Recession Group Research Articles

Medial Rectus Tendon Elongation with Bovine Pericard (Tutopatch®) in Thyroid-Associated Orbitopathy: A Long-Term Follow-Up including Oculodynamic MRI.

Introduction To assess long-term efficacy of bimedial rectus tendon elongation with Tutopatch in thyroid-associated orbitopathy (TAO). Materials and Methods Retrospective chart review of 5 patients with TAO undergoing bimedial rectus recession with Tutopatch tendon elongation between 2009 and 2015. We analyzed horizontal squint angles, motility, field of binocular single vision, dose effect of surgery, and when possible oculodynamic MRI (OD-MRI). Dose effect and motility were compared to 4 TAO patients with conventional bimedial recession. Results and Discussion In the Tutopatch group, preoperative angles ranged from 14 to 120∆ (prism diopters) at distance and 12–120∆ at near. Mean dose effect was 3.63∆/mm for the distance and 3.43∆/mm for the near angle. All patients were orthotropic at final FU (ranging from 1 to 10 years). OD-MRI showed the elasticity of Tutopatch. In the conventional recession group, preoperative angles ranged between 18 and 35∆ at distance and 12–33∆ at near. At final FU, 2 patients had reverted to their underlying microesotropia <2∆, 1 patient was orthophor, and one was reoperated for a remaining esotropia of 14∆. Dose effect was 2.95∆/mm for the distance and 2.18∆/mm for the near angle. Motility improved in both groups even after 3 months. Conclusions Dose effect for medial rectus recessions with Tutopatch in TAO was higher than previously reported, presenting a good alternative to treat large squint angles while preserving good motility.

The use of one muscle recession for horizontal strabismus

PurposeTo evaluate the outcomes of one muscle recession for horizontal comitant strabismus at a major referral hospital in the Middle East. MethodRetrospective charts review of postoperative outcomes of 90 patients who had undergone one muscle recession for small to moderate angle esotropia or exotropia. Data were collected for age, vision, amblyopia, previous surgery or botulinum toxin injection, preoperative deviation, amount and type of one muscle surgery, and postoperative deviation at the initial and last (six months or more) postoperative visit. Successful alignment was defined as ±10 prism diopters (PD) of orthophoria. ResultsSixty patients underwent medial rectus recession and 30 patients underwent lateral rectus recession. The average preoperative and last follow up deviation -respectively- was 24 ± 6.1 PD (15–35) PD and 14.62 ± 8.91 PD in the medial rectus recession group and 21.3 ± 5.1 PD (12–30) and 12.60 ± 8.74 in the lateral rectus recession group. The final success rates were 63.3% in both groups. ConclusionSingle muscle strabismus surgery to correct horizontal strabismus had a variable outcome. Larger recession may help in achieving better outcomes. Properly designed prospective studies may help in identifying the factors affecting the outcomes of single muscle strabismus surgeries.

Comparison of the Complication Incidence in Open Versus Endoscopic Gastrocnemius Recession: A Retrospective Medical Record Review

Gastrocnemius recession is a practical and effective procedure to address gastrocnemius equinus. It has been shown that an equinus deformity can lead to the development of plantar fasciitis, osteoarthritis, and foot ulcerations. The 2 approaches to gastrocnemius recession are open and endoscopic. Both are viable options; however, both also have associated complications. We compared and evaluated the postoperative complications associated with these procedures. The electronic database of our orthopedics division at the University of Florida College of Medicine, Jacksonville, was retrospectively searched to identify all cases of gastrocnemius recession (Current Procedural Terminology [CPT] code 27687), and unlisted arthroscopy (CPT code 29999) from February 2006 to February 2016. The difference in the outcome variable, the incidence of postoperative complications, was assessed using Fisher's exact test. A total of 39 patients (41 procedures) were in the open gastrocnemius recession group and 35 (39 procedures) were in the endoscopic gastrocnemius recession group. The median follow-up time was shorter in the open gastrocnemius recession group than in the endoscopic gastrocnemius recession group (9 versus 12 months; p < .001). Postoperative complications developed after 12 of the 80 procedures (15%), with a greater incidence after open than endoscopic procedures (26.8% versus 2.6%; p = .003). The complications associated with the open technique included 1 case of scar pain (2.4%), 5 of dehiscence (12.2%), 1 of infection (2.4%), 2 of calf abscess (4.9%), and 2 cases of nerve injury (4.9%). A single complication occurred with the endoscopic technique—1 case of dehiscence (2.6%). To the best of our knowledge, ours is the first study to compare the postoperative complications between these 2 techniques. We found the incidence of postoperative complications was significantly lower in the endoscopic group, emphasizing the benefit of using the endoscopic approach. These findings could prove invaluable when addressing gastrocnemius equinus in those with a greater risk of postoperative complications.

