Hipercorrección secundaria a transposición muscular aumentada

Case report:Patient with abducens palsy treated with Foster technique after injection of botulinum toxin. Exotropia, adduction limitation, face-turn inversion and diplopia were observed during the post-operative period. He was reinterviened by performing a resection on the medial rectus of the affected and toxin was injected into the lateral rectus, as it was technically impossible to remove the scleral fixation with an acceptable result. Two years later diplopia and increased exotropia reoccurred which again required resection.Conclusions:The Foster technique is our technique of choice in complete abducens palsy, however it is important to point out that there could be complications, such as overcorrections.© 2009 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights reserved.     

Espasmo de acomodación unilateral: descripción de un caso y revisión de la literatura

This case report describes a probable unilateral accommodation spasm in a 10 year-old girl with no significant medical history. The right eye showed decreased visual acuity, 0.2 to 0.6 for far distance and 0.125 for near distance. Refraction without cycloplegia showed myopization up to −6 and cycloplegic refraction of + 0.50. The patient had normal ocular motility, orthophoria, normal pupil reflex, normal anterior and posterior segments, normal optical coherence tomography. Neurophysiological tests and brain magnetic resonance imaging were all normal. Treatment with atropine 1% drops for 15 days improved distance visual acuity to 0.8. Accommodation spasm is a rare condition and is usually bilateral. Imaging test are necessary because it may be associated with ocular or head trauma. Treatment consists of cycloplegic drugs (atropine, cyclopentolate); however, there is no defined guideline.     

Transposición del vientre del oblicuo inferior sin desinserción en el tratamiento de la hipertropia en aducción

PurposeTo evaluate the efficacy and safety of inferior oblique muscle transposition and myopexy in patients with mild/moderate inferior oblique muscle overaction, with or without diplopia.MethodWe retrospectively analysed data for the 12 patients who underwent the technique. Data were collected from October 2018 to September 2021. Surgery was performed by suturing the inferior oblique belly to the sclera at 5 mm posterior to the temporal end of the inferior rectus. All 12 patients had mild hypertropia (≤ 6 prism diopters [pd]) in primary position and mild/moderate inferior oblique overaction. Mean preoperative hypertropia was 4.42 pd ± 1.62. Diplopia was recorded in 10 cases. The diagnoses were fourth nerve paresis (9), unilateral primary inferior oblique overaction (2) and dissociated vertical deviation (1). Torticollis was observed in 7 cases, 2 had subjective torsion and 2 objective torsion.ResultsMean age was 46.86 ± 25.1 years (50%: men). Diplopia resolved in 9 of the 10 cases. The mean final vertical deviation was 1.5 ± 2.93 (P = .001) pd in straight gaze. Of 7 mild overshoot in adduction, it disappeared in 3 and 4 remained the same. Of 5 moderate overshoot in adduction, 2 improved to mild and 3 disappeared. Torticollis was eliminated in 5 patients and improved in another 2. Mean time from surgery was 14.08 ± 8.05 months. There were no overcorrections.ConclusionsInferior oblique muscle transposition with myopexy is a safe and effective procedure in patients with mild-to-moderate inferior oblique muscle overaction and small-angle hypertropia, with or without diplopia.     

Suplementación nutricional con omega 3 en retina: relación entre volumen y concentración en productos comerciales

Objective

To analyse the morphometric characteristics and the concentration of (docosahexaenoic acid) DHA and eicosapentaenoic acid (EPA) of the different nutritional supplements with omega 3 available on the market for retinal disease.

Relación entre grosor coroideo y densidad vascular en población joven sana

Background and purposeThe purpose is to analyze choroidal vascular density (VD) in healthy individuals and to compare it with choroidal thickness (CT).Materials and methodsCross-sectional study enrolling healthy individuals between 18 and 35 years old of Caucasian race and with an axial length (AL) 21–26 mm. Choroid was imaged with swept-source optical coherence tomography angiography (OCTA) Triton DRI (Topcon) and a macular cube of 6 mm × 6 mm was obtained. CT values were automatically given by the software. VD values were obtained through codifying colors of the VD map into numbers.ResultsOne hundred and two (51 patients) were analyzed. Mean age was 27.32 ± 3.94 years old, mean intraocular pressure was 18.07 ± 2.38 mmHg, and mean AL was 23.71 ± 0.66 mm. CT was higher in the vertical axis and lower when approaching nasal and temporal sides. The highest CT was in superior macula. The highest choroidal VD were in the fovea and in the juxtapapillary region. The lowest choroidal VD were found in superior and inferior macular areas. Moderate inverse correlations between CT and choroidal VD were found in the juxtapapillary and inferior regions.ConclusionsThe choroid has a thickness pattern that differs from retina. Choroidal vessels represent a very high percentage of choroid in the peripapillary region and in the fovea. On the contrary, superior and inferior macula reveals low values of VD.     

