Smartphone as a tool for evaluating oblique muscle dysfunction / Uso do smartphone como ferramenta para avaliar disfunções de músculos oblíquos

ABSTRACT Purpose: The aim of this study was to describe a simple, accessible, and reliable method using a smartphone for evaluating oblique muscle dysfunctions. Methods: The photograph rotation tool in the iPhone PHOTO app was used by 75 examiners to evaluate 22 photographs from only 9 patients, captured in infra- and supra-dextroversion, and infra- and supra-levoversion, as not all the patients were photographed in the 4 positions mentioned. Each patient received a score for the superior and inferior oblique muscle functions, ranging from -4 (hypofunction) to 4 (hyperfunction) or 0 (normal function), using preediting and postediting photographs. These values were compared with the scores previously given by trained personnel in strabismus screening. The difference in score between the two groups was expressed in natural (whole and non-negative) numbers. The mean and pattern deviation were then calculated. Results: The scores of most of the edited photos showed a lower mean than those of the unedited ones, except for a patient with left superior oblique hyperfunction. The patients with no oblique dysfunction and those with right superior oblique hyperfunction demonstrated (after editing the photograph) scores with greater similarity with their initial scores (p<0.05 and p<0.01, respectively). Similar results were found in the patients with oblique hypofunctions and right inferior oblique hyperfunction (p<0.01). Conclusion: The proposed method for assessing muscular function in vertical strabismus is reproducible, accessible, simple, and reliable, and provides better consistency to the admeasurement.

RESUMO Objetivo: Descrição de um método simples, acessível e confiável para a medida das disfunções dos músculos oblíquos, utilizando-se smartphone. Métodos: Foi utilizado o recurso de rotação de fotografias do aplicativo FOTOS do iPhone®; 75 examinadores avaliaram 22 fotos de 9 pacientes, obtidas em infra e supra dextroversão, infra e supra levoversão (nem todos os pacientes foram fotografados nas 4 posições citadas). Conferiu-se aos pacientes uma pontuação para a função do músculo oblíquo superior e músculo oblíquo inferior, que variou de -4 (negativo para hipofunção) a +4 (positivo para hiperfunção), ou 0 (normofuncionantes), antes e depois da edição das fotografias. Esses valores foram comparados à avaliação prévia atribuída pelos assistentes do estrabismo. Computou-se a diferença da pontuação entre eles em números naturais (inteiros e não negativos); foram calculadas média e desvio padrão dessas medidas. Resultado: A medida da maioria das fotos editadas apresentou média inferior as não editadas, à exceção de um paciente com hiperfunção de oblíquo superior esquerdo. Pacientes sem disfunção de oblíquos demonstraram, após edição das fotos, maior similaridade com o valor inicialmente determinado (p<0,05), assim como os pacientes com oblíquo superior direito hiperfuncionantes (p<0,01). Os mesmos resultados são encontrados nos pacientes com hipofunção dos oblíquos e hiperfunção de oblíquo inferior direito (p<0,01). Conclusão: O método utilizado para medida das funções musculares nos estrabismos verticais é reprodutível, acessível, simples, confiável, e confere maior uniformidade à aferição.

Smartphone as a tool for evaluating oblique muscle dysfunction.

PURPOSE: The aim of this study was to describe a simple, accessible, and reliable method using a smartphone for evaluating oblique muscle dysfunctions. METHODS: The photograph rotation tool in the iPhone PHOTO app was used by 75 examiners to evaluate 22 photographs from only 9 patients, captured in infra- and supra-dextroversion, and infra- and supra-levoversion, as not all the patients were photographed in the 4 positions mentioned. Each patient received a score for the superior and inferior oblique muscle functions, ranging from -4 (hypofunction) to 4 (hyperfunction) or 0 (normal function), using preediting and postediting photographs. These values were compared with the scores previously given by trained personnel in strabismus screening. The difference in score between the two groups was expressed in natural (whole and non-negative) numbers. The mean and pattern deviation were then calculated. RESULTS: The scores of most of the edited photos showed a lower mean than those of the unedited ones, except for a patient with left superior oblique hyperfunction. The patients with no oblique dysfunction and those with right superior oblique hyperfunction demonstrated (after editing the photograph) scores with greater similarity with their initial scores (p<0.05 and p<0.01, respectively). Similar results were found in the patients with oblique hypofunctions and right inferior oblique hyperfunction (p<0.01). CONCLUSION: The proposed method for assessing muscular function in vertical strabismus is reproducible, accessible, simple, and reliable, and provides better consistency to the admeasurement.

Medical monitoring of patient with cavernous hemangioma of the retina and intracranial involvement.

PURPOSE: To describe a case report of Cavernous Hemangioma of the Retina (CHR) and highlight the importance of investigating intracranial system when retinal vascular alterations are present. OBSERVATIONS: Patient of 26 years old, with right eye fundus alteration since 7 years old, no visual complaint. In the exam, there were sacular lesions with hematic content in the macula, configurating liquid level, associated with whitish lesion suggestive of fibrosis, compatible with cavernous hemangioma; best visual accuity of 20/20 both eyes. Comparing the current retinography with the previous one, there was no significant lesion progression of the exam. By neuroimaging investigation, the Magnetic Ressonance Imaging showed multiple cavernomas. As his sister had been diagnosed with cerebral cavernous malformation 3 years before, due to termic hiposensitivity on left leg investigation, familial multiple cavernous malformation syndrome was defined. CONCLUSION: Imaging investigation of the Central Nervous System should be considered when CHR is observed. Clinical monitoring is necessary, interventional treatment is selected only for particular cases.