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1.
Eur J Ophthalmol ; 30(1): 132-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30360648

RESUMO

PURPOSE: To determine the possible predictors of the motor outcome after corrective surgery for acquired comitant esotropia. METHODS: The study included 40 patients with acquired comitant esotropia. After evaluation of the visual, sensory, and motor status; cycloplegic refraction; fundus examination; and spectacle prescription, all patients underwent corrective strabismus surgery. A successful motor outcome was defined as 0 to 10 prism diopters of horizontal tropia. Statistical analysis of the results was done using the chi-square tests. RESULTS: At the sixth postoperative month, 90% achieved a successful motor outcome, while 2.5% had a consecutive exotropia >10 prism diopters, and 7.5% had a residual esotropia >10 prism diopters. A statistically significant relationship existed between the motor outcome and the following: preoperative results of the Worth four-dot test at 6 m (p = .011) and 0.33 m (p = .009), preoperative distant (p = .016) and near (p = .017) angles of esotropia with glasses, postoperative near angles of deviation at 1 week (p = .005), 1 month (p < .001), 6 weeks (p < .001), 3 months (p = .001), and 6 months (p < .001) following surgery, postoperative distant angles of deviation at 6 weeks (p < .001) and 3 months (p = .03) following surgery, 6 week (p = .01) and 6 month (p = .036) postoperative results of the Worth four-dot test at 0.33 m, and the 6-month postoperative sensory outcome (p = .006). CONCLUSION: Preoperative and postoperative sensory and motor functions are predictors of the 6-month postoperative motor outcome.


Assuntos
Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Esotropia/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento
2.
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
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.
Strabismus ; 27(4): 205-210, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31746262

RESUMO

Purpose: Here we aimed to describe seven pediatric patients with cyclic strabismus and report the outcome of their surgical treatment.Methods: Seven children with acquired esotropia manifesting in a 48-h cycle were included in the study. Four of them were boys, and three of them were girls. All cases had a large angle of deviation and associated suppression on the esotropic day and small angle of deviation with fusion on the other day. A complete ocular motility examination was performed for seven consecutive days. For all cases, we planned strabismus surgery according to the amount of deviation on the strabismic day. Postoperatively, the deviation angles were recorded at the first week, first month, and third month. Later, the patients were examined at 3-month intervals.Results: The mean age at presentation was 4.42 ± 3.69 years (1-12 years). The mean angle of esotropia at near fixation preoperatively was 36.4 ± 14.9 pd (prism dioptre) (20-60 pd) on the esotropic day. The mean angle of esotropia on the esotropic day at distance fixation was 32.1 ± 6.9 pd (20-40 pd). The mean follow-up period was 18.4 ± 5.5 months (12-25 months). The mean duration of esotropia before surgery was 11.1 ± 9.4 months (3-29 months). Following surgery, orthophoria within 10 pd was achieved and maintained in all cases.Conclusion: When treating children with cyclic strabismus, the best surgical results can be achieved when surgery is planned according to the amount of deviation on the strabismic day.


Assuntos
Esotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Criança , Pré-Escolar , Percepção de Profundidade/fisiologia , Movimentos Oculares/fisiologia , Feminino , Fixação Ocular/fisiologia , Humanos , Lactente , Masculino , Periodicidade , Período Pós-Operatório , Estudos Retrospectivos
5.
Strabismus ; 27(4): 199-204, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31637944

RESUMO

Cerebral palsy, neurological abnormalities, prematurity or periventricular lesions may affect motor and sensory fusion mechanisms that favorably control eye alignment. White matter damage of immaturity (WMDI) is a form of white matter brain injury characterized by the necrosis of white matter near the lateral ventricles. In these cases, it is difficult to establish fusion after strabismus surgery and consecutive deviations may be seen more frequently especially in association with WMDI. The aim of this study is to evaluate and compare the cerebral magnetic resonance imaging (MRI) findings in operated infantile esotropia cases with and without consecutive exotropia and to relate them to the occurance of consecutive exotropia.Seventeen patients that had consecutive exotropia after bilateral medial rectus recession surgery for infantile esotropia were included in this study (group 1) and patients that were operated with the same diagnosis with a successful surgical outcome (≤10 PD of deviation) were recruited as group 2. Age, sex, consanguinity, associated systemic and neurological diseases, prematurity, visual acuity, angle of deviations at first visit, at last and follow-up visit and after surgery, cycloplegic retinoscopy, fundus and cerebral MRI findings were recorded. Demographic and clinical findings of patients in two groups and MRI findings were evaluated and compared.The mean age at the time of first examination was 8.21 ± 6.62 and 7.45 ± 4.94 months in infantile esotropia patients with (group 1) and without consecutive exotropia (group 2), respectively. The mean cycloplegic refractive errors (+1.92 ± 1.57 D vs. +2.30 ± 1.10 D), the mean preoperative angle of deviation (46.33 ± 18.8 PD vs. 34.8 ± 12.5 PD), sex, percentage of consanguinity, percentage of prematurity, presence of latent nystagmus, dissociated vertical deviation and amblyopia and fundus findings were similar in both groups. Patients with consecutive exotropia had a mean deviation angle of 37.5 ± 9.48 PD postoperatively. Cerebral MRI findings were consistent with WMDI (three patients), myelinization delay (one patient), septooptic dysplasia (one patient) and periventricular cysts (one patient) in group 1. Cerebellar hemispheres and vermis hypoplasia (one patient), myelinization delay (one patient), cerebellar atrophy (one patient) were the MRI findings of patients in group 2.White matter damage of immaturity was only present in the consecutive exotropia group. This finding may suggest that WMDI can be a risk factor for consecutive deviation in infantile esotropia patients.


