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Purpose: To compare changes of vertical palpebral fissure height after bilateral lateral rectus (BLR) recessions versus unilateral lateral rectus (LR) recession and medial rectus (MR) muscle scleral plication, for treatment of intermittent exotropia., Methods: This prospective, comparative, randomized study included 40 patients with intermittent exotropia who were divided into two groups: 20 patients who underwent BLR recessions (BLR recession group) and 20 patients who underwent unilateral LR recession and MR muscle scleral plication (recession-plication group). Eyelid evaluation included measurement of margin reflex distance 1 (MRD1) and margin reflex distance 2 (MRD2) at 1 week, 6 weeks, and 3 months postoperatively. Angle of deviation and any incomitance were also recorded at each visit., Results: There was no significant statistical difference in eyelid measurements after the surgery between both groups ( P = 1.00). There was no significant statistical difference in ocular alignment after the surgery between both groups ( P = 1.00). Also, there was no significant statistical difference in lateral incomitance after the surgery between both groups ( P = 1.00)., Conclusions: Both the unilateral recession and plication of horizontal rectus muscles technique and bilateral recession provide comparable surgical results for correction of exotropia without significant palpebral fissures changes or lateral incomitance. [ J Pediatr Ophthalmol Strabismus . 20XX;X(X):XXX-XXX.] .

Purpose: To compare the effect of unilateral versus bilateral lateral rectus (LR) recession for correction of small to moderate exotropia., Methods: Records of all patients with exotropia 14-35 prism diopters (∆), operated upon by the authors, were included in a retrospective study to compare the effect of unilateral (Group 1) versus bilateral (Group 2) LR recession. The study end-point was the last follow-up visit scheduled at least 3 months postoperatively. A successful outcome was defined as 0-10∆ of horizontal tropia., Results: The study included 154 patients (47 in Group 1 and 107 in Group 2). Patients were followed up for 3-120 months (26.7 ± 24.88). A successful outcome was achieved in 83% in Group 1 and 82.2% in Group 2 (p = .976), with higher success in group 1 for surgical target angles up to 25∆. All failures in Group 1 were due to undercorrections., while the 17.8% failure rate in Group 2 comprised 15% undercorrections and 2.8% overcorrections (p = .419). Persistent lateral incomitance was seen in 29.5% in Group 1 versus 2.3% in Groups 2 (p < .001). Lateral incomitance was encountered in 71% of those undergoing 10 mm unilateral recessions, versus 20% of those who had smaller recession doses. Limited ductions were mild, and exceeded -1 in only 4 cases: 3 had had 10 mm and 1 had had 9 mm unilateral LR recession., Conclusions: Unilateral and bilateral LR recessions offer essentially equal success rates. Unilateral recessions are advised for angles up to 25∆, without exceeding 10 mm., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: The purpose of this study is to compare the effect of subscleral trabeculectomy (SST) augmented with mitomycin C (MMC) versus Ologen implant as secondary procedures for treatment of primary congenital glaucoma., Methods: This is a retrospective study evaluating records of 38 eyes that had undergone SST with MMC (Group M, 17 eyes) versus Ologen (Group O, 21 eyes) by the authors of the study. The study primary endpoint was set at 5-9 months postoperatively, and the secondary endpoint was the last follow-up. A successful outcome was an intraocular pressure (IOP) ≤18 mmHg for infants <1 year and ≤20 mmHg for older ones., Results: The follow-up duration was 1.25-51 (26.79 ± 27.583) months in Group M and 0.25-103 (22.86 ± 28.991) months in Group O ( P = 0.673). The mean preoperative IOP was 28.06 ± 3.929 in Group M and 26.95 ± 6.095 in Group O ( P = 0.522). A reduction of IOP was significant in Group M at all follow-up visits but starting at the 4 th postoperative month in Group O. Recorded IOP in Groups M and O, respectively, was 14.9 ± 6.437 and 12.1 ± 5.043 at the primary endpoint and 22.35 ± 8.536 and 22.52 ± 10.152 ( P > 0.05) at the secondary endpoint. A successful outcome was achieved in Groups M and O, respectively, in 47.1% and 47.6% at the primary endpoint and in 47.1% and 52.4% at the secondary endpoint ( P > 0.05). Cataract, posterior synechiae, and pupillary abnormalities were insignificantly different in both the groups ( P = 0.623)., Conclusion: Ologen implant was comparable to MMC in terms of efficacy and safety. Reoperations are inadvisable before 4 months of Ologen implants., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Saudi Journal of Ophthalmology.)

