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1.
Vestn Oftalmol ; 136(6. Vyp. 2): 242-248, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33371656

RESUMO

Treatment of vertical strabismus will almost inevitably involve surgery when it is associated with hyperfunction of the inferior oblique muscle due to the weakness of vertical fusion (3.0-4.0 ave dptr), the presence of cyclotropy and torsional diplopia. Many operations aimed at weakening the lower oblique muscle have been described. However, they have a number of negative aspects associated with high invasiveness, difficulty of technical implementation due to the need for manipulations in the inaccessible area of the eye in proximity to the optic nerve, macular area, large vessels, as well as long duration of the operation, inability to dosage the result of the operation, low functional results. They are, to a large extent, absent in the operation of anterior transposition in which the neurofibrovascular bundle serves as the axis of rotation of the lower oblique muscle changing the vector of its action and increasing the effectiveness of treatment. Despite all the advantages of that technique, its use is still limited due to the lack of methods for controlling the amount of anterior transposition for the treatment of hyperfunction of the inferior oblique muscle, especially of small degrees.


Assuntos
Estrabismo , Humanos , Músculos Oculomotores/cirurgia , Estrabismo/diagnóstico , Estrabismo/etiologia , Estrabismo/cirurgia , Resultado do Tratamento
2.
Plast Reconstr Surg ; 146(6): 1268-1273, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234956

RESUMO

Upper eyelid ptosis correction is a complex procedure. The ethnic differences in the Asian upper eyelid anatomy are compounded by the technical challenges of primary and revision ptosis correction. The authors present a technique of upper eyelid ptosis correction that estimates the exact location of suture fixation that uses the musculoaponeurotic junction of the levator as the reference point. The preoperative considerations in determining the fixation point relative to the musculoaponeurotic junction include the following: A, the extent of ptosis correction needed; B, the degree of compensatory brow elevation with eye opening; and C, eye dominance. The benefits of this approach are the shortened operative time because of more precise preoperative planning and greater predictability and reproducibility of the results. The authors have found that this technique produced consistent and superior results for ptosis correction in Asian patients.


Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Sistema Musculoaponeurótico Superficial/anatomia & histologia , Pontos de Referência Anatômicos , Grupo com Ancestrais do Continente Asiático , Pálpebras/anatomia & histologia , Pálpebras/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Músculos Oculomotores/anatomia & histologia , Músculos Oculomotores/cirurgia , Planejamento de Assistência ao Paciente , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sistema Musculoaponeurótico Superficial/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
PLoS One ; 15(11): e0242366, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33186391

RESUMO

PURPOSE: To report and evaluate strabismus surgery in children with Angelman syndrome, in order to optimize and standardize surgical approach. Other purposes are to understand the possible relation between ocular findings and motor ability, and between improvement in ocular alignment and changes in motor skills in this population. DESIGN: Observational cross-sectional study. METHODS: Medical records of pediatric patients with Angelman syndrome, who underwent strabismus surgery, were investigated. Collected data included: genotype, gender, age at the time of surgery, refractive error, pre-operative strabismus, surgical procedure, surgical outcome, gross and fine motor development assessment pre- and post-operatively. RESULTS: Seventeen subjects, aged 3-15 years, were investigated. Fourteen patients were exotropic, three esotropic. Most patients presented astigmatism. Considering the exaggerated response to standard amounts of surgery and the risk of consecutive strabismus on long term follow-up reported by previous studies in children with developmental delay, a reduction of the amount of strabismus surgery was applied. Post-operatively, all patients presented with a significative reduction of the baseline deviation angle, with all esotropic patients and 7 exotropic patients (59%) achieving orthotropia. The surgical outcomes were variable according to the type and the amount of baseline strabismus, but no case presented with exaggerated surgical response. At baseline, patients showed important delays in all motor abilities, and, post-operatively, presented a significant improvement in walking and fine motor tasks. Pre- and post-operative motor abilities were negatively correlated to astigmatism, anisometropia, and amount of deviation. CONCLUSIONS: According to our data, the standard nomograms for strabismus surgery may be successfully applied in subjects with Angelman syndrome and exotropia. Our data suggest that the reduction of the deviation angle improves motor skills in strabismic pediatric patients with Angelman syndrome.


