Binocular Vision Research Articles

An artificial intelligence platform for the screening and managing of strabismus.

Considering the escalating incidence of strabismus and its consequential jeopardy to binocular vision, there is an imperative demand for expeditious and precise screening methods. This study was to develop an artificial intelligence (AI) platform in the form of an applet that facilitates the screening and management of strabismus on any mobile device. The Visual Transformer (VIT_16_224) was developed using primary gaze photos from two datasets covering different ages. The AI model was evaluated by 5-fold cross-validation set and tested on an independent test set. The diagnostic performance of the AI model was assessed by calculating the Accuracy, Precision, Specificity, Sensitivity, F1-Score and Area Under the Curve (AUC). A total of 6194 photos with corneal light-reflection (with 2938 Exotropia, 1415 Esotropia, 739 Vertical Deviation and 1562 Orthotropy) were included. In the internal validation set, the AI model achieved an Accuracy of 0.980, Precision of 0.941, Specificity of 0.979, Sensitivity of 0.958, F1-Score of 0.951 and AUC of 0.994. In the independent test set, the AI model achieved an Accuracy of 0.967, Precision of 0.980, Specificity of 0.970, Sensitivity of 0.960, F1-Score of 0.975 and AUC of 0.993. Our study presents an advanced AI model for strabismus screening which integrates electronic archives for comprehensive patient histories. Additionally, it includes a patient-physician interaction module for streamlined communication. This innovative platform offers a complete solution for strabismus care, from screening to long-term follow-up, advancing ophthalmology through AI technology for improved patient outcomes and eye care quality.

Prevalence and associated factors of myopia among adolescents aged 12–15 in Shandong Province, China: a cross-sectional study

Myopia is a growing concern worldwide, especially among adolescents. This study aimed to investigate the prevalence and associated factors of myopia in adolescents aged 12–15 in Shandong Province, China. This cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and involved stratified random cluster sampling of 128,678 students from 186 middle schools across 17 cities in Shandong Province. Data collection was conducted from March to April 2024. We excluded students with organic eye diseases, abnormal binocular vision functions, or a history of eye injuries or surgeries. Myopia was assessed using the standard logarithmic visual acuity chart and autorefractor without inducing ciliary muscle paralysis. A comprehensive questionnaire survey was conducted to gather demographic characteristics and daily life behaviors. With the chi-squared test for univariable analysis and multivariable logistic regression for identifying significant factors. This study included 126,375 participants, with a gender distribution of 51.02% male and 48.98% female. The overall prevalence of myopia was 71.34%. Higher prevalence was observed in girls (72.26%) compared to boys (70.45%), and the prevalence increased with age, peaking at 73.12% in 15-year-olds. Urban residents had a higher prevalence (71.86%) than rural (70.39%). Factors such as increased frequency of eye usage while lying down or leaning forward, frequent use of eyes while walking or riding in a car, prolonged screen time, and extended homework duration were associated with higher odds of developing myopia. Conversely, higher frequency of outdoor exercise, maintaining proper posture during reading and writing, greater distance from eyes to screen, and longer sleep duration were associated with lower odds. Additionally, female gender, older age, urban residence, and parental history of myopia increased the risk. The high prevalence of myopia among adolescents in Shandong Province was influenced by a combination of demographic, behavioral, and environmental factors. The study highlighted the importance of lifestyle modifications, such as increasing outdoor activities and maintaining proper visual habits, limiting the duration of screen exposure and homework sessions, and extending sleep duration, to mitigate the risk of developing myopia. These findings underscored the need for targeted public health interventions and educational campaigns to address this significant public health issue.

