Factores del estrabismo incomitante para mejorar el pronóstico de los casos / Factors of incomitant strabismus to improve the prognosis of cases / Fatores no estrabismo incomitante para melhorar o prognóstico dos casos

El estrabismo es una alteración de la visión binocular, es decir, la pérdida de paralelismo de los ejes visuales. Las personas que padecen estrabismo presentan disminución de la profundidad visual y percepción de dimensionalidad. Se estima que este padecimiento ocular, afecta alrededor del 2 al 4 % de la población infantil. La clasificación de los estrabismos y su misma definición han sido parte de un debate mundial durante años. La edad de aparición, el ángulo de desviación, el ojo desviado, y la magnitud del ángulo en distancia de enfoque tambien; sin embargo, siempre debe confirmarse con exámenes más exhaustivos luego de un primer diagnóstico realizado por un profesional de la salud visual. Objetivo. Identificar las características de los estrabismos incomitantes, formas de diagnóstico, clasificación y factores para poder manejarlos específicamente y mejorar el pronóstico del caso. Metodología. Se realizó una síntesis de la información disponible de literatura sobre el estrabismo incomitante a través de un análisis bibliográfico donde se empleó descriptores de búsqueda para lo cual se revisaron las bases de datos: Google académico y Proquest Prisma. Se realizó el análisis de referencias desde el año 2010 al 2020 y como resultado se obtuvieron 34 referencias que describen una clasificación de estrabismos, tipo de diagnóstico y tratamiento. Conclusión. Se considera fundamental aumentar la conciencia pública sobre el tema del diagnóstico temprano de afectaciones oculares para generar medidas de prevención que busquen atenuar la ocurrencia de esta alteración. Delimitar el tipo de estrabismo incomitante podría evitar consecuencias irreparables para el paciente.

Strabismus is an alteration of binocular vision, that is, the loss of parallelism of the visual axes. People suffering from strabismus have decreased visual depth and dimensionality perception. It is estimated that this ocular condition affects about 2 to 4% of the child population. The classification of strabismus and its very definition have been part of a worldwide debate for years. The age of onset, the angle of deviation, the deviating eye, and the magnitude of the angle in focusing distance as well; however, it should always be confirmed with more exhaustive examinations after a first diagnosis by an eye care professional. Objective. To identify the characteristics of incomitant strabismus, ways of diagnosis, classification and factors to be able to manage them specifically and improve the prognosis of the case. Methodology. A synthesis of the information available in the literature on incomitant strabismus was made through a bibliographic analysis using search descriptors for which the following databases were reviewed: Google Scholar and Proquest Prisma. The analysis of references from 2010 to 2020 was carried out and as a result 34 references were obtained describing a classification of strabismus, type of diagnosis and treatment. Conclusion. It is considered essential to increase public awareness on the issue of early diagnosis of ocular disorders in order to generate preventive measures that seek to mitigate the occurrence of this disorder. Delimiting the type of incomitant strabismus could avoid irreparable consequences for the patient.

O estrabismo é um distúrbio da visão binocular, ou seja, a perda do paralelismo dos eixos visuais. As pessoas que sofrem de estrabismo têm uma percepção de profundidade e dimensionalidade visual reduzida. Estima-se que essa condição ocular afete cerca de 2 a 4% da população infantil. A classificação do estrabismo e sua própria definição têm sido parte de um debate mundial há anos. A idade de início, o ângulo de desvio, o olho desviado e a magnitude do ângulo na distância de focalização também; no entanto, devem sempre ser confirmados por exames adicionais após um primeiro diagnóstico feito por um oftalmologista. Objetivo. Identificar as características do estrabismo incomitante, as formas de diagnóstico, a classificação e os fatores para poder tratá-los especificamente e melhorar o prognóstico do caso. Metodologia. Foi feita uma síntese das informações disponíveis na literatura sobre estrabismo incomitante por meio de uma análise bibliográfica usando descritores de pesquisa para os quais foram revisados os seguintes bancos de dados: Google Scholar e Proquest Prisma. A análise das referências de 2010 a 2020 foi realizada e, como resultado, foram obtidas 34 referências que descrevem a classificação do estrabismo, o tipo de diagnóstico e o tratamento. Conclusões. Considera-se essencial aumentar a conscientização pública sobre a questão do diagnóstico precoce de distúrbios oculares para gerar medidas preventivas que busquem mitigar a ocorrência desse distúrbio. Delimitar o tipo de estrabismo incomitante poderia evitar consequências irreparáveis para o paciente.

Clinical evaluation of vision therapy system 4 combined with traditional comprehensive training for ametropic amblyopia / 中华实验眼科杂志

