Office-based vergence and anti-suppression therapy for the treatment of small-to-moderate angle intermittent exotropia: A randomised clinical trial.

PURPOSE: To evaluate the short-term (1 week after completion of treatment) effect of office-based vergence and anti-suppression therapy (OBVAT) on the Office Control Score when compared to observation alone in children with small-to-moderate angle intermittent exotropia (IXT). METHODS: In this single-masked (examiner masked), two-arm, single-centre randomised clinical trial, 40 participants, 6 to <18 years of age with untreated IXT, were randomly assigned to OBVAT or observation alone. Participants assigned to therapy received 60 min of OBVAT with home reinforcement once per week for 16 weeks. Therapy included vergence, accommodation and anti-suppression techniques. The primary outcome measure was the comparison of the distance Office Control Score between the two groups at the primary outcome visit (i.e., 17-week follow-up visit). RESULTS: At the primary outcome visit, the OBVAT group (n = 20) had a significantly better distance Office Control Score (adjusted mean difference: -0.9; 95% CI: -0.2 to -1.5; p = 0.008; partial eta squared: 0.19) than the observation group (n = 16). Participants from the OBVAT group were more likely than those from the observation group to have ≥1 point of improvement at the 17-week visit (OBVAT group: 75%; Observation group: 25%; p = 0.006). CONCLUSIONS: In this randomised clinical trial of participants aged 6 to <18 years with IXT, we found that the OBVAT group had a significantly better distance Office Control Score than the observation group at the 17-week visit. This study provides the first data from a randomised clinical trial demonstrating the effectiveness of OBVAT for improving the control of IXT. Eye care practitioners should consider OBVAT as a viable, non-surgical treatment option for IXT. A full-scale randomised clinical trial investigating the long-term effectiveness of OBVAT in treating IXT is warranted.

Reliability of step vergence method for assessing fusional vergence in intermittent exotropia.

PURPOSE: To evaluate the reliability of the step vergence method in measuring fusional vergence in subjects with intermittent exotropia. METHODS: Thirty-two Chinese participants aged 7-20 years with intermittent exotropia (excluding the convergence insufficiency type) were enrolled in this prospective study. At the eligibility screening, visual acuity, cover test and the Office Control Score were performed. For eligible participants at study visit 1, negative and positive fusional vergence at distance and near, eye dominance and the fusion maintenance test were performed. All eligible participants returned for study visit 2 on the same day (2-4 h later), and the testing was repeated. The primary outcome measures were the intra-class correlation coefficient, coefficient of repeatability and smallest detectable change in the break and recovery points of negative and positive fusional vergence between the two study visits. RESULTS: The intra-class correlation coefficient for different vergence parameters ranged from 0.64 to 0.87. The coefficient of repeatability and the smallest detectable change for the distance positive fusional vergence break point were ±20.5 and 13.1 ∆, respectively. There was no significant difference in any vergence parameter between the first and second visits. The coefficient of repeatability and the smallest detectable change in all distance vergence parameters were high when compared to the mean value. The association between distance vergence parameters and the Office Control Score was significant only when including subjects who failed to fuse at the beginning of the test. CONCLUSION: The data demonstrate that measurement of fusional vergence with a prism bar has low repeatability in subjects with intermittent exotropia. In these individuals, convergence ability at distance is compromised, whereas other vergence parameters are not adversely affected. While the step vergence method is a valuable test in daily practice, caution is warranted when using it in clinical research.

Maintenance of normal fusion in intermittent exotropia.

PURPOSE: To evaluate the reliability of the Bagolini filter bar and striated lenses for measuring the fusion maintenance score, which is the ability of participants with intermittent exotropia to maintain normal sensorimotor fusion. METHODS: Thirty-two Chinese participants aged 7-20 years with intermittent exotropia (excluding the convergence insufficiency type) were enrolled in this prospective study. At the eligibility screening, visual acuity, cover test and assessment of the office control score were performed. At study visit 1, eligible participants underwent negative and positive fusional vergence tests at far and near, eye dominance test and the fusion maintenance test. All eligible participants returned for study visit 2 on the same day (2-4 h later) and the testing was repeated. The primary outcome measure was the intra-class correlation coefficient of the fusion maintenance score between the two study visits. RESULTS: The intra-class correlation coefficient of the fusion maintenance score was 0.84, indicating good reliability. There was no significant difference (mean difference = 0.05, p = 0.95) between the fusion maintenance scores for the first (5.62) and second study visits (5.57). The coefficient of repeatability and the smallest detectable change for the fusion maintenance scores were 7.6 and 6.3, respectively. The fusion maintenance score was significantly associated with the distance (Spearman correlation -0.57, p < 0.001) and near (Spearman correlation -0.4, p = 0.02) office control scores. CONCLUSION: These data demonstrate that the fusion maintenance score is a reliable tool to evaluate sensorimotor fusion in intermittent exotropia. These results suggest that the fusion maintenance score may be a useful outcome measure in future clinical trials to evaluate the effectiveness of treatments for intermittent exotropia.

