The influence of whole-body vibration, media, and artificial lighting on eye-movement during reading / A influência da vibração de corpo inteiro, da mídia e da iluminação artificial no movimento dos olhos durante tarefas de leitura

ABSTRACT Objective: To evaluate if participants, subjected to whole-body vibration, two different types of media (paper versus tablet) and two lighting environments (fluorescent versus LED), present a difference in eye-movement parameters during reading tasks. Methods: Fourteen adults silently read two different texts in each one of the eight randomized testing conditions (whole-body vibration versus media versus lighting), resulting in 16 different texts read per individual. Whole-body vibration was applied in the vertical direction, 5Hz and 0.8 m/s2 root-mean-square amplitude, a condition similar to those experienced by forklift truck drivers. Participants were in a sitting position with a backrest. An eye-tracker evaluated the eye-movements during the reading task. Results: Whole-body vibration significantly reduced the number of ocular fixations, and cross-correlation; and increased the reading efficiency, fixation duration, directional attack, and binocular anomalies. Neither the type of media nor the lighting environment interfered significantly with the eye-movements, both in situations with and without vibration. Conclusion: The results indicate that whole-body vibration interfered in the eye-movements during the reading task. This may impose a difficulty to process the visual information and to synchronously coordinate the binocular movements under vibration environments.

RESUMO Objetivo: Avaliar se participantes submetidos à vibração de corpo inteiro, a dois tipos diferentes de mídia (papel versus tablet) e a dois ambientes de iluminação (fluorescente versus LED) apresentam diferença nos parâmetros de movimento dos olhos durante tarefas de leitura. Métodos: Quatorze adultos leram silenciosamente dois textos diferentes em cada uma das oito condições de teste (vibração de corpo inteiro versus mídia versus iluminação), de forma aleatória, resultando em 16 textos diferentes lidos por indivíduo. A vibração de corpo inteiro foi aplicada no sentido vertical, com amplitude de 5Hz e 0,8m/s² da raiz do valor quadrático médio, em condição semelhante às vivenciadas pelos motoristas de empilhadeiras. Os participantes permaneceram em postura sentada com encosto. Um rastreador ocular avaliou os movimentos oculares durante a leitura. Resultados: A vibração de corpo inteiro reduziu significativamente o número de fixações oculares e a correlação cruzada entre os olhos e aumentou a eficiência de leitura, duração da fixação, ataque direcional e anomalias binoculares. Nem o tipo de mídia nem as condições de ambientes de iluminação interferiram significativamente nos movimentos oculares, tanto em situações com ou sem vibração. Conclusão: Os resultados indicam que a Vibração de Corpo Inteiro pode interferir nos movimentos oculares durante a leitura. Isso pode impor uma dificuldade no processamento da informação visual e na coordenação síncrona dos movimentos binoculares em ambientes de vibração.

Los movimientos oculares como medida de control ejecutivo en niños con trastorno por déficit de atención con hiperactividad / Eye movements as a measure of executive control in children with Attention Deficit Hyperactivity Disorder

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) está relacionado con dificultades a nivel de control ejecutivo. Nuevas formas de explorar este constructo contribuyen a la precisión diagnóstica, disminuir la prevalencia y la construcción de un consenso objetivo sobre los criterios del TDAH. El objetivo fue establecer las diferencias en el control ejecutivo de un grupo de niños con TDAH (N=22), con respecto al grupo control (N=15), de ambos géneros y de entre 7 y 12 años de edad, escolarizados de la ciudad de Medellín, Colombia. Se implementaron tres parámetros oculares: fijaciones, antisacadas y prosacadas, los cuales fueron registrados continuamente en un equipo de rastreo visual (Tobii T120). Los resultados indicaron un menor tiempo para el grupo con TDAH en fijaciones oculares (p<,001) que miden control de la interferencia. Un mayor número de errores de dirección en el parámetro antisacadas relacionados con el control inhibitorio. Respecto a las prosacadas, que miden la capacidad para iniciar una respuesta motora, no se encontraron diferencias significativas. Se concluyó que la población con TDAH presenta alteración en el control ejecutivo al utilizar el paradigma de rastreo ocular. Se propusieron, además, los movimientos oculares como posible marcador biológico para detectar una población en riesgo de padecer dicho trastorno.

