Exotropia Research Articles

Клинический случай поэтапного лечения ребенка с анизометропической амблиопией и гиперметропией, сочетающейся с расходящимся косоглазием

Case study A clinical case of staged treatment in a child with anisometropic amblyopia and hyperopia combined with divergent strabismus I.L. Kulikova, K.A. Aleksandrova, S.M. Pikusova, A.V. Kuzmina S. Fyodorov Eye Microsurgery Federal State Institution, Cheboksary Branch, Cheboksary, Russian Federation Postgraduate Doctors’ Training Institute, Cheboksary, Russian Federation A clinical case of a child with anisometropic amblyopia, hypermetropia and divergent strabismus is considered. Clinical and functional results of staged treatment, including refractive laser surgery and surgical correction of strabismus, are presented. This treatment makes it possible to create optimal conditions for the more effective treatment of amblyopia and preservation of orthotropia in children with anisometropic amblyopia, hypermetropia and divergent strabismus. Key words: amblyopia, hyperopia, exotropia, FS-LASIK

Differential diagnosis of thyroid orbitopathy - diseases mimicking the presentation or activity of thyroid orbitopathy.

Thyroid orbitopathy (TO) is the most common cause of orbital tissue inflammation, accounting for about 60% of all orbital inflammations. The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Magnetic resonance imaging (MRI) of the orbit is used not only to identify swelling and to differentiate inflammatory active from non-active TO, but also to exclude other pathologies, such as orbital tumours or vascular lesions. However, a group of diseases can mimic the clinical manifestations of TO, leading to serious diagnostic difficulties, especially when the patient has previously been diagnosed with a thyroid disorder. Diagnostic problems can be presented by cases of unilateral TO, unilateral or bilateral TO in patients with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and history of increasing diplopia at the end of the day. The lack of visible efficacy of ongoing immunosuppressive treatment should also raise caution and lead to a differential diagnosis of TO. Differential diagnosis of TO and evaluation of its activity includes conditions leading to redness and/or swelling of the conjunctiva and/or eyelids, and other causes of ocular motility disorders and eye-setting disorders. In this paper, the authors review the most common diseases that can mimic TO or falsify the assessment of inflammatory activity of TO.

PNPT1 Spectrum Disorders: An Underrecognized and Complex Group of Neurometabolic Disorders

An 18-year-old man presented with slowly progressive infancy-onset spasticity of the lower limbs and cerebellar ataxia, associated with painless strabismus, intellectual disability, urinary incontinence, bilateral progressive visual loss, and cognitive decline since early adolescence. A neurological examination disclosed spastic dysarthria, left eye divergent strabismus, bilateral ophthalmoparesis, impaired smooth pursuit, severe spastic paraparesis of the lower limbs with global brisk tendon reflexes, bilateral extensor plantar responses, and bilateral ankle clonus reflex. Bilateral dysdiadochokinesia of the upper limbs, Stewart-Holmes rebound phenomenon, bilateral dysmetria, and a bilateral abnormal finger-to-nose test were observed. Markedly reduced bilateral visual acuity (right side 20/150, left side 20/400) and moderate to severe optic atrophy were detected. Neuroimaging studies showed cerebellar atrophy and bilateral optic nerves and optic tract atrophy as the main findings. As a complicated Hereditary Spastic Paraplegia, autosomal dominant Spinocerebellar Ataxia, or inherited neurometabolic disorders were suspected, a large next-generation sequencing-based gene panel testing disclosed the heterozygous pathogenic variant c.162-1G>A in intron 1 of the PNPT1 gene. A diagnosis of PNPT1-related spastic ataxia was established. Clinicians must be aware of the possibility of PNPT1 pathogenic variants in cases of spastic ataxia and spastic paraplegias that are associated with optic atrophy and marked cognitive decline, regardless of the established family history of neurological compromise.

