Treatment Of Strabismus Research Articles

Surgical Outcomes Following Rectus Muscle Plication

Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection. To compare the surgical dose effect of plication with that of resection. Retrospective comparison of surgical outcomes in an academic pediatric ophthalmology and strabismus practice from July 25, 2005, through March 28, 2013, with a mean follow-up of 137 days for plication and 1243 days for resection. A single surgeon performed all procedures. Twenty-two consecutive patients underwent bilateral horizontal rectus plication or plication combined with antagonist recession (13 with esotropia and 9 with exotropia; mean [SD] age, 38 [21] years). Thirty-one consecutive patients underwent bilateral resection or resection combined with antagonist recession (12 with esotropia and 19 with exotropia; mean [SD] age, 28 [24] years). Six patients underwent vertical rectus plication. Rectus resection or plication performed by folding the anterior tendon posteriorly under the muscle margins oversewn to the poles of the scleral insertion, avoiding the anterior ciliary arteries. Postoperative binocular alignment at the first postoperative and last available examinations. Lateral rectus plication (mean [SD], 6.5 [2.2] mm) and resection (6.6 [1.6] mm) were performed for similar magnitudes of esotropia (27.9 [13.4] prism diopters [PD] for plication, 29.0 [15.2] PD for resection; P = .44). Mean (SD) initial correction by lateral rectus plication was 5.17 (0.29) PD/mm, slightly less than the 95% CI (5.51-7.75 PD/mm) for resection (6.63 [0.50] PD/mm). Medial rectus plication (mean [SD], 4.9 [0.9] mm) vs resection (5.1 [1.1] mm) was performed for similar magnitudes of exotropia (32.8 [14.2] PD for plication, 31.2 [15.6] PD for resection; P = .33). Mean (SD) initial correction by medial rectus plication (7.10 [1.65] PD/mm) was within the 95% CI (4.65-9.87 PD/mm) for resection (7.26 [1.23] PD/mm). Initial and late effects were similar. Ciliary circulation observed at surgery remained patent after plication. Plication was cosmetically acceptable and did not produce conspicuous tissue elevations. Horizontal rectus muscle plication is a rapidly performed, technically simple surgical procedure to strengthen the rectus muscles, with an equivalent (per millimeter) in surgical effect to that of medial rectus resection for treatment of esotropia and exotropia. Plication diminishes surgical trauma and does not intentionally sacrifice ciliary circulation, with the potential for reversal by suture release in the first postoperative days.

Single-stage surgery for symptomatic small-angle strabismus under topical anaesthesia

ObjectiveTo report outcomes of single-stage surgery under topical anaesthesia for the treatment of small-angle strabismus. DesignCase series. ParticipantsThirteen patients, 7 males and 6 females, with a median age of 32 years (range, 20–59 years) were included. MethodsPatients with symptomatic small-angle strabismus with stable deviations of no more than 20 prism diopters (PD) in horizontal and 10 PD in vertical were consecutively recruited from the Eye and ENT Hospital of Fudan University between January 2010 and April 2012. Single-stage surgery was performed under topical anaesthesia. Outcome measures were PD, Amblyopia and Strabismus Questionnaire (ASQE) scores, and subjective reduction of symptoms. ResultsThe median duration of symptoms was 40 months (range, 6–96 months). Nine patients had horizontal deviations, 3 had vertical deviations, and 1 had an exodeviation combined with a vertical deviation. All surgeries were completed without complications, and no patients experienced significant discomfort. All patients reported elimination of symptoms on postoperative day 1. Two patients required a second procedure at 1 week because of a return of symptoms. At 6-month follow-up, no patient reported recurrence of symptoms. The overall ASQE score improved from 70 preoperatively to 96 postoperatively (p = 0.001). ConclusionsThese results suggest single-stage surgery under topical anaesthesia is an effective treatment for small-angle strabismus. A large, randomized, prospective study to confirm these findings is warranted.