Attention Deficit Hyperactivity Disorder (ADHD) is related to difficulties at the level of the executive control. New ways of exploring this construct contribute to diagnostic accuracy, decrease the prevalence and build an objective consensus on ADHD criteria. The aim of the study was to establish the differences in the executive control of a group of children with ADHD (N=22), with respect to the control group (N=15), of both genders and between 7 and 12 years old, attending school in the city of Medellin, Colombia. Three ocular parameters were implemented: fixings, antisaccade, and prosaccades, which were recorded continuously in a visual tracking equipment (Tobii T120). The results indicated a shorter time for the group with ADHD in ocular fixations (p<0.001) that measure interference control. A greater number of address errors in the antisaccade parameter related to inhibitory control. Regarding the prosaccades, which measure the capacity to initiate a motor response, no significant differences were found. It was concluded that the population with ADHD presents alteration in the executive control when using the eye tracking paradigm. Eye movements were also proposed as a possible biological marker to detect a population at risk of suffering from this disorder.

Eye Movement Characteristics of Cooperation Degree during Image Completion Test in Psychiatric Impairment Assessment / 法医学杂志

OBJECTIVES@#To explore the difference of eye movement characteristics between uncooperative and cooperative subjects with mental disorder after cerebral trauma.@*METHODS@#Thirty-nine subjects which needed psychiatric impairment assessment were selected. According to the binomial forced-choice digit memory test （BFDMT）, all subjects were divided into cooperative and uncooperative groups. The subjects were asked to take the image completion test from Wechsler adult intelligence scale. Meanwhile, the data of eye movement track, fixation, saccade, pupil and blink were recorded by the track system of eye movement.@*RESULTS@#There were significantly differences （P<0.05） in the data of saccade between cooperative （10 cases） and uncooperative groups （29 cases）. The frequency, time, amplitude, acceleration of saccadic in uncooperative group were significantly higher than cooperation group. The saccade latencies of cooperation group increased more than uncooperative group. There was a significant difference （P<0.05） in total discrete distance, average distance and total time of fixation between two groups, while the average duration time, number and frequency of fixation had no significantly difference （P>0.05） between two groups. And the blink frequency of cooperation group was higher than uncooperative group.@*CONCLUSIONS@#Eye movement can be an objective index for the primary judgment of cooperation level.

Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy

PURPOSE: To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO). METHODS: Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0). RESULTS: Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 +/- 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 +/- 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 +/- 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 +/- 0.8 to 3.8 +/- 0.5 mm postoperatively. CONCLUSIONS: The customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.

Comparison of Astigmatism Induced by Combined Inferior Oblique Anterior Transposition Procedure and Lateral Rectus Recession Alone

PURPOSE: The purpose of this study is to compare the magnitude and axis of astigmatism induced by a combined inferior oblique (IO) anterior transposition procedure with lateral rectus (LR) recession versus LR recession alone. METHODS: Forty-six patients were retrospectively analyzed. The subjects were divided into two groups: those having concurrent inferior oblique muscle overaction (IOOA) and intermittent exotropia (group 1, 20 patients) and those having only intermittent exotropia as a control (group 2, 26 patients). Group 1 underwent combined anterior transposition of IO with LR recession and group 2 underwent LR recession alone. Induced astigmatism was defined as the difference between preoperative and postoperative astigmatism using double-angle vector analysis. Cylinder power, axis of induced astigmatism, and spherical equivalent were analyzed at 1 week, 1 month, and 3 months after surgery. RESULTS: Larger changes in the axis of induced astigmatism were observed in group 1, with 4.5° incyclotorsion, than in group 2 at 1 week after surgery (axis, 84.5° vs. 91°; p < 0.001). However, there was no statistically significant inter-group difference thereafter. Relaxation and rapid regression in the incyclotorsion of induced astigmatism were observed over-time. Spherical equivalent significantly decreased postoperatively at 1 month in both groups, indicating a myopic shift (p = 0.011 for group 1 and p = 0.019 for group 2) but did not show significant differences at 3 months after surgery (p = 0.107 for group 1 and p = 0.760 for group 2). CONCLUSIONS: Combined IO anterior transposition procedures caused an increased change in the axis of induced astigmatism, including temporary incyclotorsion, during the first week after surgery. However, this significant difference was not maintained thereafter. Thus, combined IO surgery with LR recession does not seem to produce a sustained astigmatic change, which can be a potential risk factor of postoperative amblyopia or diplopia compared with LR recession alone.

