Sliding shape extraocular muscle transposition with plication: Long-term results.

AIM: This study aims to evaluate the long-term results of sliding shape extraocular muscle transposition, which is a novel operation method of delivering both vascular protection and strengthening of the muscles and transposition of the muscles. METHODS: The patients' files were scanned retrospectively. All patients underwent a complete eye examination in addition to motility examination, both preoperatively and postoperatively. Patients were followed up for at least 1 year. Pre- and postoperative deviation measurement values and transposition effects were compared statistically. The two parameters were evaluated separately. RESULTS: In patients where 7-mm (or greater) resection was planned, the complete muscle widening transposition procedure was successful. Only two-thirds of transpositions could be achieved in patients who underwent less than 7 mm of strengthening. There was no anterior segment ischemia in the patients who underwent three rectus' muscle surgery in the same eye. Transposition effects were perfect in those whose vertical deviation was not due to monocular elevation deficiency. While resection effect was excellent in those MED (monocular elevation deficiency) and CEOMF (congenital extraocular muscle fibrosis) cases, transposition effects were limited but found at similar rates as with the standard resection and transposition procedures in CCDD (congenital cranial dis-innervation diseases) (R2-1). CONCLUSION: Even transposition effects were limited in CCDD. 'Sliding shape' design extraocular muscle plication was found to be a simple, safe, and effective procedure for patients who needed resection and transposition operation.

Brown Syndrome: Features and Long-term Results of Management.

OBJECTIVES: The goal of this study was to evaluate surgical techniques and outcomes in patients with Brown's syndrome. METHODS: A retrospective review was conducted of patients who underwent surgery of the superior oblique (SO) muscle between 2003 and 2011 at a referral center. RESULTS: In all, 190 patients (111 female and 79 male) with an age range of 4-50 years were included in the study. The right eye was affected in 98 patients, and the left eye in 92 patients. Abnormal head posture (AHP), ocular movement (OM), and hypotropia were assessed. The greatest improvement of AHP was seen following an SO temporal tenotomy (91%). Patients with a -4 limitation achieved full OM after a SO temporal tenotomy. CONCLUSION: Temporal tenotomy provided the best improvement in limitation of elevation in adduction.

Effect of lateral rectus muscle resection on abduction in Duane retraction syndrome type 1.

PURPOSE: To assess the effect of lateral rectus muscle resection on abduction in Duane retraction syndrome (DRS) type 1. METHODS: The medical records of patients with DRS type 1 were reviewed retrospectively. Fifteen patients who underwent lateral rectus resection were included. Prism and cover test and the Krimsky test were used to detect deviations. Ocular ductions, abnormal head position (AHP), and globe retraction were recorded. RESULTS: Nine (60.0%) patients were female. The mean age was 13.1 ± 2.3 (range, 2-34) years. Left eyes were included in ten (66.7%) patients. Mean follow-up time was 37.6 ± 16.6 (range, 6-70) months. All patients had AHP, 13 patients had mild globe retraction, and 2 patients had no globe retraction preoperatively. Mean lateral rectus resection was 3.1 ± 0.7 (range, 2.0-4.5) mm, and the mean medial rectus recession was 4.4 ± 0.6 (range, 3.0-5.0) mm. The mean preoperative deviation decreased from 23.3 ± 6.9 (range, 14-35) prism diopters (pd) to 2.2 ± 4.1 (range, 0-10) pd at near, and from 23.6 ± 7.1 (range, 14-35) pd to 1.8 ± 3.5 (range, 0-10) pd at distance, at 6 months postoperatively (p = 0.01). The mean limitation in abduction decreased from - 3.2 ± 0.9 to - 1.3 ± 1.1 postoperatively (p < 0.001). AHP resolved in all patients. There was not a limitation in adduction or a worsening of globe retraction in any patient. CONCLUSION: Lateral rectus resection can be used to improve abduction in patients with DRS type 1 who have mild globe retraction. We assume that this procedure has no worsening effect on globe retraction in appropriate cases.

Muscle belly union surgery with or without medial rectus recession for the treatment of high myopic strabismus fixus.

