The Challenge of Strabismus Surgery for Patients with Hemianopic Visual Field Defects Associated with Ocular Deviations.

Homonymous and heteronymous hemianopias associated with strabismus are a therapeutic challenge because surgery may result in diplopia, decrease the visual field (VF), and/or lead to recurrence of the deviation. We present four cases: two homonymous hemianopias and two heteronymous hemianopias. Of the four patients, three had exotropia and one had esotropia. The origin of hemianopias was neoplastic in two cases and traumatic in two cases. Strabismus surgery was performed in three cases, but only one case had a good result; recurrence of the deviation and diplopia occurred in the other two cases. In conclusion, exotropia may develop as a compensatory mechanism in a patient with congenital or early-onset homonymous hemianopia and realigning the eyes could reduce the binocular VF and cause diplopia. In heteronymous hemianopias, there is little risk of the surgery causing diplopia, but the strabismus is unstable because of the absence of binocular vision and vergence reflexes if VF loss includes the macula. Further, strabismus, in association with hemianopia, may be caused by coexistent cranial nerve and/or gaze palsy. The prognosis, objective, and results of the strabismus operation should be clearly discussed with the patients or their guardians before it is performed if hemianopias are present.

Role of livestock-derived amendments in soil organic carbon stocks in forage crops.

The use of organic amendments for forage production has been promoted in recent years due to the adoption of sustainable agricultural practices and the increasing cost of mineral fertilizers. Organic manures can contribute with an extra carbon to the soil to the potential addition of carbon stocks. This study aimed to measure the capacity of different organic amendments commonly available in livestock farms for forage fertilization to influence the rate of soil organic carbon (SOC) under future climate change conditions. For this purpose, on-farm processed exogenous organic matter (EOM) was analyzed for fiber and organic carbon mineralization to obtain the percentage of decomposable EOM and resistant EOM (DEOM and REOM, respectively). The RothC model was run in grasslands and forage maize under different scenarios considering specific DEOM and REOM values. The results showed that the degradability of amendments could influence SOC dynamics. The SOC of grasslands after 38 years of simulation differed by >30 % between compost and the liquid fraction of cattle slurry. Forage crops were simulated under the RCP8.5 scenario and fertilized with amendments at the recommended amounts of nitrogen for these crops. As a result, SOC stocks had a better response to organic fertilization in grassland, except under the application of the liquid fraction, with a decrease in SOC of 16 %. In cropland, only the solid fraction from mechanical separation of slurry and compost applications increased the SOC stock from 13 % to 26 % in the 2020-2090 period. Our study provides insights into how the degradability of EOM can affect simulations of the SOC stock rate over time.

Predictors and efficacy of surgical treatment for consecutive exotropia.

PURPOSE: To study the surgical outcomes of consecutive exotropia and predictive factors, and to compare the medial rectus (MR) advancement, lateral rectus (LR) recession, or a combination of both procedures. METHODS: A retrospective study of patients diagnosed with consecutive exotropia that were operated on (2000-2020) were included. The convergence was classified from 0 to +++, with good: ++/+++ and poor: 0/+. A good outcome was considered when the final horizontal deviation was < 10 prism diopters (pd). Follow-up since the surgery and the number of reoperations were registered. RESULTS: A total of 88 cases were analyzed, mean age: 33.98 ± 17.68 years (57.95%: women). The near and distance horizontal deviation mean (±SD) was 34.3 pd (±16.45) and 34.36 pd (±16.33), respectively. MR advancement was performed in 36.36%, LR recession in 27.27%, and a combination of both in 36.36%. Surgery was unilateral in 65.91% (bilateral in 34.09%). A good outcome was obtained in 69.32% and reoperations in 11.36%. The insufficiency convergence was associated with a bad outcome. The near horizontal deviation (P = .006), the vertical deviation (VD) association (P = .036) and the combination of both MR advancement and LR recession (P = .017) were predictors of a bad result. The mean follow-up was 56.5 months ± 57.65. CONCLUSION: A long-term good surgical result was obtained in most patients. The greatest near deviation, the VD association, and the combination of MR advancement and the LR recession were predictive factors for bad results.

Ophthalmologic Manifestations in Autism Spectrum Disorder.