Antielevation Syndrome after Bilateral Anterior Transposition of the Inferior Oblique Muscles

No abstract available.

Difference of Self-identity Levels between Strabismus Patients and Normal Controls

PURPOSE: To evaluate differences in self-identity in patients diagnosed with strabismus, patients who underwent strabismus surgery, and healthy control individuals. METHODS: Self-identity testing was done during a military service physical examination. There were three subject groups: subjects with strabismus (group 1), subjects who had undergone corrective strabismus surgery (group 2), and subjects free of strabismus (group 3). The self-identity test was comprised of six sub-sections (subjectivity, self-acceptance, future confidence, goal orientation, initiative, and familiarity). Statistical significance of the sub-sections was compared across the three groups. Correlations in age at the time of surgery and across the six sub-sections were investigated in group 2. RESULTS: A total of 351 subjects were enrolled in the study; 96 subjects were in group 1, 108 subjects were in group 2, and 147 subjects were in group 3. Significant differences were evident in subjectivity, self-acceptance, initiative and familiarity between groups 1 and 3. No significant differences were found between groups 2 and 3. In group 2, statistical significance was evident between age at surgery and initiative and familiarity (r = −0.333, p < 0.001; r = −0.433, p < 0.001, respectively). CONCLUSIONS: Self-identity is greater in non-strabismus subjects than strabismus subjects. Correction of strabismus may increase self-identity levels.

Primary inoculation tuberculosis: a report of a rare entity

Primary inoculation tuberculosis is an exogenous infection resulting from direct inoculation of bacteria into individuals with no acquired immunity to the organism. We report a 63-year-old male patient who was diagnosed with primary inoculation tuberculosis on the basis of clinical appearance and histopathological examination. The findings from this case emphasize the importance of clinical and histopathological findings in this rarely seen form of skin tuberculosis if the organism cannot be shown to grow in culture.

Comparative study of visual functions in premature pre-school children with and without retinopathy of prematurity / Estudo comparativo das funções visuais em pré-escolares nascidos prematuros com e sem retinopatia da prematuridade

Purpose: Observe whether there are differences in visual functions among premature infants with treated retinopathy of prematurity (ROP) in relation to preterm infants with ROP and spontaneous regression; and among these two groups with ROP and the control group without ROP. Methods: Crosssectional observational no blind study. Premature infants were born between 06/199206/2006 and were exam between 06/200912/2010; registered in data of Hospital de Olhos Sandalla Amin Ghanem; with gestational age less than or equal to 32 weeks and 1,599 g born weigh; without ROP and ROP stages II or III, in one of the eyes, with spontaneous regression or with treatment; at least three visits during the selection period at maximum 6 months in the first exam and minimum 4 years of age in reassessment (chronological age) were include. Premature that did not respond or were not located for reassessment and those that did not have conditions to do the exams were exclude. Study's groups: G1 ROP posttreatment; G2ROP postspontaneous regression; G3 without ROP (control). Visual function evaluated with visual acuity (VA), contrast sensitivity test (CST), color test (CT), eye movement, stereopsis. Results: Overall, there were 24 premature infants and 48 eyes. Normal VA: 64.28% (G1), 87.5% (G2) and 100% (G3); Normal CST: 66.67% (G1), 100% (G2) and 55.56% (G3); Normal Ishihara CT: 100% (G1 and G2) and 86% (G3); Normal Farnsworth CT: 20% (G1), 75% (G2) and 50% (G3). Normal stereoacuity: 0.00% (G1); 25% (G2) and 3.5% (G3). Strabismus: 37% (G2), 0.00% (G1 and G3). The prevalent tendency for lower response in CST and CT between the premature children in group G3 and Farnsworth color test in G1 is a curious result of this work and more study is necessary about these visual functions in older premature children. Conclusion: The visual functions showed no statistically significant difference among the groups studied. .