Surgical Dose-Effect Relationship in Single Muscle Advancement in the Treatment of Consecutive Strabismus

To evaluate the dose-effect relationship for single muscle advancement in consecutive esotropia and consecutive exotropia. Medical records from 22 patients with consecutive esotropia (n = 11) or exotropia (n = 11) were retrospectively reviewed. All patients had undergone either single lateral rectus or medial rectus advancement surgery. The alterations in muscle position and the angle deviation were measured in millimeters and prism diopters (PD) and the change in deviation was determined by subtracting the postoperative angle of deviation at 1 week from the preoperative angle. To quantify the clinical effect of muscle advancement, the ratio of the change in muscle position to the change in visual angle deviation was calculated (ie, the surgical dose-effect relationship). The mean deviation was 25.5 ± 10.4 PD preoperatively and 0 ± 6.9 PD at 1 week postoperatively. The success rate was 82% in the consecutive esotropia group and 91% in the consecutive exotropia group. The average correction ratio was 4.31 ± 0.96 PD/mm. In multiple regression analysis of total patients with consecutive strabismus and the consecutive esotropia group, the amount of muscle advancement and preoperative angle deviation were positively correlated with the correction ratio. In the consecutive exotropia group, there was no significant relationship between variables. Single muscle advancement generally provides enough correction for most consecutive strabismus cases. Surgical dose-effect relationship increases with preoperative angle deviation and amount of muscle advancement. Surgeons should consider reducing the amount of muscle advancement in patients with larger angle deviations, especially patients with consecutive esotropia.

Awareness, perceptions and knowledge of strabismus among patients visiting a tertiary eye clinic in Southwest Nigeria

The purpose of this study was to assess the perceptions, knowledge of the causes, implications and treatment of strabismus in a black population. This was a descriptive cross-sectional study utilizing a total sampling technique. Face-to-face interviews were performed using a structured questionnaire. Socio-demographic characteristics, awareness, perceived causes, effect and treatment of squint were investigated. Data was analysed using descriptive and inferential (bivariate and binary regression) analysis. A total of 405 respondents (49.6 % male, 50.4 % female) were interviewed. Ages ranged from 11 ± 90 years (mean 41.26 ± 19.00). Modal age group was 17-44 (56 %). Levels of education showed that 22.0 % had no education, while primary, secondary and tertiary levels were 12.6, 31.6 and 33.8 %, respectively. Approximately 75 % of patients were aware of strabismus. Perceived causes were unknown to 53 % while 18.0 and 12 % mentioned eye disease and congenital-related, respectively. There was no knowledge of treatment in 54 % of patients, while 21 and 25 % knew about medical and surgical treatment, respectively. The effects on social and family life were stigmatization/social misfit (23 %), psychosocial/self pity/depression/inferiority complex (88 %), burden (economic/time) (7 %), and poor cosmesis (5 %). Females were significantly more aware than males (p = 0.043, OR 0.6, CI 0.399-0.986). Age (p = 0.187) and level of education (p = 0.321) had no significant relationship with the levels of awareness. Respondents who had no education were 1.25 times less likely to be aware of squint than those who had education (OR 0.8, CI 0.693-1.642). The awareness of the cause, effects and treatment of strabismus is poor in this population. Females were more aware than males.

Alcohol Use and Positive Screening Results for Depression and Anxiety Are Highly Prevalent Among Chinese Children With Strabismus

To study associations between strabismus and alcohol use, anxiety, and depression among 10- to 17-year-old children in Guangdong, southern China. Cross-sectional, population-based study. Among 7537 children aged 6-17 years from 9 randomly selected primary and middle schools, ocular alignment was assessed with the Hirschberg light reflex, cover-uncover testing, and alternate cover testing at distance (6 m) and near (40cm). Additionally, 4000 children (53.1%) aged 10+ years received self-administered questionnaires containing screening questions on alcohol use, anxiety, and depression. Examinations were completed on 7464 of 7537 subjects (99.0%), including 3928 boys (52.6%), with a mean age of 11.1 ± 1.8 years. The prevalence of any strabismus, including exotropia (2.7%), esotropia (0.2%), and intermittent exotropia (3.9%), was 6.8%. Strabismus was more prevalent in urban students (7.3%) and female subjects (7.4%) compared to rural students (6.0%) and male subjects (6.2%) (all P < .05). In multivariate regression models, any strabismus was associated with older age and rural vs urban residence. Among 3903 children (97.6%) answering questionnaires, history of alcohol use (62.3% vs 36.3%) and positive screening responses for depression (26.0% vs 11.6%) and anxiety (10.3% vs 4.9%) were significantly (P < .01 for all) more common among children with strabismus. These Chinese children with strabismus had a significantly higher prevalence of alcohol use and possible markers of emotional problems than children without strabismus. Further research should focus on the appropriateness of classifying surgical treatment for strabismus as "cosmetic" (ineligible for reimbursement) under China's rural health insurance.

