Nilza Minguini

Characteristics of a pediatric low-vision population.

BACKGROUND Assessment of the causes of childhood blindness is important to develop preventive and therapeutic strategies that can reduce the incidence of visual impairment. METHODS A retrospective survey of the clinical records of 395 consecutive children younger than 14 years of age who were attended by the Low Vision Service of State University of Campinas (UNICAMP) was conducted. Data on the age distribution, the causes of low vision, the types of low vision aids prescribed, the follow up of their use, and improvement in visual acuity were obtained. RESULTS Congenital bilateral toxoplasmic macular scars, optic atrophy, and congenital cataracts were the major causes of low vision in this population. The optical aid most frequently prescribed was a telescope. The improvement of visual acuity with the use of aids was highly significant.

Use of Ivermectin in the Treatment of Orbital Myiasis Caused by Cochliomyia hominivorax

Orbital myiasis cases by dipterous fly larvae are rarely reported. A case of massive orbital myiasis caused by Cochliomyia hominivorax resulting in complete loss of the globe is described. Oral ivermectin was used successfully to eliminate the larvae prior to enucleation, making the mechanical removal of larvae an unnecessary procedure.

Results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus

OBJECTIVE: To evaluate the results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus. INTRODUCTION: Monocular surgery may preserve some muscles if a repeat operation is required, may help to avoid the exposure of the dominant eye to the inherent risks of a surgical procedure and may reduce surgical time. METHODS: We evaluated ninety-two consecutive patients who underwent monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus (angle of 40 prism diopters or greater). Patients were divided into group 1- esotropia and group 2 –exotropia. The postoperative follow-up was at 6 months, when the residual deviation was evaluated. In cases of residual deviations of over 15 PD (prism diopter), a second procedure was indicated. RESULTS: In all patients with preoperative deviations up to 60 PD, residual deviations were under 15 PD. Some patients with preoperative deviations of 65 PD (two in group 1 and four in group 2) and all patients with deviations over 65 PD had residual deviations over 15 PD. The 13 patients who underwent a second procedure experienced successful outcomes. Our ROC curve analysis showed that the cutoff point for obtaining a successful surgical result was 62.5 PD. No patient presented with a major limitation in respect of ocular movement. CONCLUSIONS: Monocular surgery under peribulbar anesthesia can be an alternative for horizontal large-angle strabismus given deviations of up to 60 PD. Monocular surgery did not result in successful outcomes for deviations of over 65 PD.

Surgery with intraoperative botulinum toxin-A injection for the treatment of large-angle horizontal strabismus: a pilot study

Some patients with large-angle strabismus may refuse or may not meet the criteria for binocular surgical correction. A second option for these patients involves a monocular procedure, which can be performed under peribulbar anesthesia and offers certain advantages (1). Improved surgical outcomes for conventional procedures may enhance the effectiveness of monocular surgery. In theory, this enhancement could be achieved by the coadjuvant use of intraoperative botulinum toxin A (BT) (2). To date, few reports have described the intraoperative injection of BT (3-5). Owens et al. (3) performed supramaximal monocular recession-resection surgeries and successfully used intraoperative BT in three large-angle exotropia patients. Khan (4) successfully performed two-muscle horizontal rectus surgery with simultaneous BT injection in patients with severe large-angle esotropia. Additionally, seven patients underwent bilateral medial rectus recession and bilateral BT injection, and one patient underwent a unilateral recess/resection surgery with medial rectus BT injection. These results indicated that bilateral medial rectus recession with simultaneous BT injection is a safe and effective surgical procedure for patients with severe large-angle esotropia, although more extensive studies are required to confirm these findings. Oskan et al. (5) reported the results of 10 patients with large-angle horizontal deviations (eso- or exotropia) who received BT injections into one recessed muscle and concluded that such treatment may provide greater surgical success compared to conventional horizontal rectus muscle surgeries. The results of these uncontrolled studies have reinforced the hypothesis that long-term realignment of the eyes can be achieved with surgery plus BT administration. However, the effectiveness of the addition of intraoperative BT compared to surgery alone is unclear. In this pilot study, we used a prospective, controlled, and randomized double-blind methodology to examine the effectiveness of BT injection in combination with surgical treatment compared to surgical treatment alone for the correction of large-angle horizontal deviations under local anesthesia.

Peribulbar versus general anesthesia for horizontal strabismus surgery

PURPOSE To compare the results of strabismus surgery under peribulbar and general anesthesia in cases of small and moderate angle of horizontal strabismus. METHODS Medical records of eighty-four patients with small and moderate angle horizontal strabismus who underwent strabismus surgery were reviewed. Forty-two patients were submitted to the surgery under peribulbar anesthesia and forty-two under general anesthesia. The surgery was considered satisfactory when postoperative angle was 10 prism diopters or less. RESULTS Surgery was satisfactory in all patients. Mann-Whitney test showed no difference in the preoperative angle of deviation (p=0.366) and in the postoperative results (p=0.800) between the two groups. Adjusting for the variables age and type of strabismus (esotropia and exotropia), ANCOVA (analysis of covariance) results showed no statistical difference (p=0.368). There were no complications due to surgery or anesthesia in either group. CONCLUSIONS This study suggested that there was no difference between the postoperative results of strabismus surgery under peribulbar and general anesthesia in small and moderate angle of horizontal strabismus.

Strabismus surgery learning for Ophthalmology residents of university service

PURPOSE To verify Ophthalmology residents and supervisors perceptions regarding learning and teaching strabismus surgery. DESIGN Descriptive Study. METHODS SUBJECTS 1(st) and 2(nd) year residents. Each resident studied the standard strabismus surgery technique on a CD-ROM, then performed a rabbit rectus muscle recession and a strabismus surgery on a patient. A structured questionnaire was handed to the residents, and the authors made observations including variables referring to the surgical technique applied, self-evaluation of this technique and if appropriate training was given. RESULTS Thirty-eight questionnaires were analysed. All 1(st) year residents (R1) had had some difficulty remembering the surgery sequence and 69.6% of 2(nd) year residents (R2). Concerning the surgical material handling, 93.3% of R1 and 52.2% of R2 had had any difficulty. The residents reported that during the surgery in humans, 50% remembered the experimental stage and that this training completely fulfilled their needs for 47% and partially for other 47%. CONCLUSION Experimental surgery, more practice opportunities and residents supervision may improve the teaching of strabismus surgery.

Anterior transposition compared to graded recession of the inferior oblique muscle for V-pattern strabismus

objective To compare the efficacy of anterior transposition (AT) and graded recession (GR) in the treatment of V- pattern strabismus caused by overaction of the inferior oblique muscle. methods The charts of surgically treated cases of V-pattern strabismus were analyzed retrospectively and the patients classified as AT or GR. Age, initial horizontal deviation, initial V-pattern and the amount of V-pattern correction were compared between the two groups. results There was no significant difference in age (p = 0.066), initial horizontal deviation (p = 0.59), initial V-pattern (p = 0.15) or the amount of V-pattern correction (p = 0.78) between the two groups. conclusion AT is at least as effective as GR in the treatment of V-pattern strabismus caused by overaction of the inferior oblique muscle.

Traumatic avulsion of extraocular muscles: case reports

We described the clinical, surgical details and results (motor and sensory) of the retrieving procedure of traumatically avulsed muscles in three patients with no previous history of strabismus or diplopia seen in the Department of Ophthalmology, State University of Campinas, Brazil. The slipped muscle portion was reinserted at the original insertion and under the remaining stump, which was sutured over the reinserted muscle. For all three cases there was recovery of single binocular vision and stereopsis.