Manifestaciones neuroftalmológicas en pacientes con enfermedad cerebrovascular isquémica / Neuro-ophthalmological manifestations in patients with ischemic cerebrovascular disease

La enfermedad cerebrovascular isquémica tiene una elevada incidencia y prevalencia en Cuba, y constituye la tercera causa de muerte en el país. Existen diferencias anatómicas y clínicas entre el infarto de la circulación anterior y la posterior. En ocasiones, los elementos distintivos que ayudan al diagnóstico topográfico de la enfermedad cerebrovascular isquémica son las manifestaciones neuroftalmológicas. Con el objetivo de profundizar en el conocimiento actual sobre las alteraciones neuroftalmológicas que se asocian a la enfermedad cerebrovascular isquémica, se realizó una revisión bibliográfica, donde se consultaron un total de 69 fuentes de información digital de los últimos 5 años. La circulación cerebral se divide de manera general en anterior y posterior. Los síntomas y signos principales del ictus que afecta la circulación anterior son la desviación conjugada de la mirada, la afectación de las sácadas, la hemianopsia homónima, la heminegligencia y la apraxia de la apertura ocular; mientras que las alteraciones asociadas a la afectación de la circulación posterior son el nistagmo, las anormalidades en la alineación y los movimientos oculares, así como la hemianopsia homónima con conservación macular. Se concluye que en la enfermedad cerebrovascular isquémica aparecen síntomas y signos como consecuencia de la afectación, tanto de la vía visual aferente, como de la eferente. La hemianopsia homónima es el signo más frecuente reportado(AU)

Ischemic cerebrovascular disease has a high incidence and prevalence in Cuba, and it is the third cause of death in the country. A number of anatomical and clinical differences distinguish anterior from posterior circulation infarction. On certain occasions the distinguishing elements that aid in the topographic diagnosis of ischemic cerebrovascular disease are its neuro-ophthalmological manifestations. With the purpose of gaining insight into the current knowledge about the neuro-ophthalmological alterations associated to ischemic cerebrovascular disease, a bibliographic review was conducted based on the analysis of 69 digital information sources from the last five years. Cerebral circulation is generally divided into anterior and posterior. The main symptoms and signs of the stroke that affects anterior circulation are conjugate gaze deviation, altered saccades, homonymous hemianopsia, heminegligence and eyelid opening apraxia, whereas the alterations associated to posterior circulation involvement are nystagmus, eye movement and alignment abnormalities, and homonymous hemianopsia with macular preservation. It is concluded that ischemic cerebrovascular disease presents symptoms and signs related to both the afferent and the efferent visual pathways. Homonymous hemianopsia is the most common sign reported(AU)

Update in the Diagnosis and Treatment of Strabismus

Strabismus is defined as an ocular misalignment. Since it can cause not only impaired visual function but also social handicap and tremendous emotional stress, the care of patients with strabismus should include psychological and social aspects. Although strabismus is one of the major fields in pediatric ophthalmology and neuro-ophthalmology, its precise mechanism and etiology are still unknown. It can be inherited from strabismic parents, or be derived from the anomalous structure, neurologic deficits, and refractive errors. The diagnosis of strabismus can be made by covering one eye, and the degree of strabismus can be quantified by the alternate prism cover test. Recently MRI is used widely for the diagnosis of various anomalous orbital and muscular structures, especially to investigate heterotopia of extraocular muscle pulley. The treatment modalities for strabismus are either surgical or nonsurgical. Surgical treatments can be made by recession or resection of the involved extraocular muscle. The adjustable suture technique was introduced in 1970s, which has been the gold standard among surgical treatment modalities. Nonsurgical treatments include prism, glasses, bifocal lenses, and drugs. A young strabismic patient may have amblyopia and decreased stereoacuity due to abnormal interaction between the sound eye and the deviating eye. Once amblyopia is detected, immediate treatment is needed to correct the visual dysfunction. Recent efforts to elucidate the mechanisms of strabismus are believed to unravel the mysterious pathophysiology in the near future.