Prism Diopters Of Esotropia Research Articles

Long-term Outcomes of Bilateral Lateral Rectus Recession Using a Modified Normogram for Targeting Small Overcorrection in Intermittent Exotropia.

To evaluate the surgical outcomes of a modified normogram for bilateral lateral rectus recession in the surgical management of intermittent exotropia, with a focus on achieving small overcorrection. A retrospective medical chart review of 242 patients who underwent surgery for intermittent exotropia between October 2014 and June 2020 was performed. Our modified normogram reducing amount of recession targeted for small postoperative overcorrection within 5 prism diopters (PD). Patients were observed for at least 3 years. Esodeviation was denoted by negative numbers and positive values indicated exodeviation. A satisfactory outcome was defined as if distant angle of deviation ranged between ≤10 PD of exotropia and ≤5 PD of esotropia. Recurrence was defined as an exodeviation of >10 PD at distance. Overcorrection was defined as an esodeviation of >5 PD at distance. The mean preoperative deviation angles were 29.32 ± 3.92 PD at distance and 29.88 ± 4.41 PD at near. At postoperative day 1, the mean deviation angles at distance and near were -6.22 ± 1.44 and -6.22 ± 1.49 PD, respectively. Overcorrection within 6 PD of esodeviation was seen in 168 patients (69.42%), undercorrection with exophoria was noted in 11 patients (4.55%), and overcorrection by more than 6 PD of esodeviation was seen in 63 patients (26.03%) at postoperative day 1. The long-term success rate at postoperative 3 years was 77.27% (187 of 242), with a recurrence rate of 19.83% (48 of 242) and an overcorrection rate of 2.89% (7 of 242). A positive correlation between the angle of deviation at postoperative day 1 and 3 years was observed (r = 0.22, p = 0.001). The final success rate at the final examination after a mean follow-up of 38.60 ± 7.99 months was 83.06%. Our modified normogram for bilateral lateral rectus recession in intermittent exotropia surgery resulted in successful surgical outcomes with small overcorrection, reducing the risk of consecutive esotropia due to excessive overcorrection.

Analysis of postoperative exodrift according to surgical methods for intermittent exotropia.

This study aimed to compare the periods for exodrift stabilization and the long-term surgical outcomes among different surgical methods in intermittent exotropia. The medical records of 350 patients who had undergone intermittent exotropia correcting surgery [unilateral lateral rectus recession-medial rectus resection (R&R, n = 221), bilateral lateral rectus recession (BLR, n = 51) and unilateral lateral rectus recession (ULR, n = 78)] with a postoperative follow-up period of 1.5 years or more were retrospectively reviewed. The deviation angles every 6 months after surgery, periods of exodrift stabilization and surgical outcomes were analysed. The period of postoperative exodrift stabilization was defined as when exodrift was no longer significantly different from that at the next visit (p > 0.05). An alignment of 5 PD (prism diopters) esotropia to 10 PD exotropia at a distance and near fixation was considered surgical success. The mean angle of exodeviation was significantly different among surgical procedures at postoperative 1 month (BLR > ULR > R&R, p < 0.001); however, there were no differences among the procedures at 6 months (p = 0.088). The periods of exodrift stabilization were 6 months after ULR, 1 year after BLR and 4.5 years after R&R. The surgical success and reoperation rates did not show significant differences among procedures at the final follow-up. Patients undergoing R&R showed smaller exodeviation shortly after surgery but required a longer period to stabilize the exodrift. Following ULR, exodeviation was larger in the early postoperative period, but the exodrift was stabilized earlier. Therefore, the long-term surgical outcomes were similar among ULR, BLR and R&R.