Effect of strabismus surgery on refractive power of the eye

Background The aim was to evaluate the refractive and corneal topographic changes occurring in the eyes after horizontal rectus muscle surgery, either unilateral recess–resect procedure or bilateral rectus muscle recession. Patients and methods A total of 31 eyes of 20 patients were included in this study. The patients underwent strabismus surgery for concomitant horizontal strabismus (exotropia). The patients were divided into two groups. Group A included nine patients (nine eyes), who were subjected to lateral rectus muscle recession and medial rectus resection in the same eye (R&R group). Group B included 11 patients (22 eyes) who were subjected to lateral rectus recession in both eyes (bilateral lateral rectus recession group). A full ophthalmic examination including cycloplegic automated refraction was carried out. Refraction and keratometry were assessed at 1–2 weeks preoperatively and 1 week, 1 month, and 3 months postoperatively. Corneal topography was performed before and 3 months after the operation. Preoperative and postoperative refraction was compared in terms of spherical equivalent (SE) and cylindrical power. Results The SE showed a transient statistically insignificant change toward the myopic side in the first week in both groups; these changes persisted for 2 months postoperatively and stabilized at the third month. However, the difference in SE from the preoperative values was statistically insignificant in both groups. Also, the changes in the refractive status that occurred when two muscles were operated in the same eye (R&R group) were greater than when only one muscle was operated. Conclusion Refractive status changed postoperatively, but this change was small and reversible.

Surgical outcomes of three different surgical techniques for treatment of convergence insufficiency intermittent exotropia.

PurposeTo determine the outcomes of three different techniques of strabismus surgery in patients with convergence insufficiency intermittent exotropia (CI-X(T)).Patients and methodsSixty-seven patients with CI-X(T) with near-distance disparity (NDD) ≥10 prism diopter (PD) were included in this 1-year follow-up prospective study and were randomly divided into three groups: slanted bilateral LR recession (S-BLR) group in which 22 patients underwent bilateral slanting recession of the lateral rectus (LR) muscle, the I-RR group with 23 patients who underwent improved unilateral medial rectus (MR) resection and LR recession with the amounts of resection and recession biased to near and distance deviation, respectively, and the A-BLR group with 22 patients who underwent bilateral augmented LR recession based on the near deviation. A successful outcome at distant and near was defined as exodeviation between 10 PD of exophoria/tropia and 5 PD of esophoria/tropia. Cumulative probabilities of success, preoperative and postoperative distant, near deviations, and NDD among groups were analyzed and compared.ResultsThe success rate of distant exodeviation, near exodeviation, and NDD in the three groups after 1 year was statistically insignificant (P=0.054, 0.233, and 0.142, respectively). At the 1 year follow-up, vertical pattern strabismus (V and A patterns) was a feature of the S-BLR group, whereas the rate of postoperative overcorrection and undercorrection was significant in the A-BLR and I-RR groups, respectively.ConclusionThe success rate of correction of distant exodeviation, near exodeviation, and NDD was statistically indifferent among the three groups. However, each procedure has its specific postoperative concerns, which should be considered before implementing in patients with CI-X(T).

Medial Rectus Bridge Faden Operations in Accommodative and Partially Accommodative Esotropia With Convergence Excess.

