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Purpose: To evaluate the surgical results of full horizontal tendon rectus muscle transposition to the superior rectus muscle insertion, augmented by posterior fixation sutures, in patients with double elevator palsy. Methods: In this retrospective comparative study, 17 patients treated by the augmented Knapp procedure (study group) were compared with 28 patients treated by the standard Knapp procedure (control group). Pre-operative and postoperative vertical deviation in primary position, ocular motility, binocular function, and rate of reoperation were evaluated. Results: The mean preoperative near and distance deviations (hypotropia) decreased by 93% and 97% in the study group and 68% and 69% in the control group, respectively. The improvement in near and distance deviation was statistically more significant in the study group than the control group ( P = .001 for each parameter). The mean preoperative elevation deficiency in abduction and adduction improved by 64% and 66% in the study group and 37% and 39% in the control group, respectively. The improvement in elevation deficiency in abduction and adduction was statistically significantly greater in the study group than the control group ( P = .001 and .04, respectively). Reoperation was required in 15 patients (54%) in the control group and 2 (12%) in the study group during the follow-up period of 26 ± 4 months. Conclusions: The postoperative improvement in near and distance deviation and elevation deficiency in abduction and adduction was significantly better in the augmented Knapp procedure than the standard Knapp procedure. This procedure demonstrated a stronger effect in the treatment of double elevator palsy. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):17–23.]

To quantify changes in ductions following nasal transposition of the split lateral rectus muscle (NTSLR) for treating third nerve palsy.Retrospective cohort study.A single eye from each patient with third nerve palsy treated with NTSLR with ocular motility measurements.Observation of changes in pre- and postoperative ductions. Outcome measures including patient demographic and surgical factors associated with the ability to adduct beyond the midline after NTSLR were evaluated using multivariable logistic regression.A total of 116 patients met the inclusion criteria for this study. The NTSLR significantly decreased abduction (median of 0 limitation [interquartile range (IQR), 0-0] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p0.001), with a corresponding improvement in adduction (median, -5 [IQR, -5 to -4] prior to surgery to -4 [IQR, -4 to -3] after NTSLR; p0.001). There was no change in median supraduction or infraduction after NRSLR (p0.05). The ability to adduct beyond the midline after NTSLR was demonstrated in 42% of patients. Although not statistically significant, a trend toward a postoperative ability to adduct beyond the midline was seen in patients who had concurrent superior oblique muscle tenotomy (odds ratio [OR] = 5.08; 95% CI, 0.91-40.9) or who were designated with partial rather than complete third nerve palsy (OR = 2.29; 95% CI, 0.82-6.70).NTSLR improves the horizontal midline positioning of eyes with third nerve palsy. Most eyes lose the ability to abduct, but some regain a modest ability to adduct while vertical ductions remain unchanged.

This study aims to evaluate the long-term results of sliding shape extraocular muscle transposition, which is a novel operation method of delivering both vascular protection and strengthening of the muscles and transposition of the muscles. The patients’ files were scanned retrospectively. All patients underwent a complete eye examination in addition to motility examination, both preoperatively and postoperatively. Patients were followed up for at least 1 year. Pre- and postoperative deviation measurement values and transposition effects were compared statistically. The two parameters were evaluated separately. In patients where 7-mm (or greater) resection was planned, the complete muscle widening transposition procedure was successful. Only two-thirds of transpositions could be achieved in patients who underwent less than 7 mm of strengthening. There was no anterior segment ischemia in the patients who underwent three rectus’ muscle surgery in the same eye. Transposition effects were perfect in those whose vertical deviation was not due to monocular elevation deficiency. While resection effect was excellent in those MED (monocular elevation deficiency) and CEOMF (congenital extraocular muscle fibrosis) cases, transposition effects were limited but found at similar rates as with the standard resection and transposition procedures in CCDD (congenital cranial dis-innervation diseases) (R2–1). Even transposition effects were limited in CCDD. ‘Sliding shape’ design extraocular muscle plication was found to be a simple, safe, and effective procedure for patients who needed resection and transposition operation.

