Shorter epilepsy duration is associated with better seizure outcome in temporal lobe epilepsy surgery / Curta duração de epilepsia está associada à melhor controle de crises na cirurgia de epilepsia do lobo temporal

Objective To investigate the influence of patient’s age and seizure onset on surgical outcome of temporal lobe epilepsy (TLE). Method A retrospective observational investigation performed from a cohort of patients from 2000 to 2012. Results A total of 229 patients were included. One-hundred and eleven of 179 patients (62%) were classified as Engel I in the group with < 50 years old, whereas 33 of 50 (66%) in the group with ≥ 50 years old group (p = 0.82). From those Engel I, 88 (61%) reported epilepsy duration inferior to 10 years and 56 (39%) superior to 10 years (p < 0.01). From the total of patients not seizure free, 36 (42%) reported epilepsy duration inferior to 10 years and 49 (58%) superior to 10 years (p < 0.01). Conclusion Patients with shorter duration of epilepsy before surgery had better postoperative seizure control than patients with longer duration of seizures. .

Objetivo Investigar a influência da idade no momento da cirurgia e duração das crises no resultado cirúrgico da epilepsia do lobo temporal (ELT). Método Estudo observacional retrospectivo de uma coorte de pacientes de 2000 a 2012. Resultados Um total de 229 pacientes foram incluídos. Cento e onze de 179 pacientes (62%) foram classificados como Engel I no grupo com < 50 anos de idade, ao passo que 33 de 50 (66%) no grupo com ≥ 50 anos grupo de idade (p = 0,82). Daqueles Engel I, 88 (61%) relataram a duração da epilepsia inferior a 10 anos e 56 (39%) superiores a 10 anos (p < 0,01). Do total de pacientes não sem crises, 36 (42%) relataram a duração da epilepsia inferior a 10 anos e 49 (58%) superior a 10 anos (p < 0,01). Conclusão Pacientes com menor duração da epilepsia antes da cirurgia tem melhor controle das crises pós-operatório. .

What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?

PURPOSE: To analyze pre- and post-operative factors associated with favorable long-term sensory outcome after surgical correction for infantile esotropia. METHODS: This study retrospectively examined 40 patients with infantile esotropia who underwent surgery from January 2000 to December 2010. Clinical characteristics analyzed included age at onset, age at surgery, mean preoperative deviation, amblyopia on initial visit, other associated strabismus (Inferior oblique overaction (IOOA), dissociated vertical deviation (DVD), latent nystagmus), initial and subsequent postoperative motor alignment at 1-week and 2-year follow-up, recurrence rate, and stereopsis. Long-term sensory outcome was categorized as favorable (400 arcsec). RESULTS: The mean follow-up period was 92.53 +/- 46.46 months. There were 19 patients (47.5%) in the favorable group and 21 (52.5%) in the unfavorable group. There were no statistically significant differences between the groups with respect to age at onset or surgery, presence of amblyopia, and prevalence of IOOA and DVD, latent nystagmus, or initial postoperative alignment at 1-week. There was a tendency towards worse binocularity with larger preoperative angles of esodeviation, but it was not significant. Binocularity was significantly higher among those who had surgery at age 24 months. Orthotropic alignment within +/-10 PD at 2-year follow-up was 68.4% in the favorable group and 38.1% in the unfavorable group. Reoperation was performed on 8 patients (38.1%) in the unfavorable group and no patients (0.0%) in the favorable group. CONCLUSIONS: Surgical correction of infantile esotropia within the first 2 years of life and maintenance of orthotropic alignment within +/-10 PD without additional surgery with a minimum follow-up of 2 years may be associated with favorable long-term sensory outcome in infantile esotropia.

Clinical Features and Surgical Outcomes of Infantile Esotropia According to the Age at Surgery

PURPOSE: To evaluate the clinical features, surgical outcome and factors influencing the surgical outcome of infantile esotropia according to the age at surgery. METHODS: Seventy patients with infantile esotropia followed for at least 6 months after surgery, were enrolled in a retrospective study. Patients were divided into 2 groups. Group 1 included 25 patients who underwent surgery before the age of 24 months and group 2 included 45 patients who underwent surgery after 24 months of age. The clinical characteristics including age at the initial visit, refractive error, angle of deviation, associated strabismus, success rate and reoperation rate were analyzed according to the age at surgery. RESULTS: The mean angle of esodeviation before surgery was 41.71PD and refractive error was +1.26D. Patients underwent bimedial rectus recessions at the mean age of 67.33 months. The age at the initial visit was significantly older in group 2. Surgical success is defined as the ocular alignment within +/-10PD in primary position at the last visit. Fourteen patients (56%) from group 1 and 29 (64.4%) from group 2 obtained surgical success. Reoperation was performed in 8 patients (32%) from group 1 and 8 (17.8%) from group 2, which was not statistically significantly different. Stereopsis better than 3,000 seconds of arc was obtained in 3 patients (50%) from group 1 and 16 (76.2%) from group 2. CONCLUSIONS: In group 2, the late-surgery group, the success rate was 64.4% and stereopsis was obtained in 76.2%. Surgical results were not different between the two groups.

