Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA.
J Neuroophthalmol. 2011 Sep;31(3):228-33. doi: 10.1097/WNO.0b013e318223d0a9.
Recent advances in infantile nystagmus syndrome (INS) surgery have uncovered the therapeutic importance of proprioception. In this report, we test the hypothesis that the topical carbonic anhydrase inhibitor (CAI) brinzolamide (Azopt) has beneficial effects on measures of nystagmus foveation quality in a subject with INS.
Eye movement data were taken, using a high-speed digital video recording system, before and after 3 days of the application of topical brinzolamide 3 times daily in each eye. Nystagmus waveforms were analyzed by applying the eXpanded Nystagmus Acuity Function (NAFX) at different gaze angles and determining the longest foveation domain (LFD) and compared to previously published data from the same subject after the use of a systemic CAI, contact lenses, and convergence and to other subjects before and after eye muscle surgery for INS.
Topical brinzolamide improved foveation by both a 51.9% increase in the peak value of the NAFX function (from 0.395 to 0.600) and a 50% broadening of the NAFX vs Gaze Angle curve (the LFD increased from 20° to 30°). The improvements in NAFX after topical brinzolamide were equivalent to systemic acetazolamide or eye muscle surgery and were intermediate between those of soft contact lenses or convergence. Topical brinzolamide and contact lenses had equivalent LFD improvements and were less effective than convergence.
In this subject with INS, topical brinzolamide resulted in improved-foveation INS waveforms over a broadened range of gaze angles. Its therapeutic effects were equivalent to systemic CAI. Although a prospective clinical trial is needed to prove efficacy or effectiveness in other subjects, an eyedrops-based therapy for INS may emerge as a viable addition to optical, surgical, behavioral, and systemic drug therapies.
最近在婴儿眼球震颤综合征（INS）手术方面的进展揭示了本体感受的治疗重要性。在本报告中，我们检验了这样一个假设，即局部碳酸酐酶抑制剂（CAI）布林佐胺（Azopt）对 INS 患者的眼球震颤中心凹注视质量测量值有有益影响。
使用高速数字视频记录系统，在双眼每日 3 次局部滴用布林佐胺 3 天后，获取眼动数据。通过在不同注视角度应用扩展的眼球震颤敏锐度函数（NAFX）来分析眼球震颤波形，并确定最长中心凹注视区（LFD），并与同一患者使用全身 CAI、接触镜和会聚以及其他 INS 眼肌手术后患者的先前公布数据进行比较。
局部布林佐胺通过增加 NAFX 函数的峰值（从 0.395 增加到 0.600）和 NAFX 与注视角度曲线的 50%变宽（LFD 从 20°增加到 30°），改善了中心凹注视。局部布林佐胺后 NAFX 的改善与全身乙酰唑胺或眼肌手术相当，介于软性接触镜或会聚之间。局部布林佐胺和接触镜的 LFD 改善效果相同，均不如会聚有效。
在本 INS 患者中，局部布林佐胺使 INS 眼球震颤波形在更广泛的注视角度范围内得到改善。其治疗效果与全身 CAI 相当。尽管需要前瞻性临床试验来证明在其他患者中的疗效或有效性，但基于滴眼剂的 INS 治疗方法可能成为光学、手术、行为和全身药物治疗的可行补充。
