Strabismus Patients Research Articles

Increase in blood derived mitochondrial DNA copy number in strabismus patients

BackgroundAbnormalities in mitochondrial energy homeostasis can lead to various disorders, including ocular motility aberrations. Previous studies have suggested the involvement of mitochondrial aberrations in strabismus etiology. We compared the blood-derived mitochondrial DNA (mtDNA) copy number from comitant strabismus patients with that from age-matched controls, and also compared expression of mitochondrial biogenesis genes in a separate set of extraocular muscle samples from strabismic and control subjects. MethodsBlood samples from 93 strabismic (39 esotropic, 54 exotropic) and 93 control subjectswere analyzed for mtDNA copy number through quantitative polymerase chain reaction. We also examined the expression of 6 genes involved in mitochondrial biogenesis in cDNA obtained from extraocular muscles of a separate group of 26 strabismus patients and 4 healthy controls. ResultsThe mtDNA content was significantly higher in strabismus patients as compared to the control group, both overall (fold change, 1.39; Z = −2.43 [P = 0.01]) and in strabismus subgroups (esotropia: fold change,1.42; Z = 2.59 [P = 0.0096]; exotropia: fold change, 1.41, Z = 3.35 [P = 0.00078]). No significant difference was observed in the expression of the examined biogenesis genes between strabismus and control groups. ConclusionsOur results suggest an association between mtDNA copy number and strabismus; however, further studies are required to elucidate the significance of altered mtDNA in strabismus and its possible significance with regard to the etiology of strabismus.

Effects of visual neuroplasticity training on visual perception, visual quality, and macular blood flow in patients with strabismus.

To observe the effects of visual neuroplasticity training on visual perception, visual quality, and macular blood flow in patients with concomitant strabismus postoperatively. In total, 108 patients underwent binocular strabismus correction operation, and some patients underwent neuroplasticity training. All patients underwent clinical ophthalmic examination, including measurement of best-corrected visual acuity, spherical equivalent, axis length, optical coherence tomography angiography, optical quality analysis system, and visual perception examinations. A total of 78 patients received neuroplasticity training for 1 month postoperatively, and 30 patients did not receive training. All patients underwent a visual perception examination preoperatively and at 1 day, 1 week, and 1 month postoperatively. Macular blood flow and visual quality were examined preoperatively and at 1 month postoperatively. Postoperative visual perception was better than preoperative visual perception ( P < 0.05). After neuroplasticity training, the visual perception of the trained subjects was better than that of the untrained subjects ( P < 0.05), and the blood flow in the macular area of the trained patients was lower than that of the untrained subjects ( P < 0.05). The visual quality of the untrained subjects was lower than that of the trained patients ( P < 0.05). Visual inspection system could accurately evaluate binocular visual perception in patients with concomitant strabismus. After surgical alignment of the strabismus patient, training can stimulate and integrate the formation of stereovision in a short period of time, maintain the visual quality of patients after surgery, and provide conditions for the formation of binocular visual signals and binocular stereovision, but in the short term, it will lead to the decrease of macular blood vessel density and perfusion density. However, the long-term effects of training have not been proven.

ChatGPT versus strabismus specialist on common questions about strabismus management: a comparative analysis of appropriateness and readability

Objective: Patients widely use artificial intelligence-based chatbots, and this study aims to determine their utility and limitations on questions about strabismus. The answers to the common questions about the management of strabismus provided by Chat Generative Pre-trained Transformer (ChatGPT)-3.5, an artificial intelligence-powered chatbot, were compared to answers from a strabismus specialist (The Specialist) in terms of appropriateness and readability. Patients and Methods: In this descriptive, cross-sectional study, a list of questions from strabismus patients or caregivers in outpatient clinics about treatment, prognosis, postoperative care, and complications were subjected to ChatGPT and The Specialist. The answers of ChatGPT were classified as appropriate or not, considering the answers of The Specialist as the reference. The readability of all the answers was assessed according to the parameters of the Readable online toolkit. Results: All answers provided by ChatGPT were classified as appropriate. The mean Flesch Kincaid Grade Levels of the respective answers given by ChatGPT and The Specialist were 13.75±1.55 and 10.17±2.17 (p

