Strabismus最新文献

Due to the low incidence of sixth cranial nerve palsies in children, there has been limited evidence published on this subject, especially from a population based within the UK. The incidence of etiologies has been found to vary significantly within the literature, especially with regard to neoplasms. The main aim of this study is to present the etiologies of newly diagnosed pediatric sixth nerve palsies in a UK-based population. We also take into consideration if the palsies were isolated or associated with other neurological signs or symptoms. Retrospective data collection was carried out on the medical records of 50 pediatric patients with a new-onset sixth nerve palsy. They all presented to a large tertiary referral hospital in the South of the UK between 1 January 2007 and 31 December 2017. Data collected for each patient included age, gender, ethnicity, unilateral versus bilateral, other signs and symptoms, etiology, where the patient first presented, and whether the palsy was the first presenting feature. Thirty-three (66%) patients had a new-onset sixth nerve palsy in conjunction with other neurological signs or symptoms and were considered non-isolated. Seventeen cases (34%) were found to be isolated. Etiologies included high intracranial pressure (18%), neoplasm (14%), surgery for neoplasm (14%), viral (14%), infection (12%), trauma (8%), idiopathic (6%), benign space-occupying lesion (4%), congenital (2%), inflammation (2%), Alexander's disease (2%), Kawasaki syndrome (2%), and diabetes (2%). Our study found non-isolated sixth nerve palsies to be the most common presentation. These patients had a high number of potentially sinister etiologies, the most common being high intracranial pressure followed by post-surgery for neoplasm and neoplasm. Isolated sixth nerve palsies were more commonly due to viral or idiopathic etiology; however, two cases of benign space-occupying lesion and one of neoplasm were identified.

Congenital inferior rectus hypoplasia and aplasia is a rare abnormality of the extraocular muscles, and it is the second most common after superior oblique muscle aplasia. It has been reported either in isolation or with coexisting ocular or systemic associations. We describe here cases of inferior rectus hypoplasia/aplasia, their clinical features, and surgical approach to achieve satisfactory outcomes. We retrospectively reviewed medical records from January 2009 to December 2020 of patients with vertical strabismus due to inferior rectus hypoplasia/aplasia at a tertiary eye care center. Those who underwent surgical intervention with an adequate follow up postoperatively were included in the study. Three patients who presented with congenital hypertropia and diagnosed of inferior rectus aplasia/hypoplasia and who underwent strabismus surgery were identified. Diagnosis was based on clinical examination and orbital imaging. Coexisting horizontal deviation was present in two patients. None of the patients had any other ocular, cranial, or systemic anomalies. All patients had isolated inferior aplasia/hypoplasia with normal other extraocular muscles on orbital imaging. Intraoperatively, ipsilateral superior rectus was tight in all patients. All underwent ipsilateral superior rectus recession, whereas two patients with large vertical strabismus required additional inferior oblique anteronasal transposition in the same eye. Satisfactory outcomes were achieved in all three patients without the need for resurgery. Moderate to large vertical A pattern strabismus and limitation of infraduction are common clinical findings. Orbital imaging helps not only in diagnosis but also in surgical planning. Weakening of antagonist superior rectus with anteronasal transposition of inferior oblique not only gives good surgical outcomes but also avoids potential complications related to vertical transposition of either horizontal rectus muscle.

To determine the optical coherence tomography angiography (OCTA) parameters including foveal avascular zone (FAZ) and vessel density (VD) in the amblyopic eyes compared with the fellow sound eyes and the eyes of the non-amblyopic subjects. In this case-control study, a total of 23 eyes from unilateral amblyopic children were included as cases. The sound eye of the amblyopic children was considered as the internal control and the right eyes of the non-amblyopic children were considered as the external control. All participants underwent image recording with OCTA. In the present study, an equal number of 23 unilateral amblyopic eyes and 23 right eyes of non-amblyopic age- and sex-matched children were included as the cases and controls, respectively. The average age of participants in the case and controls were 9.86 ± 3.12 and 8.5 ± 2.35 years, respectively. Twelve patients (52.2%) in the case group and 14 subjects (60.9%) in the control group were female. Whole vascular density of the macula in superficial capillary plexuses (SCP) was significantly lower in the external controls compared with the other studied groups (P = .026). However, the VD of the deep capillary plexuses (DCP) was significantly greater in the external controls than cases and internal controls (P= .029). The average FAZ area was 0.26 ± 0.06 mm² in amblyopic eyes that was significantly higher compared with fellow eyes (0.21 ± 0.07 mm²; P= .022), but it was not different with non-amblyopic eyes (0.22 ± 0.118 mm²). Based on our findings, there were no significant difference in the cases of foveal, parafoveal, and perifoveal in both superficial and deep vascular densities among amblyopic and non-amblyopic eyes, whereas deep whole density of the amblyopic eyes showed lower percent compared to non-amblyopic ones that indicates decrease blood supply of the amblyopic eyes in this region. Additionally, FAZ was larger in amblyopic eyes than internal controls.

Background: Anomalous ocular muscle insertions are a rare cause of ocular motility disturbances.

Methods: We report the clinical presentation and the intraoperative findings of two cases with an abnormally nasally inserted superior oblique tendons presenting with a Brown syndrome-like clinical picture.

