Primary versus secondary intraocular lens implantation following removal of congenital/de al of congenital/developmental catar elopmental cataracts: outcomes after acts: outcomes after at least 4 years.

BACKGROUND: The aim of this study is to evaluate the long-term outcomes of primary and secondary intraocular lens (IOL) implantation following removal of congenital/developmental cataracts. METHODS: One hundred and forty-four patients aged under 16 years who were followed up between 2003 and 2021 were analyzed retrospectively. The long-term results of children who underwent surgery before 2 years of age for congenital or developmental cataracts and underwent secondary IOL implantation after 2 years of age and those who underwent cataract surgery with primary IOL implantation after 2 years of age were compared. Patients with traumatic, secondary cataracts and cataracts due to ocular anomalies were not included in the study. RESULTS: We evaluated 64 patients (mean age 9.5 ± 4.5 years) with secondary IOL implantation and 80 patients (mean age 12.8 ± 4.1 years) with primary IOL implantation in the study. Distance and near best-corrected visual acuities were significantly better in the primary IOL group than the secondary IOL group (p < 0.001). Incidence of strabismus after primary IOL surgery was significantly lower and presence of binocular vision was more often than the secondary IOL group (p = 0.002). There was no significant difference between the two groups in terms of refraction and myopic shift (p = 0.242, p = 0.172, respectively). Mean refractive changes were significant in unilateral cases of secondary IOL group and primary IOL group (p = 0.013, p = 0.049, respectively) and myopic shift was also greater in both groups of unilateral cases than the fellow eyes (p = 0.023, p = 0.012, respectively). DISCUSSION: Visual outcomes and binocular vision were better, and the incidence of strabismus was also much less in the primary IOL group.

Botulinum toxin for the treatment of strabismus.

BACKGROUND: The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However, it is unclear how effective it is in comparison with other treatment options for strabismus. OBJECTIVES: The primary objective was to examine the efficacy of botulinum toxin therapy in the treatment of strabismus compared with alternative conservative or surgical treatment options. This review sought to ascertain those types of strabismus that particularly benefit from the use of botulinum toxin as a treatment option (such as small angle strabismus or strabismus with binocular potential, i.e. the potential to use both eyes together as a pair). The secondary objectives were to investigate the dose effect and complication rates associated with botulinum toxin. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS and three trials registers on 6 July 2022, together with reference checking to identify additional studies. We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA: We planned to include randomized controlled trials (RCTs) comparing botulinum toxin with strabismus surgery, botulinum toxin alternatives (i.e. bupivacaine) and conservative therapy such as orthoptic exercises, prisms, or lens therapy for people of any age with strabismus. All relevant RCTs identified in this update compared botulinum toxin with strabismus surgery. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane and assessed the certainty of the body of evidence using GRADE. MAIN RESULTS: We included four RCTs with 242 participants that enrolled adults with esotropia or exotropia, children with acquired esotropia, and children with infantile esotropia. The follow-up period ranged from six to 36 months. Two studies were conducted in Spain, and one each in Canada and South Africa. We judged the included studies to have a mixture of low, unclear and high risk of bias. We did not consider any of the included studies to be at low risk of bias for all domains. All four studies reported the proportion of participants who improved or corrected strabismus, defined as ≤ 10 prism diopters (PD) at six months (two studies) or ≤ 8 PD at one year (two studies). Low-certainty evidence suggested that participants treated with the surgery may be more likely to improve or correct strabismus compared with those who treated with botulinum toxin (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.53 to 0.99; I² = 50%; 4 studies, 242 participants; low-certainty evidence). One study, which enrolled 110 children with infantile esotropia, suggested that surgery may reduce the incidence of additional surgical intervention required, but the evidence was very uncertain (RR 3.05, 95% CI 1.34 to 6.91; 1 study, 101 participants; very low-certainty evidence). Two studies conducted in Spain compared botulinum toxin with surgery in children who required retreatment for acquired or infantile esotropia. These two studies provided low-certainty evidence that botulinum toxin may have little to no effect on achieving sensory fusion (RR 0.88, 95% CI 0.63 to 1.23; I² = 0%; 2 studies, 102 participants) and stereopsis (RR 0.86, 95% CI 0.59 to 1.25; I² = 0%; 2 studies, 102 participants) compared with surgery. Three studies reported non-serious adverse events. Partial transient ptosis (range 16.7% to 37.0%) and transient vertical deviation (range 5.6% to 18.5%) were observed among participants treated with botulinum toxin in three studies. In one study, 44.7% participants in the surgery group experienced discomfort. No studies reported serious adverse events or postintervention quality of life. AUTHORS' CONCLUSIONS: It remains unclear whether botulinum toxin may be an alternative to strabismus surgery as an independent treatment modality among certain types of strabismus because we found only low and very low-certainty evidence in this review update. Low-certainty evidence suggests that strabismus surgery may be preferable to botulinum toxin injection to improve or correct strabismus when types of strabismus and different age groups are combined. We found low-certainty evidence suggesting botulinum toxin may have little to no effect on achievement of binocular single vision compared with surgery in children with acquired or infantile esotropia. We did not find sufficient evidence to draw any meaningful conclusions with respect to need for additional surgery, quality of life, and serious adverse events. We identified three ongoing trials comparing botulinum toxin with conventional surgeries in the varying types of strabismus, whose results will provide relevant evidence for our stated objectives. Future trials should be rigorously designed, and investigators should analyze outcome data appropriately and report adequate information to provide evidence of high certainty. Quality of life and cost-effectiveness should be examined in addition to clinical and safety outcomes.

