Changes in lateral ocular movement after two muscle exotropia surgery / 中华实验眼科杂志

Objective This study was to identify the surgical procedures associated with changes of lateral eye movement to help inform surgical planning for patients with concomitant exotropia.Methods The medical records of 87 concomitant exotropia surgical procedures that were performed at Henan Eye Hospital from June 2014 to August 2015 were retrospectively reviewed.The deviation angle was measured by prism and alternate cover test.Photographs and arc campimeter was used to obtain changes of abduction and lateral monocular fixation field respectively.Data were compared preoperatively and postoperatively among five groups based on the surgical procedures.The surgical procedures were 0 mm for control group (61 eyes),8 mm unilateral rectus recession for lateral rectus recession (LR) group (27 eyes),5-6 mm recession/4-5 mm resection for small amount recess-resect (R-R) group (24 eyes),7-8 mm recession/5-6 mm resection for medium amount R-R group (29 eyes) and 8-10 mm recession/7-8 mm resection for large amount R-R group (33 eyes).The minimum follow-up period was 6 months.Informed consent was signed from each patient or the guardian.Results The success,overcorrection and undercorrection rate was 81.61％,5.56％ and 12.64％,respectively.Mean preoperative abduction of each group was (11.86± 1.11)mm in the control group,(12.04±0.68)mm in the LR group,(11.58 ± 1.06)mm in the small amount R-R group,(11.86±0.93)mm in the medium amount R-R group and (12.22±0.60)mm in the large amount R-R group.The postoperative mean abduction of each group was (11.81±1.03),(11.81 ±0.70),(10.78±1.05),(10.54±1.07) and (9.90±0.82)mm,respectively.Mean abduction among the five groups was not significantly different preoperatively (F =1.85,P =0.12),while it was significantly different postoperatively (F =28.04,P =0.00).The abduction between control group and small amount R-R group was not significantly different postoperatively (P =0.99),but the abduction of control group was significantly greater than that of all the R-R groups (all at P=0.00).Mean lateral monocular fixation field of each group preoperatively was (50.82 ± 3.30) ° in control group,(51.48 ±2.39)° in LR group,(50.13±3.51)° in small amount R-R group,(51.06±2.90)° in medium amount R-R group and (52.09±2.61)° in large amount R-R group.The postoperative mean lateral monocular fixation field of each group was (50.52 ± 3.51)°,(50.11 ± 2.36)°,(46.38 ± 3.67)°,(44.00 ± 3.00)°,(41.84 ±2.46)°,respectively.Preoperative lateral monocular fixation field among the five groups was not significantly different (F =1.75,P =0.14),while postoperative difference was significant (F =55.75,P =0.00).Lateral monocular fixation field between control group and LR group was not significantly different postoperatively (P=0.57),but the mean lateral monocular fixation field of control group was significantly greater than that of all the R-R groups (all at P =0.00).Conclusions The successful alignment rate of unilateral recess/resect procedure is satisfying,but it can also create abduction deficit especially in large surgical amounts eye.Patients with binocular vision will be sensitive to diplopia in side gaze;in such cases,the consequences of recess/resect procedure should be considered particularly to avoid decrease of the binocular single vision field.

Clinical Observation on Acupuncture Combined with Western Medicine in Treating Acquired Paralytic Strabismus / 中医杂志

Objective To observe clinical curative effect of acupuncture combined with western medicine in treating acquired paralytic strabismus.Methods Randomly divided 60 patients with acquired paralytic strabismus into a treatment group and a control group,with 30 cases in each group.The control group accepted compound anisodine injection for subcutaneous injection beside superficial temporal artery and oral administration of neurotrophic drugs.The treatment group accepted acupuncture treatment in addition to the treatment of the control group.Both groups were treated for 4 weeks.Before and after treatment,measured the ocular symptom scores,including eye position deviation,eyeball movement obstacle,diplopia,the first squint angle being greater than the second,compensatory head posture and evaluated the clinical curative effect.Results The clinical curative rate in the treatment group was 40.0％ and the total effective rate was 93.4％,which in the control group were 10.0％ and 66.7％ respectively.The total effective rate and curative rate in the treatment group were significantly higher than those in the control group (P＜ 0.05).After treatment,the improvement in the total ocular symptom score and diplopia,deviation of eye position,eyeball movement disorder scores were superior to those in the control group (P ＜ 0.05).Conclusion Acupuncture combined with western medicine was superior to simple western medicine in treating acquired paralytic strabismus,and could significantly improve the eye symptom.

