Type Of Strabismus Research Articles

Minimal incision surgery in strabismus: Modified fornix-based approach

ObjectiveTo evaluate the modified fornix-based technique as an approach for minimal incision surgery in strabismus. MethodsThe medical records of all consecutive patients that underwent strabismus surgery with fornix-based conjunctival incision between 2007 and 2012 were retrospectively reviewed. As a primary variable, an analysis was made of the wound size depending on the number of stitches. A descriptive study was performed on the variables related to patients and to the type of strabismus and surgery. ResultsOut of 153 patients identified, 138 with 294 surgeries were included. In 200 (68%) interventions, the incision was sutured with one stitch, in 77 (26.2%) with 2, in 13 (4.4%) with 3, and in 4 (1.4%) with 4, with the mean number of stitches being 1.39±0.64. The mean age of the patients was 39 years (2–80), and 36 (26.1%) had previous strabismus surgery, with topical anaesthesia being used in 35 (25.4%) cases. At 3 months after surgery deviation was ≤10 DP in 114 (82.6%) patients. There were no wound-related complications. ConclusionsThe modified fornix-based technique is an effective and safe approach for minimal incision surgery in strabismus, in patients at all ages, with previous history of strabismus surgery and with topical anaesthesia.

Oculocardiac Reflex during Strabismus Surgery: Experience from a Tertiary Hospital

ABSTRACTPurpose: To evaluate the incidence of the oculocardiac reflex (OCR) and its associated risk factors during strabismus surgery at a tertiary referral center.Methods: Over a 2-year period, all strabismus surgery candidates were enrolled in the study. OCR was defined as heart rate reduction ≥15% after traction on extraocular muscle(s). The rate of OCR was determined and possible associations were explored. Variables included age, gender, type of strabismus, nature of surgery (weakening versus strengthening), specified extraocular muscle, times of surgery, and the sequence of operated muscles (eg, first, second, or third operated muscle). We avoided the use of atropine pre- and postoperatively.Results: Seventy-six patients with mean age of 15±12 years were enrolled; 51.3% of subjects were male. OCR occurred in 65 out of 76 (85.5%) patients and with 84 out of 173 (48.6%) operated muscles. OCR was more common in subjects less than 20 years of age; however, it showed a decreasing trend afterwards. OCR was more frequent during operation on cyclovertical muscles than horizontal recti (P=0.02). Moreover, during procedures on horizontal rectus muscles, OCR was more common if baseline heart rate was more than 61 (P=0.008). OCR was not correlated with gender, type of strabismus, nature of surgery, times of the surgery, or the sequence of operated extraocular muscles.Conclusions: The great majority of patients undergoing strabismus surgery, especially younger subjects, those undergoing operation on cyclovertical muscles, and subjects with higher baseline heart rate, experience OCR during strabismus surgery. During surgery on cyclovertical muscles, the amount of pull is usually more due to more difficult exposure.

Strabismus in patients with cortical visual impairment: outcomes of surgery and observations of spontaneous resolution

To investigate the rate of spontaneous resolution of strabismus in patients with cortical visual impairment (CVI) at a single center over a 10-year period and to evaluate the success rate of strabismus surgery. The medical records of patients with CVI and strabismus seen between October 2003 and October 2013 were reviewed retrospectively. Patients were classified into 4 outcome groups: (1) those who experienced spontaneous resolution of strabismus, (2) those with persistent strabismus who did not undergo surgery, (3) those who achieved postoperative alignment of ≤10(Δ); and (4) those whose final postoperative alignment was 11(Δ)-25(Δ) or>25(Δ). A total of 70 patients were included. Of these, 11 patients (16%) experienced spontaneous resolution of strabismus, 27 (38%) were observed without receiving surgery, and 32 (46%) underwent strabismus surgery. Of these 32, 18 (56%) achieved alignment of ≤10(Δ); 9 (28%), alignment of 11(Δ)-25(Δ); and 5 (16%), alignment >25(Δ). The patients who did not undergo surgery were significantly older at presentation (36months vs 12-15months; P=0.03); otherwise, there were no significant differences between groups in age at surgery or spontaneous resolution, type of strabismus, or underlying cause of CVI. In our study cohort, a minority of patients with CVI and strabismus (16%) experienced spontaneous resolution of strabismus. Only 16% of patients undergoing surgery had poor final alignment (>25(Δ)). Strabismus surgery can be reasonably successful in properly selected patients with CVI and strabismus. These patients show considerable rates ofresolution of their strabismus, either spontaneously or through surgery.