Objectives To determine and evaluate the rate of diplopia after Ahmed glaucoma valve (AGV) implantation surgery. Materials and methods The records of patients who underwent AGV implantation in our hospital between the years of 2010 and 2017 were retrospectively reviewed. Patients who were referred to our strabismus department due to binocular diplopia after AGV implantation surgery were included. The details of postoperative day 1, day 7, day 15, and 1 month examinations were recorded. In the postoperative period, the onset time of diplopia complaints, diplopia type, and the presence of diplopia at distance and near fixation were noted. Ocular motility examination and deviation measurements were evaluated. Results Ten (47%) of 211 patients who underwent AGV implantation in our hospital between 2010 and 2017 met the study inclusion criteria. Six of the 10 patients were men (60%) and 4 were women (40%). The mean age of the patients was 44.5 (34-63) years. Complaints of diplopia developed at a mean of 14.5±12.3 (1-30) days after AGV implantation. The prism measurements of the patients were found to be 8.4±1.4 prism diopters (PD) exotropia and 7.1±8.8 PD hypotropia. While 8 patients had diplopia only at near distance, 2 patients had diplopia at both distance and near. Three patients were treated with prismatic glasses, and their complaints of diplopia recovered spontaneously in 5.11±4.10 months. The other 7 patients were followed up without treatment, and their diplopia complaints resolved spontaneously in 6.11±4.40 months. Conclusion Although most of the diplopia that develops after AGV implant surgery resolves without treatment, prismatic glasses might be considered as a treatment option in patients whose diplopia affects their daily lives.

To determine the success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating bilateral 3Retrospective, interventional case series.An international, multicenter registry was used for the study. The study population was all patients with bilateral 3A total of 34 patients were included, with a median age of 46 years (interquartile range [IQR] = 25-54 years) at surgery. The most common etiologies were ischemic (29%), neoplastic (15%), and congenital (12%). NTSLR performed unilaterally with alternative surgery on the opposite eye (65%) resulted in a median postoperative exotropia of 18 PD (IQR = 7-35 PD), and when performed bilaterally (35%) resulted in postoperative exotropia of 14 PD (IQR = 5-35 PD). Success was achieved in 50% of cases, intraoperative technical difficulties were reported in 18%, and vision-threatening complications occurred in 21%. Attachment of the lateral rectus muscle ≥10 mm posterior to the medial rectus insertion was associated with increased vision-threatening complications (odds ratio = 9.0; 95% CI = 1.3-99).NTSLR can address the large-angle exotropia associated with bilateral 3rd-nerve palsy. Surgeons should be aware that posterior placement of the lateral rectus muscle may increase the risk of vision-threatening complications, particularly serous choroidal effusion.

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.

The aim of this study was to report our postoperative results concerning the vertical rectus (VR) muscle union combined with lateral rectus (LR) plication for the treatment of large-angle esotropia (ET) in complete abducens nerve palsy. Medical records from 36 patients who had undergone the VR union procedure for ET treatment due to sixth-nerve palsy between July 2014 and July 2018 at Beyoglu Eye Research and Training Hospital were reviewed. One week before surgery, all patients underwent a 4-IU botulinum toxin A (btx) injection into the ipsilateral medial rectus (MR). All patients then underwent a VR muscle union procedure. A non-absorbable suture was inserted through the lateral muscular margin of each VR muscle at approximately 1/5 the width from the edge at 10 mm distance from the VR insertion. Both sutures were then tied to each other above the LR. Plication of the LR muscle using a non-absorbable suture was performed in all cases. The study population consisted of 14 (38.9%) females and 22 (61.1%) males. The mean age was 36.31 ± 19.16 years. The mean preoperative deviation angle in primary gaze into distance was 47.77 ± 18.48 prism diopter (PD). The mean deviation angle 1 year after surgery was − 1.0 ± 6.62 PD. Abduction improved from − 4.27 ± 0.46 to − 1.88 ± 0.96. The VR muscle union in combination with LR plication appears to be an effective treatment procedure for complete abducens nerve palsy patients.