Complete Genome Sequence of Pantoea ananatis Strain NN08200, an Endophytic Bacterium Isolated from Sugarcane.

Stain NN08200 was isolated from the surface-sterilized stem of sugarcane grown in Guangxi province of China. The stain was Gram-negative, facultative anaerobic, non-spore-forming bacteria. The complete genome SNP-based phylogenetic analysis indicate that NN08200 is a member of the genus Pantoea ananatis. Here, we summarize the features of strain NN08200 and describe its complete genome. The genome contains a chromosome and two plasmids, in total 5,176,640 nucleotides with 54.76% GC content. The chromosome genome contains 4598 protein-coding genes, and 135 ncRNA genes, including 22 rRNA genes, 78 tRNA genes and 35 sRNA genes, the plasmid 1 contains 149 protein-coding genes and the plasmid 2 contains 308 protein-coding genes. We identified 130 tandem repeats, 101 transposon genes, and 16 predicted genomic islands on the chromosome. We found an indole pyruvate decarboxylase encoding gene which involved in the biosynthesis of the plant hormone indole-3-acetic acid, it may explain the reason why NN08200 stain have growth-promoting effects on sugarcane. Considering the pathogenic potential and its versatility of the species of the genus Pantoea, the genome information of the strain NN08200 give us a chance to determine the genetic background of interactions between endophytic enterobacteria and plants.

Single Stage Surgical Outcomes for Large Angle Intermittent Exotropia.

Although there were many prior studies about exotropia, few focused on large-angle intermittent exotropia. The goal of this study was to evaluate single-stage surgical outcomes for large-angle intermittent exotropia and analyze risk factors that may affect the success of surgery. Records from intermittent exotropia patients with exodeviations >60 prism diopters(PD) who were surgically treated at the Zhongshan Ophthalmic Center, of Sun Yat-Sen University were reviewed. Included within this review were data on, pre- and post-operative ocular motility, primary alignment, binocular vision and complications. Patients with exodeviations ≤70PD received two-muscle surgery, while those with exodeviations >70PD were subjected to a three-muscle procedure. A total of 40 records were reviewed. The mean exodeviation was 73±9PD at distance and 75±26PD at near. There were 25 patients received two-muscle surgery and 15 the three-muscle procedure. Orthophoria (deviation within 8PD) was obtained in 77.5% of these patients and the ratios of surgical under-correction and over-correction were 15% and 7.5% respectively. However, when combining ocular alignment with binocular vision as the success criteria, success rates decreased to 30%. No statistically significant differences in success rates were obtained between the two- and three-muscle surgery groups. Seven subjects experienced an abduction deficit during the initial postoperative stages, but eventually showed a full recovery. One patient required a second surgery for overcorrection. No statistically significant risk factors for poor outcome were revealed. Our data showed that single-stage two- and three-muscle surgeries for large-angle intermittent exotropia are effective in achieving a favorable outcome.

Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia: A Large Sample Study in South China.

The clinical characteristics and surgical outcomes in a large sample of patients with intermittent exotropia (IXT) as well as an analysis of risk factors associated with surgical failures are presented in this article. Data from IXT patients who received surgical management at the Eye Hospital, in the Zhongshan Ophthalmic Center, of Sun Yat-Sen University, China from January 2009 to December 2013 were reviewed retrospectively. Included within this analysis were data from pre- and postoperative ocular motility, primary alignment, and binocular vision.A total of 1228 patients with IXT were reviewed. Males (50.4%) and females (49.6%) were nearly equally represented in this sample. Thirty-two patients (2.6%) had a family history of strabismus. The mean age at onset was 6.77  ±â€Š 6.43 years (range 7 months -48.5 years), mean duration at presentation was 7.35  ±â€Š 6.68 years (range 6 months-47 years), and mean age at surgery was 13.7  ±  8.8 years (range 3-49 years). The mean refractive error was -0.84  ±â€Š 2.69 diopter in the right eye and -0.72  ±â€Š 2.58 diopter in the left eye. Amblyopia (4.2%), oblique muscle dysfunction (7.0%), and dissociated vertical deviation (4.7%) were also present in these patients. The most common subtype of IXT was the basic type (88.1%). Orthophoria was observed in 80.5% of patients and the ratios of surgical undercorrection and overcorrection were 14.7% and 4.8%, respectively, as determined with a mean follow-up time of 7.8  ±â€Š 3.7 months. When combining ocular alignment with binocular vision as the success criteria, the success rate decreased to 35.6%. Multivariate risk factor analysis showed that only the loss of stereoacuity (P = 0.002) was associated with a poor outcome. There were no differences in the long-term results between bilateral lateral rectus recession and unilateral lateral rectus recession with medial rectus resection.Most IXT patients displayed normal vision, with few having positive family histories, amblyopia, oblique muscle dysfunction, and dissociated vertical deviation. The most common subtype of IXT was the basic type. Long-term surgical results were less favorable when sensory status was included in the criteria for success. Patients with stereoacuity loss were at an increased risk for poor outcomes.

