Search Results (6)

Background: Alemtuzumab is a recombinant DNA-derived humanized monoclonal antibody directed against the 21–28 kd cell surface glycoprotein, CD52. Alemtuzumab is used as an organ anti-rejection therapy in transplant recipients. Neuro-ophthalmic adverse effects are rarely described, and, to our knowledge, accommodative spasm has not previously been reported in a transplant recipient. Case Description: A thirty-nine-year-old woman with genetically confirmed NPHP1-associated nephronophthisis, with stage F3 fibrosis, developed persistent bilateral blurred vision 72 h following alemtuzumab administration for a biopsy-proven acute cellular rejection, approximately six to seven weeks post-transplant. Initial attribution to hyperglycaemia and tacrolimus toxicity delayed recognition. Cycloplegic refraction confirmed a marked hyperopic shift (+2.75 D right eye, +2.50 D left eye) with significant improvement in visual acuity, consistent with accommodative spasm. Systemic evaluations excluded hyperglycaemia-related lens changes, calcineurin inhibitor neurotoxicity, and cytomegalovirus retinitis. MRI was not pursued in the absence of red flag neurological features, and because a definitive ophthalmic diagnosis had been made. Management and Outcome: The patient was managed expectantly, as cycloplegic refraction had already confirmed the diagnosis, and symptoms were improving. Therapeutic cycloplegia (e.g., atropine) was withheld to avoid impairing near vision and driving ability. Full resolution occurred within 4 to 6 weeks without intervention. Drug exposure to onset of symptoms was 72 h; onset of symptoms to diagnostic confirmation was 22 days; total symptom duration was 5.5 weeks, and recovery was 2 weeks after diagnosis. Conclusions: This case represents the first reported transplant case of alemtuzumab-associated accommodative spasm. Causality assessment supports a WHO-UMC classification of “Probable”, aligning with five Bradford–Hill considerations (temporality, biological plausibility, consistency, specificity, and analogy), but without statistical “strength of association” given that this is a single case report. Early cycloplegic refraction should be incorporated into the evaluation of post-alemtuzumab visual complaints, and clinicians should contribute to pharmacovigilance through structured reporting to capture these rare but important events. Full article

Background: Mild traumatic brain injury (mTBI) is a prevalent neurological condition that results in various physical, emotional, and cognitive impairments. The most common are visual impairments, which affect vision’s perceptual, motor, and sensory aspects. Objective: This paper analyzes the pathophysiology of mild traumatic brain injury (mTBI) and its effects on visual and oculomotor functions, focusing on the deficits of the accommodative system and their underlying mechanism. Findings: mTBI frequently causes diffuse axonal injury, resulting in abnormalities of the neurometabolic cascade that impact the brain’s visual regions. Accommodative anomalies, including insufficiency, infacility, and spasm, are markedly more common in mTBI patients than in the general population. These deficiencies present as a notable delay in accommodation response, diminished peak velocity, and compromised dynamic responses, possibly due to sensory and motor disturbances. Conclusions: Accommodation disorder is a significant but under-examined component of visual sequelae related to mTBI. Future research should concentrate on the sensory and motor factors contributing to these deficiencies to enhance diagnostic precision and customize rehabilitative strategies. Full article

Spasm of near reflex (SNR) involves intermittent spasm of one or more of the three near reflex components. Psychiatric disorders are one cause of SNR. We describe a patient with SNR diagnosed with autism spectrum disorder (ASD). A 36-year-old male with esotropia since childhood was referred due to headache and dizziness. The alternate prism cover test showed 30 prism diopters at both near and distant fixation. Four months after his first visit, he was diagnosed with ASD. Twenty-nine months after his first visit, he underwent strabismus surgery to treat concomitant esotropia. Postoperatively, the angle of strabismus improved but remained variable. Because the angle of strabismus varied, we suspected SNR; the diagnosis was performed after evaluating the patient’s microfluctuations in accommodation with Speedy-K. However, it was difficult to distinguish convergence spasm from concomitant esotropia in this patient because he has had a history of esotropia since childhood. In a patient with concomitant esotropia, if the symptoms are not exclusively due to strabismus, SNR should be suspected. Although the relationship between SNR and the pathology of ASD is unknown, it is possible that patients with ASD are more likely to develop SNR. Full article

