Vertical Deviation Research Articles

Diagnosis dan Tata Laksana Dissociated Vertical Deviation

Dissociated vertical deviation (DVD) is characterized by an upward deviation of one eye in the absence of any compensatory movement in the other eye. This condition is often seen in strabismus and can cause visual disturbances such as double vision and amblyopia. Its underlying causes are believed to be related to abnormalities of the visual pathways to control eye movements. Treatment options include observation, conservative management, and surgical intervention, depending on the severity and underlying cause.

Torsion and clinical features in patients with acquired fourth cranial nerve palsy

This retrospective study aimed to compare objective/subjective torsion and other clinical characteristics of patients with acquired trochlear nerve palsy. This study included 82 consecutive patients who were diagnosed with acquired fourth cranial nerve palsy between 2014 and 2021 and who were followed up for ≥ 6 months. The etiologies, ocular deviation, objective and subjective torsions were reviewed. The etiologies were classified as ischemic, traumatic, brain lesion, idiopathic, or other. The patients were classified into two groups according to the recovery state: full recovery and partial/no-recovery. We compared the torsion and clinical features based on the etiology and recovery state. The average age was 59.1 ± 11.1 years, and 58 (71.0%) of the patients were male. The most common cause was ischemic (n = 49, 59.7%) and other common causes included traumatic (n = 16, 19.5%), brain lesion (n = 8, 9.8%), idiopathic (n = 5, 6.1%) and others (n = 4, 4.9%). Of the 82 patients, 56 (68.3%) were assigned to the full recovery group, and 26 (31.7%) were assigned to the partial/no-recovery group. The average age and number of patients with ischemic causes of palsy were greater in the full recovery group (p = 0.026 and p < 0.000, respectively). The vertical deviation angle, tilted angle on the Lancaster red-green test (LRGT), proportion of patients who experienced subjective torsion on the LRGT, and head tilt were smaller in the full recovery group (p = 0.037, 0.042, 0.045, and 0.006, respectively). Ischemic trochlear nerve palsy, advanced age, a small deviation angle at the primary position, and few cases of excyclotorsion on LRGT were characteristic of the full recovery group of acquired unilateral trochlear nerve palsy patients.

CALOTRITON: a convective boundary layer height estimation algorithm from ultra-high-frequency (UHF) wind profiler data

Abstract. Long time series of observations of atmospheric dynamics and composition are collected at the French Pyrenean Platform for Observation of the Atmosphere (P2OA). Planetary boundary layer depth is a key variable of the climate system, but it remains difficult to estimate and analyse statistically. In order to obtain reliable estimates of the convective boundary layer height (Zi) and to allow long-term series analyses, a new restitution algorithm, named CALOTRITON, has been developed. It is based on the observations of an ultra-high-frequency (UHF) radar wind profiler (RWP) from P2OA with the help of other instruments for evaluation. Estimates of Zi are based on the principle that the top of the convective boundary layer is associated with both a marked inversion and a decrease in turbulence. Those two criteria are respectively manifested by larger RWP reflectivity and smaller vertical-velocity Doppler spectral width. With this in mind, we introduce a new UHF-deduced dimensionless parameter which weighs the air refractive index structure coefficient with the inverse of vertical velocity standard deviation to the power of x. We then search for the most appropriate local maxima of this parameter for Zi estimates with defined criteria and constraints such as temporal continuity. Given that Zi should correspond to fair-weather cloud base height, we use ceilometer data to optimize our choice of the power x and find that x=3 provides the best comparisons. The estimates of Zi by CALOTRITON are evaluated using different Zi estimates deduced from radiosounding according to different definitions. The comparison shows excellent results with a regression coefficient of up to 0.96 and a root-mean-square error of 71 m, which is close to the vertical resolution of the UHF RWP of 75 m, when conditions are optimal. In more complex situations, that is when the atmospheric vertical structure is itself particularly ambiguous, secondary retrievals allow us to identify potential thermal internal boundary layers or residual layers and help to qualify the Zi estimations. Frequent estimate errors are observed nevertheless; for example, when Zi is below the UHF RWP first reliable gate or when the boundary layer begins its transition to a stable nocturnal boundary layer.

