Surgical Outcome of Inferior Oblique Myectomy versus Recession-Anteriorization in the Treatment of Inferior Oblique Overaction.

Purpose: This study aimed to compare the surgical outcome of inferior oblique myectomy, IOM versus inferior oblique recession-anteriorization, IORA in the treatment of inferior oblique overaction, IOOA. Patients and Methods: A retrospective chart review was performed over a 12-year period, from 2009 to 2021. Eighty-nine patients diagnosed with IOOA who underwent IOM or IORA were included. The primary outcome was postoperative residual IOOA (grade 0 to +4) and percentage favorable outcome, defined as IOOA grade ≤1+ at 6 months post operation, in each group. The outcomes were compared between the two surgical procedures (IOM and IORA). The secondary outcome was the percentage of postoperative anti-elevation syndrome cases for each surgical procedure. Results: The median age at the time of surgery was 10.50 years (interquartile range, IQR: 2.83 to 28.33) in the IOM group and 5.08 years (IQR: 2.75 to 29.42) in the IORA group. The favorable outcome at 6 months was 90.91% in the IOM group, which was lower than the 95.74% in the IORA group but the difference was not statistically significant (P-value = 0.390, 95% CI: 0.07-2.82). The only surgical complication, anti-elevation syndrome, was detected in 3.77% of IOM cases and 5.80% of IORA cases, with an odds ratio of 0.64 on comparing the IOM group to the IORA group (P-value = 0.611, 95% CI: 0.11-3.62). Conclusion: These two weakening procedures are effective for treating IOOA. Although IORA seemed slightly superior to IOM in terms of favorable outcomes, the difference was not statistically significant. Moreover, the myectomy procedure was easier, was less time-consuming, had a lower risk of globe perforation and presented fewer complications such as anti-elevation syndrome.

Optimal Duration of Monocular Occlusion to Eliminate Fusion Effect in Intermittent Exotropia.

Purpose: To determine the optimal duration of monocular occlusion in patients with intermittent exotropia. Patients and Methods: This prospective cohort study enrolled 40 patients with intermittent exotropia at Ramathibodi Hospital between May 2023 and September 2023. Angles of deviation at distance (6 m) and near fixation (0.33 m) were measured before and after monocular occlusion for 30, 60, and 90 minutes. All measurements were performed by a single ophthalmologist. The mean angle of deviation was calculated at each time point. Results: The mean age at presentation was 12.5 years (range, 5-33 years). The mean angles of deviation before monocular occlusion were 27.8 ± 15.1 prism diopters (PD) at distance and 26 ± 13.7 PD at near fixation. At distance, mean angles of deviation after monocular occlusion were 32.2 ± 14.6, 32.9 ± 15.0, and 32.6 ± 14.7 PD at 30, 60, and 90 minutes, respectively. At near fixation, mean angles of deviation after monocular occlusion were 37.4 ± 15.0, 39.8 ±14.3, and 39.5 ± 14.6 PD at 30, 60, and 90 minutes, respectively. All angles significantly differed from the pre-occlusion deviation (all P < 0.01). For deviation at distance, there was no statistically significant difference between 60 and 30 minutes of monocular occlusion (P = 0.48). For deviation at near fixation, there was a significant difference between 60 and 30 minutes of monocular occlusion (P = 0.048), but the difference of 2.5 PD was not clinically significant. There were no statistically significant differences between 90 and 60 minutes of monocular occlusion at distance or near fixation (both P = 0.82). Conclusion: Monocular occlusion is necessary to eliminate the fusion effect in patients with intermittent exotropia; 30 minutes of monocular occlusion is sufficient to achieve the maximum angle of deviation.

Clinical features and incidence of visual improvement following systemic antibiotic treatment in patients with syphilitic uveitis.

To describe the clinical features, longitudinal pattern, and incidence rate of improvement of visual acuity (VA) following antibiotic therapy in patients with syphilitic uveitis. A total of 36 patients were included in this retrospective study from 2009 to 2020. The longitudinal patterns of mean VA values during follow-up were analyzed using a linear mixed model. Most patients were men with HIV coinfection (81%) and presented with panuveitis (49%). The mean VA at baseline improved from 0.97 to 0.39 logMAR at 6 months and remained stable thereafter. The cumulative incidence of VA ≥ 20/25 achieved by 2 years was 70%. Receiving antibiotic therapy within four weeks of the onset of ocular symptoms (adjusted hazard ratio [aHR] 3.4, P = 0.012), absence of HIV coinfection (aHR 8.2, P < 0.001), absence of neurosyphilis (aHR 6.5, P = 0.037), better presenting VA (aHR 5.0, P = 0.003), and intermediate uveitis as opposed to panuveitis (aHR 11.5, P = 0.013) were predictive of achieving VA ≥ 20/25. Men with HIV coinfection represented the majority of our patients. Visual outcomes, in response to antibiotics, were favorable. Delayed treatment, poor presenting VA, presence of HIV coinfection, and concomitant neurosyphilis decreased the likelihood of VA restoration.