Unilateral Horizontal Rectus Muscle Recessions for Pediatric Comitant Strabismus.

INTRODUCTION: Compared to bilateral horizontal rectus muscle recessions (BHR), a unilateral horizontal rectus muscle recession (UHR) confers shorter operating time and anesthesia exposure, limits complication risks to one eye, and requires less recovery from the patient. METHODS: Retrospective chart review of pediatric patients who underwent unilateral medial rectus recession (UMR) for esotropia (ET), or unilateral lateral rectus recession (ULR) for exotropia (XT). Primary successes were defined as maximum distance deviation at post-operative month 3: -12 to +5 for ET, -5 to +12 for XT. Rates of postoperative horizontal incomitance (HI) >5 PD and success for small medium, and large (in mm, respectively, ET: <5, 5-6 mm, >6; XT: <8, 8-10, >10) recessions were analyzed. RESULTS: Seventeen ETs and 40 XTs were analyzed. Overall primary success was 71.9% (p = .02). Significantly, 80% (95% CI: 67.60,92.40) XTs succeeded. ETs were equally likely to succeed (53.9%) or fail (47.1%) (p = .22). For patients without significant preoperative HI, average postoperative HI was 3.90 PD (95% CI: 0.20, 7.60) for ETs; 5.48 PD (95% CI: 3.65, 7.32) for XTs. CONCLUSIONS: UHR was 71.9% successful in treating pediatric comitant strabismus. ULR for XT, particularly small to medium deviations, was most likely to succeed. In contrast to prior reports, large UMR and ULR were less likely to succeed and post-operative incomitance was frequent but rarely clinically significant.

Red Flags in the Assessment of Adult Ophthalmoplegia.

Acquired ophthalmoplegia can represent a harbinger of vision and life-threatening disease. Recognition of select clinical "red flags" on history or examination can facilitate early diagnosis. This article reviews relevant clinical pearls for the detection of dire causes of acquired ophthalmoplegia in adults including myasthenia gravis, carotid cavernous fistula, giant cell arteritis, and thiamine deficiency. Prompt treatment of all of these disorders can either reverse or halt the progression of visual manifestations.

Positive angle kappa: a possible sign of aniridia.

INTRODUCTION AND PURPOSE: Aniridia is a panocular disorder with variable expressivity, caused by PAX6 mutations. Foveal hypoplasia and nystagmus occur in both aniridia and albinism. Individuals with albinism have a moderately positive angle kappa. This study evaluates the angle kappa in individuals with aniridia. PATIENTS AND METHOD: We performed a retrospective chart review of recorded angle kappa for individuals with aniridia. In addition, we prospectively examined the monocular corneal light reflex in each eye of patients with congenital aniridia and central fixation. We recorded other ocular characteristics and the results of gene testing. Patients with eccentric fixation or corneal surgery were excluded, as were patients with retinal abnormalities that might have influenced the angle kappa. RESULTS: We included sixteen individuals with congenital aniridia and found that all had a positive angle kappa. Two patients underwent pattern visual evoked potential (VEP) testing with monocular stimulation and were found to have a reversal of polarity, indicating misrouting of the retino-striate fibers. CONCLUSION: The phenotype of aniridia is variable. However, a positive angle kappa may be considered to be a frequent clinical feature of aniridia.

Evaluation of vision-specific quality-of-life in albinism.

INTRODUCTION: Human albinism is a genetic condition associated with visual impairment that affects many aspects of daily life. Office measurements of visual acuity do not necessarily reflect daily visual function and health status. This study used the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to determine the effect of albinism-associated ophthalmopathy on quality of life (QOL). METHODS: We administered the NEI-VFQ, which consists of 25 questions about QOL (VFQ-25) and 14 questions about well-being (VFQ-39), to 44 consenting participants with albinism older than the age of 18 years. RESULTS: Nineteen male and 25 female subjects completed the study. Median age was 30.5 years (range, 18-79 years). Mean best-corrected visual acuity was 20/83 (range, 20/20 to 20/320). Forty-eight percent reported that they were currently able to drive with their condition. Participants perceived midscale problems with their general vision (median subscale score 60.0). Visual acuity correlated moderately with overall NEI-VFQ composite scores (r(s) = 0.40, p = 0.01 for VFQ-25 and r(s) = 0.36, p = 0.02 for VFQ-39). Most notable impairment was recorded for distance acuity, vision-specific mental health, and vision-specific role difficulties (VFQ-39 median subscale scores 66.7, 70.0, and 75.0, respectively). Differences by sex were insignificant. Greater ceiling effects were noted for the VFQ-25 than for the VFQ-39. CONCLUSIONS: The NEI-VFQ-39 is a method to evaluate self-reported effects of vision-related QOL in albinism and may be used as a baseline for evaluating outcomes in interventional studies in these patients.

Positive angle kappa in albinism.

BACKGROUND: Albinism is an inherited disorder of deficient melanin production. There is a high prevalence of strabismus in patients with albinism. We investigated the prevalence of a positive angle kappa in patients with albinism and report its effect on assessment of binocular alignment. METHODS: We retrospectively reviewed the charts of 207 consecutive patients with the diagnosis of albinism seen at the University of Minnesota between 1984 and 2002. Angle kappa and alignment using prism and alternate-cover test (PACT) and Krimsky measurements were recorded. RESULTS: In 99.6% of our patients with albinism, angle kappa was noted to be positive. The mean difference between PACT and Krimsky measurements was 17.11 prism diopters in the more exotropic (or less esotropic) direction per Krimsky test. Because of the high prevalence of a positive angle kappa, esodeviations often appeared less and exodeviations appeared greater than when measured using PACT. CONCLUSIONS: Positive angle kappa can be considered another clinical feature of albinism. Consideration should be given to the effect of positive angle kappa on alignment as observed by Krimsky measurement when planning extraocular muscle surgery, particularly when preoperative sensory testing suggests binocular potential.