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The incidence of myopia among Chinese adolescents is progressively rising, indicating a distinct trend toward younger age onset.This paper aims to comprehensively review the impact of various visual performance on myopia and its progression, with a specific emphasis on accommodative function, convergence function, and ocular position. A meticulous exploration of accommodation function, encompassing accommodative amplitude, accommodative facility, accommodative response, positive relative accommodation, and negative relative accommodation, has been undertaken to elucidate its contributory role in myopia progression. Concurrently, an exhaustive analysis of convergence function has been conducted including esotropia and exotropia, convergence insufficiency and convergence excess, fusional function vergence, divergence insufficiency, and excess, providing a nuanced understanding of convergence's implications for myopia advancement. Furthermore, the influence of ocular position on myopia progression, along with other factors affecting perceptual ocular position and intermittent exotropia, is discussed. The primary objective of this article is to unveil the multifaceted visual performance influencing myopia and its progression, elucidating the paramount significance of accommodative function, convergence function, and ocular position in this context.
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Ocular accommodation refers to the process by which the ciliary muscle creates a clear image of the object in the retina by changing the refractive power of the lens. When the accommodation ability of the eye is insufficient, the imaging focus falls on the region behind the retina and hyperopic defocus is easily formed, resulting in axial growth and leading to the development of myopia, and it is found that most myopic patients usually have some accommodation dysfunction. Myopia has become a public health problem in China, and the prevalence of adolescents has increased dramatically. How to prevent and stop the occurrence and development of myopia is a major challenge. Previous studies have found that ocular accommodation dysfunction is associated with the occurrence and development of myopia, and the measurement of parameters related to accommodation function has certain guiding significance for the prevention and control of myopia. The purpose of this paper is to review the correlation between myopia and ocular accommodation function, with a view to providing new ideas for the prevention, control and treatment of myopia.
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Objective:To explore the effects of conflicting stimuli generated by different chromatic lights on visual display terminal (VDT) on accommodative response and microfluctuation of myopes and emmetropes, and to investigate the possible relationship between chromatic light, accommodation and the development and progression of myopia.Methods:A non-randomized controlled trial was conducted.Forty-one subjects aged 22 to 30 years old were enrolled, including 19 emmetropes in emmetropic group and 22 myopes in myopic group.The subjects had the normal color vision and no ocular organic diseases.The interventions were screens of different colors.There were 7 chromatic light conditions, including 3 monochromatic lights (red, green, blue), 3 bichromatic lights (red+ green, red+ blue, green+ blue) and 1 polychromatic light (white=red+ green+ blue). Subjects were asked to look at a black E target on a VDT at a distance of 33 cm for more than 20 seconds.The background color of the VDT was changed randomly in the 7 chromatic light conditions.The accommodative responses were recorded with the Grand Seiko WAM-5500 automatic infrared refractor every 0.2 seconds and the accommodative microfluctuation was calculated as the standard deviation of the accommodative response.Accommodative response and accommodative microfluctuation under different chromatic light conditions were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No.2019-1564). Written informed consent was obtained from each subject.Results:No statistically significant difference was found in the accommodative response between the two groups ( Fgroup=2.626, P=0.113). There was a statistically significant difference under different chromatic light conditions between the two groups ( Flight=39.070, P<0.01). There were similar trends in the effects of various color lights in both groups, with the largest accommodative response under monochromatic red light, followed by the bichromatic light containing red light, and then the smallest accommodative response under monochromatic blue light, and the differences were statistically significant (all at P<0.05). The accommodative microfluctuations under red, green, blue, red+ blue, red+ green, blue+ green and white light conditions were (0.142±0.033), (0.128±0.038), (0.131±0.043), (0.139±0.039), (0.127±0.034), (0.131±0.043) and (0.139±0.042)D in emmetropic group, and (0.178±0.043), (0.164±0.043), (0.159±0.039), (0.174±0.042), (0.166±0.036), (0.159±0.031) and (0.174±0.035)D in myopic group, respectively, showing statistically significant differences between them ( Fgroup=12.146, P<0.01; Flight=2.782, P<0.05). The accommodative microfluctuations under the 7 light conditions were higher in myopic group than in emmetropic group, and the differences were statistically significant (all at P<0.05). In myopes, the accommodative microfluctuation was the largest under red light, which was significantly larger than that under blue light, and was the smallest under blue+ green light (all at P<0.05). There was no significant difference in the accommodative microfluctuation between bichromatic light and its two monochromatic lights, or between the polychromatic light (white light) and its three monochromatic lights (all at P>0.05). There was no significant effect of various chromatic lights on the accommodative microfluctuation in emmetropic group (all at P>0.05). Conclusions:The accommodative microfluctuation is greater in myopes than in emmetropes.The stimuli produced by long-wavelength light cause larger accommodative microfluctuation, while conflicting stimuli generated by different chromatic lights do not increase accommodative microfluctuation.
