A 2020 Update on 20/20 X 2: Diplopia after Inadvertent Strabismus Surgery Complications.

The goals of successful strabismus surgery include the optimization of binocular potential through the establishment, reestablishment, or improvement of ocular alignment leading to a reduction or resolution of diplopia, as well as an improvement of compensatory head position or cosmesis. Fortunately, the incidence of new postoperative diplopia in patients without diplopia prior to strabismus surgery is extremely uncommon (less than 2%). Alternatively in a patient with preoperative diplopia that persists postoperatively, it is important to establish whether the diplopia is unchanged, increased, or of the same magnitude but shifted to a more disruptive position of gaze. During preoperative planning, the surgeon tries to anticipate and thus avoid postoperative diplopia. If the postoperative diplopia is unexpected, then a dispassionate evaluation of the outcome to identify planning, mechanical, or other factors is necessitated. These factors will be explored below systematically in the preoperative, intraoperative, and postoperative phases.

Ophthalmic manifestations of Gaucher disease: the most common lysosomal storage disorder.

Gaucher disease (GD) results from a deficiency of glucocerebrosidase activity and the subsequent accumulation of the enzyme's metabolites, principally glucosylsphingosine and glucosylceramide. There are three principal forms: Type I, which is the most common, is usually considered non-neuronopathic. Type II, III and IIIc manifest earlier and have neurological sequelae due to markedly reduced enzyme activity. Gaucher's can be associated with ophthalmological sequelae but these have not been systematically reviewed. We therefore performed a comprehensive literature review of all such ophthalmic abnormalities associated with the different types of Gaucher disease. We systematically searched the literature (1950 - present) for functional and structural ocular abnormalities arising in patients with Gaucher disease and found that all subtypes can be associated with ophthalmic abnormalities; these range from recently described intraocular lesions to disease involving the adnexae, peripheral nerves and brain. In summary, Gaucher can affect most parts of the eye. Rarely is it sight-threatening; some but not all manifestations are amenable to treatment, including with enzyme replacement and substrate reduction therapy. Retinal involvement is rare but patients with ocular manifestations should be monitored and treated early to reduce the risk of progression and further complications. As Gaucher disease is also associated with Parkinsons disease and may also confer an increased risk of malignancy (particularly haematological forms and melanoma), any ocular abnormalities should be fully investigated to exclude these potential underlying conditions.