Purpose: Here we aimed to describe seven pediatric patients with cyclic strabismus and report the outcome of their surgical treatment.Methods: Seven children with acquired esotropia manifesting in a 48-h cycle were included in the study. Four of them were boys, and three of them were girls. All cases had a large angle of deviation and associated suppression on the esotropic day and small angle of deviation with fusion on the other day. A complete ocular motility examination was performed for seven consecutive days. For all cases, we planned strabismus surgery according to the amount of deviation on the strabismic day. Postoperatively, the deviation angles were recorded at the first week, first month, and third month. Later, the patients were examined at 3-month intervals.Results: The mean age at presentation was 4.42 ± 3.69 years (1-12 years). The mean angle of esotropia at near fixation preoperatively was 36.4 ± 14.9 pd (prism dioptre) (20-60 pd) on the esotropic day. The mean angle of esotropia on the esotropic day at distance fixation was 32.1 ± 6.9 pd (20-40 pd). The mean follow-up period was 18.4 ± 5.5 months (12-25 months). The mean duration of esotropia before surgery was 11.1 ± 9.4 months (3-29 months). Following surgery, orthophoria within 10 pd was achieved and maintained in all cases.Conclusion: When treating children with cyclic strabismus, the best surgical results can be achieved when surgery is planned according to the amount of deviation on the strabismic day.

Purpose: To evaluate the possible hemodynamic changes following strabismus surgery via optical coherence tomography angiography. Methods: Thirty-two eyes of 16 patients who underwent strabismus surgery in one eye were included in the study. Fellow eyes were used as a control group. The vessel densities of the superficial and deep capillary plexus and superficial and deep foveal avascular zones were measured preoperatively and 3 months postoperatively. Results: The mean superficial and deep foveal avascular zones measurements were 0.84 ± 0.09 and 0.76 ± 1.13 mm 2 , respectively. The mean vessel density of the superficial capillary plexus was 1.23 ± 0.12 and 11.13 ± 1.04 mm 2 preoperatively in the 1- and 3-mm zones, respectively, whereas the mean vessel density of the deep capillary plexus was 1.13 ± 0.16 and 10.11 ± 1.28 mm 2 preoperatively. Postoperatively, the mean superficial and deep foveal avascular zones changed to 0.20 ± 0.13 and 0.23 ± 0.12 mm 2 , respectively. Postoperatively, the mean vessel density of the superficial capillary plexus changed to 1.47 ± 0.11 and 12.75 ± 1.10 mm 2 , and the mean vessel density of the deep capillary plexus changed to 1.56 ± 0.12 and 13.91 ± 1.35 mm 2 in 1- and 3-mm zones, respectively. There was a statistically significant increase in vessel density measurements of the superficial and deep capillary plexus, and a statistically significant decrease in measurements of the superficial and deep foveal avascular zone postoperatively ( P < .05). In the fellow eyes, there was no statistically significant change in any of the measurements ( P > .05). Conclusions: Following strabismus surgery, vessel density of the fovea may increase and the foveal avascular zone may decrease according to optical coherence tomography angiography measurements. [ J Pediatr Ophthalmol Strabismus . 2019;56(2):95–100.]

Background: In the treatment of infantile and accommodative esotopia medial rectus (MR) recession combined posterior fixation suture (Faden operation) can be used. But, there is very limited literature on effect of ocular parameters (axial length, medial rectus width and the distance of medial rectus insertion to limbus) to this operation. Objective: To evaluate effects of ocular parameters on medial rectus Faden operations with recession for esotropia. Material and Methods: In this retrospective study, 38 patients (57 eyes) who underwent Faden operation with unilateral or bilateral recession (4 - 4.5 mm) on medial rectus were divided into three groups according to axial length, medial rectus width and the distance of medial rectus insertion to limbus. Preoperative and postoperative deviations compared. Results: 11 cases were infantile esotropia, 46 cases were acquired esotropia. Female/male rate was 19/19. The mean preoperative amount of esotropia at near was 49.95 ± 17.36 prism diopters (PD) and postoperative 1 week 11.77 ± 11.14 PD, 1 month 12.02 ± 11.52 PD and 6 months 9.46 ± 10.19 PD. The mean preoperative amount of esotropia at distance was 38.84 ± 19.03 PD and postoperative 1 week 7.25 ± 11.29 PD, 1 month 6.54 ± 10.52 PD and 6 months 4.40 ± 9.08 PD. Due to axial length, in shorter eyes, the decrease in mean post-operative deviation was statistically significant. Due to medial rectus width and the distance of medial rectus insertion, there was no statistically significant difference. Conclusions: Axial length has an effect on medial rectus Faden operations with recession but medial rectus width and medial rectus insertion distance from limbus do not.

