Ocular Motility Research Articles

Assessing REALTER simulator: analysis of ocular movements in simulated low-vision conditions with extended reality technology.

Immersive technology, such as extended reality, holds promise as a tool for educating ophthalmologists about the effects of low vision and for enhancing visual rehabilitation protocols. However, immersive simulators have not been evaluated for their ability to induce changes in the oculomotor system, which is crucial for understanding the visual experiences of visually impaired individuals. This study aimed to assess the REALTER (Wearable Egocentric Altered Reality Simulator) system's capacity to induce specific alterations in healthy individuals' oculomotor systems under simulated low-vision conditions. We examined task performance, eye movements, and head movements in healthy participants across various simulated scenarios. Our findings suggest that REALTER can effectively elicit behaviors in healthy individuals resembling those observed in individuals with low vision. Participants with simulated binocular maculopathy demonstrated unstable fixations and a high frequency of wide saccades. Individuals with simulated homonymous hemianopsia showed a tendency to maintain a fixed head position while executing wide saccades to survey their surroundings. Simulation of tubular vision resulted in a significant reduction in saccade amplitudes. REALTER holds promise as both a training tool for ophthalmologists and a research instrument for studying low vision conditions. The simulator has the potential to enhance ophthalmologists' comprehension of the limitations imposed by visual disabilities, thereby facilitating the development of new rehabilitation protocols.

Correlation of Retinal Nerve Fibre Layer Thickness in Optical Coherence Tomography with Visual Outcome in Optic Neuritis

Abstract Purpose: In this study, the changes in optical coherence tomography (OCT) were correlated with the post-treatment visual outcome of optic neuritis, thereby determining the patients who are at risk of optic atrophy. Design: Prospective observational study. Methodology: All patients presenting to the outpatient department (OPD) with acute visual loss, pain on ocular movements and colour desaturation were subjected to comprehensive ophthalmic examination and OCT retinal nerve fibre layer (RNFL) analysis. All patients were treated with an Optic Neuritis Treatment Trial (ONTT) regimen and followed for one year. Results: Of 25 patients, 40% were 20 to 40 years of age, and females outnumbered males by 28%. The right eye had 48% unilateral affection and 12% bilateral affection; 56% had a central scotoma, and 24% had a centrocaecal scotoma. The most common aetiologies are as follows: idiopathic (84%), multiple sclerosis (MS) (12%) and Devic’s disease (4%). 60% presented with a visual acuity of 6/60–1/60 and 32% with a visual acuity of 6/18–6/36. Patients whose RNFL thickness was below 90 microns post-treatment had poorer visual outcome. Conclusion: In this study, optic neuritis was more common in females of 20 to 45 years with unilateral affection in the right eye. The most common field defect was central scotoma, and the most common cause of optic neuritis was idiopathic. It was also found that the visual acuity in optic neuritis can range from 6/18 to no PL. Of the 25 patients in the study, three patients had retrobulbar neuritis and six patients developed disc pallor during recovery after treatment.

Delayed manifestation of a full-thickness traumatic macular hole: Probable causes and consequences – A case report

A 23-year-old male experienced a cricket ball injury to his right eye 1 day ago. Right eye visual acuity was counting fingers close to face. He presented with anterior uveitis, commotio retinae, and vitreous hemorrhage. Steroids and cycloplegics were given. Fundus showed resolved vitreous hemorrhage, a healthy optic disc, patchy epiretinal membrane, choroidal ruptures, peripapillary scarring, and 20/80 vision on follow-up. Patient developed a full-thickness macular hole 11 months after trauma, decreasing vision to 20/120. Exam and optical coherence tomography showed no abnormal posterior vitreous detachment. Macular hole surgery closed the hole with a normal foveal contour without improving vision. At the last follow-up 6 months after surgery, the hole was closed and vision improved to 20/120. A delayed traumatic macular hole unrelated to vitreomacular traction or cystoid macular edema deroofing has not been reported in literature. Traumatic macular hole development may be delayed by secondary epiretinal membrane contraction, ocular movements, or expansion of choroidal rupture.

