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Yadav B, Saxena R, Dhiman R, Kochhar KP, Patil A, Sharma P, Sihota R, Tandon R. Effect of topical brinzolamide on visual function and waveform in patients of infantile nystagmus syndrome: A randomized control trial. Indian J Ophthalmol 2024; 72:976-982. [PMID: 38905461 PMCID: PMC11329828 DOI: 10.4103/ijo.ijo_1010_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/20/2023] [Accepted: 12/10/2023] [Indexed: 06/23/2024] Open
Abstract
PURPOSE To evaluate the effect of topical carbonic anhydrase inhibitor (brinzolamide) versus placebo on visual function and waveforms in infantile nystagmus syndrome (INS). DESIGN Prospective, placebo-controlled, double-blind, cross-over study. METHODS Setting- A tertiary eye care center. Patients- Cases of idiopathic INS with and without abnormal head posture aged ≥10 years who had not received previous treatment for nystagmus. Intervention- Patients were randomized into two groups. Group 1 was given placebo for 3 months, and after a washout period of 7 days started on topical brinzolamide for the next 3 months. In group 2, the order was reversed. The drops were administered topically three times (every 8 hours) in both eyes. Outcome measure- Binocular best corrected visual acuity (BCVA) using the ETDRS chart, eXpanded nystagmus acuity function (NAFX) score and INS waveforms obtained from eye movement recordings, intraocular pressure (IOP) by Goldmann applanation tonometer, near stereopsis by TNO stereo test, and change in abnormal head posture before and after intervention in the null position. RESULTS A total of 29 cases completed the study (23 with abnormal head posture; 6 without abnormal head posture). A significant improvement was noted in INS waveform characteristics, mean NAFX score (P < 0.001), and mean binocular visual acuity (P < 0.001) with topical brinzolamide in comparison to baseline as well as placebo. No significant change in head position and stereopsis was noted. No side effects were reported with 3 months of brinzolamide therapy. CONCLUSIONS While brinzolamide shows improvement in visual acuity and NAFX score in idiopathic INS, its clinical significance needs further evidence.
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Affiliation(s)
- Bhupendra Yadav
- Department of Ophthalmology, Strabismus and Neuro-ophthalmology Services, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Department of Ophthalmology, Strabismus and Neuro-ophthalmology Services, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rebika Dhiman
- Department of Ophthalmology, Strabismus and Neuro-ophthalmology Services, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal P. Kochhar
- Department of Physiology, Cognitive Neurophysiology Lab, All India Institute of Medical Sciences, New Delhi, India
| | - Ashlesh Patil
- Department of Physiology, Cognitive Neurophysiology Lab, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Sharma
- Department of Ophthalmology, Strabismus and Neuro-ophthalmology Services, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ramanjit Sihota
- Department of Ophthalmology, Strabismus and Neuro-ophthalmology Services, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Department of Ophthalmology, Strabismus and Neuro-ophthalmology Services, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Effects of Topical Brinzolamide on Infantile Nystagmus Syndrome Waveforms: Eyedrops for Nystagmus: Erratum. J Neuroophthalmol 2023; 43:e363. [PMID: 37974371 DOI: 10.1097/wno.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
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Chang MY, Binenbaum G, Heidary G, Cavuoto KM, Morrison DG, Trivedi RH, Kim SJ, Pineles SL. Surgical Treatments to Improve Visual Acuity in Infantile Nystagmus Syndrome: A Report by the American Academy of Ophthalmology. Ophthalmology 2023; 130:331-344. [PMID: 36435636 PMCID: PMC9979093 DOI: 10.1016/j.ophtha.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To review the literature on the efficacy of surgical procedures to improve visual acuity (VA) in patients with infantile nystagmus syndrome (INS). METHODS Literature searches were last conducted in January 2022 in the PubMed database for English-language studies with no date restrictions. The combined searches yielded 354 abstracts, of which 46 were reviewed in full text. Twenty-three of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. RESULTS One included study was a randomized trial; the remaining 22 were case series. The 23 studies included children and adults with INS and a variable proportion with anomalous head position (AHP), strabismus, and sensory diagnoses. The surgical interventions evaluated included large recessions, tenotomy and reattachment (TAR), myectomy with or without pulley fixation, and anterior extirpation of the 4 horizontal rectus muscles, as well as various procedures to correct an AHP in which VA was reported as a secondary outcome. The data were mixed, with improvements in binocular best-corrected visual acuity (BCVA) ranging from no improvement to 0.3 logarithm of the minimum angle of resolution (logMAR), or 3 lines. (Most studies were in the range of 0.05-0.2 logMAR.) Statistically significant improvement in VA was noted in 12 of 16 studies (75%) that performed statistical analyses, with no clear advantage of any single procedure. Complications and reoperations were lowest in patients who underwent TAR and highest in those who underwent myectomy or anterior extirpation. CONCLUSIONS The best available evidence suggests that eye muscle surgery in patients with INS results in a modest improvement in VA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Melinda Y Chang