Botulinum toxin uses in strabismus: A review of the injections performed during one year in a general hospital

ObjectiveTo analyze the indications, dosage and efficacy of botulinum toxin A injection performed in patients in a Strabismus Department. MethodsIn this prospective study, botulinum toxin A was injected into 28 patients diagnosed with strabismus. Data were obtained from the records of patients that were evaluated during 2013 in the Strabismus Unit of Rey Juan Carlos Hospital (Móstoles, Madrid, Spain) in order to assess the indications and dosage of botulinum toxin A use in strabismus, as well as its clinical effect and differences in pediatric and adult patients. The outcomes in the last visit, at least 14 months after the injections, were analyzed. ResultsAn analysis was performed on the data from 11 children, 6 females (54.5%), and 17 adults, 11 males (64%). The mean age was 4.42±3.48 years and 58.71±18.07 years in the children and adult groups, respectively.The majority of cases in both groups were esotropia (81.8% in children and 47.1% in adults). However, the pathologies in the adult group were quite heterogeneous, including four patients with exotropia (26.5%), four with hypertropia (26.5%), and one with isolated nystagmus (5.9%).The mean number of the botulinum toxin injections in children was 1.45±0.93, although 72.7% received a single injection. In the adult group, the mean number of injections was 3.27±1.41.There was a statistically significant difference between pre- and post-injection in the tropia and phoria measurements in children and adults group (p<.05). In both groups there was a statistically significant improvement in post-injection torticollis when compared with the pre-injection measurement (p<.05).An improvement in the stereoacuity could be detected in four children.Two children (18.2%) and five adults (29.4%) required subsequent surgical intervention.Eight adult patients (49.1%) complained of diplopia in the primary position, which was resolved in six cases with toxin injection, whereas two needed surgery for diplopia correction. ConclusionsBotulinum toxin is a very useful tool in the management of strabismus, obtaining better sensory and motor results in children, but it is also effective as a symptomatic treatment in some types of strabismus in adults.

Cirugía de mínima incisión en estrabismo: técnica base fórnix modificada

ObjectiveTo evaluate the modified fornix-based technique as an approach for minimal incision surgery in strabismus. MethodsThe medical records of all consecutive patients that underwent strabismus surgery with fornix-based conjunctival incision between 2007 and 2012 were retrospectively reviewed. As a primary variable, an analysis was made of the wound size depending on the number of stitches. A descriptive study was performed on the variables related to patients and to the type of strabismus and surgery. ResultsOut of 153patients identified, 138 with 294 surgeries were included. In 200 (68%) interventions, the incision was sutured with one stitch, in 77 (26.2%) with 2, in 13 (4.4%) with 3, and in 4 (1.4%) with 4, with the mean number of stitches being 1.39±0.64. The mean age of the patients was 39years (2-80), and 36 (26.1%) had previous strabismus surgery, with topical anaesthesia being used in 35 (25.4%) cases. At 3months after surgery deviation was ≤10DP in 114 (82.6%) patients. There were no wound-related complications. ConclusionsThe modified fornix-based technique is an effective and safe approach for minimal incision surgery in strabismus, in patients at all ages, with previous history of strabismus surgery and with topical anaesthesia.