Comprehensive analysis of strabismus reoperations: clinical insights and progression factors

BackgroundTo compare and analyze clinical characteristics of patients undergoing two surgeries and multiple surgeries and explore relevant factors to lay the foundation for clinical prediction.MethodsA retrospective analysis was conducted on clinical data from all patients who underwent twice and multiple strabismus surgeries at Tianjin Eye Hospital between October 2012 and September 2021. Patients were divided into Group A (two surgeries) and Group B (more than two surgeries) based on the cumulative number of surgeries performed. Clinical details at the first recurrence, including sex, age, native place, overall medical history, onset time, visual acuity, affected muscle(s), etc., were documented. Non-parametric tests and chi-square tests were used to analyze clinical characteristics in each group. Binary and ordered logistic regression analysis assessed parameters associated with multiple reoperations. A linear mixed-term model observed factors impacting affected muscle(s) during surgery. Researchers examined clinical traits related to secondary strabismus variables.ResultsAmong the 910 included patients, 840 required two surgeries (Group A) and 70 underwent more than two surgeries (Group B). Significant differences were found in age, onset time, interval time, and secondary factors. Regression analysis highlighted the significant impact of interval time on the reoperation rate, effectively predicting outcomes in patients with concomitant strabismus. Other ophthalmoplegia and secondary factors significantly influenced reoperation rates in patients with non-concomitant strabismus. Interval time, esotropia, and exotropia were linked to concomitant secondary strabismus patients, while the number of surgeries, DVD, esotropia, exotropia, and esotropia V-pattern were associated with non-concomitant secondary strabismus patients. In a longitudinal study, patients with multiple surgeries showed a correlation between the vertical deviation angle magnitude and the number of involved extraocular muscles. Regression analysis revealed that in patients with concomitant strabismus, interval time, exotropia, and esotropia influenced the total number of muscles during surgery. For patients with non-concomitant strabismus, interval time, secondary factors, and SOP impacted the total number of muscles during surgery.ConclusionsInterval time in patients with concomitant strabismus, as well as secondary and other ophthalmoplegia in non-concomitant strabismus, are the main factors for multiple reoperations.

Нарушение подвижности глазного яблока у пациентов с травматическим косоглазием

Relevance. Limitation of eyeball mobility is one of the main signs of traumatic strabismus. The following main factors of its occurrence have been identified: trauma to the eye and periorbital region, orbital fracture, concussion and severe cranio-orbital or traumatic brain injury. Oculomotor function may suffer due to paresis/paralysis of the extraocular muscle, its mechanical damage or entrapment in the area of the fracture of the orbital bones (in cases where strabismus has developed as a result of an orbital fracture), or due to the formation of severe tissue fibrosis and restriction. Purpose. To study the dynamics of oculomotor function before and after surgical treatment of traumatic strabismus in patients with dystopia of the eyeball and without it. Material and methods. A retrospective analysis of outpatient records of 269 patients with traumatic strabismus was carried out. Results. Dystopia of the eyeball was detected in 34%. Exophthalmos accounts for approximately a third of all dystopias occurring in traumatic strabismus. An isolated fracture of the orbital wall did not cause exophthalmos. In such cases, other types of dystopias were noted. But in more extensive and severe injuries to the skull, exophthalmos occurred in 10% of cases. Among all cases of exophthalmos, in 40% it developed as a result of injury to the eye or periorbital region, in 60% – with severe cranio-orbital damages (COD) and head injury. It was found that as a result of surgical treatment, the number of patients with normal eyeball mobility increased from 16 to 24%. Lack of eyeball mobility was noted in 7% of patients, while before treatment their number was almost 19%. In the group without dystopia with moderate oculomotor disorders, after treatment, the mobility of the eyeball did not improve in 65% of patients; it improved in 31% of patients; in the group with dystopia, 41% retained the same degree of mobility limitation, and improvement (decrease in the degree of limitation) was detected in 55% of patients. Conclusion.It has been established that dystopia causes more severe oculomotor disorders. However, adequate surgical treatment can improve eye mobility in more than half of the patients. Key words: traumatic strabismus, dystopia, orbital rupture, eyeball mobility, restriction, fibrosis

