Abnormal Head Posture Research Articles

Парез горизонтального взора – какую тактику ведения выбрать

Purpose. To analyze the success of using prisms in conjugate horizontal gaze paresis compared to other treatment methods. Material and methods. The study involved 30 patients with conjugate horizontal gaze paresis. The average age of patients at the time of treatment was 57.8±6.68 years. The average period of clinical follow-up for strabismus symptoms in patients after the appropriate treatment was 12.6±3.8 months. The patients were divided into two groups: the first group (main group) of 15 patients who underwent prismatic correction in combination with etiopathogenetic treatment and 15 patients (control group) who underwent etiopathogenetic treatment without prismatic correction. Results. The treatment results were evaluated according to three criteria: absence of abnormal head posture (AHP) and diplopia, as well as elimination of esotropia. Based on our data, the AHP angle did not reveal statistically significant difference at the stage before treatment (p=0.999), however, during treatment in the first group (using prismatic correction), it was 4.4 times less than in the second group (p<0.001). Similar data were obtained in relation to esotropia. Results of the statistical analysis showed that during treatment, frequency of binocular single vision exposed a statistically significant increase (p<0.05) in both the first and second groups. Conclusion. Thus, for 15 patients with conjugate horizontal gaze paresis, prismatic correction made it possible to create conditions for shifting the image perceived by a patient to a straight field of gaze, as well as to eliminate the occurrence of induced heterotropia and diplopia in the attempt to look straight and, accordingly, the formation of AHP. The proposed method provided an opportunity to reduce complaints and improve the patients' quality of life. Key words: conjugate horizontal gaze paresis, diplopia, abnormal head posture, Fresnel prisms

NYSTAGMUS IN CHILDHOOD: A SYSTEMATIC REVIEW

Nystagmus is an involuntary rhythmic oscillation of the eyes that results in decreased visual acuity owing to the excessive motion of pictures on the retina. This is because nystagmus causes the eyes to move in a repetitive pattern. It is of the utmost importance to differentiate infantile nystagmus from acquired nystagmus. In order to accomplish this, it is necessary to take into consideration not only the time at which the nystagmus first appeared, but also the features of its waveform. Oscillations of the eyes that are involuntary, often conjugate, and frequently rhythmic are referred to as nystagmus. Infantile nystagmus syndrome (INS) is the condition that accounts for the majority of cases of nystagmus in children. Because this ailment can last a person's entire life, it is essential that they are familiar with all of the treatment choices that are at their disposal. The primary foci of this review are the underlying etiology of nystagmus, the psychosocial and functional implications of nystagmus, and the current methods of treatments, which include optical, pharmacological, surgical, and rehabilitative treatment approaches. At this time, the brain mechanisms that are responsible for INS are not completely known. The evidence is limited to mostly pre- and post-study designs, and there are few objective comparisons of treatment procedures. The treatment choices are meant to increase the foveation length or correct abnormal head positions. Individualized management of INS should be implemented. The patient and the patient's physician are the ones who should make the decision regarding which treatment will be most beneficial for the patient in question.

Fixel-Based Analysis Reveals Whole-Brain White Matter Abnormalities in Cervical Dystonia.

Cervical dystonia (CD) is a form of isolated focal dystonia typically associated to abnormal head, neck, and shoulder movements and postures. The complexity of the clinical presentation limits the investigation of its pathophysiological mechanisms, and the neural networks associated to specific motor manifestations are still the object of debate. We investigated the morphometric properties of white matter fibers in CD and explored the networks associated with motor symptoms, while regressing out nonmotor scores. Nineteen patients affected by CD and 21 healthy controls underwent diffusion-weighted magnetic resonance imaging. We performed fixel-based analysis, a novel method evaluating fiber orientation within specific fiber bundles, and compared fiber morphometric properties between groups. Moreover, we correlated fiber morphometry with the severity of motor symptoms in patients. Compared to controls, patients exhibited decreased white matter fibers in the right striatum. Motor symptom severity negatively correlated with white matter fibers passing through inferior parietal areas and the head representation area of the motor cortex. Abnormal white matter integrity at the basal ganglia level may affect several functional networks involved, for instance, in motor preparation and execution, visuomotor coordination, and multimodal integration. This may result in progressive maladaptive plasticity, culminating in overt symptoms of dystonia. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Cervical Dystonia in a Headache Population: General Medical Education (GME) Training to Standardize Screening (P11-12.005)

