Association of preoperative sensory monofixation with surgical failure in adult-onset divergence insufficiency-type esotropia.

We investigated the frequency of sensory monofixation in patients with adult-onset divergence insufficiency esotropia and whether preoperative sensory monofixation was associated with surgical failure. Twenty-five patients with esotropia greater at distance than near who underwent bilateral medial rectus recessions were included. Near stereoacuity was measured preoperatively and 8 weeks postoperatively using the Randot Preschool test. Patients with best-corrected visual acuity worse than 0.3 logMAR in either eye or preoperative diplopia "rarely" or "never" in straight-ahead gaze at distance were excluded to minimize the inclusion of decompensated childhood strabismus. Sensory monofixation was defined as stereoacuity of 200 arcsec or worse and bifixation as 40 or 60 arcsec. Surgical failure was defined as esodeviation of >4Δ or exodeviation of >10Δ at distance or near, assessed 8 weeks (range, 6-17 weeks) postoperatively. We calculated the frequency of monofixation and surgical failure rates among patients with preoperative monofixation and those with preoperative bifixation. Preoperatively, sensory monofixation was common in divergence insufficiency-type esotropia (16 of 25 [64%]; 95% CI, 45%-83%). None of those with preoperative sensory monofixation had surgical failure, which does not support an association of surgical failure with preoperative monofixation.

The effect of axial length to basement-membrane opening to fovea distance on optical coherence tomography.

BACKGROUND: Optical Coherence Tomography (OCT) lateral scaling is influenced by axial length (AL). There is a need to incorporate a method to correct this measurement bias for accurate lateral OCT measurement. PURPOSE: To identify the correlation of optic-nerve-to-fovea distance measurement to AL by OCT) as an internal factor for lateral scaling. METHODS: Using Heidelberg Spectralis OCT, distance from the basement membrane opening at the optic disc margin to the centre of the fovea (BMO-fovea distance) was measured in 135 eyes (77 subjects, ages 25-85). These measurements were correlated with AL measurements from Zeiss IOLMaster 700 using linear regression before and after correction for ocular magnification. Statistical analysis including Shapiro-Wilk test for normality, Pearson correlation, and multivariate analysis of the association between disc-fovea distance and AL was performed using Wizard statistical software for mac. RESULTS: After lateral scaling, the mean distance between the fovea and BMO was 3.60 ± 0.25 mm (median: 3.59; range 3.07-4.23 mm). There was a significant positive correlation between AL and Bennett's formula-corrected BMO-fovea distance (p <0.001, r = 0.354). CONCLUSIONS: While there is significant variability in BMO-fovea distances, it is positively correlated with AL. A standard method is needed to improve the lateral scaling measurements in order to unify the results for enface OCT imaging.

An Integrated Mycobacterium tuberculosis Infection Session: Utilizing an Online Collaborative Platform in a Synchronous Classroom Setting.

Introduction: Tuberculosis (TB) remains a major public health concern worldwide. It is important to provide high-quality instructional sessions to students about the pathogenesis and risk factors of TB, as medical students are likely to encounter TB infections in clinical practice. Methods: We describe an interactive instructional session integrating immunology and microbiology concepts of Mycobacterium tuberculosis infection that was presented to first-year medical students in their respiratory organ systems course. The session included a pretest primer followed by a brief review of mucosal immunity with an emphasis on the respiratory system. Using an online collaborative application, learners created a study guide on a shared spreadsheet while faculty provided real-time feedback. Following the cloud-based portion, faculty presented interactive lectures using student-created content. The session concluded with a formative posttest. We evaluated the session with responses to an optional student survey. Results: One hundred fourteen students (37% male and 63% female) completed the survey across 4 years from 2016 to 2019. The session received high student satisfaction ratings across five questions, with 83% of students indicating they were slightly satisfied to strongly satisfied. The students had an absolute increase in their scores of 31% on the posttest as compared to the pretest mean (p < .001). Discussion: We developed an interactive TB instructional session that integrates disciplines, contains real-time instructor feedback, and promotes teamwork in a large class setting. The session allows medical students to learn content and create their own study guide using online collaboration technology.