Driving Skills Tested on Simulator After Strabismus Surgery: A Prospective Study.

Purpose: The sense of vision is responsible for 90% of the information obtained by the motorist. Improvement in binocular visual acuity (VA) and visual field (VF) achieved after strabismus surgery could have beneficial effects on driving. Our study sought to identify functional improvements (VA and VF) and improvements in driving ability following strabismus surgery. Methods: In a prospective cohort study, the following parameters are analyzed before and 3 months after strabismus surgery: simulated driving performance (including eye movements and actions on vehicle control), binocular VA, binocular VF, and self-confidence during driving. Results: Twenty patients participated in the study. The mean preoperative logMAR binocular VA and stereopsis do not significantly differ from the postoperative. The mean Esterman VF score increases from 91.3 (±17.2) preoperatively to 96.9 (±13.9) postoperatively (P = 0.045). The mean self-confidence directed at driving scores decreases from 20.5 (±10.3) points before surgery to 11.0 (±6.0) points after surgery (P < 0.001). The distance at which the road signs are identified is significantly higher after surgery. The average speed of the vehicle and the speed near the targets (30 m) increase significantly after strabismus surgery. A significant decrease in ocular movements near targets is also observed. The number of brake pedal depressions and the rate of brake pedal depressions slightly decrease after surgery. Conclusions: This study demonstrates the potential beneficial effects of strabismus surgery on driving ability, with significant improvements in self-confidence during driving, VF, and driving on a simulator. Translational Relevance: This was the first study to use a driving simulator in strabismus.

Surgical treatment of Metarhizium anisopliae sclerokeratitis and endophthalmitis.

A 55-year-old nurse was referred with a 5-month history of right eye corneal abscess. The initial injury occurred when doing lawn work. The infection worsened despite multiple antibiotic, antiviral, and steroid treatments. Visual acuity was limited to hand motion. On examination, there was keratitis, ocular hypertension, and a secondary cataract. Corneal scrapings grew a filamentous fungus, identified as Metarhizium anisopliae (MA). Despite intensive antifungal treatment with topical, intravitreous, and systemic voriconazole, purulent corneal melting and scleritis with endophthalmitis rapidly appeared. An emergency surgical procedure including sclerocorneal transplantation, cataract surgery, a pars plana vitrectomy using temporary keratoprosthesis, and scleral crosslinking was necessary. One year after the surgery, there was no recurrence of infection. Functional outcome remained very poor. This is the first case of sclerokeratitis and endophthalmitis caused by MA ever reported. The infection was successfully treated with an aggressive combination of medical and surgical treatments.