Assuntos

RESUMO

UNLABELLED: A prospective study was performed over a 10 year period on 25 children with infantile esotropia and neurological problems to answer this question. From November 1996 to March 2006 they were treated with injections of botulinum toxin (Botox) of both medial rectus extraocular muscles. Mean age was 26.4 months, (range 9-76 months) and mean initial angle was 35 prism diopters (PD)(range 20-60 PD). RESULTS: 18 patients (72%) remained orthotropic+/-10 PD at 29 months (range 6-59 months). Average number of injection treatments was 1.5 per patient. We compared our success rate data with those obtained with primary conventional strabismus surgical procedures in 2 previously published series. Treatment with botulinum toxin seemed to produce better results than one surgical series and at least equally similar results to the other one. Because there are, as well, so many other advantages to the injection procedure including superior safety and economy, we now use botulinum injections as our primary treatment in these patients.

Assuntos

Assuntos

Assuntos

RESUMO

Propósito: Describir el comportamiento de la desviación vertical presente en estrabismos verticales restrictivos a la maniobra de inclinación cefálica de Bielschowsky (MICB). Métodos: 18 pacientes con estrabismo vertical fueron evaluados mediante medición de la desviación vertical con Cover Test (CT) alternado con prismas en las 11 posiciones de la mirada y mediante ducciones pasivas para detección de restricción. No se incluyeron estrabismos paréticos, con ducciones pasivas negativas ni pacientes con cirugías previas sobre los músculos extraoculares de acción vertical. Resultados: Identificamos dos grupos de pacientes Grupo 1: integrado por 9 pacientes con hipotropia restrictiva secundarias a fractura de piso de órbita, síndrome de Brown, contractura de recto inferior, “heavy eye”, contractura de recto superior de ojo fijador contralateral y Grupo 2: formado por 9 pacientes con hipertropia restrictiva por contractura de recto superior o síndrome de Jampolsky, ninguno de los cuales tenía como antecedente una paresia del oblicuo superior previa a la contractura del recto superior. Los pacientes del grupo 1 mostraron aumento de la hipotropia al inclinar la cabeza hacia el lado contrario al afectado y disminución de la desviación vertical al inclinar hacia el lado de la hipotropia. En el grupo 2, de las hipertropias restrictivas, todos mostraron un aumento de la hipertropia al inclinar hacia el hombro ipsilateral y disminución de la misma al inclinar hacia el hombro contralateral. Conclusiones: Los estrabismos verticales restrictivos muestran un comportamiento de la desviación vertical a la maniobra de inclinación cefálica de Bieslchowsky que podría explicase por los recientes hallazgos de Pansell y col. Estos hallazgos amplían la utilidad de la maniobra de inclinación cefálica para diagnóstico de estrabismos veticales de diverso origen.

Purpose: To report the vertical deviation behavior to Bielschowsky head tilt test (BHTT), in restrictive vertical strabismus. Methods: Eighteen patients with vertical strabismus were evaluated by prism cover test in the eleven positions of gaze and by forced ductions to detect restrictions. Paretic deviations, cases with negative forced ductions or with previous surgery on the vertical rectus muscles were excluded. Results: Two groups of patients were indentified: Group 1: 9 patients with restrictive hypotropia secondary to blow out floor fracture, Brown syndrome, inferior rectus contracture, (heavy eye) and Group 2: 9 patients with restrictive hypertropia (Jampolsky syndrome) neither of whom had SO palsy previous to SR contracture. Group 1: the patients had greater hypotropia in contralateral head tilt and better ocular alignment in ipsilateral tilt. Group 2: the cases had greater hypertropia in ipslilateral head tilt and better ocular alignment in contralateral tilt. Conclusion: Patients with restrictive vertical strabismus had BHTT responses which could be explained by Pansell et al reports. These finding increase the potential uses of BHTT as a diagnostic tool for vertical strabismus.

Assuntos

RESUMO

Objetivo: El síndrome de Brown (SB) se caracteriza por restricción activa y pasiva de la elevación en adducción. Puede ser congénito o adquirido, intermitente o permanente, uni o bilateral; este último se presenta en el 10 por ciento de los casos. Nuestro objetivo es describir 9 casos de SB bilateral y revisar la literatura al respecto. Pacientes: se describen características clínicas de 9 casos y se revisa la literatura. Resultados: De los 9 casos, 2 eran de sexo masculino, y 7 de sexo femenino. Edad promedio: 5.7 años. 1 caso intermitente. Los casos publicados en diferentes series son: 13/126 (Brown), 3/8 (Clark y Noel), 7/36 (Waddell ) y 1/30 (Eustis). Entre los casos bilaterales hay alta incidencia de casos familiares. Conclusión: Se confirma que el cuadro es más común en mujeres. 7/9 tenía alineamiento en posición primaria. Todos tenían déficit bilateral de elevación y anisotropía en V. Frente a un caso de SB bilateral es conveniente examinar a los familiares en busca de casos asintomáticos.

