Strabismus最新文献

Background: For small-angle strabismus, unilateral medial rectus recession (UMR) offers many advantages over bilateral procedures (BMR), including a shorter operative time, faster recovery and fewer complications, while preserving the contralateral medial rectus muscle. However, the asymmetric nature of the procedure poses a theoretical risk of induced incomitance in the direction of action of the recessed muscle. This study aims to compare the incidence and nature of induced incomitance following unilateral and bilateral medial rectus recession in the management of non-accommodative esotropia.

Methods: Through a retrospective chart review, we identified 43 patients who underwent surgical management for esotropia in the form of UMR (n = 21) or BMR (n = 22). The exclusion criteria included previous strabismus surgery and simultaneous surgery on the oblique muscles. Measurements of deviation in lateral gaze were obtained pre- and post-operatively using the prism cover test (PCT) in nine positions of gaze. Incomitance was defined as a horizontal deviation difference of > 5PD between primary and lateral gaze.

Results: Surgically induced incomitance was observed in 2 patients (9.5%) in the UMR cohort and 2 patients (9.1%) in the BMR cohort (p = 1.00). The mean magnitude of induced incomitance among affected patients was 9 PD in UMR vs. 8 PD in BMR. No statistically significant associations were found between the occurrence of incomitance and age, pre-operative deviation, amount of recession or follow-up duration (p > .05). All patients suffering from post-operative incomitance reported diplopia that resolved over time and did not need further intervention. Higher values of incomitance were associated with a more prolonged period of diplopia.

Conclusion: Our data demonstrates comparably low rates of induced incomitance in the management of esotropia after UMR and BMR, with no significant statistical difference. Our findings support the viability of unilateral recessions for small-to-moderate esotropias.

Introduction: Extraocular muscle trauma can occur blunt or penetrating injury. This report highlights medial rectus muscle rupture after trauma.

Methods: A 41-year-old male presented with double vision after hitting a wall while riding a bike.

Results: Initial examination revealed right exotropia with -3 adduction limitation. Systemic corticosteroids were given to relieve orbital edema. The right medial rectus muscle could be partially retrieved upon strabismus surgery. Postoperatively, the patient complained of blurred vision, and optical coherence tomography revealed serous retinal detachment near upper vascular arcade, which did not affect the macula. Serous elevation decreased upon tapering the corticosteroids.

Discussion: Rupture of the medial rectus muscle can occur after blunt trauma and can occasionally be treated by retrieving the muscle in the early posttraumatic period. However, it should be borne in mind that factors related to the treatment of or trauma itself may threaten vision, therefore meticulous follow-up is mandatory.

Objectives: This case report aims to present a case with traumatic rupture of the inferior rectus muscle and its management.

Methods: A 62-year-old male patient presented with a complaint of double vision following blunt head trauma. Orthoptic examination was performed to assess ocular alignment and motility. Surgical exploration of the inferior bulbar conjunctiva was conducted to identify the extent of the injury.

Results: The patient had limited downgaze with diplopia. Surgical exploration confirmed rupture of the left inferior rectus muscle horizontally as well as vertically. Both ends of the ruptured muscle could be partially found, and the posterior Tenon's capsule was successfully repaired. Botulinum toxin was injected to the left superior rectus muscle.

Conclusion: The findings highlight the importance of detailed orthoptic examination and surgical exploration in diagnosing and managing such complex ocular muscle injuries. Surgical repair combined with botulinum toxin injection presents a viable combined approach for restoring ocular alignment and function in similar cases.

Introduction: Ocular myasthenia gravis is a protean disorder and can present with myriad disorders of ocular motility. The diagnosis may not be obvious at presentation and strabismus surgery has occasionally been performed with unexpected outcomes. Strabismus surgery can be performed on patients with ocular myasthenia gravis who have stable ocular deviations, although outcomes may vary.

Case report: We report two patients who were operated for strabismus and were diagnosed as ocular myasthenia gravis later, when classic signs appeared. The first patient underwent right medial rectus recession and left lateral rectus plication for a left sixth nerve palsy surgery. He developed recurrent strabismus and ptosis 3 months after surgery and was diagnosed as ocular myasthenia gravis on the basis of positive ice test, fatigue test and repetitive nerve stimulation test. He was started on a tapering regime of oral steroids and pyridostigmine. This reduced the deviations to a level correctable by prisms eventually becoming orthophoric in primary position. The second patient had a severe undercorrection of strabismus after large recess resect procedure on the right eye for large angle exotropia. Five months after surgery, he presented with right eye ptosis and a recurrence of strabismus. He tested positive for anti-acetylcholine receptor antibodies. The ptosis improved with oral steroids and pyridostigmine and he eventually went into a natural remission. The ocular deviation, however, remained unchanged.

Discussion: The emergence of ocular myasthenia in patients undergoing strabismus surgery is a rare occurrence but should be suspected in patients with unexpected outcomes after strabismus surgery.