Background/aimsTo determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy.MethodsAn international, multicentre, registry of patients with unilateral 3rd-nerve palsy treated with NTSLR was created. Patients with concurrent surgery on the contralateral eye were excluded. Primary outcome was horizontal alignment within 15 prism dioptres (PD) of orthotropia. Incidence of technical difficulties and vision-threatening complications by 6 months post-procedure were reported.ResultsNinety-eight patients met inclusion criteria. Median age was 33.5 years (IQR 10.75–46). Aetiologies included congenital (31%), neoplastic (16%) and traumatic (15%). Twenty-five per cent of patients had prior ipsilateral strabismus surgery. Median exotropia decreased from 70PD preoperatively (IQR 50–90) to 1PD postoperatively (IQR 0–15.5), with a success rate of 69%. Performing concurrent superior oblique muscle tenotomy (SOT) was independently associated with success (p=0.001). Technical challenges occurred in 30% of cases, independently associated with a history of ipsilateral strabismus surgery (p=0.01). Eleven per cent of patients had vision-threatening complications, independently associated with more posterior placement of the split lateral rectus (LR) muscle (preducedthis risk.ConclusionNTSLR significantly improved primary position alignment altered by 3rd-nerve palsy. Concurrent SOT and placement of the split LR muscle ≤4.25 mm posterior to the MR muscle insertion optimised outcomes. NTSLR proved technically challenging when prior ipsilateral strabismus surgery had been performed.

Objectives: The goal of this study was to evaluate surgical techniques and outcomes in patients with Brown’s syndrome. Methods: A retrospective review was conducted of patients who underwent surgery of the superior oblique (SO) muscle between 2003 and 2011 at a referral center. Results: In all, 190 patients (111 female and 79 male) with an age range of 4-50 years were included in the study. The right eye was affected in 98 patients, and the left eye in 92 patients. Abnormal head posture (AHP), ocular movement (OM), and hypotropia were assessed. The greatest improvement of AHP was seen following an SO temporal tenotomy (91%). Patients with a -4 limitation achieved full OM after a SO temporal tenotomy. Conclusion: Temporal tenotomy provided the best improvement in limitation of elevation in adduction.

Purpose To evaluate the results of a temporal whole superior oblique (SO) tendon disinsertion technique compared with other SO tendon–weakening procedures. Methods The medical records of patients who underwent an SO procedure at University of Health Sciences Beyoglu Eye Research and Training Hospital from January 2008 to January 2018 for treatment of Brown syndrome were reviewed retrospectively. Patients with follow-up of at least 12 months were included. The following data were included in our analysis: pre- and postoperative ocular ductions, versions, and vertical deviations; presence of abnormal head position (AHP); complications; and success rates of procedures. Results The record review identified 158 patients, of whom 52 patients had nasal tenotomy, 6 had nasal tenectomy, 48 had SO tendon elongation by suture spacer and 6 by silicone spacer, and 46 patients had temporal tendon disinsertion of the SO. The rate of AHP decreased from 91.3% to 4.3% postoperatively, and the preoperative mean limitation of elevation in adduction and hypotropia decreased from −3.60Δ ± 0.65Δ and −2.26Δ ± 4.28Δ to −0.47 ± 0.79 and −0.34 ± 2.67Δ postoperatively, respectively, in the temporal tendon disinsertion group. SO palsy was not observed after temporal disinsertion surgery, but undercorrection, overcorrection, and adhesion were seen in 8.7%, 8.7%, and 4.3% of patients, respectively, and a second surgery was needed for 17.4% of patients because of vertical deviations. The success rate of temporal tendon disinsertion technique was not significantly different from those of the other SO procedures (P = 0.91). Conclusions Temporal disinsertion of the SO tendon may be as effective as other SO-weakening procedures.

Purpose To evaluate the results of surgery involving the union of the superior rectus muscle and the lateral rectus muscle with or without medial rectus recession (MRc) for the treatment of high myopic strabismus fixus over a 20-year period. Methods The medical records of patients who underwent muscle belly union for the treatment of high myopic strabismus fixus were reviewed retrospectively. Patients were classified according to the timing of MRc. In group 1, MRc was performed before muscle union surgery; in group 2, MRc was performed concurrent with muscle union surgery; in group 3, MRc was not performed; in group 4, MRc was performed after muscle union surgery. Results A total of 50 eyes of 40 patients were included. Mean esotropia decreased from 57.27Δ ± 25.45Δ (range, 8Δ-100Δ) before surgery to 11.67Δ ± 13.85Δ (range, −18Δ to 45Δ) after (P Conclusions Muscle union surgery successfully corrected the restrictive esotropia and hypotropia. MRc in addition to muscle union surgery was not necessary for some patients, for whom preoperative esotropia was lower.