Objective:To assess the effectiveness of Vision Therapy System 4 (VTS4) combined with traditional comprehensive training for ametropic amblyopia.Methods:A non-randomized controlled clinical study was performed.A total of 168 children aged 4-10 years with ametropic amblyopia were enrolled in The First Affiliated Hospital of Zhengzhou University from January 2018 to March 2021.The children were assigned to conventional comprehensive training combined with Vision Therapy System 4 group (conventional+ VTS4 group) and conventional group according to the preference of their guardian.Patients in conventional+ VTS4 group (84 children) received conventional comprehensive training combined VTS4 and patients in conventional group (84 children) were treated with conventional comprehensive training only, and the intervention was continuously used for over a year.Best corrected visual acuity (BCVA) of the patients converted to the logarithm of the minimum angle of resolution (LogMAR) units was examined by international standard visual acuity chart before and after therapy.Spherical equivalent of the patients was detected by optometry under cycloplegic conditions and skiascopy.Binocular and fusion vision was examined with a synoptiscope.The stereopsis was evaluated using Titmus Stereogram.The ocular axial length (AL) and mean keratometry (Km) were measured with the IOLMaster 500.The basic cure rate, BCVA, reconstruction rate of stereopsis, △SE, △AL and △Km following training were compared to evaluate the effectiveness and myopic shift between two groups.The patients in conventional+ VTS4 group were divided into 4-5 years old group and 6-10 years old group, with 42 cases in each group, and the basic cure rate, BCVA, reconstruction rate of stereopsis were compared to evaluate the therapeutic effect between the two groups.The basic cure was defined as acuity improved to ≥0.9, with reduced myopic diopter and stable therapy outcome over 6 months.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2021-KY-0891-002). Written informed consent was obtained from guardians prior to any medical examination.Results:The basic cure rate of conventional+ VTS4 group was 58.33%(49/84), which was significantly higher than 40.48%(34/84) of conventional group ( χ2=5.358, P=0.021). The BCVA in the conventional+ VTS4 group was better than that in conventional group, showing a statistically significant difference ( Z=-2.537, P=0.011). The recovery rates of binocular vision, fusion vision and stereo vision were 87.93%(51/58), 78.33%(47/60) and 70.77%(46/65) in conventional+ VTS4 group, which were higher than 65.57%(40/61), 57.81%(37/64) and 52.86%(37/70) in conventional group, respectively, with significant differences between them ( χ2=8.259, 5.968, 4.566; all at P<0.05). No significant difference was found in △SE, △AL, and △Km between conventional group and conventional+ VTS4 group (all at P>0.05). The basic cure rate was 69.05%(29/42) in the children aged 4-5 years group, which was higher than 47.62%(20/42) in 6-10 years group, respectively, showing a significant difference ( χ2=3.967, P=0.046). Both BCVA and the stereo vision recovery rate in the 4-5 years old group were better than those in the 6-10 years old group ( Z=-2.046, P=0.041; χ2=4.624, P=0.032). Conclusions:A combination therapy of VTS4 and conventional comprehensive training can improve the visual acuity and reconstruct the fusion and stereopsis of children with ametropic amblyopia, without causing additional myopic drift.

Binocular vision problems associated with refractive surgery and the use of risk screening / 中华实验眼科杂志

Although binocular vision problems do not appear to be one of the common complications of refractive surgery, the available evidence suggests that these problems can occur after refractive surgery, and preoperative binocular vision status may predict the risk of postoperative binocular vision anomalies.Furthermore, because ophthalmologists usually do not clearly recognize binocular vision, or they do not pay enough attention to it, the existing literature may underestimate the actual prevalence of binocular vision problems after refractive surgery.This paper discusses the existing literature on refractive surgery-related binocular vision anomalies and recommends a screening protocol and risk stratification.It also discusses the expected results of binocular vision testing, the diagnostic criteria for common binocular vision problems, and strategies for treating these anomalies before and after refractive surgery.

Binocular vision problems associated with refractive surgery and the use of risk screening / 中华实验眼科杂志

Although binocular vision problems do not appear to be one of the common complications of refractive surgery,the available evidence suggests that these problems can occur after refractive surgery,and preoperative binocular vision status may predict the risk of postoperative binocular vision anomalies.Furthermore,because ophthalmologists usually do not clearly recognize binocular vision,or they do not pay enough attention to it,the existing literature may underestimate the actual prevalence of binocular vision problems after refractive surgery.This paper discusses the existing literature on refractive surgery-related binocular vision anomalies and recommends a screening protocol and risk stratification.It also discusses the expected results of binocular vision testing,the diagnostic criteria for common binocular vision problems,and strategies for treating these anomalies before and after refractive surgery.

The impact of resection of skull base tumor via an endoscopic endonasal approach on the visual function of vision impaired patients and the analysis of factors affecting their visual recovery / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the visual outcomes of patients with visual impairment after resecting skull base tumor via an endoscopic endonasal approach, and to analyze the factors affecting visual recovery.@*Methods@#One hundred and fifty-three patients with skull base tumor who suffered from preoperative visual impairment from Skull Base Surgery Center of Xuanwu Hospital were operated through an endoscopic endonasal approach. Both preoperative and postoperative visual function outcomes as well as factors that might have affected their visual recovery were analyzed retrospectively by Chi square test and Logistic regression analysis.@*Results@#Complete resection was achieved in 85.6% of the patients using this technique. The rate of postoperative visual recovery in the female group (86.1%) was higher than that in the male group (73.9%), the benign group (90.2%) higher than the malignant group (20.0%), the group without optic atrophy (97.1%) higher than the one with (51.2%), and the acute group (96.6%) higher than the chronic group (80.0%). Significant differences were found between the abovementioned groups (χ2 value was 5.849, 87.860, 79.757, 4.745, respectively, all P<0.05). The degree of optic atrophy and the property of tumors were significantly associated with visual improvement after treatment (Wold χ2 value was 18.597 and 35.623, all P<0.001).@*Conclusions@#Our results indicate that endoscopic endonasal surgery shows its ability both to resect skull base tumors and to improve visual function in the majority of patients. The timing of treatment for patients suffered from preoperative visual impairment should be selected in early stage before optic atrophy occurs.

Sintomas visuais e insuficiência de convergência em docentes universitários / Visual symptoms and convergence insufficiency in university teachers

Resumo Objetivo: Investigar a prevalência de desconforto visual e insuficiência de convergência (IC) em docentes universitários. Métodos: Tratar-se de um estudo transversal, com 60 docentes de ambos os sexos, tendo sido utilizado o questionário Convergence Insufficiency Symptom Survey, validado para a população brasileira. Resultados: Dos docentes entrevistados 55,0% eram do sexo feminino. 48,3% responderam dedicar menos que duas horas por dia à leitura, sendo que 40,0% dos entrevistados disseram que fazem pausas de 30 minutos à uma hora durante a leitura e 63,3% afirmaram passar entre 2 a 5 horas por dia em frente ao computador. Em relação à investigação sobre as doenças do sistema visual, 25,0% relataram apresentar miopia, sendo que 55,0% dos indivíduos usam óculos e destes 41,7% o usam com frequência. Quanto à investigação da prevalência de insuficiência de convergência, obteve-se frequência de (1,8) %. Conclusão: Constatou-se que a maioria dos entrevistados se apresentou com desconforto visual e uma pequena porcentagem foram acometidos pela IC.

