Treatment Of Strabismus Research Articles

The causative diseases, common comorbidities and surgical procedures of 948 cases of horizontal sensory strabismus

Objective: To investigate the common causes, onset age of vision impairment and complications of sensory strabismus, and to explore the effective surgical methods for sensory strabismus and associated complications. Methods: In this retrospective study, there were 948 cases of surgical treatment for sensory strabismus from 2005 to 2015 in Tianjin Eye Hospital, including 822 cases of sensory exotropia and 126 cases of sensory esotropia. Causative disease, onset age of vision impairment, eye movement, horizontal and vertical deviation and surgical methods were evaluated. Statistical methods included independent samples t test, Mann-Whitney U test and chi-squared test. Results: Congenital or traumatic cataract was the most common cause of sensory strabismus. Anisometropia, optic atrophy, corneal opacity and retinal detachment were also primary reasons. The mean onset age of vision impairment was (2.3±4.2) years in the sensory esotropia group and (8.8±9.0) years in the exotropia group, and a positive correlation was found between the two groups (t=-8.00, P<0.01). Sensory strabismus occurred with A- or V-pattern in 100 cases (10.5%), nystagmus in 42 cases (5.1%), DVD in 57 cases (6%) and oblique overaction in 134 cases (14.1%;including 54 cases with A- or V-pattern). No statistically significant difference existed between the relevance ratio of A- or V-pattern, oblique overaction and the type of strabismus (χ(2)=0.13, 0.04; P>0.05), but significance difference existed between the relevance ratio of nystagmus, DVD and the type of strabismus (χ(2)=48.33, 12.04; P<0.01). Conclusions: The leading cause of sensory strabismus was cataract. The onset age of vision impairment was earlier in the sensory esotropia group than the exotropia group. Patients were more likely to suffer from DVD and nystagmus in the sensory esotropia group than the exotropia group. Surgeons should make a comprehensive assessment before surgery to design a rational surgical procedure. (Chin J Ophthalmol, 2018, 54: 283-287).

Universal principles of justice and respect for cultural and religious diversity in the capability approach

Summary Should a theory of justice that yields universal principles for the allocation of goods be sensitive to cultural differences, and should there be a limit to the respect for cultural and religious diversity? I address this question from a liberal point of view and more specifically based on the Sen-Nussbaum capability approach. Three possible arguments within this approach are analyzed: dignity, internalist essentialism, and positive freedom. The interplay between a universal principle of distribution and respect for cultural and religious diversity is demonstrated by using a particular version of the capability approach that is applicable to the health care sphere, namely the Sufficiency of Basic Human Functional Capabilities. I discuss the account's commitment to a universal allocation principle and its respect for cultural and religious diversity, and demonstrate the possible tension between them using two examples: treatment of congenital strabismus and the definition of death as a prerequisite for organ removal. It is shown that liberals can present and defend universal principles of justice if they can clearly define what the universal principles for justice require and if they can provide strong justification for these universal claims. I argue that by means of the same argument in favour of respecting cultural diversity, liberals can justify not respecting it under certain circumstances. It is shown why these circumstances apply to the case of congenital strabismus and why in the case of the definition of death respect for religious and cultural pluralism is compatible with universal principles of justice.

Interventions for eye movement disorders due to acquired brain injury.

Interventions for eye movement disorders due to acquired brain injury.

Botulinum toxin as an initial therapy for management of sixth nerve palsies caused by nasopharyngeal carcinomas.

PurposeThe purpose of this study is to evaluate the efficacy and safety of botulinum toxin injection as a primary treatment for strabismus in a cohort of patients with nasopharyngeal carcinoma (NPC)-related chronic sixth nerve palsy.Patients and methodsWe retrospectively reviewed all cases of NPC-related sixth nerve palsy receiving botulinum toxin injection in the Hong Kong Eye Hospital between January 2009 and January 2016. Only cases with diplopia for at least 6 months; and failed a trial of Fresnel prism therapy were recruited. We excluded cases with prior strabismus surgery and multiple cranial nerve palsies. Patients were offered botulinum toxin injection as primary treatment for their strabismus and were given further injections or offered surgery if diplopia persisted. Success with botulinum toxin was defined as a final distant orthophoria of <15 PD in primary gaze, no diplopia in primary position, and no head turn, as measured 6 months after the last injection, without requiring a second treatment.ResultsA total of 25 patients were included in the study. All patients received concurrent chemo-radiotherapy for NPC. There was a statistically significant reduction in the mean deviation at distant after the last injection compared to that at presentation (P<0.001, Wilcoxin signed rank test). Overall, 7 patients (28%) achieved clinical success and 15 patients (64%) remained diplopia-free by repeated botulinum toxin injections alone. Nine patients went on to receive definitive surgery and all achieved good ocular alignment after surgery. Transient ptosis or vertical deviation was seen in 7 patients, which resolved within 3 months and no serious complications arose from the treatment in our series.ConclusionsBotulinum toxin injection is a relatively less-invasive alternative to surgery that can be done under a topical anesthesia setting, which improves patient's quality of life via reduction in diplopia. It is a recommendable initial option in patients with chronic nerve palsies who may have higher risks associated with strabismus surgery.

