Strabismus最新文献

Purpose: Many factors influence pupil diameter, including ocular surgery. The purpose of this study was to investigate the effects of strabismus surgery performed through a limbal incision on static and dynamic pupillometry.

Method: Static and dynamic pupillometry measurements were made and compared in 32 eyes of 32 patients who were scheduled to undergo horizontal muscle recession and resection through a limbal incision in one eye preoperatively and postoperatively on 10 day and at months 1 and 3.

Results: All postoperative scotopic pupil diameter measurements of the cases were found to be significantly higher than the preoperative scotopic pupil diameter (p = .0027). In the dynamic pupillometry analysis, a significant difference was found between preoperative and postoperative day 10 and month 1 pupil diameter values of the cases for the measurements taken at seconds 1 and 2 and (p¹=0.0033, p²=0.0039, and p⁵=0.0238). No significant difference was found between preoperative and postoperative values for dynamic pupillometry pupil dilation velocities at any evaluation point.

Conclusion: We believe that after strabismus surgery, the balance between the parasympathetic and sympathetic nervous systems, which determine the pupil diameter, is disrupted to the detriment of the parasympathetic nervous system.

Purpose: Accurate identification of extraocular muscle insertions in previously operated muscles, along with defining their positions, caliber, and surrounding structures via pre-operative imaging, aids surgical planning for re-operations. Methods: This narrative review summarizes imaging tools and techniques for strabismus re-operation planning, including anterior segment OCT (AS-OCT), ultrasound biomicroscopy (UBM), CT, and MRI. Results: Imaging enables a more predictable surgical course and better informs patients about procedure outcomes. Discussion: Key steps include selecting the optimal modality, understanding relevant anatomy, and using appropriate probes or sequences for accurate acquisition and interpretation. Conclusions: This review details nuances of each technique and their utility in strabismus reoperation scenarios.

Purpose: This study evaluated an abbreviated prism adaptation protocol integrated with alternate prism cover testing (APCT) for more precise measurement of  maximum deviation anglesin acute acquired comitant esotropia (AACE).

Methods: This retrospective study analyzed 89 AACE patients who underwent unilateral medialrectus recession combined with lateral rectus resection between September 2020 and March 2023. Each patient underwent both traditional APCT and abbreviated prism adaptation protocol (APCT-abbreviated PAT) measurement preoperatively.Surgical planning was based on APCT-abbreviated PAT results, while traditional APCT measurements were recorded for comparison of the two measurement protocols. Surgical outcomes were evaluated at 3 months postoperatively, with success defined as residual deviation ≤5 prism diopters (PD) and absence of symptomatic diplopia in daily activities.

Results: The study population (mean age: 34.1 ± 14.9 years; mean spherical equivalent [SE]: -4.46 ± 2.53 diopters) exhibited significantly greater preoperative deviation measurements with APCT-abbreviated PAT compared to conventional APCT alone. The mean differential was 11.2 PD (95% CI: 7.7-14.7) for distance fixation and 9.6 PD (95% CI: 5.2-14.0) for near fixation (both p < .001). Surgical planning was based on the APCT-abbreviated PAT measurements. At 3-month follow-up, all subjects achieved successful surgical outcomes with alignment within 5 PD and absence of symptomatic diplopia in daily activities. Worth four-dot testing demonstrated significant improvement in binocular sensory function,with 85.4% achieving normal fusion at distance and 100% at near fixation postoperatively (p < .001). No patients exhibited suppression atpostoperative follow-up.

Conclusions: An abbreviated prism adaptation protocol integrated with alternate prism cover testing facilitates quantification of maximum deviationangles in AACE. All patients achieved successful surgical outcomes at 3-monthfollow-up, supporting the clinical utility of this approach for accurate preoperative measurement and surgical planning in AACE patients.

Purpose: Monocular elevation deficiency (MED), formerly termed double elevator palsy, is a rare ocular motility disorder characterized by restriction of elevation in all gaze positions. Ptosis frequently accompanies MED but may be mistaken for simple congenital ptosis, potentially resulting in suboptimal surgical planning. While frontalis sling and levator resection are the most frequently employed techniques for MED-associated ptosis, these procedures carry a considerable risk of lagophthalmos and suboptimal cosmetic outcomes. To date, the use of Müller muscle - conjunctival resection (MMCR) in this context has not been described. Methods: We report the case of a 14-year-old girl initially diagnosed with congenital ptosis who was subsequently found to have MED. Ophthalmic examination revealed marked elevation deficit and mild hypotropia in the right eye, consistent with MED. As strabismus surgery was declined, ptosis correction was prioritized. Preoperative margin-reflex distance (MRD) measured 1.5 mm on the right and 4 mm on the left. A phenylephrine test demonstrated a partial positive response, increasing MRD to 2.5 mm. Considering the poor Bell's phenomenon and risk of exposure keratopathy, a 9-mm MMCR was performed under general anesthesia. Results: The surgery was completed without intraoperative or postoperative complications. At the one-month follow-up, eyelid contour and height were satisfactory, with the right MRD improved and symmetrical to the fellow eye. No lagophthalmos, corneal exposure, or epithelial keratopathy were observed. Functional and cosmetic outcomes were favorable, and the results remained stable at the 6-month and 1-year follow-up visits. Conclusion: This case highlights the diagnostic challenge of distinguishing MED-associated ptosis from isolated congenital ptosis and underscores the importance of comprehensive motility assessment. Traditional procedures for ptosis in MED, such as frontalis sling or levator resection, may predispose to lagophthalmos, particularly in patients with poor Bell's phenomenon. In contrast, MMCR offers a minimally invasive posterior approach that preserves the anterior lamella and reduces the risk of exposure keratopathy. To our knowledge, this is the first reported pediatric MED case successfully managed with MMCR. The procedure provided stable functional and aesthetic results, suggesting that MMCR may represent a safe and effective alternative in selected patients with MED when strabismus surgery is deferred.