Abstract Objective: To investigate the prevalence of visual discomfort and convergence failure in professors. Methods: A cross-sectional study was done, consisting of 60 teachers of both sexes, of the Centro Universitário FAG, which used the Convergence Insufficiency Symptom Survey, validated for the Brazilian population. Results: Of those surveyed 55.0% are female. 48.3% respondents spend less than two hours a day reading, with 40.0% of respondents said they do 30-minute breaks for one hour during reading and 63.3% said they spend between 2-5 hours a day in front of the computer. With regard to research on diseases of the visual system, 25.0% reported having myopia, with 55.0% of individuals use these glasses and 41.7% use it frequently. The research of the prevalence of convergence insufficiency, gave an average of 12.4(1.8) %. Conclusion: It was found that most respondents presented with visual discomfort and small percentages were affected by CI.

Forma clínica e fatores de risco associados ao estrabismo na binocularidade visual / Clinical forms and risk factors associated with strabismus in visual binocularity

RESUMO Objetivo: Identificar e analisar fatores de risco associados ao estrabismo, dados oftalmológicos e antecedentes pessoais e familiares. Métodos: Estudo prospectivo, descritivo e analítico realizado com 240 pacientes que consultaram pela primeira vez nos ambulatórios de estrabismo. Foram avaliadas a frequência e associação entre estrabismo, dados de exames oftalmológicos e antecedentes pessoais e familiares para identificação dos fatores de risco. Resultados: Observou-se maior prevalência de estrabismo em mulheres (56,96%) em relação aos homens (43,02%). A faixa etária mais atendida no ambulatório de estrabismo foi composta de crianças até 15 anos de idade (83,54%). Encontrou-se mais esotropia (55,27%) que exotropia (42,20%) e parcela menor de estrabismo vertical isolado (2,53%). A prematuridade foi associada ao estrabismo convergente (p=0,023) e não ao divergente (p=0,086). O diabetes mellitus materno foi associado à esotropia (p=0,024) e exotropia (p=0,036) no filho, mas a hipertensão arterial materna, uso de medicamentos para hipertensão e diabetes durante a gravidez e drogas ilícitas não foram estatisticamente significativos. Pacientes com paralisia cerebral tiveram mais associação com exotropia (p=0,008) que esotropia (p=0,019). Malformações congênitas, consanguinidade entre os pais e traumas oculares não apresentaram associação estatisticamente significativa para o estrabismo. A maioria dos pacientes com estrabismo apresentou boa acuidade visual corrigida e fundoscopia normal. Na análise de proporções a hipermetropia foi mais frequente na esotropia (68,7%). Conclusão: Os fatores de riscos internos e externos podem interferir na formação e desenvolvimento do olho na fase de plasticidade ocular, com prejuízo da binocularidade visual, podendo resultar em estrabismo. Há divergências com relação aos fatores de risco realmente associados e mais estudos são necessários para a identificação.

ABSTRACT Objective: To identify and analyze risk factors associated with strabismus, the eye data and personal and family history. Methods: A prospective, descriptive and analytical study, with 240 patients who consulted for the first time in strabismus clinics. We evaluated the frequency and association between strabismus and data eye examination and personal and family history to identify risk factors. Results: There was a higher prevalence of strabismus in women (56.96%) compared to men (43.02%). The age group most satisfied in strabismus clinic are children up to 15 years of age (83.54%). Met more esotropia (55.27%) than exotropia (42.20%) and lower portion of isolated vertical strabismus (2.53%). Preterm birth was associated with convergent strabismus (p = 0.023) but not the diverging (p = 0.086). Maternal diabetes mellitus was associated with esotropia (p = 0.024) and exotropia (p = 0.036) on the child, but the mother’s high blood pressure, medications for hypertension and diabetes during pregnancy and illicit drugs was not statistically significant. Patients with cerebral palsy association with exotropes had more (p = 0.008) which esotropia (p = 0.019). Congenital malformations, consanguinity between parents and ocular trauma showed no statistically significant association for strabismus. Most patients with strabismus showed good visual acuity, normal fundus. In the analysis of proportions farsightedness was more common in esotropia (68.7%). Conclusions: Internal and external risk factors can interfere in the formation and development of the eye in eye plasticity phase with impaired visual binocularity and may result in strabismus. There are differences with respect to risk factors associated truly and more studies are needed to identify.

Therapeutic evaluation of lateral rectus super-recession surgery for large angle divergence excess exotropia / 中华实验眼科杂志

Background In clinic practice,three or four rectus muscles often are needed to perform operation for the correction of large angle (＞50Δ) exotropia to avoid eye limited abduction due to lateral rectus superrecession.However,recent study reported that lateral rectus super-recession surgery can effectively correct large angle exotropia without remarkable abduction limitation.This outcome still need to be verified in clinical practice.Objective This study was to observe the outcome of bilateral rectus super-recession or medial rectus resection of the combined non-dominant eye for large angle exotropia.Methods A series case study was carried out.Fifty-one patients with intermittent or constant exotropia were enrolled in Tianjin Eye Hospital from May 2013 to October 2014.There were 29 intermittent exotropia and 22 constant exotropia among the 51 patients.Combined with adjustable sutures,bilateral lateral rectus super-recession or medial rectus resection of combined non-dominant eye was performed in all the eyes,and the examination of the anterior segment,fundus,ocular movement and binocular vision were performed before and after surgery.The deviation angle was measured by prism and alternate cover test.The individualized surgery procedure was designed according to medical history,ocular movement,sensory status and deviation angle.The patients were followed-up for at least 6 months.The eye position,ocular movement and binocular sensory function were compared between peoperation and postoperation.This study was approved by the Ethics Committee of Tianjin Eye Hospital.Written informed consents before the operation were obtained from all patient or their parents.Results Thirty-three patients underwent bilateral lateral super-recession and 18 patients underwent bilateral lateral super-recession of the medial rectus resection of the combined non-dominant eye.The mean angle of exotropia for seeing distance of 5 meters was (-70.57 ± 16.46) Δ (from-52 Δ to-120 Δ) and was (-75.65 ±16.14) Δ for seeing near (33 cm) (from-55Δ to-130Δ).The mean amount of left eye recession was 8-15 mm ([11.17±1.67] mm) and the right eye recession was 9-15 mm ([11.28±1.62] mm).The medial rectus of the dominant eye was resected by 3-6 mm.At the end of following-up,the mean angle of exotropia for seeing distance was (-3.45±4.20) Δ (from +4Δ to-14Δ) and was (-5.49±3.96) Δ for seeing near (from +4Δ to-14Δ).Surgical outcome was effective in 41 patients (80.4％),and 10 patients were undercorrected.The stereopsis of 32 patients improved after surgery,and 18 of 27 patients without preoperative stereopsis function obtained stereopsis after surgery.No ocular motility disorder was found in this group of patients after surgery.Conclusions Bilateral lateral rectus super-recesssion or medial rectus resection of combined non-dominant eye can effectively correct large angle exotropia and reduce the number and amount of surgical muscles without ocular motility disorder.

