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Indian Journal of Ophthalmology Feb 2022We aimed to study the success of prism in regard to diplopia resolution score and associated factors in patients presenting with symptomatic diplopia arising from...
PURPOSE
We aimed to study the success of prism in regard to diplopia resolution score and associated factors in patients presenting with symptomatic diplopia arising from various etiologies.
METHODS
In this descriptive, retrospective study diplopia resolution among 31 patients who were prescribed prism were analyzed.
RESULTS
Fifty-four patients were evaluated for diplopia and 31 were included for the study done over 3 years. The mean follow-up was 15 months. Esotropia, exotropia, and hypertropia were seen in 39%, 51%, and 19.4% of patients, respectively. Furthermore, 71% received Fresnel prism and 29% were given ground glass prism. The mean prism power prescribed was 13.3 PD. 87% had complete resolution of diplopia; 96.8% continued usage of prism. High success rates were seen among patients with decompensated strabismus, sixth and fourth nerve palsy. Horizontal prism and oblique prism in the form of Fresnel prism yielded complete resolution of diplopia (P = 0.028). There was no association between the success of prism and etiology (P 0.058), history of trauma (P = 0.212), and type of deviation (P = 0.387). The study showed that oblique Fresnel prism can be considered for combined deviation.
CONCLUSION
Our study showed prism to be effective in alleviating diplopia over a varied range of etiologies.
Topics: Diplopia; Esotropia; Humans; Oculomotor Muscles; Retrospective Studies; Strabismus; Trochlear Nerve Diseases; Vision, Binocular
PubMed: 35086246
DOI: 10.4103/ijo.IJO_939_21 -
Ophthalmology Apr 2024To assess the duration, incidence, reversibility, and severity of adverse events (AEs) in patients with thyroid eye disease (TED) treated with teprotumumab. (Observational Study)
Observational Study
PURPOSE
To assess the duration, incidence, reversibility, and severity of adverse events (AEs) in patients with thyroid eye disease (TED) treated with teprotumumab.
DESIGN
Multicenter, retrospective, observational cohort study.
PARTICIPANTS
Patients with TED of all stages and activity levels treated with at least 4 infusions of teprotumumab.
METHODS
Patients were treated with teprotumumab between February 2020 and October 2022 at 6 tertiary centers. Adverse event metrics were recorded at each visit.
MAIN OUTCOME MEASURES
The primary outcomes measure was AE incidence and onset. Secondary outcome measures included AE severity, AE reversibility, AE duration, proptosis response, clinical activity score (CAS) reduction, and Gorman diplopia score improvement.
RESULTS
The study evaluated 131 patients. Proptosis improved by 2 mm or more in 77% of patients (101/131), with average proptosis improvement of 3.0 ± 2.1 mm and average CAS reduction of 3.2 points. Gorman diplopia score improved by at least 1 point for 50% of patients (36/72) with baseline diplopia. Adverse events occurred in 81.7% of patients (107/131). Patients experienced a median of 4 AEs. Most AEs were mild (74.0% [97/131]), 28.2% (37/131) were moderate, and 8.4% (11/131) were severe. Mean interval AE onset was 7.9 weeks after the first infusion. Mean resolved AE duration was 17.6 weeks. Forty-six percent of patients (60/131) demonstrated at least 1 persistent AE at last follow-up. Mean follow-up was 70.2 ± 38.5 weeks after the first infusion. The most common type of AEs was musculoskeletal (58.0% [76/131]), followed by gastrointestinal (38.2% [50/131]), skin (38.2% [50/131]), ear and labyrinth (30.5% [40/131]), nervous system (20.6% [27/131]), metabolic (15.3% [20/131]), and reproductive system (12.2% [16/131]). Sixteen patients (12.2%) discontinued therapy because of AEs, including hearing loss (n = 4), inflammatory bowel disease flare (n = 2), hyperglycemia (n = 1), muscle spasms (n = 1), and multiple AEs (n = 8).
