Showing papers on "Strabismus published in 2011"
TL;DR: The advent of a new adult strabismus specific quality-of-life questionnaire and its subsequent validation will make quantification of improvement easier and the wider medical community and the public at large should be made aware of the benefits of corrective strabistismus surgery in adults.
Abstract: Correction of adult strabismus is not a cosmetic procedure but one that restores normality to an individual's appearance that has been altered by a disease process. Two fundamental principles underpinning facial attractiveness are symmetry and averageness—manifest strabismus affects both of these giving an unconscious signal of poor genetic history. The presence of manifest strabismus adversely affects many aspects of patients' lives including finding a partner, job prospects and interaction with peers, and may manifest more seriously as psychiatric disorders. Surgical correction has been shown to be safe and effective for the functional problems of strabismus in adults but the hugely positive effects on the psychosocial aspects are only now becoming apparent. The advent of a new adult strabismus specific quality-of-life questionnaire and its subsequent validation will make this quantification of improvement easier. The wider medical community and the public at large should be made aware of the benefits of corrective strabismus surgery in adults.
68 citations
TL;DR: Although there were no significant differences in any PedsQL scores between children with and without amblyopia, even after adjusting for gender, age, race, and family income, further study using vision-specific instruments is required to explore the impact of both strabismus and Amblyopia on pediatric quality of life.
68 citations
TL;DR: Severe visual impairment is common in pediatric patients with cataract in China and late surgical treatment are the major reasons and deserve greater attention.
68 citations
TL;DR: Most children with a history of high-risk prethreshold ROP develop strabismus at some time during the first 6 years of life.
Abstract: Purpose To present strabismus data for children who participated in the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Methods The prevalence of strabismus, categorized as present or absent, was tabulated for all children with history of high-risk prethreshold retinopathy of prematurity (ROP) who participated in the ETROP randomized trial and were examined at 9 months to 6 years of age. Relationships among strabismus and demographic measures, eye characteristics, and neurodevelopmental factors were analyzed. Results Among the 342 children evaluated at 6 years, the prevalence of strabismus was 42.2%. Even with favorable acuity scores in both eyes, the prevalence of strabismus was 25.4%, and with favorable structural outcomes in both eyes the prevalence of strabismus was 34.2%. Of children categorized as visually impaired as the result of either ocular or cerebral causes, 80% were strabismic at the 6-year examination. Of 103 study participants who were strabismic at 9 months, 77 (74.8%) remained so at 6 years. Most strabismus was constant at both the 9-month (62.7%) and the 6-year examination (72.3%). After multiple logistic regression analysis, risk factors for strabismus were abnormal fixation behavior in one or both eyes ( P P P = 0.025), and history of anisometropia ( P = 0.04). Strabismus surgery was performed for 53 children. By 6 years, the cumulative prevalence of strabismus was 59.4%. Conclusions Most children with a history of high-risk prethreshold ROP develop strabismus at some time during the first 6 years of life.
64 citations
TL;DR: Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach.
Abstract: Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of 'no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach.
58 citations
TL;DR: The PVS identified children with amblyopia or strabismus with high sensitivity and specificity, while successful treatment restored normal BIN scores in amblyopic patients without strabistismus.
Abstract: Purpose. The Pediatric Vision Scanner (PVS) detects strabismus by identifying ocular fixation in both eyes simultaneously. This study was undertaken to assess the ability of the PVS to identify patients with amblyopia or strabismus, particularly anisometropic amblyopia with no measurable strabismus. Methods. The PVS test, administered from 40 cm and requiring 2.5 seconds of attention, generated a binocularity score (BIN, 0%-100%). We tested 154 patients and 48 controls between the ages of 2 and 18 years. BIN scores of amblyopic children and controls were measured, and 21 children received sequential PVS measurements to detect any changes in BIN resulting from amblyopia treatment. Results. With the pass/refer threshold set at BIN 60%, sensitivity and specificity were 96% for the detection of amblyopia or strabismus. Assuming a 5% prevalence of amblyopia or strabismus, the inferred positive and negative predictive values of the PVS were 56% and 100%, respectively. Fixation accuracy was significantly reduced in amblyopic eyes. In anisometropic amblyopia patients treated successfully, the BIN improved to 100%. Conclusions. The PVS identified children with amblyopia or strabismus with high sensitivity and specificity, while successful treatment restored normal BIN scores in amblyopic patients without strabismus. The results support the hypothesis that the PVS detects strabismus and amblyopia directly. Future strategies for screening by nonspecialists may thus be based on diagnostic detection of amblyopia and strabismus rather than the estimation of risk factors, allowing for rapid, accurate identification of children with amblyopia early in life when it is most amenable to treatment.
