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2.
Medicine (Baltimore) ; 98(37): e17163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517867

RESUMO

RATIONALE: Diplopia due to ocular motility disturbance is a common complication after glaucoma drainage device (GDD) surgery. The treatment options include prescription prism glasses, strabismus surgery or GDD removal. However, to the best of our knowledge, GDD size reduction surgery has not been reported. PATIENT CONCERNS AND DIAGNOSES: An 83-year-old woman diagnosed with primary open angle glaucoma was referred to Tsukazaki Hospital due to uncontrolled intraocular pressure (IOP) in December 2015. We performed an EXPRESS shunt surgery on both eyes in January 2016 and a needling procedure on the left eye in May 2017. Thereafter, because IOP in her left eye remained high, we performed Baerveldt 350-mm implantation in her inferotemporal area by placing the tube at the sulcus on December 3, 2017. The next day, 4Δ hypertropia (HT) was detected in the left eye in alternate cover testing in primary gaze, and diplopia in the inferotemporal direction was demonstrated. Although IOP was controlled well between 15 and 20 mmHg in her left eye, diplopia did not improve. INTERVENTIONS: Three weeks later, we performed a plate size reduction surgery for the Baerveldt 350-mm implant. In this procedure, we cut and removed the plates placed beneath the lateral rectus muscle and inferior rectus muscle, which were thought to be responsible for diplopia. OUTCOMES: Diplopia improved subjectively, but there was no drastic objective change. We prescribed prism glasses (3Δ base down for the left eye) for remaining mild diplopia. On January 21, 2019, significant objective improvement (2Δ HT with less ocular motor dysfunction demonstrated in the Hess chart) was finally observed. LESSONS: Early plate size reduction surgery, which was not immediately but ultimately effective in improving motor disturbance in our case, could be a potential option to relieve operation-induced motor disturbance. However, notably, tube shunt surgery has the risk of motility disturbances, which might require additional treatment.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto/cirurgia , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Idoso de 80 Anos ou mais , Feminino , Humanos
3.
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
4.
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
5.
Curr Opin Ophthalmol ; 30(5): 314-318, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313749

RESUMO

PURPOSE OF REVIEW: Congenital fibrosis of the extraocular muscles (CFEOM) is caused by abnormal development of the innervation of extraocular muscles. We update the recent literature regarding the clinical, anatomic, genetic, and molecular characteristics of CFEOM. Surgical considerations are addressed. RECENT FINDINGS: CFEOM is broken down into three main subtypes, CFEOM1, CFEOM2, and CFEOM3. Several recent reports of individuals, as well as family pedigrees, highlight the phenotypic heterogeneity of CFEOM. Intracranial and intraorbital radiologic findings have enhanced our understanding of the disease pathophysiology. Molecular genetics research has increased our understanding of the development of extraocular muscles and their innervation as well as pathophysiology of CFEOM. SUMMARY: Our understanding of the pathophysiology of CFEOM has increased with the recent contributions from neuroimaging, molecular genetics, and pedigree analysis. Surgical management of patients with CFEOM continues to be challenging.


Assuntos
Fibrose , Oftalmoplegia , Blefaroptose/fisiopatologia , Blefaroptose/cirurgia , Oftalmopatias Hereditárias/fisiopatologia , Oftalmopatias Hereditárias/cirurgia , Fibrose/classificação , Fibrose/fisiopatologia , Fibrose/cirurgia , Humanos , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/cirurgia , Oftalmoplegia/classificação , Oftalmoplegia/fisiopatologia , Oftalmoplegia/cirurgia , Fenótipo
6.
World Neurosurg ; 131: 197-199, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31299312

