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To evaluate the outcomes of combined bupivacaine HCL (BPX) injection in the medial rectus (MR) muscle with recession of the lateral rectus muscle in the treatment of convergence insufficiency-type intermittent exotropia (CI-IXT).The medical records of patients who underwent combined injection-recession treatment from January 2019 to January 2020 for CI-IXT were reviewed retrospectively along with a group of age-matched controls with IXT without CI who underwent only unilateral LR recession during the same period. The following data were extracted from the record: age at surgery, average follow-up period, angle of deviation at distance and near and the difference between them before and after surgical procedure, correction of near and distance deviations, and recession dosage. Successful outcome was defined as a distance deviation in primary gaze between ≤10A total of 10 patients and 20 controls were included. Average follow-up was 13.9 ± 3.67 months in the BPX group and 15.9 ± 3.61 months in the control group (P = 0.17). Postoperative distance deviation measured 8.30BPX injection combined with unilateral lateral rectus recession yields outcomes comparable to bilateral lateral rectus recession for distance deviations, and results in reduction of the distance-near difference in the angle of exotropia.

Purpose To investigate hemodynamic changes in retinal and choroidal vasculature after surgical inferior oblique (IO) weakening through optical coherence tomography angiography (OCTA). Methods The medical records of patients who underwent unilateral IO-weakening surgery at a single institution were retrospectively reviewed. Patients who had OCTA measurements before surgery and on postoperative days 7 and 30 were included. Vessel density was determined for the superficial capillary plexus (SCP), deep capillary plexus (DCP), the choriocapillaris (CCP) and the foveal avascular zone (FAZ). Results The study included 72 eyes of 36 patients. Fellow eyes were used as a control group. The preoperative and postoperative week 1 and month 1 mean central vessel densities of the SCP were 20.48% ± 3.52%, 20.68% ± 3.83%, and 23.56% ± 5.65%, respectively, in the operated eye; those of the DCP were 16.72% ± 3.33%, 16.08% ± 4.65%, and 20.85% ± 7.09%, respectively. The mean FAZ areas were 341.29 ± 88.04 μm2, 341.30 ± 98.25 μm2, and 316.02 ± 74.61 μm2, respectively. We detected no significant changes in SCP, DCP, and FAZ in the postoperative period. The mean central vessel density of the CCP increased significantly from the preoperative level of 54.06% ± 2.86% to 55.55% ± 2.63% at postoperative week 1, but there was no significant difference between baseline and postoperative month 1 (P = 0.001 and P = 0.515, resp.). Conclusions IO muscle surgery does not seem to cause alterations in retinal hemodynamics, although it can transiently increase the central vessel density of the CCP during the early postoperative period.

Purpose To quantify vessel density of superficial capillary plexus (SCP), deep capillary plexus (DCP), and the foveal avascular zone (FAZ) of children's amblyopic eyes and to compare the measurements with those of companion eyes and age-matched controls. Methods Fifteen patients with strabismic amblyopia, and 15 age-matched controls were included in this cross-sectional study. SCP, DCP, and FAZ were measured via optical coherence tomographic angiography (OCTA). Results Mean subject age was 8.2 ± 2.3 years in the amblyopia group and 8.6 ± 2.2 years in the control group. The mean SCP at 1 mm, 2 mm, and 3 mm zones were (in the order amblyopic eye, companion eye, control) 1.399 ± 0.088, 5.854 ± 0.195, 12.866 ± 0.346; 1.467 ± 0.084, 5.979 ± 0.182, 12.965 ± 0.321; and 1.559 ± 0.052, 6.343 ± 0.190, 13.819 ± 0.423. SCP was significantly lower in amblyopic eyes than in companion eyes and controls ( P P P > 0.05). Conclusions Vessel density of SCP and DCP of eyes with amblyopia is lower than that of the companion eye and the age-matched controls.