Balancing predictability and flexibility through operation volume-constrained visual flight rule operations in low altitude airspaces

The advancement in uncrewed aircraft systems such as small drones and advanced air mobility vehicles such as Electric Vertical Take Off and Landing aircraft (eVTOL) has called for airspace integration at low altitudes of both traditional aircraft, such as helicopters and new entrants, such as drones and eVTOL. Currently, the trajectories and necessary buffers around them of flights operating under visual flight rules are not possible to predict. This research proposes the use of flight mission characteristics to model the trajectory and evaluates temporal, lateral and vertical deviations to define the safety buffers which can be used to generate operation volumes, geo-fencing such low-altitude flights and separating them from other traffic in a safe and efficient manner. Real flight test data obtained for the purposes of this study and pilots’ interviews assure high fidelity and practicability of the proposal.

Design and characterization of an antiproton deceleration beamline for the PUMA experiment

We report on the design and characterization of an antiproton deceleration beamline, based on a pulsed drift tube, for the PUMA experiment at the Antimatter Factory at CERN. The design has been tailored to high-voltage (100kV) and ultra-high vacuum (below 10−10mbar) conditions. A first operation achieved decelerating antiprotons from an initial energy of 100keV down to (3898±3)eV, marking the initial stage in trapping antiprotons for the PUMA experiment. Employing a high-voltage ramping scheme, the pressure remains below 2×10−10mbar upstream of the pulsed drift tube for 75% of the cycle time. The beamline reached a transmission of (55±3)% for antiprotons decelerated to 4keV. The beam is focused on a position sensitive detector to a spot with horizontal and vertical standard deviations of σhoriz=(3.0±0.1)mm and σvert=(3.8±0.2)mm, respectively. This spot size is within the acceptance of the PUMA Penning trap.

Исследование изменения геометрических параметров образцов, наплавленных методом GMAW при воздействии на электрическую дугу продольного магнитного поля

Introduction. The paper presents the results of research of additive manufacturing process by electric arc with axial feeding of steel filler wire in protective gas environment (GMAW technology) with additional influence of external longitudinal magnetic field on electric arc. Purpose of work: an experimental study of the effect of a longitudinal magnetic field during additive manufacturing by an electric arc with axial feed of filler wire made of structural steels in a protective gas environment on the change in the geometrical characteristics of the layers being surfaced. Research Methods. The manufacturing of specimens was carried out on a 5-axis additive machine based on a CNC machine. Surfacing was carried out in the following modes: voltage 17.5 V; current 55–65 A; wire diameter 1.2 mm; wire material Sv-08G2S; wire feed rate 2,267 mm/min; approximate roll diameter 3.0 mm; roll length 50 mm; number of wires per one roll 312.5 mm; number of layers when surfacing the wall 5; magnet operation mode: alternating current with frequency 50 Hz, voltage 30 V; measured magnetic induction 5.7 mTl; initial height of the magnet above the substrate 10 mm; electrode stickout 10 mm; shielding gas: welding mixture CO2-Ar; gas pressure (flow rate) 0.15 MPa. Results and discussion. The conducted experimental study showed that the effect of longitudinal magnetic field had a statistically significant effect on the change in the dimensions of the singular, namely an increase in the width of the layers being surfaced by 34.1 %, with a calculated significance index close to zero, and a decrease in height by 20.2 %, with a calculated significance index equal to 2.7105. The effect of longitudinal magnetic field had a statistically significant effect on the change of the overall dimensions of the specimens consisting of five layers, namely, the width of the specimens increased by 11.2 % with a calculated significance index of 4.3103, and the height of the specimens decreased by 10.3 % with a calculated significance index of 6.3105. The effect of longitudinal magnetic field had no statistically significant effect on the change of the vertical deviation from straightness for the side walls of the specimens, with a calculated significance index of 0.3277, and had no statistically significant effect on the change of the error of the width of the walls of the specimens, with a significance index of 0.098.

Outcomes for Intermittent Exotropia Using Three Common Surgical Approaches.

