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ABSTRACT: The "Early Treatment for Retinopathy of Prematurity Cooperative" reported a failure rate of 55.2% using laser in zone 1 for treatment of retinopathy of prematurity (ROP). We need to offer better alternatives for those patients. We undertook this study to evaluate the efficacy of combined laser-ranibizumab therapy for ROP with threshold-prethreshold and "plus disease" and to study development of the newborn.
This is a prospective, experimental, longitudinal and open study including newborns of either <32 weeks of gestation or with a birth weight <1500 g, with threshold-prethreshold retinopathy or "plus disease." The effect of treatment was analyzed and development of the newborn was determined.
We studied 34 eyes of 17 patients. Age at birth was 29.9 ± 2.6 weeks. Birth weight was 1,120 ± 253 g. The statistics demonstrated an important relationship between severity of retinopathy and early birth age, along with a high probability of threshold-prethreshold disease at 29.4 weeks of age or 1204 g birth weight. The Bayley scale reported normal development in 23.5% of cases, global retardation in 23.5%, psychomotor retardation but normal mental behavior in 29.4%, and mental retardation but normal psychomotor development in 23.5%. We demonstrated regression of retinopathy in all cases. Persistence of vascular tortuosity was present in 17.6% of cases without vascular dilatation, and vitreous membrane development was demonstrated in 11.7% of patients.
Laser-ranibizumab treatment has allowed a better control of retinopathy for threshold-prethreshold and "plus disease" in this group of patients.
Cirugia y cirujanos 05/2011; 79(3):207-214, 225-32. · 0.14 Impact Factor
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ABSTRACT: We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD).
This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed.
Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found.
Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.
Cirugia y cirujanos 77(4):267-73; 249-55. · 0.14 Impact Factor
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ABSTRACT: We undertook this study to describe the causes of Parinaud syndrome (PS) with diplopia to determine a topographic diagnosis and prognosis.
We studied patients with PS from January 1980 to January 2004 and reviewed causes and treatment. We identified all strabismus associated with PS.
We included 18 patients with diplopia, 6 females and 12 males. Median age was 28 years old, SD 22 (10; CI 95%). Results are strabismus related: III nerve palsy in 15 patients (79%), optical nerve damage in 8 (44.4%), VII nerve palsy in 3, IV nerve palsy 2, bilateral III nerve palsy 2, nystagmus 2, Foville syndrome 2, one-and-a-half syndrome (1). The following causes were reported: tumors (6), brain stroke (4), cranial trauma (3), neurocysticercosis (2). Orthoposition under botulinum toxin treatment was obtained in 1.72 +/- 1.1 (0.65 CI 95%). Surgery was done in nine patients, and only one patient had spontaneous resolution of diplopia and PS.
It is important to identify the topographic diagnosis and prognosis of brain diseases such as the complete study of strabismus-related PS. In this way we can learn more about the extent of damage and can identify recurrences quickly in order to offer better control.
Cirugia y cirujanos 74(3):147-51. · 0.14 Impact Factor
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ABSTRACT: We undertook this study to demonstrate the incidence of vitreoretinal dystrophies in a Mexican population.
This was a retrospective, observational, descriptive, transverse study. We analyzed the files of patients treated at the Retina Department of a medical center for state employees (ISSSTE) from January 1991 to December 2006 to obtain the incidence of vitreoretinal dystrophies.
We studied 36,300 patient files. We found an incidence of 0.008% for familial exudative vitreoretinal dystrophy, 0.008% for X-linked juvenile retinoschisis, 0.005% for Wagner disease and 0.005% for Goldmann-Favre disease. We present here a representative case of each type of dystrophy.
Vitreoretinal dystrophies are uncommon diseases and are difficult to diagnose. Even though their incidence is low, the poor evolution to blindness requires identification of early signs in order to offer timely and opportune treatment.