To compare the measurements of cycloplegic refraction and refraction (R1-1) under general anesthesia (GA) when using the same portable auto-refractometer (ARF) in pediatric patients.36Thirty-six to 60-month-old patients who underwent refraction measurements using a portable ARF (Retinomax® K plus 3, Righton, Japan), who did not receive prior cycloplegics under this GA and who had cycloplegic refraction using 1% cyclopentolate and the same Retinomax® device3 months prior this GA, between 2015 and 2018, were included in this study. The agreement (Bland-Altman analysis) and correlation (Pearson correlation) between the mean values of the measurements were analyzed.Two-hundred-twenty-two right eyes of 222 patients (114 male and 108 female) were included in this study. The mean age was 45.04 ± 11.24 months. The mean spherical refractions (R1-1, R2-1) under GA and cycloplegic refraction were 1.08 ± 3.50 diopter (D) (-8.00 to +8.00) and 2.58 ± 3.28 D (-6.50 to +9.25), respectively. A strong positive correlation was detected between the two measurements (r = 0.95). When comparing measurements, the mean measurement under GA was -1.49 D (95% confidence interval: lower limit, -3.63; upper limit, +0.63) more myopic than the mean cycloplegic refraction (R1-1) value (Bland-Altman analysis test). The differences between the measurements were within ± 1 D in 92 eyes (41.44%) and within ± 2 D in 180 eyes (81.01%). No significant difference was detected when comparing the cylindrical refractive error values (Refractive measurements under GA were more myopic than cycloplegic refraction (R1-1) measurements. It is important to consider that complete cycloplegia is not achieved under GA.

Purpose: To determine the factors affecting the risk of deterioration and evaluate the refractive error change in patients with fully accommodative esotropia. Methods: Patients diagnosed as having fully accommodative esotropia (esotropic deviation that started before 7 years of age and less than 8 to 10 prism diopters [PD] of esotropia with full hyperopic correction and/or bifocals) were included in this retrospective population-based cohort study. Refractive error changes were recorded. For comparisons, patients were divided into two groups: nondecompensated fully accommodative esotropia group and decompensated fully accommodative esotropia group. Results: Two hundred and twenty-three patients met the inclusion criteria. The mean follow-up time was 5.94 ± 0.31 years (range: 5 to 8 years). The changes in spherical equivalent in the younger than 7 years, 7 to 12 years, and 12 to 17 years groups were statistically significant ( P < .001). The decrease of hypermetropia was 0.13 diopters/year between 7 and 12 years and 0.06 diopters/year between 12 and 17 years. Forty-one of 223 patients (18.4%) discontinued spectacle therapy during the follow-up period. Hyperopic error and presence of amblyopia were lower, whereas visual acuity level and presence of near-distance disparity were higher in the spectacle discontinuation group ( P < .001, .007, .01, and 0.01, respectively). Deterioration of fully accommodative esotropia occurred in 30 of 223 patients (13.5%). Boys were more likely to require strabismus surgery ( P = .32). The mean age at presentation, esotropia angle with and without refractive correction at both near and distance fixation, near distance disparity, and inferior oblique overaction were significantly higher in patients with decompensated fully accommodative esotropia. Conclusions: Hyperopic error increased from the initial level until 7 years of age, followed by a myopic shift thereafter. Few children had resolution of fully accommodative esotropia and could discontinue spectacle therapy. Children with male gender, higher esotropia angle, older age at presentation, near-distance disparity, and inferior oblique overaction experienced a greater deterioration of the fully accommodative esotropia. [ J Pediatr Ophthalmol Strabismus . 2020;57(4):217–223.]

