is a secondary adductor, it is expected to commonly observe esotropia in thyroid-associated inferior rectus myopathy, but this can be improved after the IRM recession. However, variable outcomes regarding the changes in horizontal strabismus after IRM recession ± IRM nasal transposition have been encountered in patients with thyroid eye disease (TED). We, therefore, examined the changes in 62 patients with TED in this retrospective, observational, comparative study. The patients were classified into 3 groups based on the results of postoperative changes in horizontal strabismus: Groups A (reduced esotropia), B (unchanged esotropia), and C (increased esotropia). Consequently, Groups A, B, and C included 23 (38.7%), 11 (17.7%), and 27 (43.5%) patients, respectively. In the multivariate linear regression analysis, the angle of preoperative esotropia (P < 0.001) and the amount of IRM nasal transposition (P = 0.049) were significant predictors of postoperative changes in horizontal strabismus. The results of our study will be helpful to ophthalmologists for formulating an effective preoperative surgical plan.


Assuntos
Oftalmopatia de Graves/complicações , Músculos Oculomotores/fisiopatologia , Estrabismo/complicações , Estrabismo/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/diagnóstico por imagem , Estudos Retrospectivos , Estrabismo/diagnóstico por imagem , Estrabismo/cirurgia , Resultado do Tratamento
5.
Invest Ophthalmol Vis Sci ; 61(4): 8, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32282917

RESUMO

Purpose: To investigate the longitudinal change in horizontal and vertical ocular alignment in normal and prism-reared infant monkeys during the critical developmental period. Methods: Ocular alignment was measured using Hirschberg photographic methods in 6 infant monkeys reared under prism-viewing from day 1 after birth to 4 months, and 2 monkeys reared with normal visual experience. Photographs were acquired twice a week for the first 6 months of life and analyzed to identify pupil center and the first Purkinje image from which eye positions and strabismus angle were calculated. Results: At 3 weeks after birth, prism monkeys presented with significant horizontal ocular misalignment. A gradual change in alignment was seen in all prism-reared monkeys stabilizing at approximately 11 weeks, at which time 5 monkeys were exotropic (mean, 16° XT; range, 13°-24°) and 1 monkey was esotropic (5° ET). A reduction in ocular misalignment was observed after exposure to normal visual environment at 16 weeks, but at 34 weeks of age, that is, 18 weeks after removal of prisms, prism-reared monkeys displayed a mean horizontal strabismus of 7° XT (range, 2° ET to 20° XT), which was still significantly different from normal monkeys. Conclusions: Prism-rearing disrupts binocular fusion mechanisms, and horizontal and vertical strabismus is seen to develop as early as 3 weeks of age in monkey models, equivalent to approximately 3 months in humans. The time course of change in alignment overlaps with disruption in various visual sensory functions, suggesting a causal temporal link between sensory and motor mechanisms for alignment.


Assuntos
Modelos Animais de Doenças , Erros de Refração/fisiopatologia , Estrabismo/fisiopatologia , Visão Binocular/fisiologia , Animais , Animais Recém-Nascidos , Feminino , Estudos Longitudinais , Macaca mulatta , Masculino , Neurônios/fisiologia , Córtex Visual/fisiopatologia
6.
Zhonghua Yan Ke Za Zhi ; 56(3): 171-175, 2020 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-32187945

RESUMO

Horizontal strabismus, the most common type of strabismus, can be complicated by the disorder of inferior oblique muscle or superior oblique muscle. It may cause problems such as compensatory head posture, vertical diplopia, torsional diplopia, and abnormal binocular fusion. In horizontal strabismus cases, the disorder of oblique muscles should be recognized, and appropriate surgical methods should be chosen, so that the best postoperative ortho and binocular vision could be obtained. (Chin J Ophthalmol, 2020, 56: 171-175).