Monocular elevation deficit management

Aim The aim of the study is to study cases of monocular elevation deficit (MED), and find an appropriate procedure to follow in management. Patients and methods This prospective study included 21 patients presenting with MED, complete ocular examination including ocular motility examination in all directions, forced duction test (FDT) were performed, then cases having hypotropia in the affected eye in primary position were operated, and the choice of operation was depending on the result of FDT. Results The total number of cases was 21 patients, 18 patients had hypotropia in primary position accompanied by pseudoptosis, and three cases had no hypotropia. Sixteen cases of hypotropia had positive FDT, inferior rectus muscle recession by hang back procedure was performed in them, while in two cases of hypotropia with negative test, Knapp’s muscle transposition was performed. All operated cases had postoperative good ocular alignment and spontaneous regaining of normal lid position except two cases. Cases with no hypotropia were not operated and only followed up. Conclusion MED or double elevator palsy, can present with hypotropia and pseudoptosis, so requiring management, or presenting with normal eyes in primary position, requiring follow up. The choice of surgical procedure depended on results of FDT.

Neurological disorders associated with patent foramen ovale

The foramen ovale between the right and left atria remains open in 15–25% of people over 18 years of age and in most of them it does not manifest itself clinically. At the same time, the defect is associated with a number of diseases and conditions: the development of atrial fibrillation, worsening the degree of hypoxemia in patients with pulmonary diseases, etc. There are studies devoted to the influence of a patent foramen ovale on the occurrence and course of cryptogenic stroke, migraine, syncope, dizziness, transient global amnesia, visual impairment and ocular movement disorders. However, the actual contribution of patent foramen ovale to the development of neurological disorders remains a matter of debate. The purpose of this work was to assess the significance of a patent foramen ovale in the development of neurological disorders in adults and children by analyzing literature data for the period from 2012 to 2022. In the process of studying the literature, a high prevalence of the defect was identified among patients with stroke and migraine (especially migraine with aura). At the same time, data from randomized clinical trials in patients with stroke and migraine showed selectively high effectiveness of closure of the patent foramen ovale in certain groups of patients. The association of patent foramen ovale with transient global amnesia, syncope, and dizziness has been confirmed in a limited number of studies. Cases of visual impairment and ocular movement disorders associated with the presence of a patent foramen ovale have been described. Thus, it was concluded that a patent foramen ovale is a risk factor for the development of neurological disorders only in certain groups of patients with stroke and migraine. The connection between the defect and the development of transient global amnesia, syncope, dizziness, visual impairment, as well as the development of neurological pathology in children requires further research.

Orbital compartment syndrome after pterional craniotomy for arachnoid cyst resection

Abstract Orbital Compartment Syndrome (OCS) represents a critical medical emergency characterized by heightened orbital pressure, jeopardizing blood flow and posing a risk to the optic nerve. Often stemming from surgical procedures such as craniotomies for arachnoid cyst resection, OCS necessitates swift diagnosis and intervention. We report the case of a 77-year-old female in São Paulo, Brazil, who underwent left pterional craniotomy for arachnoid cyst resection. Postoperatively, she manifested reduced visual acuity in the left eye, restricted ocular movement, and peripalpebral hematoma indicative of orbital compression syndrome. Computed tomography scans confirmed pneumocephalus and pneumo-orbital complications, prompting an immediate diagnosis of OCS. Immediate interventions, including lateral canthotomy and cantholysis, were employed, resulting in successful decompression and substantial symptom improvement within a 10-day period. This case underscores the significance of preoperative imaging, prompt diagnostic measures, and collaborative postoperative care in managing orbital complications following neurosurgery.

Reduced maximal range of ocular movements and its response to acute levodopa challenge in Parkinson's disease.

Although restriction of vertical ocular range of motion is known to be the hallmark of progressive supranuclear palsy (PSP), the maximal amplitude of ocular movement has not been quantitatively assessed despite of accumulating evidences of oculomotor dysfunction in Parkinson's disease (PD). Here, we evaluated the maximal oculomotor range and its response to levodopa in PD, and compare findings to atypical parkinsonism. We recruited 159 healthy controls (HC) as well as 154 PD, 30 PSP, and 16 multiple system atrophy (MSA) patients. Oculomotor range was assessed using a kinetic perimeter-adapted device for the vertical and horizontal axes (four positions). Parameters were reassessed after levodopa challenge and compared among PD, PSP, and MSA patients. Maximum oculomotor range in PD patients was reduced as compared to HC. Levodopa improved oculomotor range in all directions; corrective effects of upward range positively correlated with improvements in Unified Parkinson's Disease Rating Scale III and bradykinesia sub-scores among PD patients. Although oculomotor range was markedly restricted among PSP and MSA patients, the beneficial effects of levodopa was less pronounced. Reduced oculomotor range of motion was more significant among PSP as compared to PD or MSA patients; MSA patients did not significantly differ from PD patients. The range of upward gaze was optimally sensitive for differentiating among PD, PSP, and MSA patients. Maximum oculomotor range was reduced among PD patients significantly improved by levodopa treatment. Variations in, as well as the positively effects of levodopa on, the range of upward gaze assist diagnostic differentiation among PD, PSP, and MSA patients.

