RESUMEN
PURPOSE: To investigate how frequently botulinum toxin, when used as a postoperative diplopia test, reduces the angle of deviation prior to subsequent strabismus surgery. METHODS: A retrospective study of 39 adult patients with constant concomitant horizontal strabismus who had undergone botulinum toxin injections to assess the risk of postoperative diplopia and then subsequently underwent strabismus surgery. RESULTS: Fourteen out of 39 patients (36%) sustained a reduction of 15 prism diopters or more for near and/or distance when comparing the pre-injection angle of deviation with the preoperative angle of deviation. CONCLUSION: Approximately one-third of patients receiving botulinum toxin as a postoperative diplopia test maintained a significant reduction in the angle of their deviation prior to undergoing surgery.
Asunto(s)
Toxinas Botulínicas Tipo A , Diplopía/diagnóstico , Movimientos Oculares , Complicaciones Posoperatorias/diagnóstico , Estrabismo/cirugía , Adolescente , Adulto , Anciano , Diplopía/etiología , Diplopía/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Pronóstico , Estudios Retrospectivos , Estrabismo/fisiopatología , Adulto JovenRESUMEN
Diplopia is a rare but well recognised complication following retrobulbar and peribulbar local anaesthesia but it has not been widely reported following sub-tenon's local anaesthesia (STLA). We report on a 76-year-old woman who developed vertical diplopia after left phacoemulsification. She had received a STLA. She had left hypotropia measuring 30 prism diopters for near and distance. She was managed with occlusion but there was no improvement in her findings over 6 months. Ocular motility opinion was then sought and a presumptive diagnosis of inferior rectus fibrosis was made. She subsequently underwent a left inferior rectus recession using adjustable sutures. Postoperatively she had a residual left hypotropia measuring 8 prism dioptres and single vision. Possible causes of inferior rectus fibrosis include muscle damage during traumatic sub-tenon's block or myotoxicity due to local anaesthetic agents. This case highlights the importance of close supervision of inexperienced staff administering regional anaesthetics.
Asunto(s)
Anestesia Local/efectos adversos , Diplopía/etiología , Lidocaína/efectos adversos , Anciano , Diplopía/cirugía , Femenino , Fibrosis , Humanos , Implantación de Lentes Intraoculares , Músculos Oculomotores/patología , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Facoemulsificación , Técnicas de Sutura , Cápsula de Tenon , Campos VisualesRESUMEN
INTRODUCTION: Dorsal midbrain syndrome (DMS) is characterized by upgaze paralysis, convergence-retraction nystagmus, and eyelid retraction. Impaired downgaze and pupillary light-near dissociation may co-exist, while less common features including exotropia and convergence paralysis have also been described. However, loss of motor fusion is not a well recognised finding in DMS. PURPOSE: To describe DMS associated with loss of motor fusion. METHODS: Retrospective case series. RESULTS: Five patients (age 21-80 years) presented with features of DMS due to severe head injury (n=1), brainstem stroke (n=3) and pinealoma (n=1). All five complained of constant diplopia with horizontal and vertical separation and had an exotropia (range 20Δ to 70Δ), absent convergence and motor fusion. Two underwent strabismus surgery and subsequently had a variable improvement in their motor fusion. The remaining three patients were managed with occlusion. CONCLUSION: This case series illustrates the complexity of ocular motility findings associated with DMS and highlights the potential difficulties in the management of patients with loss of motor fusion.
Asunto(s)
Encefalopatías/diagnóstico , Mesencéfalo/patología , Trastornos de la Motilidad Ocular/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Encefalopatías/etiología , Encefalopatías/cirugía , Lesiones Encefálicas/complicaciones , Neoplasias Encefálicas/complicaciones , Infartos del Tronco Encefálico/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiología , Trastornos de la Motilidad Ocular/etiología , Trastornos de la Motilidad Ocular/cirugía , Glándula Pineal/patología , Pinealoma/complicaciones , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: To describe a novel use of conjunctival autograft in the management of surgically induced scleral necrosis that occurred after squint surgery. METHODS: Interventional case report. RESULTS: A 22-year-old man underwent bilateral adjustable squint surgery. Two weeks postoperatively, he developed conjunctival retraction and an area of scleral necrosis/melting with 80% thinning. The surrounding conjunctiva was markedly inflamed with raised edges. Screening for autoimmune and vasculitic conditions did not provide any positive results. The conjunctiva surrounding the area of scleral melt was excised and the area covered by a conjunctival autograft resulting in complete healing of the scleral melt within 1 month of surgery. CONCLUSION: The pathogenesis of surgically induced scleral necrosis not associated with autoimmune conditions may be the result of the products of inflammation and lytic enzymes released by the surrounding conjunctival tissue initiating the scleral melting process. This type of surgically induced scleral necrosis may be successfully managed by excision of the surrounding inflamed conjunctiva, thus removing a potential source of collagenases, and covering the exposed sclera by a conjunctival transplant obviating the need for prolonged high-dose immunosuppression.
Asunto(s)
Conjuntiva/trasplante , Exotropía/cirugía , Tejido de Granulación/cirugía , Complicaciones Posoperatorias , Escleritis/cirugía , Tejido de Granulación/patología , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos , Escleritis/etiología , Trasplante Autólogo , Adulto JovenRESUMEN
We report the case of a 33-year-old male with a negative angle kappa which became apparent following surgery for a consecutive exotropia.
Asunto(s)
Músculos Oculomotores/fisiopatología , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Complicaciones Posoperatorias , Estrabismo/cirugía , Visión Binocular/fisiología , Acomodación Ocular , Adulto , Humanos , Masculino , Privación Sensorial , Estrabismo/fisiopatologíaAsunto(s)
Absceso/microbiología , Aspergilosis/microbiología , Endoftalmitis/microbiología , Infecciones Fúngicas del Ojo/microbiología , Trasplante de Corazón/efectos adversos , Absceso/diagnóstico , Absceso/terapia , Anciano , Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico , Aspergilosis/terapia , Aspergillus fumigatus/aislamiento & purificación , Quimioterapia Combinada , Endoftalmitis/diagnóstico , Endoftalmitis/terapia , Enucleación del Ojo , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/terapia , Humanos , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Masculino , Cuerpo Vítreo/microbiologíaRESUMEN
We report the case of a 20-year-old female who developed progressive esotropia, which was associated with low myopia and restricted extraocular movements.
Asunto(s)
Esotropía/etiología , Miopía/complicaciones , Miopía/fisiopatología , Músculos Oculomotores/fisiopatología , Adulto , Toxinas Botulínicas/administración & dosificación , Toxinas Botulínicas/uso terapéutico , Progresión de la Enfermedad , Esotropía/tratamiento farmacológico , Esotropía/fisiopatología , Esotropía/cirugía , Femenino , Humanos , Inyecciones Intramusculares , Músculos Oculomotores/efectos de los fármacos , Procedimientos Quirúrgicos Oftalmológicos , Índice de Severidad de la EnfermedadRESUMEN
Human extraocular muscles are richly endowed with sensory receptors. The precise role of afferent signals derived from these proprioceptors in ocular motor control and spatial localization has been the subject of considerable debate for more than a century. Laboratory-based and clinical studies have increasingly suggested that proprioceptive signals from extraocular muscles influence visuomotor behavior.