Background: We aimed to evaluate the existence of accommodative microfluctuations in eyes after cataract surgery. Methods: This retrospective observational cohort study included 1160 eyes of 713 patients (mean age: 72.5 ± 8.3 years) who underwent phacoemulsification, intraocular lens insertion, and an evaluation of accommodative microfluctuations with an autorefractometer. Patients with posterior segment disorders resulting in visual acuity impairment and those with unavailable medical information were excluded. High-frequency components (HFCs), between 1.0–2.3 Hz, based on fast Fourier transform analysis of the accommodative microfluctuation data were examined at postoperative 2–3 (2 M) and 6 months (6 M). The relationships between the HFCs and patient age, manifest refraction, and axial length were analyzed. Results: Increased HFC values (>65) were observed at a constant rate after cataract surgery, with prevalence rates of 33.4% at 2 M and 34.7% at 6 M. Postoperatively, at 2 M, increased HFC values were significantly more common for eyes with axial length ≥26 mm than for those with axial length <26 mm (p = 0.0056). However, they were not significantly correlated to age or postoperative manifest refraction. Conclusions: At 2 M postoperatively, increased HFC values presented more frequently in eyes with a greater axial length; hence, the precise detection and understanding of postoperative accommodative spasms in high myopia patients is important. Full article

Purpose: To determine the prevalence of refractive errors in a group of 8-year-old school children in northwestern Poland. Material and Methods: In 2017–2019, refractive errors were examined in a group of 1518 Caucasian children aged 8 years old with cycloplegia. Refraction was obtained with a hand-held autorefractor (Retinomax 3). The refractive error reading was expressed as the spherical equivalent (SE) as myopia (≤−0.5 D), emmetropia (>−0.5 D to ≤+0.5 D), mild hyperopia (>+0.5 D to ≤+2.0 D) and hyperopia (>+2.0 D), and astigmatism (≤−0.75 DC) and anisometropia (≥1.00 D). Data analysis was performed using Statistica 13.5 software and included Pearson’s chi-squared and Mann–Whitney U tests. p-values of <0.05 were considered statistically significant. Results: Mild hyperopia was most common (37.6%), myopia was observed in 16.8% and astigmatism in 10.6% of participants. Pseudomyopia concerned up to 51.91% children. Girls were significantly more likely to have mild hyperopia (p = 0.0144) and were significantly more likely to wear glasses (p = 0.00093). Conclusions: Screening children for refractive errors after cycloplegia is key for detecting accommodative spasm and refractive errors. The largest group of children presented with mild hyperopia, which is a physiological feature of refraction in 8-year-old children, but myopia and astigmatism were the most common refractive errors. Full article

This review has identified evidence about pseudomyopia as the result of an increase in ocular refractive power due to an overstimulation of the eye’s accommodative mechanism. It cannot be confused with the term “secondary myopia”, which includes transient myopic shifts caused by lenticular refractive index changes and myopia associated with systemic syndromes. The aim was to synthesize the literature on qualitative evidence about pseudomyopia in terms that clarify its pathophysiology, clinical presentation, assessment and diagnosis and treatment. A comprehensive literature search of PubMed and the Scopus database was carried out for articles published up to November 2021, without a data limit. This review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Following inclusion and exclusion criteria, a total of 54 studies were included in the qualitative synthesis. The terms pseudomyopia and accommodation spasm have been found in most of the studies reviewed. The review has warned that although there is agreement on the assessment and diagnosis of the condition, there is no consensus on its management, and the literature describes a range of treatment. Full article