PURPOSETo assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the ...causes of dissatisfaction. METHODSA survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery. RESULTSThe questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4th nerve palsy, and exotropia, while 3rd nerve palsy was the cause of the most dissatisfaction. CONCLUSIONSAccording to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4th cranial nerve.
To assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the causes of ...dissatisfaction.
A survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery.
The questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4th nerve palsy, and exotropia, while 3rd nerve palsy was the cause of the most dissatisfaction (86%).
According to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4th cranial nerve.
El objetivo es valorar la percepción de los cirujanos de estrabismo en España sobre la satisfacción de los pacientes tras la cirugía, analizando cuáles consideran que son los tipos de estrabismo con pacientes más satisfechos y las causas de insatisfacción.
Se realizó una encuesta a los miembros de la Sociedad Española de Estrabología mayores de 50 años, que estuvieran en activo y cuya principal actividad quirúrgica fuera la cirugía de estrabismo, con ejercicio de su profesión en España y más de 20 años de experiencia quirúrgica. La encuesta constaba de 18 preguntas acerca de la percepción sobre la satisfacción de los pacientes según el tipo de estrabismo, la edad del paciente y la causa de insatisfacción más frecuente tras la cirugía.
Se incluyeron 29 encuestas de cirujanos con un media de experiencia quirúrgica de 31 años. La causa de insatisfacción percibida más frecuente fue el estrabismo residual. No se encontraron diferencias en el índice de satisfacción entre niños y adultos. La cirugía que consideran que produce mayor satisfacción es la endotropía, seguida de la parálisis del IV par descompensada y la exotropía, mientras que la parálisis del III par craneal es la que más descontento causa (86%).
Según la opinión de los cirujanos, la endotropía es la cirugía más satisfactoria para el paciente seguida de la exotropía, los estrabismos verticales y la parálisis traumática del IV par craneal.
OBJECTIVETo evaluate the effect of glaucoma on visual function, as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age. MATERIAL AND ...METHODSAn observational and prospective study was designed using the questionnaire GQL-15 (Glaucoma Quality of Life) and conducted on children and caregivers. The questionnaire VFQ-25 (Visual Functioning Questionnaire) was conducted on children. Different variables of the clinical history that could influence the quality of life and visual function were recorded. RESULTSThe study included 24 patients with a mean age of 9.13±3.08 years, and included 3 with unilateral involvement, and 20 diagnosed with primary congenital glaucoma. Parents reported a worse quality of life than children. The result of the GQL-15 survey was 32.3±11.56 points in children and 37.52±14.59 points in caregivers (P=.001). The parameter most related to quality of life and visual function was the mean deviation (MD) of the visual field in the best eye. A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field (children: R=0.63, P<.01, caregivers: R=0.81, P<.001). CONCLUSIONSFunctional loss has an impact on the quality of life and visual function in children with glaucoma, although the quality of life perceived by the caregivers is worse than that perceived by the child.
Adjustable suture procedures allow addressing the unpredictability of some postoperative results in strabismus surgery. The purpose of the study was to compare the effectiveness of adjustable and ...non-adjustable suture in the treatment of horizontal strabismus in children and adults.
Prospective study including patients undergoing strabismus surgery to correct horizontal strabismus with fixed hanging suture (non-adjustable suture group) and adjustable suture. Visual acuity, amblyopia, deviation, oblique muscle involvement, previous surgeries, nystagmus, need for adjustment, and complications were recorded. The variables were recorded in the immediate postoperative period, at one week and at 3 and 6 months.
186 patients were included: 157 (84.4%) with adjustable suture and 29 (15.6%) with non-adjustable suture, of which 119 were children and 67 were adults. Postoperatively, 19 children (16.0%) and 19 adults (28.4%) required adjustment (p = 0.044). Of 157 patients with adjustable suture, it was adjusted in 20% (32/157). Success after adjustment was higher for adjustable suture (91.72% vs 79.31%; p = 0.043) and remained for 6 months (p < 0.05). Previous surgery (p = 0.004) and exotropia (p = 0.018) correlated with the need for adjustment.
