Surgically Induced Scleritis Associated With Suture Hypersensitivity Following Strabismus Surgery.

A 67-year-old woman with history of mild suture hyper-sensitivity presented with localized scleritis after strabismus surgery. After infection was ruled out, the patient was prescribed topical and systemic non-steroidal anti-inflammatory drugs and systemic steroids, which led to full clinical resolution. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e4-e6.].

Carotid blood flow in abnormal head posture: a prospective observational study exploring facial asymmetry in strabismus.

PURPOSE: To investigate whether abnormal head posture (AHP) induces changes in common carotid artery blood flow (CCBF), thereby leading to the development of facial asymmetry in the setting of strabismus and ocular torticollis. METHODS: This was a prospective observational study of pediatric subjects in an urban ophthalmology clinic who underwent bilateral carotid artery ultrasound examination with spectral Doppler in an upright, straight-head posture and with a head tilt of 30°-45° to the right and left. The primary outcome was change in carotid flow on the side of the head tilt. The secondary outcome was change in blood flow on the contralateral side of the head tilt. RESULTS: Seventeen subjects were enrolled, and 34 carotid arteries were assessed. There was no significant difference between upright, straight-head position and head tilt in ipsilateral (7.8 ± 1.8 mL/s vs 7.5 ± 2.0 mL/s [P = 0.4312]) or contralateral (7.8 ± 1.8 mL/s vs 8.1 ± 2.4 mL/s [P = 0.3401]) CCBF. CONCLUSIONS: CCBF does not fluctuate with AHP and thus does not appear to be the etiology for facial asymmetry in strabismus.

Surgical outcomes for esotropia in children with high accommodative convergence/accommodation ratio.

PURPOSE: To assess if high accommodative convergence/accommodation (AC/A) ratio impacts surgical outcomes in children with esotropia (ET), and evaluate the appropriate target angle in surgical dosing in the presence of high AC/A ratio. METHODS: A retrospective chart review identified patients who underwent primary bilateral medial rectus (BMR) recessions for ET. Patients were excluded if follow-up was ≤2 months. Basic demographic information, visual acuity, stereopsis, alignment, and target angle for surgery were collected. High AC/A was defined as ≥10 prism diopter (Δ) deviation at near compared to distance. Outcome parameters were near and distance deviations ≤10Δ within orthophoria, and/or stereopsis postoperatively. Yates' continuity correction, unpaired t-test, regression analysis, and one-way ANOVA were used. RESULTS: We identified 103 patients, 23 with high AC/A and 80 with normal AC/A, preoperatively. Mean age was 4.0 ± 2.5 years. Surgical success measured by postoperative alignment was 48% and 45% in the high AC/A and normal AC/A groups, respectively (P = 1.0). There was a statistically significant difference in preoperative near deviation between high AC/A and normal AC/A groups (P = 0.0015); however, there was no significant difference in preoperative distance deviation (P = 0.061). In addition, there was not a significant difference in preoperative or postoperative stereopsis between high AC/A and normal AC/A groups (P = 0.88 and P = 0.44, respectively). There was a significant difference in the normal AC/A and high AC/A groups when target angle was directed toward preoperative near deviation as determined by one-way ANOVA (F = 170.88, P < 0.0001 and F = 14.61, P = 0.0010, respectively). CONCLUSION: In the setting of ET treated with BMR recession, the presence of high AC/A does not affect surgical success as measured by alignment and stereopsis. In addition, when high AC/A is present, surgical dosing with a target angle toward near deviation was found to yield the best surgical outcomes in our patient population.

Retinoschisis and hyperopia associated with partial monosomy of 6q and partial trisomy of 11q.

BACKGROUND: Retinoschisis, or retinal lamellar splitting, can occur in a number of hereditary conditions. The most common cause of congenital or childhood onset retinoschisis is the clinical entity known as juvenile retinoschsis, which is caused by mutations in the X-linked retinoschisis 1 gene. Genes other than X-linked retinoschisis 1 gene have rarely been implicated in association with hereditary retinoschisis. METHODS: We describe a 9-year-old male who presented with several phenotypic features associated with partial monosomy of chromosome 6q and partial trisomy of chromosome 11q, including myelomeningocele, mental and growth retardation, seizures, microcephaly, scoliosis, and facial dysmorphisms, as well as novel ocular findings including bilateral retinoschisis and hyperopia. RESULTS: This case report highlights the necessity for a detailed ophthalmic examination of patients with both 6q deletions as well as 11q duplications to ensure accurate and timely diagnosis and treatment of the complications associated with the described ocular conditions.

Comparison of inferior oblique myectomy to recession for the treatment of superior oblique palsy.

PURPOSE: To compare inferior oblique (IO) myectomy with recession for the treatment of superior oblique (SO) palsy. METHODS: A retrospective review of medical records identified all patients with SO palsy who underwent IO weakening procedures. Patients were excluded if IO muscle surgery was bilateral, combined with other vertical muscle surgery and if follow up was less than 4 weeks. Good outcome parameters were: improvement of deviation in primary gaze, resolution of diplopia in primary and reading gazes and correction of head tilt to the contralateral side. We analysed subsets of subjects with large preoperative vertical deviations (>15Δ) and those with small-moderate deviations (≤15Δ). Comparisons were made using Wilcoxon rank sum and Fisher's exact tests. RESULTS: Eighty-five patients met the study criteria. Forty-three eyes underwent myectomy, and 42 underwent recession of the IO. Those patients who underwent myectomy compared with recession had less postoperative hypertropia (HT) in primary gaze (p<0.001) and were more likely to meet criteria for success as measured by ≤4Δ residual HT (p=0.056). This difference was pronounced (p=0.005) in patients with preoperative small-moderate deviations, but statistical significance was lost in patients with large preoperative deviations. There was no difference between the two groups with respect to resolution of diplopia or anomalous head tilt. CONCLUSIONS: IO weakening procedures, including both recession and myectomy, are effective in the treatment of SO palsy. While the two procedures were similar in treatment of diplopia and abnormal head tilt, our findings support myectomy as slightly more effective than recession in improving HT in primary gaze; this difference is more pronounced in individuals with small-moderate preoperative hyperdeviations.