Strabismus最新文献

PurposeBotulinum 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.

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: 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: 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.

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: To study and evaluate the change in retinal nerve fiber layer (RNFL) and macular thickness and its clinical correlation with visual outcome following amblyopia therapy. Methods: In this prospective interventional study, children with moderate to severe amblyopia were given optical correction and part-time occlusion therapy. Visual assessment and optical coherence tomography (OCT) were performed at days 0 and 3, 6 months of follow-up. Results: A total of 30 children aged from 5 to 12 years with a mean age of 5.26 ± 1.65 years with moderate to severe amblyopia were included. About 19 patients (63.33%) were males and 11 patients (36.66%) were females. Anisometropia was the most common cause of amblyopia in our study population affecting 46.67% of patients. The mean global RNFL thickness in amblyopic eyes before and after patch therapy were 111.13 um and 104.96 um respectively (6.17 um thinner than better eyes). The macular thickness before and after patch therapy was 227.06 um and 226.80 um respectively (0.26 um thinner than better eyes). Conclusions: Part-time occlusion therapy results in visual gain in children with moderate to severe amblyopia. However, it causes thinning in both the RNFL and macular thickness at days 0 and 3, 6 months of follow-up.

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.

Background: The management of exotropia (XT) in the presence of hyperopia is challenging, as these patients are at an increased risk of developing amblyopia and compromised binocular vision. This study aims to evaluate the management approaches and clinical outcomes in XT associated with hyperopia.

Methods: A systematic review was conducted with a comprehensive search across PubMed, Web of Science, and Google Scholar, following PRISMA 2020 guidelines. The search strategy utilized a combination of free-text keywords and MeSH terms, including "Exodeviation," "Exotropia," "Intermittent Exotropia," and "Hyperopia." The search was restricted to articles published between 1991 and 2024 that examined various management modalities for XT. Four independent reviewers screened and assessed the eligibility of articles based on predefined guidelines. Excluded studies included animal research, case reports, narrative reviews, abstracts, conference proceedings, editorials, non-English publications, and other systematic reviews.

Results: A total of 10 studies from 6 countries with 1,090 participants with a mean age of 8.1 years, 194 of whom were hyperopic. Eight studies found that under-correcting hyperopia by 1.00 to 2.50 diopters was effective in treatment of XT. Three studies recommended full cycloplegic correction in cases with hyperopia exceeding 5.00 diopters. Surgical intervention was more effective and led to improvements in stereoacuity. Furthermore, postoperative correction of hyperopia resulted in favorable long-term outcomes. Notably, postoperative success rates were higher in hyperopic patients than in those with emmetropia.

Conclusion: The management of XT associated with hyperopia should be individualized, accounting for the AC/A ratio, fusional status, control of XT, stereoacuity, the degree of hyperopia, and the refractive difference between the two eyes.

Purpose: To report the clinical presentation and surgical outcomes of patients with Duane syndrome with primary position hypertropia, with or without coexisting horizontal deviation.

Methods: We retrospectively reviewed records of patients diagnosed with Duane syndrome with vertical and associated horizontal deviations from January 2008 to July 2017. We collected data regarding patient age, gender, refractive error, presence or absence of amblyopia and history of strabismus surgery, as well as clinical subtype of Duane syndrome, abnormal head posture, measurement of horizontal and vertical deviation, and outcomes of strabismus surgery. Success was defined as post-operative primary position hypertropia <4 prism diopters (PD) and horizontal deviation <10 PD.

Results: During this period, a total of 590 patients with Duane syndrome were seen. Of these, 18 patients (10 males and 8 females) met the study criteria, giving a prevalence of 3%. Median age was 21 years. Seventy-eight percent cases had type III Duane syndrome. Ten patients underwent surgical correction, of which four patients had to undergo a second procedure after a median of 19 months. Sixty-seven percent of the patients had associated primary position exotropia with median deviation of 30 PD. Seventeen percent of patients had only primary position hypertropia with median 10 PD. All patients had overshoots. Primary position horizontal deviation improved from 25 PD to orthotropia, and vertical deviation improved from 10 PD to orthotropia. Lateral rectus recession with Y split was the most frequent procedure performed, and we saw a median reduction of 10 PD hypertropia with this procedure. Median follow-up period was 13 months. Success was achieved in 60% of the patients who underwent surgery. Given the small sample size, it was difficult to compare the efficacy of different procedures.

Conclusion: Current study suggests that primary position vertical deviation might exist in 3% of patients with Duane syndrome. All patients had associated overshoots, which were predominantly of a mixed mechanism. Forty percent of the patients needed re-surgery. Well-designed, prospective possibly multicentric studies are necessary to understand the mechanism of overshoot, and consequently the primary position hypertropia to plan accurate management for these patients.

Objective: This study aims to evaluate and compare the accuracy and performance of two large language models (LLMs), ChatGPT-4.0 and DeepSeek-R1, in answering pediatric ophthalmology-related questions. Methods: A total of 44 multiple-choice questions were selected, covering various subspecialties of pediatric ophthalmology. Both LLMs were tasked with answering these questions, and their responses were compared in terms of accuracy. Results: ChatGPT-4.0 correctly answered 82% of the questions, while DeepSeek-R1 achieved a higher accuracy rate of 93% (p: 0.06). In strabismus, ChatGPT-4.0 answered 70% of questions correctly, while DeepSeek-R1 achieved 82% (p: 0.50). In other subspecialties, ChatGPT-4.0 answered 89% correctly, and DeepSeek-R1 achieved 100% accuracy (p: 0.25). Conclusion: DeepSeek-R1 outperformed ChatGPT-4.0 in overall accuracy, particularly in pediatric ophthalmology. These findings suggest the need for further optimization of LLM models to enhance their performance and reliability in clinical settings, especially in pediatric ophthalmology.