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INTRODUCTION AND OBJECTIVE: Botulinum toxin (BT) is used in a variety of therapeutic applications, including the treatment of strabismus. Two injection techniques coexist - transconjunctival injection and open sky injection. The goal of this study was to evaluate the results of BT injections in esotropia in children under 10 years of age and to compare the two techniques. PATIENTS AND METHOD: This is a retrospective, monocentric study, including children who received BT injections to treat their strabismus by the aforementioned techniques between 2014 and 2017. The results of these injections were recorded, and subgroup analyses (injection technique, age, degree of deviation, type of strabismus) were performed. The primary endpoint was the optimal success rate defined as residual strabismus less than or equal to 10 Δ. RESULTS: The study included 68 children with a mean age of 28.9 months and a mean deviation angle of 34.7 Δ. Patients received 1.2 BT injections. The success rate was 38% at 6 months, 35% at 12 months, and 35% at 24 months. There was 33% transient ptosis and 5% consecutive exotropia. There was no evidence of significant difference in success rate between the transconjunctival and open sky injection methods, baseline angles, age of injection, or type of strabismus. CONCLUSION: BT injection is effective and safe in pediatric esotropia, regardless of the injection method.

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OBJETIVO: Se considera que las aves rapaces diurnas constituyen el grupo de animales con una agudeza visual (AV) más alta. El objetivo de este trabajo es revisar la literatura publicada recientemente en relación con el sistema visual de este grupo de animales. MATERIAL Y MÉTODOS: Búsqueda bibliográfica realizada en PubMed. El algoritmo de búsqueda utilizado fue (raptor OR falcon OR kestrel OR hawk OR eagle) AND (vision OR «visual acuity» OR eye OR macula OR retina OR fovea OR «nictitating membrane» OR «chromatic vision» OR ultraviolet). La búsqueda se restringió a los campos título y resumen, solo para otros animales (excluyendo humanos) y sin restricción temporal. RESULTADOS: El algoritmo propuesto localiza un total de 97 artículos. CONCLUSIONES: Se considera que las rapaces están dotadas de la AV más alta del reino animal, aunque la mayor parte de los trabajos estudian un individuo o un pequeño grupo de individuos y la metodología es heterogénea. La especie más estudiada es el halcón peregrino (Falco peregrinus) con una AV estimada de 140 ciclos/grado, si bien algunas águilas están dotadas de AV similares. La forma tubular del ojo, la gran pupila y la alta densidad de fotorreceptores hacen posible esta extraordinaria AV. En algunas especies, tanto los estudios histológicos como la tomografía de coherencia óptica demuestran la existencia de 2 fóveas. Parece que la fóvea de localización nasal (profunda) es la que ofrece una AV más alta, sin embargo, la función exacta de cada una de estas se desconoce. El humor vítreo contenido sobre la fóvea profunda podría comportarse como una tercera lente y añadir cierta magnificación al sistema óptico

OBJECTIVE: Diurnal birds of prey (raptors) are considered the group of animals with highest visual acuity (VA). The purpose of this work is to review all the information recently published about the visual system of this group of animals. MATERIAL AND METHODS: A bibliographic search was performed in PubMed. The algorithm used was (raptor OR falcon OR kestrel OR hawk OR eagle) AND (vision OR «visual acuity» OR eye OR macula OR retina OR fovea OR «nictitating membrane» OR «chromatic vision» OR ultraviolet). The search was restricted to the «Title» and «Abstract» fields, and to non-human species, without time restriction. RESULTS: The proposed algorithm located 97 articles. CONCLUSIONS: Birds of prey are endowed with the highest VA of the animal kingdom. However most of the works study one individual or a small group of individuals, and the methodology is heterogeneous. The most studied bird is the Peregrine falcon (Falco peregrinus), with an estimated VA of 140 cycles/degree. Some eagles are endowed with similar VA. The tubular shape of the eye, the large pupil, and a high density of photoreceptors make this extraordinary VA possible. In some species, histology and optic coherence tomography demonstrate the presence of 2 foveas. The nasal fovea (deep fovea) has higher VA. Nevertheless, the exact function of each fovea is unknown. The vitreous contained in the deep fovea could behave as a third lens, adding some magnification to the optic system

