Abou Khzam Rayan, El Jalbout Nahia Dib, Seif Roland, Sadaka Ama
Lebanese American University Gillbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon.
Department of Ophthalmology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon.
Am J Ophthalmol Case Rep. 2022 Apr 16;26:101531. doi: 10.1016/j.ajoc.2022.101531. eCollection 2022 Jun.
To report convergence insufficiency in a patient with Parkinson's' disease stimulated by turning on the deep brain stimulator.
72-year-old male with Parkinson's disease and hypertension presenting for the evaluation of blurry vision at near and mid distance that started after activation of an implanted Deep brain stimulator.Baseline ophthalmologic evaluation prior to deep brain stimulator implantation surgery and with the deep brain stimulator turned off demonstrated a full motility, centered eyes for distance and near and a best corrected visual acuity of 20/20, normal pupil exam, confrontational visual fields and dilated fundus exam. Following this examination, the Deep brain stimulator was turned on and re-evaluation few minutes later demonstrated the same findings except for a 6-prism diopter exotropia at near consistent with convergence insufficiency.Following our evaluation a set of +3 diopters base-in prisms were added to near glasses with total relief of symptoms. The patient did not require surgical adjustment of the deep brain stimulator leads.
Given the therapeutic effects of deep brain stimulation on convergence insufficiency reported in several studies, in addition to the influence of deep brain stimulation as Parkinson's Disease treatment in areas possibly associated with vergence control, convergence insufficiency secondary to deep brain stimulation does not seem very unlikely, although not often reported. Further studies are needed to optimize deep brain stimulation surgery to maximize benefits and limit adverse events, as well as being aware of convergence insufficiency as a possible cause for visual disturbance.
报告一名帕金森病患者在开启脑深部电刺激器后出现集合不足的情况。
一名72岁男性，患有帕金森病和高血压，因植入脑深部电刺激器后出现近距和中距视物模糊前来评估。在脑深部电刺激器植入手术前且关闭该刺激器时进行的基线眼科评估显示，眼球运动完全正常，远近视力时双眼均居中，最佳矫正视力为20/20，瞳孔检查正常，视野检查正常，散瞳眼底检查正常。此次检查后，开启脑深部电刺激器，几分钟后重新评估发现，除了近距时出现6棱镜度外斜视，符合集合不足外，其他检查结果相同。经我们评估后，在近用眼镜上加了一副+3棱镜度底向内的棱镜，症状完全缓解。患者无需对脑深部电刺激器电极进行手术调整。
鉴于多项研究报道了脑深部电刺激对集合不足的治疗效果，除了脑深部电刺激作为帕金森病治疗手段对可能与聚散控制相关区域的影响外，脑深部电刺激继发的集合不足虽然报道不多，但似乎并非不太可能。需要进一步研究以优化脑深部电刺激手术，使益处最大化并限制不良事件，同时要意识到集合不足可能是视觉障碍的一个原因。
