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1.
J Pediatr Ophthalmol Strabismus ; 58(4): 224-231, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288760

RESUMO

PURPOSE: To subjectively evaluate the degree of visual fatigue in children attending online classes during the coronavirus 2019 (COVID-19) pandemic and objectively evaluate accommodation and vergence dysfunction in these children. METHODS: Children aged between 10 and 17 years with recent onset of asthenopia symptoms were included. Symptoms were evaluated using the Convergence Insufficiency Symptom Survey (CISS) questionnaire. A CISS score of 16 or greater was considered symptomatic. Binocular vergence and accommodation parameters were objectively evaluated. For ease of comparison, children were divided into two groups: children using digital devices for less than 4 hours/day and children using digital devices for 4 hours/day or more. RESULTS: A total of 46 children with a mean age of 14.47 ± 1.95 years were evaluated. The mean duration of online classes during the COVID-19 pandemic was 3.08 ± 1.68 hours/day, which is higher than before the COVID-19 pandemic (0.58 ± 0.71 hours/day, P < .00001). The mean CISS scores were 21.73 ± 12.81 for children using digital devices less than 4 hours/day and 30.34 ± 13.0 for children using digital devices for 4 hours/day or more (P = .019). Mean near exophoria (P = .03), negative fusional vergence (P = .02), negative relative accommodation (P = .057), and accommodation amplitude (P = .002) were different between the two groups. The Spearman correlation between the symptomatic CISS score and the duration of online classes showed a linear association (coefficient rs = 0.39; P = .007). In the multivariate analysis, only the duration of online classes longer than 4 hours was a significant risk factor (P = .07) for the symptomatic CISS score. CONCLUSIONS: Online classes longer than 4 hours were more detrimental to abnormal binocular vergence and accommodation parameters than online classes shorter than 4 hours. [J Pediatr Ophthalmol Strabismus. 2021;58(4):224-231.].


Assuntos
Acomodação Ocular/fisiologia , COVID-19/epidemiologia , Convergência Ocular/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Pandemias , Visão Binocular/fisiologia , Adolescente , Criança , Comorbidade , Feminino , Humanos , Masculino , SARS-CoV-2 , Inquéritos e Questionários
2.
Arq. bras. oftalmol ; 84(2): 133-139, Mar,-Apr. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1153127

RESUMO

ABSTRACT Purpose: This study was conducted to further define the specific clinical characteristics of patients with Brown syndrome and evaluate the outcomes of superior oblique tenotomy in its surgical management. Methods: A retrospective analysis of the medical charts of 45 patients with Brown syndrome was performed, which revealed that 11 patients underwent superior oblique tenotomy due to abnormal head posture and/or hypotropia and 1 patient underwent bilateral superior oblique tendon elongation with a silicone band due to abnormal head posture. In the last patient, silicone bands were removed at the postoperative 3rd month due to the lack of improvement in the abnormal head posture and the limitation of elevation in adduction. Simultaneous horizontal rectus muscle surgery was performed in four patients. Results: There was a predominance of female gender, right eye, congenital form, unilaterality, A-pattern, and an abnormal head posture type with a combination of chin up and head tilting. Bilateral form was observed only in female patients. Amblyopia was detected in two patients. Among patients aged >5 years, 40% had reduced stereopsis. Abnormal head posture was found in 60% of patients. More than half of them were diagnosed with a vertical and/or horizontal deviation. Tenotomy procedure eliminated the abnormal head posture in all patients and significantly improved the mean limitation of elevation in adduction and hypotropia (p=0.001, p=0.012). Two patients developed inferior oblique overaction in the operated eye. There was complete spontaneous resolution in two patients. Conclusions: The clinical features of patients with Brown syndrome in our study are considerably consistent with those of previous reports. The present study demonstrated the effectiveness of superior oblique tenotomy with less overcorrection in the surgical treatment of Brown syndrome.(AU)