Purpose: To compare the differentiating clinical features of subjective cyclovertical deviation and objective ocular torsion in elderly patients with cyclovertical sagging eye syndrome (CSES) versus superior oblique palsy (SOP). Study design: Prospectivestudy. Methods: Patients with CSES (n = 22) and unilateral SOP (n = 20) aged ≥50 years were included. Subjective cyclovertical deviation was measured in the primary, secondary, and third-gaze positions using a synoptophore. The disc-fovea angle (DFA), which evaluates objective ocular torsion, was measured using fundus photographs. Results: The subjective vertical deviation of the primary position was 1.3° (median) in the CSES group and 4.3° in the SOP group (p < .001). Vertical deviation was larger in the SOP than CSES group in all gaze positions (p < .05). The subjective cyclodeviation of the primary gaze was -6.0° (-: excyclo) in the CSES and SOP groups(p = .48). Cyclodeviation was larger in the SOP group in downgaze positions (p < .05). The mean DFAs were -11.5° in CSES group and -11.8° in SOP group for the hypertrophic eye (p = .85), and -12.2° in CSES group and -16.3° in SOP group for the hypotropic eye (p < .01). The ratio of patients with a larger DFA in the hypertropic than hypotropic eye was 9/22 (41.0%) in the CSES group and 4/20 (20%) in the SOP group. Conclusions: SOP has a larger hypertropia than SES. Excyclotorsion does not help distinguish in primary position but if it is somewhat larger in downgaze more likely SOP. DFA showed no obvious clinical differences; it is difficult to distinguish the two diseases from DFA.

Introduction: Inferior rectus (IR) recession surgery is commonly performed for vertical strabismus, yet overcorrection risk remains high (21-50%) due to factors like lower lid retractors, suture dissolution, and muscle tension in thyroid eye disease (TED). This study aims to contribute novel insights by comparing clinical outcomes of IR recession using absorbable and non-absorbable sutures.

Methods: A retrospective study (01/12/20-31/01/23) was conducted at a tertiary referral center on patients undergoing IR recession with absorbable or non-absorbable sutures. The following data were collected: absorbable vs non-absorbable suture use, age at operation, sex, date of operation, surgical indication, presence of TED, adjustable vs non-adjustable suture technique, surgeon training level, number of muscles recessed, IR distance recessed, and time from surgery to final follow-up.

Results: Thirty-two IR recession procedures were evaluated (26 absorbable, 6 non-absorbable cases) with a mean follow-up of 3.6 months. Both groups achieved similar success in vertical deviation control with no significant difference in success rates for distance (p = .48) or near fixation (p = .21). Overcorrection occurred in 23.1% (absorbable) and 16.7% (non-absorbable) cases, with no statistical difference (p = .61). Logistic regression analysis was performed, which showed that TED (p = .99), surgeon training level (p = .20), adjustable sutures (p = .89) and number of muscles operated on (p = .28) did not significantly impact success for absorbable sutures.

Conclusion: This study demonstrates that IR recession surgeries using absorbable sutures yield outcomes comparable to those using non-absorbable sutures, with no significant difference in success rates and overcorrection rates consistent with existing literature. These findings suggest that absorbable sutures are equally viable in use for IR recession surgeries.

Objectives: To evaluate the accuracy of Anterior Segment Optical Coherence Tomography (ASOCT) in measuring the limbal muscle insertion distance (LMID) of previously operated horizontal recti muscles in strabismus reoperations, compared to intraoperative caliper measurements. Methods: Thirty adult patients (60 muscles) undergoing strabismus reoperation of horizontal recti muscles for residual/consecutive strabismus were enrolled. Enrolled subjects underwent preoperative ASOCT measurements of the LMID of previously operated horizontal recti muscles, which were compared with intraoperative caliper values obtained during reoperation. Results: ASOCT successfully imaged 90% of the muscles. The mean LMID for medial rectus (MR) and lateral rectus (LR) measured by ASOCT was 7.96 ± 2.02 mm and 8.74 ± 2.81 mm, respectively, which were within 1 mm of intraoperative caliper measurements (7.93 ± 2.81 mm for MR, 9.03 ± 2.79 mm for LR). Bland-Altman plot showed a strong agreement for MR and a good agreement for LR between the two measured values, with excellent interclass correlation coefficients between the two methods of measurement (MR: 0.96, LR: 0.98; p < .001). Conclusion: In our study, 100% of LMIDs that could be visualized using ASOCT were within 1 mm of their intraoperative measured values. Therefore, ASOCT is a reliable tool for measuring the LMID of previously operated horizontal recti muscles, where the scarred tissue from older surgeries/lost data about previous surgeries makes it difficult for the operating surgeon to plan reoperations.

Purpose: Bupivacaine injection in the extraocular muscles is an emerging treatment for small angle strabismus. The aim of the study was to identify if it can be used as an effective alternative to surgery in patients with age-related distance esotropia (ARDE). Methods: All patients receiving either strabismus surgery or bupivacaine injections for ARDE at Aintree University Hospital in 2022-2024 were identified through surgical logbooks and electronic records. Electronic records were retrospectively analyzed to collect data on the age, visual acuity, surgical details, complications and pre- and post-operative horizontal deviation in primary gaze at distance and near fixation. Data were also collected on whether patients had any prior and subsequent treatment (prisms, surgery or bupivacaine) and whether they experienced diplopia at follow-up. Complete success was determined as there were no symptoms of diplopia and no need for further treatment. Results: Eight bupivacaine injections (BPX) and 11 lateral rectus resections (LRR) were performed on patients with ARDE. The average follow-up length was 44 and 143 days in the LRR and BPX group, respectively. The LRR group reduced the average horizontal distance deviation from 14 prism diopters (PD) (range 6-20) to 3.9 PD (range 0-8) (1d.p.). 7/11 (64%) of the procedures qualified as a complete success. The BPX group reduced the average horizontal distance deviation from 7.3 PD(1d.p.) (range 6-10) to 4.1 PD (range 1-15) (1d.p.). 5/8 (63%) of the procedures were a complete success. Conclusion: Bupivacaine injection can be used to successfully treat ARDE as an alternative or adjuvant to strabismus surgery.

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.

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.