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara M Cavuoto
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Rupal H Trivedi
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Sharma P. Calming the Visual Storm: Management of Childhood Nystagmus. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1757889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AbstractChildhood nystagmus creates a visual storm both for the affected child and the treating doctor. This problem occurring in the development phase of the child affects not only the vision but also the general development, if not diagnosed and managed in time. Moreover, some forms may even harbor a neurological tumor needing timely management. First, a brief introduction of nystagmus classification, a simplified approach to diagnose the common childhood nystagmus, and the value of electrophysiology will be presented. Next, the approach to treatment, using a thorough clinical examination, illustrated by patient examples of different types of nystagmus will be presented. The different forms of childhood nystagmus are described: idiopathic infantile nystagmus syndrome (IINS), sensory nystagmus (SN), fusion maldevelopment nystagmus (FMDN), spasmus nutans syndrome (SNS), nystagmus blockage syndrome, periodic alternating nystagmus, and others as well as their specific management. The role of electronystagmography and that of neuroimaging in specific conditions is life saving and is described. The role of auditory biofeedback, acupuncture, medical treatment, and surgical procedures like Augmented Anderson procedure, Hertle-Dell'Osso procedure, supra maximal retro-equatorial recession, and posterior fixation have been elucidated. Newer techniques have simplified the management options and improved the functional outcomes in childhood nystagmus. To conclude, children with nystagmus of types IINS, FMDN, SNS, or SN need to be managed differently. It is thus possible to timely manage these children, not only to save their life and improve their vision but also to improve their living quotient.
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Affiliation(s)
- Pradeep Sharma
- Pediatric and Neuro-Ophthalmology, Centre for Sight, New Delhi, India
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Papageorgiou E, Lazari K, Gottlob I. The challenges faced by clinicians diagnosing and treating infantile nystagmus Part II: treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1970533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eleni Papageorgiou
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Katerina Lazari
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Irene Gottlob
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Neurology, Cooper University Hospital, Neurological Institute, Camden, New Jersey, USA
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Cham KM, Abel LA, Busija L, Kowal L, Bachar Zipori A, Downie LE. Surgical interventions for infantile nystagmus syndrome. Cochrane Database Syst Rev 2021; 2:CD013390. [PMID: 33598911 PMCID: PMC8094175 DOI: 10.1002/14651858.cd013390.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infantile nystagmus syndrome (INS) is a type of eye movement disorder that can negatively impact vision. Currently, INS cannot be cured, but its effects can potentially be treated pharmacologically, optically, or surgically. This review focuses on the surgical interventions for INS. Despite the range of surgical interventions available, and currently applied in practice for the management of INS, there is no clear consensus, and no accepted clinical guidelines regarding the relative efficacy and safety of the various treatment options. A better understanding of these surgical options, along with their associated side effects, will assist clinicians in evidence-based decision-making in relation to the management of INS. OBJECTIVES To assess the efficacy and safety of surgical interventions for INS. SEARCH METHODS We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ISRCTN registry, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) to 3 July 2020, with no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) studying the efficacy and safety of surgical options for treating INS. DATA COLLECTION AND ANALYSIS Our prespecified outcome measures were the change from baseline in: binocular best-corrected distance visual acuity; head posture; amplitude, frequency, intensity, and foveation period durations of the nystagmus waveform; visual recognition times; quality of life and self-reported outcome measures; incidence of adverse effects with a probable causal link to treatment; and permanent adverse effects after surgery. Two review authors independently screened titles and abstracts and full-text articles, extracted data from eligible RCTs, and judged the risk of bias using the Cochrane tool. We reached consensus on any disagreements by discussion. We summarised the overall certainty of the evidence using the GRADE approach. MAIN RESULTS We only identified one eligible RCT (N = 10 participants), undertaken in India. This trial randomised participants to receive either a large retro-equatorial recession of the horizontal rectus muscle of 9 mm on the medial rectus and 12 mm on the lateral rectus, or a simple tenotomy and resuturing