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@#Spontaneous consecutive exotropia (SCXT) in conservatively managed accommodative esotropia is not widely discussed. The author presents a case series of 4 patients with SCXT describing patient characteristics and possible risk factors. Management modifications based on this series are proposed. Four cases of patients who initially presented with accommodative esotropia and later developed SCXT are presented. The age range at presentation was between 4 months to 3 years, with total follow-up ranging between 8–15 years. All four cases presented with esotropia on or before the age of 3 years, with initial hyperopia ranging between +1.50 to +4.25. The SCXT occurred between ages 2–7 years. Possible risk factors identified include amblyopia, dissociated vertical deviation, rapid control of esodeviation, inferior oblique overaction, and poor follow-up during the course of their strabismus. The author recommends earlier tapering of hyperopia correction following initial control with full cycloplegic refraction. Identified risk factors should alert the specialists to be wary of SCXT.
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The study aimed to examine the distribution of Accommodative Facility (AF) and Amplitude of Accommodation (AA) and compare the findings with established guidelines.Place and Duration of Study: Mzuzu University, Malawi. Between May and July 2022.Methods: This cross-sectional study was conducted among students at Mzuzu university in Malawi. We recruited 77 students using a stratified random sampling technique. The participants' age ranged from 16 to 35 years of age. We measured AA using the push-up method while AF was measured using +/- 1.50 Diopters (D) flippers. Both techniques utilized black reading material on white background held at 40 centimeters (cm). Next, we measured the accommodation facility by counting the number of Cycles per Minute (c/m). We utilized the Pearson correlation test and the One-way ANOVA where appropriate. The value of p< 0.05 was considered statistically significant. Results: The participants comprised 44 (57.1%) males and 33 (42.9%) females. Monocular AA was 10.04D (SD=2.71) and Binocular AA was 10.51 (3.641). The difference was statistically significant (p=0.04). While Monocular AF and Binocular AF were 9 c/m (SD= SD=1.84) and 8.96 (SD=1.539) respectively but the difference was non-significant (p=0.868). AF and AA were not significantly different between males and females. All the parameters decreased with age. The measured AA was significantly higher than using Hofstetter’s formula.Conclusion: The study provides a cut-off value for practitioners diagnosing Accommodation anomalies. However, indices in the study differ from the well-established guidelines hence practitioners should endeavor to perform the clinical assessment instead of relying on equations.
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Purpose: To derive and provide, for the first time, comprehensive analytic formulas for scleral softening volume efficacy (SVE) for accommodative gain (AG) via the increased space between ciliary body and lens (SCL) and mobility of the posterior vitreous zonules (PVZ).Study Design: To increase the AG of presbyopic eye by a new procedure, laser scleral softening (LSS).Place and Duration of Study: New Taipei City, Taiwan, between June 2022 and July 2022.Methodology: The SVE is calculated based on the time and spatial integral of the scleral temperature profiles, T(z,t), solutions of a heat diffusion equation. Analytic formulas for SVE is derived based on the covered area given by a triangle area. The SVE of a 3-D model is governed by the "volume" covered by the laser beam, or its spot size area, the effective penetration depth (z"), which is an increasing function of laser dose, but a decreasing function of the absorption coefficient (A), due to the Beer's law of laser intensity, I(z)=I0exp(-Az). The efficacy depth-range (dZ) and time-ranges (dT) are defined for efficient softening with T(z,t)>T*, where T* is the scleral softening threshold temperature.Results: The accommodative gain is proportional to the 3-D SVE given by: SEV(3D) = SEV(1D) x laser beam spot (2-D area) x total number of spots (N) acting on the sclera, which is proportional to the efficacy ranges dZ and dT, in which dZ is an increasing of laser irradiation time, whereas dT is a decreasing function of depth. Softening of the scleral tissue after a thermal laser leading to the increase of PVZ mobility and SCL. However, the actual relation of SVE and the PVZ and SCL changes require measured data.Conclusion: Safety and efficacy of scleral softening for presbyopia treatment depend upon the laser parameters (intensity, dose, spot size, wavelength) and the effective depths. The SVE is proportional to the efficacy depth-range (dZ) and time-range (dT), in which dZ is an increasing of laser irradiation time and dT is a decreasing function of depth. The AG is proportional to the SVE(in 3-D).
