Strabismus最新文献

Objective: The aim is to report a very rare case of a fibroblastic tumour in the medial rectus muscle of the right eye in a young adult. Methods: A 28-year-old patient presented to the strabismus clinic with large-angle exotropia in the right eye. The patient had previously undergone strabismus surgery in both eyes, and the old photos showed increasing exotropia from childhood to adulthood. On examination, the patient had a best corrected visual acuity of 20/20, 85 PD of exotropia with a -4 limitation of adduction, and retinal evaluation was unremarkable. In view of the chronicity of the deviation, increasing exotropia over time, and limitation of the ocular motility in adduction, a magnetic resonance imaging was performed. Results: Orbital magnetic resonance imaging (MRI) undertaken to identify the extraocular muscle position revealed a bulky and thickened right medial rectus muscle with post-contrast enhancement and without fat stranding and orbital extension. A muscle biopsy was performed, and a series of histopathological stains revealed that the tumour cells were positive for CD34 and vimentin. Immuno histochemistry and histopathology suggested a benign fibroblastic tumour (superficial CD34+ fibroblastic tumour) with low malignant potential. Conclusion: This report describes a fibroblastic tumour of the eye muscle identified on neuroimaging and confirmed on histopathology. Such a presentation is very rare and to the best of our knowledge has not been previously reported in ophthalmic literature.

Introduction: Postoperative agitation is a common complication of sevoflurane anesthesia in children and might lead to self-harm and recovery disruption. This study aimed to compare the prophylactic effect of dexmedetomidine and remifentanil on postoperative agitation after anesthesia with sevoflurane. Methods: In this clinical trial, 60 children aged 2 to 7 years with ASA class І, II, candidates for elective strabismus surgery, were randomly assigned to three groups using block randomization. Patients in the first group D received 0.5 µgr/kg dexmedetomidine, the second group R received 0.1 µgr/kg remifentanil, and another group C received normal saline at the end of anesthesia. Children's agitation degree was measured by the Pediatric Anesthesia Emergence Delirium (PAED) scales and the 4-point agitation scale at the time of extubation, entering the recovery room, 10, 20, and 30 minutes after entrance. Data analysis was performed using descriptive and inferential statistical tests. Results: The postoperative agitation and pain were significantly lower among children who received dexmedetomidine compared with those in remifentanil and the control group (p < .001). It was observed that the administration of dexmedetomidine at the end of anesthesia significantly decreased the incidence of postoperative agitation (p < .001). None of the patients in group D had a PAED score of over 12. Conclusion: Based on PAED and the 4-point scales, none of the cases in group D had experienced postoperative agitation; this made a significant statistical difference compared with groups C and R (p-value <. 001). Although both dexmedetomidine and remifentanil can prevent and attenuate postoperative agitation, dexmedetomidine administration seems significantly more effective.

Introduction: Physical activity in adolescence plays an important role in reducing the lifetime risk of chronic disease. Recent studies have shown that individuals with amblyopia may have difficulties with coordinating balance and may be at greater risk of developing fine motor impairments. The purpose of this study was to determine if there is an association between the presence of amblyopia and physical activity (PA) in adolescents. Methods: Adolescent patients aged 12-18 years with a history of childhood amblyopia were age- and gender-matched to control patients with no other ocular pathology aside from refractive error. Each participant's best corrected visual acuity and refractive error were recorded in addition to their height and weight to calculate body mass index (BMI). A 32-question electronic survey was used to calculate self-reported physical activity level (PAL) score and type of PA over the previous seven days. The Ainsworth Compendium of Physical Activities was taken as a reference to calculate Metabolic Equivalent of Task (MET) minutes for the most frequently performed activity. Results: A total of 26 adolescents with amblyopia (10 strabismic, 16 anisometropic) and 26 healthy controls were recruited. The MET-minute values were 2404.3 ± 2313.9 in the control group and 905.6 ± 1196.0 in the amblyopia group (p = .008). The PAL scores were similar between amblyopia and control groups (1.15 ± 0.70 versus 1.24 ± 0.60, p = .63); however, BMI was significantly higher in amblyopia participants (25.2 ± 6.3 versus 21.1 ± 5.4, p = .003). When compared with controls, amblyopes perceived physical activity to be of significantly lower importance in their lives compared to controls (p = .009). Discussion: Amblyopic adolescents may represent a population with increased vulnerability to significantly lower energy expenditure and higher BMI. Future studies with a larger number of participants and further investigation into the impact of refractive error on physical activity are warranted.

