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Esotropiile dobandite

Esotropiile dobandite. Dr. Oana ANDREI www.oftalmix.ro. ET secundara ET consecutiva ET @miopiei medii ET paralizia/insuficienta divergentei. ET CONCOMITANTE. ET. Cauza mecanica. Miogenice Orbitare Iatrogenice. ET INCOMITANTE. Cauza paretica. www.oftalmix.ro.

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Esotropiile dobandite

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  1. Esotropiile dobandite Dr. Oana ANDREI www.oftalmix.ro

  2. ET secundara • ET consecutiva • ET@miopiei medii • ET paralizia/insuficienta divergentei ET CONCOMITANTE ET Cauza mecanica • Miogenice • Orbitare • Iatrogenice ET INCOMITANTE Cauza paretica www.oftalmix.ro

  3. ET asociata miopiei medii(Von Graefe (1864) / Bielschowsky (1922)) Caracteristici: • [-4D,-10 D] • Debut treptat la varsta adulta,d.ob>30 ani • Diplopie homonima D>>A • Motilitate N /minima limitare a abductiei (-1) • Morfolologie orbita N, neurologic N • Von Graefe/ Bielschowsky: ET beningna exacerbata de lucrul aproape indelungat fara corectie optica • Tratament: • prisme BT- Fresnel • Recesie bi-MDI, recesieMDI/rezectie MDE, rezectie bi-MDE • Toxina Botulinica: rezultate neincurajatoare (J.Lee) www.oftalmix.ro

  4. Caracteristici: Apare la varstnici Diplopie homonima D Divergenta fuzionala redusa ET constanta sau usor redusa in lateroversie Velocitatile sacadice; normale sau usor reduse Examinarea motilitatii: abductie: full sau (<-1); fara end-point nystagmus Tratament: Prisme Fresnel BT Chirurgie ET insuficienta/paralizia divergentei(Parinaud 1883: paralizie, Duane: insuficienta) Demer& Mittelman: modificari la nivelul Pulley-ilor MEO • Paralizia divergentei: • Tumori pontine, Malformatie Arnold –Chiari, Hidrocefalie • Consult neurologic+ imagistica www.oftalmix.ro

  5. ET incomitante • DIPLOPIE orizontala homonima • Pozitie compensatorie a capului • Limitarea abductiei • FDT+(restrictie)/-(pareza) Retractia globului Durere Cresterea presiunii intraoculare restrictie www.oftalmix.ro

  6. Oftalmopatia tiroidiana • Orbitopatie autoimuna @ boala tiroidiana autoimuna-hiper/hipo/eutiroidie • Precede/concomitent/urmeaza HIPERtiroidia • Autolimitanta • 2 faze: acuta inflamatorie, cicatriciala www.oftalmix.ro

  7. ET@ oftalmopatiei tiroidiene Modificari MEO: FAZA INFLAMATORIE: • Crestere in volum- (infiltare cu fimfocite,plasmocite, fibrocite)>>diminuarea miscarilor oculare !!durere • Pareza musculara in miopatiile congestive severe@ hipertiroidism FAZA CICATRICEALA: • Restrictie mecanica (fibroza) !!durere Ordinea afectarii MEO in oftalmopatia tiroidiana www.oftalmix.ro

  8. Sectiune coronala CT MDInf MDI www.oftalmix.ro

  9. Simptomatologie si semne Diplopie frecvent: ET si Hipo Limitarea miscarilor oculare • Exoftalmie • Durere • Scaderea AV !!! • Retractie pleoapa superioara AHP: CU, FT-R www.oftalmix.ro

  10. Faza inflamatorie Prisme Fresnel Folie ocluziva/ LC ocluziva? (suprafata oculara?) Toxina botulinica Faza cicatriceala Fara evolutie 3 luni (clinic, paraclinic: Hess chart si CVBinoculara) CHIRURGIE Metode de Tratament in ET din Oftalmopatia Tiroidiana www.oftalmix.ro

  11. CHIRURGIE: ORDINEA interventiilor: Decompresie - chirurgia MEO - pleoape • Suturi ajustabile • INTOTDEAUNA RECESIE !!! • Postoperator toxina botulinica suplimentar! www.oftalmix.ro

  12. POSTOPERATOR-2luni PREOPERATOR OD:Recesie MDInf, MDI suturi ajustabile www.oftalmix.ro

  13. ET progresiva @ miopiei mariHeavy Eye SyndromeMyopic Strabismus Fixus • Miopii>-10DS;ax~30mm • Pulleys :MDE inf –depresorMDSnazal- adductor • ET+hipoT • Abductie limitata- restrictie mecanica in timp • Downshoot! • Rar diplopie www.oftalmix.ro

  14. Heavy Eye Syndrome www.oftalmix.ro

  15. Tratament • YOKOYAMA 2001: Unire MDS&MDE la ecuator +/- recesie MDI f (rezultatul FDT) Kenneth W. Wright, Lisa Thompson :Color Atlas of Strabismus Surgery: Strategies and Techniques, 2007 www.oftalmix.ro

  16. Multumesc!

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