Treatment Of Strabismus Research Articles

Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors.

Strabismus is a common ophthalmic disease in the process of child body development, in which the two eyes cannot gaze at the target at the same time, and the incidence of this disease of children is higher. In children with esotropia, exotropia, and up and down strabismus and other typical symptoms, the cause is genetic, innerve, and refractive and regulated, and not receiving timely treatment may lead to stereo vision and diplopia and other phenomena, affecting their learning and life. Surgical treatment is the main treatment for strabismus at present. Traditional orthodontic surgery is performed by doctors under the naked eye, often due to improper operation or suture error and other factors, resulting in more postoperative complications, such as more tissue damage, conjunctival congestion, and muscle suture reaction, which seriously affect the clinical effect of surgical treatment. In recent years, with the continuous development of microsurgical technology, the correction of strabismus under a microscope has been widely carried out in clinic. The operation under the microscope makes the operation more delicate and accurate, overcomes the defects of traditional surgery, and highlights the advantages of minimally invasive surgery. The purpose of this study was to investigate the effect of microsurgical techniques in the treatment of strabismus in children and to analyze the factors influencing the outcome. The results showed that microsurgical strabismus correction in the treatment of strabismus children has short operation time, less intraoperative blood loss, short hospital stay, high efficiency, and less complications, which is worthy of popularization. Age, preoperative strabismus angle, refractive error, distance stereopsis injury, near stereoscopic injury, and duration of disease were all independent influencing factors of postoperative efficacy.

Attitude and related factors towards strabismus among adults living in Gondar town, Northwest Ethiopia: a community-based cross-sectional study

ABSTRACT Cultural belief in Ethiopia showed that strabismus can be caused by exposure to sunlight during infancy, an outrage from God, and looking sideways. In addition, Ethiopians also believe that strabismus can resolve by its self and is a sign of good luck. Due to these reasons many patients with strabismus come to eye care clinics after developing amblyopia. This study aimed to assess the level of attitude and related factors toward strabismus among adults living in Gondar town, Northwest Ethiopia. A community-based cross-sectional study was conducted on a sample size of 634 adults from April 9 to April 23, 2019. Data were collected using a pretested structured questionnaire through face-to-face interviews, and the study participants were chosen by applying a multistage random sampling technique. Data were entered with EPI info version 7 and imported into SPSS version 20 for analysis. Frequency, statistical summary, and cross-tabulations were used for the descriptive analysis of the entered data. Binary logistic regression was fitted, and all independent variables with a P-value of less than 0.2 in the bivariable analysis were entered into a multivariable binary logistic regression. Variables with a P-value of less than or equal to 0.05 were considered statistically significant. Respondents who answered greater than or equal to the median score of attitude-related questions were designated to have a favorable attitude toward strabismus. In this study, 602 adults were participated with a response rate of 94.9% and the median age of the participants was 33 ± 14 years. The overall proportion of favorable attitudes toward strabismus was 71.8%. Having secondary school as an educational status (AOR = 2.8 (95% CI: 1.2, 6.4)) and heard about strabismus (AOR = 7.4 (95%CI: 3.7, 14.9)) were positively whereas being unemployed (AOR = 0.3(95% CI: 0.1, 0.7)) and high monthly income (AOR = 0.5(95%CI: 0.3, 0.9)) were negatively associated with a favorable attitude regarding strabismus. Eighty-five percent (88.5%) of participants agreed that early treatment of strabismus had a better outcome. Besides, 57.6% of participants have agreed that untreated strabismus can cause amblyopia. About three fourth of the study participants had a favorable attitude toward strabismus. Educational status, heard about strabismus, occupation, and monthly income were significantly associated with a favorable attitude toward strabismus. Most of the study participants agreed that untreated strabismus can cause poor cosmoses. Fear of surgery and high cost were reported by study participants as the main barriers to seeking treatment of strabismus.

A 2020 Update on 20/20 X 2: Diplopia after Glaucoma Surgery

ABSTRACT New-onset diplopia is an important complication that may occur following several types of ocular surgery, including glaucoma surgery. Surgeons should be aware of the possibility of ocular motility disturbances after glaucoma surgery, whereas strabismus experts must understand the mechanisms and the most appropriate management of these forms of strabismus. The incidence, mechanisms, characteristics and treatment of diplopia and strabismus after glaucoma surgery will be reviewed.