<h3>Objective:</h3> To highlight the importance of GME training on screening for cervical dystonia in patients presenting for headaches or cervicalgia. <h3>Background:</h3> Cervical dystonia (CD) is a condition of involuntary overactivation of the cervical musculature resulting in abnormal head posture. Notably, comorbid headache in CD is present in up to 75% of patients. Although the prevalence of CD is reported to be quite low, underdiagnosis or misdiagnosis is common. This is likely due to the challenging physical diagnosis often requiring a movement disorder specialist, and the lack of focused training in neurology residency programs. Although CD can improve with Botulinum toxin (BT), greater than 50% of patients remain untreated. <h3>Design/Methods:</h3> From 2017–2020, an IRB-reviewed Quality Improvement Project was initiated by a Movement Disorder Neurologist in a GME-Residency program. Chart review was performed on all patients presenting for headache, migraine, or cervicalgia, and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was performed to assess for comorbid cervical dystonia. <h3>Results:</h3> During this timeframe, 6455 patients presented for headache, migraine, cervical dystonia, or cervicalgia. 306 patients were diagnosed with both cervicalgia and headache. Of those patients, 5% were ultimately diagnosed with cervical dystonia. All diagnoses of cervical dystonia were made by a Movement Disorder Neurologist or resident trained in this screening approach. All patients diagnosed with cervical dystonia had chronic headaches, and most had daily headaches. Of patients diagnosed with cervical dystonia, 86% were started on treatment with BT, with a 91% success rate. <h3>Conclusions:</h3> Patients with cervical dystonia commonly present to Neurology for headache or migraine, as comorbid pain is frequent. Underdiagnosis of dystonia may lead to suboptimal treatment choices. Formalized training of residents to use TWSTRS on patients with headache and cervicalgia may enhance diagnosis and improve treatment outcomes. <b>Disclosure:</b> Dr. Inoue has nothing to disclose. Dr. Dalton has nothing to disclose. Dr. Hack has nothing to disclose. Dr. Baker has nothing to disclose.

Effectiveness of modified inferior oblique muscle belly transposition for V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.

To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction. Thirteen cases (23 affected eyes) of V-pattern exotropia with inferior oblique muscle overaction (+ or ++) who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed. The amount of V-pattern, grade of inferior oblique overaction, degree of vertical strabismus, abnormal head posture, and the fovea-disc angle were evaluated before and after surgery. The V-pattern was corrected in all cases, and the amount of V-pattern reduced by 17.85±5.13 prism diopter (PD) on average (t=16.07, P<0.001). The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0% (20/23). The degree of the fovea-disc angle has a mean reduction of 5.45°±2.87° (t=3.95, P=0.003) after surgery. The mean vertical deviation in 5 cases with a small-angle hypertropia (5.23±3.06 PD) in the primary position reduced by 3.15±1.86 PD (t=6.10, P<0.001). No serious complications were observed. The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern, which is safe and easy to perform.

Pre- and postsurgical measurements in patients with strabismus sursoadductorius a retrospective study.

Strabismus sursoadductorius is the most common strabismus of the oblique eye muscles. The changes in squint angle, elevation in adduction, abnormal head posture and binocular vision were collected to get an overview of the results at the largest clinic in Austria. This study is a retrospective study. The orthoptic and ophthalmologic parameters of 102 patients who were treated in the Department of Ophthalmology and Optometry between January 2017 und September 2020 were collected and statistically analysed. The mean age was 12.2 ± 14.8 years. The squint angle changed from 18.3 ± 6.3 presurgical to 13.4 ± 9.7 (p = 0.09) with Hirschberg measurement. The squint angle changed from 12.5 ± 7.7 to 6.7 ± 4.9 (p < 0.01) at distance and from 12.5 ± 7.6 to 6.1 ± 4.5 (p < 0.01) at near with the prism covertest. Elevation in adduction showed a highly significant change (p < 0.01) from 15 ± 5.6 to 1.4 ± 2.8 degrees on average postsurgical. In binocular vision at distance there was also a highly significant (p < 0.01) change with 21.6% to postsurgical 37.3% positive tests. At near, the positives also increased significantly (p = 0.01) from 32.4% to 39.2%. There was no significant change in stereo vision (p = 1.0). Presurgical 52.9% of the sample had an abnormal head posture, postsurgical it was 38.2%, this change is also highly significant (p < 0.01). The change was significant to highly significant for most parameters (i.e., squint angle, elevation in adduction, and abnormal head posture).

