Outcome Of Strabismus Surgery Research Articles

Strabismus Surgery for Psychosocial Reasons-A Literature Review.

Strabismus surgery may be undertaken for visual benefit, to improve or eliminate diplopia symptoms, or to restore or improve binocular single vision (BSV). In patients without visual symptoms or expected visual benefit, strabismus surgery may still be undertaken if the presence of strabismus causes the patient psychosocial symptoms. To evaluate strabismus surgery undertaken for psychosocial reasons, evidence of postoperative outcomes in this specific cohort is needed. A systematic search of the literature was conducted (1946-2023) to identify evidence where postoperative outcomes were reported for adult patients (age 18 years and above) who had undergone strabismus surgery for psychosocial reasons. Sixty-nine papers were included in the literature review. Most sources of evidence included patients within heterogeneous cohorts of strabismus surgery outcomes, with a range of symptoms and differing surgical aims. In adults who underwent strabismus surgery for psychosocial reasons, improved postoperative ocular alignment and/or improved health related quality of life (HRQoL) were common. Strabismus surgery outcomes appeared to be measured satisfactorily at three months postoperatively. Additional surgical outcomes, including an expanded field of vision, unexpected BSV, improved binocular summation, improved task performance and improved eye movements have been reported, but not fully investigated. There was a lack of consensus on how postoperative success should be defined and measured. A core outcome set for strabismus has been suggested and there is potential to add to the available evidence by investigating which outcome measures are most relevant to those with strabismus and psychosocial symptoms. There is a growing need for robust evidence in this specific subgroup of patients due to a lack of evidence specifically reporting postoperative outcomes in adults with strabismus and psychosocial symptoms.

Prematurity May Affect the Postoperative Sensory Results in Children With Strabismus.

To analyze the motor and sensory outcomes of strabismus surgery in children born preterm (premature group) and full-term (control group). The study was performed at a tertiary university hospital. Children who underwent strabismus surgery between 2012 and 2019 were retrospectively reviewed. The success of surgery, postoperative over-correction and undercorrection rates, and stereopsis and fusion test results were compared between the premature and control groups. There were 70 patients in the premature group (mean gestational age: 31.25 weeks; range: 24 to 35 weeks) and 242 patients in the control group. The amounts of preoperative and postoperative deviations and overcorrection, undercorrection, and success rates were similar between the premature and control groups (P > .05). Stereopsis improved from 560 to 300 arc/sec postoperatively in the premature group (P = .066) and from 1,156 to 685 arc/sec in the control group (P < .001). The rate of fusion increased from 12.5% to 25% in the premature group (P = .50) and from 17% to 47% in the control group (P < .001). The analysis of strabismus subgroups revealed significant improvement of fusion in full-term patients (P < .001) and not in preterm patients (P = .50) with esotropia. Preoperative amount of deviation was the only risk factor for surgical success (P < .001). Age, sex, history of prematurity, and spherical equivalent refraction were not correlated with undercorrection (P > .05). Regardless of the type of strabismus, although the functional results after strabismus surgery were similar in preterm and full-term patients, the gain of stereopsis and central fusion was significantly higher in full-term patients compared to preterm patients. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Postoperative outcome and influencing factors of strabismus surgery in infants aged 1-6years.

To evaluate the postoperative outcome of strabismus surgery performed in children aged 1-6 years by investigating the change of the preoperative angle of deviation (AOD), elevation in adduction, best-corrected visual acuity (BCVA) and refractive error. Retrospective chart review of 62 children who received strabismus surgery between January 2018 and December 2021 at the Department of Ophthalmology and Optometry of the Medical University of Vienna. Age, sex, type of strabismus, AOD, BCVA, refractive error and visual acuity were evaluated with respect to the postoperative outcome. Mean follow-up was 13.55 ± 11.38 months with a mean age of 3.94 ± 1.97 years (range: 1.0-6.0) at time of surgery. 74.19% of patients (n = 46) had isolated or combined esotropia, 12.90% (n = 8) had isolated or combined exotropia and 12.90% (n = 8) had isolated strabismus sursoadductorius. Mean preoperative AOD of 15.69 ± 16.91°/15.02 ± 14.88° (near/distance) decreased to 4.00 ± 9.18°/4.83 ± 7.32° (near/distance) at final follow-up (p < 0.001). BCVA improved from 0.26 ± 0.26/0.25 ± 0.23 (left/right) to 0.21 ± 0.25/0.20 ± 0.23 (left/right) (p = 0.038). There was no significant change regarding refractive error (p = 0.109) or elevation in adduction (p = 0.212). Success rate which was defined as a residual AOD of less than 10° was 74.19% (n = 46). In 3.23% (n = 2) retreatment was necessary. Strabismus surgery in infants was shown to have a satisfactory outcome with a low retreatment rate. Surgical success rate was not linked to age, sex, type of strabismus or the preoperative parameters AOD, refractive error and visual acuity in this study.

