Inferior oblique muscle belly transposition and myopexy for diplopia.

To evaluate the outcomes of and review the indications for Inferior oblique muscle belly transposition in adults with diplopia and small-angle hypertropia associated with mild or moderate upshoot in adduction. We retrospectively analyzed data for the six patients who underwent the technique. Surgery was performed by suturing the inferior oblique belly to the sclera at 5 mm posterior to the temporal pole of the inferior rectus. Data were collected from October 2018 to April 2020. All six patients had diplopia and mild hypertropia (≤6 prism diopters [pd]) in primary position. Mean preoperative hypertropia was 4.17 pd (range, 2-6 pd). Mean age was 51 ± 28.71 years. The diagnoses were fourth nerve paresis (5) and dissociated vertical deviation (1). All patients had mild/moderate upshoot in adduction. Torticollis was observed in four cases. Diplopia resolved in 5 of the 6 cases. The mean final vertical deviation was 2 pd in straight gaze. Torticollis was eliminated in 2 patients and improved in another 2. The upshoot in adduction was totally eliminated in the six patients. Transitory mild limitation of elevation in adduction was observed in two patients during the first week after surgery. No ocular torsion was diagnosed after surgery. Mean time from surgery was 11.5 months. No overcorrections were recorded. Inferior oblique muscle belly transposition with myopexy is a good alternative procedure in patients with diplopia associated with mild-to-moderate upshoot in adduction and small-angle hypertropia.

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures.

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th ) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic.

Surgical treatment for small-angle vertical strabismus.

To assess the indications for and results obtained with partial vertical recti muscle recession in patients with diplopia and small-angle vertical strabismus. Retrospective study of patients who underwent partial temporal or nasal recession of the superior rectus (SR) or inferior rectus (IR). Outcome was considered favorable when diplopia had resolved in primary position and downward gaze at the end of the follow-up. A total of 17 cases were included. Mean age was 69.11 years (47% women). The diagnoses were fourth nerve paresis (6), hypertropia (3), incomplete third nerve paresis (3), sagging eye (1), age-related strabismus (1), ocular myasthenia gravis (1), and restrictive strabismus after retinal surgery (2). Mean preoperative vertical deviation was 6.11 pd in primary position, and postoperative vertical deviation was 2.05 (the mean difference was statistically significant, p < 0.001). Surgery was performed on the right eye in 29.41% of patients and on the left eye in 70.58%. The SR was treated in 11 cases (temporal pole in 7 and nasal in 4) and the IR in 6 (temporal pole in 3 and nasal in 3). Mean recession was 4.14 mm ± 0.42. Outcome was favorable in 76.47% of cases at the end of the follow-up (mean, 10 months), and the previous torsion was eliminated in 5. No overcorrections were recorded. Partial SR or IR recessions were successful in most cases of small-angle vertical strabismus. There were no overcorrections in primary position gaze.

Orbital magnetic resonance imaging is useful in age-related distance esotropia.

PURPOSE: To describe findings for orbital magnetic resonance imaging (MRI) in patients with age-related distance esotropia (ARDE). METHODS: We compared 31 orbital MRI from patients with ARDE (77±7 SD years) with 2 control groups: 32 orbits from individuals aged 18-50 years (33±8 SD years) and 16 orbits from individuals aged >60 years (77±7 SD years). MRI scans were acquired using 3D fast field echo in T1 sequence without fat saturation. Exclusion criteria for all groups were neurological or thyroid disease and a relevant ophthalmological history (e.g., high myopia, diplopia from another etiology, complicated cataract surgery, etc.). Muscle displacement and characteristics of the lateral rectus-superior rectus (LR-SR) intermuscular band were analyzed. RESULTS: The analysis of the muscles and angles revealed a series of statistically significant differences (p<0.07) between the groups. Subjects with ARDE had LR pulley positions 1.32±0.19mm lower than in younger controls, and the medial rectus (MR) pulley positions were 0.68±0.19mm lower than in younger. Older controls had LR and MR pulley positions 0.85±0.20mm and 0.49±0.23mm lower than in younger. ARDE subjects had LR pulley positions 0.46±0.26mm lower than in older control group. The LR-SR band was absent in 35.5% of ARDE patients and in 12.5% of older control group (p=0.168). CONCLUSIONS: MRI showed that displacements of LR and LR-SR band degeneration could facilitate the diagnosis of patients with ARDE.

Minimally Invasive Strabismus Surgery (MISS) Compared with the Fornix Approach in Pediatric Horizontal Strabismus Surgery.

OBJECTIVE: To compare minimally invasive strabismus surgery (MISS) with the fornix approach in horizontal strabismus operations. PATIENTS AND METHODS: We performed a retrospective study of all patients aged ≤ 12 years who underwent symmetrical surgery of the medial or lateral recti over a 1-year period. MISS was performed in one eye, and fornix opening was performed in the contralateral. We compared pre- and postoperative visual acuity (VA), conjunctival hyperemia, swelling after surgery, and operating time. The techniques were performed by 2 surgeons after a 4-year training period. RESULTS: The sample comprised 16 patients, with a mean age of 6.75 ± 3.02 years. The medial rectus was operated on in 9, the lateral rectus in 7 cases. Recession was performed in 14 muscles (mean dose, 5 mm) and plication in 2 (5.5 mm and 7 mm, respectively). MISS was performed in 12 right eyes and 4 left eyes. Preoperative VA was 0.77 in MISS and 0.80 in the control group. VA was 0.83 in MISS and 0.76 in the control group 1 day after surgery. No significant differences were found for conjunctival hyperemia between the MISS and fornix groups 1 day or 1 week after surgery. Nevertheless, moderate/severe conjunctival hyperemia was less frequent in the MISS group (31.3% versus 62.5%). No significant differences were found for operating time (14.43 minutes [MISS] vs 12.37 minutes [control]). CONCLUSION: The MISS technique was similar to the fornix approach in the early postoperative period with respect to VA, conjunctival inflammation, and operating time in pediatric horizontal strabismus surgery.