PURPOSE: To evaluate the results of surgery involving the union of the superior rectus muscle and the lateral rectus muscle with or without medial rectus recession (MRc) for the treatment of high myopic strabismus fixus over a 20-year period. METHODS: The medical records of patients who underwent muscle belly union for the treatment of high myopic strabismus fixus were reviewed retrospectively. Patients were classified according to the timing of MRc. In group 1, MRc was performed before muscle union surgery; in group 2, MRc was performed concurrent with muscle union surgery; in group 3, MRc was not performed; in group 4, MRc was performed after muscle union surgery. RESULTS: A total of 50 eyes of 40 patients were included. Mean esotropia decreased from 57.27Δ ± 25.45Δ (range, 8Δ-100Δ) before surgery to 11.67Δ ± 13.85Δ (range, -18Δ to 45Δ) after (P < 0.001); mean hypotropia, from 6.05Δ ± 9.13Δ (range, 0Δ-13Δ) before to 1.20Δ ± 3.03Δ (range, 0Δ-10Δ) after (P < 0.001). Mean abduction improved from -2.82 ± 1.17 (range, -4 to 0) before to -0.75 ± 0.92 (range, -3 to 0) after (P < 0.001); mean elevation, from -1.62 ± 1.62 (range, -4 to 0) before to -0.57 ± 0.90 (range, -3 to 0) after (P < 0.001). Preoperative esotropia and postoperative limitation in abduction were significantly lower in group 3 (P = 0.03; P = 0.01). CONCLUSIONS: Muscle union surgery successfully corrected the restrictive esotropia and hypotropia. MRc in addition to muscle union surgery was not necessary for some patients, for whom preoperative esotropia was lower.

Assessment of Refractive Error Changes and Factors for Decompensation in Patients With Fully Accommodative Esotropia.

PURPOSE: To determine the factors affecting the risk of deterioration and evaluate the refractive error change in patients with fully accommodative esotropia. METHODS: Patients diagnosed as having fully accommodative esotropia (esotropic deviation that started before 7 years of age and less than 8 to 10 prism diopters [PD] of esotropia with full hyperopic correction and/or bifocals) were included in this retrospective population-based cohort study. Refractive error changes were recorded. For comparisons, patients were divided into two groups: nondecompensated fully accommodative esotropia group and decompen-sated fully accommodative esotropia group. RESULTS: Two hundred and twenty-three patients met the inclusion criteria. The mean follow-up time was 5.94 ± 0.31 years (range: 5 to 8 years). The changes in spherical equivalent in the younger than 7 years, 7 to 12 years, and 12 to 17 years groups were statistically significant (P < .001). The decrease of hypermetropia was 0.13 diopters/year between 7 and 12 years and 0.06 diopters/year between 12 and 17 years. Forty-one of 223 patients (18.4%) discontinued spectacle therapy during the follow-up period. Hyperopic error and presence of amblyopia were lower, whereas visual acuity level and presence of near-distance disparity were higher in the spectacle discontinuation group (P < .001, .007, .01, and 0.01, respectively). Deterioration of fully accommodative esotropia occurred in 30 of 223 patients (13.5%). Boys were more likely to require strabismus surgery (P = .32). The mean age at presentation, esotropia angle with and without refractive correction at both near and distance fixation, near distance disparity, and inferior oblique overaction were significantly higher in patients with decompensated fully accommodative esotropia. CONCLUSIONS: Hyperopic error increased from the initial level until 7 years of age, followed by a myopic shift thereafter. Few children had resolution of fully accommodative esotropia and could discontinue spectacle therapy. Children with male gender, higher esotropia angle, older age at presentation, near-distance disparity, and inferior oblique overaction experienced a greater deterioration of the fully accommodative esotropia. [J Pediatr Ophthalmol Strabismus. 2020;57(4):217-223.].

Laser in situ keratomileusis (LASIK) in patients with superior steepening on corneal topography: Is it safe and predictable?

