[Clinical classification of variable angle exotrophy]. / Clasificación clínica de la exotropía de ángulo variable.

BACKGROUND: Variable exotropia is determined by a series of mechanisms that provide different clinical characteristics to outline individual therapy. There is no specific categorization that can identify such an entity. A clinical classification is proposed that includes different clinical features in accordance with the mechanisms involved in the variability genesis of such exotropias. METHODS: Patients with a diagnosis of variable angle exotropia without previous surgery were included. A complete ophthalmic and strabismus exploration was performed. Variability characteristics were studied and grouped by entries in the classification proposed. RESULTS: Ninety patients were examined from the Pediatric Ophthalmology and Strabismus Unit of the General Hospital of Mexico O.D., with a diagnosis of variable angle exotropia. The following forms of presentations were found: secondary variable angle exotropia due to neurological alteration in 32 cases (35.5%), secondary variable angle exotropia due to monocular bad vision in 19 cases (21.2%), dissociated horizontal deviation in 14 cases (15.5%), mixed variable angle exotropia in 22 cases (4.5%) and primary variable angle exotropia in 3 cases (3.33%). CONCLUSIONS: This classification allows categorization of all patients of variable angle exotropia into proposed categories. The most common mechanism responsible for variability is neurological alteration. Primary variable angle exotropias are rare and are present in a minimum percentage.

[Unilateral tucking of the inferior rectus muscle for dissociated vertical deviation]. / Plegamiento del recto inferior unilateral para el tratamiento de la desviación vertical disociada.

BACKGROUND: There are several options for the treatment of dissociated vertical deviation (DVD). The most discouraging results are those cases of poor vision. The fold of the inferior rectus is presented as a therapeutic option for poor vision. METHODS: Patients with spontaneous DVD and monocular poor vision were included. A maximum folding of the inferior rectus was performed only in the eye with poor vision. Evaluation of the spontaneity and magnitude of the DVD was done in the pre- and postoperatively with a minimum 6-month follow up. RESULTS: Nineteen patients were included, finding a decrease in the spontaneity (p = 0.05) and the magnitude of the DVD (p = 0.01) at the maximum follow-up time. Limitation of the elevation of 2+ was observed in the immediate postoperative period in all cases. The limitation remained in 16 patients. In two patients, hypotropia of 5 DP was observed in the primary position. No cases of alteration of the lower palpebral position were observed. CONCLUSIONS: Unilateral maximum tucking of the inferior rectus muscle decreases the magnitude and spontaneity of DVD.

[Clinical features of strabismus in psychomotor retardation]. / Características clínicas del estrabismo en retraso psicomotor.

BACKGROUND: In psychomotor retardation there is an abnormal development of mental, sensory and motor skills associated with ocular manifestations. There are biological and psychosocial risk factors that predispose an individual to neurological damage. From 50% to 80% of patients with strabismus retardation have special features that differentiate it from the rest of strabismus in healthy patients. OBJECTIVE: To determine the most common type of strabismus in patients with psychomotor retardation and their clinical features. MATERIAL AND METHODS: Patients with psychomotor retardation and strabismus were included. An ophthalmological examination was performed, as well as an evaluation of the characteristics of strabismus, including perinatal and post-natal history. RESULTS: Esotropia was the most frequent squint with 65.3%, followed by exotropia with 32.7%. The variability in the squint magnitude was 60% in both types, and 6 patients had dissociated vertical deviation. Most of the patients started to present strabismus since they were born. The most frequent perinatal risk factors were threatened miscarriage, pre-eclampsia, foetal distress, and hypoxia. CONCLUSIONS: Esotropia is the most common type of strabismus in psychomotor retardation. The variability of squint magnitude is a characteristic in these patients. The moderate variability is the most frequent in both esotropia and exotropia. The most common refractive error is hyperopic astigmatism in esotropia and the myopic kind in exotropia.

[Treatment of spontaneous dissociated vertical deviation with the pharmacological penalization of the fixing eye]. / Tratamiento de la desviación vertical disociada espontánea con penalización farmacológica del ojo fijador.