Purpose: To ascertain whether electromyographic control when injecting botulinum toxin in the horizontal rectus muscles is necessary, and to compare the open sky and closed sky injection techniques that are used without electromyographic control., Methods: The records of 135 patients with horizontal strabismus who received botulinum toxin injections were reviewed retrospectively. Sevoflurane or propofol anesthesia was used in children, and topical benoxinate hydrochloride was used in adults. Patients received a bilateral injection of 2.5 to 15 IU of botulinum toxin, without electromyographic control, into the medial or lateral rectus muscles to correct esotropia or exotropia, respectively. An open sky technique was used in 31 patients, and a closed sky technique was used in 104 patients. Postoperative alignment within 10 prism diopters (PD) of orthotropia was considered a successful outcome., Results: A successful outcome at 6 months of follow-up was achieved in 47% of all patients: 59% of patients in the open sky group and 44% of patients in the closed sky group ( P = .151). Botulinum toxin injection corrected a mean of 14 ± 9.705 PD in patients in the open sky group and 31 ± 20.589 PD in patients in the closed sky group to obtain mean residual angles of 21 ± 16.692 and 13 ± 11.901 PD, respectively., Conclusions: The results obtained without electromyographic assistance were not remarkably different from the studies using electromyographic control. Moreover, because the results of the open sky technique were not significantly superior to the closed sky technique, the latter was favored to shorten the operative time and postoperative convalescence, and to reduce the risk of postoperative adhesions and scarring, which made re-operations difficult. [ J Pediatr Ophthalmol Strabismus . 2022;59(6):388-395.] .

Purpose: To compare the histopathological effects of injecting two concentrations of Bupivacaine (5 mg/ml and 7.5 mg/ml) in the superior rectus muscle of rabbits, and to compare these to conventional extraocular muscle surgery in previous studies., Methods: Eighteen albino rabbits' eyes were used. The superior rectus muscles were injected with Bupivacaine 5 mg/ml (Group B5, 10 eyes) or 7.5 mg/ml (Group B7, 8 eyes). The rabbits were sacrificed and eyes enucleated 6 weeks later for histopathological evaluation. Results were compared to the average of those obtained, by three previous studies, after conventional superior rectus resection in rabbits., Results: Foreign body reaction was absent in all specimens. Conjunctival and scleral inflammation, perimuscular adhesions, intramuscular fibrosis, conjunctival and scleral oedema and muscle atrophy were higher in group B7, while conjunctival hyperaemia and muscle hypertrophy were higher in group B5 ( p  > 0.05). On comparison to conventional surgery, conjunctival inflammation and hyperaemia, foreign body reaction, and adhesions were less after bupivacaine injection ( p  > 0.05 for all except for intensity of conjunctival inflammation in B5 versus conventional surgery). Scleral inflammation was more frequent after bupivacaine injection ( p  < 0.05). Muscle fibrosis was more frequent in group B7 and conventional surgery than in group B5 ( p  > 0.05)., Conclusions: Both Bupivacaine concentrations effectively produced the desired muscle hypertrophy and fibrosis, so the lower concentration may be used for muscle strengthening to correct strabismus. Bupivacaine injection, although produced no foreign body reaction, did not significantly lower the development of undesired postoperative adhesions and caused more scleral inflammation.

