Strabismus最新文献

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 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.

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: Although there are guidance tables in the literature on surgical dosage for primary medial rectus resection-lateral rectus recession surgery, there is a lack of consensus on the surgical gains in medial rectus re-advancement (MRR) for the management of consecutive exotropia. We compared the surgical outcomes of primary medial rectus resection-lateral recession (RR) surgery, to MRR in patients with consecutive exotropia. Methods: Retrospective, electronic note review of consecutive patients undergoing primary RR surgery for basic exotropia (RR group), convergence insufficiency-type exotropia, and divergence excess, and consecutive patients undergoing MRR with or without lateral rectus recession (MRR group) for consecutive exotropia in a teaching university hospital. Results: There were 84 patients in the RR group and 27 patients in the MRR group. The median age in the RR group was 25.50 years (range 4-79) and 45 years (18-87) in the MRR group (p = .002). Median follow-up was 7 months (3-43) in the RR group and 1 month (1-12) in the MRR group. Post-operatively, there was a median exotropia reduction of 27.00 prism diopters (PD) (range +5, -65; p < .0001) for near, and 27.00 PD (+10, -51; p < .0001) for distance in the RR group. In the MRR group, the median exotropia reduction was 34.50 PD (2, -67; p < .0001) for near and 33.00 PD (1, -67; p < .0001) for distance. There was a greater reduction in the exotropia in the MRR group compared to the RR group for distance (p = .047), but this did not meet statistical significance for near (p = 0.10). The median dose-effect relationship (PD/millimeter) was higher in the MRR group both for near deviation (2.90 vs 2.15, p = .0073) and for distance deviation (2.91 vs 2.15, =0.0041). Conclusion: Based on our study cohort, medial rectus re-advancement appears to have a greater dose-effect in reducing the distance angle of deviation for both near and distance compared to primary recess-resect surgery. Further prospective longitudinal studies would shed further light on the dose-effect relationship over time.

Introduction: Amblyopia is two Snellen line difference between both eyes. Red filter therapy is a treatment option for amblyopia based on principle of syntonic phototherapy. The purpose of this study is to assess the stereopsis in amblyopic patient using syntonic phototherapy.

Methods: A Qusai experimental study was conducted from August 2021 to December 2021 at Madina Teaching Hospital Faisalabad. A total 30 subjects of both gender and ages ranging between 8 to 18 years were included through a non-probability purposive sampling technique. The sample was considered of 15 anisometropic amblyopes and 15 strabismic amblyope. Data was collected using a Performa and pre assessments of stereopsis by Titmus fly chart were recorded without red filter. Red filter glasses were prescribed for 4 week, post assessment data was recorded after 4 weeks. Data was analyzed by using Paired sample T test and Independent Sample T test in SPSS 20 software.

Results: After syntonic phototherapy significant improvement was seen, mean stereopsis was 48.00000 (p = 0.002) in anisometropic amblyopes while mean improvement of stereopsis 1.670.93333 (p = 0.00) in strabismic amblyopes. Anisometropic amblyopic patients showed significantly better improvement in stereopsis (p = 0.00) by syntonic phototherapy as compared to strabismic amblyopes.

Conclusion: Significant improvement was seen in stereopsis, while improvement was more significant in anisometropic amblyopes as compared to strabismic amblyopes. Children were obsessed with the red filter glasses while their parents found syntonic therapy simple plus facile and gave good results. So, eye care professionals must be aware of this new therapy and they should keep syntonic phototherapy in mind whenever they are dealing with amblyopic patients.

Purpose: The anatomy of the extraocular rectus muscle insertions is clinically relevant in the field of ophthalmology. This descriptive cadaveric study determines the relative degree orientation of the superior, lateral, and inferior rectus muscles with respect to the medial rectus and investigates the distances between the rectus muscle insertions. Method: Thirty cadavers (50% female, mean age = 81.86 years, SD 12.16) were included for a total of 60 eyes. For each eye, a lateral canthotomy and cantholysis were performed followed by a peritomy. Muscle hooks were then used to access and isolate the rectus muscles. The degree orientation was determined by marking the muscle midpoints at insertion, using the center of the cornea as the vertex, and measuring the angle with the Angle Meter 360 application (© Alexey Kozlov) (Figure 1). The distances between rectus muscles were measured from the same muscle midpoints using calipers. Results: The degree orientations with respect to the medial rectus are displayed in Figure 2 and were as follows: superior rectus (mean = 93.14, SD = 3.04, min. 82.3, max. 100.3), lateral rectus (mean = 180.21, SD = 5.65, min. 170.5, max. 190.6), and inferior rectus (mean = 90.57, SD = 4.47, min. 84.0, max. 98.9). The distances (measured in mm) between rectus muscle midpoints at insertion included medial rectus to inferior rectus (mean = 13.64, SD = 0.54), inferior rectus to lateral rectus (mean = 13.79, SD = 0.75), lateral rectus to superior rectus (mean = 13.54, SD = 0.63), and superior rectus to medial rectus (mean = 13.83, SD = 0.75). The relative distances between the midpoints of the extraocular muscles observed in males versus females showed statistically significant differences in medial rectus to inferior rectus (13.8 vs. 13.5, p = .01), inferior rectus to lateral rectus (14.1 vs. 13.5, p = .03), and superior rectus to medial rectus (14.0 vs. 13.5, p = .04), respectively (Table 1). Conclusion: This is an important study of the extraocular muscle degree orientation performed with an innovative measuring approach. The degree orientation of the insertions relative to the medial rectus may have surgical application in the field of ophthalmology.