Assuntos
Esotropia/diagnóstico , Exotropia/diagnóstico , Leucoencefalopatias/diagnóstico , Imagem por Ressonância Magnética , Substância Branca/diagnóstico por imagem , Pré-Escolar , Esotropia/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos
6.
Semin Ophthalmol ; 34(7-8): 541-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31657259

RESUMO

Regarding the review article by Escuder AG, Hunter DG, entitled "The Role of Botulinum Toxin in the Treatment of Strabismus" Seminars in Ophthalmology. 2019;34(4): 198-204, we cannot agree with you more with your point of view about the dosage preparation for botulinum toxin A (BTA) in the strabismus surgery. Moreover, we also included a case series that used BTA as an adjunct in the surgery for large-angle sensory exotropia and abducens nerve palsy.


Assuntos
Doenças do Nervo Abducente/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Exotropia/terapia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Exotropia/fisiopatologia , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Adulto Jovem
7.
Korean J Ophthalmol ; 33(5): 446-450, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612655

RESUMO

PURPOSE: To address the natural course of intermittent exotropia with small exodeviations (less than 20 prism diopters [PD]) according to the status of suppression, and to evaluate whether suppression testing at the initial visit can assist in predicting the progression of intermittent exotropia. METHODS: Clinical records of patients at the Korea University Anam Hospital, Seoul, Korea diagnosed between January 2014 and December 2018 with basic-type intermittent exotropia and initial distance deviations of less than 20 PD, older than four years of age and a minimum of three follow-up visits within a 6-month span were retrospectively reviewed. The participants were divided into two groups, the suppression group and the non-suppression group, based on the Vectogram results at the initial visit. Clinical characteristics, rate of surgery, and rate of progression were compared between the two groups. RESULTS: A total of 71 patients were included. Among them, 16 patients (22.5%) had visual suppression at the initial visit, while 55 patients (77.5%) had no suppression. At the initial visit, the mean distant angle of deviation was 13.7 ± 3.2 PD (range, 4 to 18 PD) in the suppression group and 12.7 ± 3.4 PD (range, 10 to 18 PD) in the non-suppression group. Ten patients (62.5%) underwent surgery in the suppression group and 12 patients (21.8%) underwent surgery in the non-suppression group (p < 0.01). Eleven patients (68.8%) in the suppression group and 13 (23.6%) in the non-suppression group developed progression (p < 0.01). CONCLUSIONS: Suppression testing was important to predict the progression of intermittent exotropia, in patients with exodeviation angles less than 20 PD at the initial visit.


Assuntos
Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Progressão da Doença , Exotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Prognóstico , Estudos Retrospectivos
8.
J Korean Med Sci ; 34(38): e252, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31583872

RESUMO

BACKGROUND: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children. METHODS: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance. RESULTS: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P = 0.027 and P = 0.022, respectively). CONCLUSION: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).


Assuntos
Exotropia/cirurgia , Criança , Pré-Escolar , Exotropia/diagnóstico , Feminino , Humanos , Lactente , Masculino , Músculos Oculomotores/cirurgia , Período Pós-Operatório , Prognóstico , Recidiva , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular , Acuidade Visual
9.
Strabismus ; 27(4): 215-217, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31621456

RESUMO

The authors describe a patient with Parry-Romberg syndrome (PRS) who had acquired monocular elevation deficit (MED), ptosis, and facial hemiatrophy. A 12-year-old female patient manifested progressive ptosis and hypotropia companied with progressive hemifacial atrophy was conducted to the ophthalmology clinic for diagnosis and treatment. Forced duction and generation testing confirmed that her incomitant hypotropia was caused by paralytic muscles and not due to restriction, so it was diagnosed as MED. Knapp procedure was conducted to correct her eye positions. Six months later, the frontal muscle suspension surgery was performed to treat her ptosis. Postoperatively, the patient had orthotropia without residual left hypotropia in the primary position and her left upper eyelid function improved significantly. The ocular motor defect, in this case, is best explained by nerve paresis rather than muscle fibrosis.