Assuntos
Síndrome de Angelman/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Esotropia/cirurgia , Exotropia/cirurgia , Feminino , Seguimentos , Humanos , Itália , Masculino , Músculos Oculomotores/cirurgia , Período Pós-Operatório , Refração Ocular , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual , Percepção Visual/fisiologia
4.
Zhonghua Yan Ke Za Zhi ; 56(11): 853-858, 2020 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-33152844

RESUMO

Objective: To investigate the long-term clinical efficacy and safety of the bilateral superior oblique tendon suture spacer in treatment of A-pattern strabismus with superior oblique overaction (SOOA). Methods: Retrospective case series study. Twenty-one A-pattern strabismus patients who received the quantitative bilateral superior oblique tendon suture spacer with a complete follow-up from January 2009 to August 2017 were enrolled. Among these patients, 19 were exotropic and 2 were esotropic, including 11 males and 10 females, aged (14±9) years. Patients with unilateral superior oblique overaction, Broun syndrome or Helveston syndrome were excluded. The A-pattern strabismus, objective torsion, function of the superior oblique muscle and binocular vision were examined pre-and post-operatively. Paired t-test was used for normal distribution data, Wilcoxon rank-sum test was used for non-normal distribution data, Spearman rank correlation test and simple linear regression were used to analyze the correlation between the two variables. Results: The follow-up was 12 to 109 months (mean, 26±17 months). Twenty patients showed good alignment in the primary position with a deviation angle less than 10 prism diopter (PD), and 1 patient with esotropia had an angle greater than 15 PD. All the patients had no A pattern after surgery. The average pre-and post-operative A-patterns were (23.81±9.47) PD and (0.90±3.59) PD (t=11.29, P<0.01), respectively, and the average corrected A pattern was (23.52±9.68) PD.The average pre-and post-operative torsion was 3.18°±3.26° and -4.81°±4.13° (t=8.87, P<0.01), espectively, and the average corrected torsion was 7.95°±3.88°. No patient complained of torsional diplopia after surgery. The average amount of pre-and post-operative SOOA was 3.0 (2.0) and 0.0 (1.0) in 42 eyes (Z=-5.78, P<0.01), respectively. Suture extension of the superior oblique tendon was related with the pre-operative SOOA (r=0.47, P<0.01), but was not related with the pre-operative torsion (r=0.02, P=0.88). The linear regression results was suture extension=2.71× the grade of pre-operative SOOA (t=27.93, P<0.01). Conclusions: The bilateral superior oblique tendon suture spacer can improve the A-pattern, objective torsion and SOOA, with no torsional diplopia or V pattern after the long-term follow-up. It is a safe and effective superior oblique muscle weakening procedure. (Chin J Ophthalmol, 2020, 56: 853-858).


Assuntos
Músculos Oculomotores , Estrabismo , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Estrabismo/cirurgia , Suturas , Tendões/cirurgia , Resultado do Tratamento , Visão Binocular , Adulto Jovem
5.
Vestn Oftalmol ; 136(5): 142-148, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33056976

RESUMO

Vertical strabismus caused by hyperfunction of the inferior oblique muscle is a common oculomotor disorder. It is found in one third of all patients with strabismus, and in 70% of cases it is combined with esotropia. To date, there is no single approach to determining the degree of hyperfunction of the inferior oblique muscle, and the most common classifications are very subjective and inaccurate. Thus, in connection with the need to understand the severity of the disease, as well as to determine the tactics of treatment and prognosis of the surgical outcomes, it is necessary to standartize the classification of this pathology. The mechanism of action of the inferior oblique muscles of the eye is very complex and depends on the position of the eyeball at the time of their contraction. In addition to horizontal and vertical movements, they provide torsional movement. Any impairment of these muscles leads to the development of not only vertical strabismus, but excyclotropia that reduces the effectiveness of strabismus treatment. To identify all the symptoms associated with hyperfunction of the inferior oblique muscle, taking into account the peculiarities of its triple action, it is necessary to conduct a thorough diagnostic study.


