Strabismus最新文献

{"title":"A clinical-biomechanical model of combined resection-recession surgery of the inferior rectus muscle in incomitant strabismus.","authors":"José Alberto Reche-Sainz","doi":"10.1080/09273972.2026.2755475","DOIUrl":"https://doi.org/10.1080/09273972.2026.2755475","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a simplified clinical-biomechanical framework for two observations in inferior rectus resection-recession surgery: the shortening-to-recession ratio (S/R, where S is the resection or shortening amount and R is the recession amount) is generally below unity, and satisfactory primary-position alignment may coexist with postoperative infraduction limitation.</p><p><strong>Methods: </strong>A conceptual biomechanical framework was developed based on two distinct consequences of inferior rectus recession: alteration of alignment-related force balance and alteration of anterior muscle-globe geometry. Resection was considered to compensate primarily for the alignment-related component, whereas recession was assumed to influence both static alignment and dynamic force transmission. Published clinical case series were used for contextual comparison; no systematic review or pooled analysis was performed.</p><p><strong>Results: </strong>The framework separates the alignment-related effect of recession from the associated alteration of anterior muscle-globe geometry, explaining how satisfactory primary-position alignment can coexist with postoperative infraduction limitation. The predominantly subunitary S/R ratios reported in clinical series are consistent with this interpretation and support the mechanical plausibility of non-1:1 compensation; optimal surgical dosage remains empirical.</p><p><strong>Conclusions: </strong>Inferior rectus resection-recession surgery addresses two partially independent biomechanical objectives: restoration of primary-position alignment and preservation of dynamic downgaze function. This framework helps interpret both commonly used subunitary surgical ratios and the dissociation between alignment and function observed in practice.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-6"},"PeriodicalIF":0.7,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149289910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oculopalpebral synkinesis in congenital ptosis: a case series expanding the spectrum of congenital cranial dysinnervation disorders.","authors":"Samapika Priyadarsini Tripathy, Paromita Dutta, Uttam Dhaka, Ruchita Sontakke, Parul Jain, Meenakshi Wadhwani","doi":"10.1080/09273972.2026.2754381","DOIUrl":"https://doi.org/10.1080/09273972.2026.2754381","url":null,"abstract":"<p><p><i>Purpose</i>: Oculopalpebral synkinesis is an involuntary change in eyelid position linked to eye movement, distinct from the jaw-triggered eyelid movement of the Marcus Gunn jaw-winking phenomenon (MGJWP). It is increasingly considered part of the spectrum of congenital cranial dysinnervation disorders (CCDDs), yet only isolated case reports have described it.<i>Methods</i>: We examined three patients with congenital ptosis whose eyelid position varied with gaze. Eye movements were documented with clinical photographs.<i>Results</i>: Case 1, an 8-year-old boy, had right congenital ptosis with a classic MGJWP and a monocular elevation deficit. The right ptosis worsened on levoversion, and the left upper eyelid, which had no baseline ptosis, moved intermittently up and down on adduction: a double synkinesis. Case 2, a 25-year-old woman, had severe bilateral ptosis and jerk nystagmus since birth, without MGJWP; ptosis worsened in the adducting eye and improved in the abducting eye. Case 3, a 9-year-old girl, had severe right ptosis, right exotropia of 10°, bilateral torsional nystagmus and mild bilateral limitation of elevation, with alternating blepharoptosis in a reciprocal pattern between the two eyelids. MRI of the brain was normal where reported.<i>Conclusion</i>: The same eyelid phenomenon can arise from different aberrant connections between the horizontal rectus muscles and the levator palpebrae superioris, with or without a trigeminal component. We propose that these cases form a distinct group of CCDDs in which synkinesis occurs without significant limitation of ocular motility. Functional MRI and genetic studies are needed to clarify the cause.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-5"},"PeriodicalIF":0.7,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149289847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease specific postoperative drift patterns in vertical and torsional strabismus.","authors":"Yoshihito Mochizuki, Junichiro Hiratake, Akiko Masuda, Fumi Gomi","doi":"10.1080/09273972.2026.2726815","DOIUrl":"https://doi.org/10.1080/09273972.2026.2726815","url":null,"abstract":"<p><strong>Purpose: </strong>To compare postoperative changes in vertical and torsional alignment and stereopsis among patients with vertical or torsional diplopia caused by thyroid eye disease (TED), superior oblique palsy (SOP), and sagging eye syndrome (SES), and to identify disease-specific postoperative patterns.