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ABSTRACT A 12-year-old boy with Donnai-Barrow syndrome diagnosed intra-uterus presented esotropia, high myopia, nystagmus, and optic disk staphyloma in an ophthalmologic examination. The patient had associated Fanconi syndrome and sensorineural hearing loss as well as facial manifestations as hypertelorism, downward slanting of palpebral fissures and low ear implantation. Magnetic resonance imaging revealed agenesis of the corpus callosum. To our knowledge, this is the first reported case associated with esotropia, nystagmus, and optic disk staphyloma.

RESUMO Paciente do sexo masculino, 12 anos, com diagnóstico intrauterino de síndrome de Donnai-Barrow, apresentava ao exame oftalmológico esotropia, alta miopia, nistagmo e estafiloma de disco óptico. Associado ao quadro, apresentava síndrome de Falconi e perda auditiva neurossensorial, além de alterações faciais, como hipertelorismo, inclinação inferior das fissuras palpebrais e implantação baixa das orelhas. Ressonância magnética revelou agenesia de corpo caloso. Ao nosso conhecimento, este é o primeiro caso relatado associando esotropia, nistagmo e estafiloma de disco óptico.

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We report the case of a previously healthy 48-year-old man who developed an isolated abducens nerve palsy 18 days after presenting with coronavirus disease (COVID-19) confirmed by reverse transcriptase polymerase chain reaction. His main complaint at arrival was double vision. Ocular examination revealed a sixth cranial nerve palsy in the left eye. The incomitant esotropia at arrival was 30 prism diopters. Abduction was markedly limited, while adduction was normal in the left eye. The patient underwent complete clinical, neurological, and neuroimaging investigations, including cerebrospinal fluid sample analysis to rule out infectious causes. A conservative approach with orthoptic therapy and Fresnel prism was opted. Eight months after the onset of COVID-19, regression of the strabismus was observed, and the patient reported complete recovery of the diplopia. This case suggests that isolated abducens nerve palsy caused by severe acute respiratory syndrome coronavirus 2 infection may improve with a conservative approach.

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RESUMO Objetivo: Avaliar um novo tipo de gancho muscular (gancho milimetrado de Felício) e sua eficácia em cirurgias de estrabismo. Métodos: Buscando uma abordagem independente, com a mínima participação do auxiliar, o novo instrumento foi usado em cirurgias de retrocesso e ressecção, para comparar sua eficácia e segurança com a técnica tradicional. Participaram do estudo 14 pacientes divididos em dois grupos. Resultados: O grupo operado por meio da técnica tradicional teve média de idade foi de 14,7 anos, e o grupo que usou o novo gancho teve média de 17 anos. Ambos os grupos obtiveram redução semelhante do estrabismo inicial, sendo, em média, de 87,84% no grupo tradicional e de 93,04% com o novo gancho, porém sem relevância estatística (p=0,274). Conclusão: O gancho milimetrado de Felício mostrou-se opção útil ao cirurgião na realização da cirurgia de estrabismo com redução da importância do auxiliar, de forma segura e reprodutível.

ABSTRACT Objective: To evaluate a new type of muscle hook (Felício's millimeter hook) and its effectiveness in strabismus surgeries. Methods: Seeking an independent approach, with minimal assistance from the assistant, the new instrument was used in retrocession and resection surgeries, to compare its efficacy and safety with the traditional technique. Results: 14 patients participated in the study, divided into two groups. The group who underwent surgery with the traditional technique had a mean age of 14.7 years and the group using the new hook, 17 years. Both groups obtained a similar reduction in initial strabismus, with an average of 87.84% in the traditional group and 93.04% with the new hook, but without statistically significant difference (p=0.274). Conclusion: Felicio's millimeter hook proved to be a useful option for the surgeon in performing strabismus surgery with a reduction in the importance of the assistant, in a safe and reproducible way.