To compare a single surgeon's surgical outcomes for treating intermittent exotropia using bilateral lateral rectus recession (BLR), unilateral lateral rectus recession and medial rectus resection (RR), and unilateral lateral rectus recession and medial rectus plication (RP). A retrospective review of all surgeries for basic intermittent exotropia between 2015 and 2023 was performed. Only patients with initial correction using BLR, RR, or RP were included. Exclusion criteria included age older than 18 years, vertical deviation, any nonrefractive ocular diagnoses, prior ocular surgery, and inadequate follow-up. There were 460 patients identified; 123 met inclusion criteria with 54 in the BLR group, 41 in the RR group, and 28 in the RP group. The average pre-operative distance alignment (and standard error) values for the BLR, RR, and RP groups were 25.07 (7.35), 22.44 (5.95), and 23.84 (6.42) prism diopters (PD), respectively. At 1 year, the postoperative distance alignment values for the BLR, RR, and RP groups were 8.72 (7.89), 7.46 (6.31), and 12.83 (6.82) PD, respectively (P = .03). A subanalysis found a significant difference between the BLR and RP (P = .02) and RR and RP (P = .02) groups. There was no difference between the BLR and RR groups (P = .57). This study of three surgical approaches for intermittent exotropia found RP had a significantly larger angle of exodeviation compared to BLR and RR at 1 year of follow-up. Both BLR and RR were equally effective approaches for treating intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 2024;61(4):287-290.].

Strabismus management in retinoblastoma survivors

PurposeTo report the result of strabismus surgery in eye-salvaged retinoblastoma (Rb) patients.MethodsA retrospective case series including 18 patients with Rb and strabismus who underwent strabismus surgery after completing tumor treatment by a single pediatric ophthalmologist.ResultsA total of 18 patients (10 females and 8 males) were included with a mean age of 13.3 ± 3.0 (range, 2–39) months at the time tumor presentation and 6.0 ± 1.5 (range, 4–9) years at the time of strabismus surgery. Ten (56%) patients had unilateral and 8(44%) had bilateral involvement and the most common worse eye tumor’s group was D (n = 11), C (n = 4), B (n = 2) and E (n = 1). Macula was involved by the tumors in 12 (67%) patients. The tumors were managed by intravenous chemotherapy (n = 8, 47%), intra-arterial chemotherapy (n = 7, 41%) and both (n = 3, 17%). After complete treatment, the average time to strabismus surgery was 29.9 ± 20.5 (range, 12–84) months. Except for one, visual acuity was equal or less than 1.0 logMAR (≤ 20/200) in the affected eye. Seven (39%) patients had exotropia, 11(61%) had esotropia (P = 0.346) and vertical deviation was found in 8 (48%) cases. The angle of deviation was 42.0 ± 10.4 (range, 30–60) prism diopter (PD) for esotropic and 35.7 ± 7.9 (range, 25–50) PD for exotropic patients (P = 0.32) that after surgery significantly decreased to 8.5 ± 5.3 PD in esotropic cases and 5.9 ± 6.7 PD in exotropic cases (P < 0.001). The mean follow-up after surgery was 15.2 ± 2.0 (range, 10–24) months, in which, 3 (17%) patients needed a second surgery.ConclusionStrabismus surgery in treated Rb is safe and results of the surgeries are acceptable and close to the general population. There was not associated with tumor recurrence or metastasis.

Clinical effect of superior oblique re-tucking for recurrent or residual compensatory head position

