Electromyograph assistance and Mendonça's forceps - a comparison between two methods of botulinum toxin A injection into the extraocular muscle

PURPOSE: To compare two methods of botulinum toxin A (BTA) injection into the extraocular muscle (EOM): the electromyographically (EMG) guided injection and the injection using Mendonça's forceps. METHODS: Twenty-nine (29) patients with strabismus and low visual acuity in one eye were examined at the Department of Ophthalmology of UNIFESP. They were divided into 2 groups - group I with 17 patients receiving the botulinum toxin A injection using Mendonça's forceps, and group II with 12 patients receiving the toxin with electromyographical guidance. The patients of both groups were examined on the 7th and 14th day after intervention and the outcome of both methods of botulinum toxin A injection were compared. Friedman and Mann-Whitney correlation tests were used in the statistical analysis of the data. RESULTS: Although the follow-up examinations on the 7th and 14th days showed a different behavior between both methods, there was no statistically significant difference between the mean values of the correction attained in both groups at the end of this study. CONCLUSION: No statistically significant difference was shown between the two groups. Mendonça's forceps can be a safe alternative to electromyography to locate an extraocular muscle for botulinum toxin A injection.OBJETIVO: Comparar dois métodos de aplicação de toxina botulínica A (TBA) em músculo ocular externo: com auxílio de eletromiógrafo (EMG) e com a pinça de Mendonça. MÉTODOS: Foram analisados no Departamento de Oftalmologia da UNIFESP 29 pacientes que apresentavam estrabismo e baixa acuidade visual em um olho. Foram divididos em dois grupos: grupo I - 17 pacientes que receberam a toxina botulínica A por meio de injeção com auxílio da pinça de Mendonça e grupo II - 12 pacientes que receberam a toxina botulínica A por injeção guiada pelo eletromiógrafo. Os pacientes dos dois grupos foram avaliados no 7º e no 14º dia após aplicação. Compararam-se os resultados dos dois grupos neste período de tempo. Os testes de correlação de Friedman e Mann-Whitney foram usados para análise estatística. RESULTADOS: Houve diferença estatística entre as médias de desvio pré-aplicação e em pelo menos um período (7º ou 14º dia) após aplicação, tanto no grupo dos pacientes em que foi utilizada a pinça, quanto no grupo de pacientes em que foi utilizado o eletromiógrafo. Não houve diferença estatística dos desvios pré-aplicação e pós-aplicação entre os dois grupos. CONCLUSÃO: Os dois métodos de aplicação da toxina botulínica A são equivalentes e portanto, o uso da pinça de Mendonça pode ser método alternativo ao uso do eletromiógrafo, para guiar a injeção de toxina botulínica A.Universidade Federal de São Paulo (UNIFESP) Setor de Motilidade Ocular ExtrínsecaUniversidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Oftalmologia Setor de Motilidade Ocular ExtrínsecaUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, Setor de Motilidade Ocular ExtrínsecaUNIFESP, Depto. de OftalmologiaUNIFESP, Depto. de Oftalmologia Setor de Motilidade Ocular ExtrínsecaSciEL

Surgical results of strabismus correction in patients with myelomeningocele

Purpose: Myelomeningocele is one of the most common birth defects. It is associated with severe neurological deficiencies, and ocular changes, such as strabismus, are very common. The purpose of this study was to describe indications for strabismus surgery in patients with myelomeningocele and to evaluate the results achieved with surgical correction. Methods: We retrospectively reviewed records of all patients with myelomeningocele who underwent surgery for strabismus correction in a 5-year period in an institution for disabled children. Results: The main indications for strabismus surgery were esotropia and A-pattern anisotropia. Excellent surgical results were achieved in 60.9% of patients, satisfactory in 12.2%, and unsatisfactory in 26.9%. Conclusion: Patients with myelomeningocele and strabismus had a high incidence of esotropia and A-pattern anisotropia. Strabismus surgery in these patients had an elevated percentage of excellent and satisfactory results, not only for the ocular deviation, but also for improvement of head posture

Prevalência de erros refrativos na sequência de Möbius

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 -0,50 D e <+2,00 D). A prevalência de astigmatismo maior que 0,75D foi 40%. CONCLUSÃO: A prevalência de erros refrativos, pelo equivalente esférico, no grupo estudado foi de 42,4%.Universidade Federal de São Paulo (UNIFESP) Department of OphthalmologySão Paulo University Department of OphthalmologySanta Casa Medical School Department of OphthalmologyUniversity of Illinois Department of Ophthalmology & Visual SciencesAltino Ventura FoundationUNIFESP, Department of OphthalmologySciEL