Quality of life of patients with strabismus.

To evaluate the impact of strabismus on quality of life. This cross-sectional study included 101 individuals aged 7-67 years with strabismus. They were interviewed and made to answer a questionnaire with 20 questions intended to assess the individual's interaction with their social and working environment, sensory perception, and limitations in their daily lives. There were five types of possible responses for each question: never, rarely or very few times, sometimes, frequently, and always. The questionnaire was based on the AS-20 and contained 11 questions assessing psychosocial aspects and 9 questions assessing functional aspects. Among those who were interviewed, 24.8% had undergone surgical correction of strabismus. We observed a significant impact of strabismus on the quality of life of the interviewed individuals. Feelings of sadness and inferiority because of strabismus were reported by 74.2% and 58.4% respondents, respectively. In terms of functionality, 12.1% reported difficulty in reading, 14% said they had difficulty in depth perception (stereopsis), and 17.8% frequently or always associated pain or burning sensation in the eyes to strabismus. A significant difference was detected in the quality of life scores for the psychosocial aspect among patients who had and had not undergone surgery (Wilcoxon test, 158; p<0.001). Individuals who had undergone surgery had a better quality of life from the psychosocial perspective. In this evaluation, we found a significant negative interference of strabismus on quality of life from both the functional and psychosocial perspectives. This demonstrated the importance of treatment for strabismus, regardless of age, because it can interfere with the functional well-being of the individual.

Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period.

Purpose:To evaluate the demographics and management outcomes of strabismus surgery in patients with third cranial nerve palsy.Methods:This retrospective study includes subjects with third cranial nerve palsy. We evaluated age, sex, laterality, severity of involvement, etiology, frequency of clinical findings, and types and results of treatments.Results:52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between January 1999 and January 2009. Etiologies of third nerve palsy included congenital in 16 (30.8%), trauma in 26 (50%) and other causes in 10 (19.2%) patients. In 24 patients (46.2%), the palsy was complete. The most common type of strabismus was exotropia associated with hypotropia (40%). Medical treatment was used in 25 (48%) and surgical treatment in 46 (88.4%) subjects. One time strabismus surgery was performed in 30 (65.2%), 2 times in 11 (24%) and 3 times in 5 (10.8%) subjects. The most common operation was large horizontal recession and resection in 78.2% of cases. Mean horizontal deviation in primary position was 66±29 prism diopters (PD) before surgery decreasing to 21±19, 13±12 and 6±8 PD after first, second and third surgery, respectively. Corresponding figures for mean vertical deviation were 13±15, 7±12, 4±6 and 1±2 PD, respectively. Abnormal head posture was 10-30° in 11 (21.1%) cases before treatment which completely resolved after surgery.Conclusion:Surgical management of strabismus in patients with third nerve palsy is difficult and challenging, however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.

Surgical Procedure Joining the Lateral Rectus and Superior Rectus Muscles With or Without Medial Rectus Recession for the Treatment of Strabismus Associated With High Myopia