Do Temporomandibular Disorder Patients with Joint Pain Exhibit Forward Head Posture? A Cephalometric Study.

To evaluate head and cervical posture in individuals with or without temporomandibular disorders (TMDs) and to assess the correlations between pain, severity of symptoms, and posture. A total of 384 patients (129 males and 255 females) was included. The Fonseca Anamnestic Index (FAI) was used to assess the severity and prevalence of TMD and the presence of temporomandibular joint (TMJ) pain. Patients were divided into three groups: the TMD-free group, TMD without TMJ pain group, and TMD with TMJ pain group. Subsequently, the patients with TMJ pain were further divided into mild TMD and moderate/severe TMD groups. Nine parameters were traced on cephalograms to characterize the head and cervical posture. TMD patients with TMJ pain showed increased forward head posture (FHP) than patients without TMJ pain and TMD-free subjects. No significant difference was observed between the TMD patients without TMJ pain and TMD-free subjects. In the TMD patients with the TMJ pain group, the moderate/severe TMD patients demonstrated increased FHP compared to mild TMD patients. TMD patients with joint pain had greater CVT/RL (B = 3.099), OPT/RL (B = 2.117), and NSL/C2' (B = 4.646) than the patients without joint pain after adjusting for confounding variables (P < 0.05). TMD patients with TMJ pain showed increased FHP compared to other groups, and FHP became more significant as TMD severity increased in male patients, indicating the FHP might play an important role in the development of TMJ pain. In the clinical assessment of TMD, the patients' abnormal head and cervical posture might be considered.

Herpes simplex virus-1 associated third cranial nerve palsy in pediatric age group

A 4-year-old female patient presented with drooping of the right upper eyelid of 10 days duration. There was a history of low grade fever 15 days ago which subsided with the use of oral paracetamol. Abnormal head posture with mild upper lid ptosis was noted on right side. Right pupil was fixed and mid-dilated. She was diagnosed with right-sided third cranial nerve palsy. Serum and cerebrospinal fluid samples were positive for IgM antibodies to herpes simplex virus-1. The patient was treated with systemic steroids and anti-virals. The patient responded well to treatment, and there was complete resolution of ocular signs 45 days after presentation.

Selective denervation for cervical dystonia.

Cervical dystonia (spasmodic torticollis) is a condition that involves sustained, involuntary contraction of neck and shoulder muscles, leading to abnormal movements and head posture. The authors present the case of a 41-year-old man with severe right rotational torticollis for 1.5 years due to predominant right cervical paraspinal and left sternocleidomastoid muscle hyperactivity. Following failed medical management, the patient elected to undergo surgical treatment for his torticollis. In their video, the authors discuss the steps of selective denervation using a modified Bertrand procedure, highlighting the associated anatomy and surgical planes. At the 1.5-year follow-up, the patient had no pain and his head position remained straight. The video can be found here: https://stream.cadmore.media/r10.3171/2022.9.FOCVID2291.

Duane syndrome: An overview on the current management.

Duane syndrome is one of the most common restrictive congenital strabismus characterized by variable horizontal duction deficits with globe retraction and shoots on attempted adduction and narrowing of the palpebral aperture. It is now listed as a congenital cranial dysinnervation disorder. The disease is usually unilateral with female preponderance. Basic etiopathogenesis involves dysinnervation of the lateral rectus (LR) due to aplastic/hypoplastic abducens nucleus with a secondary aberrant supply to the LR by the medial rectus (MR) subnucleus of the oculomotor nerve. Diagnosis of the disease is usually clinical. Due to the variable presentation of the disease, surgical management is a challenge and has to be individualized to achieve alignment in the primary gaze, reduction in globe retraction, upshoots and downshoots, and correction of any abnormal head posture. Differential recessions of the lateral and MR muscles are done to correct esotropia or exotropia in the primary gaze. For globe retraction and shoots, Y-split or periosteal fixation of the LR muscles is done depending on the severity.

