Strabismus最新文献

Introduction: Cysticercosis is a systemic parasitic disease caused by the larvae of the tapeworm Taenia and has varied clinical manifestations. Ocular involvement can be intraocular or extraocular and can mimic various etiologies and patterns of strabismus. This study reports 3 cases of orbital myocysticercosis mimicking clinical presentation of inverse Duane's retraction syndrome and discuss the clues to the clinical diagnosis. Methods: Retrospective review of medical records of three patients with medial rectus muscle cysticercosis with clinical findings mimicking acquired inverse Duane's retraction syndrome. Results: Review of medical records identified 3 patients with myocysticercosis presenting as inverse Duane's retraction syndrome with exotropia, esotropia and orthophoria in primary gaze, restricted horizontal movements and globe retraction in abduction. Ultrasound B scan or orbital computerized tomography scan confirmed the diagnosis of medial rectus muscle cysticercosis in all patients. All 3 patients were treated with oral albendazole with resolution of the cyst on follow up imaging and improvement in clinical findings. Discussion: Cysticercosis is a common parasitic infection in India and responds well to medical management. These 3 cases highlight the unusual presentation of medial rectus muscle cysticercosis presenting as acquired inverse Duane's retraction syndrome. Sudden onset strabismus and restricted extraocular movements along with signs of orbital or adnexal inflammation in a child or young adult residing in endemic areas should be evaluated to rule out myocysticercosis. Inflammation is usually painless with minimal tenderness despite marked signs of orbital or adnexal involvement. Diagnosis relies on high clinical suspicion and imaging such as ultrasound B scan, MRI, or CT, which can reveal the cyst and scolex within the muscle. Relative rarity of this presentation of myocysticercosis as inverse Duane's retraction syndrome makes it imperative for clinicians to be aware of this entity to clinch the diagnosis early and initiate prompt treatment.

Introduction: Monocular elevation deficiency (MED) can be congenital and acquired. The underlying etiology usually guides the surgical management of MED. In cases with tight inferior rectus (IR) on forced ductus test, IR recession is preferred, and in cases with Superior rectus palsy, vertical transposition of horizontal recti (Knapp's Procedure) is the treatment of choice. The purpose of this case series is to report the long-term outcomes of inferior rectus recession with conjunctival recession in treating congenital monocular elevation deficiency (MED). Methods: It included 10 patients of congenital MED who underwent inferior rectus recession (IRR) with conjunctival recession (CR) from 2019 to 2021 with a minimum follow-up of 2 years. They all underwent complete pre-operative orthoptic evaluation, including the prism bar cover test (PBCT), and had primary position vertical deviation only. A forced duction test (FDT) was done, and 6 mm of IRR with CR was performed on all, irrespective of the FDT findings. Results: The mean age of the participants was 18 years; the mean pre-operative vertical deviation was 33 prism diopter (PD), and horizontal alignment was within 8 PD. FDT for IR was positive in 5 and negative in 5 patients. Orthophoria was achieved in 7 patients following 6 mm of IRR with CR, with a mean post-op vertical deviation of 8.9 (p-value 0.01). (mean post-op vertical correction achieved was 24.1 PD), while 2 needed Knapp's procedure and 1 needed SR recession in the fellow eye. We also noticed an improvement in elevation from preop -3.4 to mean postop -1.7 (p-value 0.0001) after IRR. This alignment was maintained till 2 years of follow-up. Discussion: This case series shows that 6 mm IRR-CR is an effective and reliable procedure for correcting vertical deviations up to 24 PD in cases of congenital MED regardless of FDT findings.

Introduction: Brown syndrome involves restricted elevation in adduction due to superior oblique tendon anomalies. Marcus-Gunn jaw-winking Syndrome (MGJWS) is a congenital synkinesis between jaw movement and eyelid elevation. Their coexistence along with ptosis in the same eye is extremely rare.

Methods: We report a case of an 8-year-old girl presenting with right eye motility restriction consistent with findings of Brown Syndrome along with MGJWS and ptosis.

Results: The patient showed right hypotropia with limited elevation in adduction, consistent with Brown syndrome. Ptosis resolved with mouth opening or jaw movement, consistent with MGJWS.

Discussion: This is the first pediatric report of Brown syndrome with ipsilateral MGJWS and ptosis. The combination of mechanical restriction and dysinnervation underscores the complexity of congenital cranial dysinnervation disorders and highlights the importance of thorough clinical evaluation.

