Strabismus最新文献

Purpose: Increasing demand within paediatric ophthalmology services presents a growing challenge to timely and effective patient care. Advanced Clinical Practice (ACP) roles have emerged as a strategy to extend clinical capacity and alleviate consultant and medical workload. This service evaluation explores the early impact of an ACP clinic at Oxford University Hospitals NHS Foundation Trust. Methods: A retrospective analysis was conducted of all patients seen in the ACP clinic between the August 12, 2022, and the September 19, 2025. Data collected included patient demographics, ophthalmic diagnosis, management outcome, and whether consultant ophthalmologist input was required. The clinic accepted referrals across the full range of paediatric ophthalmology. Results: A total of 278 patient appointments were conducted over the evaluation period. 66% were managed independently by the ACP. Consultant input was required in 34% of cases, with the most common reason being the need for prescribing (53%), which the ACP was not authorized to provide. Diagnoses seen ranged from anterior segment disease, eyelid conditions, and posterior segment presentations, with the most common diagnosis being chalazia making up 23% of presentations. The most common management given to patients was reassurance prior to discharge (33%) followed by pharmacological management (26%), active monitoring (22%), conservative advice (16%), and surgical listing (3%). Conclusion: The ACP clinic safely managed a wide variety of cases that would otherwise have required consultant appointments, significantly reducing medical workload. Limitations included the inability to prescribe independently, restricting clinical autonomy. This model demonstrates the potential for ACPs to enhance paediatric ophthalmology services and highlights areas for future role development.

Introduction: This study aimed to evaluate the long-term efficacy of the Cambridge Visual Stimulator (CAM) in pediatric amblyopia, by comparing outcomes of standard occlusion therapy alone versus occlusion combined with CAM.

Methods: In this retrospective cohort, 112 patients (112 eyes) aged ≤10 years with strabismic or anisometropic amblyopia were assigned to one of two groups. Group 1 (n = 64) received three hours/day of occlusion therapy; Group 2 (n = 48) received the same occlusion regimen plus a supervised 5-day CAM course (six rotating high-contrast spatial-frequency disks, 18 minutes daily). Best-corrected visual acuity was recorded in logMAR at baseline, 6 months, and 12 months. Within-group improvements were analyzed using the Wilcoxon signed-rank test, and between-group differences with the Mann - Whitney U test. P-value of <0.05 was considered statistically significant.

Results: Both groups showed significant acuity gains at 6 and 12 months versus baseline (p < .001 for all comparisons). Numerically, Group 2 improved more (6 months: -0.137 ± 0.231 vs. -0.127 ± 0.196; 12 months: -0.192 ± 0.267 vs. -0.190 ± 0.225), but these differences did not reach significance (6 months p = .402; 12 months p = .883).

Conclusion: Occlusion therapy markedly enhances visual acuity in amblyopic children, whereas adjunctive CAM yields only limited additional benefit. Prospective, larger-scale trials are needed to determine whether specific subgroups - such as treatment-resistant cases - may derive clinically meaningful gains from CAM.

Introduction: Horizontal Gaze palsy with concurrent esotropia and substituted convergence is a rare clinical presentation. Methods: We report a case of a 6-year-old child being treated for pontine medulloblastoma who presented with bilateral abducens and bilateral facial nerve palsy. The patient progressed to develop right sided horizontal gaze palsy with bilateral abducens palsy and substituted convergence. In view of limited abduction in his right eye, a modified Nishida procedure was performed followed by botulinum toxin to the right medial rectus both of which failed in improving the ocular alignment. Subsequently, the patient underwent an asymmetric, bilateral recess-resect procedure. Results: The recess-resect procedure resulted in a correction of his compensatory face turn and ocular deviation with orthotropia in primary position and binocular single vision. Conclusion: This case report reiterates the importance of asymmetric recess-resect surgery rather than vertical rectus transposition surgery in such a case.