To evaluate the outcomes of a surgical procedure involving the muscle union of the superior rectus (SR) and lateral rectus (LR) muscles with or without medial rectus (MR) recession for the treatment of strabismus associated with high myopia and the anatomic changes from before and after surgery. Thirty-five eyes of 20 patients who had undergone a muscle union of the SR and LR muscles with or without MR recession for treatment of acquired strabismus associated with an inferior displacement of the LR and nasal displacement of the SR in magnetic resonance imaging of the orbit due to axial high myopia were observed prospectively. Main outcome measures were the angles of the dislocation of the globe, angles of horizontal or vertical deviations, abductions, and supraductions. The angles of the dislocation of the globe were analyzed using magnetic resonance imaging (1.5 Tesla Magnet; Siemens Symphonia, Munich, Germany). The axial lengths ranged from 26 to 36 mm (mean: 30.6 ± 2.8 mm). The angle of dislocation of the globe changed from 178º ± 10º to 101º ± 6º, the angle of esotropia changed from 58.6 ± 2.5 to 6.8 ± 1.4 prism diopters (PD); and the angle of hypotropia changed from 12.5 ± 1.3 to 3.3 ± 1.1 PD postoperatively. Abduction and supraduction improved significantly after surgery. At the 4-year follow-up, the postoperative outcomes were stable. In the treatment of strabismus caused by high myopia, the surgical procedure involving the muscle union of the SR and LR muscles with or without MR recession was effective on both the restoration of the dislocated globe into the muscle cone and the improvement of ocular motility.

Uso da toxina botulínica para correção de estrabismo

PURPOSE: Evaluate the results and complications from type A botulinum toxin for strabismus treatment. METHODS: Type A botulinum toxin (Prosigne®) was used in 20 patients from Faculdade de Medicina do ABC (FMABC) ophthalmology ambulatory from 2006 to 2009, for esotropia treatment. The application was performed in 15 children with esotropia smaller than 50 prism diopter (PD) in both medial rectus muscles, and in 5 adults with esotropia due to VI nerve paralysis or paresis, only in the opposite muscle. The [...]

Assessment of Cortical Dysfunction in Infantile Esotropia Using fMRI

Functional magnetic resonance imaging (fMRI) is popular in the field of neuroimaging. The aim of this study was to explore the neural basis of infantile esotropia and locate the cortical region of fusion function defects using blood oxygen level-dependent fMRI (BOLD-fMRI). Subjects (5 with infantile esotropia and 8 normal) were presented with a visual stimulus (letter E). The BOLD-fMRI was used to measure the visual cortex response as the distance between the E and the eyes changing from 20 to 100 cm using a block experimental design. Data were processed offline using statistical parametric mapping and compared between the 2 groups. Areas activated in the visual cortex of normal subjects were located in the bilateral frontal gyrus and left lingual visual cortex (p<0.001). The BOLD signal in the left cingulate gyrus, bilateral precuneus, and left angular gyrus was higher in the infantile esotropia group than in the controls (p<0.001). None of the visual cortical areas showed higher signal in the control individuals than in those with infantile esotropia (p<0.001). The bilateral frontal gyrus and left lingual visual cortex regulate normal fusion function in human eyes. In infantile esotropia, the left cingulate gyrus, bilateral precuneus, and left angular gyrus visual cortex may compensate for the fusion dysfunction. These insights may help improve the diagnosis and treatment of strabismus.

Partial rectus muscle transposition for strabismus with lateral rectus muscles paralysis

To investigate surgical approach for paralytic strabismus with lateral rectus muscles paralysis and evaluate its clinical effects. Design retrospective, observational case series. 28 patients (31 eyes) who underwent augmented partial rectus muscle transposition (APRMT) in the treatment of paralytic strabismus with lateral rectus muscles paralysis from May 2009 to May 2011 at Eye & ENT Hospital of Fudan University were included in this study. The following data were analyzed: (1) The procedure that was performed, (2) The angle of deviation of primary position, (3) The presence of compensatory head posture, (4) The presence of diploma in the primary position, (5) The binocular single visual fields, (6) The motility of the affected eye. According to the results of rectus muscle forced traction test and examination before and after operation, among 31 eyes in 28 patients, 8 eyes were treated with APRMT, 10 eyes were treated with recession of antagonistic muscle of paralytic rectus muscle combined with APRMT, 7 eyes were treated with APRMT and recession of yoke muscle, 6 eyes were treated with APRMT and recession of yoke muscle combined with recession of antagonistic muscle. 17 among 28 patients were orthotopicin the primary position while others were in mild under correction with deviation no more than 10 prism degrees during 5 months (range: 3-8 months) follow-up in average. The diploma and abnormal head posture were eliminated in 26 patients except one patient who was appeared with 10 prism degrees under correction postoperatively and was resolved by wearing prisms thereafter. Binocular single visual fields were extended from 27.0° ± 6.4 ° preoperatively to 40.5° ± 4.8 ° postoperatively (t = -34.692, P < 0.001). Ocular movement was improved from -4.9 ± 0.4 to -2.9 ± 0.9 postoperatively (t = -13.418, P < 0.001). APRMT can safely and effectively correct the primary position in paralytic strabismus with lateral rectus muscles paralysis, eliminate the presence of diploma in primary position and abnormal head posture, and improve the ability of the ocular movement, furthermore, significantly expand the scope of binocular single visual fields. The results also demonstrate that rectus muscle forced traction test is a key measurement to determine the surgical procedure.