Purpose: To perform a bibliometric analysis in the field of amblyopia research to examine current global trends and future research hotspots and compare contributions from different countries, institutions, authors and journals. Methods: Literature related to amblyopia published from 1 January 2000, to 31 December 2024, was retrieved from the Web of Science Core Collection (WoSCC) database. The language of the included studies was limited to English, and the types of publications were articles and reviews. Visualization and bibliometric network analysis were performed using VOSviewer and CiteSpace. A cooperation network among countries, institutions, authors and journals was drawn. We conducted co-occurrence analysis on the keywords to identify the research hotspots. Results: A total of 4714 papers on amblyopia were identified from 2000 to 2024. In 2000, only 81 papers were published; however, by 2024, 292 papers had been published. Over the past 25 years, a total of 3618 universities or institutions in 94 countries or regions have published research papers related to amblyopia. The United States ranked first with 1607 papers, followed by China and England. McGill University published the most research papers on amblyopia, with 166 published papers, accounting for 3.5% of all publications on the subject. The top three journals contributing to this field were the Journal of Aapos, Investigative Ophthalmology & Visual Science and the Journal of Pediatric Ophthalmology & Strabismus. Binocular iPad games, ocular dominance plasticity and research on the visual cortex of the brain will become future research hotspots in this field. Conclusion: In this work, the publications were primarily from the United States and Europe.Plasticity of the visual cortex and the dominant eye has received attention from researchers in the field of amblyopia, and new technologies such as virtual reality technology have begun to be applied to treat amblyopia. This study reveals the hotspots and trends in this field through bibliometric analysis.

Purpose: This study compared fibrin glue (FG), buried suture knot (BSK), and exposed suture knot (ESK) for conjunctival closure in bilateral symmetrical squint surgery through fornix incision.

Method: This study enrolled patients over 10-years age undergoing bilateral, symmetric strabismus surgery. Pre-operative anterior segment optical coherence tomography (ASOCT) and slit-lamp photography were performed on the pre-determined surgical quadrant. All the patients underwent strabismus surgery using a fornix incision. Eyes were randomized using a block design to one of the 3 conjunctival closure groups. Conjunctival closure time was recorded. Post-operative assessments were conducted at 1 day, 1 week, 2 weeks, and 6 weeks. These assessments included: patient-reported pain, foreign body sensation (FB), itching, watering. Clinical signs of conjunctival hyperemia, discharge, and chemosis were assessed using a standardized scale. ASOCT and slit-lamp photography of the surgical site were done at each post-operative visit. Conjunctival thickness was measured from ASOCT images. Statistical analysis was performed by SPSS 23.0 version. Variables with p value < 0.05 were considered as statistically significant.

Results: A total of 30 eyes were randomized to FG, BSK, or ESK group. The FG group demonstrated significantly faster conjunctival closure time (37.2 ± 29.0 s) compared to BSK (171.6 ± 53.1 s) and ESK (148.7 ± 51.0 s) (p < .001). Patient-reported symptoms were similar across groups; however, FG showed significantly greater comfort than BSK at two-weeks (p = .030). Objectively, FG exhibited significantly less inflammation than ESK at one-week (p = .013) and BSK at two-weeks (p = .015). Both BSK and ESK eyes and not FG eyes showed a significant increase in conjunctival thickness at six-weeks when compared to their pre-operative thickness. The BSK group developed a significantly thicker conjunctiva at two-weeks compared to both FG (p = .033) and ESK (p = .022). Complications in the FG group included one eye each with wound gaping and bacterial surgical site infection, while the ESK group had one eye with Tenon-cyst.

Conclusion: Long-term patient comfort was comparable across all closure methods following fornix incision strabismus surgery. FG significantly reduced surgical time and early objective inflammation, offering an efficiency advantage. Both BSK and ESK techniques showed no significant difference in postoperative outcome or long-term comfort.