Understanding parental hurdles in accessing strabismus treatment

PurposeTo explore the parental factors that impede early intervention for strabismus and thus identify strategies for improving access to specialized care. MethodsThis hospital-based cross-sectional study included 110 parents of children under 19 years with strabismus receiving treatment at the squint clinic of a tertiary health care center in north India. A pre-validated survey questionnaire was administered to the participants, that had a section about the socio-demographics of the participants, another section addressed the parental knowledge about strabismus about diagnosis, and the need for an eye examination. It also sought information about referral source, the felt need for squint examination, and reasons for not seeking treatment. ResultsA total of 110 parents/guardians of strabismus patients (59 exotropes and 51 esotropes) were interviewed using a survey questionnaire. Parents themselves identified 80% of cases, and a substantial link (P ​< ​0.0001) was found between the education status of parents and the age of identification of strabismus. Fear of surgical outcomes (41.79%) was a significant barrier to timely surgery with a higher percentage of parents expressing fear of surgical outcomes (P ​= ​0.025). The cost of surgery (34.33%) and the non-availability of facilities (23.88%) also delayed the intervention. ConclusionsIt is essential to educate parents about the importance of strabismus therapy at an appropriate time, stressing its reconstructive rather than merely cosmetic nature, as there are notable gaps in their knowledge. Also, we need to do away with the fear of surgical outcomes of surgical interventions for strabismus.

Surgical Planning for Pattern Strabismus in Patients with Intermittent Exotropia: Evaluating Techniques and Outcomes

&amp;lt;i&amp;gt;Background or purpose&amp;lt;/i&amp;gt;: Intermittent exotropia is the most common cause of divergent deviation. Pattern strabismus may coexist with horizontal deviations in up 35% of cases. Managing pattern strabismus concomitantly with the correction of horizontal strabismus poses a challenge due to imbalances in force vectors. This study aims to evaluate the effects of planning an intermittent exotropia surgery considering the presence of pattern strabismus and its surgical resolution. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: Observational retrospective study of patients with intermittent exotropia who underwent surgical correction at center between 2017 and 2022. Patients were categorized by the presence of pattern strabismus and furthermore by surgical technique for the correction of said incomitance (weakening of inferior oblique muscles or vertical transposition of lateral rectus muscles). Outcomes of post-surgical horizontal deviation and presence of postoperative pattern strabismus were statistical analyzed between groups using SPSS software v28.0. A p-value &amp;lt;0,05 was considered significant. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: A total of 169 patients had surgical correction for intermittent exotropia. Pattern strabismus was observed in 35,5% of patients, primarily V-pattern (88,3%). Most were male (58, 35%) with mean age of 15,13±16,38 years. 41,7% patients with pattern strabismus underwent correction of the incomitance. All techniques showed significant reduction of horizontal near (p&amp;lt;0,001) and distance (p&amp;lt;0,001) deviation. However, incomitance correction favored strongly not only the collapsing of pattern strabismus (p=0,027) but also achieved better results in postoperative distance (p=0,002) and near (p=0,031) horizontal deviation. The two techniques for resolution of pattern strabismus showed comparable results in postoperative horizontal near deviation values and resolution of pattern strabismus, favoring vertical transposition in horizontal distance deviation values (p=0,015). &amp;lt;i&amp;gt;Conclusions&amp;lt;/i&amp;gt;: The presence of pattern deviations should be actively persecuted in pre-operatively appointments to plan the surgery appropriately, as benefits in correcting the vertical incomitance are supported by this study findings. Both vertical transposition of lateral rectus muscles and weakening of inferior oblique muscles are effective techniques to correct vertical incomitances.