Objectives: The purpose of this study was to describe the ophthalmologic manifestations found in patients with autism spectrum disorder (ASD) and to assess their prevalence in the different types of ASD. Materials and Methods: This prospective observational study included 344 patients with ASD seen over a period of 8.5 years. They were classified into four subgroups (autism, Asperger syndrome, pervasive developmental disorders not otherwise specified [PDD-NOS], and other). Data obtained from ophthalmological examinations were compared between the groups. Statistical analysis was performed with chi-square, Kruskal-Wallis, and Mann-Whitney tests. Results: Refractive defects were detected in 48.4% of the patients, with the most prevalent being hyperopia and astigmatism. There was a higher prevalence of myopia in Asperger syndrome. Evaluation of extraocular motility revealed the presence of strabismus in 15.4% of patients, with a statistically significantly higher prevalence in autism and the "other" disorders group. The most frequent type of strabismus was exotropia. Convergence was found to be normal in 43.6% of the patients. Nystagmus was observed in only 0.9% of patients. In the binocular sensory tests performed, patients with Asperger syndrome had significantly better results compared to the other groups. Optic nerve abnormalities were found in 4% of patients, with significantly higher prevalence in the "other" disorders group. Conclusion: Ophthalmologic manifestations occur more frequently in patients with ASD than in the general child population. Of these, the most frequent are refractive defects and ocular motility disorder. Therefore, we consider it necessary to perform an ophthalmological evaluation in patients with ASDs.

Central Mini-plication of the Medial Rectus for Convergence Insufficiency.

Five cases with a mean (± SD) age of 61 (12.02) years are described to study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia and near exotropia: mean preoperative deviation: 18 (± 2) pd. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. A central mini-plication of the medial rectus (MR) muscles was performed in 5 patients (4 unilateral). Overcorrection at distance vision was recorded in 3 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision in any case. None of the cases operated on had overcorrection at the end of follow-up. The final horizontal deviation was ≤8 pd at near vision, except for 1 case. Symptoms and diplopia resolved in every case but 2/5 required reoperations. The mean follow-up was 8 (2.12) months. Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.

Long term outcomes of strabismus surgery for third nerve palsy / Resultados a largo plazo de la cirugía de estrabismo para parálisis del III par

Purpose: To report long-term outcomes of strabismus surgery for treatment of third nerve palsy. Methods: We performed a 15-year retrospective study of patients who had undergone surgery. We analyzed preoperative mean deviation (at 6 months, 1 year after surgery, and at the end of follow-up), type of surgery, and factors predicting outcomes. A final deviation < 10 prism diopters (pd) was considered a good esthetic outcome, and no diplopia in the primary position at the end of follow-up was considered a good functional outcome. Results: Surgery was performed in 31 cases. Mean age was 36.27 years (women, 51.6%). Total and complete third nerve palsy was recorded in 22.6% and acquired palsy in 80.6%. Mean preoperative horizontal deviation (HD) in primary position was 40.24 pd (near) and 44.29 (distance) and 14.33 pd in vertical deviation (VD). Mean final HD was 8.94pd (near) and 11.35pd (distance), and mean final VD was 6.13. One surgery was performed in 68.9%. A favorable esthetic outcome was obtained in 64.5% and a successful functional outcome in 72.2%. Statistically significant differences were found between near HD (p = 0.019) and distance HD (p = 0.035) at 1 year compared with the end of follow-up and between VD at 6 months and 1 year after surgery (p = 0.03). Mean follow-up was 6.05 years. No specific factors predicted a successful outcome. Conclusions: Esthetic and functional results were similar. No predictors of successful outcome were identified. HD was better 1 year after surgery, and VD improved during follow-up

