Need For Strabismus Surgery Research Articles

What decides the nature of extraocular muscle injury? The probable mechanism of flap tear and rupture

The assessment of nature and the extent of extraocular muscle injuries during initial visit in ocular emergencies is of paramount importance to avoid/minimize the subsequent need for strabismus surgery. Based on our experience in managing acute globe and orbital injuries and cases of strabismus, we propose the probable mechanism involved in the occurrence of extraocular muscle flap tear and a complete rupture of the muscle. During high-velocity injuries when the forces are equally transmitted along the orbital bony framework and the globe, then due to differential shearing forces created between the global and the orbital fibres leads to a flap tear. In the second scenario, if the forces are only directed along the bony framework, then the globe continues to be in continuous motion leading to increased tension between the muscles and the globe. Thus the weaker portions between these two structures are at risk of complete separation, that is along the insertion of muscle onto the globe or the musculotendinous portion.

Extra-ocular movement restriction and diplopia following orbital fracture repair

PurposeTo report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used. MethodsA chart review was conducted identifying all patients >18years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision. ResultsTen patients were identified with a mean time to primary orbital fracture repair at 9days (range 1–48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia. ConclusionsClinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma.

Early alignment versus delayed alignment in patients with hyperopia and esotropia

To compare the clinical outcomes in hyperopic and esotropic patients with and without early alignment after spectacle correction. The medical records of patients with hyperopia and esotropia who were initially treated at a single center with full spectacle correction of their hyperopia from 1994 to 2009 were retrospectively reviewed. Patients with ≤10(Δ) of residual esotropia after 2months were assigned to the early-alignment group; those with >10(Δ) were assigned to the delayed-alignment group. The main outcome measure was final stereoacuity of each group. Of 136 patients who met the inclusion criteria, 85 (63%) were aligned after 2months, whereas 51 (37%) had residual esotropia. The early-alignment group had more patients with high-grade stereoacuity ≤100 arcsec (37% vs 19%) and significantly better stereoacuity results overall (P=0.037). Almost 70% of patients with poor alignment at 2months required strabismus surgery, whereas 30% improved after over 1year in spectacles alone, achieving a final alignment of ≤10(Δ) without surgery. These results suggest that earlier correction of esotropia results in better final stereoacuity. The desire for early correction, however, should be tempered by the knowledge that 30% of patients with poor early alignment may eventually achieve alignment without surgery, a result that should be considered when counseling parents about the need for strabismus surgery.

Surgical outcome of strabismus

Introduction: Strabismus is encountered daily by paediatric ophthalmologists and orthoptists in their practice.Strabismus and amblyopia affect 5% of the population. The aim of the study was to determine the surgicaloutcome of strabismus.Methods: It was a prospective study conducted at Nepal Eye Hospital from 2010 to 2011 with the samplesize of 40. Patients undergoing strabismus surgery either for esotropia or exotropia were included in the study.Detailed preoperative and postoperative orthoptic evaluation of all the patients was done apart from the anteriorand posterior segment examination and the surgical outcome was assessed.Results: Forty patients of which 52.5% males and 47.5% females with mean age of 21.025 years underwentstrabismus surgery. Manifest divergent squint was present in 61%, manifest convergent squint in 38% andintermittent squint in 5% of patients. 87.5% underwent 2 muscle surgery, 10% underwent 3 muscle surgeryand 2.5% underwent single muscle surgery. Postoperative deviation for near was 0 ???? in 10%, 2-8 ???? in 37.5%and 10-15???? in 27.5%. Similarly, postoperative deviation for distance was 0???? in 22%, 2-8???? in 27% and 10-15????in 22%. Binocular single vision was present in 50% patients preoperatively and 53% patients postoperatively.Conclusion: Though cosmesis has been improved in most of the patients after strabismus surgery, binocularsingle vision and stereopsis improved in very minimal percentage of patients as the surgery was done after theage of visual maturation in most of the cases. This accentuates the need for strabismus surgery within the yearsof cortical plasticitydoi: http://dx.doi.org/10.3126/mjsbh.v12i2.12921

