Integrated Intraoperative Optical Coherence Tomography in Strabismus Surgery.

Combined cataract and strabismus surgery with adjustable sutures

Corneal topographic changes after extraocular muscle surgery

Purpose Strabismus and Pediatrics Ophthalmology surgeries are pivotal in addressing early-onset visual disorders. An 11-year retrospective study at a tertiary hospital center aimed to elucidate evolving surgical trends, focusing on esotropia cases. Methods The surgical records from January 2009 to January 2020 were analyzed according to the baseline diagnosis. Esotropia cases were evaluated based on the patients’ deviation types, surgical techniques, and pre-operative characteristics. A total of 2050 surgeries were performed over the study period. Results Strabismus surgery accounts for 70% of the department’s surgical activity. A trend toward a decrease in esotropia surgeries and a proportional increase in exotropia surgeries was noticeable. Esotropia cases, with a median surgical age of 6 years (p25-p75, 4–10) and uniform gender distribution (females, 54.8%), predominantly involved high angular deviations. Posterior fixation sutures emerged as the preferred surgical technique for esotropia. Conclusion The study’s insights, while aligning with prior European research, introduce new dimensions to the understanding of strabismus surgeries, emphasizing the significance of early interventions, evolving surgical preferences, and the challenges posed by severe deviations.

Adjustable Suture Technique Is Associated with Fewer Strabismus Reoperations in the Intelligent Research in Sight Registry

Cosmetic Squint Surgery was indicated in nine patients who also had high intra-ocular pressure in the eye requiring the squint surgery. It was decided to combine the two procedures. The standard technique for the recession and resection of the extra-ocular muscles was used with a slight modification that the size of the conjunctival incisions for the exposure of the extra-ocular muscles was restricted to the minimum level so that the conjunctival flap for the trabeculectomy site could be formed without any interference from the squint surgery. The cosmetic results of the squint surgery remained excellent in all patients and the intra-ocular pressure was also controlled satisfactorily in eight patients out of the nine. It is concluded that if the eye undergoing glaucoma surgery has any cosmetically significant deviation, it can be safely and reliably straightened in one go by combining the two procedures.

PurposeTo clarify the actual status of strabismus surgery and botulinum toxin (BTX) therapy in Japan in the year 2021.Study designCross-sectional study.MethodsWe conducted a national survey of strabismus treatment in 2021 using a questionnaire consistent with a previous 2013 survey, incorporating additional questions about BTX therapy.ResultsAmong the 378 responding institutions, strabismus surgery or BTX therapy, or both, was performed at 185 institutions (49%; total cases, 10,767). In 151 (40%), 32 (8%), and 2 (1%) institutions, surgery only, surgery and BTX therapy, and BTX therapy only were performed, respectively. The distribution of institutions where strabismus surgery was performed consisted of 4 prefectures, accounting for 48% of the total, whereas no strabismus surgery was performed at any institution in 3 prefectures. Although the highest percentage of patients (23%) was aged between 10 and 19 years, 48.2% of the patients were aged 20 years or older, and 17% of them were aged 60 years or older. Exotropia (XT) was the most common type of strabismus (55%) followed by esotropia (ET) (24%). In terms of complex surgeries, 80.2% (more than 100 cases) were performed at institutions with more than 100 cases. Of the 34 institutions where BTX therapy was performed, 52% were performed at a single institution, and 18% were performed at 2 institutions where no strabismus surgery was performed. Patients with scarring in the extraocular muscles, such as thyroid eye disease, were the most treated, followed by those with ET, who were mainly given injection treatment.ConclusionInstitutions where strabismus surgery and BTX therapy could be performed were concentrated and limited.

Strabismus, Strabismus Surgery, and Reoperation Rate in the United States: Analysis from the IRIS Registry

Commentary: Scleral penetration or perforation during strabismus surgery.