RESUMO Objetivo: Definir mais detalhadamente as características clínicas específicas de pacientes com síndrome de Brown e avaliar os resultados da tenectomia do músculo oblíquo superior no manejo cirúrgico da síndrome de Brown. Métodos: Prontuários de 45 pacientes com síndrome de Brown foram analisados retrospectivamente. Onze pacientes submetidos à tenectomia do músculo oblíquo superior devido a postura anormal da cabeça ou a hipotropia e um paciente submetido ao alongamento bilateral do tendão do oblíquo superior com uma faixa de silicone devido a postura anormal da cabeça. Neste último paciente, a faixa de silicone foi removida no terceiro mês pós-operatório devido à ausência de melhora na postura anormal da cabeça e à limitação da elevação em adução. Quatro pacientes submeteram-se simultaneamente à cirurgia do músculo reto horizontal. Resultados: Houve predominância de sexo feminino, olho direito, forma congênita, acometimento unilateral, padrão em "A" e um tipo de postura anormal da cabeça combinando queixo elevado e inclinação da cabeça. A forma bilateral foi vista apenas em pacientes do sexo feminino. Foi constatada ambliopia em 2 pacientes. Dentre os pacientes acima de 5 anos de idade, 40% tinham estereopsia reduzida. Postura anormal da cabeça estava presente em 60% dos pacientes. Mais da metade dos pacientes foi diagnosticada com um desvio vertical, horizontal ou ambos. O procedimento de tenectomia eliminou a postura anormal da cabeça em todos os pacientes e melhorou significativamente a limitação média da elevação em adução e a hipotropia (p=0,001 e p=0,012). Dois pacientes desenvolveram hiperação do músculo oblíquo inferior no olho operado. Resolução completa ocorreu espontaneamente em 2 pacientes. Conclusões: O quadro clínico dos pacientes com síndrome de Brown no nosso estudo é bastante consistente com os relatos iniciais na literatura. Este estudo mostrou a eficácia da tenectomia do oblíquo superior, com menor hipercorreção no tratamento cirúrgico da síndrome de Brown.(AU)


Assuntos
Humanos , Tendões/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Ambliopia/diagnóstico , Estudos Retrospectivos
3.
Optom Vis Sci ; 98(3): 222-233, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33771952

RESUMO

SIGNIFICANCE: The results of this study suggest that clinicians providing vergence/accommodative therapy for convergence insufficiency in children should not suggest that such treatment will lead to improvements in attention when compared with placebo treatment. PURPOSE: This study aimed to compare the effects of 16 weeks of vergence/accommodative therapy and placebo therapy on changes in attention for children in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial. METHODS: Three hundred ten children 9 to 14 years old with convergence insufficiency were assigned to receive treatment with office-based vergence/accommodative therapy or placebo therapy. Attention tests were administered at baseline and after 16 weeks of treatment. The primary measure of attention was the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior (SWAN) scale. Other measures included the Swanson, Nolan, and Pelham checklist; the Homework Problems Checklist; and the d2 Test of Attention. Within and between-group differences are reported using Cohen d effect sizes. RESULTS: For the SWAN, there was no significant difference between the groups for the inattention scale parental report (d = 0.036; 95% confidence interval, -0.21 to 0.28) or for the hyperactivity impulsivity scale parental report (d = -0.003; 95% confidence interval, -0.24 to 0.24). Similar results were found for teacher reports and the secondary measures (d estimates from -0.97 to +0.10). There were, however, large within-group changes with d ≥ 1 in both treatment groups for the SWAN, the Homework Problems Checklist, and the d2 Test of Attention. CONCLUSIONS: These results suggest that vergence/accommodative therapy is no better than placebo therapy in improving attention. Large improvements in inattention, completing homework, and selective and sustained attention were found in each group. However, these improvements cannot be attributed to improvements in vergence and accommodation and are likely due to nonspecific effects of an intensive therapy regimen.