Assuntos
Doenças Musculares/fisiopatologia , Músculos Oculomotores/fisiopatologia , Estrabismo/fisiopatologia , Diplopia , Humanos , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Visão Binocular
7.
Zhonghua Yan Ke Za Zhi ; 56(3): 197-204, 2020 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-32187948

RESUMO

Objective: To observe the number of blood vessels and the anatomical characteristics of the anterior ciliary vessels (ACVs) in the horizontal rectus muscles of patients with concomitant horizontal strabismus. Methods: Cross-sectional study. From July 2016 to September 2019 patients with concomitant horizontal strabismus treated by realignment surgeries in Xiamen Eye Center of Xiamen University were included. Patients who had previous operations on eyes were excluded. The high resolution surgical imaging of ACVs in the horizontal rectus muscles was performed during operation. The photos of ACVs in muscles were tagged and observed to compare the distribution of the various numbers of blood vessels and morphological characteristics of the ACVs in the medial and lateral rectus muscles. In addition, muscle tissues about 4 mm with an intact sheath were gained from patients undergoing the muscle resection. The muscle sections were stained with hematoxylin-eosin staining, and the arteriovenous properties and their distribution in muscles and fascia tissues were observed. The chi-square test was used for statistical analysis. Results: A total of 387 patients with concomitant horizontal strabismus (176 with esotropia, 211 with exotropia) were enrolled in this study, among whom 198 were male and 189 were female. The age ranged from 1 to 68 years (median, 13 years). Photos of ACVs in 742 horizontal rectus muscles from 383 patients were observed. Of the 351 medial rectus muscles, 24 (6.8%) contained 1 major (or bundle of) ACV, 163 (46.4%) contained 2 major (or bundles of) ACVs, and 164 (46.7%) contained 3 or more major (or bundles of) ACVs. Of the 391 lateral rectus muscles, 161 (41.2%) contained 1 major (or bundle of) ACV, 156 (39.9%) contained 2 major (or bundles of) ACVs, and 74 (18.9%) contained 3 or more major (or bundles of) ACVs. The distribution of ACVs in the medial and lateral rectus muscles was statistically different (χ(2)=133.87, P<0.01). According to the number and morphological characteristics of vessels, the ACVs in the medial and lateral rectus muscles were divided into 4 and 3 categories, respectively, as well as various types and subtypes. The rate of patients whose both eyes had the same type of ACVs in the medial or lateral rectus muscles was 31.6% (25/79) and 26.1% (29/111), respectively, and there was no significant difference (χ(2)=0.69, P=0.41). However, the ACVs of the same type from both eyes of the same patient were not identical in morphology. The ACVs in the medial and lateral rectus muscles with collateral circulation accounted for 3.7% (13/351) and 24.3% (95/391), respectively, and the difference was statistically significant (χ(2)=63.07, P<0.01). The hematoxylin-eosin staining of the medial lateral rectus tissues from 4 patients showed that the ACVs contained arteries and veins. The vessels in the medial rectus muscles were distributed in muscle tissue and fascia tissue, while the vessels in the lateral rectus muscles were only distributed in fascia tissue. Conclusions: Compared with the lateral rectus muscles, there are about 50% medial rectus muscles contain more than 3 major (or bundles of) vessels in patients with concomitant horizontal strabismus. The accompanying patterns of arteries and veins of ACVs are varied. ACVs are distributed in muscle tissue of the medial rectus muscles and in fascia tissue of the medial and lateral rectus muscles. (Chin J Ophthalmol, 2020, 56: 197-204).


Assuntos
Esotropia/fisiopatologia , Exotropia/fisiopatologia , Músculos Oculomotores/irrigação sanguínea , Estrabismo/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
BMC Ophthalmol ; 20(1): 9, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906894

RESUMO

BACKGROUND: To determine whether a sense of deviation remains in adults with successful motor alignment who fulfil diplopia criteria after surgery and to examine the factors associated with this judgement. METHODS: This was a retrospective study. Adult patients defined as having a successful outcome based on more than 1 year of post-operative follow-up visits were included in the study. The sense of deviation was determined at the last visit. Pre- and post-operative deviation and characteristics including age, gender, education level, occupation, diagnosis, size of deviation, extraocular movement (EOM), binocular function, and health-related quality of life (HRQOL) were recorded. RESULTS: In total, 22 (24%) of the 91 adults with successful surgical outcomes reported a sense of deviation. No significant differences were noted between subjects with and without a sense of deviation regarding patient demographics, pre- and post-operative deviation, changes in deviation, sensory fusion or EOM. Subjects with a sense of deviation had an increased prevalence of and larger post-operative vertical deviation, poorer stereo function, and lower HRQOL scores than those with no sense of deviation. The presence of post-operative vertical deviation was associated with a sense of deviation. CONCLUSIONS: Approximately one-fourth (24%) of adults defined as having successful surgical outcomes who still had a sense of deviation exhibited worse stereo function, higher vertical deviation size and lower HRQOL scores. The presence of 3 to 5 prism dioptres(pd) of vertical deviation would be the main factor associated with a sense of deviation post-operatively.