Recidiva orbital da leucemia linfoide aguda LLA em crianças: relato de caso

INTRODUCTION: The recurrence of childhood ALL involving the eyeball is a rare event, occurring in 2.2% of children. The presence of specific orbital and ocular lesions is associated with a higher frequency of bone marrow relapses and CNS involvement, leading to a lower survival rate. OBJECTIVES: Conduct a longitudinal observational analysis of cases of orbital recurrences of ALL in children undergoing treatment at a reference oncology hospital in Western Paraná. CASE REPORT 1: 1-year-old female patient, undergoing treatment for ALL, presented with a whitish lesion in her left eye. In consultation with an ophthalmologist, an alteration of the red reflex with vitritis was observed in the left eye, and in the right eye an elevated lesion suggestive of an intraocular mass was seen. After months of investigation, it was concluded that there was orbital recurrence of ALL, and treatment was initiated according to BFM-90 for recurrences. CASE REPORT 2: 2-year-old female patient, undergoing treatment for ALL, presented skin lesions, right periocular edema and divergent strabismus. MRI of the orbit showed diffuse thickening of the optic nerves in their intraconal and canicular segments and part of the cisternal path, suggestive of infiltration of the optic nerves by the underlying disease. After confirming the diagnosis of ALL orbital recurrence, treatment was carried out according to the BFM-90 protocol. CONCLUSION: Through this research, the importance of a thorough evaluation of ophthalmological signs and symptoms in patients diagnosed with ALL was evidenced, for an early diagnosis and treatment.

Contrast sensitivity and aspects of binocular vision alteration in school-aged children after head injury.

Aim: The research aimed to establish whether contrast sensitivity is a reliable method of evaluation in the case of school-aged children after head injury, and also to establish aspects of binocular vision alteration in the acute phase of TBI. Materials and methods: Forty-eight individuals with persisting visual symptoms after brain injury have been examined. Results: The rate of contrast sensitivity was determined to be 61%-100% in the research group in 56,3%-58,3% cases, compared to the control group, in which the prevalence was 93,7%-95,8% cases. Repeated evaluation during 4 months after the head trauma revealed an incidence of 83,3%-89,6% for the research group and 97,9% for the control group in the same 61%-100% interval. Binocular vision proved to be unchanged in 79,17% of patients, being determined as absent only in 4,16% of patients who later presented a secondary divergent strabismus. Conclusions: Contrast sensitivity is an easily performed method for the group of school-aged children after head injury. Although it is often considered by children an interesting game, its results should be taken into consideration while suspecting a traumatic optic neuropathy. Since most of the pediatric patients aged between 7-18 years, show a slight decrease of contrast sensitivity ability after head trauma, this examination should be performed as a part of ophthalmological evaluation in pediatric patients following head injury.

Polioencephalopathy in Eurasier dogs.

Polioencephalopathies secondary to inborn errors of metabolism have been described in dogs, but few genetically characterized. Clinically and genetically characterize polioencephalopathy in a family of Eurasier dogs. Three Eurasier dogs (littermates) presented with early onset movement disorders (9 weeks in 2, 4-6 months in 1). Progressive gait abnormalities were detected in 2 of the dogs, persistent divergent strabismus in 1, whereas consciousness and behavior remained intact in all dogs. One dog was euthanized at 25 months. Video footage was assessed in all dogs, and Dogs 1 and 2 had examinations and investigations performed. Whole genome sequencing of Dog 1 and further genetic analyses in the family were performed. A cohort of 115 Eurasier controls was genotyped for specific variants. Episodes were characterized by generalized ataxia, as well as a hypermetric thoracic limb gait, dystonia, and irregular flexion and extension movements of the thoracic limbs. Magnetic resonance imaging of the brain in Dogs 1 and 2 identified symmetrical, bilateral T2 and fluid attenuated inversion recovery hyperintense, T1 hypo to isointense, nonenhancing lesions of the caudate nucleus, lateral and medial geniculate nuclei, thalamus, hippocampus, rostral colliculus and mild generalized brain atrophy. Genetic analyses identified a homozygous mitochondrial trans-2-enoyl-CoA reductase (MECR) missense variant in all 3 dogs, and a homozygous autophagy-related gene 4D (ATG4D) missense variant in Dogs 1 and 2. We describe a presumed hereditary and progressive polioencephalopathy in a family of Eurasier dogs. Further research is needed to establish the role of the MECR gene in dogs and the pathogenic effects of the detected variants.

