Strabismus最新文献

Purpose: To investigate the clinical effects ofvirtual reality (VR) technology in children with intermittent exotropia (IXT) after surgery and analyze the factorsinfluencing binocular vision recovery. Methods: In this retrospective study, 142 childrenwith IXT were divided into two groups according to whether they underwent VR training or conventional training after surgery. Controlgroup: 66 cases underwent conventional training (lens sequencing training, flipper training, polarized stereogram, andcheiroscope training). VR group: 76 patients underwent regular VR visualtraining. We evaluated preoperative and postoperative binocular vision (simultaneousperception, fusion, and stereopsis) and compared the binocular vision recoveryrates between the two groups. Logistic regression analysis was used to analyzethe factors influencing recovery of distance stereopsis. Result: Among the 142 children with IXT, we could not detect any significant differences in the simultaneous perceptionand near stereopsis recovery rates between the two groups preoperativelyand postoperatively. The fusion recovery rate in the VR group (85.5%) washigher than that in the control group (69.7%) (χ² = 5.187; P  < 0.05). The distance stereopsis recovery rate in the VR group (65.2%) was higherthan that in the control group (40.9%) (χ² = 7.786; P  < 0.05). The simultaneous perception, fusion, and stereopsis recovery rates at 3 and 6 monthspostoperatively were greater than those preoperatively in both the groups. Logisticregression analysis showed that age at onset (odds ratio(OR)=1.826, p < .05), age at surgery (OR = 0.840, p < .05), preoperation deviation (OR = 1.067, p < .05) and 6 months postoperation deviation (OR = 0.750, p < .05) were riskfactors that affected distance stereopsis recovery in children with IXT. Conclusion: VR technology can be used as a new trainingtool to promote simultaneous perception, fusion, and stereopsis recovery in IXTafter surgery. The age at onset and deviation at 6 months postoperatively wererisk factors that affected the recovery of distant stereopsis.

Purpose: To compare the surgicaloutcomes of patients with acute acquired comitant non-accommodative esotropia(AACE) with and without pre-operative prism adaptation test (PAT).

Methods: The records of patientsdiagnosed with AACE who underwent strabismus surgery between January 2018 andDecember 2020 were reviewed. Those who had pre-operative PAT performed by asingle surgeon and those who had surgery without PAT by another single surgeonwere included in the analysis. The surgical outcomes were compared between thetwo groups, and postoperative alignment within 8 PD was considered a surgicalsuccess.

Results: Thirty-six patients were included in the study; 15 underwent a 30-minute PATpre-operatively. The mean age in the PAT and non-PAT groups was 16.6 ± 7.7 years and 12.3 ± 5.8 years, respectively, and was comparable (p = .06). The meanpre-operative esotropia (40 ± 8.5PD vs 40 ± 15.6, p = .7) and medial rectusrecession (5.31 ± 0.8 mm vs 5.45 ± 0.7 mm, p = .6) were similar in both groups (p < .05). The median postoperative follow-up duration was 8 months (IQR:9.75 months). Five of 15 (33%) were prism responders (angle of deviationincreased by 10 PD). The median change in esotropia at presentation andpost-PAT was 4.5 PD (IQR: 12.5 PD). Overall surgical success was similarbetween the groups (80% vs 81%; p = .9). Only one patient in the non-PAT groupexperienced postoperative diplopia.

Conclusion: Surgical outcomes werecomparable, irrespective of the prism adaptation test. The prism adaptationtest did not reveal consistently higher target angles; hence, for comparabledeviation, the medial rectus recession and surgical outcomes did not differ, irrespective of whether PAT was performed pre-operatively.

Purpose: Oculomotor nerve palsies (ONPs) have a varied range of clinical presentations. Though they are mainly divided into ischemic and non-ischemic variants, with the former being more common, a detailed clinic-radiological evaluation is needed in all cases to ascribe an etiology in all cases.