The epidemiology and disease pattern of pediatric ocular morbidities in Western India: The National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS (NIMBUS) study report 1.

Purpose: To determine the pattern of pediatric ocular morbidities in western India. Methods: This was a retrospective longitudinal study that included all consecutive children aged ≤15 years who presented to the outpatient department of a tertiary eye center for the first time. Patient demographics, best-corrected visual acuity (BCVA), and ocular examination data were compiled. Subgroup analysis was also performed based on age group (years): ≤5, 5-10, and >10-15. Results: A total of 11,126 eyes of 5563 children were included in the study. The mean age of the study population was 5.15 (±3.32) years with males (57.07%) being predominant. Approximately half of the patients (50.19%) were under the age of 5 years, followed by those aged 5-10 years (45.1%) and >10-15 years (4.71%). Among the study eyes, the BCVA was ≥20/60 in 58.57%, indeterminable in 35.16%, and <20/60 in 6.71%. The commonest ocular morbidity noted was refractive error (28.97%) followed by allergic conjunctivitis (7.64%) and strabismus (4.95%) in the total study cohort and also after age stratification. Conclusion: Refractive error, allergic conjunctivitis, and strabismus are the major causes of ocular morbidity in pediatric eyes at a tertiary care center. Planning screening programs at the regional and national levels is crucial to decreasing the burden of eye disorders. These programs also need to have a suitable referral mechanism established and be smoothly connected to primary and secondary health-care centers. This will help to assure quality eye care delivery, while also reducing the strain of overworked tertiary centers.

Strabismus in pediatric orbital wall fractures.