Awareness in the general population about binocular single vision and its importance

Introduction: Stereo vision adds an extra dimension to aid depth perception and gives a binocular advantage in task completion. Aim: To study the perception of the presence and importance of binocular vision in the general population. Materials and Methods: A standard questionnaire in the local language was circulated amongst 500 people in the outpatient department (OPD). Group 1 had studied < 12th standard, and Group 2 had studied up to 12th standard or more. Results: More participants in Group 2 said that the purpose of having two eyes was to see, for aesthesis, and also for a better quality of vision than those in Group 1 (P = 0.011 s); they knew that it was advantageous to have both eyes work together as one unit than did those in Group 1. (P = 0.010 s) Similarly, Group 2 knew why a squint developed (P = 0.002) and that there was a relationship between a squint and binocular single vision (BSV) (P = 0.000). Group 2 knew that a squint could be treated (P < 0.0001 s). Group 1 did not know the importance of the early treatment of strabismus (P < 0.0001 s). Participants in both groups were aware that they could face difficulty in doing certain jobs due to less vision in one eye (P = 0.201 ns); as well as that visual impairment in children could be prevented in at least some children if vision testing was done during the preschool years. Conclusion: It is important to raise awareness among the general population of the concept of binocular vision and its relationship to strabismus.

The features of diagnosis and treatment of unilateral concomitant strabismus with visual fixation defect in preschool children

BACKGROUND:Particular difficulties in treatment of children with monolateral strabismus are associated with the presence of severe amblyopia in the squinting eye in combination with a visual fixation defect (acentral or intermittent).
 AIM:To assess the anatomical and functional status of children with visual fixation defects, to find out the causes of failures in treatment of this group of patients, to determine the tactics of their management.
 MATERIALS AND METHODS:The study included 92 children of preschool age (from 3 to 7 years) with monolateral concomitant strabismus. The follow-up period for the children ranged from 12 to 72 months. The average age of the examined children was 4.6 1.1 years. Three variants of visual fixation were identified in the squinting eye: central visual fixation (CVF) 68 eyes; intermittent visual fixation (IVF ) 7 eyes; and acentral visual fixation (AVF) 17 eyes. All patients underwent a comprehensive examination: visometry; strabometry; autorefractometry; determination of the critical frequency of light flashes; assessment of visual fixation; optical coherence tomography of the retina. All children underwent passive and active pleoptics.
 RESULTS:The visual acuity of children with CVF significantly increased due to pleoptics. At the same time in cases of IVF and even more in those of AVF, visual acuity remained significantly lower than that of the fixating eye, pleoptics were ineffective in this group of patients. In patients with CVF, the critical frequency of light flashes of the squinting eye increased in statistically significant figures, while in IVF and AVF, the difference between squinting and fixing eye remained. According to OCT data, changes in the macular area were detected in 18 (75%) eyes in patients with IVF and AVF, which allows us to distinguish organic pathology from amblyopia.
 CONCLUSIONS:In children with monolateral strabismus, it is necessary to determine visual fixation of the squinting eye. At IVF and AVF, it is mandatory to conduct optical coherence tomography of the macular area to exclude organic pathology. In patients with monolateral concomitant strabismus with IVF and AVF, surgery on oculomotor muscles is indicated.

Adjustable Sutures in the Treatment of Strabismus: A Report by the American Academy of Ophthalmology

To review the scientific literature that evaluates the effectiveness of adjustable sutures in the management of strabismus for adult and pediatric patients. Literature searches were performed in the PubMed database through April 2021 with no date limitations and were restricted to publications in English. The searches identified 551 relevant citations, of which 55 were reviewed in full text. Of these, 17 articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. The search included all randomized controlled studies regardless of study size and cohort studies of 100 or more patients comparing the adjustable versus nonadjustable suture technique, with a focus on motor alignment outcomes or reoperation rates. The literature search yielded no level I studies. Of the 17 articles that met the inclusion criteria, 11 were rated level II and 6 were rated level III. Among the 12 studies that focused on motor alignment outcomes, 4 small randomized clinical trials (RCTs) did not find a statistically significant difference between groups, although they were powered to detect only very large differences. Seven of 8 nonrandomized studies found a statistically significant difference in motor alignment success in favor of the adjustable suture technique, both overall and in certain subgroups of patients. Successful motor alignment was seen in both exotropia (in 3 studies that were not limited to children) and esotropia (in 1 study of adults and 2 of children). The majority of included studies that reported on reoperation rates found the rates to be lower in patients who underwent strabismus surgery with adjustable sutures, but this finding was not uniformly demonstrated. Although there are no level I studies evaluating the effectiveness of adjustable sutures for strabismus surgery, the majority of nonrandomized studies that met the inclusion criteria for this assessment reported an advantage of the adjustable suture technique over the nonadjustable technique with respect to motor alignment outcomes. This finding was not uniformly demonstrated among all studies reviewed and warrants further investigation in the development and analysis of adjustable suture techniques.

