To determine the long-term outcome of prismatic correction in consecutive esotropia after bilateral lateral rectus (BLR) recession in children.
Of 392 children with exotropia who received BLR ...recession, 44 developed consecutive esotropia. Five children underwent reoperation and 39 were treated with base-out prism glasses. The clinical characteristics and the efficacy of prismatic correction defined as the duration of prism treatment and the annual rate of decline in esodeviation angle (prism dioptres (PD)/year) after prismatic correction, clinical success rates based on postoperative alignment at distance, and the change in stereopsis were evaluated in the children who were treated with base-out prism glasses.
After a mean follow-up duration of 37.0±11.5 months, a successful motor outcome was achieved in 66.7% of patients and stereoacuity was improved or maintained in 79.2%. No patient lost stereopsis as a result of overcorrection. Prism glasses were prescribed an average of 7.4±8.1 months after surgery. During prism wear, the annual rate of decline in esodeviation was 4.2±6.7 PD. The mean duration of prism wear was 24.0±10.5 months and 82.1% were weaned off prisms at the last follow-up examination.
In patients with consecutive esotropia after BLR recession, the angle of esodeviation continuously decreased and 82% were weaned off prism glasses after 3 years. Prismatic correction achieves good motor outcome while maintaining a favourable sensory status in most patients with consecutive esotropia after BLR recession.
We describe a four-year-old girl with bilateral severe iris hypoplasia and secondary ocular hypertension. Genetic testing revealed a de novo deletion in the FOXC1 gene, establishing the diagnosis of ...Axenfeld-Rieger syndrome (ARS). The girl developed a gradually increasing exotropia, up to 95 prism diopters by the age of 3 years wherefore strabismus surgery was performed. Intra-operatively, only very rudimentary developed medial and lateral rectus muscles were found. This is the first observation of pronounced hypoplasia of both medial and lateral rectus muscles associated with ARS.
Purpose
Levator muscle dystrophy has been commonly accused being the main pathology of congenital ptosis, nevertheless, few reports drew attention to the existence of congenital aponeurotic defects. ...This study aims at highlighting the detailed clinical and surgical features of aponeurotic maldevelopment together with the efficacy of simple aponeurosis repair.
Methods
This is a retrospective nonrandomised study including patients with congenital ptosis who underwent levator muscle surgery throughout 4 years. Patients’ records were reviewed for the preoperative clinical assessment and photographs, intraoperative recorded data, and videos as well as postoperative data and photographs.
Results
Twenty-seven eyes of 22 patients (9.4%) out of 287 eyes were recorded to have absent levator muscle at its typical anatomical insertion site intraoperatively. The mean preoperative MRD1 was (0.44 ± 1.17 mm). The mean levator function was 8.56 ± 3.89 mm, with higher-than-normal crease position (mean value 10.07 ± 1.62 mm). 25 eyes of included cases (92.6%) showed total absence of the levator aponeurosis edge which only was revealed after cutting through the orbital septal covering of the preaponeurotic fat.
Conclusion
Congenital aponeurotic defect is an established yet under reported entity of congenital ptosis with reproducible characteristic intraoperative findings. Simple aponeurosis repair could achieve ptosis correction in such cases.
To determine whether intermittent exotropia (IXT) surgery affects contrast sensitivity (CS), this retrospective study evaluated the changes in monocular and binocular CS and the binocular summation ...ratio (BSR) quantified as the ratio between the values of the binocular and the better monocular CS score (BSR = binocular CS score/better monocular CS score) after surgery for IXT. The subjects were patients who had undergone IXT-correcting surgery with a postoperative follow-up of > 3 months and had pre- and postoperative records of Mars CS test scores. In total, 64 patients (128 eyes) were evaluated. Both the binocular and monocular CS scores of the operated eyes were significantly worse on postoperative 1 day than the preoperative scores, but they were recovered after 1 week. The monocular CS scores of the operated eyes were significantly worse than those of the non-operated eyes until 1 week. There was no significant difference in monocular CS scores between the one-muscle and two-muscle surgeries and in binocular CS scores between the successful alignment and overcorrection groups even on the first day after surgery. The mean BSR was significantly decreased until postoperative month 1, however, recovered to preoperative levels after month 3. In conclusion, IXT-correcting surgery may temporarily worsen the CS, but it is recovered to preoperative levels. Thus, changes in CS in the immediate postoperative period after strabismus surgery should not be of concern.
Purpose
To assess the change and interrelationship of the field of binocular single vision (BSV) and the quality of life (QoL), tested with two different tools, after one or two strabismus surgeries ...in patients with Graves' orbitopathy (GO).
Methods
Prospectively, consecutive patients with GO who were scheduled for their first strabismus surgery were recruited from five centres specialized in the treatment of GO. One week preoperatively and 3 months after the last operation, a full ophthalmic and orthoptic examination was performed. Change in field of BSV, GO‐QoL and thyroid eye disease‐QoL (TED‐QoL) was recorded.