A comparative study on visual acuity and stereopsis outcomes between perceptual learning based on cloud services and conventional therapy for amblyopia / 中华实验眼科杂志

Background Amblyopia is a developmental disorder of spatial vision that results in both monocular and binocular deficits.Conventional therapy for amblyopia which focuses on monocular training can improve visual acuity.However,how to improve the binocular function,especially stereopsis is rarely studied.Objective This study was to evaluate the outcome of perceptual learning based on cloud services of improving stcreopsis and visual acuity for amblyopia.Methods A randomized-controlled clinical study was performed.One hundred and seven amblyopic patients (178 eyes) with the age of 5-18 years old were recruited in The Second Affiliated Hospital of Anhui Medical University from July 2013 to March 2014.The patients were randomized into the perceptual learning group and the conventional therapy group.A perceptual learning based on cloud services with computer under the best corrected visual acuity was carried out in the perceptual learning group with 30-day duration as a course for 5-6 cycles,and training feedback data was obtained after each cycle for the regulation of following treatment.The dominant eye was covered during the training process.In the conventional therapy group,a training regimen of health eye covering that combined with eyesight training of amblyopic eye was performed.The stereopsis and visual acuity of the patients were estimated after training.Written informed consent was obtained from the parents or custodians of the children before entering the cohort.Results The total effective rate of visual acuity improvement is significantly higher in the perceptual learning group than that in the conventional therapy group after training (Z =6.368,P=0.012).The mean stereopsis value of the amblyopic eyes in the perceptual learning group and the conventional therapy group was (127±53) and (174±67) after training,which was significantly higher than (273 ±95) and (311 ±103) before training,respectively,and the increasing range of the mean stereopsis was considerably larger in the perceptual learning group than that in the conventional therapy group(t=12.329,9.557,15.649;all at P＜0.05).In the perceptual learning group,the improving range of mean stereopsis was larger in the severe or moderate amblyopic eyes than that in the mild amblyopic eyes,and the improving range of mean stereopsis in ametropic amblyopia was larger than that in anisometropic amblyopia (all at P ＜ 0.05).Conclusions Both perceptual learning based on cloud services and conventional therapy can improve stereopsis and visual acuity in amblyopic eyes.However,perceptual learning based on cloud services can improve the treating compliance of children.

Vision disorders in the elderly / 中华老年医学杂志

Visual impairment is one of the common problems in the elderly,and regular screening should be considered for early detection as well as prevention.This article describes some of the common causes of vision loss in older adults,including cataracts,age-related macular degeneration,ametropia (presbyopia) and diabetic retinopathy.Patients with senile cataract should be offered a manifest refraction in the early stage,and surgical treatments are indicated when their vision is less than or equal to 0.4.Prevention and treatment of age-related macular degeneration may be achieved through medication or dietary adjustment.Vascular endothelial growth factor can be used in the treatment of neovascularage-related macular degeneration.Patients with presbyopia are advised to obtain a manifest refraction.Patients with diabetic retinopathy should be regularly offered an ocular fundus examination and receive early treatment when necessary,with particular attention paid to glycaemic control.

Validez del cuestionario CISS-V15 para el diagnóstico de la insuficiencia de convergencia / Validity of the CISS-V15 questionnaire for diagnosisof the convergence insufficiency

Introducción. El cuestionario Convergence Insufficiency Symptoms Survey, (CISS-V15) es una herramienta para el diagnóstico y seguimiento del tratamiento de pacientes con insuficiencia de convergencia. Objetivo. Determinar la validez del cuestionario CISS-V15 para el diagnóstico de la insuficiencia de convergencia, frente a las pruebas clínicas con que se evalúa el estado motor ocular de los pacientes atendidos en consulta optométrica, en las ciudades de Recife y Salvador, Brasil. Métodos. Se llevó a cabo un estudio con enfoque cuantitativo, de tipo transversal y descriptivo, con 50 pacientes de dos instituciones educativas en Brasil. Se seleccionaron aquellos que cumplían con los criterios de inclusión para aplicar el cuestionario, y se identificaron los pacientes con insuficiencia de convergencia y aquellos con visión binocular normal. Se analizaron los resultados del cuestionario y las pruebas de motilidad ocular, para estimar medidas de tendencia central, y analizar los valores de sensibilidad y especificidad del cuestionario. Resultados. La prueba alcanzó una sensibilidad de 0,83 y una especificidad de 0,81. Conclusiones. Frente a las pruebas clínicas, el cuestionario CISS-V15 demostró tener validez diag-nóstica para las personas con insuficiencia de convergencia y aquellas con visión binocular normal, lo que lo convierte en una herramienta valiosa para el diagnóstico y seguimiento del tratamiento de los pacientes con insuficiencia de convergencia

Introduction: The Convergence Insufficiency Symptom Survey Questionnaire (CISS-V15) is a tool for diagnosis and monitoring of treatment of patients with convergence insufficiency. Objective: To determine the validity of the questionnaire CISS-V15 for the diagnosis of convergence insufficiency against clinical tests assessing the oculomotor state in optometric patients seen in con-sultation in the cities of Recife and Salvador, Brazil. Methods: A descriptive transversal study with a quantitative approach was conducted with 50 patients from two educational institutions in Brazil. Patients were selected from those that met the inclusion criteria for applying the questionnaire. Patients with convergence insufficiency and those with normal binocular vision were identified. The results of the questionnaire and ocular motility tests were analyzed to estimate central tendency measures and to analyze the sensitivity and specificity of the questionnaire. Results: The test had a sensitivity of 0.83 and a specificity of 0.81. Conclusions: Given the clinical test, the CISS-V15 questionnaire proved to be valid to classify individuals with convergence insufficiency, and those with normal binocular vision, which makes it a valuable tool for the diagnosis and monitoring of the treatment of patients with convergence insufficiency.

