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1.
Medicine (Baltimore) ; 102(2): e31972, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36637960

RESUMO

To investigate the clinical features of ocular myasthenia gravis (OMG) in ophthalmology. A total of 28 patients with ptosis or diplopia who were followed for at least 6 months between March 2016 and February 2022 were included in this study. The clinical symptoms of the patients and test results were analyzed. According to the positivity of serologic or electrophysiologic test, these patients were divided into 2 groups (positive and negative OMG results) and according to the clinical symptoms of diplopia or ptosis for comparison. Ptosis, diplopia, and both ptosis and diplopia were present in 6 (21.43%), 14 (50.0%), and 8 (28.57%) patients, respectively. Acetylcholine receptor auto-antibody (AchR Ab) was positive in 16 (57.14%) of 28 patients and the ice test was positive in 13 (92.86%) of 14 patients with ptosis. Abnormal thymic lesions were presented in 7 (25.0%) patients, and a definite improvement in response to pyridostigmine was observed in 27 (100.0%) patients. Both ptosis and diplopia were significantly higher in the group with positive results than that in the negative results group (P = .025). In addition, both horizontal and vertical diplopia was significantly higher in the group with AchR Ab titer > 5.0 than that in the group with AchR Ab titer < 5.0 (P = .041). After excluding cranial nerve palsy, if there is ptosis and diplopia, especially vertical diplopia, the possibility of OMG should be considered.


Assuntos
Blefaroptose , Miastenia Gravis , Oftalmologia , Humanos , Diplopia/etiologia , Estudos Retrospectivos , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Blefaroptose/diagnóstico , Blefaroptose/etiologia , Receptores Colinérgicos , Autoanticorpos
2.
Brain ; 146(1): 2-3, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36611223
3.
BMC Ophthalmol ; 23(1): 11, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604664

RESUMO

BACKGROUND: There have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular motor nerve palsy, after coronavirus disease 2019 (COVID-19) vaccination. Therefore, this study aimed to report neuro-ophthalmological symptoms in patients after COVID-19 vaccination. METHODS: This was a retrospective study based on the medical records of 10 patients who visited our ophthalmology clinic in 2021 with symptoms, such as diplopia (nine patients) and decreased visual acuity (one patient), and showed findings, such as ocular motor nerve palsy, after vaccination against COVID-19. RESULTS: One patient had third nerve palsy, two had sixth nerve palsy, and five had fourth nerve palsy. One patient complained of subjective binocular diplopia but all test results were normal. One patient presented with decreased visual acuity accompanied by a sudden increase in intraocular pressure and orbital cellulitis in the other eye. The symptoms improved gradually in most patients. Compared with previous studies, this study reported three cases of antiplatelet therapy that was initiated due to the older age of the patients and underlying diseases. CONCLUSION: As COVID-19 vaccines can cause neuro-ophthalmological diseases, such as ocular motor nerve palsy, patients' age and underlying diseases should be considered while administering them.


Assuntos
Doenças do Nervo Abducente , Vacinas contra COVID-19 , COVID-19 , Humanos , Doenças do Nervo Abducente/induzido quimicamente , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Diplopia/induzido quimicamente , Paralisia/induzido quimicamente , Estudos Retrospectivos
4.
Curr Opin Neurol ; 36(1): 26-35, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36630211

RESUMO

PURPOSE OF REVIEW: To review several etiologies of nonneurologic diplopia that the neurologist should be familiar with. The pathophysiology, clinical presentation, neuroimaging findings, and treatment options are briefly summarized for each condition. RECENT FINDINGS: Certain etiologies for diplopia can be associated with life-threatening neurologic conditions and should be investigated thoroughly for proper localization and immediate management of the underlying disease. However, nonneurological causes of binocular diplopia are very common and disabling, but are often nonemergent and may not require in-depth investigation or neuroimaging. Some of the etiologies of nonneurologic diplopia mimic cranial nerve palsies, making them confusing to evaluate when the physician is not familiar with these etiologies. Unfamiliarity with these diagnoses can lead to unnecessary neuroimaging, inefficient utilization of medical resources, and undue alarm to the patient. Recent advances in clinical diagnostic tools and neuroimaging have clarified our understanding of the diverse underlying mechanisms of nonneurologic binocular diplopia. SUMMARY: Diplopia can be a difficult symptom for the neurologist to evaluate. A systematic approach to the evaluation of diplopia can help establish the urgency and necessity of an extensive workup.This review will help to familiarize the neurologist with nonneurological causes of binocular diplopia, minimize expensive and unnecessary evaluations, and reassure patients and physicians alike.