To evaluate the results of the bilateral bridge Faden operation on the medial rectus muscles with and without recession in the treatment of accommodative and partially accommodative esotropia with convergence excess. A retrospective analysis was performed on the medical records of 103 patients who underwent the bridge Faden operation on both medial rectus muscles, with or without recession, for the treatment of accommodative and partially accommodative esotropia with convergence excess. Preoperative and postoperative near and distance deviations and near-distance disparities were evaluated. The study population consisted of 38 (37%) girls and 65 (63%) boys. The mean age was 9.32 ± 5.83 years (range: 1 to 18 years) and the mean follow-up period was 14.49 ± 2.78 months. Fifty-one patients underwent the bridge Faden operation on both medial rectus muscles with recession (recession group) and 52 patients underwent the bridge Faden operation on both medial rectus muscles without recession (no recession group). The mean preoperative amount of esotropia at near was 43.51 ± 7.00 and 24.24 ± 3.56 prism diopters (PD) for the recession and no recession groups, respectively. The mean preoperative amount of esotropia at distance was 26.63 ± 6.86 and 9.22 ± 2.09 PD for both groups, respectively. The mean preoperative near-distance disparity was 17.14 ± 3.00 and 14.05 ± 4.14 PD for both groups, respectively. In both groups, there was a statistically significant difference in the near and distance deviations and the near-distance disparity between preoperative and postoperative values (P < .05). Postoperatively, there was no significant difference between 1 month, 6 months, and 1 year and between 6 months and 1 year (P > .05). The bridge Faden operation on both medial rectus muscles either with or without recession was a successful surgical procedure in patients with accommodative and partially accommodative esotropia. During the follow-up period, the success rates did not decrease. [J Pediatr Ophthalmol Strabismus. 2017;54(6):369-374.].

Quantitative measurement of retinal vascular diameter changes in the early postoperative period after strabismus surgery

To investigate quantitatively the retinal vascular diameter changes before and after strabismus surgery, analyzing the potential hemodynamic changes that may occur in the retinal circulation. Consecutive patients with horizontal strabismus who underwent strabismus surgery were prospectively enrolled. Color fundus photographs were taken of each eye before and 1day after surgery. The retinal vessel diameters were measured using computer-assisted quantitative assessment software. Paired-sample t test was used to evaluate the central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR) before and 1day after surgery. We also analyzed those changes in different subgroups according to surgical protocols. A total of 217 eyes of 148 patients were included. Compared with the data before surgery, the mean CRAE significantly increased 1day after surgery (P=0.01), so did the AVR (P=0.003). There was no significant difference with respect to CRVE (P=0.43). The CRAE and AVR were not significantly different in the lateral rectus recession group. Strabismus surgery on horizontal rectus muscles may change retinal hemodynamics by increasing the central retinal arteriolar diameter during the early postoperative period.

Clinical and neuroradiological profile in pontocerebellar hypoplasia: A single-center experience

Objective: Pontocerebellar hypoplasia (PCH) constitutes an autosomal recessive heterogeneous group of neurodegenerative/neurodevelopmental disorder of pons and cerebellum with onset in prenatal period. Given the paucity of data on PCH from developing countries, we aimed to discuss the clinical, radiological profile and outcome of four infants with pontocerebellar hypoplasia attending our center. Methods: Data of children with psychomotor retardation seen between January 2015 and December 2015 at Neurodevelopmental clinic, PGIMER, Chandigarh was retrieved. PCH was defined by clinical and radiological criteria. Clinical features included were; delay in attainment of milestones in more than two developmental domains accompanied by severe microcephaly. Radiological evidence of cerebellar volume loss with hypoplasia of pons was included. Patient charts were reviewed for clinical features, neuroimaging, electroencephalography, biochemical investigations including serum and cerebrospinal lactate. Molecular genetic testing for the common p.A307S mutation in TSEN54 of the cases and their parents were also analyzed. Results: During this period 101 children with psychomotor retardation were evaluated at our center. Of the 101, four children with clinical and radiological evidence of Pontocerebellar hypoplasia. In addition to psychomotor retardation and severe microcephaly, spasticity; bipyramidal signs; epileptic spasms were universal in all four children. Three of the four children had optic atrophy and two had sensorineural hearing loss. Severe cerebellar hypoplasia with attenuated pons was seen in all four children. One child each had dragonfly and butterfly appearance of cerebellum on coronal section. The commonest TSEN54 p.A307S mutation in children and their parents was not detected. Conclusion: A heightened index of suspicion for pontocerebellar hypoplasia is merited in infants with severe psychomotor retardation and progressive microcephaly. Absence of the commonest TSEN54 p.A307S mutation may suggest the possible role of other novel mutations in our cohort.

