History Of Strabismus Surgery Research Articles

Conjunctival Apocrine Hidrocystoma: A Case Report and Review of Literature.

To describe the clinical features of a conjunctival apocrine hidrocystoma that developed 6 decades after a strabismus surgery and review existing literature on apocrine hidrocystomas of the conjunctiva and caruncle. Case report and review of literature on conjunctival apocrine hidrocystomas. A 71-year-old man with a history of strabismus surgery as a child presented with a cystic lesion on the nasal conjunctiva and caruncle for 1 year. Excision of the lesion showed a unilocular cavity lined by a double layer of cells with the hallmark finding of apical decapitations, confirming a diagnosis of apocrine hidrocystoma. Seven additional cases of conjunctival and caruncular apocrine hidrocystomas were reviewed. All cases presented after 50 year of age. Most cases presented nasally or within the caruncle and had a pigmented appearance. No other reported cases had a history of trauma or surgery. All cases were treated with surgical excision without recurrence. History of strabismus surgery or conjunctival trauma may lead to ectopic deposition of apocrine glands that may contribute to the formation of an apocrine hidrocystoma.

Presence of Copy Number Variants Associated With Esotropia in Patients With Exotropia

Strabismus is a common ocular disorder of childhood. There is a clear genetic component to strabismus, but it is not known if esotropia and exotropia share genetic risk factors. To determine whether genetic duplications associated with esotropia are also associated with exotropia. This was a cross-sectional study conducted from November 2005 to December 2023. Individuals with constant or intermittent exotropia of any magnitude or a history of surgery for exotropia were recruited from pediatric ophthalmic practices. Data were analyzed from March to December 2023. Genetic duplication. Presence of genetic duplications at 2p11.2, 4p15.2, and 10q11.22 assessed by digital droplet polymerase chain reaction. Orthoptic measurements and history of strabismus surgery were performed. A total of 234 individuals (mean [SD] age, 19.5 [19.0] years; 127 female [54.3%]) were included in this study. The chromosome 2 duplication was present in 1.7% of patients with exotropia (4 of 234; P = .40), a similar proportion to the 1.4% of patients with esotropia (23 of 1614) in whom it was previously reported and higher than the 0.1% of controls (4 of 3922) previously reported (difference, 1.6%; 95% CI, 0%-3.3%; P < .001). The chromosome 4 duplication was present in 3.0% of patients with exotropia (7 of 234; P = .10), a similar proportion to the 1.7% of patients with esotropia (27 of 1614) and higher than the 0.2% of controls (6 of 3922) in whom it was previously reported (difference, 2.8%; 95% CI, 0.6%-5.0%; P < .001). The chromosome 10 duplication was present in 6.0% of patients with exotropia (14 of 234; P = .08), a similar proportion to the 4% of patients with esotropia (64 of 1614) and higher than the 0.4% of controls (18 of 3922) in whom it was previously reported (difference, 5.6%; 95% CI, 2.5%-8.6%; P < .001). Individuals with a duplication had higher mean (SD) magnitude of deviation (31 [13] vs 22 [14] prism diopters [PD]; difference, 9 PD; 95% CI, 1-16 PD; P = .03), were more likely to have constant (vs intermittent) exotropia (70% vs 29%; difference, 41%; 95% CI, 20.8%-61.2%; P < .001), and had a higher rate of exotropia surgery than those without a duplication (58% vs 34%; difference, 24%; 95% CI, 3%-44%; P = .02). In this cross-sectional study, results suggest that the genetic duplications on chromosomes 2, 4, and 10 were risk factors for exotropia as well as esotropia. These findings support the possibility that esotropia and exotropia have shared genetic risk factors. Whether esotropia or exotropia develops in the presence of these duplications may be influenced by other shared or independent genetic variants or by environmental factors.

Risk Ractors for Strabismus Surgery after Pediatric Cataract Surgery in the United States.

