Background The use of medial rectus pulley posterior fixation sutures to treat esotropia with convergence excess has limited support in the literature. We describe our results using this technique to ...treat patients with large near–distance disparities. Methods We retrospectively analyzed records of patients with accommodative or partially accommodative esotropia and convergence excess 13Δ or greater treated with bilateral medial rectus muscle recessions augmented by pulley posterior fixation. Surgical doses of recessions were calculated for the mean of distance and near deviations. Primary outcome measures were ocular alignment at distance and near and near–distance disparity. Results A total of 26 patients were identified by the record review. Mean age at surgery was 5.4 years (range, 1.8-11.0 years) and mean follow-up time 12.7 months (range, 1.0-37.6 months). Mean preoperative distance esotropia was 22.9Δ (range, 0Δ -53Δ ), with a mean near–distance disparity of 26.4Δ (range, 13Δ -53Δ ). At 1 to 3 months postoperatively, mean distance deviation was 0.5Δ exotropia (range, 18Δ exotropia to 12Δ esotropia), with a statistically significant decrease in mean near–distance disparity to 4.5Δ (range, 0Δ -26Δ ; P < 0.001). Three-quarters of patients (77%) achieved 0Δ to 9Δ esotropia at 1 to 3 months, with 4 overcorrections for distance and 2 undercorrections for distance and near. At final follow-up 2 patients had persistent exotropia less than 10Δ. Conclusions Augmentation of bilateral medial rectus recessions with pulley posterior fixation resulted in a significant decrease in near–distance disparity in this group of patients with accommodative and partially accommodative esotropia and convergence excess, with a low rate of persistent overcorrection for distance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
ObjectiveQuality assurance (QA) in neuro-ophthalmology (NOPH) is often lacking. The QA registry, NODE (Neuro-ophthalmology Database), was established and implemented in tertiary NOPH clinics in ...Australia. We developed a consensus on triage categories according to Australian standardised triage categories;P1 (consult<=30 days), P2 (consult<=30-60 days) and P3 (consult>60 days).MethodsData on 410 patients at Alfred Hospital, Melbourne was collected with NODE. We developed a consensus on assignation of NOPH conditions to triage categories using recommendations from a panel of neuro-ophthalmologists with the modified Delphi approach. The average days from referral to triage and triage to the initial consultation were compared to the developed triage category standard.ResultsMost patients presenting to the service were female (n=262, 64%), aged 21 to 30 years. Common diagnoses were Idiopathic Intracranial Hypertension, IIH (24%), Optic Neuropathy, ON (17%), Headaches, (11%) Cranial Nerve Defects, CND (9%) and Eye Movement Disorders, EOMD (9%). The mean time from referral to triage was <2 days for all the common NOPH conditions. The mean time (days, +-standard deviation) from P1 category triage to initial consult for IIH was 26 (±7), ON 27 (±11), and CND was 17 (± 5). The mean time (days) from P2 triage to initial consultant for Headaches was 27 (±12), and EOMD was (±17). The mean time (days) from P3 triage to initial consultant for Myasthenia Gravis was 30 (±10).ConclusionWe have established a consensus agreement on triage categories for neuro-ophthalmological conditions. We established a QA framework for other NOPH clinics in Australia.
Fixation-linked hypotropia, or hypotropic dissociated vertical deviation, is a rare but well-defined ocular motility disorder characterized by a slow downward drift of a poor-seeing eye when the ...other eye is fixating on a distant target. It can be successfully treated with a large recession or recession-resection of the inferior rectus muscle. We report 3 cases of fixation-linked nondissociated hypotropia with unilateral high myopia and amblyopia presenting with intermittent hypotropia of the worse-seeing eye when the dominant eye was fixating on a distant target and a hypertropia of the dominant eye when the poorer-seeing eye was made to fix. We discuss the surgical management of one of these patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
5.
