Management of strabismus related to infantile glaucoma: Case series.

OBJECTIVE: To evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results. METHODS: The clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied. RESULTS: Four patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs. CONCLUSION: Strabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed.

Manejo del estrabismo asociado al glaucoma de la infancia: serie de casos / Management of strabismus related to infantile glaucoma: Case series

Objetivo Evaluar las diferentes estrategias de tratamiento del estrabismo, sus complicaciones y resultados quirúrgicos en pacientes con glaucoma de la infancia. Métodos Se analizaron las historias clínicas de 7 pacientes con glaucoma de la infancia que requirieron tratamiento quirúrgico de estrabismo. Se analizaron las variables edad en el momento de la cirugía de estrabismo, tipo de glaucoma, cirugías de glaucoma, tipo de estrabismo, su tratamiento y resultados posquirúrgicos. Resultados De los 7 pacientes incluidos en nuestro estudio, 4 fueron sometidos a cirugía de estrabismo, 2 recibieron tratamiento con toxina botulínica y uno requirió ambas técnicas. Un 71,42% de los pacientes tenía glaucoma congénito primario, un 14,28% una disgenesia de segmento anterior y un 14,28% glaucoma secundario. Fueron intervenidas 4 exotropías y 3 endotropías. La principal dificultad fue el manejo de la conjuntiva y las ampollas filtrantes. Conclusiones El estrabismo constituye una complicación frecuente asociada al glaucoma de la infancia. La estrategia de tratamiento del estrabismo en estos pacientes debe ser individualizada. En nuestra serie, el tratamiento del estrabismo mejoró el alineamiento ocular. La cirugía debe considerarse de elección, teniendo en cuenta la importancia de proteger la conjuntiva y no interferir en las cirugías de glaucoma. La toxina botulínica es una opción útil en niños cuando se requieren tratamientos conservadores (AU)

Objective To evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results. Methods The clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied. Results Four patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs. Conclusion Strabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed (AU)

Quality of life and visual function in children with glaucoma in Spain. / Estudio de la calidad de vida y la función visual en niños con glaucoma en España.

OBJECTIVE: To evaluate the effect of glaucoma on visual function, as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age. MATERIAL AND METHODS: An observational and prospective study was designed using the questionnaire GQL-15 (Glaucoma Quality of Life) and conducted on children and caregivers. The questionnaire VFQ-25 (Visual Functioning Questionnaire) was conducted on children. Different variables of the clinical history that could influence the quality of life and visual function were recorded. RESULTS: The study included 24 patients with a mean age of 9.13±3.08 years, and included 3 with unilateral involvement, and 20 diagnosed with primary congenital glaucoma. Parents reported a worse quality of life than children. The result of the GQL-15 survey was 32.3±11.56 points in children and 37.52±14.59 points in caregivers (P=.001). The parameter most related to quality of life and visual function was the mean deviation (MD) of the visual field in the best eye. A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field (children: R=0.63, P<.01, caregivers: R=0.81, P<.001). CONCLUSIONS: Functional loss has an impact on the quality of life and visual function in children with glaucoma, although the quality of life perceived by the caregivers is worse than that perceived by the child.

Electrophoretic karyotype of environmental isolates of Paracoccidioides brasiliensis.

Five of the 12 environmental isolates of the dimorphic fungus Paracoccidioides brasiliensis known to date, were analysed by contour-clamped homogeneous electric field gel electrophoresis (CHEF). The electrophoretic pattern was shown to consist of five bands, with molecular size ranging from 3.2 to 10 Mb, a model quite similar to the one found in the clinical isolates previously tested and used here as controls. However, one of the bands in the environmental isolates had a lesser weight (7.2 Mb), than the one corresponding to the clinical counterparts (8.8 Mb). This resulted in a smaller genome, approximately 29.7 Mb. The small differences that were found indicate the presence of chromosome polymorphism in this fungus.

Swim stress enhances the NADPH-diaphorase histochemical staining in the paraventricular nucleus of the hypothalamus.

Regulatory control of the hypothalamic-pituitary-adrenocortical axis (HPA) originates principally from the paraventricular nucleus (PVN), which contains an important population of nitric oxide synthesizing (NOS) neurons. In the present study, the effect of swim stress upon these neurons was investigated by means of the NADPH-diaphorase (ND) histochemical technique. A significant increase in the number of ND-neurons was observed following forced swim, especially after 30 min. These data confirm the involvement of NOS-neurons of the PVN in the response to different types of acute stressors.

Changes of environment and darkness enhance the NADPH-diaphorase staining in the rat paraventricular nucleus.

Nitric oxide (NO) plays an important role in the maintenance of autonomic homeostasis of the body. NO-producing neurons are activated in the brain during exposure to different levels of environmentally produced stimulations. These facts prompted the authors to investigate the levels of activation of NO-producing neurons of the paraventricular nucleus of the hypothalamus (PVN) following change of environment and darkness. Cryostat sections were cut and processed for the histochemical detection of the NADPH-diaphorase (ND)-activity. Following change of the environment and darkness for 12 and 24 h, statistical analysis displayed a significant increase in the number of ND-neurons, especially in the posterior magnocellular and the lateral parvicellular subdivisions of the PVN. These data indicate that the ND-neurons of the PVN are influenced by changes of the environment and darkness.

Reduced nicotinamide adenine dinucleotide phosphate-diaphorase activity in the paraventricular nucleus of the rat hypothalamus is modulated by estradiol.

Based on previous studies demonstrating that reduced nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase (ND) activity is modulated by estradiol and the discovery of a new subtype of estrogen receptor highly expressed in the paraventricular nucleus of the hypothalamus (PVN), a possible estrogen influence on this activity was investigated in the neuronal populations (magno- and parvicellular) of this nucleus. Cryostat sections were cut and processed for the histochemical detection of the ND activity. Following ovariectomy (14 days), numerical data displayed a slight decrease in the number of ND-neurons, especially in the posterior magnocellular and the medial parvicellular subdivisions, which was reversed after daily treatment with estradiol benzoate. Administration of estradiol benzoate to male rats (14 days) induced a significant increase (P < 0.05) in the number of ND-neurons, mainly at the level of the posterior magnocellular subdivision. These data indicate that paraventricular ND-neurons are influenced by estradiol.

Electrophoretic karyotype of clinical isolates of Paracoccidioides brasiliensis.

Chromosomal DNA molecules were obtained from eight clinical isolates of Paracoccidioides brasiliensis during the early staged of the yeast to mycelial transformation process and were separated by contour-clamped homogeneous electric field gel electrophoresis. In seven of the isolates, it was possible to separate five bands, albeit with two different migration patterns (A and B). In the remaining isolate only four bands were observed (pattern C). The isolated chromosomes showed molecular sizes ranging from 3.2 to 10 Mb according to Schizosaccharomyces pombe molecular size standards. The three different patterns observed had bands of 3.2, 3.8, 4.1, 5.2, 6.7, 7.2, 8.8, and 10 Mb. These data imply that at least 30 Mb of the genome are organized as chromosomal macromolecules. Due to the fact that P. brasiliensis spheroplasts are difficult to obtain, technical details are provided.