Objetivo: Reportar los resultados a largo plazo de la cirugía de estrabismo para tratar la parálisis del III par. Métodos: Realizamos un estudio retrospectivo a 15 años, de pacientes sometidos a cirugía. Analizamos la desviación media preoperatoria (a 6 meses, 1 año tras la cirugía, y al final del seguimiento), el tipo de cirugía, y los factores predictivos de los resultados. Se consideró un buen resultado estético una desviación final < 10 dioptrías prismáticas (pd), y un buen resultado funcional la ausencia de diplopía en la posición primaria al final del seguimiento. Resultados: Se practicó cirugía en 31 casos. La edad media fue de 36,27 años (mujeres, 51,6%). Se registró parálisis total y completa del III par en el 22,6% de los casos, y parálisis adquirida en el 80,6%. La desviación horizontal preoperatoria media (DH) en posición primaria fue de 40,24 pd (de cerca) y 44,29 (de lejos), y 14,33pd en desviación vertical (DV). La DH final media fue de 8,94 pd (de cerca) y 11,35 pd (de lejos), y la DV final media fue de 6,13. Se practicó cirugía en el 68,9% de los casos. Se obtuvo un resultado estético favorable en el 64,5% de los casos, y un resultado funcional exitoso en el 72,2%. Se encontraron diferencias estadísticamente significativas entre DH de cerca (p = 0,019) y de lejos (p = 0,035) a 1 año, en comparación con el final del seguimiento, y entre DV a 6 meses y 1 año tras la cirugía (p = 0,03). El seguimiento medio fue de 6,05 años. Ningún factor específico predijo un resultado exitoso. Conclusiones: Los resultados estético y funcional fueron similares. No se identificaron factores predictivos de un resultado exitoso. DH fue mejor 1 año tras la cirugía, y DV mejoró durante el seguimiento

Long term outcomes of strabismus surgery for third nerve palsy.

PURPOSE: To report long-term outcomes of strabismus surgery for treatment of third nerve palsy. METHODS: We performed a 15-year retrospective study of patients who had undergone surgery. We analyzed preoperative mean deviation (at 6 months, 1 year after surgery, and at the end of follow-up), type of surgery, and factors predicting outcomes. A final deviation <10 prism diopters (pd) was considered a good esthetic outcome, and no diplopia in the primary position at the end of follow-up was considered a good functional outcome. RESULTS: Surgery was performed in 31 cases. Mean age was 36.27 years (women, 51.6%). Total and complete third nerve palsy was recorded in 22.6% and acquired palsy in 80.6%. Mean preoperative horizontal deviation (HD) in primary position was 40.24pd (near) and 44.29 (distance) and 14.33pd in vertical deviation (VD). Mean final HD was 8.94pd (near) and 11.35pd (distance), and mean final VD was 6.13. One surgery was performed in 68.9%. A favorable esthetic outcome was obtained in 64.5% and a successful functional outcome in 72.2%. Statistically significant differences were found between near HD (p=0.019) and distance HD (p=0.035) at 1 year compared with the end of follow-up and between VD at 6 months and 1 year after surgery (p=0.03). Mean follow-up was 6.05 years. No specific factors predicted a successful outcome. CONCLUSIONS: Esthetic and functional results were similar. No predictors of successful outcome were identified. HD was better 1 year after surgery, and VD improved during follow-up.

Ammonia and greenhouse gases losses from mechanically turned cattle manure windrows: A regional composting network.

An on-farm composting network operates in the Basque Country (northern Spain), in which solid manure produced in livestock farms (mostly dairy and beef cattle) is composted through windrow turning. This network aims to produce a valuable resource (compost) for the farmers whereas the volume of the solid manure was reduced at farm level The objective of the study was to assess the gaseous losses (NH3 and GHG) from 6 on-farm composting windrows (either deep litter systems or solid fraction after slurry separation) after turning operations. Monitored turning events occurred 1 to 4 months after establishing the heaps on the field. Ammonia and greenhouse gas (GHG) losses were estimated by the open and close chamber techniques, respectively. Results showed overall low emission rates related to the long degradation period of the windrows. Maximum NH3 release was at 2.0 mg m-2 d-1 after the second/third turning events. Baseline N2O losses were below 50 mg m-2 d-1, with maximum rates close to 500 mg m-2 d-1 some days after turning works. Methane emissions were mostly below 100 mg m-2 d-1, while CO2 losses were lower than 25 g m-2 d-1. Carbon dioxide peaks (≈250 g m-2 d-1) were reached after the second/third turnings. Overall, gaseous N and C losses accounted for 0.1 and 1% of the initial N and C content of the windrows, respectively. The present study concluded that two/three turning operations in aged solid manure-derived compost windrows do not have significant effects on NH3 and GHG losses. The magnitude of the gaseous losses from on-farm composting systems is dependent on the manure management practices at farm level (e.g. moment of windrow stacking).

