Introdução: Os distúrbios oftalmológicos representam um sério problema de saúde pública considerando que muitos dos agravos à saúde ocular poderiam ser prevenidos ou adequadamente tratados. O presente estudo tem como objetivo avaliar as alterações oftalmológicas em recém-nascidos pré-termo de muito baixo peso aos dois anos de idade cronológica e compará-las entre os grupos com e sem retinopatia da prematuridade. Métodos: Estudo transversal incluindo todas as crianças nascidas em um hospital universitário entre o período de novembro de 2009 a junho de 2011, com IG < 34 semanas e peso de nascimento < 1500g, avaliadas aos dois anos de idade. Foram excluídos gêmeos, óbitos neonatais e as crianças que não compareceram a consulta de seguimento. Foi realizada a análise descritiva e comparativa dos dois grupos pelo teste de Mann Whitney e x²; odds ratio das alterações oftalmológicas entre os dois grupos através do software SPSS 20.0 e Bioestat 5.2. Resultados: Foram avaliadas 82 crianças, das quais 29 (35,3%) apresentaram o diagnóstico de ROP. Dentre os fatores de risco estatisticamente significantes destaca-se a IG (p=0,005), PN(p=0,000), tempo de internação (p=0,000), uso e tipo de O2(p=0,016), hemotransfusões (p=0,000), SNAPPE(p=0,000), broncodisplasia (p=0,000), HPIV(p=0,003). A maioria das retinopatias foram classificadas no estadiamento II (51,7%). O diagnóstico de ROP durante a internação foi associado a 4,3 vezes maior probabilidade de desenvolver estrabismo aos dois anos de idade. Conclusão: A ROP aumenta o risco de alterações oftalmológicas nos prétermos de muito baixo peso, em especial o desenvolvimento de estrabismo. / Purpose: To evaluate the ocular changes in preterm with very low birth weight, at two years of chronological age and compare them between the groups with and without retinopathy of prematurity (ROP). Methods: A cross-sectional study including all children born in a university hospital in the period from November 2009 to June 2011, with gestational age (GA) <34 weeks and birth weight <1500 g, evaluated to two years of age. Were excluded: twins, neonatal deaths and children who did not attend the follow-up consultations. Was performed a descriptive and comparative analysis for both groups by the Mann Whitney test and x²; odds ratio of ophthalmologic abnormalities between the two groups through SPSS 20.0 and Bioestat 5.2 software. Results: Were evaluated 82 children, of which 29 (35.3%) had a ROP diagnosis. Among the statistically significant risk factors following stand out the GA (p = 0.005), birth weight (p = 0.000), length of hospital stay (p = 0.000), use and type of oxygen administration (p = 0.016), blood transfusions (p = 0.000 ) Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE) (p = 0.000), bronchodysplasia (p = 0.000), periintraventricular hemorrhage (p = 0.003). Most ROP (51.7%) were classified as stage II. The diagnosis of ROP was associated with 4.3 times more likely to develop strabismus at two years of age. Conclusions: The study demonstrated that ROP increases the risk of ocular changes in preterm very low birth weight, especially the development of strabismus. / Dissertação (Mestrado)

