Clinical characteristics and surgical outcomes in patients with superior oblique muscle palsy: a retrospective study on 1057 patients.

BACKGROUND: To evaluate the clinical findings of patients with SOP who underwent surgery. METHODS: This historical cohort study was performed on 1057 SOP patients managed with surgery in Farabi Hospital, Iran, from 2011 to 2022. RESULTS: There were 990 (93.7%) patients with unilateral SOP with the mean age of 21.8 ± 14.8 years. Of these, 715 patients (72.2%) were diagnosed with congenital SOP, and 275 patients (27.8%) had acquired SOP (P < 0.001). In contrast, 67 (6.3%) patients were diagnosed with bilateral SOP, with the mean age of 19.4 ± 15.6 years. Among these, 18 cases exhibited the masked type. The mean angle of vertical deviation in primary position at far in unilateral and bilateral cases was 15.6 ± 8.3 and 13.3 ± 9.1 △, respectively (P < 0.001). In unilateral cases, abnormal head posture (AHP) was detected in 847 (85.5%) patients and 12 (1.2%) had paradoxical AHP. Amblyopia was found in 89 (9.9%) unilateral and 7 (10.3%) bilateral cases. Solitary inferior oblique myectomy, was the most common surgery in both unilateral (n = 756, 77.1%) and bilateral (n = 35, 52.2%) patients. The second surgery was performed for 84 (8.6%) unilateral and 33 (49.3%) bilateral cases (P < 0.001). The prevalence of amblyopia and the mean angle of horizontal deviation were significantly higher in patients who needed more than one surgery (all P < 0.05). CONCLUSION: Congenital SOP was more than twice as frequent as acquired SOP and about 90% of unilateral and 50% of bilateral cases were managed with one surgery. Amblyopia and significant horizontal deviation were the most important factors for reoperation. TRIAL REGISTRATION: The Institutional Review Board approval was obtained from the Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1400.012) and this study adhered to the tenets of the Declaration of Helsinki and HIPAA.

Mini Nutritional Assessment (MNA) is Rather a Reliable and Valid Instrument to Assess Nutritional Status in Iranian Healthy Adults and Elderly with a Chronic Disease.

This study aimed to evaluate the usefulness of the Mini Nutritional Assessment (MNA) to assess nutritional status of Iranian population and to compare its psychometric properties between patients suffering from a chronic disease, healthy elderly and younger adults. As a group of elderly with a chronic disease, 143 Parkinson's disease (PD) patients and as the control group, 467 healthy persons were enrolled. The Persian-translated version of MNA was filled-up through interviews together with anthropometric measurements. Cronbach's α coefficient of entire MNA was 0.66 and 0.70 in healthy individuals and PD patients, respectively. The total MNA score could significantly discriminate the ones with BMI ≥ 24kg/m(2) in both groups. In general, MNA was a valid and reliable tool for nutritional assessment. We acknowledge study limitations including lack of serum measurements and a selection bias towards mild-to-moderate PD. MNA is a more reliable tool in older healthy individuals and rather younger elderly with PD.

A rare case of inferior rectus dermoid cyst causing proptosis and optic neuropathy.

Purpose: To report a rare case of orbital dermoid cyst, involving the inferior rectus muscle, in a 26-year-old female presenting with proptosis and blurred vision in her right eye. Observations: The unique features of this case are discussed, including the location and contents of the cyst, the surgical approach, and the postoperative outcome. Conclusion and importance: The importance of considering dermoid cysts in the differential diagnosis of an orbital mass involving extraocular muscles and the need for a thorough evaluation to diagnose and manage these rare lesions.

Acute bilateral nodular scleritis following strabismus surgery in a patient with Down syndrome.

Scleritis is a rare complication of strabismus surgery. We present the case of an 11-year-old girl with Down syndrome who underwent strabismus surgery and developed bilateral symmetric nodular scleritis 3 weeks after surgery. Anterior segment optical coherence tomography revealed localized hyporeflective thickening of the sclera at the primary site of muscle insertion in both eyes. Treatment with topical and oral corticosteroids led to resolution of her condition.