BACKGROUND: Dissociated vertical deviation (DVD) is a common innervational entity frequently found in patients with congenital endotropia. It is characterized as being bilateral, asymmetric, and to a greater extent, in the non-fixating eye. It can be compensatory or non-compensatory. In the majority of cases, surgery is the treatment of choice, but spontaneous appearance of DVD is a common occurrence after surgery, sometimes to a degree similar to that prior to surgery. OBJECTIVE: Our aim was to evaluate the behavior of dissociated vertical deviation with penalization of the fixating eye. MATERIAL AND METHODS: An experimental and longitudinal study was conducted in which patients with spontaneous DVD were included, whether or not associated with horizontal deviation, with or without previous surgery. Atropine (1%) was applied every 24 h in the fixating eye for 3 months and DVD presence, magnitude, and spontaneity were evaluated at 15 days, 1 month, 3 months, and 1 month after penalization suspension. RESULTS: Eight patients were included. DVD magnitude decreased with penalization (p = 0.02) and remained unchanged when atropine was suspended (p = 0.6). With regard to decompensatory phases, DVD shifted from spontaneous to non-spontaneous during penalization (p = 0.01); when this was eliminated, deviation showed decompensation again (p = 0.03). CONCLUSIONS: Fixating eye penalization with 1% atropine reduces DVD magnitude and decompensatory phases during follow-up.

Identification of unsuspected Wolfram syndrome cases through clinical assessment and WFS1 gene screening in type 1 diabetes mellitus patients.

OBJECTIVE: Wolfram syndrome (WS) is a severe autosomal recessive pleiotropic disease primarily characterized by the association of juvenile-onset diabetes mellitus and optic atrophy. Earlier reports have shown that a proportion of WS cases may remain unrecognized due to misdiagnosis as type 1 diabetes mellitus (T1DM). The objectives of this work were to estimate the prevalence of patients fulfilling clinical criteria for WS in a cohort of subjects diagnosed as T1DM and to identify causal WFS1 gene mutations in those individuals meeting clinical criteria for the disease. METHODS: A cohort of 131 unrelated Mexican T1DM patients was collected, including 77 females and 54 males. Additional clinical anomalies suggesting WS were identified through review of medical files, detailed physical examination and/or specialized tests. WFS1 gene analysis was performed using exon-by-exon PCR amplification and direct Sanger sequencing on genomic DNA from patients reaching WS clinical criteria. RESULTS: Clinical criteria for a WS diagnosis were reached in 6 probands, corresponding to a 4.58% frequency of the disease. WFS1 mutations were identified in 4 out of 5 (80%) individuals fulfilling WS clinical criteria, including two homozygous, one compound heterozygous, and one patient with a single allele mutation. No WFS1 mutations were identified in the remaining subject. CONCLUSIONS: In our cohort, approximately 6% of cases diagnosed as T1DM were in fact patients with Wolfram syndrome. WFS1 mutations were identified in 4 out of 5 individuals (80%) fulfilling clinical criteria for WS. Clinical and genetic analyses of large cohorts of T1DM patients from different ethnic origins would help to better estimate the occurrence of WS and will lead to a better management of such patients.

Discordant retinoblastoma in monozygotic twins due to deletion of 13q14.

PURPOSE: To report discordant retinoblastoma in monozygotic twins, confirmed by GeneScan. METHODS: One twin presented unilateral retinoblastoma that was treated with enucleation; the other twin had no retinoblastoma. To confirm monozygosity, DNA from leukocytes was analyzed through GeneScan with highly polymorphic markers; to exclude 13q14 deletion, FISH analysis was performed in leukocytes and oral cells of both twins and their parents and in retinal tissue of the affected twin with the cDNA LSI RB1 probe. RESULTS: GeneScan analysis confirmed monozygosity. 13q14 deletion was observed in homozygous state in retinal tissue and in heterozygous state in oral cells and leukocytes of the affected twin. The nonaffected twin and parents showed no deletion of 13q14. CONCLUSIONS: These data show unexpected differences in monozygotic twins that could be explained by postzygotic events in embryonic development.

[Variations in Posner's test for diagnosis of dissociated strabismus]. / Variantes de la maniobra de Posner para el diagnóstico del estrabismo disociado.