Assuntos
Acomodação Ocular/fisiologia , Atenção/fisiologia , Convergência Ocular/fisiologia , Transtornos da Motilidade Ocular/terapia , Ortóptica/métodos , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Criança , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Leitura
4.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526531

RESUMO

This report describes two patients with acute-onset ptosis, oculomotor dysfunction, ataxia and drowsiness, referable to the midbrain tegmentum. Both patients had previously suffered severe closed head injuries requiring craniotomy for cerebral decompression. Serial brain scans in both cases revealed a newly developing cleft in the midbrain, with features suggestive of abnormal cerebrospinal fluid (CSF) flow across the aqueduct. A trial of acetazolamide was initiated to reduce CSF production, followed by a third ventriculostomy for CSF diversion in one patient, which resulted in arrested disease progression and partial recovery. There are only two previous reports in the literature of midbrain clefts that developed as remote sequelae of head trauma. We postulate that altered CSF flow dynamics in the aqueduct, possibly related to changes in brain compliance, may be contributory. Early recognition and treatment may prevent irreversible structural injury and possible death.


Assuntos
Encefalopatias/diagnóstico por imagem , Lesões Encefálicas Difusas/diagnóstico por imagem , Aqueduto do Mesencéfalo/diagnóstico por imagem , Craniectomia Descompressiva , Traumatismos Cranianos Fechados/cirurgia , Mesencéfalo/diagnóstico por imagem , Acetazolamida/uso terapêutico , Ataxia/fisiopatologia , Blefaroptose , Encefalopatias/fisiopatologia , Encefalopatias/terapia , Lesões Encefálicas Difusas/fisiopatologia , Inibidores da Anidrase Carbônica/uso terapêutico , Líquido Cefalorraquidiano , Progressão da Doença , Disartria/fisiopatologia , Humanos , Hidrodinâmica , Imageamento por Ressonância Magnética , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Ventriculostomia , Adulto Jovem
5.
Optom Vis Sci ; 98(1): 32-40, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394929

RESUMO

SIGNIFICANCE: Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic convergence insufficiency. PURPOSE: This study aimed to determine whether NFV is normal in untreated children with symptomatic convergence insufficiency and whether NFV improves after vergence/accommodative therapy. METHODS: This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic convergence insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies. RESULTS: At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P < .001) than normative values. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). Mean pre-therapy responses to 4° disparity divergence step stimuli were worse in the convergence insufficiency group compared with the NBV group for peak velocity (P < .001), time to peak velocity (P = .01), and response amplitude (P < .001). After therapy, the convergence insufficiency group showed statistically significant improvements in mean peak velocity (11.63°/s; 95% confidence interval [CI], 6.6 to 16.62°/s), time to peak velocity (-0.12 seconds; 95% CI, -0.19 to -0.05 seconds), and response amplitude (1.47°; 95% CI, 0.83 to 2.11°), with measures no longer statistically different from the NBV cohort (P > .05). CONCLUSIONS: Despite clinical NFV measurements that seem greater than normal, children with symptomatic convergence insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.


Assuntos
Convergência Ocular/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Acomodação Ocular/fisiologia , Adolescente , Biometria , Criança , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/terapia , Ortóptica , Visão Binocular/fisiologia
7.
J Stroke Cerebrovasc Dis ; 30(3): 105518, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33388631

RESUMO

OBJECTIVES: The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile. MATERIALS AND METHODS: This retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs ("Gaze deviation and Paresis Score, GPS") for the pre-hospital prediction of ELVO. RESULTS: A positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75-56.53). The positive Likelihood-ratio (LR+) was 29.67, the negative Likelihood ratio (LR-) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001). CONCLUSIONS: The GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.


Assuntos
Avaliação da Deficiência , Serviços Médicos de Emergência , Fixação Ocular , AVC Isquêmico/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Paresia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Procedimentos Endovasculares , Feminino , Humanos , AVC Isquêmico/etiologia , AVC Isquêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Triagem
8.
Br J Ophthalmol ; 105(1): 37-41, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32188680