CONCLUSIONS
Adverse events are commonly reported while receiving teprotumumab treatment. Most are mild and reversible; however, serious AEs can occur and may warrant treatment cessation. Treating physicians should inform patients about AE risk, properly screen patients before treatment, monitor patients closely throughout therapy, and understand how to manage AEs should they develop.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Humans; Graves Ophthalmopathy; Retrospective Studies; Diplopia; Exophthalmos; Antibodies, Monoclonal, Humanized
PubMed: 37852417
DOI: 10.1016/j.ophtha.2023.10.018 -
The British Journal of Oral &... Nov 2022The purpose of this study was to determine if three-dimensional (3D) printed orbit models and preoperative plate contouring provides benefit over traditional surgical... (Meta-Analysis)
Meta-Analysis Review
The purpose of this study was to determine if three-dimensional (3D) printed orbit models and preoperative plate contouring provides benefit over traditional surgical reconstruction of orbit fractures. This systematic review and meta-analysis searched five databases to identify cases of 3D printing for orbital fracture reconstruction. Primary outcomes were resolution of diplopia and enophthalmos, orbital volume symmetry and operation duration. Meta-analyses were used to calculate log odds ratios (OR) for diplopia and enophthalmos and absolute mean difference for orbital volume. A total of 58 articles describing 906 patient cases were included. A single article for each of diplopia and enophthalmos compared 3D printing with traditional management, which prevented answering the primary research question. However, pre-post meta-analysis showed that postoperative groups were less likely to have diplopia (n = 747, log OR = -2.35, 95%CI -1.72 to -2.98, p < 0.001, I = 10.91%) and enophthalmos (n = 486, log OR = -2.47, 95%CI -1.95 to -2.99, p < 0.001, I = 11.33%) than preoperatively. Mean orbital volume did not differ between the repaired and uninjured orbits (n = 290, mean difference = -0.13 cm, 95%CI -0.48 to 0.22, p = 0.472, I = 9.48%). Pooled mean operation duration for orbital reconstruction with 3D printing was 67.70 minutes (standard error [SE] = 4.24 minutes). Orbital reconstruction combined with 3D printing adequately restores orbital volume symmetry and improves diplopia and enophthalmos. Due to a lack of controlled studies, it remains unclear what contribution 3D printing alone makes to these results. Three-dimensional printing is likely a safe, accurate and effective adjunct; however, further controlled studies are required.
Topics: Humans; Enophthalmos; Diplopia; Plastic Surgery Procedures; Tomography, X-Ray Computed; Orbital Fractures; Printing, Three-Dimensional; Orbit; Retrospective Studies
PubMed: 35931592
DOI: 10.1016/j.bjoms.2022.07.001 -
American Journal of Otolaryngology 2021Diplopia and ocular motility restriction following orbital fracture repair are common complications. The reported rates in the literature differ greatly, in part due to...
PURPOSE
Diplopia and ocular motility restriction following orbital fracture repair are common complications. The reported rates in the literature differ greatly, in part due to varying definitions of diplopia and methods of measurement. The purpose of this study is to describe a practical and efficient in-office method for examining ocular motility and diplopia in orbital trauma patients and to report the outcomes in a series of patients who underwent orbital floor fracture repair.
MATERIALS AND METHODS
A retrospective chart review from 2012 to 2019 was conducted in patients who underwent isolated orbital floor fracture repair within 3 weeks of trauma. All patients had examinations to assess extraocular motility and subjective diplopia using the described techniques.
RESULTS
Ninety-three patients underwent orbital floor fracture repair and had adequate follow-up. Preoperatively, 71 (76%) patients had some restriction in motility and 59 (63%) patients complained of diplopia. Postoperatively, only 1 patient (1.09%) had clinically significant diplopia. Five (5.4%) additional patients demonstrated mild restriction in supraduction upon detailed ophthalmic examination that was not discovered upon subjective history. No patients had worsening of diplopia or motility after surgery.
