Comparison of the results of the modified and classical bi-medial hang-back recession in infantile esotropia.

PURPOSE: Bi-medial rectus recession, which can also be performed using a hang-back technique, is one of the surgical treatment options for infantile esotropia (IE). This study has modified the surgical approach, with outcomes compared to the traditional hang-back technique. METHODS: The bi-medial recession was performed with a modified hang-back technique in 120 IE patients and with a traditional hang-back technique in 88 cases. Surgical outcomes were reviewed and compared retrospectively. RESULTS: The patients in the two groups were compared in terms of surgery time, inferior oblique weakening surgery, and the presence of refractive error. The differences between pre-operative and postoperative first-month, sixth-month, and first-year degrees were statistically significant (p < 0.001). CONCLUSIONS: This modified novel technique aims to avoid unwanted muscle movement in the horizontal and vertical axes and a gap in the middle of the recessed muscle, as seen in the traditional hang-back technique. Further, the modified technique resulted in less over- and under-correction as well as alphabetic pattern deviation.

Isolated medial rectus muscle laceration after bird strike.

INTRODUCTION: A 66 year-old male suffered globe trauma due to A bird, a German Desert Hawk, strike. At the first examination in the emergency ünit a few hours after the injury, the patient reported persistent horizontal diplopia. CASE REPORT: He had right conjunctival laceration, mild proptosis, subconjunctival hematoma, exotropia with no adduction. Magnetic Resonance Imaging (MRI) revealed that it was suggestive of laceration of the right medial rectus muscle, at about the junction of it's anterior and middle thirds. During surgery; initially, the lacerated proximal end of the distal segment was isolated. The proximal segment of the medial rectus muscle was then carefully dissected. The two lacerated ends were then joined with 6-0 polyglactin sutures. CONCLUSION: The day after surgery, there was no deviation and diplopia in all diagnostic gaze positions.

Disinsertion-distal myectomy and tucking of inferior oblique combined with superior oblique full tendon advancement in superior oblique palsy.

PURPOSE: To assess the preliminary outcomes of inferior oblique (IO) disinsertion-distal myectomy and tucking combined with superior oblique (SO) full tendon advancement in patients with Knapp II or III superior oblique palsy. METHODS: This single-centered retrospective study included 16 eyes from 13 patients with Knapp Class II or III SO palsy. All patients underwent IO disinsertion-distal myectomy and tucking combined with SO full tendon advancement while under general anesthesia. Pre- and post-operative levels of vertical deviation in the primary position, abnormal head position, IO hyperfunction and SO hypofunction, torsion, as well as the presence of diplopia, were all measured, and the differences were statistically compared. RESULTS: Pre-operatively, 12 patients had abnormal head positions, and two had diplopia. The pre-and post-operative levels of IO hyperfunction and SO hypofunction, as well as a vertical deviation in the primary position and torsion, all differed statistically significantly (p < 0.01). CONCLUSIONS: Inferior oblique disinsertion distal myectomy and tucking combined with SO full tendon advancement surgery appears to be an effective procedure in patients with congenital and acquired Knapp Class II or III SO palsy.

A comparison of scientometric data and publication policies of ophthalmology journals.

Purpose: This retrospective database analysis study aims to present the scientometric data of journals publishing in the field of ophthalmology and to compare the scientometric data of ophthalmology journals according to the open access (OA) publishing policies. Methods: The scientometric data of 48 journals were obtained from Clarivate Analytics InCites and Scimago Journal & Country Rank websites. Journal impact factor (JIF), Eigenfactor score (ES), scientific journal ranking (SJR), and Hirsch index (HI) were included. The OA publishing policies were separated into full OA with publishing fees, full OA without fees, and hybrid OA. The fees were stated as US dollars (USD). Results: Four scientometric indexes had strong positive correlations; the highest correlation coefficients were observed between the SJR and JIF (R = 0.906) and the SJR and HI (R = 0.798). However, journals in the first quartile according to JIF were in the second and third quartiles according to the SJR and HI and in the fourth quartile in the ES. The OA articles published in hybrid journals received a median of 1.17-fold (0.15-2.71) more citations. Only HI was higher in hybrid OA; other scientometric indexes were similar with full OA journals. Full OA journals charged a median of 1525 USD lower than hybrid journals. Conclusion: Full OA model in ophthalmology journals does not have a positive effect on the scientometric indexes. In hybrid OA journals, choosing to publish OA may increase citations, but it would be more accurate to evaluate this on a journal basis.

