Plication or resection combined with antagonist recession in horizontal strabismus.

Background: Strengthening of extraocular muscles is a conventional procedure in the management of strabismus. Plication may be an alternative strengthening technique, and is less invasive than resection. This study compared plication and resection, each combined with antagonist muscle recession, in terms of success rates and changes in ocular deviation in the management of horizontal strabismus. Methods: This retrospective study recruited individuals with horizontal strabismus who underwent plication (group I) or resection (group II) coupled with antagonist muscle recession. All participants underwent a detailed baseline eye and ocular motility evaluation. Demographic and clinical data were collected, including age, sex, type of preoperative strabismus (exotropia or esotropia), baseline visual acuity, mean follow-up duration, laterality of operated eye, surgical doses of correction (resection, plication, or recession) in millimeters, preoperative strabismus magnitude in prism diopters (PD), and postoperative strabismus magnitude in PD. Successful postoperative deviation was defined as ≤10 PD. At final follow-up, the success rates and degrees of change in angle of deviation were recorded. Results: Forty-four patients were enrolled: 19 patients in group I (plication) and 25 patients in group II (resection). The groups had comparable ages, sex ratios, types of strabismus, and preoperative and postoperative angles of deviation (all P > 0.05). Despite comparable success rates between groups (73.7% in group I versus 64.0% in group II, P > 0.05), the difference (9.7%) was marginally close to the predefined clinically meaningful difference of 10%. In the esotropia subgroup, despite comparable alignment between the plication and resection groups (P > 0.05), the difference was clinically meaningful (17.3%), and both groups had higher success rates in the esotropia subtype than in the exotropia subtype. The rate of over- or undercorrection was not statistically or clinically different in the total and in each subtype of strabismus (all P > 0.05). Success rates for unilateral and bilateral cases were similar between groups (both P > 0.05). Changes in angle of deviation were similar for individuals with esotropia and exotropia between groups (both P > 0.05). Conclusions: In esotropic and exotropic strabismus, plication and resection procedures combined with antagonist recession were similarly effective. However, further randomized, large-scale, longitudinal studies with clinical and subjective evaluations could comitant strabismus, squint, esotropias, primary exotropia, exodeviation, plication, resection, recession, amblyopias.

Myopia progression in school children with prolonged screen time during the coronavirus disease confinement.

Background: Myopia, the most common refractive error, is a global public health problem with substantial visual impairment if left untreated. Several studies have investigated the association between increased near-work and restricted outdoor activities in children with myopia; however, such studies in children without myopia are scarce. We aimed to monitor the effect of the coronavirus disease-2019 (COVID-19) home confinement and mandatory virtual learning on myopic progression among myopic and non-myopic school-aged children. Methods: We conducted a retrospective chart review of children aged 6 - 12 years attending regular visits to the pediatric ophthalmology clinic in a tertiary eye hospital in Eastern Province, Saudi Arabia. Cycloplegic refraction was determined from three visits at least six months apart: two visits before the start of the COVID-19 pandemic and one during the COVID-19 home confinement. Parents were asked about the time spent in near-work and outdoor activities, the devices used during virtual learning, and the demographic characteristics of the children. Statistical analyses were conducted to compare myopia progression before and during the COVID-19 home confinement. Results: A total of 160 eyes of 80 children were analyzed. The boy (n = 46) to girl (n = 34) ratio was 1.4:1. The hyperopia (n = 131 eyes) to myopia (n = 29 eyes) ratio was 4.5:1. Most eyes exhibited a hyperopic shift before the confinement; however, all eyes displayed a myopic shift during the confinement. When comparing both eyes of the same individual, the more myopic or less hyperopic eye in the same child had a significantly greater myopic shift than the fellow eye (both P < 0.05). Children who used tablets showed a significant myopic shift (P < 0.05). Likewise, children in both age categories ( ≤ 8 and > 8 years), boys, those living in an apartment, and those having parents with bachelor's degrees experienced a significant myopic shift during COVID-19 home confinement compared to before (all P < 0.05). The mean myopic shift was greater in children aged > 8 years than in those aged ≤ 8 years. Children with and without a family history of myopia had a myopic shift in the mean spherical equivalent during COVID-19 home confinement; however, that of children with no family history was statistically significant (P < 0.05). Conclusions: Progression of myopia accelerated in children during the COVID-19 pandemic. Excessive time spent on digital screen devices at near distances is considered a substantial environmental contributor to myopic shift in children. Further multicenter studies with extended follow-up periods are needed to assess the factors contributing to myopic progression in our population.

Comparison of Dose Increments of Botulinum Toxin A with Surgery as Primary Treatment for Infantile Esotropia and Partially Accommodative Esotropia.

Purpose: To compare the effect of increment dose of botulinum toxin (BTX) injection in correlation to the angle of deviation to bilateral medial rectus recession (BMR) in infantile esotropia and partially accommodative esotropia (PAET). Methods: This was a retrospective study that included pediatric patients ≤16 years old with infantile esotropia and PAET at Dhahran Eye Specialist Hospital (DESH) from 2014 till 2021 treated with increment dose of BTX or BMR. A successful outcome is defined as ocular alignment within 10 PD of deviation after 1-3 BTX injections or one surgery with a minimum follow-up of 6 months. Results: Of 177 patients, 101 patients received BTX treatment for either infantile esotropia (n = 37) or PAET (n = 64) and 76 patients underwent BMR for either infantile ET (n = 25) or PAET (n = 51). BTX showed a higher success rate than BMR {65.3% vs 55.3% (p = 0.174)}. In patients with infantile esotropia, the success rate was comparable between BTX group and BMR group {40.5% vs 52% (p = 0.440)}. However, the success rate was statistically significantly higher in BTX group in compare to BMR group {79.7% vs 56.9% (p = 0.014)}. Consecutive exotropia was 0% in BTX group and 9.2% in BMR group (p = 0.002). Conclusion: The increment dose of BTX injection is comparable to surgery in patients with infantile esotropia but superior to the routine surgery in patients with PAET. BTX has the advantage of a shorter procedure duration, lower costs, less exposure to general anesthesia and being minimally invasive intervention.

The Efficacy of Dose Increments of Botulinum Toxin A in the Treatment of Childhood Esotropia.

BACKGROUND: Botulinum toxin is known to have a powerful chemodenervation effect, and it is a well-established alternative to incisional surgery for strabismus. This study aims to investigate the efficacy of dose increments of botulinum toxin A (BTA) for the treatment of specific ranges of angle deviation. METHODS: This was a prospective study that included patients presenting with esotropia to Dhahran Eye Specialist Hospital between 2016 and 2020, who were managed by a single surgeon. Botulinum toxin was given in different dosages (2.5, 5, 7.5, 10 international units (IU)) according to the size of deviation (11-19, 20-29, 30-39, and ≥40 prism diopters (PD)), respectively. A successful outcome was defined as deviation ≤10 PD in the last visit (a minimum of 6 months) following a single injection. RESULTS: A total of 56 patients with esotropia were included. The mean pre-treatment angle of deviation was 38.6 ± 2.5 PD. BTA injection in a dose of 2.5 IU for the 11-19 PD angle of deviation showed the highest rate of successful outcomes (75%). According to the type of esotropia, partially accommodative esotropia showed the best response to the use of dose increments (59%). The incidence of ptosis post-BTA injection was the least (37.5%) with the smallest dose (2.5 IU). CONCLUSION: BTA usage in dose increments is safe, efficient, and might be more cost-effective with less incidence of BTA associated complications. Different esotropia diagnoses have different clinical responses. However, larger studies are necessary to better predict the outcome of using dose increments.