Visión binocular en pacientes operados de esotropía congénita con cuatro años de evolución / Binocular vision in patients operated of congenital esotropia with four years of follow-up

Objetivo: describir los resultados quirúrgicos y la obtención de fusión y estereopsia en operados de esotropía congénita, después de cuatro años de seguimiento y su relación con el ángulo de desviación preoperatorio y la edad al momento de la primera cirugía. Métodos: estudio descriptivo, longitudinal y prospectivo de una serie de casos, operados de esotropía congénita desde el año 2007 al 2010, seguidos durante cuatro años por consulta en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se analizaron las variables edad al diagnóstico, ángulo de desviación preoperatorio y posoperatorio, edad al momento de la primera cirugía, presencia de fusión, estereopsia y desarrollo de ambliopía. Resultados: el ángulo de desviación preoperatorio promedio de los pacientes estudiados fue de 39,8 dioptrías y la media de la edad al momento de la primera cirugía fue 22,5 meses (DE 9,2). La media de supervivencia del alineamiento ocular fue de 39,3 meses, y fue superior en los pacientes con un ángulo de desviación preoperatorio menor de 40 dioptrías y con menos de 24 meses de edad al momento de la primera cirugía (p= 0,001). Presentaban fusión y estereopsia a los 4 años el 57,7 y el 26,9 por ciento de los pacientes. La media del número de cirugía fue de 1,42 (DE ± 0,504) a los 4 años. La causa más frecuente de segunda cirugía fue la hiperfunción del oblicuo inferior (19,2 por ciento). Conclusiones: la presencia de fusión y de estereopsia a los 4 años de evolución es mayor en aquellos pacientes con menor ángulo de desviación preoperatoria y con menos de 2 años de edad a la primera cirugía(AU)

Factores de riesgo que influyen en la no obtención de visión binocular en operados de esotropía congénita / Risk factors present in failed binocular vision of patients operated on from congenital esotropia

Objetivo: determinar los factores de riesgos que influyen en la no obtención de visión binocular en los pacientes operados de esotropía congénita. Métodos: estudio de serie de casos en pacientes operados de esotropía congénita en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido de enero de 2007 a mayo de 2010. Se analizaron las variables siguientes: fusión, estereopsis, edad quirúrgica, estabilidad del alineamiento ocular, número de cirugías, ambliopía y defecto refractivo.Resultados: el 57,7 por ciento de los pacientes alcanzó fusión y el 30,8 por ciento logró estereopsia, en un rango de 3 000 a 400 segundos de arco. Los niños operados tuvieron después de los 18 meses un riesgo cinco veces mayor de no desarrollar fusión y cuatro veces mayor de no desarrollar estereopsis que los operados antes de esa edad. Los pacientes que perdieron el alineamiento ocular tuvieron al año de la cirugía casi tres veces mayor probabilidad de no alcanzar fusión que aquellos que mantuvieron la ortotropía. La probabilidad de no desarrollar estereopsis fue casi dos veces mayor en los niños ambliopes. Conclusiones: la cirugía temprana resulta importante para mejorar los resultados funcionales visuales en los operados de esotropía congénita. La pérdida del paralelismo ocular y la ambliopía estuvieron asociadas al no desarrollo de fusión y estereopsis

Objective: to determine the risk factors that have an impact on failing to achieve binocular vision in patients operated on from congenital esotropia. Methods: a case-series study conducted in patients operated on from congenital esotropia at the Pediatric Ophthalmology service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2007 through May 2010. The following variables were analyzed: fusion, stereopsis, stability of the ocular alignment, surgical age, number of surgeries, amblyopia, and refractive defect. Results: in this group, 57.7 percent of the patients reached fusion and 30.8 percent achieved stereopsis, in a range of 3000 to 400 arc seconds. The risk of not developing fusion and the risk of not developing stereopsis in operated children aged over 18 months were 5 times higher and 4 times higher, respectively, than in children operated on before that surgical age. Those patients who lose the ocular alignment after one year of surgery were 3 times more likely to fail to achieve fusion than those who kept orthotopia. The probabilities of not developing stereopsis were almost twice greater in amblyopic children. Conclusions: the early surgery is important to improve the visual functional results in those operated on from congenital esotropia. The loss of ocular parallelism and amblyopia were associated to unsuccessful development of fusion and stereopsis