RESUMO

BACKGROUND: Superior oblique myokymia (SOM) is a rare disorder characterized by episodic microtremor of the eyeball. in patients with SOM, intermittent contraction of the superior oblique muscle causes irregular and rotatory eye movement, causing oscillopsia and diplopia. Microvascular decompression (MVD) of the trochlear nerve is potentially a definitive treatment method for SOM; however, owing to its rarity, this disorder is not well-known to neurosurgeons, and thus the optimal surgical approach has not yet been determined. CASE DESCRIPTION: A 77-year-old woman with left SOM had experienced oscillopsia for 2 years. MVD was performed via a left lateral superior cerebellar approach with the patient in the park-bench position. Her symptom resolved immediately after the surgery. CONCLUSIONS: We believe that MVD via a left lateral superior cerebellar approach can be safely performed to SOM in elderly patients like our patient. Therefore, MVD should be considered as the definitive treatment method for more patients with SOM.


Assuntos
Mioquimia/cirurgia , Transtornos da Motilidade Ocular/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Feminino , Humanos , Microtecnologia/métodos , Músculos Oculomotores , Procedimentos Cirúrgicos Vasculares/métodos
8.
Ophthalmic Plast Reconstr Surg ; 35(3): e69-e72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30908462

RESUMO

Inferior rectus avulsion following blunt trauma is rare, with even fewer reported cases of complete transection. The authors report a case of orbital floor fracture and inferior rectus muscle transection without herniation following blunt orbital trauma. This case first highlights the difficulty in diagnosing complete inferior rectus muscle transection clinically and with imaging and second that an acceptable functional outcome can be achieved by a novel surgical repair approach utilizing contiguous orbital anatomical relations of the inferior oblique and inferior rectus muscles.


Assuntos
Traumatismos Oculares/complicações , Transtornos da Motilidade Ocular/etiologia , Músculos Oculomotores/lesões , Procedimentos Cirúrgicos Oftalmológicos/métodos , Fraturas Orbitárias/complicações , Ferimentos não Penetrantes/complicações , Acidentes por Quedas , Idoso , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/cirurgia , Movimentos Oculares/fisiologia , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/cirurgia , Ruptura , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia
9.
Strabismus ; 27(1): 24-29, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30620235

RESUMO

PURPOSE: To report the surgical outcomes of the superior oblique tuck procedure in the management of superior oblique palsies performed at a single centre over a 25-year period. METHODS: A retrospective study of superior oblique tuck performed as a primary and secondary procedure by a single surgeon over a 25-year period between 1992 and 2016. We evaluated patient demographics, the angle of deviation pre- and post-surgery in prism dioptres (PD), amount of muscle tuck surgery performed (mm), complications (iatrogenic Brown's Syndrome) and improvement of diplopia post-operatively. RESULTS: 162 eyes from 162 patients were identified. Gender = 108 male patients (66.67%). Mean age at the time of surgery = 45.94 years; laterality = 85 left eyes (52.47%). 110 patients (67.90%) = congenital superior oblique palsy. Mean post-op follow-up time = 7.5 months. Mean pre-operative angle of deviation = 15.88 PD (range = 4-35 PD); mean post-operative angle of deviation = 5.09 PD (range = 0-20 PD; p < 0.0001). 157 patients (96.91%) displayed a reduction in angle of deviation post-operatively. Overall mean reduction in the angle of deviation = 10.79 PD (range = 0-34 PD). Mean amount of muscle tucking = 9.75 mm (range = 3-20 mm). 24 patients (14.82%) experienced post-operative iatrogenic Brown's syndrome but only two of these required further corrective surgery. 138 patients (85.19%) experienced improvement of diplopia post-operatively. Overall, 54 patients (33.33%) required additional extraocular muscle surgery to reduce diplopia further. CONCLUSIONS: This large series of superior oblique tuck procedures performed over a 25-year period, displays excellent surgical outcomes with regards to reduction of the angle of deviation, diplopia and limited complications.


