Journal of Binocular Vision and Ocular Motility最新文献

Purpose: Prematurely born children are at risk of numerous complications that affect the visual system. Retinopathy of prematurity (ROP) and cerebral visual impairment (CVI) are among two major causes of childhood blindness and visual impairment in industrialized nations, and large countries with emerging economies are seeing increasing childhood blindness from ROP alone, adding to the burden of disease worldwide. The purpose of this paper is to review the long-term impacts of prematurity, ROP and CVI on vision in children who were born preterm.

Method: The topics in this review of the literature include the burden of vision loss in prematurely born children world-wide, a description of ROP and CVI, effects on visual acuity, refractive errors, strabismus and binocularity, visual fields and contrast sensitivity, and risk factors for visual complications.

Results: Children who are most at risk of visual complications are those with the smallest gestational age at birth and birth weight in general. Although ROP severity and the presence of neurological impairments including CVI play a large role in the development of poor visual outcomes, premature birth alone without CVI or severe ROP increases the risk of future visual complications. Awareness of signs and symptoms of CVI are important in the management of affected children.

Conclusion: Children born preterm are at increased risk of reduced visual acuity, refractive errors, strabismus and amblyopia, complications of ROP, CVI, visual field abnormalities and reduced contrast sensitivity. Awareness of risk factors warranting close monitoring and signs and symptoms of CVI are critical to optimize the visual outcomes and overall development.

Persistent unilateral or bilateral visual deprivation at any age, particularly in children, can compromise sensory fusion and result in a type of strabismus known as sensory or secondary strabismus. There are several pathologies that can induce visual impairment, such as severe anisometropia, congenital unilateral cataract, corneal opacity, retinal diseases, and optic nerve anomalies. Sensory strabismus may be horizontal or vertical or a combination of them; however, most reports indicate the development of horizontal deviation as sensory strabismus. Regardless of the direction of the sensory strabismus, early diagnosis and management of the underlying pathology are important before strabismus treatment. The primary treatment approach for patients with sensory strabismus is surgery to correct ocular misalignment and straighten the eyes. This can help to improve the patients' symptoms and diminish the negative psychosocial impacts. In this article, we review the underlying etiologies and background pathologies associated with sensory strabismus. In addition, we investigate the determinant factors of the direction of sensory strabismus and its management strategies.

Convergence excess esotropia is a condition characterized by an esotropia which is greater for near fixation than for distance fixation after full hypermetropic correction with a single focus lens. Convergence excess esotropia may be classified according to the AC/A ratio into two subtypes: accommodative type and non-accommodative type. Bifocal glasses are a suitable option for the management of patients with a high AC/A ratio and for the hypoaccommodative type. However, the overall success rate with bifocals is still low even in selected patients. Surgery is often eventually needed for most patients with convergence excess esotropia. Surgical options that do not directly address the variability of the angle of deviation entail medial rectus recession with the target angle based on the distance deviation, the near deviation, an augmented formula based on an intermediate angle, or on a prism adaptation test. Surgical options that directly address the variability of the angle include partial myotomy, medial rectus muscle posterior scleral fixation with or without recession, pulley fixation, slanting recession, Y-splitting, or combined recession-resection of the medial rectus muscle. The review article summarizes the surgical outcome of these strategies and suggests an algorithm for the management of patients with convergence excess esotropia.

A 22-year-old male was referred from the medicine department with the chief complaint of double vision for 2 months. The patient had suffered from dengue viral hemorrhagic encephalitis for 2 months for which intensive medical care was given. On ocular examination, both eyes (OU) showed limited adduction with contralateral abducting nystagmus on attempted horizontal gaze. Magnetic resonance imaging of brain showed pontine and midbrain hemorrhages which involved the region of medial longitudinal fasciculus and caused bilateral internuclear ophthalmoplegia (INO). Bilateral INO is very rare and most commonly caused by multiple sclerosis. The presentation of dengue fever causing midbrain and pontine hemorrhages which resulted in bilateral INOs has not been previously reported, to our knowledge.

Purpose: To present a modification of the semiadjustable suture technique allowing for optional adjustment.

Methods: Short suture loops buried under closed conjunctiva were used instead of the exposed long muscle and sliding noose sutures involved in the standard semiadjustable suture procedure; an additional temporary tracing suture facilitated the retrieval of the buried muscle suture loop during adjustment.

Results: Fifty-three consecutive patients (57 rectus extraocular muscles) underwent recession with the modified semiadjustable short loop technique. The mean age was 44.5 years (range: 16-81) and mean follow-up time 8.8 months (range 1.5-28 months). Postoperative adjustment was carried out in 21 patients (39.6%). In the remaining 32 patients, cutting and removing the exposed tracing suture and the nonabsorbable traction suture was the only necessary postoperative maneuver. Five cases of persistent conjunctival hyperemia, two cases of conjunctival dehiscence and two cases with a clinically significant delle were noted; all responded to topical treatment. There were no cases of suspected muscle slippage.

Conclusions: The short loop modification of the semiadjustable suture procedure allowed for postoperative adjustment while offering the benefit of minimal manipulation for the majority of cases in which adjustment was unnecessary. No major complications in conjunctival incision or extraocular muscle healing were encountered.

Infantile cataract is one of the major causes of visual impairment in children. This article will discuss some of the techniques, challenges, complications, and compliance issues with aphakic contact lenses.