Binocular Function in Adults Before and after Strabismus Surgery

Purpose: To evaluate the state of binocular vision, the amount and direction of the ocular deviation before and after strabismus surgery in adult patients and to monitor the occurrence of postoperative complications. Methods: The retrospective study of 58 adult patients with selected types of strabismus who were surgically treated in the Eye Department of the Tomas Bata Regional Hospital in Zlín. We evaluated the amount and the degree of the primary ocular deviation and the binocular alignment before and after surgery, as well as the state of binocular vision after surgery and the occurrence of postoperative complications. Results: The average deviation in convergent strabismus before surgery was +23.46 degrees, after surgery +6.6 degrees, in divergent strabismus it was -21.5 degrees, after surgery -1.48 degrees, for vertical strabismus before surgery +12.5 degrees and +3.75 degrees after surgery and in paralytic strabismus +20 degrees before surgery and +3 degrees postoperatively. Preoperatively there was effectively no binocular vision in up to 63.9% of patients, superposition occurred in 31%, fusion in 5.1%. No patient had stereopsis before surgery. After surgery, superposition was present in 39.7%, fusion in 31% and stereopsis in 6.9% of patients. Only 22.4% of patients experienced no binocular vision after surgery. Of the selected 21 patients out of 58 with an observation period of at least 3 years, we observed an improvement or development of binocular vision functions after surgery in 12 patients and no improvement of binocular vision functions in 9 patients. In the first group, 58.3% had a stable deviation throughout the follow-up period. While in the second group the deviation was stable in only 33.3%. We can assume that the improvement in binocular vision function after strabismus surgery, leads to a greater longer-term stability of postoperative deviations. Conclusion: Strabismus surgery in adult patients is an effective and safe method, which is not only a cosmetic procedure used to adjust the position of the eyes, but also enables us to induce or improve the state of binocular vision functions.

Crouzon Syndrome (Congenital Craniofacial Dysostosis): from the Clinical Case to the Review of Craniosynostosis

Crouzon disease or Crouzon syndrome (CS) is a rare congenital anomaly that is caused by intrauterine premature closure of the coronal, sagittal and lambdoid sutures causing abnormal growth of the skull. It is considered an ultra-rare (ultra-orphan) disease, with an incidence of 1/50,000-60,000 neonates. We present the case of a 78-year-old woman with CS who presented congenital craniosynostosis with turricephaly, hypertelorism, external strabismus with bilateral exophthalmos and blindness (due to atrophy of the optic nerve of the right eye), maxillary hypoplasia, hearing loss, narrow palate, mandibular prognathism, malocclusion with crossbite, anosmia, parrot-beak nose, thin upper lip and facial asymmetry. It is a genetic disease with autosomal dominant inheritance, complete penetrance and variable expressivity. It is caused by mutations in the FGFR2 gene (chromosomal locus 10q25-10q26). From 30 to 60% of the cases are sporadic because they are new mutations (de novo mutations). The prenatal diagnosis of this entity is difficult, since the early welding of the sutures generally begins after birth. The diagnosis is fundamentally clinical, which must be complemented with imaging studies. Appropriate genetic counseling is necessary. In the future, with advances in clinical genetics, most craniosynostoses could be avoided if we incorporate the genetic study of the different genes involved (already known) to carrier screening. For this, it is necessary to promote assisted reproduction techniques (preimplantation genetic diagnosis). The cases that correspond to de novo mutations cannot be avoided through these strategies. Regarding treatment, an early diagnosis is required to plan a highly specialized surgery that allows the remodeling of the skull and face so as to achieve good aesthetic and functional results, and avoid some of the auditory and visual complications. In this article we review the embryology of the skull, craniosynostosis, and more specifically of CS.

Clinical features of Helveston syndrome and discussion of individualized surgical design.