57 citations
TL;DR: Children aged 6 years or older with a visible squint seem to be less likely to be accepted by their peers, and corrective surgery for strabismus without prospects for binocular vision should be performed before this age.
Abstract: Aim To determine the social acceptance of children with strabismus by their peers and to determine the age at which the negative impact of strabismus on psychosocial interactions emerges. Methods Photographs of six children were digitally altered in order to create pictures of identical twins except for the position of the eyes (orthotropic, exotropic and exotropic) and the colour of the shirt. One hundred and eighteen children aged 3–12 years were asked to select, for each of the six twin pairs, one of the twins to invite to their birthday party. The grouping of the pictures and the composition of the twin pairs were determined by Latin squares. Results Children younger than 6 years old did not make any significant distinctions between orthotropic children and children with strabismus. Respondents aged 6 years or older invited children with a squint to their birthday parties significantly less often than orthotropic children. The authors found no impact (p>0.1) of gender, of the colour of the shirt or of the type of strabismus, but did find a highly significant impact of age on the number of invited children with strabismus. Conclusions Children aged 6 years or older with a visible squint seem to be less likely to be accepted by their peers. Because this negative attitude towards strabismus appears to emerge at approximately the age of 6 years, corrective surgery for strabismus without prospects for binocular vision should be performed before this age.
51 citations
TL;DR: The objective is to determine the incidence of consecutive exotropia (XT) following successful surgical correction of childhood esotropia and identify factors associated with its development.
Abstract: Purpose: To determine the incidence of consecutive exotropia (XT) following successful surgical correction of childhood esotropia (ET) and identify factors associated with its development. less thanbrgreater than less thanbrgreater thanMaterial and Methods: This is a retrospective study of 85 patients with ET, aged 2-24, who underwent strabismus surgery by a single surgeon between 1958 and 1969 in Sweden, until they were successfully aligned to ET within 10 prism dioptre, after primary or reoperation(s). The charts of these patients were reviewed, and data regarding age at onset of strabismus, surgery performed and outcome were recorded. The patients were recalled for a complete orthoptic examination in 2001-2003. less thanbrgreater than less thanbrgreater thanResults: The incidence of consecutive XT in this cohort was 21% (18/85). Patients who had undergone multiple surgeries had a higher risk of developing consecutive XT compared to those successfully aligned with one surgery (p = 0.00036). Restriction of adduction and convergence postoperatively was associated with a high risk of consecutive XT (p = 0.0437). The incidence of consecutive XT did not vary with the level of visual acuity in the operated eye (p = 0.6428). Age of onset, age at surgery and amount of surgery did not appear to influence the risk for developing consecutive XT (p andgt; 0.05). less thanbrgreater than less thanbrgreater thanConclusion: This 40-year postoperative follow-up of patients with childhood ET who underwent strabismus surgery by a single surgeon in Sweden showed that multiple surgeries and presence of postoperative adduction deficit were the most important factors influencing the incidence of consecutive XT after surgery. Presence of uncorrected amblyopia did not alter the prognosis for long-term development of consecutive XT.
50 citations
TL;DR: It is demonstrated that reduced risk for nystagmus and strabismus was associated with deprivation ≤6 weeks and duration of deprivation was a significant modifiable risk factor for adverse ocular motor outcomes.