İnfantil Ekzotropyada Preoperatif Deviasyonun Cerrahi Başarı ve Duyusal Fonksiyon Üzerindene Etkisi

Background: This study aims to assess the impact of preoperative deviation on surgical success and sensory function in infantile exotropia. Furthermore, to assess the effects of late surgical timing in these patients.Materials and Methods: This retrospective study evaluated 16 subjects with infantile exotropia that underwent surgical management between 2012 and 2018. Patients with deviation ≤ 50 prism diopters (PD) were added to Group 1, and Patients with deviation &amp;gt; 50 PD were added to Group 2 to assess the impact of preoperative deviation on surgical success and sensory function. The surgical success is descri-bed as ≤5 PD esotropia and ≤10 PD exotropia for patients. The Titmus stereopsis and Worth 4-Dot tests were used for sensory function assessment.Results: The average preoperative deviation was 50,63 ± 18,7 PD (20-90). The median age at the time of surgery was 73 (24-400) months. Surgical success was observed in 75% of the patients after the first surgery, and surgical success was observed in all patients after the second surgery. The sensory function was assessed in 11 testable patients (68.7%), of which 5 (45.4%) fusion was observed in the Worth 4-Point test, and 2 (18.1%) achieved measurable stereopsis. While the preoperative deviation had an effect on fusion, it had no effect on stereopsis and surgical success(p=0,015; p=0,45; p=0,77 respectively).Conclusions: The smaller preoperative deviation may be associated with a higher rate of sensorial fusion development. Furthermore, relatively high surgical success can be achieved with late surgical timing in these patients.Keywords: Exotropia, Preoperative deviation, Strabismus, Stereopsis

Clinical Management of Monofixation Syndrome due to Microtropia

BACKGROUND: Monofixation syndrome is a binocular vision disorder characterized by peripheral fusion with a central suppression of one eye due to smallangle strabismus (microtropia) or anisometropic amblyopia. Reduced stereopsis and acuity are noted in the non-fixating eye. Although often left untreated due to good cosmetic appearance, central suppression and reduced stereopsis can affect visual performance, comfort, and depth perception. CASE REPORT: EJ, a 17-year-old Caucasian female was previously treated for amblyopia of the left eye (OS) with glasses and patching since age 8 with no improvement to vision. EJ experienced the following symptoms: blurred vision at near when reading, blurred vision at far distances, eye pain and fatigue, difficulty copying from the board, difficulty seeing at night while driving, and poor depth perception. Entering uncorrected visual acuity was 20/20-2 OD and 20/50-2 OS with Snellen Letter Chart. Near uncorrected acuity was 20/20 OD and 20/200 OS with a reduced Snellen chart at 40 cm. Microtropia of 2 to 12 prism diopters of esotropia, eccentric fixation on visuoscopy, and central suppression on various tests were measured. EJ was diagnosed with monofixation syndrome, monocular esotropia of the left eye, strabismic amblyopia of the left eye, suppression of binocular vision (OS), and fusion with defective stereopsis. The patient completed 19 sessions of in-office vision therapy with the practice of home reinforcement activities between therapy sessions. Visual performance was reassessed after 10 and 19 sessions of vision training with improvements noted in acuity, accommodation, oculomotor accuracy and speed, eye alignment, fusional vergence skills, and stereopsis. CONCLUSION: Optometric vision therapy can decrease suppression, improve central fusional ability, visual acuity, accommodative accuracy, and stereopsis in a patient with monofixation syndrome.

Recurrence of Intermittent Exotropia after Bilateral Lateral Rectus Recession.

PURPOSE:The purpose of this study was to evaluate predictive factors for intermittent exotropia (XT) recurrence after bilateral lateral rectus (BLR) recession.METHODS:This is a retrospective chart review of patients with XT who underwent BLR recession surgery between January 2007 and March 2017 with at least one postsurgical follow-up. Forty-one medical records were reviewed. Information collected included age, gender, systemic diseases, history of prematurity, family history of eye diseases, visual acuity, refraction, ocular alignment and control, stereoacuity, slit-lamp examination, fundoscopy, and amount of BLR recession. Successful alignment was defined as ≤8 prism diopters of esotropia or exotropia postoperatively.RESULTS:The mean age of patients at the time of surgery and follow-up time was 9.2 ± 12.3 years (y) and 23.6 ± 36.5 months (m), respectively. The mean amount of BLR recession was 6.5 ± 1.0 mm. Recurrence rate was 43.9% on the last follow-up. Age at surgery and at the time of last follow-up were significantly higher in the recurring group (P = 0.04 and P = 0.05, respectively). Postoperative angle of misalignment during the first 3 months was correlated with exotropia recurrence. No statistical significance was found among the remaining factors studied.CONCLUSIONS:The recurrence rate of XT in our study was 43.9%; it was increased in patients operated at older age and amid those with significant exotropia detected in the early postoperative period (within 3 months of surgery).