Assuntos
Diplopia , Neurologistas , Humanos , Diplopia/diagnóstico , Diplopia/etiologia , Neuroimagem
5.
Rev Neurol ; 76(2): 47-57, 2023 Jan 16.
Artigo em Espanhol | MEDLINE | ID: mdl-36631964

RESUMO

INTRODUCTION: The nationwide lockdown implemented in Spain in March 2020 in response to the 2019 coronavirus disease pandemic (COVID-19) could have had an effect on the clinical situation, disease management and access to care in patients with idiopathic intracranial hypertension. PATIENTS AND METHODS: A cross-sectional observational study was conducted by means of an online survey. The frequency and impact of headache, visual symptoms, dizziness, cognitive symptoms, diplopia, anxiety and depression on patients' quality of life were recorded. Disease treatment and delays experienced in accessing care were recorded. Participants were grouped according to the time elapsed since diagnosis. RESULTS: A total of 112 patients participated in the study (103 women). The average time since disease onset was 6.25 years. Headache, anxiety and depression were responsible for considerable impact in the period prior to lockdown. The impact of headache was not aggravated during lockdown, but anxiety and depression did become significantly worse. Recently diagnosed participants reported higher rates of anxiety, depression, dizziness and diplopia; chronically diagnosed participants reported a higher frequency of cognitive symptoms. CONCLUSIONS: The clinical situation of the participants deteriorated during lockdown, although the differences were smaller than previously thought. This was probably because the baseline situation was more severe than expected. Further studies are needed to clarify the medium and long-term impact of the COVID-19 pandemic on patients with idiopathic intracranial hypertension.


TITLE: Impacto del confinamiento por COVID-19 en pacientes con hipertensión intracraneal idiopática en España.Introducción. El confinamiento nacional instaurado en España en marzo de 2020 como respuesta a la pandemia por la enfermedad por coronavirus 2019 (COVID-19) pudo tener un efecto en la situación clínica, el manejo de la enfermedad y el acceso a la atención médica en pacientes con hipertensión intracraneal idiopática. Pacientes y métodos. Se realizó un estudio observacional transversal por medio de una encuesta en línea. Se registraron la frecuencia y el impacto en la calidad de vida de la cefalea, los síntomas visuales, el mareo, los síntomas cognitivos, la diplopía, la ansiedad y la depresión. Se registró el tratamiento de la enfermedad y los retrasos experimentados en el acceso a la atención médica. Se agrupó a los participantes según el tiempo de evolución desde el diagnóstico. Resultados. Participaron 112 pacientes (103 mujeres). El tiempo medio de evolución de la enfermedad fue 6,25 años. La cefalea, la ansiedad y la depresión fueron responsables de un impacto considerable en el período previo al confinamiento. El impacto de la cefalea no empeoró durante el confinamiento, pero la ansiedad y la depresión empeoraron significativamente. Los participantes diagnosticados recientemente comunicaron mayores tasas de ansiedad, depresión, mareo y diplopía; los de evolución crónica, mayor frecuencia de síntomas cognitivos. Conclusiones. La situación clínica de los participantes se deterioró durante el confinamiento, aunque las diferencias fueron menores de lo que se pensaba. Esto se debió, probablemente, a que la situación basal era más grave de lo esperado. Son necesarios más estudios para aclarar el impacto a medio y largo plazo de la pandemia por COVID-19 en pacientes con hipertensión intracraneal idiopática.


Assuntos
COVID-19 , Pseudotumor Cerebral , Humanos , Feminino , COVID-19/epidemiologia , COVID-19/psicologia , Qualidade de Vida , Espanha/epidemiologia , Pandemias , Estudos Transversais , Tontura , Diplopia , Pseudotumor Cerebral/epidemiologia , Controle de Doenças Transmissíveis , Ansiedade/epidemiologia , Ansiedade/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Depressão/epidemiologia , Depressão/psicologia
6.
Medwave ; 23(1): e2634, 2023 Jan 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36652591