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@#AIM:To describe the clinical characteristics of 20 patients with acute acquired comitant esotropia(AACE). <p>METHODS: This retrospective, observational case series study enrolled patients with AACE examined from June 2018 to May 2021 in Guangdong Jiangmen Central Hospital. The age when attacked, the duration of excessive near work before illness, symptom, refraction, AC/A, deviation and near stereopsis were analyzed. All 20 patients had unremarkable neurological finding by imageological test. <p>RESULTS: Most patients whose mean age was 24.25±5.78 years immersed in near work for more than 6h a day before illness. All patients seeked for medical help because diplopia with normal ocular motility in all directions of gaze and meaningless finding in routine ophthalmologic examinations. They were all nearsightedness whose mean spherical equivalent was -5.73±5.09D, while mean AC/A was 2.65±1.16 within the upper limit. There was no different between the distant and near deviations(<i>P</i>>0.05). Deviations might be correlated with near stereopsis(<i>P</i><0.05), however the duration from onset to treatment was irrelevant(<i>P</i>>0.05).<p>CONCLUSION: The clinical features of AACE in older children and adults who immersed excessive near work are medium myopia, diplopia, normal ocular motility, no neurological finding and limited AC/A. Moreover, it is approximate between distant and near deviations. The deviations affect near stereopsisd more, while the influence of duration from onset to treatment may be less.
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AIM: To analyze the changes of uncorrected distance visual acuity(UCDVA)and ocular accommodation before and after excimer laser photorefractive keratectomy(PRK).METHODS: A retrospective study. There were 120 patients(240 eyes)who underwent PRK surgery in our center from December 2017 to December 2019 divided into two groups according to the diopter of spherical equivalent(SE): 70 cases with SE≤-6.00D in the mild to moderate myopia group and 50 cases with -6.00D<SE≤-9.00D in the high myopia group which were observed and analyzed. The UCDVA(LogMAR), monocular accommodative amplitude(AMP), negative relative accommodation(NRA), positive relative accommodation(PRA)and monocular accommodative flipper(AF)were measured before and after operation at 1wk, 1 and 3mo. RESULTS: In the group of low-moderate myopia and high-myopia group, the UCDVA at 1wk, 1 and 3 mo after operation was significantly increased compared with those before operation(all P<0.01). The increase of UCDVA of low to moderate myopia group was better than that in the high myopia group at 3mo after operation(P<0.05). Monocular AMP in the both groups firstly decreased and increased afterwards, and there was a significant decrease than that before operation at 1wk and 1mo after operation(P<0.01). AMP reached and was better than that before operation at 3mo after operation(P<0.01). The increase of low to moderate myopia group was both higher and faster than that of high myopia group. Compared with PRA before operation, the patients of low to moderate myopia group decreased at 1wk after operation(P<0.01), postoperative levels at 1mo recovered to preoperative level(P>0.05)and postoperative at 3mo was superior to preoperative operation(P<0.05); High myopia group did not change significantly at 1wk and 1mo after operation compared with preoperative operation(P>0.05), and increased at 3mo after operation compared with preoperative level(P<0.01). For low to moderate myopia group, there was no significant difference in preoperative and postoperative NRA, and at 1wk after operation, NRA of high myopia group temporarily increased compared with preoperative operation(P<0.01). At 1mo after operation, it returned to the preoperative level(P>0.05), and significantly increased at 3mo after operation compared with preoperative operation(P<0.01). Monocular AF for both groups significantly decreased at 1wk after operation compared with preoperative operation, recovered at 1mo after operation and was significantly better at 3mo after operation(all P<0.01); The low-to-moderate group increased more than the high-myopia group.CONCLUSION: PRK has a good correction effect for myopia below -9.00D, and people in low to moderate myopia have a better postoperative UCDVA correction effect than those in high myopia. The eye accommodation will be abnormal in a short period after operation. The recovery and improvement time of accommodative function in low-moderate myopia group are shorter than that in high myopia group, but both groups can recover and improve at 3mo after operation compared with the preoperative levels.
