Structure-function relationship of reading performance in patients with early to moderate glaucoma.

PURPOSE: To assess reading performance in patients with mild to moderate primary open-angle glaucoma (POAG), and to determine the relationship between reading ability and visual field (VF), microperimetry, and optical coherence tomography (OCT) parameters. METHODS: Reading performance of 30 POAG patients examined by the Minnesota Reading Acuity Chart (MNREAD) was compared to that of 21 age-matched controls collected from Ankara University in Turkey. Humphrey Field Analyzer (HFA) 24-2 SITA Standard and 10-2 patterns, and microperimetry were used for VF measurements. All subjects underwent OCT analysis for retinal nerve fiber layer thickness (RNFLT), optic nerve head (ONH) measurements, and ganglion cell inner plexiform layer thickness (GCIPLT). The linear relationship between reading parameters and VF, microperimetry, and OCT parameters was investigated. Univariate and multiple logistic regression models were used to identify the risk factors for glaucoma. RESULTS: In POAG patients, maximum reading speed (MRS) had a significant association with average rim area, mean cup-to-disc ratio (CDR), and cup volume (p < 0.05, for all). Decreased MRS was associated with thinner average GCIPLT and inferotemporal, superior, and inferior GCIPLT quadrants (p < 0.05, for all). Global index values for the HFA 24-2/10-2 tests, microperimetry, and ONH/RNFLT parameters had no correlation with reading performance. After accounting for the better and worse eyes, gender, education, age, and visual acuity of the glaucoma patients, MRS score was 23 units lower in the worse eye (p = 0.009), critical print size (CPS) was 0.21 units larger in the better eye (p = 0.03) and 0.25 units larger in the worse eye (p < 0.001), reading accesibility index (ACC) was 0.11 units lower in the better eye (p = 0.02) and 0.13 units lower in the worse eye (p = 0.002), and RA was 0.13 units higher in the worse eye (p = 0.003) of POAG patients. CONCLUSION: POAG had significantly lower reading performance when compared to healthy subjects. Reading speed was associated with decreased macular GCIPLT indicating that reading performance may be affected in the earlier stages of the disease.

Refractive change in pediatric patients with intermittent exotropia.

PURPOSE: To determine the relationship between intermittent exotropia (IXT) and refractive change and the effects of the methods applied in IXT follow-up on refractive change. METHOD: The medical records of 228 patients with IXT (group 1) and 110 patients without strabismus (group 2) who were followed between 2008 and 2022 were analyzed retrospectively. Group 1 was divided into three subgroups: overminus correction (group 1A), patients who underwent surgery (group 1B), and patients who were observed (group 1C). RESULTS: Annual myopic progression was -0.21 ± 0.32 D (range, -1.26 to +1.92) in group 1 and -0.07 ± 0.30 D (range, -1.13 to +1.00) in group 2 (P < 0.001). Annual myopic progression was -0.26 ± 0.29 D (range, -1.26 D to +0.12 D) in group 1A, -0.25 ± 0.35 D (range, -1.15 D to +0.25 D) in group 1B, and -0.19 ± 0.33 D (range, -1.12 D to +1.92 D) in group 1C. There was no difference in annual myopic progression between the subgroups (P = 0.670). The annual change in myopic refraction between each of the group 1 subgroups and group 2 was statistically significantly different (P < 0.001, P = 0.023, P < 0.001, resp.). CONCLUSIONS: Myopia progression was significantly greater in children with IXT than in the normal population. Myopia progression did not vary with exotropia treatment.

Macular integrity assessment microperimeter, Humphrey field analyzer and OCT in glaucoma practice: a correlation study.