Objective: To determine the normal intraocular pressure in a sample of Egyptian children 0-12 years of age, and compare it to that recorded in previous studies., Methods: This is a prospective cross-sectional study, including 345 eyes. All children underwent complete history taking and ophthalmic examination. Any glaucomatous patients or glaucoma suspects were excluded. Intraocular pressure was measured using Haag Streit Perkins M2 handheld applanation tonometer under topical or general anaesthesia. Three readings were recorded for each eye and the average was calculated. Central corneal thickness was measured, using handheld pachymeter (Pachmate 2), whenever possible., Results: The study included 345 eyes of 187 children (101 males and 86 females), aged 2 months to 12 years (mean: 5.69 ± 3.42 years). The recorded IOP was 5-20 mm Hg (mean: 11.5 ± 2.34 mm Hg). Central corneal thickness was 469-742 μm (mean: 564.8 ± 42.72 μm). The mean recorded intraocular pressure showed positive correlation with increased age (p = 0.026) and increased central corneal thickness (p = 0.037), with a difference of 1 mm Hg for every 100-μm change in central corneal thickness. The mean IOP was significantly lower than that recorded by most previous studies. A detailed comparative analysis is presented comparing our findings with other studies including grouped analysis, by country, ethnicity and tonometers used., Conclusions: The mean IOP in a group of normal Egyptian children was 11.5 ± 2.34 mm Hg, with positive correlation to age and central corneal thickness. This mean intraocular pressure was lower than that previously reported in any other population., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To compare two methods of surgical augmentation (prism adaptation and the augmented surgery formula) in the management of acquired comitant esotropia., Methods: Forty patients were included in this prospective study and assigned to either the prism adaptation (20 patients) or augmented surgery (20 patients) group. After preoperative prism adaptation, patients in the prism adaptation group were classified as prism adaptation responders (fusers) or non-responders (non-fusers). All patients in the prism adaptation group underwent surgery for the prism-adapted angle. Patients in the augmented surgery group underwent surgery based on the augmented surgery formula, defined as the average of the near deviation without correction and the distance deviation with correction., Results: In the prism adaptation group, 6 patients (30%) were prism responders, whereas 14 (70%) were non-responders. The 3-month motor success rate was significantly higher in the prism adaptation group (90%) than the augmented surgery group (55%) (P = .013). The 6-month motor success rate was not significantly higher in the prism adaptation group (95%) than the augmented surgery group (80%) (P = .151). The improvement in the 6-month outcome was mainly attributed to hyperopic spectacle power reduction after 3-month postoperative evaluation to correct consecutive exotropia., Conclusions: Although prism adaptation is superior in precisely determining the surgical target angle, the success rates were comparable between the two groups after hyperopic spectacle power reduction. This obviates the need for prism adaptation, except in cases of non-accommodative esotropia. To maximize the benefit of prism adaptation, it is recommended that all patients with prism adaptation (responders and non-responders) undergo surgery for the prism-adapted angle. [J Pediatr Ophthalmol Strabismus. 2020;57(2):108-119.]., (Copyright 2020, SLACK Incorporated.)

Purpose: To determine the possible predictors of the motor outcome after corrective surgery for acquired comitant esotropia., Methods: The study included 40 patients with acquired comitant esotropia. After evaluation of the visual, sensory, and motor status; cycloplegic refraction; fundus examination; and spectacle prescription, all patients underwent corrective strabismus surgery. A successful motor outcome was defined as 0 to 10 prism diopters of horizontal tropia. Statistical analysis of the results was done using the chi-square tests., Results: At the sixth postoperative month, 90% achieved a successful motor outcome, while 2.5% had a consecutive exotropia >10 prism diopters, and 7.5% had a residual esotropia >10 prism diopters. A statistically significant relationship existed between the motor outcome and the following: preoperative results of the Worth four-dot test at 6 m ( p  = .011) and 0.33 m ( p  = .009), preoperative distant ( p  = .016) and near ( p  = .017) angles of esotropia with glasses, postoperative near angles of deviation at 1 week ( p  = .005), 1 month ( p  < .001), 6 weeks ( p  < .001), 3 months ( p  = .001), and 6 months ( p  < .001) following surgery, postoperative distant angles of deviation at 6 weeks ( p  < .001) and 3 months ( p  = .03) following surgery, 6 week ( p   =  .01) and 6 month ( p   =  .036) postoperative results of the Worth four-dot test at 0.33 m, and the 6-month postoperative sensory outcome ( p   =  .006)., Conclusion: Preoperative and postoperative sensory and motor functions are predictors of the 6-month postoperative motor outcome.