RESUMO

Chronic inflammatory demyelinating polyradiculoneuropathy is a clinically heterogeneous group of immune- mediated peripheral neuropathies that share neurophysiological manifesta-tions of demyelination and albuminocytologic dissociation. There are typical and atypical variants of this disease, some associated with antibodies against proteins of the node of Ranvier, such as neurofascin- 155. We present the case of a 38- year- old male who presented with an eight- month history of par-esthesia and progressive weakness of four limbs associated with diplopia and dysphagia. The patient was conscious, with symmetric flaccid quadriparesis of distal predominance, hyp-otrophy in the dorsum and palm of both hands, generalized areflexia, postural low frequency, and high amplitude tremor in upper limbs of left predominance, appendicular dysmetria, dys-diadochokinesia, ophthalmoparesis to dextroversion in the right eye, absent gag reflex, ataxic gait with an increased base of support and positive Romberg's sign. Cerebrospinal fluid showed albuminocytologic dissociation, and electromyography was com-patible with primarily demyelinating sensory- motor polyneuropathy. Due to clinical suspicion, we requested anti- neurofascin- 155 antibodies, which tested positive. The patient was treated with methylprednisolone at a dose of one gram per day for five days, followed by one milligram per kilogram for three months of prednisone, with progressive de-crease, which improved diplopia and dysphagia, with no effect on limb strength and even worsening of function. For this reason, treatment with rituximab was started in doses of two grams, presenting a substantial improvement in distal muscle strength, tremor, gait stability, coordination, and functionality measured with the modified Rankin scale.


La polirradiculoneuropatía desmielinizante inflamatoria crónica, es un grupo de neuro-patías periféricas inmunomediadas clínicamente heterogéneas que comparten manifes-taciones neurofisiológicas de desmielinización y disociación albuminocitológica. Se distinguen una forma típica y variantes atípicas, algunas asociadas a anticuerpos con-tra proteínas del nodo de Ranvier, como la neurofascina- 155. Presentamos el caso de un varón de 38 años, que acudió por cuadro de ocho meses de evolución, caracterizado por parestesias y debilidad progresiva de cuatro extremidades, asociado a diplopía y disfagia. El paciente estaba despierto, con cuadriparesia flácida simétrica de predominio distal, hipotrofia en dorso y palma de ambas manos, arreflexia generalizada, temblor postural de baja frecuencia y alta amplitud en miembros superiores de predominio izquierdo, dismetría apendicular, adiadococinesia, oftalmoparesia a la dextroversión en ojo dere-cho, reflejo nauseoso ausente, marcha atáxica con aumento de base de sustentación y signo de Romberg positivo. El líquido cefalorraquideo mostró disociación albuminocitológica y la electromiografía fue compatible con polineuropatía sensitivo- motora primariamente desmielinizante. Por la sospecha clínica, solicitamos anticuerpos antineurofascina- 155, que resultaron positivos. Recibió tratamiento con metilprednisolona a dosis de un gramo al día durante cinco días, seguido de un miligramo por kilogramo durante tres meses de prednisona, con disminución progresiva con lo que mejoró la diplopía y la disfagia, sin mejoría de la fuerza en extremidades e incluso empeoramiento de la funcionabilidad. Por esta razón se inició tratamiento con rituximab en dosis de dos gramos presentando una notable mejoría en la fuerza muscular distal, el temblor, la estabilidad de la marcha, coordinación y de su funcionabilidad medida con la escala de Rankin modificado.


Assuntos
Transtornos de Deglutição , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Humanos , Masculino , Adulto , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Diplopia/complicações , Transtornos de Deglutição/complicações , Tremor/complicações , Peru
8.
Front Endocrinol (Lausanne) ; 13: 1030422, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36440235

RESUMO

Objective: Thyroid-associated orbitopathy (TAO) is the most frequent cause of extraocular muscle enlargement, with consecutive restrictive strabismus. The main muscles involved are inferior and medial rectus, resulting in horizontal esotropia and/or vertical strabismus. Surgery may either establish or improve binocular single vision. The aim of the present study is to describe long-term follow-up of patients who underwent horizontal or vertical TAO strabismus surgery. Methods: This observational retrospective study included 29 patients suffering from either vertical or horizontal TAO strabismus and diplopia, of whom 11 underwent bilateral medial recti muscle recession (Group A) and 18 underwent unilateral inferior rectus muscle recession (Group B). The endpoint of the study was the assessment of changes in deviation angle and diplopia across four time points (baseline, 7 days, 6 months, and 24 months) in each group. Results: In Group A, the horizontal deviation angle significantly decreased 7 days after intervention (p < 0.001), without modifications overtime. In Group B, both deviation angles in primary and down-gaze position significantly decreased from baseline, both 7 days after surgery (p < 0.001) and at 6 months (p = 0.040). An overcorrection, with an inversion of vertical deviation angle, was observed across the different time points. Conclusions: Horizontal TAO strabismus correction leads to significant improvements of deviation angle and diplopia, with a stable undercorrection overtime. Inferior rectus recession leads to more unstable results, with a trend towards overcorrection limited to the first 6 months after surgery.