Results
A total of 59 met all the eligibility criteria of whom 15 underwent two strabismus operations. The median (interquartile range) preoperative score of the field of BSV was 0 (0–0), which improved to 73 (53–85) after the correction(s) (p < 0.001). After the first surgery, a significant higher score of the field of BSV was found in the patients who underwent one operation (76; 60–86) compared with those who underwent two 0 (0–63) operations (p < 0.001). After the second surgery, this score increased to 62 (40–76; p = 0.05). A moderate correlation was found between the score of the field of BSV and the GO‐QoL visual functioning (VF) questionnaires (r = 0.485; p < 0.001). Both the GO‐QoL and TED‐QoL for VF and appearance (AP) showed significantly higher scores after the treatment (p < 0.001).
Conclusion
After strabismus surgery in GO patients, both the field of BSV and quality of life questionnaires increase. In approximately 30% of the patients, an additional strabismus surgery is performed. This second surgery significantly expands the field of BSV and the quality of life.
Giant cell arteritis (GCA) is a systemic vasculitis of medium and large arteries often with ophthalmic involvement, including ischemic optic neuropathy, retinal artery occlusion, and ocular motor ...cranial nerve palsies. This last complication occurs in 2%-15% of patients, but typically involves only 1 cranial nerve. We present 2 patients with biopsy-proven GCA associated with multiple cranial nerve palsies.
The levator palpebrae superioris muscle (LPS) acts as the upper eyelid’s major elevator and retractor and is innervated by the oculomotor nerve. The muscle’s paralysis is manifested by ptosis.
70 ...orbits were dissected. After removing the orbital roof, the LPS’ shape and anatomical variations (i.e., the presence of accessory muscular bands or atypical formation of the muscle) were assessed. To visualize the distribution of the oculomotor nerve’s intramuscular sub-branches, the isolated levator palpebrae superioris muscles were stained using Sihler’s staining technique.
Several LPS anatomical variations were observed in the specimens examined, in seven of which (7/70; 10%) additional delicate muscular slips arose from the LPS’ lateral border and reached the lacrimal gland. Histological examination confirmed the presence of striated skeletal muscle fibers in all those cases. In three other specimens (3/70; 4.28%), supernumerary muscular bands (“tensor trochleae”) were found that linked the levator with the superior oblique muscle’s trochlea. In the next case, the LPS’ origin was double and the muscle was bipartite on its proximal half. In most cases (55/70; 78.6%), muscular branches formed a single bundle that wrapped around the superior rectus muscle’s medial border to reach the levator’s inferior surface. Intramuscular sub-branches were distributed largely within the proximal two-thirds of the LPS and formed an irregular, tree-like pattern. However, thin sub-branches and small retrograde sub-branches extended as far as the muscle’s insertion.
Plastic surgeons and ophthalmologists should be aware of the levator palpebrae superioris muscle’s anatomic variations both in planning and conducting surgeries on the upper eyelid.
MYH13 is a unique type of sarcomeric myosin heavy chain (MYH) first detected in mammalian extraocular (EO) muscles and later also in vocal muscles, including laryngeal muscles of some mammals and ...syringeal muscles of songbirds. All these muscles are specialized in generating very fast contractions while producing relatively low force, a design appropriate for muscles acting against a much lower load than most skeletal muscles inserting into the skeleton. The definition of the physiological properties of muscle fibres containing MYH13 has been complicated by the mixed fibre type composition of EO muscles and the coexistence of different MYH types within the same fibre. A major advance in this area came from studies on isolated recombinant myosin motors and the demonstration that the affinity of actin‐bound human MYH13 for ADP is much weaker than those of fast‐type MYH1 (type 2X) and MYH2 (type 2A). This property is consistent with a very fast detachment of myosin from actin, a major determinant of shortening velocity. The MYH13 gene arose early during vertebrate evolution but was characterized only in mammals and birds and appears to have been lost in some teleost fish. The MYH13 gene is located at the 3′ end of the mammalian fast/developmental gene cluster and in a similar position to the orthologous cluster in syntenic regions of the songbird genome. MYH13 gene regulation is controlled by a super‐enhancer in the mammalian locus and deletion of the neighbouring fast MYH1 and MYH4 genes leads to abnormal MYH13 expression in mouse leg muscles.
figure legend MYH genes and corresponding muscle fibres can be ranked according to speed of contraction. The MYH13 gene has been identified in three types of superfast muscles: the extraocular and laryngeal muscles of mammals and the syringeal muscles of songbirds. SR, IR, LR, MR: superior, inferior, lateral and medial rectus; SO, IO: superior and inferior oblique; TA, thyroarytenoid; DTB, dorsal tracheobronchial.
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