Reasonable personalized surgical design can achieve good treatment results for Helveston syndrome in one surgery, reducing the psychological and economic burden on patients. This article aims to explore the clinical characteristics of Helveston syndrome and the clinical effectiveness and feasibility of individualized surgical design. In this retrospective case series study, 28 patients who underwent strabismus correction for Helveston syndrome at the Affiliated Hospital of Yunnan University from June 2018 to December 2020 with complete follow-up data were enrolled. Preoperatively, all patients received standard assessment of vision, intraocular pressure, slit lamp, fundus and refractive status, excluding other eye diseases, as well as detailed special examination of strabismus. These patients were divided into two groups according to the surgical modality: the horizontal muscle surgery alone group and the horizontal muscle surgery combined with superior oblique muscle surgery (combined surgery) group. We used SPSS software for data analysis and compared the postoperative eye position, eye movement, success rate, and reoperation rate between these two groups. Clinical measurement data were compared and analyzed with Fisher's exact test for count data, the t-test for normally distributed measurement data, and the Mann-Whitney U test for non-normally distributed measurement data. P<0.05 was considered statistically significant. This study included a total of 28 patients with Helveston syndrome, including 20 males and 8 females. The average age at the time of surgery is 12.04 ± 8.67 years (range, 4-43 years). The postoperative A-pattern degree was significantly greater in the group undergoing horizontal muscle surgery alone [6.23±1.31 prism diopters (PD); range, 0-10 PD] than in the group undergoing combined surgery (0.53±0.32 PD; range, 0-4 PD; P=0.002). Superior oblique muscle overactivity was significantly reduced in the combined surgery group (0.20±0.11+; range, 0-1+) compared to the horizontal muscle surgery alone group (1.31±0.26+; range, 0-2+; P=0.002). However, there was no significant difference in success rate or reoperation rate between the two groups. Additionally, after combining the recession of the superior rectus muscle with the horizontal muscle, the number of A-pattern degrees was greatly reduced. Helveston syndrome can be improved using a personalized surgical design according to the degree of external strabismus A-pattern, superior oblique muscle overaction, and dissociated vertical deviation (DVD) degree, which improves the success rate of single surgery.

Strabismus and Exophthalmos in Children: Think of Optic Nerve Glioma

Introduction: Optic nerve gliomas are rare tumors that are mainly observed in children. Exophthalmos and strabismus are the main signs of the disease. Neuroimaging and in particular magnetic resonance imaging is of great help in the diagnosis and follow-up of these tumors. The therapeutic management of these gliomas involves different means: surgical removal, chemotherapy, radiotherapy or abstention under surveillance. The indications must be discussed on a case-by-case basis. We report in this work a case of optic nerve glioma revealed by a strabismus and a unilateral exophthalmos. Case Report: This is a 3-year-old girl from a non-consanguineous marriage, with no specific pathological ATCD, who presented with divergent strabismus with left exophthalmos evolving for 3 months. The ophthalmologic examination noted a constant wide-angle divergent strabismus on the left eye with moderate exophthalmos on the same side. Corrected visual acuity was reduced to near finger count on the left and 5/10 on the right. Somatic examination found café au lait spots on the back and trunk. Cerebral CT showed a bilateral thickening of the optic nerves, fusiform and regular, more marked on the left, isodense to spontaneous contrast, homogeneously enhancing after injection of PDC. On the left, it is responsible for a downward refoulement of the eyeball with grade 1 exophthalmos. An MRI was ordered revealing a regular well-limited fusiform thickening of the optic nerves in T1 isosignal, intermediate in T2 and FLAIR, in diffusion hypersignal without ADC restriction, intensely and finely heterogeneous enhancing after injection of contrast medium. This thickening is responsible for a grade I left exophthalmos, with widening of the optic canals posteriorly and filling of the intraconical fat evoking a glioma appearance. The child was referred to neurosurgery for management. Conclusion: The diagnosis of optic nerve glioma in children is rare, with atypical presentations both in terms .........