Assuntos
Oftalmopatia de Graves , Estrabismo , Humanos , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/cirurgia , Diplopia/cirurgia , Diplopia/complicações , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Estrabismo/etiologia , Estrabismo/cirurgia , Capsaicina , Mentol
9.
Digit J Ophthalmol ; 28(3): 69-73, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36405445

RESUMO

A 25-year-old man presented to an urgent care facility with sudden loss of vision in his right eye, diplopia, and anosmia. He tested positive by reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Nine days later, he presented at our emergency department, at which time ophthalmic examination revealed reduced visual acuity in the right eye, with poor color vision and a relative afferent pupillary defect. He had a moderate adduction deficit and mild hypertropia of the right eye, with an intermittent exotropia. Magnetic resonance imaging of the orbits revealed asymmetric, abnormal enhancement of the right optic nerve sheath extending to the right orbital apex. His ocular symptoms resolved completely with systemic steroids. All infectious and inflammatory labs returned negative except for COVID-19. Ocular findings have been consistently implicated throughout this pandemic. This case highlights an unidentified presentation with optic nerve involvement and orbital inflammation.


Assuntos
COVID-19 , Masculino , Humanos , Adulto , COVID-19/complicações , SARS-CoV-2 , Inflamação/diagnóstico , Imageamento por Ressonância Magnética/métodos , Diplopia
10.
BMC Ophthalmol ; 22(1): 395, 2022 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-36195859

RESUMO

BACKGROUND: Many researchers have noticed that there is an increasing trend of Bielschowsky acquired comitant esotropia (ACE) in recent years related to excessive near work, but the exact pathogenesis and treatment methods have not been reported yet. Therefore, we aimed to characterize the clinical features of this ACE in adults and to evaluate the efficacy of botulinum toxin (BTX) injections in these patients. METHODS: This was a prospective consecutive case series of 47 patients with Bielschowsky ACE. BTX was injected bilaterally into the medial rectus muscle of 45 patients, and twenty-seven of them (27/45) completed 10 months of follow-up after their last injection. Angle of deviation, fusion, stereopsis, subjective assessment of diplopia were documented before and after BTX treatment, and repeated measures data were compared by the Wilcoxon signed-rank test or Analysis of variance. The relationship between BTX dosage and corrected esotropia was explored by the Regression analysis. Meanwhile, possible risk factors for ACE including time spent on near work, refraction error, patients' personality, glasses wearing habits and duration of symptoms were recorded and analyzed with General Linear Models. RESULTS: The patients aged 32.32 ± 10.96 (range 15-53) years spent 8.34 ± 2.38 h on near work each day, and most myope habitually removed their glasses at near. Their chief complaint was distance diplopia, with more significant esotropia at distance (around 20 PD) than at near. This series of patients also exhibited perfectionist tendencies. However, most patients achieved orthophoria after BTX treatment, only with a mild residual esotropia (+ 3.96 ± 5.79 PD), which left them asymptomatic most of the time. CONCLUSION: This group of ACE patients was characterized by diplopia with more significant esotropia at distance. Besides excessive near-work, habitually removing myopic glasses and perfectionist tendencies may also contribute to this type of ACE. Fortunately, bilateral BTX injection safely and effectively reduced the esotropia with complete resolution of symptoms, especially for those treated at an early stage.


Assuntos
Toxinas Botulínicas , Esotropia , Miopia , Adulto , Diplopia/tratamento farmacológico , Esotropia/diagnóstico , Esotropia/tratamento farmacológico , Humanos , Músculos Oculomotores , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
11.
J Binocul Vis Ocul Motil ; 72(4): 226-229, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36279479

RESUMO

The evaluation and management of vertical strabismus is more challenging and nuanced than that of horizontal strabismus. Vertical strabismus often results from a variety of restrictive or paretic causes, which can be further characterized as either acquired or congenital. In some cases, identifying the correct etiology of the strabismus can mean uncovering a potentially life-threatening condition, such as a brain tumor or stroke. The keys to identifying the correct diagnosis are, first and foremost, a careful history, and secondly, a detailed examination. The characteristics, etiologies, and evaluation of vertical strabismus will be reviewed here.