Assuntos
Estrabismo , Movimentos Oculares , Humanos , Músculos Oculomotores/cirurgia , Estrabismo/diagnóstico , Estrabismo/etiologia , Estrabismo/cirurgia
6.
PLoS One ; 15(10): e0240026, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031390

RESUMO

This study examined the factors affecting corneal curvature change after lateral rectus recession and medial rectus resection surgery in patients with intermittent exotropia. This was a retrospective cross-sectional study in intermittent exotropia patients who underwent rectus resection surgery. The study involved 41 male and 42 female patients (mean age: 9.55 ± 5.03 years, range: 3-28 years). Corneal astigmatism analysis was performed using the Galilei G4 Dual Scheimpflug Analyzer. The values of simulated and ray tracing corneal keratometry (K) of astigmatism, including axis changes, were determined preoperatively and at 1 week and 3 months postoperatively. The factors found to affect corneal curvature change were sex, extent of surgery, and axial length. Simulated and ray tracing changes were significant preoperatively and at 1 week and 3 months after rectus resection surgery (p < 0.05); however, there were no differences in astigmatism (D) at any time. The spherical equivalent had a myopic change after rectus resection surgery with cycloplegic refraction, and in ray tracing mode, flat K was decreased at 1 week from baseline and increased 3 months later. Steep, mean K, and axis increased continuously from baseline to 1 week and 3 months. Astigmatism, in contrast, was increased at 1 week, but decreased at 3 months, with no return to baseline. Univariable linear regression analyses showed that the extent of surgery had an effect on flat K change and that sex had an effect on steep K and axis. Additionally, axial length affected steep K and astigmatism, while age had no effect on any variable. Ray tracing values were significantly different from simulated values. In ray tracing mode, rectus resection surgery may result in astigmatism shifted toward with-the-rule, and myopic changes may be caused by differences in thickness and flexibility of the sclera. Notably, age did not affect any variable.


Assuntos
Astigmatismo/patologia , Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Exotropia/patologia , Feminino , Humanos , Modelos Lineares , Masculino , Período Pós-Operatório , Refração Ocular , Estudos Retrospectivos , Resultado do Tratamento , Testes Visuais , Adulto Jovem
7.
Klin Monbl Augenheilkd ; 237(10): 1194-1201, 2020 Oct.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33059380

RESUMO

INTRODUCTION: The course of the recovery phase after general anaesthesia, during which consciousness and pain gradually return, is essentially determined by the choice of anaesthetic drug, and its total dose or duration of application. This phase is often complicated by more or less severe agitation, especially in children. In the present study we investigated whether the application of a topical anaesthetic to the conjunctiva at the end of a strabismus operation had a positive effect on the recovery behaviour of the child. PATIENTS/METHODS: This prospective, randomised, blinded study was conducted with 50 healthy, ASA class I or II children, aged 3 to 8 years undergoing their first strabismus operation. Following the surgeon's randomisation two drops of a 0,5% tetracaine-HCl ophthalmic solution were applied to the operated conjunctiva three times at 30-s intervals immediately following wound closure. The postoperative evaluation encompassed heart rate, as well as COMFORT and CHEOPS scores. The first assessment was directly postoperatively with repetitions at 15, 30, 45, 60, 75, 90 and 120 min, as well as on the day after surgery. RESULTS: The CHEOPS scores did not differ significantly between children with or without topical anaesthesia at any time during the observation period. The COMFORT scores revealed a slight, but non-significant analgesic effect at 15 and 30 min. The 60 min score showed the opposite effect, possibly indicating a slight disadvantage of the topical anaesthesia. There were no significant differences with regard to time to first request for additional systemic analgesia, to the total dose of systemic pain medication, or to when the patient was eligible for discharge to the ward. CONCLUSION: The application of topical tetracaine-HCl immediately after wound closure had no positive effects on the course of the postoperative recovery period after strabismus surgery in children. There was no evidence of an effect on pain or emergence agitation.


