Journal of Binocular Vision and Ocular Motility最新文献

Purpose: Strabismus surgery on tight extraocular muscles poses significant challenges due to limited muscle mobility and increased surgical risks. This study introduces the Suh muscle hook, a novel instrument designed to enhance surgical maneuverability and outcomes in cases of tight extraocular muscles during strabismus surgery.

Design: The Suh muscle hook features five unique design enhancements, including an ultrathin profile, a curved handle, a beveled tip, a knobbed tip, and a grooved track for needle passage. These design features aim to improve usability and efficacy in surgeries involving tight extraocular muscles.

Methods: The Suh muscle hook was meticulously designed by Epsilon. It measures 112.5 ± 0.5 mm in length and incorporates features such as a textured handle for improved grip, a 10-degree angled handle, and a 1.5 mm-wide horizontal bar with a 0.55 mm-wide grooved track for precise suturing.

Results: The innovative design of the Suh muscle hook allows for easier manipulation and suturing under tight extraocular muscles, reducing the risk of muscle rupture, scleral perforation, and other complications associated with traditional muscle hooks. The instrument's enhanced maneuverability and safety features contribute to improved surgical outcomes.

Conclusion: The Suh muscle hook represents a significant advancement in strabismus surgery, offering a safer and more precise approach to managing tight extraocular muscles. Its unique design features address the challenges posed by tight muscles, ultimately improving surgical success and patient safety in pediatric ophthalmology and strabismus practice.

Uncorrected refractive error is a key cause of childhood visual impairment in the United States. As pediatric vision issues are often asymptomatic, vision screenings are essential to identify children's eye problems. Despite the importance of vision for children's health, well-being, and academic achievement, challenges remain in ensuring that children have equitable access to vision screenings and follow-up eye care. Children of racial and ethnic minorities experience a greater burden of myopia, while longstanding disparities in eye care access have been observed across both race and socioeconomic status. Collaborations with schools and community organizations may represent effective strategies to increase children's access to eye care in underserved communities. By providing services directly at schools, school-based vision programs have demonstrated success in addressing children's refractive error and need for eyeglasses. Future work for community-based programs may engage schools, eye care professionals, and other community stakeholders in collaborations to address children's unmet eye care needs.

Purpose: To investigate changes in eye alignment before and after ICL implantation in patients with myopia having corrected distance visual acuity (CDVA) of ≥0.0 logMAR.

Subjects and methods: The medical records of 1012 patients without eye movement limitation who underwent bilateral ICL implantation were retrospectively reviewed a at the Eye Center of Sanno Hospital in Japan.

Results: Preoperatively, of 1012 patients, 30 (3.0%), 211 (20.8%), 771 (76.2%), and 126 (12.5%) demonstrated constant strabismus, intermittent strabismus, phoria, and binocular diplopia, respectively. Regarding horizontal strabismus without a vertical component, of 30 patients, 9 (30.0%) demonstrated exotropia and 2 (6.7%) exhibited esotropia. Vertical strabismus without a horizontal component was not observed. A combination of horizontal and vertical strabismus was observed in 19 (63.3%) patients. The rate of eye alignment classification agreement preoperatively and postoperatively was 98.7%, including 100%, 93.8%, and 100% in the constant strabismus, intermittent strabismus, and phoria groups, respectively. Of 1012 patients, 1.3% converted from intermittent strabismus to phoria (6.2% in the intermittent strabismus group).

Conclusions: Uncomplicated ICL implantation under topical anesthesia was not associated with eye alignment in 98.7% of patients with myopia, and 0% transitioned to constant strabismus after ICL implantation.

Myopia has been included as one of the five serious ocular conditions leading to blindness. Prevalence of myopia (between -0.50D and -5.75D) is only of concern because it tends to progress. The incidence of high myopia and pathologic myopia are directly correlated to the prevalence of myopia. Recent studies have concluded that the mean age of onset of myopia is decreasing, the progression interval and the rate of progression is increasing, and the prevalence of high myopia is increasing in older age groups. These epidemiological changes have been associated with global urbanization. High myopia and older age are two primary risk factors for potentially blinding pathologic myopia. The prevalence of myopia by the year 2050 has been estimated to be 50%. Twenty-percent of those myopic individuals are projected to have high myopia. However, these calculations were made in 2016, prior to the COVID-19 quarantine and the increase in extreme climate events. Recent global events have resulted in permanent shifts in lifestyle that may accelerate the development and progression of myopia.