Clinical Features and Surgical Outcomes of Infantile Esotropia According to the Age at Surgery

PURPOSE: To evaluate the clinical features, surgical outcome and factors influencing the surgical outcome of infantile esotropia according to the age at surgery. METHODS: Seventy patients with infantile esotropia followed for at least 6 months after surgery, were enrolled in a retrospective study. Patients were divided into 2 groups. Group 1 included 25 patients who underwent surgery before the age of 24 months and group 2 included 45 patients who underwent surgery after 24 months of age. The clinical characteristics including age at the initial visit, refractive error, angle of deviation, associated strabismus, success rate and reoperation rate were analyzed according to the age at surgery. RESULTS: The mean angle of esodeviation before surgery was 41.71PD and refractive error was +1.26D. Patients underwent bimedial rectus recessions at the mean age of 67.33 months. The age at the initial visit was significantly older in group 2. Surgical success is defined as the ocular alignment within +/-10PD in primary position at the last visit. Fourteen patients (56%) from group 1 and 29 (64.4%) from group 2 obtained surgical success. Reoperation was performed in 8 patients (32%) from group 1 and 8 (17.8%) from group 2, which was not statistically significantly different. Stereopsis better than 3,000 seconds of arc was obtained in 3 patients (50%) from group 1 and 16 (76.2%) from group 2. CONCLUSIONS: In group 2, the late-surgery group, the success rate was 64.4% and stereopsis was obtained in 76.2%. Surgical results were not different between the two groups.

Clinical Analysis of Seventeen Korean Families of Hereditary Congenital Cataract

To elucidate genetic traits, clinical findings and treatment outcomes in Korean families with hereditary congenital cataract, 24 patients(17 families)were retrospectively analysed. Genetic trait was analysed by family pedigree. Chief complaints, ages at diagnosis, bilaterality, types of lens opacity, associated systemic or ocular anomalies were examined. The final best-corrected visual acuity was compared among groups according to the presence of surgery or the age at diagnosis. Among 17 families, 15 belonged to an autosomal dominant trait and two an autosomal recessive trait. Bilateral cataracts were shown in all patients. Twelve(50.0%)out of 24 patients who had cataracts were diagnosed before 3 months of age. Five(29.4%)out of 17 patients who received surgery were done before 3 months of age. Final best-corrected visual acuity was not different between surgery group before 3 months of age and that of after 3 months of age. Associated ocular anomalies were microphthalmia(4 patients), nystagmus(4 patients), and esotropia(3 patients), but no systemic anomalies were found. These results show that most Korean families with hereditary congenital cataract have an autosomal dominant genetic trait and the age at diagnosis or surgery is too late to treat them properly.

Evaluation of Factors Influencing Stereoacuity in Exodeviation

The purpose of this study was to evaluate factors influencing stereoacuity in exodeviation. We examined the visual acuity, refractive error, angle of exodeviation, fusional status with the Worth-4-dot test, and stereoacuity with the Titmus test preoperatively in 139 exodeviated patients who had undergone operation from August 1994 to February 1997. We evaluated the association of stereoacuity to the following factors with chi-square test: sex, age at surgery, visual acuity, type and degree of refractive error, associated hypertropia, angle of exodeviation, and fusional status.The stereoacuity was normal-under 100 second of arc, when age at surgery was under 8 years, when visual acuity was 0.6 or better, when abgle of exodeviation was under 40 prowm and when fusion was intact at near only or both(p<0.05). There was no statistical significance between sex, type or degree of refractive error, associated hypertropia, and stereoacuity.Of these, age at surgery and fusional status were found to be independent factors influencing stereoacuity with discriminant analysis test. In conclusion, in aspect of perserving normal stereoacuity, age atsurgery and fusional status are important factors in the surgical criteria of exotropia.