Assuntos
Diplopia , Estrabismo , Humanos , Diplopia/diagnóstico , Diplopia/terapia , Estrabismo/diagnóstico , Estrabismo/terapia , Estrabismo/etiologia
12.
J Binocul Vis Ocul Motil ; 72(4): 230-233, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36279481

RESUMO

Divergence insufficiency-type ET is a common cause of distance diplopia in elderly adults. A recent prospective multicenter data collection study has provided additional guidance on management. Either base-out prism glasses or strabismus surgery were found to have high success rates, based on patient report of diplopia, and health-related quality-of-life domain scores. It was concluded that either prism or surgery were reasonable initial treatment strategies. Although allocation bias precluded formal comparison of prism versus surgery (evident in baseline differences between groups), there were hints that surgery may yield superior outcomes. For surgery, the most common approach was bilateral medial rectus recession, which was highly successful when assessed 10 weeks and 12 months postoperatively. It was unclear whether adjustable sutures were helpful, but in the vast majority of adjustable cases, additional recession at the time of adjustment was performed, suggesting that larger than standard surgical doses are needed.


Assuntos
Esotropia , Estrabismo , Adulto , Humanos , Idoso , Esotropia/cirurgia , Diplopia/diagnóstico , Diplopia/terapia , Procedimentos Cirúrgicos Oftalmológicos , Visão Binocular , Estudos Retrospectivos , Resultado do Tratamento , Estrabismo/cirurgia
13.
J Binocul Vis Ocul Motil ; 72(4): 243-247, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36279482

RESUMO

PURPOSE: To describe the common causes of symptomatic strabismus and treatment required to resolve diplopia in adult patients seen by one orthoptist. PATIENTS AND METHODS: Retrospective cross-sectional study of consecutive adult patients 18 years or older seen by one orthoptist over a 3-year period with a chief complaint of double vision. RESULTS: Two hundred twenty-four consecutive adult patients were examined by the author. Chief complaint was double vision, followed by blurred vision, monocular diplopia, and eye strain. Past ocular histories were significant for early-childhood strabismus in 23 patients. Amblyopia was identified in five patients. Hypertension was a medical risk factor most associated with symptomatic strabismus. Cranial nerve paresis was the most common cause of the strabismus followed by benign, age-related divergence insufficiency esotropia. Prism was the most common treatment in 53% of patients followed by Bangerter foil occlusion in 44 patients (20%). Strabismus surgery was recommended in 11 patients (5%). Manifest refraction was successful in resolving symptoms of binocular diplopia in nine heterophoric patients (5%). Opaque pirate style occlusion was not used for any patient in this series. CONCLUSIONS: Symptomatic acquired esotropia was a common type of strabismus encountered by the author and trochlear nerve paresis a common cause of symptomatic strabismus in this retrospective cross-sectional study. Press-On™ or ground-in spectacle prism of 12 prism diopters or less resolved diplopia in 124 patients (55%).


Assuntos
Esotropia , Estrabismo , Adulto , Humanos , Criança , Diplopia/diagnóstico , Diplopia/terapia , Diplopia/etiologia , Estudos Retrospectivos , Estudos Transversais , Acuidade Visual , Paresia
14.
J Binocul Vis Ocul Motil ; 72(4): 223-225, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36279483

RESUMO

Heavy eye syndrome is a condition that results in an acquired, progressive strabismus that is due to extreme myopia and long axial length. The underlying pathogenesis of the condition is due to prolapse of the supero-temporal aspect of the myopic globe causing displacement of the lateral and superior rectus muscles inferiorly and nasally, respectively. Treatments for heavy eye syndrome often target this anatomical defect and seek to re-place the globe within the extraocular muscle cone. This review will discuss current theories of pathogenesis and treatment of heavy eye syndrome.


