Challenging Management of Double Vision After Functional Endoscopic Sinus Surgery-A Series of 6 Cases.

PURPOSE: To present 6 cases of orbital trauma, diplopia and strabismus after functional endoscopic sinus surgery (FESS). DESIGN: Retrospective observational case series. METHODS: The medical charts of suitable patients were reviewed for information on medical examination, imaging studies, the type of corrective surgery, and surgical outcomes. STUDY POPULATION: All patients with diplopia and strabismus after undergoing FESS who were treated or consulted at our institution between 2008 and 2017 were included. MAIN OUTCOME MEASURES: The presence and extent of strabismus and double vision at the end of follow-up. RESULTS: Six patients complained of diplopia after FESS; all of them had proven orbital trauma. In Cases 1-5, patients suffered medial rectus (MR) muscle transection and subsequent exotropia. Their prognosis was guarded despite prompt surgical intervention, and ranged from large exotropia when direct recovery of the MR was attempted, to primary gaze orthotropia but with minimal adduction capacity, during which vertical recti transposition was attempted. Patient 6 sustained transient diplopia, although all of his extraocular muscles appeared intact on imaging. His eye position and movement were completely resolved with conservative measures only. CONCLUSIONS: Our experience was that immediate recovery procedures to reattach the muscle in cases with proven transection of the MR muscle are futile, and that definitive corrective strabismus surgery (ie, vertical muscle transposition) has a better chance to achieve favorable results.

Diode laser treatment of retinopathy of prematurity: anatomical and refractive outcomes.

PURPOSE: To examine the anatomical and refractive outcomes of infrared diode laser photocoagulation (DLPC) for the treatment of threshold retinopathy of prematurity (ROP). METHODS: The charts of all consecutive premature neonates with ROP treated by DLPC at our tertiary center from December 1, 1996, to December 31, 2004, were reviewed. RESULTS: The group included 100 neonates (194 eyes) with a mean birth weight +/- SD of 833.9 +/- 250.3 g and a mean gestational age +/- SD of 26 +/- 1.9 weeks. Sixty-two percent of neonates had zone I or posterior zone II ROP. Each eye received a mean +/- SD of 1,740 +/- 990 laser applications, and 21% of eyes received an additional 1 to 2 rows posterior to the ridge. Neonates treated after December 2003 (cutoff date of the Early Treatment of Retinopathy of Prematurity study) underwent a significantly greater number of laser applications (mean +/- SD, 2,286 +/- 1,087) than did neonates treated earlier. Anatomical results of laser treatment were favorable for 179 eyes (92.3%) at a mean follow-up +/- SD of 33.6 +/- 27.2 months. After vitreoretinal surgery, partial or total retinal detachment was documented for 2.5% of patients who received posterior-to-the-ridge laser treatment and 3.8% of patients treated only on the avascular retina. Refractive data were available for 134 eyes: 55.2% had myopia of -5 diopters (31.3%) or greater (23.9%). Strabismus was found in 21 (28.8%) of 73 neonates tested. Gestational age was correlated with corrected age at treatment, zone of ROP, number of laser applications, and spherical equivalent. Snellen visual acuity of 6/12 or more occurred in 17 of 24 patients who complied with testing. CONCLUSION: DLPC is a safe and effective treatment for ROP. Neonates of lower gestational age and birth weight require earlier and more aggressive laser treatment and may have a higher refractive error.

Intraocular pressure variations after diode laser photocoagulation for threshold retinopathy of prematurity.