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Objetivo: Determinar los resultados de la cirugía mínimamente invasiva en pacientes con estrabismos horizontales. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de 19 pacientes (16 ojos derechos, 17 izquierdos) atendidos en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el periodo comprendido entre junio de 2018 y julio de 2019, a quienes se les realizó cirugía mínimamente invasiva de estrabismo y fueron seguidos por 6 meses. Se evaluaron las variables: tipo de desviación, agudeza visual, signos posoperatorios, ángulo de desviación pre- y posquirúrgico, éxito quirúrgico, fusión, estereopsis y complicaciones. Resultados: El 73,7 por ciento de los pacientes presentaba esotropías; la media de agudeza visual pre- y posoperatoria entre los dos ojos fue muy similar; el signo posoperatorio más frecuente fue la hiperemia conjuntival ligera (75 por ciento ojos derechos y 64,5 por ciento ojos izquierdos) a las 24 horas. Se encontraron diferencias estadísticas (p < 0,001) en el ángulo de desviación horizontal en dioptrías prismáticas, pre- y poscirugía, con el 84,2 por ciento de éxito quirúrgico. El 78,6 y el 80 por ciento de los pacientes con esotropía y exotropías alcanzaron fusión, pero solo lograron estereopsis el 28,5 y el 60 por ciento de ellos respectivamente. La frecuencia de complicaciones ocurrió en el 15,8 por ciento de los pacientes. Conclusiones: Se alcanzaron buenos resultados motores, así como aceptables en los sensoriales en pacientes operados de estrabismos horizontales por cirugía mínimamente invasiva(AU)

Objective: Determine the results of minimally invasive surgery in patients with horizontal strabismus. Methods: A prospective longitudinal descriptive study was conducted of a series of 19 patients (16 right eyes, 17 left eyes) attending the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from June 2018 to July 2019. These patients underwent minimally invasive strabismus surgery and were followed up for six months. The variables considered were deviation type, visual acuity, postoperative signs, pre- and postoperative angle of deviation, surgical success, fusion, stereopsis and complications. Results: Of the patients studied, 73.7 percent presented esotropias; mean pre- and postoperative visual acuity was very similar in the two eyes; the most common postoperative sign was slight conjunctival hyperemia (75 percent right eyes and 64.5 percent left eyes) at 24 hours. Statistical differences (p < 0.001) were found in the horizontal angle of deviation in pre- and postoperative prism diopters, with 84.2 percent surgical success. 78.6 percent and 80 percent of the patients with esotropia and exotropia achieved fusion, but only 28.5 and 60 percent of them, respectively, achieved stereopsis. Complications occurred in 15.8 percent of the patients. Conclusions: Good motor results were obtained, as well as acceptable sensory results in patients undergoing minimally invasive horizontal strabismus surgery(AU)

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ABSTRACT Purposes: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. Methods: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. Results: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). Conclusion: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error.(AU)

RESUMO Objetivo: Avaliar a relação entre alterações na hipermetropia e o alinhamento ocular em pacientes com esotropia acomodativa. Métodos: Foram analisados retrospectivamente prontuários médicos de pacientes consecutivos diagnosticados com esotropia acomodativa refrativa (com esotropia eliminada ou reduzida a menos de 10 D com correção completa da hipermetropia). As medidas de refração em cicloplegia obtidas dos prontuários foram convertidas em equivalentes esféricos. Avaliaram-se ainda a presença de ambliopia, alterações do erro refrativo e o alinhamento ocular à admissão e depois do período de acompanhamento. Resultados: Setenta pacientes (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A diminuição média anual no desvio para perto e para longe com o uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, respectivamente. Os desvios miópicos totais dos olhos direito e esquerdo foram de 1,08 ± 1,35 D e 1,20 ± 1,40 D, respectivamente. Os desvios miópicos anuais foram de 0,22 D/ano e 0,26 D/ano para os olhos direito e esquerdo, respectivamente. A correlação entre a taxa de desvio miópico e a taxa de alteração do desvio para perto corrigido foi fraca. A correlação da taxa de desvio miópico não foi alta para os olhos direito e esquerdo (r=0,18, p=0,15). Conclusão: A quantidade de desvio e a hipermetropia diminuem gradualmente na esotropia acomodativa durante o acompanhamento. Por outro lado, pode não ser apropriado garantir aos pacientes que o desvio diminuirá em paralelo ao erro refrativo.(AU)

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PURPOSES: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. METHODS: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. RESULTS: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). CONCLUSION: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error.