Acute Acquired Concomitant Esotropia: Clinical features, Classification, and Etiology.

Acute acquired concomitant esotropia (AACE) is a rare, distinct subtype of esotropia. The purpose of this retrospective study was to describe the clinical characteristics and discuss the classification and etiology of AACE.Charts from 47 patients with AACE referred to our institute between October 2010 and November 2014 were reviewed. All participants underwent a complete medical history, ophthalmologic and orthoptic examinations, and brain and orbital imaging.Mean age at onset was 26.6 ±â€Š12.2 years. Of the 18 cases with deviations ≤ 20 PD, 16 presented with diplopia at distance and fusion at near vision at the onset of deviation; differences between distance and near deviations were < 8 PD; all cases except one were treated with prism and diplopia resolved. Of the 29 cases with deviations > 20 PD, 5 were mild hypermetropic with age at onset between 5 and 19 years, 16 were myopic, and 8 were emmetropic with age at onset > 12 years; 24 were surgically treated and 5 cases remained under observation; all 24 cases achieved normal retinal correspondence or fusion or stereopsis on postoperative day 1 in synoptophore; in 23 cases diplopia or visual confusion resolved postoperatively. Of the 47 cases, brain and orbital imaging in 2 cases revealed a tumor in the cerebellopontine angle and 1 case involved spinocerebellar ataxia as revealed by genetic testing.AACE in this study was characterized by a sudden onset of concomitant nonaccommodative esotropia with diplopia or visual confusion at 5 years of age or older and the potential for normal binocular vision. We suggest that AACE can be divided into 2 subgroups consisting of patients with relatively small versus large angle deviations. Coexisting or underlying neurological diseases were infrequent in AACE.

Severe microphthalmos with cyst and unusually huge dermolipoma.

PURPOSE: The purpose of this study was to report an unusual case of severe microphthalmos, together with an orbital cyst and huge ocular surface dermolipoma. METHODS: This is a clinical report relating clinical features as well as imaging and histopathologic findings, along with surgical management of the patient. RESULTS: A 5-month-old Chinese male infant was referred, with 2 large masses in the left eye that were present since birth. Ocular examination results revealed a complete absence of any eye structures in the left orbit. In its place were 2 large masses between the left upper and lower palpebral fissure. One was a 3 × 3 × 2.5-cm spherical red tumor with a smooth surface. The other was a large solid spherical tumor, 4 × 4 × 5 cm, covered with normal skin located in the temporal region and attached to the red mass by a pedicle. Orbital magnetic resonance imaging examination findings confirmed that no eye structures were present in the left orbit. However, a cystic lesion was found in the left orbit, with a low signal on T1-weighted imaging and high signal on T2-weighted imaging, and another huge spherical heterogeneous mass was located "outside" the left orbit. Anterior orbitotomy by conjunctival incision was performed under general anesthesia. A spherical cystic mass of 1.5 × 1.5 × 1.6 cm, a small eye of 0.7 × 0.7 × 0.6 cm, and a huge dermolipoma were removed completely. Pathologic examination results confirmed the diagnosis of severe microphthalmos, together with orbital dermoid cyst and dermolipoma. CONCLUSIONS: This rare case demonstrates that severe microphthalmos with a cyst may be completely covered by conjunctiva and associated with an unusually huge dermolipoma.

Rare orbital cystic lesions in children.

PURPOSE: To analyze the clinical features, imaging findings and surgical management of rare orbital cystic lesions in children. MATERIALS AND METHODS: Clinical records of 5 Chinese children with rare orbital cystic lesions including cystic teratoma, congenital cystic eye, optic nerve sheath cyst, parasitic cyst, and meningoencephalocele were reviewed. Their clinical history, symptoms and signs, ultrasonography or computed tomography/magnetic resonance imaging (CT/MRI), surgical management were presented in detail. RESULTS: Among the 5 patients, 2 were male and 3 female. The right orbit was involved in 2 patients and the left orbit in 3 patients. Ages ranged from 2 months to 11 years (mean, 4.2 years). Cystic teratoma showed a well-outlined cystic mass with a focal bone-like structure (or calcific densities) in their lumens as revealed with CT scan. Congenital cystic eye was a rare ocular malformation that existed at birth and showed a cystic lesion with no definite ocular structures in the orbit. With MRI examination, the optic nerve sheath cyst demonstrated a clear figure of the central optic nerve and the surrounding sheath cyst. Patients with parasitic cysts usually had frequent animal contact and high levels of blood eosinophils. Meningoencephalocele, the herniation into the orbit of brain tissue, had the typical CT/MRI features, with bone defect and soft tissue mass in the orbit and a homogenous appearance that was isodense with brain. CONCLUSIONS: Besides common dermoid/epidermoid cyst, rare orbital cystic lesions such as cystic teratoma, congenital cystic eye, optic nerve sheath cyst, parasitic cyst, and meningoencephalocele should be considered in children.