Assuntos
Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Doenças do Nervo Troclear/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos , Estrabismo/etiologia , Estrabismo/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Doenças do Nervo Troclear/fisiopatologia , Doenças do Nervo Troclear/cirurgia , Adulto Jovem
10.
Br J Neurosurg ; 33(1): 37-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30450990

RESUMO

PURPOSE: Management of patients presenting for various nonspecific complaints without clear neurological abnormalities and with normal ventricular size remains highly controversial. We intended to share our rationale for surgical treatment of patients who show symptoms of transient increase of intracranial pressure owing to the presence of the cyst. MATERIALS AND METHODS: We have retrospectively analyzed 28 cases of patients who presented without Parinaud syndrome nor ventricular enlargement and underwent pineal cyst removal in our centre between 2007 and 2015. We analyzed patients' age, sex, symptoms, preoperative cyst size, perioperative course, treatment outcome and neurologic status at discharge and at follow-up visits 4 and 12 months afterwards. RESULTS: Main complaints included paroxysmal headaches, nausea, vomiting, visual disturbances, syncope and transient depression of consciousness. Mean age of patients was 31 years (17-55); there were 24 females and 4 males. Mean cyst diameter was 17 mm (10-26). Decision about surgical treament was based on signs of transient increases of intracranial pressure. All patients underwent complete cyst excision via midline suboccipital craniotomy and infratentorial supracerebellar route. Short-lasting perioperative neurological signs (notably upgaze palsy) were noted in 22 cases and uniformly resolved within the observation period of 12 months. CONCLUSION: Abnormal neurological findings and ventricular enlargement are not indispensable to justify surgical treatment of pineal cysts. Judicious selection of surgical candidates based predominantly on clinical grounds can lead to excellent operative results.


Assuntos
Neoplasias Encefálicas/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Transtornos da Motilidade Ocular/cirurgia , Glândula Pineal/cirurgia , Adolescente , Adulto , Neoplasias Encefálicas/patologia , Cistos do Sistema Nervoso Central/patologia , Craniotomia/métodos , Feminino , Transtornos da Cefaleia/etiologia , Transtornos da Cefaleia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/patologia , Seleção de Pacientes , Glândula Pineal/patologia , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral , Adulto Jovem
11.
Br J Ophthalmol ; 103(4): 523-526, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29858184

RESUMO

BACKGROUND: Trapdoor fracture is a special type of orbital blowout fracture. Although early surgery is recommended, there still remain some patients delayed by various reasons. In this study, we analysed the clinical characteristics of delayed paediatric patients, especially those with different levels of ocular motility restriction before surgery. METHODS: Thirty patients (3 to 14 years old) who underwent delayed surgery for trapdoor fractures between January 2008 and September 2016 were enrolled. Their demographics, causes of injury and delay, clinical features, imaging data and follow-up information were collected. RESULTS: Muscular entrapment was found in 17 patients (group A) and soft-tissue entrapment in 13 patients (group B). 12 (7 in group A) presented with severe motility restriction and 18 (10 in group A) with mild restriction before surgery. 41.7% with severe restriction recovered after surgery, compared with 83.3% with mild restriction. Four (23.7%) in group A (all with severe restriction) and six (46.2%) in group B (half with severe restriction) presented with persistent diplopia. CONCLUSIONS: Long recovery time and a high percentage of persistent diplopia are the main problems of delayed trapdoor fracture in children. A prompt surgery within 48 hours is strongly recommended in patients with muscular entrapment even if an urgent treatment is hard to achieve. So are patients with soft-tissue entrapment and significant motility restriction. In the other patients without such indications, even though some recovery might be possible in the long term, a prompt surgery right after diagnosis is still preferable regardless of the entrapped contents.