Purpose: To assess the clinical profiles and outcomes of strabismus in pediatric patients with orbital wall fractures. Methods: A retrospective interventional study of all consecutive children of age ≤16 years who presented with traumatic orbital wall fractures with and without resultant strabismus was conducted. The details of patient demographics, clinical features, interventions, and outcomes were obtained. Results: Forty-three children presented with traumatic orbital fractures to a tertiary care center. The mean age at presentation was 11 years and there was a male predominance (72.09%). Isolated floor fracture involvement was the most common (n = 24, 55.81%), and almost half of the children had a white-eyed or trapdoor fracture (n = 21, 48.83%). Twenty-six (60.46%) children had surgical repair of fracture(s). Manifest strabismus following orbital fracture was documented in 12 children (27.90%). Of these, an exotropia was noted in seven (58.33%), hypotropia in two (16.67%), hypertropia in one (8.33%), and esotropia in one patient (8.33%), while an exotropia with hypotropia was noted in one patient (8.33%). Restrictive nature of strabismus due to either muscle entrapment or local trauma was more commonly observed in 11/12 patients (91.66%). Primary position diplopia before orbital wall fracture repair was observed in four children and after repair was observed in two children with manifest strabismus. Four children underwent strabismus surgery post-fracture repair. Conclusion: An improvement in strabismus and ocular motility was noted in majority of the patients after fracture repair. The few that underwent strabismus surgery had a restrictive nature of strabismus. Trapdoor fractures and the nature of trauma in children vary compared to adults. Persistence of strabismus may be due to an excessive time interval between trauma and fracture repair or the extensive nature of trauma.

Surgical treatment versus observation in moderate intermittent exotropia (SOMIX): study protocol for a randomized controlled trial.

BACKGROUND: Intermittent exotropia (IXT) is the most common type of strabismus in China, but the best treatment and optimal timing of intervention for IXT remain controversial, particularly for children with moderate IXT who manifest obvious exodeviation frequently but with only partial impairment of binocular single vision. The lack of randomized controlled trial (RCT) evidence means that the true effectiveness of the surgical treatment in curing moderate IXT is still unknown. The SOMIX (surgical treatment versus observation in moderate intermittent exotropia) study has been designed to determine the long-term effectiveness of surgery for the treatment and the natural history of IXT among patients aged 5 to 18 years old. METHODS/DESIGN: A total of 280 patients between 5 and 18 years of age with moderate IXT will be enrolled at Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. After initial clinical assessment, all participants will be randomized to receive surgical treatment or observation, and then be followed up for 5 years. The primary objective is to compare the cure rate of IXT between the surgical treatment and observation group. The secondary objectives are to identify the predictive factors affecting long-term outcomes in each group and to observe the natural course of IXT. DISCUSSION: The SOMIX trial will provide important guidance regarding the moderate IXT and its managements and modify the treatment strategies of IXT. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02736526 . Registered April 13, 2016.

[Morphological study of extraocular muscles in dissociated vertical deviation by magnetic resonance imaging].

Objective: To observe the changes of pulley locations and muscle volumes of extraocular rectus muscles in dissociated vertical deviation. Methods: This was a cross-sectional study. Data was collected from January 2020 to December 2020 in Tianjin Eye Hospital. The pulley locations and muscle volumes of extraocular rectus muscles in DVD patients and healthy volunteers were observed and calculated by continuous coronal MRI scan. One-way ANOVA and independent sample T test were used for statistical analysis. According to the examination results, Groups were divided into A (symmetric DVD), B (asymmetric DVD) and C (healthy volunteers). Data of symmetric DVD patients were divided into dominant eye (A-D) and non-dominant eye (A-nD), while that of asymmetric DVD patients were divided into severe DVD (B-s) and mild DVD (B-m). Volume of 4 rectus muscles and superior oblique muscle were calculated and compared to Group C, respectively. Results: Group A included 5 patients (10 eyes), 2 males and 3 females, aged (22±4) years; Group B included 4 patients (8 eyes), 2 males and 2 females, aged (28±8) years; Group C included 10 patients (20 eyes), including 4 males and 6 females, aged (25±6) years. There was no significant differences in age(F=0.45,P=0.648)or gender(χ2=0.78;P=0.833)among the three groups. There was no significant difference in pulley locations of extraocular rectus muscles between the three groups (FMR=0.52,FLR=0.62,FSR=0.72,FIR=1.16;all P>0.05). Among the four exterocular rectus muscles, the muscle volume of MR [A-D: (562.8±64.4) mm3,A-nD: (560.6±53.2) mm3,B-s: (557.0±48.7) mm3,B-m: (551.5±45.8) mm3], LR [A-D: (519.8±44.5) mm3,A-nD: (511.0±49.4) mm3,B-s: (501.0±35.6) mm3,B-m: (498.3±45.3) mm3] and SR [A-D: (472.8±66.9) mm3,A-nD: (449.4±41.7) mm3,B-s: (433.0±60.8) mm3,B-m: (412.5±54.5) mm3] in group A and group B was higher than that in group C [MR: (423.3±51.9)mm3,LR: (439.7±35.3)mm3,SR: (328.1±36.5)mm3], and the difference was statistically significant (All P<0.05). The inferior rectus muscle volume of dominant eye in group A and mild DVD eye in group B was significantly different from that of healthy volunteers in group C [(453.8±46.8) and (463.0±16.6) vs. (380.4±59.7) mm3, respectively], and the difference was statistically significant (all P<0.05). Conclusions: There are no significant changes in pulley locations of extraocular rectus muscles in patients with symmetric and asymmetric DVD, and the muscle volumes of medial, lateral and superior rectus muscle are greater than those of healthy people. However, the muscle volumes of inferior rectus muscle of dominant eye in symmetric DVD and mild DVD eye are significantly greater.

