Mauro Goldchmit

Intermittent exotropia: comparative surgical results of lateral recti-recession and monocular recess-resect

PURPOSE To compare the results between recession of the lateral recti and monocular recess-resect procedure for the correction of the basic type of intermittent exotropia. METHODS 115 patients with intermittent exotropia were submitted to surgery. The patients were divided into 4 groups, according to the magnitude of preoperative deviation and the surgical procedure was subsequently performed. Well compensated orthophoria or exo-or esophoria were considered surgical success, with minimum of 1 year follow-up after the operation. RESULTS Success was obtained in 69% of the patients submitted to recession of the lateral recti, and in 77% submitted to monocular recess-resect. In the groups with deviations between 12 PD and 25 PD, surgical success was observed in 74% of the patients submitted to recession of the lateral recti and in 78% of the patients submitted to monocular recess-resect. (p=0.564). In the group with deviations between 26 PD and 35 PD, surgical success was observed in 65% out of the patients submitted to recession of the lateral recti and in 75% of the patients submitted to monocular recess-resect. (p=0.266). CONCLUSION Recession of lateral recti and monocular recess-resect were equally effective in correcting basic type intermittent exotropia according to its preoperative deviation in primary position.

Unilateral Anterior Transposition of the Inferior Oblique Muscle for Correction of Hypertropia in Primary Position

PURPOSE To evaluate the correction of hypertropia in primary position with unilateral inferior oblique (IO) anterior transposition (IOAT). METHODS Ten patients with idiopathic (nonparalytic, restrictive, or dissociated vertical deviation) hypertropia with marked IO overaction, who underwent unilateral IOAT, were prospectively evaluated to observe the correction of the hypertropia in primary position. No previous ocular muscle surgery had been performed. Four patients had esotropia and two had exotropia. In addition to the proposed surgery, horizontal procedures were performed to correct horizontal deviation, but no vertical transposition of horizontal muscles was done. Four patients had hypertropia and IO overaction, without horizontal strabismus, and IOAT was the only procedure performed. The IO muscle was reinserted 1 mm laterally to the lateral extremity of the inferior rectus muscle insertion using only one suture. The statistical analysis was performed by Wilcoxon rank sum test. RESULTS The mean absolute correction in primary position was 18.1 prism diopters (PD) (range, 4 to 33), directly proportional to the size of the hypertropia before surgery. Nine of the 10 patients had a residual vertical deviation of </=6 PD. After surgery, 4 patients (40%) presented limited elevation in adduction (-2) in the field of the operated IO, presumably caused by the antielevator effect of the transposed muscle, which did not improve during the follow-up period (range, 2 to 79 months). CONCLUSION Unilateral IOAT is an effective technique for correction of large hypertropia associated with marked unilateral IO overaction. Some lower lid curvature deformity and some limitation of elevation were observed in forced upgaze in some patients, but this was of no cosmetic importance.

Surgical correction of strabismus in Lambert-Eaton myasthenic syndrome: case reports

Lambert-Eaton myasthenic syndrome is a rare and acquired autoimmune disorder. We describe two female patients with medial rectus paresis as the only ocular manifestation. After a unilateral medial rectus recession and lateral rectus resection procedure, both patients recovered normal adduction. To our knowledge, this is the first report of surgery for extraocular muscle paresis in Lambert-Eaton myasthenic syndrome.

Projeto piloto de informatização dos prontuários do setor de motilidade ocular extrínseca da Santa Casa de São Paulo

PURPOSE To develop a system of support to the research in the field of the computer science, based on the automatic search of information, on the percentage of patients with certain characteristics and the crossing of this information among themselves. METHODS A computer with Pentium III 650 MHz processor, 128 MB RAM, 32 MB video plate, free 20 MB in the hard disk and fitted with Windows 98/2000/XP. The data base used to store the information is Interbase version 6.1 and the program was developed in Delphi 5.0 language. Three hundred and four charts of esotropia-operated patients were registered in the Extrinsic Ocular Motility Sector of the Departament of Ophthalmology of the College of Medical Sciences of the Santa Casa of Misericórdia of São Paulo, in the period from 07/02/1976 to 03/09/1992. To include the patients in the program, a questionnaire was elaborated, with the relevant clinical variations of this type of misalignment. Examples of totalizations and crossings of information were presented. RESULTS This new program will be able to contribute to scientific research, accelerating data collection. After registering the patients any type of survey, election of a specific group of patients or crossing of data may be obtained in seconds. CONCLUSION This can be made for all ophthalmologic specialties, varying the questionnaire in accordance with each specialty.