RESUMO

BACKGROUND: Stereoacuity relies on accurate binocular alignment. Convergence insufficiency (CI) a binocular motor disorder, interferes with near work. OBJECTIVE: To investigate the association between convergence amplitude (CA) and stereoacuity in a large paediatric cohort. METHODS: Retrospective chart review included patients aged 6-17 years; excluded patients with amblyopia, manifest strabismus or visual acuity <20/30 in either eye. Stereoacuity, measured by Randot test was defined as normal (≤40arcsec), subnormal (50-400arcsec) and poor (>400 arcsec). CA, measured using base out prism bar was defined by fusion break point (BP) and recovery point (RP), as none (BP=0), poor (BP <20 prism diopter (PD)), borderline (BP <30 PD or RP <20 PD), good (BP ≥30 PD and RP ≥20 PD) and excellent (does not break at 40PD). RESULTS: In 2200 subjects included, we found an increased prevalence of normal stereoacuity as convergence ability improves (χ2 test, p<0.001) with a negative correlation between stereoacuity and BP (Pearson correlation -0.13, p<0.001).CI was significantly associated with below normal stereopsis OR 1.86 (95% CI 1.3 to 2.7, p<0.001). Conversely, prevalence of CI was similar, whether or not CI-symptoms were reported. Follow-up data of at least 2.5 years from presentation was available for a small subgroup of 21 patients treated for CI. Convergence improved in 14 (66%), rate of normal stereoacuity increased from 29% at baseline to 76% at last follow-up (p=0.006). CONCLUSIONS: CA affects stereoacuity function in children. Evaluation of CA is required in all cases with poor stereoacuity, especially when other etiologies are amiss. The role of convergence improvement exercise on stereoacuity warrants further investigation.


Assuntos
Percepção de Profundidade/fisiologia , Transtornos da Motilidade Ocular/diagnóstico , Acuidade Visual/fisiologia , Adolescente , Criança , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Estudos Retrospectivos , Testes Visuais , Visão Binocular/fisiologia
9.
Eur J Ophthalmol ; 31(1): 263-270, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31690103

RESUMO

PURPOSE: To analyze the anatomical and functional ophthalmic parameters after the surgical removal of various intraorbital foreign bodies. METHODS: A retrospective analysis of medical records was performed featuring detailed history, ophthalmic examination, orbital computed tomographic scans, treatment details, and outcomes. The analyzed anatomical factors included extraocular movements, the position of the eyeball (proptosis, dystopia, and enophthalmos), and fullness of orbital sulci. The functional assessment was based on visual acuity, pupillary reactions, and diplopia. The outcomes were defined as complete, partial, and failure after a minimum follow-up of 1 year. RESULTS: Of 32 patients, the organic and inorganic intraorbital foreign bodies were surgically removed from 18 (56.25%) and 14 (43.75%) orbits, respectively. At presentation, anatomically the extraocular movement restriction, proptosis/dystopia/enophthalmos, and orbital sulcus fullness were noted in 26 (81.25%), 24 (75%), and 15 (46.88%), respectively. Functionally, diminished visual acuity, diplopia, and pupil abnormalities were seen in 27 (84.38%), 14 (43.75%), and 8 (25%), respectively. After intraorbital foreign body removal at a mean follow-up of 14 months, the improvement of anatomical factors (same sequence) were observed in 8 (30.77%), 20 (83.33%), and 12 (80%), respectively. In functional factors (same sequence), the improvement was noted in none (0%), 13 (92.86%), and 5 (62.5%), respectively. Hence, the majority of patients (n = 20, 62.5%) achieved partial success, while 8 (25%) had complete success. Four (12.5%) had treatment failure despite similar management protocols. CONCLUSION: The anatomical outcomes are better than the functional outcomes after surgical removal of the intraorbital foreign bodies. The visual acuity does not improve considerably after the surgical removal of intraorbital foreign bodies. Overall, the wooden intraorbital foreign bodies have poorer anatomical and functional prognosis.