Abstract: Background Many children treated for cataracts develop strabismus and nystagmus; however, little is known about the critical period for adverse ocular motor outcomes with respect to age of onset and duration. Methods Children who had undergone extraction of dense cataracts by the age of 5 years were enrolled postoperatively. Ocular alignment was assessed regularly throughout follow-up. Fixation stability and associated ocular oscillations were determined from eye movement recordings at ≥5 years old. Multivariate logistic regression was used to evaluate whether laterality (unilateral vs bilateral), age at onset, and/or duration of visual deprivation were associated with adverse ocular motor outcomes and to determine multivariate odds ratios (ORs). Results A total of 41 children were included. Of these, 27 (66%) developed strabismus; 29 (71%) developed nystagmus. Congenital onset was associated with significant risk for strabismus (OR, 5.3; 95% CI, 1.1-34.1); infantile onset was associated with significant risk for nystagmus (OR, 13.6; 95% CI, 1.6-302). Duration >6 weeks was associated with significant risk for both strabismus (OR, 9.1; 95% CI, 1.9-54.2) and nystagmus (OR, 46.2; 95% CI, 6.0-1005). Congenital onset was associated with significant risk for interocular asymmetry in severity of nystagmus (OR, 25.0; 95% CI, 2.6-649), as was unilateral cataract (OR, 58.9; 95% CI, 5.1-2318). Conclusions Laterality (unilateral vs bilateral) and age at onset were significant nonmodifiable risk factors for adverse ocular motor outcomes. Duration of deprivation was a significant modifiable risk factor for adverse ocular motor outcomes. The current study demonstrated that reduced risk for nystagmus and strabismus was associated with deprivation ≤6 weeks.
47 citations
TL;DR: The use of HRQoL measures in patients with amblyopia and/or strabismus is a developing area and further research is necessary to determine the impact of issues such as diplopia and poor cosmesis upon patient groups, and the influence of ethnicity and parental reporting in these patients.
Abstract: Background/aims Health-related quality of life (HRQoL) measures are used in healthcare to help inform clinical decision-making and policy-making decisions. A number of disease-specific or condition-specific measures have been developed and applied in ophthalmology; however, their use in the specific fields of amblyopia and strabismus are not as established. The purpose of this study is to identify and discuss specific HRQoL instruments that may be used in the investigation and management of patients with amblyopia and/or strabismus. Methods A systematic literature review was undertaken in November 2009. The electronic databases of AMED (Allied and Complementary Medicine: 1985 to November 2009), the British Nursing Index and Archive (1985 to October 2009), Ovid Medline In-Process and Other Non-Indexed Citations and Ovid Medline (1950 to present) and PsycINFO (1806 to November Week 1 2009) were searched. No language restrictions were applied to the search. Results Four instruments were identified: the Amblyopia and Strabismus Questionnaire (A&SQ), the Amblyopia Treatment Index (ATI), the Adult Strabismus Questionnaire (AS-20) and the Intermittent Exotropia Questionnaire (IXTQ). Conclusion The use of HRQoL measures in patients with amblyopia and/or strabismus is a developing area. Further research is necessary to determine the impact of issues such as diplopia and poor cosmesis upon patient groups, and to determine the influence of ethnicity and parental reporting in these patients.
46 citations
TL;DR: The findings suggest that eye surgery influences somatosensory properties of extra-ocular muscles leading to improvement of postural control and that binocular visual perception could influence the whole body.
TL;DR: Amniotic membrane transplantation seems to help prevent recurrence of adhesions in patients with restrictive strabismus caused by conjunctival scarring, fat adherence syndrome, or rectus muscle contracture.
TL;DR: Results from neurophysiological experiments suggest that activity within the SOA cells is important in determining the state of horizontal strabismus possibly by altering vergence tone in extraocular muscle.