Cross-cultural adaptation and validation of the Arabic convergence insufficiency symptom survey (Arab-CISS) in Saudi Arabia

Background: Convergence insufficiency (CI) is a common binocular vision disorder characterized by difficulty maintaining close visual focus. The Convergence Insufficiency Symptom Survey (CISS) is widely used to assess the presence and severity of CI symptoms, yet its applicability across different linguistic and cultural groups requires validation. This study aimed to translate, validate, and culturally adapt the CISS for Arabic-speaking populations, focusing on a sample from Saudi Arabia. Methods: Following established guidelines for questionnaire adaptation, the CISS was translated into Arabic and back-translated to ensure accuracy. The Arab-CISS underwent rigorous validation processes, including expert review and pre-testing. A sample of 104 participants from Qassim University, aged 18–40 years, was recruited with a Best-Corrected Visual Acuity (BCVA) of 0.1 (20/25) or better in both eyes. Internal consistency was evaluated using Cronbach’s alpha, and test–retest reliability was assessed through the Intraclass Correlation Coefficient (ICC). Results: The Arab-CISS demonstrated excellent internal consistency (Cronbach’s alpha = 0.88) and test–retest reliability (ICC = 0.93, 95% confidence interval (CI): 0.69–0.97). The Bland–Altman analysis supported these findings, showing minimal mean difference between test and retest scores (−0.1 ± 1.51), indicating stable and consistent responses over time without significant bias. Conclusion: The Arab-CISS is a reliable and valid instrument for assessing CI symptoms among Arabic-speaking individuals. Its introduction is a significant step toward improving the diagnosis and management of CI in Arabic-speaking populations.

Age-Matched Comparative Analysis of Binocular Vision Anomalies among Children with Dyslexia in Northern Nigeria.

Background: Dyslexia, a neurodevelopmental disorder affecting reading skills, poses significant challenges to children's academic performance and quality of life. Despite its rising prevalence and adverse effects, understanding of its relationship with vision anomalies remains limited, particularly in low-resource settings like Nigeria. This study aims to assess the prevalence of binocular vision anomalies (BVAs) among children with and without dyslexia in Kano, Nigeria. Methods: This is a hospital-based, cross-sectional, matched-paired, controlled study conducted at the Aminu Kano Teaching Hospital (AKTH) Eye Clinic in Northern Nigeria. The study included school children who visited the AKTH Eye Clinic from January 2018 to December 2022. Visual acuity tests, external eye examinations and accommodative, binocular vision and oculomotor skills tests were conducted. Descriptive statistics, independent t-tests, Mann-Whitney U tests and Fisher's exact tests were conducted, with a significance level set at p < 0.05. Results: Forty-four children aged 12 ± 2 years participated. Children with dyslexia reported higher rates of visual symptoms than those without dyslexia, Blurring vision, visual distortion and eye strain were the most prevalent (p < 0.05) BV symptoms. Accommodative insufficiency), was the most common visual abnormality, and was significantly higher in children with dyslexia than those without dyslexia (45.5% vs. 18.2%). However, other visual anomalies showed no significant difference between groups. There was a high prevalence of binocular vision anomalies in both groups. Binocular test findings showed dyslexic children had significantly lower distance positive fusional vergence recovery values (p = 0.005). All cases of convergence insufficiency alone were found in the non-dyslexic group. Conclusions: The study found that children with dyslexia residing in Northern Nigeria demonstrated higher rates of visual symptoms, more accommodative insufficiency and lower distance positive fusional vergence recovery values compared to their non-dyslexic counterparts.

Study on status of binocular vision in different occupations

Study on status of binocular vision in different occupations

Prevalence of non-strabismic binocular vision anomalies (NSBVA) among university students of North India

Prevalence of non-strabismic binocular vision anomalies (NSBVA) among university students of North India

Clinical profile and associations of binocular vision dysfunction at a vision therapy clinic of a tertiary eye institute in India

Clinical profile and associations of binocular vision dysfunction at a vision therapy clinic of a tertiary eye institute in India