</p><p><strong>Methods: </strong>This retrospective study included 57 patients (25 with TED, 14 with SOP, and 18 with SES) who underwent strabismus surgery for vertical or torsional diplopia at Hyogo Medical University between January 2021 and December 2023. Vertical deviation was measured by alternate prism cover test, torsional deviation by synoptophore, and stereopsis by the Titmus stereo test (six-grade scoring). Surgical effects were defined as the change in deviation per millimeter of muscle recession. Postoperative measurements were obtained at 1 day, 3 months, and 6 months. Statistical analyses included paired t-tests, Kruskal-Wallis test, and Spearman correlation.</p><p><strong>Results: </strong>Vertical deviation significantly improved from preoperative to 6 months postoperatively in all groups (TED: 29.5→5.7 PD; SOP: 26.9→5.1 PD; SES: 7.9→2.8 PD). Torsional deviation improved significantly only in SES (<i>p</i> = .026). Stereopsis improved significantly only in TED (<i>p</i> = .040). The surgical effect was greatest in TED (5.1 ± 1.9 PD/mm) and smallest in SES (2.9 ± 1.6 PD/mm) (<i>p</i> = .004). Improvement in vertical deviation correlated positively with stereopsis improvement (<i>r</i> = 0.352, <i>p</i> = .009).</p><p><strong>Conclusions: </strong>Postoperative alignment dynamics differ among TED, SOP, and SES. Vertical alignment continues to improve for several months in TED and SOP but stabilizes earlier in SES. Recognizing these disease-specific patterns may aid in determining the optimal timing for adjustable suture adjustment or reoperation in cases of persistent vertical diplopia.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-8"},"PeriodicalIF":0.7,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149289836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the 20-20-20 rule during laptop gaming on binocular vision and dry eye parameters in healthy adults.","authors":"Biswas Vishal, Majumder Roshni, Kumar Raj, Awasthi Supriya, Rahul Singh","doi":"10.1080/09273972.2026.2748362","DOIUrl":"https://doi.org/10.1080/09273972.2026.2748362","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the effects of adherence versus non-adherence to the 20-20-20 rule during prolonged digital gaming on binocular vision function and dry eye parameters.</p><p><strong>Methods: </strong>This study involved 100 healthy adults from April 2025 to July 2025, recruited through a controlled lab-based experiment. Binocular vision parameters included Near point of Accommodation (NPA), Near Point of Convergence (NPC), Binocular accommodative facility (BAF), Vergence Facility (VF). Tear quantity evaluation included the Schirmer-I test, symptoms assessments included Convergence insufficiency symptoms survey (CISS) questionnaire and Ocular Surface Disease Index (OSDI) questionnaire. Participants were divided into two groups: Group A adhered to the 20-20-20 rule during 40 minutes of gaming, and Group B did not adhere to this rule. The participants played an \"Endless running game\" for 40 minutes, with the primary investigator monitoring each participant during the task .</p><p><strong>Results: </strong>On comparing post-intervention results between participants who adhered to the 20/20/20 rule and those who did not, statistically significant differences were found in near point of accommodation (NPA), near point of convergence (NPC), and vergence facility (VF) (<i>p</i> < .05). In each of these parameters, greater deterioration was observed among individuals who did not adhere to the 20/20/20 rule.</p><p><strong>Conclusion: </strong>The 20-20-20 rule appears to be an effective strategy for preventing binocular vision dysfunction and ocular surface changes associated with prolonged digital gaming.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-8"},"PeriodicalIF":0.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149276875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of highly myopic strabismus with large exotropia after Yokoyama procedure.","authors":"Juan Lorenzo Simpao, Toshiaki Goseki, Hiromi Onouchi","doi":"10.1080/09273972.2026.2749666","DOIUrl":"https://doi.org/10.1080/09273972.2026.2749666","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Highly myopic strabismus (heavy eye syndrome) is characterized by superotemporal prolapse of the elongated globe, resulting in nasal displacement of the superior rectus (SR) muscle and inferior displacement of the lateral rectus (LR) muscle. This abnormal extraocular muscle configuration can result in restrictive esotropia, limitation of abduction, and progressive binocular diplopia. The Yokoyama procedure restores the extraocular muscle paths by uniting the SR and LR muscle bellies and generally provides excellent ocular alignment. Persistent postoperative exotropia is uncommon and its management has rarely been described. We report a case of persistent large-angle exotropia following an uncomplicated bilateral Yokoyama procedure despite satisfactory postoperative muscle repositioning on orbital magnetic resonance imaging (MRI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 72-year-old woman with high myopia and progressive horizontal diplopia underwent ophthalmologic and strabismus evaluation, including orbital MRI before and after bilateral Yokoyama procedures. Ocular alignment, axial length, and SR-LR displacement angles were assessed. Following development of persistent postoperative exotropia, the patient was observed for six months. Because the deviation did not improve spontaneously and postoperative MRI demonstrated satisfactory SR and LR repositioning, bilateral medial rectus (MR) plication was subsequently performed while preserving the SR-LR union.