Impact of phosphoinositide-3-kinase and vitamin D3 nuclear receptor single-nucleotide polymorphisms on the outcome of malignant melanoma patients.

BackgroundSeveral studies associating single nucleotide polymorphisms (SNPs) frequencies with tumors outcome have been conducted, nevertheless malignant melanoma literature data are inconclusive.Therefore we evaluate the impact of different genotypes for phosphoinositide-3-kinase (PI3K) and vitamin D3 nuclear receptor (VDR) SNPs on melanoma patients’ outcome.Materials and methodsGenomic DNA of 88 patients was extracted from blood and tumor samples. SNPs were determined by PCR using TaqMan assays. We selected polymorphisms of the regulatory and catalytic subunit of PI3K (PIK3R1 and PIK3CA genes, respectively), analyzing rs2699887C>T of PIK3CA and rs3730089G>A of PIK3R1 SNPs. Furthermore we considered the following VDR SNPs: rs2228570A>G (Fok1), rs731236A>G (Taq1) and rs1544410C>T (Bsm1).Progression free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method and with Mantel-Haenszel log-rank test.ResultsThe statistical analysis for Fok1 of VDR showed a significant difference in PFS after the first line therapy (median PFS= 21.2 months in the homozygous recessive genotype group vs. 3.3 months of homozygous dominant and heterozygous ones, p= 0.03). In particular, in homozygous recessive patients for Fok1 SNPs of VDR a high rate of histological regression and BRAF (B- Rapidly Accelerated Fibrosarcoma gene) mutation were observed. Furthermore, more efficacy of BRAF +/- MEK (MAPK-ERK-Kinase) inhibitors therapies in homozygous recessive patients vs. homozygous dominant and heterozygous ones was shown.ConclusionsOur study showed a significant correlation between homozygous recessive genotype of Fok1 SNPs of VDR gene and an increased PFS in patients who underwent a first line therapy with BRAF inhibitors.

Suspension recession of inferior oblique versus graded recession technique in V-pattern strabismus with primary inferior oblique overaction

Purpose The aim of this study was to evaluate the efficacy of inferior oblique suspension recession ‘modified hang-back’ in cases with V-pattern strabismus and primary inferior oblique overaction (IOOA), compared with standard graded recession technique.Patients and methods Thirty patients (60 eyes) presenting with V-pattern strabismus with primary IOOA were enrolled and randomized for inferior oblique weakening intervention − that is, suspension recession (group A), or standard graded recession (group B).Results In group A, the mean postoperative V-pattern exotropia was 4.8±2.7 PD as compared with a mean of 26.42±6.26 PD preoperatively (P≤0.001). Meanwhile, for the esotropic subgroup, the values were 2.57±1.13 and 15.62±4.17 PD, respectively (P≤0.001). For group B patients, the mean V-pattern exotropia was 2±1.5 PD, compared with a preoperative mean value of 23.12±10.66 PD (P≤0.001), and the mean pattern esotropia was 2.28±1.79 PD, compared with a preoperative mean value of 17.14±3.93 PD (P≤0.001), with a highly significant statistical difference between patients within the same group (P≤0.001), as well as between the two groups as regards the exotropic subgroups (P≤0.02). A significant improvement in IOOA was noted in group B, whereas the postoperative hypertropia in lateral gaze was 0.97±1 PD, compared with 5.06±2 in group A (P≤0.001).Conclusion Although considerable results were achieved with the suspension recession technique, the postoperative impact of the procedure as regards the control of IOOA may be still questionable, with significant superior results of the standard recession technique.

Plication as an alternative to resection in horizontal strabismus: A randomized clinical trial.

