Etiología y evolución de la diplopía binocular en pacientes con paresia o parálisis oculomotoras / Etiology and Course of Binocular Diplopia in Patients with Oculomotor Paresis or Paralysis

Objetivo: Determinar la etiología y evolución de la diplopía binocular en pacientes con paresia o parálisis oculomotoras. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer y cumplían con los criterios de inclusión en el periodo comprendido entre mayo del 2018 a junio del 2019. Se evaluaron las variables: edad, sexo, factores de riesgo, etiología, opciones de tratamiento y eliminación de diplopía. Resultados: La edad media de la muestra estudiada fue de 56,8 años y predominó el sexo masculino (56,7 por ciento versus 43,3 por ciento). El factor de riesgo más frecuente fue el microvascular (86,7 por ciento), 14 pacientes con hipertensión arterial y 12 con diabetes mellitus. Predominó también la etiología microvascular en 18 pacientes de 30. El 66,7 por ciento de la muestra estudiada resolvió solo con tratamiento médico y el 86,7 por ciento de los casos eliminaron la diplopía en todas las posiciones diagnósticas de la mirada. Conclusiones: El nervio craneal más frecuente afectado es el sexto y prevaleció la etiología microvascular en el sexto y tercer nervio craneal, sin embargo, para el cuarto es la traumática la única causa encontrada, lo cual concuerdan con la literatura revisada(AU)

Objective: To determine the etiology and evolution of binocular diplopia in patients with oculomotor paresis or paralysis. Methods: A descriptive, longitudinal and prospective study was carried out, from May 2018 to June 2019, of a series of cases that were assisted in the consultation of the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology and met the inclusion criteria. The variables evaluated were age, sex, risk factors, etiology, treatment options and elimination of diplopia. Results: The mean age of the studied sample was 56.8 years and the male sex predominated (56.7 percent versus 43.3 percent). The most frequent risk factor was microvascular (86.7 percent), fourteen patients with arterial hypertension and 12 with diabetes mellitus. Microvascular etiology also predominated in 18 patients out of 30. The medical treatment only solved 66.7 percent of the studied sample and 86.7 percent of cases eliminated diplopia in all diagnostic gaze positions. Conclusions: The most frequently affected cranial nerve is the sixth and microvascular etiology prevailed in the sixth and third cranial nerves, however, for the fourth traumatic is the only cause found, which is consistent with the literature reviewed(AU)

Diplopía binocular por paresia o parálisis oculomotoras: resultados de las opciones de tratamiento / Binocular Diplopia due to Oculomotor Paresis or Palsies: Outcomes of Treatment Options

Objetivo: Determinar resultados de las opciones de tratamiento para la diplopía binocular en pacientes con paresia o parálisis oculomotoras. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se evaluaron las variables: edad, sexo, etiología, opciones de tratamiento, limitación de los movimientos oculares, eliminación de diplopía, fusión y estereopsis. Resultados: La etiología más frecuente fue la microvascular. El 66,7 por ciento de la muestra estudiada se resolvió solo con tratamiento médico, de ellos el 100,0 por ciento con diagnóstico de paresias o parálisis del tercer nervio craneal, seguido por el sexto y cuarto con 63,6 por ciento y 33,3 por ciento, respectivamente. Necesitaron tratamiento médico, quirúrgico y aplicación de toxina botulínica seis pacientes, el 33,3 por ciento del cuarto y el 22,7 por ciento del sexto nervio craneal. El resto de las opciones de tratamiento solo con un paciente. No se halló asociación significativa entre opciones de tratamiento y nervio craneal afectado. El 86,6 por ciento finalizó sin limitación de los movimientos oculares. El 86,7 por ciento de los casos eliminaron la diplopía en todas las posiciones diagnósticas de la mirada. El 76,7 por ciento logró fusión y el 56,7 por ciento estereopsis. Conclusiones: El tratamiento médico y el combinado de médico más inyección de toxina botulínica y cirugía de músculos extraoculares fueron las opciones más utilizadas y permitieron alineamiento ocular y eliminación de la diplopía binocular(AU)