Outcomes of Strabismus Surgery Following Teprotumumab Therapy

PurposeTo investigate the results of patients undergoing surgical treatment for strabismic diplopia in thyroid eye disease (TED) following teprotumumab. DesignMulticenter, retrospective, case series. MethodsWe report 28 patients who underwent extraocular muscle surgery for strabismic diplopia after treatment with teprotumumab at 7 different academic centers. Elapsed time from last teprotumumab dose to the date of surgery, previous orbital decompression, primary preoperative horizontal and vertical deviation, surgical procedure, and 2-month postoperative results were collected from the patient records. ResultsSixteen (57%) patients were diplopia-free after one surgery. Three (11%) chose prism spectacles to correct residual diplopia, 2 (7%) used compensatory head posture to resolve diplopia, and 1 (4%) had intermittent diplopia and was functionally improved (choosing no prisms or further surgery). These were considered treatment successes. Three (11%) patients required reoperation, and all were diplopia-free after their second procedure. ConclusionsMost patients requiring surgery for strabismic diplopia following teprotumumab achieve good outcomes with success rates comparable to series published before the availability of teprotumumab.

Outcomes and Factors Associated with Successful Strabismus Surgery for Abducens Nerve Palsies: A Retrospective Study and Literature Review.

Several studies reported surgical outcomes for abducens nerve palsy, but information on factors that affect treatment success remains lacking. These factors are crucial for developing a treatment plan and providing disease counseling. This study aimed to investigate the outcomes of strabismus surgery for abducens nerve palsy and determine the factors that influence its success, including a review of relevant literature. This retrospective analysis included abducens nerve palsy cases, focusing on surgical interventions and relevant patient data, at the outpatient clinics of Phramongkutklao Hospital from April 1, 2012, to April 30, 2022. A relevant literature review included the surgical success rate and factors that influence surgical outcomes. This study enrolled 32 patients, including 19 with partial and 13 with complete abducens nerve palsy. The overall success rate of strabismus surgery was 78.1%. Trauma was the leading cause of abducens nerve palsy in this population (28.13%). Fisher's exact and Mann-Whitney U-tests revealed that shorter abducens nerve palsy onset and smaller preoperative angle were significantly associated with successful surgical outcomes of strabismus surgery among the groups. In contrast, subgroup analysis revealed that only preoperative smaller angles were significantly associated with good surgical outcomes in horizontal strabismus surgery. However, the vertical rectus muscle transposition group demonstrated no significant factors. The literature review revealed that the success rate of surgery in abducens nerve palsy was 25%-82.6% for horizontal rectus muscle surgery and 46.2%-91% for rectus muscle transposition. The surgical success rate for abducens nerve palsy reached 78.1%, including 78.95% for partial and 76.92% for complete abducens nerve palsy. Notably, a shorter onset preceding surgery and a smaller preoperative angle significantly correlated with successful surgical outcomes one year postoperatively.

Unusual outcome of strabismus surgery in a case of Apert syndrome: A case report

Abstract Apert syndrome (AS) is a form of acrocephalosyndactyly, which is characterized by craniosynostosis, midfacial hypoplasia, and symmetrical syndactyly of the hands and feet. A 3-year-old female with craniosynostosis, high-arched palate, syndactyly, strabismus, and diagnosed as a case of Apert syndrome was brought to the outpatient department. Strabismus evaluation revealed 35 prism diopters of left convergent squint. Magnetic resonance imaging of the brain and orbit revealed hypoplastic extraocular muscles. A plan to carry out a bilateral medial rectus recession was made. However, intraoperatively, normal-sized muscles were found and the plan was modified to carry out only a left eye medial rectus recession of 5.5 mm. The patient was orthophoric postoperatively, indicating the unusual postoperative outcome in such a case. This report aimed to underline the challenges of managing a case of strabismus and the variable postoperative outcomes encountered in a case of Apert syndrome.

