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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 -
Magnetic resonance imaging reveals possible cause of diplopia after Baerveldt glaucoma implantation.PloS One 2022To assess if ocular motility impairment, and the ensuing diplopia, after Baerveldt Glaucoma device (BGI) implantation, is related to the presence of a large fluid... (Observational Study)
Observational Study
PURPOSE
To assess if ocular motility impairment, and the ensuing diplopia, after Baerveldt Glaucoma device (BGI) implantation, is related to the presence of a large fluid reservoir (bleb), using Magnetic Resonance Imaging (MRI).
METHODS
In a masked observational study (CCMO-registry number: NL65633.058.18), the eyes of 30 glaucoma patients with (n = 12) or without diplopia (n = 18) who had previously undergone BGI implantation were scanned with a 7 Tesla MRI-scanner. The substructures of the BGI-complex, including both blebs and plate, were segmented in 3D. Primary outcomes were a comparison of volume and height of the BGI-complex between patients with and without diplopia. Comparisons were performed by using an unpaired t-test, Fisher's Exact or Mann-Whitney test. Correlations were determined by using Spearman correlation.
RESULTS
The median volume and height of the BGI-complex was significantly higher in patients with compared to patients without diplopia (p = 0.007 and p = 0.025, respectively). Six patients had an excessively large total bleb volume (median of 1736.5mm3, interquartile range 1486.3-1933.9mm3), four of whom experienced diplopia (33% of the diplopia patients). Fibrotic strands through the BGI plate, intended to limit the height of the bleb, could be visualized but were not related to diplopia (75% versus 88%; p = 0.28).
CONCLUSIONS
With MRI, we show that in a significant number of diplopia cases a large bleb is present in the orbit. Given the large volume of these blebs, they are a likely explanation of the development of diplopia in at least some of the patients with diplopia after BGI implantation. Additionally, the MR-images confirm the presence of fibrotic strands. As these strands are also visible in patients with a large bleb, they are apparently not sufficient to restrict the bleb height.
Topics: Humans; Diplopia; Glaucoma; Glaucoma Drainage Implants; Intraocular Pressure; Magnetic Resonance Imaging; Visual Acuity
PubMed: 36264982
DOI: 10.1371/journal.pone.0276527 -
American Journal of Ophthalmology Jul 2017To describe the causes of diplopia in patients with an epiretinal membrane (ERM) and presenting diplopia. (Observational Study)
Observational Study
PURPOSE
To describe the causes of diplopia in patients with an epiretinal membrane (ERM) and presenting diplopia.
DESIGN
Retrospective observational case series.
METHODS
We reviewed patients diagnosed with an ERM, who had been seen by both retinal and strabismus specialists in a tertiary medical center. Data recorded: orthoptic evaluation, retinal misregistration (optotype-frame test, and synoptophore central peripheral superimposition slides at 5 and 10 degrees), and cause of any diplopia (retinal misregistration vs strabismus vs optical/refractive error). We defined central-peripheral rivalry-type diplopia as presenting symptomatic diplopia with evidence of retinal misregistration, and where other causes did not fully explain diplopia. The frequency of each cause of diplopia in patients with ERM was determined.
RESULTS
Of 50 patients with ERM, 25 had symptomatic diplopia and 25 had no diplopia. Eleven of 25 diplopic patients (44%) had retinal misregistration as the sole cause (central-peripheral rivalry-type diplopia), 7 (28%) strabismus (1 of 7 initally appeared to have central-peripheral rivalry-type diplopia), 1 (4%) optical/refractive error (monocular diplopia), 2 (8%) mixed retinal misregistration (central-peripheral rivalry-type diplopia) and strabismus, and for 4 (16%) diplopia cause was indeterminate. Unexpectedly, 15 of 25 patients without diplopia (60%) had evidence of retinal misregistration.
CONCLUSIONS
Patients with ERM and presenting diplopia may have 1 of several causes of diplopia, most commonly retinal misregistration (central-peripheral rivalry-type diplopia). Nevertheless, diplopic patients with retinal misregistration may also have treatable strabismus or optical/refractive error as the primary barrier to single vision and therefore many potential barriers to single vision should be considered.
Topics: Aged; Aged, 80 and over; Diplopia; Epiretinal Membrane; Female; Humans; Male; Middle Aged; Retina; Retrospective Studies; Tomography, Optical Coherence; Vision, Binocular; Visual Acuity
PubMed: 28456546
DOI: 10.1016/j.ajo.2017.04.014 -
Indian Journal of Ophthalmology Aug 2022To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current...
PURPOSE
To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current study is carried on how FVT affects the duration of treatment, sensory fusion, and exotropic drift.