Suture plication in the treatment of complicated paralytic strabismus

Complicated strabismus frequently requires multiple surgeries to improve ocular alignment, double vision and anomalous face posture.

Knowledge and Perception toward Strabismus in Uttar Pradesh, India

Strabismus is a common eye condition having a potential subsequent impact on the psychological and socioeconomic domains of individuals suffering from strabismus. Therefore this study aimed to find out the level of knowledge and treatability of strabismus in Uttar Pradesh. Strabismus is the misaligned condition of eye. It is most likely to result in double vision and sometimes asthenopic symptoms. It is commonly called by different names; squint, crossed eyes, deviating eyes. AIM- To find out the level of knowledge and treatability of strabismus among adult people in Uttar Pradesh, India. METHODS- This is a cross sectional study that was conducted among adult people who live in U.P, India. By using an online self administered questionnaire. RESULT-Out of 57 participants, 40 .4% reported the correct definition of strabismus .the majority of responders agreed that strabismus is treatable (56.1%). In addition, a statically significant relation was found between knowledge of strabismus treatability and age, gender, work state , and level of education. Most participants were aware of the risk factors and complication of strabismus. Conclusion-Our study found that the majority of participants had good knowledge of the definition, treatment, and complications of untreated strabismus. Participant’s age, education level, work state incomes were the main factors found to be significantly associate with knowledge of strabismus treatment options.

Short-Term Near Stereoacuity Improvements Following Favorable Surgical Alignment in Exotropic and Esotropic Patients

ABSTRACT Purpose Surgical treatment for strabismus is to promote binocular vision, and the study is to evaluate the effect of surgical realignment on near stereopsis in exotropic and esotropic patients. Methods The records of patients who underwent strabismus surgery were retrospectively reviewed. Visual acuity, ocular deviations, fusion control, ocular motility, strabismus subtype and duration, surgery procedures, and stereopsis at before and at one month after surgery were collected. RMANOVA was performed to analyze stereopsis improvement by surgery. A logistic analysis was used to investigate the factors for stereopsis improvement. Results 143 exotropic and 40 esotropic patients were enrolled. The stereopsis was not significantly improved in patients with exotropia (p > .05), but not in esotropic patients (p < .01). Small degree of near deviation (β = 0.01), without vertical surgery (β = 0.11), and the high pre-surgery Titmus (β = −0.44) were related factors for stereopsis improvement in exotropia patients; male (β = 0.21) and the high pre-surgery Titmus (β = −0.36) were related factors for stereopsis improvement in esotropia patients. Conclusion The loss of stereopsis was significantly restored by surgery in esotropia patients and the extent of stereopsis recovery by surgery depends on the deviation at near distance, vertical surgery, and pre-surgery stereopsis in exotropes and on sex and pre-surgery Titmus in esotropes.

Botulinum Toxin Injection of the Inferior Oblique Muscles for V-Pattern Strabismus and Primary Position Hypertropia

To evaluate outcomes of botulinum toxin (BTX) injection of the inferior oblique (IO) muscle. Retrospective case series. Setting: Single center, ophthalmology department at Boston Children's Hospital. All patients treated with IO muscle injection of BTX (onabotulinumtoxinA) between 2010 and 2020. Sensorimotor evaluations at short-term (<2 months), medium-term (2-4 months), and long-term (≥4 months) intervals. Primary outcomes included median improvement in V-pattern strabismus and primary position hypertropia. Secondary outcomes included IO muscle overaction. Wilcoxon signed-rank tests were performed to identify differences before and after injection. Record review identified 20 patients with a median age of 4.5 (range, 1-69) years. Median BTX dose injected (31 IO muscles) was 5.0 (range, 3.0-7.0) units. Indications included V-pattern strabismus (N=8), hypertropia (N=7), or both (N=5). Median long-term interval was 6.4 (range, 4.1-26.6) months. Injections were concurrent with treatment of horizontal strabismus in all but 3 cases. Median V-pattern magnitude changed from 10 prism diopters (PD) preoperatively to 0 PD short-term (P=.006) and 3.5 PD long-term (P=.34). Median hypertropia changed from 8.5 PD preoperatively to 1.5 PD short-term (P=.01) and 8 PD long-term (P=.87). Median IO muscle overaction grade improved significantly at short-term (P < .001) and long-term (P=.007) intervals. There were no complications associated with the IO muscle injections. BTX injection of the IO muscles can be a useful adjunct to the management of V-pattern strabismus. Intervention for primary position hypertropia may be helpful for short-term relief with no expectation of long-term benefit.

