[Show abstract][Hide abstract] ABSTRACT: To assess the prevalence of refractive errors in Möbius sequence.
This study was carried out during the Annual Meeting of the Brazilian Möbius Society in November 2008. Forty-four patients diagnosed with the Möbius sequence were submitted to a comprehensive assessment, on the following specialties: ophthalmology, neurology, genetics, psychiatry, psychology and dentistry. Forty-three patients were cooperative and able to undertake the ophthalmological examination. Twenty-two (51.2 %) were male and 21 (48.8%) were female. The average age was 8.3 years (from 2 to 17 years). The visual acuity was evaluated using a retro-illuminated logMAR chart in cooperative patients. All children were submitted to exams on ocular motility, cyclopegic refraction, and fundus examination.
From the total of 85 eyes, using the spherical equivalent, the major of the eyes (57.6%) were emmetropics (>-0.50 D and <+2.00 D). The prevalence of astigmatism greater than or equal to 0.75 D was 40%.
The prevalence of refractive errors, by the spherical equivalent, was 42.4% in this studied group.
Arquivos brasileiros de oftalmologia 08/2013; 76(4):237-9.
[Show abstract][Hide abstract] ABSTRACT: To investigate the contribution of the individual ocular components, i.e. anterior chamber depth, lens thickness and vitreous chamber depth, to total axial length in patients with esotropic amblyopia.
The study population consisted of 74 children, aged between 5 and 8 years: thirty-seven patients with esotropic amblyopia and 37 healthy volunteers (control group). The participants underwent a comprehensive ophthalmological examination, including cycloplegic refraction and A-scan ultrasonography. Anterior chamber depth, lens thickness, vitreous chamber depth and total axial length were recorded. Paired Student's t-tests were used to compare biometric measurements between amblyopic eyes and their fellow eyes and between right and left eyes in the control group. To evaluate the contribution of the ocular components to the total axial length, we report the individual components as a percentage of total axial length.
The comparison between amblyopic and fellow eyes regarding the individual contribution from ocular components to the total axial length revealed greater contribution from lens thickness (P=0.001) and smaller contribution from vitreous chamber depth (P=0.001) in amblyopic eyes, despite similar contribution from anterior chamber depth (P=0.434). The comparison between right and left eyes in the control group showed similar contributions from anterior chamber depth (P=0.620), lens thickness (P=0.721), and vitreous chamber depth (P=0.483).
This study shows differences between amblyopic and non-amblyopic eyes when the total axial length is broken down into the individual contribution from the ocular components.
Arquivos brasileiros de oftalmologia 02/2012; 75(1):38-42.
[Show abstract][Hide abstract] ABSTRACT: To study the oculometric parameters of hyperopia in children with esotropic amblyopia, comparing amblyopic eyes with fellow eyes.
Thirty-seven patients (5-8 years old) with bilateral hyperopia and esotropic amblyopia underwent a comprehensive ophthalmic examination, including cycloplegic refraction, keratometry and A-scan ultrasonography. Anterior chamber depth, lens thickness, vitreous chamber depth and total axial length were recorded. The refractive power of the crystalline lens was calculated using Bennett's equations. Paired Student's t-tests were used to compare ocular biometric measurements between amblyopic eyes and their fellow eyes. The associations of biometric parameters with refractive errors were assessed using Pearson correlation coefficients and linear regression. Multivariable models including axial length, corneal power and lens power were also constructed.
Amblyopic eyes were found to have significantly more hyperopic refraction, less corneal power, greater lens power, shorter vitreous chamber depth and shorter axial length, despite similar anterior chamber depth and lens thickness. The strongest correlation with refractive error was observed for the axial length/corneal radius ratio (r(36) = -0.92, p < 0.001 for amblyopic and r(36) = -0.87, p < 0.001 for fellow eyes). Axial length accounted for 39.2% (R(2)) of the refractive error variance in amblyopic eyes and 35.5% in fellow eyes. Adding corneal power to the model increased R(2) to 85.7% and 79.6%, respectively. A statistically significant correlation was found between axial length and corneal power, indicating decreasing corneal power with increasing axial length, and they were similar for amblyopic eyes (r(36) = -0.53, p < 0.001) and fellow eyes (r(36) = -0.57, p < 0.001). A statistically significant correlation was also found between axial length and lens power, indicating decreasing lens power with increasing axial length (r(36) = -0.72, p < 0.001 for amblyopic eyes and r(36) = -0.69, p < 0.001 for fellow eyes).