Introduction: Canine tooth syndrome is a rare condition defined by the simultaneous presence of superior oblique palsy and Brown syndrome, resulting from pathological changes in the trochlear region. This syndrome can develop through various mechanisms, including dog bites, head trauma, infections, inflammation, and scarring. This report highlights its occurrence following sinus surgery for the first time. Methods: Medical and surgical records of an 18-year-old girl who presented with reading position diplopia after sinus surgery for right-side frontoethmoidal osteoma were retrospectively reviewed. Results: Strabismus examination revealed 8 Prism Diopter (PD) primary position hypertropia in the right eye that increased to 20 PD in downgaze. In the upward gaze to the left, the right eye showed 12 PD hypotropia with a positive forced duction test. The patient exhibited simultaneous signs of paresis and restriction of the right superior oblique muscle, consistent with type 7 of the Knapp classification. The patient declined strabismus surgery, and vertical diplopia was managed with prism spectacles. Long-term follow-up showed spontaneous resolution of superior oblique paresis leaving the patient with isolated Brown syndrome in the right eye. Discussion: Canine tooth syndrome can arise as a complication of frontoethmoidal sinus surgery due to excessive intraoperative manipulation of the superior and medial orbital wall, particularly in the trochlear region.

Purpose: Diplopia or heterotropia may occur during physical exercise. However, the influence of exercise on phoria is still unknown. The purpose of this study is to evaluate the effects of a physical activity involving both aerobic and anaerobic exercise on horizontal phoria. Methods: Twenty young adult competitive soccer players (19 males, 1 female) were included and divided equally in two groups by manifest refraction: ametropic (n = 10) and emmetropic (n = 10) subjects. Horizontal phoria was evaluated by a Risley-Maddox rotating prism after a complete dissociation with a 5 Δ prism placed base-up on the non-dominant eye during five different times before (at rest) and after an aerobic-anaerobic workout (immediately, 5 min, 10 min, 25 min). Results: Ametropic subjects had myopia in either eye (median spherical equivalent of -0.63 D [interquartile range from -4.45 to -0.47 D]). Emmetropic subjects were at baseline significantly more esophoric than ametropic subjects (+0.90 ± 1.37 vs. -2.20 ± 2.57 Δ, p = .003). On average emmetropic subjects showed a quadratic course of increasing esophoria, peaking at 10 min (+1.65 ± 2.03 Δ) and then decreasing (+1.25 ± 1.78 Δ), returning to baseline in 50% of cases; while ametropic subjects had a quadratic course of increasing exophoria, peaking at 5 min (-4.00 ± 2.71 Δ) and then decreasing (-2.40 ± 2.80 Δ), returning to baseline in 80% of cases. The variations of phoria induced by physical exercise were significant throughout the time (repeated measures ANOVA p < .001, η_p²  = 0.42). The interaction of time with refractive state on phoria was significant for quadratic term (p = .001, η_p²  = 0.48). Ametropic subjects showed on average higher angles (p = .049, η_p²  = 0.20) and higher variations from baseline phoria (quadratic interaction p = .015, η_p²  = 0.29). Conclusions: Phoria is significantly affected by physical exercise, following a quadratic course of increasing and then decreasing angle. Myopic subjects were on average exophoric, displayed higher angles and variations from baseline, peaked before but recovered at last assessment more than emmetropic subjects. Refractive state may have a major role on predicting the progression; however, whether it is due to manifest refraction itself, accommodation or baseline phoria must be ascertained. Any reliable conclusion cannot be drawn due to small sample size and missing physiological measurements. Fluctuating phoria may provide a basis for decreased stereopsis and altered motion perception, thus affecting sports performance.