Refractive features and amblyopia in Duane's Retraction Syndrome: A review of the 582 patients.

PURPOSE: To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS). METHOD: This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022. RESULTS: The mean age of patients was 19.4 ± 11.9 (range, 3-70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia. CONCLUSION: This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.

Fluoxetine as a possible treatment for adult amblyopia: results of a double-blind, randomized, placebo-controlled trial.

PURPOSE: To evaluate the effects of oral fluoxetine on visual acuity and visual-evoked potential (VEP) parameters in adults patching for amblyopia. METHODS: In this randomized clinical trial, adults (>18 years of age) with anisometropic or strabismic amblyopia were assigned randomly to a treatment (fluoxetine) group or a placebo group. Standard treatments for amblyopia (glasses prescription and patching) were prescribed for 4 months for all patients beforehand. The first group received fluoxetine (20 mg per day) and the second group received a placebo for 3 months, both continuing patching. Visual acuity evaluation and VEP were performed before and after treatment. RESULTS: A total of 55 participants were included: 29 in the fluoxetine group and 26 in the placebo group. Mean age was 27.2 ± 8.6 years (18-54). The mean logMAR visual acuity of the amblyopic eye improved by 0.20 ± 0.24 (0-0.8) in the fluoxetine group (P < 0.001) and by 0.08 ± 0.15 (0-0.7) in the placebo group (P = 0.01); mean logMAR improvement was significantly higher in the fluoxetine group than in the placebo group (P = 0.04). At the end of the study, mean visual acuity of the fluoxetine group (0.36 ± 0.21 log MAR) was better than the placebo group (0.43 ± 0.35 log MAR). Among the VEP parameters, N75 amplitude did not change significantly in either group relative to baseline, but the changes were statistically significantly different between the two groups (P = 0.05); N135 latency improved from baseline in the fluoxetine group (P = 0.03). CONCLUSIONS: In our study cohort, fluoxetine treatment resulted in greater improvement in visual acuity than placebo during patching for adult amblyopia.

Internuclear Ophthalmoplegia Following COVID-19 with Abnormal Findings on Neuroimaging; A Case Report.

COVID-19 had been reported to be associated with neuro-ophthalmic complications. However, there is a shortage of evidence regarding internuclear ophthalmoplegia (INO) presentation after COVID-19 infection with related brain magnetic resonance imaging (MRI). Herein, we report a case of INO in a 69-year-old woman with presentation of diplopia following COVID-19 infection, along with her neuroimaging. We concluded that it is important to recognize the possibility of INO in patients with diplopia after COVID-19 and to consider brain MRI as an informative tool in these patients.

Eccentric Fixation and Good Visual Acuity in a Child with Large Traumatic Macular Hole: A Case Report.

A girl of 8 years old was referred to our clinic with a history of penetrating injury to her left eye 6 years ago with light perception vision and a large traumatic macular hole in her right eye. Her right eye's vision was 4/10 when she first visited our clinic. Considering the patient's one-eye status, her parents' reluctance to undergo surgery, and the possibility of spontaneous closure of traumatic macular holes, it was determined to observe the patient and evaluate her visual acuity and macular hole condition. In 2 years, the final best corrected visual acuity was 8/10 in the right eye, with infratemporal eccentric fixation in visuoscopy. In addition to evaluating and reporting this case as a traumatic macular hole, we will discuss the role of nonsurgical treatment and the possibility of good visual acuity with eccentric fixation in a child with large traumatic macular hole.

No-split, no-tenotomy transposition of only the superior rectus muscle combined with medial rectus recession in patients with complete abducens nerve palsy.