Orientador: Keila Miriam Monteiro de Carvalho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T19:40:07Z (GMT). No. of bitstreams: 1 Millan_Tatiana_M.pdf: 2201742 bytes, checksum: 9fbc6126d8358be88ca29d8f5d863b72 (MD5) Previous issue date: 2007 / Resumo: Objetivo: Avaliar os resultados da cirurgia monocular na correção de estrabismos horizontais de grande ângulo sob anestesia peribulbar. Métodos: Foram avaliados 92 pacientes submetidos à cirurgia monocular de estrabismo horizontal de grande ângulo (ângulo igual ou superior a 40 dioptrias prismáticas - DP) sob anestesia peribulbar no Hospital das Clínicas/UNICAMP. Os pacientes foram divididos em dois grupos: grupo 1 ¿ esotropias e grupo 2 ¿ exotropias. A cirurgia constava de retrocesso e ressecção dos retos horizontais no olho não dominante. O seguimento pós-operatório foi de 6 meses, quando foram avaliados o desvio residual e a movimentação ocular. Foi considerado como sucesso cirúrgico um desvio residual de até 15 DP. Em casos de desvios maiores que 15 DP, um segundo procedimento era indicado. Resultados: Em todos os pacientes com desvio de até 60 DP foi alcançado sucesso cirúrgico. Nos pacientes com desvio de 65 DP, a cirurgia teve sucesso em 1 de 3 pacientes do grupo 1 e em 5 de 9 pacientes do grupo 2 . Em desvios superiores a 65 DP, todos apresentaram desvios residuais maiores que 15 DP. Destes, 13 pacientes se submeteram a um segundo procedimento e, em todos, houve sucesso cirúrgico. A Análise da Curva ROC mostrou o ponto de corte do desvio pré-operatório para obter sucesso cirúrgico, que foi de 62,5 DP. Nenhum paciente apresentou limitação importante da movimentação ocular. Não houve complicações cirúrgicas ou anestésicas. Conclusões: A cirurgia monocular pode ser uma opção para correção de estrabismos horizontais de grande ângulo, sob anestesia peribulbar, até desvios entre 60 e 65 DP. Acima de 65 DP, a cirurgia monocular não foi suficiente para se obter sucesso pós-operatório / Abstract: Purpose: Evaluate the results of monocular surgery for large-angle horizontal strabismus under peribulbar anesthesia. Methods: Ninety-two patients submitted to monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus (angle of 40 prism dioptre or greater) in Clinical Hospital of State University of Campinas were evaluated. The patients were divided into group 1 ¿ esotropias and group 2 - exotropias. The surgery consisted of recession and resection procedures of the horizontal rectus. The postoperative follow-up was of 6 months, when it was evaluated the resisual deviation and the ocular movement. A residual deviation until 15 PD was considered a successful result. In cases of residual deviation over 15 PD, a second procedure was indicated. Results: In all patients until 60 PD preoperative deviations, successful surgery results were achieved. In the patients with 65 PD preoperative deviations, successful surgery results were obtained in 1 of 3 patients in group 1 and in 5 of 9 patients in group 2. All patients with deviations over 65 PD presented residual deviation over 15 PD. Thirteen patients were submitted to a second procedure. Successful results were obtained in all of them. The ROC Curve Analysis showed the cut point to get a successful surgery result: 62,5 PD. No patient presented important limitation of the ocular movement. There were no complications from surgery or anesthesia. Conclusions: The monocular surgery can be an alternative for horizontal large-angle strabismus under peribulbar anesthesia until deviations between 60 and 65 PD. In the deviations over 65 PD, the monocular surgery did not achieve successful results / Mestrado / Oftalmologia / Mestre em Ciências Médicas

No / PURPOSE. To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia. METHODS. The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality. RESULTS. Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional. CONCLUSIONS. The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus.

No description available.

La stéréopsie est souvent présente, bien qu’altérée, chez les sujets microstrabiques. Cependant, leur seuil de stéréopsie serait différent selon que le test utilisé contient (stéréopsie locale) ou non (stéréopsie globale) des contours définis. Peu d’études ont évalué empiriquement la différence de performance selon le type de tests utilisé. Le premier article est une étude rétrospective de 26 enfants microstrabiques. La majorité des enfants (73 %) possédaient un seuil de stéréopsie locale normal ou légèrement inférieur à la normale. Une absence de stéréopsie locale a été observée chez les 7 autres enfants (27 %). Aucune stéréopsie globale n’était mesurable chez 25 des 26 enfants étudiés. La stéréopsie locale est donc présente chez les enfants microstrabiques, mais ceux-ci montrent généralement une absence de stéréoperception globale. La seconde étude avait pour objectif d'étudier le rôle du scotome de suppression dans la perception stéréoscopique de sujets microstrabiques. Trois tâches psychophysiques de stéréopsie locale et globale ont été effectuées chez 9 enfants microstrabiques et 9 enfants contrôles appariés, en utilisant deux grandeurs de cible (4° et 12°). Aucune amélioration des performances n’a été notée chez les sujets microstrabiques pour la tâche de stéréopsie locale, mais les seuils de stéréopsie globale étaient inférieurs avec la cible de 12°. La zone de suppression semble jouer un rôle dans le déficit de stéréopsie globale des sujets microstrabiques. Le scotome de suppression pourrait être partiellement responsable du déficit stéréoscopique puisque même avec l’augmentation de la taille angulaire des stimuli stéréoscopiques, la stéréoperception des microstrabiques demeurent inférieure à celle des sujets normaux. / Stereopsis is often present, although decreased, in subjects with microstrabismus. However, their threshold would differ depending on whether the test contains (local stereopsis) or not (global stereopsis) defined contours. Few studies have evaluated empirically the performance difference depending on the type of tests used. The first article is a retrospective study of 26 microstrabismic children. Majority of the children (73 %) had a normal local stereopsis threshold or slightly lower than normal. An absence of local stereopsis was observed in the 7 other children (27 %). No global stereopsis was measured on 25 of the 26 children. Local stereopsis is present, although reduced, among microstrabismic children, but they generally show a lack of global stereoperception. The objective of the second study was to examine the potential role of the suppression in the stereoscopic perception. Three psychophysical tasks of local and global stereopsis were performed on 9 microstrabismic children and 9 matched controls children using two size of stimulus (4° and 12°). No performance improvement has been noted in microstrabismic subjects for the local stereopsis task, but their global stereopsis thresholds were lower with the target of 12°. The suppression scotoma seems to play a role in global stereopsis deficits noted in subjects with microstrabismus. The area of suppression might be partly responsible for the stereoscopic deficits present in microstrabismic subjects since even with the increase of the angular size of the stereoscopic stimuli, the stereoperception of microstrabimic subjects remain lower than in normal subjects.