Assuntos
Diplopia/etiologia , Transtornos da Motilidade Ocular/etiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Fraturas Orbitárias/cirurgia , Tempo para o Tratamento/tendências , Adolescente , Criança , Pré-Escolar , Diplopia/cirurgia , Movimentos Oculares/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/lesões , Músculos Oculomotores/fisiopatologia , Fraturas Orbitárias/diagnóstico , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
J AAPOS ; 22(5): 361-365.e1, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30227248

RESUMO

PURPOSE: To introduce a modified method of anterior transposition of inferior oblique (ATIO) and compare with traditional method in terms of efficacy and complications. METHODS: The medical records of patients who had undergone unilateral ATIO and were followed for at least 6 months were reviewed retrospectively. The patients were divided into two groups according to the surgical method: modified ATIO (modified group, n = 16) and traditional ATIO (traditional group, n = 15). In modified ATIO, the anterior nasal fibers of the inferior oblique muscle were anchored to the sclera and the posterior temporal fibers were folded and buried under the fixed anterior nasal fiber of inferior oblique muscle. In the traditional method, both the anterior and posterior fibers were fixed with individual suturing. Postoperative change in vertical deviation and grade of inferior oblique overaction (IOOA) were analyzed. Complications, including antielevation syndrome, fat adherence syndrome, and lower lid deformity were assessed. RESULTS: Both modified and traditional methods effectively weakened the action of the inferior oblique muscle. The efficacy of the two methods did not differ in terms of change in vertical deviation (P = 0.225) and grade of IOOA (P = 0.169). Antielevation syndrome occurred more frequently in the traditional group than in the modified group (8/15 vs 2/16, resp. [P = 0.019]). Incidences of fat adherence syndrome (0/15 vs 0/16 [P = 1.0]) and lid deformity (3/15 vs 1/15 [P = 0.678]) were not different. CONCLUSIONS: Modified ATIO was comparable to traditional ATIO in correcting vertical deviation and IOOA and had a lower risk of antielevation syndrome compared with traditional ATIO.


Assuntos
Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Adolescente , Criança , Pré-Escolar , Movimentos Oculares/fisiologia , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Esclera/cirurgia
14.
Am J Ophthalmol ; 195: 171-175, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30098349

RESUMO

PURPOSE: To describe a phenomenon, depression in attempted abduction, not previously recognized as a feature of Duane syndrome (DS). DESIGN: Retrospective, observational case series. METHODS: Setting: Institutional practice. PATIENT POPULATION: Patients diagnosed with esotropic DS at Boston Children's Hospital from 2002 to 2015. Patients with clinical photographs documenting horizontal gaze were included. Patients with prior strabismus surgery were excluded. OBSERVATION PROCEDURES: Patients were classified into 3 groups according to their vertical eye position in attempted abduction: midline group, depression group, and elevation group. Group assignment was performed by 3 independent ophthalmologists. Baseline characteristics, eye movement, and ocular deviation were compared among the 3 groups. MAIN OUTCOME MEASURES: Horizontal and vertical deviation on attempted abduction in the DS eye. RESULTS: Depression in attempted abduction was present in 74 of 113 unilateral patients (66%) and 18 of 42 gradable eyes (43%) of bilateral patients. Abduction limitation was significantly less severe in the midline group (median: -3.0) than in the depression group (median: -4.0) (P = .01). Vertical deviation in attempted abduction was more severe in the elevation group than in the depression group (P = .003). CONCLUSIONS: Depression of the eye in attempted abduction has not been widely described, yet it is present in the majority of DS patients. It is more likely to occur with more severe abduction limitation. This phenomenon is likely another form of dysinnervation in DS, the result either of anomalous vertical rectus muscle activation or asymmetric lateral rectus muscle innervation during attempted abduction. Awareness of vertical deviation in attempted abduction may facilitate surgical planning in affected patients.


Assuntos
Síndrome da Retração Ocular/diagnóstico , Esotropia/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Técnicas de Diagnóstico Oftalmológico , Síndrome da Retração Ocular/cirurgia , Esotropia/cirurgia , Movimentos Oculares , Feminino , Humanos , Lactente , Masculino , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Visão Binocular/fisiologia , Acuidade Visual
15.
Strabismus ; 26(3): 111-117, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29889586