BACKGROUND: Attention is usually given to inferior steepening on corneal topography in the evaluation of a patient's suitability for LASIK surgery. The aim of this study is to investigate long-term refractive results with superior steepening. METHODS: Patients who underwent LASIK surgery between 2015 and 2019 in our refractive surgery department were retrospectively reviewed. The patients with a ≥ 1.0 D superior-inferior (S-I) quadrant difference in the tangential map, using a Scheimpflug camera with a Placido disc topographer (Sirius), were included in the study. Preoperative and postoperative best-corrected and uncorrected visual acuity (Snellen), cylindrical refraction values, and spherical equivalent (SE) values were compared. Adverse events were recorded. RESULTS: Fifty eyes of 28 patients participated in the study. The mean age of the patients was 27.5 ± 8.0 (19-59). Sixteen patients were female (57.1%), and 12 (42.8%) patients were male. The average follow-up time was 29.8 ± 11.1 months (12-61). Average central corneal thickness was 549.4 ± 26.0 (498-602) µm. Average minimal corneal thickness was 549.1 ± 26.9 (497-598) µm. Preoperative S-I quadrant difference (D) was 1.87 ± 0.7 (1.0-3.99). Posterior elevation (Kvb) was 11.2 ± 1.9 (9-17) µm. The preoperative SE value was - 1.7 ± 2.1 (- 6.25-3.25) and improved to - 0.3 ± 0.44 D (- 1.25-0.75) (p < 0.001). Preoperative cylindrical refraction values were - 2.04 ± 1.7 (- 6.25-0), and postoperative values were - 0.47 ± 0.4 (- 2-0) D (p < 0.001). Uncorrected visual acuity was median 1.0 (0.4-1.0) with 38 eyes (76%) having 20/20 postoperative uncorrected visual acuity. No sight threatening complications or ectasia findings were observed during the 2 years postoperative follow-up time. CONCLUSIONS: Abnormal corneal topographies with (S-I) asymmetry result in predictable results after LASIK.

Anterior-Approach Versus Posterior-Approach Levator Advancement Surgery in Aponeurotic Ptosis.

PURPOSE: To compare the effectiveness and complications of levator reinsertion in aponeurotic ptosis surgery using anterior and posterior approaches. METHODS: Seventy-eight (36 females, 42 males) patients with acquired aponeurotic ptosis were evaluated. Pre- and postoperative margin reflex distance, symmetry of height, contour and skin crease, corneal problems, and lagophthalmus were evaluated and compared between the 2 groups. Independent and paired samples t-test, Pearson Chi-square, and Fisher exact test were used to evaluate the results. RESULTS: The anterior approach was performed on 43 eyelids and the posterior approach was performed on 35 eyelids. The mean age of the anterior-approach group was 62.1 ±â€Š11 years, and posterior-approach group was 50.1 ±â€Š15.1 years, respectively (P < 0.001). The male-female ratio was 28/15 in the anterior-approach group, and 14/21 in the posterior approach group (P = 0.027). The success rate of the anterior approach was 69.8% and the posterior approach was 57.1% (P = 0.248). The mean margin reflex distance change was statistically significant in both anterior- and posterior-approach techniques (P < 0.001, P < 0.001, respectively). Three (6.9%) patients in the anterior-approach group and 11 (31.4%) in the posterior-approach group required reoperation (P = 0.005). Lagophthalmus rates were similar (3 eyes in the anterior versus 7 eyes in the posterior group, P = 0.103). CONCLUSIONS: Both anterior- and posterior-approaches are effective and safe techniques for aponeurotic ptosis treatment. The posterior approach seems to be preferred by female and younger patients because there is no undesirable scar formation although it has the disadvantage of higher rates of reoperation.

Comparison of different tendon transposition techniques for the treatment of monocular elevation deficiency type 2.