Clinical features of strabismus in psychomotor retardation

Abstract Background In psychomotor retardation there is an abnormal development of mental, sensory and motor skills associated with ocular manifestations. There are biological and psychosocial risk factors that predispose an individual to neurological damage. From 50% to 80% of patients with strabismus retardation have special features that differentiate it from the rest of strabismus in healthy patients. Objective To determine the most common type of strabismus in patients with psychomotor retardation and their clinical features. Material and methods Patients with psychomotor retardation and strabismus were included. An ophthalmological examination was performed, as well as an evaluation of the characteristics of strabismus, including perinatal and post-natal history. Results Esotropia was the most frequent squint with 65.3%, followed by exotropia with 32.7%. The variability in the squint magnitude was 60% in both types, and 6 patients had dissociated vertical deviation. Most of the patients started to present strabismus since they were born. The most frequent perinatal risk factors were threatened miscarriage, pre-eclampsia, foetal distress, and hypoxia. Conclusions Esotropia is the most common type of strabismus in psychomotor retardation. The variability of squint magnitude is a characteristic in these patients. The moderate variability is the most frequent in both esotropia and exotropia. The most common refractive error is hyperopic astigmatism in esotropia and the myopic kind in exotropia.

Aplicaciones clínicas de la toxina botulínica en el estrabismo: estudio de las inyecciones realizadas durante un año en un hospital general

ObjectiveTo analyse the indications, dosage and efficacy of botulinum toxin A injection performed in patients in a Strabismus Department. MethodsIn this prospective study, botulinum toxin A was injected into 28 patients diagnosed with strabismus. Data was obtained from the records of patients that were evaluated during 2013 in the Strabismus Unit of Rey Juan Carlos Hospital (Móstoles, Madrid, Spain) in order to assess the indications and dosage of botulinum toxin A use in strabismus, as well as its clinical effect and differences in paediatric and adult patients. The outcomes in the last visit, at least 14 months after the injections, were analysed. ResultsAn analysis was performed on the data from 11 children, 6 females (54.5%), and 17 adults, 11 males (64%). The mean age was 4.42±3.48 years and 58.71±18.07 years in the children and adult groups, respectively.The majority of cases in both groups were esotropia (81.8% in children and 47.1% in adults). However the pathologies in the adult group were quite heterogeneous, including 4 patients with exotropia (26.5%), 4 with hypertropia (26.5%), and one with isolated nystagmus (5.9%).The mean number of the botulinum toxin injections in children was 1.45±0.93, although 72.7% received a single injection. In the adult group, the mean number of injections was 3.27±1.41.There was a statistically significant difference between pre- and post-injection in the tropia and phoria measurements in children and adults group (P<.05). In both groups there was a statistically significant improvement in post-injection torticollis when compared with the pre-injection measurement (P<.05).An improvement in the stereoacuity could be detected in 4 children.Two children (18.2%) and 5 adults (29.4%) required subsequent surgical intervention.Eight adult patients (49.1%) complained of diplopia in the primary position, which was resolved in 6 cases with toxin injection, whereas 2 needed surgery for diplopia correction. ConclusionsBotulinum toxin is a very useful tool in the management of strabismus, obtaining better sensory and motor results in children, but it is also effective as a symptomatic treatment in some types of strabismus in adults.

Postoperative Shifts in Adult Strabismus Patients with Visual Deficits

ABSTRACTObjective: To evaluate the effects of corrective surgery in adult strabismic patients with visual deficits and the stability of postoperative alignments. Methods: Retrospective study. Alignment and binocular visual function were evaluated in adult patients with visual deficits (best corrective visual acuity (BCVA) <0.3 in one or both eyes) with at least 6 months postoperative follow-up. The results in these patients were compared to those in patients with normal or nearly normal vision (BCVA ≥ 0.6 in the worse eye) matched by the type of strabismus, magnitude of deviation, age at the time of corrective surgery, and length of time before final follow-up.Results: Sixty-four patients aged 28.3 ± 12.0 (17~65) years were included in the visual deficit group, and 64 subjects aged 26.8 ± 9.4 (17~58) years were included in the matched control group. No significant difference was found in the age or deviation angle between the two groups. The surgery was considered a success in 42 patients (65.6%) in the visual deficit group and 55 patients (86%) in the control group at the last visit (Χ2 = 7.19, p = 0.008). Normal or partially normal stereo acuity was achieved by three patients in the visual deficit group and 29 patients in the control group. An average shift toward exotropia of 7.3 prism diopter (PD) in the visual deficit group and 4.9 PD in the control group was observed between postoperative day 1 and the final visit (t = 2.08, p = 0.04). Of the 22 patients in the visual deficit group that were defined as “not a success,” 20 were under-corrected, and two were over-corrected.Conclusion: Adults with poor vision experienced positive results from corrective surgery via a postoperative shift toward exotropia. Full correction of deviation and postoperative shift should be considered before surgery.

