Prism Diopters Of Orthotropia Research Articles

Treatment of partially accommodative esotropia in children using a medial rectus muscle fenestration technique

To report the results of bilateral fenestration of the medial rectus muscle in cases of partially accommodative esotropia in pediatric patients. In this fenestration technique, two splitting incisions are made by blunt dissection parallel to the muscle fibers on the superior and inferior borders of the medial rectus muscle, leaving a thin strip of muscle fibers on each edge. The wide, central part of the muscle is excised from its insertion to a point 5-8 mm from the insertion, depending on the angle of the esotropia. Sutures are not used in this procedure. Children with partially accommodative esotropia and no high ratio of accommodative convergence to accommodation who underwent surgery from February 2018 to August 2019 were prospectively enrolled. The success rate was defined as alignment within 8 prism diopters of orthotropia at the last follow up. A total of 61 children were included. The procedure was well tolerated by patients and reduced the angle of esotropia for distance from 22.20Δ ± 4.22Δ to 2.72Δ ± 4.71Δ (P<0.001) and caused no incomitance or distance-near disparity. Satisfactory horizontal alignment defined as alignment within 8Δ of orthotropia at distance was achieved in 88% of the cases at 3-6 months' follow-up. There were no overcorrections. In our study cohort, the fenestration technique reduced the angle of deviation in cases of partially accommodative esotropia.

Modified Y-splitting Procedure for the Treatment of Duane Retraction Syndrome.

Objectives:To present the outcomes of modified lateral rectus Y-splitting combined with either unilateral or bilateral horizontal rectus recession in Duane Retraction Syndrome (DRS) with significant upshoot or downshoot.Ma­te­ri­als and Met­hods:A total of 12 patients including 10 patients with Type I DRS and 2 with Type III DRS underwent modified Y-splitting surgery. Amount of additional recessions varied with the degree of preoperative deviation by intraoperative adjustable suture technique. Preoperatively 3 patients had esotropia (ET), 6 had exotropia (XT), and 3 patients had orthotropia. The mean preoperative deviation was 19.3 prism diopters (PD) (range, 18-20 PD) in ET patients and 19.2 PD (range, 16-20 PD) in XT patients.Re­sults:Postoperatively, all patients had significant correction in horizontal deviation and aligned within 4 PD of orthotropia, and no patients exhibited abnormal head posture. Co-contraction and globe retraction were markedly reduced and abnormal ocular vertical movement disappeared or significantly decreased in all cases. No patients experienced recurrence of ocular motility disorders in the mean 26-month (range, 13-66 months) follow-up period.Conclusion:Modified Y-splitting surgery combined with co-contracting horizontal muscle recession technique seems to be a safe and effective treatment in DRS.

Binocular Function in Pseudophakic Children

The author reports the results of visual and binocular tests performed on patients who had primary insertion of intraocular lenses following the removal of cataracts in their childhood. Monocular and binocular tests were performed on 21 patients using the same equipment for sensory testing for binocularity on all patients before the history was abstracted from the clinical records. These patients were selected from a consecutive series and observed for a minimum of 5 years by their surgeons. The mean age at surgery performed on the first eye was 6.3 years. The mean age at the date of the author's examination was 16.5 years and the mean length of follow-up was 10.3 years. All but 2 patients had motor alignment within 8 prism diopters of orthotropia at near. Fusion and some stereopsis was found in 15 patients, but only 4 of these demonstrated fine (60 seconds of arc or better) stereoacuity. Patients with fine versus gross stereoacuity were compared and found to be similar in type of cataract, age at first surgery, interval between surgeries, length of follow-up, and refraction, but different in the quality of best-corrected visual acuity. Although satisfactory motor alignment, fusion, and some stereopsis is present in the majority of patients, fine stereoacuity is uncommon in pseudophakic children.

Short-Term Motor and Sensory Outcomes in Acquired Nonaccommodative Esotropia of Childhood

Information on the management of acquired nonaccommodative esotropia (ANAET) of childhood is incomplete. Most prior reports combine the results of patients with both accommodative and nonaccommodative esodeviations. The primary objective of this study was to describe the early postoperative motor and sensory results of children with acquired nonaccommodative esotropia.The medical records of 72 consecutive children with ANAET who underwent surgical correction at East Tennessee State University College of Medicine from August 1, 1995 through October 1, 2001 were retrospectively reviewed.The median age at surgery for the 72 study patients was 43.8 months with a median angle of deviation of 30 prism diopters (PD) at both distance and near. Ten patients (13.9%) required a second surgical procedure while one patient (1.4%) required a third. The cumulative probability of a second surgery within two years of the first procedure was 24% (95% CI 4–43%). During a median postoperative follow-up period of 7.1 months, 64 (88.9%) patients were within 8 PD of orthotropia on the last postoperative examination. Normal postoperative stereoacuity was achieved in several children whose deviation began after 30 months of age, as well as in one child who was misaligned for at least two years prior to surgery.Although the postoperative follow-up on these patients with acquired nonaccommodative esotropia managed without prism adaptation is short, the motor results are similar to other studies on patients with acquired esotropia, with sensory outcomes superior to those obtained in children with congenital esotropia.