Strabismus最新文献

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.

Purpose: Suture granuloma is a recognized complication of strabismus surgery caused by a foreign body reaction to retained suture material. There is currently no standardized management strategy, although non-surgical treatments such as topical or oral steroids and beta blockers are commonly employed. However, treatment courses are often prolonged, and subsequent surgical excision may still be required. Methods: We describe the case of a nine-year-old female patient who developed large suture granulomas after uncomplicated right eyed lateral rectus recession and medial rectus resection surgery using 6/0 VICRYL. This occurred over the new insertion sites within three weeks despite sterile intraoperative techniques and good post-operative drop compliance. Results: There was no response to initial treatment with hourly dexamethasone 0.1% drops and oral ibuprofen, and repeat orthoptic assessment showed an early deterioration in post-operative control of the deviation. The patient was taken back to theatre for early revision surgery and found to have extensive granulation tissue overlying the retained suture fragments. The sutures and granulation tissue were completely excised, and there was subsequently good healing with no recurrence. A panel of expert opinion was surveyed to review current opinions in managing suture granuloma; this revealed a range of different practices, however very few respondents employed early excision. Conclusion: We suggest that prompt surgical intervention for suture granuloma can produce safe and effective results without the need for prolonged medical therapy and should be employed earlier in the management of severe cases following a short trial of intensive anti-inflammatory medications. Given the comparative rarity of suture granuloma it may be considered for monitoring, for example, by BOSU.

Purpose: To examine the association between emotional states and binocular vision functions in university students.

Methods: This cross-sectional study involved university students aged between 19 and 35 years who did not have any ocular or systemic diseases. The assessment of emotional states was conducted using the Depression, Anxiety, and Stress Scale (DASS) questionnaire. The relationship between binocular vision functions and each emotional state was examined.

Results: A total of 82 individuals were examined, with an average age of 22.38 ± 2.91 years, of which 57.3% were male. The mean scores for stress, anxiety, and depression across the entire sample were 15.78 ± 9.07, 8.61 ± 6.75, and 9.02 ± 7.50, respectively. 52.4% of participants were classified as having normal stress levels, 51.2% demonstrated normal anxiety levels, and 61% were within the normal range for depression; the remaining individuals exhibited varying degrees of emotional distress. Monocular accommodation facility was higher in females (β = 3.37, p < .001), and was associated with higher stress scores (β = 0.11, p = .022), larger near exophoria (β = 0.20, p = .003), and greater accommodation response (β = 1.79, p = .075), while it was lower in individuals with better stereoacuity (β = -0.01, p = .002). Furthermore, accommodation amplitude decreased with increasing age (β = -0.28, p = .001), more myopic spherical equivalent (β = -0.38, p = .005), better stereoacuity (β = -0.01, p = .021), closer near point of convergence (β = -0.21, p = .025), and higher depression scores (β = -0.07, p = .081), and increased with higher stress scores (β = 0.08, p = .016). No significant correlations were found between anxiety or depression and the binocular vision parameters that were assessed.

Conclusion: Stress is significantly linked to accommodative functions among university students, underscoring the importance of incorporating stress considerations into clinical assessments of binocular vision function.

Introduction: Superior oblique palsy (SOP) is the most common cyclovertical muscle palsy, often presenting with vertical misalignment, excyclorotation, and abnormal head posture. The superior oblique tuck (SOT) is a widely accepted treatment option, though carries risks such as iatrogenic Brown syndrome. While a temporal approach is conventionally used, this case presents an alternative nasal approach to the SOT in a patient who had already undergone a temporal SOT.

Methods: A 71-year-old female presented with persistent diplopia and a left head tilt. Examination revealed right hypertropia and excyclorotation in primary gaze, consistent with right SOP. Initial management with inferior oblique disinsertion yielded little improvement, and a subsequent temporal SOT also failed to correct the misalignment. Given persistent symptoms, a revision SOT was performed, using a nasal approach due to extensive scarring temporally.

Results: Six months postoperatively, diplopia improved significantly in primary and downgaze. Vertical deviation in the left eye reduced from 7Δ BD pre-operatively to 1Δ BU in primary position and from 21Δ BD to 4Δ BD in laevodepression and excyclorotation improved. A mild iatrogenic Brown syndrome resulted, though this improved over time.

Discussion/conclusion: In conclusion, this case highlights the nasal SOT as a viable surgical option in the management of SOP where alternative treatment options have been exhausted.