OBJECTIVE: To compare and correlate retinal sensitivities measured with macular integrity assessment microperimetry (MAIA-MP) and Humphrey field analyzer (HFA) 10-2 tests with structural parameters obtained from optical coherence tomography (OCT) in primary open-angle glaucoma (POAG) and ocular hypertension. METHODS: This study included 63 participants (22 with POAG, 20 with ocular hypertension, and 21 control individuals). All participants underwent HFA 10-2 and MAIA-MP (macular retinal sensitivity tests) and measurements for optic nerve head (ONH), peripapillary retinal nerve fibre layer thickness (PRNFLT), and ganglion cell inner plexiform layer thickness (GCIPLT) using OCT. The relationship between macular retinal sensitivity and OCT parameters was evaluated by Pearson correlation analysis and linear regression modelling. RESULTS: POAG cases had a strong association between the MAIA-MP and ONH parameters (optic disc area [ODA], p = 0.037; cup volume, p = 0.043), PRNFLT (average, p = 0.009; inferior PRNFLT, p = 0.004), and GCIPLT in all macula sectors (p ≤ 0.005 for all). HFA 10-2 had a moderate correlation with the ONH parameters (cup-to-disc ratio [CDR], p = 0.042; vertical CDR, p = 0.037; cup volume, p = 0.037; ODA, p = 0.014), PRNFLT (average, inferior, and nasal, p < 0.05 for all), and GCIPLT in all macula sectors (p < 0.005 for all). OHT cases had a weak correlation between HFA 10-2 and nasal and superior PRNFLTs (p = 0.035 and p = 0.047, respectively). CONCLUSION: MAIA-MP and HFA 10-2 functional parameters have strong correlations with the structural parameters obtained by OCT in POAG cases. Both devices are useful in assessing the central visual field in glaucoma, with MAIA-MP potentially beneficial in patients with limited cooperation or poor vision.

Microperimetry, Humphrey field analyzer, and optical coherence tomography in detecting glaucoma: a comparative performance study.

PURPOSE: To evaluate and compare the diagnostic performance of microperimetry (MP), visual field (VF) 10-2 and 24-2 tests, and spectral-domain optical coherence tomography (SD-OCT) in primary open-angle glaucoma (POAG). METHODS: The study consisted of 35 POAG and 42 control eyes were enrolled in this prospective study. Eligible participants were ≥ 50 years old. VF assessments were carried out using the Humphrey field analyzer (HFA) and Macular Integrity Assessment. Optic nerve head (ONH), retinal nerve fiber layer thickness (RNFLT), and ganglion cell inner-plexiform-layer thickness (GCIPLT) were measured by SD-OCT. Areas under the receiver operating characteristic curves (AUC) and sensitivities at 95% specificity were calculated for each parameter. RESULTS: HFA 24-2 had the largest AUC value among the functional parameters to differentiate POAG from control eyes [AUC: 0.950 (0.906-0.994), sensitivity at 95%:60]. HFA 24-2 showed a significantly better performance than the 10-2 test (p = 0.036). Among the SD-OCT structural parameters, minimum GCIPLT had the largest AUC value to differentiate POAG from control eyes [AUC: 0.952 (0.905-0.999), sensitivity at 95%:80]. In comparison of the functional and structural parameters, HFA 24-2 showed a significantly better performance than the 10-2 test (p = 0.036). In macular parameters, minimum GCPLT performed significantly better than HFA 10-2 (p = 0.015) in detecting POAG. There was no statistically significant difference between the comparative diagnostic performance of the RNFL, ONH, HFA, and MP (p > 0.05 for all comparisons). CONCLUSION: The structural and functional test results revealed that GCIPLT measurements had the highest diagnostic performance in detecting POAG. HFA 24-2 test performed better than 10-2 test in distinguishing glaucoma from healthy eyes. MP showed a similar performance with HFA 10-2 and may be considered a complementary diagnostic tool.

Combined Rectus Muscle Transposition With Posterior Fixation Sutures (Augmented Knapp Procedure) for the Surgical Treatment of Double Elevator Palsy.