Purpose: To evaluate the factors and preoperative clinical features associated with recurrence after surgical correction of intermittent exotropia (IXT). Methods: The medical files of patients who underwent surgery for IXT at a single center between July 2021 and June 2024 were retrospectively reviewed. Final motor success was defined as ocular alignment within 10 prism diopters (PD) of exodeviation to 5 PD of esodeviation at both distance and near. Recurrence was defined as a postoperative deviation greater than 10 PD at distance and near during follow-up. Factors evaluated included age at surgery, duration between symptom onset and surgery, preoperative angle of deviation, stereoacuity, binocular fusion, spherical equivalent, type of surgery, presence of amblyopia, fixation preference and other associated strabismic features. The relationship between these factors with and recurrence was analyzed. Result: A total of 58 patients (34 male, 58.5%) were included. The mean age was 21.2 ± 11.7years, and the mean follow-up was 12.3 ± 5.3months. Forty-one patients underwent bilateral lateral rectus recession, three underwent unilateral lateral rectus recession with medial rectus resection, and 14 underwent combined operation, bilateral lateral rectus recession with oblique muscle - weakening procedures. Surgical success at final visit was achieved in 34 (58.6%). There was no relation between recurrence and the type of intermittent exotropia in patients, sex, age at surgery, family history, consanguinity, amblyopia, anisometropia, abnormal ocular motility, fixation preference, binocular function, or surgical method (p >.05). However, a long duration of exotropia and high preoperative deviations at both distance and near were found to be related to postoperative recurrence. Conclusions: The overall surgical success rate in this study was 58.6%. Moreover, longer duration of preoperative exodeviation and larger preoperative deviation at both distance and near were identified as significant risk factors for postoperative recurrence.

Purpose: To evaluate the long-term efficacy of botulinum toxin A (BoNT-A) in children with acute acquired comitant esotropia (AACE).

Methods: This retrospective study included pediatric patients treated with BoNT-A for AACE between January 2021 and September 2024. Deviation angles at near (40 cm) and distance (5 m) were recorded before treatment and at 1, 3, 6, 12 months, and final follow-up. Outcomes were categorized as successful (≤10 prism diopters [PD]), partially successful (11-20 PD), or unsuccessful ( >20 PD).

Results: Twenty patients (mean age 5 ± 1 years; 65% female) were included. BoNT-A was administered a mean of 4 ± 2 weeks after symptom onset. A second injection was required in 35% of patients. At final follow-up (mean: 20.4 ± 12.0 months), mean near and distance deviations were 8 ± 17 PD and 10 ± 17 PD, respectively. Thirteen patients (65%) had successful outcomes, four (20%) were partially successful, and three (15%) were unsuccessful. Patients receiving a single injection had significantly better outcomes than those requiring a second (p = .041). Mild, self-resolving ptosis occurred in two cases (10%).

Conclusion: Early treatment with BoNT-A provides a high rate of motor alignment in pediatric AACE and may reduce the need for surgery. These results support its use as an effective first-line treatment option.

Purpose: This study evaluates the effectiveness of prism therapy in patients with ocular motor palsies affecting the oculomotor (nerve III), abducens (nerve VI), and trochlear (nerve IV) nerves, focusing on four key criteria: deviation, diplopia, head posture, and ptosis.

Methods: A comparative analysis was conducted on patients diagnosed with nerve III, nerve VI, or nerve IV palsy. Deviation measurements, diplopia occurrence, head posture abnormalities, and ptosis presence were assessed before and after prism therapy. Statistical analysis was performed to determine significant changes within each group and to compare outcomes across the three palsy types.

Results: Therapeutic prism use resulted in significant improvements in ocular deviation and diplopia across all groups (p < .05). Mean deviation decreased from 22Δ to 12Δ in third nerve palsy, from 38Δ to 14Δ in sixth nerve palsy, and from 18Δ to 8Δ in fourth nerve palsy. Diplopia in primary gaze was reduced from over 80% to below 21% across all groups. Although cyclodeviation was observed only in 29% of fourth nerve palsy cases, 71% of those patients reported subjective improvement. No statistically significant differences were found between the groups regarding treatment success (p > .9).

Conclusion: Prism therapy appears effective in improving ocular alignment and visual symptoms across all three types of ocular motor palsy. Its benefits extend to reducing diplopia and abnormal head posture, and selectively improving ptosis and torsional symptoms in certain cases. These findings support the broader application of prism therapy as a valuable non-surgical management strategy.

Purpose: Acute acquired comitant esotropia (AACE) is a subtype of non-accommodative esotropia for which the exact underlying mechanism remains unclear. With most AACE adults being myopic, it is crucial to detect and rectify myopic over-correction in AACE considering its possible role in inducing and/or worsening eso-deviations. This report aims to emphasize the importance of appropriate refraction and suitable myopic prescriptions in managing AACE.

Results: This report presents two middle-aged patients with moderate myopia who were diagnosed with AACE. At initial presentation, both were found to have varying AACE control and angles ranging from 4∆ to 14∆ on prism cover test. Manifest refraction with fogging revealed that they have been over-corrected for myopia. Immediate improvements in AACE symptoms, control and measurements were noted with new myopic prescriptions - one fully corrected and the other intentionally under-corrected - of a difference in at least -0.38 diopter sphere (spherical equivalent) in both eyes alone.

Conclusion: Appropriate and early refraction alongside well-fitted prescriptions is essential in managing AACE. Further research is required to establish the potential of intentional myopic under-correction as a new, alternative conservative management for AACE.

Introduction: High myopia can lead to dislocation of the posterior globe and restrictive strabismus, most commonly presenting as esotropia-hypotropia. This report highlights a rare case of esotropia-hypertropia associated with an inferotemporal staphyloma. Methods: A 45-year-old male presented with long-standing esotropia and recent-onset foreign body sensation in the right eye. Examination revealed >45° esotropia and 10° hypertropia, with marked limitation in abduction and infraduction. MRI showed inferotemporal globe herniation, superior displacement of the lateral rectus, and nasal displacement of the inferior rectus. Surgical management, performed under general anesthesia, included medial rectus recession combined with an inverted Yokoyama procedure by uniting the lateral and inferior rectus muscles. Results: Postoperatively, the patient achieved orthotropia in primary gaze with improved ductions. No intraoperative or postoperative complications occurred. The patient reported both functional and cosmetic satisfaction. Discussion: While the classic Yokoyama procedure addresses esotropia-hypotropia in high myopia, this case demonstrates that its principles can be adapted for atypical anatomical variants such as esotropia-hypertropia. The inverted approach offers a safe and effective option in carefully selected cases.

Purpose: To evaluate the association between strabismus and dry eye disease (DED), with a particular focus on the effect of alternation status on DED. Methods: Eighty eyes of 40 patients with constant strabismus were evaluated in this prospective, cross-sectional study. DED was evaluated using the Ocular Surface Disease Index (OSDI), Schirmer I test, noninvasive tear breakup time (NITBUT), tear film breakup time (TBUT). NITBUT values, including first breakup time (first NITBUT) and average breakup time (average NITBUT), were automatically calculated using a Scheimpflug corneal topography device. Results: The mean age was 16.9 ± 11.8 years, with an average deviation duration of 11.3 ± 11.4 years. Eighteen patients had good alternation, and 22 had poor alternation. Patients with poor alternation exhibited shorter first NITBUT and average NITBUT values in the deviating eyes compared to their sound eyes (p = .026 and p = .048, respectively). No significant correlations were found between DED findings and age, gender, deviation type or angle (all p > .05). However, OSDI scores correlated significantly with age (p < .001), duration of deviation (p < .001), and alternation status (p = .004). Additionally, the difference in first NITBUT values between the two eyes increased with a larger angle of distant deviation (p = .024) and worsening alternation status (p = .036). Conclusion: DED signs and symptoms may be more pronounced in the deviating eye of strabismus patients with poor alternation. Closer monitoring for DED in strabismus patients with poor alternation, especially in older individuals, may be advisable.

Aim: Definitions and cutoff values for impaired near point of convergence, and for dominant/non-dominant hand completion of line bisection and cancellation tasks, in older adults are lacking. In this study, we investigate the measurements, response times, and accuracy in a non-clinical population with healthy eyes and cognition.

Methods: This was a prospective cross-sectional study recruiting adults older than 50 years. Demographic data included hand dominance, sex, age, and ethnicity. The average of three near point of convergence measurements was recorded. Accuracy and speed of task completion were recorded for two-line bisection tasks (3 lines and 10 lines) and for the clock cancellation task, using dominant and non-dominant hands.

Results: A total of 240 participants (161 female), with mean age of 61.23 years (SD8.71, range 50-97) were recruited. All participants had best corrected visual acuity of better than 0.1logMAR in each eye with no ocular pathology, and with no neurological disease. Overall mean near point of convergence was 9.22 cm (SD4.13), with slight decrease in convergence with increasing age (mean 11.71 cm in the 80th decade). Error cutoff for line bisection was determined as 6 mm with greater accuracy for the 10-line vs 3-line task. Error cutoff for the clock cancellation task was 42 with mean completion time of 1.5 minutes.

Conclusions: We report normative ranges of older adults ( >50 years) to which future clinical comparisons can be made when evaluating near point of convergence and visual inattention. Further research is required in acquired brain injury populations to take into consideration any additional impact on task completion due to co-morbidities/associated sequelae of the brain injury.