Assuntos
Blefaroptose/etiologia , Hemiatrofia Facial/complicações , Estrabismo/etiologia , Blefaroptose/cirurgia , Criança , Feminino , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia
10.
Strabismus ; 27(4): 223-229, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31612771

RESUMO

PURPOSE: To evaluate success of nasal loop myopexy as a primary procedure in correcting the ocular deviation in primary position when combined with recession and resection procedure (R&R) in exotropia hypotropia complex in high myopia and to explore the probable cause for deviation. CASE REPORTS: We present a case series of three adult males with exotropia hypotropia complex and high myopia with large angle exotropia and hypotropia, with deflection of the courses of superior and medial recti seen intraoperatively. We performed a conventional recession and resection procedure, which was combined with a nasal loop myopexy between the superior rectus (SR) and medial rectus (MR) in the same session, under local anesthesia, to correct the deflected course of SR and MR; with the aim of correcting the deviation in primary position and improving ocular motility, mainly elevation in abduction. RESULTS: We present a case series of three adult males with exotropia hypotropia complex, who were operated between March 2017 and October 2017. In all the three cases described above, it was noted that the preoperative exotropia and hypotropia improved following the combination of nasal loop myopexy with a conventional recession and resection procedure, as shown by improvement in ocular deviation in the primary position (measured by prism bar cover test, PBCT). First patient improved from 50 prism exotropia with 16 prism hypotropia to 5 prisms exophoria and 6 prisms hypotropia in left eye. Second patient improved from 45 prism right exotropia and 10 prism hypotropia to 10 prisms exotropia and 6 prism hypotropia. Third patient improved from 40 prism left exotropia and 20 prisms hypotropia to 10 prism esotropia and 5 prisms hypotropia. Ocular motility showed no restriction following surgery in any of the gazes. Limitation of elevation in abduction, caused due to SR deflection, improved due to repositioning of SR and MR in their anatomical positions in all the cases. In the first patient elevation in abduction improved from -4 to -1; in the second and third patients, it improved from -2 to 0. None of the three adult patients experienced any side effects following the procedure. CONCLUSION: The combination of recession and resection procedures with nasal loop myopexy was found to be effective in correcting the ocular deviation and limitation to elevation in abduction by correcting the deflected course of superior rectus and medial rectus to result in an effective improvement of elevation in abduction. One case had an overcorrection of exotropia. There were no other major complications.


Assuntos
Exotropia/cirurgia , Miopia Degenerativa/complicações , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Adulto , Exotropia/fisiopatologia , Movimentos Oculares/fisiologia , Humanos , Masculino , Estudos Retrospectivos , Visão Binocular/fisiologia , Adulto Jovem
11.
Curr Opin Ophthalmol ; 30(6): 472-475, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31503076

RESUMO

PURPOSE OR REVIEW: Superior oblique myokymia is a rare, monocular condition that typically presents in healthy adults. In this article, we review the proposed pathophysiology, describe the typical clinical presentation, and discuss the recommended work up and various treatment options. RECENT FINDINGS: Treatment for this condition ranges from observation and reassurance to various topical and systemic medications. Both strabismus surgery and neurosurgery are reserved for patients who fail medical therapy or are intolerant to medication secondary to side effects. SUMMARY: Due to its episodic nature, SOM is often under-diagnosed. We highlight key features in a patient's clinical history and the examination findings that suggest and support the diagnosis, with review of available treatment options.


Assuntos
Doenças do Nervo Troclear/fisiopatologia , Humanos , Músculos Oculomotores/cirurgia , Doenças do Nervo Troclear/diagnóstico , Doenças do Nervo Troclear/terapia
12.
World Neurosurg ; 132: e28-e33, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521756