Surgical results of the slipped medial rectus muscle after hang back recession surgery.

AIM: To analyze the surgical results of a slipped medial rectus muscle (MRM) after hang back recession surgery for esotropia. METHODS: Twenty-one patients who underwent re-exploration for diagnosed slipped muscle after hang back recession surgery were included in this retrospective study. Dynamic magnetic resonance imaging was performed to identify the location of the slipped muscle. Ocular motility was evaluated with assessment with prism and cover test in gaze at cardinal positions. The operations were performed by the same consultant. Intraoperative forced duction test was performed under general anesthesia. The empty sheath of the slipped MRM was resected and the muscle was advanced to the original insertion site in all patients. RESULTS: The average age of 21 patients who had consecutive exotropia with a slipped MRM at the time of presentation was 17.4±5.4y (5-50y). The average duration between the first operation and the diagnosis of the slipped muscle was 25mo (12 to 36mo). The mean follow up after the corrective surgery was 28mo. The mean preoperative adduction limitation in the field of action of the slipped muscle was -2.26 (ranging from -1 to -4). All patients had full adduction postoperatively. CONCLUSION: The diagnosis of the slipped muscle should be confirmed during the strabismus surgery. The slipped muscle may be caused due to insufficient suture and excessive rubbing of the eye. When divergent strabismus is observed after the recession of the MRM, a slipped muscle should be considered in the differential diagnosis.

Optic nerve head topographic analysis and retinal nerve fiber layer thickness in strabismic and anisometropic amblyopia.

We compared the optic nerve head topography and retinal nerve fiber layer (RNFL) thickness of the strabismic and anisometropic amblyopic eyes with the normal fellow eyes and age-matched controls and concluded that, although amblyopia is a functional visual loss, RNFL thickness and optic nerve head topographic changes in strabismic and anisometropic amblyopic eyes may be affected by amblyopia. Further histopathological and clinic confirmations are needed.

Effectiveness of disinsertion-resection and tucking of the inferior oblique muscle in patients with unilateral long-standing superior oblique muscle palsy.

PURPOSE: To investigate the effectiveness and safety of disinsertion-resection and tucking of the inferior oblique muscle in patients with unilateral long-standing superior oblique muscle palsy and secondary inferior oblique muscle overaction. METHODS: Between April 2000 and January 2005, the records of 31 patients who underwent disinsertion-resection and tucking of the inferior oblique muscle for treatment of unilateral long-standing (> 6 months) superior oblique muscle palsy were retrospectively reviewed. A comprehensive ocular examination including best-corrected visual acuity measurements, ductions, versions, and deviations at near and distance in the diagnostic positions of gaze, head tilt test, abnormal head position, dilated fundus, field of binocular fixation, and Lee screen test was performed prior to and after surgery. RESULTS: All patients had Knapp's class I unilateral superior oblique muscle palsy. The mean preoperative score of inferior oblique muscle overaction was +3.03 and the mean vertical deviation was 15.9 PD in primary position. The follow-up period ranged from 4 to 82 months. Inferior oblique muscle overaction diminished in 29 patients, and 2 patients had +1.0 overaction in adduction of the affected eye. The vertical deviation in these patients had some residual but smaller hypertropia. CONCLUSIONS: Disinsertion-resection and tucking of the inferior oblique muscle was safe, simple, and effective in eliminating inferior oblique muscle overaction and abnormal head posture, and in reducing the hyperdeviation in patients with unilateral long-standing superior oblique muscle palsy.

Comparison of the inferior oblique weakening by disinsertion or disinsertion-resection and tucking in the patient with infantile esotropia.

The effectiveness of disinsertion vs disinsertion-resection and tucking procedure of the inferior oblique muscle for infantile esotropia was studied. Preoperative muscle overaction scores were +3.2 +/- 0.6 and +3.3 +/- 0.48 for the two groups, respectively. Postoperatively, there was + 0.52 average score in five Group I cases, whereas there were none in Group 2. We conclude that the disinsertion-resection and tucking procedure is more effective than simple disinsertion.

Bifid right lateral rectus: a case report.

Abnormal insertions are the commonest cause of congenital defects in ocular motility. In this paper, a patient with a bifid right lateral rectus muscle is presented and discussed. To the best of our knowledge this patient is the first known case of an abnormal bifid lateral rectus muscle with no systemic association.