Joubert syndrome-derived induced pluripotent stem cells show altered neuronal differentiation in vitro.

Joubert syndrome (JS) is a recessively inherited congenital ataxia characterized by hypotonia, psychomotor delay, abnormal ocular movements, intellectual disability, and a peculiar cerebellar and brainstem malformation, the "molar tooth sign." Over 40 causative genes have been reported, all encoding for proteins implicated in the structure or functioning of the primary cilium, a subcellular organelle widely present in embryonic and adult tissues. In this paper, we developed an in vitro neuronal differentiation model using patient-derived induced pluripotent stem cells (iPSCs), to evaluate possible neurodevelopmental defects in JS. To this end, iPSCs from four JS patients harboring mutations in distinct JS genes (AHI1, CPLANE1, TMEM67, and CC2D2A) were differentiated alongside healthy control cells to obtain mid-hindbrain precursors and cerebellar granule cells. Differentiation was monitored over 31days through the detection of lineage-specific marker expression by qRT-PCR, immunofluorescence, and transcriptomics analysis. All JS patient-derived iPSCs, regardless of the mutant gene, showed a similar impairment to differentiate into mid-hindbrain and cerebellar granule cells when compared to healthy controls. In addition, analysis of primary cilium count and morphology showed notable ciliary defects in all differentiating JS patient-derived iPSCs compared to controls. These results confirm that patient-derived iPSCs are an accessible and relevant in vitro model to analyze cellular phenotypes connected to the presence of JS gene mutations in a neuronal context.

Clinical assessment of corneal alterations in endocrine disorders

Corneal alterations are frequent in many endocrine disorders like Grave’s ophthalmopathy and diabetes mellitus. Since early diagnosis of such a change can prevent visual impairment, it presents a challenge to an ophthalmologist.Clinical assessment & significance of corneal alterations in endocrine disorders.1. To conduct comprehensive assessment of corneal alterations in endocrine disorders. 2. To Identify specific corneal abnormalities in patients with endocrine disorders. 3. To delineate the clinical significance of corneal alterations in endocrine disorders by determining their impact on visual function and guiding therapeutic strategies.This study was a prospective, observational, hospital-based study conducted over a period of two years including 150 patients of different endocrine disorders. Ocular examination included physical examination to check for any pain on ocular movements, ophthalmoplegia, diplopia, or proptosis. Visual acuity was examined by Snellen’s chart, anterior segment by slit-lamp, intra-ocular pressure by non-contact tonometer, qualitative measurement of corneal sensation by a cotton-wisp and central corneal thickness was measured by pachymetry. Corneal endothelial cell parameters like endothelial cell density (ECD), coefficient of variation of cell area (CV), percentage of hexagonal cell (HEX) were measured by clinical specular microscope.The age range was 14 to 82 years with mean age being 48.43±14.2 years. The male to female ratio was 1.34:1. Type-2 diabetes mellitus was the most frequently encountered endocrine disorder (64.7%), followed by hypothyroidism (13.3%). Addison’s disease was the least encountered (0.7%). The most severe changes to the cornea, such as chronic epithelial abnormalities, superficial punctate keratopathy, altered corneal sensations, and dry eyes, were observed in patients with type 2 diabetes, followed by Graves’s ophthalmopathy and hypothyroidism. Patients with T2DM and T1DM had elevated CCT values, reduced endothelial cell density, abnormally high coefficient of variance and low hexagonal cells.The present study showed that different corneal alterations can be possible in endocrine disorders. So all endocrine disorders should undergo comprehensive ophthalmological examination to prevent visual impairment.