Purpose: To assess refractive amblyopia risk factors in Lebanese children aged 3 to 6 years through school-based automated vision screenings, comparing outcomes between public and private schools. Methods: A school-based vision screening was conducted across multiple regions in Lebanon, including 990 children aged 3 to 6 years from both public and private schools. Trained personnel utilized the Plusoptix S12 photoscreener for vision screening. Referral criteria were based on established guidelines set by the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and data were analyzed to determine the prevalence of refractive errors and to compare between school types. Results: The study revealed a high referral rate of 17.6%, with significant differences observed between public and private schools (27.7% vs. 13.6%, p<.001). Astigmatism was the most prevalent refractive error (8.2%), followed by myopia (2.2%) and hyperopia (1.3%). Public schools exhibited higher rates of astigmatism, hyperopia, and myopia compared to private schools. Significant regional variations were also noted, with schools in the capital Beirut having the highest referral rate (23.1%) and Mount Lebanon showing the lowest prevalence of astigmatism (4.9%). Conclusion: The rate of referral in our cohort was 17.6% according to the AAPOS referral criteria with astigmatism being the most common refractive error. The referral rate was higher in public schools compared to private ones, highlighting the need for structured and comprehensive vision screening programs in Lebanon, particularly targeting public school children.

Purpose: To compare the effect of combinational office-based and home-based orthoptic training regimens with part-time patching in participants with intermittent exotropia. Methods: In a randomized clinical trial study, patients with a diagnosis of IXT were involved and randomly assigned to three groups. Patients in the control group were followed with part-time patch therapy. For the Intervention 1 group, in-office and home-based orthoptic training was prescribed along with playing with a video game software (PIVOT). For Intervention 2 group the same management protocol was incorporated except using the video game software. Evaluation of the control scale and degree of deviation, accommodation, convergence, and stereopsis was performed at baseline and at 1.5 months, 3 months, and 6 months follow-ups. Results: A total of 53 patients (21 males and 32 females) with a mean age of 10.15 ± 3.80 years (range 5-18 years) completed the treatment and follow-up visits. The angle of deviation at distance decreased significantly in all groups (p < .05). No significant reduction of near angle of deviations was found in the control group (p = .38). In the intervention groups, positive fusional vergence (PFV), stereopsis, near point of convergence (NPC), and control scale of deviation at distance improved significantly compared to the control group (all, p < .05). At six months follow-up, patients in the Int 1. group showed significantly increased amplitude of accommodation and positive relative accommodation (PRA) compared to the patients in the Int 2. and control groups (all, p < .05). Conclusion: Compared to part-time patch therapy, orthoptic training is more effective in the management of children with IXT. Using video games as a home-based therapy can improve accommodative abilities in these patients.

