RESUMEN
Patients with Parkinson's disease (PD) commonly complain of impaired visual function and difficulty reading, despite normal visual acuity. Although previous studies have evaluated contrast sensitivity, color vision, visuospatial processing, visual hallucinations, and ocular movements, none has systematically evaluated the ocular complaints and ocular findings of PD patients. Thirty patients with early untreated PD and 31 control subjects without neurologic or known ocular diseases were ophthalmologically evaluated for the frequency of visual complaints, dry eyes, blepharitis, visual hallucinations, reduced blink rate, blepharospasm, and convergence insufficiency. Ocular complaints suggesting ocular surface irritation, altered tear film, visual hallucinations, blepharospasm, decreased blink rate, and decreased convergence amplitudes were more common in PD patients than in control subjects. These findings likely account for many of the visual difficulties commonly encountered by PD patients. These ocular abnormalities frequently respond to treatment.
Asunto(s)
Oftalmopatías/etiología , Enfermedad de Parkinson/complicaciones , Trastornos de la Visión/etiología , Adulto , Anciano , Blefaritis/epidemiología , Blefaritis/etiología , Síndromes de Ojo Seco/epidemiología , Síndromes de Ojo Seco/etiología , Oftalmopatías/diagnóstico , Oftalmopatías/epidemiología , Femenino , Alucinaciones/epidemiología , Alucinaciones/etiología , Humanos , Masculino , Persona de Mediana Edad , North Carolina/epidemiología , Trastornos de la Motilidad Ocular/epidemiología , Trastornos de la Motilidad Ocular/etiología , Prevalencia , Encuestas y Cuestionarios , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/epidemiologíaRESUMEN
PURPOSE: The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers. METHODS: Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed. RESULTS: The mean grating visual acuity (LogMAR) for the affected eye was 0.70 +/- 0.32 for the IOL group and 0.87 +/- 0.31 for the CL group (P =.19). The mean interocular difference in grating visual acuity was 0.26 +/- 0.30 for the IOL group and 0.50 +/- 0.28 for the CL group (P =.048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P =.24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P =.003). CONCLUSIONS: Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy.
Asunto(s)
Afaquia Poscatarata/fisiopatología , Extracción de Catarata , Seudofaquia/fisiopatología , Estrabismo/fisiopatología , Agudeza Visual , Afaquia Poscatarata/terapia , Catarata/congénito , Lentes de Contacto , Humanos , Incidencia , Lactante , Implantación de Lentes Intraoculares , Seudofaquia/terapia , Reoperación , Privación Sensorial , Estrabismo/etiología , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
INTRODUCTION: Parkinson's disease is associated with multiple abnormalities of both the afferent and efferent visual systems. Blepharospasm, paucity of blinking, apraxia of lid opening, visual neglect, reduced vergence, reduced upgaze, and blurred vision are reported findings in these patients. The association of these findings with the disease, and their duration, severity, and treatment have not been systematically investigated. PATIENTS AND METHODS: Patients with Parkinson's disease were prospectively examined. An age-matched control group was recruited from accompanying family members and volunteers. Data recorded included presence of visual complaint, the severity of the Parkinson's disease by Hoehn and Yahr Stage (scale = 1 to 5), duration of disease, pharmacologic therapy, visual acuity, ocular motility, accommodation, convergence amplitudes, and the near point of convergence. RESULTS: Thirty-nine patients were entered into each group, each with 21 men and 18 women. The average patient had had the disease for 8.9 years with a severity index of 2.6. Asthenopia, upgaze deficiency, and convergence insufficiency were significantly more common in the patients with Parkinson's disease than in the controls. Mean geometric visual acuity was poorer in the Parkinson's patients (20/39 compared with 20/28); P < .001). DISCUSSION: Visual complaints were significantly more common in the Parkinson's patients than in the age-matched controls. The frequency of ocular abnormalities was not related to the duration of the disease. Increasing severity seemed to be correlated with the presence of convergence insufficiency and a decline in acuity.