Immediate Postoperative Alignment Following Bimedial Rectus Recession for Esotropia in Children Compared to Adults.

To determine whether the immediate postoperative alignment among patients undergoing successful bilateral weakening surgery for esotropia is different in children compared to adults. The medical records of all patients undergoing surgery for esotropia by a single surgeon at a major academic referral center between January 1, 2002, and July 1, 2014 (n = 544), were retrospectively reviewed. Exclusion criteria included those with prior strabismus surgery, unilateral surgery, strengthening procedures, vertical or superior oblique surgery, and those wearing hyperopic spectacles for accommodative esotropia. Additionally, all patients had to have a 1- and 6-week postoperative examination and 8 prism diopters (PD) or less of deviation at their 6-week examination. Ninety-five (17.5%) of the 544 patients met the inclusion criteria. Surgery was performed at a median age of 3.7 years (range: 7 months to 86 years) for a median esodeviation of 35 PD (range: 12 to 70 PD). Among the 73 patients younger than 11 years, the immediate mean postoperative alignment was 9 PD of exotropia (range: 14 PD esotropia to 30 PD exotropia) compared to 2 PD of exotropia (range: 9 PD esotropia to 30 PD exotropia) in the 22 patients 11 years or older (P = .001). Seventy-one percent of successfully aligned patients younger than 11 years were exotropic in the immediate postoperative week compared to 23% of those 11 years or older (P < .001). Twenty-four (32.8%) of the younger cohort had an immediate overcorrection of 15 PD or more compared to 1 (4.5%) in the older cohort (P = .006). Successful bilateral strabismus surgery for children with esotropia results in a significantly greater overcorrection, compared to adults, in the immediate postoperative period. [J Pediatr Ophthalmol Strabismus. 2018;55(5):299-305.].

Efficacy of Botulinum Toxin in the Treatment of Convergence Spasm

ABSTRACTBackground: Previous studies have shown that botulinum toxin can be an important adjunct to management of convergence spasm. However, we have not experienced the same level of success in our cohort of patients. Methods:Using retrospective review, we collected data on patients presenting to our department with convergence spasm. This included presenting symptoms, examination findings, response to atropine and plus lenses, number and dosage of botulinum toxin injections received, and the status at last follow-up/discharge. Results: We identified a total of 6 patients with a male: female ratio of 1:1 and mean age of 44.3 years. Commonest symptom was diplopia followed by headache and blurred vision. Depression was present in 4 out of 6 patients.Average pre-injection deviation for near was 32.5 PD ET (Prism Diopters esotropia) and for distance was 27.7 PD ET. All of the patients received botulinum toxin injections to the medial rectus muscle. The response to toxin was variable with an average near deviation at 2 weeks of 10 PD XT (exotropia), range 20 PD XT to 25 PD ET and at 3 months 12.5 PD ET (10 PD XT to 35 PD ET). At the last follow-up, after the toxin effect had worn off, all the patients returned to the pre-injection levels and the symptoms recurred. Conclusion: The response of patients with convergence spasm to botulinum toxin was variable with a recurrence of the deviation once the effect wore off. In our experience, botulinum toxin has a limited role in the management of convergence spasm.

Factors affecting surgical outcome of intermittent exotropia.

PURPOSE:The purpose of this study was to investigate the factors affecting surgical outcome in intermittent exotropia.DESIGNS:This was a retrospective interventional study.METHODS:Intermittent exotropic patients who had undergone surgical correction with a postoperative follow-up period of 1 month or more were included in the study. Surgical success was defined as an alignment between 10 prism diopters (PD) of exotropia or 5 PD of esotropia at 1 month. After data collection, data were analyzed in SPSS version 23 software. The main outcome measures were the factors affecting surgical outcome.RESULTS:We included 101 patients, including 52 (51.5%) male and 49 (48.5%) female. Among them, 62 (61.4%) patients achieved surgical success. Undercorrection was the primary reason of surgical failure. Multivariate regression analysis showed that a larger preoperative angle of deviation was associated with unfavorable surgical outcome (P = 0.053, odds ratio [OR] =0.97, 95% confidence interval [CI] = 0.94–1.00), and the presence of postoperative day 1 (POD 1) diplopia correlated significantly with higher surgical success (P = 0.001, OR = 4.54, 95% CI = 1.80–11.43). The presence of POD 1 diplopia was highly associated with POD 1 esotropia (P = 0.005, OR = 7.26, 95% CI = 1.84–28.58).CONCLUSION:In intermittent exotropia, larger preoperative angle of deviation may predict a lower surgical success rate. Despite a worrisome issue, the presence of diplopia on first POD is associated with immediate postoperative alignment of esotropia and predicts a higher surgical success.