Cirugia y cirujanos 76(1):13-21. · 0.14 Impact Factor
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ABSTRACT: We undertook this study to demonstrate the visuomotor alterations, intelligence level and depression changes in children with recurrent strabismus.
Children with recurrent strabismus were studied with the Human Figure Test, Lauretta Bender Visuomotor Test, Intelligence Level of Weschler, WISC-R, and WPPSI. Complete exploration of strabismus was made.
We included nine children aged 6.8 years (SD 2). Overfunction of oblique muscles and dissociated strabismus were related to recurrence of strabismus. Stereovision was present in five cases previous to recurrence (rate: 170 sec of arc), and three lost this with recurrence of strabismus. Psychological test determined difficulties in socialization and signs of aggression, including data on depression and "dullness." Bender Test showed relevant defects in fine hand movement, level: 5.4 (SD 1.7). Santucci evaluation for Bender was 3.83 (SD 2.1). Correlation coefficient between values was significant for Santucci evaluation and stereovision (0.89). Global Intelligence Coefficient was 88.1 (SD 12), which was subnormal and poorer in executive function (84).
We have demonstrated relevant alterations in visuomotor abilities in patients with strabismus, especially related to stereovision deficiency, effect on learning, intelligence and depression.
Cirugia y cirujanos 76(2):101-7. · 0.14 Impact Factor
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ABSTRACT: A review of neuronal and psychomotor alterations related to delay of amblyopia treatment was carried out.
We reviewed various studies to explain the anomalies of visual cortex because of the prevalence of anomalous stimulus in patients with amblyopia.
Visual pathways are developed embryologically. The newborn has ocular dominance columns ready to be stimulated, but visual alterations present at this time will generate neuronal changes in visual cortex.
Delay of amblyopia treatment with anomalous visual stimulus will provoke organic changes in visual cortex, inducing alterations of brain functions depending on binocularity. Memory and learning have also been related to this condition.
Cirugia y cirujanos 75(6):481-9. · 0.14 Impact Factor
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ABSTRACT: We undertook this study to evaluate the long-term effects of threshold retinopathy of prematurity (ROP) treatment using Argon laser under indirect ophthalmoscopy, as well as to analyze ocular diseases in those patients.
This is a descriptive, observational, longitudinal and prospective study carried out from March 1991 to February 2005, including patients with threshold retinopathy of prematurity for treatment using Argon laser under indirect ophthalmoscopy. Related ocular diseases were also reported. Descriptive statistics were applied.
Follow-up was maintained for 14 years, 6.50 +/- 1.39 (CI 95%, p < 0.05), and 170 patients were studied. Weight was 1216.50 +/- 152.03 g (CI 95%, p < 0.05). Retinopathy was not present in 42% (72), in stage I-III, 46% (78), and threshold stage, 12% (20). Forty eyes were treated with Argon laser. After treatment, no progressive disease was found in 92.75%. We found high myopia in 20%, macular displacement 7.5%, strabismus 35%, retinal detachment (5%), optical nerve atrophy 5%, and ocular atrophy 5%.
We were able to demonstrate that Argon laser treatment under indirect ophthalmoscopy has been effective in the control of threshold disease. The most important related ocular diseases were strabismus and myopia. Long-term monitoring has permitted us to initiate timely treatment for ocular diseases related to prematurity.
Cirugia y cirujanos 74(2):73-8. · 0.14 Impact Factor
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ABSTRACT: Our aim was to demonstrate metabolic changes occurring in brain cortex during strabismus treatment.
Single photon emission computed tomography (SPECT) of brain was made in patient with strabismus. The study only included congenital esotropia and excluded patients with other anomalies. Strabismus treatment was carried out with botulinum toxin or surgery. Brain SPECT was done prior to and after treatment. Changes were analyzed and related with strabismus response.