Objective: To evaluate the effects of re-tucking the superior oblique muscle on recurrent or residual compensatory head position. Methods: A retrospective case series study was conducted. 12 recurrent or residual compensatory head position patients (12 eyes) with congenital superior oblique palsy who underwent superior oblique re-tucking in Tianjin Eye Hospital from March 2015 to February 2021 were included. All patients had a history of superior oblique tucking procedure and showed signs of superior oblique muscle palsy without inferior oblique muscle overaction. During surgery, the Guyton forced duction test is used to evaluate the relaxation of the superior oblique muscle tendon, which affects the re-tucking length of the muscle.Their head position, vertical deviation, eye movement, fovea-disa angle, and Bielschowsky head tilt test were assessed pre-and post-surgery. Statistical analysis was performed using ttest and paired samples Wilcoxon signed rank test. Results: Out of the 12 patients, 8 were male and 4 were female, aged between 2 and 9 years. The initial surgery was done at age 6, with a superior oblique recession length of (7.17±1.03) mm. Recurrent head tilt occurred in 11 patients after (3.82±0.98) months postoperatively, and 1 patient had residual head tilt, with a followup period of six months or more. Ocular motility examination revealed underaction of the superior oblique muscle, positive Bielschowsky's head tilt test, and Guyton forced duction tese indicating relaxation of the paralyzed superior oblique muscle tendon. Scar adhesion was observed at the stop of the superior oblique muscle, as well as the previous sutures. The scar and the sutures around the stop of the superior oblique muscle were released, the mean re-tucking amount was(7.83±1.59)mm. Follow-up at 12 to 18 months postoperatively showed disappearance of compensatory head position, significant improvement in superior oblique muscle lag, normal ocular motility, and no occurrence of Brown syndrome. The results of Bielschowsky head tilt were negative in 9 cases and still positive in 3 cases after superior oblique re-tucking. The primary vertical deviation was 2.5 (2.0, 5.3) prism diopter pre-operatively and 1 (0, 1) prism diopter post-operatively, respectively. The difference was statistically significant (U=6.00, P<0.001). The total amount of FDA in both eyes was (-22.04±5.47)° and (-15.27±6.08)° pre-and post-operatively, respectively. The difference was statistically significant (t=2.87, P=0.009). All 12 patients have normal eye movement after superior oblique re-tucking procedure. All patients had no compensatory head position at last follow-up. Conclusions: Superior oblique re-tucking is suitable for patients with relaxation of the superior oblique muscle tendon and extrocular rotation as the main sign. It can effectively and safely correct the recurrent or residual compensatory head position after re-tucking the superior oblique muscle.

Comparative evaluation of accuracy of implants placed with thermoplastic and three-dimensional-printed surgical guides: A randomized controlled trial.

The current study was planned to evaluate the accuracy of dental implant placement with two different types of surgical guides: Thermoplastic and three-dimensional (3D) printed. A total of 32 implants were placed in 20 healthy, partially dentate individuals with an isolated single missing tooth. The implant sites were randomly allocated into two treatment groups: Group A (thermoplastic implant surgical guide, n = 16 implants) and Group B (3D printed implant surgical guide, n = 16 implants). All the cases in both groups were digitally planned according to a defined protocol, and a comparison of the planned and actual implant positions was performed using the medical image analysis software. The differences in the outcome variables, i.e., angular deviation (AD), 3D error at the entry, 3D error at the apex (3D EA), vertical deviation (VD), and composite deviation, were statistically analyzed. All the outcome variables showed improvements, but statistically significant improvement was shown by AD (P = 0.005), 3D EA (P = 0.01), and VD (P = 0.007). The mean and standard deviation (SD) for AD, (3D EA), and VD were 5.58° ±1.93°, 0.96 ± 0.32 mm, and 0.58 ± 0.36 mm, respectively, for group A. The mean and SD for AD, (3D EA), and VD were 3.94° ± 0.64°, 0.64 ± 0.35 mm, and 0.29 ± 0.13 mm, respectively, for group B (P < 0.05). Within the limits of the study, dental implants placed using 3D-printed surgical guides were positioned clinically with greater accuracy, and fewer deviations were observed from their presurgical planned positions as compared to the thermoplastic surgical guides.

Effect of vertical central plication on vertical deviations

PurposeTo evaluate the surgical effect of the Wright central plication on vertical rectus muscles to correct vertical strabismus. MethodsIn this multicenter, retrospective, observational outcomes study, data were collected from two surgeons in different practice settings (2017-22). All patients who underwent vertical rectus central plication were included; those undergoing any concurrent strabismus surgery for vertical strabismus were excluded. Primary outcome was amount of strabismus correction in prism diopters per vertical rectus central plication. Secondary outcome was to determine factors associated with better or worse surgical outcomes and patient and patient responses. Data were analyzed using descriptive and bivariate statistics. ResultsA total of 36 patients were included. Mean age was 60 years. Mean follow-up was 8.4 months. Of the 36 patients, 11 (31%) had idiopathic strabismus, and 7 (19%) had congenital superior oblique palsy. The remainder had a history that included prior ocular surgery, trauma, and Brown syndrome; 16 (44 %) had prior strabismus surgery. Of 31patients with preoperative diplopia, 23 (74%) had postoperative resolution of diplopia, and 10 of 16 patients with preoperative prisms (63%) no longer required prisms postoperatively. Mean vertical deviation change was 4.7Δ. Subgroup analysis removing patients with congenital superior oblique palsy showed a larger response of 5.5Δ. 78% of patients had a final deviation <5Δ. No complications or induced postoperative diplopia was reported. ConclusionsIn our study cohort, vertical rectus central plication corrected approximately 5Δ (range, 4.5Δ-5.5Δ) of vertical strabismus due to a variety of causes.