To determine the cumulative incidence of strabismus surgery after pediatric cataract surgery and identify the associated risk factors. US population-based insurance claims retrospective cohort study. Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics Data Mart (2003-2021) and IBM MarketScan (2007-2016). Individuals with at least 6 months of prior enrollment were included, and those with a history of strabismus surgery were excluded. The primary outcome was strabismus surgery within 5 years of cataract surgery. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), intraocular lens (IOL) placement, nystagmus and strabismus diagnoses before cataract surgery, and cataract surgery laterality. Kaplan-Meier estimated cumulative incidence of strabismus surgery 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models. Strabismus surgery was performed on 271/5822 children included in this study. The cumulative incidence of strabismus surgery within 5 years after cataract surgery was 9.6% (95% CI, 8.3%-10.9%). Children who underwent strabismus surgery were more likely to be of younger age at the time of cataract surgery, of female sex, have a history of PFV or nystagmus, have a pre-existing strabismus diagnosis, and less likely to have an IOL placed (all P < 0.001). Factors associated with strabismus surgery in the multivariable analysis included age 1 to 4 years (HR, 0.50; 95% CI, 0.36-0.69; P < 0.001) and age > 5 years (HR, 0.13; 95% CI, 0.09-0.18; P<0.001) compared with age < 1 year at time of cataract surgery, male sex (HR, 0.75; 95% CI, 0.59-0.95; P<0.001), IOL placement (HR, 0.71; 95% CI, 0.54-0.94; P= 0.016), and strabismus diagnosis before cataract surgery (HR, 4.13; 95% CI, 3.17-5.38; P < 0.001). Among patients with strabismus diagnosis before cataract surgery, younger age at cataract surgery was the only factor associated with increased risk of strabismus surgery. Approximately 10% of patients will undergo strabismus surgery within 5 years after pediatric cataract surgery. Children of younger age, female sex, and with a pre-existing strabismus diagnosis undergoing cataract surgery without IOL placement are at greater risk. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Profile of orthoptic clinic patients at a tertiary care Government Medical University in North India: A 6-year review

Aim: This study aims to study clinicodemographic profile of patients presenting to orthoptic clinic over the previous 6 years. Methods: Records of all new patients registered at the orthoptic clinic over 6 years' (January 1, 2014, to December 31 2019) were retrieved. Details of patient demographics, clinical presentation and management were studied in this hospital-based descriptive observational study after obtaining institutional ethical clearance. Records that were incomplete and those of patients with a history of strabismus surgery at presentation were excluded from analysis. Exact binomial confidence intervals (CIs) were calculated for the estimates of proportion. The results were reported as percentage (95% CIs). Descriptive statistics were used for subtypes of strabismus and amblyopia. Results: Out of 1548 patients, 896 were male (57.88%) and 652 (42.12%) were female. Mean age at presentation was 18.53 ± 10.41 years. Comitant strabismus was seen in 1083 (69.96%) and incomitant in 203 (13.11%). Among comitant deviations exotropia (XT) was commonest (n = 511, 47.18%), 6th nerve palsy (34%) was the most common cause among incomitant deviations, Duane retraction syndrome (DRS) constituted 24% of restrictive strabismus and amblyopia was present in 16.71% (n = 331) of patients. The left eye (LE) was more frequently involved in unilateral amblyopia (P < 0.0001). Conclusions: In our study, male to female ratio was 1.37. XT, 6th Nerve palsy, and DRS were the commonest types of comitant, paralytic and restrictive deviations respectively. Prevalence and severity of different types of amblyopia have also been described.

THE PREVALENCE OF STRABISMUS IN CHILDREN AT SCHOOL AGE IN SOHAG CITY

Objective: The aim of the study is to determine the prevalence of different types of strabismus inprimary school children; grade one in Sohag city. Background: Strabismus is the most commonamblyogenic factor. Children with untreated strabismus and/or amblyopia will lack the ability to fullydevelop binocular single vision. They may have psychosocial difficulties later in life. Design: A crosssectional study was employed to determine the prevalence of strabismus among primary schoolchildren (grade one) in Sohag city from November 2017 to April 2018. Methods: Visual acuity,autorefraction, Hirschberg's test and cover test using a pen light torch were performed for 584 out of 841students (age range 5.5–7 years). Children with any type of strabismus or had a history of strabismussurgery were subjected to a full ophthalmic examination including slit lamp, extraocular musclesexamination, Worth 4 dots test, and fundus examination. Results: Students with strabismus are 8 of 584students. Four of them are boys and the others are girls. Three of the detected cases are esotropias (twoboys and one girl) with a prevalence of 0.5%. The other five detected cases are distributed as threecases of exophorias (two girls and one boy) with a prevalence of 0.5% and two cases of esophorias (onegirl and one boy) with a prevalence of 0.3%. In the present study, 506 students (255 males and 251females) are emmetropic (< ± 1.00 D) with a percentage of 86.6% and the other 78 students (40 malesand 38 females) are with refractive errors with a percentage of 13.4%. Most of them are with astigmatism(9.3%) then myopia (2.9%) and hypermetropia (1.2%). Conclusion: In this study, the prevalence ofstrabismus in children at school age in Sohag city is 1.4% with no statistically significant association withgender.