Cuantificación y cualificación del dolor postquirúrgico en la cirugía de pterigión con autoinjerto conjuntival

ObjectiveQuantify and define post-surgical pain after pterygium surgery with conjunctival autografts.Material and methodsThe study included 17 patients. The parameters analysed were, gender, age, pterygium TCL classification, primary characteristics or relapse, usage of isolated tissue adhesive or extra fixation with stitches. A visual analogue pain scale was used immediately after surgery, on the days 2 and 3 post-surgery, and the characteristics of the pain and the frequency of it in days 2 and 3 following the surgery.ResultsA total of 17 eyes of 17 patients were operated. The majority of patients (52.9%) showed moderate pain on the visual analogue scale immediately after surgery. On day 2 after surgery the pain level was mild in the majority of patients with characteristics of sharp pain and lash pain predominantly. On day 3 after surgery, mild pain was also predominant, with characteristics of stinging and lash pain in majority of patients.ConclusionsUsing scales and pain characteristics we can quantify and define post-surgical pain after pterygium surgery with conjunctival auto-grafts resection immediately after surgery and in the following days.     

Anormalidad en la visión del color como única manifestación de hidrocefalia normotensiva

Clinical case

The case is presented of a 73-year-old male patient who referred to having black and white vision. Computed tomography showed normal pressure hydrocephalus (NPH). Magnetic resonance imaging was not performed because the patient refused to undergo further examinations.

Demodicosis ocular: una revisión

Demodex folliculorum and Demodex brevis are ectoparasites that inhabit the skin of humans. They have been related to alterations in the ocular surface, such as, dysfunction of Meibomian glands, blepharitis, chalazion, etc. Ocular demodicosis is characterised by the pathognomonic presence of cylindrical dandruff at the base of the eyelashes, and various symptoms including, among others, itching, lacrimation, and hyperaemia. A bibliographic review was carried out on the role of Demodex spp. in ocular disease, including publications made by the scientific society between 2005 and 2018. A significant relationship was found between prevalence and incidence of Demodex spp. in eye diseases. D. folliculorum is usually found more frequently than D. brevis in ocular infestation, with the prevalence or incidence of infestation by both species increasing with the age of the patient. In patients with blepharitis or other infectious diseases of the ocular surface, unresolved with antibacterial treatment, the search for Demodex spp. should be considered.     

Valores de normalidad de sensibilidad retiniana y fijación foveal mediante microperimetría fotópica y escotópica en población sana

PurposeTo determine normal values of fotopic and scotopic retinal sensitivity and foveal fixation obtained by microperimetry, using MP3-S microperimeter (Nidek, Gamagori, Japan), in a healthy population.MethodsObservational, cros-sectional, single centre study. Fotopic and scotopic microperimetry (MP) was performed using with a customized 13-point fovea-centered pattern in healthy volunteers without ocular pathology. A intraclass correlation coefficient was performed to evaluate fotopic and scotopic MP reliability.ResultsWe analyzed 102 eyes of 54 healthy volunteers (mean age 49.8 ± 15 years old). The fotopic and scotopic mean retinal sensitivity (MRS) was 28.87 ± 3.3 dB and 15.72 ± 1.9 dB (95% CI 15.35-16.09), respectively, showing a significant statistical difference (P < .05). No differences were found when comparing MRS by gender group. However, when analyzing the MRS by age groups, statistically significant differences were found in both modalities of the test, MRS being higher in the group of subjects under 35 years of age, with 30.3 ± 1.7 dB in the photopic and 16.3 ± 1.3 dB in the scotopic, and lower in the group of older than 65 years, with 26.7 ± 2.2 dB in the photopic and 13.8 ± 1.8 dB in the scotopic, with P = .0001. The reliability analysis of both tests revealed an excellent reliability of the fotopic MP with a Cronbach alpha of 0.958 and a good reliability of 0.841 in scotopic MP.ConclusionMP is a test with good reliability both under photopic and scotopic conditions. MRS and fixation stability under photopic and scotopic conditions do not differ according to sex, but it does decrease with age. There is a positive correlation between photopic and scotopic MRS.     

Respuesta a ranibizumab en pacientes con degeneración macular húmeda con tracción vitreomacular

PurposeThe purpose of the present study is to compare the responses to ranibizumab between wet age-related macular degeneration patients, with and without accompanying vitreomacular traction syndrome.MethodsOur database of optical coherence tomography files was searched for eyes of age-related macular degeneration patients that had been treated with ranibizumab, and that had evidence of vitreomacular traction. A control group was selected from the same database for comparison.The case history of each selected individual was reviewed for data regarding the evolution of visual acuity in that patient, and the number of intravitreal injections that had been required to date.ResultsFrom a database of 373 eyes, clear images of vitreomacular traction were obtained for a total of 18 eyes.The mean follow-up period was 20.6 months (SD = 10.6, range = 10.4-31.7).Patients in the vitreomacular traction group had been given an average of 5.1 injections versus an average of 4.2 injections in patients in the control group.The mean changes in visual acuity (which was measured using ETDRS charts) were -15 letters and -4 letters in the vitreomacular traction and control groups (P=.07), respectively.ConclusionsAfter ranibizumab treatment, age-related macular degeneration patients with accompanying vitreomacular traction showed a tendency to have a poorer prognosis in terms of visual acuity than patients without this finding. In addition, higher numbers of intravitreal injections were required to obtain clinical responses in patients with vitreomacular traction.     