Optometrists’ perspectives on speciality programme development in South Africa

Background: South Africa (SA) has postgraduate research-based master’s and doctorate qualifications in optometry with no clinical coursework qualifications in special interest fields. As a result, it hinders professional growth and career path for optometrists and further limits patients’ access to various care pathways from would-be upskilled optometrists.Aim: To explore optometrists’ perspectives on postgraduate programme development in special interest fields of optometry for SA.Setting: Study population of practicing optometrists registered with the Health Professions Council of South Africa (HPCSA).Methods: A quantitative cross-sectional descriptive design was employed, utilising an online questionnaire developed with the Evasys survey system v8.2. Non-probability sampling was used to access eligible participants.Results: From 424 survey responses, 83.5% had undergraduate qualifications and 95.5% worked in patient-facing environments. Participants responded positively (88%) to this need for educational expansion. Educational needs in Ocular Disease (75.6%), Paediatric Optometry (66.4%), Binocular Vision (65.1%) and sub-specialties of myopia control (41.2%) and Specialised Contact Lens Fitting (31%) were reported. With combined ‘highly important’ and ‘likely important’ responses, participants indicated that obtaining professional recognition (94.9%) and to improve patient care (98.8%) were the main drivers for pursuing additional education and training.Conclusion: A notable demand was found for coursework postgraduate programmes by the study populations from which professional recognition can be awarded in various special interest fields of optometry. The benefit of improved patient care from upskilled optometrists was expressed.Contribution: The findings would contribute towards the development of a conceptual framework for postgraduate education and training for optometrists in SA.

Online Measurement of Melt-Pool Width in Direct Laser Deposition Process Based on Binocular Vision and Perspective Transformation.

Direct laser deposition (DLD) requires high-energy input and causes poor stability and portability. To improve the deposited layer quality, conducting online measurements and feedback control of the dimensions, temperature, and other melt-pool parameters during deposition is essential. Currently, melt-pool dimension measurement is mainly based on machine vision methods, which can mostly detect only the deposition direction of a single melt pool, limiting their measurement range and applicability. We propose a binocular-vision-based online measurement method to detect the melt-pool width during DLD. The method uses a perspective transformation algorithm to align multicamera measurements into a single-coordinate system and a fuzzy entropy threshold segmentation algorithm to extract the melt-pool true contour. This effectively captures melt-pool width information in various deposition directions. A DLD measurement system was constructed, establishing an online model that maps the melt-pool width to the offline deposited layer width, validating the accuracy of the binocular vision system in measuring melt-pool width at different deposition angles. The method achieved high accuracy for melt-pool measurements within certain deposition angle ranges. Within the 30°-60° measurement range, the average error is 0.056 mm, with <3% error. The proposed method enhances the detectable range of melt-pool widths, improving cladding layers and parts.

0.01% Atropine Eye Drops in Children With Myopia and Intermittent Exotropia

Exotropia and myopia are commonly coexistent. However, evidence is limited regarding atropine interventions for myopia control in children with myopia and intermittent exotropia (IXT). To evaluate the efficacy and safety of 0.01% atropine eye drops on myopia progression, exotropia conditions, and binocular vision in individuals with myopia and IXT. This placebo-controlled, double-masked, randomized clinical trial was conducted from December 2020 to September 2023. Children aged 6 to 12 years with basic-type IXT and myopia of -0.50 to -6.00 diopters (D) after cycloplegic refraction in both eyes were enrolled. Participants were randomly assigned in a 2:1 ratio to 0.01% atropine or placebo eye drops administered in both eyes once at night for 12 months. The primary outcome was change in cycloplegic spherical equivalent from baseline at 1 year. Secondary outcomes included change in axial length (AL), accommodative amplitude (AA), exotropia conditions, and binocular vision at 1 year. Among 323 screened participants, 300 children (mean [SD] age, 9.1 [1.6] years; 152 male [50.7%]) were included in this study. A total of 200 children (66.7%) were in the atropine group, and 100 (33.3%) were in the placebo group. At 1 year, the 0.01% atropine group had slower spherical equivalent progression (-0.51 D vs -0.75 D; difference = 0.24 D; 95% CI, 0.11-0.37 D; P < .001) and AL elongation (0.31 mm vs 0.42 mm; difference = -0.11 mm; 95% CI, -0.17 to -0.06 mm; P < .001) than the placebo group. The mean AA change was -3.06 D vs 0.12 D (difference = -3.18 D; 95% CI, -3.92 to -2.44 D; P < .001) in the atropine and placebo groups, respectively. The 0.01% atropine group had a decrease in near magnitude of exodeviation whereas the placebo group had an increase (-1.25 prism diopters [PD] vs 0.74 PD; difference = -1.99 PD; 95% CI, -3.79 to -0.19 PD; P = .03). In the atropine vs placebo group, respectively, the incidence of study drug-related photophobia was 6.0% (12 of 200 participants) vs 8.0% (8 of 100 participants; difference = -2.0%; 95% CI, -9.4% to 3.7%; P = .51) and for blurred near vision was 6.0% (12 of 200 participants) vs 7.0% (7 of 100 participants) (difference = -1.0%; 95% CI, -8.2% to 4.5%; P = .74). The findings of this randomized clinical trial support use of 0.01% atropine eye drops, although compromising AA to some extent, for slowing myopia progression without interfering with exotropia conditions or binocular vision in children with myopia and IXT. Chinese Clinical Trial Registry Identifier: ChiCTR2000039827.