PURPOSE: To compare results of three different tendon transposition techniques (Knapp procedure and two modified techniques) for the treatment of type 2 monocular elevation deficiency (MED) patients. METHODS: The medical records of patients with MED type 2 operated on at a single institution from 2000 to 2016 were reviewed retrospectively. Patients were divided into three vertical transposition groups: (1) full tendon width, (2) augmented surgery; and (3) partial tendon width. Surgical success was defined as no severe limitation of upgaze, hypotropia of <6Δ, and no hypertropia in primary position. Pre- and postoperative vertical deviations in the primary position and limitations in elevation levels were compared. RESULTS: A total of 39 patients were included. The pre- and postoperative deviations in the full-tendon group were 22.50Δ ± 4.17Δ and 3.50Δ ± 1.27Δ, respectively; in the augmented surgery group, 23.75Δ ± 4.78Δ and 1.75Δ ± 1.14Δ; and in the partial-tendon group, 20.50Δ ± 3.98Δ and 4.12Δ ± 2.78Δ. Corrected vertical deviations were 19Δ, 23Δ, and 16Δ, respectively. The pre- and postoperative limitation of elevations were -2.80 and -0.80 in the full-tendon group, -3.20 and -0.90 in the augmented surgery group, and -2.37 and -1.12 in the partial-tendon group. The pre- and postoperative vertical deviation improvements and limitations of elevation were statistically significant (P < 0.05) in all groups. Success was achieved in 29 patients (74%). CONCLUSIONS: In this study cohort, all three procedures were reasonably effective in improving vertical deviations and limitation of elevation.

Vertical rectus muscle union combined with lateral rectus plication for complete abducens nerve palsy.

PURPOSE: The aim of this study was to report our postoperative results concerning the vertical rectus (VR) muscle union combined with lateral rectus (LR) plication for the treatment of large-angle esotropia (ET) in complete abducens nerve palsy. METHODS: Medical records from 36 patients who had undergone the VR union procedure for ET treatment due to sixth-nerve palsy between July 2014 and July 2018 at Beyoglu Eye Research and Training Hospital were reviewed. One week before surgery, all patients underwent a 4-IU botulinum toxin A (btx) injection into the ipsilateral medial rectus (MR). All patients then underwent a VR muscle union procedure. A non-absorbable suture was inserted through the lateral muscular margin of each VR muscle at approximately 1/5 the width from the edge at 10 mm distance from the VR insertion. Both sutures were then tied to each other above the LR. Plication of the LR muscle using a non-absorbable suture was performed in all cases. RESULTS: The study population consisted of 14 (38.9%) females and 22 (61.1%) males. The mean age was 36.31 ± 19.16 years. The mean preoperative deviation angle in primary gaze into distance was 47.77 ± 18.48 prism diopter (PD). The mean deviation angle 1 year after surgery was - 1.0 ± 6.62 PD. Abduction improved from - 4.27 ± 0.46 to - 1.88 ± 0.96. CONCLUSION: The VR muscle union in combination with LR plication appears to be an effective treatment procedure for complete abducens nerve palsy patients.

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.

Optical Coherence Tomography Angiography: Are There Any Changes in Measurements After Strabismus Surgery?

PURPOSE: To evaluate the possible hemodynamic changes following strabismus surgery via optical coherence tomography angiography. METHODS: Thirty-two eyes of 16 patients who underwent strabismus surgery in one eye were included in the study. Fellow eyes were used as a control group. The vessel densities of the superficial and deep capillary plexus and superficial and deep foveal avascular zones were measured preoperatively and 3 months postoperatively. RESULTS: The mean superficial and deep foveal avascular zones measurements were 0.84 ± 0.09 and 0.76 ± 1.13 mm2, respectively. The mean vessel density of the superficial capillary plexus was 1.23 ± 0.12 and 11.13 ± 1.04 mm2 preoperatively in the 1- and 3-mm zones, respectively, whereas the mean vessel density of the deep capillary plexus was 1.13 ± 0.16 and 10.11 ± 1.28 mm2 preoperatively. Postoperatively, the mean superficial and deep foveal avascular zones changed to 0.20 ± 0.13 and 0.23 ± 0.12 mm2, respectively. Postoperatively, the mean vessel density of the superficial capillary plexus changed to 1.47 ± 0.11 and 12.75 ± 1.10 mm2, and the mean vessel density of the deep capillary plexus changed to 1.56 ± 0.12 and 13.91 ± 1.35 mm2 in 1- and 3-mm zones, respectively. There was a statistically significant increase in vessel density measurements of the superficial and deep capillary plexus, and a statistically significant decrease in measurements of the superficial and deep foveal avascular zone postoperatively (P < .05). In the fellow eyes, there was no statistically significant change in any of the measurements (P > .05). CONCLUSIONS: Following strabismus surgery, vessel density of the fovea may increase and the foveal avascular zone may decrease according to optical coherence tomography angiography measurements. [J Pediatr Ophthalmol Strabismus. 2019;56(2):95-100.].