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AIM: To investigate the visual fatigue of patients with accommodative asthenopia and the difference in scores before and after treatment by using the asthenopia survey scale(ASS), and to evaluate its reliability, validity and responsiveness in this population.METHODS: A total of 112 patients with accommodative asthenopia were admitted to the department of ophthalmology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine and recruited online were investigated using the ASS questionnaire, and 48 subjects were randomly selected and retested 1wk later. A variety of reliability, validity and responsiveness indicators were used to evaluate the scale.RESULTS: The overall Cronbach's α coefficients of the scale entries was 0.91; The split-half reliability coefficients was 0.86; Repeated measurement correlation coefficient of the scale total score was 0.74, there was no significant difference before and after(P>0.05); The results of confirmatory factor analysis showed that the absolute fit index of the three-factor structural model was χ2/df<2.0, RMSEA=0.08; The correlation coefficients of each dimension's total score and the scale's total score were 0.92, 0.90 and 0.83 respectively; The standard association validity analysis showed statistically significant differences between groups(P<0.01). Response analysis was statistically significant before and after treatment(P<0.01).CONCLUSION: The ASS has high reliability, validity and responsiveness in the clinical evaluation of accommodative asthenopia, and it's an effective tool for clinical research and screening of asthenopia in this population.
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@#AIM: To investigate the efficacy and safety of orthokeratology combined with 0.01% atropine in controlling low to moderate myopia in adolescents.<p>METHODS: A prospective non-randomized controlled study was conducted among 120 eyes of 120 adolescents with low to moderate myopia. 60 eyes in the control group were treated with orthokeratology, and 60 eyes in the combined group were treated with orthokeratology combined with 0.01% atropine. The best corrected distant visual acuity(BCDVA), best corrected near visual acuity(BCNVA), refraction, axial length, accommodative amplitude, photopic pupil diameter, mesopic pupil diameter, lipid layer thickness(LLT), tear film break up time(BUT)and complications were determined before treatment and at 1a after treatment. <p>RESULTS: There were no significant differences in BCDVA and BCNVA within and between the two groups before and after treatment(<i>P</i>>0.05). After treatment, the spherical equivalents of both groups progressed significantly(<i>P</i><0.01), and the average changes of spherical equivalent refractive error in the combined group and the control group were 0.21(0.03, 0.53)D and 0.40(0.15, 0.74)D respectively(<i>P</i><0.01). The axial lengths of both groups were increased significantly(<i>P</i><0.01), and the axial length elongations of the combined group and the control group were(0.13±0.19)mm and(0.22±0.21)mm respectively(<i>P</i><0.01). There were no significant differences in the accommodative amplitude, photopic and mesopic pupil diameters of the control group before and after treatment(<i>P</i>>0.05). After treatment, the accommodative amplitude of the combined group decreased significantly, while the photopic and mesopic pupil diameters significantly increased, respectively(<i>P</i><0.01). The accommodative amplitude of the combined group was smaller than that of the control group, while the photopic and mesopic pupil diameters were larger than those of the control group at 1a after treatment(<i>P</i><0.01). The LLT and BUT in both groups were significantly reduced from baseline(<i>P</i><0.01), but both showed no significant differences between the two groups at baseline and at 1a after treatment(<i>P</i>>0.05). During the treatment period, there was no difference in the incidence of total adverse reactions between the combined group and the control group(26.7% <i>vs</i> 15.0%, <i>P</i>>0.05). <p>CONCLUSION: Combined treatment with 0.01% atropine and orthokeratology would be a safe and more effective choice of treatment to control the development of myopia in adolescents.
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?AIM: To determine the status of non - strabismic binocular vision anomalies ( NSBVA) among students of a Malaysian private university uses visual display units ( VDU) .?METHODS: A cross- sectional study was conducted among university students who use VDU 3h or more from January 2019 to May 2019. A convenient sampling method was utilized. All subjects had gone through primary eye-examinations to satisfy the inclusion criteria. Those who satisfy the inclusion criteria, further gone through the NSBVA assessment. The descriptive analysis was done to rule out the percentage of NSBVA and Chi-square test of independence was carried out to observe the association of NSBVA with age, gender and hours of VDU usage.?RESULTS: A total of 140 students including 88 females ( 62. 9％) and 52 males ( 37. 1％) participated in this study. The mean age of the participants was 22. 54 ± 1. 48 years and the mean VDU usage hours were 5. 76 ± 2. 49h. The percentage of NSBVA is 40％ among the students those who use VDU. The occurrence of accommodative and vergence anomalies among the VDU users is 17. 86％ and 22. 14％ respectively. There was a moderate association between gender and NSBVA (P=0. 010). However, there was no significant association observed for age ( P =0. 334) and hours of VDU usage ( P=0. 835) with NSBVA.?CONCLUSION:NSBVA is 40％ among the students of a Malaysian private university uses VDU. Accommodation insufficiency ( 15％) and convergence insufficiency ( 10％) is more common among all NSBVA for VDU users.