A GOOD RESULT IN COMBINATION OF LARGE SUPERIOR RECTUS RECESSION AND PRISMATIC GLASSES IN UNILATERAL DISSOCIATION VERTICAL DEVIATION: A CASE REPORT

Introduction : Severe DVD is one of the indications for surgery. There are guidelines recommended for management based on grading of severity and the surgeon’s preference. Large recession of superior rectus muscle and prismatic glasses yield good result in unilateral DVD reported in this paper.&#x0D; Case Illustration : A 21 year-old student stated difficulty in working with his microscope since 2 years ago. He had a history of double vision since childhood. The visual acuity in both eyes were 5/5. Qualitative strabismus examination resulted in hypertropia RE and intermittent exotropia. When the occluder was removed from RE, a non fixating eye would appear elevated and did not correspond with the contralateral eye hypotropia. Krimsky test revealed RE hypertropia 30? PD, exotropia 10? PD. Sensory evaluation using WFDT was normal in near and crossed diplopia in distance. Patient diagnosed with unilateral DVD then underwent superior rectus recession in 10 mm. The following month, patient was still experiencing vertical diplopia. The patient was given 3 PD prismatic glasses. Consequently, diplopia was absent and stereoacuity test using TNO was 480 seconds of arch&#x0D; Discussion : DVD can’t be fully corrected by surgery due to central cortical innervational problem. The residual symptom can be corrected by conservative management. Large SR recession in combination with prismatic glasses was found to improve vertical deviation and reduce diplopia.&#x0D; Conclusion : While large superior rectus recession can significantly improve vertical deviation, it can not completely remove binocular symptom

Jednooczny deficyt unoszenia gałki ocznej – obraz kliniczny i metody leczenia chirurgicznego

The aim of this paper is to present Monocular Elevation Deficiency, previously known as a double elevator palsy. Monocular Elevation Deficiency is the limitation of elevation of the affected eye in both adduction and abduction. This condition can lead to hypotropia and can be associated with ptosis or pseudoptosis. Monocular Elevation Deficiency can be congenital or acquired, what can cause serious consequences like amblyopia. For paediatric patients early treatment is essential to avoid amblyopia and obtain binocular vision. Most of Monocular Elevation Deficiency cases require surgical treatment, however there are types of this motility disorder which require only observation. The choice of surgical procedure varies according to nderlying cause and the strabological examination results. Generally, the result of forced duction test is the most important component in choosing an adequate procedure in the management of Monocular Elevation Deficiency. There is a broad range of surgeries in this form of strabismus: Knapp’s procedure and it’s modifications, recession of inferior rectus muscle or other types of operations on contralateral eye. The main rule in treatment Monocular Elevation Deficiency is that the vertical deviation has to be corrected first to ensure the pseudoptosis element is eliminated, and as a second step ptosis can be surgically cured.

Teprotumumab for Thyroid Eye Disease-related Strabismus.

To assess and quantify teprotumumab's effect on thyroid eye disease-related strabismus by change in measured horizontal and vertical deviations and change in extraocular motility. We reviewed a series of patients with thyroid eye disease-related strabismus treated with teprotumumab. Exclusion criteria included age under 18 years, strabismus of alternate etiology, or thyroid eye disease-related reconstructive surgery during the treatment course. Primary outcomes were absolute (prism diopters) and relative (%) differences in horizontal and vertical deviations in primary position at distance, as well as change in ductions of the more affected eye. Secondary outcomes included incidence and timing of strabismus surgery postteprotumumab. Thirty-one patients were included, with mean age 63 years and thyroid eye disease duration 10 months. After teprotumumab, there was 6 prism diopters (39%) mean reduction in vertical deviation ( p < 0.001), without significant change in mean horizontal deviation ( p = 0.75). Supraduction, abduction, adduction, and infraduction significantly improved in the more restricted eye ( p < 0.01, p < 0.01, p = 0.04, and p = 0.01, respectively). Thirty-five percent of patients underwent strabismus surgery posttreatment, at an average 10 months after last infusion. Teprotumumab produced a statistically significant reduction in vertical but not horizontal strabismus angles in primary position at distance. Extraocular motility in all 4 ductions also improved. A substantial minority of patients still required strabismus surgery following teprotumumab.