Successful treatment of strabismus in a child with Moebius syndrome

Successful treatment of strabismus in a child with Moebius syndrome

Diagnosis and treatment of strabismus caused by nasal endoscopic surgery

Objective: Strabismus with diplopia is the main orbital complication of functional endoscopic sinus surgery (FESS). This study was to analyze clinical findings, treatment and outcomes of such cases. Methods: Retrospective case series. Twenty-three cases were divided into 3 groups based on the disease severity: group A, partial transection of the medial rectus muscle, group B, complete transection of the medical rectus, group C, transection of the medial rectus combined with the other orbital injuries. Complete ophthalmology examinations, including eye alignment, eye motility, force duction test, force generation test, general eye exam, and medical imaging (orbital CT or MRI), were performed for each case. The treatment included botulinum toxin (Botox) injection to the lateral rectus muscle, transposition of the vertical rectus muscle, and orbital surgery if needed. Results: In group A with Botox injection, all the cases achieved single vision in primary position, but still remained some adduction weakness. In group B treated by vertical transposition surgery combined with Botox, 22% of the cases got single vision in primary gaze. In group C, even with more efforts of treatment, the cases with orbital injury can only get cosmetic improvement, and diplopia and adduction dysfunction were found in most cases. Conclusions: Due to the variety of the complications of FESS, force duction test is a crucial exam to detect the direction and severity of synechia in the orbit, which will give solid information to surgery approach as well as prognosis. Botox injection at early stage will minimize the contraction of antagonist lateral rectus, helping to postpone the transposition surgery which may cause anterior segment ischemia when performed right after the medial rectus transection injury. Botox may even reduce the synechia by minimizing the scarring process. Partial vertical rectus transposition combined with muscle resection may effectively correct the eye misalignment in primary gaze and improve eye motility. The prognosis of FESS induced orbital complications is quite related with the severity of the injury. Botox combined with surgery may help medial rectus transection cases to achieve single vision in primary gaze, but when there is any other orbital injury, treatment may only improve cosmetic appearance. (Chin J Ophthalmol, 2017, 53: 917-923).

Strabismus-associated myopia. Review

Abstract Introduction The treatment of strabismus associated with myopia is often a therapeutic challenge for the ophthalmologist. The strabismus associated with myopia has certain peculiarities and there are even certain types of strabismus that occur exclusively in myopia, such as strabismus fixus, requiring treatments with specific surgical techniques. Materials and methods It is important to make a correct differential diagnosis, because there are many conditions described with this association. A review is presented of strabismus associated with myopia, together with its treatment adjusted to refractive error. Results Measurements of strabismus may be altered by the prismatic effect of the spectacles. Surgical results may be unpredictable if myopia is not taken into account. Better results were obtained with the techniques of anatomical replacement described by Yokoyama than with traditional retro-insertion-resection. Conclusion For the diagnosis and appropriate treatment of strabismus, it is important to make a correct measurement of the angle of deviation, and perform image tests prior to surgery in certain cases. The anatomical characteristics of the myopic eye should also be taken into account during surgery.

Surgical interventions for vertical strabismus in superior oblique palsy.

