Journal of Aapos最新文献

Purpose: To compare the outcomes of augmented-dose surgery for acute acquired comitant esotropia (AACE) based on either the single Maddox rod test (SMRT), or the prism and alternate cover test (PACT), in cases where there is a clinically significant difference in the deviation using the two tests.

Methods: The medical records of AACE patients who underwent augmented-dose surgery with a difference of ≥5^Δ in preoperative deviations on PACT and SMRT were reviewed retrospectively. Augmented-dose surgery was based on the SMRT or PACT. Success was defined as elimination of diplopia and deviations ≤10^Δ assessed with the PACT (PACT success) or with the SMRT (SMRT success) at both near and distance.

Results: There were 18 patients in the SMRT group and 15 in the PACT group. In the SMRT group, the rate of PACT success was 94%, and SMRT success, 78%; postoperative distance esodeviation on PACT and SMRT were 0.72^Δ ± 1.64^Δ and 5.94^Δ ± 4.73^Δ, respectively. In the PACT group, the rate of PACT success was 80%, and SMRT success, 33%; postoperative distance esodeviation was 4.07^Δ ± 5.15^Δ (PACT) and 13.73^Δ ± 7.96^Δ (SMRT). The SMRT success rate was significantly higher in the SMRT group than in the PACT group (P = 0.010). The postoperative distance deviation was smaller in the SMRT group (P < 0.05).

Conclusions: In our cohort of AACE patients, those whose augmented-dose surgery was based on the SMRT achieved more favorable surgical outcomes than those based on the PACT when there was a difference of ≥5^Δ in preoperative deviations assessed with the two methods.

Background: To measure patient satisfaction with synchronous telehealth care, we administered the Telemedicine Satisfaction Questionnaire (TSQ) to assess the quality of care provided, its similarity to face-to-face meetings, and patients' perception of the interaction.

Methods: The Portuguese version of the TSQ was administered during 2022 to patients who received postoperative synchronous telehealth care after strabismus surgery in Curitiba, Brazil, from 2020 to 2022. The interval between the questionnaire application and teleconsultation ranged from 2 to 22 months after the telehealth encounter. All patients received synchronous telehealth care from the same surgeon (LMH) between postoperative days 7 and 10 and attended an in-person consultation on postoperative day 30, 6 months after surgery, and yearly thereafter.

Results: We analyzed the data for 53 patients, of whom 26 (49%) were male and 28 (53%) were <18 years of age. Synchronous telehealth care was considered an excellent experience, with an overall average TSQ rating of 4.3 on a scale of 1-5. The mean score for quality of care provided was 4.1; for similarity of care to face-to-face meetings, 4.5; and for patients' perception of the interaction, 4.5.

Conclusions: Patient perceptions of the quality of care in the telehealth encounter were positive.

In cases of recurrent exotropia, medial rectus resection after bilateral lateral rectus recession is often considered for reoperations. The surgical amount of medial rectus resection is typically determined according to the standard surgical dose table; however, postoperative variability has been noted in the surgical outcomes. In the current study, medial rectus tendon width (MRTW) was measured intraoperatively, and surgical dose-response was calculated as the ratio between amount of correction and resected medial rectus. The MRTW exhibited a positive correlation with age at time of surgery and surgical dose-response. MRTW could thus merit further study as a potential intraoperative predictor of surgical dose-response when considering medial rectus resection in patients with recurrent exotropia.

The purpose of this case series is to consider whether preterm infants having gestational age (GA) ≥32 weeks and birth weight (BW) ≥1500 g exposed to unblended oxygen should be screened earlier than the current guidelines adopted from Kenya for the third epidemic of retinopathy of prematurity (ROP). Cases of such infants with severe, treatment-requiring ROP at St Francis Hospital Nsambya, Kampala, Uganda, were reviewed for severe ROP requiring treatment prior to 30 days of life. Since 2022, 3 infants required treatment prior to 30 days of life. All infants received unblended oxygen for 5-10 days after birth and were on room air at the time of treatment. GA ranged from 32 to 34 weeks, and all had BW >1500 g. All infants had chronological age of 2 weeks at treatment. Preterm babies who are born at GA ≥32 weeks and exposed to unblended oxygen may be at risk of developing severe, treatment-requiring ROP earlier than the adopted guidelines from other countries have suggested.

We report the case of a 7-year-old girl with Knobloch syndrome who presented with retinal detachment due to a macular hole, which was treated with vitrectomy and silicone oil tamponade. The macular hole persisted, and recurrent silicone oil emulsification required exchanges, with two subsequent vitrectomies. Finally, an amniotic membrane graft was used to seal the macular hole in an effort to avoid silicone oil dependence for retinal attachment. The macular hole was successfully closed, and the retina remained attached 6 months after surgery.

We present the case of a 57-year-old man with vertical diplopia who was diagnosed with acquired left eye supranuclear double depressor palsy after ischemic stroke, with small infarcts at the bilateral medial posterior thalami, left midbrain, and left occipital lobe. Given the different innervation of the two depressors, intact vestibulo-ocular reflex, and the healthy inferior rectus muscle morphology observed intraoperatively, the lesion likely involved the supranuclear vertical gaze center or its pathway. His strabismus was treated successfully with recession and resection of vertical rectus muscles, resulting in no significant deviation in either the vertical or horizontal directions in primary gaze at 6 months' follow-up.

Purpose: To evaluate risk factors associated with severe retinopathy of prematurity ROP (sROP) in two separate cohorts of infants.