Exploring WNT2 polymorphisms in comitant strabismus: A genetic association study

BackgroundStrabismus is a complex oculomotor condition characterized by a misalignment of the visual axis. The genetics of strabismus are poorly defined although a few candidate genes have been identified, among which is the WNT2 gene. Our study was designed to assess the association of single nucleotide polymorphisms (SNPs) of WNT2 in Pakistani strabismus patients. MethodsA total of six SNPs, three intronic and three in the 3́ untranslated region, were screened in the current study. Logistic regression was performed using a dominant, recessive and additive model to determine the association of SNPs with strabismus and its clinical subtypes: esotropia and exotropia. Furthermore, haplotype analysis was performed. ResultsRegression analysis revealed an association of rs2896218, rs3779550, rs2285544 and rs4730775 with strabismus under the dominant model. When analyzed separately, rs2896218 and rs2285544 were found to be associated with both esotropia and exotropia, while rs4730775 was significantly associated only with exotropia under the dominant model. Based on clinical parameters, rs2896218, rs2285544 and rs4730775 were also found to be associated with the group of strabismus patients who were diagnosed at birth, but not in the group of patients who were diagnosed later in life. Haplotype analysis revealed that the haplotype A T T (corresponding to rs2896218, rs3779550 and rs2285544) was significantly more prevalent in the strabismus group. ConclusionOverall, the results of the present study suggest an association of WNT2 polymorphisms with strabismus and its subtypes in the Pakistani population, though further studies are needed to elucidate their role in strabismus etiology.

IL-22/IL-22RA1 Promotes Human Tenon's Capsule Fibroblasts Proliferation and Regulates Fibrosis Through STAT3 Signaling Pathway.

Purpose: Although it is now understood that most antiglaucoma surgeries fail because of scarring of the filtering tract, the underlying mechanism remains to be elucidated. The present study investigated the mechanism by which the interleukin (IL)-22/IL-22 receptor alpha 1 (IL-22RA1) signaling pathway regulates scar formation in glaucoma patients. Method: A total of 31 glaucoma patients who underwent trabeculectomy surgery with uncontrollable intraocular pressure because of scarring and 19 strabismus patients as the control patient group were included in the present study. ELISA was performed to measure the content of IL-22 in peripheral blood. Serum from patients was used to incubate human Tenon's capsule fibroblasts (HTFs) cells and IL-22 antibody rescued the effect of IL-22 on the biological functions. qPCR and Western blot were performed to determine IL-22RA1 mRNA and protein expression levels. Flow cytometry was performed to assess the cell cycle distribution and the Cell Counting Kit-8 assay was used to analyze cell proliferation. Results: The ELISA assay revealed that the serum IL-22 level of glaucoma patients was significantly higher than the healthy group (29.80 ± 5.1 ng/µL vs. 5.21 ± 0.9 ng/µL). After incubation with patient serum, the proliferation and activation of human Tenon fibroblasts (HTFs) were promoted. IL-22 mediated the biological function of HTFs via directly binding IL-22RA1. Moreover, transfection of the siR-IL-22RA1 or IL-22RA1 gene resulted in significant antifibrosis or profibrosis in HTFs. When a signal transducer and activator of transcription (STAT) 3 inhibitor (BAY) was introduced to the IL-22RA1 overexpression group, IL-22-induced proliferation was reduced in HTFs. Additionally, glaucoma patients had increased levels of IL-22 expression following surgery. Conclusions: The IL-22/IL-22RA1/STAT3 signaling pathway promoted fibroblast cell proliferation and alpha-smooth muscle actin, potentially regulating fibrosis in glaucoma filtration tracts. Our results provide hitherto undocumented insights into the pathophysiology of postoperative scarring.

The Outcome of Inferior Oblique Myectomy for Apparent Inferior Oblique Overaction Associated with Craniosynostosis.

Strabismus in patients with craniosynostosis is common, but surgical correction of strabismus in these patients remains challenging. We report our findings in six patients (four of whom were Korean) with craniosynostosis who underwent strabismus surgery to specifically address V-pattern horizontal strabismus with moderate-to-severe inferior oblique (IO) overaction, using IO myectomy at a single tertiary hospital between 2005 and 2016. We recorded preoperative characteristics including sex, age, type of strabismus, versions grading, refractive error, and visual acuity. The grading of cyclorotation of horizontal rectus muscles by V-pattern categorized using coronal computed tomography imaging. Of the six patients, exodeviation was found in four patients and vertical deviation in two patients in primary position. One patient had both horizontal and vertical strabismus. Available computed tomography imaging showed that V-patterns were category 1 (mild) in two patients, category 2 (moderate) in one patient, and category 3 (severe) in two patients. Complete success was defined as absence of IO overaction any more. Overall complete success rate of IO myectomy was 83.3%. IO myectomy appeared to have some benefits in V-pattern horizontal strabismus with moderate-to-severe IO overaction in patients with craniosynostosis.