La stéréopsie est souvent présente, bien qu’altérée, chez les sujets microstrabiques. Cependant, leur seuil de stéréopsie serait différent selon que le test utilisé contient (stéréopsie locale) ou non (stéréopsie globale) des contours définis. Peu d’études ont évalué empiriquement la différence de performance selon le type de tests utilisé. Le premier article est une étude rétrospective de 26 enfants microstrabiques. La majorité des enfants (73 %) possédaient un seuil de stéréopsie locale normal ou légèrement inférieur à la normale. Une absence de stéréopsie locale a été observée chez les 7 autres enfants (27 %). Aucune stéréopsie globale n’était mesurable chez 25 des 26 enfants étudiés. La stéréopsie locale est donc présente chez les enfants microstrabiques, mais ceux-ci montrent généralement une absence de stéréoperception globale. La seconde étude avait pour objectif d'étudier le rôle du scotome de suppression dans la perception stéréoscopique de sujets microstrabiques. Trois tâches psychophysiques de stéréopsie locale et globale ont été effectuées chez 9 enfants microstrabiques et 9 enfants contrôles appariés, en utilisant deux grandeurs de cible (4° et 12°). Aucune amélioration des performances n’a été notée chez les sujets microstrabiques pour la tâche de stéréopsie locale, mais les seuils de stéréopsie globale étaient inférieurs avec la cible de 12°. La zone de suppression semble jouer un rôle dans le déficit de stéréopsie globale des sujets microstrabiques. Le scotome de suppression pourrait être partiellement responsable du déficit stéréoscopique puisque même avec l’augmentation de la taille angulaire des stimuli stéréoscopiques, la stéréoperception des microstrabiques demeurent inférieure à celle des sujets normaux. / Stereopsis is often present, although decreased, in subjects with microstrabismus. However, their threshold would differ depending on whether the test contains (local stereopsis) or not (global stereopsis) defined contours. Few studies have evaluated empirically the performance difference depending on the type of tests used. The first article is a retrospective study of 26 microstrabismic children. Majority of the children (73 %) had a normal local stereopsis threshold or slightly lower than normal. An absence of local stereopsis was observed in the 7 other children (27 %). No global stereopsis was measured on 25 of the 26 children. Local stereopsis is present, although reduced, among microstrabismic children, but they generally show a lack of global stereoperception. The objective of the second study was to examine the potential role of the suppression in the stereoscopic perception. Three psychophysical tasks of local and global stereopsis were performed on 9 microstrabismic children and 9 matched controls children using two size of stimulus (4° and 12°). No performance improvement has been noted in microstrabismic subjects for the local stereopsis task, but their global stereopsis thresholds were lower with the target of 12°. The suppression scotoma seems to play a role in global stereopsis deficits noted in subjects with microstrabismus. The area of suppression might be partly responsible for the stereoscopic deficits present in microstrabismic subjects since even with the increase of the angular size of the stereoscopic stimuli, the stereoperception of microstrabimic subjects remain lower than in normal subjects.