Assuntos
Esotropia , Transtornos da Motilidade Ocular , Estrabismo , Adulto , Humanos , Diplopia/diagnóstico , Diplopia/terapia , Imageamento por Ressonância Magnética/efeitos adversos , Músculos Oculomotores/patologia , Estrabismo/complicações , Síndrome
15.
PLoS One ; 17(10): e0276527, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36264982

RESUMO

PURPOSE: To assess if ocular motility impairment, and the ensuing diplopia, after Baerveldt Glaucoma device (BGI) implantation, is related to the presence of a large fluid reservoir (bleb), using Magnetic Resonance Imaging (MRI). METHODS: In a masked observational study (CCMO-registry number: NL65633.058.18), the eyes of 30 glaucoma patients with (n = 12) or without diplopia (n = 18) who had previously undergone BGI implantation were scanned with a 7 Tesla MRI-scanner. The substructures of the BGI-complex, including both blebs and plate, were segmented in 3D. Primary outcomes were a comparison of volume and height of the BGI-complex between patients with and without diplopia. Comparisons were performed by using an unpaired t-test, Fisher's Exact or Mann-Whitney test. Correlations were determined by using Spearman correlation. RESULTS: The median volume and height of the BGI-complex was significantly higher in patients with compared to patients without diplopia (p = 0.007 and p = 0.025, respectively). Six patients had an excessively large total bleb volume (median of 1736.5mm3, interquartile range 1486.3-1933.9mm3), four of whom experienced diplopia (33% of the diplopia patients). Fibrotic strands through the BGI plate, intended to limit the height of the bleb, could be visualized but were not related to diplopia (75% versus 88%; p = 0.28). CONCLUSIONS: With MRI, we show that in a significant number of diplopia cases a large bleb is present in the orbit. Given the large volume of these blebs, they are a likely explanation of the development of diplopia in at least some of the patients with diplopia after BGI implantation. Additionally, the MR-images confirm the presence of fibrotic strands. As these strands are also visible in patients with a large bleb, they are apparently not sufficient to restrict the bleb height.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma , Humanos , Implantes para Drenagem de Glaucoma/efeitos adversos , Vesícula , Pressão Intraocular , Diplopia/etiologia , Acuidade Visual , Glaucoma/diagnóstico por imagem , Glaucoma/cirurgia , Imageamento por Ressonância Magnética/métodos
16.
Front Immunol ; 13: 1000912, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36275763

RESUMO

A 27-year-old woman was admitted to our hospital for fever, associated with headache, nausea, and vomiting, and she rapidly developed mild left facial nerve palsy and diplopia. Neurological examination revealed mild meningitis associated with bilateral VI cranial nerve palsy and mild left facial palsy. As central nervous system (CNS) infection was suspected, a diagnostic lumbar puncture was performed, which revealed 1,677 cells/µl, 70% of which were polymorphonuclear leukocytes. Moreover, multiplex PCR immunoassay was positive for Neisseria meningitidis, supporting the diagnosis of bacterial meningitis. Finally, IgG oligoclonal bands (IgGOB) were absent in serum and cerebrospinal fluid (CSF). Therefore, ceftriaxone antibiotic therapy was started, and in the following days, the patient's signs and symptoms improved, with complete remission of diplopia and meningeal signs within a week. On the contrary, left facial nerve palsy progressively worsened into a severe bilateral deficit. A second lumbar puncture was therefore performed: the CSF analysis revealed a remarkable decrease of pleocytosis with a qualitative modification (only lymphocytes), and oligoclonal IgG bands were present. A new brain MRI was performed, showing a bilateral gadolinium enhancement of the intrameatal VII and VIII cranial nerves bilaterally. Due to suspicion of para-infectious etiology, the patient was treated with oral steroid (prednisolone 1 mg/kg/day), with a progressive and complete regression of the symptoms. We suggest that in this case, after a pathogen-driven immunological response (characterized by relevant CSF mixed pleocytosis and no evidence of IgGOB), a para-infectious adaptive immunity-driven reaction (with mild lymphocyte pleocytosis and pattern III IgGOB) against VII and VIII cranial nerves started. Indeed, steroid administration caused a rapid and complete restoration of cranial nerve function.