Introduction: Acute acquired comitant esotropia (AACE) is a disorder characterized by the sudden onset of horizontal diplopia with comitant deviation across gaze positions. Traditionally considered rare, its incidence has increased in association with prolonged near work and digital device use. While most reports involve children and young adults with larger deviations, small-angle forms in adults remain underrecognized and therapeutically challenging. This study aimed to describe the clinical characteristics, associated risk factors, and treatment outcomes of adult patients diagnosed with AACE with small-angle deviations. Methods: This retrospective observational study included patients diagnosed with AACE at a tertiary center between 2022 and 2024. Included patients had a confirmed diagnosis of AACE, defined by acute-onset diplopia, comitant esotropia with ≤20 prism diopters (PD) in primary gaze, ≤5 PD variation in lateral gaze, and a minimum follow-up of 6 months. Data collected included visual acuity, refractive status, neuroimaging findings, and treatment outcomes. Exclusion criteria included age over 55 years, high myopia (>-6.00 diopters-D-), ocular pathologies inconsistent with AACE, or prior history of amblyopia or strabismus. Results: The cohort included 16 patients (mean age 36.9 ± 7.7 years; 62.5% male). All presented with distance diplopia; four (25%) also had diplopia at near. Mild myopia (≤-1.00 D) was present in 75% of cases, with overall myopia in 87.5%. Mean esodeviation measured 7.94 ± 5.76 prism diopters (PD) at distance and 0.50 ± 1.51 PD at near. Most patients (81.3%) reported more than 6 hours per day of digital device use. Neuroimaging was normal in all cases. Initial treatments included surgery (n = 9), botulinum toxin injection (n = 7), prisms (n = 3), and observation (n = 2). Four patients required sequential therapies. Surgical outcomes were successful in 88.9% of cases, with botulinum toxin achieving resolution in 71.4%. Ultimately, 87.5% of patients experienced complete resolution of diplopia, without treatment-related complications. Discussion: AACE appears to be associated with excessive use of electronic devices, predominantly affecting young males with previously normal binocular vision. Early diagnosis and individualized treatment - particularly minimally invasive surgery or botulinum toxin - are effective and safe approaches.

Purpose: Symptomatic esophoria (SE) is a latent esodeviation that progresses into a manifest esotropia. Symptoms may include diplopia, headaches, and asthenopia. One muscle surgery is controversial due to concerns about undercorrections and/or the development of horizontal gaze incomitance. The aim of this retrospective observational study was to compare undercorrection rates in SE patients receiving standard orthoptic evaluation versus those supplemented with a prism adaptation test (PAT).

Methods: We reviewed records of patients with SE who underwent unilateral medial recession (UMRc) surgery at the Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark, from 1 January 2017, to 31 August 2023. We collected information on whether PAT was conducted, demographics, and medical and ophthalmological history. Primary outcome was undercorrection after unilateral medial recession. Secondary outcomes included amount of lateral incomitance and changes in the angle of deviation following PAT.

Results: Forty-one SE patients were included, with 29 in the non-PAT group and 12 in the PAT group. After adjusting for baseline deviation, the mean difference in deviation at near (AODn) and distance (AODd) was lower in the PAT group compared to the non-PAT group, respectively (p = .4 and p = .02). Mean adjusted AODd difference in ipsilateral and contralateral gaze to the side of UMRc was also lower in the PAT group compared to the non-PAT group, respectively (p < .001 and p = .009).

Conclusion: SE patients who underwent PAT had lower residual deviation and were less prone to ipsilateral gaze incomitance on the side of the UMRc, compared with those who did not undergo PAT.

Purpose: Reoperation may be necessary after strabismus surgery. Although different variables have been studied as predispoding to a reoperation, there is no consensus in this issue. In this study, in addition to previously studied parameters, it was aimed to investigate the effects of accommodative convergence/accommodation (AC/A) ratio, near convergence point (NPC), forced duction positivity and optical biometry on reoperation rates in strabismus surgery.

Methods: Data of patients between 2010 and 2021 with minimum follow-up of 12 months were retrospectively reviewed. The study group (Group 1) included 77 patients who underwent surgery for strabismus for a second time, and the control group (Group 2) included 75 patients. Patients' surgical outcomes with a deviation of less than 10 prism diopters (PD) were defined as successful. Sex, family history of strabismus, presence of neurological comorbidities, follow-up time, spherical equivalent values, visual acuity, amblyopia, ocular rotations, preoperative and postoperative distance angles of deviation, asymmetric/symmetric surgery, diplopia, fixation preference, AC/A, NPC, stereopsis, forced duction test positivity and ocular biometry values were evaluated.

Results: Asymmetric surgery, fixation preference, younger age at first surgery, shorter follow-up time, greater preoperative angle of deviation, a more distant NPC and greater lens thickness were found to be statistically significant predictors of reoperation (p < .05). There was no statistically significant difference in AC/A values (p = .92) and forced duction test positivity (p = 1) between the reoperation and control groups. Although amblyopia was more common in the reoperation group than in the control group, the difference was not statistically significant (p = .08).

Conclusion: Asymmetric surgery, fixation preference, younger age at first surgery, shorter follow-up time, greater preoperative angle of deviation, a more distant NPC and greater lens thickness were found to be statistically significant for reoperation. In this study, convergence insufficiency was more frequent in the reoperation group. There may have been an increase in lens thickness to increase convergence in this group. Also, as optical biometric data changes with age, this may have affected the data results. Accordingly, it would be appropriate to investigate the parameters we studied with larger case series.