Objetivo: Observar se há diferença nas funções visuais entre os prematuros com retinopatia da prematuridade (ROP) pós-tratamento em relação aos prematuros com retinopatia da prematuridade pós-regressão espontânea. E entre cada um destes grupos com o controle sem ROP. Métodos: Estudo transversal, observacional, não cego. Incluídas crianças prematuras nascidas entre 06/1992-06/2006 e examinadas entre 06/2009 e 12/2010; idade gestacional menor ou igual a 32 semanas e peso ao nascimento menor ou igual a 1.599 g; cadastrados no banco de dados do Hospital de Olhos Sandalla Amin Ghanem; com diagnóstico de retinopatia estágio II ou III em pelo menos um dos olhos com regressão espontânea ou por tratamento da ROP e sem retinopatia da prematuridade; mínimo de três consultas no período de seleção; máximo de seis meses de idade cronológica para o primeiro exame no HOSAG; idade cronológica mínima de quatro anos no período da reavaliação. Foram excluídas crianças prematuras que não responderam ou não foram localizados para os exames de reavaliação; e que não ofereciam condições de realização dos exames, por apresentarem comprometimento severo do sistema nervoso central ou síndromes impeditivas. Os prematuros foram divididos em três grupos: G1- prematuros com ROP pós-tratamento; G2- com ROP pós-regressão espontânea; e G3- sem ROP. Função visual avaliada por meio da acuidade visual (AV), teste de sensibilidade ao contrate (TSC), teste de cores (TC), exame de motricidade ocular e estereopsia. Resultados: Foram examinados 24 prematuros (48 olhos). No grupo G1 formado por 7 prematuros; G2, 8 prematuros e G3, 9 prematuros. AV normal: 64,28% (G1), 87,5% (G2) e 100% (G3); TSC normal: 66,67% (G1), 100% (G2) e 55,56% ...

Postoperative Stabilization of the Strabismic Angle in Intermittent Exotropia

PURPOSE: To analyze the postoperative strabismic angle for five years or more and to investigate when the angle stabilized in intermittent exotropia. METHODS: We retrospectively reviewed the clinical records of 89 patients who had undergone surgery for intermittent exotropia. The postoperative strabismic angles measured were analyzed at one-year intervals up to five years postoperatively. We divided them into two groups according to their age at the time of surgery. Group 1 was less than 5 years of age, while Group 2 participants were 5 years of age or older. RESULTS: For our 89 total patients, average exo-angles were 7.8 +/- 7.26, 7.9 +/- 7.51, 9.5 +/- 7.05, 10.1 +/- 6.87, and 9.4 +/- 6.90 prism diopters at one, two, three, four, and five years postoperatively, respectively. Average exo-angles between postoperative year one and year three, as well as between postoperative year two and year three, were statistically significant (p = 0.015, 0.022). However, the angles were not statistically significant between postoperative year three and year four or between years three and five, respectively (p = 0.707, p = 0.948). The stabilization characteristics of the angle were somewhat different according to age group. In Group 1, the average exo-angle in postoperative years one and three were statistically significant (p = 0.016), but the angle in the same period was not statistically significant in Group 2 (p = 0.203). CONCLUSIONS: There was no significant interval change after three years postoperatively in intermittent exotropia, but if the patient's age at surgery was 5 years or higher, no significant change of exo-angle was found following postoperative year one in this study.