Purpose: Monocular Elevation Deficiency (MED) is characterized by limited ability to elevate the affected eye in any gaze position, while maintaining normal duction in all other gazes. The type of surgeries described in MED include Knapp's surgery, vertical muscle recession and resection, contralateral superior rectus recession. Recently, the Nishida's procedure has also been explored as a treatment for isolated cases of MED. Hence, we conducted this study to evaluate the surgical outcome of Modified Nishida's procedure in cases of MED in a series of 15 patients. Methods: This prospective interventional study was performed on 15 patients with MED attending the Strabismus Clinic and outpatient department of our tertiary care centre over a period of 1 year from October 2023 to October 2024. In this study, 15 patients of age more than 13 years with Type 2 Congenital MED with negative forced duction test for inferior rectus, hypotropia more than 10 prism diopters and no horizontal deviation were included. Patients with previous history of strabismus surgery or with bleeding diathesis were excluded. Preoperatively, ocular deviation was measured using vertical prisms in terms of prism diopters (PD). Elevation deficit was noted in all the patients on a scale of 0 to -4 with 0 indicating full rotation and -4 indicating severe limitation (not crossing midline). All patients underwent Modified Nishida's procedure following forced duction test for inferior rectus. Postoperatively, all the measurements were recorded at the end of first week, first month and the final follow up was done at the end of third month. Primary outcome included correction of vertical deviation at 3 months post Modified Nishida's procedure. Secondary outcome included assessment of elevation deficit. Results: The mean age of the patients was 23.33 ± 15.73 years. There was statistically significant improvement in mean hypotropia from preoperative measurement of vertical deviation of 28.67 ± 9.904 PD to 7.60 ± 10.176 PD (p < 0.001) at the final follow up. There was statistically significant improvement in elevation deficit ranging from mean value of -3.47 ± 0.74 at baseline to -2.73 ± 0.70 postoperatively at final follow up (p < 0.01). Conclusion: The study demonstrated that the Modified Nishida's procedure is effective in managing MED in terms of improvement of vertical deviation and elevation deficit.

Introduction: Acute acquired comitant esotropia (AACE) is a rare type of esotropia for which until now the main treatment modalities prescribed are prism glasses, botulinum toxin injection and surgery. The purpose of our study is to compare the surgical outcomes in patients with AACE managed with and without pre-operative prism adaptation test (PAT). Methods: We have done a prospective, interventional study for the duration of one year. Forty patients with AACE were randomly divided into two groups by computerized randomization - those undergoing surgery after pre- operative PAT and those undergoing surgery without it. In control group (Group C), patients underwent surgery based on the angle of deviation at distance measured by prism bar cover test (PBCT) and wearing full cycloplegic correction, while in test group (Group T), patients underwent surgery based on the preoperative prism-adapted angle at distance wearing prism power determined by PBCT and wearing full cycloplegic correction. The primary outcome was post-operative deviation and secondary outcome was stereopsis. Post-operatively, patients were followed up at week 1, week 4 and final follow-up was done at week 12. Results: The mean age of the 40 patients was 13.95   ±   5.36 years. The age of the youngest and the oldest patients enrolled were 8 years and 35 years, respectively. The mean SD (standard deviation) of the PBCT for distance (measured in prism diopters - PD), PBCT for near (measured in prism diopters - PD) and stereopsis for near (measured in seconds of arc using Titmus Fly Test) at last follow-up visit (week 12) in the test versus control group were as follows: 1.70 ±   1.42 PD versus 4.75   ±   3.39 PD, 2.55   ±   1.82 PD versus 6.95   ±   3.35 PD and 74.90 ± 53.47 sec of arc versus 48.60   ±   31.97 sec of arc, respectively, which were statistically significant (p  =  <0.01, p = <0.01 and p = .03, respectively). The change in visual acuity and spherical equivalent in each group was insignificant. Discussion: Surgical outcomes in patients of AACE are better when surgical planning is done after performing pre-operative PAT as opposed to when surgery is planned without PAT. Better motor alignment (less under correction and over correction) and better sensory results in terms of improvement in stereopsis were observed. We recommend the use of pre-operative PAT in surgical planning in patients of AACE.

