Asunto(s)
Esotropía/complicaciones , Enfermedades del Nervio Óptico/complicaciones , Nervio Óptico/anomalías , Vasos Sanguíneos , Niño , Esotropía/diagnóstico , Fondo de Ojo , Humanos , Imagen por Resonancia Magnética , Masculino , Oftalmología , Disco Óptico/fisiopatología , Nervio Óptico/patología , Enfermedades del Nervio Óptico/diagnóstico , Pupila , Visión OcularRESUMEN
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.
Asunto(s)
Esotropía/complicaciones , Exotropía/complicaciones , Discapacidad Intelectual/complicaciones , Trastornos Psicomotores/complicaciones , Amenaza de Aborto/epidemiología , Adolescente , Asfixia Neonatal/epidemiología , Astigmatismo/complicaciones , Causalidad , Parálisis Cerebral/complicaciones , Niño , Preescolar , Femenino , Sufrimiento Fetal/epidemiología , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Masculino , Edad Materna , Nistagmo Patológico/complicaciones , Preeclampsia/epidemiología , Embarazo , Embarazo en Adolescencia , Efectos Tardíos de la Exposición Prenatal , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
PURPOSE: To investigate the contribution of the individual ocular components, i.e. anterior chamber depth, lens thickness and vitreous chamber depth, to total axial length in patients with esotropic amblyopia. METHODS: The study population consisted of 74 children, aged between 5 and 8 years: thirty-seven patients with esotropic amblyopia and 37 healthy volunteers (control group). The participants underwent a comprehensive ophthalmological examination, including cycloplegic refraction and A-scan ultrasonography. Anterior chamber depth, lens thickness, vitreous chamber depth and total axial length were recorded. Paired Student's t-tests were used to compare biometric measurements between amblyopic eyes and their fellow eyes and between right and left eyes in the control group. To evaluate the contribution of the ocular components to the total axial length, we report the individual components as a percentage of total axial length. RESULTS: The comparison between amblyopic and fellow eyes regarding the individual contribution from ocular components to the total axial length revealed greater contribution from lens thickness (P=0.001) and smaller contribution from vitreous chamber depth (P=0.001) in amblyopic eyes, despite similar contribution from anterior chamber depth (P=0.434). The comparison between right and left eyes in the control group showed similar contributions from anterior chamber depth (P=0.620), lens thickness (P=0.721), and vitreous chamber depth (P=0.483). CONCLUSIONS: This study shows differences between amblyopic and non-amblyopic eyes when the total axial length is broken down into the individual contribution from the ocular components.
Asunto(s)
Ambliopía/diagnóstico por imagen , Cámara Anterior/diagnóstico por imagen , Esotropía/diagnóstico por imagen , Cristalino/diagnóstico por imagen , Cuerpo Vítreo/diagnóstico por imagen , Ambliopía/etiología , Biometría , Estudios de Casos y Controles , Niño , Preescolar , Topografía de la Córnea , Esotropía/complicaciones , Humanos , UltrasonografíaRESUMEN
PURPOSE: To investigate the contribution of the individual ocular components, i.e. anterior chamber depth, lens thickness and vitreous chamber depth, to total axial length in patients with esotropic amblyopia. METHODS: The study population consisted of 74 children, aged between 5 and 8 years: thirty-seven patients with esotropic amblyopia and 37 healthy volunteers (control group). The participants underwent a comprehensive ophthalmological examination, including cycloplegic refraction and A-scan ultrasonography. Anterior chamber depth, lens thickness, vitreous chamber depth and total axial length were recorded. Paired Student's t-tests were used to compare biometric measurements between amblyopic eyes and their fellow eyes and between right and left eyes in the control group. To evaluate the contribution of the ocular components to the total axial length, we report the individual components as a percentage of total axial length. RESULTS: The comparison between amblyopic and fellow eyes regarding the individual contribution from ocular components to the total axial length revealed greater contribution from lens thickness (P=0.001) and smaller contribution from vitreous chamber depth (P=0.001) in amblyopic eyes, despite similar contribution from anterior chamber depth (P=0.434). The comparison between right and left eyes in the control group showed similar contributions from anterior chamber depth (P=0.620), lens thickness (P=0.721), and vitreous chamber depth (P=0.483). CONCLUSIONS: This study shows differences between amblyopic and non-amblyopic eyes when the total axial length is broken down into the individual contribution from the ocular components.
