Outcome study of surgical alignment before six months of age for congenital esotropia.
ABSTRACT Recently, several ophthalmic surgeons have reported surgical alignment with congenital esotropia in patients younger than 6 months of age to improve the quality of the binocular result.
The author performed a multicenter independent study of the motor and sensory results obtained in a group of patients younger than 6 months of age. These patients underwent surgical alignment by other investigators to within 10 prism diopters for a minimum of 6 months. The patients had been followed for a minimum of 4 years and were required to have sufficient maturity and normal neurologic status to reliably respond to tests for fusion and stereopsis. The patients were examined and analyzed by the author before any knowledge of the clinical record.
Sixteen patients underwent surgical alignment at an average age of 4.2 months. Follow-up examination took place at an average age of 7.1 years. Motor and sensory tests showed 11 patients to have a small or negligible motor misalignment at near point with both binocular fusion and gross stereopsis ability. One patient, aligned by 3 months of age, demonstrated reproducible refined stereoacuity on sensory testing. The author observed, however, that alignment by 4 or 5 months of age did not result in better quality of binocularity than a previously studied group of patients who underwent alignment at 6 months of age.
Binocularity that includes refined stereoacuity remains an elusive target and rare outcome for the ophthalmologist treating congenital esotropia, despite the use of very early surgical alignment.
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ABSTRACT: This study examines whether brief periods of binocular vision could preserve stereopsis in monkeys reared with optical strabismus. Starting at 4 weeks of age, six infant monkeys were reared with a total of 30 prism diopters base-in split between the eyes. Two of the six monkeys wore prisms continuously, one for 4 weeks and one for 6 weeks. Four of the six monkeys wore prisms but had 2 hours of binocular vision daily, one for 4, one for 6, and two for 16 weeks. Five normally reared monkeys provided control data. Behavioral methods were used to measure spatial contrast sensitivity, eye alignment, and stereopsis with Gabor and random dot targets. The same pattern of results was evident for both local and global stereopsis. For monkeys treated for 4 weeks, daily periods of binocular vision rescued stereopsis from the 10-fold reduction observed with continuous optical strabismus. Six weeks of continuous strabismus resulted in stereo blindness, whereas daily periods of binocular vision limited the reduction to a twofold loss from normal. Daily periods of binocular vision preserved stereopsis over 16 weeks of optical strabismus for one of the two monkeys. Two hours of daily binocular vision largely preserves local and global stereopsis in monkeys reared with optical strabismus. During early development, the effects of normal vision are weighed more heavily than those of abnormal vision. The manner in which the effects of visual experience are integrated over time reduces the likelihood that brief episodes of abnormal vision will cause abnormal binocular vision development.Investigative ophthalmology & visual science 03/2011; 52(7):4872-9. · 3.43 Impact Factor
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ABSTRACT: Diastolic dysfunction is considered the first marker of diabetic cardiomyopathy. However, preclinical systolic alteration was also recently described by strain, but its association with diastolic dysfunction has never been investigated. One hundred fourteen patients with type 2 diabetes mellitus (DM) with controlled blood pressure and without overt heart disease were prospectively enrolled and compared with 88 age-matched controls. All subjects underwent comprehensive echocardiography, including diastolic evaluation according to current recommendations and speckle-tracking imaging. The prevalence of diastolic dysfunction, the determinants of diastolic parameters, and the association between preclinical systolic and diastolic dysfunctions were studied. Diastolic parameters were altered in patients compared with controls, with lower E/A ratios, longer mitral deceleration and isovolumic relaxation times, and higher E/e' ratio. Diastolic dysfunction occurred in 47% of patients with DM (33% and 14% with grade I and II diastolic dysfunction, respectively) and systolic alteration (longitudinal strain ≥ -18%) in 32% of patients. Whereas longitudinal systolic strain was independently associated with DM and gender, diastolic parameters were influenced by many factors, including age, rate-pressure product, history of hypertension, and body mass index. Systolic alteration occurred in 28% of patients with DM with normal diastolic function and in 35% with diastolic dysfunction. Diastolic dysfunction diagnosed according to current recommendations is frequent in patients with DM but is also influenced by other factors. Systolic strain alteration may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form of diabetic cardiomyopathy.Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 09/2011; 24(11):1268-1275.e1. · 2.98 Impact Factor
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ABSTRACT: Voice disorders have a multifactorial genesis and may be present in various ways. They can cause a significant communication handicap and impaired quality of life. To assess the effect of vocal fold lesions and voice quality on voice handicap and psychosomatic well-being. Female patients, aged 18-65 years, who were referred to the outpatient clinic with voice problems were subsequently assessed. Laryngostroboscopic examination and acoustic voice analysis were carried out, and the patients were asked to fill in the Voice Handicap Index (VHI) and Symptom Check List-90 questionnaires. Eighty-two patients were included. In 43 patients (52.4%), a vocal fold lesion was observed. The VHI and psychosomatic well-being did not differ significantly between patients with and without a vocal fold lesion. The patients with a vocal fold lesion showed lower scores on the Dysphonia Severity Index (DSI) compared with those without a vocal fold lesion. However, the DSI was not correlated with voice handicap and psychosomatic well-being, except for the VHI physical subscale. Objective measurement does not necessarily correlate with the subjective appraisal of the patient's voice handicap and psychosomatic well-being. Furthermore, the criterion of the presence of a vocal fold lesion as the base of indemnity that is applied by health insurance institutions should be questioned.Journal of voice: official journal of the Voice Foundation 08/2011; 26(4):466-70. · 0.95 Impact Factor