The Effect of Surgical Treatment of Horizontal Strabismus on Refractive Changes in Adult Patients

Concomitant strabismus and refractive anomalies are often common pathological conditions in adult patients. The patient’s desire to get rid of both problems poses a question to the surgeon about the order of surgical interventions. With non-accommodative concomitant strabismus, the question is not so unambiguous. Despite a significant number of studies devoted to this topic, there is still no unequivocal opinion on the significance of refractive error after strabismus surgery. Thus, it remains an urgent task to study of possible surgically induced refractive changes after interventions on extraocular muscles and their assessment during the observation period.Purpose. Evaluation of the effect of surgical treatment of horizontal strabismus in adults on refractive and astigmatic status.Patients and methods. A prospective study of 30 patients with concomitant convergent or divergent strabismus. Each patient underwent surgery for horizontal strabismus, which consisted in recession and resection of the extraocular muscles of one eye. The spheroequivalent (SE) and cylinder (Cyl) values were determined before surgery, 1, 3, and 6 months after surgery. Refractive changes were calculated in the postoperative period, both for the spheroequivalent and for the cylinder, after 1 month (SIRC1), 3 months (SIRC2) and 6 months (SIRC3). In addition, the difference (d) between SIRC1 and SIRC3 was calculated to determine if they were temporary or permanent. Analysis of the induced changes in the magnitude and direction of astigmatism was performed using vector analysis.Results. The dynamics of SE values within 6 months after surgery shifted to insignificant myopia, however, no significant static difference in this parameter was found (p = 0.17). The mean change in spherical equivalent (SE) refraction was 0.22 ± 0.47 diopters in SIRC1, 0.15 ± 0.44 diopters in SIRC2, and 0.12 ± 0.51 diopters in SIRC3. There was no statistically significant difference between changes in surgically induced refraction at different times after surgery (p = 0.34). The difference (SIRC d) between SIRC1 and SIRC3 for the spheroequivalent was 0.096 ± 0.480 and can be interpreted as a decrease in surgically induced refraction error within 6 months after surgery. Surgically induced astigmatism at different times after surgery was: SIRC1 = 0.44 ± 0.39, SIRC2 = 0.47 ± 0.41, SIRC3 = 0.43 ± 0.29. There was no statistically significant difference in this parameter during the study period (p = 0.1). The difference (SIRC d) between SIRC1 and SIRC3 for astigmatism was 0.0001 ± 0.3200, which indicates stable values of astigmatism. According to the vector analysis, the magnitude and axis of preoperative astigmatism was 1.131 ± 0.410 ax172 and is close to the actual postoperative values of 1.17 ± 0.50 ax172. The vector of surgically induced astigmatism was 0.43 ± 0.10 ax84. These changes were not statistically or clinically significant.Conclusion. In general, the refractive and astigmatic status does not change after surgical treatment of horizontal strabismus. However, in this study, there was a myopic refraction shift during the first 3–6 months after surgery. In this connection, it is possible to recommend refractive operations to adult patients 3–6 months after strabismus surgery.

Early post-operative angle as a predictor of surgical success in adult patients with intermittent exotropia

ABSTRACT Purpose: Intermittent exotropia is a condition where divergent strabismus is present at certain times or fixation distances and is surgically treated with bilateral lateral rectus recession or unilateral lateral rectus recession with medial rectus resection. The main purpose of our study is to assess the relationship between the initial post-operative deviation and surgical outcomes in adult exotropes undergoing recess-resect surgery. Methods: A retrospective chart review was performed on adult patients who underwent unilateral recess-resect surgery for intermittent exotropia between March 2010 and February 2022 at a single institution with at least 3 months of follow-up. Based on their motor alignment at 2 weeks following surgery, they were categorized as having exodeviation, esodeviation within 10 PD and esodeviation exceeding 10 PD. Surgical success was defined as motor alignment within 10 PD of exotropia and 5 PD of esotropia at distance and near at final follow-up. Results: 93 patients were included, 55% female and average age was 37 years. At postoperative week 2, 26 patients demonstrated residual exodeviation (Group A), 53 patients demonstrated an esodeviation of within 10 PD (Group B) and 14 patients demonstrated an esodeviation greater than 10 PD (Group C). There were no significant differences in pre-operative and demographic factors between the group. At the final follow-up, surgical success was observed in 57 patients: 12 in Group A, 41 in Group B and 4 in Group C (P < .01). Conclusion: Overcorrection of within 10 PD at 2 weeks following surgery showed a more favorable surgical outcome compared to exodeviation or esodeviation exceeding 10 PD.