Methods: We performed a retrospective study of the Merative MarketScan Commercial Database between 2003 and 2022. Infants with ROP were stratified into two cohorts: group A (defined as infants with both birth weight [BW] <1000 g and gestational age [GA] <29 weeks) and group B (defined as infants with either BW ≥1000 g or GA ≥29 weeks). Infants with sROP were defined as those who received treatment for ROP. Outpatient and inpatient claims using International Classification of Diseases and Current Procedural Terminology codes were used to identify neonatal comorbidities. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for sROP requiring treatment with respect to various comorbidities.

Results: A total of 425 of 8,789 infants with ROP developed sROP (4.8%). We identified 2,726 infants in group A, of whom 387 (14.2%) required a procedure, and 6,063 in group B, of whom 38 (0.6%) required a procedure. In group A, intraventricular hemorrhage (OR = 1.38; 95% CI, 1.09-1.74) and patent ductus arteriosus ligation (OR = 1.65; 95% CI, 1.25-2.16) were the comorbidities that significantly increased the odds of sROP on multivariable analysis. In group B, infection (OR = 1.96; 95% CI, 1.01-3.80) was the only comorbidity that significantly increased the adjusted odds of sROP.

Conclusions: Risk factors for sROP may differ between smaller and larger infants. Infection may serve as an important risk factor for ROP progression amongst larger infants due to its connection with poor postnatal growth.

Purpose: To evaluate the outcome of surgery based on a monocular occlusion test in patients with acquired nonaccommodative esotropia (ANAET).

Methods: Patients with ANAET in which the angle of esodeviation increased by at least 10^Δ after 1 hour of monocular patching were enrolled prospectively.

Results: A monocular occlusion test was performed for 32 patients, of whom 14 patients showed significant change in the angle of esotropia. The mean age was 21.4 (range, 5-50) years, and 8 (57%) were females. The mean spherical equivalent was 0.24 D for right eyes and 0.35 D for left eyes. The mean angle of esotropia before occlusion was 9.9^Δ ± 6.4^Δ (range, 2^Δ-20^Δ) for distance and 13.8^Δ ± 6.6^Δ (range, 4.5^Δ-25^Δ) for near. The mean angle of esotropia after monocular occlusion was 22.3^Δ ± 5.1^Δ (range, 12^Δ-30^Δ) for distance and 24.6^Δ ± 6.2^Δ (range, 12^Δ-32.5^Δ) for near. Bimedial rectus muscle recession was performed for all the patients according to near esotropia after 1 hour of monocular occlusion. Patients were followed for 12 months. Final mean angle of esodeviation was 1.0^Δ ± 2.2^Δ (range, 0^Δ-6^Δ) for distance and 3.6^Δ ± 3.2^Δ (range, 0^Δ-10^Δ) for near. But for a single case, patients achieved alignment <8^Δ of esodeviation after surgery. There was no report of diplopia or other complications postoperatively.

Conclusions: The findings advocate incorporating monocular occlusion into the preoperative assessment to determine the surgical target in ANAET patients.

Background: Congenital nasolacrimal duct obstructions that persist after 9 months of age often require surgical intervention through probing and stenting of the tear duct. These procedures typically occur under general anesthesia in an operating room setting. We propose a novel approach using intravenous sedation outside the operating room.

Methods: We reviewed the medical records of patients at a tertiary pediatric hospital treated for nasolacrimal duct obstruction from 2018 to 2023 using monocanalicular Monoka, Masterka, and LacriJet nasolacrimal stents. All procedures were performed outside of the operating room under intravenous sedation provided by a specialized sedation team. Symptom resolution, sedation duration and complications were reviewed for each type of stent.

Results: A total of 64 patients (81 stents) were included in our analysis. Of the 81 stents used, 32 were Monoka, 15 Masterka, and 34 LacriJet. Symptoms resolved in 86% of the eyes. Sedation side effects were minor and infrequent. Occasionally brief apnea, hypoxia, hypotension or laryngospasm occurred, but in no cases were patients harmed or was hospitalization required. A single factor analysis of variance showed no statistically significant difference between the stents for recurrence or sedation time. The Fisher exact test suggested a higher risk of side effects in the Monoka group.

Conclusions: In our pediatric patient cohort, nasolacrimal duct stenting procedures have a high success rate and safety profile when performed under deep sedation outside of the operating room.

Purpose: To assess the relationship of sensory and motor ocular dominance to transient eye closure (TEC) under bright light conditions in patients with intermittent exotropia.

Methods: Forty patients (age range, 7-40 years) with intermittent exotropia were included in this prospective study. Motor and sensory ocular dominance were evaluated using the hole-in-the-card and Worth 4-Dot tests. Presence of any outward eye deviation or TEC was assessed and recorded in all participants under bright light conditions. Based on the fusion control grade of exodeviation, patients were assigned to good, fair, and poor control groups, and the results were compared.

Results: A total of 23 patients (58%) showed TEC under bright light: 18 (45%) in the good control group, 14 (35%) in the fair control group, and 8 (20%) in the poor control group. Eighteen patients (56%) with good and fair control showed TEC in the dominant eye. Five (63%) with poor control closed their nondominant eyes, and in all of them, outward eye deviation was observed before TEC. The angle of deviation at far and near and the degree of near stereopsis were not related to presence of TEC (P = 0.70, P = 0.06, and P = 0.34, resp.).

Conclusions: In patients with intermittent exotropia who exhibit TEC under bright light, those with good control tend to close the dominant eye, whereas in the majority of patients with poor control, spontaneous deviation occurs and is then followed by TEC of the nondominant eye.