RESUMO

Convergence excess esotropia describes a heterophoria with binocular single vision (BSV) on distance viewing that becomes esotropic on accommodation upon near fixation. Prism adaptation test (PAT) is a procedure routinely used to reveal the maximum angle of deviation preoperatively for many types of strabismus and has been shown to improve surgical outcomes; however, it is not conventionally used for convergence excess esotropia. AIM: This study compares the angle of deviation at 1/3 m and 6 m before and after prism adaptation in subjects with convergence excess esotropia to determine if a masked distance angle of deviation can be demonstrated similar to the masked near angle of deviation in some intermittent exotropes. Surgical results are reported. RESULTS: Fifty-eight children with convergence excess esotropia were prescribed prism adaptation prior to strabismus surgery and 49 met the inclusion criteria. A median increase in the angle of deviation of 20 prism dioptres (PD) was seen at both 1/3 m and 6 m following PAT. These changes were statistically significant (p < 0.001) at both distances. Following one surgical procedure, 83.6% were fully binocular postoperatively. CONCLUSION: Prism adaptation frequently reveals an otherwise masked large distance angle of deviation in convergence excess esotropia. Convergence excess esotropia can be subdivided into two categories: true and simulated. Those with true convergence excess exhibit a manifest convergent strabismus when viewing a close object and a small, well-controlled latent strabismus upon fixation of a distant object. Those with simulated convergence excess have a comparable near deviation to those with true convergence excess but can be shown to have a distance deviation that approaches the size of the near strabismus once the normal fusional mechanisms are disrupted by a period of prism adaptation.


Assuntos
Adaptação Ocular/fisiologia , Esotropia/fisiopatologia , Óculos , Transtornos da Motilidade Ocular/fisiopatologia , Acomodação Ocular/fisiologia , Criança , Pré-Escolar , Esotropia/cirurgia , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/cirurgia , Período Pós-Operatório , Visão Binocular/fisiologia
16.
Strabismus ; 26(2): 84-89, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29494263

RESUMO

PURPOSE: The purpose of this study is to investigate clinical and histopathologic features of consecutive exotropia. METHODS: Thirty patients with consecutive exotropia and negative forced duction testing underwent unilateral medial rectus resection and advancement. Abnormal scleral attachment (appearance of stretched scar or slipped muscle) was documented and compared with histopathology results. The term "stretched scar" is used when tendon-like scar appears between muscle fibers and scleral attachment. The term "slipped muscle" is used when a thin capsule is attached to the sclera and the muscle fibers retracted posteriorly in the capsule. Histopathologic results of resected medial rectus muscles of 11 control patients were compared with cases of consecutive exotropia. Surgical success was defined as <10 PD deviation at both distance and near, 6 months after the surgery. Dose-response and risk factors for abnormal scleral attachment were also evaluated. RESULTS: Forty percent of the cases had abnormal scleral attachment. Nineteen patients (63%) showed successful results. The mean dose-responses were for near 4.7 and for distance 4.2 prism diopters per millimeters of resection plus advancement. Preoperative medial rectus underaction was a risk factor for abnormal scleral attachment. The mean muscle percentage in pathology was 10 ± 18.7 in patients with abnormal scleral attachment, 28.3 ± 27.9 in other consecutive exotropia patients, and 26.5 ± 30.6 in 11 control eyes. CONCLUSION: This study showed surgical success of 63% with one-muscle surgery in consecutive exotropia. Calculated dose-responses could be helpful in surgical planning. In the cases with preoperative medial rectus underaction, risk of abnormal scleral attachment is increased.


Assuntos
Exotropia/diagnóstico , Músculos Oculomotores/patologia , Exotropia/cirurgia , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Fatores de Risco , Tendões/cirurgia , Adulto Jovem
18.
Korean J Ophthalmol ; 32(2): 134-139, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29560617