Abstract: We have earlier shown that monkeys reared with daily alternating monocular occlusion for the first few months of life develop large horizontal strabismus, A/V patterns, dissociated vertical deviation (DVD), and dissociated horizontal deviation (DHD). Here, we present results from neurophysiological experiments that show that neuronal activity of cells within the supraoculomotor area (SOA) of juvenile strabismic monkeys is correlated with the angle of strabismus. There was no modulation of SOA cell activity with conjugate eye position as tested during horizontal smooth pursuit. Comparison of SOA population activity in these strabismic animals and normal monkeys (described in the literature) suggests that both vergence (misalignment in the case of the strabismic animals) thresholds and vergence position sensitivities are different in the strabismic animals compared to the normals. Our data suggest that activity within the SOA cells is important in determining the state of horizontal strabismus possibly by altering vergence tone in extraocular muscle.
TL;DR: The anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP, and retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.
Abstract: Purpose: To assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP) Methods: We performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007 Retinal reattachment status, visual acuity and postoperative complications were evaluated Results: Twenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined The mean follow-up period was 56 years In 9 (43%) out of 21 eyes, retinas were eventually reattached The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination Postoperative intraocular hemorrhage occurred in nine eyes (43%) Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD Conclusions: After following-up for a mean of 56 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications
TL;DR: The data show no association between refraction and strabismus in children with Down syndrome and esodeviations has been found to be the most common type of astigmatism in the authors' study group.
Abstract: Purpose: The aims of the present population-based, cross-sectional study were to examine the frequency and type of strabismus, refractive errors and nystagmus in children and young adults with Down syndrome (DS) in Macedonia and Croatia.Methods: A total of 170 unselected children and young adults with DS aged 1–34 years were examined for ocular findings. The ocular examination included: a visual acuity assessment, cycloplegic refraction, ocular alignment and ocular motility.Results: Strabismus was found in 45 of 170 children (26.5%), and esodeviation was the most common type. Nine (20%) had exodeviation and 4 (8.9%) vertical deviation. In 27 of 32 esotropic patients, the strabismus was regarded as acquired esodeviations. The frequency of strabismus was lowest in the high-grade hyperopia group (5%). Concerning esodeviations, fewer cases (3%) were in the high-grade hyperopia group. Most of the cases with esodeviations were in correlation with low-grade hyperopia (31%), myopia (28 %) and emetropia (16%). Hyp...
TL;DR: The objective was to determine the change in refractive error and the prevalence of amblyopia and strabismus among preschool children in Hong Kong over a period of 10 years.
Abstract: Background: To determine the change in refractive error and the prevalence of amblyopia and strabismus among preschool children in Hong Kong over a period of 10 years.
Design: Two cross-sectional population-based studies conducted in 1996 to 1997 (part A) and 2006 to 2007 (part B)
Participants: Children attending randomly selected kindergarten participated in the study.
Methods: Ocular alignment, visual acuity, cover and uncover tests, cycloplegic refraction, slit-lamp and fundi examination were performed under a standardized testing environment.
Main Outcome Measures: The prevalence of amblyopia (best-corrected visual acuity ≤6/12 in one or both eyes, or a bilateral difference of ≥2 best-corrected visual acuity lines), strabismus and significant refractive error (hyperopia ≥+2.50 D; myopia ≥−1.00 D; astigmatism ≥2.00 D) among preschool children.
Results: Of the 601 children in part A of the study, reduced visual acuity was presented in 3.8%; whereas strabismus was found in 1.8%. The commonest type of refractive error was astigmatism in 6.3% of children, followed by hyperopia (5.8%) and myopia (2.3%). Among 823 children in part B, reduced visual acuity was presented in 2.7% of children, and strabismus was found in 1.7%. The commonest type of refractive error was myopia (6.3%), followed by astigmatism (5.7%) and hyperopia (5.1%). The percentage of children having myopia has significantly increased (P = 0.001).
Conclusion: A significant increase in myopia has been noted in Hong Kong preschoolers. Visual screening programmes may need to be tailored to correspond to the local population and be adjusted accordingly from time to time.
TL;DR: The endpoints to consider when contemplating best age for surgery in an individual child with IE should be: degree of binocular vision restored or retained, postoperative angle and long-term stability of the angle and number of operations needed or chance of spontaneous regression.
TL;DR: The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery, while primary gaze diplopia was eliminated in 73.9% of Patients through orbital wall repair.