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RESUMEN La deficiencia monocular de la elevación se define como la limitación de la elevación del ojo afectado desde cualquier posición de la mirada, con ducciones normales en todas las demás posiciones. La pseudoptosis se puede presentar en posición primaria de la mirada; sin embargo, el 25 por ciento de los casos puede mostrar una ptosis verdadera. Se presenta un paciente masculino de 11 años de edad con antecedentes de estrabismo hacia adentro desde que nació, quien llevó tratamiento con oclusiones y cristales desde el primer año de edad. Al examen oftalmológico presentaba una agudeza visual mejor corregida de 1,0/0,4; a 6 metros en el ojo derecho 30 ∆ b externa ~18 ∆ b superior y en el ojo izquierdo 30 ∆ b externa ~18 ∆ b inferior; a 33 centímetros en el ojo derecho 30 ∆ b externa ~25 ∆ b superior y en el ojo izquierdo 30 ∆ b externa ~25 ∆ b inferior y limitación de la elevación en todas las posiciones horizontales de la mirada en el ojo derecho. Se realizó la prueba de ducción forzada y se encontró una restricción del recto inferior derecho, por lo que se decidió retroinsertar este músculo y ambos rectos medios. Se indicó la corrección óptica y la rehabilitación con oclusiones que mejoró la visión a 1,0/0,7. La cirugía correctiva logró la ortotropía y la mejoría de la agudeza visual(AU)

ABSTRACT Monocular elevation deficiency is defined as a limitation in the elevation of the affected eye from any position of gaze with normal ductions in all other positions. Pseudoptosis may occur in the primary position of gaze, but 25 percent of the cases are true ptosis. A case is presented of a male 11-year-old patient with a history of inward strabismus since birth, treated with occlusions and lenses as of his first year of life. At ophthalmological examination, best corrected visual acuity was 1.0/0.4; at 6 meters in the right eye 30 ∆ b outer ~18 ∆ b upper, and in the left eye 30 ∆ b outer ~18 ∆ b lower; at 33 centimeters in the right eye 30 ∆ b outer ~25 ∆ b upper, and in the left eye 30 ∆ b outer ~25 ∆ b lower, and elevation limitation in all horizontal gaze positions of the right eye. The forced duction test revealed a restriction in the lower right rectus muscle. It was thus decided to insert back the right rectus muscle and both medial rectus muscles. Optical correction and rehabilitation with occlusions improved the patient's vision to 1.0/0.7. Corrective surgery achieved orthotropy and improved visual acuity(AU)

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ABSTRACT Objective: To evaluate the results of the surgical technique described by Crouch in the correction of lateral rectal paralysis (LR) esotropia. Methods: A study conducted of six patients with VI cranial nerve palsy, with more than three months, and associated contracture of the medial rectus muscle. The causes of paralysis varied in traumatic, congenital and neuropathic. The patients underwent surgical correction, performed with a technique consisting of the instillation of the superior rectus muscle (SR) and its suture above the insertion of the LR muscle, completed with Foster´s suture (suture joining, 8mm of the muscle insertion, the body of the SR and LR). The patients were followed for six months. Results: Five patients presented preoperative deviation between 30 and 50 prismatic diopter (PD), and one patient presented a deviation greater than 100 PD, and therefore, the patient required surgical reintervention due to residual deviation. The other five patients presented postoperative orthoppy, with better visual acuity and no vertical deviations. Conclusion: The surgery proposed by Crouch has been shown to be a good alternative to conventional techniques, such as Carlson-Jampolsky surgery, being a technically simpler procedure with good results.