Assuntos
Dor Pós-Operatória , Estrabismo , Anestesia Local , Criança , Pré-Escolar , Humanos , Músculos Oculomotores/cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Estrabismo/cirurgia
8.
Ophthalmologe ; 117(10): 1006-1014, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32964287

RESUMO

BACKGROUND: Strabismus surgery is frequently carried out in university centers. The aim of this work was to calculate the costs of strabismus surgery at a university hospital and to assess the remuneration of costs for outpatient procedures. MATERIAL AND METHODS: Of all strabismus surgeries at the Hanover Medical School in the years 2018 and 2019, relevant surgical data, such as patient age, number of muscles operated on, incision to suture time, attendance time of the surgeons and anesthetists as well as the nursing staff, were evaluated based on the clinics own information system. During this process, the costs for personnel, material, room rental charges and overheads were computed applying cost unit accounting. RESULTS: A total of 302 operations (inpatient proportion 92.1%) were carried out in most cases with the patient under general anesthesia. The mean patient age was 31 years (median 26 years), with 33 patients being children under 6 years of age. On average 1.84 muscles were treated per intervention. The mean incision to suture time was 51.5 min, mean anesthesia time was 85 min, the attendance time of surgical as well as anesthesia nursing staff each accounted for 104 min, the additional time in the postanesthesia care unit added 66 min. Average personnel costs originating from the overall process amounted to 642.14 €, with the addition of 109.23 € for material and medication (surgery and anesthesia) and costs for cleaning and room rental (including overheads) of 178.71 €. Therefore, the overall costs of an average strabismus surgery in our collective added up to 930.08 € (minimum 491.01 €, maximum 1729.29 €). Cost accounting of subgroups yielded substantially higher costs for anesthesia in children as well as for higher numbers of muscles operated on due to different treatment duration (37 min for 1 muscle to 72 min for 3 muscles) and anesthesia time, especially in children <6 years of age (on average 22 min longer than adults and children >5 years; the differences being 11 min for 1 muscle, 25 min for 2 muscles and 30 min for 3 or more muscles). The pure costs of a strabismus surgery at this clinic seem on average to exceed the revenues for strabismus surgery in the outpatient sector calculated by the German uniform evaluation benchmark (EBM) by about a factor of 2. CONCLUSION: It could be shown that the purely economically calculated costs for strabismus surgery at a university clinic are significantly higher than the revenues achieved in the outpatient sector according to paragraph 115b, section 1, of the Social Security Act V (SGB V). Under these circumstances, such operations cannot be performed in a cost-effective manner.


Assuntos
Oftalmologia , Estrabismo , Adulto , Criança , Pré-Escolar , Hospitais Universitários , Humanos , Músculos Oculomotores/cirurgia , Estrabismo/cirurgia , Suturas
9.
Niger J Clin Pract ; 23(9): 1243-1247, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913163

RESUMO

Aim: This study aimed to determine the effects of strabismus surgery on choroidal thickness in paediatric patients with Spectral Domain-Optical Coherence Tomography (SD-OCT). Material and Methods: Sixty eyes of 60 children with esotropia were included. The mean age was 9.5 ± 3.1 years. The choroidal thickness was measured using SD-OCT, which was performed before the surgery and 1 week, 1 month and 3 months postoperatively. At the same time, the patients' visual acuity was evaluated. Results: There were no statistically significant differences between the preoperative and postoperative values in terms of the visual acuity (P > 0.05). When compared to the preoperative values, decreases were found in the choroidal thicknesses in all of the areas measured during the first week evaluation (P < 0.05). In the postoperative first month, significant decreases were also found in the choroidal thicknesses in all the areas measured (P < 0.05); however, in the postoperative third month, there were no changes in any of the areas (P > 0.05). Conclusions: We observed that there was a significant decrease in the choroidal thickness during the early postoperative period and no significant change in the late postoperative period in paediatric patients of double horizontal muscle surgery. Moreover, these early changes in the choroid in paediatric patients show that it does not cause a functional loss.