Vitreous hemorrhage and Rhegmatogenous retinal detachment that developed after botulinum toxin injection to the extraocular muscle: case report

BackgroundThe authors report a case of a rare complication that occurred after botulinum toxin injection to the extraocular muscle, which was easily overlooked and successfully corrected by surgery.Case presentationA 34-year-old female patient visited our clinic for diplopia and ocular motility disorder after removal of an epidermoid tumor of the brain. At her initial visit, her best-corrected visual acuity (BCVA) was 20/20 for both eyes. An alternate cover test showed 45 prism-diopter esotropia and 3 prism-diopter hypertropia in the right eye. Following 6 months of observation, the deviation of the strabismus did not improve, and botulinum toxin was injected into the right medial rectus (RMR). After 6 days, she visited our clinic with decreased visual acuity of her right eye. The BCVA was found to be 20/50 for her right eye. Funduscopic examination presented a retinal tear inferonasal to the optic disc with preretinal hemorrhage. Subretinal fluid nasal to the fovea was seen on optical coherence tomography (OCT). Barrier laser photocoagulation was done around the retinal tear; however, her visual acuity continued to decrease, and vitreous hemorrhage and subretinal fluid at the lesion did not improve. In addition, a newly developed epiretinal membrane was seen on OCT. An alternate cover test presented 30 prism-diopter right esotropia. 19 weeks after RMR botulinum toxin injection, she received pars plana vitrectomy, membranectomy, endolaser barrier photocoagulation, and intravitreal bevacizumab (Avastin®) injection. After 4 months, her visual acuity improved to 20/20, and only 4 prism-diopter of right hypertropia and 3 prism-diopter of exotropia were noted. Vitreous opacity and the epiretinal membrane were completely removed, as confirmed by funduscopic and examination.ConclusionsSudden loss of vision after injection of botulinum toxin into the extraocular muscle may suggest a serious complication, and a prompt, thorough ophthalmic examination should be performed. If improvements are not observed, rapid surgical intervention is recommended to prevent additional complications.

Slipped extraocular muscles: characteristics and surgical outcomes

ObjectiveTo study the frequency and characteristics of slipped extraocular muscles after strabismus surgery and report the postoperative outcomes longitudinally. DesignRetrospective chart review. ParticipantsElectronic medical records of 493 patients who underwent strabismus surgery and were found to have a slipped muscle intraoperatively were reviewed. MethodsRecords were retrieved and operative reports were screened for the presence of slipped muscles. Data pertaining to the eye examination and surgery were collected, including vision, ocular motility in all positions, duction limitations, slipped muscle, empty sheath length, amount of slippage, amount of advancement, and amount of recession of the antagonist muscle. ResultsTwelve patients (mean age 29.1 ± 6.4 years; 5 males) were found to have 15 slipped medial rectus muscles. Average amount of slippage was 15.7 ± 2.0 mm; from limbus empty sheath length was 5.9 ± 1.9 mm. Average preoperative deviation was 32.2 ± 10.0 prism diopters (PD) exotropia. Mean follow-up after corrective surgery was 13.3 months (1 week to 42 months). Four patients were transiently overcorrected postoperatively (7.0 ± 7.0 PD esotropia). The rest had mean residual exotropia of 13.5 ± 9.2 PD with a change of 26.6 ± 10.3 PD from baseline (p < 0.001). Intraoperative mean muscle movement was 10.3 ± 2.2 mm with a mean postoperative change of 2.6 PD for each 1 mm of muscle advancement. There was no significant increase over time in the postoperative angle of deviation during all follow-up periods except for 1 patient who was re-explored after 4 years. ConclusionsSlipped muscle should be suspected in the presence of limited ductions and consecutive deviations after strabismus surgery. A change of 2.6 PD for every 1 mm of medial rectus muscle advancement was observed and maintained over time.