Purpose: This case series aims to study the effect of medial transposition of the split lateral rectus (MTSLR) muscle used as a primary procedure for surgical management of complete third nerve palsy. Methods: A retrospective review of all cases with complete third nerve palsy which underwent surgical intervention in a tertiary care center from 2019 to 2023 was undertaken, and only cases underwent isolated MTSLR as a primary procedure were included. Data collection included age, etiology, laterality, follow-up, preoperative and postoperative deviation, and postoperative complications. Results: A total of 12 patients (14 eyes) were identified, and mean follow-up after surgery was 15.4 months (range; 7-37 months). Mean age at time of surgery was 34.5 years (range; 2-65 years). Right eye was involved in 5 patients, left eye in 5 patients, while two cases were bilateral. Surgical success (within 10PD of orthotropia) was achieved in all patients. Mean primary gaze exotropia (XT) improved from 96.2PD before surgery (range; 60-130 PD) to 1.8PD after surgery (range; 6PD ET to 8PD XT) (p ˂ .0001). Mean primary position Hypotropia, which was present in 5 cases only, improved from 4.2PD (range 5-14PD) to 0.7PD (range 0-4PD). Abduction significantly declined from a mean of 0 to -3.9 postoperatively, with no significant improvement of limited adduction. No postoperative complications have been encountered, apart from transient postoperative horizontal diplopia in one patient which resolved spontaneously. Conclusion: MTSLR muscle attains long term acceptable aesthetic results and functional alignment when used as a primary procedure for treatment of complete oculomotor nerve palsy, with low rate of postoperative complications.

Purpose: To describe a case of upper eyelid retraction secondary to previous superior recti recessions in association with stretched scars. Case Report: A 26-year-old female patient presented with upper eyelid retraction and exotropia for four years. She had undergone bilateral medial and superior rectus recessions for the treatment of esotropia and dissociated vertical deviation five years earlier at another institution. The patient was otherwise healthy, and an evaluation for thyroid eye disease was negative. During surgery, stretched scars were found in both superior recti and the left medial rectus. The scarred segments were excised, and the muscles were reattached to the sclera using 6-0 polyglactin sutures. One year postoperatively, the patient was orthotropic and had no upper eyelid retraction. Discussion: Stretched scars, characterized by elongated muscular insertions, are a known cause of secondary strabismus and are thought to be associated with wound healing issues. Although they are a common cause of consecutive exotropia following medial rectus recessions, there are only a few reports of stretched scars in recessed superior rectus muscles in the literature. We report the case of eyelid retraction secondary to previous superior recti recessions in which the development of stretched scars might have played a role in the occurrence of the retraction.

Purpose: To evaluate surgically induced refractive changes (SIRC) after congenital ptosis surgery. Methods: Data from 24 pediatric patients (age less than 18years old) who underwent congenital ptosis correction surgery between 2012 and 2020 and underwent cycloplegic refraction prior to and at least 3months postoperatively was retrieved from medical records at Sheba Medical Center. The Surgically induced refractive change (SIRC), marginal reflex distance-1 (MRD-1) after surgery were compared to before surgery.

Results: Twenty-four patients were included in this study (16 boys and 8 girls) in a median age at the time of surgery of 1.82years. Eighteen patients underwent frontalis sling (FS), 3 levator resection (LR), 2 Müller's muscle-conjunctival resection (MMCR) and 1 LA (l levator advancement). MRD1 improved from 1.04 mm pre-operatively to 2.36 mm post-operatively (p < .001, paired samples t test). A significant surgically induced refractive change was found post-operatively in the operated eye and most patients were found to have more than 0.5D change in all examined parameters (sphere, cylinder, and spherical equivalent).

Conclusions: Congenital ptosis surgery induces refractive change in most of the patients. Close follow up including frequent examination of cycloplegic refraction is required in order to determine the preferable timing of ptosis surgery and treatment following surgery.

Purpose: Intermittency of deviation in Intermittent Exotropia (IXT) is well assessed by control scores. However, they do not reflect the impact of strabismus on the patient's Quality of Life (QOL). We describe the use of a global score, including control of the deviation using the Lactose score at distance (DCS) and near (NCS), but also the impact on QoL through the assessment of functional signs (FS) and psychosocial impact (PSI). The methodology used to build this IXT Global Score (IXTGS) is described in a previous publication. The goal of this study was to judge the interobserver reliability of this score and its subscores and to evaluate trends in different types of IXT.

Methods: Ninety-eight patients aged 3 to 80 years with IXT were included, with exodeviation up to 50 prism diopters (PD). Eleven cases had convergence insufficiency type exotropia, and 87 were basic IXT. All had normal binocular vision. They were examined successively by an orthoptist and a strabismologist who both scored the beforementioned items. Interexaminator variance was evaluated using the IntraclassCorrelation Coefficient (ICC) score.

Results: Interexaminator variations were minor for the score and its subscores, as reflected by high ICC scores. There is a strong correlation between the distance angle of deviation and DCS and PSI, and between Near angle and NCS and FS. Control scores are not correlated with QoL scores, which shows that they explore different aspects, and are complementary.

Conclusion: The proposed IXTGS seems reliable and reproducible. It offers a global view of the case, but it is the analysis of subscores that seems interesting in therapeutic decision-making and follow-up. We believe that the association of an abnormal Control Score and QoL score should prompt treatment. If only one of them is affected, decision of treatment should be discussed.