Abstract: Purpose: To report the management outcomes of diplopia in patients with blowout fracture. Materials and Methods: Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. The inferior wall alone was involved in 22 (56.4%) patients, medial wall alone was involved in 14 (35.8%) patients, and the medial and inferior walls were involved in three (7.6%) patients. Each fracture was reconstructed with a Medpore® implant. Strabismus surgery or prism correction was performed in required patients for the management of persistent diplopia. Mean postoperative follow up was 6.5 months. Results: Twenty-three (58.9%) patients with diplopia underwent surgical repair of blowout fracture. Diplopia was eliminated in 17 (73.9%) patients following orbital wall surgery. Of the 23 patients, three (7.6%) patients required prism glasses and another three (7.6%) patients required strabismus surgery for persistent diplopia. In four (10.2%) patients, strabismus surgery was performed without fracture repair. Twelve patients (30.7%) with negative forced duction test results were followed up without surgery. Conclusions: In our study, diplopia resolved in 30.7% of patients without surgery and 69.2% of patients with diplopia required surgical intervention. Primary gaze diplopia was eliminated in 73.9% of patients through orbital wall repair. The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery.
TL;DR: Children with congenital ptosis are at risk of anisometropic and strabismic amblyopia, which may progress during early development and should be examined at regular intervals to evaluate and treat these potential complications.
Abstract: Purpose To determine the frequency of amblyopia and its associations among children with congenital ptosis. Methods A retrospective chart review of 92 active patients with congenital ptosis in the practices of 2 of the authors. The main outcome measures were relative eyelid ptosis severity, presence and type of strabismus, refractive error, and amblyopia. Results Amblyopia was identified in 22 of 92 patients (23.9%), in almost every case occurring in the context of coexisting anisometropia or strabismus and affecting the eye with the more severe ptosis (P = 0.0001). Amblyopia was more likely to occur in cases with greater relative eyelid asymmetry and did not develop in children with symmetric ptosis. In several cases, anisometropia and amblyopia were not initially apparent but progressively developed during follow-up. Conclusions Children with congenital ptosis are at risk of anisometropic and strabismic amblyopia, which may progress during early development. Patients should be examined at regular intervals to evaluate and treat these potential complications.
TL;DR: Data suggest that, in animals with sensory-induced strabismus, central innervation to extraocular muscles is responsible for setting the state of strabistsus, and Mechanical factors such as muscle length adaptation and pulley heterotopy or static torsion likely do not play a major role in determining properties in a sensory- induced strabs.
Abstract: METHODS. Burst-tonic activity of 21 MRMNs in the oculomotor nucleus were recorded from two monkeys with exotropia as they performed horizontal and vertical smooth pursuit (0.2 Hz, 10°) under monocular viewing conditions. Neuronal responses and horizontal component of eye movements were used to identify regression coefficients in a first-order model for each tracking condition. RESULTS. Comparison of position, velocity, and constant parameter coefficients, estimated from horizontal tracking data with either eye viewing, showed no significant differences (P 0.07), indicating that neuronal activity could account for the horizontal misalignment. Comparison of the position, velocity, and constant parameter coefficients estimated from horizontal tracking and the cross-axis condition showed no significant differences (P 0.07), suggesting that motoneuron activity could account for most of the inappropriate horizontal crossaxis movement observed in the covered eye during vertical smooth pursuit. CONCLUSIONS. These data suggest that, in animals with sensoryinduced strabismus, central innervation to extraocular muscles is responsible for setting the state of strabismus. Mechanical factors such as muscle length adaptation (for horizontal misalignment) and pulley heterotopy or static torsion (for “A” patterns) likely do not play a major role in determining properties in a sensory-induced strabismus. (Invest Ophthalmol Vis Sci. 2011;52:6697‐6705) DOI:10.1167/iovs.11-7402
TL;DR: The upright-supine test is highly specific for differentiating skew deviation from other causes of vertical strabismus and could be added as a fourth step after the 3-step test.