PURPOSE: To evaluate the outcomes of no-split, no-tenotomy transposition of only the superior rectus muscle combined with medial rectus recession in patients with complete abducens nerve palsy. METHODS: In this procedure, the temporal margin of the superior rectus muscle, 10 mm posterior to the insertion, was secured with a nonabsorbable suture and sutured to the sclera at a distance of 12 mm from the limbus in the superotemporal quadrant, halfway between the superior rectus and lateral rectus. Success was defined as distance and near alignment of ≤8Δ and no diplopia in primary position 6 months after surgery. RESULTS: A total of 8 patients with abducens nerve palsy underwent the procedure. At the last follow-up, the mean postoperative change in primary position deviation was 42.6Δ ± 8.1Δ (range, 34Δ-57Δ) for distance and 42.1Δ ± 7.5Δ (35Δ -57Δ) for near, a significant reduction (P = 0.012). Abduction deficit also improved significantly (P = 0.010). Postoperatively, no vertical deviation or torsional diplopia was induced. At the 6 months' follow-up, compared with the first postoperative visit, an esodrift at near developed in 1 patient. Of the 8 cases, 6 fulfilled the criteria for success. CONCLUSIONS: In our small study cohort, no-split, no-tenotomy superior rectus transposition and medial rectus recession improved esotropia and abduction limitation without inducing significant vertical deviations or torsional diplopia.

Computed tomography scan to diagnose abducens nerve palsy cases with superior-compartment atrophy.

PURPOSE: To use orbital computed tomography (CT) to explore the proportion of superior-compartment lateral rectus muscle atrophy in abducens nerve palsy and its relationship with clinical findings. METHODS: Twenty-two patients with isolated unilateral abducens nerve palsy were enrolled. Orbital CT scans of all patients were acquired. All measurements were performed in two ways for normal and paretic lateral rectus muscles: posterior volume (mm3) and maximal cross-section area (mm2). These variables were also measured separately in the superior and inferior 40% of the muscle. Primary position esotropia and amount of abduction limitation was also recorded. RESULTS: The mean deviation was 23.4Δ ± 12.1Δ (range, 0Δ-50Δ); the mean limitation of abduction, -2.7 ± 1.3 (range, -1 to -5). Seven cases (31.8%) showed the gross morphologic characteristics of superior-compartment atrophy. In these 7 cases, the mean percentage of atrophy in posterior volume and in maximal cross-section was significantly greater in the superior compartment than the inferior compartment (P = 0.02 for both). The mean limitation of abduction in these 7 cases (-1.7 ± 0.9; range, -1 to -3) was significantly lower than in other cases (-3.1 ± 1.3, range, -1 to -5 [P = 0.02]). CONCLUSIONS: In our study cohort, a subgroup of abducens nerve palsy cases demonstrated evidence of superior portion lateral rectus atrophy on orbital CT. The superior-compartment-atrophy group had both a smaller primary gaze esotropia and a smaller abduction deficit, providing evidence that compartmental atrophy should be considered in patients with partially retained lateral rectus function.

Anaglyphic Three-Dimensional Movie: A Simple Binocular Method to Treat Anisometropic or Strabismic Amblyopia in Adults.

Purpose: To evaluate the efficacy of anaglyphic three-dimensional movies to treat adults with anisometropic or strabismic amblyopia. Methods: This is an interventional case series. The seven cases were put on a trial frame containing subjective refraction, fogging plus lenses for the dominant eye, correcting prism, and anaglyphic red-cyan plastic spectacles. Patients participated in 20 sessions of 1.5 h of anaglyphic three-dimensional animated movie watching in the office. Significant visual acuity (VA) improvement was defined as improvement ≥0.2 in logMAR values. Change in octaves of stereopsis was defined as halving the arcsec or 0.3 change in log arcsec. Results: The average age was 26.9 ± 10.0 (16-42) years. The mean VA in amblyopic eye improved significantly from 0.42 ± 0.19 (0.15-0.7) logMAR to 0.25 ± 0.15 (0.1-0.5) logMAR after completion of sessions (P = 0.02), and four cases showed significant VA improvement. The mean stereoacuity improved significantly from 2.6 ± 0.3 (2.1-2.9) log arcsec to 2.1 ± 0.5 (1.7-2.9) log arcsec (P = 0.04). Four cases showed ≥2 octaves improvements in stereopsis. Conclusion: A simple and readily available method of amblyopia treatment can be effective in some adult cases.

Superior Rectus Transposition Surgery: Safety, Efficacy, and Place in Therapy.

