Posterior keratoconus and iris atrophy: a fortuitous association? / Ceratocone posterior e atrofia de iris: uma associação incidental?

ABSTRACT The authors describe an unusual association between posterior keratoconus and iris atrophy, confirmed by a complete ocular evaluation, scheimpflug imaging and pachymetric curve. A hypothesis for concomitant findings is discussed.

RESUMO Os autores descrevem a rara associação entre ceratocone posterior e atrofia de íris, confirmada por avaliação oftalmológica completa, imagens de scheimpflug e curva paquimétrica. Sugere-se uma hipótese que explique a concomitância de ambas as alterações.

Cirurgia monocular para esotropias de grande ângulo: um novo paradigma / Monocular surgery for large-angle esotropias: a new paradigm

OBJETIVO: Demonstrar a viabilidade da cirurgia monocular no tratamento das esotropias de grande ângulo, praticando-se amplos recuos do reto medial (6 a 10 mm) e grandes ressecções do reto lateral (8 a 10 mm). MÉTODOS: Foram operados, com anestesia geral e sem reajustes per ou pósoperatórios, 46 pacientes com esotropias de 50δ ou mais, relativamente comitantes. Os métodos utilizados para refratometria, medida da acuidade visual e do ângulo de desvio, foram os, tradicionalmente, utilizados em estrabologia. No pós-operatório, além das medidas na posição primária do olhar, foi feita uma avaliação da motilidade do olho operado, em adução e em abdução. RESULTADOS: Foram considerados quatro grupos de estudo, correspondendo a quatro períodos de tempo: uma semana, seis meses, dois anos e quatro a sete anos. Os resultados para o ângulo de desvio pós-cirúrgico foram compatíveis com os da literatura em geral e mantiveram-se estáveis ao longo do tempo. A motilidade do olho operado apresentou pequena limitação em adução e nenhuma em abdução, contrariando o encontrado na literatura estrabológica. Comparando os resultados de adultos com os de crianças e de amblíopes com não amblíopes, não foram encontradas diferenças estatisticamente significativas entre eles. CONCLUSÃO:Em face dos resultados encontrados, entende-se ser possível afirmar que a cirurgia monocular de recuo-ressecção pode ser considerada opção viável para o tratamento das esotropias de grande ângulo, tanto para adultos quanto para crianças, bem como para amblíopes e não amblíopes.

PURPOSE: To demonstrate the feasibility of monocular surgery in the treatment of large-angle esotropias through large recessions of the medial rectus (6 to 10 mm) and large resections of the lateral rectus (8 to 10 mm). METHODS: 46 patients were submitted to surgery. They had esotropias of 50Δor more that were relatively comitant. The patients were operated under general anesthesia and received no adjustable sutures. The methods used for refractometry, measurement of visual acuity and angle of deviation were those traditionally used in strabismology. Postoperatively, measurements in primary position (and side gaze) were carried out, along with assessments of limitations to adduction or abduction of the operated eye. RESULTS: Four groups comprised the study according to four periods of time: one week, six months, two years and four to seven years. The results for the postoperative angle of deviation were compatible with those reported in the literature, and remained stable in the folllowup. The motility of the operated eye presented a slight limitation in adduction and no limitation in abduction, contradicting the findings presented in the strabologic literature. No statistically significant differences were detected in the comparison between adults and children, neither regarding amblyopes and non-amblyopes. CONCLUSION: Monocular recession-resection surgery seems to be a valid option in the treatment of large-angle esotropias, both for adults and children, as well as for amblyopes and non-amblyopes.

Thicknesses of the Fovea and Retinal Nerve Fiber Layer in Amblyopic and Normal Eyes in Children

PURPOSE: This study was designed to assess and compare the thicknesses of the fovea and the retinal nerve fiber layer in normal children and children with amblyopia. METHODS: Optical Coherence Tomography (OCT) was performed on 26 children (52 eyes total) with unilateral amblyopia that was due to anisometropia or strabismus. OCT was also performed on 42 normal children (84 eyes), for a total of 136 eyes. Retinal thickness measurements were taken from the fovea, and the retinal nerve fiber layer thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. RESULTS: The average age of the normal children was 8.5 years, and the average age of the children with amblyopia was 8.0 years. The average thickness of the fovea was 157.4 micrometer in normal eyes and was 158.8 micrometer in amblyopic eyes. The difference between the two groups was not statistically significant (p=0.551). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the normal children and the children with amblyopia were also not statistically significant (p=0.751, 0.228, 0.696 and 0.228, respectively). However, for the children with anisometropic amblyopia and the children with strabismic amblyopia, the average thicknesses of the fovea were 146.5 micrometer and 173.1 micrometer, respectively, and the retinal nerve fiber layer thicknesses were measured to be 112.9 micrometer and 92.8 micrometer, respectively, and these were statistically significant differences (p=0.046, 0.034, respectively). CONCLUSIONS: Normal thicknesses of the fovea and the retinal nerve fiber layers were established, and there were no differences in the fovea and the retinal nerve fiber layer thickness found between normal children and children with amblyopia.

La ambliopia. Su incidencia / Amblyopia: its occurrence

Se estudian 1.025 casos de la consulta de oftalmología del Centro Médico del IVSS La Victoria, en edades comprendidas entre 6 meses y 14 años, tomando como criterio de ambliopía una A.V. corregida de 20/30 y como parámetros de estudio: A.V., bionicroscopia, motilidad ocular, fondo de ojo, etc. El porcentaje de ambliopía encontrado fue de 10 por ciento en la población estudiada. Se hace énfasis que en una sociedad desarrollada la ambliopía funcional debe ser reducida al mínimo, pues, un diagnóstico precoz significa profilaxis de un daño que con el tiempo se torna irreparable