Assuntos
Diplopia/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Qualidade de Vida , Estudos Retrospectivos , Estrabismo/fisiopatologia , Visão Binocular
9.
Ophthalmology ; 127(4): 501-510, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31987642

RESUMO

PURPOSE: To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes. DESIGN: Retrospective case series review at 10 IATS sites. PARTICIPANTS: The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS. METHODS: Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010. MAIN OUTCOME MEASURES: Visual acuity (VA), strabismus, adverse events (AEs), and reoperations. RESULTS: One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1-7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00-1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (≥20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P = 0.037; and smaller cornea: OR, 3.95; P = 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P = 0.023; and smaller cornea: OR, 4.78; P = 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P = 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%). CONCLUSIONS: Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea.


Assuntos
Afacia Pós-Catarata/fisiopatologia , Extração de Catarata , Pseudofacia/fisiopatologia , Estrabismo/fisiopatologia , Acuidade Visual/fisiologia , Catarata/congênito , Feminino , Seguimentos , Humanos , Lactente , Implante de Lente Intraocular , Masculino , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Testes Visuais
11.
Am J Ophthalmol ; 214: 14-20, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31926885

RESUMO

PURPOSE: To investigate whether ophthalmologic findings in children with fetal alcohol spectrum disorders (FASD) persist into young adulthood. DESIGN: Prospective cohort study. METHODS: Thirty children (13 female) adopted from eastern Europe to Sweden in the 1990s and diagnosed with FASD by a multidisciplinary team at the median age of 7.9 years were followed up by the same team 13-18 years later. Visual acuity (VA), refraction, stereoacuity, strabismus, ocular media, and fundus were investigated. RESULTS: Median VA in right/left eye (OD/OS) was 20/32/20/32 (0.2/0.2 logMAR) in childhood and 20/22/20/20 (0.05/0.0 logMAR) in adulthood. Median (range) refraction OD/OS was +0.88/+1.25 (-8.75 to +4.75/-9.38 to +5.25) spherical equivalent diopter (D) in childhood and -0.25/-0.25 (-12 to +2.75/-13.25 to +2.63) in adulthood. Astigmatism (≥1 D) was the most common refractive error, in 13 (40%) and 14 (47%) subjects, respectively. Defective stereoacuity (>60 arc second) was noted in 20 subjects (67%) in childhood and 22 (73%) in adulthood. Heterotropia occurred in 12 subjects (40%) in childhood and 13 (43%) in adulthood. Increased tortuosity of the retinal vessels was found in 8 (27%) subjects in childhood vs 11 (37%) in adulthood. Optic nerve hypoplasia was recorded in 3 children and in 4 young adults. CONCLUSIONS: Ophthalmologic findings such as refractive errors, strabismus, and fundus abnormalities are frequent in children with FASD and persist into early adulthood. The facial features characteristic of FAS diminish with age, making a dysmorphology evaluation in adulthood less reliable. An ophthalmologic examination is an important part of the evaluation of FASD in childhood as well as in young adulthood.