Purpose: Strabismus is an ocular condition characterized by misalignment of the visual axis. The global prevalence of strabismus is about 2-3%, which varies between different countries and ethnicities. The aim of this study was to conduct a meta-analysis of studies, which had previously reported the prevalence of strabismus in Pakistan, in order to obtain the overall prevalence of strabismus in the country. Methods: All community-based studies reporting the prevalence of strabismus from Pakistan were searched using international databases and local ophthalmology journals. Information about sample size, number of individuals with strabismus, and location and duration of the study was recorded. Statistical analysis including heterogeneity testing, pooled prevalence calculation and regression analysis were done using the R software. Results: Heterogeneity tests, P_{heterogeneity} < .01, suggested high heterogeneity between the different studies. The pooled prevalence of strabismus was 0.7% [95% confidence interval (CI): 0.39%-1.23%] according to the random effects model, with a decreasing trend in prevalence from 1995 to 2020. Esotropia was more frequent than exotropia in both population-based and clinic-based studies. Conclusion: The prevalence of strabismus in Pakistan is comparatively lower than the worldwide prevalence, and it appears to be decreasing over the last three decades, consistent with global trends.

Purpose: To compare the efficacy of two methods: first, bilateral symmetric anteriorization of the inferior oblique muscle and second: combined resection and anteriorization of the inferior oblique (IO) muscle for asymmetric dissociated vertical deviation (DVD).

Design: Prospective randomized clinical trial.

Methods: This study included fifty-four patients presenting with bilateral asymmetric DVD and inferior oblique overaction (IOOA). Two equal groups were randomly allocated by odd and even number distribution. Twenty-seven patients underwent bilateral symmetric anteriorization of the IO muscle and twenty-seven patients underwent anteriorization of the IO of one eye and anteriorization with IO resection in the eye with the larger deviation. According to the difference in measured DVD between the two eyes whether less or more than 5 PD; a 3 or 5 mm resection was done, respectively.

Results: The mean post-operative reduction of DVD in the anteriorization group was 9.19 ± 3.40 PD in the right eye and 8.78 ± 4.17 PD in the left eye, which were highly significant. (p-value .0002). The resection group had a mean post-operative DVD reduction of 11.7 ± 2.74 PD in resected eyes and 7.3 ± 3.72 PD in non-resected eyes. These reductions were also highly significant (p-value 0.0001). Reduction of inter-ocular difference between both groups failed to show a statistical difference (p-value 0.285). The IOOA was significantly reduced in both groups. Improvement in the average post-operative DVD between the two groups and the post-operative improvement in IOOA failed to show a statistically significant difference (p-value 0.265 and 0.804 respectively) which showed that both procedures are effective.

Conclusion: Both surgical modalities are effective in managing asymmetric dissociated vertical deviation associated with IOOA.

Introduction: To report the unusual fundus features of a case with unilateral Duane retraction syndrome (DRS) with same-side extensive macular retinoschisis. Methods: A 75-year-old woman was diagnosed to have DRS type 3 and several multimodal fundus imaging modalities were performed. Results: There was limited abduction and adduction, globe retraction, and narrowing of the palpebral fissure on the adduction of the left eye without a compensatory face turn. Concurrently, spectral domain optical coherence tomography revealed marked macular retinoschisis and severe vitreoretinal traction without any evidence of dye leakage or pooling on fluorescein angiography in the left eye. Discussion: Various ocular abnormalities may rarely accompany DRS and the present case is the first reported case of most likely coincidental macular retinoschisis in association with DRS.

Purpose: To compare the surgical outcomes of One- versus Two-vertical muscle surgery in patients with unilateral superior oblique muscle palsy (SOP) with primary position hypertropia (HT) over 20 PD. Patients in Group 1 underwent inferior oblique anterior transposition plus resection (IOATR), while patients in Group 2 underwent inferior oblique anterior transposition (IOAT) along with contralateral inferior rectus (IR) recession. Methods: Medical data of all SOP patients treated by either procedure from 2000 to 2023 in our strabismus center were recruited. We compared surgical outcomes between Group 1 and Group 2 by analyzing HT correction, rate of under-correction, and over-correction. Results: The study included 33 patients in Group 1 and 23 in Group 2. Both groups were similar in age, sex, etiology, affected side, diplopia, and head tilt. Group 2 achieved higher HT correction in all measured gazes. Group 1 had a higher risk of under-correction (18.18% in Group 1 vs 8.69% in Group 2) while Group 2 had a higher rate of over-correction (21.73% vs 0% in Group 1). Conclusion: In patients with severe unilateral SOP, Two-vertical muscle surgery achieved higher amounts of HT correction in all gazes despite a significantly higher risk of over-correction.