Assuntos
Corioide/diagnóstico por imagem , Corioide/patologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Estrabismo/cirurgia , Tomografia de Coerência Óptica/instrumentação , Adolescente , Criança , Corioide/anatomia & histologia , Feminino , Humanos , Masculino , Tamanho do Órgão , Período Pós-Operatório , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Acuidade Visual/fisiologia
10.
Medicine (Baltimore) ; 99(36): e21401, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32898992

RESUMO

To compare the surgical outcomes of medial rectus advancement and lateral rectus recession in postoperative consecutive exotropia with single-stage adjustable suture surgery.Among 1003 patients who underwent bilateral medial rectus recession between November 1996 and March 2013, the patients who required surgery for consecutive exotopia were retrospectively reviewed. Nineteen patients underwent medial rectus advancement and 15 patients underwent lateral rectus recession. All patients underwent single-stage adjustable surgery under topical anesthesia and were followed up for at least 12 months.The mean follow-up duration was 2.4 years. At final follow-up, a successful surgical outcome was found in 12 patients (63.0%) in the medial rectus advancement group and 14 patients (93.3%) in the lateral rectus recession group (P = .039). The change in ocular deviation was correlated with the amount of recession (P = .008) and preoperative angle (P < .001) in the lateral rectus recession group.Lateral rectus recession showed a higher success rate with predictable and easily performed procedure than medial rectus advancement for the treatment of postoperative consecutive exotropia with adjustable suture.


Assuntos
Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Complicações Pós-Operatórias/cirurgia , Adolescente , Criança , Exotropia/etiologia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Período Pós-Operatório , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
11.
Middle East Afr J Ophthalmol ; 27(2): 117-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874045

RESUMO

PURPOSE: The purpose of this study is to evaluate the results of myectomy in inferior oblique overaction cases with a vertical deviation angle of <20 and ≥20 prism diopters (PD) in the primary position. METHODS: The medical records of cases with inferior oblique overaction that underwent inferior oblique myectomy for ≥6 PD hypertropia in the primary position and >+1 inferior oblique overaction were reviewed. Preoperative and postoperative examination findings and success rates were compared of cases with a deviation angle <20 PD (Group 1) and ≥20 PD (Group 2). RESULTS: The mean age of 35 (58%) female and 25 (42%) men cases of Group 1 (n = 60) were 12.8 ± 9.4 years; the mean age of 25 (58%) female and 18 (42%) male cases of Group 2 (n = 43) were 14.8 years (P = 0.340). The near hypertropia was decreased from 11 to 0.5 PD in Group 1, from 22.1 to 5.1 PD in Group 2 cases (P < 0.001). The distance hypertropia was decreased from 11.3 to 0.5 PD in Group 1 and from 23.3 to 6.1 PD in Group 2 cases (P < 0.001). The mean degree of hypertropia at near and distance was statistically significantly higher both pre- and post-operatively in Group 2 than in Group 1 (P < 0.001), and improved statistically significantly with the initial surgery in both groups (P < 0.001). The rate of the presence of stereopsis of ≥3000 s/arc and fusion, the main criteria of binocular vision (BOV), was not statistically significantly different between the Groups before (P = 0.577) and after the surgery (P = 0.678), but the presence of BOV significantly increased both in Group 1 (P < 0.001) and Group 2 (P = 0.004) postoperatively. The number of cases with surgical success was 57 (95%) and 25 (58%), respectively, in Groups 1 and 2 (P < 0.001). CONCLUSIONS: Myectomy is an effective surgical procedure that can be easily and quickly performed in inferior oblique overaction cases and has high success rates in cases with a small-to-moderate angle of deviation.


Assuntos
Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Estrabismo/cirurgia , Adolescente , Adulto , Anestesia Geral , Criança , Pré-Escolar , Percepção de Profundidade/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular/fisiologia , Adulto Jovem
12.
Middle East Afr J Ophthalmol ; 27(2): 123-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874046

RESUMO

PURPOSE: The purpose of this study was to evaluate predictive factors for intermittent exotropia (XT) recurrence after bilateral lateral rectus (BLR) recession. METHODS: This is a retrospective chart review of patients with XT who underwent BLR recession surgery between January 2007 and March 2017 with at least one postsurgical follow-up. Forty-one medical records were reviewed. Information collected included age, gender, systemic diseases, history of prematurity, family history of eye diseases, visual acuity, refraction, ocular alignment and control, stereoacuity, slit-lamp examination, fundoscopy, and amount of BLR recession. Successful alignment was defined as ≤8 prism diopters of esotropia or exotropia postoperatively. RESULTS: The mean age of patients at the time of surgery and follow-up time was 9.2 ± 12.3 years (y) and 23.6 ± 36.5 months (m), respectively. The mean amount of BLR recession was 6.5 ± 1.0 mm. Recurrence rate was 43.9% on the last follow-up. Age at surgery and at the time of last follow-up were significantly higher in the recurring group (P = 0.04 and P = 0.05, respectively). Postoperative angle of misalignment during the first 3 months was correlated with exotropia recurrence. No statistical significance was found among the remaining factors studied. CONCLUSIONS: The recurrence rate of XT in our study was 43.9%; it was increased in patients operated at older age and amid those with significant exotropia detected in the early postoperative period (within 3 months of surgery).