Rasch Analysis of the Adult Strabismus Quality of Life Questionnaire (AS-20) among Chinese Adult Patients with Strabismus.

BackgroundThe impact of strabismus on visual function, self-image, self-esteem, and social interactions decrease health-related quality of life (HRQoL).The purpose of this study was to evaluate and refine the adult strabismus quality of life questionnaire (AS-20) by using Rasch analysis among Chinese adult patients with strabismus.MethodsWe evaluated the fitness of the AS-20 with Rasch model in Chinese population by assessing unidimensionality, infit and outfit, person and item separation index and reliability, response ordering, targeting and differential item functioning (DIF).ResultsThe overall AS-20 did not demonstrate unidimensional; however, it was achieved separately in the two Rasch-revised subscales: the psychosocial subscale (11 items) and the function subscale (9 items). The features of good targeting, optimal item infit and outfit, and no notable local dependence were found for each of the subscales. The rating scale was appropriate for the psychosocial subscale but a reduction to four response categories was required for the function subscale. No significant DIF were revealed for any demographic and clinical factors (e.g., age, gender, and strabismus types).ConclusionThe AS-20 was demonstrated by Rasch analysis to be a rigorous instrument for measuring health-related quality of life in Chinese strabismus patents if some revisions were made regarding the subscale construct and response options.

Recruitment of Suitable Families to Identify Causative Genes in Hereditary Strabismus

The cause and origin of primary strabismus are not well understood. It is thought that there is multifactorial genetic inheritance. Only linkage analysis has been applied to study the genetic causes and correlations. The objective of this study was the compilation and statistical evaluation of a useful cohort of families for linkage analysis. The archives of the Department of Ophthalmology of the Justus-Liebig-University Gießen were used as a database for this study. Medical records of visits between January 2001 and July 2008 were analysed. Evaluation was based on the medical history form. The data set was scanned for index families in which at least two members had any form of primary strabismus. Patients were classified according to their type of primary strabismus. Families who were most suitable for linkage analysis were approached. A disease specific questionnaire was developed to complete the data. Between January 2001 and July 2008, 20,813 patients affected by primary strabismus were treated. The data set contained 2380 patients with a positive family history of primary strabismus. The majority presented with esotropia (67 %), followed by exotropia (21 %). In most cases (80 %), two family members were affected and the child-parent relationship contributed the largest group, including 948 cases (40 %). Affected siblings were found in 397 families (17 %). Three affected patients were identified in 432 (18 %) families. In these, the relationship parent-child-sibling occurred most frequently, with 143 cases (6 %). A positive family history of at least four related patients was found in 46 families (2 %). Forty-two families were particularly suitable for linkage analysis. Seventeen of the 42 families answered a questionnaire aimed at improving the data set. Three families finally participated in ophthalmic examinations and agreed to blood sampling to perform linkage analysis. The fraction of families with strabismus patients in more than two consecutive generations was extremely low. If these families are included in any study, this should be coupled to treatment to improve compliance.

Strabismus in patients with neurofibromatosis type 1-associated optic pathway glioma.