METHODS
This was a retrospective study for the medical record of 11 patients with consecutive esotropia after IXT surgery of 543 patients over the period of 5 year, with mean surgery age of 9.5 (range: 4-33 y). FVT was planned after minimum 6 weeks of surgery and was considered for maximum 24 weeks. Patients underwent a combination of office-based and home-based FVT. Successful outcome of therapy was considered where diplopia resolves in free space and achieves sensory fusion, stereopsis with no manifest deviation.
RESULTS
Record of 543 patients who had horizontal muscle surgery for IXT were identified and reviewed. Records of 11 patients who showed consecutive esotropia of 10 prism diopter (PD) or more with normal retinal correspondence, with or without diplopia complaint, after 6 week of surgery and had undergone vision therapy management were reviewed. A successful outcome of binocular single vision with good sensory and motor fusion with no manifest deviation or prism requirement was achieved with in the mean duration of 4.8 month of therapy. With a mean duration of 4 weeks of therapy, the mean angle of deviation reduced by 53% for distance (17 PD to 8 PD) and 27% for near (11 PD to 8 PD) and mean stereopsis improvement by 80% with 94% patients demonstrating sensory fusion on Bagolini test and 94% of patients having no symptoms of diplopia or squint.
CONCLUSION
With nonsurgical management involving refractive error correction, FVT, and prism, consecutive esotropia was resolved in 74% cases. Management of consecutive esotropia with FVT can result in satisfactory sensory fusion and successful motor alignment.
Topics: Diplopia; Esotropia; Exotropia; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Retrospective Studies; Treatment Outcome; Vision, Binocular; Visual Acuity
PubMed: 35918971
DOI: 10.4103/ijo.IJO_2849_21 -
Strabismus Jun 2022Exotropia (XT) in internuclear ophthalmoplegia (INO) is a difficult problem to treat. The purpose of this study is to describe surgical approaches in treating INO and...
Exotropia (XT) in internuclear ophthalmoplegia (INO) is a difficult problem to treat. The purpose of this study is to describe surgical approaches in treating INO and glean insight into various pre-operative factors that may affect outcomes for XT in INO. We conducted a retrospective review from 1 January 1995 - 5 January 2021 and identified seven patients with INO who underwent strabismus surgery for XT. Patient age, sex, etiology of INO, pre-operative alignment and sensorimotor exam, presence of diplopia, surgery performed, subsequent surgeries, use of adjustable sutures, post-operative alignment, presence of post-operative diplopia, presence of post-operative diplopia with use of prism correction, and length of follow-up were all collected. Initial surgeries undertaken included unilateral medial rectus (MR) plication and lateral rectus (LR) recession, bilateral medial rectus (MR) plications or resections, or bilateral MR plications combined with either unilateral or bilateral LR recessions. Chart review yielded ten charts, however two were excluded due to manifest esotropia (ET), and one was excluded due to incomplete records. Seven total patients were used in final analysis. The cohort age range was from 29 to 79 years. Pre-operative horizontal distance alignment ranged from 35 to 95 XT with an average exodeviation of 67.8 ± 22.6 prism diopters (PD). Horizontal adduction deficit ranged from -1 to -4 and was present bilaterally in all patients. A variety of initial surgical approaches were undertaken. After two muscle surgeries, distance deviation had an average change of 57.3 PD. After three muscle surgeries, distance deviation had an average change of 75 PD. After four muscle surgeries, distance deviation had an average change of 60 PD. Three patients required additional surgery for XT. Time to follow-up ranged from 1 to 58 months. Horizontal distance alignment in primary gaze at latest follow-up ranged from 30 ET to 30 XT with an average of 0 (orthotropia) ± 16.0 PD. One patient had a consecutive esotropia of 30 PD, one had a persistent exotropia of 30 PD, and five patients were orthotropic at distance. All patients reported relief of diplopia in primary gaze at near and distance either with or without use of prism. Horizontal ductions improved to some degree in all patients. Horizontal rectus surgery can treat many cases of XT in INO. Surgeons should consider INO etiology and concomitant vertical deviations when considering surgery. The degree of pre-operative adduction limitation is another important factor, though did not always dictate final motor and sensory outcomes.
Topics: Adult; Aged; Diplopia; Esotropia; Exotropia; Follow-Up Studies; Humans; Middle Aged; Ocular Motility Disorders; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Retrospective Studies; Strabismus; Treatment Outcome
PubMed: 35438603
DOI: 10.1080/09273972.2022.2061528 -
European Journal of Trauma and... Apr 2022The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical...
OBJECTIVE
The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature.
STUDY DESIGN
One thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications.
RESULTS
The average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The average orbital wall defect size was 297.9 mm (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma.