Clinical study of esodeviations in children

Esotropia or convergent strabismus is a common type of squint in children. The esodeviation, the refractive error and the amblyopia should be examined and treated early to achieve good cosmetic correction and to improve Visual acuity.A meticulous history of 25 children up to age of 12 years who presented with esodeviations was taken including the age of onset, duration and previous treatment. They were examined for amount and type of deviation by cover test, hirschberg corneal reflex test, Prism bar cover test and evaluated for refractive error under full cycloplegic correction, for Binocular Single Vision, diplopia, suppression and amblyopia by Worth four-dot test and RAF ruler. Ocular movements and fundus findings were recorded.11 male and 14 female children with esodeviations with age of presentation varying from 9 months to 12 years were evaluated for type of esotropia. In our study the most common type seen in 12 cases (48%) is refractive accommodative esotropia with high hypermetropia. Non-refractive accommodative esotropia greater for near with high AC/A ratio in 5 patients (20%), Partially accommodative (mixed) esotropia in 2 cases, acquired non-accommodative esotropia seen in 2 patients. 1 case each is seen in Infantile esotropia, in Sensory esotropia, in child with Duane’s retraction syndrome (DRS) and in child having cerebral visual impairment (CVI).Our study aimed to diagnose and manage the various types of esodeviations at an early age so as to maintain binocular alignment and a good Visual acuity to avoid progression to amblyopia.

Recovery Process for Sports-Related Concussion Assessed with Precise Ocular Motility.

Ocular motility has been linked to Sports Concussion Assessment Tool 5 scores. However, the link between ocular motility changes and assessment result changes remains unclear. Hence, we investigated that potential link in patients with sports-related concussions. We retrospectively included participants aged≥18 years who were diagnosed with a sports-related concussion. They underwent smooth pursuit eye movement assessment for allocation to the good improvement (rate of fundamental frequency≥15%) or minor improvement (<15%) groups. Sports Concussion Assessment Tool 5 scores were determined at baseline and two weeks later, and score changes were compared between the groups. Thirteen men (mean±standard deviation age: 20.6±5.0 years) were included: eight (19.0±4.5 years) in the good improvement group and five (20.6±5.7 years) in the minor improvement group. Symptom number (median=2.0 vs. 0.0), symptom severity (median=22.0 vs. 3.0), single-leg stance (median=4.0 vs. 0.5), tandem stance (median=1.0 vs. 0.0), and total errors (median=5.0 vs. 0.5) were worse (all p<0.05) in the minor improvement group. Smooth pursuit eye movement improvements measured using eye-tracking technology was linked to symptom recovery in patients with sports-related concussions. Therefore, ocular motility may be an objective indicator of sports-related concussions. Future studies with more patients are needed to confirm these findings.

Clinical effect of superior oblique re-tucking for recurrent or residual compensatory head position

Objective: To evaluate the effects of re-tucking the superior oblique muscle on recurrent or residual compensatory head position. Methods: A retrospective case series study was conducted. 12 recurrent or residual compensatory head position patients (12 eyes) with congenital superior oblique palsy who underwent superior oblique re-tucking in Tianjin Eye Hospital from March 2015 to February 2021 were included. All patients had a history of superior oblique tucking procedure and showed signs of superior oblique muscle palsy without inferior oblique muscle overaction. During surgery, the Guyton forced duction test is used to evaluate the relaxation of the superior oblique muscle tendon, which affects the re-tucking length of the muscle.Their head position, vertical deviation, eye movement, fovea-disa angle, and Bielschowsky head tilt test were assessed pre-and post-surgery. Statistical analysis was performed using ttest and paired samples Wilcoxon signed rank test. Results: Out of the 12 patients, 8 were male and 4 were female, aged between 2 and 9 years. The initial surgery was done at age 6, with a superior oblique recession length of (7.17±1.03) mm. Recurrent head tilt occurred in 11 patients after (3.82±0.98) months postoperatively, and 1 patient had residual head tilt, with a followup period of six months or more. Ocular motility examination revealed underaction of the superior oblique muscle, positive Bielschowsky's head tilt test, and Guyton forced duction tese indicating relaxation of the paralyzed superior oblique muscle tendon. Scar adhesion was observed at the stop of the superior oblique muscle, as well as the previous sutures. The scar and the sutures around the stop of the superior oblique muscle were released, the mean re-tucking amount was(7.83±1.59)mm. Follow-up at 12 to 18 months postoperatively showed disappearance of compensatory head position, significant improvement in superior oblique muscle lag, normal ocular motility, and no occurrence of Brown syndrome. The results of Bielschowsky head tilt were negative in 9 cases and still positive in 3 cases after superior oblique re-tucking. The primary vertical deviation was 2.5 (2.0, 5.3) prism diopter pre-operatively and 1 (0, 1) prism diopter post-operatively, respectively. The difference was statistically significant (U=6.00, P<0.001). The total amount of FDA in both eyes was (-22.04±5.47)° and (-15.27±6.08)° pre-and post-operatively, respectively. The difference was statistically significant (t=2.87, P=0.009). All 12 patients have normal eye movement after superior oblique re-tucking procedure. All patients had no compensatory head position at last follow-up. Conclusions: Superior oblique re-tucking is suitable for patients with relaxation of the superior oblique muscle tendon and extrocular rotation as the main sign. It can effectively and safely correct the recurrent or residual compensatory head position after re-tucking the superior oblique muscle.