Measurement of extraocular horizontal muscle insertion distance via anterior segment optical coherence tomography of healthy children and comparison with healthy adults.

PURPOSE: The aim of the study was to determine the corneal limbus-extraocular muscle insertion distance (LID), via anterior segment optical coherence tomography, in healthy children and healthy adults and to compare the results of the measurements of the two groups. METHODS: Muscle limbus distances were measured using AS-OCT in 60 healthy cases in two groups. Children aged 8-13 years were evaluated as group 1, and healthy adults aged 25-30 years were evaluated as group 2. Measurements of 120 horizontal muscles were taken by one doctor (OBO). The values were compared according to age and gender groups, and correlation between LID measurements and spherical equivalent. Statistical evaluation was performed using SPSS 16® for Windows with the Student's t test and Pearson correlation coefficient test. RESULTS: LID measurements for MR and for lateral rectus (LR) were 5.74 ± 0.75 and 6.74 ± 1.11 mm, in the pediatric age-group, and 5.73 ± 0.75 and 6.84 ± 1.15 mm, in the adult age-group, respectively. There was no statistically significant difference between the two groups in terms of MR distances. There was a slight increase in the adult values, for the LR distance. There was no significant difference in terms of gender. Correlation was found 0.62 for MR and 0.46 for LR between LID measurements and spherical equivalent in the pediatric age-group. CONCLUSIONS: In healthy individuals, different imaging modalities can be used to measure LID, but AS-OCT can be used in pediatric age-groups as a preferred imaging method because it is easy and noninvasive.

Simplified approach of Gokyigit's technique for complete cranial nerve third palsy.

PURPOSE: To evaluate a simpler approach of the medial transposition of split lateral rectus technique in patients with complete third nerve palsy. METHODS: All eyes with complet third nerve palsy were followed in our Strabismus Department between 2014 and 2016. All patients had complete oculamotor nerve palsy. All patients assed routine ophthalmologic examination. Also the ocular deviation, horizontal and vertical ocular alignments were measured at 6 m and at 1/3 m using the Krimsky corneal reflection test and alternate prism cover test with best optical correction. Same surgeon (BG) performed all procedures in general anesthesia. In this procedure, same Gokyigit's technique except upper and lower part of lateral rectus muscle was passed under the superior oblique tendon and inferior oblique tendon. Final deviation from 0 to 14 PD was considered a successful result. RESULTS: Eight patients were included in the study. The average ages were 39.4 years and male to female ratio 5:3. Patients had a preoperative horizontal deviation - 42.5 ± 2.7 PD and postoperative horizontal deviation - 1.7 ± 2.6 PD. All patients follow-up time were at least 6 months. CONCLUSIONS: Achieved to acceptable alignment in primary position, manage to diplopia and cosmetical appearance are the main aims of patients with third nerve palsy.

Foveal avascular zone area measurements with optical coherence tomography angiography in patients with nanophthalmos.