20% of patients with horizontal strabismus can benefit from a postoperative adjustment to improve the surgical result. The adjustable suture was shown to be superior to the fixed hanging suture and is an excellent surgical option, both in children and adults.
Los procedimientos con sutura ajustable permiten abordar la imprevisibilidad de algunos resultados postoperatorios en la cirugía de estrabismo. El propósito del estudio fue comparar la efectividad de la sutura ajustable y no ajustable en el tratamiento del estrabismo horizontal en niños y adultos.
Estudio prospectivo en el que se incluyeron pacientes sometidos a cirugía de estrabismo para la corrección de un estrabismo horizontal con sutura colgante fija (grupo de sutura no ajustable) y sutura ajustable. Se registró la agudeza visual, la ambliopía, la desviación, la afectación de músculos oblicuos, cirugías previas, el nistagmo, la necesidad de ajuste y las complicaciones. Las variables se registraron en el postoperatorio inmediato, a la semana y a los 3 y 6 meses.
Se incluyeron 186 pacientes: 157 (84.4%) con sutura ajustable y 29 (15.6%) con sutura no ajustable, de los cuales 119 eran niños y 67 adultos. En el postoperatorio, 19 niños (16,0%) y 19 adultos (28,4%) requirieron un ajuste (p = 0,044). De 157 pacientes con sutura ajustable, se ajustó al 20% (32/157). El éxito tras el ajuste fue superior para la sutura ajustable (91,72% vs 79,31%; p = 0,043) y se mantuvo los 6 meses (p < 0.05). La cirugía previa (p = 0,004) y la exotropía (p = 0,018) se relacionaron con la necesidad de ajuste.
Un 20% de pacientes con estrabismo horizontal se pueden beneficiar de un ajuste postoperatorio para mejorar el resultado quirúrgico. La sutura ajustable mostró ser superior frente a la sutura colgante fija y supone una excelente opción quirúrgica tanto en niños como en adultos.
PURPOSETo assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves' ophthalmopathy by optical coherence tomography. METHODSCase series of ...five patients with active Graves' ophthalmopathy (clinical activity score ≥4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o'clock (nasal and temporal). RESULTSThe study included four women and one man with a median age of 52 years (range: 38-73). Median Graves' ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249μm (174-366) and 337μm (142-443), respectively. Median chemosis was 409μm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157μm (88-187) and 197μm (99-290), respectively (P=.043; Wilcoxon) and chemosis to 59μm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). CONCLUSIONSA reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves' ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses.
OBJECTIVETo report reference values for the horizontal rectus muscles thickness using Spectral Domain optical coherence tomography (SD-OCT), and to evaluate whether there are any correlations between ...the muscle thickness and gender, age, or axial length (AL). MATERIAL AND METHODSA cross-sectional study was conducted on 131 right eyes of healthy subjects. The gender and age were recorded, and axial length was measured using an optical biometer. The medial rectus (MR) muscle thickness was measured at 7.2 and 9.2mm from the limbus, and the lateral rectus (LR) at 8.5 and 10.5mm from the limbus using OCT. A multivariate model was adjusted to determine whether gender, age, and axial length could have an impact on the muscle thickness. RESULTSMean age was 43.3±20.9 years (range 6-86), and 59% were women. Mean AL was 24.9±2.7mm (range: 20.4-33.8). Mean thickness was 188.5±51.2μm (range 69-342) for the LR at 8.5 and 186.5±45.9μm (range 75-269) at 10.5mm, and for the MR, 158.1±39.1μm (range 69-273) at 7.2mm and 193.7±55.9μm (range 105-386) at 9.2mm. A correlation was observed between the AL and MR thickness (R=-.255; P=.023) while no correlation was observed for the LR (P≥0.203). No correlations were found between thickness and gender or thickness and age (P≥0.125). CONCLUSIONSThe reference ranges of the horizontal rectus muscles thickness was described using SD-OCT, observing an association between the AL and the MR thickness.
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