Purpose To compare the choroidal thickness of children's eyes with amblyopia due to strabismus or anisometropia to the fellow eye and age-matched controls. Methods Forty patients with anisometropic amblyopia, 40 patients with strabismic amblyopia, and 40 age-matched controls were included in this cross-sectional study. Choroidal thickness was measured via the enhanced-depth imaging technique of spectral domain optical coherence tomography in all patients and controls. Choroidal thickness was measured at subfoveal area and at 500 μm intervals to the nasal and temporal to the fovea up to 2000 μm. Measurements were compared between the three groups. Results The mean ages were 7.9 ± 2.6 years (range, 4-13 years) in the anisometropic group, 9.0 ± 3.7 (range 4-15 years) years in the strabismic group, and 8.4 ± 2.6 years (range 4-15 years) in the control group. The mean subfoveal choroidal thickness in the anisometropic group was 362 ± 82 μm in the amblyopic eyes and 301 ± 54 μm in the fellow eyes; in the strabismic group, 413 ± 82 μm in the amblyopic eyes and 316 ± 54 μm in the fellow eyes. The mean subfoveal choroidal thickness was 310 ± 78 μm in control eyes. The subfoveal choroids of both anisometropic and strabismic amblyopic eyes were significantly thicker than that of the fellow eyes of the corresponding groups and the control eyes (P Conclusions The subfoveal choroid of eyes with anisometropic and strabismic amblyopia is significantly thicker than that of the fellow eye and the age-matched controls.

Purpose To evaluate the effect on ocular alignment of Y splitting the lateral rectus muscle and then reattaching the 2 ends near the medial rectus muscle insertion in patients with complete oculomotor nerve palsy. Methods All eyes with oculomotor nerve palsy treated between May 2008 and February 2010 with Y splitting and transposition of the lateral rectus muscle to the medial rectus muscle were prospectively studied. In this procedure, the lateral rectus muscle was split: the upper half was transposed to the superior border and the lower half to the inferior border of the medial rectus insertion. For the muscles that had lost the ability to stretch and strain due to fibrosis, a hang-back technique was used. In some patients, the medial rectus muscle of the same eye was subsequently strengthened or the lateral rectus muscle of the fellow eye was recessed. Final deviation from 0 Δ to 10 Δ was considered a successful result. Results A total of 10 patients were included. Patients had a preoperative horizontal deviation >45 Δ (range, 45 Δ -90 Δ ). Of the 10 patients, 5 attained stable results following surgery, and 5 with postoperative undercorrection between 20 Δ and 30 Δ required further surgeries. Postoperatively, 2 patients improved their sensorial status in a very limited range of gaze and 2 patients had symptomatic diplopia. Conclusions Acceptable aesthetic results can be achieved in the treatment of complete oculomotor nerve palsy with the transposition of the split lateral rectus muscle to the medial rectus muscle area.

Birsen Gokyigit, MD, Aslihan Ozturk, MD, Serpil Akar, MD, Pelin Kaynak Hekimhan, MD, Umut Akbas, MD, Omer Faruk Yilmaz, MD; Istanbul Beyoglu Educational and Research Hospital, Istanbul, Turkey Purpose: To introduce a new technique of inferior rectus recession operation to let larger amounts of recession without causing lower lid ptosis and comparing this method with the results obtained in conventional inferior rectus recession. Materials: This study includes 21 patients operated in our clinic. Patients’ ages were median 25.7 18.6 (4 to 73) and median follow-up was 6.6 8.8 (1 to 40) months. Eleven patients operated with conventional method were labeled as Group 1 and 10 patients operated with the new method were labeled as Group 2. Method: Without exceeding 4 mm, inferior rectus recession to whole muscle was applied in Group 1 patients. To patients in Group 2 inferior rectus recession was applied similar to vessel protective surgery but, 90% anterior fibers of muscle were detached in whole and as a thin layer with a spatula and posterior fibers were recessed 4 to 8 mm as planned. This way, lower lid retractors were not affected. Patients’ preoperative deviations and lower lid positions were recorded. Same parameters were checked 1 month postoperatively. Both groups were evaluated retrospectively by screening their files and Mann–WhitneyUtest was used in statistical evaluation. Findings: Lower lid ptosis was seen in four of Group 1. There was no ptosis in Group 2. While there was a need to apply second and third vertical muscle procedures for vertical deviations in Group 1, it was observed that there was no need for additional vertical muscle procedures in Group 2 patients. There is statistically meaningful difference between two procedures (P 0.05). Conclusion: We found that the new technique was an effective surgical method for recession of 90% of inferior rectus’ posterior fibers, permitting to do more recession, without the risk of lower lid ptosis.