We studied three children with congenital and variable esotropia for a total of three cases. In Case 1, basal SPECT showed hypoperfusion in left frontal lobe (7.38). Response to botulinum toxin was good for correcting strabismus and obtaining binocularity from third month. Control SPECT showed correction of perfusion of frontal lobe (-1.19). With Case 2, we observed hypoactivity in left parietal area (8.59); after botulinum treatment, strabismus was corrected and binocularity was demonstrated, while control SPECT showed increase of hypoactivity levels (5.95). Finally, in Case 3, strabismus was corrected at surgery with binocularity. Basal SPECT demonstrated very important hypoactivity in right hemisphere, especially in areas 3, 4, and 5 areas (-0.7, -3.71, and -11.09, respectively); in addition, positive changes after treatment were demonstrated (9.78, 6.44, and 3.22, respectively).
Metabolic changes in brain cortex took place in congenital esotropia with SPECT. In all cases, brain SPECT could demonstrate changes after treatment with improvement of different areas, and good response of motor and sensorial state. This apparently is the first report concerning metabolic changes of brain cortex related with strabismus under treatment, and demonstrates the importance of brain cortex in genesis, evolution, and stability of visual functions and with regard to the failure of these in patients with strabismus.
Cirugia y cirujanos 72(3):165-70. · 0.14 Impact Factor
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ABSTRACT: Strabismus has been related to different alterations of brain functions and learning in children. Early treatment for visuomotor functions may improve the executive areas of intelligence. We undertook this study to demonstrate changes of visuomotor function and intelligence in children after strabismus treatment.
This is a prospective study of patients with strabismus, before and after treatment. We applied the Human Figure Test, Visuomotor Bender Test, and Intelligence Test.
We included nine children with an average age of 8.7 years (± 2.4 years). Stereopsis result was 724 arc sec. Visual acuity was 0.16 logMAR ± 0.15. Verbal intelligence was 91.1 ± 11, executive intelligence (EI) was 86.7 ± 8, and global intelligence (GI) was 91 ± 10. Correlation coefficient of EI was significantly related to stereopsis (-0.2), visual acuity (-0.1) and Bender (-0.1). GI results were higher than statistical prognosis (88.16 for x = 90).
We demonstrated improvement in binocularity and psychoadaptive areas related to EI after strabismus and amblyopia treatment.
Cirugia y cirujanos 78(6):468-72. · 0.14 Impact Factor
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ABSTRACT: We undertook this study to describe central nervous system (CNS) abnormalities associated with congenital cranial dysinnervation disorders (CCDD).
This was a retrospective, observational, transversal and descriptive study including patients with congenital fibrotic strabismus. We analyzed clinical files of patients from 2001 to 2006. Neurological lesions were reported.
Restrictive strabismus was demonstrated in all cases. Sixteen patients were included: nine males and seven females. Different neurological lesions were reported: corpus callosum anomalies, severe cortipathy, epilepsy, cavum vergae, nystagmus, occipital subarachnoid cyst, and hydrocephalus. Mental retardation was reported in 56% of patients. Different malformations were reported: genital malformations, trigonocephalus, camptodactyly, mild facial hypoplasia, low set ears, and agenesis of left ear. Blepharoptosis was present in 81% of patients. The most frequent form of strabismus was exotropia (56%), hypotropia in 37.5%, hypertropia 18.7%, "A" pattern 18.7%, and esotropia in 6.25%. Affection was cranial nerve III, 93.75%; cranial nerve VI, 6.25%; cranial nerve VII, 6.25%; and lesion to cranial nerve II in eight cases (50%).
We have suggested that failure in early stages of embryology of the CNS can lead to the development of paralytic strabismus and generate secondary fibrotic changes, not only in muscle structures but also in other orbital tissues. That is the reason why we have used the term "congenital fibrotic strabismus" to report cases included in CCDD. We have demonstrated the strong association of mental retardation and neurological alterations. Multidisciplinary rehabilitation is relevant for these patients.
Cirugia y cirujanos 77(1):3-8. · 0.14 Impact Factor