Botulinum toxin for treatment of restrictive strabismus.

PURPOSE: To study the types of acquired restrictive strabismus treated in a tertiary hospital and the outcome of treatment with botulinum toxin. METHODS: We performed a 10-year retrospective study of patients with restrictive strabismus aged ≥18 years who were treated with botulinum toxin. Treatment was considered successful if the final vertical deviation was ≤5 PD, horizontal deviation ≤10 PD, with no head turn or diplopia. RESULTS: We included 27 cases (mean age, 61.9 years). Horizontal strabismus was diagnosed in 11.1%, vertical in 51.9%, and mixed in 37%. Strabismus was secondary to cataract surgery in 6 cases, high myopia in 6, orbital fractures in 5, retinal surgery in 5, Graves ophthalmopathy in 4, and repair of conjunctival injury in 1 case. Diplopia was diagnosed in all patients, head turn in 33.3%. The initial deviation was 14 PD (range, 2-40), the mean number of injections per patient was 1.6 (range, 1-3), and the mean dose was 9.5 IU (range, 2.5-22.5). At the end of follow-up, diplopia was recorded in 59.3%, head turn in 18.5%, surgical treatment in 51.9%, and need for prism glasses in 14.8%. Outcome was successful in 37% of patients (4 high myopia, 3 orbital fractures, 2 post-surgical retinal detachment, and 1 post-cataract surgery). Mean follow-up was 3±1.8 years. CONCLUSION: Vertical deviation was observed in half of the sample. The most frequent deviation was secondary to cataract surgery and high myopia. Treatment with botulinum toxin was successful in one-third of the patients at the end of follow-up.

Fat adherence syndrome following inferior oblique surgery: Treatment and outcomes / Síndrome de adherencia grasa tras cirugía del músculo oblicuo inferior: Tratamiento y resultados

Purpose: Describe surgical treatment and results in a group of patients diagnosed and operated on of fat adherence syndrome following inferior oblique surgery. Patients, material and methods: Retrospective study of 6 cases diagnosed and treated of fat adherence syndrome following inferior oblique surgery. Mean age was 24.67 years (range, 5-41), 3 males, 5 unilateral and 1 bilateral. Mean vertical deviation was 16.16pd (range, 4-25). Esotropia was associated in 4 cases, diplopia in other 2, and anomalous head posture in 3. A good outcome was considered when the final deviation was less than 10pd, with mild limitation of elevation, without anomalous head posture, and a negative duction forced test. Results: The final vertical deviation was 6.83pd (range, 0-14). A 2-4mm inferior rectus recession was performed on 4 patients associated to an inferior oblique surgery/exploration. All patients were operated on once, except 1 case. A good outcome was achieved in 3 patients. Anomalous head posture was resolved in 2 of 3 cases. Diplopia resolved after surgery. Only one case achieved orthophoria. Mean evolution time was 34.83 months (range, 6-78). Conclusion: In the treatment of the fat adherence syndrome, an inferior rectus recession is recommended, associated to inferior oblique exploration or surgery. A good favorable outcome was only achieved in half of the cases with surgical treatment. Limitation of elevation could not be completely resolved in any of the patients (AU)

Objetivo: Describir el tratamiento quirúrgico y los resultados en un grupo de pacientes con diagnóstico de síndrome de adherencia grasa tras una cirugía de oblicuo inferior. Pacientes, material y métodos: Estudio retrospectivo de 6 casos diagnosticados y tratados de síndrome de adherencia grasa tras una cirugía de oblicuo inferior. La edad media fue de 24,67 años (rango, 5-41), 3 varones, 5 cirugías unilaterales y 1 bilateral. La desviación vertical media fue de 16,16 dioptrías prismáticas (rango, 4-25). Se asoció esotropía en cuatro casos, diplopía en dos, y Tortícolis en tres. Se consideró un buen resultado cuando la desviación final fue inferior a 10pd, con leve limitación de la elevación, Tortícolis, y resultado negativo en el test de ducción forzada. Resultados: La desviación vertical final fue de 6,83pd (rango, 0-14). Se realizó una recesión del músculo recto inferior de 2 a 4mm en cuatro pacientes, asociada a una cirugía/exploración del oblicuo inferior. A todos los pacientes se les intervino una sola vez, exceptuando un único caso. Se logró un buen resultado en tres pacientes. La postura de cabeza anómala se resolvió en dos de tres casos. La diplopía se resolvió tras la intervención. En un único caso se logró ortoforia. El tiempo medio de evolución fue de 34,83 meses (rango, 6-78). Conclusión: En el tratamiento del síndrome de adherencia grasa se recomienda la recesión del músculo recto inferior, asociada a una exploración o cirugía del oblicuo inferior. Se logró un resultado favorable y bueno únicamente en la mitad de los casos con tratamiento quirúrgico. La limitación de la elevación no pudo resolverse completamente en ninguno de los pacientes (AU)