Superior oblique palsy is a common cause of vertical strabismus in adults and children. Patients may be symptomatic from binocular vertical diplopia or compensatory head tilt required to maintain single vision. Most patients who are symptomatic elect to undergo strabismus surgery, but the optimal surgical treatment for vertical strabismus in people with superior oblique palsy is unknown. To assess the relative effects of surgical treatments compared with another surgical intervention, non-surgical intervention, or observation for vertical strabismus in people with superior oblique palsy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 13 December 2016), Embase Ovid (1947 to 13 December 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 13 December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 13 December 2016, ClinicalTrials.gov (www.clinicaltrials.gov); searched 13 December 2016, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 13 December 2016. We did not use any date or language restrictions in the electronic searches for trials. We included randomized trials that compared at least one type of surgical intervention to another surgical or non-surgical intervention or observation. Two review authors independently completed eligibility screening, data abstraction, 'Risk of bias' assessment, and grading of the evidence. We identified two randomized trials comparing four different surgical treatments for this condition, two methods in each trial. The studies included a total of 45 children and adults. The surgical treatments were all procedures to weaken the ipsilateral inferior oblique muscle. One study compared inferior oblique myectomy to recession of 10 mm; the other study compared inferior oblique disinsertion to anterior transposition (2 mm anterior to the temporal border of the inferior rectus insertion).We judged both studies to be at unclear risk of bias due to incomplete reporting of methods and other methodological deficiencies.Neither study reported data on the primary outcome of this review, which was the proportion of participants with postoperative surgical success, defined as hypertropia less than 3 prism diopters (PD) in primary gaze. However, both studies reported the average reduction in hypertropia in primary gaze. One study found that at 12 months' postoperatively the average decrease in hypertropia was higher in participants who underwent inferior oblique myectomy than in those who underwent recession, however data were not available for statistical comparison. The other trial found that after at least six months of follow-up, the mean decrease in primary position hypertropia was lower in participants who underwent inferior oblique disinsertion than in those who underwent anterior transposition (mean difference (MD) -5.20 PD, 95% confidence interval (CI) -7.76 to -2.64; moderate-quality evidence).Both trials also reported the average postoperative reduction in vertical deviation in adduction. One study reported that the average reduction in hypertropia in adduction was greater in participants who underwent inferior oblique myectomy than in those who underwent recession, but data were not available for statistical comparison. The other study found a lower decrease in hypertropia in contralateral gaze in participants who underwent inferior oblique disinsertion than in those who underwent anterior transposition (MD -7.10 PD, 95% CI -13.85 to -0.35; moderate-quality evidence).Secondary outcomes with sufficient data for analysis included proportion of participants with preoperative head tilt that resolved postoperatively and proportion of participants who underwent a second surgery. These outcomes were assessed in the trial comparing inferior oblique anterior transposition to disinsertion; both outcomes favored anterior transposition (risk ratio 7.00, 95% CI 0.40 to 121.39 for both outcomes; very low-quality evidence). None of the participants who underwent inferior oblique anterior transposition or disinsertion developed postoperative hypotropia or reversal of the vertical deviation. All participants who underwent inferior oblique anterior transposition developed elevation deficiency, which the authors deemed to be clinically insignificant in all cases, whereas no participants who underwent inferior oblique disinsertion experienced this complication. Additionally, the trial comparing inferior oblique myectomy to recession reported that no participant in either group required another strabismus surgery during the postoperative period. The two trials included in this review evaluated four inferior oblique weakening procedures for surgical treatment of superior oblique palsy. We found no trials comparing other types of surgical procedures for this disorder. Both studies had enrolled a small number of participants and provided low-quality evidence due to limitations in completeness and applicability. We therefore found no high-quality evidence to support recommendations for optimal surgical treatment of superior oblique palsy. Rigorously designed, conducted, and reported randomized trials are needed to identify the optimal surgical treatment for vertical strabismus in this disorder.

THE APPLICATION OF TYPE A BOTULINUM TOXIN FOR THE TREATMENT OF PATIENTS PRESENTING WITH VARIOUS FORMS OF STRABISMUS

The use of type A botulinum toxin (BTX-A) for the treatment of strabismus was for the first time proposed in the early 1980s by the American ophthalmologist Alan Scott. The earliest applications of the botulinum toxin in the clinical practice included the treatment of strabismus and blepharospasm. The use of this agent can be particularly useful in the situations where the surgical treatment of strabismus is either undesirable or impracticable for one or another reasons; moreover, injections of BTX-A were successfully used to treat the patients presenting with severe diplopia. The results of the application of the botulinum toxin reported by different authors vary considerably which dictates the necessity of a deeper insight into the mechanisms underlying its action and their further investigation. The commonest complications of therapy with this medication are a temporary ptosis and vertical deviation. The systemic complications of BTX-A application have never been documented; its repeated injections are believed to be safe for the patients.

An update on new and unique uses of botulinum toxin in movement disorders

The therapeutic applications of botulinum toxin (BoNT) have grown manifold since its initial approval in 1989 by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and other facial spasms. Although it is the most potent biologic toxin known to man, long-term studies have established its safety in the treatment of a variety of neurologic and non-neurologic disorders. This review focuses on some novel and uncommon uses of BoNT in the treatment of movement disorders, such as oromandibular dystonia, including bruxism, anterocollis, camptocormia, tremor, tics, tardive and levodopa-induced dyskinesia, and restless legs syndrome. Despite a paucity of randomized controlled trials and lack of FDA approval for these movement disorders, there is growing body of evidence that BoNT provides benefit to patients with these hyperkinetic movement disorders and that BoNT is a safe treatment when used by clinicians skilled in the administration of the drug for these conditions.

