Kaajal D Nanda, Eve Lacey, Alki Liasis, Ken K Nischal
{"title":"Early Onset Sixth-Nerve Palsy with Eccentric Fixation.","authors":"Kaajal D Nanda, Eve Lacey, Alki Liasis, Ken K Nischal","doi":"10.3368/aoj.67.1.72","DOIUrl":"https://doi.org/10.3368/aoj.67.1.72","url":null,"abstract":"<p><strong>Purpose: </strong>To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation.</p><p><strong>Methods: </strong>A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records.</p><p><strong>Results: </strong>Four children with unilateral or asymmetric early onset sixth-nerve palsy were identified, of which three were congenital. All four had MRI and only one had a normal MRI. Age at presentation ranged from 14-42 months, but all four had marked esotropia and poor visual acuities in the worst affected eye with eccentric fixation, which became more easily or only noticeable after surgical correction. Three patients with congenital sixth-nerve palsy underwent vertical muscle transposition with Botulinum Toxin A (BTXA) to the ipsilateral medial rectus, and two of these patients also had Foster sutures to the transposed vertical muscles. The fourth patient had unilateral medial rectus recession and lateral rectus resection. The mean preoperative measurement was 55<sup>Δ</sup> ET (range 50-60<sup>Δ</sup>), and the mean postoperative measurement was 11<sup>Δ</sup> ET (range 16XT-25ET) at near, and 2<sup>Δ</sup> XT (range 15XT-14ET) at distance.</p><p><strong>Conclusions: </strong>We speculate that early onset paralytic strabismus due to congenital sixth-nerve palsy results in an inability to cross fixate which results in the development of eccentric fixation. Attempts to use reverse occlusion to negate the eccentric fixation failed. We therefore recommend early surgery for this condition to avoid this sequelae.</p>","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"67 1","pages":"72-79"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.67.1.72","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35508469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Everyday Exotropia: Learning from the Littlest","authors":"J. Petrunak","doi":"10.1080/0065955X.2017.12023633","DOIUrl":"https://doi.org/10.1080/0065955X.2017.12023633","url":null,"abstract":"ABSTRACT Background and Purpose: Early onset exodeviations in systemically and ocularly healthy young children, diagnosed at less than 1 year of age, may be of the constant, “infantile XT” type, or early X(T) type. The onset of common childhood X(T) is not clearly known. The purpose of this lecture is to discuss theories and characteristics of early onset exodeviations, and report on our observations of infantile XT and early X(T) at Children's Eye Care in Michigan. Patients and Methods: A retrospective review of 470 cases of childhood exodeviations (ages 6 months to 15 years) were reviewed and met inclusion criteria of no prior surgical treatment, no ocular, CNS or craniofacial disease, and no significant prematurity. Thirty-nine cases were diagnosed at less than 1 year of age: thirty-five patients with early X(T) and four patients with infantile XT, based upon a motility evaluation at 6 m and 1/3 m fixation using dissociative methods. The clinical characteristics and outcomes of these two groups were described and compared. Results: Comparing infantile XT and early X(T) groups, reported onset by caregivers was significantly younger in the infantile XT group (3 months vs. 6 months), and size of the deviation at both distance and near fixation ranges was significantly larger in the infantile XT group (XT-43/XT′-48Δ vs. X(T)-25/X(T)′-23Δ). Three of 4 infantile XT patients received surgery, one spontaneously resolved, and all resulted in small, residual XT, and DVD without measurable stereoacuity. Many patients with early X(T) demonstrated good/excellent control at near range and fair/poor control at distance range. Four early X(T) patients who did not receive surgical correction either resolved, remained the same, or decompensated. Surgical correction for X(T) resulted in a 50% success rate for one procedure with a minimum of 2 years postoperative follow-up. Stereoacuity outcomes did not appear to correlate with quality of control. Conclusions: Most healthy children with X(T) are diagnosed by age 5 years, although many have a reported onset by caregivers of less than 1 year of age. Good control of X(T) at near range may preclude early examinations. Motility evaluation by dissociative methods at near and far-range fixation may facilitate early diagnosis. Infantile XT is less common than early X(T), by a ratio of 1:10. Characteristics of infantile XT and early X(T) have significant differences in report onset, deviation size, and outcomes with and without surgical intervention. Patients with either infantile XT or early X(T) may spontaneously resolve over time.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"67 1","pages":"52 - 60"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0065955X.2017.12023633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42325714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Assisting the Person with Nystagmus Beyond the Office: Infantile Nystagmus Syndrome","authors":"J. Parkinson","doi":"10.1080/0065955X.2017.12023632","DOIUrl":"https://doi.org/10.1080/0065955X.2017.12023632","url":null,"abstract":"ABSTRACT Infantile nystagmus presents many challenges for clinicians when defining the characteristics, etiology, visual capabilities, and optimal visual aids for the affected individual. However, life beyond the office may present the greatest challenges from the point of view of the child and their family. Research related to the psychosocial implications and quality of life for these individuals, as well as information related to systems that support their educational and social development, are infrequent in the ophthalmic literature. The purpose of this report is to briefly outline our local pediatric ophthalmic approach for these patients, to present a limited review of applicable literature, and to introduce our regional support system that addresses educational and psychosocial challenges for children and families affected by infantile nystagmus syndrome.