Síndrome de moebius: estudo das manifestações oculares, genético-clinicas, otorrinolaringológicas e cognitivas

Realizaram-se exames oftalmologicos em 16 criancas com sindrome de Moebius, 9 do sexo masculino e 7 do sexo feminino. As idades, por ocasiao do exame oftalmologico, variaram de 8 meses a 127 meses. A fenda palpebral e a distancia margem reflexo foram medidas em todos os pacientes, havendo apenas 1 caso (6,25%) com ptose unilateral. A presenca de lagoftalmo foi constatada em 11 casos (68,8%), podendo ser unilateral ou bilateral. A acuidade visual, apesar de simetrica em ambos os olhos, foi, no geral, de nivel baixo 87,5% dos casos. A presenca de prega epicantica foi marcante em 75% dos pacientes. Estrabismo foi diagnosticado em 14 pacientes (87,5%): endotropia em 11 (78,6%) e exotropia em 3 (21,4%). Limitacao dos movimentos oculares a abducao foram encontrados em todos os pacientes. O fenomeno de Bell apresentou-se em 31 olhos (96,9%). A ametropia mais encontrada foi o astigmatismo hipermetropico composto (40,6%). O fundo de olho foi normal em todos os olhos, com excecao de 1 que apresentava fundo miopico. O exame genetico-clinico revelou em todos os pacientes: ausencia de consanguinidade parental, historia familiar negativa nas anomalias congenitas e estudo cromossomico normal. No exame otorrinolaringologico, foram detectadas: paralisia de XII nervo em 13 casos (81,2%), paralisia de X nervo em 2 casos (12,5%) e paralisia de IX nervo em 2 casos (12,5%). Na avaliacao psicologica, apenas 2 criancas (12,5%) foram classificadas como normais, quando avaliadas quanto ao nivel de desenvolvimento global ou quociente intelectualBV UNIFESP: Teses e dissertaçõe

Plication versus Resection in Horizontal Strabismus Surgery: A Systematic Review with Meta-Analysis

Purpose. The purpose of this review was to compare the efficacy of rectus muscle plication versus resection on the treatment of horizontal strabismus and to evaluate the exodrift after each technique. Methods. A research was performed in Latin American and Caribbean Literature on Health Sciences (LILACS); MEDLINE; and Cochrane Central Register of Controlled Trial (CENTRAL). The database was searched by 30 June 2019. The selection was restricted to articles published in English, Spanish, or Portuguese. There were no date restrictions in the search. A minimum mean follow-up of six months was required to access the primary outcomes. Motor alignment success was defined as postprocedure deviation within 10 prism diopters (PD) of orthotropia. Results. Seven studies were eligible for inclusion. The grouped success rate after plication was 66% (95% CI =  [43%–89%]), and the grouped success rate after resection was 68% (95% CI = [43%–89%]). High heterogeneity was observed between the estimations. There was no difference between the mean amount of deviation corrected in prism diopters, when using the mixed-model approach (SMD = 0.12; 95% CI = −0.2–0.44; p=0.45). The undercorrection rates were also analyzed. The combined odds ratio was 1.37 (95% CI = 0.59–3.16; p=0.462), and there was no statistical significance. Conclusion. Plication of horizontal extraocular muscles reveals to be an alternative to resection in strabismus surgery, with similar results. Exodrift is observed after plication and after resection in the treatment of exotropia, but randomized clinical trials are necessary to analyze and compare the follow-up

Bupivacaine and botulinum toxin to treat comitant strabismus

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

Brazilian guideline for pediatric cycloplegia and mydriasis

ABSTRACT Cycloplegia is crucial for reliable pediatric ophthalmology examinations. This document provides a recommendation for pediatric cycloplegia and mydriasis for Brazilian ophthalmologists. This article was developed based on literature reviews; the clinical experience of Brazilian specialists, as obtained through questionnaires; and the consensus of the Expert Committee of the Brazilian Pediatric Ophthalmology Society. According to the best evidence and formulations available in Brazil, this committee recommends the use of one drop of 1% cyclopentolate plus one drop of 1% tropicamide in children older than 6 months and two drops of 1% tropicamide 0-5 minutes apart for those younger than 6 months. Mydriasis may be increased by a single drop of 2.5% phenylephrine. For retinopathy of prematurity screening, the recommendation is 0.5% or 1% tropicamide, administered two or three times, 5 minutes apart, and 2.5% phenylephrine, used preferably once. In all scenarios, we recommend the use of a prior drop of 0.5% proxymetacaine