of the four horizontal rectus muscles. We did not identify any RCTs comparing a surgical intervention for INS relative to no treatment. In the single eligible RCT, both eyes of each participant received the same intervention. The participants' age and gender were not reported, nor was information on whether participants were idiopathic or had sensory disorders. The study only included participants with null in primary position and did not explicitly exclude those with congenital periodic alternating nystagmus. The study did not report funding source(s) or author declaration of interests. The evaluation period was six months. We judged this study at low risk for sequence generation and other sources of bias, but at high risk of bias for performance and detection bias. The risk of bias was unclear for selection bias, attrition bias, and reporting bias. There is very uncertain evidence about the effect of the interventions on visual acuity and change in amplitude, frequency, and intensity of the nystagmus waveform. We were unable to calculate relative effects due to lack of data. None of the participants in either intervention group reported adverse effects at six-month follow-up (very low-certainty evidence). There was no quantitative data reported for quality of life, although the study reported an improvement in quality of life after surgery in both intervention groups (very low-certainty evidence). Change in head posture, foveation period durations of the nystagmus waveform, visual recognition times, and permanent adverse effects after surgery were not reported in the included study. We judged the certainty of the evidence, for both the primary and secondary efficacy outcomes, to be very low. Due to a lack of comprehensive reporting of adverse events, there was also very low-certainty of the safety profile of the evaluated surgical interventions in this population. As such, we are very uncertain about the relative efficacy and safety of these interventions for the surgical management of INS. AUTHORS' CONCLUSIONS This systematic review identified minimal high-quality evidence relating to the efficacy and safety of surgical interventions for INS. The limited availability of evidence must be considered by clinicians when treating INS, particularly given these procedures are irreversible and often performed on children. More high-quality RCTs are needed to better understand the efficacy and safety profile of surgical interventions for INS. This will assist clinicians, people with INS, and their parents or caregivers to make evidence-based treatment decisions.
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Affiliation(s)
- Kwang M Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Larry A Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Ljoudmila Busija
- Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lionel Kowal
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Anat Bachar Zipori
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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Self JE, Lee H. Novel therapeutics in nystagmus: what has the genetics taught us so far? THERAPEUTIC ADVANCES IN RARE DISEASE 2021; 2:2633004021998714. [PMID: 37181109 PMCID: PMC10032456 DOI: 10.1177/2633004021998714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 05/16/2023]
Abstract
Nystagmus is a disorder characterised by uncontrolled, repetitive, to-and-fro movement of the eyes. It can occur as a seemingly isolated disorder but is most commonly the first, or most obvious, feature in a host of ophthalmic and systemic disorders. The number of underlying causes is vast, and recent improvements in the provision of genetic testing have shown that many conditions can include nystagmus as a feature, but that phenotypes overlap significantly. Therefore, an increase in the understanding of the genetic causes of nystagmus has shown that successful novel therapeutics for 'nystagmus' can target either specific underlying disorders and mechanisms (aiming to treat the underlying condition as a whole), or a final common pathway (aiming to treat the nystagmus directly). Plain language summary Novel treatments for a disorder of eye movement (nystagmus): what has the genetics taught us so far? Nystagmus is a disorder of eye movement characterised by uncontrolled, to-and-fro movements. It can occur as an isolated disorder, in conditions affecting other parts of the eye, in conditions affecting multiple other parts of the body or secondary to neurological diseases (brain diseases). In recent years, advances in genetic testing methods and increase in genetic testing in healthcare systems have provided a greater understanding of the underlying causes of nystagmus. They have highlighted the bewildering number of genetic causes that can result in what looks like a very similar eye movement disorder.In recent years, new classes of drugs have been developed for some of the causes of nystagmus, and some new drugs have been developed for other conditions which have the potential to work in certain types of nystagmus. For these reasons, genetics has taught us that identifying new possible treatments for nystagmus can either be dependent on identifying the underlying genetic cause and aiming to treat that, or aiming to treat the nystagmus per se by targeting a final common pathway. A toolkit based on specific treatments for specific conditions is more to have meaningful impact on 'nystagmus' than pursuing a panacea based on a 'one size fits all' approach.
