Ophthalmologic Manifestations in Autism Spectrum Disorder.

Objectives: The purpose of this study was to describe the ophthalmologic manifestations found in patients with autism spectrum disorder (ASD) and to assess their prevalence in the different types of ASD. Materials and Methods: This prospective observational study included 344 patients with ASD seen over a period of 8.5 years. They were classified into four subgroups (autism, Asperger syndrome, pervasive developmental disorders not otherwise specified [PDD-NOS], and other). Data obtained from ophthalmological examinations were compared between the groups. Statistical analysis was performed with chi-square, Kruskal-Wallis, and Mann-Whitney tests. Results: Refractive defects were detected in 48.4% of the patients, with the most prevalent being hyperopia and astigmatism. There was a higher prevalence of myopia in Asperger syndrome. Evaluation of extraocular motility revealed the presence of strabismus in 15.4% of patients, with a statistically significantly higher prevalence in autism and the "other" disorders group. The most frequent type of strabismus was exotropia. Convergence was found to be normal in 43.6% of the patients. Nystagmus was observed in only 0.9% of patients. In the binocular sensory tests performed, patients with Asperger syndrome had significantly better results compared to the other groups. Optic nerve abnormalities were found in 4% of patients, with significantly higher prevalence in the "other" disorders group. Conclusion: Ophthalmologic manifestations occur more frequently in patients with ASD than in the general child population. Of these, the most frequent are refractive defects and ocular motility disorder. Therefore, we consider it necessary to perform an ophthalmological evaluation in patients with ASDs.

Long term outcomes of strabismus surgery for third nerve palsy.

PURPOSE: To report long-term outcomes of strabismus surgery for treatment of third nerve palsy. METHODS: We performed a 15-year retrospective study of patients who had undergone surgery. We analyzed preoperative mean deviation (at 6 months, 1 year after surgery, and at the end of follow-up), type of surgery, and factors predicting outcomes. A final deviation <10 prism diopters (pd) was considered a good esthetic outcome, and no diplopia in the primary position at the end of follow-up was considered a good functional outcome. RESULTS: Surgery was performed in 31 cases. Mean age was 36.27 years (women, 51.6%). Total and complete third nerve palsy was recorded in 22.6% and acquired palsy in 80.6%. Mean preoperative horizontal deviation (HD) in primary position was 40.24pd (near) and 44.29 (distance) and 14.33pd in vertical deviation (VD). Mean final HD was 8.94pd (near) and 11.35pd (distance), and mean final VD was 6.13. One surgery was performed in 68.9%. A favorable esthetic outcome was obtained in 64.5% and a successful functional outcome in 72.2%. Statistically significant differences were found between near HD (p=0.019) and distance HD (p=0.035) at 1 year compared with the end of follow-up and between VD at 6 months and 1 year after surgery (p=0.03). Mean follow-up was 6.05 years. No specific factors predicted a successful outcome. CONCLUSIONS: Esthetic and functional results were similar. No predictors of successful outcome were identified. HD was better 1 year after surgery, and VD improved during follow-up.

Atypical restrictive strabismus secondary to an anomalous orbital structure: differential diagnosis.

Anomalous orbital structures are very rare causes of restrictive strabismus. Of the 3 types described in the literature, one involves accessory muscle fibers that are innervated by the III and/or VI cranial nerves originating in the posterior orbit and inserting on the globe, optic nerve, or extraocular muscles. Although these structures do not cause specific symptoms that enable us to make a diagnosis, we must take them into account in patients with atypical restrictive strabismus. Computed tomography and, particularly, orbital magnetic resonance imaging are essential for correct diagnosis and treatment, as the only other way to diagnose this condition is through casual findings during surgery to correct strabismus. Our patient was a child who were initially diagnosed as Duane syndrome. Magnetic resonance imaging revealed an anomalous unilateral orbital structure that limited all ocular movements except adduction, and possibly contributed to globe retraction. Surgery for strabismus did not resolve the problem: the posterior location of the orbital structure rendered surgery impossible.

Conjunctival cysts as a complication after strabismus surgery.

PURPOSE: To identify possible factors associated with the development of a conjunctival cyst after surgery for strabismus. METHODS: A descriptive, longitudinal, and retrospective study was done including 12 cases from the past 20 years presenting a conjunctival cyst as a complication of strabismus surgery. Variables included age, sex, eye and muscle operated on, surgical technique used, surgeon, type of suture, and type of conjunctival incision. Fisher's exact test and Pearson chi-square test were used for statistical analysis. RESULTS: The incidence of conjunctival cysts was 0.25%. Although ultimately statistically significant differences in the variables studied could not be demonstrated (P > .05), a greater incidence in the development of this complication in young patients who underwent recession (58.3%) as the surgical technique was observed. CONCLUSION: Recession may be a risk factor in the development of a conjunctival cyst caused by the high frequency of dragging Tenon capsule during this surgical technique.

Intramuscular Bupivacaine Injection for the Treatment of Oculomotor Paresis.

The main goal of this study is to examine the effect of intramuscular bupivacaine in oculomotor paresis, analyzing whether it is possible to obtain a stronger muscle contraction due to the muscle hypertrophy caused by the drug. An injection of 4.5 mL of a 0.50% solution of bupivacaine was administered in the paretic muscle of three patients. Magnetic resonance imaging was performed before and 3 months after injection to compare muscle cross-sectional areas. The symptoms of two patients improved and an increase of muscle cross-sectional area was observed. However, it is necessary to be prudent when employing intramuscular bupivacaine in oculomotor paresis treatment until there are more and larger studies.