Objective: The motility defect known as Brown´s síndrome is characterized by active and passive restriction of elevation in adduction. It may be either congenital or acquired, intermittent or permanent, uni or bilateral. It is bilateral in 10 percent of cases. Our purpose is to report 9 cases with bilateral Brown´s syndrome and review the cases previously published. Patients: 9 cases are described: 2 males and 7 females, average age 5,7 years who had bilateral Brown´s syndrome and review. Results: 9 cases are described: 2 males and 7 females, average age 5,7 years who had bilateral Brown´s syndrome, 1 of them was intermittent. Bilateral cases published are: 13/126 in Brown´s series, 3/28 in Clark and Noel´s, 7/36 in Waddell´s and 1/30 in that of Eustis. Among bilateral cases there is a striking incidence of familial cases. Conclusion: Brown´s statement that the disorder is more common in females than in males is confirmed in our series. It should be noted that 7 out of 9 of these patients had normal alignment in primary gaze. All cases had bilateral elevation deficit and V pattern. In bilateral cases examination of the relatives should be performed in order to detect asymptomatic familial cases.

Assuntos

RESUMO

INTRODUCTION: Pathologic alterations in neuromuscular transmission, known as Myasthenia Gravis (MG), comprise combinations (forms) of pre- and post-synaptic changes whose age at onset and clinical manifestations are dissimilar. Some forms have autoimmune features, while others have a defect due to functional or structural plaque alternations. The purpose of this work is to describe the clinical forms of MG seen in childhood, to facilitate proper diagnosis and treatment. MATERIAL AND METHODS: Retrospective data from 87 patients studied at the Ricardo Gutierrez Children's Hospital from 1990 to 2002 are presented. They were evaluated by clinical, pharmacological, electrophysiological, laboratory and radiological exams. RESULTS: Three distinct groups of patients were found: Group 1, Transient Neonatal Myasthenia Gravis (TNMG) represented 6.8% 9 (n=6) of the total number of patients. None of these six patients had ocular involvement. Group 2, Congenital Myasthenia (CMG) represented 17.2% of cases 9 (n=15). These patients had an onset of symptoms from 1 to 12 months of age. Eight cases were sporadic and the remainder familial. The most frequent symptom in this group was bilateral blepharoptosis in 13 patients. Group 3, Juvenile Myasthenia (JMG) comprised 76% of the patients (n=66). The onset of symptoms in this group ranged from 13 months to 14 years (mean 3.6 years). Thirty-nine of these children presented purely with ocular symptoms. CONCLUSIONS: Children with myasthenia gravis may present to the ophthalmologist first, with symptoms such as unilateral or bilateral blepharoptosis, diplopia, strabismus or ophthalmoplegia. Therefore, it is essential that the ophthalmologist be aware of the varied features of this disorder in children in order to diagnosis it correctly and make appropriate treatment referrals.

Assuntos

RESUMO

PURPOSE: To analyze different patterns of vertical strabismic deviations seen in unilateral superior oblique (SO) paresis, and the response to surgical treatment, in order to discern the most effective surgical indication to treat each clinical pattern. MATERIAL AND METHOD: A retrospective analysis of 110 patients with a diagnosis of unilateral SO paresis studied according to the follow protocol: a) Hypertropia (HT) measurement with alternate prism and cover test in the 9 diagnostic gaze positions; b) Determination of the deviation pattern; and c) Analysis of the results achieved with various surgical procedures. RESULTS: We found that unilateral SO paresis presented with 3 patterns of HT: 1) Patients with marked incomitance between opposite lateroversions; 2) Cases with HT equal to or greater than 20 prism diopters in primary gaze position, lower incomitance between opposite lateroversions and incomitance in up- and downgaze; and 3) A pattern of vertical deviation characterized by a strong tendency to comitance in the 9 diagnostic gaze positions, with an overtly positive Bielschowsky Head Tilt Test and extorsion of the affected eye. CONCLUSIONS: This study provides guidelines to discern the most effective surgical indication for patients with unilateral SO paresis on the basis of the presenting hypertropia pattern.

Assuntos

RESUMO

BACKGROUND: A homonymous hemianopia can be compensated for by an exotropia in the direction of the visual field defect. CASE REPORTS (AND LITERATURE REVIEW): Two young males with visual field defects and exotropia are reported. Both refused surgery when they were advised of the risk of reduction of their binocular visual field with the alignment of their eyes. CONCLUSION: Mapping of the binocular visual field is mandatory in patients with exotropia and neurological involvement to search for this rare combination which could produce a disappointing surgical outcome.

Assuntos

RESUMO

PURPOSE: To test new and recent theories on the etiology of Dissociated Vertical Deviation (DVD) with an appropriate new alternative surgical technique. METHOD: Nine patients were prospectively selected. The surgical technique used was simultaneous and symmetrical weakening of all 4 oblique eye muscles in order to reduce bilateral cyclotorsion. For analysis, "Statistical Significance" level used was p<0.05. RESULTS: Mean preoperative hypertropia was 17.9 prism diopters (pd) for the right eyes (RE) and 17.7 pd for the left eyes (LE). Mean post-surgical deviation achieved was 6.44 pd for the REs and 5.78 pd for the LEs. Statistical analysis (Wilcoxon's Test) showed a p<0.02 for both eyes. In all cases, a symmetrical correction was also obtained. CONCLUSIONS: The hypothesis that the manifest hypertropia seen in patients with DVD is secondary to cyclotorsion, mediated primarily by the oblique muscles, was validated by improving (reducing) the DVD by performing bilateral and symmetrical weakening of all four oblique extraocular muscles.

Assuntos