Search

Purpose: The aim of this study was to collect further data to estimate the risk of relevant intracranial pathology and thereby better assess the need for cranial imaging in children with acute acquired comitant esotropia (AACE). To date, there is still not enough literature on this topic to enable a consensus on the diagnostic algorithm. Methods: We analyzed data from patients with convergent strabismus who received cranial imaging via magnetic resonance imaging (MRI). Twenty-one patients received a cranial MRI for the diagnostic evaluation of AACE. The age range was from 2 to 12 years, and the mean age at the time of diagnosis was 5.5 years. Of these patients, only one exhibited insignificant MRI findings, with no therapeutic consequences. Conclusions: Our data add further evidence that AACE without neurological findings or other ophthalmologic anomalies might not be an indication for cranial MRI as a diagnostic screening tool. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Methods: Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Results: Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. Conclusion: In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos. [ABSTRACT FROM AUTHOR]

Purpose: High myopic patients may develop strabismus due to globe dislocation out of the normal extraocular muscle cone. Surgical correction of this strabismus type is possible by joining the superior and lateral rectus muscles without the need for a scleral suture called the Yokoyama procedure. Data from large patient samples and the evaluation of a potential effect of an additional medial rectus recession (MRR) have been lacking so far. Methods: We pooled retrospective patient data of 14 departments of ophthalmology in Germany and Switzerland and analysed determinants of postoperative results using multivariable regression models. Results: We included 133 patients (mean age: 59.7 ± 13.4 years, surgery between 2008 and 2017) with a mean preoperative esotropia (both Yokoyama with and without MRR) of 23.8°±4.6°. The angle of preoperative esotropia increased with age. The postoperative esotropia was 8.7° ± 9.9°, and six patients were overcorrected. While preoperative esotropia was highly associated with postoperative results, we found no association of additional MRR with any of our postoperative outcome measures. The Yokoyama procedure had a higher absolute effect in patients with higher preoperative esotropia. Conclusion: Our study confirms the positive effect of the Yokoyama procedure on strabismus due to high myopia in large‐scale real‐world data. In some cases, MRR may be needed because of muscle contracture, although additional MRR statistically did not affect the postoperative outcome. In patients with bilateral high myopic strabismus, correction of both eyes seems beneficial. The effect size of the Yokoyama procedure appears to be mainly driven by preoperative esotropia. [ABSTRACT FROM AUTHOR]

Objective: Spheno-orbital meningiomas represent a delicate subtype of intracranial meningiomas involving the sphenoid wing, orbit and important neurovascular structures such as cavernous sinus, carotid artery or optic nerve. Insidious and aggressive dural, bone and orbital involvement contains several defiances to adequate resection, which provides high rates of recurrence. Methods: This retrospective case analysis consisted of 30 patients, who were surgically treated for spheno-orbital meningiomas performing a fronto-pterional approach by or under the supervision of the senior author (J. Meixensberger) between May 2001 and February 2006. There were 22 woman and eight men with a mean age of 54·4 years. The follow-up period ranged from 3 to 75 months (mean: 33·7 months). Results: The majority of patients presented with a clinical triad of visual impairment (74%), progressive proptosis (55%) and visual field defects (40%). Total microscopic tumor resection was achieved in ten patients (33%). Visual acuity improved in 65% of the patients, and 40% of these returned to normal vision. Pre-existing cranial nerve deficits remained unchanged in the majority of patients (88%) and improved in 12%. Temporary new cranial nerve deficits occurred in three patients. The rate of permanent non-visual morbidity was 10% (three of 30 patients). Eight patients (27%) received post-operative radiotherapy with an overall tumor growth control rate of 63%. The overall recurrence rate was 27% (eight of 30 patients). Conclusion: Sufficient tumor control can be achieved with minimal morbidity and satisfying functional results. [ABSTRACT FROM AUTHOR]