PURPOSE: To compare the area of the superficial foveal avascular zone (SFAZ) and deep foveal avascular zone (DFAZ) between patients with nanophthalmos and age matched controls. METHODS: This prospective and comparative study included 19 eyes from 11 patients with nanophthalmos (study group) and 19 eyes from 19 healthy subjects (control group). SFAZ and DFAZ were measured with optical coherence tomography angiography (OCT-A). All participants underwent a standardised ocular examination including best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) anterior chamber depth (ACD), axial length (AL), and refractive error (RE) measurements. RESULTS: Mean SFAZ and DFAZ area in the nanophthalmic eyes and in the control eyes were 0.09 ± 0.12 mm2, 0.10 ± 0.10 mm2 and 0.37 ± 0.10 mm2, 0.37 ± 0.10 mm2 respectively (p < 0.001 and p < 0.001). Mean BCVA, RE, AL, ACD CMT, SFCT, were 0.40 ± 0.34 logMAR Unit, 10.0 ± 2.2 18.1 ± 1.5 mm, 2.15 ± 0.28 mm, 367.1 ± 87.4 µm, 489.2 ± 85.2 µm respectively, in nanophthalmic eyes and there was a statistically significant difference between groups (p < 0.001 for each). There were negative correlations for both SFAZ and DFAZ with RE (r = -0.733 and r = -0.758, p < 0.001), CMT (r = -0.823 and r = -0.82, p < 0.001), SFCT (r = -0.647 and r = -0.717 p < 0.001) for the entire study population. SFAZ and DFAZ area were significantly correlated with AL (r = 0.732 and r = 0.745, p < 0.001) and ACD (r = 0.614 and r = 0.654, p < 0.001). In study group, 5 eyes did not have neither SFAZ nor DFAZ, 3 eyes had only DFAZ and 1 eye had only SFAZ in the OCT-A images. CONCLUSIONS: SFAZ and DFAZ area were significantly smaller in nanophthalmic eyes than control eyes.

Duane Retraction Syndrome and Accompanying Ocular Abnormalities.

OBJECTIVES: Duane retraction syndrome (DRS) is a congenital syndrome characterized by limitation in adduction and/or abduction eye movements and narrowing of the palpebral fissure in adduction, and may include globe retraction, upshoot or downshoot. Several systemic abnormalities, syndromes, and additional ocular findings can accompany DRS. This study is an evaluation of eye findings in patients with DRS. METHODS: The records of 632 patients with DRS who were followed up between 1995 and 2016 were reviewed retrospectively. Patients with a follow-up of less than 6 months and patients with a history of eye/cranial trauma or injury were not included in the study. Before the patients were examined, a detailed anamnesis was obtained. Details of the medical records, including additional systemic diseases, were recorded. RESULTS: The average of follow-up time was 45 months (min-max: 6-128 months). There were 255 male and 377 female patients. A total of 34 patients (5.4%) had additional ocular abnormalities. The most frequently observed ocular pathologies associated with DRS were congenital ptosis (n=6, 0.94%) and coloboma of the iris (n=4, 0.63%). CONCLUSION: Most cases of DRS are observed as isolated. However, various ocular and systemic abnormalities and syndromes are associated with DRS. In particular, synkinetic syndromes may frequently be seen alongside DRS. Therefore, a complete ocular examination and anamnesis are crucial in cases with DRS.

Sliding Shape Extraocular Muscle Transposition with Plication: A Novel Method.

OBJECTIVES: This study aims to present a novel operation method of delivering both vascular protection and strengthening of the muscles, as well as the transposition of the muscles. METHODS: The patients' files were scanned retrospectively. All patients underwent a complete eye examination in addition to motility examination, both preoperatively and postoperatively. Patients were followed up at least six months. Pre- and post-operative deviation measurement values were compared statistically. Operation technique: After being exposed and the rectus muscle was freed from the facial structure as far as planned resection amount. 6-0 coated vicryl sutures were then placed through the two sides of the muscle while protecting the blood vessels. Then, each suture was placed close to the muscle insertion and was aimed at transposition side. For example, if the target was to transpose the superior rectus at the temporal side, nasal side suture was placed at temporal edge of muscle insertion, and temporal side suture is placed approximately a tendon width laterally to the insertion. RESULTS: In patients who were planned resection 7 mm and over, the procedure for complete muscle widening transposition was successful. Only 2/3 transpositions could be achieved in four patients who underwent less than 7 mm of strengthening. There was no anterior segment ischemia in three patients who underwent three rectus muscle surgery in the same eye. CONCLUSION: 'Sliding shape' design extraocular muscle plication found a simple, safe and effective procedure for patients who needed resection and transposition operation. More patients and longer follow-up are needed to understand the real effectiveness.

Surgical Management in Type 1 Monocular Elevation Deficiency.