Changes in the Amygdala Produced by Viewing Strabismic Eyes

The aim of this study was to look for the response to strabismus images in the limbic network (amygdala, hippocampus, parahippocampus) of healthy volunteers and to compare it with their reaction to viewing normal eyes. Prospective, observational study. Thirty-one healthy volunteers underwent functional magnetic resonance imaging (fMRI). Functional magnetic resonance imaging data and blood oxygen level-dependent signal changes were analyzed using the BrainVoyager QX software package (Brain Innovation, Maastricht, The Netherlands). Responses to viewing strabismus images were compared with those observed while viewing normal eye images. Strabismus images led to significant activation of the amygdala, hippocampus, parahippocampal, and fusiform gyri in 30 of 31 subjects compared with normal eye images, indicating a negative emotional response. These fMRI results confirm that strabismus influences organically not only the patient with nonparallel eyes but also observers. Treatment of strabismus therefore changes the interpersonal dynamic for patients with strabismus on a demonstrable organic basis. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Beneficial Effect of Treatment for Strabismus in Patients with Bilaterally Poor Vision, Who Cannot See Their Strabismus

ABSTRACTMethods: Retrospective case note review of management of patients with bilaterally severely reduced vision presenting with symptomatic strabismus.Results: There were 10 females and 7 males, mean age at treatment was 36 years, range 19 to 74 years. Thirteen patients had an exotropia ranging from 20 to 90Δ (mean 52Δ). Four had an esotropia ranging from 30 to 70Δ (mean 53Δ). Vision in each eye ranged from 6/24 Snellen to light perception, except for one patient with Usher's syndrome who had grossly restricted visual fields and vision of 6/12 and 6/36. The etiology was retinitis pigmentosa in 5 patients; 3 had cone dystrophy, 2 were high myopes. Other etiologies included CMV retinitis in both eyes secondary to HIV, bilateral optic atrophy post craniopharyngioma, and cortical visual impairment. All patients were unable to see well enough to assess their strabismus but were aware of its presence from family members and friends and wished improvement. Eleven patients underwent botulinum toxin injections; 2 of these then proceeded to surgery. A total of 8 patients had surgery. Post-operative angles ranged from 6Δ to 25Δ of esotropia. Five patients continue with maintenance toxin. Follow-up ranged from 3 months to 15 years.Discussion/Conclusions: This is the first report of patients with bilaterally severely reduced vision requesting treatment for strabismus that they were unable to see for themselves. All patients were pleased they had undergone treatment for their strabismus despite being unable to see the outcome.

