Purpose We conducted a study to investigate: (1) deviations caused by retinal detachment (RD) repair; (2) correlation between visual acuity and the number of surgeries to deviation size; and (3) differences between deviations following scleral buckling (SB) and pars plana vitrectomy (PPV). Methods A retrospective analysis of patients with persistent binocular diplopia following RD repair. Magnitude of manifest deviation (|dev|) in the primary position (PP) and position of greatest deviation (maxDev) was calculated. LogMAR acuity and number of previous vitreoretinal procedures were correlated to |dev| in both PP and maxDev. Manifest |dev| were compared between SB and PPV groups. Results Twenty-five patients were identified. The median |dev| was 7 prism diopters (PD) in PP and 17 PD in maxDev. We found no association between number of surgeries or VA with |dev| in either the PP (r ¼ À0.18 and r ¼ 0.08) or maxDev (r ¼ À0.26 and r ¼ À0.05). Twelve patients underwent PPV: median |dev| in PP 6 PD and maxDev 9 PD. In the SB group: median |dev| in PP 8 PD and in maxDev 22 PD. |dev| in PP showed no significant differences between PPV and SB (U ¼ 63, P ¼ 0.41); however, |dev| in maxDev, showed that SB have significantly greater deviations (U ¼ 36.0, P ¼ 0.02). Conclusion We report the largest cohort of patients with symptomatic ocular motility defects following PPV. We show no association between VA or number of procedures to strabismus magnitude. Ocular deviations in maxDev are significantly greater after SB procedures.
Aim: To evaluate in a pilot study the use of a touchscreen test in very low birth weight (VLBW) children to explore aspects of visuo-motor behaviour, measuring spatial localisation. Results in VLBW subjects will be compared with those in children born at term. It will be investigated whether any deficits found were related to parental reports of visual function difficulties. Methods: A range of visual functions were measured and IQ estimated using subtests from a standardised test. Using a touch-screen monitor to record pointing positions, in task 1 subjects pointed to sequences of visual targets as soon as they appeared and in task 2 they pointed after a memory delay. Results: Thirty-seven VLBW subjects and 32 control subjects were recruited. On task 1 there was no difference in the pointing error magnitude between the groups. Although the errors of the VLBW group were more variable, this was not statistically significant after exclusion of VLBW subjects with IQ <70. However, on task 2 the VLBW group remembered fewer complete sequences, leading to significantly higher average pointing errors when data were averaged over all sequences. When pointing error was averaged over only correctly remembered sequences, there was again no difference between the groups. Conclusions: Our results indicate that pure spatial localisation in the absence of a memory load in VLBW children is comparable to the performance of children born at term. However, deficits are apparent in VLBW children when working memory is introduced, and this is consistent with the findings of other studies.
We report a presumed damage to the left superior rectus (SR) muscle following a dog bite injury that resulted in a marked weakness of elevation and vertical diplopia. A 30-year-old male presented in October 2010 following a dog bite around his left superotemporal orbit. An ophthalmic examination was unremarkable. The patient immediately complained of vertical diplopia, which did not settle during a period of observation lasting approximately 9 months following the attack. An orthoptist examination confirmed a marked restriction of upgaze. A diagnosis of isolated SR injury, secondary to the dog bite, was suspected. A left Knapp procedure was performed. The surgery was uneventful with scar tissue found around the SR. Three months following his surgery, the patient was orthophoric in both primary positions and in the downgaze with a residual 20-prism dioptre hypotropia in the upgaze. Our patient was unusual in that the bite weakened the SR in isolation. We also show the successful management of this novel case using a simple Knapp procedure.
Introduction: Sport-related concussions are recognized in all types of sports in athletes of all ages. While concussion presentation involves transient symptoms, some may have prolonged symptoms that linger past the typical 2-week recovery time for adults. These prolonged symptoms can affect physical, emotional, cognitive, and sleep domains.Research Significance: This thesis examined adult athletes who experience prolonged symptoms of sport-related concussion to further our understanding of the type of symptoms that are common in an understudied population. Many of the psychological and sociological deficits are not evaluated in preparation for return to sport, but the aim of the thesis is to show their need to be included. Links between psychosocial and physical impairments can drive decisions regarding return to sport.
Methods:Based on the biopsychosocial model, 3 cross-sectional studies assessed which symptom domains were clinically relevant, associated with disability, and related to each other. The studies included several clinical outcome measures delivered in online format such as the concussion symptoms, fear avoidance, sleep changes, cogniphobia, pain catastrophizing, and disability post-concussion. The last study included a small sample of participants doing a qualitative interview to confirm objective findings. They were asked to reflect on mental health, sociological impacts, and physical symptoms.
Results:The concussion groups showed clinically relevant levels of concussion symptoms, mental health distress, and fear avoidance behaviour. The athletes also presented with significant changes in their abilities of daily activities. Episodic memory was also found to be a deficit for this study. Athlete interviews had statements about fear, loss of self, acceptance, and emotional regulation. Limitations included changing to online formats due to Covid-19, small sample sizes, and utilization of new outcome measures. Future work would expand on the emotional and sociological findings and address cognitive tasks for adults with prolonged symptoms. Evaluation in conjunction with physical activity or training helps an athlete return to sport.Conclusions: Adult athletes with prolonged symptoms of sport-related concussion live with many physical, emotional, and sociological impairments. It is a population that needs further research to focus on their impact and future intervention plans.
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