Comparative study between 0.5% bupivacaine versus 0.5% ropivacaine in peribulbar anesthesia for cataract surgery

Background: For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia. Aims and Objective: This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion. Material and Methods: Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment. Results: Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P&gt;0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P&gt;0.05). (P&gt;0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05). Conclusion: Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine.

Clinical features of double seronegative ocular myasthenia gravis.

To clarify the clinical features of patients with Double seronegative (DS) ocular myasthenia gravis (OMG). Sixty-one patients diagnosed with DS OMG at the Department of Ophthalmology, Hyogo Medical University Hospital over a 5-year period from 2017 were included. Patients were classified into three groups based on the initial examination findings: group P (ptosis alone), group M (ocular motility disorder alone), and group PM (combination of both). We retrospectively reviewed the patients and clarified their clinical features. There were 32 males and 29 females, with a mean age of 49.8 ± 20.9:1-82years. Twenty-one patients (34.4%) were in group P, 23 (37.7%) in group M, and 17 (27.8%) in group PM. The proportion of males (73.9%) was significantly higher in group M compared with the other two groups. The diagnosis was proven by detection of neuromuscular junction (NMJ) disorder in 73.8%, oral pyridostigmine trial test in 13.1%, and eight patients (13.1%) in group M were diagnosed after surgical treatment. The clinical symptoms were resolved by oral pyridostigmine treatment in 54.1% of cases. About 30% of patients with DS OMG had no obvious NMJ disorder, and an oral pyridostigmine trial test was necessary to diagnose these patients. Although DS OMG is often considered as the mildest form of MG, its prognosis is not optimistic and it requires aggressive therapeutic intervention. Trial registration number: 202104-750, "2016/4/18," retrospectively registered.

Neonatal Orthoptic Screening Battery (NOSB): Four-decade Experience of Orthoptic Best Practice

The present study describes the neonatal orthoptic screening battery (NOSB), a comprehensive orthoptic screening, based on four decades of application, aimed at early identification of signs and symptoms of ocular pathology or functional disorders. The NOSB allows for verifying the integrity of ocular components and early detection of functional alterations in ocular movements that could lead to the development of amblyopia or strabismus. The NOSB is the result of 45 years of screening activity in a primary health center assured by the National Health System in the city of Ragusa – Italy. It aims to examine and assess the neonate within the first 3 days of extrauterine life to identify visual system issues as early as possible. The NOSB may be conducted by Orthoptists, healthcare professionals specializing in neonatal and pediatric visual prevention. The Neonatal Orthoptic Screening battery (NOSB) here reported is proposed as a standard suitable for widespread adoption to be considered a "Best Practice".

Differential diagnosis of thyroid orbitopathy - diseases mimicking the presentation or activity of thyroid orbitopathy.