Surgical outcome of strabismus

<p><strong>Introduction: </strong></p> <p>Strabismus is encountered daily by paediatric ophthalmologists and orthoptists in their practice. Strabismus and amblyopia affect 5% of the population. The aim of the study was to determine the surgical outcome of strabismus.</p> <p><strong>Methods: </strong></p> <p>It was a prospective study conducted at Nepal Eye Hospital from 2010 to 2011 with the sample size of 40. Patients undergoing strabismus surgery either for esotropia or exotropia were included in the study. Detailed preoperative and postoperative orthoptic evaluation of all the patients was done apart from the anterior and posterior segment examination and the surgical outcome was assessed.</p> <p><strong>Results:</strong></p> <p>Forty patients of which 52.5% males and 47.5% females with mean age of 21.025 years underwent strabismus surgery. Manifest divergent squint was present in 61%, manifest convergent squint in 38% and intermittent squint in 5% of patients. 87.5% underwent 2 muscle surgery, 10% underwent 3 muscle surgery and 2.5% underwent single muscle surgery. Postoperative deviation for near was 0 ? in 10%, 2-8 ? in 37.5% and 10-15? in 27.5%. Similarly, postoperative deviation for distance was 0? in 22%, 2-8? in 27% and 10-15? in 22%. Binocular single vision was present in 50% patients preoperatively and 53% patients postoperatively.<strong>  </strong></p> <p><strong>Conclusion:</strong></p> <p>Though cosmesis has been improved in most of the patients after strabismus surgery, binocular single vision and stereopsis improved in very minimal percentage of patients as the surgery was done after the age of visual maturation in most of the cases. This accentuates the need for strabismus surgery within the years of cortical plasticity.</p>

Vertical gaze palsy in Parkinsonism: An alternative diagnosis to progressive supranuclear palsy

Vertical gaze palsy is a highly relevant clinical sign in Parkinsonian syndromes. As the eponymous sign of progressive supranuclear palsy (PSP), it is a core feature of this disease. However, the differential diagnosis of vertical gaze palsy in patients with Parkinsonism is rarely considered. We present the case of a 65-year-old gentleman with Parkinsonism who presented with diplopia secondary to oculomotor dysfunction and vertical gaze palsy. Computed tomography (CT) sacn demonstrated a thalamic haemorrhage with intraventricular extension. Neurosurgical intervention was not required. The patients spectacles were fitted with a temporary Fresnel prism over the left lens to relieve diplopia. This progressively improved without the need for strabismus surgery. Vertical gaze dysfunction occurs in patients with thalamic haemorrhage and is an important differential diagnosis of vertical gaze palsy in Parkinsonism.

Improving ophthalmic outcomes in children with unilateral coronal synostosis by treatment with endoscopic strip craniectomy and helmet therapy rather than fronto-orbital advancement

To compare long-term ophthalmic outcomes in infants treated for unilateral coronal synostosis (UCS) by endoscopic strip craniectomy (ESC) and helmet therapy with those treated by fronto-orbital advancement (FOA). Consecutive patients with UCS, uncomplicated by other suture synostosis, were identified by a retrospective review of medical records. Assessment of presence of amblyopia, cycloplegic refraction, strabismus, and strabismus surgical intervention at all visits was recorded. Between 2004 and 2010, 22 patients were treated by FOA (mean follow-up, 21.5 months) and 21 patients with ESC and helmet therapy (mean follow-up, 23.5 months). The mean aniso-astigmatism was equal; however, the SD was greater for those treated by FOA (P < 0.05). A more severe pattern of strabismus developed in those treated by FOA (P < 0.0001). Those treated by FOA were more likely to have amblyopia (P = 0.0015) and to undergo surgical correction of their strabismus (odds ratio, 6.3:1). Children with UCS treated with ESC and helmeting had less severe overelevation in adduction, amblyopia, extremes of astigmatism, and less need for strabismus surgery than those treated by FOA. Although the reason for these more favorable outcomes remains uncertain, we speculate that the earlier timing of ESC or differences in the anatomical changes resulting from the two procedures may play a role.