Assuntos
Exotropia/diagnóstico , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Adolescente , Criança , Pré-Escolar , Doença Crônica , Exotropia/fisiopatologia , Exotropia/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Oftalmoscopia , Período Pós-Operatório , Recidiva , Refração Ocular , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto Jovem
13.
Invest Ophthalmol Vis Sci ; 61(8): 6, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32634203

RESUMO

Purpose: This study identifies and characterizes the nasotemporal hemifield difference of interocular suppression in subjects who have been successfully treated for strabismus. Methods: Interocular suppression in the nasal and temporal hemifields were measured using two methods, namely, binocular phase combination and dichoptic motion coherence, both entailed suprathreshold stimuli. We tested 29 clinical subjects, who had strabismus (19 with exotropia and 10 with esotropia) but regained good ocular alignment (within 10 prism diopters) after surgical or refractive correction, and 10 control subjects. Results: Both the hemifield binocular phase combination and the hemifield dichoptic motion coherence tests revealed similar nasotemporal asymmetry of interocular suppression. Subjects with previous exotropia showed deeper suppression in the nasal hemifield, and those with previous esotropia showed deeper suppression in the temporal hemifield. This finding was consistent with the hemifield suppression theory. Furthermore, there was deeper suppression but less imbalance of nasotemporal asymmetry in the hemifield dichoptic motion coherence test. Finally, clinical stereopsis and the nasotemporal asymmetry of suppression (P < 0.05 in both tests) were negatively correlated in subjects with previous exotropia and measurable stereopsis. Conclusions: Hemifield asymmetry of interocular suppression in corrected strabismus can be measured by using static and dynamic suprathreshold stimuli. Thus, the evaluation of binocular vision in strabismus should focus on both the magnitude and the pattern of interocular suppression.


Assuntos
Percepção de Profundidade/fisiologia , Movimentos Oculares/fisiologia , Percepção de Movimento/fisiologia , Músculos Oculomotores/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/fisiopatologia , Adolescente , Feminino , Humanos , Masculino , Músculos Oculomotores/cirurgia , Estimulação Luminosa , Período Pós-Operatório , Limiar Sensorial/fisiologia , Estrabismo/cirurgia
15.
Invest Ophthalmol Vis Sci ; 61(6): 33, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32539136

RESUMO

Purpose: We examined inferior oblique muscles from subjects with over-elevation in adduction for characteristics that might shed light on the potential mechanisms for their abnormal eye position. Methods: The inferior oblique muscles were obtained at the time of surgery in subjects diagnosed with either primary inferior oblique overaction or Apert syndrome. The muscles were frozen and processed for morphometric analysis of myofiber size, central nucleation, myosin heavy chain (MyHC) isoform expression, nerve density, and numbers of neuromuscular junctions per muscle section. Results: The inferior oblique muscles from subjects with Apert Syndrome were smaller, and had a much more heterogeneous profile relative to myofiber cross-sectional area compared to controls. Increased central nucleation in the Apert syndrome muscles suggested on-going myofiber regeneration or reinnervation over time. Complex changes were seen in the MyHC isoform patterns that would predict slower and more sustained contractions than in the control muscles. Nerve fiber densities were significantly increased compared to controls for the muscles with primary inferior oblique overaction and Apert syndrome that had no prior surgery. The muscles from Apert syndrome subjects as well as those with primary inferior oblique overaction with no prior surgery had significantly elevated numbers of neuromuscular junctions relative to the whole muscle area. Conclusions: The muscles from both sets of subjects were significantly different from control muscles in a number of properties examined. These data support the view that despite similar manifestations of eye misalignment, the potential mechanism behind the strabismus in these subjects is significantly different.