A gait-based paradigm to investigate central body representation in cervical dystonia patients.

Cervical dystonia (CD) is a common adult-onset idiopathic form of dystonia characterized by an abnormal head posture caused by an excessive activity of the neck muscles. The position of the head is important to direct viewpoint in the rounding environment, and the body orientation, during gait, must be coherent with the subjective straight ahead (SSA). An alteration of the SSA, as in the case of CD patients, could affect gait when visual input is not available. The aim of this study was to probe the behavior of patients with CD during blindfolded walking, investigating the ability to walk straight ahead based only on somatosensory and vestibular information. In this observational cross-sectional study, patients with CD and healthy control subjects (HC) were compared. All participants were evaluated through a gait analysis during blindfolded walking on a GAITRite carpet, relying on their own sense of straightness. Patients with CD showed lower values of path length (p < 0.001), a lower number of steps on the carpet (p < 0.001). A higher number of CD patients deviated during the task, walking out of the carpet, (p < 0.005) compared to HS. No relation was found between the dystonic side and the gait trajectory deviation. A significant correlation was found between pain symptom and gait performance. CD patients showed dysfunctions in controlling dynamic body location during walking without visual afferences, while the dystonic side does not seem to be related to the lateral deviation of the trajectory. Our results would assume that a general proprioceptive impairment could lead to an improper body position awareness in patients with CD.

Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness.

Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by vestibular dysfunction have been described in detail. However, dizziness by the non-vestibular system, especially cervicogenic dizziness, is not well known. This paper explained the cervicogenic dizziness caused by abnormal sensory input with references to several studies. Among head and neck muscles, suboccipital muscles act as stabilizers and controllers of the head. Structural and functional changes of the suboccipital muscles can induce dizziness. Especially, myodural bridges and activation of trigger point stimulated by abnormal head posture may be associated with cervicogenic dizziness.

Аномальное положение головы: новая парадигма

Purpose. To determine the most common ocular causes and types of anomalous head position and give details of their functional features. Material and methods. The research included 105 patients with an anomalous head position. Depending on the oculomotor pathology, patients were divided into 6 groups. 1st group – 10 patients with Brown syndrome, 2nd group – 20 patients with Duane syndrome of types 1 and 2, 3rd group – 30 patients with nystagmus, 4th group – 30 patients with n. abducensparalysis, 5th group – 15 patients with n. trochlearisparalysis, and control 6th group – 20 patients with one of the above pathology, but without anomalous head posture (AHP). Results. Out of 105 patients with AHP, 83.8% had both fusion and stereopsis. There was no statistical difference in the rate of fusion or stereopsis among the different AHP types (p=0.580). The control group showed accurately low scores of stereopsis and fusion loss (5.3%) (p=0.001). The overall incidence of amblyopia in all groups of patients with AHP (with Brown, Duyane syndrome, with nystagmus by 3.7 times, with paralysis and paresis of n. abducensand n. trochlearis) is statistically significantly lower (p&lt;0.001) than in the control group. Conclusion. The most common ocular causes of anomalous head position are nystagmus and paralysis of the abducens nerve, as well as Duane syndrome and paralysis of the trochlear nerve. Head rotation is most commonly associated with congenital nystagmus, Duane syndrome, and n. abducens paralysis and paresis. Head tilt or various combinations of head tilt with a raised chin is most characteristic of n. trochlearis paralysis and paresis and Brown syndrome. AHP formation is a «protective» mechanism in terms of developing amblyopia and loss of binocular single vision. Key words: abnormal head position, binocular vision, stereopsis, amblyopia.

Disinsertion-distal myectomy and tucking of inferior oblique combined with superior oblique full tendon advancement in superior oblique palsy.