Range of Eye Movement in a Normal Population and Its Relationship to Age

PURPOSE: The purpose of this study is to measure the range of normal eye movement and to evaluate the effect of age on the range of ocular movement in a normal population. METHODS: We conducted a prospective observational study of 85 subjects aged between 5 and 91 years. Photographs were taken of the cardinal position, and these images were analyzed using an image analysis software (Adobe Photoshop 6.0, Adobe, San Jose, CA, USA). To measure the range of eye movement, the preprocessed images were analyzed using the Image J program. The range of movement of the eyeball was quantitatively measured using corneal limbal analysis. Specifically, the ranges of ocular movement according to adduction, abduction, elevation, and depression were measured. RESULTS: The normal movement ranges were 44.4 ± 6.9° in adduction, 44.8 ± 5.5° in abduction, 27.7 ± 7.6° in elevation, and 46.7 ± 8.4° in depression. Adduction, abduction, and elevation were negatively correlated with age (R² = 0.220, R² = 0.126, and R² = 0.304, respectively, all p < 0.001). However, there was no significant correlation between age and depression (R² = 0.030, p = 0.113). CONCLUSIONS: For all ages, the range of normal ocular movement in the horizontal direction was symmetric, while the range of ocular movement in elevation was smaller than that of depression. As age increased, the range of ocular movement decreased in all directions except depression, but depression did not decrease with age. When assessing eye movement, it is necessary to consider the range of ocular movements relative to both the movement direction and changes in the ocular movement range according to age.

Caracterización de colaboradores cubanos con dengue en el municipio venezolano de Bolívar / Clinical and epidemiological characterization of Cuban collaborators with dengue in the Venezuelan municipality of Bolívar

Se realizó un estudio descriptivo y retrospectivo de 18 colaboradores cubanos diagnosticados con dengue en el municipio venezolano de Bolívar, desde mayo del 2008 hasta igual periodo del 2011, con vistas a caracterizarles según variables clinicoepidemiológicas de interés, entre las cuales figuraron: edad, sexo y síntomas clínicos. Para el procesamiento y análisis de los resultados se utilizó el paquete estadístico Epi Info (versión 6.04). En la serie predominaron el grupo etario de 42-52 años (38,9 %), el sexo masculino (66,7 %); en tanto, la fiebre (100,0 %), el dolor retroorbitario, los movimientos oculares (83,3 %), y las artralgias con mialgias (77,8 %) fueron los síntomas clínicos más frecuentes. La evolución favorable en la mayoría de los pacientes puso de manifiesto la necesidad de un control epidemiológico de esta afección para disminuir su incidencia entre los colaboradores cubanos en el exterior.

A descriptive and retrospective study of 18 Cuban collaborators diagnosed with dengue in the Venezuelan municipality of Bolívar was carried out from May, 2008 to the same period of 2011, with the aim of characterizing them according to clinical and epidemiological variables of interest, among which there were: age, sex and clinical symptoms. For the prosessing and analysis of the results, the statistical package Epi Info was used (version 6.04). In the series the age group 42-52 years (38.9%), the male sex (66.7%) prevailed; while fever (100,0%), the retroorbitary pain, the ocular movements (83.3%) and the artralgias with myalgia (77.8%) were the most frequent clinical symptoms. The favorable clinical course in most of the patients showed the necessity of an epidemiological control of this disorder to decrease its incidence among the Cuban collaborators abroad.

Analysis of the structure and function of the extraocular muscle connective tissue in rabbit / 中华实验眼科杂志

Background The extraocular muscles (EOMs) Pulley in primate is related to the function of EOMs,but there are arguments about that.The location of rabbit's eyes is different from the primate.Study on the structure of the extraocular muscle connective tissue in rabbit may play a role to analyze the function of the EOMs Pulley.Objective The structure of the connective tissue around EOMs in rabbit was studied,the difference between this structure in rabbit and homan' s EOMs Pulley in past reports was analyzed,and then,the role of EOMs Pulley to ocular movement was investigated.Methods Five adult rabbits were involved.The gross anatomy of an orbit in each rabbit was observed.The other orbit was processed with paraffin imbedding and coronal serial sections.A murine monocolonal antibody to α-smooth muscle actin(α-SMA) was used to show the smooth muscle,while Weigert stain was used to show muscle and collagen,and Masson trichrome stain to show the elastin.Results An encircling ring of collagen circled every EOM.The collagen ring was thin and connected to the orbital layer muscle fiber loosely.Collagen tissues coupled to adjacent EOMs.Less elastin fibers and scanty the smooth muscle cells were embedded in the collagen.Conclusions The connective tissue around rectus in rabbit is different from that in human with developed binocular ocular movements.It shows that connective tissue around EOMs may be related to the function of ocular movements.