BACKGROUND: A particular feature of dissociated strabismus is that the frequency of presentation and its magnitude is variable. It is common to find that in certain examinations is very obvious, and in others not so much. To facilitate exploration some maneuvers are described: Bielchowsky's maneuver, Bielchowsky's phenomenon and Posner test. OBJECTIVE: to compare the presence and magnitude of the ocular movement in dissociated strabismus in Posner's Test using opaque versus translucent occluders. METHODS: Prospective, transversal, descriptive study. Patients with diagnosis of were included. Posner's test in two ways: 1) With opaque occluders, and 2) with translucent occluders was perforned. RESULTS: Ninety-five percent of the patients presented horizontal deviation. Posner's test with opaque occluder was positive in all cases (100%). Posner's test with translucent occluders was positive in 94% of the patients (p= 8). The magnitude of the ocular movement was significantly smaller using translucent occluders than opaque occluders. (p= 0.0001). CONCLUSIONS: The Posner's test using opaque occluders was more efective to demonstrate clearly and precisely the size of the ocular movement in dissociated strabismus.

Antecedentes: una característica particular del estrabismo disociado es la variabilidad en la magnitud y en la frecuencia de presentación. En ciertas exploraciones es muy evidente y en otras no tanto. Para facilitar su exploración se han descrito algunas maniobras: de Bielchowsky, del fenómeno de Bielchowsky y la prueba de Posner. Objetivo: determinar la magnitud del movimiento ocular en el estrabismo disociado al aplicar la maniobra de Posner y comparar dos modalidades de ésta: oclusores opacos y oclusores translúcidos. Material y métodos: estudio prospectivo, transversal, descriptivo y observacional efectuado en pacientes con estrabismo disociado a quienes se realizó la maniobra diagnóstica de Posner en dos modalidades: 1) con oclusores opacos, y 2) con oclusores translúcidos. Resultados: la maniobra de Posner con oclusores opacos resultó positiva en 100% de los casos. Al utilizar oclusores translúcidos la prueba diagnóstica resultó positiva en 94% de los casos (p= 0.8). La magnitud del movimiento de recuperación fue considerablemente menor con el oclusor translúcido comparado con el oclusor opaco (p= 0.0001). Conclusión: la maniobra de Posner con oclusores opacos demostró ser más efectiva para mostrar en forma más clara y precisa la magnitud del movimiento en el estrabismo disociado al compararlo con oclusores translúcidos.

[Permanent consecutive exotropia in children treated with botulinum toxin]. / Exotropía consecutiva permanente en niños tratados con toxina botulínica.

BACKGROUND: Congenital esotropia is the most frequent type of strabismus. Botulinum toxin is a treatment option with variable results. We undertook this study to determine the frequency and associated factors with consecutive permanent esotropia in patients diagnosed with congenital esotropia treated with botulinum toxin. METHODS: A retrospective review was achieved in patients with congenital esotropia treated with botulinum toxin and who remained in esotropia after a minimal follow-up of 6 months. Pre- and postnatal background, cycloplejia, magnitude of the pre-application deviation, injected dose and number of applications were analyzed. RESULTS: A total of 84 patients were included. Of all patients,12 (14.28%) remained in consecutive esotropia (six males and six females). Age range was from 5 months to 2 years (average: 10.75 months). Initial esotropia ranged from 20-50 prism diopters (PD) with an average of 37.9 ± 9.64 PD. One patient had variability in the magnitude of the deviation prior to treatment. During the maximum follow-up, the magnitude of the esotropia was from 10 to 40 (average, SD 18 ± 8.01 PD). In five subjects a variability was observed in the magnitude of the angle of deviation by a range of 10-40 PD, and in seven subjects the deviation was stable with an average of 20 PD. Eleven subjects had some degree of psychomotor delay (91.66%) and one subject had a non-significant history. CONCLUSIONS: In patients with consecutive permanent esotropia after application of botulinum toxin, the most prevalent characteristic is neurological.

[Results with botulinum toxin in patients with esotropia and psychomotor deficit]. / Resultados con la aplicación de toxina botulínica en pacientes con endotropía y retraso psicomotor.