Fentanyl Intoxication in an Eight Years Old Child after Application of 75 µg/h Transdermal Patch: A Case Report

Opioid intoxication in pediatrics is rare in Morocco. In the children’s hospital of Rabat, it is the third case that has been recorded in recent years. It is about a boy of 8 years old who after a benign trauma at the level of the back, his father attached to him a patch of fentanyl dosed at 75 µg/h given by a friend returning from abroad. After 8 hours, the father found his child unconscious with abnormal breathing, motivating him to bring him back to the emergency room of the hospital. He presented a convulsive seizure before being urgently intubated and transferred to intensive care unit. He received a triple dose a day in addition to a contininious infusion of 0,4 milligram of Naloxone. The patient woke up and was extubated after 24 hours, but he kept a divergent strabismus of the right eye for which he was sent to the ophthalmology department for further management. We highlight through this case report the severity of pediatric opioid intoxication and underscores the importance of primary prevention in combating this scourge.

Surgical management of exotropia‐hypotropia complex in high myopia

AbstractPurpose: We present an atypical clinical case of high myopia associated with divergent and vertical strabismus in the left eye (LE).Methods: A 50‐year‐old woman with a history of high myopia and deep amblyopia in the left eye (LE) referred to our center for surgical evaluation of LE exotropia. The clinical examination shows visual acuity (VA) of 10/10 in the right eye (RE) and light perception (LP) in LE. The Cover Test found an exotropia and hypotropia of the LE. In the funduscopic exam of the LE an advanced myopic choroiditis can be seen. Biometry shows an axial length (AL) of 25.10 mm in the RE and 32.25 mm in the LE. A magnetic resonance imaging (MRI) is performed where no pathological findings are evident. It was decided to intervene on the patient with divergent and vertical strabismus of the LE. Under general anaesthesia, a 7 mm shortening of the medial rectus muscle is performed with superior displacement of the insertion. In addition, a 9 mm retroinsertion of the lateral rectus muscle of the LE is performed with plication of the muscle to its anatomical position.Results: After surgery, the patient presented orthotropia without rectification.Conclusions: Exotropia‐hypotropia complex can be related with high myopia. The combination of resection and displacement of the insertion of the medial rectus together with recession and plication of the lateral rectus to its anatomical position was found to be effective in correcting the ocular deviation.

Síndrome Crouzon em um paciente de Angola: caso clínico

Introduction: Crouzon syndrome is an autosomal dominant disease characterized by craniosynostosis causing secondary alterations of the facial bones and other facial structures. This article aims to report a case of Crouzon syndrome seen at the Benguela General Hospital. Case: The patient was a female infant, one month and 14 days old, of Angolan nationality, from Benguela province, Kalomanga commune, born from a eutocic delivery at 9 months of gestational age. At the physical and dysmorphological exam, bulging of the frontal region, macrocranium, palpable coronal suture, craniosynostosis, exophthalmos, proptosis, divergent strabismus, hypertelorism, parrot nose, carpal mouth, macroglossia, ogival and cleft palate in the posterior region, short neck, excavated chest, and globous abdomen, among other manifestations, were observed. Conclusion: Early diagnosis of Crouzon syndrome allows for adequate genetic counselling and individual and family clinical follow-up. This case of a rare genetic disease shows that in Angola, in addition to the epidemiological pattern characteristic of infectious diseases, diseases of genetic nature are also represented.