Reoperação nas esotropias congênita e essencial adquirida não acomodativa

PURPOSE: 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.

Correção cirúrgica do estrabismo horizontal em portadores de alta miopia

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 10D of esotropia and 10D 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.

Prevalence of refractive errors in Möbius sequence

PURPOSE To assess the prevalence of refractive errors in Möbius sequence. METHODS 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. RESULTS 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%. CONCLUSION The prevalence of refractive errors, by the spherical equivalent, was 42.4% in this studied group.

Acquired oculomotor muscle fibrosis in infant: case report

The authors report the case of a 5 year-old boy who up to 2 years old presented normal eyes, when his right eye started to deviate upward and laterally, until be hidden under the superior lid. At the surgery, a strong passive limitation to infraduction of this eye was felt. He had already been operated on in another clinic, but the surgeon could not succeed in hooking his superior rectus. With great difficulty, the only thing that we could do was a free tenotomy of the superior rectus. As the eye was equilibrated in a moderate abduction, we performed an 8 mm recession of the lateral rectus. As there was still a small hypertropia and exotropia postoperatively, we performed in a second operation an eight millimeters resection of the medial rectus, a recession with anterior transposition of the inferior oblique and an advancement of the inferior rectus according to the Romero-Apis technique, in order to avert circulatory problems to the anterior segment of the eye. As he presented a small blepharoptosis, we did, in a third surgery, a tarsectomy according to the Fasanella-Servat technique, with good result. He ended with good eye position, almost no limitation of the horizontal movements and - 3 limitation of up and down ductions. The magnetic resonance imaging showed an altered image of the superior rectus, suggesting fibrosis post myositis.

Treatment outcomes in VI nerve palsy corrected by Carlson & Jampolsky technique

PURPOSE 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.

Gente com quem, também, se faz a revista

De entre os agradecimentos e homenagens devidas pelos Arquivos Brasileiros de Oftalmologia e que ja se tornaram tradicionais, ao fim de cada ano de trabalhos, uma delas nos e especialmente importante trazer a conhecimentos gerais. A nomeacao dos revisores dos trabalhos encaminhados a publicacao e a forma singela de expressarmos a essas pessoas a gratidao da Oftalmologia brasileira pelas horas que lhe sao graciosamente dedicadas a como ela vai se apresentar ao mundo, no presente e no futuro. De fato, a figura do analista de trabalhos numa revista cientifica identifica-se com a de seu maior patrimonio: a qualidade do que chega a luz, a garantia de confiabilidade no que se apresenta. Ao apontar impropriedades de exposicao e de conteudo num artigo que se candidata a publicacao, o conselheiro editorial beneficia um variado contingente de pessoas. Em primeiro lugar ao proprio autor, evitando-lhe a exposicao de suas omissoes e incorrecoes em materia cuja publicacao venha a ter recusada; ou permitindo-lhe seus aprimoramentos nas que vierem a ser aceitas, por seus aconselhamentos e sugestoes. Em certos casos, a contribuicao dada ao(s) autor(es) por um conselheiro editorial e, inequivocamente, maior que a de colaboradores do trabalho diretamente nomeados. Dai a razao de os Arquivos Brasileiros de Oftalmologia oferecerem aos analistas, ao fim do sigiloso processo de julgamento em que se aprova a publicacao do artigo, a oportunidade de se declararem como seus examinadores. Em segundo lugar, alem da ajuda ao(s) autor(es), vem a prestada aos editores (facilitando-lhes as decisoes sobre a publicacao) e aos revisores da apresentacao (linguagem, convencoes biblioteconomicas). E, por fim, a comunidade cientifica, aos leitores em geral, provendo-lhes a substância da qual se nutre o conhecimento, renovando-lhe e expandindolhe os limites ao de certo modo avalizar as propostas de suas superacoes. Essas responsabilidades e contribuicoes, cabentes aos conselheiros editoriais, nao sao exercidas, apenas, pelos que aparecem nomeados em cada um dos fasciculos da revista, compondo um quadro que, embora numeroso, torna-se cada dia mais insuficiente para as necessidades das revisoes. Neste ano que agora finda, por exemplo, foram recebidos ate novembro 478 artigos para analise. Como pelo menos dois revisores sao selecionados para cada materia chega-se a um total de aproximadamente 956 exames, o que daria cerca de onze trabalhos por ano a cada um dos 68 titulados como conselheiros editoriais nacionais. Gente com quem, tambem, se faz a revista