Sudden-onset trochlear nerve palsy: clinical characteristics and treatment implications

To identify clinical characteristics, etiologies, and treatment implications of sudden-onset, acquired cases of superior oblique palsy. The medical records of patients diagnosed with trochlear nerve palsy between January 2010 and January 2018 were reviewed retrospectively to identify cases of acquired trochlear nerve palsy with a specific date of onset of acute symptoms or specific causative incident. Patients with congenital palsies or an uncertain date of onset, history of other strabismus, concomitant oculomotor or abducens nerve palsies, or history of strabismus surgery were excluded. Of 214 patients with superior oblique palsy, 23 had sudden-onset, acquired palsies. There were 14 cases of unilateral palsy and 9 cases of bilateral palsy. Patients with unilateral palsy presented with vertical diplopia, while those with bilateral palsy complained of either torsional (4/9 patients) or vertical (5/9 patients) diplopia. The most common etiologies were severe trauma associated with traumatic brain injury, followed by central nervous system neoplasm and stroke. Fifteen patients underwent surgical intervention, 3 of whom required more than one surgery. Patients with acute superior oblique palsy invariably complain of vertical and/or torsional diplopia. Neuroimaging should be considered in cases of acquired superior oblique palsy without a known traumatic cause. Bilateral cases of acquired superior oblique palsy are more challenging to manage surgically because of symptomatic torsional diplopia.

The Danish Rural Eye Study: prevalence of strabismus among 3785 Danish adults - a population-based cross-sectional study.

To determine the prevalence of strabismus among Danish adults and to find the frequency of history of strabismus and strabismus surgery. Furthermore, to evaluate the prevalence of strabismus-associated amblyopia among participants with strabismus and to relate the results to the current national vision screening programme. In total, 3785 adults in the Danish Rural Eye Study underwent an interview regarding eye health, visual acuity measurement, Hirschberg test and retinal photography. Participants were categorized into groups based on their birth date in relation to the introduction of the national vision screening programme. In total, the prevalence of strabismus was 1.1% (41/3785; 95% CI: 0.8-1.5); no differences were found in relation to gender or screening status. The prevalence of exotropia (XT) was 0.3% (12/3785; 95% CI: 0.2-0.6) and of esotropia (ET) 0.8% (29/3785; 95% CI: 0.5-1.1), resulting in an XT:ET ratio of 1:2.7. A history of strabismus was present in 4.6% (174/3785; 95% CI: 4.0-5.3), and a history of strabismus surgery was present in 0.8% (32/3785; 95% CI: 0.6-1.2) of the participants. Among participants with manifest strabismus, 24% had strabismus-associated amblyopia. In this first European population-based study of strabismus prevalence in adults, the prevalence was similar to three out of five previous studies using cover test. The use of Hirschberg test may have led to an underestimation of the true prevalence. The prevalence was neither related to screening status nor gender. Our results are the first to display a predominance of ET among Caucasian Scandinavian adults.

Lateral Rectus-Medial Rectus Union: A New Surgical Technique for Treatment of Complete Third Nerve Palsy.