CONCLUSIONS
Diplopia and motility restriction following orbital fracture repair can be a persistent problem for some patients. It is important to perform a careful ophthalmic examination to detect motility deficits and diplopia that can be significant to the patient. The true rate of restriction and diplopia may be higher using detailed ophthalmic diagnostic techniques compared to subjective patient history.
Topics: Adolescent; Adult; Diagnostic Techniques, Ophthalmological; Diplopia; Female; Humans; Male; Middle Aged; Ocular Motility Disorders; Ophthalmologic Surgical Procedures; Orbital Fractures; Postoperative Complications; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 33429179
DOI: 10.1016/j.amjoto.2020.102879 -
Clinical & Experimental Optometry Sep 2020Mucocele of the paranasal sinuses is a slowly expanding benign lesion developing when there is impeded physiological drainage of the mucous produced by the epithelial... (Review)
Review
Mucocele of the paranasal sinuses is a slowly expanding benign lesion developing when there is impeded physiological drainage of the mucous produced by the epithelial lining of the paranasal sinuses, at the sinus ostium, which is an opening that connects the sinus to the nasal cavity. Aetiologies of ostial occlusion include infection, allergy, trauma, previous surgery, benign neoplasm (osteoma or fibrous dysplasia), and malignant or metastatic tumours. Mucoceles commonly develop in the frontal sinus (70-80 per cent), followed by the ethmoid (25 per cent), frontoethmoidal (10-14 per cent), and maxillary (three per cent or less) sinuses. The most common manifestations in these cases are ocular oedema, proptosis (22-83 per cent), and diplopia (28 per cent). Due to these ocular signs and symptoms, the optometrist may be first in line managing paranasal sinus disease patients, reducing the risk of permanent damage. A case report and review of frontoethmoidal mucocele will be discussed in this report, to include the role of the optometrist in its management and treatment.
Topics: Diagnosis, Differential; Diplopia; Ethmoid Sinus; Frontal Sinus; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucocele; Paranasal Sinus Diseases; Tomography, X-Ray Computed
PubMed: 31773805
DOI: 10.1111/cxo.13006 -
BMJ Case Reports Nov 2021A young woman presented to neurology with a 1 month history of progressive diplopia on lateral gaze and a 1 week history of headaches. On examination she was found to...
A young woman presented to neurology with a 1 month history of progressive diplopia on lateral gaze and a 1 week history of headaches. On examination she was found to have complex ophthalmoparesis with binocular horizontal diplopia, failure of abduction bilaterally and limited upgaze with convergence-retraction nystagmus. The rest of the neurological examination was normal. She was admitted for investigations: blood, CT brain, MR brain and lumbar puncture results were normal. Anti-GD1a antibodies were strongly positive; anti-GM1, anti-GM2 and anti-GD1b were also positive. On follow-up 3 weeks later, the complex ophthalmoplegia persisted. It was decided to treat with intravenous immunoglobulins (IVIgs) with good response but recurrence at 2 weeks post infusion. She was treated with 4 weekly IVIg courses and remains responsive and controlled over 1 year since presentation but becomes symptomatic in the week running up to each dose; thus, disease modifying treatment is currently being considered.
Topics: Diplopia; Female; Gangliosides; Headache; Humans; Immunoglobulins, Intravenous; Ophthalmoplegia
PubMed: 34794976
DOI: 10.1136/bcr-2021-244273 -
Journal of Binocular Vision and Ocular... 2022Divergence insufficiency-type ET is a common cause of distance diplopia in elderly adults. A recent prospective multicenter data collection study has provided additional...
Divergence insufficiency-type ET is a common cause of distance diplopia in elderly adults. A recent prospective multicenter data collection study has provided additional guidance on management. Either base-out prism glasses or strabismus surgery were found to have high success rates, based on patient report of diplopia, and health-related quality-of-life domain scores. It was concluded that either prism or surgery were reasonable initial treatment strategies. Although allocation bias precluded formal comparison of prism versus surgery (evident in baseline differences between groups), there were hints that surgery may yield superior outcomes. For surgery, the most common approach was bilateral medial rectus recession, which was highly successful when assessed 10 weeks and 12 months postoperatively. It was unclear whether adjustable sutures were helpful, but in the vast majority of adjustable cases, additional recession at the time of adjustment was performed, suggesting that larger than standard surgical doses are needed.