RESUMO

OBJECTIVE: To evaluate whether use of partial nondepolarizing neuromuscular blocking agents, at a train-of-four level 1, compromise facial nerve monitoring during vestibular schwannoma (VS) resection. METHODS: Sixty consecutive patients undergoing VS resection were enrolled into a partial peripheral neuromuscular blockade group or free of neuromuscular blockade group. Stimulation threshold to elicit an electromyographic response amplitude of at least 100 µV was recorded at the proximal and distal facial nerve after VS removal. The proximal-to-distal ratio of amplitude of the orbicularis oculi and oris muscles was calculated. RESULTS: All patients successfully passed the electromyography monitoring test. Mean electrical stimulation thresholds were higher in the peripheral neuromuscular blockade group than in the free of neuromuscular blockade group (0.12 mA vs. 0.06 mA at proximal site, P = 0.001; 0.08 mA vs. 0.03 mA at distal site, P = 0.0002). The differences in median proximal-to-distal amplitude ratios were not statistically significant in both groups. There was a trend toward more patients needing phenylephrine. Recovery profiles were comparable in the 2 groups. CONCLUSIONS: Although mean stimulation threshold to elicit a response amplitude was higher in the peripheral neuromuscular blockade group than in the free of neuromuscular blockade group at the proximal site, the stimulation thresholds in both groups were sufficient for facial nerve monitoring in VS surgery, indicating no clinical difference in both groups.


Assuntos
Eletromiografia , Nervo Facial , Monitorização Neurofisiológica Intraoperatória/métodos , Neuroma Acústico/cirurgia , Bloqueio Neuromuscular , Adulto , Período de Recuperação da Anestesia , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/efeitos dos fármacos , Músculos Oculomotores/cirurgia , Fenilefrina/farmacologia , Simpatomiméticos/farmacologia
13.
Strabismus ; 27(4): 211-214, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31544571

RESUMO

Scleroderma, "en coup de sabre" is a rare disorder, characterized by linear depressed scarring at frontoparietal area of the face, seldom associated with ophthalmological findings. Extraocular muscle involvement and paralytic strabismus are rarely associated with linear scleroderma. Here we are reporting a case of unilateral linear scleroderma in an 8-year-old child, with features of strabismus fixus secondary to fibrosed medial rectus (MR) muscle, enophthalmos and en coup de saber (sword-like scar) on the eyebrow. MRI orbit was suggestive of the bulky MR and the inferior rectus muscle. MR recession along with partial loop myopexy resulted in cosmetically acceptable ocular alignment in this case. Histopathology of the portion of muscle and intermuscular septum showed diffuse fibrosis of the muscle. Linear scleroderma may be the causative etiology of strabismus fixus in our case, never reported before in literature.


Assuntos
Músculos Oculomotores/patologia , Esclerodermia Localizada/complicações , Estrabismo/etiologia , Criança , Fibrose/diagnóstico por imagem , Fibrose/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/cirurgia , Órbita/diagnóstico por imagem , Esclerodermia Localizada/diagnóstico por imagem , Estrabismo/diagnóstico , Estrabismo/cirurgia
14.
J Craniofac Surg ; 30(8): 2304-2307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31478956

RESUMO

The purpose of this study was to compare the surgical outcomes of two combinational surgeries for involutional entropion: Inferior retractor tightening (IRT) + lateral tarsal strip (LTS) + skin muscle excision (SME) vs LTS + SME. The authors reviewed the records of 2 groups which were made up of 80 (85 eyelids) and 58 (63 eyelids) involutional entropion patients with 71.4 and 71.8 years on average respectively. The 2 groups were categorized into Group A and Group B by different surgical techniques. The former underwent IRT + LTS + SME surgery between April 2004 and February 2014, while the latter received LTS + SME surgery between March 2014 and February 2018. The authors evaluated the surgical outcomes of 2 combinational surgeries. In Group A, 84 out of 85 (98.8%) lids were successfully corrected and 1 (1.2%) lower eyelid suffered from recurrence during the follow-up period of 26.5 ±â€Š4.6 months. Two canthal deformity cases occurred in this group. In Group B, 62 out of 63 (98.2%) lids were successfully treated and there was 1 (1.8%) case of recurrence during the follow-up period of 21.0 ±â€Š10.0 months. No cases of complications were noted. IRT + LTS + SME procedure took 26.4 ±â€Š2.4 minutes and LTS + SME procedure took 20.6 ±â€Š3.9 minutes (P < 0.001). The LTS + SME technique exhibited a comparable success rate with the IRT + LTS + SME operation. LTS + SME appeared to be significantly faster and safer compared to the IRT + LTS + SME procedure.


Assuntos
Entrópio/cirurgia , Idoso , Anestésicos Locais , Procedimentos Cirúrgicos Dermatológicos , Entrópio/patologia , Pálpebras/cirurgia , Feminino , Humanos , Músculos Oculomotores/patologia , Músculos Oculomotores/cirurgia , Recidiva , Estudos Retrospectivos , Pele , Técnicas de Sutura , Suturas , Resultado do Tratamento
15.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519722

RESUMO

Monocular elevation deficit can result from either inferior rectus restriction, superior rectus palsy or from supranuclear causes. We report a case of monocular elevation deficit after scleral perforation repair which was managed by surgery on contra lateral eye. This improved elevation of the affected eye with no diplopia in the postoperative period.