Purpose: Adhesions between the extraocular muscles and surrounding tissues pose a main cause of failure of strabismus reoperations. Amniotic membrane (AM) transplantation during extraocular muscle surgery, to prevent the formation of adhesions, has been a subject of research during the past decade. This review aims to determine the value, indications, and tips on usage of AM transplantation during strabismus surgery., Materials and Methods: All references cited in PubMed in English were searched using the key words: amniotic membrane strabismus or amniotic membrane extraocular muscles, and a brief summary of these was described. In addition, certain articles were chosen to provide introductory information on wound healing and fibrosis, AM properties and how it works after transplantation, and AM processing and preservation., Results: AM used for transplantation during extraocular muscle surgery may be cryopreserved, dried, or fresh. It may be oriented with its stroma or epithelium towards the muscle. It may or may not be fixed with sutures. What were the best choices? Various studies attempted to answer these questions. Many of the studies reviewed, however, were inconclusive or contradictory. Fresh AM seemed effective, but carried a risk of transmission of communicable diseases. Dried membrane was not of value in preventing adhesions. Histopathologically, cryopreserved membrane prevented the development of adhesions in the region of its presence, regardless of its orientation, and without the need for suture fixation. To accentuate this histopathological effect during clinical practice, it was recommended to utilize the largest segment possible of cryopreserved membrane and limit its usage to cases where adhesions are expected to be the main cause of failure of strabismus surgery., Conclusion: Cryopreserved AM transplantation was safe and histopathologically effective in preventing adhesions. This effect was, however, less pronounced clinically. Its use during strabismus reoperations is merited if previous recommendations and precautions are considered.

Purpose: To evaluate the long-term effect of cryopreserved human amniotic membrane transplant during strabismus reoperations., Methods: A total of 15 patients with persistent strabismus were included in a prospective study to evaluate the effect of wrapping the extra-ocular muscles with cryopreserved amniotic membrane during strabismus reoperations. The study end-point was the last follow-up visit. A successful outcome was defined as 0-10∆ of horizontal tropia and 0-4∆ of vertical tropia, with no limitation of ductions exceeding -1. A cosmetically acceptable outcome was defined as a tropia of 0-15∆., Results: Maximum follow-up was 85 months (mean: 25.4 ± 25.5 months). At the last follow-up visit, a successful outcome was achieved in 46.7%, a cosmetically acceptable outcome was achieved in 66.7%, and the mean ocular deviation angles improved from 38.60 ± 14.63∆, preoperatively, to 10.6 ± 11.08∆. Motility limitation on the final follow-up visit exceeded -1 in only 4/180 muscles (2.2%)., Conclusion: The effect of cryopreserved amniotic membrane transplantation on the success of strabismus reoperations was moderate in terms of ocular alignment. Its effect was more pronounced in terms of ocular motility. The latter better reflects the level of adhesions. No long-term complications were documented, denoting safety of cryopreserved amniotic membrane usage during strabismus reoperations.

Purpose: To compare the effect of, and the rate of subsequent development of iatrogenic antielevation syndrome after, unilateral versus bilateral inferior oblique graded recession-anteriorization to treat unilateral inferior oblique overaction., Methods: Thirty-four patients with unilateral inferior oblique overaction were included in a randomized prospective study. Patients were equally divided into 2 groups. Group UNI underwent unilateral, group BI bilateral, inferior oblique graded recession-anteriorization. A successful outcome was defined as orthotropia, or within 2 ∆ of a residual hypertropia, in the absence of signs of antielevation syndrome, residual inferior oblique overaction, V-pattern, dissociated vertical deviation, or ocular torticollis., Results: A successful outcome was achieved in 11 (64.7%) and 13 (76.5%) patients in groups UNI and BI, respectively (p = 0.452). Antielevation syndrome was diagnosed as the cause of surgical failure in 6 (35.3%) and 2 (11.8%) patients, in groups UNI and BI, respectively (p = 0.106). The cause of surgical failure in the other 2 patients in group BI was due to persistence of ocular torticollis and hypertropia in a patient with superior oblique palsy and a residual V-pattern and hypertropia in the other patient., Conclusions: The differences between unilateral and bilateral inferior oblique graded recession-anteriorization are insignificant. Unilateral surgery has a higher tendency for the subsequent development of antielevation syndrome. Bilateral surgery may still become complicated by antielevation syndrome, although at a lower rate. In addition, bilateral surgery had a higher rate of undercorrection. Further studies on a larger sample are encouraged.