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Affiliation(s)
- Jay E Self
- Clinical and Experimental Sciences, Faculty of
Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD,
UK
- University Hospital Southampton, Southampton,
UK
| | - Helena Lee
- Clinical and Experimental Sciences, Faculty of
Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton, Southampton,
UK
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Hertle R, Dell'Osso L, Jacobs J, Yang D, Dumire J, Evano-Chapman M. Topical lambda-cyhalothrin in reducing eye oscillations in a canine model of infantile nystagmus syndrome. Indian J Ophthalmol 2020; 68:2190-2195. [PMID: 32971638 PMCID: PMC7728007 DOI: 10.4103/ijo.ijo_586_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cham KM, Abel LA, Busija L, Kowal L, Bachar Zipori A, Downie LE. Surgical interventions for infantile nystagmus syndrome. Hippokratia 2019. [DOI: 10.1002/14651858.cd013390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kwang M Cham
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
| | - Larry A Abel
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
| | - Ljoudmila Busija
- Monash University; Biostatistics Unit, Department of Epidemiology and Preventive Medicine; Melbourne Victoria Australia 3000
| | - Lionel Kowal
- The University of Melbourne; Department of Surgery (Ophthalmology); Level 4, Alice Hoy Building Melbourne Victoria Australia 3010
| | - Anat Bachar Zipori
- Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University; Department of Ophthalmology; 6 Weizmann Street Tel Aviv Israel 6423906
| | - Laura E Downie
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
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Abstract
Eye tracking is a useful tool when studying the oscillatory eye movements associated with nystagmus. However, this oscillatory nature of nystagmus is problematic during calibration since it introduces uncertainty about where the person is actually looking. This renders comparisons between separate recordings unreliable. Still, the influence of the calibration protocol on eye movement data from people with nystagmus has not been thoroughly investigated. In this work, we propose a calibration method using Procrustes analysis in combination with an outlier correction algorithm, which is based on a model of the calibration data and on the geometry of the experimental setup. The proposed method is compared to previously used calibration polynomials in terms of accuracy, calibration plane distortion and waveform robustness. Six recordings of calibration data, validation data and optokinetic nystagmus data from people with nystagmus and seven recordings from a control group were included in the study. Fixation errors during the recording of calibration data from the healthy participants were introduced, simulating fixation errors caused by the oscillatory movements found in nystagmus data. The outlier correction algorithm improved the accuracy for all tested calibration methods. The accuracy and calibration plane distortion performance of the Procrustes analysis calibration method were similar to the top performing mapping functions for the simulated fixation errors. The performance in terms of waveform robustness was superior for the Procrustes analysis calibration compared to the other calibration methods. The overall performance of the Procrustes calibration methods was best for the datasets containing errors during the calibration.
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Dell'Osso LF. Ocular Motor System Control Models and the Cerebellum: Hypothetical Mechanisms. CEREBELLUM (LONDON, ENGLAND) 2019; 18:605-614. [PMID: 30617628 DOI: 10.1007/s12311-018-1001-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To review our studies and "top-down" models of saccadic intrusions and infantile nystagmus syndrome with the aim of hypothesizing areas of cerebellar connections controlling parts of the ocular motor subsystems involved in both types of function and dysfunction. The methods of eye-movement recording and modeling are described in detail in the cited references. Saccadic intrusions, such as square-wave jerks and square-wave oscillations, can be simulated by a single malfunction, whereas staircase saccadic intrusions required two independent malfunctions. The major infantile nystagmus syndrome waveforms are traceable to a failure to calibrate the damping ratio of the smooth pursuit system. The use of a behavioral ocular motor system model demonstrated how putative cerebellar dysfunctions could accurately simulate both the oscillations and the ocular motor responses seen in patients with both saccadic and pursuit disorders.