To characterize the incidence, type, natural history, and treatment outcomes of strabismus in pediatric patients with neurofibromatosis type 1 (NF1) and optic pathway glioma (OPG). The medical records of consecutive patients diagnosed with NF1 and OPG at our neurofibromatosis clinic since 1985 were reviewed retrospectively. We noted age at diagnosis, reason for referral to our clinic, ophthalmologic examination results, presence or absence of strabismus, strabismus type and treatment, and final results of treatment. A total of 76 patients were included. Of these, 22 (28.9%) had strabismus: 5 (22.7%) had esotropia and 17 (77.2%) had exotropia; of those with exotropia, 10 (45%) also had hypotropia. In 12 patients (54.5%), strabismus was present at the first ophthalmologic examination. The development of strabismus preceded the diagnosis of both NF1 and OPG in 4 (5.3%) patients and the diagnosis of OPG in another 2 (2.6%) patients with known NF1. In 16 (76%) patients, the strabismus was sensory. Five patients (22.7%) underwent surgery, which resulted in a deviation angle of <10(Δ) in 1 patient, <20(Δ) in 2 patients, and >20(Δ) in 2 patients. Strabismus was the presenting symptom and led to the diagnosis of OPG in a subset of patients, including those who did not have a previous diagnosis of NF1. Exotropia, especially associated with a hypotropia, was the most common strabismic deviation seen in these patients. Sensory strabismus was the most common type seen in this population. Deviations of <10(Δ) may be difficult to achieve with strabismus surgery.

Strabismus and Micro-Opsoclonus in Machado-Joseph Disease.

We describe novel deficits of gaze holding and ocular alignment in patients with spinocerebellar ataxia type 3, also known as Machado-Joseph disease (MJD). Twelve MJD patients were studied. Clinical assessments and quantitative ocular alignment measures were performed. Eye movements were quantitatively assessed with corneal curvature tracker and video-oculography. Strabismus was seen in ten MJD patients. Four patients had mild to moderate intermittent exotropia, three had esotropia, one had skew deviation, one had hypotropia, and one patient had moderate exophoria. Three strabismic patients had V-pattern. Near point of convergence was normal in two out of three patients with exotropia. Gaze holding deficits were also common. Eight patients had gaze-evoked nystagmus, and five had micro-opsoclonus. Other ocular motor deficits included saccadic dysmetria in eight patients, whereas all had saccadic interruption of smooth pursuit. Strabismus and micro-opsoclonus are common in MJD. Coexisting ophthalmoplegia or vergence abnormalities in our patients with exotropia that comprised 50% of the cohort could not explain the type of strabismus in our patients. Therefore, it is possible that involvement of the brainstem, the deep cerebellar nuclei, and the superior cerebellar peduncle are the physiological basis for exotropia in these patients. Micro-opsoclonus was also common in MJD. Brainstem and deep cerebellar nuclei lesion also explains micro-opsoclonus, whereas brainstem deficits can describe slow saccades seen in our patients with MJD.

Características clínicas del estrabismo en retraso psicomotor

BackgroundIn psychomotor retardation there is an abnormal development of mental, sensory and motor skills associated with ocular manifestations. There are biological and psychosocial risk factors that predispose an individual to neurological damage. From 50% to 80% of patients with strabismus retardation have special features that differentiate it from the rest of strabismus in healthy patients. ObjectiveTo determine the most common type of strabismus in patients with psychomotor retardation and their clinical features. Material and methodsPatients with psychomotor retardation and strabismus were included. An ophthalmological examination was performed, as well as an evaluation of the characteristics of strabismus, including perinatal and post-natal history. ResultsEsotropia was the most frequent squint with 65.3%, followed by exotropia with 32.7%. The variability in the squint magnitude was 60% in both types, and 6 patients had dissociated vertical deviation. Most of the patients started to present strabismus since they were born. The most frequent perinatal risk factors were threatened miscarriage, pre-eclampsia, foetal distress, and hypoxia. ConclusionsEsotropia is the most common type of strabismus in psychomotor retardation. The variability of squint magnitude is a characteristic in these patients. The moderate variability is the most frequent in both esotropia and exotropia. The most common refractive error is hyperopic astigmatism in esotropia and the myopic kind in exotropia.