Abduction limitation in esotropic Duane retraction syndrome (DRS), esotropic Mobius syndrome, and sixth nerve palsy is one of the difficult-to-manage problems in strabismus surgery. The procedure of superior rectus transposition (SRT) was introduced by Johnston et al. In this procedure, the superior rectus (SR) muscle is disinserted and sutured adjacent to the insertion of lateral rectus (LR) muscle. The purpose of this review is to explore literature about efficacy and safety of SRT and its usage in strabismus surgery.

Modified transposition using silicone band for multiple rectus muscle palsies.

Purpose: To report the results of partial vertical rectus muscle transposition using a silicone band. Observations: We retrospectively gathered data on two patients with multiple vertical and horizontal extraocular muscle paresis and diplopia who had been treated with vertical rectus muscle transposition with the aid of a silicone band. Both patients had acceptable results on follow-up. Conclusion: Using the silicone band, we tried to effectively transpose the target muscles to obtain acceptable results.

A Review of Transposition Techniques for Treatment of Complete Abducens Nerve Palsy.

PURPOSE: To review various types of extraocular muscle transposition procedures for management of strabismus in sixth cranial nerve palsy with little lateral rectus (LR) muscle function, along with their pros and cons. METHODS: We performed a comprehensive review of transposition procedures in sixth cranial nerve palsy, based on literature published anytime up to March 2021. A thorough search through PubMed and Cochrane databases was performed. All types of clinical studies on different transposition procedures in LR palsy, were included. RESULTS: Eighty-six original articles in English, with full text or abstracts available, were included in the review, among which 16 are prospective studies, 48 retrospective, 3 review articles, 1 randomized clinical trial, 17 case reports, and 1 letter. Vertical rectus transposition has demonstrated promising results, especially in abduction improvement and expansion of binocular diplopia-free visual field, albeit the possible adverse effects such as anterior segment ischemia, especially in the presence of medial rectus contracture, and induced vertical deviation may become troublesome. Partial muscle transposition, single muscle transposition, and also transposition without tenotomy have all been introduced to reduce the risk of multiple muscle manipulation and ischemia. On the other hand, different adjustable transpositions are being utilized to manage concomitant or induced vertical deviations. CONCLUSION: Transposition procedures are highly effective in the treatment of esotropia caused by complete LR palsy. Various techniques for vertical muscle transposition have been proposed, with each of them having certain advantages and disadvantages.

Prevalence of malnutrition in patients with Parkinson's disease: a comparative study with healthy controls using Mini Nutritional Assessment (MNA) questionnaire.

BACKGROUND: The magnitude of malnutrition in the Parkinson's disease (PD) population has yet to be accurately quantified. OBJECTIVE: We aimed to estimate and compare the prevalence of malnourished and those at risk of malnutrition in Iranian PD patients with a matched control group using the mini nutritional assessment (MNA) and anthropometric measurements. METHODS: Nutritional status was evaluated in 143 Iranian PD patients (case group) and 145 age- and sex-matched healthy controls (control group) using the validated Persian version of the MNA. Individuals suffering from chronic comorbidities influencing nutritional state (hypertension and diabetes), following special diets and those with cognitive impairment were excluded. Using the MNA, a total score of <17 indicated malnutrition and scores of 17-23.5 signified cases at risk for malnutrition. RESULTS: The mean of total MNA score was not significantly different between two study groups [24.4 (SD = 3.8) in controls vs. 25.1 (SD = 3.4) in PD patients; P = 0.094]. Three (2.1%) PD patients were suffering from malnutrition and another 37 (25.9%) were at risk of malnutrition; while in control group similar feature was observed (2.0% malnourished and 35.2% at risk of malnutrition; P = 0.228). The mean of calf circumference (CC) was significantly lower in PD patients [34.9 (SD = 3.8) cm vs. 36.0 (SD = 5.1) cm; P = 0.046]. CONCLUSIONS: Our findings indicate the same nutritional status among mild to moderate PD patients compared with healthy controls. However, more than a quarter of the PD population was found to be at risk of malnutrition necessitating more attention towards nutritional assessment in PD.