INTRODUCTION Hemangiomas are the most common tumors of the eyelids and orbit in childhood. These tumors can produce ptosis, strabismus and anisometropia, resulting in amblyopia. The treatment of hemangiomas is a challenge with respect to the functional results (prevention of amblyopia) and cosmetic outcome. MATERIALS AND METHODS The history, clinical findings, magnetic resonance imaging (MRI), management and outcome of 15 children (3--9 months old) with hemangiomas of the eyelids and/or orbital involvement are reviewed. RESULTS Seven patients with small superficial hemangiomas were merely kept under clinical observation. In seven other patients with threatened or existing occlusion of the visual axis or refractive errors, treatment was indicated. Four children were given local Neodymium: YAG-laser therapy. In patients with large subcutaneous eyelid hemangiomas and involvement of the orbita we decided to treat with interstitial Neodymium: YAG-laser therapy in combination with systemic corticosteroids. One patient with an unknown tumor in the medial canthus was diagnosed by biopsy. During the follow-up period of 12--24 months, all untreated patients and 6 of 7 treated children showed involution of their tumors. One patient with a large eyelid and orbital hemangioma with occlusion of the visual axis did not respond to laser therapy and systemic corticosteroids; excision of the tumor was necessary. All children with eyelid hemangiomas with orbital involvement (n = 3) suffered from anisometropia with astigmatism and were treated for amblyopia. During 24 months of amblyopia treatment, the visual acuity improved in two of three cases to 0.4 and 1.0. CONCLUSION Periorbital hemangiomas must be managed by individual and interdisciplinary diagnostic and therapeutic approaches. Therapy of amblyopia remains mandatory in all cases of large eyelid hemangiomas and/or orbital involvement. [ABSTRACT FROM AUTHOR]

INTRODUCTION Age-related macular degeneration is the most common causeof irreversible loss of visual acuity, including the ability to read, in elderlypatients. One of the surgical treatment options is macular translocation with360° retinotomy. The orthoptic results of torsional muscle surgery asa second procedure are demonstrated. MATERIALS AND METHODS Between January 1999 and December 2000, the maculawas rotated upward by 12–45° in 10 eyes following complete artificialdetachment and a 360° retinotomy. In these patients, torsional surgerywas carried out as a second procedure. Depending on the resulting cyclotorsion,we performed surgery on the oblique muscles only in four patients with a cyclotropiaof 12–20° and a combination of oblique muscle surgery with surgeryof two or four rectus muscles in the remaining six eyes (cyclotropia over21°). The pre- and postoperative diagnostic techniques included visualacuity, reading vision and the orthoptic status. RESULTS Due to the unilateral ectopia of the macula, all patients presentedpostoperative strabismus with a vertical deviation of 2–10° anda subjective cyclotropia between 12° and 40°. After surgery on theoblique muscles, the patients showed a residual cyclotropia of 0–6°.In patients in whom surgery on the oblique muscles was accompanied by rectusmuscle surgery, the remaining cyclotorsion was 5–13°. Four patientsexcluded the non-operated fellow eye, six patients experienced double visionunder binocular conditions and thus required prescription of additional prismglasses. CONCLUSION Macular translocation causes diplopia under binocular conditionsbecause of the unilateral ectopia of the macular region with cyclotropia andvertical deviation. These problems can be resolved or reduced by oblique musclesurgery or in combination with additional surgery on the rectus muscles, dependingon the range of the cyclotorsion. Performing the... [ABSTRACT FROM AUTHOR]