RESUMO Objetivo: Avaliar resultados da técnica cirúrgica descrita por Crouch na correção de esotropia por paralisia do reto lateral (RL). Métodos: Estudo realizado com seis pacientes diagnosticados com paralisia de IV par craniano, com mais de três meses, e com contratura associada do musculo reto medial. As causas da paralisia variaram em traumática, congênita e neuropática. Os pacientes foram submetidos à correção cirúrgica, realizada com técnica que consiste na desinserção do músculo reto superior (RS) e sua sutura acima da inserção do músculo RL, completada com ponto de Foster (sutura unindo, a 8mm da inserção muscular, o corpo do RS e RL). Os pacientes foram seguidos por seis meses. Resultados: Cinco pacientes apresentaram, no pré-operatório, desvio entre 30 e 50 dioptrias prismáticas (DP), e um paciente apresentava desvio maior que 100DP, sendo, portanto o paciente que necessitou de reintervenção cirúrgica, por desvio residual. Os outros cinco pacientes apresentaram ortotropia no pós-operatório, com melhor da acuidade visual e sem desvios verticais. Conclusão: A cirurgia proposta por Crouch demostrou-se uma boa alternativa às técnicas convencionais, como cirurgia de Carlson-Jampolsky, sendo um procedimento tecnicamente mais simples e com bons resultados.

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Resumo O presente trabalho relata o caso de um paciente, masculino, 38 anos, com estrabismo incomitante e consequente diplopia, submetido à cirurgia debilitadora com recuo e fortalecimento com ressecção do músculo reto inferior direito. O objetivo desta técnica cirúrgica é a correção do desvio em sua posição de maior incomitância, sem prejudicar o alinhamento ocular na posição primária do olhar (PPO). O resultado satisfatório, em concordância com os dados da literatura atual, contribui para fazer desta técnica uma opção no tratamento de estrabismos incomitantes de difícil manejo.

Abstract The present study reports a case of a patient, 38-year-old man, with incomitant strabismus and consequent diplopia, submitted to debilitating surgery with recession and strengthening resection of the right inferior rectus muscle. This surgical technique aims to correct the deviation in its greater incomitence position, without impairing the ocular alignment in the primary position of the eye (PPO). The satisfactory result, in agreement with data of current literature, contributes to make this technique an option in the treatment of challenging incomitant strabismus.

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BACKGROUND AND PURPOSE: To describe the development and treatment of patients with cyclic esotropia. PATIENTS AND METHODS: The clinical course of seven patients with cyclic esotropia were retrospectively reviewed and described. All patients underwent bilateral medial rectus recession based on the deviation manifested on the day they were esotropic. Additionally, one patient had previously undergone surgery for intermittent exotropia. RESULTS: All patients developed excellent postoperative alignment. After strabismus surgery, normal eye alignment with some degree of binocularity was reached in five patients. Moreover, there was no recurrence of the cyclic deviation in any patient, and no patient experienced an overcorrection. CONCLUSIONS: Strabismus surgery aimed to correct the horizontal esotropic angle present on the day the esotropia is manifested provides a good outcome that is stable long-term, with minimal risk of overcorrection. Possible explanations for the origin of cyclic esotropia are discussed.