We observed that the correlation among the major oculometric parameters and their individual contribution to hyperopia in esotropic children were similar in amblyopic and non-amblyopic eyes. This finding suggests that the counterbalancing effect of greater corneal and lens power associated with shorter axial length is similar in both eyes of patients with esotropic amblyopia.
Ophthalmic and Physiological Optics 07/2011; 31(4):389-97. · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the simplified intraoperative adjustable suture technique for horizontal strabismus surgery.
Data charts of all patients who underwent horizontal strabismus surgery by the simplified intraoperative adjustable suture technique at the Strabismus Department of the "Hospital das Clínicas" of the University of São Paulo in the period from January 2001 to November 2005 were evaluated retrospectively. Using this technique, the adjustment was calculated based on the corneal light reflection, having considered the difference between the measures in the awake state and with the anesthetized patient.
One hundred fifty-three patients were operated on, 73 (47.8%) cases of esotropia (ET) and 80 (52.2%) of exotropia (XT). Under anesthesia, 123 (80.4%) patients had the eye position modified: 69 (56.1%) were less esotropic, 51 (41.5%) were more exotropic and 3 (2.4%) were less exotropic. Surgery was adjusted in 60 (39.2%) patients: 30 were esotropia and 30 were exotropia. Surgical success was defined as an eso- or exodeviation within 10 prism diopters, in a follow-up period of at least 180 days. The overall success rate was 71.6%.
The simplified intraoperative adjustable suture technique, described in 2003 in a study performed on 49 patients operated on by the same surgeon, was shown to be efficient in this larger series of patients operated on by different surgeons. This technique should be considered in patients who do not cooperate in other adjustment techniques, aiming at improved success rates.
Arquivos Brasileiros de Oftalmologia 02/2007; 70(1):13-8. · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To analyze the hypothesis that a reduction in sensitivity of the nasal visual hemifield would lead to an increase in the nasotemporal asymmetry of the visual field in patients under two years of age with early-onset convergent strabismus in comparison with normal patients.
Both eyes of 66 patients - 33 esotropes and 33 normals - were studied. Patients' age ranged from 7 to 30 years. The examination consisted of a static perimetry using the Humphrey field analyzer 700 Series' Sita Standard program.
An accentuation of the nasotemporal asymmetry was seen in the 33 esotropes and was related to an evident decrease of sensitivity in the most peripheral of the points studied along the horizontal meridian of the visual field. The quantitative sum of values of sensitivity of these points showed an average reduction of -15.71% in relation to the normal patients.
There was a clear accentuation of the nasotemporal asymmetry of sensitivity in esotropes when compared to normal patients. There was no difference in sensitivity between the two eyes in either normals or esotropes.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the influence of compliance with treatment, severity of amblyopia and age at the beginning of treatment in patients with strabismic amblyopia submitted to patching.
The data were selected from medical records of 569 patients seen at the Department of Ophthalmology, University of São Paulo during the period of 1983 to 2000. Exclusion criteria: loss of follow-up, age over 12 years, presence of nystagmus and other ocular diseases. The patients were divided into four groups according to age and classified based on the type of strabismus, compliance with treatment and severity of amblyopia. Statistical analysis was performed using Fisher's test.
198 (34.8%) patients were enrolled in the study. There was no difference regarding compliance among the age groups. The best success rate was obtained when there was good compliance with the treatment, independent of the degree of amblyopia. But worse compliance was observed among the patients with more severe amblyopia, who were the majority of patients of the study, and who showed the worst success rate. The success rate was not related to the patients' age.
The study showed that compliance with patching plays a fundamental role in therapeutic efficacy. Thus, age at the beginning of treatment alone did not influence the success rate since it was possible to obtain good compliance independent of age. In addition, worse results were associated with severe amblyopia and less compliance.
Arquivos Brasileiros de Oftalmologia 04/2006; 69(2):181-5. · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diplopia is an infrequent complication described for retrobulbar local anesthesia. The objective of this study is to report the clinical characteristics and treatments for this surgical complication.
Retrospective study of medical records. Period: 5.3 years ending February 2005. During this period, 20453 cataract surgeries were performed. The anesthesia used was retrobulbar block with ropivacaine diluted with hyaluronidase. Nineteen patients reported diplopia due to strabismus after the cataract surgical procedure and were referred for evaluation at the Extrinsic Ocular Motility Department.
