A Modified Bicanalicular Crawford Placement Method for Congenital Nasolacrimal Duct Obstruction: Reducing Need for Operative Room Removal.

PURPOSE: This study introduces a method for Crawford bicanalicular stent placement for congenital nasolacrimal duct obstruction by looping the ends to themselves which are tied together with dissolvable sutures to ease in-office removal. METHODS: This is a single institution, retrospective study that evaluates outcomes of patients aged 5 years and under who underwent bicanalicular stenting for congenital nasolacrimal duct obstruction by a single surgeon (G.S.E.) between 2004 and 2020. Only primary surgeries were included in the analysis. Stenting could be accompanied by balloon dilatation and/or turbinate infracture. Age, sex, follow-up time, complications, type of intervention, extrusion, recurrence, and operative room removal were recorded. RESULTS: This study included 56 eyes from 54 patients with a mean age of 19.0 ± 9.5 months (range, 8-50 months). There was a 30.3% extrusion rate, a 5.4% rate of recurrence of disease, and a 3.6% rate of operative room removal. The average follow-up time was 25.1 ± 39.8 months (range, 1-132 months). For patients with or without extrusion, there were no significant differences between age, sex, laterality, type of intervention, follow-up time, or rate of recurrence. Each eye that had recurrence (3 total) or needed operative room removal (2 total) underwent only bicanalicular stenting without accompanying procedures, although the difference in rates between procedures was also not statistically significant. CONCLUSIONS: This method had a low recurrence and operative room removal rate, with similar extrusion and complication rates to other bicanalicular stent and intubation methods for the treatment of congenital nasolacrimal duct obstruction.

Efficacy of modified cover testing for detection of incipient true strabismus with pseudostrabismus diagnosis.

BACKGROUND AND PURPOSE: Retrospective studies have shown that as many as 15% of patients with pseudostrabismus go on to develop true strabismus. This prospective study was conducted to examine the efficacy of utilizing a modified cover test technique to help identify patients with pseudostrabismus that are likely to progress to true strabismus. PATIENTS AND METHODS: Fifty-three subjects were included in the study. All were evaluated using prolonged occlusion during cover testing ("occlusive" cover test). The results of this test were analyzed for its ability to predict the development of true strabismus during a mean follow-up period of 11 months. RESULTS: The occlusive cover test was of value in detecting which subjects would later develop esotropia. CONCLUSION: The occlusive cover test should be incorporated into the evaluation of patients suspected of having pseudostrabismus to identify which patients are most at risk of presenting later with true strabismus.

Medial rectus surgery for convergence excess esotropia with an accommodative component: a comparison of augmented recession, slanted recession, and recession with posterior fixation.

UNLABELLED: Richard G. Scobee was an internationally renowned strabismologist whose life was short yet very productive. The first section of this paper describes his life and contributions to strabismology and orthoptics. The second section of this paper reports the results of our strabismological study. INTRODUCTION AND PURPOSE: Many different surgical procedures exist for the treatment of children or adults with convergence excess esotropia. We report on our results of augmented recession, slanted recession, and recession with posterior fixation of the medial rectus muscle in such situations. We also report on the incidence of induced vertical deviations. METHODS: Using a retrospective chart review of 800 patients, we excluded patients with confounding strabismus conditions and pharmacological treatments leaving 131 patients included in the study. Slanted reinsertion of medial rectus (twenty-seven patients); posterior fixation with recession of medial rectus (twenty-two patients); augmented medial rectus recession (fifty-eight patients); nonaugmented recession of medial rectus (seventy-three patients). The distance near disparity postoperatively was evaluated using a life table analysis in which all patients were grouped according to the length of time postoperatively. Induced vertical deviation was evaluated at least 6 months postoperatively. RESULTS: At all time periods postoperatively, the patients with slanted recessions showed the greatest reduction in distance near disparity and that reduction was the most stable over time. At 12- 14 months postoperatively, the range in reduction measured 7.9- 11(Δ) among all three procedures. At 15- 18 months postoperatively, the range in reduction measured 16.9- 19.3(Δ) diopters among the three procedures. At greater than 6 months postoperatively, the slanted and augmented recession groups showed up to 1(Δ) of right hypertropia and the posterior fixation and nonaugmented groups showed up to 0.6(Δ) of left hypertropia. CONCLUSIONS: All three medial rectus procedures used in our retrospective study (slanted recession, augmented recession, recession with posterior fixation) reduced the distance near disparity. The greatest and most stable reduction at all time periods postoperatively occurred with the slanted recession. The induced vertical deviation is small in all procedures and is acceptable at 1(Δ) or less. The augmented and slanted recessions are easier to perform than the posterior fixation with recession. We recommend that the slanted reinsertion of the medial rectus recession be considered as a viable option in the surgical correction of esotropia with a distance near disparity.

Manifest strabismus following pseudostrabismus diagnosis.

INTRODUCTION: Pseudostrabismus is a common diagnosis in a busy pediatric ophthalmology practice. This purpose of this study was to determine the prevalence of true strabismus in patients previously diagnosed with pseudostrabismus, to determine risk factors, and to examine the sensory outcome. METHODS: This is a retrospective review of patients diagnosed with pseudo-strabismus and with at least one follow-up visit. Age at first visit, gender, family history, birth weight, developmental history, who initially suspected strabismus and its direction, refractive error, and quality of examination were recorded. Diagnosis and sensory outcome were recorded for those patients who went on to develop a manifest deviation. RESULTS: Eighty-three patients met the inclusion criteria. Twelve percent (10/83) were later diagnosed with manifest strabismus. There was no statistically significant difference between those who went on to develop strabismus and those who did not with regard to any of the factors evaluated; however, there was a strong trend for higher risk in developmentally delayed subjects. Additionally, there was a trend for higher risk when poor patient cooperation or an inexperienced clinician precludes a good quality exam. Two subjects developed amblyopia before diagnosis. At the final exam, there was evidence of bifoveal fusion in five subjects and of peripheral fusion in three subjects. CONCLUSIONS: The prevalence of strabismus was higher in patients diagnosed with pseudostrabismus than was reported for the general pediatric population. Therefore, patients diagnosed with pseudostrabismus might be considered "at risk". With pseudostrabismus, management should reflect this increased risk of true strabismus. Confirmatory studies are needed.