Traducción y adaptación transcultural de la escala AS-20 para medir la calidad de vida en adultos con estrabismo en Colombia, prueba piloto / Translation and transcultural adaptation of the AS-20 scale to measure quality of life in adults with strabismus in Colombia, a pilot study

Antecedentes El estrabismo genera un impacto psicosocial negativo en los pacientes adultos, afectando aspectos como la autopercepción y la calidad de vida. No existe en Colombia una escala que permita medir dicho impacto. Objetivo Realizar la traducción y adaptación transcultural del instrumento AS-20 al español colombiano, para medición de la calidad de vida en pacientes adultos con estrabismo en Colombia. Materiales y métodos Prueba piloto de un estudio de corte transversal de traducción, traducción inversa y adaptación del instrumento de medición tipo escala de calidad de vida AS-20 de su idioma original en pacientes adultos con estrabismo en Bogotá, Colombia. Resultados Dieciséis pacientes fueron evaluados. El rango de edad fue entre 18 y 68 años, con un promedio de 41 años. La escala fue respondida en una media de tiempo de 10,62min. Se reportó dificultad en 3 individuos para la comprensión de 2 ítems (preguntas 8 y 14), los cuales se ajustaron, resolviendo la dificultad. Conclusión Se realizó la traducción y prueba piloto de la escala AS-20 a español colombiano identificando y corrigiendo los problemas de traducción en la prueba. Este es el primer paso del proceso de adaptación transcultural. Con base en los resultados, la validación y adaptación transcultural se puede finalizar en un próximo estudio (AU)

Background Strabismus generates a negative psychosocial impact on adult patients, affecting aspects such as self-perception and quality of life. There is no scale in Colombian Spanish that measures these impacts. Objective To carry out the translation and cross-cultural adaptation of the AS-20 instrument into Colombian Spanish, for measuring the quality of life in adult patients with strabismus in Colombia. Materials and methods Pilot test of a cross-sectional study for the translation, reverse translation, and cross-cultural adaptation of the AS-20 instrument from its original language, English, to Colombian Spanish, in adult patients with strabismus in Bogotá, Colombia. Results Sixteen patients were assessed. The age range was between 18 and 68 years with a mean age of 41 years. The scale was answered in an average time of 10.62min. Difficulty was reported in 3 individuals for understanding 2 items (questions 8 and 14), which were resolved. Conclusion The translation and pilot test of AS-20 scale into Colombian Spanish was carried out, identifying and solving translational difficulties. It is the first step in the cross-cultural adaptation process. Based on the results, the validation and cross-cultural adaptation can be completed in a future study (AU)

What Is Strabismus?

This JAMA Patient Page describes the eye condition of strabismus, its signs and symptoms, causes, diagnosis, and treatment.

Crouzon syndrome complicated with binocular strabismus and extraocular muscle fibrosis: a case report.