Purpose: To histopathologically compare the effect of different orientations of cryopreserved human amniotic membrane (AM) transplant during extraocular muscle surgery in rabbits., Methods: Fifty-two albino rabbit eyes underwent 4-mm resection of the superior rectus. Eyes were randomly divided into four groups. In Group C (Control group, 16 eyes) the muscle was not wrapped with amniotic membrane. In the three AM groups, cryopreserved AM was wrapped around the muscle, oriented with either its stroma (Group S, 15 eyes) or epithelium (Group E, nine eyes) towards the muscle, or folded on itself with the epithelium externally (Group F, 12 eyes). The rabbits were sacrificed and the eyes were enucleated 6 weeks after surgery. Histopathological examination was conducted for periamniotic, foreign body, scleral, and conjunctival inflammation, conjunctival vascularity, adhesions and muscle fibrosis., Results: In all AM eyes, the AM was surrounded by periamniotic inflammation, with no adhesions detected between the muscle and surrounding tissues in the segment where the AM was present, but detected elsewhere. Adhesions were detected in all group C eyes. Foreign body inflammation was significantly less in Group C than in each of the AM groups (p < .05), but was insignificantly different among the three AM groups (p > .05). Scleral inflammation was absent in all specimens. No significant differences were noted among all groups in terms of conjunctival vascularity, conjunctival inflammation, or muscle fibrosis (p > .05)., Conclusions: All AM orientations were equally effective in preventing the development of postoperative adhesions between the extraocular muscle and surrounding tissues.

A case of dissociated vertical deviation, ptosis, and juvenile glaucoma is described. J deformity anteriorization of the normally acting inferior oblique muscles was chosen to preserve the superior fornix for glaucoma surgeries by avoiding superior rectus recession and to prevent narrowing of the palpebral fissure by avoiding an inferior rectus tuck. [J Pediatr Ophthalmol Strabismus. 2017;54:e63-e66.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To evaluate the effects of using cryopreserved human amniotic membrane (AM) transplant during strabismus reoperations., Methods: A total of 30 patients with persistent strabismus were included in this prospective study. Patients were divided into two groups of 15 patients each. The AM group underwent strabismus reoperation with wrapping of the muscles with cryopreserved amniotic membrane. Controls underwent strabismus reoperation without an AM wrap. Final follow-up visit was scheduled between 3 and 12 months postoperatively. Surgical success was defined as 0 Δ -10 Δ of horizontal tropia and 0 Δ -4 Δ of vertical tropia, with no limitation of ductions exceeding -1. A cosmetically acceptable outcome was defined as a tropia of 0 Δ -15 Δ ., Results: Three patients were excluded in the AM group due to incomplete follow-up. A successful outcome was achieved in 7 patients in each group (58% and 47% in groups AM and C, resp.; P = 0.63). A cosmetically acceptable outcome was achieved in 10 patients in the AM group (83.3%) and 12 (80%) in the control group (P = 0.48). The mean ocular deviation angles improved to 8.7 Δ ± 12 Δ in the AM group and 12.3 Δ ± 17.4 Δ in the control group (P = 0.63). Ductions improved in 66.7% and 36.4% of the muscles with limited motility in groups AM and C, respectively (P = 0.019)., Conclusions: Wrapping the extraocular muscles with cryopreserved AM during strabismus reoperations was of limited clinical benefit. We attributed this to the small segment of AM used and to the presence of other causes of failure rather than adhesions., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to assess the efficacy of viscotrabeculotomy in the management of congenital glaucoma as compared to conventional trabeculotomy, in Egyptian infants., Methods: This is a prospective interventional randomized comparative study in which patients with primary congenital glaucoma were randomly allocated