Asunto(s)
Trastornos de la Motilidad Ocular/complicaciones , Enfermedad de Parkinson/complicaciones , Acomodación Ocular , Anciano , Anciano de 80 o más Años , Convergencia Ocular , Movimientos Oculares , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/fisiopatología , Enfermedad de Parkinson/fisiopatología , Estudios Prospectivos , Trastornos de la Visión/complicaciones , Trastornos de la Visión/fisiopatología , Agudeza VisualRESUMEN
PURPOSE: To determine whether pupillary responses to dilute tropicamide could be used as a diagnostic test for Alzheimer disease (AD). The authors also investigated whether concurrent use of an oral acetylcholinesterase inhibitor (tacrine) alters the pupillary response to dilute tropicamide in patients with AD, and whether pupillary responses to dilute tropicamide differ in young versus older control subjects. METHODS: Pupillary diameter and area of both eyes were measured in light and darkness, at 10-minute intervals for 40 minutes after random instillation of 0.01% tropicamide to one eye. Four groups of subjects were studied: 9 patients with AD, 10 who were treated with tacrine, 11 older control subjects, and 10 young control subjects. RESULTS: Mean change in anisocoria was not significantly different among groups at any of the measurement time points. Mean percent change in diameter of the treated eyes showed a trend toward faster maximum dilatation in the AD groups, but change in pupillary measurements did not identify individuals with AD. CONCLUSION: Pupillary response to dilute tropicamide did not effectively distinguish individual patients with AD from young or older control subjects.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Parasimpatolíticos , Pupila/efectos de los fármacos , Tropicamida , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/fisiopatología , Inhibidores de la Colinesterasa/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas , Parasimpatolíticos/farmacología , Pupila/fisiología , Tacrina/uso terapéutico , Tropicamida/farmacologíaRESUMEN
Residency training involves surgery by resident surgeons at various levels of experience and proficiency, supervised by an experienced attending physician. We reviewed the results of strabismus surgery performed at four institutions with two residency training programs. Five hundred twenty-two cases with follow up greater than 6 weeks were evaluated. These cases included 315 attending procedures and 207 resident procedures under direct attending supervision. Success was defined as a strabismic deviation of 8 prism diopters or less. Average postoperative follow-up was 57 weeks and did not differ between groups. There was no statistical difference between the resident success rate of 58% (121/207) and the attending success rate of 69% (217/315) after adjusting for population differences. The average final deviation of the patients postoperatively was 7 delta for the attending group and 10 delta for the resident group. Amblyopia was significantly more frequent in the resident cases (P < .001). Adjustable sutures were used significantly more often in attending cases (P < .0001). This study supports the premise that resident strabismus surgery is as successful as attending surgery.
Asunto(s)
Competencia Clínica , Internado y Residencia , Cuerpo Médico de Hospitales , Estrabismo/cirugía , Adolescente , Niño , Educación Médica , Estudios de Seguimiento , Humanos , Complicaciones Posoperatorias , Técnicas de Sutura , Resultado del TratamientoRESUMEN
Pneumatic retinopexy is advocated to treat some retinal detachment cases, in part to avoid the complication of induced strabismus sometimes associated with scleral buckling procedures (SBPs). Prospective evaluation of postoperative muscle imbalance was performed in 76 eyes of 69 patients undergoing SBP. Measureable limitation of ductions occurred in 40 (73%) of the 55 eyes for which a full set of duction measurements could be obtained. Among 53 patients without previous retinal surgery in either eye, postoperative deviations were associated with encircling scleral buckles (P = 0.00003), but not with radial scleral buckles (P = 0.6). Significant strabismus occurred in 12 patients (23%), and three required surgery or prism therapy. Candidates for pneumatic retinopexy can usually be treated by a radial scleral buckling procedure, and therefore the risk of postoperative strabismus is low if this technique is selected.
Asunto(s)
Músculos Oculomotores/fisiopatología , Curvatura de la Esclerótica/efectos adversos , Estrabismo/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Cuidados Preoperatorios , Estudios Prospectivos , Desprendimiento de Retina/cirugía , Estrabismo/fisiopatología , Pruebas de Visión , Agudeza VisualRESUMEN
Pneumatic retinopexy is increasingly recommended to treat some patients with retinal detachment to avoid the complication of induced refractive changes sometimes associated with scleral buckling procedures. Prospective evaluation of refractive changes after scleral buckling procedures was performed in 75 eyes of 69 patients. Encircling scleral buckles caused an average increased axial length of 0.99 mm and average induced myopia of 2.75 diopters. Induced astigmatism was likely to occur in patients undergoing scleral buckling surgery, but it was not related to whether a radial element was used.
Asunto(s)
Errores de Refracción/etiología , Curvatura de la Esclerótica/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pruebas de Visión , Agudeza VisualRESUMEN
Although cataract surgery is feasible in children with unilateral cataracts, visual rehabilitation depends on optical correction and conscientiously maintained amblyopia therapy. Epikeratophakia for the correction of aphakia was performed in 47 children (50 grafts). Postoperative keratometry readings showed an average increase of 12.68 diopters in early patients. With new tissue-handling techniques, the last eight patients showed an average increase of +16.80 D, with -0.64-D overrefraction for emmetropia. Visual results indicate that epikeratophakia is an effective primary procedure for patients with unilateral traumatic cataracts and that it is superior to leaving vision uncorrected in children who have had unilateral congenital cataracts removed and are contact-lens intolerant. Further studies with younger patients will be necessary to define its role in neonates; however, individual results demonstrate that good vision is obtainable with epikeratophakia.