Evaluating Turkish Readability and Quality of Strabismus-Related Websites.

Background This cross-sectional study aimed to assess the readability of strabismus-related websites and the quality of their content. Methodology This cross-sectional study evaluated the websites on strabismus disease using Ateşman and Bezirci-Yilmaz's readability formulas, which have been scientifically verified to be effective for Turkish people. The study picked texts from the first 50 websites that appeared on the screen after typing "strabismus treatment" into the Google search engine based on their Turkish reading level and information reliability. In this study, 41 of the first 50 websites were reviewed. Furthermore, two separate senior ophthalmologists evaluated the JAMA and DISCERN indexes, as well as the credibility of the content on these sites. Results The Bezirci-Yilmaz readability index indicated that the websites were readable for individuals with an average education level of 10.5 ± 2.3 years. The websites scored an average of 55.2 ± 7.9 on the Ateşman readability formula, indicating that they were readable for students in the 11-12th grade. The websites had an average JAMA score of 0.8 ± 0.7 points and a DISCERN score of 34.2 ± 8.6 points, indicating low-quality content. Conclusions The readability of websites providing information regarding strabismus was significantly higher than Turkey's average educational level. Websites should not only be designed to be easy to read so that strabismus patients may learn about their condition but should also provide higher-quality strabismus content.

Wearable apparatus for correction of visual alignment under torsional strabismus.

A wearable optical apparatus that compensates for eye misalignment (strabismus) to correct for double vision (diplopia) is proposed. In contrast to prism lenses, commonly used to compensate for horizontal and/or vertical misalignment, the proposed approach is able to compensate for any combination of horizontal, vertical, and torsional misalignment. If the action of the extraocular muscles is compromised (e.g., by nerve damage), a patient may lose their ability to maintain visual alignment, negatively affecting their binocular fusion and stereo depth perception capability. Torsional misalignment cannot be mitigated by standard Fresnel prism lenses. Surgical procedures intended to correct torsional misalignment may be unpredictable. A wearable device able to rectify visual alignment and restore stereo depth perception without surgical intervention could potentially be of great value to people with strabismus. We propose a novel lightweight wearable optical device for visual alignment correction. The device comprises two mirrors and a Fresnel prism, arranged in such a way that together they rotationally shift the view seen by the affected eye horizontally, vertically, and torsionally. The extent of the alignment correction on each axis can be arbitrarily adjusted according to the patient's particular misalignment characteristics. The proposed approach was tested by computer simulation, and a prototype device was manufactured. The prototype device was tested by a strabismus patient exhibiting horizontal and torsional misalignment. In these tests, the device was found to function as intended, allowing the patient to enjoy binocular fusion and stereo depth perception while wearing the device for daily activities over a period of several months. The proposed device is effective in correcting arbitrary horizontal, vertical, and torsional misalignment of the eyes. The results of the initial testing performed are highly encouraging. Future study is warranted to formally assess the effectiveness of the device on multiple test patients.

The distribution characteristics of strabismus surgery types in a tertiary hospital in the Central Plains region during the COVID-19 epidemic

ObjectiveThis study aimed to analyze the distribution of different types of strabismus surgery in a tertiary hospital in Central China during the three-year period of the COVID-19 pandemic.MethodsA retrospective analysis was conducted on the clinical data of strabismus patients who underwent surgery and were admitted to the Department of Strabismus and Pediatric Ophthalmology at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022.ResultsA total of 3939 strabismus surgery patients were collected, including 1357 in 2020, 1451 in 2021, and 1131 in 2022. The number of surgeries decreased significantly in February 2020, August 2021, and November and December 2022. Patients aged 0–6 years accounted for 37% of the total number of strabismus surgery patientsr. The majority (60%) of all strabismus surgery patients were diagnosed with exotropia, with intermittent exotropia accounting for the highest proportion (53%). There was no statistically significant difference in the proportion of intermittent exotropia and constant exotropia during the three-year period (χ2 = 2.642, P = 0.267 and χ2 = 3.012, P = 0.221, respectively). Among patients with intermittent exotropia, insufficient convergence type was the most common form of strabismus (accounting for over 70%). Non-accommodative esotropia accounted for more than 50% of all internal strabismus cases.ConclusionDuring the period from 2020 to 2022, the total number of strabismus surgeries in our hospital did not show significant fluctuations, but there was a noticeable decrease in the number of surgeries during months affected by the pandemic. Exotropia accounted for the highest proportion among strabismus surgery patients. Intermittent exotropia was the most common type among patients undergoing surgery for exotropia, and the most prevalent subtype was the insufficient convergence type. The age distribution of patients varied in different months, with a concentration of surgeries for strabismus patients in the 7–12 years old age group during the months of July and August each year.