Clinical risk factors for the development of consecutive exotropia: a comparative clinical study.

To compare a group of patients with consecutive exotropia with patients who had ≤10 prism diopters (PD) esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 (P=0.634). There was no significant difference of preoperative near and distant deviations among two groups (P=0.835, 0.928 respectively). The mean amount of medial rectus recession and lateral rectus resection was similar in both groups (P=0.412, 0.648 respectively). Convergence insufficiency and neurological diseases were more frequent in group 1 (P=0.007, 0.045). Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios (OR): 5.75 (1.04-31.93)]. Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors.

Risk factors for consecutive exotropia after esotropia surgery.

To evaluate the risk factors in development of postoperative exotropia following bilateral medial rectus (BMR) recession for esotropia. 108 patients who underwent BMR recession for esotropia between November 1996 and July 2010 were enrolled. 54 patients who required surgery for consecutive exotropia were compared to 54 controls whose angle of deviation showed less than five prism diopters of esotropia at all periods after BMR recession. Amblyopia, dissociated vertical deviation (DVD), refractive error, inferior oblique overaction, and multiple surgery history were evaluated as risk factors for the development of consecutive exotropia. The postoperative changes of angle of deviation were calculated. Amblyopia was found in 27 patients (50.5%) in the exotropia group, and in six patients (11.1%) in the control group (P<0.001) before esotropia surgery. DVD was detected in 16 (29.06%) patients in the exotropia group as compared to 4 (7.4%) in the control group (P=0.003). With logistic regression analysis, the odds ratio of DVD was 5.27 (95% CI 1.63-17.03; P=0.006) and of amblyopia, 8.00 (95% CI 2.94-21.80; P<0.001). There were no significant differences between the two groups with regards to the pre-operative deviation, follow up periods, degree of hyperopia, presence of anisometropia or inferior oblique overaction, and history of multiple surgery. Using linear mixed model analysis, the exotropic shift across time was higher in the consecutive exotropia group relative to the controls (P<0.001). The presence of amblyopia before esotropia surgery and DVD correlated with risk of consecutive exotropia.

Achieving postoperative target range increases success of strabismus surgery in adults: a case for adjustable sutures?

Background/aimsTo evaluate the role of achieving immediate target angles on the success of strabismus surgery.MethodsWe performed a retrospective cohort study of all patients over 12 years old undergoing strabismus surgery...

Partial Modification of the Yamada Technique in Myopic Strabismus Fixus Treatment: Case Presentation

Abstract A 41-year-old female presented with a history of gradually increasing esotropia (ET) for 23 years. The best corrected visual acuity was 20/63 in both eyes. Refraction values were -18.50 (-1.00*55) in the right eye and -13.25 (-3.00*105) in the left eye. The axial length was measured as 29.35 mm for the right eye and 28.36 mm for the left eye. The patient's ocular motility was very restricted in the left eye with values of (-4) for abduction from the midline, (-3) for elevation and (-4) for elevation in adduction. The patient's left eye had 80 prism diopters (PD) ET and 16 PD hypotropia with the prism cover test. During surgery, an 8 mm recession was first performed to the left eye medial rectus (MR). The SR and LR muscles were then divided into two for 15 mm from their insertions. The temporal half of the SR muscle and the superior half of the LR muscle were sutured together with 6/0 spatulated suture 7 mm away from the limbus at the exact midpoint of the two muscles, at the 1:30 o'clock position (Yamada procedure). A posterior fixation suture was placed on the sclera 7 mm behind the combined end of the two muscles (14 mm from the limbus) with 5/0 Ethibond suture (our modification of the Yamada procedure). Post-operative 1st day, 1st month and 6th month follow-ups were performed. On the 6th month follow-up, there was a marked decrease in the restriction of the patient’s left eye movements compared to the pre-operative period and there was 20 PD ET and 8 PD hypotropia in the primary position. Left eye movements were (+4) on abduction, (-2) on elevation and (-2) on elevation at adduction. We determined that we had achieved partial success in such cases with our partial modification of the Yamada procedure. Keywords: Esotropia, myopia, strabismus fixus

Muscle belly union associated with simultaneous medial rectus recession for treatment of myopic myopathy: results in 33 eyes

