A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years.

SIGNIFICANCE: Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial. PURPOSE: This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone. METHODS: Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (<0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner. RESULTS: A total of 182 children with anisometropic (63%), strabismic (16%; <5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines. CONCLUSIONS: In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.

Bilateral sterile sub-tenon abscess with vicryl suture reaction following strabismus surgery: A case report.

INTRODUCTION AND IMPORTANCE: After strabismus surgery, infections and complications are uncommon but avoidable with the right aseptic measures. Rarely have cases of non-infectious sub-tenon abscesses been documented in the past; these cases need to be appropriately recognized and treated. CASE PRESENTATION: In this report we describe a case of bilateral sub-tenon abscess 4 weeks after medial rectus recession. Despite receiving topical antibiotics for 7 days, there was no improvement, and multiple conjunctival cultures and sensitivity showed no growth. Both eye's sub-tenon abscess was drained, irrigated with gentamicin, and the fragile suture was removed. CLINICAL DISCUSSION: Sub-tenon abscess has been associated with bacterial infection which has more sever presentation. Several facts, including the lack of organisms in the pre-operative and intraoperative cultures, the presence of big cells resembling foreign bodies, and the improvement that occurred after suture extrusion, make infection unlikely in this case. CONCLUSION: We concluded that suture reaction is most likely to be responsible for a late-onset sub-tenon abscess with a negative culture and no response to antibiotics, and the suture should be removed.