Factors Associated with the Direction of Ocular Deviation in Sensory Horizontal Strabismus and Unilateral Organic Ocular Problems

PURPOSE: To evaluate factors associated with the direction of horizontal deviation in the sensory strabismus of patients with unilateral organic amblyopia. METHODS: The medical charts of 53 patients who had been diagnosed with sensory strabismus between 2000 and 2009 were reviewed retrospectively. The underlying ocular disease, time of onset and the duration of vision impairment, refractive error and axial length of the fixing eye, and the direction and angle of deviation were analyzed to determine the distribution of underlying diseases and any factors relevant to determining the direction of the horizontal deviation. RESULTS: Congenital cataracts were the most common underlying disease, found in 33 patients, followed by acquired cataracts, optic nerve disorders, retinal detachment, glaucoma and lens subluxation. Among the 50 patients with horizontal strabismus, 11 had esotropia and 39 had exotropia. The incidence of esotropia was significantly higher when the fixing eye had hyperopia or emmetropia, than when the eye was myopic. Age of onset of vision deterioration and at diagnosis of sensory strabismus, and the axial length of the fixing eye had no relationship to the direction of horizontal deviation. In addition, the duration of visual impairment had no significant relationship with the direction or extent of horizontal deviation. CONCLUSIONS: The most common cause of sensory strabismus was congenital cataracts and the most frequent type of strabismus was exotropia. With respect to the direction of horizontal strabismus, esotropia occurred significantly more often when the refractive error of the fixing eye was hyperopia or emmetropia than when the fixing eye was myopic.

Prueba de impulso cefálico / Head impulse test

Introducción: Dentro del estudio de la función del equilibrio, la prueba de impulso cefálico representa una herramienta rápida, sencilla y de fácil interpretación, que explora la indemnidad del reflejo óculo-vestibular. Este examen ha cobrado relevancia reciente como complemento a la prueba calórica en diversos contextos y no ha sido explorado en nuestro país. Objetivo: Explorar sensibilidad y especificidad de esta prueba en nuestro contexto local, junto con contribuir a la difusión de una herramienta de creciente relevancia en otoneurología. Material y método: Estudio prospectivo, ciego, de evaluación de test diagnóstico. En una muestra de pacientes consultando por vértigo agudo se realizó prueba de impulso cefálico al momento de la consulta inicial, y al momento de realizar prueba funcional de VIII par. Resultados: Se evaluaron 52 pacientes, 44 por ciento de ellos con disfunción vestibular según prueba calórica clásica como patrón de oro. La sensibilidad de la prueba de impulso cefálico fue de 47,6 por ciento y su especificidad de 83,9 por ciento, con un valor predictivo positivo y negativo de 66,7 por ciento y 70,3 por ciento. El acuerdo del examen entre dos evaluadores independientes fue alto (Kappa = 0,84). Discusiones: A pesar de una baja sensibilidad por sí sola, la prueba de impulso cuenta con una alta especificidad y un valor predictivo positivo razonable. Es además altamente reproducible, realizable en menos de un minuto y no genera náuseas u otros síntomas en el paciente. Consideramos este examen como un complemento al estudio de la función vestibular, con implicaciones prácticas en el inicio precoz de terapia y con importantes potencialidades en diversos ámbitos de la otoneurología.

Introduction: In balance function evaluation, head impulse test is a fast, simple and easy to interpret test, which explores the vestibulo-ocular reflex. Having gained in the last decade growing importance as a complement to traditional caloric test, this test hasn't been explored in our context yet. Aim: To assess sensitivity and specificity of this test in our context, along with contributing to the spread of an increasingly important tool in otoneurology Material and method: A prospective, blinded, diagnostic test assessment. In a sample of patients consulting for acute vertigo, head impulse test was performed at the time of initial consultation, and at the time of VIII nerve functional testing. Results: We evaluated 52 patients, 44 percent with vestibular dysfunction as shown in caloric test results as gold standard. Sensitivity of the head impulse test was 47.6 percent, its specificity 83.9 percent, with positive and negative predictive value of 66.7 percent and 70.3 percent respectively. Agreement between two independent examiners was high (Kappa = 0.84). Discussion: Despite its low sensitivity, impulse test showed a high specificity and a reasonable positive predictive value. It was also highly reproductible, and generates no nausea or other symptoms in the patient. We consider this test as a complement to vestibular function evaluation, with clinical applicationssupportingearly onset of therapy. We believe this test to withhold significant potential in various otoneurological developing applications.

