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- ItemAcesso aberto (Open Access)Análise do duplo retrocesso de retos mediais em pacientes esotrópicos portadores de incomitância longe/perto(Conselho Brasileiro de Oftalmologia, 2001-06-01) Barcellos, Ronaldo Boaventura; Andrade, Eric Pinheiro De; Carvalho, Luiz Eduardo M. Rebouças De [UNIFESP]; Souza-dias, Carlos Ramos [UNIFESP]; Universidade de São Paulo (USP); Santa Casa de São Paulo Departamento de Oftalmologia; Universidade de Santo Amaro Faculdade de Medicina; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade de Ciências MédicasIntroduction: Accommodative convergence (AC) is the convergence induced by a determined amount of accommodation (A). Besides the many techniques described to correct esotropias, great distance/near incomitance is still a challenge in avoiding secondary exotropias and esotropias. Objective: To compare the surgical results obtained with double medial rectus recession and its relationship to distance/near incomitance and high hyperopias. Methods: 33 patients with esotropia and distance/near incomitance who where submitted to double medial rectus recession at Santa Casa de São Paulo, between 1980 and 1990 were retrospectively analyzed. There were two groups: those with more than 3.50 D of hyperopias (Group I) and those with less than 3.50 D (Group II). Results: Group I had a mean of 18.18 PD correction (72.72% of correction) for distance and 27.64 PD (63.36%) for near. Group II had a mean of 20.20 PD correction for distance (87.83%) and 34.60 PD (82.78%) for near. Conclusion: There was no statistical difference regarding the amount of distance/near incomitance reduction, between Groups I and II. The total amount of correction was greater for near but, in percentage, it was similar.
- ItemAcesso aberto (Open Access)Aspectos genéticos em estrabismo(Universidade Federal de São Paulo (UNIFESP), 1998) Ferreira, Rosane da Cruz [UNIFESP]; Belfort, Rubens Junior [UNIFESP]OBJETlVoS: ldentificar a percentagem, de famil,a,s com @S de um membro afetado por estrabismo (casos familiares) e a prevalencia do estrabismo em familiares de criancas estrabicas, sendo tres criterios de diagnostico (dxl,dx2,dx3), desde os criterios mais restritos ao mais abrangente. identificar (dx2 e Percentagem de familias que apresentam diferentes tipos de estrabismo entre seus membros e identificar o modelo de heranca genetico mais provavel, segundo os tres niveis diagnosticos. PACIENTES' MATERIAL E METODOS:Foi realizado um estudo prospectivo para o qual foram selecionados como propositos os pacientes que apresentaram um desvio manifesto comitante primario. Todos os Propositos e familiares disponiveis foram submetidos a avaliaCaO Oftalmologica e ortoptica completa. O estrabismo foi diagnosticado segundo tres diferentes criterios: dxl compreendeu somente desvios horizontais manifestos e/ou qualquer desvio vertical; dx2 incluiu, alem dos individuos afetados por dxi, os que apresentaram esoforias maiores ou iguais a 7 dioptrias Prismaticas e exoforias maiores ou iguais 9 e dx3 incluiu alem dos individuos afetados por dx I e dx2, os que apresentaram, amplitudes fusionais anornais, relaCaO convergencia acomodativa/acomodacao superior a 5 A/D, estereopsia inferior ou igual a I 00 segundos de arco, teste das 4 dioptrias Prismaticas e teste duplo de Maddox com respostas anormais. os heredogramas das familias foram desenhados e estudados e a analise da segregacao genetica do estrabismo foi realizada por programa de computador especifico. RESULTADOS: Cento e dez propositos identificaram 107 familias, constituindo um total de 439 individuos examinados. A percentagem de casos familiares foi de 25,23 por cento em dxl, 36,45 por cento em dx2 e 72,9 por cento em dx3. A prevalencia de familiares dos propositos que tambem foram considerados afetados por dx l foi de 8,5 I por cento , por dx2 de 13,07 por cento e por dx3 36,78 por cento . Em 46,1 por cento das familias estudadas, foram encontrados tipos diferentes de estrabismo entre seus membros. A analise dos heredogramas evidenciou percentagem de transmissao vertical em 13,08 por cento das familias segundo dxl, em 21,49 por cento segundo dx2 e em 51,40 por cento segundo dx3, nao tendo sido encontrada consanguinidade em nenhuma das familias estudadas. A analise da segregacao genetica rejeitou a hipotese de heranca mendeliana simples..(truncado..)