Study on the connective tissue around extraocular muscle in cat / 中华实验眼科杂志

Background The extraocular muscles (EOMs) Pulley is considered as the functional origins of the recti EOMs,it is determinants of ocular motility.Objective The structure of the connective tissue around EOMs in cat was studied,and the role of EOMs Pulley to ocular movement was investigated.Methods Five adult cats were involved.The gross anatomy of an orbit in each cat was observed.The other orbit was processed with paraffin imbedding and coronal serial sections.A murine monocolonal antibody to α-smooth muscle actin (α-SMA) was used to show smooth muscle,while Masson trichrome stain was used to show muscle and collagen,and Weigert stain to show elastin.Results An encircling ring of collagen circled EOM was thin and connected to the orbital layer of muscle fiber loosely.Less elastin fibers and little smooth muscle cells were embedded in the collagen ring and connective band.Collagen ring around medial rectus and the connective band between medial rectus and inferior rectus was not more significantly developed than other bands.Conclusions The connective tissue around EOMs in cat may be related to its function of ocular movement,which is not developed.

Normal Abduction in a Patient with Duplicated Abducens Nerve

PURPOSE: To our knowledge, there has been no report of ophthalmologic findings related with a duplicated abducens nerve in the ophthalmic literature. This study reports such findings. METHODS: An ophthalmologic examination was performed in one patient with a duplicated abducens nerve, revealed with thin-sectioned magnetic resonance imaging (MRI) across the brainstem level. RESULTS: The MRI disclosed a duplicated left abducens nerve. The patient was orthotropic in five cardinal positions, and her ductions and versions were full. CONCLUSIONS: One patient with a duplicated abducens nerve showed orthotropia and normal ocular movement.

The Amounts of Horizontal Ocular Movement in Korean People and Comparison According to Methods of Measurement

PURPOSE: To estimate and standardize horizontal ocular movement of normal Korean people and, to adapt correlations among three Methods for clinical approach. METHODS: This study investigated the amounts of horizontal ocular movement in normal Korean people whose age was ranged from 20 to 79 (50 persons in each age decades) by the lateral version light reflex Method, the limbus test of motility and the imaginary vertical line Method, and compared relationships among the amounts measured with above three Methods by Spearman correlation coefficient. The study subjects were three hundred people who visited Dept. of Ophthalmology at Gyeongsang National University Hospital, whose best corrected visual acuity was no less than 20/50 Snellen visual acuity chart, who had no history of ophthalmic operation and diseases, whose age was ranged from 20 years to 79 years (50 persons in each age decades). RESULTS: In imaginary vertical line Method, the excessive ocular movements were more frequent in younger people than in elder people. With age the proportion of the excessive ocular movement was gradually decreased and that of the normal ocular movement was increased until 6th decades. With other two Methods, the amounts of horizontal ocular movement was higher in younger ages than in elder ages and they decreased with aging. There were significantly moderate correlation (rs = - 0.54 to - 0.64) between age and ocular movement, and high correlation (rs = 0.79 to 0.86) among ocular amounts measured with imaginary vertical line Method, the lateral version light reflex test, and the limbus test of motility of Kestenbaum. CONCLUSIONS: This study suggests that any Method of three is reliable clinically.

A Case of Leigh's Disease Accompanied by Limitation of Bilateral Ocular Movement

PURPOSE: Leigh's disease is a mainly autosomal recessive inherited progressive disorder, with onset in the first 2 years of life, and has ocular signs such as nystagmus, gaze palsy, nuclear ophthalmoplegia and various neurologic signs. This disease finally results in death due to respiratory difficulty after repeated fever, dehydration, poor oral intake, lethargy, and convulsion. Leigh's disease is one of central nervous diseases considered in case infants or children who have paralytic esotropia or rapidly progressive limitation of ocular movement. METHODS: Authors experienced a case of 35-month-old male who had had 15 of right esotrophia and limitation of ocular movement in abduction for 1 month. At first visit, we diagnosed as a right 6th nerve palsy. However, the patient showed rapidly progressive limitation of ocular movement in all direction except in adduction and esotropia in both eyes. RESULTS: The patient presented ocular signs earlier than other neurologic symptoms and signs. He was consulted to the department of pediatric neurology and radiology, and diagnosed as Leigh's disease.