OBJECTIVE: We undertook this study to evaluate the results of the treatment with botulinum toxin in patients with esotropia and psychomotor delay. METHODS: Patients with esotropia and delayed psychomotor development, in rehabilitation therapy and without previous surgery were included. A complete ophthalmological and strabismological exploration was performed including cycloplegic refraction with atropine 1%. Botulinum toxin was applied under sedation in both internal recti. Results were evaluated 1 week, 1 month, 3 and 6 months and after 1 year of application. The reinjection was decided if a 25 DP esotropia or greater was obtained before 3 months of the first application. A good result was considered in patients who had 10 DP of deviation and variability <10 DP. RESULTS: Thirty two patients were included. There were 14 were women and 18 men with an age range from 5 months to 5 years (average 16.8 months). Eighteen patients had variability in the angle of deviation from 20 to 45 DP of esotropia and 14 without variability with an average of 39.12 DP. Thirteen patients were reinjected. A good result was obtained in 10 patients, fair in 17 patients and poor in 5 patients due to persistence of variability in four cases and 15 DP hypertropia in one. CONCLUSIONS: Application of botulinum toxin is a therapeutic alternative in patients with esotropia and psychomotor delay.

[Modification of horizontal position with unilateral tucking of inferior rectus muscle in the surgical treatment of dissociated vertical deviation]. / Modificación de la posición horizontal con el plegamiento unilateral del músculo recto inferior para el tratamiento quirúrgico de la desviación vertical disociada.

BACKGROUND: Unilateral tucking of the inferior rectus muscle is a therapeutic alternative in the surgical treatment of dissociated vertical deviation (DVD). It is usually performed in asymmetric DVD associated with monocular low vision. Adduction is a secondary action of the inferior rectus muscle. If excessive reinforcement is done, the horizontal position can be modified toward esotropia. We undertook this study to evaluate the horizontal position modification after unilateral tucking of the inferior rectus muscle. METHODS: Unilateral tucking of the inferior rectus muscle was done in 10 patients with spontaneous DVD, without horizontal surgery and poor monocular vision. Follow-up was done for 6 months. Horizontal deviation in prism diopters (PD) was measured. For statistical analysis, Mann-Whitney U test was used with a significance level of 0.05. RESULTS: Preoperatively, horizontal deviation was between 20 PD of exotropia and 10 PD of esotropia (+/-10.34 SD). Postoperatively, horizontal deviation was between 12 PD of exotropia and 15 PD of esotropia (+/-7.82 SD). Horizontal deviation was modified between 2 and 15 PD towards esotropia, on average 9.4 PD (+/-3.70 SD) ( p = 0.03). CONCLUSIONS: Monocular inferior rectus muscle reinforcement modifies the horizontal position on average 9.4 PD towards esotropia.

Refractive errors in normal children and children with down syndrome or cerebral palsy.

BACKGROUND AND PURPOSE: The prevalence of refractive errors in the general population is between 12 to 18%. The objective of the present study was to determine the refractive errors in healthy children and compare these results in patients with Down syndrome and with cerebral palsy. MATERIAL AND METHOD: The refractive errors in patients between 6 to 12 years without ophthalmologic conditions were studied. The patients were divided into three groups: normal children, children with Down syndrome, and children with cerebral palsy. The results were compared. RESULTS: 258 patient were included: 200 normal children, 29 with Down syndrome, and 29 with cerebral palsy. Ametropia was found in 79.5% in the group of normal children, 93.2% in children with Down syndrome, and in 100% in children with cerebral palsy. Patients requiring optical correction included 30% in normal children, 48.2% in patients with Down syndrome, and 41.1% in the cerebral palsy group. Hyperopia was the most frequent refractive error in all three groups. Most of the refractive errors were mild to moderate. CONCLUSIONS: Refractive errors are more frequent in patients with Down syndrome and cerebral palsy compared with normal children.