Methods: We conducted a retrospective review of records to identify all patients with non-ischemic ONPs presenting to a tertiary care teaching hospital over 5 years.

Results: Nineteen cases of non-ischemic ONP were found. The various causes of non-ischemic ONPs included congenital, malignancy-associated, impending transtentorial herniation, tuberculous meningitis, pinealoblastoma, subacute subdural hemorrhage, parasellar lesions (sphenoid wing meningioma, petro-sphenocavernous meningioma), post-neurosurgery for meningioma, internal carotid artery aneurysm, inflammatory, and infective cavernous sinus lesions, after coiling for carotico-cavernous fistula, IgG4-related disease, post-Herpes zoster ophthalmicus, post-traumatic, and idiopathic orbital inflammatory syndrome.

Conclusion: The unique neuroanatomy of the oculomotor nerve contributes to its varied and complex presentation. The nerve is particularly susceptible in its basilar and cavernous sinus segments. Although neuroimaging may be initially deferred in a pupil-sparing ONP in patients with vasculopathic risk factors, the "rule of pupil" may not always be followed. The 19 cases that we described are discussed in detail, along with a review of the literature. This wide spectrum of presentations helps to understand and correlate the nerve's anatomical course and highlights the importance of a detailed neurological evaluation to facilitate targeted imaging of the suspected region of pathology.

Introduction and clinical importance: Brown Syndrome is a form of vertical strabismus characterized by limitation in elevation of the eye in the adducted position, main pathology attributed to superior oblique tendon-trochlear complex, which can either be congenital or acquired, secondary to trauma, inflammation, or iatrogenic in nature. Case Presentation: A 7-year-old male presented for a routine checkup to the out-patient department and upon clinical examination showed a limitation of extraocular movement of the right eye in adduction in elevation, with no deviation in primary gaze. On slit lamp examination, arcus juvenilis was observed in both the eyes with no other observable ocular abnormalities. A blood workup revealed highly deranged lipid profile levels and a diagnosis of familial hypercholesterolemia was made after pediatric medicine evaluation. Clinical discussion: Brown syndrome is an uncommon eye disorder, typically characterized by a restriction of movement in the direction of movement of superior oblique tenson, leading to inability in moving the affected eye superiorly, particularly in the adducted position. Acquired Brown syndrome can be due to a number of systemic diseases, such as dysthyroidism, rheumatoid arthritis, systemic lupus erythematosus, and many more. However, an association between dyslipidaemia or hypercholesterolemia has not been mentioned in literature. Conclusions: Brown syndrome and familial hypercholesterolemia encountered in our patient could either be a coincidental finding or could be an association which has yet to be explored. Lack of any preexisting literature highlights the need to explore more on this frontier.

Objectives: To evaluate the accuracy of Anterior Segment Optical Coherence Tomography (ASOCT) in measuring the limbal muscle insertion distance (LMID) of previously operated horizontal recti muscles in strabismus reoperations, compared to intraoperative caliper measurements. Methods: Thirty adult patients (60 muscles) undergoing strabismus reoperation of horizontal recti muscles for residual/consecutive strabismus were enrolled. Enrolled subjects underwent preoperative ASOCT measurements of the LMID of previously operated horizontal recti muscles, which were compared with intraoperative caliper values obtained during reoperation. Results: ASOCT successfully imaged 90% of the muscles. The mean LMID for medial rectus (MR) and lateral rectus (LR) measured by ASOCT was 7.96 ± 2.02 mm and 8.74 ± 2.81 mm, respectively, which were within 1 mm of intraoperative caliper measurements (7.93 ± 2.81 mm for MR, 9.03 ± 2.79 mm for LR). Bland-Altman plot showed a strong agreement for MR and a good agreement for LR between the two measured values, with excellent interclass correlation coefficients between the two methods of measurement (MR: 0.96, LR: 0.98; p < .001). Conclusion: In our study, 100% of LMIDs that could be visualized using ASOCT were within 1 mm of their intraoperative measured values. Therefore, ASOCT is a reliable tool for measuring the LMID of previously operated horizontal recti muscles, where the scarred tissue from older surgeries/lost data about previous surgeries makes it difficult for the operating surgeon to plan reoperations.