Double-under muscle transposition: an effective surgical option for large-angle paralytic strabismus

To describe our surgical outcomes using a novel muscle transposition procedure, or double-under muscle transposition (DUT), in the treatment of paralytic strabismus. In this surgery, the split halves of the superior and inferior rectus muscles opposite the paralyzed muscle are disinserted, crossed under both the remaining half and the paralyzed muscle, and anchored at opposite corners of the insertion of the paralyzed muscle. The medical records of consecutive patients who underwent DUT were retrospectively reviewed. Outcome measures were angle of deviation and duction deficit. Seven patients were included. Diagnoses included WEBINO (n=1), rupture of the medial rectus muscle (n=1), and abducens nerve palsy (n=5). DUT alone was performed in 3 patients; DUT combined with antagonist muscle recession, in 4 patients. One patient underwent the surgery bilaterally. Mean follow-up was 17±18+ months (range, 7-57). Preoperative angles of distance deviation ranged from 25Δ to 142Δ in magnitude. All except a single patient had duction limitation of grade -5. The mean change in distance deviation for DUT alone for each operated eye was 60Δ ± 6Δ (53Δ-65Δ); for combined surgery, 69Δ±23Δ (range, 52Δ-103Δ). Final mean angle of deviation at distance was +2Δ ± 3Δ (-4Δ to 0Δ), although an additional surgery was required for large overcorrections in 2 patients. Duction limitation improved in all patients. One patient experienced a postoperative vertical deviation. DUT may be an alternative for patients with severely paralytic strabismus not likely to resolve with previously reported muscle transposition surgeries. Overcorrection may occur in some cases.

Botulinum Toxin Injection for the Treatment of Strabismus: A Report by the American Academy of Ophthalmology

To review the available evidence comparing the effectiveness of extraocular muscle botulinum toxin type A (BTXA) injection with eye muscle surgery for restoring ocular alignment in children and adults with nonparalytic, nonrestrictive horizontal strabismus. Literature searches in the PubMed Cochrane Library, and clinical trial databases with no date restrictions, but limited to articles published in English, were conducted last on January 10, 2021. The searches yielded 515 citations, 40 of which were reviewed in full text by the first author. Fourteen articles met the criteria for inclusion (randomized or nonrandomized comparative studies, or case series with a minimum 50 patients; evaluating extraocular muscle BTXA injection for initial or repeat treatment of horizontal, nonparalytic, nonrestrictive strabismus; with at least 6 months of follow-up) and were graded by a methodologist. The 14 included studies consisted of 2 randomized clinical trials, 3 nonrandomized comparative studies, and 9 case series. All 5 comparative studies were graded level II evidence, and the 9 case series were graded level III evidence. Successful motor outcomes after BTXA injection were relatively consistent across 4 of the 5 comparative studies at 60%, when adjustment was made for differential selection bias in 1 of the studies. In the 4 studies, successful motor outcomes after surgery ranged from 66% to 77% with a mean follow-up of 23 to 75 months, and the outcomes were not significantly different from those after BTXA injection. In the fifth level II study, success was significantly higher with BTXA injection than with surgery (94% vs. 72%). The level III BTXA case series demonstrated higher motor success rates of 87% to 89% when children were treated in 2 muscles at a time; rates were lower in adults treated with single-muscle BTXA injection. Extraocular muscle injection of BTXA achieves a high rate of successful motor alignment, comparable with that achieved after eye muscle surgery for nonparalytic, nonrestrictive horizontal strabismus. Good alignment may require multiple BTXA injections, and it is not yet clear whether sensory outcomes are equivalent for BTXA injections versus eye muscle surgery in young children.

Fixation stability after surgical treatment of strabismus and biofeedback fixation training in amblyopic eyes

BackgroundVisual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus.MethodsParticipants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus.ResultsBaseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training.ConclusionsFixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients.