Assuntos
Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/cirurgia , Órbita/lesões , Adolescente , Adulto , Criança , Pré-Escolar , Exoftalmia/fisiopatologia , Corpos Estranhos no Olho/diagnóstico por imagem , Corpos Estranhos no Olho/fisiopatologia , Ferimentos Oculares Penetrantes/diagnóstico por imagem , Ferimentos Oculares Penetrantes/fisiopatologia , Movimentos Oculares/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos , Órbita/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Acuidade Visual/fisiologia , Adulto Jovem
10.
Optom Vis Sci ; 97(12): 1018-1022, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33252541

RESUMO

SIGNIFICANCE: Ocular tilt reaction (OTR) is an abnormal eye-head postural reaction that consists of skew deviation, head tilt, and bilateral ocular torsion. Understanding of the pathway of the vestibulo-ocular reflex (VOR) is essential because this will help to localize the pathology. PURPOSE: The aim of this study was to report a case of OTR with contralateral internuclear ophthalmoplegia (INO) and fifth and seventh cranial nerve palsies. CASE REPORT: A 51-year-old gentleman with underlying diabetes mellitus presented with sudden onset of diplopia for 3 days. On examination, his visual acuity was 20/30 bilaterally without a relative afferent pupillary defect. He had a right OTR consisting of a right head tilt, a skew deviation with a left eye hypertropia, and bilateral ocular torsion (right excyclotorsion and left incyclotorsion) with nystagmus. He also had a left adduction deficit and right abduction nystagmus consistent with a left INO. Ocular examination revealed evidence of proliferative diabetic retinopathy bilaterally. Two days after the initial presentation, the patient developed left seventh and fifth cranial nerve palsies. MRI showed left pontine infarction and multiple chronic lacunar infarctions. There was an incidental finding of a vascular loop compression on cisternal portions of the left trigeminal, facial, and vestibulocochlear nerves. Antiplatelet treatment was started on top of a better diabetic control. The diplopia was gradually resolved with improved clinical signs. In this case, the left pontine infarction had likely affected the terminal decussated part of the vestibulocochlear nerve from the right VOR pathway, medial longitudinal fasciculus, and cranial nerve nuclei in the left pons. CONCLUSIONS: The OTR can be ipsilateral to the lesion if the lesion is before the decussation of the VOR pathway in the pons, or it can be contralateral to the lesion if the lesion is after the decussation. In case of an OTR that is associated with contralateral INO and other contralateral cranial nerves palsy, a pathology in the pons that is contralateral to the OTR should be considered. Neuroimaging study can hence be targeted to identify the possible cause.


Assuntos
Infartos do Tronco Encefálico/complicações , Doenças do Nervo Facial/etiologia , Cabeça , Transtornos da Motilidade Ocular/etiologia , Postura , Anormalidade Torcional/etiologia , Doenças do Nervo Trigêmeo/etiologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Clopidogrel/uso terapêutico , Diplopia/diagnóstico , Diplopia/etiologia , Diplopia/fisiopatologia , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/fisiopatologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/fisiopatologia , Inibidores da Agregação Plaquetária/uso terapêutico , Reflexo Vestíbulo-Ocular/fisiologia , Estrabismo/diagnóstico , Estrabismo/etiologia , Estrabismo/fisiopatologia , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/fisiopatologia , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/fisiopatologia , Acuidade Visual/fisiologia
11.
Optom Vis Sci ; 97(12): 1061-1069, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33186192

RESUMO

SIGNIFICANCE: These data confirm the effectiveness of office-based vergence/accommodative therapy for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency within a double-masked longitudinal randomized clinical trial. PURPOSE: This study aimed to report changes in clinical signs and symptoms of convergence insufficiency from a randomized clinical trial evaluating the effectiveness of office-based vergence/accommodative therapy for young adults with symptomatic convergence insufficiency. METHODS: In this double-masked, randomized clinical trial, convergence insufficiency patients (n = 50; average age, 21 ± 3 years; range, 18 to 32 years) were randomized to either office-based vergence/accommodative therapy or office-based placebo therapy. Improvements in (1) near point of convergence, (2) positive fusional vergence, and (3) self-reported symptoms (Convergence Insufficiency Symptom Survey [CISS] score) were evaluated after twelve 1-hour sessions of treatment within the office comparing the results from the vergence/accommodative therapy and the placebo therapy groups. RESULTS: The mean near point of convergence improved by 6.0 and 3.1 cm in the vergence/accommodative and placebo therapy groups, respectively (mean difference of -2.9 cm; 95% confidence interval [CI], -4.6 to -1.0 cm; P < .01). The mean positive fusional vergence increased by 17.3 and 7.4Δ in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 9.9Δ; 95% CI, 4.9 to 16.0Δ; P < .001). The mean CISS score improved by 12.4 and 10.1 points in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 2.3 points; 95% CI, -8.3 to +4.6 points; P = .56). CONCLUSIONS: Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency. However, given that both treatment groups had a similar reduction in self-reported symptoms, we recommend that the CISS be revised if it is to be used as an outcome measure in future studies of convergence insufficiency.