Abstract: Objective To determine the sensitivity and specificity of a new upright-supine test to differentiate skew deviation from trochlear nerve palsy and other causes of vertical strabismus in a large number of patients. Methods The study consisted of 125 consecutive patients who sought treatment from January 1, 2008, through December 31, 2010, for vertical strabismus of various causes: skew deviation (25 patients), trochlear nerve palsy (58 patients), restrictive causes (14 patients), and other causes (eg, myasthenia gravis and childhood strabismus) (28 patients). Twenty healthy participants served as controls. The deviation was measured by the prism and alternate cover test using a near target at ⅓ m in both the upright and supine positions. A vertical strabismus that decreased by 50% or more from the upright to supine position constituted a positive test result. Results The upright-supine test result was positive in 20 of 25 patients with skew deviation (sensitivity, 80%) but negative in all patients with trochlear nerve palsy, restrictive, or other causes (specificity, 100%). Conclusions The upright-supine test is highly specific for differentiating skew deviation from other causes of vertical strabismus. This test could be added as a fourth step after the 3-step test, and if the result is positive, neuroimaging should be considered if indicated clinically.
TL;DR: The finding that the majority of adults with strabismus would trade a portion of their life expectancy to be rid of their ocular misalignment is highlighted, highlighting the many psychological and interpersonal benefits to adult strABismus surgery.
Abstract: Many adult patients with strabismus are under the misconception that nothing can be done to correct the problem or that treatment is associated with a high degree of risk. Moreover, many optometrists, comprehensive ophthalmologists and primary care physicians are similarly misinformed. In fact, most adult patients with strabismus can be successfully treated, with ∼80% of patients achieving satisfactory alignment with one surgical procedure. In addition, adult strabismus surgery carries a relatively low risk, with serious complications being anecdotal and rare. The majority of adults will experience some improvement in binocular function after strabismus surgery even if the strabismus has been longstanding. Most commonly this takes the form of an expansion of binocular visual fields; however, some patients may also regain stereopsis. Consequently, strabismus surgery in adults is not merely cosmetic in most cases. There are many psychological and interpersonal benefits to adult strabismus surgery. These benefits are highlighted by the finding that the majority of adults with strabismus would trade a portion of their life expectancy to be rid of their ocular misalignment. Although adult strabismus surgery has been shown to be highly cost-effective, many adults with strabismus can be successfully managed by non-surgical means. If an adult with strabismus is under the impression, or was told, they cannot be treated, or that treatment is risky, they should consider a referral to an ophthalmologist specifically specialising in strabismus.
TL;DR: The results are consistent with those of previous reports of more severe thyroid eye disease in smokers and raise the possibility that smoking cessation early in the disease may reduce the severity of the changes and the number of rehabilitative strabismus operations needed.
TL;DR: Adults and children rated a squinting right eye as worse compared to a left one and esotropia as more disturbing than exotropia, while almost all adults would correct all forms of strabismus, and think that surgery should be covered by compulsory health insurance.
Abstract: Visible strabismus has been shown to have adverse psychosocial consequences. It remains controversial if esotropia or exotropia is perceived more negatively. The aim of this study was to determine if esotropia or exotropia and the eye (side) in which strabismus is present are perceived differently. We also asked our adult participants: (1) if they thought visible strabismus should be corrected by surgery, (2) if they thought that strabismus surgery should only be to improve the cosmesis, and (3) if they thought that the surgery should be paid for by health insurance. One hundred adults and 61 children rated four photographs of a digitally altered picture of a boy and four of a girl, showing a large-angle esotropia or exotropia either in the left or on the right eye. The adults were additionally asked if a squint should be operated, if they considered strabismus surgery to be a cosmetic procedure, if in their opinion strabismus surgery should be covered by compulsory health insurance, and if children with strabismus are disadvantaged. Comparisons were performed using ANOVA and regression analysis. Adults perceived a squinting right eye as more disturbing than a squinting left eye p 0.1 for each). Children also found that a squinting right eye is more disturbing (p < 0.001) than a left one. Additionally, children ranked esotropia worse than exotropia (p < 0.001). Neither age nor gender had an impact on the perception of strabismus by children. Of the adults, 94% would recommend surgery for all forms of strabismus, 18% thought that surgery is only cosmetic, and 94% found that health insurance should cover strabismus surgery for everybody. Problems of squinting children named by the adults included: being made fun of by other children (53%), problems with eyesight (39%), people looking strangely at them (21%), less acceptance by peers (17%), less self confidence (6%), problems judging distances (4%), and that they are perceived as less intelligent (3%). Adults and children rated a squinting right eye as worse compared to a left one. Children perceived esotropia as more disturbing than exotropia. Neither age, nor gender, nor the fact that the respondents have friends or family members with a squint, had an impact on this ranking. Almost all adults would correct all forms of strabismus, and think that surgery should be covered by compulsory health insurance.
