Otizm Spektrum Bozukluğunda Oftalmolojik Bulgular

To report long-term outcomes of strabismus surgery for treatment of third nerve palsy. We performed a 15-year retrospective study of patients who had undergone surgery. We analyzed preoperative mean deviation (at 6 months, 1 year after surgery, and at the end of follow-up), type of surgery, and factors predicting outcomes. A final deviation <10 prism diopters (pd) was considered a good esthetic outcome, and no diplopia in the primary position at the end of follow-up was considered a good functional outcome. Surgery was performed in 31 cases. Mean age was 36.27 years (women, 51.6%). Total and complete third nerve palsy was recorded in 22.6% and acquired palsy in 80.6%. Mean preoperative horizontal deviation (HD) in primary position was 40.24pd (near) and 44.29 (distance) and 14.33pd in vertical deviation (VD). Mean final HD was 8.94pd (near) and 11.35pd (distance), and mean final VD was 6.13. One surgery was performed in 68.9%. A favorable esthetic outcome was obtained in 64.5% and a successful functional outcome in 72.2%. Statistically significant differences were found between near HD (p=0.019) and distance HD (p=0.035) at 1 year compared with the end of follow-up and between VD at 6 months and 1 year after surgery (p=0.03). Mean follow-up was 6.05 years. No specific factors predicted a successful outcome. Esthetic and functional results were similar. No predictors of successful outcome were identified. HD was better 1 year after surgery, and VD improved during follow-up.

Purpose: To study the results of horizontal rectus recession for treatment of Duane syndrome. Methods: This was a retrospective study of 17 patients with Duane syndrome who underwent strabismus surgery between 2000 and 2008 with medial rectus recession for esotropic deviation or lateral rectus recession for exotropic deviation. The amount of surgery varied individually with the angle of deviation and abnormal head posture. Head turn was graded as mild, moderate, or severe. Botulinum toxin was injected in specific cases. An angle of deviation less than 10 PD and head turn less than 5° after surgery were considered good results. Results: Treatment was successful in 12 cases (70.58%) and unsuccessful in 5 (4 with type I Duane syndrome and one with type III Duane syndrome); in 3 patients the deviation was undercorrected and 2 it was overcorrected. Ipsilateral medial rectus recession of less than 5 mm was performed in 12 patients, although 1 case with a recession of 7 experienced secondary adduction limitation. Abduction limitation was slightly improved in 29.41%. Mean follow-up was 50.59 months. Conclusions: Moderate horizontal rectus recession is a simple and effective procedure in most patients with Duane syndrome and no secondary duction limitations. The technique only slightly improved abduction in one-third of the cases.

Purpose: To study the causes of bilateral superior oblique palsy (BSOP), treatment with botulinum toxin and/or surgery, and outcome of treatment. Methods: This was an 11-year retrospective study of patients with BSOP treated with injections of botulinum toxin (Botox), surgery, or both. Treatment was considered successful when anomalous head turn and diplopia in primary gaze position and downgaze resolved. Results: Bilateral superior oblique palsy was diagnosed in 12 patients (8 male; mean age, 29.5 years). Palsy was secondary to a neoplasm in 3 cases and to head trauma in 2. In 2 cases, it was ischemic, in 2 it was congenital; the remaining cases were iatrogenic (hydrocephalus secondary to meningitis, 1), hemorrhagic ( 1 ), and idiopathic ( 1 ). The clinical manifestations recorded were diplopia ( 10 ), anomalous head posture ( 9 ), V pattern ( 12 ), subjective excyclotorsion ( 8 ), and objective excyclotorsion ( 6 ). Recovery was spontaneous in 1 case with neoplastic disease. Botox was injected in 8 cases (inferior oblique and/or inferior rectus muscles [successful in 2]), and subsequent surgery was required in 6. Two patients underwent surgery without prior injection of Botox. The most common surgical technique was recession of the inferior oblique muscle (6 patients), either as the only operation or associated with other procedures. The final result was good in 72.72% (8/11). Mean follow-up was 62.6 months (range 9-99 months). Conclusions: Causes of BSOP were varied (most frequently neoplastic). Botox was effective as the only treatment in 25% (2/8). Outcome was good in a high percentage of cases with Botox, surgery, or both.