Where and how to use botulinum toxin on the face and neck – Indications and techniques

Botulinum toxin (BT) is a proteinaceous substance that is derived from the bacterium Clostridium botulinum. It was initially used for the treatment of strabismus by Dr. Alan Scott in the late 1970s after which, it was regularly being used for the cosmetic correction of benign essential blepharospasm by the Carruthers couple. Jean Carruthers while treating one such patient noticed an improvement in the glabellar furrows with an effect on the brow of the patient as well. By the late 1980s through the 1990s, BT was used rampantly as an off-label indication to treat glabellar frown lines. In 2002, the US Food and Drug Administration approved the use of BT type A for the treatment of glabellar furrows. This changed the global scene of facial rejuvenation, heralding a new era. Ever since then, BT has proved to be effective and safe for the treatment of dynamic facial rhytides and is currently being used for various indications. These indications and techniques have evolved with a better understanding of the face and neck musculature and their interactions and actions as well as efficacy of the BT formulations. The authors present an overview of the various cosmetic indications of BT for the face and neck along with the approach to injection techniques for various muscle groups involved.

Management of strabismus related to infantile glaucoma: Case series.

To evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results. The clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied. Four patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs. Strabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed.

Новые возможности хирургического лечения паралитического косоглазия у детей

Purpose. To assess the clinical effectiveness of the developed surgical method for treating paralytic strabismus. Material and methods. The operation was performed on 32 patients with paralytic strabismus (32 eyes) aged 3 to 12 years. All patients had diplopia in the primary gaze position or in a small abduction. Convergent strabismus was diagnosed in 26 children (81%), divergent strabismus – in 6 patients (19%), in 34% of cases (11 people) strabismus was with a vertical component. Strabismus angle according to Hirshberg before surgery: horizontal deviation from 10 to 30°, vertical – from 5 to 15°. Results. On the 7–10th day after the operation, orthotropy and the appearance of mobility of the eyeball towards the affected muscle were achieved in all operated patients. In the long term (6–12 months) after surgery, 23 children (72%) fully recovered the mobility of the eyeball in 8 directions and formed stable binocular vision, and orthotropy remained. In 9 patients (28%), there was a limitation of the mobility of the eyeball to 5–7°. Conclusion. The proposed method for the surgical treatment of paralytic strabismus makes it possible to achieve in one stage the correction of the deviation angle and the improvement of mobility with the elimination of diplopia, avoids the appearance of postoperative vertical deviation and eliminates large deviation angles. Using the proposed method, it is possible to simultaneously correct both horizontal and vertical deviations. Key words: paralytic strabismus, deviation angle, horizontal deviation, vertical deviation.

Эффективность лечения содружественного косоглазия у детей с гиперметропией методом хемоденервации ботулиническим токсином типа А

Purpose. Evaluation of the effectiveness of concomitant strabismus treatment in children with hyperopia by botulinum toxin type A chemodenervation. Materials and methods. The effectiveness of using botulinum toxin type A chemodenervation was studied in 115 children (230 eyes) from 8 months to 15 years old with concomitant convergent strabismus and hyperopic refraction. All patients were divided into 3 groups: group 1–17 patients with strabismus angle up to 15° according to Hirshberg, group 2–34 patients with strabismus angle from 15 to 25° according to Hirshberg, group 3–64 patients with strabismus angle more than 25° according to Hirshberg. All children received an injection of botulinum toxin type A into the horizontal oculomotor muscles at an average dosage of 3.4. Results. In most cases (68.70%), a positive effect was achieved after one injection. Two injections were given to 30 patients (26.09%), 6 patients were given 3 injections (5.22%). Repeated injections, most often (19.13%), were required in patients with a strabismus angle of more than 25 degrees. The effectiveness of strabismus treatment depends on the initial value of the angle and the adequately selected dose. Most often, a positive result of treatment was observed after one injection of botulinum toxin type A with a volume of 2 to 4. We did not find any complications when using the denervation method. Conclusion. The method of botulinum toxin type A chemodenervation is effective in the treatment of concomitant strabismus in children with hyperopia. Key words: botulinum toxin type A, concomitant strabismus, chemodenervation, children, hyperopia.