Síndrome de retención aguda lagrimal asociada a infección por virus de Epstein-Barr

A 4 year-old boy with no previous history of eye or nasolacrimal disease was referred due to a painful mass on his left inner canthus, of 3 days onset, with no improvement in spite of oral antibiotics. On examination eyelid oedema with periocular hyperaemia was noted. Lacrimal sac palpation was painful and tonsillar exudation was reported. He was admitted and started on intravenous antibiotics. Four days later, lacrimal signs started to improve, but his general condition become worse. Head and neck computed tomography scan showed a left lacrimal sac enlargement, suggestive of acute dacryocystitis and swollen laterocervical lymph nodes. Epstein Barr virus (EBV) serology and PCR testing were positive. The child responded well after 8 days, and was discharged with oral antibiotics. Acute dacryocystic retention associated with EBV was suspected. Six months later, the patient remained asymptomatic with no tearing or other lacrimal symptoms.     

Discromatopsias y exposición a solventes orgánicos: una revisión sistemática

Objective

To evaluate recent evidence concerning the relationship between the exposure to organic solvents and the impairment of colour vision.

Afectación retiniana tras inyección accidental intravítrea de mepivacaína y epinefrina

Case report

The case is presented of a 32 year-old male with no medical history of interest who suffered a traffic accident with mild traumatic brain injury. He had a left supraciliary incised and contused wound that extended to the left upper eyelid, with no loss of vision.After palpebral anaesthetic injection, there was a sudden visual acuity decrease in the left eye and hyposphagma located between I-III at 4 mm from the limbus, with increased intraocular pressure. A whitish lesion with a central haemorrhagic focus was observed in the ocular fundus, corresponding to the area where the hyposphagma was located.

Oclusión de la arteria central de la retina como complicación oftalmológica luego de un accidente ofídico

Snakebite causes 421,000 - 1,200,000 poisonings per year due to hematotoxicity, neurotoxicity and vasculotoxicity. Ophthalmological manifestations secondary to snake bites are rare. If the snake belongs to the Viperidae family, the most frequent ophthalmologic manifestations are macular infarction, chronic open-angle glaucoma, and retinal or vitreous hemorrhage. Central retinal artery occlusion is an extremely rare ocular complication. We report the case of a 30-year-old patient, who consulted due to poor vision in her left eye weeks after suffering a snake bite (Bothrops atrox) in her left lower limb. The diagnosis was a central retinal artery occlusion in the left eye with abnormal findings in the ophthalmological physical examination and in complementary retinal and neuro-ophthalmological tests.     

Presentación orbitaria de enfermedad de Rosai-Dorfman

Objective

To report a case of orbital mass and proptosis, diagnosed as Rosai-Dorfman disease (RDD).

Adaptación cultural y validación al castellano del cuestionario National Eye Institute Visual Function Questionnaire 25

Introduction

Advances in medicine have contributed to a higher average life expectancy, as well as an increasing number of chronic diseases patients. This longevity means that the assessment of the quality of life, particularly that related to vision, has become very relevant.

Validación de la escala de graduación del color en la fotografía del nervio óptico,una alternativa para la clasificación cualitativa

BackgroundTo validate objectively the proposed Teherán-Morales's color grading scale, comparing to the subjective readings of specialists in optic nerve photography.MethodsConcordance study and diagnostic tests, in which 150 photographs of the optic nerve were evaluated, from three groups, glaucomatous neuropathy, neuropathy of other origin and control group with the Teherán-Morales's color scale and the analysis of three experts in optic nerve. Spearman's Rho correlation was performed between both analysis methods.ResultsIn the analysis of all the photographs using Spearman's Rho, we found moderate correlations that were statistically significant P < .0001, the highest was in the temporal quadrant by observer 1 (r = 0.650 95% CI 0.546 to 0.733). In photographs of optic neuropathy, the correlations become moderately high, and statistically significant P < .0001, the highest correlation was for the temporal quadrant by observer 1 (r = 0.772 95% CI 0.626 to 0.865). In the glaucoma and normal eyes groups, there were moderate to low correlations with statistical significance P < .05.ConclusionsThe Teherán-Morales's scale, for color grading, is useful in detecting color, correlates moderately with the subjective assessment of experts in the optic nerve having its best performance in optic neuropathy with very pale discs. However, in normal or glaucomatous optic discs, it has a low correlation, compared to the subjective clinical assessment.