BACKGROUND: Crouzon syndrome, a rare genetic disorder characterized by premature closure of coronal sutures, results in skull and facial deformities along with abnormal brain and ocular development. CASE PRESENTATION: Here, we report a case of a 27-year-old ethnic han male patient who presented with complex binocular strabismus secondary to Crouzon syndrome. At the time of surgery, extraocular muscles were found to be fibrotic and results of the pathological examination revealed degeneration of muscle fibers, which were replaced by adipose tissue. The entire exome sequencing DNA testing indicated that the patient and his father possessed the fibroblast growth factor receptor 2 (FGFR2) gene c.G812T:p.G271V heterozygous mutation. Binocular strabismus corrective surgery was performed in this patient with a satisfactory outcome. CONCLUSIONS: This case demonstrates that Crouzon syndrome patients can show an FGFR2 gene c.G812T:p.G271V mutation and display clinical symptoms such as extraocular muscle fibrosis, exotropia, exophthalmos, and a pointed head deformity.

Strabismus surgery alleviates functional and psychosocial problems.

Strabismus is a common condition affecting both children and adults. Strabismus patients may experience double vision, abnormal head position and loss of stereovision. The psychosocial negative impact of strabismus may be severe, affect self-esteem, social relationships, and job opportunities. Strabismus is a congenital condition or a result of an illness in later life and surgical treatment should be considered as reconstructive surgery and not downrated as just ¼a cosmetic procedure«. Strabismus surgery is safe, effective and addresses functional as well as psychosocial problems.

Long-term retinal changes after strabismus surgery, suspected signs of past scleral perforations.

Purpose: Scleral perforation during strabismus surgery is considered a rare complication that usually results in no significant consequences. The true rate of such occurrences is difficult to evaluate due to the young age of most patients and the occult nature of most events. This study aimed to evaluate long-term retinal changes under the suture areas in patients post-strabismus surgery as presumed signs indicating past undiscovered scleral perforations. Methods: The study population consisted of patients with a follow-up of at least 10 years post-strabismus surgery at the [redacted for review] Eye Institute and with no known retinal conditions as well as with wide fundus visibility. We performed slit-lamp retinal periphery examinations in search of retinal scars or changes at the suture sites. Results: Seventy-one eyes from 43 patients were examined. The mean age (±standard deviation [SD]) at the time of examination was 27 years (±14), and the mean number of strabismus surgeries per patient was 1.8. Three of the examined eyes showed retinal changes at the suture sites, yielding an overall incidence rate of suspected perforation/penetration of 4.2% per eye and 3.6% per strabismus surgery. These three patients were all asymptomatic. Conclusion: Scleral perforations during strabismus surgeries could remain unnoticed since a comprehensive exam of the retinal periphery is challenging in young children, especially during the postoperative period. While retinal changes caused by inadvertent scleral perforations appear to have no clinical sequelae in a time frame of 10 years, such changes should be noted for future fundoscopic examinations.

The effect of virtual reality technology in children after surgery for concomitant strabismus.

Purpose: This study aimed to investigate the effect of virtual reality (VR) technology in children after surgery for concomitant strabismus. Methods: A total of 200 children with concomitant exotropia or concomitant esotropia were randomly divided into a training group and a control group according to the single even number random method (100 cases in each group). Patients in the training group received VR intervention training within 1 week after surgery. Patients in the control group did not receive any training. Results: Six months after the surgery, the orthophoria (the far or near strabismus degree was ≤8Δ) rate was significantly higher in the training group than in the control group (P = 0.001), while the eye position regression rate (compared to the strabismus degree within 1 week after the surgery, the amount of regression >10Δ) was significantly lower in the training group than in the control group (P = 0.001). Six months after the surgery, the number of children with simultaneous vision and remote stereovision was significantly higher in the training group than in the control group (P = 0.017 and 0.002, respectively). The differences in the number of patients with peripheral stereopsis, macular stereopsis, and stereopsis in macular fovea centralis at 1, 3, and 6 months after the surgery between the training and the control groups were not statistically significant (P = 0.916, 0.274, and 0.302, respectively). Conclusion: The intervention of VR technology after strabismus correction effectively improved children's visual function and maintained their eye position.