Asunto(s)
Extracción de Catarata , Visión Ocular/fisiología , Niño , Preescolar , Femenino , Humanos , Masculino , Periodo Posoperatorio , Agudeza VisualRESUMEN
We constructed a low-vision aid for a 61-year-old patient who had familial macular degeneration and a visual acuity of 20/300. The aid consisted of a spectacle lens incorporating his distance prescription as the carrier, a high-plus bifocal reading addition, and the high-minus ocular lens of a Galilean telescope of variable magnification. The objective lens of the telescope can be carried as a folding, dual-lens, hand magnifier.
Asunto(s)
Anteojos , Degeneración Macular/terapia , Humanos , Lentes , Masculino , Persona de Mediana EdadRESUMEN
We performed epikeratophakia for the correction of aphakia in 31 children, ages 2 months to 7 years, who had unilateral congenital or traumatic cataracts. In 27 patients with more than 4 months of follow-up, 23 of 30 (77%) grafts were successful. In the 15 patients with 6 months or more followup, the average increase in corneal curvature was 12.39 diopters. The average overrefraction needed to achieve emmetropia was + 2.14 diopters spherical equivalent. Two patients operated on within the first year of life have achieved 6/15 (20/50) visual acuities, as measured by visual evoked potentials. One patient operated on in the second year of life achieved 5/30 visual acuity, as measured by Allen cards. Two patients operated on for traumatic cataracts at ages 2 and 4 years achieved 6/9 (20/30) and 8/30 (Allen cards) visual acuities, respectively. Five older patients who had congenital cataracts or persistent hyperplastic vitreous showed some improvement in visual function. Advantages of epikeratophakia include the placement of most of the correction directly on the eye in a permanent attachment and the elimination of contact lens manipulation in uncooperative patients, so that more time and energy can be devoted to the occlusion therapy.
Asunto(s)
Trasplante de Córnea , Factores de Edad , Afaquia Poscatarata , Niño , Preescolar , Lentes de Contacto , Potenciales Evocados Visuales , Anteojos/normas , Estudios de Seguimiento , Humanos , Lactante , Cuidados PosoperatoriosRESUMEN
Five patients required secondary surgical procedures after receiving epikeratophakia grafts. A neonate underwent epikeratophakia in combination with extracapsular cataract extraction, followed one week later by peripheral iridectomy and nine months later by strabismus surgery. A 53-year-old male had surgery to correct retinal detachment 4-1/2 months after epikeratophakia surgery for the correction of aphakia. A five-year-old male had epikeratophakia after removal of a traumatic cataract; five weeks later, retinal detachment necessitated vitrectomy, 360 degrees buckle, and cyclocryotherapy. A 4-1/2-year-old female had epikeratophakia for aphakia, followed nine months later by strabismus surgery. A 38-year-old female with keratoconus received a plano epikeratophakia graft, in combination with an extracapsular cataract extraction and anterior vitrectomy, followed two weeks later by an Ocutome vitrectomy. In all cases, the epikeratophakia grafts and interfaces remained clear, and in four of the five patients in whom secondary procedures were successful, vision continued to improve with time.
Asunto(s)
Catarata/congénito , Trasplante de Córnea , Queratocono/cirugía , Desprendimiento de Retina/complicaciones , Adulto , Extracción de Catarata , Preescolar , Córnea/anomalías , Lesiones de la Cornea , Anomalías del Ojo , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Iris/complicaciones , Masculino , Persona de Mediana Edad , Estrabismo/complicaciones , Cuerpo Vítreo/cirugíaRESUMEN
Epikeratophakia is a form of refractive surgery in which the recipient's epithelium is removed and a pre-shaped donor lenticule is sutured to the patient's cornea. Seventeen patients ranging in age from two months to 6.6 years received 19 epikeratophakia grafts for the correction of aphakic vision. The correction provided by the graft in combination with vigorous amblyopia therapy has yielded some improvement in vision in the 12 patients with successful grafts. This procedure may be particularly suitable for pediatric aphakic patients because it is extraocular and reversible and may be employed as a secondary procedure or in conjunction with cataract extraction. Only with longer follow-up of these and additional patients can these preliminary results be validated and the risk/benefit ratio of this procedure be assessed.