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@#AIM: To determine the status of non-strabismic binocular vision anomalies(NSBVA)among students of a Malaysian private university uses visual display units(VDU).<p>METHODS: A cross-sectional study was conducted among university students who use VDU 3h or more from January 2019 to May 2019. A convenient sampling method was utilized. All subjects had gone through primary eye-examinations to satisfy the inclusion criteria. Those who satisfy the inclusion criteria, further gone through the NSBVA assessment. The descriptive analysis was done to rule out the percentage of NSBVA and Chi-square test of independence was carried out to observe the association of NSBVA with age, gender and hours of VDU usage.<p>RESULTS: A total of 140 students including 88 females(62.9%)and 52 males(37.1%)participated in this study. The mean age of the participants was 22.54±1.48 years and the mean VDU usage hours were 5.76±2.49h. The percentage of NSBVA is 40% among the students those who use VDU. The occurrence of accommodative and vergence anomalies among the VDU users is 17.86% and 22.14% respectively. There was a moderate association between gender and NSBVA(<i>P</i>=0.010). However, there was no significant association observed for age(<i>P</i>=0.334)and hours of VDU usage(<i>P</i>=0.835)with NSBVA. <p>CONCLUSION: NSBVA is 40% among the students of a Malaysian private university uses VDU. Accommodation insufficiency(15%)and convergence insufficiency(10%)is more common among all NSBVA for VDU users.
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@#AIM: To determine the status of non-strabismic binocular vision anomalies(NSBVA)among students of a Malaysian private university uses visual display units(VDU).<p>METHODS: A cross-sectional study was conducted among university students who use VDU 3h or more from January 2019 to May 2019. A convenient sampling method was utilized. All subjects had gone through primary eye-examinations to satisfy the inclusion criteria. Those who satisfy the inclusion criteria, further gone through the NSBVA assessment. The descriptive analysis was done to rule out the percentage of NSBVA and Chi-square test of independence was carried out to observe the association of NSBVA with age, gender and hours of VDU usage.<p>RESULTS: A total of 140 students including 88 females(62.9%)and 52 males(37.1%)participated in this study. The mean age of the participants was 22.54±1.48 years and the mean VDU usage hours were 5.76±2.49h. The percentage of NSBVA is 40% among the students those who use VDU. The occurrence of accommodative and vergence anomalies among the VDU users is 17.86% and 22.14% respectively. There was a moderate association between gender and NSBVA(<i>P</i>=0.010). However, there was no significant association observed for age(<i>P</i>=0.334)and hours of VDU usage(<i>P</i>=0.835)with NSBVA. <p>CONCLUSION: NSBVA is 40% among the students of a Malaysian private university uses VDU. Accommodation insufficiency(15%)and convergence insufficiency(10%)is more common among all NSBVA for VDU users.
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Background: Ocular dominance is the physiological preference of one eye over the other, hence its input is favoured when there is conflicting information to the two eyes. Accommodation is the mechanism by which the eye changes focus from distant to near images and is produced by a change in the shape of the crystalline lens. The aim of this study was to compare the accommodative amplitude, facility and lag in the dominant and non-dominant eye.Methods: This cross sectional study was carried out on 80 visually normal subjects. Ocular dominance was determined using hole-in-the- card method. Amplitude of accommodation, accommodative facility and response was measured monocularly and randomly using push up method, ±2.00DS flipper lenses and Nott technique respectively.Results: Results obtained from the study showed that the right eye was dominant in 62.5% of subjects. The mean (SD) for accommodative amplitude, facility and response (lag) in the dominant eye was 11.08 (2.16) D, 10.00 (1.52) cycles per minute and 0.62 (0.27) respectively. The mean (SD) for accommodative amplitude, facility and lag in the non-dominant eye was 10.98 (2.20) D, 9.86 (1.44) cycles per minute and 0.60 (0.25) D respectively.Conclusions: It may be inferred that the dominant eye has more accommodative amplitude, facility and lag than the non-dominant eye but this difference was not statistically significant.