Graded rectus tenotomy in small angle hypertropia due to sagging eye syndrome

IntroductionSES is an orbital connective tissue degeneration in which adnexal laxity is associated with inferior shift of the lateral rectus (LR) and other rectus pulleys. Asymmetrical LR sag causes hypotropia and excyclotropia in the more affected eye. We aimed to develop a surgical nomogram for graded rectus tenotomy (GRT), a minimally invasive surgery, in treatment of small angle vertical strabismus in SES.MethodsWe reviewed a 3-year surgical experience in 21 patients with vertical strabismus ≤10Δ caused by SES who underwent adjustable GRT under topical anesthesia that permitted intraoperative alignment measurements. Superior oblique palsy and pattern strabismus were excluded.ResultsAverage patient age was 69 ± 12 years (10 males, 11 females). Mean preoperative central gaze hypertropia measured 4.6Δ ± 2.5Δ. The hypotropic inferior rectus (IR) was tenotomized temporally in 17, and the hypertropic superior rectus (SR) in 4 eyes. Mean tenotomy was 67Δ ± 18% of width at the scleral insertion, reducing hypertropia to zero intra-operatively and 0.9Δ ± 1.7Δ at last follow-up 127 ± 104 days postoperatively. Linear regression demonstrated that 30%-90% tenotomy corrected 3Δ - 6Δ hypertropia (R = 0.55, P = 0.008).DiscussionThe effect of peripheral GRT is moderately predictable, making this technique useful for amelioration of cyclovertical diplopia due to small-angle hypertropia in SES that is otherwise prone to overcorrection by alternative strabismus surgery. However, adjustable technique under topical anesthesia is preferred for optimal outcomes. Even under topical anesthesia, vessel sparing is readily performed during peripheral GRT of the IR.ConclusionsGRT precisely corrects small angle hypertropia in SES, and is convenient for intra-operative adjustment under topical anesthesia. IntroductionSES is an orbital connective tissue degeneration in which adnexal laxity is associated with inferior shift of the lateral rectus (LR) and other rectus pulleys. Asymmetrical LR sag causes hypotropia and excyclotropia in the more affected eye. We aimed to develop a surgical nomogram for graded rectus tenotomy (GRT), a minimally invasive surgery, in treatment of small angle vertical strabismus in SES. SES is an orbital connective tissue degeneration in which adnexal laxity is associated with inferior shift of the lateral rectus (LR) and other rectus pulleys. Asymmetrical LR sag causes hypotropia and excyclotropia in the more affected eye. We aimed to develop a surgical nomogram for graded rectus tenotomy (GRT), a minimally invasive surgery, in treatment of small angle vertical strabismus in SES. MethodsWe reviewed a 3-year surgical experience in 21 patients with vertical strabismus ≤10Δ caused by SES who underwent adjustable GRT under topical anesthesia that permitted intraoperative alignment measurements. Superior oblique palsy and pattern strabismus were excluded. We reviewed a 3-year surgical experience in 21 patients with vertical strabismus ≤10Δ caused by SES who underwent adjustable GRT under topical anesthesia that permitted intraoperative alignment measurements. Superior oblique palsy and pattern strabismus were excluded. ResultsAverage patient age was 69 ± 12 years (10 males, 11 females). Mean preoperative central gaze hypertropia measured 4.6Δ ± 2.5Δ. The hypotropic inferior rectus (IR) was tenotomized temporally in 17, and the hypertropic superior rectus (SR) in 4 eyes. Mean tenotomy was 67Δ ± 18% of width at the scleral insertion, reducing hypertropia to zero intra-operatively and 0.9Δ ± 1.7Δ at last follow-up 127 ± 104 days postoperatively. Linear regression demonstrated that 30%-90% tenotomy corrected 3Δ - 6Δ hypertropia (R = 0.55, P = 0.008). Average patient age was 69 ± 12 years (10 males, 11 females). Mean preoperative central gaze hypertropia measured 4.6Δ ± 2.5Δ. The hypotropic inferior rectus (IR) was tenotomized temporally in 17, and the hypertropic superior rectus (SR) in 4 eyes. Mean tenotomy was 67Δ ± 18% of width at the scleral insertion, reducing hypertropia to zero intra-operatively and 0.9Δ ± 1.7Δ at last follow-up 127 ± 104 days postoperatively. Linear regression demonstrated that 30%-90% tenotomy corrected 3Δ - 6Δ hypertropia (R = 0.55, P = 0.008). DiscussionThe effect of peripheral GRT is moderately predictable, making this technique useful for amelioration of cyclovertical diplopia due to small-angle hypertropia in SES that is otherwise prone to overcorrection by alternative strabismus surgery. However, adjustable technique under topical anesthesia is preferred for optimal outcomes. Even under topical anesthesia, vessel sparing is readily performed during peripheral GRT of the IR. The effect of peripheral GRT is moderately predictable, making this technique useful for amelioration of cyclovertical diplopia due to small-angle hypertropia in SES that is otherwise prone to overcorrection by alternative strabismus surgery. However, adjustable technique under topical anesthesia is preferred for optimal outcomes. Even under topical anesthesia, vessel sparing is readily performed during peripheral GRT of the IR. ConclusionsGRT precisely corrects small angle hypertropia in SES, and is convenient for intra-operative adjustment under topical anesthesia. GRT precisely corrects small angle hypertropia in SES, and is convenient for intra-operative adjustment under topical anesthesia.