Objective: To determine outcomes of treatment options for binocular diplopia in patients with oculomotor paresis or paralysis. Method: A descriptive, longitudinal and prospective study was carried out of a series of cases that were assisted at the consultation of the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology. The variables evaluated were age, sex, etiology, treatment options, limitation of ocular movements, elimination of diplopia, fusion and stereopsis. Results: The microvascular etiology was the most frequent. 66.7 percent of the studied sample was resolved only with medical treatment, 100.0 percent of them had a diagnosis of paresis or paralysis of the third cranial nerve, followed by the sixth and fourth with 63.6 percent and 33.3 percent, respectively. Six patients required medical and surgical treatment and application of botulinum toxin, 33.3 percent of the fourth and 22.7 percent of the sixth cranial nerve. The rest of the treatment options with only one patient. No significant association was found between treatment options and affected cranial nerve. 86.6 percent finished without limitation of eye movements. 86.7 percent of cases eliminated diplopia in all diagnostic gaze positions. 76.7 percent achieved fusion and 56.7 percent stereopsis. Conclusions: Medical treatment and combined medical treatment plus botulinum toxin injection and extraocular muscle surgery were the most used options and allowed ocular alignment and elimination of binocular diplopia(AU)

Application of fresnel prism in patients with different types of binocular diplopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To discuss the efficacy of fresnel prism in different types of binocular diplopia patients.<p>METHODS: This retrospective study reviewed 20 patients who received fresnel prism treatment between June 2018 and November 2020 in Jiangmen Central Hospital. Eight of them were diagnosed as acute acquired comitant esotropia, five patients were thyroid-associated ophthalmopathy, and seven patients were eye misalignment caused by cranial nerve palsies. The outcome measures were deviation, near stereoacuity, asthenopia and driving ability at pre-treatment and post-treatment.<p>RESULTS: The deviations were decreased after treatment. There were significant differences between pre-treatment and post-treatment(<i>P</i><0.05). The patients with acute acquired comitant esotropia or eye misalignment caused by cranial nerve palsies recovered near stereoacuity meanwhile significant difference between before and after treatment(<i>P</i><0.05). There were no significant differences between before and after treatment in patients with thyroid-associated ophthalmopathy(<i>P</i>>0.05). Thirteen patients recovered in the driving ability while fifteen patients were cured of asthenopia. There were significant differences between before and after treatment(all <i>P</i><0.05).<p>CONCLUSION: Fresnel prism treatment could decrease deviations in binocular diplopia patients, improved near stereoacuity and quality of life.

Health-related quality of life and binocular vision in patients with diplopia in acute-onset comitant esotropia with press-on prism improves / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To assess the effect of press-on prisms in patients with acute-onset comitant esotropia and diplopia,focusing primarily on vision-related quality of life and binocular vision.METHODS:Retrospective case-series study.Totally 16 acute-onset comitant esotropia patients with diplopia who received treatment in the Huzhou Central Hospital were included in this study from March 2014 to March 2017.Vision-related quality of life before press-on prism correction and 1mo after press-on prism correction were performed with the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (CHI-NEI-VFQ-25).In each time of follow-up,we made a minute examination,includes worth four dot test and stereo tests.Data was statistically analyzed with paired sample t test,Chi-square test and Fisher's exact test.RESULTS:Except the degree of eye pain,color vision and perimetry,the indicators from CHI-NEI-VFQ-25 table including general health status,overall vision,mental health,social role difficulties,social functional,near activities,distant activities,independency and driving of acute-onset comitant esotropia patients with diplopia were obviously significant improved 1 mo after press-on prism correction (P＜0.05).One month after press-on prism correction,the fusion function and stereo acuity were significant enhanced (P＜0.05).CONCLUSION:Press-on prism correction may be helpful for binocular vision recovery in acute-onset comitant esotropia patients with diplopia,so as improve the vision-related quality of life.