Duane syndrome: Clinical features and surgical management

ObjectiveTo further define the clinical features of Duane syndrome and analyze the surgical outcomes in a subset of these patients. DesignRetrospective chart review. ParticipantsA retrospective chart review of 75 patients with Duane syndrome was performed. MethodsComplete ophthalmologic and orthoptic data were extracted from the patients’ charts, and patients were classified into group I, II, or III based on forced primary position (PP) deviation. Eighteen patients had strabismus surgery to correct the ocular misalignment with its related abnormal head posture. ResultsFifty-six percent of the cases were in group I, 16% in group II, and 28% in group III. Fifty-seven percent were female, 91% were unilateral, and 66% had left eye involvement. Ninety-six percent had fissure-narrowing/globe retraction on adduction; 67% had an upshoot, downshoot, or both; and 63% had an A, V, or X pattern. The A patterns correlated with downshoots in 100% of cases, V patterns with upshoots in 88%, and X patterns with upshoots/downshoots in 100%. In the 18 surgical candidates, there were 14 patients in group I, 4 in group II, and 0 in group III. An excellent surgical outcome occurred in 78% of patients and a fair-to-poor outcome in 22%. Upshoots/downshoots and fissure-narrowing/globe retraction patients showed modest improvement after surgery. ConclusionsThere was a consistent relationship among the type of strabismus, head position, and motility defect. The type of upshoot/downshoot correlated strongly with the A, V, or X pattern. Postoperative improvements of abnormal head posture and PP alignment were achieved in the surgical subset of patients.

Divergence insufficiency: increasing numbers of surgeries and changing referral pattern for a common type of adult strabismus

Divergence insufficiency: increasing numbers of surgeries and changing referral pattern for a common type of adult strabismus

Hot topics in treatment of intermittent exotropia

Intermittent exotropia is the most common type of exotropia, and also is one of the most difficult types of strabismus to deal with. Surgery is the main choice of treatment and non-surgical treatment is used only under certain indications. Long-term outcomes of the surgery for intermittent exotropia are related to many factors, such as age, course of the disease, perceptual state of visual cortex, timing of surgery, types of intermittent exotropia, the surgical methods, preoperative measurements of exodeviations, target angle of surgery, postoperative treatment of overcorrection or undercorrection, and so on. It is significant to pay attention to these issues to improve success rate of the surgeries. In this paper, recent progress of clinical studies of intermittent exotropia were reviewed to arouse the attentions of domestic ophthalmologist to the standardization of diagnosis and treatment of intermittent exotropia.

Surgical Planning for Duane Retraction Syndrome

Introduction: Duane retraction syndrome (DRS) a type of relatively rare type of restrictive strabismus. Methods and results: Six cases of DRS comprising of all sub types and their outcome was discussed simultaneously explaining how to plan surgical treatment for each component of DRS in each case. Horizontal, vertical deviations, abnormal head position, globe retraction and upshoots /downshoots were correctable in all cases of DRS. Conclusion: Satisfactory surgical results can be achieved by operating cases of DRS with individualized surgical planning.