- ItemAcesso aberto (Open Access)Autologous grafting of extraocular muscles: experimental study in rabbits(Conselho Brasileiro de Oftalmologia, 2005-06-01) Meireles-teixeira, Jorge [UNIFESP]; Bicas, Harley E. A.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)PURPOSE: To evaluate the feasibility of autologous extraocular muscle grafting as a type of muscle expansion surgery. METHODS: The left superior rectus muscle of twenty-nine rabbits was resected and this fragment was attached to the endpoint of the respective right superior rectus (test group). Thereafter, the superior rectus of the left eye was reattached to the sclera (control group). Both groups were examined during different postoperative periods in order to assess their outcomes. RESULTS: The presence of hyperemia was slightly more frequent in the grafted group. Secretion and muscle atrophy were negligible in both groups. Fibrosis was greater in grafted animals. These muscles were weaker than the control muscles, although the force required to split muscular parts was always greater than the physiological one. CONCLUSIONS: This surgical technique was reliable and useful if one intends to achieve muscle expansion without the intrinsic risks of dealing with heterologous/artificial materials.
- ItemAcesso aberto (Open Access)Bupivacaine and botulinum toxin to treat comitant strabismus(Conselho Brasileiro de Oftalmologia, 2012-04-01) Hopker, Luisa Moreira [UNIFESP]; Zaupa, Priscila Fernandes [UNIFESP]; Lima Filho, Acácio Alves de Souza [UNIFESP]; Cronemberger, Monica Fialho [UNIFESP]; Tabuse, Marcia Keiko Uyeno [UNIFESP]; Nakanami, Célia Regina [UNIFESP]; Allemann, Norma [UNIFESP]; Mendonça, Tomás Scalamandré [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. METHODS: Eight patients (five female) were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique). RESULTS: Mean change in alignment was 10 prism diopters after 180 days (n=6). An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. CONCLUSION: In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxinum A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.
- ItemAcesso aberto (Open Access)Correção cirúrgica da esotropia progressiva do alto míope pela técnica de Yamada: relato de dois casos(Conselho Brasileiro de Oftalmologia, 2005-08-01) Ejzenbaum, Fábio [UNIFESP]; Goldchmit, Mauro; Souza-dias, Carlos R.; Universidade Federal de São Paulo (UNIFESP); Irmandade da Santa Casa de Misericórdia de São Paulo Faculdade de Ciências Médicas Departamento de OftalmologiaProgressive esotropia fixus is a disease present in high myopic patients with a large angle esotropia associated with hypotropia with poor surgical results. This paper has the purpose to describe Yamada's surgical technique (hemitranspositions of the superior rectus and lateral rectus) applied to 2 patients with good surgical results.
- ItemAcesso aberto (Open Access)Correção cirúrgica do estrabismo horizontal em portadores de alta miopia(Conselho Brasileiro de Oftalmologia, 2001-04-01) Ejzenbaum, Fábio [UNIFESP]; Goldchmit, Mauro [UNIFESP]; Souza-dias, Carlos R. [UNIFESP]; Vadas, Marcelo F. Gaal; Santa Casa de São Paulo Departamento de Oftalmologia; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro Departamento de Oftalmologia setor de Motilidade Extrínseca Ocular; Santa Casa de São Paulo Faculdade de Ciências Médicas; Universidade de São Paulo (USP)Purpose: To analyze results of correction of horizontal strabismus surgical in high myopia patients. Methods: A retrospective chart review of 24 patients with esotropia and high myopia (greater than -6.00 spherical diopters) and 17 patients with exotropia and high myopia compared with their control groups. Deviation between 10delta of esotropia and 10delta of exotropia was considered a surgical success. Results: We noticed a high incidence of bad results among the esotropic patients with high myopia. Conclusion: There is a tendency of bad results among the esotropic patients with myopia greater than -6.00 when compared with patients with spherical refractive error between -0.75 and +3.50.