PURPOSE: To evaluate the surgical results of full horizontal tendon rectus muscle transposition to the superior rectus muscle insertion, augmented by posterior fixation sutures, in patients with double elevator palsy. METHODS: In this retrospective comparative study, 17 patients treated by the augmented Knapp procedure (study group) were compared with 28 patients treated by the standard Knapp procedure (control group). Pre-operative and postoperative vertical deviation in primary position, ocular motility, binocular function, and rate of reoperation were evaluated. RESULTS: The mean preoperative near and distance deviations (hypotropia) decreased by 93% and 97% in the study group and 68% and 69% in the control group, respectively. The improvement in near and distance deviation was statistically more significant in the study group than the control group (P = .001 for each parameter). The mean preoperative elevation deficiency in abduction and adduction improved by 64% and 66% in the study group and 37% and 39% in the control group, respectively. The improvement in elevation deficiency in abduction and adduction was statistically significantly greater in the study group than the control group (P = .001 and .04, respectively). Reoperation was required in 15 patients (54%) in the control group and 2 (12%) in the study group during the follow-up period of 26 ± 4 months. CONCLUSIONS: The postoperative improvement in near and distance deviation and elevation deficiency in abduction and adduction was significantly better in the augmented Knapp procedure than the standard Knapp procedure. This procedure demonstrated a stronger effect in the treatment of double elevator palsy. [J Pediatr Ophthalmol Strabismus. 2022;59(1):17-23.].

Cyclic strabismus: what measured angle of strabismus should guide surgery?

Purpose: Here we aimed to describe seven pediatric patients with cyclic strabismus and report the outcome of their surgical treatment.Methods: Seven children with acquired esotropia manifesting in a 48-h cycle were included in the study. Four of them were boys, and three of them were girls. All cases had a large angle of deviation and associated suppression on the esotropic day and small angle of deviation with fusion on the other day. A complete ocular motility examination was performed for seven consecutive days. For all cases, we planned strabismus surgery according to the amount of deviation on the strabismic day. Postoperatively, the deviation angles were recorded at the first week, first month, and third month. Later, the patients were examined at 3-month intervals.Results: The mean age at presentation was 4.42 ± 3.69 years (1-12 years). The mean angle of esotropia at near fixation preoperatively was 36.4 ± 14.9 pd (prism dioptre) (20-60 pd) on the esotropic day. The mean angle of esotropia on the esotropic day at distance fixation was 32.1 ± 6.9 pd (20-40 pd). The mean follow-up period was 18.4 ± 5.5 months (12-25 months). The mean duration of esotropia before surgery was 11.1 ± 9.4 months (3-29 months). Following surgery, orthophoria within 10 pd was achieved and maintained in all cases.Conclusion: When treating children with cyclic strabismus, the best surgical results can be achieved when surgery is planned according to the amount of deviation on the strabismic day.

The effects of topical carbonic anhydrase inhibitor in treatment of nystagmus.

OBJECTIVE: To evaluate the effects of topical carbonic anhydrase inhibitor (CAI), brinzolamide (Azopt), for treatment of nystagmus patients. MATERIALS AND METHODS: Patients who used Brinzolamide for treatment of nystagmus were retrospectively analyzed. 23 patients were included in this study. The patients' diagnosis were idiopathic infantile nystagmus 18 (78.2%) and oculocutaneous albinism in 5 (21.8%). Azopt eye drop was used in both eyes, 3 times a day. Detailed eye examination in all of the patients before treatment and repeated at the end of the first week after treatment. SPSS 16.0 computer program was used for evaluation of DATAs. RESULTS: The mean follow-up was 32 ± 28 months. 23 patients 15 (65.2%) were male and 8 (34.7%) were female and the mean age was 12.6 ± 5.5. Before the management of topical brinzolamide, abnormal head position (AHP) were observed in 18 patients. After that we found reduction of nystagmus in 5 (22.7%) of the patients, increase in vision in 9 (40.9%) and reduced AHP in 18.3%. There is no identified change in 4 (18.1%). CONCLUSION: The medical treatment of nystagmus with topical brinzolamide was found effective in our series but, wider series and longer follow-up studies are needed.