Assuntos
Doenças dos Nervos Cranianos , Meningites Bacterianas , Feminino , Humanos , Adulto , Bandas Oligoclonais , Ceftriaxona , Gadolínio , Diplopia , Leucocitose , Meios de Contraste , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/etiologia , Prednisolona , Meningites Bacterianas/complicações , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Paralisia , Imunoglobulina G , Antibacterianos
17.
Rinsho Shinkeigaku ; 62(11): 873-876, 2022 Nov 26.
Artigo em Japonês | MEDLINE | ID: mdl-36288968

RESUMO

The patient was a 32-year-old man with no HIV infection and possible syphilis infection at the age of 22 years. At the age of 29 years, he visited an ophthalmologist for diplopia due to right oculomotor nerve palsy. He underwent diplopia strabismus surgery for unexplained oculomotor nerve palsy. At the age of 31 years, he had a left oculomotor nerve palsy and was referred to our department. He was diagnosed with neurosyphilis based on positive serum and cerebrospinal fluid syphilis antibodies. MRI showed aneurysm, asymptomatic cerebral hemorrhage, and contrast enhancement of the left oculomotor nerve, leading to the diagnosis of meningovascular syphilis. The patient's symptoms improved with penicillin and corticosteroids. The oculomotor nerve palsy may be due to microcirculatory disorder caused by syphilitic cerebral endarteritis.


Assuntos
Aneurisma Intracraniano , Neurossífilis , Doenças do Nervo Oculomotor , Sífilis , Masculino , Humanos , Adulto Jovem , Adulto , Aneurisma Intracraniano/complicações , Sífilis/complicações , Diplopia , Microcirculação , Doenças do Nervo Oculomotor/etiologia , Neurossífilis/complicações , Neurossífilis/diagnóstico , Hemorragia Cerebral/complicações
18.
Arch. Soc. Esp. Oftalmol ; 97(10): 565-571, Oct. 2022.
Artigo em Espanhol | IBECS | ID: ibc-209651

RESUMO

Propósito Analizar la eficacia y la seguridad de la transposición del oblicuo inferior con miopexia en pacientes con hiperfunción primaria o secundaria del oblicuo inferior leve-moderada, con o sin diplopía. Método Estudio observacional retrospectivo de 12 pacientes tratados con dicha técnica entre octubre de 2018 y septiembre de 2021. Se suturó el oblicuo inferior a esclera a 5mm posterior a la inserción temporal del recto inferior. Todos tenían desviación vertical de pequeño ángulo (media ±DE: 4,42±1,62) en posición primaria (≤6 dioptrías prismáticas [dp]), hipertropia en aducción leve-moderada y 10 tenían diplopía. Los diagnósticos fueron: paresia del IVnervio (9), DVD (1) e hipertropia en aducción unilateral (2). De los 12 casos, 7 presentaban tortícolis, 2 torsión subjetiva y 2 torsión objetiva. Resultados La edad media de la muestra fue 46,86±25,1 años (50% hombres). De los 10 casos con diplopía, en 9 se resolvió. La desviación vertical media final en mirada al frente fue: 1,5dp ±2,93 (p=0,001). De 7 casos con hipertropia en aducción leve, en 3 desapareció y 4 quedaron igual. De 5 casos con hipertropia en aducción moderada, 2 mejoraron a leves y en 3 desapareció. El tortícolis se resolvió en 5 casos, y en otros 2 mejoró. El tiempo de seguimiento medio fue de 14,08±8,05 meses. No se registraron hipercorrecciones. Conclusiones La transposición del oblicuo inferior con miopexia es una nueva técnica eficaz y segura en pacientes con leve-moderada hipertropia en aducción e hipertropia de pequeño ángulo, con o sin diplopía (AU)


Purpose To evaluate the efficacy and safety of inferior oblique muscle transposition and myopexy in patients with mild/moderate inferior oblique muscle overaction, with or without diplopia. Method We retrospectively analysed data for the 12 patients who underwent the technique. Data were collected from October 2018 to September 2021. Surgery was performed by suturing the inferior oblique belly to the sclera at 5mm posterior to the temporal end of the inferior rectus. All 12 patients had mild hypertropia (≤6 prism diopters [pd]) in primary position and mild/moderate inferior oblique overaction. Mean preoperative hypertropia was 4.42pd ±1.62. Diplopia was recorded in 10 cases. The diagnoses were fourth nerve paresis (9), unilateral primary inferior oblique overaction (2) and dissociated vertical deviation (1). Torticollis was observed in 7 cases, 2 had subjective torsion and 2 objective torsion. Results Mean age was 46.86±25.1 years (50%: men). Diplopia resolved in 9 of the 10 cases. The mean final vertical deviation was 1.5±2.93 (P=.001) pd in straight gaze. Of 7 mild overshoot in adduction, it disappeared in 3 and 4 remained the same. Of 5 moderate overshoot in adduction, 2 improved to mild and 3 disappeared. Torticollis was eliminated in 5 patients and improved in another 2. Mean time from surgery was 14.08±8.05 months. There were no overcorrections Conclusions Inferior oblique muscle transposition with myopexy is a safe and effective procedure in patients with mild-to-moderate inferior oblique muscle overaction and small-angle hypertropia, with or without diplopia (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estrabismo/cirurgia , Transtornos da Motilidade Ocular , Músculos Oculomotores/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Diplopia/etiologia , Diplopia/cirurgia
20.
Zhonghua Yan Ke Za Zhi ; 58(9): 693-700, 2022 Sep 11.
Artigo em Chinês | MEDLINE | ID: mdl-36069090