To assess the preliminary outcomes of inferior oblique (IO) disinsertion-distal myectomy and tucking combined with superior oblique (SO) full tendon advancement in patients with Knapp II or III superior oblique palsy. This single-centered retrospective study included 16 eyes from 13 patients with Knapp Class II or III SO palsy. All patients underwent IO disinsertion-distal myectomy and tucking combined with SO full tendon advancement while under general anesthesia. Pre- and post-operative levels of vertical deviation in the primary position, abnormal head position, IO hyperfunction and SO hypofunction, torsion, as well as the presence of diplopia, were all measured, and the differences were statistically compared. Pre-operatively, 12 patients had abnormal head positions, and two had diplopia. The pre-and post-operative levels of IO hyperfunction and SO hypofunction, as well as a vertical deviation in the primary position and torsion, all differed statistically significantly (p < 0.01). Inferior oblique disinsertion distal myectomy and tucking combined with SO full tendon advancement surgery appears to be an effective procedure in patients with congenital and acquired Knapp Class II or III SO palsy.

Candidate Genes in Testing Strategies for Linkage Analysis and Bioinformatic Sorting of Whole Genome Sequencing Data in Three Small Japanese Families with Idiopathic Superior Oblique Muscle Palsy.

Idiopathic superior oblique muscle palsy is a major type of paralytic, non-comitant strabismus and presents vertical and cyclo-torsional deviation of one eye against the other eye, with a large vertical fusion range and abnormal head posture such as head tilt. Genetic background is considered to play a role in its development, as patients with idiopathic superior oblique muscle palsy have varying degrees of muscle hypoplasia and, rarely, the complete absence of the muscle, that is, aplasia. In this study, whole genome sequencing was performed, and single nucleotide variations and short insertions/deletions (SNVs/InDels) were annotated in two patients each in three small families (six patients in total) with idiopathic superior oblique muscle palsy, in addition to three normal individuals in one family. At first, linkage analysis was carried out in the three families and SNVs/InDels in chromosomal loci with negative LOD scores were excluded. Next, SNVs/InDels shared by the six patients, but not by the three normal individuals, were chosen. SNVs/InDels were further narrowed down by choosing low-frequency (<1%) or non-registered SNVs/InDels in four databases for the Japanese population, and then by choosing SNVs/InDels with functional influence, leading to one candidate gene, SSTR5-AS1 in chromosome 16. The six patients were heterozygous for 13-nucleotide deletion in SSTR5-AS1, except for one homozygous patient, while the three normal individuals were wild type. Targeted polymerase chain reaction (PCR) and direct sequencing of PCR products confirmed the 13-nucleotide deletion in SSTR5-AS1. In the face of newly-registered SSTR5-AS1 13-nucleotide deletion at a higher frequency in a latest released database for the Japanese population, the skipping of low-frequency and non-registration sorting still resulted in only 13 candidate genes including SSTR5-AS1 as common variants. The skipping of linkage analysis also led to the same set of 13 candidate genes. Different testing strategies that consisted of linkage analysis and simple unintentional bioinformatics could reach candidate genes in three small families with idiopathic superior oblique muscle palsy.

Clinical characteristics and surgical approach in Duane retraction syndrome: a study of 691 patients.

To evaluate the clinical findings of different types of Duane retraction syndrome (DRS). Retrospective. This study was performed on 691 patients with DRS who underwent surgery. Clinical examinations included laterality, abnormal head posture (AHP), corrected distance visual acuity (CDVA), refractive error, amblyopia, deviation, overshoots, and type of surgery. The mean age of patients with DRS was 16.7 ± 12.5 (range 1.0-73) years. The patients included 396 (57.3%) women and 295 (42.7%) men (P < 0.001). DRS type I, was observed in 429 (62.1%), II in 168 (24.3%), III in 88 (12.7%) and IV in 6 (0.9%) patients. Unilateral DRS was observed OS in 628 (90.9%) [471 (%78.9) and OD in 157 (21.1%) eyes (P < 0.001)]. O ther clinical findings were AHP (n = 522, 78.1%), overshoot (n = 236, 34.2%) and amblyopia (n = 118, 17.1%). The prevalence of overshoot in types I, II, and III was 17.5% (75/429), 60.7% (102/168) and 64.8% (57/88), respectively (P < 0.001). The prevalence of amblyopia was significantly lower in patients with AHP (80/522, 15.3%) compared to patients with normal head posture (38/169, 22.5%) (P = 0.023). The mean angle of deviation in the primary position (PP) at distance was 21.7 ± 11.5 △ for esotropic group and 17.8 ± 12.4 △ for exotropic group. Sixty-two (9.0%) patients required second surgery for resolving residual misalignment (1.1 surgeries for each patient). About two-thirds of DRS patients had AHP, one-third had overshoots, and one-sixth had amblyopia. The results show that different types of DRS are associated with different epidemiological and clinical characteristics.