Environ, 2% des enfants de moins de 7 ans sont porteurs d'un strabisme (Williams et al., 2008) entraînant une perturbation de leur système visuel. Dans un premier temps, nous allons étudier les mouvements oculaires pendant la lecture d'un texte et pendant la poursuite d'une cible chez des enfants strabiques et de comparer ces résultats à des enfants non strabiques du même âge. Dans un second temps, nous avons étudié l'équilibre postural en condition de simple et de double tâche, puis nous avons examiné le rôle des informations proprioceptives sur le contrôle postural chez ces enfants. Nous émettons l'hypothèse selon laquelle le déficit visuel des enfants strabiques est à l'origine d'un retard ou d'un mauvais traitement cognitif de l'information visuelle ainsi qu'à l'origine d'un développement moteur modifiés s'appuyant sur d'autres systèmes sensoriels pour compenser leur déficit visuel. Quatre études publiées dans des revues internationales ont été réalisés pour tester ces hypothèses. L'ensemble de ces travaux a été réalisé afin d'apporter une meilleure compréhension des mécanismes et des interactions entre oculomotricité et contrôle postural chez les enfants strabiques. Ceci permet d'apporter des éléments fondés à l'aide au diagnostic, à la prise en charge rééducative mais aussi chirurgical de ces enfants strabiques. / Approximately 2% of children under 7 years old suffer strabismus (Williams et al., 2008), leading to a deficit in their visuel system. Firstly, we studied eye movements during reading and during smooth pursuit in strabismic children and compared these results to non strabismic age-matched children. Secondly, we studied postural control in both simple and double task, and the role of proprioceptive information on postural control in these children. We hypothesize that visual deficit in strabismic children delayed cognitive processing of visual information, and modified motor development by using other sensory systems to compensate their visual deficit. Four peer reviews were conducted to confirm these assumptions. Taken together, these studies provide a better understanding about mechanisms and interactions between oculomotricity and postural control in strabismic children. These findings allow to bring evidence for improve the diagnosis, rehabilitation treatment and also surgical treatment of strabismic children.

Made available in DSpace on 2014-12-17T14:56:07Z (GMT). No. of bitstreams: 1 JesseHNB_DISSERT.pdf: 2206144 bytes, checksum: 191ca3ce00f97e4019b5bdb2bc9ab914 (MD5) Previous issue date: 2012-10-18 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The vision is one of the five senses of the human body and, in children is responsible for up to 80% of the perception of world around. Studies show that 50% of children with multiple disabilities have some visual impairment, and 4% of all children are diagnosed with strabismus. The strabismus is an eye disability associated with handling capacity of the eye, defined as any deviation from perfect ocular alignment. Besides of aesthetic aspect, the child may report blurred or double vision . Ophthalmological cases not diagnosed correctly are reasons for many school abandonments. The Ministry of Education of Brazil points to the visually impaired as a challenge to the educators of children, particularly in literacy process. The traditional eye examination for diagnosis of strabismus can be accomplished by inducing the eye movements through the doctor s instructions to the patient. This procedure can be played through the computer aided analysis of images captured on video. This paper presents a proposal for distributed system to assist health professionals in remote diagnosis of visual impairment associated with motor abilities of the eye, such as strabismus. It is hoped through this proposal to contribute improving the rates of school learning for children, allowing better diagnosis and, consequently, the student accompaniment / A vis?o ? um dos cinco sentidos do corpo humano e, em crian?as, ? respons?vel por at? 80% da percep??o do mundo ao redor. Estudos revelam que 50% das crian?as com m?ltiplas defici?ncias possuem alguma defici?ncia visual, sendo que 4% de todas as crian?as s?o diagnosticadas com estrabismo. O estrabismo ? uma defici?ncia ocular associada ? capacidade de movimenta??o dos olhos, caracterizada por qualquer desvio no alinhamento ocular perfeito. Al?m do aspecto est?tico, a crian?a pode relatar vista emba?ada ou dupla . Problemas oftalmol?gicos n?o diagnosticados corretamente s?o motivos de muitos abandonos da escola. O Minist?rio da Educa??o do Brasil aponta as defici?ncias visuais como um grande desafio aos educadores de crian?as, principalmente no processo de alfabetiza??o. O exame oftalmol?gico tradicional para diagn?stico do estrabismo pode ser realizado induzindo os movimentos oculares atrav?s de instru??es do m?dico ao paciente. Esse procedimento pode ser reproduzido com aux?lio computacional atrav?s da an?lise de imagens capturadas em v?deo. Este trabalho apresenta uma proposta de sistema de teleoftalmologia para auxiliar profissionais da sa?de no diagn?stico a dist?ncia de defici?ncias visuais associadas ? capacidade motora dos olhos, como o estrabismo. Espera-se atrav?s deste trabalho contribuir diretamente para a melhoria dos ?ndices do aprendizado escolar infantil, permitindo melhores condi??es de diagn?stico e, consequentemente, acompanhamento do aluno