- ItemSomente MetadadadosEfeito do retrocesso e anteriorização do músculo oblíquo inferior hiperfuncionante(Universidade Federal de São Paulo (UNIFESP), 1995) Carvalho, Luis Eduardo Morato Reboucas de [UNIFESP]; Moreira, José Belmiro de Castro [UNIFESP]
- ItemAcesso aberto (Open Access)Genetic aspects of strabismus(Conselho Brasileiro de Oftalmologia, 2002-03-01) Ferreira, Rosane da Cruz [UNIFESP]; Oelrich, Faye; Bateman, Bronwyn; Universidade Federal de São Paulo (UNIFESP); UCLA Jules Stein Eye Institute Department of Ophthalmology; University of Colorado The Children's Hospital Rocky Mountain Lions Eye InstitutePurpose: To evaluate the genetic aspects of strabismus. Methods: Ophthalmic and orthoptic evaluations were performed prospectively on 110 strabismic probands and 478 relatives. We used 3 different criteria in the diagnosis of strabismus: primary diagnosis (dx1) defined as any manifest horizontal or vertical deviation, a secondary diagnosis (dx2) including esophoria (>7 prism diopters) or exophoria (>9 prism diopters), and a tertiary diagnosis (dx3) including abnormal fusional amplitudes, accommodative convergence/accommodation (AC/A) ratio, and/or stereopsis; monofixation syndrome; 4 prism diopters base out; and/or abnormal Maddox test responses. Analyses were carried out within mating types. Results: Hypotheses of autosomal dominant or recessive inheritance with no sporadics were rejected. Based on the dx1, 25% of the families had more than one individual affected and there was vertical transmission in 13%; adding dx2 there were 36% of the families with more than one affected and 21% had vertical transmission; and adding dx3, there were 73% with more than one affected and 51% with vertical transmission. Conclusions: There is evidence for a pattern consistent with an autosomal dominant form of strabismus in most families.
- ItemAcesso aberto (Open Access)Mudanças na refração após cirurgia de correção de esotropia(Conselho Brasileiro de Oftalmologia, 2001-08-01) Vadas, Marcelo F. Gaal; Monteiro, Mário Luiz Ribeiro; Gomes, José Álvaro Pereira [UNIFESP]; Universidade de São Paulo (USP); Santa Casa de São Paulo Departamento de Oftalmologia; Universidade Federal de São Paulo (UNIFESP)Purpose: To evaluate changes in refraction and corneal curvature following surgery for correction of acquired esotropia. Methods: 42 eyes of 21 patients with acquired moderate angle esotropia without any other form of strabismus were prospectively enrolled and submitted to a complete ophthalmological examination followed by recess/resect procedure in a single eye. Data from the fellow eye were selected as control. Ophthalmological assessment was carried out preoperatively, 1 month after surgery and 6 months after surgery, where astigmatism was compared using vector analysis and the polar value concept. Results: The eyes submitted to surgery revealed a significant (p<0.05) decrease in spherical equivalent, from 3.28 ± 1.98 diopters to 3.05 ± 1.95 diopters. Refraction data disclosed a significant increase in the 90° component of net astigmatism, from 0.458 ± 0.594 diopters to 1.002 ± 0.718 diopters, which was also observed in keratometric readings:1.083 ± 0.560 diopters to 1.690 ± 0.591 diopters. Surgically induced astigmatism, assessed using refraction data was 0.63 ± 0.27 diopters at an average axis of 92.30 ± 14.91 degrees, and 0.71 ± 0.27 diopters at an average axis of 94.45 ± 15.69 degrees as obtained by keratometric readings. This is visually demonstrated by the corneal topography difference map. Conclusions: There is a statistically significant and clinically relevant increase in with-the-rule astigmatism in esotropic patients submitted to monocular recess/resect surgery. This change is stable at a 6 month follow-up and is associated with a decrease in mean spherical equivalent.