To describe a new surgical technique for the treatment of complete third nerve palsy. This study included patients with chronic complete third nerve palsy. The lateral rectus muscle was split, followed by disinsertion of the superior and inferior halves, which were passed between the sclera and superior and inferior rectus muscles, respectively. Then the medial rectus muscle was sutured as posteriorly as possible from its insertion and cut. Next, the distal stump of the medial rectus muscle was split into two halves and united with the superior and inferior halves of the lateral rectus muscle. Finally, the proximal portion of the medial rectus muscle was sutured back to its original insertion. In cases with hypotropia and a functional superior oblique muscle, superior oblique tenectomy was also performed. Success was defined as postoperative horizontal deviation of 10 prism diopters (PD) or less and vertical deviation of 5 PD or less. Ten patients with a mean age of 32.4 ± 18.4 years had surgery using this technique; 2 of them had a history of strabismus surgery. Mean exotropia was 84 ± 14.9 PD, which reduced to 6.5 ± 8.2 PD. Mean vertical deviation was 16.5 ± 10 PD, which reduced to 2.5 ± 3.5 PD. Mean follow-up was 13.2 ± 7.9 months, and the success rate was 70% and 90% for horizontal and vertical deviations, respectively. The lateral rectus-medial rectus union technique is an effective and long-lasting procedure to overcome large-angle exotropia associated with complete third nerve palsy. This method can also be employed as a reoperation procedure. [J Pediatr Ophthalmol Strabismus. 2019;56(1):10-18.].

Efficacy and Safety of Low-to-Moderate Dose Oral Corticosteroid Treatment in Ocular Myasthenia Gravis.

To evaluate the response to corticosteroid therapy as a primary treatment for ocular myasthenia gravis. Patients diagnosed as having ocular myasthenia gravis by an acetylcholine receptor binding antibody test between January 2011 and September 2015 were included in the study and started receiving treatment with a corticosteroid. Patients with a blowout fracture, hyperthyroidism, diabetes mellitus, hypertension, cardiovascular disease, or history of strabismus surgery were excluded. Disappearance of diplopia and ptosis were considered a response to treatment. Methylprednisolone therapy was administered to 29 patients (19 men and 10 women; average age: 49 ± 16.5 years) as an initial treatment. A total of 6 patients were lost to follow-up. Twenty-three of 29 patients (82.6%) were regarded as having presented a response to treatment. The average treatment duration was 3 weeks for patients responding to primary treatment. Eight patients complained of adverse effects from steroid therapy such as heartburn, insomnia, weight gain, and myalgia. A corticosteroid could be considered as an initial treatment for patients diagnosed as having ocular myasthenia gravis by an acetylcholine receptor binding antibody test. [J Pediatr Ophthalmol Strabismus. 2018;55(5):339-342.].

Vertical Muscle Transposition with Augmentation for Treatment of Exotropia Caused by Iatrogenic Lost Medial Rectus Muscle

ABSTRACTPurpose: To evaluate the results of vertical muscle transposition with augmentation in cases of exotropia caused by iatrogenic lost medial rectus muscle.Methods: This is a retrospective review of 5 cases of lost medial rectus with exotropia and marked limitation of adduction that underwent surgery. All cases had a history of strabismus surgery on the medial rectus and failed attempt at retrieval of the lost muscle.Results: Five patients fulfilled the criteria. Full tendon vertical muscle transposition with augmentation sutures was done for all cases. Surgery led to a significant reduction of the angle of exotropia 25.8±13.6 ?D (P=0.027) and improvement in adduction of 7.5±3.8 degrees (P=0.034). There were no complications.Conclusions: Isolated vertical muscle transposition with augmentation is a useful option to improve the exotropia and adduction deficit in patients with iatrogenic lost medial rectus muscle.

Sensorimotor outcomes by age 5 years after monocular cataract surgery in the Infant Aphakia Treatment Study (IATS)