to either group A or B; viscotrabeculotomy (VT); and trabeculotomy (T), respectively. Patients were followed up regarding intra-ocular pressure (IOP), cup/disc (C/D) ratio and horizontal corneal diameter (HCD) for 6 months. A probability value (p value) <0.05 was considered significant., Results: Twenty-one eyes in group A and 20 eyes in group B were enrolled in the study. The mean preoperative IOP was 23.5 and 24.3 mmHg in the VT and T groups, respectively. Postoperatively, IOP dropped at six months to 14.7 and 17 mmHg in the VT and T groups, respectively. That was significant in either group when compared to preoperative IOP, but not significant between both groups at the same point of comparison., Conclusions: Both techniques were equally effective in the reduction in IOP in the management of congenital glaucoma, but viscotrabeculotomy did not appear to add more benefit to the surgical outcome than classic trabeculotomy., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To histopathologically evaluate the effect of cryopreserved human amniotic membrane (AM) transplant on preventing the development of postoperative adhesions after extraocular muscle surgery., Methods: Ten albino rabbits were used. The superior rectus muscles were bilaterally resected. In right eyes, the muscle was wrapped with cryopreserved human AM (group AM). In left eyes, the muscle was not wrapped with AM and served as a control group (group C). The rabbits were killed, and the eyes were enucleated 6 weeks after surgery to perform histopathological examination., Results: On histopathological examination, the AM was present in eight eyes, surrounded by periamniotic inflammation, with no adhesions detected between rectus muscle and sclera, conjunctiva and Tenon's capsule in the segment where the AM was present, but detected elsewhere. Adhesions were detected in the other two eyes of group AM, in which the AM was absent, and in all group C eyes. When comparing eye pairs of each rabbit, AM eyes showed significantly less adhesions between the muscle and sclera (p = 0.009) and between the muscle and Tenon's capsule and conjunctiva (p = 0.008), in the region of AM application, and significantly more foreign body inflammation (p = 0.031), than C eyes. The differences between AM and C eye pairs, in terms of conjunctival inflammation and vascularity and muscle fibrosis, were insignificant (p > 0.05)., Conclusions: Cryopreserved AM is effective in reducing postoperative extraocular muscle adhesions. Its application is, therefore, recommended during strabismus reoperations., (© 2013 The Authors. Acta Ophthalmologica © 2013 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To histopathologically evaluate the influence of lyophilized human amniotic membrane transplant on the development of postoperative adhesions and fibrosis after extraocular muscle surgery., Methods: Ten albino rabbits were used. The superior rectus muscle was resected 4 mm in both eyes. In right eyes, the superior rectus muscle was wrapped with lyophilized (air-dried, freeze-dried) human amniotic membrane (group AM). In left eyes, the superior rectus muscle was not wrapped with amniotic membrane, and served as a control group (group C). The rabbits were sacrificed and the eyes were enucleated 6 weeks after surgery to perform histopathological examination., Results: Two rabbits died 1 week after surgery and were excluded. Histopathological evaluation of both eyes of the remaining 8 rabbits was done. The amniotic membrane was not seen in all eyes. On comparing eye pairs of each rabbit, right eyes showed significantly less conjunctival inflammation (p = 0.034), but insignificantly less foreign body inflammation (p = 0.625), adhesions between sclera and muscle (p = 0.206), muscle fibrosis (p = 1.000), and conjunctival hyperemia (p = 0.059) as compared to left eyes., Conclusions: Lyophilized amniotic membrane insignificantly reduces postoperative adhesions and fibrosis, when used to wrap the operated upon extraocular muscles, limiting the benefit of this membrane in strabismus surgery.