OBJETIVO: Investigar a contribuição individual da profundidade da câmara anterior, da espessura do cristalino e da profundidade da câmara vítrea para o comprimento axial total em pacientes com ambliopia por esotropia. MÉTODOS: Foram incluídas 74 crianças com idade entre 5 e 8 anos, sendo 37 pacientes com ambliopia por esotropia e 37 voluntários sadios (grupo controle). Foi realizado exame oftalmológico completo, incluindo refração sob cicloplegia e ultrassonografia modo A. Foram registrados profundidade da câmara anterior, espessura do cristalino, profundidade da câmara vítrea e comprimento axial total. A contribuição individual de cada componente para o comprimento axial total foi relatada como valor porcentual e teste t de Student pareado foi utilizado para a comparação entre olho amblíope e olho contralateral e entre olho direito e esquerdo no grupo controle. RESULTADOS: Olhos amblíopes, quando comparados aos olhos contralaterais, apresentaram maior contribuição da espessura do cristalino (P=0,001), menor contribuição da profundidade da câmara vítrea (P=0,001) e contribuição semelhante da profundidade da câmara anterior (P=0,434) para o comprimento axial total. A comparação entre olho direito e olho esquerdo no grupo controle mostrou contribuições semelhantes da profundidade da câmara anterior (p=0,620), da espessura do cristalino (P=0,721) e da profundidade da câmara vítrea (P=0,483) para o comprimento axial total. CONCLUSÕES: Este estudo mostrou diferenças entre olhos amblíopes e não amblíopes quando o comprimento axial total é dividido nas contribuições individuais dos seus componentes.
Asunto(s)
Niño , Preescolar , Humanos , Ambliopía , Cámara Anterior , Esotropía , Cristalino , Cuerpo Vítreo , Ambliopía/etiología , Biometría , Estudios de Casos y Controles , Topografía de la Córnea , Esotropía/complicacionesRESUMEN
INTRODUCTION: Congenital esotropia is a convergent deviation of the eyes when fixating on an object. It appears during the first six months of life and affects muscle structure and physiology, as well as the relation of the eyes with the environment, retinal relations and neural integration phenomena. Amblyopia develops in 30-50% of those affected. Timely surgery is effective in most cases. OBJECTIVE: Describe surgical results in congenital esotropia cases treated in the Pediatric Ophthalmology and Strabismus Service of the Ramon Pando Ferrer Ophthalmology Institute in Havana between January 2008 and May 2009. METHODS: A descriptive, retrospective study was carried out through review of 127 cases (aged 1-18 years, 55 male and 72 female) operated on for congenital esotropia between January 2008 and May [corrected] 2009. Variables used were: age at surgery, degree of preoperative amblyopia, type of fixation, refractive error, associated conditions, type of surgery performed and pre- and postoperative deviation angles. RESULTS: The largest number of congenital esotropia cases were found in children <2 years old (38.6%). Before surgery, 37% of cases studied showed mild amblyopia; 22.8% moderate and 12.6% severe; 27.6% did not cooperate with visual acuity testing. With respect to fixation: 91.3% showed central fixation and 8.7% eccentric. Refractive errors found were: mild hyperopia (65.4%), moderate hyperopia (29.1%), and myopia (5.5%). Associated conditions were: overaction of the inferior oblique muscles (48%), latent nystagmus (16.5%), and dissociated vertical deviation (8.7%); no alterations were found in 26.8% of cases. The most frequently used surgical treatment was bilateral medial rectus muscle recession (92.1%). The most common preoperative deviation angle range was 3140 prism diopters (PD) in 51.9% of patients; the postoperative deviation angle most commonly found after 12 months was <10 PD in 64.6% (orthotropia). CONCLUSIONS: Surgery, most commonly with medial rectus muscle resection, was effective in correcting congenital esotropia.
Asunto(s)
Esotropía/congénito , Esotropía/cirugía , Adolescente , Factores de Edad , Ambliopía/etiología , Ambliopía/cirugía , Niño , Preescolar , Cuba , Esotropía/complicaciones , Femenino , Humanos , Lactante , Masculino , Procedimientos Quirúrgicos Oftalmológicos/métodos , Evaluación de Resultado en la Atención de Salud , Estudios RetrospectivosRESUMEN
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.