Management of Duane retraction syndrome with prismatic glasses.

PURPOSE: To report the results of using prismatic glasses for Duane retraction syndrome (DRS). METHODS: Data were obtained from the records of patients who were evaluated during the year 2000 in the Strabismus Unit of the Beyoglu Eye Training and Research Hospital. The average follow-up was 12.2±17.7 months. In all cases, 2 main variables were evaluated: horizontal deviation in the primary position and face turn. Prismatic glasses were provided to patients according to the degree of shift in the primary position. RESULTS: The mean age of patients was 11.2 years. An analysis was performed on the data collected from 12 cases; 7 patients were females (58.3%) and 5 were males (41.7%), with 11 (91.7%) cases being of type I DRS. All 12 patients had abnormal head posture (face turn) and an angle of mean deviation equaling 10 PD (prism dioptri). CONCLUSION: Treatment was individualized on a case-by-case basis. Prismatic glasses are useful for eliminating abnormal head posture and ocular misalignment in selected cases.

Risk factors for treatment failure and recurrence of anisometropic amblyopia.

PURPOSE: The aim of this study was to identify factors associated with failed vision improvement and recurrence following occlusion therapy for anisometropic amblyopia in children aged 7-9 years. METHODS: We retrospectively reviewed the medical records of 64 children aged 7-9 years who had been diagnosed as having anisometropic amblyopia and were treated with patching. Functional treatment failure was defined as final visual acuity in the amblyopic eye of worse than 20/32. Improvement of fewer than two logMAR lines was considered relative treatment failure. Recurrence was defined as the reduction of at least two logMAR levels of visual acuity after decreased or discontinued patching. RESULTS: Functional and relative success rates were 51.6 and 62.5 %, respectively. The most important factor for functional treatment failure [adjusted odds ratio (OR) (95 % confidence interval, CI) 11.57 (1.4-95.74)] and the only risk factor for recurrence [adjusted OR (95 % CI) 3.04 (1.13-8.12)] were the same: high spherical equivalent (SE) of the amblyopic eye. A large interocular difference in the best-corrected visual acuity was found to be a risk factor for both functional and relative failure. CONCLUSION: High SE of the amblyopic eye was the most influential risk factor for treatment failure and recurrence in compliant children aged 7-9 years.

An Atypical Case of Microphthalmos With Cyst: Cyst Masquerading as Phthisical Eye.

A 6-year-old boy diagnosed with congenital microphthalmic OS was referred for prosthetic eye fitting. He was otherwise healthy without known congenital anomalies. His visual acuity was 20/20 in the OD and no light perception in the OS. His disfigured OS with a conjunctivalized opaque cornea appeared smaller than his OD. He had left esotropia with severely restricted ductions in all directions of gaze. The preoperative orbital MRI of the patient revealed a small orbital cyst posteroinferior to the OS. Because the patient could not tolerate the prosthetic eye worn over his disfigured eye, evisceration was planned. During the surgery, blunt dissection of the conjunctiva and Tenon's capsule uncovered a large orbital cyst that was misdiagnosed as phthisis bulbi preoperatively based on the clinical examination and imaging findings. The structure that was thought to be an orbital cyst on orbital MRI was the microphthalmic eye. Enucleation with cyst excision was performed. Patient had uneventful postoperative course and has been wearing an artificial eye for 1 year since surgery.

A novel technique for inferior rectus recession.