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Affiliation(s)
- Louis F Dell'Osso
- From the Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and CASE Medical School; and the Department of Neurology, Case Western Reserve University and University Hospitals Case Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA.
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Nieves-Moreno M, Morales Fernández L, Domingo Gordo B, Maillo E, Diaz E, Gómez-de-Liaño R. Topical brinzolamide in congenital nystagmus: A retrospective study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:571-576. [PMID: 28734565 DOI: 10.1016/j.oftal.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the effect of treatment with topical brinzolamide on visual acuity and nystagmus intensity in patients with congenital nystagmus. MATERIAL AND METHODS A retrospective study was designed in which the clinical records of 14 patients with congenital nystagmus were reviewed. All patients underwent a complete ophthalmological examination and a Perea video-oculography (VOG) before, and three days after, initiation of treatment with topical brinzolamide (Azopt). Five expert researchers evaluated the intensity of nystagmus by video before and after treatment. Finally, the subjective improvement of the patients was recorded. RESULTS Statistically significant differences were found in pre- and post-treatment binocular near visual acuity. A slight increase in the frequency of nystagmus was found, which was statistically significant with the horizontal gaze to the left and with the gaze downwards (P=.04, P=.03, respectively). The kappa index concordance between the researchers evaluating the intensity of nystagmus was 0.014. Only two of the patients noticed improvement in visual acuity, and one patient noticed improvement in the aesthetic aspect. CONCLUSIONS In spite of an improvement in nystagmus, it was slight, not cosmetically appreciable by patients in most cases, and was not related to a significant improvement in visual acuity or in patient quality of life. Further studies are needed to evaluate the effects of topical brinzolamide, and to establish potential therapeutic indications in nystagmus.
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Affiliation(s)
- M Nieves-Moreno
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España.
| | - L Morales Fernández
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - B Domingo Gordo
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - E Maillo
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - E Diaz
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - R Gómez-de-Liaño
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
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Aygit ED, Ocak OB, İnal A, Fazıl K, Akar S, Gokyigit B. The effects of topical carbonic anhydrase inhibitor in treatment of nystagmus. Int Ophthalmol 2017; 38:265-269. [PMID: 28204987 DOI: 10.1007/s10792-017-0456-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the effects of topical carbonic anhydrase inhibitor (CAI), brinzolamide (Azopt), for treatment of nystagmus patients. MATERIALS AND METHODS Patients who used Brinzolamide for treatment of nystagmus were retrospectively analyzed. 23 patients were included in this study. The patients' diagnosis were idiopathic infantile nystagmus 18 (78.2%) and oculocutaneous albinism in 5 (21.8%). Azopt eye drop was used in both eyes, 3 times a day. Detailed eye examination in all of the patients before treatment and repeated at the end of the first week after treatment. SPSS 16.0 computer program was used for evaluation of DATAs. RESULTS The mean follow-up was 32 ± 28 months. 23 patients 15 (65.2%) were male and 8 (34.7%) were female and the mean age was 12.6 ± 5.5. Before the management of topical brinzolamide, abnormal head position (AHP) were observed in 18 patients. After that we found reduction of nystagmus in 5 (22.7%) of the patients, increase in vision in 9 (40.9%) and reduced AHP in 18.3%. There is no identified change in 4 (18.1%). CONCLUSION The medical treatment of nystagmus with topical brinzolamide was found effective in our series but, wider series and longer follow-up studies are needed.
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Affiliation(s)
- Ebru Demet Aygit
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sokak No:2 Beyoglu, Istanbul, Turkey.
