No abstract

Topical anesthesia in strabismus surgery is a useful technique in the treatment of extraocular muscle pathology, with few limitations. Appropriate monitoring by an anesthetist is vital to ensure adequate control of pain and possible side effects and to enable conversion to general anesthesia. The oculocardiac reflex is infrequent. For experienced strabismus surgeons, the total surgical time is comparable with topical and general anesthesia.

Purpose: To study the subfoveal choroidal thickness (SFCT), macular ganglion cell layer (GCL-IPL) and central macular thickness (CMT) in Caucasian children, and to analyze these optical coherence tomography (OCT) parameters depending on the spherical equivalent (SE). Methods: Cross-sectional study of SFCT, GCL-IPL, and CMT in Caucasian children, analyzed with spectral-domain OCT Cirrus 5000 and Enhanced-depth imaging technique. Correlation between these three OCT parameters, age, sex, and spherical equivalent was analyzed. The eyes were classified into three groups: group 1 included eyes with SE < 0, group 2 included eyes with SE between 0 and +2.00, and group 3 eyes with SE > +2.00. Results: Hundred ninety-eight eyes of 121 subjects were studied. The mean age was 9.22 years (range 3–16); 61.1% were female. The mean SFCT was 351.04 ± 84.08 µm, being 310.04 ± 82.84µm in group 1 (n = 62), 373.14 ± 83.16 µm in group 2 (n = 71) and 365.18 ± 73.16 µm in group 3 ( n = 65); statistically significant differences were found between groups 2 and 3, compared with group 1. GCL-IPL thickness was significantly thinner ( p < 0.001) in group 1, compared with group 3. There were no statistically significant differences between the three groups regarding CMT. Correlation with age, and sex was not found. Conclusions: SFCT and GCL-IPL thickness were significantly thinner ( p < 0.001) in myopic children when compared with a non-myopic pediatric population. However, it seems that there is not a correlation among the three OCT parameters studied, age and sex, when they are analyzed depending on refractive error.

Purpose: To study the clinical signs, treatment and prognosis of strabismus after sub-Tenon's anesthesia for cataract surgery. Methods: Eight patients without previous strabismus developed incommitant diplopia immediately after cataract surgery; the left eye was affected in five patients and the right eye in three. Restrictive strabismus was diagnosed with the cover test, prisms, and active and passive ductions in all cases. In seven cases the deviation was vertical and in one patient it was horizontal. The average deviation was 17.5 S.D. 9.84 (range 5-35) prismatic dioptres in primary position. The deviation increased looking upward in seven cases, and looking sideways to the left in the other. It was considered to be a good result if the diplopia disappeared after treatment. Results: Botulinum toxin was the first treatment applied in four patients, but only one showed a good response and required no further therapy. Strabismus surgery was required in four cases, and prisms were adapted in three. Three patients required two strabismus operations. A good result was achieved in all cases, with the average time interval being 10.12 (SD 5.5) months. ORIGINAL ARTICLE RESUMENObjetivo: Estudiar las características del estrabismo secundario a la cirugía de catarata con anestesia subtenoniana; su tratamiento y pronóstico. Método: Ocho enfermos sin estrabismo previo presentaron diplopía inmediatamente después de la cirugía de catarata; cinco de ojo izquierdo, tres de ojo derecho. La exploración con cover test, prismas y ducción activa y pasiva mostró estrabismo restrictivo: siete de componente vertical y uno horizontal. La desviación media fue de 17,5 DE: 9,84 dioptrías prismáticas (rango 5-35) en la mirada al frente. La posición máxima de desviación fue en supraversión en siete, y en levoversión en otro. Todos tenían diplopía invalidante. Se considera buen resultado si desaparecía la diplopía con el tratamiento. Resultados: Cuatro casos recibieron tratamiento quirúrgico, en uno sólo se inyectó toxina botulínica y en tres se pusieron prismas. La toxina botulínica se empleó como primera opción en cuatro casos y sólo fue eficaz en un enfermo. De los cuatro casos operados, tres necesitaron dos cirugías y un paciente sólo un tiempo quirúrgico. Se consiguió buen resultado en los ocho pacientes tratados. El tiempo medio de evolución fue de 10,12 DE: 5,46 meses. 142ARCH SOC ESP OFTALMOL 2006; 81: 141-146 MERINO P, et al.

The main goal of this study is to examine the effect of intramuscular bupivacaine in oculomotor paresis, analyzing whether it is possible to obtain a stronger muscle contraction due to the muscle hypertrophy caused by the drug. An injection of 4.5 mL of a 0.50% solution of bupivacaine was administered in the paretic muscle of three patients. Magnetic resonance imaging was performed before and 3 months after injection to compare muscle cross-sectional areas. The symptoms of two patients improved and an increase of muscle cross-sectional area was observed. However, it is necessary to be prudent when employing intramuscular bupivacaine in oculomotor paresis treatment until there are more and larger studies.