Comparison of Outcomes of Unilateral Lateral Rectus Recession for Exotropia between First and Second Operations

PURPOSE: To compare the outcomes of unilateral lateral rectus recession between the first operation and second operation for exotropia. METHODS: Thirty-two patients who underwent unilateral lateral rectus recession for exotropia of 15 to 20 prism diopters (PD) were investigated. The follow-up period was at least 6 months. We classified 17 patients without a surgical history for exotropia (first operation group) and 15 patients with a previous procedure (second operation group). Surgical success was defined as an exodeviation or esodeviation of less than 10 PD at the primary position. Postoperative deviation angles and success rates were compared between the two groups. RESULTS: There were no significant differences in the age, gender, visual acuity (logarithm of the minimal angle of resolution), preoperative deviation, and amount of recession between the two groups. Postoperative deviations were -1.7 +/- 5.5:1.3 +/- 5.1 PD at one day, 4.3 +/- 3.8:5.6 +/- 5.1 PD at 1 month, 4.3 +/- 4.3:3.0 +/- 8.1 PD at 3 months, and 5.0 +/- 4.3:4.5 +/- 7.2 PD at 6 months post-operation, and there was no statistically significant difference between the two study groups. Surgical success rate were 95.2:100% at one day, 95.2:92.9% at 1 month, 90.5:85.7% at 3 months, and 90.0:92.9% a 6 months post-operation. CONCLUSIONS: In patients with exotropia of 15 to 20 PD, no significant difference was found in terms of the postoperative deviation angle and the surgical success rate between the first operation and the second operation groups. Unilateral lateral rectus recession can lead to similar results in 15 to 20 PD exotropia for the first operation or recurrent exotropia.

Comparison of Outcomes of Unilateral Lateral Rectus Recession for Exotropia between First and Second Operations

PURPOSE: To compare the outcomes of unilateral lateral rectus recession between the first operation and second operation for exotropia. METHODS: Thirty-two patients who underwent unilateral lateral rectus recession for exotropia of 15 to 20 prism diopters (PD) were investigated. The follow-up period was at least 6 months. We classified 17 patients without a surgical history for exotropia (first operation group) and 15 patients with a previous procedure (second operation group). Surgical success was defined as an exodeviation or esodeviation of less than 10 PD at the primary position. Postoperative deviation angles and success rates were compared between the two groups. RESULTS: There were no significant differences in the age, gender, visual acuity (logarithm of the minimal angle of resolution), preoperative deviation, and amount of recession between the two groups. Postoperative deviations were -1.7 +/- 5.5:1.3 +/- 5.1 PD at one day, 4.3 +/- 3.8:5.6 +/- 5.1 PD at 1 month, 4.3 +/- 4.3:3.0 +/- 8.1 PD at 3 months, and 5.0 +/- 4.3:4.5 +/- 7.2 PD at 6 months post-operation, and there was no statistically significant difference between the two study groups. Surgical success rate were 95.2:100% at one day, 95.2:92.9% at 1 month, 90.5:85.7% at 3 months, and 90.0:92.9% a 6 months post-operation. CONCLUSIONS: In patients with exotropia of 15 to 20 PD, no significant difference was found in terms of the postoperative deviation angle and the surgical success rate between the first operation and the second operation groups. Unilateral lateral rectus recession can lead to similar results in 15 to 20 PD exotropia for the first operation or recurrent exotropia.