Thyroid orbitopathy (TO) is the most common cause of orbital tissue inflammation, accounting for about 60% of all orbital inflammations. The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Magnetic resonance imaging (MRI) of the orbit is used not only to identify swelling and to differentiate inflammatory active from non-active TO, but also to exclude other pathologies, such as orbital tumours or vascular lesions. However, a group of diseases can mimic the clinical manifestations of TO, leading to serious diagnostic difficulties, especially when the patient has previously been diagnosed with a thyroid disorder. Diagnostic problems can be presented by cases of unilateral TO, unilateral or bilateral TO in patients with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and history of increasing diplopia at the end of the day. The lack of visible efficacy of ongoing immunosuppressive treatment should also raise caution and lead to a differential diagnosis of TO. Differential diagnosis of TO and evaluation of its activity includes conditions leading to redness and/or swelling of the conjunctiva and/or eyelids, and other causes of ocular motility disorders and eye-setting disorders. In this paper, the authors review the most common diseases that can mimic TO or falsify the assessment of inflammatory activity of TO.

Gaze analysis: A survey on its applications

The examination of ocular movements has a wide range of applications due to the current developments in sensors that are now able to collect this biometric. This type of investigation is known as “gaze analysis”. The gaze has successfully examined a subject's physical and mental status in the past. As a result, over the last few decades, a large and diverse amount of literature on this subject has been generated and presented. The aim of this study is to collect and debate current gaze analysis methods based on their application field. Due to the context-specific needs for performance and efficiency, the eye movements under research are frequently evaluated from completely distinct perspectives. As a result, a collection of data, methods, and discussions ranging from the medical community to virtual and augmented reality, as well as human computer interface and remote learning, has been produced. In addition to providing a peek of novel observation on the issue of gaze analysis, the gaps between and within areas are also discussed to provide points for researchers to pursue.

Ophthalmic exam and ophthalmology residents' subspecialty preference.

To evaluate residents' perceptions and attitudes toward the various aspects of a comprehensive ophthalmic examination, and to determine if these factors correlate with their choices for fellowship and future career plans. This is a cross-sectional study. A questionnaire on the perception of the ophthalmic exam was sent via SurveyMonkey to ophthalmology residents throughout Israel. Eighty of them (one-half of all ophthalmology residents in 2019) completed it. The first part related to how they perceived each component of the ophthalmic evaluation. The second part related to their future fellowship plans. The Chi-squared test was used to compare categorical variables and Student's t-test and One-way ANOVA were used to compare continuous variables. Multivariate logistic regression analysis was applied as needed to detect interactions between variables and to exclude confounder effects. Slit-lamp examination of the anterior and posterior segments ranked as the most likeable aspects, whereas gonioscopy, ocular motility examination and visual acuity assessment were least likeable. Anterior segment and retina subspecialties were the ones most sought after. Forty-nine respondents (61.3%) noted a direct correlation between their preferred parts of comprehensive ophthalmic evaluations and their choice of subspecialty. Perceptions of selected components of those evaluations were significantly associated with responders' intentions to pursue anterior segment, retina, or oculoplastic fellowships (P<0.05). Perspectives of residents toward the ophthalmic examination, and most specifically its individual components, play an important role in their choice of subspecialty training.

Ocular Movement Disorder after Scleral Buckling Surgery in Patients with Retinal Detachment

Ocular Movement Disorder after Scleral Buckling Surgery in Patients with Retinal Detachment

SURGICAL OUTCOME OF MUSCLE TRANSPLANTATION AS A MONOCULAR SURGERY FOR LARGE ANGLE STRABISMUS

Introduction: The management of large-angle strabismus can be difficult for surgeons, and successful outcomes may require multiple surgeries. However, modern surgical techniques aim to achieve desired results with a single operation. Muscle transplantation is one such technique that increases the effective muscle length, allowing for a large correction in a one-stage surgery. Objective: To report the outcome of muscle transplantation surgery in large-angle strabismus. Case Illustration: Three patients presented with large-angle strabismus, of which two cases showed &gt;50∆ ET and one case had &gt;50∆XT. All patients had normal anterior and posterior segment findings and underwent muscle transplantation under general anaesthesia. The first and second cases showed good alignment post-surgery, with no limitations in ocular motility in all gaze directions and improved visual acuity. However, none of the cases achieved stereoscopic vision due to chronic strabismus. In the third case, improvement in the primary position was observed two weeks post-operative, but ocular motility still had limitations. Conclusion: Muscle transplantation is a good option to correct large-angle strabismus, specifically in the unilateral case in a single procedure.