Resultados con la aplicación de toxina botulínica en pacientes con endotropía y retraso psicomotor / Results with botulinum toxin in patients with esotropia and psychomotor deficit

Objetivo: Evaluar los resultados del tratamiento con toxina botulínica en pacientes con endotropía y retraso psicomotor. Material y métodos: Se incluyeron pacientes con endotropía y retraso del desarrollo psicomotor menores de siete años, en tratamiento de rehabilitación y sin cirugía previa. Se les realizó exploración oftalmológica y estrabológica completa incluyendo cicloplejía con atropina a 1 %. Se aplicó toxina botulínica en ambos rectos internos bajo sedación y se evaluaron los resultados a la semana, al mes, a los tres y seis meses y al año. Se decidió reinyección si se obtuvo endotropía residual mayor de 25 dioptrías (dp) antes de los tres meses de la primera aplicación. Se consideró un buen resultado cuando hubo desviación dentro de las 10 dp y variabilidad menor o igual a 10 dp. Resultados: Se incluyeron 32 pacientes, 14 mujeres y 18 hombres. El rango de edad era de cinco meses a cinco años, con un promedio de 16.8 meses. Se encontraron 18 pacientes con variabilidad en el ángulo de desviación de 20 a 45 dp de endotropía y 14 sin variabilidad, con un promedio de 39.12 dp. Se reinyectaron 13 pacientes. En 10 pacientes hubo buen resultado, en 17 regular y en cinco malo. Los malos resultados fueron por persistencia de variabilidad importante en cuatro pacientes y en uno hipertropía mayor de 15 dp.Conclusiones: La aplicación de toxina botulínica es una alternativa terapéutica en pacientes con endotropía y retraso psicomotor.

OBJECTIVE: We undertook this study to evaluate the results of the treatment with botulinum toxin in patients with esotropia and psychomotor delay. METHODS: Patients with esotropia and delayed psychomotor development, in rehabilitation therapy and without previous surgery were included. A complete ophthalmological and strabismological exploration was performed including cycloplegic refraction with atropine 1%. Botulinum toxin was applied under sedation in both internal recti. Results were evaluated 1 week, 1 month, 3 and 6 months and after 1 year of application. The reinjection was decided if a 25 DP esotropia or greater was obtained before 3 months of the first application. A good result was considered in patients who had 10 DP of deviation and variability <10 DP. RESULTS: Thirty two patients were included. There were 14 were women and 18 men with an age range from 5 months to 5 years (average 16.8 months). Eighteen patients had variability in the angle of deviation from 20 to 45 DP of esotropia and 14 without variability with an average of 39.12 DP. Thirteen patients were reinjected. A good result was obtained in 10 patients, fair in 17 patients and poor in 5 patients due to persistence of variability in four cases and 15 DP hypertropia in one. CONCLUSIONS: Application of botulinum toxin is a therapeutic alternative in patients with esotropia and psychomotor delay.

Modificación de la posición horizontal con el plegamiento unilateral del músculo recto inferior para el tratamiento quirúrgico de la desviación vertical disociada / Modification of horizontal position with unilateral tucking of inferior rectus muscle in the surgical treatment of dissociated vertical deviation

Introducción: La cirugía de reforzamiento unilateral del recto inferior es una alternativa terapéutica en el tratamiento quirúrgico de la desviación vertical disociada (DVD), indicada en casos de DVD muy asimétrica con mala visión monocular. Dado que el músculo recto inferior tiene como acción secundaria la aducción, al realizar un reforzamiento amplio de éste puede modificarse hacia adentro la posición horizontal. El objetivo del presente estudio fue conocer la modificación de la posición horizontal después del plegamiento monocular en U del músculo recto inferior del ojo con mala visión. Material y métodos: Se realizó plegamiento del recto inferior monocular en 10 pacientes con DVD espontánea, sin cirugía horizontal y mala visión monocular; se llevó a cabo seguimiento mínimo de seis meses. Se cuantificó la magnitud de la desviación horizontal en dioptrías prismáticas (dp) en el pre y posoperatorio. El análisis estadístico se realizó con U de Mann- Whitney, con nivel de significancia de 0.05. Resultados: La desviación preoperatoria osciló entre 20 dp de exotropía y 10 dp de endotropía (± 10.34); en el posoperatorio, de 12 dp de exotropía a 15 dp de endotropía (± 7.82). La posición horizontal se modificó entre 2 y 15 dp hacia adentro, con una media de 9.4 ± 3.70 dp (p = 0.03). Conclusiones: El reforzamiento monocular del recto inferior modifica 9.4 dp en promedio la posición horizontal hacia adentro.(aU)