Refractive surgery and strabismus Kowal, Lionel; Battu, Ravindra; Kushner, Burton
Clinical & experimental ophthalmology,
February 2005, Volume:
33, Issue:
1
Journal Article
Peer reviewed
This review discusses the potential for strabismic complications after refractive surgery for hyperopia, myopia, anisomyopia, astigmatism and monovision, and how to avoid these complications. ...Guidelines are given for assessing patients with strabismus seeking refractive surgery. Screening tests are suggested that lead to stratification of refractive surgery patients into different risk groups each warranting a different intensity of evaluation.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background
Infantile nystagmus syndrome (INS) is a type of eye movement disorder that can negatively impact vision. Currently, INS cannot be cured, but its effects can potentially be treated ...pharmacologically, optically, or surgically. This review focuses on the surgical interventions for INS.
Despite the range of surgical interventions available, and currently applied in practice for the management of INS, there is no clear consensus, and no accepted clinical guidelines regarding the relative efficacy and safety of the various treatment options. A better understanding of these surgical options, along with their associated side effects, will assist clinicians in evidence‐based decision‐making in relation to the management of INS.
Objectives
To assess the efficacy and safety of surgical interventions for INS.
Search methods
We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ISRCTN registry, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) to 3 July 2020, with no language restrictions.
Selection criteria
We included randomised controlled trials (RCTs) studying the efficacy and safety of surgical options for treating INS.
Data collection and analysis
Our prespecified outcome measures were the change from baseline in: binocular best‐corrected distance visual acuity; head posture; amplitude, frequency, intensity, and foveation period durations of the nystagmus waveform; visual recognition times; quality of life and self‐reported outcome measures; incidence of adverse effects with a probable causal link to treatment; and permanent adverse effects after surgery.
Two review authors independently screened titles and s and full‐text articles, extracted data from eligible RCTs, and judged the risk of bias using the Cochrane tool. We reached consensus on any disagreements by discussion. We summarised the overall certainty of the evidence using the GRADE approach.
Main results
We only identified one eligible RCT (N = 10 participants), undertaken in India. This trial randomised participants to receive either a large retro‐equatorial recession of the horizontal rectus muscle of 9 mm on the medial rectus and 12 mm on the lateral rectus, or a simple tenotomy and resuturing of the four horizontal rectus muscles. We did not identify any RCTs comparing a surgical intervention for INS relative to no treatment.
In the single eligible RCT, both eyes of each participant received the same intervention. The participants’ age and gender were not reported, nor was information on whether participants were idiopathic or had sensory disorders. The study only included participants with null in primary position and did not explicitly exclude those with congenital periodic alternating nystagmus. The study did not report funding source(s) or author declaration of interests. The evaluation period was six months.
We judged this study at low risk for sequence generation and other sources of bias, but at high risk of bias for performance and detection bias. The risk of bias was unclear for selection bias, attrition bias, and reporting bias.
There is very uncertain evidence about the effect of the interventions on visual acuity and change in amplitude, frequency, and intensity of the nystagmus waveform. We were unable to calculate relative effects due to lack of data. None of the participants in either intervention group reported adverse effects at six‐month follow‐up (very low‐certainty evidence). There was no quantitative data reported for quality of life, although the study reported an improvement in quality of life after surgery in both intervention groups (very low‐certainty evidence).
Change in head posture, foveation period durations of the nystagmus waveform, visual recognition times, and permanent adverse effects after surgery were not reported in the included study.
We judged the certainty of the evidence, for both the primary and secondary efficacy outcomes, to be very low. Due to a lack of comprehensive reporting of adverse events, there was also very low‐certainty of the safety profile of the evaluated surgical interventions in this population. As such, we are very uncertain about the relative efficacy and safety of these interventions for the surgical management of INS.
Authors' conclusions
This systematic review identified minimal high‐quality evidence relating to the efficacy and safety of surgical interventions for INS. The limited availability of evidence must be considered by clinicians when treating INS, particularly given these procedures are irreversible and often performed on children. More high‐quality RCTs are needed to better understand the efficacy and safety profile of surgical interventions for INS. This will assist clinicians, people with INS, and their parents or caregivers to make evidence‐based treatment decisions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
8.
Assessing abnormal head posture: a new paradigm Halachmi-Eyal, Orly; Kowal, Lionel
Current opinion in ophthalmology,
2013-September, 2013-Sep, 2013-09-00, 20130901, Volume:
24, Issue:
5
Journal Article
PURPOSE OF REVIEWWe aim to give a systematic approach on how to assess the cause of a patientʼs abnormal head posture (AHP).