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"67 1","pages":"43 - 51"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0065955X.2017.12023632","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46122764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Sheep in Wolves' Clothing? Nystagmoid Eye Movements","authors":"J. Lambert","doi":"10.1080/0065955X.2017.12023628","DOIUrl":"https://doi.org/10.1080/0065955X.2017.12023628","url":null,"abstract":"ABSTRACT Nystagmoid eye movements are involuntary eye movements that are not pure forms of nystagmus. Nystagmus, by definition, is involuntary eye movements off of fixation that are initiated by a slow phase. By contrast, nystagmoid movements are often saccades that interrupt fixation or have a fast phase followed by a slow phase. Types of nystagmoid eye movements include saccadic intrusions, such as square wave jerks and ocular flutter/opsoclonus, voluntary nystagmus, superior oblique myokymia, as well as the Heimann-Bielschowsky phenomenon. In addition, sensory intermittent exotropia is a clinical entity that should be on the differential when considering patients with involuntary eye movements, many of whom will also have a history of decreased visual acuity. Other ocular comorbidities in these patients include optic nerve and retinal pathology, as well possible neurological findings such as head trauma or demyelinating disease.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"67 1","pages":"27 - 30"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0065955X.2017.12023628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45226721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Congenital Cranial Dysinnervation Disorders: A Literature Review.","authors":"Rebecca Fels","doi":"10.3368/aoj.67.1.89","DOIUrl":"https://doi.org/10.3368/aoj.67.1.89","url":null,"abstract":"<p><p>Congenital cranial dysinnervation disorders (CCDD) is a new term describing a collection of non-progressive neurogenic syndromes. Initially referred to as congenital fibrosis syndrome, it was thought that the primary problem was extraocular muscular maldevelopment. Recent advancements in genetics and neuro-radiology have now determined the initial observation of fibrotic muscles is secondary to a primary lack of innervation from deficient, absent, or misguided cranial nerves. This presentation provides an overview of the known genes and phenotypes currently recognized within the CCDD domain. It will also highlight areas of current research being done in the area of cranial nerve development. Increased knowledge and awareness of these disorders has resulted in more research being conducted. These studies have provided a more complete understanding of efferent motor system development and are leading to improved treatment strategies for patients.</p>","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"67 1","pages":"89-92"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.67.1.89","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35401738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Early Onset Sixth-Nerve Palsy with Eccentric Fixation","authors":"Kaajal D. Nanda, Eve Lacey, A. Liasis, K. Nischal","doi":"10.1080/0065955X.2017.12023636","DOIUrl":"https://doi.org/10.1080/0065955X.2017.12023636","url":null,"abstract":"ABSTRACT Purpose: To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation. Methods: A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records. Results: Four children with unilateral or asymmetric early onset sixth-nerve palsy were identified, of which three were congenital. All four had MRI and only one had a normal MRI. Age at presentation ranged from 14–42 months, but all four had marked esotropia and poor visual acuities in the worst affected eye with eccentric fixation, which became more easily or only noticeable after surgical correction. Three patients with congenital sixth-nerve palsy underwent vertical muscle transposition with Botulinum Toxin A(BTXA) to the ipsilateral medial rectus, and two of these patients also had Foster sutures to the transposed vertical muscles. The fourth patient had unilateral medial rectus recession and lateral rectus resection. The mean preoperative measurement was 55Δ ET (range 50–60Δ), and the mean postoperative measurement was 11Δ ET (range 16XT-25ET) at near, and 2Δ XT (range 15XT-14ET) at distance. Conclusions: We speculate that early onset paralytic strabismus due to congenital sixth-nerve palsy results in an inability to cross fixate which results in the development of eccentric fixation. Attempts to use reverse occlusion to negate the eccentric fixation failed. We therefore recommend early surgery for this condition to avoid this sequelae.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"67 1","pages":"72 - 79"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0065955X.2017.12023636","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42527793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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