To describe the results achieved using muscle belly union associated with the recession of the ipsilateral medial rectus muscle to treat myopic myopathy and restore the normal anatomical relationship of superior and lateral rectus (LR). A retrospective, nonrandomized study performed on 33 eyes of 26 patients who underwent muscle belly union between January 2004 and October 2012. We preoperatively and postoperatively recorded: best-corrected visual acuity; refraction; intraocular pressure; complete orthoptic assessment, including the angle of deviation and maximal abduction measured using the Goldmann perimeter. Pictures of the eyes in all gaze directions were taken before and after the surgical treatment. Anatomical relationships between muscle cone and eye globe were preoperatively analyzed using magnetic resonance imaging (MRI). Surgical complications were noted. The follow-up period was 6 months. Preoperative mean BVCA was 0.97 ± 0.96 logMAR (ranging from 0.1 to 3 logMAR) and no changes were detected during postoperative controls. Preoperative mean hypotropia and esotropia were, respectively, 10.2 ± 3.9 prism diopters (PD) and 46.2 ± 15.5 PD. Postoperative mean hypotropia was 2.48 ± 2.00 PD (P<0.001) and mean esotropia was 7.36 ± 9.09 PD (P<0.001). A statistical incrementation of mean maximal abduction (P<0.001) was also noticed. Muscle belly union-coupled with the recession of the ipsilateral medial rectus muscle when considered convenient-is the elective surgical technique in myopic myopathy, when a downward displacement of LR muscle is shown on MRI with coronal sections.

The Effect of Unilateral Medial Rectus Resection for Recurrent Intermittent Exotropia

Purpose: The purpose of this study is to investigate the effect of unilateral medial rectus muscle resection (UMR) for the treatment of recurrent intermittent exotropia after bilateral lateral rectus muscle recession (BLR). Methods: Medical records of 121 subjects who underwent UMR for the treatment of recurrent intermittent exotropia after BLR with more than six months of follow-up were reviewed. Patients were classified into two groups, the 4-mm group who underwent 4-mm UMR and the 5-mm group who underwent 5-mm UMR. Successful postoperative motor alignment was defined as within 10 prism diopters (PD) of exotropia and four PD of esotropia. Results: The mean time interval between the primary surgery and recurrence was 13.55 ± 20.78 months (1-120 months). Average follow-up period after secondary surgery was 27.42 ± 15.98 months (6-48 months). Cumulative success rate at six months after UMR was 87.1% in the 4-mm group and 88.2% in the 5-mm group, respectively, and that at 24 months was 72.7% in the 4-mm group and 50.0% in the 5-mm group (p = 0.132). The average effect of resection was 4.87 ± 0.91 PD/mm in the 4-mm group and 4.73 ± 0.84 PD/mm in the 5-mm group (p = 0.374). Conclusions: Because of recurrent intermittent exotropia, less time is required for surgery in UMR after BLR, and patients and parents are more likely to accept a secondary surgery because of single muscle surgery. Therefore, UMR may be an effective surgical method for patients with 16-30 PD of recurrent intermittent exotropia. J Korean Ophthalmol Soc 2014;55(11):1681-1686

A Case of Acquired Ocular Motor Apraxia Accompanied with Esotropia due to Multiple Brain Infarcts

Purpose: We present a case of acquired ocular motor apraxia accompanied with esotropia due to multiple brain infarcts. Case summary: A 59-year-old male was referred for diplopia that started 9 years before presentation and continued after multiple brain infracts including right cerebellum, right occipital lobe, medulla oblongata and inferior pons. At initial examination, his best corrected visual acuity was 20/22 in the right eye and 20/25 in the left eye and he had 12 prism diopter (PD) esotropia at distance and near in primary gaze with correction. His duction and version were normal; however, his horizontal saccade was notably decreased. Two years and 8 months after presentation, the patient had 15 PD esotropia at distance and near with correction. His duction and version were normal and vertical saccadic eye movements were observed. However, horizontal saccade disappeared. The patient also exhibited a distinguishing head thrust following the order for saccadic eye movement. He was diagnosed with an acquired ocular motor apraxia accompanied with esotropia. During the follow-up period the patient underwent bilateral recession of the medial rectus. The usual diplopia and his horizontal esodeviation improved to 3 PD of esotropia at distance. Conclusions: Multiple brain infarcts can result in an acquired ocular motor apraxia accompanied with esotropia. Varying types of ocular motor disorders should be considered in patients with a previous medical history of brain infarct. J Korean Ophthalmol Soc 2014;55(9):1396-1400

Augmented surgical amounts for intermittent exotropia to prevent recurrence.

