Standard strabismus surgery in thyroid ophthalmopathy.

INTRODUCTION: Techniques for the surgical treatment of thyroid related strabismus vary and include non-adjustable (standard), [postop'] adjustable suture, and a newer procedure aimed at correcting restriction rather than using dose/response tables.This study reports the results utilizing standard strabismus procedures for the treatment of thyroid ophthalmopathy. METHODS: Charts of 31 consecutive patients who underwent surgery in the pst 5 years for restrictive strabismus secondary to thyroid ophthalmopathy were retrospectively reviewed. All surgery was performed by recession and reattachment of the muscle to the globe, allowing for no postoperative adjustment. Standard doses were used for all primary surgery and slightly modified in some cases of reoperation, but the general principal was from a standard published nomogram. RESULTS: All 31 patients had preoperative diplopia and restricted motility. 22 patients wore prisms prior to surgery. Of the 31 patients who underwent surgery 9 required a second operation. After reoperation 5 patients (16%) continued to have diplopia. However, 4 of these patients were able to achieve single binocular vision with a small amount of prism. Only 2 patients were unable to achieve single binocular vision with or without prism. 22 patients (71%) had full ocular motility after surgery. After one surgery, 25 of 31 patients (81%) were satisfied with the results of surgery. This increased to 29 patients (94%) after reoperation. CONCLUSION: The results of this study indicated that strabismus surgery for restrictive thyroid ophthalmopathy using standard technique and table amounts of surgery can provide excellent results and patient satisfaction.

The role of the random dot Stereo Butterfly test as an adjunct test for the detection of constant strabismus in vision screening.

BACKGROUND: A goal of vision screening is the detection of amblyopia risk factors, including strabismus. The random dot Stereo Butterfly test requires no instruction, has a simple pass/fail response with no monocular clues, and is easily administered. The purpose of this study was to determine whether this test could be used as a cost-effective and reliable component of preschool vision screening. METHODS: The Stereo Butterfly was presented to children with no previous history of ocular problems or treatment. The test was presented with the use of polarized glasses at a 16-inch testing distance. A "pass" was recorded if the patient reported seeing a butterfly; a "refer" was denoted otherwise. Vision and motility measurements were recorded, and the patient underwent a complete eye examination with cycloplegic refraction. RESULTS: A total of 281 children 3 to 6 years of age were tested: 221 children passed the test. Of those who passed, 7 (3.2%) had intermittent strabismus, 1 had a small-angle constant strabismus, 60 failed screening for constant strabismus (of whom 24 [40%] had constant strabismus), and 6 were false-negative results. The sensitivity of the Stereo Butterfly for detecting constant strabismus was 96%; the specificity, 86%. CONCLUSIONS: The Stereo Butterfly test may be a valuable adjunctive tool in vision screening programs for the detection of manifest strabismus because it is easy to administer and effectively detects constant strabismus. It has a high specificity for detection of constant strabismus but, if used alone, the low positive predictive value would allow for many false-positive results.