Changes in the electromyography of the lateral and medial muscles after the electrostimulation treatment of lateral muscles in children with convergent concomitant strabismus

PurposeIt is known that physiotherapeutic treatment of convergent concomitant strabismus with electrostimulation of extraocular rectus muscles is applied. Assessment of changes in the electromyography of the muscles after the course of treatment was not carried out, due to absence of a method of surface electromyography (SEMG) of the rectus muscles.To identify changes in the SEMG before and after electrostimulation of the external rectus muscles in children with concomitant strabismus the work was doneMethodsElectrostimulation of the lateral rectus muscles of both eyes was performed using the Amplipulse‐5 apparatus in a standard procedure in 12 children (24 eyes) with convergent concomitant strabismus with deviation 12‐ 24pr.dptr. SEMG was done with the M‐TEST‐2 electromyograph, according to the method developed by us earlier. Patients were examined before and after treatment.ResultsAmplitudes of the biopotentials of the SEMG of the lateral rectus muscle decreased slightly after treatment (11,55 ± 2,3 mV ÷ 10,64 ± 0,7 mV, p&gt; 0.05), while the frequency increased significantly (49, 7 ± 3,6Hz ÷ 63,18 ± 8,2Hz, p &lt;0.05). Ranges of the SEMG biopotential amplitudes and frequency of the medial rectus muscle decreased slightly after treatment (11.48 ± 0.5 mV ÷ 10.2 ± 0.9 mV, 101.96 ± 5.6 Hz ÷ 94.7 ± 19, 5 Hz, p&gt; 0.05).Deviation became less in average on 12,2±4,6 pr.dptr. en with concomitant strabismus.ConclusionsThe method of surface electromyography allows estimating changes in the biopotentials of the external rectus of the eye before and after electrostimulation (amplitude, frequency). Electrostimulation treatment decrease the imbalance between the lateral and medial rectus muscles biopotentials of SEMG in children with a convergent concomitant strabismus.

Amblyopia and strabismus: trends in prevalence and risk factors among young adults in Israel

AimsTo estimate the prevalence of amblyopia, present strabismus and amblyopia risk factors (ARFs) among young adults in Israel and to analyse trends over time of prevalence rates.MethodsWe conducted a cross-sectional...

Improved surgical treatment of V-Pattern Strabismus with pseudo-overaction of the inferior oblique muscles in craniofacial syndromes

V-pattern strabismus with pseudo-overaction of the inferior oblique muscles is a common finding in craniofacial syndromes that is related to extorsion of the orbits. Over the years, numerous procedures have been employed to treat this motility disorder with limited success. We report on historical surgeries as well as a novel procedure that intorts the eyes in order to counter-balance the underlying extorsion of the orbits.

Revisión del estrabismo en miopes

IntroductionThe treatment of strabismus associated with myopia is often a therapeutic challenge for the ophthalmologist.The strabismus associated with myopia has certain peculiarities and there are even certain types of strabismus that occur exclusively in myopia, such as strabismus fixus, requiring treatments with specific surgical techniques. Materials and methodsIt is important to make a correct differential diagnosis, because there are many conditions described with this association.A review is presented of strabismus associated with myopia, together with its treatment adjusted to refractive error. ResultsMeasurements of strabismus may be altered by the prismatic effect of the spectacles.Surgical results may be unpredictable if myopia is not taken into account.Better results were obtained with the techniques of anatomical replacement described by Yokoyama than with traditional retro-insertion-resection. ConclusionFor the diagnosis and appropriate treatment of strabismus, it is important to make a correct measurement of the angle of deviation, and perform image tests prior to surgery in certain cases. The anatomical characteristics of the myopic eye should also be taken into account during surgery.

Botulinum toxin: State of the art.

Botulinun neurotoxin (BoNT) has emerged as one of the most multipurpose therapeutic agents in modern medicine with more clinical applications than any other drug currently on the market. Initially developed in the treatment of strabismus and neurologic movement disorders, the use of botulinun neurotoxin has been expanding during the past 3 decades to include the treatment of a variety of ophthalmologic, gastrointestinal, urologic, orthopedic, dermatologic, dental, secretory, painful, cosmetic, and other conditions. In addition to onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), and RimabotulinumtoxinB (Myobloc or NeuroBloc) there are other novel botulinun neurotoxin products currently in development. With a better understanding of the cellular mechanisms of botulinun neurotoxin and advances in biotechnology, future botulinun neurotoxin products will likely be even more effective and customized to the specific indication and tailored to the needs of the patients. © 2017 International Parkinson and Movement Disorder Society.