Application of Ocular Trauma Score in Mechanical Ocular Injury in Forensic Medicine / 法医学杂志

Objective T o evaluate the application value for the prognosis of m echanical ocular injury cases using ocular traum a score (O TS). Methods Four hundred and eleven cases of m echanical ocular traum a w ere retrospectively review ed. O f the 449 eyes, there w ere 317 closed globe injury and 132 open globe injury. O T S variables included num erical values as initial visual acuity, rupture, endophthalm itis, perforat-ing or penetrating injury, retinal detachm ent and relative afferent pupillary block. T he differences be-tw een the distribution of the final visual acuity and the probability of standard final visual acuity w ere com pared to analyze the correlation betw een O T S category and final visual acuity. T he different types of ocular traum a w ere com pared. Results C om pared w ith the distribution of final visual acuity in standard O T S score, the ratio in O T S-3 category w as statistically different in present study, and no differences w ere found in other categories. Final visual acuity show ed a great linear correlation w ith O T S category (r=0.71) and total score (r=0.73). C om pared w ith closed globe injury, open globe injury w as generally associated w ith low er total score and poorer prognosis. R upture injury had poorer prognosis com pared w ith penetrating injury. Conclusion T he use of O T S for the patients w ith ocular traum a can provide re-liable inform ation for the evaluation of prognosis in forensic m edicine.

Cambios del estado oculomotor en pacientes de 18 a 25 años diagnosticados con insuficiencia de convergencia (IC) de la Universidad El Bosque, tras el tratamiento sugerido de ortóptica durante tres meses, 2013 / Oculomotor status changes in patients 18 to 25 years diagnosed with convergence insufficiency (CI) of the universidad el bosque, after orthoptics suggested treatment for three months, 2013

Estudio de casos prospectivo longitudinal, cuyo propósito es valorar los cambios de las condiciones binoculares, en pacientes diagnosticados con insuficiencia de convergencia, tras el tratamiento sugerido de ortóptica durante tres meses, con el fin de establecer el porcentaje de mejoría. Durante el desarrollo de esta investigación, se establecieron como criterios de inclusión: exoforia (X´) en visión próxima <20 Dioptrías prismáticas (Dpt), reservas fusiónales positivas (RFP) <15 Dpt, amplitud de acomodación baja (AA), punto próximo de convergencia (PPC) ≥6cm, acomodación relativa positiva (ARP) <2.50 y edades entre 18-25 años. Un total de 7 pacientes fueron incluidos; quienes firmaron el consentimiento informado. Inicialmente se valoró el estado oculomotor de cada paciente y respondieron la encuesta de síntomas pre-tratamiento; posteriormente fueron instruidos para realizar ejerciciosy/o terapia visual diarios en casa por 30 minutos. Una vez, finalizado el tratamiento, se tomaron medidas, las cuales evidenciaron cambios significativos en el PPC con luz ruptura/ recuperación (p = 0.0022) / (p = 0.0017); PPC con objeto real ruptura/ recuperación (p = 0.0040) / (p= 0.0017); reservas fusiónales positivas en visión próxima ruptura/ recobro (p = 0.0017) / (p = 0.0027). El 100% de los pacientes presentaron una ruptura ≤6cm y una recuperación de 7 ±3,6 cm en el PPC con luz; con objeto real el 71,4% presento una ruptura ≤ 6cm y una recuperación de 9 ±1,2 cm; las RFP incrementaron en el 85,7% siendo esta ≥15Δ en ruptura y una recuperación ≥15Δ en el 71,4% y en la encuesta el 48% de los pacientes reportaron mejoría de sus síntomas. Con lo anterior, se puede concluir que el tratamiento sugerido de ortoptica, presentó cambios y mejoras significativas de los signos clínicos los cuales se acompañan de una reducción de síntomas, los que permiten mejoras en la calidad de vida de los jóvenes universitarios y el restablecimiento de las condiciones binoculares.

Prospective longitudinal study of cases, the purpose is evaluate the changes in binocular conditions, in patients diagnosed with convergence insufficiency after orthoptic suggested treatment for three months, with the objective of determine the percentage of improvement. During the development of this investigation, were established as inclusion criteria: exophoria (X) in near vision <20 prism diopters (DPT), positive fusional reserves (RFP) <15 Dpt, low amplitude accommodation (AA), next point Convergence (CPP) ≥6cm, positive relative accommodation (PRA) low and ages 18-25 years. A total of 7 patients were included; They signed the informed consent. Initially the oculomotor status of each patient were evaluated and respondents survey of pretreatment symptoms; then they were instructed to perform exercises and / or vision therapy daily at home for 30 minutes.. Once treatment is completed, measures were taken, which showed significant changes in the PPC with break light / recovery (p = 0.0022) / (p = 0.0017); PPC real object breakdown / recovery (p = 0.0040) / (p = 0.0017); positive fusional reserves near sighted ness breakdown / recovery (p = 0.0017) / (p = 0.0027). 100% of patients had a breakdown and recovery ≤6cm 7 ± 3.6 cm in the PPC with light; real object with 71.4% showed a break ≤ 6cm and a recovery of 9 ± 1.2 cm; RFPs increased by 85.7% this being ≥15Δ in breaking ≥15Δ recovery and 71.4% in the survey and 48% of patients reported improvement in their symptoms. With this, one can conclude that the treatment suggested orthotopic, introduced significant changes and improvements in the clinical signs which are accompanied by a reduction in symptoms, which allow improvements in the quality of life in college students and restoring binocular conditions.