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 evaluate the results of the bilateral bridge Faden operation on the medial rectus muscles with and without recession in the treatment of accommodative and partially accommodative esotropia with convergence excess. Methods: A retrospective analysis was performed on the medical records of 103 patients who underwent the bridge Faden operation on both medial rectus muscles, with or without recession, for the treatment of accommodative and partially accommodative esotropia with convergence excess. Preoperative and postoperative near and distance deviations and near–distance disparities were evaluated. Results: The study population consisted of 38 (37%) girls and 65 (63%) boys. The mean age was 9.32 ± 5.83 years (range: 1 to 18 years) and the mean follow-up period was 14.49 ± 2.78 months. Fifty-one patients underwent the bridge Faden operation on both medial rectus muscles with recession (recession group) and 52 patients underwent the bridge Faden operation on both medial rectus muscles without recession (no recession group). The mean preoperative amount of esotropia at near was 43.51 ± 7.00 and 24.24 ± 3.56 prism diopters (PD) for the recession and no recession groups, respectively. The mean preoperative amount of esotropia at distance was 26.63 ± 6.86 and 9.22 ± 2.09 PD for both groups, respectively. The mean preoperative near–distance disparity was 17.14 ± 3.00 and 14.05 ± 4.14 PD for both groups, respectively. In both groups, there was a statistically significant difference in the near and distance deviations and the near–distance disparity between preoperative and postoperative values ( P < .05). Postoperatively, there was no significant difference between 1 month, 6 months, and 1 year and between 6 months and 1 year ( P > .05). Conclusions: The bridge Faden operation on both medial rectus muscles either with or without recession was a successful surgical procedure in patients with accommodative and partially accommodative esotropia. During the follow-up period, the success rates did not decrease. [ J Pediatr Ophthalmol Strabismus . 2017;54(6):369–374.]

The aim of this study was to compare three different methods to measure visual acuity (VA) in healthy and amblyopic preschool children: a Snellen E chart (SE), a single Lea symbols (SLS), and a crowded Lea symbols (CLS). Seventy-eight eyes of 54 patients (28 females, 26 males) were included in this cross-sectional, comparative study. The control group consisted of 30 healthy cases, and the amblyopic group consisted of 24 patients with amblyopia. Best-corrected VA (BCVA) measurements with SLS, CLS, and SE were compared in control eyes (CE), amblyopic eyes (AE), and fellow eyes (FE) separately. The mean age of the cohort was 5.7 ± 0.7 years (range 5–7 years). The mean refractive error was +1.02 ± 0.36 D (diopter, spherical equivalent) in CE, +5.59 ± 2.45 D in AE, and +3.96 ± 2.38 D in FE. The median BCVA (logMAR) was (in order of SLS, CLS, and SE) 0.00 [interquartile range (IQR) 0.10], 0.10 (IQR 0.10), 0.00 (IQR 0.10) in CE, 0.25 (IQR 0.33), 0.35 (IQR 0.30), 0.25 (IQR 0.38) in AE, and 0.10 (IQR 0.08), 0.10 (IQR 0.00), 0.10 (IQR 0.10) in FE. There was no statistically significant difference between the three methods in terms of the CE or FE (p > 0.05). In contrast, there was a statistically significant difference in AE (p

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 results of three different tendon transposition techniques (Knapp procedure and two modified techniques) for the treatment of type 2 monocular elevation deficiency (MED) patients. Methods The medical records of patients with MED type 2 operated on at a single institution from 2000 to 2016 were reviewed retrospectively. Patients were divided into three vertical transposition groups: (1) full tendon width, (2) augmented surgery; and (3) partial tendon width. Surgical success was defined as no severe limitation of upgaze, hypotropia of Results A total of 39 patients were included. The pre- and postoperative deviations in the full-tendon group were 22.50Δ ± 4.17Δ and 3.50Δ ± 1.27Δ, respectively; in the augmented surgery group, 23.75Δ ± 4.78Δ and 1.75Δ ± 1.14Δ; and in the partial-tendon group, 20.50Δ ± 3.98Δ and 4.12Δ ± 2.78Δ. Corrected vertical deviations were 19Δ, 23Δ, and 16Δ, respectively. The pre- and postoperative limitation of elevations were −2.80 and −0.80 in the full-tendon group, −3.20 and −0.90 in the augmented surgery group, and −2.37 and −1.12 in the partial-tendon group. The pre- and postoperative vertical deviation improvements and limitations of elevation were statistically significant (P Conclusions In this study cohort, all three procedures were reasonably effective in improving vertical deviations and limitation of elevation.