This is a report a case of presumed scleral perforation during globe retropulsion as part of the Guyton exaggerated traction test in a patient with a history of bilateral keratoconus and scleral thinning. Perforation was indicated by the sudden occurrence of hyphema and globe softening. Postoperatively, the hyphema resolved, the intraocular pressure normalized, and the patient regained preoperative visual acuity., (Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Various techniques have been used to reduce adhesions after strabismus surgery. Wrapping the extraocular muscles with cryopreserved amniotic membrane has been reported to yield good results. In the case reported here, we used lyophilized amniotic membrane to wrap the extraocular muscles. Extensive adhesions developed, and inelastic, fibrotic muscles were discovered at a subsequent operation., (Copyright © 2010 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Purpose: To compare the effect of medial rectus slanting recession versus medial rectus recession with downward transposition for correction of V-pattern esotropia without significant oblique muscle dysfunction., Methods: A total of 18 patients having V-pattern esotropia, without significant oblique muscle dysfunction were included in this randomized, prospective study. These were divided equally into 2 groups. The SLANT group underwent bilateral medial rectus muscle slanting recession: the lower pole of the medial rectus muscle was recessed a larger amount than the upper pole on the basis of the angles of esotropia in upgaze and downgaze, respectively. The TRANS group underwent bilateral medial rectus recession according to the angle of esotropia in the primary position, with half-tendon width downward transposition. Patients were followed for at least 6 months., Results: Postoperatively, esotropia in the primary position was corrected to within 10Delta of orthotropia in 8 of 9 patients in the SLANT group and 7 of 9 patients in the TRANS group. All uncorrected patients showed a residual esotropia. All studied patients showed collapse of V-pattern esotropia to less than 10Delta difference between upgaze and downgaze. The mean V-pattern collapse was from 31.1Delta to 5.33Delta (25.8Delta) in the SLANT group and from 27.8Delta to 5.6Delta (22.2Delta) in the TRANS group. The difference between both groups was insignificant (p = 0.17). Both techniques significantly collapsed the esodeviation and V pattern (p < 0.05)., Conclusions: Both slanting medial rectus recession and medial rectus recession with downward transposition corrected V-pattern esotropia, with no clinically or statistically significant differences in success rate., (Copyright 2010 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Purpose: To evaluate the value of prism adaptation in planning strabismus reoperations., Methods: Of 15 patients with persistent strabismus, 9 underwent prism adaptation prior to strabismus reoperation and 6 underwent strabismus reoperation without preoperative prism adaptation. Corrective surgery was performed on the same or new muscles. Follow-up ranged from 3 months to 2 years. A horizontal deviation of 10 prism diopters or less was considered a successful outcome. Statistical analysis of the results was done., Results: Of the 9 patients who had prism adaptation, 3 (33%) were responders and 6 (67%) were nonresponders. A successful outcome was achieved in 6 patients (67%) who had prism adaptation and 3 patients (50%) who did not. The difference between groups was statistically insignificant (P > .05)., Conclusion: These results suggest that the benefits of prism adaptation are not significant enough to justify the time consumption and expenses of this test when planning strabismus reoperations, but a larger group of patients should be studied.

Purpose: We sought to evaluate the sensory status of patients with acquired esotropia who were able to re-establish stable alignment by optical correction and surgery and to determine the possible predictors of the different sensory outcomes., Methods: Thirty-four successfully aligned esotropic patients were included in the study. Preoperative evaluation comprised history taking, measurement of visual acuity, evaluation of the sensory status (using the Worth 4-Dot test, and the Titmus Stereo test), measurement of ocular deviation, cycloplegic refraction, and fundus examination. All patients underwent successful surgical alignment to within 10 prism diopters (Delta) of orthotropia. At each postoperative follow-up visit, the sensory functions and ocular alignment were assessed. Statistical analysis of the results was performed., Results: Among the 34 patients included in the study, 62% achieved fusion, 17% had diplopia, 15% had suppression, and 6% had a variable response to the Worth 4-Dot test at 6 months after surgery. Stereopsis was achieved in 32% as determined by the Titmus Stereo test. Statistical analysis revealed a significant relationship between the sensory status and the duration of strabismus (P=.00002), the age at surgery (P=.00289), and postoperative ocular alignment (P=.02211)., Conclusion: Early surgical and optical ocular alignment of strabismic patients is advisable to achieve fusion and stereopsis.