Assuntos
Percepção de Profundidade/fisiologia , Transtornos do Espectro Alcoólico Fetal/diagnóstico , Refração Ocular/fisiologia , Erros de Refração/diagnóstico , Estrabismo/diagnóstico , Acuidade Visual/fisiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Transtornos do Espectro Alcoólico Fetal/etiologia , Transtornos do Espectro Alcoólico Fetal/fisiopatologia , Seguimentos , Idade Gestacional , Humanos , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/etiologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Estudos Prospectivos , Erros de Refração/fisiopatologia , Doenças Retinianas/diagnóstico , Doenças Retinianas/fisiopatologia , Vasos Retinianos/patologia , Microscopia com Lâmpada de Fenda , Estrabismo/fisiopatologia , Adulto Jovem
12.
Am J Ophthalmol ; 213: 97-108, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31770515

RESUMO

PURPOSE: To determine the effect of horizontal rectus muscle surgery on distance-near incomitance. DESIGN: Prospective, comparative, interventional case series. METHODS: Prospective evaluation of patients >7 years old who had medial or lateral rectus muscle surgery at the University of Arkansas Medical Center or Arkansas Children's Hospital between December 2009 and January 2012. Prism and alternate cover testing was performed at distance (6 m) and near (0.3 m) fixation after >1 hour of monocular occlusion at preoperative and postoperative examinations within 1 week, and closest to 1 year after surgery. The change in distance-near incomitance was calculated. Patients with extraocular muscle fibrosis or paralysis were excluded. RESULTS: Forty-five patients met inclusion criteria. Twenty-five patients had medial rectus muscle surgery, and 20 patients had lateral rectus muscle surgery. Postoperative examinations showed a change in distance-near incomitance ≤10 prism diopters (PD) in 42 of 44 patients evaluated within 1 week after surgery and in all 28 patients evaluated 6-24 months after surgery. Horizontal rectus muscle surgery did not induce a clinically significant change in distance-near incomitance (±2 PD equivalence, TOST confidence interval, -1.8 +1.6 PD, P value = 0.014). Contrary to traditional teaching, medial rectus muscle surgery was not more likely to induce a greater effect at near fixation (P = 0.80) and lateral rectus muscle surgery was not more likely to induce a greater effect at distance fixation (P > 0.99). CONCLUSION: Horizontal rectus muscle surgery does not induce a clinically significant effect on distance-near incomitance. Contrary to traditional teaching, medial rectus muscle surgery does not induce a greater effect on ocular alignment at near fixation and lateral rectus muscle surgery does not induce a greater effect on ocular alignment at distance fixation. It is not necessary to consider distance-near incomitance when choosing between medial rectus and lateral rectus muscle surgery.


Assuntos
Percepção de Distância/fisiologia , Fixação Ocular/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Visão Binocular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Estudos Prospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento , Adulto Jovem
14.
Am J Ophthalmol ; 213: 226-234, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31887281

RESUMO

PURPOSE: Manual measurements of strabismus are subjective, time consuming, difficult to perform in babies, toddlers, and young children, and rely on the examiner's skill and experience. An automated system, based on eye tracking and dedicated full occlusion glasses, was developed to provide a fast, objective, and easy-to-use alternative to the manual measurements of strabismus. This study tested the efficacy of the system in determining the presence of strabismus in children, as well as its type and the amount of deviation, in addition to differentiating between phorias and tropias. DESIGN: A prospective, masked, inter-rater reliability study. METHODS: A prospective, masked, cross-sectional study included 69 children, 3-15 years of age. A cover-uncover test and a prism alternating cover test (PACT) for the primary gaze, at a distance of 50 cm, were performed by 2 independent, masked examiners and by the automated system. RESULTS: A high correlation was found between the automated and the manual test results (R = 0.9 and P < 0.001 for the horizontal deviation, and R = 0.91 and P < 0.001 for the vertical deviations, with 100% correct identification of the type of deviation). The average automated test duration was 46 seconds. The Bland-Altman plot, used to compare the 2 measurement methods, showed a mean value of -2.9 prism diopters (PD) and a half-width of the 95% limit of agreement of ±11.4 PD. CONCLUSION: The automated system provides precise detection and measurements of ocular misalignment and differentiated between phorias and tropias. It can be used in participants from the ages of 3 years old and up.