Phenotypic variations in ocular features among siblings with oculocutaneous albinism.

Purpose:To assess the clinical profiles, presenting ocular features, and variations in the phenotypic features in siblings with oculocutaneous albinism (OCA).Methods: Electronic medical records of consecutive siblings diagnosed with albinism from January 2016 to December 2020 were reviewed to identify the affected siblings. The variations in their phenotypic characteristics were studied.Results: Significant variations were observed in the clinical features between the siblings (n = 42). A difference of >2 lines in visual acuity was observed in 50% (n = 21) of the sibling pairs. Compound hyperopic astigmatism was the commonest refractive error. The refractive status was different in 80.95% (n = 34) pairs. Although individually strabismus and abnormal head posture were observed in one-third and one-fourth of individual children, respectively, both siblings with similar strabismus were seen in only 16.67% (n = 7) and with a similar abnormal head posture in 13.33% (n = 5). Nystagmus was the most consistent finding across these siblings with a similar nature of horizontal jerk or pendular in 65% of sibling pairs.Conclusion: This study observed significant variations in phenotypic presentations among siblings with OCA. Such differences in clinical manifestations and severity would be helpful in appropriate counseling of these families as the need for rehabilitation services is likely to vary across siblings.

Atlantoaxial Instability in Children, 26 Years of Experience

Study Design: Retrospective case study.&#x0D; Objective: To determine the history, clinical and imaging signs, diagnosis, treatment and clinical follow-up.&#x0D; Summary of Background Data: The cranio vertebral junction (CVJ) is a complex transitional area between the skull, the upper cervical spine, the brain and the upper cervical cord. It concerns all ages. Instability can be the result of congenital malformations or traumatic injury.&#x0D; Methods: It is a retrospective study of patients files in department of paediatricneurosurgery and the department of pediatric orthopedic of Marseille, during 26 years , Between 16th October 1981 and 16th June 2007 In each medical record, we determined identity, circumstances of instability discovery, clinical and paraclinical signs, diagnosis, therapeutic protocol and patient's outcome after treatment.&#x0D; The inclusion criteria were the medical records with complete information regarding the patients, who were treated for atlantoaxial instability (AAI). Patients presenting clinical instability with incomplete files, have been excluded.&#x0D; Results: In our retrospective study, 22 children have been treated for AAI, with 10 boys (45%) and 12 girls (55%), aged 5 to 17 years old, mean age was 10.&#x0D; the main circumstance of lesion was accident 45,5%, sport accident 27,3%, road accident 18,2%), the others circumstances are 55,5%.&#x0D; The past history included : congenital malformation in 18,2% (Down’s syndrome, Klippel- Fiel’s syndrome, cardiac malformation), sport accident(9,0%), neurological deficit (13,7%), cervical trauma already treated(4,5%), learning deficit (4,5%), and plagiocephaly (4,5%); for 45,6%, there was no evidence etiology.&#x0D; The clinical signs were quadriparesis (31,9%), quadriplegia (13,6%), torticoli (9,1%), quadriplegia and priapism (4,5%), headache and dizziness (4,5%), abnormal head position attitude (4,5%). Clinical exam was normal for 31,9%.&#x0D; Standard X-ray was performed for 50,0%, CT scan for 50,0% and MRI for 40,8%.&#x0D; These paraclinical examination showed that AAI were traumatic in 59,1% (luxation 36,4%, odontoïdum fracture 13,7%, C1C2 dislocation 4,5 %, C2 arch, articular fracture and pseudoarthrosis 4,5%), congenital malformation in 40,9%.&#x0D; The orthopedic treatment was used for 13,5% of the patients and surgical treatment was used for 86,5% of the patients (posterior approach72,8 %, anterior approach 9,2%, anterior and posterior approach 4,5%).&#x0D; Complications were observed in 33% of the patients (consisted of infections 14%, Medulla oblongata compression 5%, basilar impression)&#x0D; 72% of the patients recovered without sequela after 15years of follow up, 28% had a neurological deficit during the same time .13% conserved their deficit 5 years after treatment.&#x0D; Conclusion: In many cases, AAI is an insidious affliction in many cases. A neurological deficit is a sinister presentation often leading to significant sequela even after treatment.