- ItemAcesso aberto (Open Access)Reoperação nas esotropias congênita e essencial adquirida não acomodativa(Conselho Brasileiro de Oftalmologia, 2011-06-01) Ejzenbaum, Fábio [UNIFESP]; Marques, Adele Christina Manso; Ferreira Pinto, Janine Radd; Souza-dias, Carlos Ramos; Goldchmit, Mauro; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade de Ciências Médicas Departamento de OftalmologiaPURPOSE: To analyze the results in patients reoperated from congenital and essential esotropia. METHODS: A retrospective chart review of 393 patients who underwent surgery from 2000-2004 was performed. Subjects were divided into two groups: Congenital esotropia (91patients) and essential esotropia (302 cases). RESULTS: Among congenital cases we had 9 reoperations (9.9%). There were undercorrections (3.3%), overcorrections (2.2%), anisotropia (V) (1.1%), hypotropia (1.1%) and dissociatd vertical divergences (2.2%). Among the essential cases, there were 31 (10.3%) reoperations due to undercorrections (n=6.6%), overcorrections (n=2%) and hypotropias (1.7%). CONCLUSIONS: Outcomes reoperations rates were 9.9% and 10.2% between congenital and essential esotropias with a higher rate of undercorrections. Amblyopia in both groups and deviations higher than 50∆ in essential esotropias seems to be the most important factors for poor results.
- ItemAcesso aberto (Open Access)Toxina botulínica no tratamento de estrabismo horizontal em crianças com paralisia cerebral(Conselho Brasileiro de Oftalmologia, 2006-08-01) Cronemberger, Monica Fialho [UNIFESP]; Mendonça, Tomás Scalamandré [UNIFESP]; Bicas, Harley Edison do Amaral [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)To evaluate the efficacy of botulinum toxin injection in the treatment of horizontal strabismus in children with cerebral palsy. METHODS: A group of 24 patients, age 6 - 156 months, with cerebral palsy and horizontal strabismus (17 esotropias ranging from 25 to 45 PD and 7 exotropias ranging from 20 to 45 PD) were treated with botulinum toxin (34 medial rectus and 14 lateral rectus muscles). The children underwent full ophthalmic examination. The injection treatment was performed after sedation using Mendonça's forceps. The follow-up was done after 7 days, 15 days and monthly. Deviation less or equal of 10 PD after 6 months of follow-up was considered successful. However, if patients did not achieve this result a second application could be performed. RESULTS: In the group of esotropia (n=17) 47.1% had successful results with only one application after two years of follow-up. All of these patients had previous deviation less than or equal to 35 PD. In the exotropia group a single injection was not sufficient to achieve successful result. The side effects included: subconjutival hemorrhage in 4 (16.7%) patients, transient vertical deviation in 4 (16.7%) and transient ptosis in 22 (91.7%). CONCLUSION: The use of botulinum toxin was a good alternative in the treatment of children with cerebral palsy and esotropia.
- ItemAcesso aberto (Open Access)Treatment outcomes in VI nerve palsy corrected by Carlson & Jampolsky technique(Conselho Brasileiro de Oftalmologia, 2007-12-01) Ejzenbaum, Fábio [UNIFESP]; Pinto, Janine Radd Ferreira; Souza-dias, Carlos Ramos; Goldchmit, Mauro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de São Paulo Faculdade de Ciências Médicas Department of OphthalmologyPURPOSE: To study the results of Carlson & Jampolsky technique in 31 patients with VI nerve palsy. METHODS: We had 23 unilateral and 8 bilateral cases. The mean unilateral preoperative esotropia was 56.8 PD ± 24 PD (30 PD to 100 PD) and they had a mean postoperative follow-up of 14 ± 17.9 months (3 to 72). The mean bilateral preoperative esotropia deviation angle in primary position was 74.5 PD ± 20.7 PD (45 PD to 100 PD) and the mean postoperative follow-up was 14.7 ± 15.7 months (4 to 47). RESULTS: In the unilateral group, 18 patients had good results and reoperation was not necessary. Out of 5 patients who were reoperated (2 undercorrections and 3 overcorrections), 2 had to use prismatic glasses. Among the bilateral patients, 2 cases were reoperated (1 undercorrection and 1 overcorrection), and the undercorrected patient remained with esotropia (ET13 PD), and also had to use prismatic glasses. CONCLUSIONS: Carlson & Jampolsky technique was useful to treat patients with VI nerve palsy. We had low reoperation rates and, among the 7 patients who needed a second intervention, only 3 did not achieve good results.