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Preoperatively, the patient had 35 prism diopters (PD) of esotropia at distance with limitation of bilateral abduction and elevation. Axial lengths were 27.19 mm in the right eye and 26.91 mm in the left eye. Orbital MRI demonstrated nasal displacement of the SR and inferior displacement of the LR, with SR-LR displacement angles of 142° and 144°, respectively. Following bilateral Yokoyama procedures, approximately 55 PD of exotropia developed on the first postoperative day and persisted with little spontaneous improvement over three months. Repeat MRI demonstrated restoration of the normal SR-LR relationship, with displacement angles improving to 97° and 95°, confirming successful anatomical correction despite persistent exotropia. After six months of observation, bilateral 7-mm MR plication was performed. One month later, ocular alignment improved to near orthotropia, with resolution of diplopia and recovery of stereopsis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Persistent large-angle exotropia may occur despite successful anatomical correction following the Yokoyama procedure. Postoperative orbital MRI can help distinguish persistent muscle malposition from successful SR and LR repositioning. When satisfactory muscle positioning is confirmed and spontaneous improvement does not occur, preserving the SR-LR union and addressing the residual horizontal deviation with MR plication may provide an effective secondary surgical strategy. This case highl","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-5"},"PeriodicalIF":0.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149276872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between binocular vision components and visual evoked potentials with reading difficulties in elementary school children.","authors":"Alireza Jamali, Razieh Ahangarani, Mehdi Khabazkhoob, Ali Mirzajani, Amirmahmoud Jafarzadehpour, Alireza Mohamadi, Ebrahim Jafarzadehpur","doi":"10.1080/09273972.2026.2721446","DOIUrl":"https://doi.org/10.1080/09273972.2026.2721446","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the relationship between visual function and neural processing with reading/writing defects in elementary school children.</p><p><strong>Methods: </strong>This case-control study included 28 boys (8-12 years old) with poor academic performance (study group) and 14 healthy, age-matched controls. All participants underwent a comprehensive optometric evaluation, including visual acuity, refractive error, heterophoria, accommodation and convergence facility, fusional reserves, and monocular Visual evoked potentials (VEPs) using 15- and 60-checkerboard patterns (ISCEV standards).</p><p><strong>Results: </strong>No significant differences were found in uncorrected or best-corrected visual acuity between groups (<i>p</i> > .05). However, the study group demonstrated significantly greater hyperopia (+0.07 ± 0.61 D vs. -0.12 ± 0.23 D, <i>p</i> = .025), reduced monocular (6.93 vs. 9.07 cycles/min, <i>p</i> < .001) and binocular (6.04 vs. 8.00 cycles/min, <i>p</i> < .001) accommodative facility, as well as lower vergence facility (6.93 vs. 8.71 cycles/min, <i>p</i> < .001). The study group also exhibited greater exophoria at near (4.61 Δ vs. 2.57 Δ, <i>p</i> < .001) and a reduced distance base-out blur point (10.36 Δ vs. 11.71 Δ, <i>p</i> = .043). VEP measurements revealed a significantly prolonged P100 latency at the 15' check size (112.86 vs. 109.07 ms, <i>p</i> = .043) and higher F_mod values at both 15' (<i>p</i> = .029) and 60' (<i>p</i> = .031) in the study group compared to controls.</p><p><strong>Conclusion: </strong>Children with reading difficulties exhibit distinct subclinical visual deficits, particularly in accommodative function, alongside delayed neural processing despite normal visual acuity. Binocular functional assessments and neurophysiological tests should be integrated into assessments of poor academic performance.