To compare the incidence of consecutive esotropia post bilateral lateral rectus recession (BLR) surgery using absorbable compared to non-absorbable sutures for the treatment of childhood exotropia. Retrospective Cohort study. Medical records of all children who underwent BLR surgery between January 2019 and January 2022 in a single medical center by a single surgeon were analyzed. Either absorbable or non-absorbable sutures were used. The incidence of consecutive esotropia (greater than 8 PD) was the primary outcome. A total of 130 children were included. The mean age was 6.45 ± 3.13 years, 54% were female. Sixty-five of the children underwent surgery with the use of absorbable sutures and 65 with the use of non-absorbable sutures. Consecutive esotropia occurred in 14 children (21.5%) in the absorbable group and in 5 children (7.7%) in the non-absorbable group (OR = 3.29, 95% CI = 1.11-9.77; p = .025). After adjustment for follow-up time using the Kaplan - Meier survival analysis, the difference between groups remained significant (p = .049). Secondary surgery due to consecutive esotropia occurred in 10 children (15.4%) in the absorbable group and in 3 children (4.6%) in the non-absorbable group (OR = 3.75, 95% CI = 1.001-14.628; p = .04). There were no other complications in either of the groups. The use of non-absorbable sutures in BLR surgery reduces the incidence of consecutive esotropia compared to absorbable sutures.

Background: The management of exotropia (XT) in the presence of hyperopia is challenging, as these patients are at an increased risk of developing amblyopia and compromised binocular vision. This study aims to evaluate the management approaches and clinical outcomes in XT associated with hyperopia.

Methods: A systematic review was conducted with a comprehensive search across PubMed, Web of Science, and Google Scholar, following PRISMA 2020 guidelines. The search strategy utilized a combination of free-text keywords and MeSH terms, including "Exodeviation," "Exotropia," "Intermittent Exotropia," and "Hyperopia." The search was restricted to articles published between 1991 and 2024 that examined various management modalities for XT. Four independent reviewers screened and assessed the eligibility of articles based on predefined guidelines. Excluded studies included animal research, case reports, narrative reviews, abstracts, conference proceedings, editorials, non-English publications, and other systematic reviews.

Results: A total of 10 studies from 6 countries with 1,090 participants with a mean age of 8.1 years, 194 of whom were hyperopic. Eight studies found that under-correcting hyperopia by 1.00 to 2.50 diopters was effective in treatment of XT. Three studies recommended full cycloplegic correction in cases with hyperopia exceeding 5.00 diopters. Surgical intervention was more effective and led to improvements in stereoacuity. Furthermore, postoperative correction of hyperopia resulted in favorable long-term outcomes. Notably, postoperative success rates were higher in hyperopic patients than in those with emmetropia.

Conclusion: The management of XT associated with hyperopia should be individualized, accounting for the AC/A ratio, fusional status, control of XT, stereoacuity, the degree of hyperopia, and the refractive difference between the two eyes.

Purpose: To report the clinical presentation and surgical outcomes of patients with Duane syndrome with primary position hypertropia, with or without coexisting horizontal deviation.

Methods: We retrospectively reviewed records of patients diagnosed with Duane syndrome with vertical and associated horizontal deviations from January 2008 to July 2017. We collected data regarding patient age, gender, refractive error, presence or absence of amblyopia and history of strabismus surgery, as well as clinical subtype of Duane syndrome, abnormal head posture, measurement of horizontal and vertical deviation, and outcomes of strabismus surgery. Success was defined as post-operative primary position hypertropia <4 prism diopters (PD) and horizontal deviation <10 PD.