Duane Retraction Syndrome: The Role of Botulinum Toxin A Injection in Adults and Its Impact on Quality of Life in an Indian Population.

To evaluate the role of botulinum toxin A in the treatment of adults with Duane retraction syndrome and its impact on quality of life. A total of 25 adults with unilateral Duane retraction syndrome were selected for this interventional case series. Botulinum toxin was injected in the appropriate horizontal recti. The parameters assessed were ocular deviation (▵), overshoots, and abnormal head posture. Patients were followed up at 1 day, 10 days, and 3 months after the injection. The outcome was categorized on the basis of deviation/abnormal head posture/overshoots as: (1) significant improvement (< 8 prism diopters [PD]/< 5 degrees/≤ grade 1); (2) partial improvement (8 to 20 PD/5 to 15 degrees/≤ grade 2); and (3) no improvement (> 20 PD/> 15 degrees/≥ grade 3). Patients with partial/significant improvement were considered to have a favorable outcome. The impact on quality of life was assessed using the Adult Strabismus-20 Questionnaire scores 10 days after injection. There was a significant reduction in ocular deviation in esotropic and exotropic Duane retraction syndrome at 10 days (P = .001) and 3 months (P = .04) after botulinum toxin injection. The abnormal head posture improved from 11.58 ± 7.43 to 7.86 ± 6.25 degrees at 10 days. Botulinum toxin had a positive impact on the Adult Strabismus-20 Questionnaire scores, which significantly improved (P < .05) at 10 days. A favorable outcome was noted in 21 patients at 10 days but only 4 patients at 3 months. Three patients developed ptosis and 1 patient with orthotropic Duane retraction syndrome developed transient exotropia. In adults with Duane retraction syndrome, botulinum toxin can have a useful diagnostic role by providing insight to patients and setting realistic expectations. It can identify patients likely to benefit from further treatment and also has a positive impact on quality of life. [J Pediatr Ophthalmol Strabismus. 2023;60(1):46-51.].

Supramaximal Horizontal Rectus Recession–Resection Surgery for Complete Unilateral Abducens Nerve Palsy

PurposeTo review the surgical procedures and outcomes of supramaximal horizontal rectus recession–resection surgery for abduction deficiency and esotropia resulting from complete unilateral abducens nerve palsy.MethodsA total of 36 consecutive cases diagnosed as complete abducens nerve palsy, receiving supramaximal medial rectus recession (8.5 ± 1.4 mm, range: 6–10) combined with a supramaximal lateral rectus resection (11.1 ± 1.7 mm, range: 8–14) as performed over the period from 2017 to 2020, were reviewed retrospectively. All surgeries were performed by a single surgeon. Pre- and post-operative ocular motility, ocular alignment, forced duction test, binocular vision, abnormal head posture, and surgical complications were assessed.ResultsOf these 36 cases, 23 (63.8%) were followed up for greater than 2 months (Mean ± SD = 8.4 ± 6.0, range: 2–24) after surgery and the collected data was presented. Mean ± SD age of these patients was 41.7 ± 14.4 (range: 12–67) years with 73.9% being female. Trauma (52.2%, 12/23) and cerebral lesions (21.7%, 5/23) were the primary etiologies for this condition. Esodeviation in primary position improved from 55.5 ± 27.2 prism diopters (PD) (range: +25 to +123) to 0.04 ± 7.3 PD (range: −18 to +12) as assessed on their last visit. Pre-operative abduction deficits of −5.6 ± 1.0 (range: −8 to −4) reduced to −2.4 ± 1.4 (range: −4 to 0) post-operatively. The mean dose-effect coefficient of 2.80 ± 1.20 PD/mm (range: 1.07–6.05) was positively correlated with pre-operative esodeviation. Rates of overcorrection and ortho were 69.6 and 26.1%, respectively, on the first day after surgery, while on their last visit the respective levels were 4.3 and 82.6%.ConclusionSupramaximal horizontal rectus recession–resection surgery is an effective treatment method for complete abduction deficiency. The dose-effect was positively correlated with pre-operative esodeviation. Overcorrection on the first day post-operatively is required for a long-term satisfactory surgical outcome.