Purpose:Resections and plications tighten recti although the latter are less traumatic, potentially reversible, quicker, and vascularity preserving. To compare inflammation, scarring, and alignment in horizontal strabismus, operated uniocularly by either resections or plications (with recessions): recession and resection (R&R) or recession and plication (R&P) groups. This was a prospective, patient and assessor blind, randomized trial.Methods:All consenting strabismus patients qualifying for the first-time uniocular horizontal rectus surgeries underwent detailed ocular examination and were randomized into standard R&R or R&P groups. For the latter, we folded the tendon-muscle strap the desired amount using 6-0 polyglactin, suturing it to its insertion, entailing no disinsertion. We compared the groups for inflammatory grades (individually for congestion, chemosis, discharge, foreign-body sensation, and drop intolerance and aggregated to a total inflammatory score (TIS), scar visibility (SV) at 1 m, and successful alignment (≤10 prism diopter of orthotropia). We used Mann–Whitney and Fisher's exact tests, with significance at P ≤ 0.05.Results:We randomized 40 patients: 22 to R&R and 18 to R&P. The groups were comparable in age, strabismus onset and duration, and strabismus amount. The inflammatory scores, both individual and TIS, were comparable at all time-points: all P > 0.05. SV proportions were not significantly different: 16/22 in R&R versus 9/18 in R&P; P = 0.19. There were no significant differences in success rates: 14/22 versus 10/18, P = 0.74.Conclusion:Our study shows that plication is similarly effective as resection, when combined with recession in horizontal strabismus, and should be resorted to more frequently.

Surgical results for consecutive exotropia.

PURPOSE:To evaluate the surgical results of medial rectus (MR) muscle advancement with or without recession of the antagonist muscle for consecutive exotropia.METHODS:Medical records of patients with consecutive exotropia (n = 27) were retrospectively reviewed. All patients received one-eye surgery with MR advancement, lateral rectus (LR) recession, or combined surgery. The pre- and post-operative angle of deviation was recorded. Characteristics were compared between groups. The follow-up period was at least 3 months.RESULTS:The overall successful rate was 62.96%, with 50% in MR advancement group, 60% in LR recession group, and 71.4% in combined group. Patients in combined group had larger preoperative deviation. There were comparable surgical results between patients with inferior oblique (IO) muscle overaction receiving correction simultaneously and patients without IO muscle overaction.CONCLUSIONS:The overall surgical successful rate for consecutive exotropia in this study was 62.96%. Combined MR advancement and LR recession yielded better results than MR advancement or LR recession alone although it was not statistically significant.

Relationship between school rhythm and physical activity in adolescents: the HELENA study

ABSTRACTThe aim was to assess the relationship between school rhythm and physical activity (PA) in adolescents. The study included 2024 adolescents (12.5–17.4 years). Participants wore an accelerometer for 7 days. A short school rhythm was defined as a short time at school with short recesses and less time in teaching per day (Group 1). A long school rhythm was defined as a longer time at school with more time in teaching and recess (Group 2). Adolescents in Group 1 performed less moderate to vigorous PA (MVPA) than those in Group 2 per week (P < .0001), especially during school days (recess: 3.9 ± 4.0 vs. 9.8 ± 7.9 min · day−1; P < .0001; teaching hours: 14.5 ± 9.8 vs. 19.1 ± 12.0 min · day−1; P < .0001). Adolescents in Group 1 were less likely to meet the PA recommendations than were adolescents in Group 2: 30.7% vs. 34.1% (P < .0001). During school days, the percentage of adolescents who spent more than 2 h · day−1 in sedentary activities was greater in the Group 1 (P < .001). Our results suggest that leisure-time out-of-school hours is used mainly for sedentary activities, and that school time provides a good opportunity for promoting PA.

Disconnected Geography: A Spatial Analysis of Disconnected Youth in the United States

Since the Great Recession, US policy and advocacy groups have sought to better understand its effect on a group of especially vulnerable young adults who are not enrolled in school or training programs and not participating in the labor market, so called ‘disconnected youth.’ This article distinguishes between disconnected youth and unemployed youth and examines the spatial clustering of these two groups across counties in the US. The focus is to ascertain whether there are differences in underlying contextual factors among groups of counties that are mutually exclusive and spatially disparate (non-adjacent), comprising two types of spatial clusters – high rates of disconnected youth and high rates of unemployed youth. Using restricted, household level census data inside the Census Research Data Center (RDC) under special permission by the US Census Bureau, we were able to define these two groups using detailed household questionnaires that are not available to researchers outside the RDC. The geospatial patterns in the two types of clusters suggest that places with high concentrations of disconnected youth are distinctly different in terms of underlying characteristics from places with high concentrations of unemployed youth. These differences include, among other things, arrests for synthetic drug production, enclaves of poor in rural areas, persistent poverty in areas, educational attainment in the populace, children in poverty, persons without health insurance, the social capital index, and elders who receive disability benefits. This article provides some preliminary evidence regarding the social forces underlying the two types of observed geospatial clusters and discusses how they differ.