Shared decision making and patients satisfaction with strabismus care\u2014a pilot study

BackgroundStrabismus is a complex disease that has various treatment approaches each with its own advantages and drawbacks. In this context, shared decisions making (SDM) is a communication process with the provider sharing all the relevant treatment alternatives, all the benefits, and risks of each procedure, while the patient shares all the preferences and values regarding his/her choices. In that way, SDM is a bidirectional process that goes beyond the typical informed consent. Therefore, it is known a little of the extent to which SDM influences the satisfaction with the treatment outcome along with strabismus patients. To study this correlation, an SDM-Q-9 questionnaire was provided within surgical consultations where treatment decisions were made; the SDM-Q-9 aims to assess the relationship between the post-operative patient’s satisfaction and their SMD score.MethodsThe study is considered a prospective observational pilot study. Eligible patients were adult patients diagnosed with strabismus, who had multiple treatment options, were given at the right of choice without being driven into a physician’s preference. Ninety-three strabismus patients were asked to fill out the SDM-Q-9 questionnaire related to their perception of SDM during the entire period of strabismus treatment. After the treatment, patients were asked to rate their satisfaction level with the surgical outcome as excellent, good, fair, and poor. Descriptive statistics and the linear regression statistical tests (Spearman, Mann Whitney U, and Kriskal–Wallis) were used as analysis tools.ResultsThe average age of the participants was 24, where 50.6% were women. The mean SDM-Q-9 score among patients was 32 (IQR = 3). The postoperative patient satisfaction was rated as being excellent by 16 (17.2%) patients, good by 38 (40.9%), fair by 32 (34.4%), and poor by 7 patients (7.5%). Data analysis by linear regression statistical tests showed a positive correlation between the SDM-Q-9 score and the patient satisfaction related to the surgery outcome (B = 0.005, p < 0.001). Criteria in assessing patients’ satisfaction were age, gender, and strabismus type. A positive correlation between SDM and real satisfaction (r = 0.834, p < 0.01) was found with age, and no significant relationship was found while taking into consideration the responder’s gender and the strabismus type.ConclusionsAssessing patient satisfaction after choosing a treatment for strabismus method helped us evaluate the gaps in constructive dialogue that would lead to a positive outcome for both patient and clinician. The correlation between the SDM process and the patients’ satisfaction with surgery outcome, adjusted by age, has been established. These findings can serve as a springboard to further communicative improvements related to the SDM process and between patients and physicians, thereby consequently leading to patients’ satisfaction raise in strabismus care. The study underlines the importance of further analysis and validation of on-ground interactions among the adolescent and adult patients and the clinicians across the strabismus management trajectory. A multicentral study and its validation will follow.

The attitude towards strabismus and barriers for its treatment in parents from rural and urban areas

It has been observed that children having strabismus who are being left untreated face a lot of psychosocial and functional difficulties in adulthood. In this study, an attitude and a barrier scale was structured and validated on the basis of the adult strabismus 20 questionnaire and a Barrier Scale. The attitude scale had two subscales-psychosocial subscale and functional subscale. A total of 1747 children; 828 from urban and 919 from rural areas, between the age group of 5 to 12 years were screened from urban and rural schools for strabismus. 36 children with strabismus were identified and studied on the basis of various parameters. None of these children had taken previous treatment for strabismus. The ratio of urban is to rural school children was 5:7 and the ratio between male and female was 7:5. 25 (69.4%) had exotropia, 11(30.6%) had esotropia among which 18(50%) had moderate degree of squint, 12(33.3%) had mild degree of squint. Mean Scores in the psychosocial subscale scale in Urban and rural areas were as 65.89±31.19 and 59.56±26.74 with p value 0.51. Mean Scores in Functional Subscale were as 77.63±32.58 and 66.67±31.66 with p value of 0.31. The most important barrier for treatment was the unawareness of the treatment of strabismus at the appropriate time. The attitude of parents towards strabismus was based on an amalgamation of multiple variables like age of the child, amount of squint, type of squint and also the gender of the child.

Botulinum Toxin: An Update on Pharmacology and Newer Products in Development.

Since its introduction as a treatment for strabismus, botulinum toxin (BoNT) has had a phenomenal journey and is now recommended as first-line treatment for focal dystonia, despite short-term clinical benefits and the risks of adverse effects. To cater for the high demand across various medical specialties, at least six US Food and Drug Administration (FDA)-approved formulations of BoNT are currently available for diverse labelled indications. The toxo-pharmacological properties of these formulations are not uniform and thus should not be used interchangeably. Synthetic BoNTs and BoNTs from non-clostridial sources are not far from clinical use. Moreover, the study of mutations in naturally occurring toxins has led to modulation in the toxo-pharmacokinetic properties of BoNTs, including the duration and potency. We present an overview of the toxo-pharmacology of conventional and novel BoNT preparations, including those awaiting imminent translation from the laboratory to the clinic.