Murciano-Granadina Goat Performance and Methane Emission after Replacing Barley Grain with Fibrous By-Products.

The aim of this experiment was to study the effects of substituting dietary barley grain with orange pulp or soybean hulls on energy, nitrogen and carbon balance, methane emission and milk performance in dairy goats. Twelve Murciano-Granadina dairy goats in midlactation were selected and divided into three groups based on similar body weight (42.1 ± 1.2 kg) and milk yield (2.16 ± 0.060 kg/goat/day). The experiment was conducted in an incomplete crossover design where one group of four goats was fed a mixed ration of barley grain (BRL), another group of four goats replaced barley grain with orange pulp (OP) and the last group of four goats with soybean hulls (SH). After adaptation to diets, the goats were allocated to individual metabolism cages and intake, faeces, urine and milk were recorded and analysed. Then, gas exchange measurements were recorded by a mobile open-circuit indirect calorimetry system using a head box. Dry matter intake was similar for all three groups (2.03 kg/d, on average). No influence of the diet was observed for energy balance and the efficiency of use of metabolizable energy for milk production was 0.61. The OP and SH diets showed greater (P < 0.05) fat mobilization (-42.8 kJ/kg of BW0.75, on average) than BRL (19.2 kJ/kg of BW0.75). Pentadecanoic acid (15:0) and heptadecanoic acid (17:0) were potential biomarkers of rumen function because the higher contents found in the milk of OP and SH goats than BRL suggest a negative impact of these diets on rumen bacterial metabolism; probably linked to the lower nitrogen supply of diet OP to synthesize microbial protein and greater content of fat in diet SH. Replacement of cereal grain with fibrous by-products did not increased enteric methane emissions (54.7 L/goat per day, on average). Therefore, lactating goats could utilize dry orange pulp and soybean hulls diets with no detrimental effect on milk performance.

Fat adherence syndrome following inferior oblique surgery: Treatment and outcomes.

PURPOSE: Describe surgical treatment and results in a group of patients diagnosed and operated on of fat adherence syndrome following inferior oblique surgery. PATIENTS, MATERIAL AND METHODS: Retrospective study of 6 cases diagnosed and treated of fat adherence syndrome following inferior oblique surgery. Mean age was 24.67 years (range, 5-41), 3 males, 5 unilateral and 1 bilateral. Mean vertical deviation was 16.16pd (range, 4-25). Esotropia was associated in 4 cases, diplopia in other 2, and anomalous head posture in 3. A good outcome was considered when the final deviation was less than 10pd, with mild limitation of elevation, without anomalous head posture, and a negative duction forced test. RESULTS: The final vertical deviation was 6.83pd (range, 0-14). A 2-4mm inferior rectus recession was performed on 4 patients associated to an inferior oblique surgery/exploration. All patients were operated on once, except 1 case. A good outcome was achieved in 3 patients. Anomalous head posture was resolved in 2 of 3 cases. Diplopia resolved after surgery. Only one case achieved orthophoria. Mean evolution time was 34.83 months (range, 6-78). CONCLUSION: In the treatment of the fat adherence syndrome, an inferior rectus recession is recommended, associated to inferior oblique exploration or surgery. A good favorable outcome was only achieved in half of the cases with surgical treatment. Limitation of elevation could not be completely resolved in any of the patients.

Bilateral superior oblique palsy: etiology and therapeutic options.