Background In conjunction with hydrocephalus many ophthalmological abnormalities are described. Results of visual field diagnosis remain a matter of further discussion. The aim of this study was to investigate visual field deficits of children with shunted hydrocephalus. Materials and methods From Dec. 2007 until Dec. 2008 all children over 6 years of age treated with hydrocephalus in our institute were included. The children received an ophthalmological investigation concerning strabismus and binocular function, ophthalmoscopy, visual acuity and refraction. The special focus was visual field diagnosis, which we made with all children having cognitive conditions. The investigation was made by using the 'Goldmann' - perimeter (static perimetry). Children with and without visual field defects were compared concerning age at the time of ophthalmological examination, genesis of hydrocephalus and FOH of current CT or MRI scans. Results Fifty-six children were investigated. There were 24 females and 32 males. The mean age was 14.7 years. The following orthoptic pathologies were diagnosed: 29 children had strabismus, 17 exotropia, 12 esotropia, 4 children hypotropia, 2 hypertropia and 3 children heterophoria. Nystagmus was found in 10 children. The ocular fundus investigation showed 13 children with optic nerve atrophy. A visual field diagnosis was possible with 42 of the 56 patients. The investigation was incomplete in 14 patients with cognitive deficits or inadequate compliance. 24 of 42 children showed a concentric visual field constriction between 10° and 50° out of the centre. Children with visual field deficits were older than those with normal visual field (p = 0.1). Nine of 10 children with postmeningitic hydrocephalus had a visual field defect (p = 0.035). Children with visual field defects had a significant higher FOH (p = 0.017). Conclusion Our results suggest that children with shunted hydrocephalus have a superior risk of having ophthalmological abnormalities. Visual field deficit is often a problem of these patients. Visual field diagnostic can complete the ophthalmological monitoring in patients with hydrocephalus especially in patients with large ventricles. Children with postmeningitic hydrocephalus should be monitored more frequently and intensively. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that patients suffering from endocrine orbitopathy (EO) seem to present with profound asymmetry in proptosis. As asymmetry might pose a major problem in planning decompression surgery, information on the amount of variation between sides and a concise evaluation method should be available. Therefore, a study based on a concise 3D cephalometric analysis was conceived to evaluate globe position., Methods: A 3D-cephalometric analysis was performed on computed tomography (CT) data from 52 orbitopathy and 54 control data sets. Using 36 anatomic landmarks, 33 distances were evaluated to measure sagittal, vertical, and horizontal globe position., Results: EO patients presented with marked exophthalmos and statistically significant asymmetry. Depending on the 2 measured distances, 38% and 42%, respectively, presented sagittal asymmetry of >2 mm, and 12% and 13%, respectively, presented with sagittal asymmetry >4mm. No such asymmetry was seen in the control group. Furthermore, EO patients showed a larger interglobe distance due to lateral globe position. Marked asymmetry correlated with male sex. Proptosis measured to the deep bony orbit correlated with values measured to the orbital aperture or with constructed Hertel values., Conclusions: Use of 3D cephalometry and CT-based analysis confirmed findings from previous clinical studies on profound sagittal asymmetry in EO. Endocrine orbitopathy leads to a sagittal-lateral globe displacement that is even more pronounced in the current study than in earlier investigations. Concerning surgical therapy, presurgical asymmetry, especially if profound, has to be considered to achieve an esthetic symmetrical outcome. Use of 3D orbital analysis is an appropriate method to describe globe position beyond clinical measurements., Competing Interests: Disclosures: The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Object: Many ophthalmological abnormalities are described in conjunction with hydrocephalus. The results of visual field diagnosis remain a matter of further discussion. The aim of this study was to investigate visual field deficits in children with shunt-treated hydrocephalus., Methods: All children over 6 years of age treated for hydrocephalus at the authors' institute between December 2007 and December 2008 were included in the study. The children underwent an ophthalmological investigation for strabismus and binocular function, ophthalmoscopy, visual acuity, and refraction. The special focus was the visual field diagnosis, which the authors established in all children with cognitive conditions. The investigation was made by using the Goldmann visual field examination (kinetic perimetry). Children with and without visual field defects were compared concerning age at the time of ophthalmological examination, genesis of hydrocephalus, and fronto-occipital horn ratio measured on current CT or MR images., Results: Complete investigations were undertaken in 56 children (24 girls and 32 boys, mean age 15.1 years). The following orthoptic pathological entities were diagnosed: 29 children have a strabismus in 29 cases, 17 of these have an exotropia, 12 an esotropia, 4 children a hypotropia, 2 a hypertropia and 3 children a heterophoria. A nystagmus was found in 10 children. The ocular fundus investigation showed 13 children with an optic nerve atrophy. A visual field diagnosis was possible in 44 of the 56 patients and was incomplete in 12 patients with cognitive deficits or inadequate compliance. In 24 of 42 children there was a concentric visual field constriction between 10° and 50° out of the center. Children with visual field deficits were older than those with a normal visual field (p = 0.051). Nine of 10 children with postmenigitic hydrocephalus had a visual field defect (p = 0.025). In children with visual field defects the fronto-occipital horn ratio was significantly higher (p = 0.013)., Conclusions: The results suggest that children with shunt-treated hydrocephalus have a higher risk of having ophthalmological abnormalities. Visual field deficits are often a problem in these patients. A diagnostic visual field examination can complete the ophthalmological monitoring in patients with hydrocephalus, especially in patients with large ventricles. Children with postmeningitic hydrocephalus should be ophthalmologically monitored more frequently and intensively.