PURPOSE: To introduce a novel technique of inferior rectus recession operation to allow larger amounts of recession without causing lower lid retraction and to compare this method with the results obtained in standard inferior rectus recession. MATERIAL AND METHODS: This study included 20 patients operated on in the authors' clinic. The median age of the patients was 24.5±18.6 (4-73) years and the median follow-up was 9.3±11.8 (3-43) months. Ten patients operated on with the standard method were labeled Group 1 and ten patients operated on with the new method were labeled Group 2. Without exceeding 4 mm, inferior rectus recession to the whole muscle was performed in Group 1 patients. Inferior rectus recession was also performed on patients in Group 2 following the new method. Using a spatula, approximately 10% of the muscle surface fibers were detached intact as a thin layer, and the remaining 90% of deeper fibers were recessed 4-8 mm as planned. Patients' preoperative deviations and lower lid positions were recorded. The same parameters were checked in the first and third month postoperatively. Both groups were evaluated retrospectively by screening their files, and the Mann-Whitney U test was used for statistical evaluation. RESULTS: Lower lid retraction was seen in four patients of Group 1. There was no retraction in Group 2. While there was a need to perform additional vertical muscle procedures for vertical deviations and lower lid retractions in Group 1, it was observed that there was no need for additional procedures in Group 2 patients. There was a statistically meaningful difference between the two procedures (P<0.05). CONCLUSION: This novel technique was found to be an effective surgical method for permitting more recession without the risk of lower lid retraction.

Surgical procedure joining the lateral rectus and superior rectus muscles with or without medial rectus recession for the treatment of strabismus associated with high myopia.

PURPOSE: To evaluate the outcomes of a surgical procedure involving the muscle union of the superior rectus (SR) and lateral rectus (LR) muscles with or without medial rectus (MR) recession for the treatment of strabismus associated with high myopia and the anatomic changes from before and after surgery. METHODS: Thirty-five eyes of 20 patients who had undergone a muscle union of the SR and LR muscles with or without MR recession for treatment of acquired strabismus associated with an inferior displacement of the LR and nasal displacement of the SR in magnetic resonance imaging of the orbit due to axial high myopia were observed prospectively. Main outcome measures were the angles of the dislocation of the globe, angles of horizontal or vertical deviations, abductions, and supraductions. The angles of the dislocation of the globe were analyzed using magnetic resonance imaging (1.5 Tesla Magnet; Siemens Symphonia, Munich, Germany). RESULTS: The axial lengths ranged from 26 to 36 mm (mean: 30.6 ± 2.8 mm). The angle of dislocation of the globe changed from 178º ± 10º to 101º ± 6º, the angle of esotropia changed from 58.6 ± 2.5 to 6.8 ± 1.4 prism diopters (PD); and the angle of hypotropia changed from 12.5 ± 1.3 to 3.3 ± 1.1 PD postoperatively. Abduction and supraduction improved significantly after surgery. At the 4-year follow-up, the postoperative outcomes were stable. CONCLUSIONS: In the treatment of strabismus caused by high myopia, the surgical procedure involving the muscle union of the SR and LR muscles with or without MR recession was effective on both the restoration of the dislocated globe into the muscle cone and the improvement of ocular motility.

Transcanalicular diode laser assisted dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction: 2-year follow up.

PURPOSE: To evaluate the success rate of 980 nm transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) and to consider the time and the reasons of failure. METHODS: Hundred and thirty eyes of 125 patients who underwent of TDL-DCR for the treatment of PANDO are included in this retrospective, noncomparative, nonrandomized, interventional study. The mean follow-up time was 24.29 months (range 8-34 months). Functional success was described as disappearance of epiphora and presence of a patent ostium on lacrimal irrigation. Anatomical success was described as a patent ostium to irrigation but continuing epiphora. Patients with persistent epiphora and a closed ostium were classified as a surgical failure. RESULTS: At third month follow up, 85.4% of cases had complete resolution of their symptoms. The functional success rate decreased to 67.7% at 6 months, to 63.3% at first year, and to 60.3% at second year, while the patency of the lacrimal drainage system was restored in 93.1%, 74.6%, 69.5%, and 68.2% of the cases, respectively. The average total amount of delivered laser energy was 1322.7 J. No correlation could be found between the age of the patient, delivered laser energy, and the surgical success (p = 0.38, p = 0.62). CONCLUSIONS: Transcanalicular diode laser-assisted DCR is a fast and relatively easy alternative surgical method, which avoids a facial skin scar, to treat PANDO. The functional success rate is higher in the first months but decreases to low 60 %'s at the end of first year and remains the same at the second-year follow up.