Analysis of the Effects of Medial Rectus Muscle Resection for Recurrent Exotropia

PURPOSE: The purpose of this paper is to investigate how much correction is obtained per millimeter of medial rectus (MR) resection for recurrent exotropia after bilateral lateral rectus (BLR) recession, and to determine the difference in the effects between unilateral and bilateral resection, and the influence of previous lateral rectus (LR) recession on the effects of MR resection. METHODS: A total of 59 patients who had undergone MR resection after BLR recession were included in this study. The unilateral group consisted of 38 patients and bilateral group, 21 patients. Thirty patients in the unilateral group were divided into two groups: patients who had undergone previous LR recession of 7 mm or greater (21 patients) and less than 7 mm (9 patients). Main outcome measures were average deviation corrected per millimeter of MR resection at 1 month postoperative. RESULTS: The average effect of MR resection was 4.2 prism diopters (PD, 2.0 to 6.7 PD)/mm. The average effect in the unilateral group was 4.2 PD/mm and 4.1 PD/mm in the bilateral group. There was no significant difference between groups (P = 0.60). The average effect in the recession 7 mm or greater group was 4.0 PD/mm, and the average effect in the recession less than 7 mm group was 4.2 PD/mm (P = 0.698). CONCLUSIONS: The effect of MR resection per millimeter was variable. The laterality and previous amount of LR recession did not influence the effect of MR resection. These variable outcomes dictate that caution be exercised when MR resection is performed for recurrent exotropia.

Analysis of the Effects of Medial Rectus Muscle Resection for Recurrent Exotropia

PURPOSE: The purpose of this paper is to investigate how much correction is obtained per millimeter of medial rectus (MR) resection for recurrent exotropia after bilateral lateral rectus (BLR) recession, and to determine the difference in the effects between unilateral and bilateral resection, and the influence of previous lateral rectus (LR) recession on the effects of MR resection. METHODS: A total of 59 patients who had undergone MR resection after BLR recession were included in this study. The unilateral group consisted of 38 patients and bilateral group, 21 patients. Thirty patients in the unilateral group were divided into two groups: patients who had undergone previous LR recession of 7 mm or greater (21 patients) and less than 7 mm (9 patients). Main outcome measures were average deviation corrected per millimeter of MR resection at 1 month postoperative. RESULTS: The average effect of MR resection was 4.2 prism diopters (PD, 2.0 to 6.7 PD)/mm. The average effect in the unilateral group was 4.2 PD/mm and 4.1 PD/mm in the bilateral group. There was no significant difference between groups (P = 0.60). The average effect in the recession 7 mm or greater group was 4.0 PD/mm, and the average effect in the recession less than 7 mm group was 4.2 PD/mm (P = 0.698). CONCLUSIONS: The effect of MR resection per millimeter was variable. The laterality and previous amount of LR recession did not influence the effect of MR resection. These variable outcomes dictate that caution be exercised when MR resection is performed for recurrent exotropia.

Wildervanck syndrome associated with cleft palate and short stature.

We report a case of Wildervanck syndrome exhibiting Klippel-Feil anomaly, Duane retraction syndrome and deafness. Since the first case was reported in 1952, there have been more reports describing this triad, either complete or incomplete. Our patient had the complete triad of the syndrome along with cleft palate and short stature. Also, a review of the literature regarding this syndrome is presented here.

Posicionamento palpebral superior e inferior em diferentes graus de rotação ocular ao longo do meridiano vertical / Upper and lower eyelid position in different degrees of downgaze and upgaze

OBJETIVO: Quantificar a relação entre o posicionamento do olho e das pálpebras, em diferentes posições do olhar, ao longo do meridiano vertical, em indivíduos normais. MÉTODOS: Foi quantificada a posição das pálpebras superior e inferior e do olho, de dez indivíduos normais, por meio do processamento da imagem da fenda palpebral usando o programa NIH Image. Foram medidas as distâncias margem-centro pupilar superior e inferior em sete posições do olhar ao longo do meridiano vertical, ou seja -30, -20, -10, 0, +10, +20 e +30 graus (sinais: negativos infraducção e positivos supraducção). RESULTADOS: Em relação à distância margem superior-centro da pupila, nota-se que o maior valor é obtido na posição primária do olhar, ou seja, tanto quando se olha para cima, como para baixo, essa distância diminui. A redução na distância margem superior-centro da pupila é um pouco maior no olhar para cima. Em relação à distância margem inferior-centro da pupila, nota-se que o valor é maior no olhar para cima e menor no olhar para baixo, em relação à posição primária do olhar. No que tange à fenda palpebral, pode-se notar que no olhar para cima a fenda aumenta até 20 graus de rotação ocular. No olhar para baixo, ela diminui. CONCLUSÃO: Os dados do presente trabalho mostram que a altura da fenda palpebral varia de acordo com a amplitude da mirada vertical e que considerações sobre o valor da magnitude da distância entre a margem palpebral e o centro da pupila devem levar em conta o grau de rotação ocular vertical.