BackgroundPostoperative nausea and vomiting (PONV) is one of the most common adverse outcomes after strabismus surgery. The primary outcome of this prospective, randomized, double-blind study was to compare the incidences of nausea or vomiting, and patient satisfaction of ondansetron and ramosetron after strabismus surgery under general anesthesia. The secondary outcome was to investigate whether the number of involved extraocular muscles (EOMs) in strabismus surgery was related to PONV.MethodsOne hundred and five patients (aged 18–60 years) undergoing strabismus surgery were allocated randomly to one of the three groups: placebo, ondansetron, or ramosetron. Patients received 2 ml placebo, 4 mg ondansetron, or 0.3 mg ramosetron at the end of surgery. Each of the three groups was subdivided into two subgroups according to the number of EOMs involved in the surgery: subgroup S, single-muscle correction; subgroup M, multiple-muscle correction. The incidences of nausea or vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as primary outcome. With regard to subgroups S and M in the placebo, ondansetron and ramosetron groups, incidences of nausea or vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as seconadary outcome.ResultsThe incidence of nausea was significantly lower in the ramosetron group at 2 h (9.4 %) than in the placebo (45.2 %) and ondansetron (34.7 %) groups (P < 0.05). The incidence of nausea was also significantly lower in the ramosetron group at 24 h than in the other groups (P < 0.05). Patients in the ramosetron group were more satisfied at 2 h (8.11 ± 0.98) and 24 h (8.50 ± 0.67) after surgery than those in the other groups (P < 0.05). With regard to subgroups S and M in the placebo, ondansetron and ramosetron groups, there were no significant differences in either the incidence of nausea or patient satisfaction.ConclusionRamosetron has superior antiemetic activity to ondansetron in adult strabismus surgery patients. The number of EOMs involved in strabismus surgery was not related to the incidence of PONV.Trial registrationClinical Research Information Service (CRiS) Identifier: KCT0000688. Date of registration: 27 February 2013.

Objective To study the influence of corneal protection on the ocular surface and its clinical significance in strabismus surgery. Methods Strabismus patients aged from 7 to 45 years old were collected and divided into 3 groups according to the difference of corneal protection. At different time points, the first noninvasive tear film break-up time, average noninvasive tear film break-up time, and tear meniscus height were measured and the cornea fluorescein staining was evaluated. On the first day after surgery, the symptom of photophobia was observed. Finally, all the data were analyzed by statistics. Results The tear film break-up time wasn’t influenced by the surgery. Against other two groups,the occurrence rate of the symptom of photophobia and the positive cornea fluorescein staining were lower in the group B. The tear meniscus height of the group B increased little at 1 day after surgery and decreased to the preoperative level at one week after surgery. Conclusions Protecting the cornea in strabismus surgery by the 2% hydroxypropyl methycellulose can make patients more comfortable after operation.It’s simple and meaningful to do this during the surgery. Key words: Corneal protection; Strabismus surgery; The cornea fluorescein staining; Photophobia

Objective To investigate the relationship between smoking status and the use of strabismus surgery in the management of patients with thyroid eye disease.Methods All patients with thyroid eye disease hospitalized form January 2000 to December 2009 were followed-up.Basic information and frequency of strabismus surgery were compared between different smoking status.Results Of 208 patients seen during the study period,55 were nonsmokers,40 were passive smokers,21 were ever-smokers and 81 were smokers.Of the smokers,81 of 264 underwent strabismus surgery,compared with only 55 of 338 nonsmokers at presentation.The hazards ratio of having strabismus surgery during management for ever-smokers versus nonsmokers was 1.121.Compared passive smokers with nonsmokers,the hazard ratio were 1.59.Conclusions There is an increased use of strabismus surgery in active smokers at presentation than in nonsmokers. Key words: Tobacco smoke pollution; Thyroid eye disease; Strabismus surgery

ABSTRACTPurpose: Surgical management of ophthalmic Graves’ disease traditionally involves, in order, orbital decompression, followed by strabismus surgery and eyelid surgery. Nunery et al. previously described two distinct sub-types of patients with ophthalmic Graves’ disease; Type I patients exhibit no restrictive myopathy (no diplopia) as opposed to Type II patients who do exhibit restrictive myopathy (diplopia) and are far more likely to develop new-onset worsening diplopia following medial wall and floor decompression. Strabismus surgery involving extra-ocular muscle recession has, in turn, been shown to potentially worsen proptosis. Our experience with Type II patients who have already undergone medial wall and floor decompression and strabismus surgery found, when additional decompression is necessary, deep lateral wall decompression (DLWD) appears to have a low rate of post-operative primary-gaze diplopia.Methods: A case series of four Type II ophthalmic Graves’ disease patients, all of whom had already undergone decompression and strabismus surgery, and went on to develop worsening proptosis or optic nerve compression necessitating further decompression thereafter. In all cases, patients were treated with DLWD. Institutional Review Board approval was granted by the University of Kansas.Results: None of the four patients treated with this approach developed recurrent primary-gaze diplopia or required strabismus surgery following DLWD.Conclusions: While we still prefer to perform medial wall and floor decompression as the initial treatment for ophthalmic Graves’ disease, for proptosis following consecutive strabismus surgery, DLWD appears to be effective with a low rate of recurrent primary-gaze diplopia.