Persistent diplopia after cataract surgery occurred in 19 (0.093%) of the 20453 cases. The types of deviations found were: exotropia (n=3), esotropia (n=5), hypertropia (n=1), exotropia + hypertropia (n=5) and esotropia + hypertropia (n=5). Small deviations and dysfunction of the lateral rectus muscles were most commonly seen. Prism was applied to 4 patients, eye muscle surgery was the option in 8 patients, orthoptic treatment was performed in 3 patients and for 2 patients the decision was to only observe progress. Overall, binocular vision was restored in eleven of the nineteen patients.
Persistent diplopia due to strabismus is an infrequent complication after cataract surgery with retrobulbar block. Etiology of this disorder of extrinsic ocular motility is variable, including mixed components. We stress the importance of adequate preoperative history of strabismus and evaluation of extrinsic ocular motility. Considering the reported incidence of this problem is as high as one in 25 cataract surgeries, one should advise the patient of the possibility of persistent postoperative diplopia and the possible need for surgical intervention and/or prism to treat the symptoms.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the charts of patients with sensorial strabismus regarding range of different aspects, such as etiology, the type and the amount of deviation, relationship between the type of deviation and the patient's age when the disease occurred and the surgical outcome.
A retrospective analysis of data charts of 191 patients seen at the section of Ophthalmology at the University of São Paulo, from September 1990 to July 2002.
There were 84 male and 107 female patients. The most frequent diagnosis responsible for low vision in the squinted eye was atrophic chorioretinitis in 49 patients. Eighty-seven were exotropes and 97 were esotropes. Fifty patients were operated on, but 8 of them were lost to follow-up. In 90.5% the surgical outcome was successful: less than 15 prismatic diopters of hyper or undercorrection after surgery.
The good surgical outcome seen in this and other studies enhances and justifies the need for surgical correction of this type of strabismus.
Arquivos Brasileiros de Oftalmologia 01/2006; 69(1):71-4. · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJETIVO: Avaliar os prontuários dos pacientes com estrabismo sensorial em aspectos variados, como etiologia, tipo e medida do desvio, correlação do tipo do desvio com a idade de aparecimento da doença de base, e resultado cirúrgico dos casos operados. MÉTODOS: Avaliação dos prontuários médicos dos pacientes com estrabismo sensorial atendidos no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP - no setor de Motilidade Ocular Extrínseca, no período de setembro de 1990 a julho de 2002. RESULTADOS: Foram avaliados 84 pacientes masculinos e 107 femininos; o diagnóstico mais freqüente para baixa visual foi coriorretinite atrófica em 49 casos. Oitenta e sete pacientes tinham exotropia e 97 tinham esotropia. Oitenta e dois pacientes tiveram cirurgia indicada, e 50 foram operados. Em 42 deles, foi constatado sucesso cirúrgico de 90,5% (desvio longe e perto menor ou igual a 15 dioptrias prismáticas). CONCLUSÕES: O bom resultado cirúrgico observado neste e em outros estudos reforça a necessidade da correção cirúrgica nesses casos.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: To develop a neural network model for planning of the surgical strategy of patients with sensorial strabismus. METHODS: In this retrospective study, medical records of 95 patients with sensorial strabismus were reviewed. All patients were seen at the Strabismus Sector of the Hospital das Clínicas of the University of São Paulo. The neural network was designed containing 3 layers. Sixty-eight patients were used in the training and validation set, and 27 in the test set. RESULTS: In the 68 patients used in the training and validation set, 37 had exotropia, and 31 esotropia. The backpropagation approach was used for training the neural network. A learning rate of 0.6, and a tolerance error of 0.05 were used. In the 27 patients used in the test set, 18 had exotropia, and 9 had esotropia. The efficacy of the neural network was analyzed using the average of the difference between the indication supplied by the network and the original indication. In patients with exotropia, the average error was 0.4 mm (±0.4), for recession of the lateral rectus muscle, and 0.3 mm (±0.3), for the resection of the medial rectus muscle. In the esotropia group, the average error was 0.2 mm (±0.2) for the recession of the medial rectus muscle, and 0.5 mm (±0.3) for resection of the lateral rectus muscle. CONCLUSION: As the artificial neural network can simulate a biological central nervous system, and is able to carry out cognitive tasks, it can be a viable option to help the surgical planning for strabismus correction.