Purpose: To evaluate the surgical outcomes of two inferior oblique muscle weakening procedures in the management of unilateral superior oblique muscle palsy (SOP). Methods: Files of all SO palsy patients with 11-20 PD hypertropia (HT) who were treated either by inferior oblique myectomy (IOM) or inferior oblique anterior transposition (IOAT) were retrospectively reviewed. Demographic characteristics such as sex, age, etiology, simultaneous horizontal deviation, and diplopia were noted. The two techniques were compared through HT correction (in the primary position, contralateral gaze, and ipsilateral tilt) and head tilt correction. Subgroup analysis was performed in the moderate group (11-15 PD HT) and large group (16-20 PD HT). Results: This study included 69 patients in the IOM group and 55 patients in the IOAT group. The demographic characteristics of both groups were similar. Although both procedures successfully corrected the abnormal head tilt, IOAT achieved significantly more HT correction compared to IOM (p-value: 0.003). While both techniques were equally effective in the moderate group, IOAT resulted in more primary position HT correction (16.4 vs. 12.9 PD) in the large group. However, anti-elevation syndrome occurred in 5.4% of patients treated by IOAT. Conclusions: IOAT achieved more HT correction compared to IOM, particularly in patients with large preoperative HT. The lower risk of under-correction following IOAT must be weighed against its potential risk of anti-elevation syndrome.

Background: Publications on optical coherence tomography (OCT) parameters in amblyopic eyes compared to fellow eyes are discordant. Our study not only compares OCT data of fellow and amblyopic eyes, but is the first study to deliver pilot results on OCT parameter changes after long-term electronic monitoring of occlusion therapy.

Methods: Thirty eyes with strabismic, anisometropic or mixed amblyopia and the corresponding fellow eyes underwent OCT of the macula and optic disc with a Topcon 3D-OCT-2000. In a subgroup of six patients, the same examinations were additionally performed at the end of long-term objectively measured occlusion therapy with Occlusion-Dose-Monitoring (ODM) of ≥2135 hours. Paired t-tests or matched pairs Wilcoxon tests were performed to compare optic disc values, macular thickness, as well as thickness of different layers of the macula of the amblyopic eye versus the fellow eye. Specifically, the Ganglion Cell Layer (GCL) with the Inner Plexiform Layer (IPL) designated as GCL+, as well as combined with the Retinal Nerve Fiber Layer (RNFL) designated as GCL++, were analyzed. For the subgroup of patients with follow-up OCT, the same tests were performed to compare the values in both eyes before and after occlusion therapy.

Results: Average thickness (AT) and total volume (TV) of the macula of amblyopic eyes (282.0 ± 13.0 µm; 7.98 mm³ ±0.37) were increased (marginally significant p=0.0495 for both) compared to fellow eyes (278.6 µm ± 13.3; 7.88 mm³ ±0.37), all other parameters did not differ. In the group with follow-up OCT, the AT and TV of the amblyopic eyes significantly decreased after occlusion (278.8 µm before vs. 268.3 µm after and 7.89 mm³ before vs. 7.59 mm³ after; p = .031 for both). The thicknesses of inner retinal layers were not significantly different between amblyopic and fellow eyes or after therapy.

Conclusions: Our results suggest that the macula of amblyopic eyes may be thicker than in fellow eyes, particularly in eyes with moderate-to-severe amblyopia. Occlusion therapy may lead to a thinning of the macula in the amblyopic eye or both eyes. The layers included in GCL+ and GCL++ do not seem to be the substrate of the observed structural changes.

Introduction: Trauma to extraocular muscle without globe perforation is rare. This case report describes the clinical features and principles of repair of the simultaneous injury to two extraocular muscles sustained from a goat's horn. Methods: Case records of the 36-year-old man who suffered trauma to his left eye were reviewed. Results: Examination revealed diplopia, hypotropia of the left eye, and a lacerated superior conjunctiva through which a muscle tendon prolapsed. Magnetic resonance imaging (MRI) of the orbit indicated discontinuity and fuzziness of the left superior rectus muscle (SR). Surgical exploration showed that the prolapsed tendon belonged to the superior oblique muscle (SO). Avulsion of SR was also noted 14 mm from its insertion. The proximal end of SR was anastomosed with the distal segment. The proximal end of the SO could not be traced. Postoperatively, the elevation improved marginally and there was a small hypotropia. His diplopia was managed with prisms. Discussion:The goat's horn acted like a hook and avulsed two contiguous muscles from orbit in a posterior to anterior direction. The hypertropia due to SO avulsion was compensated partly by the hypotropia due to the concurrent damage to the SR. Immediate surgical intervention resulted in a good alignment.