RESUMO

PURPOSE: To analyze stereopsis change before and after inferior oblique weakening surgery. METHODS: We retrospectively reviewed the medical records of 31 patients who had undergone inferior oblique weakening surgery. The factors analyzed included sex, age at surgery, preoperative and postoperative visual acuity (VA), time from first detection to surgery, degree of inferior oblique overaction (IOOA), primary/secondary IOOA, exotropia/hypertropia, bilaterality, and type of surgery. RESULTS: Eighteen patients with a mean age 7.3 ± 3.1 years exhibited stereopsis of 60 arc seconds or better before surgery and 17 had stereopsis better than 60 arc seconds after surgery. Postoperatively, stereopsis improved in 13 patients and deteriorated in 9. Better preoperative VA and the absence of superior oblique underaction were associated with better preoperative stereopsis. Better preoperative VA, postoperative VA, and the presence of head tilt were associated with better postoperative stereopsis. Unilateral inferior oblique weakening surgery and accompanying hypertropia were associated with improved stereopsis, while the absence of hypertropia was associated with deteriorated stereopsis. CONCLUSIONS: In this retrospective study, 58.1% of patients tended to have bifoveal fixation. When a vertical deviation is present in the primary position due to unilateral IOOA, IO weakening surgery can be expected to improve binocular function.


Assuntos
Percepção de Profundidade/fisiologia , Exotropia/cirurgia , Miotomia , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adolescente , Criança , Pré-Escolar , Exotropia/fisiopatologia , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Acuidade Visual/fisiologia
19.
Br J Ophthalmol ; 102(6): 715-717, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29567790

RESUMO

Management options in third nerve palsy are limited as four of the six extraocular muscles are involved. Surgery has to be tailored on a case-to-case basis. Aim of this retrospective case series is to report 1-year outcomes of a modified surgical technique entailing full tendon transposition of lateral rectus to medial rectus augmented with posterior fixation sutures in four patients with complete third nerve palsy. All four cases showed significant improvement of vertical and horizontal deviation with long-term stability of correction. Choice of route of full tendon augmented transposition of lateral rectus to medial rectus can aid in achieving good correction of the vertical misalignment in addition to horizontal correction.


Assuntos
Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Técnicas de Sutura , Transferência Tendinosa/métodos , Adolescente , Adulto , Criança , Síndrome da Retração Ocular/cirurgia , Esotropia/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Suturas , Resultado do Tratamento
20.
Eye (Lond) ; 32(4): 693-700, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29271419

RESUMO

PurposeTo determine the outcomes of three different techniques of strabismus surgery in patients with convergence insufficiency intermittent exotropia (CI-X(T)).Patients and methodsSixty-seven patients with CI-X(T) with near-distance disparity (NDD) ≥10 prism diopter (PD) were included in this 1-year follow-up prospective study and were randomly divided into three groups: slanted bilateral LR recession (S-BLR) group in which 22 patients underwent bilateral slanting recession of the lateral rectus (LR) muscle, the I-RR group with 23 patients who underwent improved unilateral medial rectus (MR) resection and LR recession with the amounts of resection and recession biased to near and distance deviation, respectively, and the A-BLR group with 22 patients who underwent bilateral augmented LR recession based on the near deviation. A successful outcome at distant and near was defined as exodeviation between 10 PD of exophoria/tropia and 5 PD of esophoria/tropia. Cumulative probabilities of success, preoperative and postoperative distant, near deviations, and NDD among groups were analyzed and compared.ResultsThe success rate of distant exodeviation, near exodeviation, and NDD in the three groups after 1 year was statistically insignificant (P=0.054, 0.233, and 0.142, respectively). At the 1 year follow-up, vertical pattern strabismus (V and A patterns) was a feature of the S-BLR group, whereas the rate of postoperative overcorrection and undercorrection was significant in the A-BLR and I-RR groups, respectively.ConclusionThe success rate of correction of distant exodeviation, near exodeviation, and NDD was statistically indifferent among the three groups. However, each procedure has its specific postoperative concerns, which should be considered before implementing in patients with CI-X(T).


Assuntos
Exotropia/cirurgia , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Convergência Ocular/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Estrabismo/cirurgia , Visão Binocular/fisiologia , Acuidade Visual , Adulto Jovem
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