Botulinum toxin as an adjunct to monocular recession-resection surgery for large-angle sensory strabismus

To evaluate the result of using intraoperative botulinum toxin A (BTA) as an adjunct tomonocular recession-resection surgery in the management of large-angle sensory strabismus. The medical records of patients diagnosed with sensory strabismus with constant large-angle strabismus were reviewed retrospectively to identify those who underwent monocular recession-resection surgery combined with 5 units of BTA injection into the recessed muscle of the nonfixating eye. Surgical outcome was considered successful if the final deviation was within the range of 0Δ-10Δ. A total of 13 patients (mean age, 31.04±18.5years) were included, 8 with exotropia and 5 with esotropia. The mean follow-up period was 52.77±10.9months. The mean preoperative deviation was 66Δ ± 16Δ in the esodeviation group and 56Δ ± 5Δ in the exodeviation group. The final postoperative mean deviation was 6Δ ± 7Δ in the esodeviation group and 6Δ ± 8Δ in the exodeviation group. There were 7 patients (87.5%) with final deviation of ≤10Δ in the exodeviaton group and 4 (80%) in the esodeviation group. Adjunctive usage of BTA with conventional surgery appears to enhance surgical outcomes by increasing the amount of expected correction. The combined use of BTA with monocular recession-resection rectus muscle surgery may be a good alternative in the treatment of large-angle sensory strabismus with the advantage of less risk of potential complications compared to supramaximal surgery or surgery in the "good" eye.

Botulinum therapy in post-traumatic strabismus and diplopia treatment

In the article, a first-hand experience of paretic post-traumatic strabismus treatment using botulinum toxin type A is presented. Analysis of strabismus angle alteration and of diplopia severity has been performed.

The role of rectus muscle myectomy in the management of large-angle strabismus for Graves' ophthalmopathy.

PurposeRetrospective noncomparative case series to investigate the role of rectus muscle myectomy for the treatment of large-angle strabismus in patients with Graves' ophthalmopathy.Patients and methodsData from 47 consecutive patients with Graves' ophthalmopathy who underwent complete myectomy for large-angle strabismus (strabismus greater than 25 prism diopters (PDs)) were collected retrospectively. Pre- and postoperative deviations in primary and reading position were measured in PDs. Postoperative deviation of <5 diopters in primary gaze and functional binocular vision in central 30° field were considered as successful surgical outcomes.ResultsPatients undergoing complete myectomy of the restricted muscles in large-angle strabismus achieved a 78.7% success rate after the first surgery. Reoperation performed on seven patients resulted in 85.7% success rate in reoperation group. The overall success rate was 91.5%. The mean efficacy of the isolated rectus muscle myectomy was 34.3±7.7 PDs.ConclusionsThe complete rectus muscle myectomy technique is effective and predictable in the treatment of large-angle strabismus in patients with Graves' ophthalmopathy.

Botulinum toxin for the treatment of strabismus.

Botulinum toxin for the treatment of strabismus.

Automatic diagnosis of strabismus in digital videos through cover test

Background and Objective: Medical image processing can contribute to the detection and diagnosis of human body anomalies, and it represents an important tool to assist in minimizing the degree of uncertainty of any diagnosis, while providing specialists with an additional source of diagnostic information. Strabismus is an anomaly that affects approximately 4% of the population. Strabismus modifies vision such that the eyes do not properly align, influencing binocular vision and depth perception. Additionally, it results in aesthetic problems, which can be reversed at any age. However, the use of low cost computational resources to assist in the diagnosis and treatment of strabismus is not yet widely available. This work presents a computational methodology to automatically diagnose strabismus through digital videos featuring a cover test using only a workstation computer to process these videos.Methods: The method proposed was validated in patients with exotropia and consists of eight steps: (1) acquisition, (2) detection of the region surrounding the eyes, (3) identification of the location of the pupil, (4) identification of the location of the limbus, (5) eye movement tracking, (6) detection of the occluder, (7) identification of evidence of the presence of strabismus, and (8) diagnosis.Results: To detect the presence of strabismus, the proposed method achieved a specificity value of 100%, and (2) a sensitivity value of 80%, with 93.33% accuracy in diagnosis of patients with extropia. This procedure was recognized to diagnose strabismus with an accuracy value of 87%, while acknowledging measures lower than 1Δ, and an average error in the deviation measure of 2.57Δ.Conclusions: We demonstrated the feasibility of using computational resources based on image processing techniques to achieve success in diagnosing strabismus by using the cover test. Despite the promising results the proposed method must be validated in a greater volume of video including other types of strabismus.