PURPOSE: To quantify the relation between eye and eyelids placement in different positions during downgaze and upgaze in healthy subjects. METHODS: The position of the eye and eyelids of 10 healthy individuals was quantified by palpebral fissure image processing with NIH Image software. Upper and lower mid-pupil margin distance was measured in 7 positions: -30, -20, -10, 0, +10, +20 and +30 degrees (positive signs correspond to upgaze and negative signs to downgaze) along vertical meridian. RESULTS: The upper mid-pupil margin distance decreases in upgaze and even more in downgaze. The lower mid-pupil margin distance increases in upgaze and decreases in downgaze. About the palpebral fissure height, it gets larger in upgaze until 20 degrees and smaller in downgaze. CONCLUSION: Our data showed that the interpalpebral fissure height varies with vertical meridian gaze amplitude and that considerations about mid-pupil margin distance must consider the amount of upgaze or downgaze.

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.

Estrabismos: da teoria à prática, dos conceitos às suas operacionalizações / Strabismus: from theory to practice, from concepts to its operational attainment

Analisam-se particularidades inerentes ao estudo dos estrabismos, tais como as dificuldades para suas definições e os diferentes modos com os quais eles podem ser concebidos, a relatividade com que as posições binoculares possam ser interpretadas e os elementos referenciais necessários para a circunscrição dessas questões. A partir daí, discute-se o conceito de posição primária do olhar e as condições de sua operacionalização, concluindo-se pela impossibilidade de concretização desse ponto "zero", a partir do qual seriam feitas as medidas dos estrabismos e as quantificações de movimentos oculares. A seguir, passa-se ao exame da construção dos múltiplos sistemas referenciais aplicáveis à quantificação dos estrabismos, de cuja falta de consenso sobre qual deles usar decorrem implicações práticas elementares, como a falta de padronização do modo de superposição ortogonal de prismas, para a medida de desvios combinados, horizontal e vertical. Comenta-se a assimetria funcional das rotações oculares e suas exceções. Também se analisa a precisão com que se pode fazer a medida de um estrabismo, levando à conclusão sobre a impropriedade de uso de medidas fracionárias com as unidades angulares mais comumente usadas. Finalmente, são comentados alguns problemas técnicos dessas avaliações, tais como o das dificuldades operacionais relacionadas à dioptria-prismática, os subordinados ao uso de prismas e os da ocorrência de efeitos prismáticos pelo uso de lentes convencionais.

Some particular points concerning the study of strabismus are analyzed, specially, the difficulties for definitions and the different ways it can be conceived, besides the relativity of binocular positions interpretation, and the necessary referential elements for circumscribing such questions. Then, the concept of primary position of gaze is discussed as well as the conditions for its operational attainment, leading to the conclusion that it is materially impossible to achieve this "zero" point, from which all other measurements of strabismus or ocular movements should be done. In sequence, the construction of multiple referential systems applying the quantification of strabismus are examined. The lack of consensual agreement about which should be used as the standard system causes elementary practical implications, as the lack of agreement about how to superimpose orthogonal prisms for the measurement of associated horizontal and vertical deviations. The functional asymmetry of ocular rotations and its exceptions are commented. The accuracy that the measurements of strabismus can be performed is analyzed, leading to the conclusion that fractional figures using the commonest angular unities are improper. At last, some technical problems related to such evaluations are also commented, as operational difficulties related to prism-diopter unity, concerning the use of prisms, and prismatic effects due to the use of conventional optical glasses.