Treatment for diplopia in patients with myasthenia gravis

The purpose of this study was to describe the treatment experiences and outcomes of patients with myasthenia gravis (MG) whose initial presenting symptom was diplopia A retrospective review was performed on a group of patients with MG whose initial presenting symptom was diplopia. The mean age of onset was 45.5 ± 16.9 years, and the mean follow-up period was 45.4 ± 39.7 months. Exotropia with vertical heterotropia was the most common type of deviation. The mean horizontal deviation was 20.1 ± 17.9 prism diopters, and the mean vertical deviation was 14.8 ± 11.1 prism diopters. Limitation of eye movement was found in 20 patients (71.4 %) during the follow-up period. After conventional treatment for MG, six patients (21.4 %) showed a good response with resolution of diplopia. Four patients (14.3 %) showed a partial response to treatment. Eighteen patients (64.3 %) showed minimal or no response; among them, ten (35.7 %) had an angle of deviation of 15 prism diopters or more. Six patients underwent strabismus surgery. Four were symptom free, and satisfactorily aligned after surgical treatment. One patient had intermittent diplopia despite the small amount of deviation, and one patient experienced recurrence of exotropia with diplopia during the 10-year follow-up. In multivariable analysis, the only factor associated with the need for strabismus surgery was the initial angle of deviation (p = 0.016). Patients with MG who have a larger angle of deviation at presentation tend to require strabismus surgery after stabilization of the disease. Strabismus surgery is one treatment option for patients with MG who have a large angle of deviation and respond poorly to conventional treatment.

Predictive value of trial frames in the treatment of accommodative esotropia

Purpose: To determine if correction of hyperopia with trial frames fitted in the initial office visit of a child with esotropia can be used to predict the response to spectacle correction when evaluating a child for nonaccommodative esotropia. Methods: Patients presenting with a new-onset esotropia underwent a cycloplegic refraction and were then fitted with trial frames containing their full cycloplegic correction. Their alignment was evaluated while wearing the trail frames. The patients returned for another assessment after wearing their glasses for 1 month. A comparison was then made between the predicted and actual reduction in their esotropia provided by the glasses. Patients who continued to have an esotropia of at least 10Δ were considered to have a nonaccommodative component to their strabismus. Results: Twenty-three patients 2 to 8 years of age completed the study. Trial frames were 71% (10/14) sensitive and 100% (9/9) specific for the presence of nonaccommodative esotropia. The positive-predictive value for nonaccommodative esotropia was 100% (10/10). The negative-predictive value for nonaccommodative esotropia was 69% (9/13). Conclusions: Trial frame analysis may be helpful in predicting which patients with acquired esotropia may require surgery. A positive trial frame test may allow the strabismus surgeon to appropriately counsel families regarding the eventual need for strabismus surgery.

Comparison of clinical characteristics of familial and sporadic acquired accommodative esotropia

Purpose: To compare the clinical characteristics of patients with familial and nonfamilial acquired accommodative esotropia. Methods: We recruited 48 patients from 33 families with acquired accommodative esotropia (an inward deviation of the eyes of 10 PD or more, a hypermetropia greater than or equal to +1.50 D, and an onset of esotropia at, or later than, 1 year of age). Our control group consisted of 20 patients with no known family history. Spherical error of refraction, stereoacuity, and need for strabismus surgery were determined and the 2 groups were compared. Results: No statistically significant difference was found between the spherical equivalent error of refraction in familial cases (mean = +4.50 OD, +4.63 OS; range = +1.50 to +10.30 OD, +2.00 to +9.38 OS) versus those with nonfamilial disease (mean = +4.93 OD, +5.02 OS; range = +2.50 to +11.00 OD, +2.50 to +10.90 OS) (P = .47 OD; P = .47 OS). There also was no difference between the percentage of patients with familial disease who had some degree of stereoacuity (58%) and those without a family history (59%) (P > .99). Patients with familial acquired accommodative esotropia did not require more surgical interventions (26%) than those with nonfamilial acquired accommodative esotropia (30%) (P = .79). Conclusions: The general clinical characteristics of familial and nonfamilial acquired accommodative esotropia are very similar. (J AAPOS 2001;5:18-20)

Outcome of sixth nerve palsy or paresis in young children.

This study evaluated the ophthalmological outcome following sixth nerve palsy or paresis in 64 children 7 years of age and younger. The outcomes considered were vision, residual strabismus and the need for strabismus surgery. Etiologies included tumor, hydrocephalus, trauma, infection, malformation, and idiopathic and miscellaneous causes. Strabismus surgery was performed on 24% of the patients, with residual strabismus present in 66% of the patients. Neurologists and ophthalmologists should monitor visual acuity in these young children at frequent intervals be prepared to institute amblyopia therapy early in the course of the ocular misalignment if permanent visual disability is to be avoided.