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Turkish Journal of Ophthalmology Feb 2021To determine and evaluate the rate of diplopia after Ahmed glaucoma valve (AGV) implantation surgery.
OBJECTIVES
To determine and evaluate the rate of diplopia after Ahmed glaucoma valve (AGV) implantation surgery.
MATERIALS AND METHODS
The records of patients who underwent AGV implantation in our hospital between the years of 2010 and 2017 were retrospectively reviewed. Patients who were referred to our strabismus department due to binocular diplopia after AGV implantation surgery were included. The details of postoperative day 1, day 7, day 15, and 1 month examinations were recorded. In the postoperative period, the onset time of diplopia complaints, diplopia type, and the presence of diplopia at distance and near fixation were noted. Ocular motility examination and deviation measurements were evaluated.
RESULTS
Ten (47%) of 211 patients who underwent AGV implantation in our hospital between 2010 and 2017 met the study inclusion criteria. Six of the 10 patients were men (60%) and 4 were women (40%). The mean age of the patients was 44.5 (34-63) years. Complaints of diplopia developed at a mean of 14.5±12.3 (1-30) days after AGV implantation. The prism measurements of the patients were found to be 8.4±1.4 prism diopters (PD) exotropia and 7.1±8.8 PD hypotropia. While 8 patients had diplopia only at near distance, 2 patients had diplopia at both distance and near. Three patients were treated with prismatic glasses, and their complaints of diplopia recovered spontaneously in 5.11±4.10 months. The other 7 patients were followed up without treatment, and their diplopia complaints resolved spontaneously in 6.11±4.40 months.
CONCLUSION
Although most of the diplopia that develops after AGV implant surgery resolves without treatment, prismatic glasses might be considered as a treatment option in patients whose diplopia affects their daily lives.
Topics: Adult; Diplopia; Female; Glaucoma; Glaucoma Drainage Implants; Humans; Intraocular Pressure; Male; Middle Aged; Retrospective Studies; Trabeculectomy; Visual Acuity
PubMed: 33631898
DOI: 10.4274/tjo.galenos.2020.12269 -
JAMA Ophthalmology Feb 2023Thyroid eye disease (TED) results in varying degrees of proptosis and diplopia negatively affecting quality of life (QoL), producing possibly substantial visual changes,...
IMPORTANCE
Thyroid eye disease (TED) results in varying degrees of proptosis and diplopia negatively affecting quality of life (QoL), producing possibly substantial visual changes, disfigurement, and disability.
OBJECTIVE
To determine the association of varying TED severities with QoL in a non-TED population by assessing health state utility scores.
DESIGN, SETTING, AND PARTICIPANTS
This qualitative study, conducted from April 20, 2020, to April 29, 2021, assessed health states for active, moderate-severe TED, and values were elicited using time trade-off methods. Six health states of varying severity were determined from 2 placebo-controlled clinical trials (171 patients with TED and clinical activity score ≥4, ±diplopia/proptosis) and refined using interviews with US patients with TED (n = 6). Each health state description was validated by interviews with additional TED patient advocates (n = 3) and physician experts (n = 3). Health state descriptions and a QOL questionnaire were piloted and administered to a general population. Visual analog scales (VASs) were also administered to detect concurrence of the findings.
MAIN OUTCOMES AND MEASURES
TED health state utility scores and whether they differ from one another were assessed using Shapiro-Wilk, Kruskal-Wallis, pairwise Wilcoxon rank sum, and paired t tests.
RESULTS
A total of 111 participants completed time trade-off interviews. The mean (SD) utility value was 0.44 (0.34). The lowest (worse) mean utility value was observed in the most severe disease state (constant diplopia/large proptosis) with 0.30 (95% CI, 0.24-0.36), followed by constant diplopia/small proptosis (0.34; 95% CI, 0.29-0.40), intermittent or inconstant diplopia/large proptosis (0.43; 95% CI, 0.36-0.49), no diplopia/large proptosis (0.46; 95% CI, 0.40-0.52), and intermittent or inconstant diplopia/small proptosis (0.52; 95% CI, 0.45-0.58). The highest (best) mean value, 0.60 (95% CI, 0.54-0.67), was observed for the least severe disease state (no diplopia/small proptosis).
CONCLUSIONS AND RELEVANCE
These findings suggest that patients with active, moderate-severe TED may have substantial disutility, with increasing severity of proptosis/diplopia more likely to have detrimental associations with QoL. These health state scores may provide a baseline for determining QoL improvement in these TED health states (utility gains) treated with new therapies.
Topics: Humans; Graves Ophthalmopathy; Quality of Life; Exophthalmos; Surveys and Questionnaires; Diplopia
PubMed: 36580313
DOI: 10.1001/jamaophthalmol.2022.3225 -
Journal of AAPOS : the Official... Aug 2022To evaluate the prevalence of retinal misregistration, that is, misalignment of retinal elements that affect central and peripheral fusion, and the effect of surgery in...
PURPOSE
To evaluate the prevalence of retinal misregistration, that is, misalignment of retinal elements that affect central and peripheral fusion, and the effect of surgery in patients with epiretinal membrane (ERM).