Although the incidence of acquired esotropia associated with moderate myopia is on the rise, there is minimal research on the clinical profile and pathophysiology of this condition. To gain deeper insights into the clinical characteristics and management of these patients, a literature search was conducted, resulting in the identification of six relevant studies. Collectively, these studies encompassed a total of 304 patients. The mean age of onset of esotropia across all studies was 37.52 years. The mean deviations for distance were not considerably larger than those reported at near, even though symptoms were reported more frequently at distance. The overall mean of the distance deviation was 25.16 prism diopters, and the overall mean of the near deviation was 20.82 prism diopters. There were very few reports of vertical deviations across all studies. Limited data suggests that increased near work may be associated with larger esodeviations. Only three articles assessed surgical management; however, it appears that surgical correction may need to be increased by approximately one-third compared to traditional surgical tables and smaller deviations may require even greater augmentation.

Parinaud syndrome, also known as dorsal midbrain syndrome, is a condition affecting the dorsal midbrain region of the brainstem that presents with a triad of ophthalmic clinical findings, including upgaze paresis, convergence retraction nystagmus, and light-near dissociation. This case report will discuss the clinical presentation of Parinaud syndrome in a four-year-old patient who was seen in an out-patient clinic for intermittent exotropia 5 months after a suboccipital craniotomy resection of a pineal mass and ventriculoperitoneal (VP) shunt placement for associated hydrocephalus. Current literature is relatively sparse regarding the presentation of Parinaud syndrome in the pediatric population, with little known about prognosis and potential for recovery. The purpose of this case report is to identify the neuro-ophthalmic clinical findings associated with a pineal mass, examine how these findings may present in a pediatric patient, and discuss in detail the neuroanatomy and pathophysiology of the major clinical findings associated with Parinaud syndrome.

COVID-19 had been reported to be associated with neuro-ophthalmic complications. However, there is a shortage of evidence regarding internuclear ophthalmoplegia (INO) presentation after COVID-19 infection with related brain magnetic resonance imaging (MRI). Herein, we report a case of INO in a 69-year-old woman with presentation of diplopia following COVID-19 infection, along with her neuroimaging. We concluded that it is important to recognize the possibility of INO in patients with diplopia after COVID-19 and to consider brain MRI as an informative tool in these patients.

Purpose: To identify a correlation between the degree of congenital ptosis and levels of refractive error, visual stimulus deprivation and anisometropic amblyopia, and any improvement with surgical intervention.

Methods: A prospective investigation of 30 patients aged 3 months to 8 years, with a diagnosis of unilateral or bilateral congenital ptosis. A full orthoptic assessment and cycloplegic refraction were performed and patients requiring surgical intervention for ptosis were at surgeon discretion.

Results: The mean age at presentation was 27.1 months. The prevalence of amblyopia ranged from 19 to 29%. There was no significant difference in the levels of astigmatism throughout the follow-up period between patients who underwent surgical intervention and who did not. There was a significant improvement in the visual acuity of the affected eye (p = .03) and both eyes open (p = .02), in patients who did not undergo surgery. This was then repeated on patients who underwent surgical intervention which showed no significant difference in the affected eye or both eyes open; p = .27, p = .32, respectively.

Conclusion: There is no significant change in the levels of astigmatism in both patients who underwent surgery and those who did not. Conservative management of congenital ptosis, while counterintuitive, proves not to deleteriously affect the visual potential of these patients.

Homonymous and heteronymous hemianopias associated with strabismus are a therapeutic challenge because surgery may result in diplopia, decrease the visual field (VF), and/or lead to recurrence of the deviation. We present four cases: two homonymous hemianopias and two heteronymous hemianopias. Of the four patients, three had exotropia and one had esotropia. The origin of hemianopias was neoplastic in two cases and traumatic in two cases. Strabismus surgery was performed in three cases, but only one case had a good result; recurrence of the deviation and diplopia occurred in the other two cases. In conclusion, exotropia may develop as a compensatory mechanism in a patient with congenital or early-onset homonymous hemianopia and realigning the eyes could reduce the binocular VF and cause diplopia. In heteronymous hemianopias, there is little risk of the surgery causing diplopia, but the strabismus is unstable because of the absence of binocular vision and vergence reflexes if VF loss includes the macula. Further, strabismus, in association with hemianopia, may be caused by coexistent cranial nerve and/or gaze palsy. The prognosis, objective, and results of the strabismus operation should be clearly discussed with the patients or their guardians before it is performed if hemianopias are present.