Improved sensory status and quality-of-life measures in adult patients after strabismus surgery

To evaluate the change in sensory status and quality-of-life measures in adults with long-standing childhood-onset constant strabismus. Consecutive patients with childhood-onset, long-term constant strabismus were enrolled. Sensory status was examined with Bagolini striated glasses test and Worth 4-dot test. Stereopsis was tested with the Lang and TNO stereopsis tests. Quality of life was studied with 2 different questionnaires (Short Form Health Survey [SF-36] and the Amblyopia and Strabismus Questionnaire [A&SQ]), which patients completed before and 3 months after strabismus surgery. A total of 20 patients (age range, 18-63 years) were included, 10 of whom were esotropic and 10 of whom were exotropic. Of these, 13 obtained a satisfactory postoperative alignment and demonstrated an increase of sensory status with Bagolini striated glasses. Six patients who demonstrated suppression preoperatively achieved fusion and stereopsis postoperatively. The mean score in all domains of the A&SQ improved significantly, particularly with regard to social contact and cosmesis (P=0.00067), distance estimation (P=0.000312), and visual disorientation (P=0.004777). Similarly, the mean score in 7 of 8 areas in the SF-36 improved significantly, particularly with regard to physical function (P=0.000564), general health (P=0.002296), vitality (P=0.002891), social function (P=0.004234), and mental health (P=0.000334). The overall mean score of both questionnaires improved in all patients with a satisfactory postoperative alignment and increase of sensory status. Surgical treatment of strabismus in adults with long-standing childhood-onset constant strabismus can result in patients feeling that their quality of life has improved and can restore binocular sensory function.

Presence of Fusion in Albinism after Strabismus Surgery Augmented with Botulinum Toxin (Type A) Injection

It is commonly accepted that albino patients with strabismus rarely achieve binocularity and depth perception after strabismus surgery. The presence of retino-geniculo-cortical misrouting, a hallmark of the visual system in albinism, does not necessarily cause total loss of binocular vision, however, not even in albino patients with strabismus. Recently some degrees of stereopsis were reported in albinism patients with minimal clinical nystagmus, if any, in the absence of strabismus. It is possible that patients with albinism and strabismus have binocular visual potential which appears after strabismus correction and provides appropriate postoperative alignment in the long term. Here we present two cases of clinically diagnosed oculocutaneous albinism, an 18-year-old girl and a 16-year-old boy, both with exotropia ≥40 prism diopter, who gained acceptable alignment and fusion after surgical correction of their strabismus as demonstrated on Bagolini testing. In cases of albinism accompanied by visual pathway abnormalities and strabismus, binocular visual potential is not impossible, and some levels can be expected. Thus, these patients, like other cases of strabismus, may benefit from treatment of strabismus at an earlier age to achieve appropriate alignment, cosmetic satisfaction, and a possibly increased chance of fusion.

Development and application of the Chinese version of the adult strabismus quality of life questionnaire (AS-20): a cross-sectional study

BackgroundPatients with strabismus experience visual dysfunction, self-image disorders, low self-esteem, and social and emotional barriers, which adversely influence their health-related quality of life (HRQoL). Currently no strabismus-specific questionnaire is available in China to identify patients’ quality of life and to evaluate the effectiveness of strabismus treatment. The aims of the present study were to validate the Chinese-language version of the Adult Strabismus Quality of Life Questionnaire (AS-20) and to evaluate the impacts of strabismus on the quality of life among Chinese strabismus patients.MethodsTwo hundred and fifty-five Chinese adults with strabismus, one hundred visually normal adults and one hundred patients with other eye diseases completed the Chinese version of AS-20. Psychometric properties of the Chinese AS-20 were examined by Cronbach’s α coefficient, test-retest and split-half reliability, and construct and criterion-related validity. Independent-samples t test and one-way ANOVA analyses were conducted to explore the impact of demographic factors and clinical characteristics on HRQoL in Chinese strabismic adults.ResultsThe final AS-20 in Chinese (AS-C) included 18 items and two subscales: psychosocial (12 items) and function (6 items). The Cronbach’s α was 0.908 for overall scale, with 0.913 and 0.808 for 'psychosocial’ and 'function’ subscales respectively, indicating high internal consistency reliability. The mean of the overall AS-C score among strabismus patients was 62.80 ± 18.94, significantly lower than that in visually normal adults (t = -18.693, P < 0.001), and in patients with other eye diseases (t = -5.512, P < 0.001).ConclusionsThe AS-C is a culturally appropriate tool to evaluate the HRQoL in Chinese strabismus adults. The psychosocial health well-being and overall quality of life in strabismic patients should receive greater emphasis.

