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With the development of strabismology, the issues of using Botox in various eye movement pathologies are gaining relevance. The literature analysis shows that the data concerning the effectiveness of Botox are ambivalent and as a rule, are based on short-term results. The review presents the data on the efficiency of the botulinum toxin in the treatment of various oculomotor system diseases in comparison with traditional surgical interventions. Indications for such therapy, application techniques, doses and complications are discussed. The generalized modern data on the functional features of the onset of various pathologies in strabismology help assess the potentials of optimizing strabismus treatment with type A botulinum toxin. To search for the data published between 1973 and 2022, select and summarize them we used Google Scholar, PubMed and eLibrary databases.

Purpose. To analyze changes in binocular vision functions in patients with acutely acquired esotropia after preoperative correction by prisms. Material and methods. The study included 16 patients with acutely acquired esotropia with diplopia. Depending on the tactics of preoperative case management, two groups were distinguished. Eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years old (mean age, M±sd – 17.5±1.9 years). This group underwent preoperative prismatic correction of diplopia and the deviation angle, as well as eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years (18.5±1.9 years). Patients in this group underwent surgery without prior prismatic correction. Fresnel prisms were used to select and assign prismatic correction. The patien s were monitored dynamically. Results. In the course of treatment 1 group (prismatic correction followed by surgical correction) according to the indicator of Worth’s four-dot test color test, revealed a statistically significant increase in the frequency of value of the binocular single vision (p=0.041), the frequency of the presence of stereovision according to the Fly-test (p=0.013), fusion amplitude in the distance by 1.11 times (p=0.033) and near fusion amplitude by 1.15 times (p=0.003). Significant differences between the groups were observed only in the frequency of stereovision presence according to the Fly-test after treatment, which was 2.0 times higher in group 1 (p=0.041). Conclusion. Prismatic correction in combination with surgical treatment had better curative benefits than surgery itself in improving both binocular and stereoscopic visual functions.

Purpose. Analysis the effectiveness of prismatic correction in the treatment of congenital horizontal nystagmus. Material and methods. The study included 20 patients with congenital horizontal nystagmus. Depending on the type of nystagmus and compensatory mechanisms to reduce its amplitude, two groups were identified: 10 patients with pendular nystagmus and nystagmus blockage syndrome (mean age, M±sd, 5.8±1.9 years) and 10 patients with jerky nystagmus and abnormal head posture and a null zone (5.7±2.1 years). Fresnel prisms were used to select and prescribe prismatic correction. Patients were under dynamic control from 6 months to 2 years with an assessment of the results every 3 months. Results. During treatment (using prism correction), uncorrected visual acuity had a statistically significant increase of 1.8 and 1.5 times both in the first (p=0.004) and the second (p=0.001) group, respectively. A similar, and even more pronounced, change in visual acuity was observed for corrected visual acuity – in the first group it increased 3 times (p=0.001) and in the second group 2.2 times (p=0.001). Conclusion. Prismatic correction in pendular nystagmus and esotropia allows to simulate (eliminate) nystagmus blockage syndrome and, thereby, to improve the quality of vision of the patient. In its turn, prismatic correction in jerky nystagmus with abnormal head posture allows to move null zone into the primary position of gaze, increase visual acuity due to the optimal optical correction and improve the patient’s quality of life.

Background. Primary inferior oblique muscle overaction (PIOOA) may occur for various reasons and happens to 72 % patients with infantile esotropia. The criterion for the first surgical step is prevalence of vertical or horizontal deviation. The choice of tactics weakening inferior oblique muscle is ambiguous.Aims: to carry out retrospective analysis of PIOOA frequency in patients with infantile esotropia; to assess influence of esodeviation reduction by a surgical, chemodenervational or prismatic method on the existing PIOOA dynamics; to assess clinical and functional results of PIOOA treatment.Methods and methods. The retrospective analysis of 572 patients’ cases lay in assessment of PIOOA frequency and rate in patients with infantile esotropia that manifested under 9 months, with different treatment tactics. The prospective part of the research included two groups of patients. Group 1 (106 patients, 222 eyes) – studying the influence of surgical treatment of PIOOA. Group 2 (127 patients, 207 eyes) – studying the effectiveness of surgical PIOOA treatment. Conclusion. PIOOA frequency in case of different treatment tactics for patients with infantile esotropia is from 17 to 69 %, and the degree of its clinical manifestation is from 1.2 ± 0.4 to 2.6 ± 0.8. Bilateral weakening of medial rectus muscle reduces its probability up to 17–19 %, and the degree of its manifestation up to 1.2 ± 0.4. In cases of combination of PIOOA with infantile esotropia from 20 to 25° with paretic component, it is reasonable to carry out esodeviation reduction by means of bilateral recession, chemorecession or prismatic correction as the first treatment stage, whereas the rate of existing PIOOA is credibly reduced. In cases of choice of tactics, which is necessary for clinically significant reduction or elimination of PIOOA, it is reasonable to carry out chemorecession, marginal partial myotomy or myectomy depending on the PIOOA manifestation.