Microscopic versus Endoscopic Stapes Surgery – A Meta-Analysis

Abstract Background The microscope is the conventional method used by ear surgeons to view the middle ear structures, allowing for binocular vision and the freedom of both hands. Its main disadvantage is the need for an unobstructed, direct view of the operating area. The end-aural incision, drilling of the bony auditory canal, and regular repositioning of the patient and the surgeon are a few examples of how the operation has to adapt to the microscope. Nevertheless, the microscope has proven itself as the tool of choice in stapes surgery with reliable outcomes. Objective to compare endoscopic and microscopic interventions in stapes surgery regarding intraoperative and post-operative outcomes. Patients and Methods The review was a meta analytic &amp; systematic review that included randomized controlled trials (RCT), case series and retrospective studies which studied the comparison of microscopic and endoscopic stapes surgery, 15 articles published between 2014 and 2020 were included in our study. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020. Results Our results showed that the injury to the chorda tympani nerve was significantly higher in microscopic vs endoscopic groups. And also as regard the operative times, it was significant longer in microscopic vs. endoscopic groups. But there is no significant difference as regarde pain, dizziness, perforation of tympanic membrane, delayed conductive hearing &amp; post-operative Air- bone gap improvement and taste disturbance between both groups. Conclusion Endoscopic stapes surgeries are technically feasible, safe and promising. Overall, our study indicates endoscopic and microscopic stapes surgery has similar audiological success, with some data suggesting a lower risk of chorda tympani injury and postoperative taste disturbance with the endoscope. Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar complications (chorda tympani nerve injury, pain, Perforation of tympanic membrane, taste disturbance, Dizziness, and delayed conductive hearing). Shorter operative times shorter and lower postoperative air-bone gap were found in endoscopic stapes surgery. Superior visibility with the endoscope was consistently reported in all the studies. This meta-analysis of the current evidence supports the use of endoscopic techniques for stapes surgery.

Binocular Vision Status in Coal Miners

Context: Low light in mines can cause ocular problems such as binocular vision impairment and poor hand–eye coordination. These eye diseases must be monitored. Aims: To evaluate the binocular vision status of coal mine workers. Settings and Design: This was a prospective cross-sectional study of the coal mining industry in Digwadih, Jharkhand. Methods and Material: In the present study, 134 coal miners underwent a thorough, comprehensive ocular examination and binocular vision evaluation; seventy were excluded because of ocular disorders. After discussing the goals of the study, the subjects provided signed informed consent. For statistical analysis, descriptive statistics were analyzed using Microsoft Excel. The normality of the data was then verified using the Kolmogorov–Smirnov test. Results: All participants were male and aged between 25 and 35 years. Nonstrabismus binocular vision dysfunctions (NSBVDs) were observed in coal miners. Convergence insufficiency was the most prevalent factor. Apart from the NSBVD, many coal miners have a chalazion with the highest percentile of 11.2. Conclusions: Poor mine lighting causes NSBVD, which affects miners’ vision. Binocular vision defects may reduce productivity if not detected or treated.