PURPOSE: To evaluate the outcome of surgical treatment in patients with type 1 monocular elevation deficiency. METHODS: Patients who were diagnosed as having type 1 monocular elevation deficiency by forced duction test and exaggerated traction test between 2000 and 2016 were retrospectively reviewed. Epidemiologic and clinical features of the patients were noted. The efficacy of ipsilateral inferior rectus recession to vertical misalignments and limitation of elevation were evaluated. The clinical features of the patients who did not achieve surgical success after inferior rectus recession were determined. The surgical and functional results of contralateral superior rectus recession were evaluated for patients who had residual hypotropia under inferior rectus recession. RESULTS: Thirty-nine patients were included in the study. Preoperatively, vertical deviations were 20.53 ± 4.50 prism diopters (PD) for near and 22.21 ± 5.12 PD for distance. After inferior rectus recession, the amount of vertical deviation corrected was 15 ± 1.14 PD for near and 17.01 ± 2.00 PD for distance. Ten (25.64%) patients did not achieve surgical success (> 6 PD residual hypotropia). Nine patients (preoperative inferior rectus recession measurements = 28.77 ± 7.25 PD for near and 27 ± 7.44 PD for distance) underwent contralateral superior rectus recession as a second surgery. After contralateral superior rectus recession, 7 of 9 (77.78%) patients achieved surgical success. The limitation of elevation significantly improved after both surgeries (Wilcoxon test, P < .05). No diplopia or other complications after surgeries were reported. CONCLUSIONS: Inferior rectus recession is the first surgical option for patients with type 1 monocular elevation deficiency. Contralateral superior rectus recession is an effective alternative surgical treatment for residual hypotropia after ipsilateral inferior rectus recession. [J Pediatr Ophthalmol Strabismus. 2018;55(6):369-374.].

Comparison of visual acuity measurements via three different methods in preschool children: Lea symbols, crowded Lea symbols, Snellen E chart.

PURPOSE: The aim of this study was to compare three different methods to measure visual acuity (VA) in healthy and amblyopic preschool children: a Snellen E chart (SE), a single Lea symbols (SLS), and a crowded Lea symbols (CLS). METHODS: Seventy-eight eyes of 54 patients (28 females, 26 males) were included in this cross-sectional, comparative study. The control group consisted of 30 healthy cases, and the amblyopic group consisted of 24 patients with amblyopia. Best-corrected VA (BCVA) measurements with SLS, CLS, and SE were compared in control eyes (CE), amblyopic eyes (AE), and fellow eyes (FE) separately. RESULTS: The mean age of the cohort was 5.7 ± 0.7 years (range 5-7 years). The mean refractive error was +1.02 ± 0.36 D (diopter, spherical equivalent) in CE, +5.59 ± 2.45 D in AE, and +3.96 ± 2.38 D in FE. The median BCVA (logMAR) was (in order of SLS, CLS, and SE) 0.00 [interquartile range (IQR) 0.10], 0.10 (IQR 0.10), 0.00 (IQR 0.10) in CE, 0.25 (IQR 0.33), 0.35 (IQR 0.30), 0.25 (IQR 0.38) in AE, and 0.10 (IQR 0.08), 0.10 (IQR 0.00), 0.10 (IQR 0.10) in FE. There was no statistically significant difference between the three methods in terms of the CE or FE (p > 0.05). In contrast, there was a statistically significant difference in AE (p < 0.05). The mean VA measurement with SLS was higher compared with CLS in AE. A positive and strong correlation between the three charts was found in all of the groups (p < 0.001). CONCLUSION: We found SLS, CLS, and SE to be consistent: all three methods can be used to obtain measurements of VA in healthy and amblyopic preschool children.

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.

A New Side Effect of Intravitreal Dexamethasone Implant (Ozurdex®).

Dexamethasone implant, 0,7 mg (Ozurdex, Allergan, Inc., Irvine, CA, USA), is drug mostly used in the treatment of the diabetic macular edema and edema related to retinal vein occlusion. By reporting this case we aimed to report a new side effect of 0.7 mg intravitreal dexamethasone implant that has not been reported in the literature before.