Arquivos Brasileiros de Oftalmologia 06/2004; 67(3):459-462. · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJETIVO: Avaliar a eficácia de técnica simplificada de cirurgia ajustável per-operatória, sob anestesia geral, para a correção de desvios horizontais. MÉTODOS: Estudo prospectivo de 49 pacientes portadores de desvio horizontal, 22 com esotropia (ET) e 27 com exotropia (XT), da Secção de Motilidade Ocular Extrínseca da Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Todos os pacientes foram submetidos à cirurgia utilizando-se a técnica de ajuste per-operatório. O ajuste foi realizado comparando-se a medida do desvio em milímetros (mm) do reflexo de luz na córnea no pré-operatório e a medida tomada no per-operatório, em plano anestésico profundo. Nas ET, o reflexo foi medido a partir do lado temporal do limbo e nas XT, do lado nasal. Todo o cálculo para o ajuste ou não, foi feito baseado nas medidas em milímetros, não se convertendo mm em dioptrias prismáticas, e nem se utilizando a pupila como ponto de referência. RESULTADOS: 28 pacientes (57,1%) apresentaram alteração do desvio em plano anestésico profundo. Em 25 pacientes (51,0%) foi necessária a realização do ajuste. Estabelecendo-se como critério de sucesso cirúrgico ortotropia, eso ou exotropia até 10 dioptrias prismáticas no pós-operatório após, no mínimo, 6 meses, a taxa de sucesso foi 75,6%. CONCLUSÃO: Os resultados mostraram que a técnica é eficiente. A técnica de cirurgia simplificada com ajuste per-operatório descrita pelos autores, oferece mais uma opção de tratamento cirúrgico visando diminuir o número de reoperações e aumentar a taxa de sucesso nas correções dos desvios, principalmente nos casos de mais difícil planejamento e que não colaboram para ajuste com anestesia tópica e/ou pós-operatório. Por ser técnica simplificada, pode ser mais facilmente realizada por cirurgiões menos experientes, aumentando a sua utilização em maior número de casos.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate the efficacy of recession and graded anterior transposition of the inferior oblique (IO) muscle to correct or to reduce V-pattern strabismus and associated IO overaction.
The technique used was that proposed by Wright, using the temporal border and the insertion of the inferior rectus as the reference points to locate the new insertion. In a retrospective study, 51 patient histories were analyzed and from this group, 22 patients were selected as most typical examples. Patients with hypertropias greater than 6 prism diopters (PD), a dissociated vertical deviation (DVD) greater than 8 PD or decompensated DVD were excluded.
A total of 44 eye surgeries on 22 patients were analyzed. We observed favorable results ("statistically significant") concerning the reduction of the IO overaction or V incomitance. In 45.5% (20 eyes) the IO function was normalized, in 15.9% (7 eyes) there was a reduction to -1 (underaction) and in 34.1% (15 eyes) there was a reduction, but there still remained a +1 overaction. In 77.3% of the patients there was a "satisfactory" outcome of the V pattern, defined as a residual incomitance less than 10 PD.
In this group of patients with V-pattern strabismus and IO overaction, the recession and measured, graded anterior transposition based on Wright's technique showed satisfactory results ("statistically significant") in correcting the V incomitance and normalizing or reducing the IO overaction.
[Show abstract][Hide abstract] ABSTRACT: To report the clinical features of strabismus associated with Graves' orbitopathy, and the results of surgery with adjustable suture under drop anesthesia.
The charts of 13 patients who had surgical treatment for strabismus related to Graves' orbitopathy at Hospital das Clínicas of University of São Paulo were retrospectively reviewed. Ocular motility, sensorial examination and the follow-up after strabismus correction were studied.
Preoperatively, the most common type of deviation was esotropia with hypotropia. Adjustable recession was done in nine patients and a second surgery occurred in 3 patients. After follow-up of at least six months, 8 of 13 patients were orthotropic or had a small phoria with some degree of binocular vision.
In this study, 62% (8/13) of patients showed hypotropia with esotropia, probably because fibrotic and restrictive muscles (medial and inferior rectus). In nine of 13 patients adjustable recession with a good postoperative alignment of the eyes was performed. Adjustment of strabismus surgery under drop anesthesia in patients with Graves' orbitopathy was successful in restoring binocular vision with minimum complications.
Arquivos Brasileiros de Oftalmologia 71(3):370-4. · 0.38 Impact Factor