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RESUMO Introdução: A dificuldade na obtenção de resultados previsíveis é um grande desafio atual da cirurgia corretiva de estrabismo. Os resultados não desejados podem ocorrer em cerca de 51% dos procedimentos e a dificuldade pode ser devida ao fato da cirurgia ser realizada sobre tecidos perioculares bastante moles e com difícil referência para a localização anatômicas das estruturas. Objetivo: Identificar e analisar as principais causas responsáveis por reoperações nos usuários submetidos à cirurgia corretiva de estrabismo, atendidos no Centro de Oftalmológico do HUUFMA, em São Luís-MA. Métodos: Estudo do tipo pesquisa documental retrospectiva dos registros institucionais, por meio da coleta de dados dos prontuários físicos e eletrônicos no sistema ambulatorial interno do HUUFMA. Resultados: A taxa de reoperação analisada foi de 7,31%. Foram operados 89 pacientes menores de 15 anos (72,35%), 23 na faixa de 15 a 30 anos (18,69%) e 11 pacientes maiores de 30 anos (8,94%). A média da idade dos 123 operados foi de 10,32 anos. O sexo feminino foi prevalente na população (58,53%). Conclusão: O desvio Esotrópico (ET) foi o tipo de desvio mais comum no grupo de reoperados. Os resultados inesperados e os maiores desvios foram nos pacientes com relatos de comorbidades e/ou síndromes associadas ao estrabismo, assim como o desvio horizontal congênito (Dhc) foi prevalente entre as queixas apresentadas. A anestesia geral foi mais relatada em pacientes de menor faixa etária. O tempo médio decorrido entre a primeira e a segunda cirurgia foi de 10,54 meses e houve relativa prevalência das subcorreções nas reoperações.

ABSTRACT Introduction: The difficulty in obtaining predictable results is a great challenge on the strabismus surgery field. Procedures can lead to an undesirable development in about 51% of patients, and this difficulty may be due to surgery being perfomed on soft periocular tissues in which anatomical structure can be tricky to locate. Objective: Identify and analyse the main causes of reoperation on strabismus surgery patients treated at Centro Oftamológico do HUUFMA, in São Luís-MA. Methods: A retrospective documental research based on institutional registries, through data collection from physical and eletronic patient records of HUUFMA's ambulatorial internal system. Results: The analysed reoperation rates were in about 7,31%. 89 patients under 15-year-old (72,35%), 23 patients aged between 15 to 30 (18,69%), and 11 patients over the age of 30 (8,94%) were submitted to surgery, with total number of 123 patients and mean age of 10,32 years. Female patients have prevailed in the population (58,53%). Conclusion: Esotropic deviation was the most common deviation in the reoperated group. The unexpected results and greatest deviations occurred on patients with reported comorbidities and/or syndromes associated with strabismus, such as dissociated horizontal deviation (DHD), which was prevalent among the presented complaints. General anesthesia was most reported in lower age patients. The average time elapsed between the first and the second procedure was 10,54 months, and a relative prevalence of the undercorrections occurred on reoperations procedures.

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PURPOSE: To conduct a 10-year follow-up on the surgical correction of large-angle esotropia using monocular surgery, verifying surgical stability over time in both adults and children, and investigating the presence of consecutive exotropia among reviewed patients. METHODS: The angles of deviation in primary position were measured using prism cover testing in patients with good vision in both eyes and the Krimsky method in those with severe amblyopia. Among the 46 patients who underwent surgery, 40 were evaluated 10 years post-surgery. Student's t-test and McNemar's test were used for statistical analyses. RESULTS: No significant differences in the angles of deviation in primary position were found between measurements taken 6 months and 10 years post-surgery (p=0.922), as well as between children and adults (p=0.767). Among the 40 reviewed patients, only five presented with exotropia, all of which were small (the largest being XT 15Δ). Therefore, large consecutive exotropia over time was not observed. CONCLUSION: Our results suggest that monocular surgery to correct large-angle esotropia using large medial rectus recessions and broad lateral rectus resections was viable and safe in both adults and children over short and long terms.