Flat leaf formation realized by cell-division control and mutual recessive gene regulation

Most of the land plants generally have dorsoventrally flat leaves, maximizing the surface area of both upper (adaxial) side and lower (abaxial) side. The former is specialized for light capturing for photosynthesis and the latter is specialized for gas exchange. From findings of molecular genetics, it has been considered that the coupled dynamics between tissue morphogenesis and gene regulation for cell identity is responsible for making flat leaves. The hypothesis claims that a flat leaf is generated under two assumptions, (i) two mutually recessive groups of genes specify adaxial and abaxial sides of a leaf, (ii) cell divisions are induced at the limited region in the leaf margin where both of two groups are expressed. We examined the plausibility and possibility of this hypothesis from the dynamical point of view. We studied a mathematical model where two processes are coupled, tissue morphogenesis induced by cell division and deformation, and dynamics of gene regulations. From the analysis of the model we found that the classically believed hypothesis is not sufficient to generate flat leaves with high probability. We examined several different modifications and revision of the model. Then we found that a simple additional rule of polarized cell division facilitates flat leaf formation. The result of our analysis gives prediction of possible mechanism, which can be easily verified in experiments.

Disconnected Geography: A Spatial Analysis of Disconnected Youth in the United States

Since the Great Recession, US policy and advocacy groups have sought to better understand its effect on a group of especially vulnerable young adults who are not enrolled in school or training programs and not participating in the labor market, so called ‘disconnected youth.’ This article distinguishes between disconnected youth and unemployed youth and examines the spatial clustering of these two groups across counties in the US. The focus is to ascertain whether there are differences in underlying contextual factors among groups of counties that are mutually exclusive and spatially disparate (non-adjacent), comprising two types of spatial clusters – high rates of disconnected youth and high rates of unemployed youth. Using restricted, household-level census data inside the Census Research Data Center (RDC) under special permission by the US Census Bureau, we were able to define these two groups using detailed household questionnaires that are not available to researchers outside the RDC. The geospatial patterns in the two types of clusters suggest that places with high concentrations of disconnected youth are distinctly different in terms of underlying characteristics from places with high concentrations of unemployed youth. These differences include, among other things, arrests for synthetic drug production, enclaves of poor in rural areas, persistent poverty in areas, educational attainment in the populace, children in poverty, persons without health insurance, the social capital index, and elders who receive disability benefits. This article provides some preliminary evidence regarding the social forces underlying the two types of observed geospatial clusters and discusses how they differ.

Y-Split Recession vs Isolated Recession of the Lateral Rectus Muscle in the Treatment of Vertical Shooting in Exotropic Duane Retraction Syndrome

To compare the results of 2 surgical procedures in the management of vertical shooting in exotropic Duane retraction syndrome (XT-DRS). This was a prospective, interventional study of consecutive patients with XT-DRS with vertical shooting on adduction operated on from August 2012 to January 2015. A total of 25 patients were identified and were divided into 2 groups: the Y-split (Y) group, which included 12 patients, who underwent Y-splitting with recession of the lateral rectus muscle (LR); and the isolated recession (R) group, which included 13 patients, who underwent isolated LR recession. Surgical outcomes in both groups were compared in terms of improvements in vertical shoots, ocular deviation, and face turn. Upshoot, downshoot, XT, and face turn showed significant postoperative improvement in both groups (p&lt;0.001). When comparing the groups, the difference in the average correction of the upshoot and downshoot was statistically significant (p = 0.0004 and 0.0174, respectively) in benefit of the Y-group. One case of horizontal overcorrection (consecutive esotropia) with another case of horizontal undercorrection (persistent XT) were reported postoperatively in the Y-group. In our series, both procedures achieved comparable results in the correction of XT and face turn. The combined Y-split recession procedure attained a more significant improvement of upshoot and downshoot but with higher incidence of postoperative complications.

Inferior Oblique Weakening and Abnormal Head Position: Controlled Myotomy versus Recession.