Correlation of Strabismus Surgical Outcomes Graded by Goal-Determined Metric With Patient Satisfaction Survey

PurposeWhile strabismus surgery outcomes can be objectively measured, patient perception of results may differ. We present surgical outcomes graded by a prospective, “goal-determined metric” and compare these outcomes to results of a patient satisfaction survey. DesignValidity analysis comparing a clinical “goal-determined metric” to patient satisfaction MethodsGoal-determined metric outcomes (2018-2021) for two surgeons treating esotropia or exotropia for diplopia control or reconstructive goals were collected. Inclusion required complete post-operative examination 2-6 months after surgery and a satisfaction survey. ResultsRecord review identified 275 patients; 228 (median age 41 years (IQR 13-59)) met inclusion criteria. For the entire cohort, 87% were graded as “excellent” outcomes, and 78% of patients were overall “very satisfied”. Agreement between patients’ and surgeons’ grading was 75-79% for all reconstructive surgery and for treatment of diplopia from esotropia. Agreement was lower, though not statistically different, for treatment of diplopia from exotropia (64%; 95% CI 43-80%) (P=0.184). Pre-operative risk factors, concurrent vertical or oblique surgery, and sex did not affect outcomes or satisfaction. Performance of activities requiring distance viewing improved more than performance of activities at near after esotropia-diplopia surgery (odds ratio 3.0 (95% CI: 1.5-6.4, P=0.004)). For reconstructive cases achieving “much better” eye alignment, 62% and 72% (previously esotropic and exotropic) reported enhanced self-confidence. ConclusionsOutcomes graded by goal-determined metric correlated well with many aspects of patient satisfaction. Patient-perceived improvement in appearance was important regardless of goal. Greater improvement in performance of activities requiring distance rather than near viewing characterized treatment of diplopia from esotropia.

Acquired comitant esotropias – comparison of surgical outcomes of accommodative vs non-accommodative types

ABSTRACT Purpose: To compare the motor and sensory outcomes of strabismus surgery and the factors affecting surgical success in acquired acute non-accomodative esotropia (ANAET) and partially accommodative refractive esotropia (pARET). Methods: A retrospective chart review of patients with ANAET and pARET who underwent unilateral or bilateral horizontal rectus muscle surgery between January 2020 and December 2021 was conducted. Patients with postoperative follow-up of at least six weeks were included. Patients with pattern deviation, lateral incomitance, and near-distance disparity were excluded. Motor success was defined as a postoperative deviation within eight prism diopters of orthophoria. Sensory success was defined as presence of binocular single vision (BSV) for both distance and near (Worth four dot test). The effect of factors like age at onset, age at surgery, amblyopia before surgery, duration of squint before treatment, presence or absence and magnitude of vertical deviation, preoperative angle of deviation, and spherical equivalent on the motor and sensory success in each group were analyzed and compared. Results: 38 patients with ANAET and 33 patients with pARET were included. The mean age of onset of esotropia was 8.55 ± 4.65 years and 4.39 ± 2.27 years (p < .001) and the mean age at surgery was 10.62 ± 4.99 years and 7.89 ± 2.84 years (p = .006) in the ANAET and the pARET group respectively. The mean duration of the final follow-up was 38.51 weeks in the ANAET and 48.68 weeks in the pARET group (p = .089). Patients were successfully aligned for both distance and near in 81.5% of patients in the ANAET and 78.9% of patients in the pARET group at the final follow-up (p. 0.775). A BSV for both distance and near at the final follow-up was seen in 81.2% vs 66.6% of patients in the ANAET and the pARET group respectively (p = .25). A good near stereoacuity (<120 arcsecs) was seen in 60.6% and 41.9% of the ANAET and the pARET groups respectively (p = .175). The percentage of patients in the ANAET group who had orthophoria, any esodeviation, and any exodeviation for distance at the final follow-up was 63.1%, 34.2% and, 2.6%. The percentage of patients in the pARET group in similar categories was 36.3%, 42.4% and, 21.2%. None of the demographic and preoperative factors were found to affect the surgical outcomes in the two groups. Conclusions: The motor and sensory outcomes were similar in the two groups. A higher proportion of ANAET patients remained orthophoric during the follow-up. The patients in the pARET group showed a tendency toward exodrift.

