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The synoptophore has been used clinically to assess simultaneous perception and sensory fusion in strabismic patients; however, due to suppression or the visual condition of patients with normal stereopsis, a synoptophore does not always detect simultaneous perception or sensory fusion. A cheiroscope may be a better alternative.The aim of this work was ro determine whether a cheiroscope could be useful for examining simultaneous perception and sensory fusion in strabismus patients.Thirty-three patients with strabismus who could undergo cheiroscopic tracing were categorised into two groups: the intermittent exotropia group (XT; n = 19; mean age 9.8 ± 5.6 yrs, range 5-23 yrs) and the esotropia group (ET; n = 14; mean age 10.2 ± 6.0 yrs, range 4-23 yrs). Two sizes of square line drawings (20° and 6°) were used for the cheiroscopic tracing. The cheiroscopic tracing results were compared with those of synoptophore testing for simultaneous perception and sensory fusion.The rate of cheiroscopic tracing of detecting sensory fusion was significantly higher than that of the synoptophore. With the synoptophore, simultaneous perception was detected in 89.5% and 85.7% of the XT and ET patients, and sensory fusion was detected in 73.7% and 71.4%, respectively. The synoptophore identified 11 patients who had no simultaneous perception or sensory fusion. Among them, eight patients were associated with suppression and two patients were 4 years old.Cheiroscopic tracing is useful for determining the presence of simultaneous perception and sensory fusion if they are not detected by a synoptophore due to age 5 years or suppression.

Saccadic eye movement plays an important role in the rapid movement of the eyes to visual targets; however, it has not been fully investigated in patients with an orbital floor fracture. Thus, this study investigated saccadic eye movement before and after surgery in patients with an orbital floor fracture. The saccadic peak velocity (PV) was recorded using an eye-tracking device before and after surgery in nine eyes of nine patients with an orbital floor fracture. The type of fracture was a depressed fragment fracture in all cases, and there was no trap-door fracture. Ocular motility and diplopia were evaluated by the Hess area ratio (HAR%) and the scoring of binocular single vision (BSV). The preoperative HAR% and those at 1 month post-surgery and the final post-surgery observation were 62 ± 6%, 83 ± 11%, and 91 ± 8%, respectively. The preoperative, 1 month post-surgery, and final observation post-surgery BSV scores were 34 ± 18, 46 ± 8, and 50 ± 8 points, respectively. The postoperative HAR% and BSV were significantly improved at the final post-surgery observation (p < .05 each). The saccadic PVs of adduction, abduction, and downgaze before and after surgery were not significantly different in both the non-injured eyes and the injured eyes. However, the upgaze saccadic PVs at 1 month and the final post-surgery observation in the injured eyes were significantly increased (p < .05 each). The saccadic PV may be useful to evaluate detailed and precise extraocular muscle function before and after surgery for orbital floor fractures.

Purpose To observe the change in horizontal smooth pursuit in patients with intermittent exotropia before and after strabismus surgery. Methods The smooth pursuit of patients with intermittent exotropia was recorded using a video eye-tracker before and 1 week, and 1, 3, and 6 months after strabismus surgery. Subjects were asked to track a step-ramp target moving at ±6.1°/sec horizontally as accurately as possible under binocular viewing. The differences in gain (eye velocity divided by target velocity) and amplitude of smooth pursuit between right and left eyes before and after surgery were compared. Results A total of 9 patients (mean age, 22.2 ± 13.9 years) were included. Mean preoperative ocular alignment at near was 59.1Δ ± 34.7Δ. The difference in gain between the left and right eyes before surgery was 0.23 ± 0.1; in amplitude, 3.0° ± 3.7°. These values were improved at 1 week after surgery (gain, 0.08 ± 0.06; amplitude, 0.9° ± 0.65°) and continued to improve for 6 months after surgery; however, ocular alignment at near reverted from 5.9Δ ± 10.5Δ to 18.9Δ ± 17.5Δ by 6 months after surgery. Conclusions In this small patient cohort, surgical correction of ocular alignment improved binocular coordination of smooth pursuit in intermittent exotropia. In the long term, the improvement of the binocular coordination of smooth pursuit tended to remain, although the eye position partially reverted to the presurgical state.

Objective To quantify fixation stability of the upward gaze in patients with myasthenia gravis (MG) using an eye tracker. Methods and analysis In this study, 21 normal subjects, 5 patients with MG with diplopia, 5 patients with MG without diplopia and 6 patients with superior oblique (SO) palsy were included. Subjects fixated on a target in the upward direction for 1 min. The horizontal (X) and vertical (Y) eye positions were recorded using an eye tracker. Fixation stability was first quantified using the bivariate contour ellipse areas (BCEA) of fixation points as an index of whole stability. Then, the SDs of the X and Y eye positions (SDX and SDY, respectively) were quantified as indices of directional stability, with the data divided into three 20 s fractions to detect temporal fixation fluctuation. Results BCEAs were larger in patients with MG (both with and without diplopia) than normal subjects and patients with SO palsy, without significant differences among the three 20 s fractions. Compared with normal subjects, SDXs were larger only in patients with MG with diplopia; SDYs were larger in both patients with MG with and without diplopia. In addition, SDYs in patients with MG with diplopia were larger than those in patients with MG without diplopia and patients with SO palsy. Furthermore, a significant difference among the three 20 s fractions was detected for SDYs in patients with MG with diplopia. Conclusion Patients with MG, especially those with diplopia, exhibit fixation instability in the upward gaze. Non-invasive quantification of fixation stability with an eye tracker is useful for precisely identifying MG-specific fatigue characteristics. Trial registration number UMIN000023468; pre-results.

Purpose: To examine ocular findings in Japanese patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis. Methods: A retrospective study was conducted. Information on the ocular, cutaneous, systemic, and virologic findings on pediatric and adult patients was obtained from medical records. Results: A total of 77 (45 male and 32 female) patients were enrolled in the study: 4 children had varicella, 68 adults had herpes zoster ophthalmicus, and 5 adults had acute retinal necrosis. Children with varicella had eruptions on the eyelid. Patients with herpes zoster ophthalmicus had eruptions, conjunctivitis, keratitis, iridocyclitis, and other findings. Patients with acute retinal necrosis had intracameral cells and retinal lesions. Some patients with herpes zoster ophthalmicus had malignancy, type 2 diabetes mellitus, or other disease. One pregnant woman developed acute retinal necrosis shortly after varicella infection. A total of 48% of patients with negative Hutchinson sign had ocular lesions, while all patients with positive sign showed ocular lesions. Patients with varicella and herpes zoster ophthalmicus had good visual acuity at the last visit. Some patients with acute retinal necrosis had poor visual acuity at the last visit. Conclusions: Patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis had several ocular complications. Some patients with acute retinal necrosis had poor visual outcomes. Ophthalmologists should be aware that acute retinal necrosis may develop shortly after varicella infection.