To evaluate sensorimotor outcomes among children in the Infant Aphakia Treatment Study (IATS). Secondary outcome analysis was performed in this randomized, multicenter, clinical trial comparing treatment of unilateral aphakia with a primary intraocular lens (IOL) or contact lens (CL) correction. The alignment characteristics and sensory status of children through age 5years were evaluated. In the IATS study, 91 of 112 children (81%) developed strabismus through age 5years. Of 34 infants who were orthotropic at near 12months after cataract surgery, at age 5years 14 (41%) were orthotropic at distance, and 15 (44%) were orthotropic at near at age 5years without strabismus surgery. Eight of 56 children (14%) in the CL group and 13 of 56 (23%) in the IOL group were orthotropic at distance (P=0.33) at 5years of age and had no history of strabismus surgery. Thirteen of 48 (27%) who underwent cataract surgery prior to 49days of age compared to 8 of 64 (13%) who had surgery after 49days were orthotropic (P=0.085). Median visual acuity in the operative eye was 0.4 logMAR (20/50) for children with orthotropia or microtropia (<10(Δ)) versus 1.10 logMAR (20/252) for strabismus ≥10(Δ) (P=0.0001). Stereopsis was detected in 12 of 21 children (57%) with orthotropia versus 16 of 89 (18%) children with strabismus (P=0.0006). IOL placement does not reduce the development of strabismus after monocular congenital cataract surgery. Improved ocular alignment by age 5years correlated strongly with improved visual acuity and stereopsis.

A Case of Sclerocorneal Cyst in a 4-Year-Old Female

Purpose: To report a case of sclerocorneal cyst found in a 4-year-old female following strabismus surgery treated with cyst wall excision and scleral graft. Case summary: A 4-year-old female with a history of strabismus surgery performed 1.5 year prior presented with a whitish lesion in cornea and sclera which developed 1 month ago. Slit-lamp examination revealed a 4.2 × 3.5 mm-sized cyst at the superotemporal part of the cornea, extending into the sclera at 3-o’clock. Cyst fluid, precipitate aspiration, and cyst wall excision were performed. Scleral patch graft was used to cover the scleral defects after excision. Upon histopathological examination, the cyst wall was lined with nonkeratinized stratified squamous epithelium and numerous degenerated epithelial cells were present in the cyst aspirate. Conclusions: Sclerocorneal cyst can rarely develop following trauma or surgery. In this report, the sclerocorneal cyst, possibly induced by previous strabismus surgery, was treated successfully without recurrence using cyst wall resection. J Korean Ophthalmol Soc 2015;56(4):602-606

3D Asthenopia in Horizontal Deviation

Purpose: This study was conducted to investigate the asthenopic symptoms in patients with exotropia and esotropia while watching stereoscopic 3D (S3D) television (TV).Methods: A total 77 subjects who more than 9 years of age were enrolled in this study. We divided them into three groups; Thirty-four patients with exodeviation (Exo group), 11 patients with esodeviation (Eso group) and 32 volunteers with normal binocular vision (control group). The S3D images were shown to all patients with S3D high-definition TV for a period of 20 min. Best corrected visual acuity, refractive errors, angle of strabismus, stereopsis test and history of strabismus surgery, were evaluated. After watching S3D TV for 20 min, a survey of subjective symptoms was conducted with a questionnaire to evaluate the degree of S3D perception and asthenopic symptoms such as headache, dizziness and ocular fatigue while watching 3D TV.Results: The mean amounts of deviation in the Exo group and Eso group were 11.2 PD and 7.73PD, respectively. Mean stereoacuity was 102.7 arc sec in the the Exo group and 1389.1 arc sec in the Eso group. In the control group, it was 41.9 arc sec. Twenty-nine patients in the Exo group showed excellent stereopsis (≤60 arc sec at near), but all 11 subjects of the Eso group showed 140 arc sec or worse and showed more decreased 3D perception than the Exo and the control group (p < 0.001, Kruskal–Wallis test). The Exo group reported more eye fatigue (p < 0.001, Kruskal–Wallis test) than the Eso and the control group. However, the scores of ocular fatigue in the patients who had undergone corrective surgery were less than in the patients who had not in the Exo group (p < 0.001, Kruskal–Wallis test) and the amount of exodeviation was not correlated with the asthenopic symptoms (dizziness, r = 0.034, p = 0.33; headache, r = 0.320, p = 0.119; eye fatigue, r = 0.135, p = 0.519, Spearman rank correlation test, respectively).Conclusion: Symptoms of 3D asthenopia were related to the presence of exodeviation but not to esodeviation. This may indicate that S3D symptoms are closely related to the convergence demand.

Refractive surgery in patients with accommodative and non-accommodative strabismus: 1-year prospective follow-up

AimTo determine the efficacy and safety of keratorefractive surgery in patients with accommodative and non-accommodative strabismus in a prospective study.MethodsPreoperative assessment included uncorrected (UCVA) and best-corrected visual acuity (BCVA), manifest...

