Strabismus最新文献

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.

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: Symptomatic esophoria (SE) is a latent esodeviation that progresses into a manifest esotropia, causing substantial discomfort such as diplopia, headaches, and asthenopia. Surgery for esophoria is prone to undercorrection, necessitating repeated interventions. Addition of preoperative prism adaptation testing (PAT) reveals significantly larger angles of deviation (AOD). The aim of this retrospective study was to compare rates of repeated surgical interventions in SE patients with or without PAT as a supplement to standard orthoptic evaluation. Methods: We reviewed records of patients with SE who underwent surgery at the Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark, from January 1, 2017, to August 31, 2023. We collected information on whether PAT was conducted, demographics, and medical and ophthalmological history. Primary outcome was the need for repeated intervention either by reoperation or by postoperative adjustment of sutures. Results: One hundred and five SE patients were included, with 61 in the non-PAT group and 44 in the PAT group. Repeated surgical interventions were less frequent in the PAT group (23%) compared to the non-PAT group (48%) (P 0.009). PAT resulted in an increase in median AOD at near and distance by 14PD and 16PD, respectively (p < .001 and p < .001). Conclusions: In this observational study, SE patients undergoing PAT had significantly lower rates of repeated surgical interventions and a significant increase in baseline AOD, compared to those who did not undergo PAT.

Purpose: Detecting changes in stereothresholds aids in the diagnosis and management of binocular vision disorders. However, there is variation in the stereoacuity levels measured across a range of stereotests. There are limited data assessing how stereotests respond to degradations of stereoacuity. Therefore, the aim of this study is to compare stereothresholds obtained from four different stereotests across different conditions of induced monocular blur. Methods: Stereoacuity was measured once for each Bangerter foil condition (no foil, 0.2 foil, 0.4 foil) using the Frisby, TNO, Lang-Stereopad and Asteroid stereotests. Inclusion criteria were age ≥18 years, no history of conditions that could impair stereoacuity, best-corrected monocular visual acuity of equal to or better than 0.3 logMAR, an interocular difference of less than 0.2 logMAR, up to date refractive correction (within the last 2 years) if required, and the ability to provide informed written consent. Significance of the differences in values between tests was calculated using the Kruskal-Wallis test, with further pairwise comparisons made via post-hoc analysis. Results: Fifty-one visually normal adults (67% female) of mean age 25 years ±8.35 were included. Statistically significant differences were achieved for most pairwise comparisons (p < .05), except when comparing TNO and Asteroid. The TNO and Lang-Stereopad tests degraded by the same median values between foil conditions, with Frisby showing the least median change between foils (0.135 median difference between 0.2 and 0.4 foils, p < .001). Conclusions: Stereotests detect stereoacuity degradation to varying extents, with the Asteroid test being most sensitive to change via monocular blur. The reasons for these differences lie in the varying methods of presentation. It is therefore recommended that test selection remains constant between appointments for the purpose of assessing subtle changes to aid patient management. Further evaluation of the ability to detect alterations in stereothresholds is required in people with impaired stereoacuity.

Purpose: To evaluate the effect of preoperative prism adaptation test (PAT) on the angle of squint in intermittent exotropia (XTint). Methods: In this single-center retrospective study, we reviewed the medical records of patients with the diagnosis of XTint, aged at least 12 years, who were treated by strabismus surgery for the first time. The maximum angle of squint (AOS) for far (F) and near (N) fixation and PAT results before surgery as well as AOS (F) and AOS (N) after surgery and results of binocular function tests were considered. PAT included wearing a prism based on the largest angle for about 60 min, without changing the prism power. Results: One hundred patients (between 12 and 78 years, mean age 32 ± 17 years) were included in the study. Before surgery, AOS was -33.6 ± 13.3 pdpt (F) and -34.4 ± 15.5 pdpt (N). After PAT, the mean AOS was not significantly different with AOS(F) = -32.7 ± 12.4 and AOS(N) = -34.6 ± 12.9 pdpt (p ≥ .057). However, in 82% of patients, AOS (F) and/or AOS (N) in- or decreased by at least 3 pdpt after PAT. The absolute distance-near difference (DND) was 6.6 ± 7.1 pdpt before PAT. After PAT, it was significantly lower with 3.5 ± 3.3 pdpt (p < .001). Conclusion: In 82% of patients with XTint, there was a change in AOS of more than the dose relevant angle change of ≥3 pdpt. The absolute distance-near difference decreased significantly after PAT. Therefore, we recommend using a PAT for preoperative examination of patients with XTint.

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.