Examination of binocular disparity information of normal vision children / 中华全科医师杂志

To explore the binocular disparity information for children with a normal vision based on computer-assisted evaluation system.We examined the random dot zero-order disparity,line zero-order disparity,2nd-order disparity and random dot motion parallax for 97 children with normal vision.And 94 children reached 100″ vision disparity both in random dot zero-order disparity and line zero-order disparity (pass rate of 96.9％) ; all 94 cases passed the 2nd-order disparity and random dot motion parallax.Thus children with a normal vision develop their stereopsis.

Clinical features and visual function of recurrent neuromyelitis optica / 中华眼底病杂志

Objective To observe the clinical features and visual function of recurrent neuromyelitis optica (NMO).Methods Thirty-four patients with NMO were enrolled in this retrospective case series study.The patients included two males and 32 females.The average first onset age was (35.03± 14.56) years old and the average recurrent rate were (4.24±2.45) times.The recurrent rate of optic neuritis (ON) ranged from two to 12 times.The recurrent rate of ON was two times in 15 eyes of 10 patients,≥three times in 37 eyes of 24 patients.Vision acuity,direct ophthalmoscope,fundus pre-set lens examination,visual field and visual evoked potential (VEP) were evaluated.Clinical features were observed.The abnormal rate of optic nerve including optic edema and atrophy; abnormal rate of visual field including decreasing retinal sensitivity,central and paracentral scotoma,ring scotoma,half field defects,tunnel visual field,visual field centrality constriction; abnormal rate of VEP including Prolonged latent phase and/or decreasing amplitude of P100 wave from patients of first episode or recurrence was analyzed.Serum NMO-IgG was detected from 28 patients hy indirect immunofluorescence technique to observe its positive rate.Results All patients were characterized by repeated episodes of ON and myelitis.The main clinical feature of ON was visual loss,and the main clinical features of myelitis included sensory disability,dyskinesia and vesicorectal disorder.Blindness rate was 41.67％ after the first attack of ON,33.33％ after two relapses,and 64.86％ after ≥ three relapses.The difference of blindness rate between first attack and two episodes was not significant (x2=0.270,P=0.603).However,the blindness rate in patients having ≥ three episodes was significantly higher than those having two episodes (x2=4.300,P=0.038).With recurrence rate increasing,the abnormal rate of the optic nerve (x2 =6.750,P =0.034) and VEP(x2 =6.990,P =0.030)increased.But the abnormal rate of visual field did not increase along with recurrent rate (x2 =0.660,P=0.718).Seropositive rate of NMO-IgG did not differ significantly between patients with first attack ON and that with recurrent ON (x2 =1.510,P =0.470).But the seropositive patients had significantly higher bilateral blindness rate than seronegative patients (x2=5.063,P=0.027).Conclusions NMO are characterized by recurrent ON and myelitis.Visual loss,sensory disability,dyskinesia and vesicorectal disorder are the main clinical features.With recurrence rate increasing,the blindness rate,abnormalities the optic nerve and the abnormity rate of VEP increase.Seropositive recurrent NMO patients have higher bilateral blindness rate than seronegative patients.

Reoperação nas esotropias congênita e essencial adquirida não acomodativa / Reoperation in congenital and essential acquired non acomodative esotropia

OBJETIVO: Analisar os resultados das reoperações nas esotropias congênita e essencial adquirida não acomodativa. MÉTODOS: Foram avaliados retrospectivamente 393 prontuários de pacientes com diagnóstico de esotropia (91 esotropias congênitas e 302 adquiridas) no Departamento de Oftalmologia da Santa Casa de São Paulo, operados entre os anos de 2000 e 2004. RESULTADOS: No grupo dos portadores de esotropia congênita, 9 pacientes foram reoperados (9,9 por cento). As indicações para a nova intervenção foram: subcorreções (3,3 por cento), supercorreções (2,2 por cento), anisotropia (V) (1,1 por cento), hipotropia (1,1 por cento) e divergências visuais dissociadas (2,2 por cento). No grupo dos portadores de esotropia essencial adquirida não acomodativa 31 pacientes foram reoperados (10,3 por cento). As indicações para a nova intervenção foram: subcorreções (n=6,6 por cento), supercorreções (n=2 por cento) e hipertropias (n=1,7 por cento). CONCLUSÕES: A porcentagem de reoperação nos casos de esotropia congênita e essencial adquirida não acomodativa foram 9,9 por cento e 10,2 por cento respectivamente, com predominância de subcorreções nas indicações para a realização de nova cirurgia. A presença de ambliopia e desvios maiores que 50∆ na esotropia essencial adquirida não acomodativa (EEANA) foram os mais importantes fatores para maus resultados.

PURPOSE: To analyze the results in patients reoperated from congenital and essential esotropia. METHODS: A retrospective chart review of 393 patients who underwent surgery from 2000-2004 was performed. Subjects were divided into two groups: Congenital esotropia (91patients) and essential esotropia (302 cases). RESULTS: Among congenital cases we had 9 reoperations (9.9 percent). There were undercorrections (3.3 percent), overcorrections (2.2 percent), anisotropia (V) (1.1 percent), hypotropia (1.1 percent) and dissociatd vertical divergences (2.2 percent). Among the essential cases, there were 31 (10.3 percent) reoperations due to undercorrections (n=6.6 percent), overcorrections (n=2 percent) and hypotropias (1.7 percent). CONCLUSIONS: Outcomes reoperations rates were 9.9 percent and 10.2 percent between congenital and essential esotropias with a higher rate of undercorrections. Amblyopia in both groups and deviations higher than 50∆ in essential esotropias seems to be the most important factors for poor results.