Assuntos
Acomodação Ocular/fisiologia , Convergência Ocular/fisiologia , Transtornos da Motilidade Ocular/terapia , Ortóptica/métodos , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Autorrelato , Inquéritos e Questionários , Visão Binocular/fisiologia , Adulto Jovem
13.
J Stroke Cerebrovasc Dis ; 29(11): 105139, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066880
14.
Invest Ophthalmol Vis Sci ; 61(10): 21, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32780865

RESUMO

Purpose: We compared the adaptive capacities of reflexive fusional convergence and divergence in 10 participants with untreated convergence insufficiency (CI) to 10 age-matched binocularly normal controls (BNCs) in an effort to elucidate the functional basis of CI. Methods: Vergence responses were monitored binocularly at 250 Hz using video-based infrared oculography, while single and double-step disparity stimuli were viewed dichoptically. The double-step stimuli were designed to induce an adaptive increase in the convergence or divergence reflexive fusional response dynamics. Results: As expected, convergence responses in the CI population were significantly slower at baseline (BNC 12.0 ± 1.8°/s vs. CI 7.4 ± 2.5°/s; P < 0.001), but divergence response velocities were similar between groups (P = 0.38). Critically, we observed an impaired adaptive change in convergence peak velocities in the CI group when compared to BNCs (-18.2% ± 27.3% vs. 25.4% ± 9.8%; P < 0.001). Adaptive changes in reflexive fusional divergence responses were similar between groups (P > 0.5) and significantly less robust when compared to BNC convergence. Conclusions: The results support the hypothesis that the adaptive capacities of vergence are related to the strength of the underlying reflexive fusional response. Combined, the evidence suggests that the clinical condition of convergence insufficiency is underpinned by an underdeveloped or perturbated reflexive fusional vergence response mechanism. We relate these observations to different clinical guidelines for the management and treatment of this condition.


Assuntos
Convergência Ocular/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Adaptação Fisiológica/fisiologia , Adulto , Estudos de Casos e Controles , Eletroculografia/métodos , Humanos , Estimulação Luminosa , Adulto Jovem
15.
Biomed Res Int ; 2020: 4723402, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802847

RESUMO

Background: The professional Quality of Life Scale (QLS) can provide a valuable reference for the diagnosis of visual function anomalies. In the present study, we aimed to design a novel QLS to specially quantify the life quality of schoolchildren with nonstrabismic binocular vision anomalies (NSBVAs) in China. Methods: The novel QLS, named QOL-CVF20, was established based on classical vision-related scales and the administration of the questionnaire to 116 schoolchildren with NSBVAs and 100 healthy schoolchildren in China. The diagnostic reference value between QOL-CVF20 and VF-14 was evaluated on the questionnaires to 240 schoolchildren with NSBVAs and 238 healthy schoolchildren. Results: All the subjects could complete the QOL-CVF20 questionnaires independently. QOL-CVF20 had good structural validity, content validity, and discriminant validity, when it was applied in Chinese schoolchildren. The average score of the NSBVA group was significantly lower than that of the control group (49.0 ± 6.9 vs. 69.7 ± 6.7, respectively; P < 0.01). Moreover, the average score of cured NSBVA schoolchildren after treatment (61.8 ± 22.6) was significantly improved (P < 0.01). Receiver operating characteristic curve analysis showed that QOL-CVF20 reflected strong separation between the NSBVA and healthy groups (AUC = 0.901). Meanwhile, QOL-CVF20 could detect individuals with NSBVAs with specificity of 0.847 and sensitivity of 0.846. The critical value of 58.50 in QOL-CVF20 could be effectively applied for quality of life assessment in schoolchildren with NSBVAs. Conclusions: QOL-CVF20 could quantify the life quality of schoolchildren with NSBVAs and might be served as a valuable reference for early diagnosis and clinical evaluation of NSBVAs.