CONCLUSION
Results of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm.
Topics: Adolescent; Adult; Diplopia; Female; Fractures, Multiple; Humans; Male; Orbital Fractures; Polydioxanone; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 34128084
DOI: 10.1007/s00068-021-01716-x -
Acta Medica Portuguesa Oct 2020Percutaneous coronary intervention is a coronary revascularization procedure that may rarely result in thromboembolic events. Although infrequent, ophthalmological...
Percutaneous coronary intervention is a coronary revascularization procedure that may rarely result in thromboembolic events. Although infrequent, ophthalmological complications of percutaneous interventions include a wide range of clinical presentations, with differing severity and outcomes. In this case report, an 83-year-old woman, with multiple cardiovascular risk factors, presents with horizontal diplopia after a percutaneous transluminal coronary angioplasty. After ophthalmological evaluation and a head computed tomography scan, the diagnosis of isolated ischemic internuclear ophthalmoplegia was established. After six months of follow-up, the patient showed complete recovery of her symptoms and ocular movements. We discuss the post-percutaneous intervention ophthalmic complications that, although uncommon, must be recognized by health care providers.
Topics: Aged, 80 and over; Angioplasty, Balloon, Coronary; Diplopia; Female; Head; Humans; Myocardial Revascularization; Ophthalmoplegia; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33135624
DOI: 10.20344/amp.11751 -
Scientific Reports Oct 2019This study is aimed to determine the relationship between orbital fracture sites in each CT scan view and postoperative diplopia. Data for 141 patients of orbital wall...
This study is aimed to determine the relationship between orbital fracture sites in each CT scan view and postoperative diplopia. Data for 141 patients of orbital wall fracture were analyzed retrospectively. One group of examiners reviewed sagittal, coronal and axial CT scans. Descriptive statistical analysis was used to assess each fracture area and its potential relationship with the occurrence of postoperative diplopia. Among the three anatomical views, sagittal sections were significantly associated with post-operative diplopia (PD) (p = 0.044). For orbital wall fractures in a single location, C1 (p = 0.015), A1 (p = 0.004) and S3 (p = 0.006) fractures were significantly related to PD. Orbital wall fractures found in more than one location resulted in a higher probability of PD in all sections:, C1 + C2 group (p = 0.010), C1 + C2 + C3 group (p = 0.005), A1 + A2 group (p = 0.034), A3 + A1 group (p = 0.005), S1 + S2 group (p < 0.001), S2 + S3 group (p = 0.006) and S1 + S2 + S3 group (p < 0.001). For combinations of two or three sections, we found that only fractures involving both coronal and sagittal sections led to a significantly increased risk of PD (p = 0.031). PD is the main posttreatment complication of orbital bone fracture reduction. In addition to the known myogenic cause (failure to relieve entrapment) of diplopia, both trauma and surgical manipulation can compromise ocular motor nerve function and possibly result in the development of neurogenic causes of diplopia. Careful assessment of patient symptoms (whether preoperative diplopia is present), and the location of orbital fractures (and the influence of related musculature, fat, and nerves) on CT scans are strongly related to surgical success.
Topics: Adult; Diplopia; Female; Fracture Fixation; Humans; Male; Middle Aged; Oculomotor Nerve; Orbit; Orbital Fractures; Postoperative Complications; Preoperative Period; Retrospective Studies; Risk Assessment; Risk Factors; Strabismus; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31616002
DOI: 10.1038/s41598-019-51127-7 -
Journal of Healthcare Engineering 2022To observe and analyze the occurrence rate, improvement time, and influencing factors of diplopia after intermittent exotropia in children.
OBJECTIVE
To observe and analyze the occurrence rate, improvement time, and influencing factors of diplopia after intermittent exotropia in children.
METHODS
A total of 135 children with intermittent exotropia treated in our hospital from February 2019 to April 2021 were recruited. A reasonable surgical plan was exerted according to the preoperative examination of the children, the children were divided into groups according to their age, degree of strabismus, visual acuity, and binocular visual function, and the postoperative diplopia occurrence rate and improvement time of diplopia in different groups were observed and compared.