BACKGROUND: Unilateral tucking of the inferior rectus muscle is a therapeutic alternative in the surgical treatment of dissociated vertical deviation (DVD). It is usually performed in asymmetric DVD associated with monocular low vision. Adduction is a secondary action of the inferior rectus muscle. If excessive reinforcement is done, the horizontal position can be modified toward esotropia. We undertook this study to evaluate the horizontal position modification after unilateral tucking of the inferior rectus muscle. METHODS: Unilateral tucking of the inferior rectus muscle was done in 10 patients with spontaneous DVD, without horizontal surgery and poor monocular vision. Follow-up was done for 6 months. Horizontal deviation in prism diopters (PD) was measured. For statistical analysis, Mann-Whitney U test was used with a significance level of 0.05. RESULTS: Preoperatively, horizontal deviation was between 20 PD of exotropia and 10 PD of esotropia (+/-10.34 SD). Postoperatively, horizontal deviation was between 12 PD of exotropia and 15 PD of esotropia (+/-7.82 SD). Horizontal deviation was modified between 2 and 15 PD towards esotropia, on average 9.4 PD (+/-3.70 SD) ( p = 0.03). CONCLUSIONS: Monocular inferior rectus muscle reinforcement modifies the horizontal position on average 9.4 PD towards esotropia.

Correlación objetivo-cosmética del resultado de la cirugía para la corrección del estrabismo horizontal / Correlation objective-cosmetic outcome of surgery for horizontal strabismus correction

Introducción: Los resultados del tratamiento del estrabismo se reportan generalmente como buenos cuando se encuentran dentro de las 10 DP de desviación postoperatoria de hipo o hipercorrección. Objetivo: La justificación del presente estudio es conocer el grado de correlación existente entre el aspecto cosmético subjetivo y la medición objetiva en dioptrías prismáticas en el resultado del tratamiento quirúrgico del estrabismo. Material y método: Se realizó un estudio prospectivo incluyendo a aquellos pacientes con estrabismo horizontal a quienes se les hubiese practicado un procedimiento quirúrgico correctivo. Aleatoriamente se solicitó a uno de los cuatro médicos oftalmólogos especialistas en estrabismo que emitiera un concepto subjetivo sobre el resultado quirúrgico basado en la siguiente escala: E excelente: aparente ortoposición; B bueno: desviación pequeña; R regular: desviación mediana (notoria); y M malo: desviación grande. Después se procedió a documentar el estudio clínico objetivo, para relacionarlos. Resultados: Se incluyeron 79 pacientes. La evaluación subjetiva mostró que 39 casos presentaban una aparente ortoposición (E) (49,37 por ciento), 29 una desviación pequeña (B) (36,71 por ciento), 10 una desviación mediana (R) (12,66 por ciento), y 1 solo caso una desviación grande (M) (1,26 por ciento). En la evaluación objetiva se encontraron 49 pacientes (62,03 por ciento) dentro de las 10 DP de desviación postquirúrgica. Conclusiones: En la evaluación del resultado quirúrgico para la corrección de los estrabismos es importante tomar en cuenta otros factores diferentes a la medición clínica objetiva y absoluta de las 10 DP desde la ortoposición.

Introduction: Surgical results in strabismus are generally considered good if the post operative if the post operative deviation is within 10 prismatic diopters of orthotropia. Purpose: To investigate correlation between subjective cosmetic and objective measurements in surgical results. Material and Methods: Prospective study including all horizontal strabismus patients on which a surgical procedure was performed. One of four strabologists was asked randomly to judge subjetivelly the surgical result based on the following scale. E: Excellent, apparent orthotropia; B: Good, small deviation; R: Regular, notorious deviation; and M: Bad, evident deviation. This assessment was then correlated with the objective clinical evaluation of patients. Results: 79 patients were included. Subjective evaluation showed that 39 had apparent oethotropia (E= 49.37 percent), 29 a small deviation (G= 36.71 percent), 10 a noticiable deviation ( R= 12.66 percent) and only one case a big deviation (B= 1.26 percent). Objective evaluation showed that 49 patients (62.03 percent) were within 10 prismatic diopeters of alignement. Conclusion: It is important to consider factors other than objective measurements (< 10 PD) in the evaluation of strabismus surgical results.