Ceratoplastia autóloga ipsilateral rotacional em ceratocone após 24 meses de seguimento / Refractive and topographic changes of ipsilateral rotational autokeratoplasty with a crescent-shape 0.5 mm resection of the inferior cornea in keratoconus after a 24 months follow-up

INTRODUÇÃO: A ceratoplastia penetrante autóloga ipsilateral rotacional pode ser uma alternativa para minimizar o problema de longas filas de espera para transplante por ceratocone. OBJETIVO: Apresentar os resultados visuais em portadores de ceratocone após ceratoplastia penetrante autóloga ipsilateral rotacional associada à ressecção de 0,5 mm de crescente corneana inferior. MÉTODOS: Estudo prospectivo, longitudinal, de intervenção, analítico, investigando os resultados visuais de 15 pacientes (18 olhos), com diagnóstico de ceratocone, submetidos a ceratoplastia penetrante autóloga ipsilateral rotacional (CPAIR) por meio de duas trepanações, coincidentes superiormente e com diferença de 0,5 mm inferiormente. Após ressecção da cunha resultante das duas trepanações inferiores, o disco corneano foi rotado de 180° e suturado com 24 pontos diametralmente opostos. Os pacientes foram acompanhados por um período de 24 meses. RESULTADOS: Ao comparar os dados de 1º e 2º anos de pós-operatório aos do pré-operatório, observou-se melhora significante de: acuidade visual, linhas de visão, equivalente esférico, diminuição do astigmatismo topográfico e das curvaturas corneais máxima e média. Houve adelgaçamento corneano, com diminuição do número de células endoteliais da córnea. CONCLUSÃO: Observou-se melhora dos parâmetros oftalmológicos decorridos 6, 12 e 24 meses da ceratoplastia penetrante autóloga ipsilateral rotacional associada à ressecção de 0,5 mm na porção inferior corneana, mas ao longo do seguimento houve redução da acuidade visual com aumento do astigmatismo.

INTRODUCTION: Ipsilateral rotational penetrating autokeratoplasty technique may be an alternative to minimize the problem of long waiting lists for transplantation due to keratoconus. PURPOSE: To report the visual outcomes in keratoconus patients after ipsilateral rotational penetrating autokeratoplasty technique (IRPAK) associated with a crescent-shape resection of 0.5 mm of the inferior cornea. METHODS: According to a prospective, longitudinal, interventional, analytic study, the authors investigated the visual results of 15 patients (18 eyes) with keratoconus, who underwent an ipsilateral rotational penetrating autokeratoplasty, by two coincident trepanations superiorly and with a difference of 0.5 mm inferiorly. After resection of this corneal crescent, a 180° rotation of the corneal disk was performed, which was fixed with 24 sutures diametrically opposed. The patients were followed-up for a period of 24 months. RESULTS: Comparing data of the first and second postoperative years to preoperative data, there were: significant improvements in visual acuity, vision lines and spherical equivalent; reduction of topographic astigmatism and maximum and mean corneal curvatures. There was also a decrease in corneal thickness associated to a reduction of corneal endothelial cell count. CONCLUSION: There was an improvement of ophthalmologic parameters 6, 12 and 24 months after ipsilateral rotational penetrating autokeratoplasty associated with a crescent-shape resection of 0.5 mm of the inferior cornea, but along the follow-up there was reduction of visual acuity with increased astigmatism.

O impacto da visão monocular congênita versus adquirida na qualidade de visão autorrelatada / Impact of congenital versus acquired monocular vision as self-reported vision

Objetivos: Quando a visão de um olho está preservada (visão monocular) e há alto risco, baixo prognóstico e/ou recursos limitados para a cirurgia do olho contralateral, não é claro se o beneficio da binocularidade supera o da reorientação para visão monocular. O objetivo é quantificar o impacto da qualidade de visão referida entre a condição binocular e monocular e, nesse último caso, entre congênita e adquirida. Métodos: Pacientes com acuidade visual (AV) com AV>0,5 em cada olho foram submetidos ao questionário estruturado de 14 perguntas (VF-14), onde a pontuação de 0 a 100 indica o nível de satisfação do paciente com sua visão, variando de baixo a alto respectivamente. Dados epidemiológicos e pontuações dos quatro grupos foram registrados e submetidos à análise estatística. Resultados: A entrevista pelo VF-14 com 56 indivíduos revelou que a pontuação mais alta foi similar entre os controles e os portadores de visão monocular congênita, e níveis intermediários e baixos foram obtidos por indivíduos com visão monocular adquirida e cegos bilaterais, respectivamente (p<0,001). As atividades mais difíceis para os indivíduos com visão monocular adquirida foram identificar letras pequenas, reconhecer pessoas, distinguir sinais de trânsito e assistir TV. Conclusão: O estudo confirmou que a perda da visão tem impacto desfavorável no desempenho referido das atividades sendo maior na visão monocular adquirida do que na congênita. Os dados sugerem que medidas de reabilitação devem ser consideradas para melhorar a qualidade da visão em doenças intratáveis ou de alto risco ou de baixo prognóstico.

Purpose: When the vision in one eye is preserved (monocular vision) and there is high risk, low prognosis and/or limited resources to the fellow eye surgery, it is unclear if the benefit of binocularity outweighs the reorientation for monocular vision. The goal is to quantify the impact of the quality of vision of both binocular and monocular condition, and in this latter case, between congenital and acquired. Methods: Patients with visual acuity (VA)>0.5 in each eye underwent a structured questionnaire of 14 questions (VF-14), which the score 0-100 indicates the level of patient satisfaction with their vision, ranging from low to high respectively. Epidemiological data and scores of the four groups were recorded and analyzed statistically. Results: The interview by the VF-14 with 56 subjects revealed that the highest score was similar between controls and patients with congenital monocular vision, and low and intermediate levels were obtained by individuals with acquired monocular vision and bilaterally blind, respectively (p<0.001). The more difficult activities for individuals with acquired monocular vision were to identify small print, recognize people, to distinguish traffic lights and watch TV. Conclusion: The study confirmed that the vision loss has an adverse impact on the performance of such activities being higher in congenital than in acquired monocular vision. The data suggest that rehabilitation measures should be considered to improve the quality of vision in intractable diseases, high risk or low prognosis.