Comparative Assessment of Short-Term Tendon-Scleral Postoperative Inflammation and α-Smooth Muscle Actin Expression following Oral and Topical Diclofenac Administration for Strabismus Surgery in Rabbits

PurposeWound healing and fibrosis modulation are considered pivotal for the long-term outcome of strabismus surgery. Nonsteroidal anti-inflammatory drugs, including diclofenac sodium, are inflammation suppressive drugs that may modulate wound healing, including postoperative inflammation. This study aimed to compare the effect of oral and 0.1% topical diclofenac sodium on short-term inflammation and α-smooth muscle actin (α-SMA) expression at the tendon-scleral attachment site following strabismus surgery in an experimental rabbit model.MethodsSuperior rectus recession was performed in 12 eyes of six New Zealand rabbits. Rabbits were divided into three groups: oral diclofenac 2 × 5 mg/kg for three days (group A), 0.1% diclofenac sodium eye drops 3 times/day for three days (group B), and controls (group C). On postoperative day 14, enucleation was performed. Macroscopic adhesion score, microscopic adhesion score, percentage of postoperative inflammation area (Masson’s trichrome staining), and α-SMA (immunohistochemistry staining) were assessed. Data analysis was performed using a semi-quantitative and quantitative assessment with ImageJ. All groups were compared with reciprocal staining intensity (RSI) values to measure α-SMA expression.ResultsAll groups showed no difference in macroscopic (p = 0.13) and microscopic adhesion scores (p = 0.28). The percentage of postoperative inflammation area in group B (12.44% (8.63–18.29)) was significantly lower than group A (26.76% (21.38–37.56) p = 0.03) and group C (27.80% (16.42–36.28), p = 0.04). Comparative RSI analysis found that group B had a significantly lower α-SMA expression than group C (174.08 ± 21.78 vs 212.58 ± 12.06, p = 0.04).ConclusionThe results suggest that compared to oral, the administration of topical diclofenac showed a more significant reduction of short-term postoperative inflammation and α-SMA expression at the tendon-scleral attachment site following strabismus surgery.

Postoperative drift and dose-response of strabismus surgery in thyroid eye disease: predicting desired outcomes with intraoperative adjustable sutures

ObjectifPrésenter les résultats de la correction chirurgicale du strabisme secondaire à l'ophtalmopathie thyroïdienne réalisée par l'insertion de sutures de type « nœud papillon » (bow-knot) ajustables en cours de chirurgie sous anesthésie locale et concevoir des modèles de prédiction de la correction chirurgicale et de la déviation postopératoire en fonction de la relation dose-effet de l'intervention. MéthodesNous avons procédé à une analyse rétrospective des dossiers de patients opérés entre 2016 et 2021. Le résultat était jugé satisfaisant si la diplopie avait disparu et s'accompagnait d'un alignement vertical (< 5 DP) et horizontal (< 10 DP) stable en position primaire du regard. La correction de la diplopie subjective au moyen de prismes permettant un alignement moteur était considérée comme un résultat passable. Dans les autres cas, le résultat était jugé médiocre. RésultatsAu total, 73 patients ont été admis à cette étude (60 femmes, soit 82 %). Les déviations horizontales et verticales moyennes en période préopératoire se chiffraient à 26,9 DP (é.-t. : 19,1) et à 11,8 DP (é.-t. : 7,6), respectivement. La déviation horizontale moyenne était de –3,2 DP (é.-t. : 5,2), tandis que la déviation verticale moyenne était de –3,4 DP (é.-t. : 3,3). Une analyse de régression linéaire a permis d’établir une relation dose-effet de 2,37 DP/mm pour la récession du droit médial (p < 0,0001; r2 = 0,777) et de 3,75 DP/mm pour la récession unilatérale du droit inférieur (p < 0,0001; r2 = 0,922). Les taux de réussite se déclinaient comme suit : satisfaisant chez 62 patients (85 %), passable chez 7 patients (10 %) et médiocre chez 4 patients (5 %). ConclusionsLa récession musculaire réalisée au moyen de sutures ajustables pendant l'intervention est une technique efficace pour corriger le strabisme secondaire à l'ophtalmopathie thyroïdienne. Il est possible d'obtenir une relation dose-effet prévisible avec une tendance vers une surcorrection. Une sous-correction proportionnelle à l'ampleur de la chirurgie prévue devrait être la cible de choix en période postopératoire immédiate. On n'a pas pu établir de corrélation entre d'autres variables, notamment la décompression orbitaire et la chirurgie à la fois verticale et horizontale, et la relation dose-effet ou la déviation postopératoire. Cela dit, d'autres études devront être réalisées afin de valider nos résultats.