PURPOSE: To study the causes of bilateral superior oblique palsy (BSOP), treatment with botulinum toxin and/or surgery, and outcome of treatment. METHODS: This was an 11-year retrospective study of patients with BSOP treated with injections of botulinum toxin (Botox), surgery, or both. Treatment was considered successful when anomalous head turn and diplopia in primary gaze position and downgaze resolved. RESULTS: Bilateral superior oblique palsy was diagnosed in 12 patients (8 male; mean age, 29.5 years). Palsy was secondary to a neoplasm in 3 cases and to head trauma in 2. In 2 cases, it was ischemic, in 2 it was congenital; the remaining cases were iatrogenic (hydrocephalus secondary to meningitis, 1), hemorrhagic (1), and idiopathic (1). The clinical manifestations recorded were diplopia (10), anomalous head posture (9), V pattern (12), subjective excyclotorsion (8), and objective excyclotorsion (6). Recovery was spontaneous in 1 case with neoplastic disease. Botox was injected in 8 cases (inferior oblique and/or inferior rectus muscles [successful in 2]), and subsequent surgery was required in 6. Two patients underwent surgery without prior injection of Botox. The most common surgical technique was recession of the inferior oblique muscle (6 patients), either as the only operation or associated with other procedures. The final result was good in 72.72% (8/11). Mean follow-up was 62.6 months (range 9-99 months). CONCLUSIONS: Causes of BSOP were varied (most frequently neoplastic). Botox was effective as the only treatment in 25% (2/8). Outcome was good in a high percentage of cases with Botox, surgery, or both.

Congenital fibrosis of the extraocular muscles: magnetic resonance imaging findings and surgical treatment.

PURPOSE: We analyzed findings of orbital and cranial magnetic resonance imaging (MRI) in patients with congenital fibrosis of the extraocular muscles (CFEOM). We described surgery and its outcome. MATERIAL AND METHOD: Nine out of 10 patients with clinical findings of CFEOM underwent orbital and cranial MRI to perform a study of the extraocular muscles and cranial nerves. A multimodality workstation platform developed by the imaging laboratory of our hospital for PC computer allowed us to visualize and measure the cross sections of the extraocular muscles in a coronal section. Surgery was indicated to resolve strabismus. Outcome was considered favorable if the final deviation was < 10 pd in the primary position without head turn. RESULTS: In 8 cases (6 males, 5 unilateral [3 left eye]), MRI revealed atrophy of at least 1 of the extraocular muscles supplied by the third nerve. Five patients had third nerve aplasia or hypoplasia. Clinical findings were compatible with a probable diagnosis of CFEOM in all 10 patients. Four patients underwent ptosis surgery before being diagnosed with CFEOM. Four patients underwent surgery to correct strabismus and, of these, 2 required multiple interventions (1 needed 4 interventions). Outcome was successful in only 2 cases. CONCLUSION: Orbital and cranial MRI provided useful information about extraocular muscles and cranial nerves in CFEOM. Surgery must be performed on an individual basis; the number of reoperations is high. The outcome of surgery was favorable in half of the cases.

Atypical restrictive strabismus secondary to an anomalous orbital structure: differential diagnosis.

Anomalous orbital structures are very rare causes of restrictive strabismus. Of the 3 types described in the literature, one involves accessory muscle fibers that are innervated by the III and/or VI cranial nerves originating in the posterior orbit and inserting on the globe, optic nerve, or extraocular muscles. Although these structures do not cause specific symptoms that enable us to make a diagnosis, we must take them into account in patients with atypical restrictive strabismus. Computed tomography and, particularly, orbital magnetic resonance imaging are essential for correct diagnosis and treatment, as the only other way to diagnose this condition is through casual findings during surgery to correct strabismus. Our patient was a child who were initially diagnosed as Duane syndrome. Magnetic resonance imaging revealed an anomalous unilateral orbital structure that limited all ocular movements except adduction, and possibly contributed to globe retraction. Surgery for strabismus did not resolve the problem: the posterior location of the orbital structure rendered surgery impossible.

Horizontal rectus surgery in Duane syndrome.