Assuntos
Movimentos Oculares/fisiologia , Músculos Oculomotores/diagnóstico por imagem , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/diagnóstico , Visão Binocular/fisiologia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Estrabismo/fisiopatologia , Estrabismo/cirurgia , Resultado do Tratamento
16.
J Craniofac Surg ; 31(5): e477-e479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516216

RESUMO

A 34-year-old man with Basedow disease consulted us to treat disfiguring proptosis. On examination, the patient showed right lower eyelid retraction and right inferior rectus muscle enlargement, which were consistent with thyroid eye disease. Hertel's exophthalmometric examination demonstrated proptosis of 25.5 and 24.0 mm on the right and left sides, respectively. Computed tomography (CT) images revealed absence of the sphenoid door jamb. To correct both exorbitism and exophthalmos, the patient underwent bilateral "shallow" decompression of the lateral and medial orbital walls with orbital fat removal under general anesthesia. The authors removed 2.5 and 1.0 mL of orbital fat from the inferolateral quadrant of the right and left orbits, respectively. At 3 months postoperatively, based on the measurements of the axial globe position on sagittal CT images, postoperative proptosis reductions of 7.5 and 6.5 mm were observed on the right and left sides, respectively.


Assuntos
Descompressão Cirúrgica , Exoftalmia/cirurgia , Órbita/cirurgia , Doenças da Glândula Tireoide/cirurgia , Tecido Adiposo/cirurgia , Adulto , Exoftalmia/diagnóstico por imagem , Exoftalmia/etiologia , Oftalmopatia de Graves , Humanos , Masculino , Músculos Oculomotores/cirurgia , Órbita/diagnóstico por imagem , Período Pós-Operatório , Osso Esfenoide/cirurgia , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X
17.
Br J Oral Maxillofac Surg ; 58(8): 966-969, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32507643

RESUMO

We aimed to investigate the feasibility and efficacy of early correction of severe blepharoptosis after double-eyelid blepharoplasty using conjoint fascial sheath (CFS) suspension. From July 2013 to July 2016, 23 patients (25 eyes) with severe blepharoptosis were treated with CFS suspension and followed up for 12-36 months. The levator function, margin reflex distance, patients' satisfaction with the appearance of the double eyelids, and complications were retrospectively analysed. Full correction was achieved in 24 eyes and overcorrection in one eye. No undercorrection was noticed. Postoperatively the mean levator function was significantly increased (from 1.5 to 10.2mm) and the margin reflex distance was significantly increased from -1.0 to 4.8mm. All patients were satisfied with the appearance of the double eyelids. No recurrence of blepharoptosis occurred postoperatively. One patient had postoperative chemosis and was well-managed with conservative treatments. CFS suspension is a safe and effective way to treat severe blepharoptosis after double-eyelid blepharoplasty. The treatment is effective in the long term.


Assuntos
Blefaroplastia , Blefaroptose , Blefaroptose/cirurgia , Pálpebras/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
PLoS One ; 15(6): e0234017, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479558

RESUMO

We report the long-term surgical results of augmented lateral rectus muscle (LR) recession for dissociated horizontal deviation (DHD) without concomitant exotropia (XT) or esotropia (ET). This retrospective review included patients with DHD without XT or ET who underwent augmented LR recession and were followed-up for ≥12 months. Each patient's medical records were evaluated to identify their demographics, preoperative angle of deviation, surgical procedure, success rate, and reoperation rate. A total of 11 patients with DHD were included (median patient age at surgery, 6 years; interquartile range [IQR], 5 to 10 years). Four patients (36.4%) had a history of infantile ET while three patients (27.3%) had a history of unilateral cataract surgery for congenital cataract. The median preoperative angle of DHD in the unilateral eye was 20 prism diopters (PD) (IQR, 15 to 25 PD). The median amount of LR recession was 8.0 mm (IQR, 7.5 to 8.0 mm). Three patients (27.3%) underwent simultaneous surgery for dissociated vertical deviation. At the final examination after a median follow-up period of 32 months (IQR, 24 to 58 months), 10 patients (91%) showed successful alignment. The long-term successful alignment rate after augmented LR recession for DHD was good; thus, application of this technique is appropriate in patients with DHD.