| | - Osman Bulut Ocak
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sokak No:2 Beyoglu, Istanbul, Turkey
| | - Aslı İnal
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sokak No:2 Beyoglu, Istanbul, Turkey
| | - Korhan Fazıl
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sokak No:2 Beyoglu, Istanbul, Turkey
| | - Serpil Akar
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sokak No:2 Beyoglu, Istanbul, Turkey
| | - Birsen Gokyigit
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sokak No:2 Beyoglu, Istanbul, Turkey
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Hertle RW, Yang D, Adkinson T, Reed M. Topical brinzolamide (Azopt) versus placebo in the treatment of infantile nystagmus syndrome (INS). Br J Ophthalmol 2014; 99:471-6. [PMID: 25336575 DOI: 10.1136/bjophthalmol-2014-305915] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To test the hypothesis that the topical carbonic anhydrase inhibitor brinzolamide (Azopt) has beneficial effects versus placebo on measures of nystagmus and visual acuity in adult subjects with infantile nystagmus syndrome (INS). DESIGN Prospective, cross-over, double masked clinical trial. METHODS SETTING Single centre. STUDY POPULATION Five subjects ≥18 years old with typical INS and best-binocular visual acuity in their primary position null zone ETDRS 55 letters to 85 letters (20/200 to 20/50) and had no previous treatment for nystagmus. INTERVENTION In a randomised order, each subject received one drop of Azopt or placebo in both eyes three times a day separated by a washout period of at least a week followed by Azopt or placebo in both eyes three times a day; thus each subject got the drug and placebo, each acting as his or her own control. OUTCOME MEASURES The nystagmus acuity function and INS waveforms obtained from eye movement recordings, binocular optotype visual acuity, using the ETDRS protocol analysed individually and as a group before and after Azopt and placebo. RESULTS Versus placebo and baseline measures, topical Azopt significantly improved; INS waveform characteristics in the primary position null zone, group mean values of the nystagmus acuity function across gaze (p<0.01) and group mean ETDRS binocular letter visual acuity (p<0.05). There was a predictable decrease in intraocular pressure (IOP) without any systemic or ocular adverse events. CONCLUSIONS Although a prospective large-scale clinical trial is needed to prove effectiveness, an eye-drop-based therapy for INS may emerge as a viable addition to optical, surgical, behavioural and systemic drug therapies for INS. TRIAL REGISTRATION NUMBER NCT01312402.
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Affiliation(s)
- Richard W Hertle
- Children's Hospital Medical Center, Akron, Ohio, USA Department of Ophthalmology, SUMMA Medical Center, Akron, OH, USA NEOMED, Rootstown, OH, USA
| | - Dongsheng Yang
- Children's Hospital Medical Center, Akron, Ohio, USA NEOMED, Rootstown, OH, USA
| | | | - Michael Reed
- Children's Hospital Medical Center, Akron, Ohio, USA Department of Ophthalmology, SUMMA Medical Center, Akron, OH, USA NEOMED, Rootstown, OH, USA
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Abstract
OPINION STATEMENT Patients with congenital and acquired forms of nystagmus are commonly encountered in clinical practice. Many report visual symptoms, such as oscillopsia and blurred vision, which can be alleviated if the nystagmus can be suppressed. Pharmacologic, optical, and surgical treatments are available, with the choice of treatment depending on the characteristics of the nystagmus and the severity of the associated visual symptoms. Downbeat nystagmus can be treated with 4-aminopyridine, 3,4-diaminopyridine, or clonazepam. Upbeat nystagmus can be reduced with memantine, 4-aminopyridine, or baclofen. Torsional nystagmus may respond to gabapentin. Acquired pendular nystagmus in patients with multiple sclerosis is often partially suppressed by gabapentin or memantine. Acquired pendular nystagmus in patients with oculopalatal tremor can respond to gabapentin, memantine, or trihexyphenidyl. Although acquired periodic alternating nystagmus is often completely suppressed by baclofen, memantine can be effective in refractory cases. Seesaw nystagmus can be reduced with alcohol, clonazepam, or memantine. Infantile nystagmus may not cause significant visual symptoms if "foveation periods" are well developed, but the nystagmus can be treated in symptomatic patients with gabapentin, memantine, acetazolamide, topical brinzolamide, contact lenses, or base-out prisms to induce convergence. Several surgical therapies have also been reported to improve infantile nystagmus syndrome (INS), but selection of the appropriate therapy requires preoperative evaluation of visual acuity and nystagmus intensity in different gaze positions. Other treatment options for nystagmus include botulinum toxin injections into the extraocular muscles or retrobulbar space. Electro-optical devices are currently being developed, in order to noninvasively negate the visual consequences of nystagmus.
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Affiliation(s)
- Matthew J Thurtell
- Department of Ophthalmology & Visual Sciences, University of Iowa, 200 Hawkins Dr PFP, Iowa City, IA, 52242, USA,
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