Introduction: The ORTHOPHTALMO study aims to evaluate the diagnostic parameters of the screening protocol for amblyopia and risk factors for amblyopia in 3-year-olds recommended in 2019 by the French Association for Pediatric Ophthalmology and Strabismus (AFSOP). This protocol uses visual acuity, photoscreening refraction, and cover test examination performed by an orthoptist. Patient referral to an ophthalmologist is only according to recommended referral criteria. Methods: A prospective, single-center study was performed between September 2020 and June 2021 on a consecutive series of 3-year-olds consulting the Ophthalmology Centre of Clinique Rive Gauche, Toulouse, France, for vision screening. Patients were first examined by an orthoptist following the screening protocol recommended by AFSOP. All patients were then systematically examined by an ophthalmologist for cycloplegic refraction measurement (reference examination). The ophthalmologist was blinded to the referral conclusion and refraction measurements of the orthoptist. Results: A total of 300 patients (149 girls and 151 boys) were included. Examination by an orthoptist was unreliable/incomplete in 7% of cases. An abnormality was detected by the orthoptist in ≥1 of the screening tests among 42% of patients; these patients were thus considered as requiring referral to an ophthalmologist. Reference ophthalmological examination found 41% of patients required treatment. The diagnostic parameters of this screening protocol were 90% for sensitivity and 89% for specificity. Discussion: We validate the effectiveness and feasibility of the AFSOP screening protocol for detection of amblyopia and risk factors for amblyopia in 3-year-olds as well as the recommended criteria for referral to an ophthalmologist.ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT04395560.Number: NCT04395560.

Introduction: Social media is a widely-used avenue for the public to find health information. In particular, Instagram is a popular social media platform among adults who may have children within the amblyogenic age range, and it may be used to find amblyopia-related information. The purpose of this study is to assess the quality of the amblyopia information on Instagram. Methods: The top 200 publicly available Instagram posts about amblyopia from October to December 2022 were reviewed and scored using the Currency, Reliability, Authority, and Purpose (CRAP) test. Results: A quarter of posts were from healthcare providers (ophthalmologists, optometrists, opticians), and only 3% of posts were specifically from pediatric ophthalmologists. Most posts, however, were from businesses (51%), which were of lower quality than posts by providers. Discussion: Instagram represents a tremendous opportunity to educate the public. Better utilizing this resource may allow medical professionals to broadly spread accurate, unbiased data.

Purpose: To determine the agreement between phoropter Risley prism and prism bar fusional vergence amplitudes in a normative group of school-aged children, aged 8 to 17 years. Method: This prospective cross-sectional study utilized multistage sampling to recruit participants with normal binocular vision. Horizontal fusional vergence amplitudes were measured at distance and near using the phoropter with Risley prisms and the prism bar. Result: The study included 422 normal participants (48.1% male, 51.9% female) with a mean age of 12.39 ± 1.94 years. There were significant differences in the base-in break, base-in recovery, base-out blur, base-out break, and base-out recovery at distance and near between phoropter Risley prism and prism bar fusional vergences (p < 0.05); amplitudes for phoropter Risley prism were higher than that for prism bar. Their mean differences were clinically meaningful except for base-in recovery at distance; however, there was no level of agreement on Bland Altman analysis. Conclusion: Fusional vergence amplitudes measured with the phoropter Risley prism and prism bar should not be considered interchangeable in African schoolchildren.

Introduction: Topical anesthesia strabismus surgery is practised in selected surgical situations in the management of adult strabismus. Careful patient selection and patient co-operation throughout the surgery forms the crux of successfully completing the procedure.

Objective: To discuss and identify the scope of topical anesthesia in strabismus surgery based on the current level of evidence.

Methods: A literature search of articles pertaining to the use of topical strabismus surgery was carried out and summarized. The pre-operative considerations and patient counseling, timing of administration of topical anaesthetic, nuances in the surgical technique, benefits and limitations were evaluated.

Results: The patients with relatively smaller angle of deviation, single eye surgery and patients who have not had previous strabismus surgery were preferred candidates for topical strabismus surgery. It offers the additional advantage of performing an adjustable suture technique with a one stage adjustment.

Discussion: A pre-operative office room force duction test (FDT) is important both for assessing patient co-operation and from the patient perspective with regards to the level of comfort or discomfort they may experience. The results with regards to the successful completion of the procedure and its benefits and limitations support the use of topical anesthesia in strabismus surgery in a select few.

Conclusion: This review concludes that topical anesthesia strabismus surgery can be the procedure of choice in select surgical situations in the management of adult strabismus.