Purpose. Randomized controlled trial aimed at comparing surgical outcomes in a group of patients suffering from hyperfunction of the inferior oblique (IO) muscle with abnormal head position (AHP). The surgical techniques being compared are Recession and (thread) Controlled Myotomy. Materials and Methods. The group of 20 patients suffering from medium-high hyperfunction of the IO was assessed through an ophthalmological and orthoptic examination. 10 patients underwent traditional Recession (Group A) and 10 were treated with Controlled Myotomy (Group B). Results. The average age was 19 years ± 10.7 SD. After 1 year, 20% of Group A showed a small Vertical Deviation associated with a small AHP, while 80% had orthophoria and 40% of them had a small AHP. 80% of Group B showed a small Vertical Deviation associated with an equally small AHP, while 20% had orthophoria with a full resolution of AHP. Conclusion. Based on the results obtained and the fewer intrasurgical risks involved, thread Controlled Myotomy proved to be a valid alternative to Recession. Furthermore, in case of Recession, over the long period a small residual AHP remained in the patients who had orthophoria, unlike Myotomy which led to a total resolution.

Effect of Inferior Oblique Weakening Procedures Combined with Surgery for Intermittent Exotropia

Purpose: To investigate whether combining inferior oblique weakening procedures with bilateral lateral rectus recession as a surgical approach to intermittent exotropia enhances postoperative horizontal angle of deviation over bilateral lateral rectus recession alone. Methods: Patients were allocated to one of two surgical groups: a bilateral lateral rectus recession group (Group 1) or a bilateral lateral rectus recession with bilateral inferior oblique weakening group (Group 2). Group differences in the angle of distance deviation were evaluated preoperatively and at 3and 12-months postoperatively. Results: There were no significant differences in preoperative factors or angles of deviation between Group 1 (n = 98) and Group 2 (n = 77); no significant intergroup difference in the angle of deviation was observed at any postoperative time point (p > 0.05). Conclusions: Combined inferior oblique weakening procedures did not significantly influence the horizontal angle of deviation after surgery for intermittent exotropia. Accordingly, there is no need to revise the surgical amount of lateral rectus recession. J Korean Ophthalmol Soc 2015;56(2):249-253

The Effect of Clonidine on Hemodynamics, Recovery and Post-Operative Pain in Laparoscopic Gynaecological Surgeries: A Comparative Study Involving Two Routes of Administration

Background: Laparoscopy requires creation of a pneumoperitoneum which produces a significant rise in heart rate, mean arterial pressure, reduction in venous return and systemic vascular resistance. Various pharmacologic agents are used to control hemodynamic changes associated with pneumoperitoneum. Aim: To compare the effects of Clonidine administered intravenously (group IV) and intraperitoneally (group IP) on hemodynamics,recovery and post-operative pain in patients undergoing elective laparoscopic gynaecological surgeries. Study design: Randomized controlled trial. Methodology: Sixty patients undergoing elective laparoscopic gynaecological surgeries were selected. General anaesthesia was administrered in all cases.After inserting ports Group IV: received Clonidine 1µg/kg i.v along with Ropivacaine 0.25% 20cc intraperitoneally using a ryles tube introduced and directed towards hepatophrenic recess Group IP: received Clonidine 1µg/kg along with Ropivacaine 0.25% 20cc.intraperitoneally Vitals weremonitored every 30min during the procedure. Postoperatively oxygen saturation,heart rate, and blood pressure weremonitored.Aldrete recovery scoring system was used to assessreadiness for discharge. When the score was>8, and pain was monitored using VAS scoring in lying and sitting posture next 12hours. Statistical Analysis: Continous data was analysed using student t-test while categorical data was analysed using fisher’s exact test and chi square test. Results: Intravenous Clonidine significantly reduced the MAP (group IP: 80.5±6.7,group IV: 67.44±5.6) during intraoperative period while intraperitoneal group showed reduced MAP in postoperative period (group IP: 75.98±7.35, group IV: 83.36±17.05). Heart rate both during intraoperativeperiod (group IP: 63.2±6.35, group IV: 77.6±9.35) and postoperative period (group IP: 75.6±7.35, group IV: 83.36±17.05) showed significant decrease in intraperitoeal group. Intraperitoneal Clonidine showed better hemodynamic contr