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-10"},"PeriodicalIF":0.7,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative therapies versus patching for childhood amblyopia: a modality-stratified meta-analysis.","authors":"Elia de Esteban Maciñeira, Andrea Gonzalez-Galdo, Manuel F Bande","doi":"10.1080/09273972.2026.2746556","DOIUrl":"https://doi.org/10.1080/09273972.2026.2746556","url":null,"abstract":"<p><strong>Purpose: </strong>Patching remains the standard treatment for childhood amblyopia but is constrained by adherence and psychosocial burden, motivating pharmacologic, optical, and binocular/digital alternatives that differ fundamentally in mechanism. Rather than asking whether alternatives are, on average, equivalent to patching - a question prior syntheses have answered by pooling mechanistically dissimilar interventions - we asked a more clinically useful question: does efficacy depend on the <i>type and generation</i> of therapy?</p><p><strong>Methods: </strong>A PROSPERO-registered systematic review and meta-analysis (PRISMA 2020) searched PubMed/MEDLINE, EMBASE, and Cochrane CENTRAL (2000-23 July 2026) for randomized controlled trials (RCTs) comparing an alternative therapy with patching as the active comparator in children predominantly aged ≤9 years. The primary outcome was change in amblyopic-eye best-corrected visual acuity (BCVA, logMAR). Mean differences (MD = Δintervention - Δpatching; negative favors the experimental therapy) were pooled with random-effects models (REML, Hartung-Knapp). A modality subgroup analysis was prespecified; analyses by device generation and by treatment duration were post hoc exploratory analyses prompted by clinical heterogeneity.</p><p><strong>Results: </strong>Eleven RCTs (1582 children randomized; 1467 contributing to the primary-outcome analysis) were included (nine of the eleven tested binocular/digital therapies; atropine and Bangerter filters were each represented by a single trial). Overall, alternative therapies did not differ from patching (MD + 0.005 logMAR; 95% CI - 0.022 to +0.032; <i>p</i> = .68), but heterogeneity was substantial (I² = 62%). This pooled null concealed a modality-dependent pattern: atropine (MD + 0.034), Bangerter filters (+0.040) and first-generation binocular games favored patching, whereas contemporary dichoptic/eye-tracking therapies did not (between-subgroup <i>p</i> = .046). Within the binocular/digital subgroup, the contrast between first-generation games (+0.041) and contemporary dichoptic systems (-0.016) was the most robust signal in the dataset (between-subgroup <i>p</i> = .002).</p><p><strong>Conclusion: </strong>In children predominantly aged ≤9 years, these exploratory analyses suggest that efficacy may depend on which binocular therapy is used rather than on binocular therapy per se: contemporary dichoptic/eye-tracking systems showed no statistically detectable difference from patching, whereas first-generation games, penalization and Bangerter filters did not exceed it. The pooled null should not be read as uniform equivalence, and the absence of a detectable difference does not establish non-inferiority to patching. These generation-stratified findings identify potentially important heterogeneity within binocular therapies and generate a hypothesis requiring confirmation in adequately powered, modality-specific trials.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-12"},"PeriodicalIF":0.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potocki-Shaffer syndrome associated with Brown syndrome: expansion of the ocular phenotype in a child with an 11p11.2-p11.12 deletion.","authors":"Feyza Çalış Karanfil, Sabiha Güngör Kobat, Pınar Bingöl Kızıltunç, Huban Atilla","doi":"10.1080/09273972.2026.2746025","DOIUrl":"https://doi.org/10.1080/09273972.2026.2746025","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the first reported case of Potocki-Shaffer syndrome (PSS) associated with Brown syndrome and to expand the ocular phenotype of this rare contiguous gene deletion syndrome.</p><p><strong>Methods: </strong>Retrospective case report with multidisciplinary ophthalmologic, neurologic, radiologic, and genetic evaluation over a 5-year follow-up period.</p><p><strong>Results: </strong>A 9-month-old girl presented with congenital esotropia, nystagmus, and facial dysmorphism. Ocular motility examination demonstrated bilateral limitation of elevation in adduction, consistent with Brown syndrome, together with right esotropia. During multidisciplinary follow-up, she was diagnosed with Potocki-Shaffer syndrome based on characteristic clinical features, including biparietal foramina, developmental delay, obesity and epilepsy. Chromosomal microarray analysis identified a heterozygous 6.903-Mb deletion at 11p11.2-p11.12 [arr[hg19] 11p11.2p11.12(43,686,617- 50,589,224)×1], encompassing the principal Potocki-Shaffer syndrome genes EXT2, ALX4, and PHF21A.</p><p><strong>Conclusion: </strong>This report documents the first known association between Potocki-Shaffer syndrome and Brown syndrome, thereby expanding the ocular phenotype of this rare genetic disorder. Recognition of this association may facilitate earlier diagnosis and prompt comprehensive multidisciplinary evaluation in children presenting with strabismus accompanied by developmental delay, craniofacial abnormalities, neurological manifestations, and skeletal anomalies.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-4"},"PeriodicalIF":0.