Insuficiencia de convergencia / Convergence insufficiency

Este artículo se propone hacer una revisión sobre la insuficiencia de convergencia, su definición, etiología,signos, síntomas y tratamiento, para lo cual se realizó una búsqueda de artículos en bases de datosdesde 1980 hasta el 2010. En la práctica clínica es común encontrar pacientes con insuficiencia deconvergencia, problema de la visión binocular que consiste en la dificultad para obtener o mantener una convergencia adecuada sin esfuerzo. Aunque es una condición benigna que se produce porque las capacidades visuales del paciente no son suficientes con respecto a su demanda en visión próxima, ocasionagran sintomatología y astenopia en el paciente, dificultando su rendimiento y calidad de vida. La prevalencia de insuficiencia de convergencia se encuentra entre el 4 al 6%. El tratamiento implica la corrección óptica apropiada de cualquier error refractivo y la realización de terapia activa. El tratamiento recomendado consta de tres fases, cada una con objetivos diferentes que son desarrolladas en casa y en el consultorio durante 12 a 24 semanas dependiendo de la severidad de la condición, la edad del paciente y las funciones que se encuentran alteradas.

The purpose of this article is to review about convergence insufficiency, its definition, etiology, signs, symptoms and treatment. It was made an article search in data bases from 1980 to 2010. Convergence Insufficiency (CI) is one of the most common binocular vision problems and it has been defined as the inability to maintain an adequate convergence without effort. This is typically a benign and idiopathic condition that represents a lack of concordance between visual abilities and its near work demands,the main complaint is near vision asthenopia. The prevalence is 4.2% to 6%. Treatment involves the correction of any refractive error, and active therapy. The recommended treatment has three phases each one with different goals at home and office during 12to 24 months depending on the variety of the condition, patient’s age and anomalous visual functions.

Cirurgia de catarata: características e opiniões de pacientes com visão mono versus binocular / Cataract surgery: characteristics and opinions of patients with monocular versus binocular vision

OBJETIVO: Verificar em dois grupos de pacientes com visão monocular (grupo 1) e com visão binocular (grupo 2), a serem submetidos à cirurgia de catarata num hospital universitário, opiniões em relação ao problema ocular, à qualidade da visão e à cirurgia de catarata. MÉTODOS: Foi realizado estudo transversal e comparativo, de forma consecutiva, por meio de questionário estruturado, aplicado por entrevista a pacientes, elaborado a partir de estudo exploratório e medidas acuidade visual e causa da perda visual. RESULTADOS: A amostra foi constituída por 96 indivíduos do grupo 1 (50,0 por cento homens; 50,0 por cento mulheres, com idade entre 41 e 91 anos, média 69,3 anos ± 10,4 anos) e 110, do grupo 2 (40,9 por cento homens; 59,1 por cento mulheres, com idade entre 40 e 89 anos, média 68,2 anos ± 10,2 anos). A maioria dos indivíduos de ambos os grupos apresentava baixa escolaridade. Não houve diferença estatisticamente significante entre os grupos em relação ao sexo (p=0,191), à idade (p=0,702) e à escolaridade (p=0,245). Não exerciam atividade laboral 95,8 por cento dos indivíduos do grupo 1 e 83,6 por cento, do grupo 2 (p=0,005) e 30,4 por cento do grupo 1 mencionaram não ter possibilidade de trabalhar por causa da deficiência visual. Observou-se acuidade visual do olho a ser operado menor que 0,05 em 40,6 por cento (grupo 1) e 33,6 por cento (grupo 2), entre 0,25 e 0,05. Quase a totalidade dos indivíduos de ambos os grupos afirmou ter dificuldade para realização das atividades de vida diária e qualificou como insuficiente a respectiva acuidade visual; 71,9 por cento dos entrevistados do grupo 1 e 71,6 por cento, do grupo 2 mencionaram saber a causa da visão fraca; desses, 87,1 por cento do grupo 1 e 83,3 por cento do grupo 2 referiram a catarata como causa da baixa acuidade visual. CONCLUSÃO: Os indivíduos de ambos os grupos tiveram acesso à cirurgia de catarata com acuidade visual menor do que a idealmente indicada; os pacientes com visão monocular apresentaram acuidade visual significativamente menor em relação aos com visão binocular; a maioria dos entrevistados de ambos os grupos referiu dificuldades para realizar atividades cotidianas como consequência da baixa visão; muitos indivíduos de ambos os grupos desconheciam a causa da dificuldade visual ou a atribuíram a outra causa que não a catarata.

PURPOSE: To verify in two groups of patients: monocular (group 1) and binocular vision (group 2) to be submitted to cataract surgery at an University Hospital, opinions, expectances and emotional reactions related to the ocular problem, to the quality of vision and to cataract surgery. METHODS: A transversal comparative and consecutive study was performed using a structured questionnaire applied by patients interview. The questionnaire was elaborated from a previous exploratory study; visual acuity and cause of the visual loss were evaluated. RESULTS: The sample was constituted by 96 persons of group 1 (50.0 percent male; 50.0 percent female, ages ranging from 41 to 91 years; average 69.3 years ± 10.4 years) and 110 persons of group 2 (40.9 percent male; 59.1 percent female, ages ranging from 40 to 89 years; average 68.2 years ± 10.2 years). The majority of persons of both groups presented low educational level. There was no statistically significant difference between the groups in relation to gender (p=0.191), age (p=0.702) and educational level (p=0.245). No work activity was mentioned in 95.8 percent of the persons of group 1 and 83.6 percent of group 2 (p=0.005) and 30.4 percent of group 1 informed the impossibility to work due the visual impairment. Visual acuity of the eye to be operated was less than 0.05 in 40.6 percent (group 1) and in 33,6 percent (group 2), presented visual acuity ranging from 0.05 to 0.25. Almost the totality of the persons of both groups informed difficulties to perform activities of daily life and qualified as insufficient their visual acuities; 71.9 percent of the patients of group 1 and 71.6 percent of group 2 informed to know the reason of low vision; among these, 87.1 percent of group 1 and 83.3 percent of group 2 mentioned cataract as the reason of low visual acuity. CONCLUSION: It was concluded that the patients of both groups were submitted to cataract surgery with visual acuities less than the visual ...