Surgical treatment of patientswithconvergent concomitant strabismus: clinical effectiveness and longterm outcomes

Objective:The study aimed to evaluate the clinical efficacy, early and long-term outcomes of a modified surgical treatment method of convergent concomitant strabismus in children. Materials and methods: Thestudy enrolled 159 children (88 girls (55.3%) and 71 boys (44.7%)) aged 4 to 8 years (mean age, 6.05 ± 0.82 years) suffering from convergent concomitant strabismus. Of a total number, 57 children underwenttraditionalsurgicalintervention(controlgroup), and102 children underwent surgical intervention with the proposed modified approach (main group). Results and Discussion: In the distant timeframe (1-3 years after surgery), 141 children were examined.Inthe remotepostoperativeperiod,thecorrect eyeposition was preserved in 46 children (49.5%) in the main group vs.5children (10.4%) in the control group (OR = 8.42, 95% CI [3.06- 23.14], p&lt;0.05). A secondary deviation occurred in 3 main group children (3.2%) compared to 7 control group children (14.6%) (OR = 5.12, 95% CI [1.26-20.81], p&lt;0.05). In the long-term period, 32 (34.4%) childrenin the main group and 30 (62.5%) in the control group required repeated surgery to eliminate secondary divergent strabismus and residual deviation angle (OR = 3.18, 95% CI [1.54-6.56],p&lt;0.05). Conclusion. Thus, the proposed modified surgical treatment method of convergent concomitant strabismus in children is more effective than traditional methods. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 570-576

Distant Ocular Manifestations after New Coronavirus Infection

Purpose. Theoretically substantiate and practically identify ocular manifestations after the transferred SARS-CoV-2 virus.Patients and methods. For the study we were invited patients who had recovered from SARS-CoV-2 at the hospital of V.M. Buyanova, the age from 20 to 65 years old in period from 2020 to 2021. The total number of patients was 68 people. The patients had with them the results of PCR tests or ELISA tests, or an extract from the hospital confirmed COVID-19 case and also a clinical blood test and CT scan of the chest organs for the period of illness. Before the start of the study, the patients were asked to fill out a questionnaire “Questionnaire for patients who have had a new coronavirus infection” (Appendix 1). For a detailed study of this group of people, each underwent visometry, pneumotonometry, B-scan, a slit lamp study and also a slit lamp study with a 60D lens using 0.5 % Mydriacyl eye drops in the absence of contraindications and pupillography.Results. As a result of the work carried out, we concluded that the virus is capable of causing inflammation of the choroid of the eyeball, uveitis. Moreover, in our study, we identified patients with acquired intermittent divergent strabismus, anisocoria, ptosis, and accommodation disorder. And, in this regard, we came to the conclusion that the coronavirus belongs to the group of neurotropic, as it is able to affect the nervous tissue and cause the above clinical picture. In other words, the virus negatively affects the somatic and autonomic innervation of the oculomotor nerve. As a result of these lesions, we get the corresponding tetrad of symptoms: heterotropy, mydriasis, ptosis, accommodation paralysis.Conclusions. One of the extraordinary complications of coronavirus infection is damage effect to the fibers of the oculomotor nerve, the signs include: strabismus, mydriasis, ptosis and accommodation paralysis. Thus, this clinical picture is associated with the affinity of the virus to the nervous tissue. And as a result, this ability of the virus can probably infect various areas of the brain, which will lead to corresponding complications, not only from the oculomotor nerve, but also from other cranial nerves with the manifestation of the corresponding symptoms, which in theory can aggravate the patient’s condition , causing deep disturbances of motor and sensory innervation.