Topics: Adult; Humans; Aged; Esotropia; Diplopia; Ophthalmologic Surgical Procedures; Vision, Binocular; Retrospective Studies; Treatment Outcome; Strabismus
PubMed: 36279481
DOI: No ID Found -
Journal of Binocular Vision and Ocular... 2022To describe the common causes of symptomatic strabismus and treatment required to resolve diplopia in adult patients seen by one orthoptist.
PURPOSE
To describe the common causes of symptomatic strabismus and treatment required to resolve diplopia in adult patients seen by one orthoptist.
PATIENTS AND METHODS
Retrospective cross-sectional study of consecutive adult patients 18 years or older seen by one orthoptist over a 3-year period with a chief complaint of double vision.
RESULTS
Two hundred twenty-four consecutive adult patients were examined by the author. Chief complaint was double vision, followed by blurred vision, monocular diplopia, and eye strain. Past ocular histories were significant for early-childhood strabismus in 23 patients. Amblyopia was identified in five patients. Hypertension was a medical risk factor most associated with symptomatic strabismus. Cranial nerve paresis was the most common cause of the strabismus followed by benign, age-related divergence insufficiency esotropia. Prism was the most common treatment in 53% of patients followed by Bangerter foil occlusion in 44 patients (20%). Strabismus surgery was recommended in 11 patients (5%). Manifest refraction was successful in resolving symptoms of binocular diplopia in nine heterophoric patients (5%). Opaque pirate style occlusion was not used for any patient in this series.
CONCLUSIONS
Symptomatic acquired esotropia was a common type of strabismus encountered by the author and trochlear nerve paresis a common cause of symptomatic strabismus in this retrospective cross-sectional study. Press-On™ or ground-in spectacle prism of 12 prism diopters or less resolved diplopia in 124 patients (55%).
Topics: Adult; Humans; Child; Diplopia; Esotropia; Retrospective Studies; Cross-Sectional Studies; Visual Acuity; Strabismus; Paresis
PubMed: 36279482
DOI: No ID Found -
Acta Neurologica Belgica Apr 2023As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which... (Review)
Review
INTRODUCTION
As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which patients would most likely benefit from the new treatments.
METHODS
We reviewed the clinical files of all MG patients seen at the Department of Neurology of the Antwerp University Hospital during the years 2019, 2020 and 2021.
RESULTS
163 patients were included. Age at diagnosis varied from the first to the eighth decades, with a peak of incidence from 60 to 70 years for both genders, and an additional peak from 20 to 30 years in women. Diplopia and ptosis were by far the most common onset symptom. At maximum disease severity, 24% of the patients still had purely ocular symptoms and 4% needed mechanical ventilation. 97% of the patients received a treatment with pyridostigmine and 68% with corticosteroids, often in combination with immunosuppressants. More than half reported side effects. At the latest visit, 50% of the patients were symptom-free. Also, half of the symptomatic patients were fulltime at work or retired with no or mild limitations in daily living. The remaining patients were working part-time, on sick leave, or retired with severe limitations.
DISCUSSION AND CONCLUSION
The majority of MG patients are doing well with currently available treatments, but often at the cost of side effects in the short and in the long term. A significant group is in need of better treatments.
Topics: Humans; Female; Male; Belgium; Myasthenia Gravis; Pyridostigmine Bromide; Blepharoptosis; Diplopia
PubMed: 36658451
DOI: 10.1007/s13760-023-02187-0 -
Journal of Neuro-ophthalmology : the... Mar 2024
Topics: Humans; Diplopia; Nystagmus, Pathologic
PubMed: 38170591
DOI: 10.1097/WNO.0000000000002070