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@#AIM: To investigate the incidence and risk factors of near vision impairment(NVI)in patients with asthenopia.<p>METHODS: Totally 51 patients(102 eyes)with visual fatigue in our hospital from May 2017 to May 2018 were enrolled. According to whether the near vision of daily life is damaged, it is divided into daily near vision impairment group(24 cases)and no near vision impairment group(27 cases). General information of all patients were collected, and routine eye examination, subjective optometry and binocular eye movement parameter detection were detected.<p>RESULTS: In the survey, 27 patients(53%)with near vision impairment in naked eye and 24 patients(47%)with impaired near vision in daily life, and all patients had a significant improvement in visual acuity after correct optometry, and there was no one who has best corrected near visual acuity impairment. The age of patients with daily near vision impairment was significantly higher than that of patients without near vision impairment. The proportion of patients aged ≥45 years was significantly higher than that without near vision impairment(<i>P</i><0.01). NRA/PRA, vergence \〖BO(40cm)\〗, and amplitude of vergence(40cm)were significantly different between the two groups(<i>P</i><0.05).<p>CONCLUSION: Nearly half of patients with asthenopia would suffer NVI. The increase of age and imbalance between NRA and PRA as the predominant risk factors for its development.
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Purpose: The aim of this study is to identify common causes, associated ophthalmological abnormalities, and systemic comorbidities in children in Andhra Pradesh, India, with cerebral visual impairment (CVI). Methods: A retrospective review of case records of all children aged <16 years with diagnosis of CVI seen between January 2016 and December 2016 was carried out. Data were collected for their age, gender, cause of CVI, refraction, accommodation, anterior and posterior segment examination findings, and systemic problems. Results: A total of 124 patients were identified and studied (80 boys and 44 girls, mean age 5.23 years, 44.8% aged <2 years). The most common causes of CVI were hypoxic杋schemic encephalopathy (HIE) (34.4%), undetermined etiology (32.8%), neonatal seizures, and infantile spasms (16% each). The most common presenting complaints were poor vision (76%) and squint (11.2%). Profound visual impairment was seen in 88.8%, and 11.2% had high functioning CVI. Fifty-eight (46.4%) patients had significant refractive errors, 40 (32.25%) had strabismus, 4 (3.2%) had visually significant cataract, and 40 (32%) had optic atrophy. Motor delay was observed in 39.5%, speech delay was evident in 22.4%, and cognitive delay in 16%. Conclusion: HIE is the most common cause (one-third) of CVI in our population, and the majority of them presented at age <2 years (44.8%) with profound visual impairment (88.8%). A significant number of them have treatable ophthalmic conditions such as refractive errors (46.4%), accommodative insufficiency (12.1%), and cataract (3.2%), and more than one-third of them also have delay in other areas of development.
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PURPOSE: To compare the characteristics and surgical outcomes in patients with tenacious proximal fusion (TPF) and high accommodative convergence/accommodation ratio (AC/A) types of intermittent exotropia. METHODS: This study retrospectively enrolled 40 patients with intermittent exotropia, 23 with TPF and 17 with high AC/A. Binocular function was evaluated by Worth's 4-dot test. Patients underwent lateral rectus recession, and surgical outcomes were compared. Surgical success was defined as less than ±10 prism diopters (PD) at 12 months postoperatively. RESULTS: The proportion of diplopia at near, evaluated by Worth's 4-dot test, was significantly higher in patients with high AC/A than in those with TPF (35.3% vs. 4.3%, p = 0.029). The mean preoperative angles of deviation in TPF and high AC/A types were 28.3 ± 4.4 and 28.8 ± 4.5 PD at distances, and 14.7 ± 4.2 and 15.1 ± 4.1 PD at near. Twelve months after surgery, the mean angles of deviation in TPF and high AC/A types were 2.9 ± 9.8 and 1.2 ± 9.6 PD, respectively, at distance and 1.7 ± 7.7 and −1.3 ± 11.3 PD at near. The surgical success rates were similar in the TPF and high AC/A types (74.0% vs. 64.7%). Five (21.7%) patients with TPF and 2 (11.8%) with high AC/A type experienced recurrence, with consecutive esotropia occurring in 1 (4.3%) patient with TPF and 4 (23.5%) patients with high AC/A. CONCLUSIONS: The proportion of diplopia at near was higher in patients with high AC/A type than in those with TPF intermittent exotropia. However, the surgical success rates were not significantly different between the types.