The Prevalence of Strabismus in 7-Year-Old Schoolchildren in Iran

Purpose: To determine the prevalence of tropia and phoria in Iran and their association with some related factors.Methods: In a cross-sectional population-based study, multistage randomized cluster sampling was used to select participants from among grade 1 students in the primary schools of 7 cities of Iran. After obtaining their parents’ approval, the students underwent the measurement of uncorrected and corrected visual acuity, cycloplegic refraction, and cover test. Distant and near cover test were performed at 6 m and 40 cm, respectively, with the best corrected visual acuity. Tropia and phoria were measured separately.Results: Of 4157 selected students, 3675 participated in the study. The prevalence of strabismus was 1.68% (95% CI 1.13–2.23). The prevalence of strabismus was 2.17% (95% CI 1.06–3.29) in boys and 1.27% (95% CI 0.57–1.96) in girls (p = 0.216). Moreover, 1.27% (95% CI 0.82–1.72) of the children had exotropia and 0.44% (95% CI 0.22–0.65) had esotropia. The prevalence of constant and intermittent strabismus was 0.73% (95% CI 0.26–1.19) and 0.96% (95% CI 0.55–1.36), respectively. Phoria was detected in 32.98% (95% CI 24.25–41.71) of the children in this study. The prevalence of residual amblyopia was 23.77% (95% CI 9.45–38.08) in strabismic and 1.43% (95% CI 0.09–1.96) in non-strabismic children (p < 0.001). The odds of strabismus were significantly higher in hyperopic and astigmatic children.Conclusion: This study showed the prevalence of tropia and phoria across Iran. Exotropia was the most common type of tropia in Iran and intermittent strabismus was the most common type of strabismus. Due to prevalent amblyopia in strabismus, attention should be directed toward careful screening and treatment.

Relative Prevalence of Various Types of Strabismus in Patients Attending NGO&amp;apos;s Medical Centers in Gaza Strip

Research question : what is the relative prevalence of various types of strabismus in Gaza strip ? Objective: to determine the most common types of strabismus in people who live in Gaza strip. Study design : a population-based sample of people with strabismus living in Gaza strip. Setting: NGO's medical centers of Gaza Strip – Palestine namely Eye specialty hospital of the Public Aid Society located in Gaza city, clinic of Yaffa hospital located in Deir Elbalah city and ophthalmology clinic of Abu Madkour Medical center located in Rafah city . Participants : patients with any type of strabismus attending those centers. Study period : 4th November 2012 to 4th May 2013 .Sample size : 226 cases which included 122 females and 104 males. Study variables : type of strabismus by gender, refractive error and degree of consanguinity between parents of those patients. Statistical analysis : SPSS was used for all statistical analyses . Results : esotropia is the most prevalent type of strabismus in Gaza Strip reaching 55.3% of all strabismus patients , exotropia comes second reaching 29.7% , followed by paralytic and restrictive strabismus ( 7.9% and 6.2% respectively ). The most common association with those types of strabismus was inferior oblique overaction reaching 16.8% of all cases. Conclusions: esotropia and exotropia respectively are the most common types of strabismus in Gaza strip. These data support the assumption that strabismus screening of children in developing countries could be useful in early detection of strabismus, appropriate management of it and prevention of strabismic amblyopia .

Ophthalmic findings in children with nonsyndromic craniosynostosis treated by expansion cranioplasty.

The ocular and systemic abnormalities of nonsyndromic craniosynostosis are often considered to be less severe than those of syndromic craniosynostosis and are less well described. The purpose of this article was to describe the frequency and nature of ophthalmic abnormalities in children treated for nonsyndromic craniosynostosis by expansion cranioplasty. A retrospective review identified 88 consecutive children with nonsyndromic craniosynostosis who underwent expansion cranioplasty with distraction osteogenesis. Assessment of presence and type of strabismus, refractive error, and amblyopia before and 6 months after surgery was recorded. Children with a mean age of 24.4 months were treated for nonsyndromic craniosynostosis (27 with coronal and 61 with sagittal and/or lambdoid). One-fourth of the patients had a fixation preference. Significant refractive errors were found in 45 (51%) of the 88 patients: hyperopia in 27%, myopia in 5%, and astigmatism in 35%. Anisometropia was present in 20%. Of the 85 patients who completed orthoptic examination, 48 (56%) had strabismus: exodeviation in 26%, esodeviation in 14%, and vertical deviation in 5%. Fourteen patients (16%) had abnormal head posture. Significant refractive error and strabismus were more likely to occur in cases with coronal synostosis. The procedures used for cranial vault expansion improved the abnormal head posture but did not affect the refractive error or ocular misalignment. Of children with nonsyndromic craniosynostosis who need neurosurgical correction, more than half were found to have significant refractive error and strabismus. Our findings support the importance of ophthalmic evaluation in these children.