TL;DR: General features of AACE type 2 are concomitance of strabismus, absence of an accommodative component even in the presence of hyperopic refractive errors, and no neurological pathology.
Abstract: Purpose To study the clinical features and surgical outcome of type 2 (Burian-Franceschetti) acute acquired concomitant esotropia (AACE). Methods Retrospective analysis of children with AACE type 2. All patients underwent strabismus surgery to restore ocular alignment. All children underwent a complete assessment including medical history and pre- and postoperative ophthalmological and orthoptic examinations. Postoperative follow-up was at least 12 months in all cases. Results A total of 25 consecutive patients were included. All but 2 patients (92%) were aligned within 8 ∆ or less of orthotropia. Of the 25, 15 (60%) regained normal stereovision. In 6 additional cases (24%) some level of binocular vision (Titmus test, 200″ to 3000″) was demonstrated. All of the patients who finally achieved normal stereopsis had lower levels of binocularity on the first postoperative day. The mean interval between surgery and first occurrence of full stereovision was 18 months (range, 2 to 58 months). Conclusions General features of AACE type 2 are concomitance of strabismus, absence of an accommodative component even in the presence of hyperopic refractive errors, and no neurological pathology. The potential for normal binocular vision plays a key role in defining this entity. The reemergence of full stereopsis may take several years.
TL;DR: It is imperative that great attention should be given to ocular alignment in addition to management of refractive error and intense amblyopia therapy during long-term follow-up in children with cataract and ectopia lentis.
Abstract: PURPOSE: To evaluate the prevalence and types of strabismus in children with cataract and ectopia lentis. METHODS: The authors retrospectively evaluated 860 children treated in the ophthalmological department of Children's Hospital "Agia Sophia" during the past decade. Their medical files with reference to strabismus prevalence, correlation between the time of strabismus occurrence and lens extraction surgery, and type of strabismus were studied. RESULTS: Of the 822 children with cataract, 337 had congenital cataract and 485 had acquired cataract. Strabismus occurred in 199 (24.2%) patients; 113 (56.8%) patients had esotropia and 86 (43.2%) patients had exotropia. Of the 38 children with ectopia lentis, strabismus occurred in 5 (13.2%); 1 patient had esotropia and 4 patients had exotropia. There is no significant difference in the time of appearance of strabismus in relation to the cataract operation, whereas there is a significant difference in ectopia lentis, although this may be a result of the small sample size. The incidence of strabismus is higher in patients with unilateral cataracts (27.4%) than in those with bilateral cataracts (19.6%). Strabismus occurred more frequently in patients with congenital cataracts (30.3%) than in acquired cases (20%), with esotropia being more common in congenital cataracts (76.5%) and exotropia more common in acquired cataracts (63.9%). CONCLUSION: The authors believe it is imperative that great attention should be given to ocular alignment in addition to management of refractive error and intense amblyopia therapy during long-term follow-up.
TL;DR: A relationship between strabismus in children and social phobia, depression, and anxiety on a symptom basis was underlined by the data.