Cirugía de los músculos extraoculares para la corrección de la posición compensadora de la cabeza en el nistagmo / Surgery of the extraocular muscles for the correction of the compensator position of the head in nistagmus

Se estudiaron 12 pacientes con diagnóstico del nistagmo y posición compensadora de la cabeza (PCC) asociado o no a estrabismo. Todos presentaron PCC en los tres ejes: horizontal, vertical y sagital, con predominio del componente rotacional. A todos ellos se les realizó cirugía de Anderson: debilitamiento amplio de los rectos horizontales responsables de la posición del bloqueo, más cirugía horizontal. Se concluye que en los pacientes con nistagmo y PCC con franco predominio de la rotación es innecesario realizar cirugía sobre los músculos verticales.

Estudio comparativo del resultado del tratamiento quirúrgico para la endotropia congénita con y sin limitación de la abducción

Se presenta un estudio comparativo que incluyó 30 pacientes don diagnóstico de endotropia congénita divididos en dos grupos: sin y con limitación de la abducción; se efectuó cirugía correctora de la desviación en ambos. El resultado mostró ser estadísticamente no significativo. Se comentan los factores que pudieron influir en el resultado.

Endotropia recidivante: presentación de dos casos / Recurrence esotropia: Presentation two cases

Se presentan dos casos de pacientes adultos, con historia de estrabismo desde la infancia y sin antecedentes de tratamiento. Fueron operados con diagnóstico de endotropia posicional inervacional primaria, con buen resultado inmediato y recurrencia de la endotropia en el postoperatorio tardío. Se determinó que la causa de la recidiva era una hipermetropía mal valorada en el estudio clínico inicial. Se presenta la revisión de la bibliografía y el análisis de los factores que condicionan un mal resultado en el tratamiento quirúrgico de la endotropia.

Comportamiento de los complejos de hiperfunción vertical asociados a endotropia / Behavior overaction complexes associated with vertical esotropia

Se realizó un estudio retrospectivo en 158 casos con diagnóstico de endotropia de etiología diversa asociada a incomitancias verticales. Los pacientes fueron divididos para su estudio en tres grupos: 1.- complejos de hiperfunción de superiores. 2.- complejos de hiperfunción de inferiores y 3.- otros, que incluyó a los complejos monoculares de hiperfunción y otras asociaciones. Los principales resultados que se encontraron fueron: en el 46.2 por ciento de los casos se asoció a complejos de hiperfunción de superiores, con un promedio de edad de 10.3 años. En el 44.3 por ciento se asoció a complejos de hiperfunción de inferiores, con un promedio de edad de 5.1 años. En el tercer grupo quedaron el 9.5 por ciento de los casos. La diferencia en los promedios de edad entre los grupos 1 y 2 fue estadísticamente significativa. (p=.0026507). Se estudiaron también los casos en que las incomitancias verticales eran significativas, encontrando que predominan los casos con hiperfunción de inferiores (57.6 por ciento).

Resultados del tratamiento quirúrgico en la endotropia monocular vs alterna: estudio comparativo / Results of the surgical treatment in the monocular esotropia vs alrnate cases. A compartive study

Estudio restrospectivo que tiene como objetivo determinar si existen diferencias entre los pacientes con endotropia posicional inervacional primaria monocular y alterna en el resultado del tratamiento quirúrgico y estabilidad del resultado. Se estudiaron los expediente de 66 pacientes, 41 con desviación alterna y 25 con desviación monocular, recopilando la desviación preoperatoria, postoperatoria inmediata, y a su más largo seguimiento. Los pacientes fueron operados con el mismo procedimiento quirúrgico. Los pricipales resultados mostraron que no existe diferencia estadísticamente significativa en la respuesta al tratamiento inmediato ni diferencia en la estabilidad del resultado entre pacientes con endotropia posicional inervacional primaria, monocular vs alterna, el tiempo promedio de seguimiento fue de 1 años y 5 meses, con un rango de 3 meses a 10 años.

Sección del recto interno como complicación de la cirugía de Caldwell-Luc / Medial rectus section as a Caldewll-Luc surgical complication

Se describe el caso de un paciente que presentó una sección del recto interno después de una cirugía de Cadwell-Luc. Se plantean las diferentes complicaciones oculares que pueden presentarse en la cirugía de los senos paranasales, se comentan las alternativas de tratamiento y pronóstico y se presenta el resultado postoperatorio