Estrías angioides y tumor hipofisario: ¿asociación o hallazgo incidental? / Angioid streaks and pituitary tumor: ¿association or incidental finding?

Las estrias angioides de la retina se aprecian como líneas dentelladas rosadas u oscuras radiando irregularmente en todas direcciones desde el área peripapilar hacia la periferia de la retina. Corresponden a roturas del componente elástico de la membrana de Bruch. Su presencia indica una enfermedad sistémica siendo las más importantes el pseudoxantoma elástico, la enfermedad de Paget ósea y la drepanocitosis, Los tumores hipofisiarios raramente se han asociado a está condición existiendo apenas tres descriptores en la literatura. A estas adicionamos tres pacientes más, no obstante, aun no puede asegurarse si se trata de una asociación o de un simple hallazgo incidental.

Retinal angioid streaks can be seen as rough lines pink or dark, irregularly radiating in all directions from the peripapilar area to the periphery of the retina. They correspond of breaks in the elastic component of the Bruch membrane. Its presence indicates a systemic disease being the most important pseudoxanthoma elasticum, bone Paget's disease and sickle cell disease. Pituitary tumors have rarely been associated with this condition and exist just three descriptions in the literature. To these we add three more patients, however, still not be tightened if it's an association or a simple incidental finding.

Botulinum toxin in the management of acquired motor fusion deficiency.

Acquired disruption of motor fusion is a rare condition characterized by intractable diplopia. Management of these patients is extremely difficult. Prisms in any combination or even surgery may not help relieve their symptoms. We describe a longstanding case of acquired motor fusion disruption which was managed successfully with botulinum toxin injection.

Visual control in children with developmental dyslexia / Controle visual em crianças com dislexia do desenvolvimento

PURPOSE: To assess binocular control in children with dyslexia. METHODS: Cross-sectional study with 26 children who were submitted to a set of ophthalmologic and visual tests. RESULTS: In the dyslexic children less eye movement control in voluntary convergence and unstable binocular fixation was observed. CONCLUSION: The results support the hypothesis that developmental dyslexia might present deficits which involve the magnocellular pathway and a part of the posterior cortical attentional network.

OBJETIVO: Avaliar o controle binocular em crianças com dislexia. MÉTODOS: Estudo transversal do qual participaram 26 crianças, nas quais foram aplicadas uma série de exames oftalmológicos e visuais. RESULTADOS: Nas crianças com dislexia observou-se controle menor na convergência voluntária e na estabilidade da fixação binocular. CONCLUSÃO: Os resultados apóiam a hipótese de que na dislexia do desenvolvimento podem ocorrer déficits que envolvem a via visual magnocelular e uma parte da rede cortical posterior da atenção.

Diamond burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions / Ceratectomia superficial com broca de diamante no tratamento de lesões anteriores da córnea

PURPOSE: To evaluate the efficacy and safety of diamond burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions. METHODS: A retrospective review of 23 eyes (23 patients). Pre- and postoperative visual acuities and refractions, slit-lamp biomicroscopic findings, and the incidence of recurrence of disease after keratectomy were studied. RESULTS: Nineteen eyes had map-dot-fingerprint basement membrane dystrophy and 4 had Salzmann's nodular degeneration. All patients presented with decreased vision, as well as varying degrees of glare, halos, and monocular diplopia. Postoperative follow-up ranged from 3 to 39 months (mean 10.6 months), and no recurrence of the original disease occurred within this period. This procedure improved the best-corrected visual acuity from 20/36 (LogMar 0.250) to 20/24 (LogMar 0.076) by LogMar statistical evaluation (p<0.001) and caused a statistically non-significant (p=0.232) myopic change in the mean refractive spherical equivalent (-0.36 diopter ± SD 2.28 preoperatively to -0.71 ± 2.26 postoperatively). Glare and monocular diplopia were subjectively reduced or eliminated in all patients. One patient had mild anterior stromal haze which decreased the bestcorrected visual acuity from 20/25 to 20/30. CONCLUSION: Diamond burr superficial keratectomy appears to be an effective and safe method of removing visually-significant anterior corneal opacities.