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ABSTRACT Purpose: To conduct a 10-year follow-up on the surgical correction of large-angle esotropia using monocular surgery, verifying surgical stability over time in both adults and children, and investigating the presence of consecutive exotropia among reviewed patients. Methods: The angles of deviation in primary position were measured using prism cover testing in patients with good vision in both eyes and the Krimsky method in those with severe amblyopia. Among the 46 patients who underwent surgery, 40 were evaluated 10 years post-surgery. Student's t-test and McNemar's test were used for statistical analyses. Results: No significant differences in the angles of deviation in primary position were found between measurements taken 6 months and 10 years post-surgery (p=0.922), as well as between children and adults (p=0.767). Among the 40 reviewed patients, only five presented with exotropia, all of which were small (the largest being XT 15Δ). Therefore, large consecutive exotropia over time was not observed. Conclusion: Our results suggest that monocular surgery to correct large-angle esotropia using large medial rectus recessions and broad lateral rectus resections was viable and safe in both adults and children over short and long terms.

RESUMO Objetivo: Conduzir um acompanhamento de 10 anos de correção cirúrgica de esotropias de grande ângulo com cirurgia monocular, verificando a estabilidade cirúrgica ao longo do tempo em adultos e crianças, investigando a presença de exotropias consecutivas entre os pacientes revisados. Métodos: Os ângulos de desvio em posição primária foram medidos usando teste de cobertura prismática em pacientes com boa visão em ambos os olhos e o método de Krimsky naqueles com ambliopia severa. Entre os 46 pacientes operados, 40 foram avaliados 10 anos após a cirurgia. O teste t-Student e o de McNemar foram usados para análises estatísticas. Resultados: Não foram encontradas diferenças significativas nos ângulos de desvio em posição primária entre as medidas realizadas 6 meses e 10 anos pós-operatórios (p=0,922, assim como entre crianças e adultos (p=0,767). Entre os 40 pacientes revisados, apenas cinco apresentaram exotropias, todas pequenas (sendo o maior XT 15Δ). Portanto grandes exotropias consecutivas ao longo do tempo não foram observadas. Conclusão: Nossos resultados sugerem que a cirurgia monocular para corrigir a esotropias de grande ângulo usando amplos recuos do reto medial e grandes ressecções do reto lateral foi viável e segura tanto em adultos quanto em crianças em curto como a longo prazo.

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La esotropía aguda del adulto es un estrabismo no frecuente, de aparición tardía, por encima de los 7 años de edad y puede verse en edades avanzadas, el comienzo es brusco; se caracteriza desde el punto de vista clínico por diplopía, comitancia y relación binocular normal. Objetivo: Ofrecer una enseñanza clínico-quirúrgica de esotropía comitante aguda del adulto, relacionada con el estrés físico, además de ser infrecuente. Presentación de caso: Paciente femenina de 29 años de edad ,que acudió a la consulta de Oftalmología en agosto del 2014, la que refirió que hace 13 años después de sumergirse en un río notó desviación del ojo derecho hacia adentro de forma súbita, acompañado esto de visión doble permanente. En el examen oftalmológico se le realizó de forma minuciosa exploración sensorial y se llegó al diagnóstico definitivo de esotropía comitante aguda del adulto. Conclusiones: La esotropía comitante aguda del adulto tipo Franceschetti, es una forma especial de estrabismo, es infrecuente. A la paciente se le realizó tratamiento quirúrgico, sin el cual no se hubiera logrado el alineamiento ocular y restauración de la visión binocular(AU)

Acute isotropy in the elderly is a non frequent strabismus of late appearance, after the age of seven and can be seen at advanced age. The starting is rough; it is characterized, from the clinical point of view, by diplopia, concomitance and normal binocular relationship. Objective: To offer a clinical and surgical teaching of acute concomitant diplopia in the elderly related to physical stress, out of been non frequent. Case presentation: a 29 year old female patient who came into the eye consultation on August, 2014 complaining of right eye sudden inner deviation after sinking in a river, it was accompanied by permanent double vision. On eye examination she was performed a detailed sensorial exploration and definitely diagnosed as having concomitant isotropy. Conclusion: Franceschetti´s concomitant isotropy in the elderly is a special non frequent form of strabismus. The patient was performed surgical treatment needed to fulfill an ocular lining and restoration of binocular vision(AU)