Evaluation of Factors Affecting the Outcomes of Strabismus Surgery and Treatment of Amblyopia

Evaluation of Factors Affecting the Outcomes of Strabismus Surgery and Treatment of Amblyopia

Larger Than Larger: Huge Amounts of Recession-Resection Surgery for Third Nerve Palsy.

To describe the characteristics and management outcomes of strabismus surgery in patients with third cranial nerve palsy and identify factors associated with long-term outcomes. A 10-year retrospective study of patients with third cranial nerve palsy who underwent strabismus surgery was performed at Zhongshan Ophthalmic Center, Sun Yat-sen University, China, between August 2010 and January 2021. Clinical characteristics and factors associated with long-term outcomes were evaluated. Success of surgery was defined as esotropia of 15 prism diopters (PD) or less at postoperative day 1 (POD1) or any deviation of 10 PD or less at postoperative month 2 (POM2) or later. A total of 91 patients were included, with a mean age of 24.02 ± 15.38 years (range: 2 to 64 years). Forty-one patients (45.1%) were diagnosed as having complete palsy. Congenital palsy accounted for 40.7% (n = 37). Mean follow-up time was 2.50 ± 1.78 years (range: 8 months to 8 years). One-step surgery was performed in 78.0% of cases (n = 71), a staging procedure in 7.7% (n = 7), and reoperations in 14.3% (n = 13). Most patients had supra-maximal recession and resection of the horizontal rectus muscle with additional techniques, including horizontal rectus transposition, superior oblique transposition, traction sutures, and fixation of the globe. The mean surgical dosage performed on the horizontal rectus muscle was 18.52 ± 5.69 mm (range: 8 to 35 mm). Success rates at postoperative month 8 (POM8) were 69.0% (49 of 71) in the one-step surgery group, 57.1% (4 of 7) in the staging surgery group, and 46.2% (6 of 13) in the reoperation group. Preoperative horizontal deviation (odds ratio [OR]: 1.07, 95% CI: 1.02 to 1.13, P = .011), horizontal deviation at POD1 (OR: 0.86, 95% CI: 0.76 to 0.97, P = .016), and horizontal deviation at POM2 (OR: 1.53, 95% CI: 1.18 to 1.98, P = .001) were associated with the outcomes at POM8. Patients with partial palsy had a higher success rate than those with complete palsy (76.0% vs 51.2%, P = .014). Supra-maximal recession and resection with additional techniques yields satisfying surgical results in patients with third nerve palsy when a larger surgical dose is performed for an initial overcorrection for 15 to 25 PD at POD1. The cases with complete palsy showing a larger deviation were prone to failure. [J Pediatr Ophthalmol Strabismus. 2023;60(3):184-194.].

Outcomes and risk factors of surgical management of thyroid eye disease-related diplopia.

To evaluate the outcomes of strabismus surgery in patients with thyroid eye disease (TED) and to assess the influence of preceding treatments such as steroid administration, orbital decompression and radiotherapy. Retrospective study on a cohort of patients with TED undergoing strabismus surgery. Data collection included clinical features, smoking status, preceding steroid therapy, orbital radiation therapy and orbital decompression. Qualitative evaluation, assessing diplopia and quality of life and quantitative evaluation, assessing the eye misalignment were analysed 1 year after the last squint surgical procedure. Seventy-nine patients were identified. Ninety-five surgical procedures were performed on 92 eyes. A significant overall improvement of ocular motility was registered (p < 0.001, paired t-test). Forty-five (57%) patients had excellent outcomes, twenty-three (29%) had good outcomes and eleven (14%) had poor outcomes. The average number of muscles operated was significantly greater in patients who underwent orbital bone decompression (1.58 ± 0.63; p = 0.0082; 95% CI 1.413-10.214). Quantitative and qualitative outcomes were not associated with the preceding therapy: steroid (p = 0.75), radiotherapy (p = 0.95) or orbital bone decompression (p = 0.25). The success rate was no different between adjustable and fixed sutures (p = 0.8). Strabismus surgery in TED patients resulted in a high success rate in reducing diplopia and improving ocular motility. The success rate was not negatively associated with previous therapies. Indeed, resolution of diplopia required more squint procedures in patients who have previously undergone to orbital decompression.