Assuntos
Transtornos da Motilidade Ocular , Qualidade de Vida , Inquéritos e Questionários , Visão Binocular , Criança , China , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/fisiopatologia
16.
Epileptic Disord ; 22(3): 281-290, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32554361

RESUMO

Jeavons syndrome (JS) is mainly characterized by eyelid myoclonia with or without absences. It is thought to be underdiagnosed rather than have a rare prevalence. We aimed to investigate the electroclinical features of JS to determine possible factors influencing the diagnosis. We retrospectively identified the medical records of 32 cases (0.55%) from 5,796 patients with epilepsy. The inclusion criteria were: (1) eyelid myoclonia with or without absences; (2) generalized paroxysmal activity on EEG; and (3) discharges triggered by eyelid closure and/or intermittent photic stimulation. Eighteen (56.2%) of the patients were female. The mean age at seizure onset was 8.7±5.3 years and the mean age at admission to hospital was 17.8±10.7 years. A family history of epilepsy was present in 15 (46.8%) patients. Eyelid myoclonias were noticed in six (18.7%) patients by themselves. Based on the analysis of video-EEG recordings, 26 (81.2%) patients were sensitive to eye closure, 22 (68.7%) had photoparoxysmal responses, and 16 (50%) presented with absence seizures. Ten (31.2%) patients had focal epileptic discharges. Eight (25%) patients were on monotherapy. Seven (21.8%) patients achieved seizure freedom. Three patients underwent ketogenic diet therapy, which was effective in two patients. A vagus nerve stimulator was implanted into three patients, one of whom reported seizure reduction. Eyelid myoclonias are the main seizure type of JS but are usually overlooked. The time interval between seizure onset and clinical diagnosis suggests that this syndrome continues to be under-recognized. The genetic heterogeneity and phenotypic variability are likely to be more extensive than currently recognized, making the diagnosis more phalangine. [Published with video sequence].


Assuntos
Epilepsia Tipo Ausência/fisiopatologia , Mioclonia/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Eletroencefalografia , Epilepsia Tipo Ausência/etiologia , Feminino , Humanos , Masculino , Estimulação Luminosa , Estudos Retrospectivos , Síndrome , Adulto Jovem
17.
Sci Rep ; 10(1): 7261, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32350350

RESUMO

The aim of this prospective study was to compare surgical outcomes of slanted bilateral lateral rectus (LR) recession for intermittent exotropia (IXT) with convergence insufficiency (CI) according to their response to preoperative monocular occlusion. This prospective study included 55 children who underwent slanted bilateral LR recession for IXT with CI. Patients were divided into two groups according to their response to preoperative monocular occlusion for 2 hours. The True CI group was defined as having near-distance differences of ≥10 PD before and after occlusion; the Masked CI group as having near-distance differences of <10 PD and ≥10 PD prior to and after occlusion. Slanted procedure reduced distance and near exodeviations from 32.1 PD and 43.0 PD to 3.5 PD and 4.4 PD, and collapsed near-distance differences from 10.9 PD to 1.0 PD at 3 years postoperatively. Cumulative probabilities of surgical success were 76%, and the mean recurrence was 50 months at 3 years postoperatively; the True CI and Masked CI groups showed cumulative success rates of 89% and 55%, respectively (p = 0.0052). Patients in the True CI group demonstrated surgical outcomes superior to those demonstrated by patients in the Masked CI group after slanted bilateral LR recession.