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Fundamentación. La esotropía aguda del adulto es un estrabismo no frecuente, de aparición tardía, por encima de los 7 años de edad y puede verse en edades avanzadas, el comienzo es brusco; se caracteriza desde el punto de vista clínico por diplopía, comitancia y relación binocular normal. Objetivo: Ofrecer una enseñanza clínico-quirúrgica de esotropía comitante aguda del adulto, relacionada con el estrés físico, además de ser infrecuente. Presentación de caso: Paciente femenina de 29 años de edad ,que acudió a la consulta de Oftalmología en agosto del 2014, la que refirió que hace 13 años después de sumergirse en un río notó desviación del ojo derecho hacia adentro de forma súbita, acompañado esto de visión doble permanente. En el examen oftalmológico se le realizó de forma minuciosa exploración sensorial y se llegó al diagnóstico definitivo de esotropía comitante aguda del adulto. Conclusiones: La esotropía comitante aguda del adulto tipo Franceschetti, es una forma especial de estrabismo, es infrecuente. A la paciente se le realizó tratamiento quirúrgico, sin el cual no se hubiera logrado el alineamiento ocular y restauración de la visión binocular.(AU)

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Fundamentación. La esotropía aguda del adulto es un estrabismo no frecuente, de aparición tardía, por encima de los 7 años de edad y puede verse en edades avanzadas, el comienzo es brusco; se caracteriza desde el punto de vista clínico por diplopía, comitancia y relación binocular normal. Objetivo: Ofrecer una enseñanza clínico-quirúrgica de esotropía comitante aguda del adulto, relacionada con el estrés físico, además de ser infrecuente. Presentación de caso: Paciente femenina de 29 años de edad ,que acudió a la consulta de Oftalmología en agosto del 2014, la que refirió que hace 13 años después de sumergirse en un río notó desviación del ojo derecho hacia adentro de forma súbita, acompañado esto de visión doble permanente. En el examen oftalmológico se le realizó de forma minuciosa exploración sensorial y se llegó al diagnóstico definitivo de esotropía comitante aguda del adulto. Conclusiones: La esotropía comitante aguda del adulto tipo Franceschetti, es una forma especial de estrabismo, es infrecuente. A la paciente se le realizó tratamiento quirúrgico, sin el cual no se hubiera logrado el alineamiento ocular y restauración de la visión binocular.(AU)

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Purpose: The purpose of this review was to examine the efficacy of botulinum toxin in the treatment of infantile esotropia and to evaluate the average response of BT and its complication rates. Methods: A research was performed in the Latin American and Caribbean Literature on Health Sciences (LILACS), MEDLINE, and Cochrane Central Register of Controlled Trial (CENTRAL). The database was searched between December 28, 2016 and January 30, 2017. The selection was restricted to articles published in English, Spanish, or Portuguese. There were no date restrictions in the search. Results: Nine studies were eligible for inclusion. The grouped success rate of BT treatment in infantile esotropia was 76% (95% confidence interval [CI]: 61%-89%). For the success rate, I2 of 94.25% was observed, indicating a high heterogeneity (P < 0.001). The complication rates were also analyzed. The grouped consecutive exotropia (XT) rate was 1% (95% CI: 0%-2%). The grouped ptosis rate was 27% (95% CI: 21%-33%). The grouped vertical deviation rate was 12% (95% CI: 4%-22%). The mean change of the deviation after BT injection was -30.7 (95% CI: -37.7, -23.8), demonstrating a significant improvement in alignment. Conclusions: Botulinum toxin injection into medial recti muscles reveals to be a safe procedure and a valuable alternative to strabismus surgery in congenital esotropia, especially in moderate deviations.

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