Insuficiencia de convergencia con diplopía: tratamiento quirúrgico en adultos / Convergence insufficiency with diplopia: Surgical treatment in adults

Propósito Estudiar los resultados del mini plegamiento central del recto medial (RM) en las insuficiencias de convergencia de adultos con diplopía. Método Análisis retrospectivo de una muestra de 9 casos (7 mujeres). Se recogieron los datos de la dosis de plegamiento del RM, la hipercorrección inmediata posquirúrgica y al final del seguimiento, la desviación final de cerca y de lejos, la diplopía y el tiempo de seguimiento desde la cirugía. Se consideró buen resultado la desaparición de la diplopía, mejoría de los síntomas y una exotropía final de cerca ≤8dioptrías prismáticas (dp). Resultados Se realizó un mini-plegamiento central del RM en 9 pacientes (8 unilaterales). Edad media: 58,66 años (SD: 21,39). La media de la desviación preoperatoria de cerca fue de 16,22 (±2,99) dp y de lejos 6,88 (±4) dp. Se registró hipercorrección en visión lejana en 5 casos que se resolvió a los 3 meses después de la operación. No hubo hipercorrección en visión de cerca excepto en un caso. Ninguno de los casos operados presentó hipercorrección al final del seguimiento. La desviación horizontal final fue ≤8dp en visión cercana, excepto en 3 casos (media: 6,22). Los síntomas y la diplopía se resolvieron en 8 casos. El seguimiento medio fue de 10,33 meses. Conclusión El mini-plegamiento central de 1 o 2 músculos rectos mediales puede mejorar los síntomas y signos de exotropía asociados a la insuficiencia de convergencia cuando los ejercicios y los prismas son rechazados por los pacientes o cuando estos abordajes no han resuelto el problema (AU)

Objective To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia. Methods The study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. Results A central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (± SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (± 2.9) pd and distance preoperative deviation: 6.88 (± 4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months. Conclusion Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem (AU)

Convergence insufficiency with diplopia: Surgical treatment in adults.

OBJECTIVE: To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia. METHODS: The study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. RESULTS: A central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (±SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (±2.9) pd and distance preoperative deviation: 6.88 (±4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up. The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months. CONCLUSION: Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.

Efectividad de la cirugía monocular en la exotropía sensorial de gran ángulo / Effectiveness of the surgery monocular in the sensorial exotropia of great angle

La exotropía sensorial se define como una desviación ocular divergente unilateral o bilateral, dada por anomalías oculares congénitas o adquiridas; es más frecuente en adultos. El objetivo de la cirugía de estrabismo en el adulto es restablecer la visión binocular, reduciendo la diplopía y al lograr el alineamiento ocular, mejorar su estética, por lo que antes de realizar la cirugía se debe tratar la causa que provoca la baja visión. El procedimiento quirúrgico de elección es la cirugía monocular, pero si la desviación es grande se realizará cirugía binocular. Se presenta una paciente femenino de 25 años de edad portadora de lentes de contacto por miopía elevada del ojo derecho (9,00 -0.75 x 105º con 0,2 de agudeza visual mejor corregida), exotropía de más de 25º por Hirschberg, limitación de aducción del ojo derecho y por método de oclusor y prismas a 6 metros sin cristales y con sus lentes de contacto, ambos ojos 50 ∆ b interna, no estereopsia y suprime ojo derecho. Por todas las ventajas que presenta la cirugía monocular, se decidió realizarla en el ojo derecho, se colocó anestesia local peribulbar, se realizó recesión amplia del recto lateral a 12 mm y se realizó 8 mm de resección del recto medial; en el postoperatorio se logró 10 ∆ b interna y por momentos ortotropia; refirió diplopía post quirúrgica que resolvió espontáneamente. Los resultados quirúrgicos en la exotropía sensorial son menos alentadores ya que con el tiempo pueden evolucionar hacia la hipercorrección o hacia la recurrencia(AU)

Sensory exotropía is defined as a unilateral or bilateral divergent ocular deviation, given by congenital or acquired ocular anomalies, and is more frequent in adults. The objective of the strabismus surgery in adults is to reestablish binocular vision, reduce diplopía, improve ocular alignment and enhance quality of life; before performing surgery the cause of low vision should be treated. The preferred surgical procedure is a monocular approach, but if there is a large deviation a binocular procedure should be performed. The case presented Is a 25 year-old female with high myopia of the right eye (-9.00 -0.75 x 105º with 0.2 of best corrected visual acuity), exotropía of more than 25º for Hirschberg, limitation of aducción of the right eye and with both the oclusor method and prisms to 6 meters without glasses and with her contact lenses, both eyes have 50∆ of internal base, no estereopsia and suppression of the right eye. For its advantages a monocular approach (of the right eye) was preferred, with peribulbar anesthesia: recession to 12mm of the lateral rectus combined with 8 mm of resection of the medial rectus; in the postoperative she presented a 10∆ intern base deviation and for moments ortotropia; she referred diplopia that solved spontaneously. The surgical results in sensory exotropía are less encouraging since they have higher hypercorrection and recurrence rates(AU)