Modern approaches to visual rehabilitation of patients with neuromotor disorde

Background. Approximately 50 % of children with cerebral palsy have vision problems, manifested in strabismus, impaired eye mobility, refractive errors, nystagmus development and partial atrophy of the optic nerve.The aim: to present a clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy (CP).Materials and methods. A clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy is presented. General anesthesia was used to perform a two-stage treatment under one anesthesia: the first stage – laser myopia correction by femtosecond extraction of the lenticule through a small access (SMILE) to both eyes, the second stage was the strabismus correction by performing tenoscleroplasty of the external rectus muscle and resection of the internal rectus muscle of both eyes. The sequence of stages is due to the relative traumatism of strabismus surgery, in some cases, accompanied by a reaction from the bulbar conjunctiva and the cornea in the form of edema, which, during subsequent femtosecond vision correction, can affect the refractive result and worsen visual acuity in the postoperative period.Results. The performed treatment let significantly increase uncorrected visual acuity, achieve a correct and stable eye position, which became the basis for changing the vision nature from monocular to binocular.Conclusion. Thus, modern laser and surgical technologies in combination with an adequate anesthesia allow rehabilitating patients as much as possible in a short time, even with severe forms of cerebral palsy, and significantly improving the quality of life.

Horizontal Gaze Palsy and Progressive Scoliosis in Dizygotic Twins

ABSTRACT Horizontal gaze palsy and progressive scoliosis (HGPPS) is a rare autosomal recessive disorder caused by mutations in the ROBO3 gene. Clinical presentation consists of impairment of conjugate horizontal eye movements together with a progressive scoliosis beginning in childhood. We report dizygotic twins with HGPPS that had absence of conjugate horizontal eye movements combined with divergent strabismus and synergistic divergence. One of them also had a congenital palpebral ptosis and vertical strabismus of the right eye. Onset of scoliosis occurred in childhood with rapid progression in the second decade of life. Brain imaging showed characteristic features of the disease such as hypoplasia of the pons and a midline cleft of the brainstem with a butterfly-like bifid appearance. Genetic analysis revealed a pathogenic homozygous mutation on the ROBO3 gene. These siblings and a previous report of two other individuals with the same disorder from the same small geographical region with less than 38000 inhabitants, likely represent a founder effect.

BRAIN AND EYE AS POTENTIAL TARGETS FOR IONIZING RADIATION IMPACT. PART IV - FETAL RADIATION-INDUCED BINOCULAR VISION DISORDERS: A PILOT STUDY. IMMUNOHISTOCHEMICAL CHANGES OF NON/IRRADIATED EYEBALL MUSCLES AFFECTED BY STRABISMUS. EVIDENCE OF A POSSIBLE MECHANISM OF THE STRABISMUS DEVELOPMENT IN PERSONS EXPOSED TO FETAL RADIATION.

to assess the peculiarities of the development of strabismus and binocular vision disorders in people who were exposed to ionizing radiation in utero; to investigate the changes in distribution and appearance of myosin, dystrophin, and collagen IV between non-irradiated persons with normal binocular vision and patients with strabismus. 583 persons, irradiated in utero because of the Chornobyl disaster were examined (at the time of examination average age was 11.3 ± 0.1 years). The control group - 808 people - Kyiv residents. Overall, 15 non-irradiated eyeball muscle samples were examined. 10 were from strabismus patients and 5 were controls. To evaluate morphological structure haematoxylin and eosin staining were used. For the detection of myosin, dystrophin, and collagen IV biotin-avidin (IMH) immunohistochemistry method was performed. Semi-quantitative grading method was used for the evaluation of immunoreactive structure appearance and local distribution. An increased frequency of divergent strabismus (p = 0.04190) and heterophoria (p = 0.002603) was found in the group exposed to prenatal (fetal) radiation because of the Chornobyl disaster compared to the control group. The relative risk of heterophoria was 5.08 (1.42 - 18.13). A decrease in dystrophin, myosin, and collagen IV positive structures was observed in non-irradiated strabismus-affected eyeball muscles compared to the control group. Detected changes indicate an increased probability in the development of strabismus in persons who had been exposed to fetal radiation. Non-irradiated strabismus-affected eyeball muscles are characterized by diminished myosin, dystrophin, and collagen IV immunohistochemical structures. Additionally, determined qualitative morphological changes in skeletal striated muscle fibers lead to the changed structural organization, indicating possible muscular dystrophy. Thereby, the presence of dystrophic processes in the eyeball muscles may play a significant role in the morphopatogenesis of strabismus. Further morphological studies are necessary to clarify the development of binocular vision disorder and the methods of their correction. These studies would be especially important to populations that were exposed to radiation.