Assuntos
Diagnóstico por Computador , Exame Físico , Estrabismo/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Estrabismo/fisiopatologia , Visão Binocular/fisiologia
15.
Indian J Ophthalmol ; 68(1): 170-173, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856501

RESUMO

Purpose: To report the surgical outcomes in six patients of Helveston syndrome using a "four oblique" procedure. The popular methods for surgical management include superior rectus recessions alone or combined with superior oblique tenectomy. However, large angle exotropia correction would entail a higher risk of anterior segment ischemia when the superior rectus needs to be operated along with the horizontal recti. Hence, we evaluated the long-term results of this uncommon procedure. Methods: This was a retrospective review of six patients diagnosed to have manifest dissociated vertical deviation (DVD) with A pattern exotropia with bilateral superior oblique over action. All patients underwent horizontal muscle recessions/resections for exotropia along with bilateral posterior tenectomy of the superior oblique with inferior oblique anterior transpositioning. Results: The median age was 10 years (Range 5-26 years). The mean postoperative follow-up was 26 ± 14.02 months (Range 12-48 months). The mean reduction in exotropia was from 36.5 ± 21.06 PD (Range 15-65 PD) to 6.1 ± 3.06 PD (Range 3-10 PD). The procedure corrected the A pattern from a mean 23 ± 7 PD (Range 15-35 PD) to 7.6 ± 3.2 PD (Range 3-10 PD). The average DVD in the right eye reduced from 14 ± 4.3 PD (Range 8-20 PD) to 5.3 ± 1.2 PD and in the left eye from 14.33 ± 3.6 PD (Range 10-18 PD) to 4.1 ± 1.1 PD. The DVD asymmetry reduced from 6.33 ± 3.4 PD to 1.5 ± 1.3 PD. Conclusion: "Four oblique" procedure with horizontal muscle surgery seems to be an effective method for significantly correcting the A pattern as well as reducing the DVD with good long-term outcome in our case series.


Assuntos
Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Doenças do Nervo Troclear/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Exotropia/fisiopatologia , Movimentos Oculares , Feminino , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Poliglactina 910 , Refração Ocular/fisiologia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Técnicas de Sutura , Suturas , Tendões/cirurgia , Doenças do Nervo Troclear/fisiopatologia , Acuidade Visual/fisiologia
16.
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
17.
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
18.
Eur J Ophthalmol ; 30(4): 658-667, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31014078

RESUMO

INTRODUCTION: Amblyopia is speculated to be an untreatable disease in the patient, who is beyond the critical period of vision; however, currently, it is treatable in adults. PURPOSE: This study aimed to elucidate whether the treatment is useful in both anisometropic amblyopia and strabismic amblyopia. In addition, the differences were detected between anisometropic amblyopia and strabismic amblyopia after the same perceptual treatment and whether the suppression in anisometropic amblyopia or strabismic amblyopia could be decreased before and after the treatment. METHODS: A binocular perceptual learning was applied for the treatment, the suppression was measured, and the patients were followed up for 2 months after training. Anisometropic amblyopia and strabismic amblyopia groups were subjected to the assessment of stereo, visual acuity, contrast sensitivity, and suppression before and after the training. RESULTS: After 6 weeks of "Diploma Gabor Orientation Coherence" training, in the anisometropic amblyopia group, the outcomes of visual acuity (t = 3.114, p = 0.026) and contrast sensitivity (t = 7.786, p = 0.001) were increased significantly. While in the strabismic amblyopia group, the outcomes of stereo (t = 2.987, p = 0.040) and contrast sensitivity (t = 3.638, p = 0.022) were increased significantly. CONCLUSION: After Diploma Gabor Orientation Coherence training in the same frequency and in the same duration, the anisometropic amblyopia group got an improvement in visual acuity, but the strabismic amblyopia group got an improvement in stereo. As there are evidences to show that anisometropic amblyopia and strabismic amblyopia were injured in different pathways, we think the diverse results might come from the different pathway injury in anisometropic amblyopia and strabismic amblyopia.