Results: During this period, a total of 590 patients with Duane syndrome were seen. Of these, 18 patients (10 males and 8 females) met the study criteria, giving a prevalence of 3%. Median age was 21 years. Seventy-eight percent cases had type III Duane syndrome. Ten patients underwent surgical correction, of which four patients had to undergo a second procedure after a median of 19 months. Sixty-seven percent of the patients had associated primary position exotropia with median deviation of 30 PD. Seventeen percent of patients had only primary position hypertropia with median 10 PD. All patients had overshoots. Primary position horizontal deviation improved from 25 PD to orthotropia, and vertical deviation improved from 10 PD to orthotropia. Lateral rectus recession with Y split was the most frequent procedure performed, and we saw a median reduction of 10 PD hypertropia with this procedure. Median follow-up period was 13 months. Success was achieved in 60% of the patients who underwent surgery. Given the small sample size, it was difficult to compare the efficacy of different procedures.

Conclusion: Current study suggests that primary position vertical deviation might exist in 3% of patients with Duane syndrome. All patients had associated overshoots, which were predominantly of a mixed mechanism. Forty percent of the patients needed re-surgery. Well-designed, prospective possibly multicentric studies are necessary to understand the mechanism of overshoot, and consequently the primary position hypertropia to plan accurate management for these patients.

Objectives: This case report aims to present a case with traumatic rupture of the inferior rectus muscle and its management.

Methods: A 62-year-old male patient presented with a complaint of double vision following blunt head trauma. Orthoptic examination was performed to assess ocular alignment and motility. Surgical exploration of the inferior bulbar conjunctiva was conducted to identify the extent of the injury.

Results: The patient had limited downgaze with diplopia. Surgical exploration confirmed rupture of the left inferior rectus muscle horizontally as well as vertically. Both ends of the ruptured muscle could be partially found, and the posterior Tenon's capsule was successfully repaired. Botulinum toxin was injected to the left superior rectus muscle.

Conclusion: The findings highlight the importance of detailed orthoptic examination and surgical exploration in diagnosing and managing such complex ocular muscle injuries. Surgical repair combined with botulinum toxin injection presents a viable combined approach for restoring ocular alignment and function in similar cases.

Background: For small-angle strabismus, unilateral medial rectus recession (UMR) offers many advantages over bilateral procedures (BMR), including a shorter operative time, faster recovery and fewer complications, while preserving the contralateral medial rectus muscle. However, the asymmetric nature of the procedure poses a theoretical risk of induced incomitance in the direction of action of the recessed muscle. This study aims to compare the incidence and nature of induced incomitance following unilateral and bilateral medial rectus recession in the management of non-accommodative esotropia.

Methods: Through a retrospective chart review, we identified 43 patients who underwent surgical management for esotropia in the form of UMR (n = 21) or BMR (n = 22). The exclusion criteria included previous strabismus surgery and simultaneous surgery on the oblique muscles. Measurements of deviation in lateral gaze were obtained pre- and post-operatively using the prism cover test (PCT) in nine positions of gaze. Incomitance was defined as a horizontal deviation difference of > 5PD between primary and lateral gaze.

Results: Surgically induced incomitance was observed in 2 patients (9.5%) in the UMR cohort and 2 patients (9.1%) in the BMR cohort (p = 1.00). The mean magnitude of induced incomitance among affected patients was 9 PD in UMR vs. 8 PD in BMR. No statistically significant associations were found between the occurrence of incomitance and age, pre-operative deviation, amount of recession or follow-up duration (p > .05). All patients suffering from post-operative incomitance reported diplopia that resolved over time and did not need further intervention. Higher values of incomitance were associated with a more prolonged period of diplopia.

Conclusion: Our data demonstrates comparably low rates of induced incomitance in the management of esotropia after UMR and BMR, with no significant statistical difference. Our findings support the viability of unilateral recessions for small-to-moderate esotropias.