CHANGES IN STEREOSCOPIC VISION TOWARDS STRABISMUS CORRECTION SURGERY IN DR MOHAMMAD HOESIN CENTER HOSPITAL, PALEMBANG

Abstract&#x0D; Introduction &amp; Objectives : This study aims to determine the improvement of binocular vision function after restoring the lost fusion with strabismus correction&#x0D; Methods : A before and after design clinical trial study was carried out at the Eye Polyclinic of the Moh. Hoesin Hospital in Palembang from June 2021 to February 2022 with a sample of 16 people. Stereoscopic vision examination was carried out with the TNO Stereo Test (Toegepast Natuurwetenschappeelijk Onderzoek) examination before and after strabismus correction was carried out. Analysis of research results with SPSS version 22.0.&#x0D; Results : In this study it was found that stereoscopic vision before surgery could improve significantly after strabismus correction and dichoptic training for 1 month (p&lt;0.05) as much as 68.75%. Meanwhile, confounding factors such as the type of deviation, the magnitude of the deviation, the initial onset of the deviation and the duration of the deviation did not significantly influence the incidence of increased stereoscopic vision improvement in the study subjects (p&lt;0.05).&#x0D; Conclusion : There is an increase in the value of binocular vision in strabismus patients after strabismus surgery and undergoing dichoptic vision training for 1 month. Dichoptic training can improve the function of binocular vision.

SUCESSFULL MANAGEMENT OF CHILDHOOD BASIC-TYPE ESOTROPIA IN ADULT PATIENT

Introduction : Strabismus in adults may indicate other pathological causes, such as neurological disorders or trauma. Diagnosis of esotropia in adult patients has to be made carefully to determine the right treatment. Management’s goal of strabismus in adult patients is mainly cosmetic by diminishing deviation.&#x0D; Case Illustration : A 46-year-old woman, complaint of inward deviation of both eyes since childhood. There were no complaints of double vision, headaches, nor trauma history. Visual acuity of right eye was 0.4 with BCVA and left eye was 0.8 with BCVA 0.8. Hirschberg test was 45o (Figure 2A). Prism cover test was 75 PD base out in near and distance. Patient was diagnosed with basic-type esotropia. The patient already given spectacles but the deviation persisted so she underwent bilateral medial rectus recess surgery (Figure 2B). Ocular alignment without spectacles 1 week after surgery showed orthotropia and small esophoria. (Figure 2C).&#x0D; Discussion : Each esotropia types has a different treatment approach. Basic-type esotropia with large deviation usually needs surgical treatment. Management of childhood onset strabismus in adult patients is challenging because those patients have lesser ability to maintain fusion. Older patients and large deviation are poor prognostic factors to achieve good functional and cosmetics outcome after strabismus surgery.&#x0D; Conclusion : Establishing a definite diagnosis in adult strabismus patients, including esotropia, is challenging. Careful diagnosis and management decision will determine the outcome of the patient’s condition.