Clinical Manifestations and Oculomotor Abnormalities in Congenital Esotropia

Congenital esotropia, which shows various clinical signs and oculomotor abnormalities is a manifest inward deviation with onset between birth and 6 months of age.Author prospectively evaluated the frequency of clinical signs and oculomotor abnormalities in 18 patients [male:10, female:8]with congenital esotropia. Age distribution of patients is ranging 7 months to 16 years of age.Onset between 2 and 4 months of age were reported in 11[61%]out of 18 patients.Thirteen patients had predominant eye, and 4 patients showed cross fixation.Five out of 18 patients showed normal visual acuity, 4 patients showed decreased visual acuity of both eyes and 9 patients showed amblyopia in one eye.Head turning or tilting was found in 13 patients[72%]. Inferior oblique overaction more than 2 at least in one eye and dissociated vertical deviation were found in 9[50%] and 7 patients[39%]respectively.The frequency of oculomotor abnormalities, pursuit asymmetry and latent fixation nystagmus was 83%[15 out of 18 patients]and 72%[13 out of 18 patients]respectively, and both of pursuit asymmetry and latent fixation nystagmus were observed in 12 patients[67%]. High frequency of oculomotor abnormalities in congenital esotropia suggest an importance of not only examination of clinical symptoms but also examination of oculomotor abnormalities.

A Case of Oculomotor Abnormalities in Congenital Esotropia

Eye alignment is related with binocular connection in the visual cortex during critical period between postnatal 3 and 5 months. Authers examined horizontal pursuit and latent fixation nystagmus using electronystagmogram(ENG)in 6 year old female patient, who was diagnosed a congenital esotropia showing V patten esodeviation, both inferior oblique overaction, dissociated vertical deviation and head turn. In the pursuit examination, symmetric pursuit was observed under binocular viewing. However asymmetric pursuit was observed with smooth pursuit toward temporo-nasal direction and irregular saccade toward naso-temporal direction under monocular viewing. We could observe jerky nystagmus with decelerating velocity under monocular viewig, direction of which was toward fixating eye and degree of which was increased in abduction and decreased in adduction. The direction of pursuit asymmetry and nystagmus were instantaneously reversed when changing occluding eye. The results of ENG were not changed after successful strabismus surgery. We report a typical case of congenital esotropia as one of oculomotor disorders showing asymmetric pursuit and latent fixation nystagmus, which findings were proved by ENG.

Seven-Millimeter Bilateral Recessions of the Medial Rectus Muscles for Congenital Esotropia

We studied the success rate of bilateral 7mm medical rectus recession for 24 patients with large angle congenital esotropia through long-term follow-up. The success rate was 100%(24/24) at immediate postoperative period, 83.3%(20/24) at postoperative 6 months, 79.1%(19/24) at postoperative 1 year, 64.1%(9/14) at postoperative 18 months and 54.5% (6/11) at postoperative 2 years. Residual esotropia rate was 0%(0/24) at immediate postoperative period, 16.6%(4/24) at postoperative 6 months, 16..6%(4/24) at postoperative 1 year, 14.2%(2/14) at postoperative 18 months and 18.1%(2/11) at postoperative 2 years. Consecutive exotropia rate was 0%(0/24) at immediate postoperative period, 0%(0/24) at postoperative 6 months, 4.1 %(1/24) at postoperative 1 year, 21.4%(3/14) at postoperative 18 months and 27.2%(3/11) at postoperative 2 years. Residual esotropia may develop before 6 months and consecutive exotropia after 1 year postoperatively.

Clinical Analysis of Congenital Esotropia I

Congenital esotopia is a constant esodeviation with a documented onset within the first six months of life, stably large angle and normal central nervous system. We examined 24 congenital esotropic patients with brain CT, electroencephalogram and the general developmental status. The rates of abnormal findings on brain CT were 8.3% and on electroencephalogram it were 33.3%. Four cases(l6.7%) of mild developmental delay and 2 cases(8.3%) of severe developmental delay were found pediatric consultation.

Clinical Analysis of Congenital Esotropia I

Congenital esotopia is a constant esodeviation with a documented onset within the first six months of life, stably large angle and normal central nervous system. We examined 24 congenital esotropic patients with brain CT, electroencephalogram and the general developmental status. The rates of abnormal findings on brain CT were 8.3% and on electroencephalogram it were 33.3%. Four cases(l6.7%) of mild developmental delay and 2 cases(8.3%) of severe developmental delay were found pediatric consultation.