High-Precision Drilling by Anchor-Drilling Robot Based on Hybrid Visual Servo Control in Coal Mine

Rock bolting is a commonly used method for stabilizing the surrounding rock in coal-mine roadways. It involves installing rock bolts after drilling, which penetrate unstable rock layers, binding loose rocks together, enhancing the stability of the surrounding rock, and controlling its deformation. Although recent progress in drilling and anchoring equipment has significantly enhanced the efficiency of roof support in coal mines and improved safety measures, how to deal with drilling rigs’ misalignment with the through-hole center remains a big issue, which may potentially compromise the quality of drilling and consequently affect the effectiveness of bolt support or even result in failure. To address this challenge, this article presents a robotic teleoperation system alongside a hybrid visual servo control strategy. Addressing the demand for high precision and efficiency in aligning the drilling rigs with the center of the drilling hole, a hybrid control strategy is introduced combining position-based and image-based visual servo control. The former facilitates an effective approach to the target area, while the latter ensures high-precision alignment with the center of the drilling hole. The robot teleoperation system employs the binocular vision measurement system to accurately determine the position and orientation of the drilling-hole center, which serves as the designated target position for the drilling rig. Leveraging the displacement and angle sensor information installed on each joint of the manipulator, the system utilizes the kinematic model of the manipulator to compute the spatial position of the end-effector. It dynamically adjusts the spatial pose of the end-effector in real time, aligning it with the target position relative to its current location. Additionally, it utilizes monocular vision information to fine-tune the movement speed and direction of the end-effector, ensuring rapid and precise alignment with the target drilling-hole center. Experimental results demonstrate that this method can control the maximum alignment error within 7 mm, significantly enhancing the alignment accuracy compared to manual control. Compared with the manual control method, the average error of this method is reduced by 41.2%, and the average duration is reduced by 4.3 s. This study paves a new path for high-precision drilling and anchoring of tunnel roofs, thereby improving the quality and efficiency of roof support while mitigating the challenges associated with significant errors and compromised safety during manual control processes.

Laser vision correction and binocular vision – case reports

Laser vision correction (LVC) is the removal of refractive errors, by changing the geometry of the cornea. It doesn’t directly affect binocular vision. However, the condition of the patient’s binocular vision is a very important. That affects the quality of life, which also indirectly translates into the patient’s satisfaction with the LVC procedure. Based on the presented cases, this article proves how important it is to examine binocular vision before laser vision correction. The influence of the prismatic effect of spectacle lenses on the control of binocular vision and the risk of strabismus decompensation, whichis most often associated with double vision. The described cases are people with problems with binocular vision. The article includes methods of treatment (contact lens test, vision therapy) to check and eliminate the above-mentioned problem.

Do MCH prisms change asthenopic complaints when reading?

Purpose. Asthenopic symptoms mostly occur during demanding near-sighted tasks and are related to binocular symptoms (e. g. heterophoria), among others. Correction of symptomatic heterophoria with prismatic glasses is one way to treat the symptoms. This study investigates the effect of wearing a horizontal prismatic correction for 6 months. Material and Methods. A total of 87 subjects were assigned to a heterophoric prism group (N = 32), a heterophoric control group (N = 31) or an orthophoric control group (N = 24) according to their MCH heterophoria. In the heterophoric prism group, the subjects were prescribed glasses with a prismatic correction for 6 months according to their distance correction; in contrast, the subjects in the heterophoric control group had to wear glasses without prismatic correction for the same period. The effect of the prisms on complaints due to asthenopic symptoms was investigated by comparing the total sum obtained in the CISS questionnaire at the beginning of the study and after 6 months (before and after wearing glasses) for the 3 groups. Results. A (long-term) prism effect was not apparent in the CISS total score. In both the heterophoric prism group and in the heterophoric control group, the CISS total score increased slightly and non-significantly after 6 months. When considering the heterophoric subjects with an increased CISS score at baseline, a nevertheless slight but non-significant decrease of symptoms was observed. All changes were observed in both the heterophoric prism group and the heterophoric control group. An additional analysis using binocular profiles showed a reduction in symptoms by numbers and specifically for subjects with reduced vergence flexibility. Conclusion. Wearing an individual, horizontal prismatic correction had no effect on the overall CISS-score for our test subjects. Further methods that allow a systematic recording of symptoms and optometric parameters are probably necessary to observe an effect. These could be binocular profiles that classify individuals according to their binocular parameters. Keywords horizontal heterophoria, asthenopic symptoms, prismatic correction, binocular vision