Asunto(s)
Toxinas Botulínicas Tipo A/efectos adversos , Esotropía/tratamiento farmacológico , Exotropía/inducido químicamente , Toxinas Botulínicas Tipo A/uso terapéutico , Daño Encefálico Crónico/complicaciones , Preescolar , Discapacidades del Desarrollo/complicaciones , Susceptibilidad a Enfermedades , Enfermedades en Gemelos , Esotropía/complicaciones , Esotropía/congénito , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , MéxicoRESUMEN
PURPOSE: Myopic strabismus fixus is characterized by acquired progressive esotropia and hypotropia associated with restricted elevation and abduction. Treatment is difficult, with recurrence of the large-angle esotropia even after surgery. The aim of this study was to describe two cases of myopic strabismus fixus successfully treated with Yamada's surgical technique. METHODS: Two patients with myopic strabismus fixus were submitted to hemitransposition of the superior rectus (SR) and lateral rectus (LR) muscles with scleral fixation at 7 mm from the limbus. In one patient, the hemitransposition was associated with ipsilateral MR muscle recess as described by Yamada, while in the other, botox injection into the MR muscle was performed. In both cases Yamada's procedure was associated with 4 mm resection of the hemitransposed portions of the SR and LR muscles to increase the muscular tonus and then improve surgical effects. RESULTS: The patient submitted to the MR recess presented with satisfactory ocular alignment after 6 months postoperative. The other patient submitted to botox injection at the MR muscle presented recurrent esotropia after 3 months. RM recess was then performed and an excellent ocular alignment was achieved. CONCLUSIONS: Yamada's surgical technique can provide acceptable ocular alignment in cases of myopic strabismus fixus. The surgical effects can be potentialized with resection of the hemitransposed portions of the SR and LR muscles. In addition, we demonstrated that botulinum toxin injection at the RM muscle is not an effective treatment in these cases.
Asunto(s)
Miopía/complicaciones , Músculos Oculomotores/trasplante , Estrabismo/complicaciones , Estrabismo/cirugía , Trasplante Heterotópico , Adulto , Anciano , Toxinas Botulínicas Tipo A/administración & dosificación , Esotropía/complicaciones , Esotropía/cirugía , Femenino , Humanos , Inyecciones Intramusculares , Imagen por Resonancia Magnética , Fármacos Neuromusculares/administración & dosificación , Fotograbar , Esclerótica/cirugía , Estrabismo/diagnóstico , Estrabismo/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Resultado del TratamientoRESUMEN
The authors report a case of a female patient who presented, for the second time, diplopia and acute esotropia during pregnancy. There was no trauma involved neither was systemic disease. The patient was treated with conventional occlusion, and, soon after delivery, the squint was resolved.
Asunto(s)
Diplopía/complicaciones , Esotropía/complicaciones , Complicaciones del Embarazo , Enfermedad Aguda , Adulto , Diplopía/diagnóstico , Esotropía/diagnóstico , Femenino , Humanos , Embarazo , Recurrencia , Remisión EspontáneaRESUMEN
Os autores relatam o caso de uma paciente que apresentou quadro reincidente de esotropia aguda e diplopia durante o período gestacional. Não havia história de trauma ou qualquer alteração sistêmica, excetuando-se a gravidez. Tratamento oclusivo alternado foi instituído, e após o parto houve remissão espontânea dos sinais e sintomas.
The authors report a case of a female patient who presented, for the second time, diplopia and acute esotropia during pregnancy. There was no trauma involved neither was systemic disease. The patient was treated with conventional occlusion, and, soon after delivery, the squint was resolved.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Diplopía/complicaciones , Esotropía/complicaciones , Complicaciones del Embarazo , Enfermedad Aguda , Diplopía/diagnóstico , Esotropía/diagnóstico , Recurrencia , Remisión EspontáneaRESUMEN
UNLABELLED: A prospective study was performed over a 10 year period on 25 children with infantile esotropia and neurological problems to answer this question. From November 1996 to March 2006 they were treated with injections of botulinum toxin (Botox) of both medial rectus extraocular muscles. Mean age was 26.4 months, (range 9-76 months) and mean initial angle was 35 prism diopters (PD)(range 20-60 PD). RESULTS: 18 patients (72%) remained orthotropic+/-10 PD at 29 months (range 6-59 months). Average number of injection treatments was 1.5 per patient. We compared our success rate data with those obtained with primary conventional strabismus surgical procedures in 2 previously published series. Treatment with botulinum toxin seemed to produce better results than one surgical series and at least equally similar results to the other one. Because there are, as well, so many other advantages to the injection procedure including superior safety and economy, we now use botulinum injections as our primary treatment in these patients.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Niños con Discapacidad , Esotropía/tratamiento farmacológico , Esotropía/cirugía , Enfermedades del Sistema Nervioso/complicaciones , Fármacos Neuromusculares/uso terapéutico , Músculos Oculomotores/cirugía , Niño , Preescolar , Esotropía/complicaciones , Humanos , Lactante , Inyecciones , Estudios Prospectivos , Resultado del Tratamiento , Visión BinocularRESUMEN
Objetivo: Existen algunas esotropias congénitas (ET.C.) que presentan una evolución espontánea de la esodesviación hacia una exotropía, sin que medie tratamiento médico-quirúrgico alguno. El propósito de este trabajo es determinar qué porcentaje de ET.C. presentan esta evolución espontánea y sus características clínicas. Método: Estudio retrospectivo de pacientes portadores de ET.C visualmente adultos que no han recibido tratamiento médico-quirúrgico. Fueron seleccionados 86 pacientes. Resultados: De los 86 pacientes 14 evolucionaron espontáneamente desde la esotropia hacia la exo, estando 7 ortotrópicos y 7 exotrópicos. Conclusión: El 16.27 por ciento de las E T. C. evolucionarían espontáneamente a la exodesviación. Sus características clínicas permiten alertar cuáles pacientes podrían seguir esta tendencia y postergar una eventual cirugía.