Assuntos
Diplopia/etiologia , Transtornos da Motilidade Ocular/cirurgia , Oftalmoplegia/etiologia , Esclera/lesões , Adulto , Diagnóstico Diferencial , Diplopia/diagnóstico , Diplopia/prevenção & controle , Movimentos Oculares/fisiologia , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/patologia , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Oftalmoplegia/fisiopatologia , Período Pós-Operatório , Esclera/patologia , Esclera/cirurgia , Perfuração Espontânea/cirurgia , Resultado do Tratamento
16.
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
17.
BMC Ophthalmol ; 19(1): 173, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391009

RESUMO

BACKGROUND: To describe the clinical characteristics and the outcomes of strabismus surgery for acute acquired comitant esotropia (AACE). METHODS: Medical records of 45 AACE patients were retrospectively analyzed. The insertion location of medial rectus was compared between the AACE patients and comitant exotropic patients. The location was also compared with those measured in other studies. Surgical outcome measurements included amount of deviation and level of binocularity at last follow-up. RESULTS: The distance from medial rectus to limbus was shorter in AACE patients than in patients with comitant exotropia. The distance was also shorter in AACE patients than patients in other studies. Out of the 45 patients, 2 had neurological diseases. Neostigmine test was negative in all patients. The age at onset of AACE was 5-47 years (mean 19.1 ± 7.3 years), one patient was 5 years (2.2%), 20 patients were 11-17 years (44.5%) and the other 24 patients were 18-47 years old (53.3%). The mean cycloplegic refraction was - 4.1 ± 3.0 diopters (D) and 41 patients were myopic (91%). The angle of deviation was 40.5 ± 19.5 prism diopters (PD) at distance and 35.6 ± 19.9PD at near preoperatively. The angle was 0.8 ± 1.6 PD at distance and 0.7 ± 1.8 PD at near postoperatively. Diplopia resolved in patients who underwent strabismus surgery, with no recurrence during the follow-up period. Thirty patients had stereopsis postoperatively. CONCLUSIONS: AACE seems to occur mostly in older children and adults and myopes. The distance from the insertion to limbus of medial rectus was shorter in patients with AACE. Good results can be achieved by strabismus surgery.


Assuntos
Percepção de Profundidade/fisiologia , Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Acuidade Visual , Doença Aguda , Adolescente , Adulto , Criança , Esotropia/diagnóstico , Esotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Korean J Ophthalmol ; 33(4): 353-358, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389211

RESUMO

PURPOSE: To evaluate the long-term efficacy of slanted lateral rectus recession in children for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency. METHODS: The medical records of 53 patients with convergence insufficiency intermittent exotropia who underwent slanted bilateral lateral rectus recession performed by a single surgeon and received follow-up for more than 12 months were retrospectively analyzed. Deviation angles at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively and on the last visit were reviewed. Surgical success was defined as postoperative residual distance and near deviation angles ≤8 prism diopters and a difference between the near and distance angles ≤8 prism diopters. RESULTS: The mean duration of follow-up was 24 months (range, 12 to 61 months). On the last visit, the residual deviation angles were ≤8 prism diopters in 75.5% for distance, 62.3% for near, and 81.1% for the near-distance difference. Surgical success was achieved in 31 (58.5%) patients, and none of them manifested limitations in eye movements or diplopia at the last follow-up visit. CONCLUSIONS: Slanted lateral rectus recession is an effective surgical method for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency.


Assuntos
Convergência Ocular/fisiologia , Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Adolescente , Criança , Pré-Escolar , Exotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
19.
Indian J Ophthalmol ; 67(9): 1479-1481, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31436205

RESUMO

Management of head tilt in infantile nystagmus syndrome (INS) is a challenge. In this case report, we have described successful management of right-sided head tilt in a child with INS by operating on three oblique muscles (superior oblique anterior tenectomy in the right eye, Harada-Ito procedure in the left eye, and inferior oblique recession in the left eye). The child had complete correction of head tilt without causing any cyclovertical strabismus or torsional diplopia postoperatively.


Assuntos
Movimentos Oculares/fisiologia , Movimentos da Cabeça/fisiologia , Nistagmo Patológico/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Postura/fisiologia , Criança , Humanos , Masculino , Nistagmo Patológico/fisiopatologia , Músculos Oculomotores/fisiopatologia
20.
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
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