PURPOSE: To study the results of horizontal rectus recession for treatment of Duane syndrome. METHODS: This was a retrospective study of 17 patients with Duane syndrome who underwent strabismus surgery between 2000 and 2008 with medial rectus recession for esotropic deviation or lateral rectus recession for exotropic deviation. The amount of surgery varied individually with the angle of deviation and abnormal head posture. Head turn was graded as mild, moderate, or severe. Botulinum toxin was injected in specific cases. An angle of deviation less than 10 PD and head turn less than 5º after surgery were considered good results. RESULTS: Treatment was successful in 12 cases (70.58%) and unsuccessful in 5 (4 with type I Duane syndrome and one with type III Duane syndrome); in 3 patients the deviation was undercorrected and 2 it was overcorrected. Ipsilateral medial rectus recession of less than 5 mm was performed in 12 patients, although 1 case with a recession of 7 experienced secondary adduction limitation. Abduction limitation was slightly improved in 29.41%. Mean follow-up was 50.59 months. CONCLUSIONS: Moderate horizontal rectus recession is a simple and effective procedure in most patients with Duane syndrome and no secondary duction limitations. The technique only slightly improved abduction in one-third of the cases.

Conjunctival cysts as a complication after strabismus surgery.

PURPOSE: To identify possible factors associated with the development of a conjunctival cyst after surgery for strabismus. METHODS: A descriptive, longitudinal, and retrospective study was done including 12 cases from the past 20 years presenting a conjunctival cyst as a complication of strabismus surgery. Variables included age, sex, eye and muscle operated on, surgical technique used, surgeon, type of suture, and type of conjunctival incision. Fisher's exact test and Pearson chi-square test were used for statistical analysis. RESULTS: The incidence of conjunctival cysts was 0.25%. Although ultimately statistically significant differences in the variables studied could not be demonstrated (P > .05), a greater incidence in the development of this complication in young patients who underwent recession (58.3%) as the surgical technique was observed. CONCLUSION: Recession may be a risk factor in the development of a conjunctival cyst caused by the high frequency of dragging Tenon capsule during this surgical technique.

Etiology and treatment of pediatric sixth nerve palsy.

PURPOSE: To describe the causes and treatment of sixth (abducens) nerve palsy in a series of pediatric patients. METHODS: This was a 14-year retrospective study of sixth nerve palsy in children under 14 years of age. Outcomes studied included horizontal deviation, degree of limitation of abduction, and head turn. Patients were treated with botulinum toxin injection at the time of diagnosis; surgery was indicated if treatment with botulinum toxin was unsuccessful. Success was defined as final deviation of orthotropia with no head turn or diplopia. RESULTS: Sixth nerve palsy was diagnosed in 15 patients (10 boys; mean age, 4.1 years) between 1995 and 2008. Involvement was bilateral in 2 cases and unilateral in 13 (7 right eyes). Causes included neoplasm (4 cases), trauma (2), idiopathic (3), congenital (2), viral (2), and inflammatory (1). Neoplastic causes were associated with other neurologic signs. Recovery was spontaneous in 5 cases (2 idiopathic, 1 traumatic, 1 congenital, and 1 inflammatory). Botulinum toxin was successful in 7 of 10 patients treated, with follow-up surgery required in the remaining 3 cases. The final result was good in all cases. In all 15 patients, mean time from diagnosis to resolution was 39 months (range, 5 to 170 months). CONCLUSIONS: Neoplasms were the most frequent cause of sixth nerve palsy in our patient population. Recovery was spontaneous in one third of the patients. Most required treatment with botulinum toxin, which was successful in most cases. Surgery was successful after a single procedure.

Intramuscular Bupivacaine Injection for the Treatment of Oculomotor Paresis.

The main goal of this study is to examine the effect of intramuscular bupivacaine in oculomotor paresis, analyzing whether it is possible to obtain a stronger muscle contraction due to the muscle hypertrophy caused by the drug. An injection of 4.5 mL of a 0.50% solution of bupivacaine was administered in the paretic muscle of three patients. Magnetic resonance imaging was performed before and 3 months after injection to compare muscle cross-sectional areas. The symptoms of two patients improved and an increase of muscle cross-sectional area was observed. However, it is necessary to be prudent when employing intramuscular bupivacaine in oculomotor paresis treatment until there are more and larger studies.