Long-term results of deeper muscle fibers recession of an inferior rectus operation.

PURPOSE: To report the efficacy in preventing lower eyelid retraction and long-term results of a new technique of inferior rectus (IR) recession for vertical strabismus and compare this method with the results obtained by a conventional IR recession operation. METHODS: This retrospective study included 35 patients who underwent a new IR recession method (study group) and 22 patients who underwent the conventional IR recession (control group) for vertical strabismus. In the study group, an IR recession was applied to the deeper fibers and included approximately 90% of the IR muscle thickness. This group was divided into two subgroups: small IR recessions (4 to 6 mm) and large IR recessions (7 to 8 mm). In the control group, an IR recession of the entire muscle was applied without exceeding 6 mm. The photographs were analyzed for lower eyelid position. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs at final follow-up examination. The main outcome measures were the margin-to-reflex distance, lower eyelid retraction, and vertical deviation angles (at near and distance fixation). RESULTS: The mean change in margin-to-reflex distance after surgery was 0.03 mm in the small IR recessions group, 0.1 mm in the large IR recessions group, and 2.04 mm in the control group. Postoperatively, the lower eyelid retraction in the study group, which occurred after both small and large IR recessions, was significantly less than that in the control group (P < .001). There was no significant difference between the study and control groups in improvements in near and distance vertical deviations and success ratios (P > .05). CONCLUSIONS: At long-term follow-up, recession of the deeper fibers layer, including approximately 90% of the IR muscle thickness, was a procedure that minimized or eliminated the possibility of lower eyelid retraction and did not limit the success of strabismus surgery.

Is y-split recession of the medial rectus muscle as effective as scleral retroequatorial myopexy of the medial rectus muscle for partially accommodative esotropia with convertgence? A report of results in 61 cases.

PURPOSE: To compare the results of a medial rectus (MR) Y-split recession with those of a MR retroequatorial myopexy for the treatment of partially accommodative esotropia with convergence excess. METHODS: In this retrospective study, patients who underwent bilateral MR Y-split recession or bilateral MR retroequatorial myopexy for partially accommodative esotropia with convergence excess (accommodative convergence: accommodation ratios greater than 5 prism diopters:diopters) between March 2006 and January 2011 were included. RESULTS: Sixty-one patients underwent bilateral MR Y-split recession, and 60 patients underwent retroequatorial myopexy of the bilateral MR muscles. Satisfactory binocular alignment was achieved in 77 percent of the patients who underwent MR Y-split recession by the final examination and 78 percent of patients who underwent a MR retroequatorial myopexy. There was no statistically significant difference in near or distance deviation or the near-distance disparity at the postoperative 1 month or final examination. The proportions of patients who had a successful alignment at the final examination did not differ between the two groups. No patients had any complications. CONCLUSION: We determined that both the MR Y-split recession and MR retroequatorial myopexy achieved satisfactory results for the treatment of partially accommodative esotropia with convergence excess though both techniques had some disadvantages.

Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy.