Alteration Ocular Motility in Retinitis Pigmentosa: Case-Control Study.

To evaluate ocular motility (OM) disorders and strabismus in a sample of patients with retinitis pigmentosa (RP) and a control sample. In this cross-sectional retrospective analysis, we studied a sample of RP patients with a mean age of 48.74 years and an average visual acuity of 7/10 based on Snellen optotype and a sample of control patients with similar mean age (49 years [men], 47 years [women]) and sex and an average visual acuity of 9.9/10, with the aim of assessing correlations between alteration of OM and strabismus in RP patients based on age, high refractive defect, or severely impaired binocular vision. The examination followed a protocol of testing for anamnesis and best-corrected visual acuity, as well as a complete eye examination, corneal reflex, cover test, OM, Hess screen, and Lang test. At the first orthoptic evaluation, 45.16% of patients showed strabismus, 41.93% exotropia (25% of cases intermittent), 3.22% esotropia, and 6.45% vertical deviation. Later evaluation showed strabismus in 25.80% of patients, exotropia in 19.35% (9.67% intermittent), esotropia in 3.22%, and vertical deviation in 3.22%. Assessment of eye motility study showed 51.6% overaction of the inferior oblique and hypofunction of the superior rectus, and 18% overaction of the lateral rectus and hypofunction of the medial rectus. According to our results, alterations in OM and strabismus in RP patients are not correlated with age or high refractive defect. Therefore, motility disorders and strabismus are attributed to a genetic factor to which men are more susceptible. The incidence of OM disorder was 77.42%, and strabismus was present in 45.16% of patients.

A Case Study of Ground Settlement and Volume Loss from Pipe Jacking and Microtunelling Activities for Sewerage Pipe Installation in Ipoh, Perak.

A case study of sewerage pipeline installation utilizing pipe jacking and MTBM in Ipoh, Perak, Malaysia was conducted to analyse the ground response by quantifying the soil volume loss and ground surface settlement. The sewerage pipeline installation involves tunnelling and jacking beneath the KTMB railway track for 191m from jacking to receiving pit.The excessive horizontal and vertical deviation of MTBM when excavating through very loose sand and soft clay leads to an uncontrolled overcut and affecting the magnitude of the ground surface settlement where 100mm and 130mm for horizontal and vertical deviation respectively produce 49mm of ground surface settlement. The maximum settlement for the railway track was 12mm over 30m chords length (0.0004) after two months of project completion still within the allowable limit set by KTMB (11mm over 10m chords for intervention (0.001). The volume loss calculated from this project ranging from 0.80% to 12.68% contributes by the lowest and the highest ground surface settlement which is - 3mm and - 51 mm, respectively which varied from the 8mm estimated ground surface settlement by assuming 2% of volume loss. It was found that the trough width parameter K = 0.5 matches the settlement trough of collected field data. In conclusion, soil volume loss and ground surface settlement was affected by the MTBM deviation.

Outcomes of "a new modification of Jensen technique combined with medial rectus recession" in patients with complete sixth cranial nerve palsy.

To report the outcomes of "our modified Jensen technique" for treating esotropia in cases with complete sixth cranial nerve (CN VI) palsy. This study is a 30-year case series of isolated complete CN VI palsy who underwent combined medial rectus recession and our modified Jensen operation. We modified the original technique by anchoring the muscle-unifying sutures to the sclera near the equator using a non-absorbable suture. Major outcomes such as postoperative diplopia, face turn, horizontal and vertical eye deviations, and abduction limitation were assessed. Successful surgery was defined as orthotropia or esotropia equal to or less than 8 prism diopters (PD) and the absence of any vertical deviation. Fifty-three cases with a mean age of 28 years old were included in this study. The male-to-female ratio was 3 to 1. Forty-five cases (85%) presented with unilateral palsy, whereas 8 patients (15%) had bilateral palsy. Trauma was the most common etiology (85%). Diplopia or face turn, presented in 42 patients before the operation, remained in seven cases after the operation. Primary position esotropia, which was the main complaint in all patients, decreased from 49 PD to 4 PD in unilateral palsy and from 101 PD to 10 PD in bilateral palsy. The mean reduction of abduction deficit was 1.78 in unilateral and 1.75 in bilateral palsy. The success rate was 76% in unilateral and 62% in bilateral palsy. Our modified Jensen operation was effective in treating patients with complete CN VI palsy, producing no significant permanent complications.