Purpose: To evaluate the outcome of surgical treatment in patients with type 1 monocular elevation deficiency. Methods: Patients who were diagnosed as having type 1 monocular elevation deficiency by forced duction test and exaggerated traction test between 2000 and 2016 were retrospectively reviewed. Epidemiologic and clinical features of the patients were noted. The efficacy of ipsilateral inferior rectus recession to vertical misalignments and limitation of elevation were evaluated. The clinical features of the patients who did not achieve surgical success after inferior rectus recession were determined. The surgical and functional results of contralateral superior rectus recession were evaluated for patients who had residual hypotropia under inferior rectus recession. Results: Thirty-nine patients were included in the study. Preoperatively, vertical deviations were 20.53 ± 4.50 prism diopters (PD) for near and 22.21 ± 5.12 PD for distance. After inferior rectus recession, the amount of vertical deviation corrected was 15 ± 1.14 PD for near and 17.01 ± 2.00 PD for distance. Ten (25.64%) patients did not achieve surgical success (> 6 PD residual hypotropia). Nine patients (preoperative inferior rectus recession measurements = 28.77 ± 7.25 PD for near and 27 ± 7.44 PD for distance) underwent contralateral superior rectus recession as a second surgery. After contralateral superior rectus recession, 7 of 9 (77.78%) patients achieved surgical success. The limitation of elevation significantly improved after both surgeries (Wilcoxon test, P < .05). No diplopia or other complications after surgeries were reported. Conclusions: Inferior rectus recession is the first surgical option for patients with type 1 monocular elevation deficiency. Contralateral superior rectus recession is an effective alternative surgical treatment for residual hypotropia after ipsilateral inferior rectus recession. [ J Pediatr Ophthalmol Strabismus . 2018;55(6):369–374.]

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.

Ebru Demet Aygit,1 Murat Kocamaz,1 Asli Inal,1 Korhan Fazil,1 Osman Bulut Ocak,1 Serpil Akar,2 Birsen Gokyigit1 1Strabismus Department, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey; 2Ophthalmology Department, Medicine Faculty, Baskent University, Istanbul, Turkey Purpose: To report the results of using prismatic glasses for Duane retraction syndrome (DRS). Methods: Data were obtained from the records of patients who were evaluated during the year2000 in the Strabismus Unit of the Beyoglu Eye Training and Research Hospital. The average follow-up was 12.2±17.7months. In all cases, 2 main variables were evaluated: horizontal deviation in the primary position and face turn. Prismatic glasses were provided to patients according to the degree of shift in the primary position. Results: The mean age of patients was 11.2years. An analysis was performed on the data collected from 12 cases; 7 patients were females (58.3%) and 5 were males (41.7%), with 11(91.7%) cases being of type I DRS. All 12 patients had abnormal head posture (face turn) and an angle of mean deviation equaling 10PD (prism dioptri). Conclusion: Treatment was individualized on a case-by-case basis. Prismatic glasses are useful for eliminating abnormal head posture and ocular misalignment in selected cases. Keywords: Duane, prismatic glasses, abnormal head posture

Objectives: To evaluate ocular biometric parameters including anterior chamber depth (ACD), corneal curvature (CC), central corneal thickness (CCT), horizontal corneal diameter, and corneal biomechanical properties using ocular response analyzer (ORA) in eyes with hypermetropic anisometropia and to compare the results with those obtained for the healthy eyes of the patients. Materials and Methods: Sixty-four eyes of 32 patients followed with the diagnosis of hypermetropic anisometropia-related ambliyopia were included in the study. Group 1 (n=32) consisted of eyes with hypermetropic anisometropia, and group 2 (n=32) consisted of healthy eyes of the same patients. Cycloplegic refraction, best-corrected visual acuity (BCVA), corneal topography, axial length (AL) measurement, biomicroscopy, and fundus examinations were performed. Corneal hysteresis (CH), corneal resistance factor (CRF), and Goldmann-correlated intraocular pressure (IOPg) measurements were recorded. Results: Mean age of the patients was 9.5±2.4; 13 were male and 19 were female. Mean spherical equivalent was +5.42±1.8 D and +1.9±1.28 D in group 1 and group 2, respectively (p