RECENT FINDINGSOver the decades, many important clinical observers and ...teachers have described diagnostic techniques for patients with AHP. Recently, Wong has added a new set of office-based diagnostic criteria that expand and solidify the office assessment of AHP.
SUMMARYWe describe old and new, well known and poorly known office techniques for the assessment of AHP.
IMPORTANCE: Binocular amblyopia treatment using contrast-rebalanced stimuli showed promise in laboratory studies and requires clinical trial investigation in a home-based setting. OBJECTIVE: To ...compare the effectiveness of a binocular video game with a placebo video game for improving visual functions in older children and adults. DESIGN, SETTING, AND PARTICIPANTS: The Binocular Treatment of Amblyopia Using Videogames clinical trial was a multicenter, double-masked, randomized clinical trial. Between March 2014 and June 2016, 115 participants 7 years and older with unilateral amblyopia (amblyopic eye visual acuity, 0.30-1.00 logMAR; Snellen equivalent, 20/40-20/200) due to anisometropia, strabismus, or both were recruited. Eligible participants were allocated with equal chance to receive either the active or the placebo video game, with minimization stratified by age group (child, age 7 to 12 years; teenager, age 13 to 17 years; and adult, 18 years and older). INTERVENTIONS: Falling-blocks video games played at home on an iPod Touch for 1 hour per day for 6 weeks. The active video game had game elements split between eyes with a dichoptic contrast offset (mean SD initial fellow eye contrast, 0.23 0.14). The placebo video game presented identical images to both eyes. MAIN OUTCOMES AND MEASURES: Change in amblyopic eye visual acuity at 6 weeks. Secondary outcomes included compliance, stereoacuity, and interocular suppression. Participants and clinicians who measured outcomes were masked to treatment allocation. RESULTS: Of the 115 included participants, 65 (56.5%) were male and 83 (72.2%) were white, and the mean (SD) age at randomization was 21.5 (13.6) years. There were 89 participants (77.4%) who had prior occlusion. The mean (SD) amblyopic eye visual acuity improved 0.06 (0.12) logMAR from baseline in the active group (n = 56) and 0.07 (0.10) logMAR in the placebo group (n = 59). The mean treatment difference between groups, adjusted for baseline visual acuity and age group, was −0.02 logMAR (95% CI, −0.06 to 0.02; P = .25). Compliance with more than 25% of prescribed game play was achieved by 36 participants (64%) in the active group and by 49 (83%) in the placebo group. At 6 weeks, 36 participants (64%) in the active group achieved fellow eye contrast greater than 0.9 in the binocular video game. No group differences were observed for any secondary outcomes. Adverse effects included 3 reports of transient asthenopia. CONCLUSIONS AND RELEVANCE: The specific home-based binocular falling-blocks video game used in this clinical trial did not improve visual outcomes more than the placebo video game despite increases in fellow eye contrast during game play. More engaging video games with considerations for compliance may improve effectiveness. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12613001004752
PURPOSE OF REVIEWMyopia is a global problem, being particularly prevalent in the urban areas of east and southeast Asia. In addition to the direct economic and social burdens, associated ocular ...complications may lead to substantial vision loss. With prevalence of myopia above 80% and high myopia over 20%, it is crucial to control myopia. The aim of this review to is provide an update on the interventions to slow the onset of myopia and retard its progression.
RECENT FINDINGSThe epidemic of myopia is characterized by increasingly early onset, combined with high myopia progression rates. There are two pathways for myopia controlfirstly to slow the onset of myopia and secondly to reduce or prevent progression. Increased time outdoors can reduce the onset of myopia. Atropine 0.01% dose offers an appropriate risk-benefit ratio, with no clinically significant visual side effects balanced against a significant 50% reduction in myopia progression. Orthokeratology contact lenses can slow axial length elongation, but infective keratitis is a risk. Peripheral defocussing lenses may both have a role in slowing myopic progression in a subset of children and further help our understanding of the physiologic control of ocular growth.
SUMMARYMyopia control can be achieved by slowing the onset of myopia, which now appears to be possible through increasing time outdoors and slowing the progression of myopia with interventions like atropine and orthokeratology.
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