METHODS
This prospective interventional case-series was performed on 32 patients with symptomatic ERM with the complaint of binocular diplopia or decreased visual acuity. After the diagnosis of ERM, optotype frame, synoptophore, and lights on-off tests were used to evaluate retinal misregistration. Patients with severe symptoms underwent surgery and were followed for 3 months.
RESULTS
Of the 32 patients, 6 (19%) had preoperative diplopia. Optotype frame, synoptophore, and lights on-off tests had positive results in 20 (63%), 19 (63%), and 11 (34%) cases, respectively. Of the 6 diplopia cases, 5 showed positive results in all 3 tests and 1 was positive on optotype frame and synoptophore testing. Of the 26 cases without diplopia, 15 (58%) showed positive results in at least one test, including 6 (23%) in all three tests, 6 (23%) in two tests, and 3 (12%) in only one test. Ten patients underwent surgery. Postoperatively, all patients had negative lights on-off test, but optotype frame and synoptophore tests were negative in eight patients (80%). Two cases (20%) had postoperative diplopia, including 1 case with postoperative new-onset diplopia.
CONCLUSIONS
The prevalence of retinal misregistration was higher than the rate of diplopia. Surgery improved diplopia and results of tests of retinal misregistration.
Topics: Diplopia; Epiretinal Membrane; Humans; Prospective Studies; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 35842076
DOI: 10.1016/j.jaapos.2022.05.002 -
The Journal of Craniofacial Surgery May 2023Orbital trapdoor fractures in children and adolescents can cause persistent problems with vision and appearance. Early surgery is recommended, although, because of the...
INTRODUCTION
Orbital trapdoor fractures in children and adolescents can cause persistent problems with vision and appearance. Early surgery is recommended, although, because of the rarity of these fractures, there is a lack of evidence regarding the optimal timing of surgery.The objective of this study was to examine the effect of the time from trauma to surgery on the recovery time and severity of diplopia in children and adolescents with orbital trapdoor fractures.
MATERIALS AND METHODS
A retrospective cohort study was performed of all orbital fractures in children and adolescents aged 0 to 20 years, treated at a tertiary referral center in 2005-2017. Data relating to demographics, cause of injury, surgery, time of follow-up, and final outcomes were extracted. The cases of trapdoor fracture were specifically examined with regard to the time from trauma to surgery and diplopia at last follow-up, which was the primary outcome.
RESULTS
One hundred thirty-five patients, aged 2.4 to 20 years (mean 17.0), were treated for orbital fractures during the period; 37 (27%) had an isolated orbital floor fracture and 12 (9%) had a trapdoor fracture. All patients with trapdoor fractures underwent surgery; the mean time to surgery was 11.9 days in 2007-2011 and 1.1 days in 2012-2017. Although statistical significance cannot be proven in this small and retrospective study, a shorter time from trauma to surgery seems to lead to fewer problems with diplopia and 2 patient cases that highlight this are presented.
CONCLUSIONS
Delayed surgical intervention in pediatric orbital trapdoor fractures increases the risk of delayed recovery and persistent diplopia. Other factors, such as the degree of muscle incarceration and necrosis and the surgeon's experience and skill, may, however, also influence the outcomes.
Topics: Adolescent; Humans; Child; Retrospective Studies; Treatment Outcome; Orbital Fractures; Diplopia; Oculomotor Muscles
PubMed: 36728445
DOI: 10.1097/SCS.0000000000009163 -
Journal of AAPOS : the Official... Jun 2022We present the case report of a patient who presented with intermittent diplopia and left hypertropia associated with an apparent left superior oblique palsy. After...
We present the case report of a patient who presented with intermittent diplopia and left hypertropia associated with an apparent left superior oblique palsy. After dissociation with cover testing, he showed conjugate rhythmic vertical eye movements present in all gazes, thought to represent rapid rhythmically alternating fixation. The vertical rhythmic movement resolved after strabismus surgery.
Topics: Diplopia; Eye Movements; Humans; Male; Oculomotor Muscles; Strabismus; Trochlear Nerve; Trochlear Nerve Diseases
PubMed: 35550859
DOI: 10.1016/j.jaapos.2022.02.010 -
Archivos de La Sociedad Espanola de... Jul 2023To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia.
OBJECTIVE
To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia.
METHODS
The study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up.
RESULTS
A central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (±SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (±2.9) pd and distance preoperative deviation: 6.88 (±4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up. The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months.
CONCLUSION
Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.
Topics: Humans; Adult; Female; Middle Aged; Exotropia; Treatment Outcome; Diplopia; Ophthalmologic Surgical Procedures; Retrospective Studies; Ocular Motility Disorders; Myopia
PubMed: 37031738
DOI: 10.1016/j.oftale.2023.02.006 -
Survey of Ophthalmology 2021A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V,...
A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V, and VI). She was initially diagnosed with Tolosa-Hunt syndrome and had a partial response to systemic corticosteroids. Skull base biopsy eventually showed poorly differentiated carcinoma consistent with perineural spread of squamous cell carcinoma.