Purpose: Some congenital esotropias progress spontaneously to an exodeviation, with no medical or surgical intervention. Our purpose is to asses this phenomenon and its clinical characteristics. Method: Retrospective study of 86 visually mature, untreated, congenital esotropia patients. Results: Out of 86 cases, 14 spontaneously evolutioned from esotropia to exo, being 7 ortotropic and 7 exotropic. Conclusion: 16.27 percent of congenital esotropias spontaneously evolutioned to exodesviations. Their clinical characteristics allows a recognition of cases potentially following this trend, and eventually delay surgery in this patients.
Asunto(s)
Humanos , Esotropía/complicaciones , Esotropía/congénito , Estudios RetrospectivosRESUMEN
Segundo a clássica teoria de Helmholtz, a posiçäo de repouso do sistema acomodativo é o infinito. Esse modelo näo é mais válido, visto que para a maioria das pessoas a posiçäo de repouso do sistema é intermediária. O presente trabalho discute algumas implicaçöes clínicas dessa nova abordagem, especialmente uma possível relaçäo entre a acomodaçäo tônica e deterioraçäo das esotropias acomodativas
Asunto(s)
Humanos , Acomodación Ocular/fisiología , Esotropía/complicaciones , Esotropía/fisiopatologíaRESUMEN
Se hace un resumen del tratamiento ortóptico del estrabismo congénito en niños desde los 6 meses de edad. Se muestra las distintas formas de oclusión. La revisión de historias clínicas demuestra que las cirugías tempranas no garantizan al paciente visión binocular ni estereopsis. El seguimiento ortóptico postquirúrgico es ideal. Con su variedad de formas de tratamiento ayuda a complementar el éxito de la cirugía y mantener en lo posible una buena agudeza visual en ambos ojos
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Ortóptica/métodos , Estrabismo/congénito , Esotropía/clasificación , Esotropía/complicaciones , Esotropía/cirugía , Nistagmo Patológico/complicacionesAsunto(s)
Humanos , Masculino , Femenino , Preescolar , Adolescente , Adulto , Esotropía/complicaciones , Exotropía/fisiopatología , Procedimientos Quirúrgicos OperativosRESUMEN
We tested whether near retinoscopy, a noncycloplegic retinoscopic technique, was applicable to the optic correction of patients with accommodative esodeviations. We performed a study in 17 patients with accommodative esotropia to compare the refractive values obtained by near retinoscopy and by cycloplegia, as measured by two examiners. The interobserver variability was the same for the two techniques for the refractive values of the horizontal and vertical meridia and spherical equivalent. For the astigmatism, there was greater variability for near retinoscopy. The correlation between the two methods was good, but the variability of the differences was high. We recommend that near retinoscopy should be employed only as a noninvasive method for screening refractive errors in children.
Asunto(s)
Esotropía/complicaciones , Refracción Ocular , Errores de Refracción/diagnóstico , Acomodación Ocular , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Midriáticos , Pronóstico , Errores de Refracción/complicaciones , Pruebas de Visión/métodosAsunto(s)
Esotropía/complicaciones , Nistagmo Patológico/complicaciones , Estrabismo/complicaciones , Animales , Niño , Esotropía/fisiopatología , Esotropía/terapia , Potenciales Evocados Visuales , Fijación Ocular , Humanos , Nistagmo Patológico/fisiopatología , Nistagmo Patológico/terapia , Nistagmo Fisiológico , Síndrome , Percepción VisualRESUMEN
Visually evoked potentials (VER) were studied in 16 patients over 3 months of age with congenital or very early loss of vision in one eye. Seven patients (group I) developed an oculomotor syndrome in the sound eye characterized by jerky nystagmus in abduction, adduction fixation preference, and head-turn toward the side of the fixating eye. The other nine patients (group II) failed to develop the above-described syndrome. In group I, VER response asymmetry was found in six cases, with crossed predominance in four and direct predominance in two. The 7th patient showed a symmetric response. In group II, eight of the nine patients showed symmetric VER responses, and one showed asymmetric response with crossed predominance. Recorded VER asymmetries seem to correlate with oculomotor disturbances.