Assuntos
Bandagens , Exotropia/cirurgia , Transtornos da Motilidade Ocular/complicações , Adolescente , Criança , Pré-Escolar , Percepção de Profundidade , Exotropia/complicações , Exotropia/fisiopatologia , Feminino , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Cuidados Pré-Operatórios , Estudos Prospectivos , Resultado do Tratamento , Visão Binocular
18.
Semin Ophthalmol ; 35(2): 103-115, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32228341

RESUMO

Multiple sclerosis (MS) is an acquired demyelinating and inflammatory neurodegenerative disease affecting the central nervous system (CNS). Clinical and subclinical ocular disturbances occur in almost all patients with MS. The objective of this narrative review was to collect and summarize the available scientific information on oculomotor, accommodative and binocular alterations that have been reported in MS. A systematic search strategy with the following descriptors was carried out: multiple sclerosis, ocular motility disorders, internuclear ophthalmoplegia, nystagmus, vergences, fixation, pupil reflex, accommodation and stereopsis. According to the search, some oculomotor alterations were found to be commonly reported in MS, such as alterations in saccades and nystagmus. In contrast, accommodative, vergence and stereopsis alterations have not been comprehensively studied despite their relevance, with only minimal evidence showing a potential negative impact of the disease on these aspects. In conclusion, oculomotor impairment is a common component of disability in MS patients and should be considered when managing this type of patients. More research is still needed to know the real impact of this disease on binocular vision and accommodation.


Assuntos
Acomodação Ocular/fisiologia , Esclerose Múltipla/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Visão Binocular/fisiologia , Percepção de Profundidade/fisiologia , Humanos , Movimentos Sacádicos/fisiologia
20.
Neurology ; 94(16): e1702-e1715, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32234823

RESUMO

OBJECTIVE: To characterize subclinical abnormalities in asymptomatic heterozygote NPC1 mutation carriers as markers of neurodegeneration. METHODS: Motor function, cognition, mood, sleep, and smell function were assessed in 20 first-degree heterozygous relatives of patients with Niemann-Pick disease type C (NPC) (13 male, age 52.7 ± 9.9 years). Video-oculography and abdominal ultrasound with volumetry were performed to assess oculomotor function and size of liver and spleen. NPC biomarkers in blood were analyzed. 18F-fluorodesoxyglucose PET was performed (n = 16) to detect patterns of brain hypometabolism. RESULTS: NPC heterozygotes recapitulated characteristic features of symptomatic NPC disease and demonstrated the oculomotor abnormalities typical of NPC. Hepatosplenomegaly (71%) and increased cholestantriol (33%) and plasma chitotriosidase (17%) levels were present. The patients also showed signs seen in other neurodegenerative diseases, including hyposmia (20%) or pathologic screening for REM sleep behavior disorder (24%). Cognitive function was frequently impaired, especially affecting visuoconstructive function, verbal fluency, and executive function. PET imaging revealed significantly decreased glucose metabolic rates in 50% of participants, affecting cerebellar, anterior cingulate, parieto-occipital, and temporal regions, including 1 with bilateral abnormalities. CONCLUSION: NPC heterozygosity, which has a carrier frequency of 1:200 in the general population, is associated with abnormal brain metabolism and functional consequences. Clinically silent heterozygous gene variations in NPC1 may be a risk factor for late-onset neurodegeneration, similar to the concept of heterozygous GBA mutations underlying Parkinson disease.


Assuntos
Hepatomegalia/diagnóstico por imagem , Heterozigoto , Peptídeos e Proteínas de Sinalização Intracelular/genética , Transtornos da Motilidade Ocular/fisiopatologia , Esplenomegalia/diagnóstico por imagem , Adulto , Idoso , Colestanóis/sangue , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/fisiopatologia , Medições dos Movimentos Oculares , Família , Feminino , Hepatomegalia/epidemiologia , Hepatomegalia/genética , Hexosaminidases/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Doença de Niemann-Pick Tipo C/diagnóstico por imagem , Doença de Niemann-Pick Tipo C/genética , Doença de Niemann-Pick Tipo C/fisiopatologia , Doença de Niemann-Pick Tipo C/psicologia , Transtornos da Motilidade Ocular/epidemiologia , Transtornos da Motilidade Ocular/genética , Transtornos do Olfato/epidemiologia , Fenótipo , Tomografia por Emissão de Pósitrons , Transtorno do Comportamento do Sono REM/epidemiologia , Esplenomegalia/epidemiologia , Esplenomegalia/genética , Ultrassonografia
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