Topics: Aged; Biopsy; Diagnosis, Differential; Diplopia; Female; Humans; Magnetic Resonance Imaging; Ophthalmoplegia; Tolosa-Hunt Syndrome
PubMed: 33129799
DOI: 10.1016/j.survophthal.2020.10.005 -
Acta Neurologica Belgica Oct 2021We investigated the ophthalmologic manifestations and factors that influence outcomes in patients with myasthenia gravis (MG). We retrospectively analyzed the prevalence...
We investigated the ophthalmologic manifestations and factors that influence outcomes in patients with myasthenia gravis (MG). We retrospectively analyzed the prevalence of neuro-ophthalmologic findings and clinical and outcome measures of 100 consecutive patients (53 males, 47 females), aged 55.7 ± 17.5 (range 15-85) years with an established diagnosis of MG. Forty-eight patients had purely ocular symptoms at the onset of disease (OMG) and 52 patients presented with generalized symptoms (GMG). Overall, 21 patients presented with extraocular muscle (EOM) weakness. Bilateral EOM weakness was seen in 12 patients, and unilateral EOM weakness was seen in nine patients. Diplopia responded partially to immunosuppressive treatments in 60% of patients with ophthalmoparesis. Twenty-five (52.1%) patients with ocular-onset MG converted to secondary GMG at a mean time of 14.5 months. Patients who developed secondary GMG were younger and had an earlier age of disease onset when compared with patients with pure OMG (p < 0.05). Patients with secondary GMG presented more frequently with ptosis and diplopia (72% vs. 28%) compared with patients with pure ocular MG who presented more frequently with isolated ptosis (66.7% vs. 33.3%) (p = 0.02). Remission and minimal manifestation status were achieved in 50 (79.3%) of all patients with a clinical follow-up ≥ 3 years. Poor outcome was associated with the presence of thymoma (p < 0.05). Myasthenic ophthalmoparesis is bilateral and heterogeneous and partly responds to treatment with immunotherapy. Younger patients with ptosis and diplopia at disease onset had an increased risk of secondary GMG. The presence of thymoma increases the risk for poor prognosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blepharoptosis; Diplopia; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Myasthenia Gravis; Ocular Motility Disorders; Treatment Outcome; Young Adult
PubMed: 33439450
DOI: 10.1007/s13760-020-01556-3 -
Studies in History and Philosophy of... Aug 2022In contrast to earlier theorists within the Greek optical tradition, who relied almost exclusively on geometrical diagrams to articulate and explain vision, Ptolemy...
In contrast to earlier theorists within the Greek optical tradition, who relied almost exclusively on geometrical diagrams to articulate and explain vision, Ptolemy employed several material instruments in his investigation of sight. These included rulers, glass cylinders, mirrors, and a bronze plaque designed to measure angles of incidence and reflection. These devices allowed Ptolemy to expand the operational definition of vision far beyond that of his predecessors, as he explicated several previously unexamined visual behaviors, including binocular vision, diplopia, and refraction. This article argues that these tools did more than make new phenomena visible; they also set the parameters for what these phenomena looked like-sometimes to such a degree that features of these instruments merged with the visual behaviors that they rendered visible. In some cases, this occurred as a type of "double-exposure," where the investigative tool became layered over top of the process of sight, such as when Ptolemy's "ruler" for investigating binocular vision became a template for imagining the mechanism of spatial perception employed by the eyes. In other cases, this merging occurred as a type of "technological afterimage," where the instrument provided an implicit model for phenomena it was not directly investigating. Ptolemy's bronze plaque stands as an example of this second type, insofar as it inspired his account of ocular geometry and facilitated novel assertions about the eye's operations, even though it did not directly inspect these features. In general, this article thus outlines how the technologies of investigation can structure patterns of thought and naturalize certain physical arguments, whether for the phenomena that they directly articulate or for those indirectly associated with their particular use cases.
Topics: Afterimage; Diplopia; Humans; Male; Optics and Photonics; Refraction, Ocular; Vision, Binocular
PubMed: 35843010
DOI: 10.1016/j.shpsa.2022.06.011 -
Seminars in Neurology Dec 2021Visual complaints are commonly encountered by the practicing neurologist. We review assessment of vision loss, diplopia, and positive visual phenomena, all of which... (Review)
Review
Visual complaints are commonly encountered by the practicing neurologist. We review assessment of vision loss, diplopia, and positive visual phenomena, all of which require a thoughtful evaluation to localize disease and refine management. While many causative entities are unlikely to cause poor visual outcomes, including dry eyes, migraine, and congenital strabismus, others may threaten vision, life, or both, such as posterior communicating artery aneurysms, pituitary apoplexy, or temporal arteritis. A systematic approach to vision loss and diplopia is reviewed along with focused differential diagnoses.
Topics: Diplopia; Humans; Neurologists; Outpatients; Pituitary Apoplexy; Strabismus; Vision Disorders
PubMed: 34826873
DOI: 10.1055/s-0041-1726362