OBJETIVO: Avaliar a eficácia e segurança da ceratectomia superficial com broca de diamante no tratamento das lesões anteriores da córnea. MÉTODOS: Foi realizado estudo retrospectivo de 23 olhos de 23 pacientes. Foram avaliados acuidade visual e refração pré e pós-operatório, biomicroscopia e incidência de recorrência da doença após ceratectomia. RESULTADOS: Dos 23 olhos avaliados, 19 olhos apresentavam distrofia da membrana basal (map-dot-fingerprint) e 4 degeneração nodular de Salzmann. Todos os pacientes apresentavam diminuição da acuidade visual, assim como graus variados de ofuscamento, halos e diplopia monocular. O seguimento pós-operatório variou entre 3 e 39 meses (média de 10,6 meses) e não houve recorrência da doença original nesse período. O procedimento melhorou a acuidade visual com melhor correção de 20/36 (LogMar 0,250) para 20/24 (LogMar 0,076) com p<0,001. Em relação as mudanças refracionais não houve significância (p=0,232) sendo o equivalente esférico pré-operatório de - 0,36 ± 2,28DE e pós-operatório de -0,71 ± 2,26DE. As queixas de ofuscamento e diplopia monocular diminuíram ou foram eliminadas em todos os pacientes. Apenas 1 paciente apresentou nubécula no estroma anterior com diminuição da acuidade visual com melhor correção de 20/25 para 20/30. CONCLUSÃO: Ceratectomia superficial com broca de diamante parece ser método efetivo e seguro para remover opacidades anteriores de córnea.

Anterior Transposition of Inferior Oblique Muscle for Treatment of Unilateral Superior Oblique Muscle Palsy with Inferior Oblique Muscle Overaction

Although many weakening procedures for the inferior oblique muscle have been advocated, there is some controversy as to the most beneficial procedure for weakening overacting inferior oblique muscles. This study was undertaken to determine if unilateral anterior transposition of the inferior oblique muscle alone could be a safe and effective procedure for treating unilateral superior oblique palsy from the perspective of hypertropia, inferior oblique overaction, and abnormal head posture. The records of 33 patients, who underwent anterior transposition of the inferior oblique muscle for unilateral superior oblique palsy at our institution between Jan 1995 and Dec 2002, were retrospectively reviewed. The average preoperative inferior oblique overaction was 2.3 +/-0.64, and the hypertropia in the primary position was 12.3 +/-7.69 prism diopter (PD). Twenty-six patients showed head tilt to the opposite direction preoperatively. After the anterior transposition of the inferior oblique, inferior oblique overaction was diminished in 32 patients (97%). Twenty-six out of 33 patients (79%) had no hypertropia in the primary position at last postoperative assessment. Of the 26 patients with head tilt before surgery, 21 patients (81%) achieved full correction after surgery. Satisfactory results were obtained in most of the patients in our study with the exception of three patients who required additional surgery. No patient demonstrated postoperative hypotropia in the primary position. None of the patients noticed elevation deficiency or lower lid elevation. The anterior transposition of the inferior oblique was found to be safe and effective for treating superior oblique palsy with secondary overaction of the inferior oblique muscle.

Prevalencia de alteraciones en el campo visual de pacientes con migraña / Prevalence of alterations in the visual field in patients with migraine

El objetivo de nuestro estudio es conocer la prevalencia de alteraciones en el campo visual de pacientes con migraña, determinar si la pérdida del campo visual es transitoria o permanente y evaluar la existencia de una correlación anatómica que explique la alteración del campo visual en esta entidad. Se evaluaron 35 pacientes con migraña y un grupo control de 35 pacientes con cefalea tensional. En el primer grupo se encontraron tres pacientes (8.5 por ciento) con alteraciones campimétricas, uno de ellos portador de migraña con aura y dos con aura prolongada. Las alteraciones campimétricas observadas fueron bicuadrantanopsia inferior derecha, hemianopsia binasal y reducción concéntrica. En el grupo control no se encontraron alteraciones campimétricas (p-0.24). Los tres pacientes con alteraciones campimétricas mostraron zonas de isquemia en la región occipital en la tomografía axial computarizada. Los resultados muestran que la frecuencia de presentación de alteraciones campimétricas entre los grupos no tuvo significancia estadística. Sin embargo, cabe hacer notar que aproximadamente uno de cada diez pacientes con migraña pueden presentar alteraciones campimétricas. Las alteraciones campimétricas se correlacionaron con zonas de isquemia en la región occipital. En los pacientes con migraña es recomendable realizar la evaluación del campo visual, particularmente en aquellos pacientes que han experimentado fenómenos visuales.