Incidence of Strabismus Post–Plaque Brachytherapy in Patients With Uveal Melanoma

PurposeTo determine the incidence and type of strabismus in patients with uveal melanoma treated with plaque brachytherapy. DesignRetrospective incidence estimation study SettingMulticenter Patient Population438 eyes of 438 patients with uveal melanoma treated with plaque brachytherapy between October 2011 to May 2021. InterventionIodine 125 plaque brachytherapy Main Outcome MeasuresVariables reviewed included incidence of non-resolving strabismus post-plaque brachytherapy, type of strabismus developed, extraocular muscles operated, and modality of treatment received. ResultsFour hundred thirty-eight patients underwent plaque brachytherapy treatment for uveal melanoma. Eleven patients developed strabismus post plaque brachytherapy (2.5%, n=11/438). Of these patients, five (1.1%, n=5/438) developed strabismus immediately post-operation. Specifically, two patients (0.5%, n=2/438) developed strabismus immediately post-operation due to slipped muscles, two patients (0.5%, n=2/438) due to decompensated phorias, and one patient (0.5%, n=1/438) due to a fibrotic muscle. Six patients (1.4%, n=6/438) developed late onset sensory strabismus. A total of 355 (81.1%, n=355/438) patients had their extraocular muscles disinserted during surgery, with the lateral rectus being the most common, accounting for 45.4% (n=161/355). Followed by the superior rectus at 26.8% (n=95/355). Strabismus surgery was the most common treatment modality, comprising 72.7% (n=8/11) of patients. ConclusionThe incidence of strabismus following plaque brachytherapy treatment for uveal melanoma was low, and primarily classified as late onset sensory strabismus. Previous studies may underestimate the long-term incidence of strabismus post plaque brachytherapy by focusing primarily on strabismus present immediately post-operatively.

The effect of strabismus surgery on psychosocial and functional quality of life

Aims: To evaluate the effect of strabismus surgery on psychosocial and functional quality of life. Methods: 50 adult strabismus patients who presented to our outpatient clinic with the complaint of strabismus in one eye were included in the study. Routine ophthalmologic examinations and strabismus controls were performed. With the diagnosis of monocular fixed eso/exotropia, unilateral horizontal muscle retraction and resection surgery were planned, and preoperative adult strabismus score (AS-20), Rosenberg self-esteem, body perception, and social appearance anxiety questionnaires were applied. A postoperative PD of 10 or less was considered success, and the questionnaires were repeated at the 2nd postoperative month. Results: The mean age of the patients was 21.54±3.95 (16-32) years. Twenty-two of the patients were female, and 28 were male. Pre-operative and post-operative strabismus AS-20 score, Rosenberg self-esteem, body perception, and social appearance anxiety scales showed statistically significant differences (p&lt;0.05, p&lt;0.001, p&lt;0.001, p&lt;0.001, p&lt;0.001). Conclusion: Strabismus is an important disease that can cause difficulties in social life both in childhood and adulthood. The aim of strabismus surgery is to restore normal facial appearance as well as functional correction. Our study results showed that successful strabismus surgery can improve the psychosocial and functional quality of life.

Community Knowledge, Attitude, and Practices Related to Strabismus and Strabismus Treatment and Surgery in Al-Jouf Region, Saudi Arabia.

Strabismus is the misalignment of the visual axis of both eyes caused by abnormalities in binocular vision or anomalies of neuromuscular control of ocular motility.This study aimed to assess the community knowledge, attitude, and practices related to strabismus and strabismus treatment and surgery in the Al-Jouf region of Saudi Arabia. This study utilized a quantitative cross-sectional design. The consented volunteering adult participants were randomly selected through sequential enrollment to the completion of the target sample size from five population groups constituting the Al-Jouf region of Saudi Arabia. The data were collected through an online validated self-administered questionnaire. The collected data were analyzed using descriptive and inferential statistics. The study included 340 participants; 67.6% of them were females and 32.4% were males. Only 66.8% of participants correctly defined strabismus. Symptoms of strabismus were identified as double vision (58.5%), blurred vision (48.2%), headache (31.8%), eye fatigue (41.5%), and difficulty reading (47.1%). Regarding risk factors of strabismus, 48.5% reported family history, 39.4% reported uncorrected refractive errors, and 23.2% reported long screen time. Complications of untreated strabismus were reported as low self-confidence (39.1%), vision loss (27.6%), poor interpersonal relationships (25.9%), amblyopia (42.6%), and cosmetic stigma (14.1%). Only 45.6% of the participants agreed to marry someone with strabismus or allow their relatives to do so. The majority of participants (72.6%) would advise a strabismus patient to visit an ophthalmologist. Despite a higher knowledge regarding strabismus among females, younger agers, higher education, single persons, workers/students, and those inhabiting the capital city of the region, such association did not reach significance. The study shows a moderate level of knowledge, attitude, and practices among the general population of Al-Jouf Saudis towardstrabismus. There was no significant relationship between knowledge of strabismus and any of the demographic characteristics of the participants. This might prove detrimental to the early detection and treatment of strabismus to prevent its complications and improve its outcomes and the quality of patients' lives. Institution of correlation plans are mandated by the Ministry of Health and interested stakeholders.