Crotoxin in humans: analysis of the effects on extraocular and facial muscles

Crotoxin is the main neurotoxin of South American rattlesnake Crotalus durissus terrificus. The neurotoxic action is characterized by a presynaptic blockade. The purpose of this research is to assess the ability of crotoxin to induce temporary paralysis of extraocular and facial muscles in humans. Doses of crotoxin used ranged from 2 to 5 units (U), each unit corresponding to one LD50. We first applied 2U of crotoxin in one of the extraocular muscles of 3 amaurotic individuals to be submitted to ocular evisceration. In the second stage, we applied crotoxin in 12 extraocular muscles of 9 patients with strabismic amblyopia. In the last stage, crotoxin was used in the treatment of blepharospasm in another 3 patients. No patient showed any systemic side effect or change in vision or any eye structure problem after the procedure. The only local side effects observed were slight conjunctival hyperemia, which recovered spontaneously. In 2 patients there was no change in ocular deviation after 2U crotoxin application. Limitation of the muscle action was observed in 8 of the 12 applications. The change in ocular deviation after application of 2U of crotoxin (9 injections) was in average 15.7 prism diopters (PD). When the dose was 4U (2 applications) the change was in average 37.5 PD and a single application of 5U produced a change of 16 PD in ocular deviation. This effect lasted from 1 to 3 months. Two of the 3 patients with blepharospasm had the hemifacial spasm improved with crotoxin, which returned after 2 months. This study provides data suggesting that crotoxin may be a useful new therapeutic option for the treatment of strabismus and blepharospasm. We expect that with further studies crotoxin could be an option for many other medical areas.

Prise en charge des diplopies induites dans les décompressions orbitaires : étude de 87 interventions chez 51 patients

To evaluate early strabismus treatment in patients suffering from diplopia after orbital decompression for dysthyroid orbitopathy. We conducted a chart review of 51 patients (87 orbits) who underwent orbital decompression from July 1998 to June 2007. Ocular deviations, incidence of diplopia according to the type of decompression performed and the type and results of strabismus surgery were evaluated. Diplopia was induced by decompression in 34.2% of patients, with no statistically significant difference with respect to the type of decompression performed. Forty-nine percent of patients had postoperative diplopia. Strabismus surgery was performed on average 10.9weeks after decompression. Diplopia persisted in two patients (8%). Early strabismus surgery and the intraoperative relaxed muscle positioning technique appear to provide favorable results. It allows for a more rapid rehabilitation. Better adapted choice of decompression technique may improve final outcomes.

Botulinum Toxin Injection into the Superior Rectus for Treatment of Strabismus

Botulinum toxin injected into the superior rectus (SR) has rarely been described in the literature. We conducted a database search to identify all cases of SR toxin from 1982 to 2010 at our institution. Out of a total of 7575 patients in the database, only eight cases of SR toxin were identified, all of which had residual hypertropia following previous ocular surgery. This surgery comprised: retinal surgery (3 patients), strabismus surgery for thyroid eye disease (2), and transposition for VI nerve palsy (2 patients). In seven out of eight cases, a long-lasting mean reduction of 10Δ was achieved from between two and three injections. Ptosis occurred in all but one case, but resolved. We conclude that SR toxin injection has very limited indications, but may be considered in residual hypertropia presumed secondary to a tight or overacting SR where the patient can tolerate the temporary iatrogenic ptosis.