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OBJECTIVE: Diurnal birds of prey (raptors) are considered the group of animals with highest visual acuity (VA). The purpose of this work is to review all the information recently published about the visual system of this group of animals. MATERIAL AND METHODS: A bibliographic search was performed in PubMed. The algorithm used was (raptor OR falcon OR kestrel OR hawk OR eagle) AND (vision OR «visual acuity¼ OR eye OR macula OR retina OR fovea OR «nictitating membrane¼ OR «chromatic vision¼ OR ultraviolet). The search was restricted to the «Title¼ and «Abstract¼ fields, and to non-human species, without time restriction. RESULTS: The proposed algorithm located 97 articles. CONCLUSIONS: Birds of prey are endowed with the highest VA of the animal kingdom. However most of the works study one individual or a small group of individuals, and the methodology is heterogeneous. The most studied bird is the Peregrine falcon (Falco peregrinus), with an estimated VA of 140 cycles/degree. Some eagles are endowed with similar VA. The tubular shape of the eye, the large pupil, and a high density of photoreceptors make this extraordinary VA possible. In some species, histology and optic coherence tomography demonstrate the presence of 2foveas. The nasal fovea (deep fovea) has higher VA. Nevertheless, the exact function of each fovea is unknown. The vitreous contained in the deep fovea could behave as a third lens, adding some magnification to the optic system.

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Objetivo: Determinar la importancia relativa de las distintas formas de anisocoria en un centro sanitario de nivel secundario. Métodos: Estudio prospectivo longitudinal, incluyendo todos los pacientes remitidos por este motivo a la consulta de Neuroftalmología del Hospital Universitario del Henares, Madrid, España, desde noviembre de 2008 hasta octubre de 2011. Se estudiaron las diferencias en el diámetro pupilar en condiciones de alta y baja luminosidad. Los pacientes fueron sometidos a una exploración oftalmológica completa, y a las pruebas de apraclonidina, cocaína, pilocarpina 0,125% y pilocarpina 2% en caso de considerarse necesario. Resultados: Treinta y dos casos de anisocoria fueron referidos durante estos 3 años. No se encontró asociación con la edad ni el sexo. Los diagnósticos fueron: pupila de Adie, 4 casos; síndrome de Horner, 5 casos; midriasis unilateral episódica benigna, 3 casos; causas locales, 4 casos; anisocoria fisiológica, 5 casos. A pesar de una completa historia clínica y exploración, la causa de la anisocoria no se pudo determinar en 11 casos. En 4 de estos casos el paciente padecía migrañas y en otros 4 consumía psicofármacos. En 3 casos ambos factores de riesgo estaban presentes. En un caso la anisocoria fue la pista inicial que llevó al diagnóstico de un paraganglioma cervical. Conclusiones: La anisocoria es un signo clínico que no traduce habitualmente enfermedad grave. Con nuestros protocolos, un número alto de los casos de anisocoria queda sin filiar. La migraña y los psicofármacos podrían estar asociados a estas formas de anisocoria(AU)

Objetive: To determine the relative importance of the different forms of anisocoria in a General Hospital. Methods: A prospective, longitudinal study was conducted including all patients referred for this reason to the Neuro-Ophthalmology Unit of the Henares University Hospital, Madrid (Spain), from November 2008 to October 2011. The differences in pupil diameter were studied under high and low luminosity. The patients were given a full ophthalmological examination, as well as performing the apraclonidine, cocaine, pilocarpine 0.125% and pilocarpine 2% tests, if they were considered necessary. Results: Thirty-two cases of anisocoria were referred during the three years of the study. No relationship was found with age or gender. The diagnostic results were: Adie's pupil, 4 cases; Horner syndrome, 5 cases; benign episodic unilateral mydriasis, 3 cases; local causes, 4 cases; physiological anisocoria, 5 cases. Despite a full clinical history and examination, the cause of the anisocoria could not be determined in 11 cases. In 4 of these cases, the patient suffered from migraines and in another 4 psychotropic drugs were taken. Both risk factors were present in 3 cases. In one case the anisocoria was the initial clue that led to the diagnosis of a cervical paraganglioma. Conclusions: Anisocoria is a clinical sign that does not usually signify a serious disease. With our protocols, a high number of anisocoria cases are still of unknown origin. Migraines and psychotropic drugs could be linked to these forms of anisocoria(AU)

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OBJECTIVE: [corrected] To determine the relative importance of the different forms of anisocoria in a General Hospital. METHODS: A prospective, longitudinal study was conducted including all patients referred for this reason to the Neuro-Ophthalmology Unit of the Henares University Hospital, Madrid (Spain), from November 2008 to October 2011. The differences in pupil diameter were studied under high and low luminosity. The patients were given a full ophthalmological examination, as well as performing the apraclonidine, cocaine, pilocarpine 0.125% and pilocarpine 2% tests, if they were considered necessary. RESULTS: Thirty-two cases of anisocoria were referred during the three years of the study. No relationship was found with age or gender. The diagnostic results were: Adie's pupil, 4 cases; Horner syndrome, 5 cases; benign episodic unilateral mydriasis, 3 cases; local causes, 4 cases; physiological anisocoria, 5 cases. Despite a full clinical history and examination, the cause of the anisocoria could not be determined in 11 cases. In 4 of these cases, the patient suffered from migraines and in another 4 psychotropic drugs were taken. Both risk factors were present in 3 cases. In one case the anisocoria was the initial clue that led to the diagnosis of a cervical paraganglioma. CONCLUSIONS: Anisocoria is a clinical sign that does not usually signify a serious disease. With our protocols, a high number of anisocoria cases are still of unknown origin. Migraines and psychotropic drugs could be linked to these forms of anisocoria.