Assuntos
Ambliopia/terapia , Anisometropia/terapia , Aprendizagem por Discriminação/fisiologia , Estrabismo/terapia , Visão Binocular/fisiologia , Percepção Visual/fisiologia , Adulto , Ambliopia/fisiopatologia , Anisometropia/fisiopatologia , Sensibilidades de Contraste/fisiologia , Percepção de Profundidade/fisiologia , Feminino , Humanos , Masculino , Estrabismo/fisiopatologia , Acuidade Visual/fisiologia , Adulto Jovem
19.
Eur J Ophthalmol ; 30(4): 676-679, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31106643

RESUMO

OBJECTIVE: To assess the efficacy of "Yokoyama Procedure," on non-highly myopic patients with acquired esotropia and hypotropia. METHODS: The study involved 10 eyes of 5 patients with eso-hypotropia. Inclusion criteria were acquired esotropic-hypotropic strabismus with lateral rectus inferior displacement and superior rectus nasal displacement confirmed by magnetic resonance imaging, refractive errors between ±6 D, and axial length < 27 mm. Range of full duction movements and maximum angles of abduction-sursumduction was measured in each eye before and after surgery. All patients underwent T1- and T2-weighted magnetic resonance imaging. The surgery was aimed at creating a junction between the muscle bellies of the superior and lateral rectus muscles. This junction was made approximately 14 mm behind the insertions using a non-absorbable mersilene 5/0 suture (Yokoyama procedure). RESULTS: Mean patient age was 64.8 ± 4.8 years. The mean globe axial length was 25.4 ± 0.76 mm and a mean corresponding spherical equivalent refraction of -3.7 ± 1.7 D was observed. Eight eyes on 10 had mild limitation in abduction, while the remaining 2 had no limitation. Three out of 10 eyes showed a moderate limited sursumduction, 5 eyes were categorized as mild, and the remaining 2 had no limitation. No evident post-operative limitation was present in any eye, in both abduction and sursumduction (p < 0.01). Pre-operative esotropia and hypotropia were, respectively, 32 ± 11 prismatic diopters and 25 ± 5 prismatic diopters, and they were significantly reduced after surgery as 9 ± 1.7 prismatic diopters and 6 ±1 prismatic diopters (p = 0.043), respectively. CONCLUSION: Yokoyama procedure is an effective, fast, reversible procedure to face eso-hypotropic acquired strabismus, even in patients with a clear magnetic resonance imaging displacement of superior and lateral rectus muscles, and absence of globe dislocation and of elevated myopia.


Assuntos
Esotropia/cirurgia , Miopia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Idoso , Esotropia/diagnóstico por imagem , Esotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miopia/diagnóstico por imagem , Miopia/fisiopatologia , Músculos Oculomotores/diagnóstico por imagem , Estrabismo/diagnóstico por imagem , Estrabismo/fisiopatologia , Estrabismo/cirurgia , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual/fisiologia
20.
Acta Ophthalmol ; 98(1): 89-97, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31313886

RESUMO

PURPOSE: Children with Down syndrome (DS) more often have strabismus, refractive errors, accommodative lags and reduced visual acuity (VA) than typically developing children. In this study, we compare the effects of bifocal glasses with those of unifocal glasses in children with DS. Changes in angle of strabismus, accommodation and refractive error were analysed in this paper. METHODS: In a multicentre randomized controlled trial, 119 children with DS, aged 2-16, were randomly allocated for bifocal or unifocal glasses (with full correction of refractive error in cycloplegia). The 15 centres, all in the Netherlands, followed the participants for 1 year. Changes in refractive error, accommodative accuracy, strabismus, binocularity and stereopsis were compared across 4 subsequent visits. RESULTS: Refractive errors and accommodative errors showed no significant change throughout the course of our study in either intervention group. The manifest angle of strabismus, however, reduced significantly in the bifocal group. This improvement was observed shortly after the children received their new correction (~6 weeks) (linear regression: t = 3.652, p < 0.001) and remained present in the final measurements after 1 year (linear regression: t = 3.604, p < 0.001). The percentage of children with positive binocularity and stereo tests showed no significant differences between the groups. CONCLUSION: Bifocals with full correction of refractive error reduce the manifest angle of strabismus within a few weeks. No effects on accommodation, refractive error, stereopsis and binocularity occurred over the course of 1 year.


Assuntos
Acomodação Ocular/fisiologia , Percepção de Profundidade/fisiologia , Síndrome de Down/complicações , Óculos , Refração Ocular/fisiologia , Estrabismo/terapia , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estrabismo/etiologia , Estrabismo/fisiopatologia
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