Purpose:The purpose was to evaluate the results of bilateral lateral rectus (BLR) recession which is based on augmented surgical amounts of classical surgical table of Parks’ for basic and pseudo-divergence excess type intermittent exotropia [X(T)].Materials and Methods:Patients with X(T) operated by the same surgeon and followed-up for at least 6 months were included. Patients with prior surgery, neurobehavioral and musculoskeletal conditions, strabismus different from that mentioned above X(T) were excluded. All the patients received BLR only. The amount of the recession was increased by the amount needed to correct 5 prism diopters (PD) more X(T) than what was measured. After the operation, 1st week, 2nd and 6 months measurements were recorded. The patients were grouped according to their 1st week (3–7 days) postoperative examination as: >10 PD esotropia (Group 1), ≤10 PD esotropia (Group 2), exotropia (Group 3), and orthotropic (Group 4), respectively. Final surgical outcomes were classified as “good” (≤10 PD exotropia and ≤5 PD esotropia), “recurrence” (>10 PD exotropia) and “overcorrected” (>5 esotropia).Results:Thirty-seven patients were included. The mean age was 6.78 ± 2.87 years (range: 2–12 years). Mean preoperative deviation was 29.72 ± 8.07 PD (range: 15–45 PD) at distance and 20.94 ± 11.65 PD (range: 10–45 PD) at near (P < 0.0001). There were 21 (56.8%) patients in Group 1, 9 (24.3%) patients in Group 2, 1 (2.7%) patient in Group 3 and 6 (16.2%) patients in Group 4. Initial esotropia was achieved in 30 (30/37) of the patients. Twenty-eight of them had good results at the end of the 6 months. Overall “motor surgical” success rate was found to be 89.2% (33/37 patients), with 1 (2.7%) overcorrection and 3 (8.1%) recurrences at the end of the 6 months.Conclusion:This study demonstrated that early overcorrection of 10–20 PD after X(T) surgery can achieve acceptable motor outcomes in the first 6 months postoperative period.

Traumatic 6 th Nerve Palsy Managed with Medial Rectus Recession with Hangback Sutures and Hummelsheim Procedure

Traumatic paralytic esotropia due to 6 th nerve palsy is not uncommon but difficult to manage. We reported a case of 38-year-old male who sustained head injury in road traffic accident 15 years ago and inward deviation of his left eye. His vision in right eye was 20/20 and counting fingers at one foot in the left eye. He had >70 prism diopters esotropia in the left eye with restriction of movements in all directions of gaze except adduction. His forced duction test was positive. Examinations of the anterior and posterior segments of both eyes were within normal limits. Magnetic resonance imaging suggested old traumatic insult in the left eye. Diagnosis of left eye traumatic 6 th nerve palsy with medial rectus contracture was made. Left medial rectus recession with hangback sutures and Hummelsheim procedure were performed. Postoperatively, the patient's vision in the left eye had improved to 20/80 the esotropia had reduced to 15 prism diopters (delta).

Presumed Acute Adenoviral Dacryoadenitis Associated with Epidemic Keratoconjunctivitis: A Case Report

Traumatic paralytic esotropia due to 6th nerve palsy is not uncommon but difficult to manage. We reported a case of 38‑year‑old male who sustained head injury in road traffic accident 15 years ago and inward deviation of his left eye. His vision in right eye was 20/20 and counting fingers at one foot in the left eye. He had >70 prism diopters esotropia in the left eye with restriction of movements in all directions of gaze except adduction. His forced duction test was positive. Examinations of the anterior and posterior segments of both eyes were within normal limits. Magnetic resonance imaging suggested old traumatic insult in the left eye. Diagnosis of left eye traumatic 6th nerve palsy with medial rectus contracture was made. Left medial rectus recession with hangback sutures and Hummelsheim procedure were performed. Postoperatively, the patient's vision in the left eye had improved to 20/80 the esotropia had reduced to 15 prism diopters (delta).