Abstract: Objective To investigate the rate of social phobia, anxiety, depression, and other psychiatric problems in children with strabismus. Design Prospective, cross-sectional, case-control study. Participants Forty-two children with strabismus and 47 control subjects 8-13 years of age were enrolled in this study. Methods After the ophthalmologist's examination, all cases were assessed by a psychiatrist based on the structured interview technique of Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version (Kiddie-SADS-PL). The Screen for Child Anxiety Related Emotional Disorders (SCARED) was administered to each subject to evaluate social phobia. All participants completed the Children's Depression Inventory (CDI). Results Age as well as sex and income were comparable between the strabismus patients and control groups. Social phobia was diagnosed in 8 (19.04%) of the 42 strabismic children and in 1 (2.12%) of the control subjects. The CDI and SCARED (total score, social phobia, separation anxiety) scores of strabismus patients were significantly higher than the control group ( p = 0.001, p = 0.004, p = 0.0001, p = 0.05, respectively). Conclusions A relationship between strabismus in children and social phobia, depression, and anxiety on a symptom basis was underlined by our data.
TL;DR: Ophthalmic alterations in AS were observed more frequently than has been previously reported, except for ocular hypopigmentation, which was observed less frequently.
Abstract: Purpose To provide detailed information about opthalmological findings in a group of patients with Angelman syndrome (AS). Methods Consecutive patients with a genetically confirmed diagnosis of AS were submitted to ophthalmic and orthoptic examinations. Strabismus, visual acuity, cycloplegic refraction, and iris and fundus pigmentation were evaluated. Parents were also examined to compare the extent of fundus pigmentation. Results A total of 34 patients were identified, representing 3 genetic classes: deletion, uniparental disomy, and mutation. Ametropia >1 D was present in 97% of cases: myopia in 9%, hyperopia in 76%, and astigmatism in 94%. Myopia and anisometropia were found only in the genetic deletion group. Strabismus, most frequently exotropia, was found in 24 patients (75%). Ocular hypopigmentation was observed in 18 subjects (53%), with choroidal involvement in 3 cases and isolated iris involvement in 4. Hypopigmentation was observed in all of the 3 genetic classes. Conclusions Ophthalmic alterations in AS were observed more frequently than has been previously reported, except for ocular hypopigmentation, which was observed less frequently.
TL;DR: The intraoperative relaxed muscle positioning technique improved ocular alignment and relieved diplopia in most patients with dysthyroid strabismus and patients with more severe disease were more likely to require reoperation.
Abstract: Purpose In the relaxed muscle positioning technique of treating strabismus for thyroid eye disease (TED), the most restricted muscles, as determined by preoperative assessment of ductions and intraoperative forced ductions, are recessed to the positions where they rest freely on the globe without tension. The purpose of this technique is to identify preoperative characteristics that are predictive of reoperation and evaluate outcomes. Methods Retrospective review of patients with TED who underwent strabismus surgery using the relaxed muscle positioning technique between 1999 and 2009. Preoperative characteristics; surgical outcomes at 2, 6, and 12 months; and the outcomes of reoperations were evaluated. Outcomes were categorized as excellent (no diplopia in primary and reading gazes without prisms), good (diplopia requiring ≤10Δ correction), and poor (persistent diplopia in primary or reading gazes despite prism or attempted prism correction). Results Of 63 TED patients treated during the study period, 58 met inclusion criteria. Of these, 45 patients (78%) underwent only one strabismus surgery; 10 (17%), 2 surgeries; and 3 (5%), 3. Excellent outcomes were achieved in 48 (83%), good in 4 (7%), and poor in 6 (10%). Mean follow-up was 12.1 months (range, 1.5 months to 11.5 years). There was an increased likelihood for reoperation in patients with multiple treatment modalities for Graves disease (P = 0.03) and larger horizontal deviations (P = 0.03). Conclusions The intraoperative relaxed muscle positioning technique improved ocular alignment and relieved diplopia in most patients with dysthyroid strabismus. Patients with more severe disease were more likely to require reoperation.
TL;DR: Fibrin glue proved to be as effective as sutures in closing conjunctival wounds in strabismus surgery and might be considered as an alternative to sutured surgery in this prospective trial.
Abstract: Purpose
To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery.