Strabismus最新文献

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.

Objective: To determine the surgical dose-responses of the bilateral medial rectus recession in acute acquired comitant esotropia (AACE) compared to infantile esotropia. Design: Retrospective study. Methods: The medical records of patients diagnosed with AACE and infantile esotropia who underwent bilateral medial rectus muscle recession (BMRR) were reviewed. Patient characteristics, ocular examinations and surgical data were collected. A motor success was defined as horizontal deviation within 10 prism diopters (PD) of ortho, and a sensory success was defined as no diplopia at 6 months after the surgery. Results: A total of 114 patients were included. There were 39 patients with AACE [median (Q1-Q3) age was 20 (15-25) years, 56% was female] and 75 patients with infantile esotropia [median (Q1-Q3) age was 3 (1-5) years, 56% was female]. The surgical dose-responses of BMRR in AACE at distance and near were 2.67 PD/mm (r² = 22.8%) and 3.48 PD/mm (r² = 32.9%), respectively. The surgical dose-responses of BMRR in infantile esotropia at distance and near were 3.91 PD/mm (r² = 17.8%) and 4.64 PD/mm (r² = 18.0%), respectively. Seventy-four percent of patients with AACE and 63% of patients with infantile esotropia achieved a motor success. Eighty-five percent of patients with AACE achieved a sensory success. The postoperative drift at distance and at near was not significant in both groups [AACE 0 PD (-6 to 10), p = .26 and 2 PD (-2 to 6), p = .44; infantile esotropia [8 PD (0-14), p = .12 and 4 PD (0-10), p = .22]. Conclusions: The BMRR in infantile esotropia had a larger surgical dose-response than in AACE. In both groups, the surgical dose-responses at near were greater than at distance. There was no significant postoperative drift at distance and at near in both groups.

Purpose: To facilitate visual appreciation of the anatomical relationships among the extraocular muscles and the orbital suspensory system, these tissues were realistically rendered using Blender, a three-dimensional (3D) modeling software. Methods: Information on the size and position of the globe and extraocular muscles (EOMs) in healthy adult participants was obtained from published studies and was used to create a detailed, realistic 3D model of the orbital pulley system. Results: The 3D model successfully rendered realistic anatomical structures and illustrated the relationship among the orbital pulleys, globe, Tenon's fascia, and EOMs. Key features of the model include a) a pulley sleeve for each rectus EOM, with a central pulley ring; b) pulley array, interconnecting bands linking the rectus pulley rings to the oblique muscles; and c) pulley slings attached anteriorly to the lateral and nasal orbital walls, and posteriorly to Tenon's fascia forming a continuous enclosure around the globe. Conclusions: This educational model provides an anatomically accurate visualization accessible to strabismus specialists, ophthalmologists, and extraocular surgeons. The model also holds potential for adaptation to depict pathological anatomy in strabismus caused by orbital pulleys disorders.

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.