Results: Case no 1 was a 5-year-old girl presenting with a chin up position. There was bilateral limitation of elevation in adduction, -4 on the right side and -3 on the left side with +1 downshoot on adduction on either side Patient was orthotropic in down-gaze with small V-pattern exotropia. Case no 2 was a 4-year-old boy presenting with an esotropia of 35Δ that was partially corrected with his spectacles to 20Δ. Ductions showed -4 defective elevation in adduction of the right eye. Surgical exploration in both cases revealed abnormal nasal insertion of the superior oblique tendons. The line of insertion had a convexity facing superonasally. The posterior fibers were inserted 7-8 mm posterior and just nasal to the nasal border of the superior rectus insertion, while the anterior fibers were shorter and inserted 5 mm nasal and 4 mm posterior to the nasal edge of superior rectus insertion. In both cases, there was an improvement in the elevation on adduction after superior oblique lengthening.

Conclusions: Abnormal nasal insertion of the superior oblique muscle enhances the depressor effect of the muscle and can create a Brown-like picture.

In the early 19^th century the doctrine of identical retinal points, linked with the Vieth-Müller circle, was a pillar of German physiological optics. It was challenged by Wheatstone's observations of stereoscopic depth perception announced in 1838; he also advanced a cognitive theory of binocular vision that attacked physiological interpretations. In 1841 Brücke mounted a defense of the doctrine by questioning Wheatstone's observations and offering an alternative interpretation in terms of the integration over time of a rapid sequence of convergence eye movements. The theory could not be sustained because of evidence that stereoscopic depth occurred without eye movements. Brücke also questioned Wheatstone's observations that with some stereoscopic displays stimulation of identical retinal points could result in double vision. The binocular combination of circles differing in size was accounted for by differentially dissociating accommodation in opposite directions for each eye from convergence. Despite the negative reaction to Brücke's proposals, his speculations about the nature of rapid eye movements and of their neural basis were ahead of his time.

Age-related distance esotropia (ARDET) is characterized by an esodeviation greater at distance than near in older aged patients and generally managed with prism spectacles or surgery. The purpose of this study is to describe the prevalence, clinical characteristics, and natural history of age-related distance esotropia in a defined population. The medical records of all adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with an esodeviation at least 2 prism diopters (PD) greater at distance than near, from 1 January 1985, through 31 December 2004, were retrospectively reviewed. Seventy-three (9.7%) of 751 new cases of adult-onset strabismus were diagnosed with age-related distance esotropia during the 20-year period. The mean age of onset was 70 years (range, 19 to 93 years) and 48 (65.8%) were female (p = .007). The mean angle of esodeviation was 7.6 (range, 2 to 20) prism diopters (PD) at distance and 0.4 (range, 10 PD of XT to 12 PD of ET) PD at near. The Kaplan-Meier rate of progression, as defined by a ≥ 6 prism diopter (PD) increase in esotropia, was 50% by 15 years after diagnosis. Half of the patients had hypertension, while one-third had coronary artery disease or other cardiac comorbidities. Age-related distance esotropia comprised 1 in 10 adults with new-onset strabismus in this population and was significantly more common among women. Hypertension and cardiovascular disease may be risk factors for this form of strabismus, and approximately half of the patients worsened over a 15-year period.

Infantile nystagmus syndrome (INS) is often characterized by an identifiable null zone. When the null zone is not in the straight-ahead gaze, a compensatory head posture (CHP) is adopted by the patient to achieve best possible vision. Various surgical procedures have been recommended to correct a CHP which is clinically predominant in one dimension of yaw (lateral rotation), pitch (anterior or posterior flexion/extension) or roll (lateral flexion). However, the presence of a complex CHP which is clinically evident in more than one dimension, warrants either a combination of multiple techniques or a stepwise approach. We report the case of a 26-year-old male with INS with an eccentric null and a multi-dimensional complex CHP of 30º left face turn, 20º right head tilt and 10º chin depression. The patient was managed by all four horizontal rectus muscle recession and resection with full tendon vertical transposition to address the face turn and head tilt. He underwent lateral rectus muscle (LR) recession with upward transposition and medial rectus muscle (MR) resection with downward transposition in the right eye. MR recession with upward transposition and LR resection with downward transposition were performed in the left eye. Postoperatively. the head posture improved significantly for both distance and near viewing. The chin depression also reduced after the procedure. He developed transient diplopia due to a small vertical deviation after the surgery, which was managed by prisms and fusional exercises. Thus, horizontal rectus muscle recession and resection combined with vertical transposition may be helpful to simultaneously improve the head tilt associated with the face turn, obviating the need for vertical rectus muscle or oblique muscle surgery.

In patients with intermittent exotropia (IXT), to investigate the correlation between fusional convergence amplitude and saccade during refusion, as well as the differences in saccade caused by suppression.

We measured the fusional convergence amplitude using a synoptophore. Suppression was assessed in 15 patients with IXT (mean age 18.1 ± 11.0 yrs, range 8-54 yrs) having diplopia during exotropia. We performed the cover-uncover test and recorded the saccade during the shift from exotropia to binocular fixation using an eye-tracking system. We analyzed the correlation between the fusional convergence amplitude on the one hand and the saccade peak velocity (PV), the saccade amplitude, and the saccade amplitude of the fusion on the other. We also investigated the difference of those saccade variables between patients with and without suppression.

In 15 patients with IXT, the median fusional convergence amplitude was 14 (range 0-60) °, and suppression was confirmed in 11 patients. When the cover was removed from the dominant eye, the fusional convergence amplitude showed a positive correlation with the saccade PV and the amplitude in non-dominant eye (r = 0.570, p = 0.042 and r = 0.669, p = 0.012, respectively). The mean saccade PV, the mean saccade amplitude and the mean saccade amplitude of the fusion were not significantly different with the presence or the absence of the suppression.

The fusional convergence amplitude was correlated with saccade in patients with IXT. The saccade during refusion can thus be used to quantitatively evaluate sensory and/or motor fusion.