Eyeball simulator for extraocular muscles.

Learning about human eye movements broadens our comprehension of the visuomotor system and aids in the effective management of strabismus. One's clinical practice is improved by a dynamic simulation of human eye movements using physical models of the extraocular muscles (EOMs). We use our eyeball model to teach the basics of strabismus to undergraduate students and ophthalmology residents. In Listing's plane, extraocular movements of each muscle and the angle demonstration are being used to familiarize students with their knowledge. The degree of the residents' understanding of strabismus is significantly influenced by the eyeball strabismus simulator. This model is an inexpensive, Do It Yourself (DIY) model that is simple to build.

Observation on the curative effect of horizontal rectus transposition combining recess-resect treatment on monocular elevation deficiency with horizontal strabismus.

Purpose: To explore the clinical effect of horizontal rectus transposition combining recess and resect treatment on monocular elevation deficiency (MED) with horizontal strabismus. Methods: Ten patients (10 eyes) scheduled to undergo horizontal rectus transposition combining recess-resect surgery to treat MED with horizontal strabismus in the ME Department of Ophthalmology of the First Affiliated Hospital of Guangxi Medical University between July 2016 and February 2022 were included in the study. The degree of vertical and horizontal prism strabismus, the grading of upper movement of the paralyzed eye, and the improvement of binocular vision were evaluated before and after the surgery. Results: Horizontal rectus transposition combined with recess and resect treatment was used to treat 10 patients with MED combined with horizontal strabismus. A good curative effect was seen in eight patients. The differences in the degree of vertical strabismus, the degree of horizontal strabismus, and the movement function of the paretic eyes before and after surgery were significantly different (all P < 0.05). The binocular haplopia function in six patients was reconstructed in the primary position after surgery. Conclusion: Horizontal rectus transposition combining recess-resect is easy to perform, and the number of recti involved in the surgery is small. This approach can effectively correct the eye position, improve eye movement, and reconstruct binocular vision in patients with MED by combining horizontal strabismus.

Case Report: Acquired Brown Syndrome after COVID-19 Vaccination.

SIGNIFICANCE: Brown syndrome, or superior oblique tendon sheath syndrome, is characterized by limitation of elevation on adduction. The disorder is thought to involve the trochlea/superior oblique tendon complex through traumatic, surgical, and inflammatory mechanisms. It could be an indication of multiple underlying immunological or rheumatological disorders. PURPOSE: This study aimed to report an unusual strabismus after receiving the first dose of a live attenuated coronavirus disease 2019 (COVID-19) vaccine. CASE REPORT: A 31-year-old female patient presented with painful vertical diplopia and tenderness of the left trochlear area 3 days after the first dose of COVID-19 vaccination. She had a compensatory chin elevation and face turn to the right, as well as a left 10-prism-diopter hypotropia in the primary position, which increased to 15 prism diopters in the right gaze and disappeared in the left gaze. Ocular motility revealed the limitation of elevation on adduction. The patient denied any history of ocular trauma and was consequently investigated for dysthyroid disease and various immunological and rheumatological disorders, which were excluded. A Hess chart was obtained to document the motility disorder. CONCLUSIONS: We report a case of acquired Brown syndrome in a 31-year-old otherwise healthy woman shortly after COVID-19 vaccination. It is possible that the patient may have developed trochleitis and/or superior oblique tenosynovitis brought on by cross-reacting antibodies generated by the immune response to the vaccine. In the age of the widest vaccination campaign in human history, it is highly likely that we will continue to observe many unexpected potential adverse effects of these vaccines in our clinical practice.

[Recommendations for Progressive Myopia in Childhood and Adolescence. Statement of the DOG, BVA and the Bielschowsky Society for Strabismus Research and Neuroophthalmology - Status June 2022]. / Empfehlungen bei progredienter Myopie im Kindes- und Jugendalter.