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PURPOSE: This study aimed to assess the detection and characteristics of feeder vessels (FV) of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). METHODS: A retrospective study of 59 consecutive eyes presenting subfoveal CNV secondary to ARMD was performed. Feeder vessels were detected by means of indocyanine green video angiography using a confocal scanning laser ophthalmoscope. The following factors were analyzed: patient age, visual acuity using Snellen lines and/or ETDRS, fluorescein angiographic (FA) patterns, size of CNV, and time of evolution. The following characteristics of FV also were evaluated: FV pattern (umbrella or racquet-like pattern), number, width and the location with respect to the fovea. RESULTS: FV were detected in 36 subfoveal CNV (61%). No significant differences were noted between the presence of FV in terms of visual acuity (U Mann-Whitney, p=0.816), FA patterns (Fisher's exact probability test p=0.265), size of the CNV (U Mann-Whitney, p=0.267) and time of evolution (U Mann-Whitney, p=0.099). The most common pattern FV was a the racquet-like pattern, inserted in the subfoveal CNV from an extrafoveal origin on the nasal side after a variable course of approximately 1.27 mm (range 0.1-2.9 mm), with a diameter of 83.3 microm (range 20-150 microm). CONCLUSIONS: FV were detected in 36 subfoveal CNV (61%) in ARMD. Only 16 subfoveal CNV (25.4%) were considered eligible for FV treatment.

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Objetivo: Detectar y caracterizar los vasos nutricios(VNA) de las membranas neovasculares(NVC) subfoveales en la degeneración macular asociadaa la edad (DMAE).Métodos: Estudio retrospectivo en 59 ojos consecutivoscon NVC subfoveal secundaria a DMAE.Los VNA fueron detectados gracias a la videoangiografíaverde-indocianina, con un oftalmoscopioláser confocal de barrido. Se analizaron los factoressiguientes: edad, AV con los optotipos de Snelleny/o ETDRS, patrón de la AFG, tamaño de la NVCy tiempo de evolución. En los VNA se estudió elpatrón angiográfico, en paraguas o en raqueta, elnúmero, grosor y localización con respecto a lafóvea.Resultados: Se detectaron VNA en 36 NVC subfoveales(61%). No se encontraron diferencias significativasentre la presencia de vaso nutricio y la AV (U Mann Whitney, p=0,816), el patrón de la AFG(fisher test, p=0,265), el tamaño de la NVC (UMann Whitney, p=0,267), o el tiempo de evolución(U Mann Whitney, p=0,099). El patrón de la AFGmás común fue el tipo raqueta, con nacimientonasal extrafoveal, con un recorrido medio de 1,27mm (rango 0,1-2,9) y un diámetro medio de 83,3μm (rango 20-150).Conclusiones: Se pudo identificar VNA en el 61%de una población con NVC bien o mal delimitadas,y solo 16 NVC subfoveales (25,4%) reunieron lascaracterísticas necesarias para realizar tratamientocon láser del VNA

Purpose: This study aimed to assess the detection and characteristics of feeder vessels (FV) of subfoveal choroidal neovascularization (CNV) in agerelated macular degeneration (ARMD). Methods: A retrospective study of 59 consecutive eyes presenting subfoveal CNV secondary to ARMD was performed. Feeder vessels were detected by means of indocyanine green video angiography using a confocal scanning laser ophthalmoscope. The following factors were analyzed: patient age, visual acuity using Snellen lines and/or ETDRS, fluorescein angiographic (FA) patterns, size of CNV, and time of evolution. The following characteristics of FV also were evaluated: FV pattern (umbrella or racquet-like pattern), number, width and the location with respect to the fovea. Results: FV were detected in 36 subfoveal CNV (61%). No significant differences were noted between the presence of FV in terms of visual acuity (U Mann-Whitney, p=0.816), FA patterns (Fisher’s exact probability test p=0.265), size of the CNV (U Mann-Whitney, p=0.267) and time of evolution (U Mann-Whitney, p=0.099). The most common pattern FV was a the racquet-like pattern, inserted in the subfoveal CNV from an extrafoveal origin on the nasal side after a variable course of approximately 1.27 mm (range 0.1-2.9 mm), with a diameter of 83.3 μm (range 20-150 μm). Conclusions: FV were detected in 36 subfoveal CNV (61%) in ARMD. Only 16 subfoveal CNV (25.4%) were considered eligible for FV treatment

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