Outcomes of Strabismus Surgery Following Teprotumumab Therapy

PurposeTo investigate the results of patients undergoing surgical treatment for strabismic diplopia in thyroid eye disease (TED) following teprotumumab. DesignMulticenter, retrospective, case series. MethodsWe report 28 patients who underwent extraocular muscle surgery for strabismic diplopia after treatment with teprotumumab at 7 different academic centers. Elapsed time from last teprotumumab dose to the date of surgery, previous orbital decompression, primary preoperative horizontal and vertical deviation, surgical procedure, and 2-month postoperative results were collected from the patient records. ResultsSixteen (57%) patients were diplopia-free after one surgery. Three (11%) chose prism spectacles to correct residual diplopia, 2 (7%) used compensatory head posture to resolve diplopia, and 1 (4%) had intermittent diplopia and was functionally improved (choosing no prisms or further surgery). These were considered treatment successes. Three (11%) patients required reoperation, and all were diplopia-free after their second procedure. ConclusionsMost patients requiring surgery for strabismic diplopia following teprotumumab achieve good outcomes with success rates comparable to series published before the availability of teprotumumab.

Jet grouting to new depths in the Lambeth Group and Thanet Formation beneath London

A jet grouting trial was undertaken within the Thames Tideway Tunnel shaft at Kirtling Street in Battersea, SW London, to assess the viability of the technique within the Lambeth Group and Thanet Formation sediments up to 60 m below ground level. There was no precedent industry experience of jet grouting in the UK at this depth and in these soil types. Four, separate, upper and lower grout columns were constructed respectively within upper and lower granular zones inside the shaft footprint, and then exhumed for inspection and measurement during ensuing excavation within the diaphragm wall lining. Target diameters for the upper columns were achieved within granular channel sand and Laminated Bed material, with minimal vertical deviation. These were not so successfully achieved, however, within stiff cohesive Laminated Bed and Lower Shelly Clay materials. Formation of the lower columns was severely restricted in dense gravel belonging to the ‘Pebble Bed’ and stiff gravelly clay, at the top of the Upnor Formation, but target diameters were being achieved in the lower portion of the formation, comprising Upnor sand. At their base, the column diameters were, again, restricted in the very dense sand at the top of the Thanet Formation.

Surgical outcome of inferior oblique anteriorization in unilateral superior oblique palsy with large angle hypertropia

Purpose The aim of this study was to assess the effect of unilateral inferior oblique (IO) anteriorization as a single muscle surgery for treatment of unilateral superior oblique palsy (SOP) with large angle hypertropia. Patients and methods This is a retrospective study that included 28 patients, for whom IO anteriorization was performed for treatment of ipsilateral SOP with large angle hypertropia more than or equal to 20 prism diopters (PD). The patients were evaluated preoperatively and 3 months postoperatively for the vertical deviation (VD) in primary position and in adduction. Residual hypertropia less than or equal to 6 PD in primary position postoperatively was considered a successful outcome, together with improvement of the abnormal head tilt. Results The mean age of the patients was 30.75±17.05 years. The mean preoperative VD in the primary position was 25.29±4.50 PD. It significantly decreased postoperatively to 5.54±5.25 PD (P&lt;0.001). The mean preoperative VD in adduction was 30.57±7.89 PD and decreased postoperatively to 8.50±5.27 PD (P&lt;0.001). The preoperative IO overaction grade was 2.61±0.99 and decreased postoperatively to 0.39±0.50 (P&lt;0.001). Successful outcome was reported in 75% of the cases and improvement of head tilt occurred in 78% of the patients. Conclusion IO anteriorization could be a simple one muscle surgery to correct large angle VD associated with unilateral SOP with a favorable outcome.