RESUMO

Objective: To evaluate the efficacy and safety of superior rectus transposition (SRT) with/without augmented suture and vertical rectus transposition (VRT) for the treatment of strabismus caused by complete abducens nerve palsy. Methods: This was a retrospective cohort study. Forty-two patients (42 eyes) with complete abducens nerve palsy underwent strabismic surgeries from January 2015 to November 2020 in Tianjin Eye Hospital. According to the different procedures, the patients were divided into three groups: SRT group (16 cases, SRT with medial rectus recession), superior rectus transposition with augmented suture (SRTA) group (13 cases, SRT with Buckley suture and medial rectus recession) and VRT group (13 cases). The preoperative and postoperative (1, 6 and 12 months) data including deviations, ocular motility, binocular vision and surgical complications among three groups were analyzed and compared. χ2 test was used for comparison of count data among three groups. The measurement data were compared among three groups by the repeated measures ANOVA. LSD-t test was used for within-group comparison and between-group comparison. Results: There was no difference in sex ratio, age and course of disease among the groups (all P>0.05). The horizontal deviations of the three groups at 1, 6 and 12 months after surgeries was lower than that before surgeries, and the difference was statistically significant (all P<0.001). The horizontal deviations of the SRT group, SRTA group and VRT group at 12 months after surgeries were (+0.8±5.8), (+0.8±4.5), (+1.2±2.5) prism diopters (PD), respectively, lower than that of the preoperative (+82.8±17.2), (+77.7±26.1), (+71.5±18.6) PD. However, there was no significant difference among different postoperative follow-up timepoints (all P>0.05). There was no difference in horizontal deviations before surgeries and at 1, 6 and 12 months after surgeries among three groups (P>0.05). There were significant differences in the scales of abduction motility among preoperative, postoperative 1, 6 and 12 months measurements for three group (all P<0.001). The scales of abduction before surgeries in the SRT group, SRTA group, and VRT group were (-4.4±0.5), (-4.4±0.5), (-4.5±0.5) scale and at 12 months after surgeries were (-2.3±0.7), (-2.2±0.5), (-2.1±0.6) scale respectively. But there was no change among different postoperative follow-up timepoints (all P>0.05). Preoperative and postoperative 1-, 6-and 12-month abduction motility was similar among three groups (P>0.05). There were significant differences in the scales of adduction limitation among preoperative, postoperative 1-, 6-and 12-months measurements for three group (all P<0.05). But there was no change among different postoperative follow-up timepoints (all P>0.05). There were significant differences between the SRT group [(-0.9±0.6), (-0.8±0.6) scale] and the SRTA groups [(-1.5±0.5), (-1.4±0.5) scale] (t=-2.62, -2.52) and between the SRTA group and the VRT group [(-0.8±0.8), (-0.6±0.7) scale] (t=2.62, 3.01) at 6 and 12 months after surgeries (all P<0.05). The outcomes of binocular vision at postoperative 12 months were similar among three groups (P>0.05). No patient had torsional diplopia and anterior segment ischemia. Only 2 patients from the SRTA group had hypotropia of 4 to 5 PD in the primary position associated with supraduction limitation. Conclusions: SRT with/without augmented suture and VRT are effective and safe procedures for the treatment of strabismus caused by complete abducens nerve palsy. They could correct deviations, improve abduction motility and restore binocular vision, with stable outcomes and a small risk of vertical and torsional diplopia.


Assuntos
Doenças do Nervo Abducente , Esotropia , Estrabismo , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/cirurgia , Diplopia/cirurgia , Esotropia/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Suturas/efeitos adversos , Visão Binocular/fisiologia
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