Factors Determining Improvement in Stereopsis and Binocularity After Good Postoperative Alignment in Patients With Childhood-Onset Strabismus.

Introduction: The purpose of the present study was to determine the factors that affect the outcome of strabismus surgery in terms of improvement in stereopsis and binocularity.Methods: Data were collected prospectively from patients with childhood-onset, concomitant, constant strabismus greater than 30 prism diopters (PD) with postoperative alignment within 10 PD. Pre- and postoperative stereopsis and binocularity testing were performed using the Titmus fly test, random dot test, Bagolini striated glass test, and Worth four dot test at one, four, and 12 weeks postoperatively.Results: A total of 73 patients (55% males and 45% females) who underwent surgery at our center were studied. The mean age at the time of surgery was 16 ± 7.7 years (range: 5-35 years). We found that factors such as age of strabismus onset, type of deviation, and amblyopia had a statistically significant influence on the postoperative surgical outcome. A statistically insignificant relationship was noted with gender, refractive error, and duration of strabismus. Patients who had strabismus after six months of age noticed a significant improvement in stereopsis (p-value = 0.000) than those who had strabismus before six months of age (p-value = 0.660). Further, there was a statistically significant improvement in patients having exotropia (p-value = 0.018) or combined horizontal and vertical deviations (p-value = 0.000), but there was no significant improvement in patients with esotropia (p-value = 0.180). Moreover, non-amblyopes had a significantly better postoperative stereopsis than amblyopes (p-value = 0.006). Although there was no association between preoperative deviation and improvement in stereopsis (p-value = 0.081), patients having preoperative deviation in the range of 31-45 PD had a statistically significant improvement in stereopsis (p-value = 0.000). There was no significant difference between postoperative residual deviation and final stereopsis (p-value > 0.05). All the results were the same for both the Titmus test and the random dot test. Binocular fusion was observed in 34 subjects, and uniocular suppression was noted in 38 subjects preoperatively. It was observed that only one patient gained binocular single vision postoperatively.Conclusion: The presence of amblyopia, esotropia, early onset of strabismus (within six months of age), and a larger preoperative deviation (>45 PD) were associated with poorer stereopsis. In patients with horizontal strabismus, the coexistence of vertical deviation had a positive impact on the postoperative stereopsis. Gender, refractive error, and duration of strabismus did not influence the final stereopsis in our study.

Outcome of Strabismus Surgery for Exotropia in a 4-year-old with Silver-Russell Syndrome (SRS): A Case Report

Silver-Russell Syndrome (SRS) is a rare disorder associated with prenatal and postnatal growth retardation with associated characteristic facial and ocular features including strabismus. We report the outcome of strabismus surgery performed for exotropia in a 4-year-old patient with SRS. The patient presented with decreased visual acuity and constant exotropia of the right eye noted since 3 months of age. Systemic SRS characteristics consisted of relative macrocephaly, short stature, forehead prominence and stunted growth pattern. An X-pattern exotropia is consistent with bilateral tight lateral recti muscles with over-elevation in adduction of the left eye was present. Patient underwent unilateral right lateral rectus recession and right medial rectus resection for a 50-prism diopter constant exotropia. Patient had a favorable outcome of within 8 prism diopters from orthotropia at 1st, 3rd-, 6th- and 12th-month post-operatively.

Surgical outcomes of strabismus surgery in sensory exotropia

Surgical outcomes of strabismus surgery in sensory exotropia

Ophthalmologic characteristics and outcomes of children with cortical visual impairment and cerebral palsy