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Humanos , Diplopía , Esotropía , Exotropía , Recurrencia , Estudios Retrospectivos , TelescopiosRESUMEN
PURPOSE: To report a case of acute angle closure after cataract surgery using an accommodative intraocular lens (IOL), WIOL-CF® (GELMED, Praha, Czech). CASE SUMMARY: A 46-year-old male patient underwent phacoemulsification and implantation of WIOL-CF® into the capsular bag. Seven months after the surgery, a sudden increase in intraocular pressure (IOP) associated with angle closure was observed. Ultrabiomicroscopy revealed a dislocated WIOL-CF® that was pushing the peripheral iris anteriorly. Despite the use of IOP-lowering medication and peripheral laser iridotomy, IOP was not controlled. After the use of cycloplegics, the angle was widened and IOP decreased; however, after nine days, the WIOL-CF® was completely dislocated into the anterior chamber and so was removed. CONCLUSIONS: When performing cataract surgery using WIOL-CF®, a possibility of dislocation of IOL and subsequent angle closure should be considered.
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Humanos , Masculino , Persona de Mediana Edad , Cámara Anterior , Catarata , Luxaciones Articulares , Glaucoma , Presión Intraocular , Iris , Lentes Intraoculares , Midriáticos , FacoemulsificaciónRESUMEN
PURPOSE: To find clinical factors related to the long-term outcome of binocularity in accommodative esotropia. METHODS: Forty-nine patients with accommodative esotropia who were followed over 5 years after successful optical alignment within 8 prism diopters of orthophoria at near and distance with glasses including bifocals were included. The patients who had stereo acuity better than 50 seconds/arc and central fusion without suppression scotoma at the final visit were divided into the bifoveal fusion group and the others were divided into the peripheral fusion group. Clinical factors were analyzed between the two groups (Chi-square test, student t-test). RESULTS: Of the 49 patients, 15 patients were included in the bifoveal fusion group and 34 patients were included in peripheral fusion group. Mean follow-up was 88.9 +/- 25.4 months. Clinical factors that were significantly related to the bifoveal fusion group were older age of onset, shorter duration of misalignment, intermittent esotropia at the initial visit and after initial optical correction, smaller residual deviations at distance after initial optical correction and at the final visit, and lesser amblyopia. CONCLUSIONS: To obtain better levels of long-term binocularity, optical correction should be done as early as possible, before the presence of constant eye misalignment or amblyopia, and the residual esodeviations after optical correction should be kept as small as possible.
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Humanos , Edad de Inicio , Ambliopía , Esotropía , Anteojos , Estudios de Seguimiento , Vidrio , Escotoma , TelescopiosRESUMEN
PURPOSE: To report clinical aspects of children diagnosed with refractive accommodative esotropia after wearing their first glasses to correct hyperopia accompanied with esodeviation. METHODS: The present study included 75 children followed up for at least 24 months. Age, spherical equivalent of refractive error, angle of deviation and presence of amblyopia were analyzed according to the duration between first wearing glasses and control of esotropia within 8 PD (2 months). RESULTS: The mean age was 4.48 +/- 2.08 years and mean follow-up was 50.17 months. Initial deviation angle without glasses was 25.43 +/- 10.07 PD at far, 27.72 +/- 11.45 PD at near, spherical equivalent was +4.86 +/- 2.41 D in right eyes, +5.05 +/- 1.06 D in left eyes and 8 of 75 patients (10.67%) had 2 months had less hyperopia (+4.02 D vs. 5.17 D), more severe esodeviation both at far (30.79 +/- 10.79 PD vs. 24.17 +/- 9.56 PD, p = 0.03) and at near distance (34.00 +/- 14.20 PD vs. 26.25 +/- 10.31 PD, p = 0.02) and higher initial amblyopia prevalence rates (71.5% vs. 47.5%). CONCLUSIONS: Several patients needed longer follow-up until esotropia was controlled within 8 PD after wearing hyperopic glasses considering the amount of hyperopia and angle of esodeviation.