Since the last and at the same time first statement of the German ophthalmological societies on the possibilities of reducing myopia progression in childhood and adolescence, many new details and aspects have emerged in clinical research. This second statement updates the previous document and specifies the recommendations on visual and reading behavior as well as on pharmacological and optical therapy options, which have been both refined and newly developed in the meantime.

Effectiveness of diagnosis and early treatment of ocular motility alterations in premature infants.

Objective: Prematurity often results in important developmental sequelae of brain structures, particularly those involved in processing visual information, such as the optic nerve, primary visual cortex and visuomotor integration areas. The aim of this study is to analyse the functionality of the sensory and motor pathways of the visual system by means of an orthoptic-ophthalmological assessment. Materials and methods: In this retrospective study, 151 records were examined, covering a period from 2000 to 2020, of preterm patients with gestational age < 32 weeks and birth weight ≤ 1,500 g up to an average age of about 8 years, referred to the Centre for Paediatric Ophthalmology and Strabology of the Ophthalmology Clinic of the Policlinico Umberto I, La Sapienza University of Rome, who underwent a complete ophthalmological and orthoptic assessment including the following tests measurement of ocular deviations according to the Hirschberg method, Lang I-II test, Titmus Stereotest, objective convergence assessment and ocular motility examination. Results: From the charts reviewed, 24.5% (37/151) of patients had Retinopathy of the Premature (ROP); while 38% of the whole sample (57/151) had strabismic amblyopia, of the latter only 31.5% (18/57) had ROP. In 8% of patients (12/151) the stereoscopic sense was absent, in 45% (8/151) stereopsis was gross (> 60 seconds of arc). In addition, 20.52 % (31/151) had a manifest eye deviation. 7.28% (11/151) had hypermetropia in the right eye (RE); 7.95% (12/151) hypermetropia in the left eye (OS); 3.31% of the patients (5/151) had myopia in the RE; 2% (3/151), myopia in the left eye (LE). In addition, the study of ocular motility revealed varying degrees of alteration poorly correlated with prematurity status. Conclusion: It was found that amblyopia, stereopsis and objective convergence are more affected by ROP than strabismus, refractive defects and ocular motility, indicating that premature children are particularly susceptible to ophthalmological and orthoptical alterations.

Ocular morbidity and co-morbidities in children attending a nodal district early intervention center in Uttar Pradesh.

Purpose: To obtain epidemiological data on children with ocular morbidity attending a nodal district early intervention center (DEIC). Methods: : After parental consent, we recruited children with ocular morbidity. After detailed history and clinical evaluation, along with pediatric consultation and relevant neuro-radiological and ancillary investigation, information was entered in a pretested proforma: especially looking for perinatal morbidity, including developmental delay (DD). Visual acuity (VA) was assessed by age-appropriate means by an ophthalmic assistant trained to work with children with special needs. We diligently looked for strabismus and performed dilated ophthalmoscopy. Using JASP, we summarized data as means and proportions and reported 95% CIs. We explored the association of disability percentage with possible predictor variables using regression. Results: We enrolled 320 children, with a mean age of 34.43 ± 31.35 months; two-thirds were male; one-third belonged to lower socioeconomic status (36%), with most parents being illiterate. The mean presenting VA was 1.8 logMAR for both eyes, range: 0 to 3. Sixty-one percent were hyperopic and 27% were myopic. High refractive error, (>±6D) occurred in nine; anisometropia in one; strabismus in 149, mostly esotropia; congenital cataract in 25, whereas 63 had abnormal fundus. Seventy-six received a diagnosis of cerebral visual impairment (CVI). On multivariate linear regression (MLR), younger age, presence of DD, and CVI significantly predicted a higher disability percentage. Logistic regression revealed that statutory disability is likely associated with DD (odds ratio [OR]:13.43); whereas older age was protective (OR: 0.977). Conclusion: Our study suggests that in DEIC children with ocular morbidity, younger children, and the presence of DD significantly predict both greater disability and the likelihood of statutory levels.