RESULTS
Postoperative diplopia occurred in 74 of 135 children with intermittent exotropia, and the postoperative incidence of diplopia was 54.81%. All diplopia occurred on the first day after the operation. There were 62 cases of contradictory diplopia (83.78%) and 12 cases of fusion of powerless diplopia (16.22%). Except for 1 case of amalgamated powerless diplopia, diplopia was not significantly improved after 6 months, which seriously affected the life of the children after the second operation, and all the others were significantly improved within 90 days. The improvement time of diplopia was 3-90 days, and the average improvement time of diplopia was 13.25 ± 3.16 days. According to their age, the children were divided into the 3-6 years old group ( = 69), the 7-10 years old group ( = 47), and the 11-14 years old group ( = 19). Postoperative diplopia occurred in 25 cases (36.23%) in the 3-6 years old group, 34 cases (72.34%) in the 7-10 years old group, and 16 cases (84.21%) in the 11-14 years old group. There was a significant difference in the incidence of postoperative diplopia among the three groups ( < 0.05). There was a significant difference in the improvement time of diplopia among the three groups ( < 0.05). According to the degree of strabismus before the operation, the children were divided into the <50△ group ( = 74) and the ≥50△ group ( = 61). Postoperative diplopia occurred in 32 cases (43.24%) in the <50△ group and 43 cases (70.49%) in the ≥50△ group. There was a significant difference in the incidence of postoperative diplopia between the two groups ( < 0.05). There was a significant difference in the improvement time of diplopia among the three groups ( < 0.05). According to the results of the visual acuity examination, the patients were divided into the ≥0.8 (naked eye) group ( = 21), the ≥0.8 (ametropia) group ( = 32), and the <0.8 (amblyopia) group ( = 32). Among them, diplopia occurred in 10 cases (47.62%) in the ≥0.8 (naked eye) group, 40 cases (48.78%) in the ≥0.8 (ametropia) group, and 24 cases (75.00%) in the <0.8 (amblyopia) group. The incidence of diplopia in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant ( < 0.05). The postoperative diplopia improvement time in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant ( < 0.05). There was no significant difference in diplopia occurrence rate and diplopia improvement time between the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group ( > 0.05). According to the results of binocular visual function examination, 92 cases had a primary function, 45 cases (48.91%) had diplopia after the operation, the average recovery time of diplopia was 12.58 ± 3.16, 43 cases had no primary function, and 30 cases (69.77%) had diplopia after the operation. The average recovery time of diplopia was 13.02 ± 3.84. There was a significant difference in the incidence of diplopia between the two groups ( = 5.162). There was no significant difference in the recovery time of diplopia between the two groups ( = 0.570, < 0.05). In 80 cases with secondary function, diplopia occurred in 36 cases (45.00%), and the average recovery time of diplopia was 10.14 ± 2.88; in 55 cases without secondary function, diplopia occurred in 39 cases (70.91%), and the average recovery time of diplopia was 14.86 ± 3.73. There was a significant difference in the incidence of diplopia between the two groups ( = 8.861, < 0.002). There was a significant difference in the recovery time of diplopia between the two groups ( = 6.469, < 0.001). In 77 cases with tertiary function, diplopia occurred in 32 cases (41.56%), and the average recovery time of diplopia was 9.61 ± 2.39; in 58 cases without tertiary function, diplopia occurred in 43 cases (74.14%), and the average recovery time of diplopia was 13.11 ± 3.05. There was a significant difference in the incidence of diplopia between the two groups ( = 14.221 < 0.001). There was a significant difference in the recovery time of diplopia between the two groups ( = 5.355, < 0.001).
CONCLUSIONS
The age, degree of strabismus, visual acuity, and binocular visual function of children with intermittent exotropia are significant factors affecting the occurrence rate and recovery time of diplopia after the operation. The younger the age, the smaller the degree of strabismus, the better the vision and the second or third grade of visual function, the smaller the occurrence rate of diplopia, and the shorter the recovery time of diplopia. Thus, the above influencing factors have a certain guiding significance in predicting the improvement of postoperative diplopia and the time of diplopia disappearance. The purpose of intermittent exotropia surgery in children is not only to correct eye position and improve appearance but also to establish normal retinal correspondence in order to obtain binocular monocular function. Furthermore, postoperative diplopia in children with concomitant exotropia is very common; therefore, careful examination, comprehensive analysis, and surgical plan should be designed according to the above factors. Stereoscopic vision training as early as possible after the operation is beneficial to the establishment of normal retinal correspondence and the elimination of diplopia.
Topics: Adolescent; Amblyopia; Child; Child, Preschool; Chronic Disease; Diplopia; Exotropia; Humans; Ophthalmologic Surgical Procedures; Refractive Errors; Strabismus
PubMed: 35320998
DOI: 10.1155/2022/2611225 -
Journal of AAPOS : the Official... Feb 2023Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when... (Review)
Review
Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when treating patients with binocular diplopia. We review the reported surgical options and, through illustrative cases, provide our own perspective on managing this disorder.
Topics: Humans; Oculomotor Muscles; Retrospective Studies; Oculomotor Nerve Diseases; Strabismus; Diplopia; Vision, Binocular
PubMed: 36640897
DOI: 10.1016/j.jaapos.2022.11.017