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of accommodative function in individuals aged 40-50 years with stage 1 hypertension without hypertensive retinopathy compared with age-matched healthy controls.","authors":"Elham Mashayekhi, Shahin Keshtkar Rajabi, Morad Amir Ahmad, Abbasali Yekta, Mehdi Khabazkhoob, Fereshteh Shokrollahzadeh","doi":"10.1080/09273972.2026.2746560","DOIUrl":"https://doi.org/10.1080/09273972.2026.2746560","url":null,"abstract":"<p><strong>Purpose: </strong>To compare accommodative function between middle-aged adults with stage 1 hypertension and age-matched healthy controls and to investigate the association between blood pressure and accommodative parameters.</p><p><strong>Methods: </strong>This cross-sectional analytical study included 63 participants aged 40-50 years, comprising 33 patients with stage 1 hypertension without hypertensive retinopathy and 30 healthy controls. All participants underwent standardized systemic and ophthalmic examinations. Accommodative function was evaluated using accommodative amplitude (AA), monocular accommodative facility (MAF), accommodative response assessed by monocular estimation method retinoscopy (MEM), positive relative accommodation (PRA), and negative relative accommodation (NRA).</p><p><strong>Results: </strong>A total of 63 participants were included. MAF and PRA were significantly lower in the hypertension group than in the control group (both <i>p</i> < .05). No significant between-group differences were observed in AA, accommodative response (MEM), or NRA (all <i>p</i> > .05). Diastolic blood pressure was positively correlated with accommodative response (<i>r</i> = 0.356, <i>p</i> = .042). In multiple linear regression analysis, hypertension was independently associated with MAF (β =  -1.936, <i>p</i> = .001) and PRA (β = 0.259, <i>p</i> = .002).</p><p><strong>Conclusions: </strong>Patients with stage 1 hypertension without hypertensive retinopathy showed reduced MAF and PRA despite preserved AA. These findings suggest that dynamic accommodative function may be affected early in hypertension, before clinically detectable ocular complications develop.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-11"},"PeriodicalIF":0.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progression of intermittent exotropia in surgical and non-surgical patients: a retrospective cohort study.","authors":"Grant M Welk, Trisha Y C Pecoraro, Ashley Zhou, David O Hodge, Brian Mohney","doi":"10.1080/09273972.2026.2730290","DOIUrl":"https://doi.org/10.1080/09273972.2026.2730290","url":null,"abstract":"<p><strong>Purpose: </strong>Intermittent exotropia (IXT) is a common form of childhood strabismus, and greater exodeviation or poorer control at presentation are known factors influencing the decision to pursue surgery. However, existing studies have not tracked pre-operative progression longitudinally or directly compared these changes between patients who undergo surgery and nonsurgical controls. This study aimed to compare the clinical features and pre-operative progression of IXT between surgically and nonsurgically managed children matched by duration of follow-up.</p><p><strong>Methods: </strong>The medical records of patients < 19 years diagnosed with IXT from 1 January 2002, through 31 August 2023 at a single institution were retrospectively reviewed. Patients with premature birth, neurologic disease, developmental delay, or other forms of exotropia were excluded. All patients who underwent surgery were observed from diagnosis until strabismus surgery was recommended and matched one-to-one with non-surgically-managed controls based on a similar observation duration. Control was assessed at distance and near using a standardized office-based severity scale ranging from 0 to 5.</p><p><strong>Results: </strong>Eighty-one surgical patients diagnosed with IXT were matched with 81 non-surgical patients with IXT. Surgical patients (49 female, median age 3.7 years) were followed for a median of 23 months compared to 27 months for non-surgical patients (48 female, median age 4.0 years). Surgical patients had worse initial median distance control (2.3 vs 2.0; <i>p = .004)</i> and near horizontal exodeviation (25.0 prism diopters [PD] vs 20.0 PD; <i>p</i> = .035) compared to controls. After the pre-operative observation period, surgical patients demonstrated worse control and horizontal exodeviation at both distance (4.0 vs 2.0; 30.0 PD vs 25.0 PD; <i>p</i> < .001) and near (2.0 vs 1.0; 28.9 PD vs 21.6 PD; <i>p</i> < .001).</p><p><strong>Conclusion: </strong>Children who ultimately underwent surgery for intermittent exotropia not only presented with more severe disease but also demonstrated objectively greater deterioration in control and exodeviation during observation than matched nonsurgical peers. These findings underscore the progressive nature of clinically significant IXT and highlight the utility of serial, office-based control assessments in identifying patients likely to require surgery.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-6"},"PeriodicalIF":0.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}