Objective To investigate the effect of diplopia on the quality of life and to explore appropriate methods of nursing care after strabismus surgery in children. Methods It was a retrospective study.The study involved 150 children patients who underwent strabismus surgery from 2011 and 2015 in Department of Ophthalmology, the Third Hospital of Mianyang. Using telephone follow-up to evaluate the effect of diplopia on daily life, the SPSS 22.0 statistical software was utilized for data analysis. Results In 150 diplopiaon children after strabismus surgery, the length of diplopiaon lasted 3 to 30 days with the average time (11.4±2.51)d. The physical activities accounted for 50.0%, in which attention occupied 38.7%, study 25.3%, emotion 18.0% and housework performance 16.7%, and it did not affected sleep quality. Multiple liner regression analysis showed that the quality of life had negative correlation with length of diplopiaon, and had nothing relationship with gender and ages. Conclusions Postoperative diplopia obviously affected the quality of life of partial children patients, so nursing staff should provide psychology nursing, health education, safety management, safety instruction after management and postoperative follow-up. Key words: Children; Nursing; Strabismus surgery; Diplopia; Quality of life

Objective To observe the behavioral response of dressing cover the wound or not after strabismus surgery in children. Methods A total of 120 strabismus children aged between 3 and 7 years weighing 15-34 kg were randomly divided into 4 groups (n=30 each) under general anesthesia.Group A:one eye with no dressing cover; Group B:both eyes with no dressing cover; Group C:one eye with dressing cover and bandaging; Group D:both eye with dressing cover and bandaging.The score grades in the recovery period in children:quiet one point; wiping the eyes two points; crying three points; grasping dressing and crying four points,and heart rate before and after awakening were observed. Results There were no significant differences between the groups in age,gender and body weight.The operation time in group B and D (21.45±4.79,20.09±4.88) was significantly longer than that in group A and C (15.34±4.85,16.22±4.80).The score (2.90±1.12,3.0±0.90)and heart rate (124±28,132±35) during recovery period in group C and D were significantly higher than that in group A and B (1.33±0.75,1.60±0.96; 94±18,98±20). Conclusions The incidence of rubbing eyes,crying and grasping dressing after strabismus surgery in children is significantly lower in non-covered group than that in covered,which can pass through the recovery period stably. Key words: Children; Strabismus surgery; General anesthesia; Cover dressing; Management

Objective To evaluate the changes of the intraocular pressure (IOP) in subjects with thyroid-associated ophthalmopathy (TAO) treated with orbital decompression or extraocular muscle surgery.Methods The medical records of patients with TAO who visited in our department and underwent orbital decompression or strabismus surgery from Dec.2008 through Dec.2009 were reviewed and analyzed retrospectively. The IOPs before and after surgery in both primary gaze and upgaze were all measured. Results Of the 16 eyes that underwent orbital decompression, the mean pre-operative IOPs were 17.86± 4.32 mmHg and 23.55± 7.16 mmHg in gaze and upgaze, respectively. The post-operative IOPs were 14.57± 3.86 mmHg and 18.77± 4.83 mmHg in upgaze, respectively. The mean pre-operative IOPs in the 19 eyes that underwent strabismus surgery were 17.89± 3.85mmHg and 23.12± 6.98mmHg in gaze and upgaze, respectively. The post-operative IOPs were 15.85± 3.60 mmHg and 17.88± 3.59 mmHg in gaze and upgaze. In subjects with a pre-operative IOP＞21 mmHg or in treatment for glaucoma we observed a greater reduction in IOP (P＜ 0.005). Conclusions Orbital decompression or extraocular muscle surgery can reduce IOPs in TAO patients significantly. Key words: Thyroid-associated ophthalmopathy; Orbital decompression; Strabismus surgery; IOP; Glaucoma