The purpose of our study was to analyze the effectiveness of the use of Fresnel prisms for various disorders of the eye movement.Material and methods. The studied group included 40 patients with prismatic correction and was divided into 2 groups of patients depending on the type of strabismus: 25 patients with incomitant strabismus, 15 patients with comitant strabismus. Elastic Fresnel prisms (EFP) were chosen and prescribed for prismatic correction. The patients were under dynamic monitoring under conditions of continuous use of EFP and positional trainings were performed if necessary (when doubling wasn’t completely compensated by EFP). The study had a prospective character.Results and its discussion. The prismatic correction made it possible to eliminate diplopia in direct gaze position and peripheral gaze directions in all 25 patients with paretic strabismus. In 18 out of 20 cases, the prismatic correction allowed to achieve functional recovery without subsequent chemorecession or surgical treatment. In 8 patients with comitant strabismus after the first stage of surgical treatment with stable deviation, binocular vision was formed under natural conditions. In 1 year, dynamic prismatic correction contributed to the recovery of 7 patients without surgical treatment with orthophoria in vivo.Conclusion. Prismatic correction of diplopia as an independent or additional functional method of treatment contributes to the achievement of the comitance of the eye muscles.

In the context of the development of modern strabismology debatable issues still remain, among which the most important and long-term is the choice of tactics for the treatment of primary hyperfunction of the inferior oblique muscle. This article presents a literature review of the most significant publications of national and foreign authors concerning this topic. Criteria of differential diagnostics of primary and secondary hyperfunction of the inferior oblique muscle are presented. The main pathophysiological mechanisms of its occurrence are identified: imbalance between the superior and inferior oblique muscles, horizontal muscle dystopia, as well as prolonged occlusion and prismatic correction. The epidemiology of primary hyperfunction of the inferior oblique muscle, which develops in patients under the age of 4 years in more than half of cases, is summarized. Congenital esotropia operated on toddlers is not a clear guarantee of success in the prevention of the development of the current pathology. Primary hyperfunction occurs equally in patients with accommodative and intermittent forms of esotropia, less often in cases of acquired esotropia. The analysis of different classifications of primary hyperfunction is provided. The indications for surgical treatment and the criteria for evaluation of its efficiency are considered. The mono- or bilaterality of hyper-elevation in adduction, its symmetry, the presence of a V pattern determine the tactics and methods of treatment, the choice of which depends on the degree of hypertropy in combination with horizontal deviation.Positive and negative aspects of the most frequently performed surgical interventions on the inferior oblique muscle; technical features of marginal myotomy, myoectomy, recession and anteriorization were evaluated.

Early detection of children sight disturbances allows ophthalmologists to prescribe in time preventive activities and treatment, to stop developing pathology, and to prevent complications initiation. The purpose of our study was to elaborate and introduce into practice a method of distant screening examinations of schoolchildren using telecommunication facilities. Material and methods. We developed an interactive computer program for distant examination of visual acuity, long or short sight shift in refraction , diagnostics of astigmatism and pathology of macular area. The results of the examination were automatically recorded in a computer database. The program was hosted on the clinic website. Examination was performed simultaneously for up to 5 schoolchildren sitting in a computer class of their schools. The examination lasted from 4 to 8 minutes for the group depending on the quantity of the invoked tests. Results and discussion. 28,983 schoolchildren underwent the distant screening of vision. Visual acuity of 1.0-0.9 was revealed in 14345 people (49.5 %), 0.8-0.2 - in 11187 people (38.6 %) and less than 0.1 - in 3451 people (11.9 %). The test is not specific in terms of the type of pathology, but it allows us to conclude that more than half of schoolchildren have a reduced vision. A method of distant screening vision examinations is reliable and high-performance. Database of the examination results is helpful to diagnose pathology at early stage, to track its dynamics and to inform parents in time on whether an expanded investigation and ophthalmological treatment of their children is necessary.

Introduction. To summarize our fifteen-years clinical experience of using Botox in strabismology and determine the indications for the most effective use of chemodenervation in the complex treatment of oculomotor system pathology.Patients and methods. To carry out chemodenervation of extraocular muscles, Botox was used. The optimal dose of Botox for intramuscular injection ranged from 1.25 to 5.0 units. The choice of dosage depends on the patient’s age, the type oculomotor system pathology, the level of muscular dysfunction and the purpose of the treatment. The treatment was performed in 376 patients with various disorders of oculomotor system. At the time of treatment, the patients’ ages ranged from 12 to 78 years. Injection of Botox into the extraocular muscles in all cases was the primary method of treatment.Results. In general, the state of relative functional recovery was achieved in 71.81% of cases (in 270 patients). The best results were obtained in treatment of decompensated heterophories, acute heterotrophies, atypical heterotrophies and primary hyperfunction of the inferior oblique muscles (in 100% of cases). In these conditions, the binocular vision was preserved in patients, and the imbalance of the oculomotor system did not show any sign of incomitance. However, patients with paralysis and paresis of the cranial nerves chemodenervation allowed creating conditions for a more complete restoration of muscular functions, to avoid the occurrence of a secondary imbalance in the oculomotor system. In 70.3% cases (185 patients), subsequent surgical treatment was not required. Reliable functional results of treatment allowed creating the optimal algorithm for chemodenervation.Discussion. Chemodenervation of extraocular muscles is an effective independent and additional method of complex treatment of oculomotor system pathology and expands opportunities in patients’ rehabilitation. To achieve maximum functional results, it is necessary to select patients correctly for this procedure, taking into account its appropriateness and advantages over alternative methods of treatment, selection of optimal dosages of Botox.