Cortical visual impairment (CVI) is the most common cause of pediatric visual impairment in developed countries, and cerebral palsy (CP) is diagnosed in approximately half of children with CVI. It is unknown whether children with CVI who also have CP (CVI+CP) have different characteristics and outcomes (with regard to visual acuity, strabismus, and response to strabismus surgery) than children with CVI without CP (CVI-CP). The medical records of all children with CVI, with and without CP, evaluated at our institution between 2013 and 2019 were retrospectively reviewed. Presentation and outcomes of children with CVI+CP were compared to those with CVI-CP. A total of 151 children with CVI+CP and 153 children with CVI-CP were included. Children with CVI+CP were more likely to be diagnosed with significant refractive error (53.6% vs 41.2%; P=0.03), optic atrophy (46.4% vs 32.7%; P=0.01), and strabismus (82.8% vs 72.5%; P=0.03) at presentation. Good ocular alignment after strabismus surgery was achieved in 30% of children with CVI+CP and 63.6% of children with CVI-CP (P=0.48). Of 9 children with long-term (≥8years) postoperative follow-up, 100% of CVI-CP patients achieved good outcomes compared with 0% of CVI+CP patients (P=0.0079). Visual acuity at presentation and the percentage of patients who experienced improvement in visual acuity did not differ between groups. In our study cohort, children with CVI+CP had a higher likelihood of ophthalmic comorbidities and may have worse long-term strabismus surgery outcomes than children with CVI-CP.

Strabismus Surgery Outcomes and Their Determinants in Patients with Chronic Sixth Nerve Palsy.

PURPOSE:Patients with chronic sixth nerve palsy (CSNP) comprise a heterogeneous population, and the optimal surgical solution remains uncertain. Here, we present the success rate and factors associated with the success of strabismus surgeries for CSNP.METHODS:This was a retrospective cohort study of patients with strabismus due to CSNP operated on between 2015 and 2019 in a tertiary eye hospital in central Saudi Arabia. Surgical success was defined as a horizontal deviation of ≤10 prism diopters (PDs) assessed at least 12 months after surgery. Differences between groups with respect to the primary outcome were assessed.RESULTS:Fifty-five patients were analyzed with a median follow-up of 24 (range 12–48) months. Superior rectus and inferior rectus transposition (34.5%) and medial rectus recession with lateral rectus resection (32.7%) were the main surgeries performed. The overall success rate was 67.3% (95% confidence interval 54.9–79.7). Bilateral CSNP (P = 0.05), a higher preoperative angle of deviation (P = 0.002), or a greater degree of preoperative limitation of abduction (P = 0.012), but not the type of surgery (P = 0.09), were more likely to result in an under-corrected outcome of >10 PD. The preoperative deviation angle showed a trend toward being associated with a poor outcome after surgery (P = 0.06). Six patients with high-angle deviation before surgery required second surgery.CONCLUSION:While the surgical procedure does not impact outcomes, the severity of preoperative horizontal deviation might impact surgical success and the need for reoperation. Patients with severe CSNP should be counseled appropriately about the chances of surgical success and the potential need for further interventions.

Результаты хирургии косоглазия с гиперфункцией нижней косой мышцы

Результаты хирургии косоглазия с гиперфункцией нижней косой мышцы

Surgical treatment of strabismus in thyroid eye disease: characteristics, dose–response, and outcomes

To describe the surgical management, dose-response, and postoperative outcomes of strabismus surgery in patients with thyroid eye disease. The medical records of patients operated on between 2014 and 2018 were reviewed retrospectively. Patient characteristics and surgical data were collected. Motor success was defined as vertical deviation of ≤5Δ and horizontal deviation of ≤10Δ; sensory success, as no diplopia in primary gaze. A total of 76 patients (mean age, 62.2±12.9years; 50 females) underwent 87 surgeries, most commonly unilateral inferior rectus recession (unilateral IR, 48%) and bilateral medial rectus recession (bilateral MR, 23%). Motor success was achieved in 69% and sensory success in 58%. For unilateral IR surgery, the dose-responses were 3.25Δ/mm (SE=0.616; β=0.650; P<0.001) at distance and 2.48Δ/mm (SE=0.752; β=0.472; P=0.002) at near; for bilateral MR surgery, 3.93Δ/mm (SE=0.997; β=0.680; P=0.001) at distance and 5.05Δ/mm (SE=1.374; β=0.655; P=0.002) at near. Median (Q1, Q3) postoperative drift was toward overcorrection for both procedures (unilateral IR, -2Δ [-8, 0] at distance and -2Δ [-7, 0] at near; bilateral MR, -2Δ [-8, 2] at distance and -2Δ [-10, 0] at near). Sex, age, duration of strabismus, prior orbital decompression, and concurrent vertical and horizontal procedures were not associated with dose-response or postoperative drift. Concurrent vertical and horizontal surgery did not affect the motor success rate, dose-response, or postoperative drift. Although unilateral IR surgery had a larger dose-response at distance, bilateral MR surgery had a larger dose-response at near. Most procedures tended to have a postoperative drift toward overcorrection.