A Robust Monocular and Binocular Visual Ranging Fusion Method Based on an Adaptive UKF.

Visual ranging technology holds great promise in various fields such as unmanned driving and robot navigation. However, complex dynamic environments pose significant challenges to its accuracy and robustness. Existing monocular visual ranging methods are susceptible to scale uncertainty, while binocular visual ranging is sensitive to changes in lighting and texture. To overcome the limitations of single visual ranging, this paper proposes a fusion method for monocular and binocular visual ranging based on an adaptive Unscented Kalman Filter (AUKF). The proposed method first utilizes a monocular camera to estimate the initial distance based on the pixel size, and then employs the triangulation principle with a binocular camera to obtain accurate depth. Building upon this foundation, a probabilistic fusion framework is constructed to dynamically fuse monocular and binocular ranging using the AUKF. The AUKF employs nonlinear recursive filtering to estimate the optimal distance and its uncertainty, and introduces an adaptive noise-adjustment mechanism to dynamically update the observation noise based on fusion residuals, thus suppressing outlier interference. Additionally, an adaptive fusion strategy based on depth hypothesis propagation is designed to autonomously adjust the noise prior of the AUKF by combining current environmental features and historical measurement information, further enhancing the algorithm's adaptability to complex scenes. To validate the effectiveness of the proposed method, comprehensive evaluations were conducted on large-scale public datasets such as KITTI and complex scene data collected in real-world scenarios. The quantitative results demonstrate that the fusion method significantly improves the overall accuracy and stability of visual ranging, reducing the average relative error within an 8 m range by 43.1% and 40.9% compared to monocular and binocular ranging, respectively. Compared to traditional methods, the proposed method significantly enhances ranging accuracy and exhibits stronger robustness against factors such as lighting changes and dynamic targets. The sensitivity analysis further confirmed the effectiveness of the AUKF framework and adaptive noise strategy. In summary, the proposed fusion method effectively combines the advantages of monocular and binocular vision, significantly expanding the application range of visual ranging technology in intelligent driving, robotics, and other fields while ensuring accuracy, robustness, and real-time performance.

Impact of Prolonged Screening and COVID-19 Infection on Acquired Colour Vision Deficiencies Assessed by the Farnsworth–Munsell 100 Hue Test

Over the past decade, global screening time has increased, a trend intensified by the COVID-19 pandemic, leading to the integration of screens into daily life. Studies have documented the adverse effects of prolonged screening on ocular health and binocular vision, such as dry eye syndrome, blurry vision, headaches, myopia, and visual fatigue. However, it remains unclear if prolonged screening affects the development of colour vision defects. Objectives: This study aimed to determine the relationship between (a) prolonged screening and acquired colour vision deficiencies and (b) COVID-19 infection and acquired colour vision deficiencies. Methods: A population of 50 individuals with normal trichromatic vision, aged 20 to 30 years, with an average daily screening time of 516.7 min, was evaluated. Participants were initially screened using the Ishihara 32-plate Test to exclude those with congenital colour vision deficiencies. The Farnsworth–Munsell 100 Hue Test (FM100H) and Square Root Total Error Score (√TES) were used to evaluate acquired colour vision deficiencies under standardized conditions. The dataset underwent dual analysis: (1) detailed statistical scrutiny and (2) comparison of √TES values with historical data from 1982, 1991, 2001, and 2002. Results: The global group had a √TES (Mean ± SD) of 5.40 ± 1.58, the COVID-19 subgroup 5.46 ± 1.62, and the non-COVID-19 subgroup 5.32 ± 1.51. No significant differences were found between the √TES values from this population and those reported in previous studies. Statistical analysis showed no significant correlation between gender and COVID-19 infection with √TES values. Conclusions: Neither screening time nor COVID-19 infection appears to significantly impact the occurrence of permanently acquired colour vision deficiencies in individuals aged 20 to 30 years.

Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut.

Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients.

Extraocular Muscle Transplantation Surgery for Primary Treatment of Extra Large-angle Squint.

Large-angle horizontal ocular deviations will commonly require bilateral surgery to correct the primary ocular deviation. However, considering the need for full correction with one surgical procedure and patients' reluctance to be operated on the good eye, such large horizontal ocular deviations may be managed with true muscle transplantation. The authors present a case series of patients who underwent this procedure and develop a surgical table to guide management. Patients with horizontal squints measuring 80 prism diopters (PD) or larger in all age groups who underwent extraocular muscle transplantation surgery between January 2019 and June 2022 in Nigeria were included. Preoperative deviation of the squint, sensory evaluation, surgical dosage, and outcomes were documented. Part of the resected muscle was transplanted to give additional recession in the antagonist muscle. Success was defined as deviation corrected by 60% or more or postoperative ocular alignment within 10 PD or less, six weeks postoperatively. Fourteen patients with extra-large-angle strabismus were operated. Male/female ratio was 0.6:1. Mean preoperative deviation of 89.6 9.3 collapsed to 6.6 1.8 PD at six weeks and continued to improve to a mean deviation of 2.5 PD at six months postoperatively. When the subgroup of patients who were 18 years were analyzed, the outcome was equally successful; preoperative deviation of 89.4 PD collapsed to 1.4 PD, six months postoperatively. There were equal success rates when those with sensory strabismus were compared with those with binocular vision; preoperative deviation of 92.5 PD in the sensory group and 88.5 PD in the binocular group collapsed to 5.9 PD and 1 PD, respectively, six months after surgery. A viable alternative for treating extra-large-angle strabismus in adults and children in developing countries was described with good postoperative outcome. In addition, a new expanded surgical dosage table for muscle transplantation surgery corrections of up to 130 PD was developed.

Clinical effects of neuroendoscopic infratentorial supracerebellar approach surgical technique for resecting pineal tumors: a retrospective study

ObjectivePineal tumors are relatively rare central nervous system lesions with a predilection for the pediatric population. This article aims to explore the clinical effects of neuroendoscopic infratentorial supracerebellar approach for resecting tumors in the pineal area. MethodsThis is a retrospective study that included patients who underwent neuroendoscopic infratentorial supracerebellar approach to resect nine tumors in the pineal area at the Department of Neurosurgery of the Second Hospital of Lanzhou University from December 2017 to October 2023. ResultsThe results of postoperative MRI revealed that all tumors were resected. Five patients received postoperative radiotherapy, three patients received radiotherapy along with chemotherapy, and one patient received neither radiotherapy nor chemotherapy. The pathological results showed that four patients were diagnosed with germinoma, two patients with teratoma, two patients with mixed germ cell tumors, and one patient with central neurocytoma. After surgery, one patient developed psychiatric symptoms, two patients developed binocular upward vision and diplopia, and one patient developed unstable walking and diplopia. With a follow-up of 1.7–4.8 years, all nine patients lived normally. Furthermore, none of them had tumor recurrence or death. ConclusionThe simple neuroendoscopic infratentorial supracerebellar approach has some safety and efficacy. It is suitable for tumors in the pineal region where the disease is mainly located below the Galen vein complex.