Assuntos
Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Estrabismo/diagnóstico , Resultado do Tratamento , Adulto Jovem
19.
Aesthetic Plast Surg ; 44(5): 1577-1583, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32458041

RESUMO

BACKGROUND: The aging process affects skin, muscle and fat of the eyes in a different manner. Their individual rejuvenation would require specific surgical treatment according to their particular demands during lower eyelid blepharoplasty. This would require the separate management of the skin and the muscle by separating them into two different flaps. Basing on the anatomy, during sub-ciliary myocutaneous incision in conventional lower eyelid transcutaneous blepharoplasty most of innervations of the lower orbicularis oculi muscle are transected and denervation sequelae at the pretarsal orbicularis oculi muscle would be expected. However, sub/ciliary approach is still popular. The absence of signs or symptom of denervation of in our large case series even though injury to the motor innervation of the orbicularis oculi muscle during the operation led the authors to investigate the discrepancy between the anatomical concept and clinical outcomes. The study aimed to investigate the residual functionality of the orbicularis oculi muscle after lower eyelid transcutaneous blepharoplasty according to Reidy Adamson-s flap. MATERIALS AND METHODS: Ten patients were enrolled in the study. Orbicularis oculi muscle functionality was investigated with electroneurography before and at least 6 months after the surgical procedure. Investigated parameters are: Compound Muscle Action Potential (CMAP) as expressions of quantity of activated muscular fibers by the electrical stimulation of the facial nerve. Pre- and post-op collected data were compared and statistically analyzed. RESULTS: The mean age was 52.9; minimum follow-up 6 months; twenty eyes were investigated; 1 patient was excluded. Postoperative data did not show any significant reduction in the CMAP at all. CONCLUSION: The study suggests that the buccal branch and medial branch of the zygomatic nerve of the facial nerve supplies efficiently to the orbicularis oculi innervation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Blefaroplastia , Pré-Escolar , Pálpebras/cirurgia , Músculos Faciais/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Transplante de Pele
20.
Am J Ophthalmol ; 217: 68-73, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360860

RESUMO

PURPOSE: Patients with idiopathic nystagmus syndrome often develop an abnormal head position. A horizontal face turn can be treated with the augmented Kestenbaum procedure, while patients with a chin up or chin down position can be treated with surgery on the vertical recti and/or oblique muscles. Although rare, some patients may have a head tilt with no face turn. We report 5 patients who underwent horizontal transposition of the vertical rectus muscles to correct a head tilt. DESIGN: Retrospective case series. METHODS: Five cases from 2 different tertiary referral eye centers and 3 different surgeons were reviewed and analyzed. Surgery for the patients consisted of either a 7-mm or full tendon-width transposition of the vertical rectus muscles of each eye to induce cyclotorsion in the direction of the head tilt. The presenting clinical histories, measurements, and surgical outcomes were reviewed. The primary outcome measure was correction of head tilt. RESULTS: Of 5 patients, 2 had previous horizontal face turns that were corrected with an augmented Kestenbaum procedure and later developed a head tilt, while 3 patients presented primarily with a head tilt. Age at surgery ranged from 5 to 8 years. Initial tilts were measured between 20-45°. Surgery was performed bilaterally except in 1 patient with history of morning glory disc anomaly and therefore transposition surgery was only performed on fixating eye for that patient. Postoperatively, 3 of 5 patients had near complete (0-5°) resolution of their tilt. One patient had a persistent 5-degree head tilt and a small chin up that was nullified with vertical prisms in spectacles. CONCLUSION: Transposition of the vertical rectus to induce cyclotorsion in the direction of the head tilt improves abnormal head titling in patients who have idiopathic nystagmus syndrome. This procedure was safely performed in patients with previous augmented Kestenbaum procedures with no incidence of anterior segment ischemia in our cases.


Assuntos
Movimentos da Cabeça/fisiologia , Cabeça/fisiopatologia , Nistagmo Patológico/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Postura/fisiologia , Acuidade Visual , Criança , Pré-Escolar , Feminino , Fixação Ocular , Humanos , Masculino , Nistagmo Patológico/fisiopatologia , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos , Síndrome , Resultado do Tratamento
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