PURPOSE: To evaluate the effect on ocular alignment of Y splitting the lateral rectus muscle and then reattaching the 2 ends near the medial rectus muscle insertion in patients with complete oculomotor nerve palsy. METHODS: All eyes with oculomotor nerve palsy treated between May 2008 and February 2010 with Y splitting and transposition of the lateral rectus muscle to the medial rectus muscle were prospectively studied. In this procedure, the lateral rectus muscle was split: the upper half was transposed to the superior border and the lower half to the inferior border of the medial rectus insertion. For the muscles that had lost the ability to stretch and strain due to fibrosis, a hang-back technique was used. In some patients, the medial rectus muscle of the same eye was subsequently strengthened or the lateral rectus muscle of the fellow eye was recessed. Final deviation from 0(Δ) to 10(Δ) was considered a successful result. RESULTS: A total of 10 patients were included. Patients had a preoperative horizontal deviation >45(Δ) (range, 45(Δ)-90(Δ)). Of the 10 patients, 5 attained stable results following surgery, and 5 with postoperative undercorrection between 20(Δ) and 30(Δ) required further surgeries. Postoperatively, 2 patients improved their sensorial status in a very limited range of gaze and 2 patients had symptomatic diplopia. CONCLUSIONS: Acceptable aesthetic results can be achieved in the treatment of complete oculomotor nerve palsy with the transposition of the split lateral rectus muscle to the medial rectus muscle area.

Rick factors for secondary exotropia following a retroequatorial myopexy of the medial rectus muscle with recession for esotropia. A retrospective study of 448 cases.

PURPOSE: To determine which factors are important in the development of secondary exotropia and the incidence of secondary exotropia occurring after a retroequatorial myopexy of the medial rectus muscle with recession in the treatment for partially accommodative esotropia associated with convergence excess. METHODS: In this retrospective study, the patients that underwent retroequatorial myopexy on both medial rectus muscles with recessions for partially accommodative esotropia associated with convergence excess were included. The incidences and angles of secondary exotropia at near and distance fixation were evaluated and the risk factors for secondary exotropia were analyzed. RESULTS: Four hundred forty-eight patients had retroequatorial myopexy on both medial rectus muscles with recessions. Three hundred forty-nine of 448 patients maintained satisfactory near and distance binocular alignment at the final follow-up. Secondary exotropia occurred in 37 of these patients and residual esotropia occurred in 62 patients. There were no significant differences between the incidences and angles of secondary exotropia at near and distance fixation. The preoperative absence of binocularity was the only independent risk factor for developing secondary exotropia after a retroequatorial myopexy of medial rectus muscle with recession. CONCLUSION: We determined that secondary exotropia was not a common result of retroequatorial myopexy of the medial rectus muscles with recession. We determined that the preoperative absence of binocularity was the only independent risk factor identified in this study.

Is Duane retraction syndrome part of the VACTERL association?

We report here a patient with type 1 Duane's retraction syndrome and multiple congenital abnormalities as a result of the VACTERL association. The presented combination of Duane's retraction syndrome and the VACTERL association has not been reported in the literature. The present case was instructive for reviewing the continuous spectrum of ocular anomalies that accompany the VACTERL association.

Medial rectus Faden operations with or without recession for partially accommodative esotropia associated with a high accommodative convergence to accommodation ratio.

AIMS: To evaluate the results of Faden operations on the medial rectus (MR) muscles with or without recession for the treatment of partially accommodative esotropia associated with a high accommodative convergence to accommodation (AC : A) ratio and to determine whether there was a decrease in the effects of posterior fixation over time. METHODS: In this retrospective study, 108 of 473 patients who underwent surgery for partially accommodative esotropia with a high AC : A ratio received Faden operations on both MR muscles, and 365 received symmetric MR muscle recessions combined with a Faden operation. RESULTS: For the Faden operation, a satisfactory outcome of 76.9% at 1 month postoperation, decreased to 71.3% by the final follow-up visit (mean 4.8 years). A moderate positive correlation was observed between the increase in the postoperative near deviation and postoperative time. For the Faden operations combined with MR recession, a satisfactory outcome of 78.9% at 1 month post-operation, decreased to 78.4% by the final follow-up visit. CONCLUSION: A Faden operation of the MR muscles with or without recession is an effective surgical option for treating partially accommodative esotropia associated with a high AC : A ratio. For Faden operations of the MR muscles without recession, the effects of the posterior fixation decline over time.