PURPOSE: To investigate the intraocular pressure (IOP) variations occurring after indirect diode laser photocoagulation for threshold retinopathy of prematurity. DESIGN: Prospective, nonrandomized, comparative study. PARTICIPANTS: A study group-21 consecutive premature babies (42 eyes) undergoing diode laser photocoagulation for retinopathy of prematurity-and control groups-32 premature babies (64 eyes) undergoing retinal examination with or without scleral indentation. INTERVENTION: Intraocular pressure was measured with a portable electronic tonometer before, immediately after, and 1, 2, and 3 days after diode laser photocoagulation in the study group; before retinal examination in control group 1; and before and after retinal examination with scleral indentation in control group 2. MAIN OUTCOME MEASURE: Intraocular pressure after diode laser photocoagulation for threshold retinopathy of prematurity. RESULTS: Mean IOP in the study group rose from 15 mmHg (standard deviation [SD] = 4.1) before coagulation to 33.2 mmHg (SD = 7.8; range, 20-50) immediately after, and then dropped to 22.2 (SD = 5.2), 16.5 (SD = 3), and 14.5 mmHg (SD = 2.1) 1, 2, and 3 days later, respectively. All the changes were statistically significant at P<0.0001, except for the difference between days 2 and 3 (P = 0.096). Mean baseline IOPs were 16.3 mmHg (SD = 3.7) in control group 1 and 15.7 mmHg (SD = 2.3) in control group 2 (P = 0.84 between control group 1 and study group, and P = 0.32 between control group 2 and the study group). At termination of the retinal examination with scleral indentation (control group 2), IOP measured 15.1 mmHg (SD = 2.2) (P = 0.49 compared with baseline). CONCLUSIONS: Intraocular pressure may be significantly elevated after diode laser photocoagulation for retinopathy of prematurity. The mechanism and long-term clinical implications of this observation should be investigated.

Presbyopia among normal individuals.

BACKGROUND: To define ocular variables that might affect the need for early use of reading glasses. METHODS: A retrospective, non-randomized clinical trial was conducted at an aero-medical center. The charts of 100 healthy male pilots who suffered from presbyopia were reviewed. All subjects had undergone a complete eye examination every year for 30 years. Ocular parameters measured at the ages of 20, 30, 40, 45, and 50 years were recorded. Individuals were divided into two groups: those who needed reading glasses at the age of 45 years or earlier (group 1) and those who had needed reading glasses after 45 years of age (group 2). RESULTS: Of all the ocular variables examined each year, two differed significantly between the two groups. Refraction at age 20 was 0.1+/- 0.3 D in group 1 and 0.0 +/- 0.3 D in group 2 ( P <0.05). Amplitude of accommodation at age 20 was 9.5 +/- 1.2 D in group 1 and 9.9 +/- 1.0 D in group 2 ( P <0.05). CONCLUSION: Hyperopia and low amplitude of accommodation at the age of 20 might predispose to early development of presbyopia in normal individuals.

Ocular manifestations of ataxia-telangiectasia.

PURPOSE: To report the manifestations of ataxia-telangiectasia (A-T) on the ocular sensory and motor systems. DESIGN: A prospective observational case series. METHODS: In a single tertiary care institition, a comprehensive ophthalmologic evaluation was made of patients with A-T as part of a systemic/neurologic evaluation. Sixty-three A-T patients between the ages of 2 and 28 years were examined. RESULTS: In 58 A-T patients whose visual acuity could be measured, best-corrected visual acuity in the better eye was 20/20 to 20/30 in 39 (67%), 20/40 to 20/50 in 17 (29%), and 20/60 to 20/80 in 2 (4%). The mean geometric visual acuity of the better eye was 20/31. Telangiectatic vessels were seen in the bulbar conjunctiva in 57 of 63 patients (91%) and on the skin of the face of 21 patients (33%). Twenty-four of 63 patients (38%) had strabismus. Esodeviations were the most common, seen in 15 individuals. Apraxia of horizontal gaze was observed in 19 of 63 patients (30%). Hypometric saccades were evident in 48 (76%), pursuit abnormalities in 43 (63%), and nystagmus in 18 (29%). Accommodation was deficient in the 54 patients in whom it was measured. No posterior segment vascular anomalies were detected. CONCLUSIONS: Visual acuity of 20/50 was present in 96% of the patients we examined. Telangiectatic vessels on the bulbar conjunctiva were seen in nearly every patient, though these are of no functional significance. Ocular motor abnormalities, especially strabismus, are a common finding in A-T. Poor accommodation and abnormal eye movements may lead to reading difficulty reported by patients with A-T.