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: Botulinum toxin A (BTX) injected into the inferior oblique muscle temporarily simulates the post-operative effect of an inferior oblique myectomy (IOM). This can aid in surgical planning, especially given the irreversible nature of IOM. This study evaluates the efficacy of BTX as a pre-operative simulator and compares its effects to those of IOM. To our knowledge, this is the largest reported series of patients undergoing pre-operative BTX simulations, prior to IOM.

Methods: A retrospective review was conducted on all patients receiving inferior oblique BTX between 1 January 1994 and 1 January 2024, by a single surgeon using an electromyography-guided technique. Data, including diagnosis, procedure, and orthoptic measurements, were obtained from electronic and archived paper records. Successful outcome was defined as subjective improvement in symptoms, or objectively as, reduction of vertical angle deviation in primary position by at least 50%, or post-procedure vertical deviation in primary position of ≤5 Prism Dioptres (PD).

Results: Sixty-eight patients underwent inferior oblique BTX within the study period. Of these, 48/68 patients (71%) had an improvement in subjective symptoms. Subsequently, 36/48 patients (78%) underwent IOM, 4/48 (8%) patients are awaiting IOM, 4/48 (8%) patients requested repeat BTX despite IOM being offered, and 4/48 (8%) patients had complete resolution with no further intervention. Following IOM, 34/36 (94%) achieved the defined successful outcome, with no significant difference between vertical deviation measurements following BTX or IOM (p < .05). No post-operative diplopia or other complications were identified, and 3/36 (8%) patients demonstrated an asymptomatic over-correction. BTX was deemed unsuccessful in 20 patients (29%). Within this cohort, 12 had no improvement (despite repeat treatment with a higher dose), 3 patients were lost to follow-up, 1 patient died and 4 patients developed problematic diplopia in the primary position, which resolved when the BTX wore off.

Conclusions: Inferior oblique BTX is a useful and reliable tool for IOM simulation, prior to irreversible surgery. Its temporary effect on vertical deviation in primary position is comparable to IOM, and can also be used as a tool to identify patients at risk of diplopia, or failure of treatment.

Introduction: divergence insufficiency esotropia is a common cause for acquired esotropia and diplopia in adults. We present a novel procedure, superior plication of the lateral rectus using non-absorbable sutures, to address this condition and analyze the surgical outcomes. Methods: This is a retrospective cohort analysis. Adult patients operated on by a single surgeon for adult-onset esotropia between 1/2022 and 6/2023 were included. Demographic and medical histories, as well as measurements of deviation preoperatively and postoperatively were extracted and compared. Intraoperative and postoperative complications were noted. Results: Included were 15 patients with a mean age of 51.1 ± 12.6 years, 67% were female and 67% were myopic. All underwent normal neuroimaging and negative myasthenia work up, and all reported diplopia. On last postoperative follow-up (mean 9.1 ± 6.1 months) only one case had manifest deviation. Overall mean distance deviation decreased from 25.7 ± 11 prism diopters (PD) to 0.16 ± 0.8 PD (p < .001) and near from 19.4 ± 16 PD to 0 ± 0 PD (p < .001). No patients had diplopia or required prisms postoperatively. Suture extrusion was documented in two cases, and one case of pyogenic granuloma was noted and was responsive to topical therapy. Discussion: This study presents a novel surgical procedure for the treatment of adult-onset esotropia. Among consecutive cases operated using the technique, one patient had mild esotropia on follow-up and no patients had diplopia. Minimal postoperative complications were noted, with suture extrusion being the most common. Superior lateral rectus plication appears to be a safe and reliable option for the treatment of adult-onset esotropia.

Purpose: The study sought to compare the number of cycles (NOS) for the first and second thirty-seconds (FASTS) within 1 min of accommodative facility (AF) and vergence facility (VF) testing to explore possibilities of reducing testing time to 30 s. Methods: In this cross-sectional study, a multistage sample of school children (aged 8-17 years) was taken through ocular-visual screening. Eligible participants (586) underwent refraction, stereo-acuity measurement, AF testing using ± 2D lens flippers, and VF testing using 3^Δ BI/12^Δ BO flipper prisms. The NOS within the FASTS of AF and VF tests were compared, respectively. Results: A statistically insignificant mean difference of 0.01 cycles was found between the NOS for the FASTS of monocular AF in the right eye (Wilcoxon Signed Rank test, p = .715). Statistically significant differences of 0.06, 0.14, and 0.09 cycles (Wilcoxon Signed Rank test, p < .05) which are not clinically meaningful were found for monocular AF in the left eye, binocular AF, and VF with no level of agreement on Bland Altman analysis, respectively. There were no clinically meaningful differences between the first 30-s cycles multiplied by two (FTSMT) and the full 1-min test period cycles for monocular AF, binocular AF, and VF. Conclusion: The FTSMT approach may be applied during gross screening to shorten testing time as further study is recommended for its diagnostic validity.