Long-term efficacy of excimer laser in situ keratomileusis in the management of children with high anisometropic amblyopia.

BACKGROUND: Children with anisometropic amblyopia are often noncompliant with traditional treatment including spectacules and contact lenses. This study was to evaluate the long-term efficacy of excimer laser in situ keratomileusis (LASIK) for children with high anisometropic amblyopia. METHODS: A retrospective analysis of 24 children with high unilateral anisometropic amblyopia, who underwent LASIK during the period between August 2000 and September 2005 in our hospital, was conducted. The mean age of these children was (7.4 +/- 1.9) years (range 5 - 14 years) and the mean follow-up period was (33.3 +/- 14.2) months (range 18.5 - 74.2 months). After LASIK, visual acuity, refraction and far or near stereoacuity were analyzed. Near stereoacuity was measured by the random-dot butterfly stereogram and the pre-school random-dot stereogram, while far stereoacuity was measured by the synoptophore with Yan's random-dot stereogram. RESULTS: Mean preoperative uncorrected visual acuity was 0.06 +/- 0.05, while mean postoperative uncorrected visual acuity was elevated to 0.43 +/- 0.33. Mean preoperative best-corrected visual acuity was 0.26 +/- 0.22, while mean postoperative best-corrected visual acuity was elevated to 0.67 +/- 0.40. For patients with myopic anisometropia, preoperative mean spherical equivalent refraction was (-8.01 +/- 2.70) D while postoperative value significantly reduced to (-1.32 +/- 2.47) D. For patients with hyperopic anisometropia, preoperative mean spherical equivalent refraction was (+7.35 +/- 1.55) D while postoperative value significantly reduced to (+3.30 +/- 0.86) D. These results demonstrated that there was statistical difference in these parameters between preoperative and postoperative tests. At the last follow-up, 20 patients had near stereoacuity, and the mean near stereoacuities measured by the random-dot butterfly stereogram and the preschool random-dot stereogram were (149.00 +/- 152.93)'' and (201.05 +/- 235.94)'', respectively. In contrast, 11 patients had far stereoacuity, and the mean far stereoacuity measured by the synoptophore was (210.91 +/- 217.51)''. Three cases of patients developed mild corneal complications. CONCLUSION: LASIK for the correction of high anisometropia in children with monocular amblyopia may be safe and effective, and this can help effectively conduct postoperative amblyopia training and improve the cure rate.

[The clinic value of fixed visual field examination in patients with thyroid-associated ophthalmopathy].

PURPOSE: To evaluate the clinical value of fixed visual field examination on thyroid-associated ophthalmopathy patient. METHODS: The fixed visual field examination was conducted on 27 thyroid-associated ophthalmopathy patients. RESULTS: When the ocular-motor deficit ratio is less than value -4, the patient's fixed visual field is between 0-15 degree; when the ocular-motor deficit ratio is less than value -3, the patient's fixed visual field is between 18-28 degree; when the ocular-motor deficit ratio is less than value -2, the patient's fixed visual field is between 28-38 degree; when the ocular-motor deficit ratio is less than value -1, the patient's fixed visual field is between 40-43 degree; when the ocular-motor system is normal, the patient's fixed visual is between 45-50 degree. CONCLUSION: The results from the fixed visual field examination can give direct and accurate evaluation on how and where the ocular muscle has been affected by the thyroid-associated ophthalmopathy.

[Refractive error and the intraocular pressure: findings in the Chinese eyes].

PURPOSE: To analysis the correlation between the refractive error and the intraocular pressure. METHODS: The IOP was measured in 142 eyes with noncontact tonometer. The refractive error were determined with an autorefractometer(TOPCON-7100). RESULTS: The analysis of variance showed that IOP of medium myopia is the highest, and a significant IOP difference between medium myopia and severe myopia, and IOP of patients less than 19yrs is significantly higher than patients more than 30 yrs; and there is also no significant influence of gender on patients' IOP, mean IOP(13.04 +/- 2.97) mmHg. CONCLUSION: These results suggest that when medium myopia IOP is relatively higher, or when a young patient less than 19 whose IOP is relatively higher than usual, that may mean the eye is under an unstable situation.