Giant Secondary Conjunctival Inclusion Cysts: A Late Complication of Strabismus Surgery

To present giant conjunctival inclusion cysts as a late complication of strabismus surgery. Retrospective case series of selected patients. Four patients with a history of strabismus surgery who had developed giant conjunctival inclusion cysts. A chart review was performed. The patient's ocular history, ophthalmic examinations, and imaging (ultrasound/ultrasound biomicroscopy and/or computed tomography) were recorded. Surgical excision with subsequent histopathologic correlation was obtained in 3 cases. Clinical and imaging characteristics with histopathologic correlation. Four patients with giant conjunctival inclusion cysts had a history of strabismus surgery. Ultrasound biomicroscopy was performed in 3 cases and revealed large, cystic, well-circumscribed tumors with low internal reflectivity and hyperechoic components. Computed tomography of the orbits was used to evaluate posterior extension. Their size induced limitation in motility, strabismus, and problems related to chronic exposure. Histopathologic evaluations were consistent with benign inclusion cysts of the conjunctiva. Giant conjunctival inclusion cysts may appear decades after strabismus surgery. Tumor size, cystic nature, and involvement of underlying structures can be determined by ultrasonography and radiographic imaging. Complete surgical removal can be curative.

Management of Intracorneal Epithelial Cysts With Ethanol Irrigation and Cyst Wall Excision

The clinical and pathologic characteristics and the surgical treatment of 2 patients with intrastromal corneal epithelial cysts are described. This interventional case report presents 2 young patients with decreased vision and cosmetic impairment caused by intracorneal epithelial cysts. The first patient had history of strabismus surgery, and the second patient had undergone corneal laceration repair. The cysts had enlarged gradually and dissected into the cornea, threatening the visual axis. Both patients were treated with drainage of cyst contents, chemical cytodestruction with 96% ethanol for 1 minute in a closed system, followed by cyst wall excision. Corneal clarity and appearance improved significantly after surgery. In the first patient, best-corrected visual acuity was 20/20 before the operation and remained stable. In the second patient, best-corrected visual acuity improved from 20/400 to 20/60 after the procedure. Histopathologic findings revealed that the cyst walls were composed of nonkeratinized stratified squamous epithelium. No recurrence was noted up to 8 and 3 months in the first and second patients, respectively. No complication occurred during the follow-up period. Intracorneal epithelial cysts may be treated safely and effectively with a combination of drainage of cyst contents, irrigation with 96% ethanol, and cyst wall excision with good visual and cosmetic results.

Surgical Management of Strabismus: An Atlas of Strabismus Surgery

This latest edition of Helveston's surgical atlas represents a truly scholarly approach to the subject of the surgical management of strabismus. It contains considerably more material than the previous edition and is therefore worthwhile reading even for those clinicians who have read earlier editions. This book is, in fact, far more than a surgical atlas. It is a treatise on the surgical management of strabismus. Helveston kept the same format of line drawings that worked so well in the first three editions. They are clear, easy to interpret, and convey their intended meanings well. The format permits the book to be read enjoyably in its entirety (something that I would recommend as being well worth the effort) or to be used as a reference. The book begins with a history of strabismus surgery. The next sections deal with details of instrumentation, suture material, knots, and needles. The information is presented

Atlas of Strabismus Surgery

The third edition of Dr Eugene Helveston's book on strabismus surgery provides a concise and simple review of the subject, obviously representing the author's own dictum that the strabismus surgeon should keep learning from experience and remain appropriately skeptical. The first part of the book includes a section on the history of strabismus surgery, a short anatomical review, and notes on instrumentation and anesthesia. Various types of muscle operations are summarized with the aid of line drawings. Complications of surgery are mentioned, and a brief section deals with the use of botulinum A toxin injection. Then there is a summary of the amounts of recession and resection of muscles, which Dr Helveston has found to be appropriate for his cases. The final section contains some clinical examples. "The strabismus surgeon should keep learning from experience and remain appropriately skeptical." <i>Atlas of Strabismus Surgery</i>is mainly for ophthalmology residents, as there