Purpose: To report the efficacy in preventing lower eyelid retraction and long-term results of a new technique of inferior rectus (IR) recession for vertical strabismus and compare this method with the results obtained by a conventional IR recession operation. Methods: This retrospective study included 35 patients who underwent a new IR recession method (study group) and 22 patients who underwent the conventional IR recession (control group) for vertical strabismus. In the study group, an IR recession was applied to the deeper fibers and included approximately 90% of the IR muscle thickness. This group was divided into two subgroups: small IR recessions (4 to 6 mm) and large IR recessions (7 to 8 mm). In the control group, an IR recession of the entire muscle was applied without exceeding 6 mm. The photographs were analyzed for lower eyelid position. Digital image analysis was used to standardize each patient’s preoperative and postoperative photographs at final follow-up examination. The main outcome measures were the margin-to-reflex distance, lower eyelid retraction, and vertical deviation angles (at near and distance fixation). Results: The mean change in margin-to-reflex distance after surgery was 0.03 mm in the small IR recessions group, 0.1 mm in the large IR recessions group, and 2.04 mm in the control group. Postoperatively, the lower eyelid retraction in the study group, which occurred after both small and large IR recessions, was significantly less than that in the control group ( P < .001). There was no significant difference between the study and control groups in improvements in near and distance vertical deviations and success ratios ( P > .05). Conclusions: At long-term follow-up, recession of the deeper fibers layer, including approximately 90% of the IR muscle thickness, was a procedure that minimized or eliminated the possibility of lower eyelid retraction and did not limit the success of strabismus surgery. [J Pediatr Ophthalmol Strabismus 2014;51(1):17–26.]

PurposeTo report the postoperative results of full-tendon vertical rectus transposition (VRT) augmented with lateral fixation suture for the treatment of type 1 Duane syndrome and sixth nerve palsy and to determine whether there was a decrease in the effect of the Foster suture over time.MethodsThis retrospective, consecutive case series included patients who underwent a full-tendon VRT transposition with lateral fixation for type 1 Duane syndrome or sixth nerve palsy. The primary outcome measures included deviation, abnormal head posture(AHP), abduction deficiency, and postoperative binocular single visual field (BSVF).ResultsEighty-seven patients (87 eyes: 40 eyes with Duane syndrome and 47 eyes with sixth nerve palsy) were included in this study. In Duane syndrome patients, the deviation was reduced by a mean of 95%, the AHP was eliminated in 86% of patients, the abduction was improved by 42%, and a useful BSVF of ∼67% of normal was achieved at 1 year post operation. In sixth nerve palsy patients, the deviation was reduced by 99%, the abduction was improved by 59%, and a useful BSVF of ∼71% of normal was achieved at 1 year post operation. In both groups, the improvements in deviation angle and abduction were stable postoperatively. Sixteen patients needed reoperation for undercorrection.ConclusionVRT surgery with posterior fixation is an effective treatment method for complete sixth nerve palsy and Duane syndrome with esotropia, AHP, and abduction deficiency. The procedure carries a small risk of reoperation for undercorrection. The effect of the Foster suture did not decline over time. © 2013 Macmillan Publishers Limited. All rights reserved.

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.

The aim of this study was to identify factors associated with failed vision improvement and recurrence following occlusion therapy for anisometropic amblyopia in children aged 7–9 years. We retrospectively reviewed the medical records of 64 children aged 7–9 years who had been diagnosed as having anisometropic amblyopia and were treated with patching. Functional treatment failure was defined as final visual acuity in the amblyopic eye of worse than 20/32. Improvement of fewer than two logMAR lines was considered relative treatment failure. Recurrence was defined as the reduction of at least two logMAR levels of visual acuity after decreased or discontinued patching. Functional and relative success rates were 51.6 and 62.5 %, respectively. The most important factor for functional treatment failure [adjusted odds ratio (OR) (95 % confidence interval, CI) 11.57 (1.4–95.74)] and the only risk factor for recurrence [adjusted OR (95 % CI) 3.04 (1.13–8.12)] were the same: high spherical equivalent (SE) of the amblyopic eye. A large interocular difference in the best-corrected visual acuity was found to be a risk factor for both functional and relative failure. High SE of the amblyopic eye was the most influential risk factor for treatment failure and recurrence in compliant children aged 7–9 years.