Changes in retinal and choroidal blood flow after one or two horizontal rectus muscle surgeries by optical coherence tomography angiography

Purpose To evaluate the retinal and choroidal microvasculature after one or two horizontal rectus muscle surgeries in strabismus patients using swept-source optical coherence tomography angiography (SS-OCTA). Methods 30 eyes of 26 patients who underwent horizontal rectus muscle surgery were included in this study. Group A, A’ and Group B , B’ respectively consisted preoperative and postoperative measurements of patients who underwent one or two horizontal rectus muscle surgeries. We analyzed the vessel density (VD) of the superficial vascular complex (SVC), the deep vascular complex (DVC), the choriocapillary layer (CC), choroidal vascular index (CVI), choroidal thickness (T-Ch) and retinal nerve fiber layer thickness (T-RNFL) preoperatively, and one week postoperatively. Results Only in the nasal sector of the perifoveal zone, the VD in SVC demonstrated a significant increase in Group A’ (p = 0.027). There was a statistically significant difference in the VD changes of SVC between Group A and Group B (p = 0.043). The VD in DVC did not change significantly in the whole macular compared with the preoperative. Moreover, in both Group A’ and Group B’, the VD in CC showed a reduction in a single sector of the parafoveal area (p < 0.05). Group A’ have increased CVI in the nasal sector of the perifoveal region (p = 0.008). In addition, the T-Ch increase in the perifoveal region was more significant in Group B’ than in Group A’ (p < 0.05). Group A’ showed statistically significant decreases in T-RNFL in the foveal and parafoveal regions (p < 0.05). Conclusion This study revealed that the increase in choroidal thickness was more significant after two rectus muscle surgery. In addition, there were microvascular changes in sectional macular regions after strabismus surgery. OCTA is an excellent way to study the impact of strabismus surgery on the macular structure and blood flow.

Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy in localizing horizontal rectus muscle insertions.

To evaluate the viability and precision of measuring the distance from the limbus to extraocular muscle insertion using anterior segment optical coherence tomography (AS-OCT) and panoramic ultrasound biomicroscopy (UBM) before and after strabismus surgery. We recruited primary strabismus patients and measured the limbus-insertion distance by AS-OCT and UBM preoperatively, 2 weeks, and 1, 3, and 6 months postoperatively. Values were also measured using callipers intraoperatively before and after the planned procedures. Preoperative AS-OCT and UBM values were compared to intraoperative calliper measurements as the gold standard. Postoperative AS-OCT and UBM values were compared to the new postoperative limbus-insertion distance. The limit of agreement deemed clinically acceptable was defined as 1 mm. A total of 85 horizontal muscles of 40 patients, including 48 lateral rectus muscles and 37 medial rectus muscles, were analysed. Primary muscles could be successfully detected by AS-OCT (95%) and UBM (100%). At 2 weeks and 1, 3, and 6 months postoperatively, the new rectus muscle attachment site detection rate by AS-OCT was 6%, 32%, 80%, and 89%, respectively, and that by UBM was 24%, 60%, 85%, and 93%, respectively. The Bland-Altman plots revealed better consistency in pairs of AS-OCT, UBM, and calliper measurements of primary muscles than postoperative muscles. For primary muscles, 89% of AS-OCT measurements fell within the permissible range of surgical measurements (1 mm), but this dropped to 67% at 6 months postoperatively (P < 0.001). The accuracy of UBM measurements of primary muscles was 81%, and this decreased to 59% at 6 months postoperatively (P = 0.001). AS-OCT and UBM performed well in terms of imaging primary horizontal rectus muscles, but showed decreased accuracy and reproducibility in postoperative muscle measures.