Binocular vision & strabismus quarterly最新文献

Duane Retraction Syndrome is a congenital eye movement disorder characterized by a failure of cranial nerve VI to develop normally, resulting in restriction or absence of abduction, restricted adduction and narrowing of the palpebral fissure and retraction of the globe on attempted adduction. Patients with Duane Retraction Syndrome appear to have a significant increase in the number of associated congenital malformations. In the present paper, the authors report a case of Duane Retraction Syndrome with a unique hand abnormality not reported previously.

Objective: To examine sensorial strabismus due to congenital toxoplasmosis to elucidate differences and similarities between cases with esotropia (ET) and with exotropia (XT).

Methods: Restrospective analysis of 49 patients treated between 2002 and 2007. Visual acuity, cycloplegic refraction, strabismus patterns, presence of nystagmus, site of scar, surgery performed and strabismus surgical outcome obtained were evaluated.

Results: Mean age: 5 years old. 25 patients had bilateral involvement: 10 had ET, 10 XT and 4 were aligned. 15/24 unilateral cases presented with XT, 7 ET and other 2 orthotropia. 6/8 patients with the right eye affected, manifest ET and 14/16 patients with their OS affected had XT. (P=0.01)

Conclusion: In bilateral cases of ocular toxoplasmosis ET and XT are found in similar proportions; in unilateral cases, XT is more frequent and the left eye is affected in most cases by both the toxoplasmosis and the strabismus. Esotropia appears more frequently in cases where the right eye is so affected, whereas XT predominates in cases where the left eye is affected.

We present the case of a 29 man complaining of intractable diplopia during the last 5 years. He had undergone several surgical procedures for the treatment of his infantile strabismus since age 6 years. After surgery, the patient had been treated on 4 occasions with Botox. He also performed antisuppression exercises to encourage binocular vision. On our examination, the patient showed a 20/20 visual acuity in both eyes and a strabismic dysfunction with slight alphabet pattern, which induced a disturbing constant diplopia. Several treatment options were considered as occlusion therapy or cosmetic contact lenses, but they were not used because they were not acceptable esthetically or not tolerated. Finally, an optical penalization was induced by means of a black corneal tattooing placed at the centre of the cornea. The patient was followed for a period of 18 months, showing a complete elimination of diploia with esthetical acceptance and no inflammatory signs.

Purpose: To intruduce a new method for rectus muscle recession in order to minimize the riSk of a lost or slipped muscle and scleral perforation and compare it with the conventional method.

Patients and methods: In a prospective study between May 2002 and December 2006, 69 patients underwent recession with the modified technique, and 50 patients underwent recession with the conventional method. We compared the results of strabismus surgery in these non-randomized series with esotropia or exotropia treated with conventional surgery with the modified technique surgery. Patients in the modified technique group were high risk patients that had large angle recession, thin sclera or less exposure sugical field.

Results: Surgical outcomes were not significantly different in the two treatment groups that based on their findings had been classified into four subgroups. No complications such as globe penetration, muscle slippage or lost muscle were observed during the follow up period of 12 months.

Conclusions: It seems that the modified method introduced in this study can reduce the complications and risks involved in conventional and suspension-recession methods and it is safe and effective for muscle recession. It can decrease the risk of globe perforation since the sclera behind the insertion is penetrated only superficially because of anchor suturing to the muscle insertion stump, and the possibility of lost or slipped recessed muscles would be minimized.

Purpose: To describe a case of an incidental finding of bilateral corectopia detected by photo screening which ultimately led to the diagnosis of multiple sclerosis.

Methods: Case presentation and literature review.

Results: Corectopia may be congenital or acquired. Midbrain corectopia is commonly caused by infarction and demyelinating disease can cause autonomic pupil abnormalities resulting in corectopia.

Conclusion: A careful history and ocular examinatin can aid in determining the etiology of corectopia. Additional genetics or neurologic consultation may be necessary to diagnosis systemic disease.

Introduction: Value analysis in health care calculates the economic value added (EVA) that results from improvements in health and health care. Our purpose was to develop an EVA model and to apply the model to typical and hypothetical (instantaneous and perfect) cures for amblyopia, surgical strabismus and asthma, as another, but non-ophthalmological disease standard for comparison, in the United States.

Methods: The model is based on changes in utility and longevity, the associated incremental costs, and an estimate of the value of life. Univariate sensitivity analyses were performed to arrive at a plausible range of outcomes.

Results: For the United States, the EVA for current practice amblyopia care is 12.9B dollars (billion) per year, corresponding to a return on investment (ROI) of 10.4% per yr. With substantial increases in investment aimed at maximal improvement ("perfect cure"), the EVA is 32.7B per yr, with ROI of 5.3% per yr. The EVA for typical surgical strabismus care is 10.3B per yr. A perfect cure may yield EVA of 9.6B per yr. The EVA for asthma is 1317B per yr (ROI 20.4% per yr.., while a perfect cure may yield EVA of 110 B per yr. Sensitivity analysis demonstrated the relatively large effects of incidence, utility, and longevity, while incremental costs have a relatively minor effect on the EVA.

Conclusion: The economic value added by improvements in patient-centered outcomes is very large. Failing to make the necessary investments in research, prevention, detection, prompt treatment and rehabilitation of these diseases, at virtually any conceivable cost, appears economically, medically, morally and ethically deficient and consequently wasteful at very least economically for our society.

Background and purpose: Monocular diplopia is an infrequent but disabling complication following laser peripheral iridotomy, or following cataract surgery. Our purpose is to clarify the intraocular mechanism of monocular diplopia (and binocular triplopia) of physical origin and its relation to the physiology and arrangement of the visual directions of the retinal areas in each eye.

Case reports: This is a report of one patient who developed monocular diplopia following an "exposed" laser peripheral iridotomy, and of a second patient who developed monocular diplopia due to a swollen opacified central posterior capsule following cataract surgery.

Conclusion: Monocular diplopia of physical origin results from stimulation, by an object of regard, of two separate retinal areas that have two different visual directions due to optical ocular pathology.

Background: Resection of the lateral rectus in Duane retraction syndrome (DRS) with esotropia (ET) and limited abduction can be a useful component of surgical planning in specific circumstances, when combined with medial rectus (MR) recession. This article reports the results of a prospective series of patients for whom this approach was used successfully.

Methods: Seven patients were treated, aged 3 to 52 years, with uniltaeral DRS with the following features: 1) ET at least 25 PD; 2) "mild" retraction on adduction; 3) clinically normal adduction; 4) significantly limited abduction; 5) no or mild upshoots/downshoots; and 6) positive forced duction to abduction at surgery. surgery involved MR recession up to 5.0 mm and LR resection of maximum 3.5 mm. Postoperative followup was at least 6 months in all cases.

Results: ET angles ranged from 25 to 32 PD; abduction limitations ranged from -3.5 to -4. All patients had face turn postures preoperatively. Postoperatively, the binoclar alignment in primary position was orthotropia and head postures wre eliminated in all patients. Abduction postoperatively ranged from -1 to -2.5; adduction ranged from -0.5 to -1. Two patients had minimal worsening of upshoots and downshoots after surgery.

Conclusion: In treating DRS with ET and limited abduction, a small LR resection can be a safe and effective component of surgery. It has a low risk of worsening retraction or "crippling" adduction when done in appropriate cases.