Strabismus最新文献

{"title":"Challenges in management of congenital enophthalmos due to anomalous accessory orbital extraocular muscle bands.","authors":"Priya Goyal, Shailja Tibrewal, Daniel R Lefebvre, Suma Ganesh, David G Hunter","doi":"10.1080/09273972.2024.2344538","DOIUrl":"10.1080/09273972.2024.2344538","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital enophthalmos is a rare condition characterized by posterior displacement of the globe, often associated with bony orbital anomalies or whole globe development defects. The purpose of this report is to present two unrelated cases of congenital enophthalmos secondary to anomalous accessory orbital bands and to describe characteristics of orbital imaging that differentiate this condition from the other causes.</p><p><strong>Methods: </strong>The case records of two patients who presented with congenital enophthalmos and were discovered to have anomalous accessory orbital extraocular muscle bands were reviewed. The clinical features, initial diagnosis, high resolution magnetic resonance imaging (MRI) findings, and surgical outcomes were noted. A 3-dimensional reconstruction model was used to understand the approach and surgical management in one of the cases.</p><p><strong>Results: </strong>Both patients presented with unilateral severe enophthalmos, globe retraction, and restricted ocular motility in all directions since birth. High-resolution MRI of the orbits revealed a short anomalous band, isointense to the muscle, arising from a rectus muscle belly and attaching to the posteroinferior part of the globe adjacent to the optic nerve. The caliber of the extraocular muscles and ocular motor nerves was normal. In one patient, surgery was not pursued due to the extreme posterior location of the band with proximity to the optic nerve. In the other patient, the deviation did not improve, despite successfully severing the accessory band, due to extensive scarring.</p><p><strong>Conclusion: </strong>Anomalous accessory orbital extraocular muscle bands are a rare and often overlooked cause of congenital enophthalmos when associated with limited ocular motility. Imaging the orbit can aid in diagnosis and help differentiate it from other causes. Safe surgical approaches to address the problem are limited, and available approaches may not be effective. These two cases highlight that the management of accessory extraocular muscle bands causing enophthalmos can be extremely challenging and difficult to improve even with intensive surgical intervention.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"195-201"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789837","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":"Comparison of Cambridge vision stimulator (CAM) therapy with passive occlusion therapy in the management of unilateral amblyopia; a randomized clinical trial.","authors":"Masoud Khorrami-Nejad, Mohammad Reza Akbari, Ruaa Abdulhussein, Elham Azizi","doi":"10.1080/09273972.2024.2353153","DOIUrl":"10.1080/09273972.2024.2353153","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited studies on the effectiveness of Cambridge vision stimulator (CAM) therapy as a management strategy in amblyopic patients. In addition, all these studies have a low sample size. The main purpose of this study was to compare the effect of CAM therapy with passive occlusion therapy in the management of unilateral amblyopia.</p><p><strong>Methods: </strong>In this randomized clinical trial study, 110 cooperative amblyopic children, who had not been managed previously, were randomly divided into two groups of CAM therapy (<i>n</i> = 55) and passive occlusion therapy (<i>n</i> = 55). In the CAM procedure, five discs with different spatial frequencies (SF) (2, 6, 15, 20, 30 cycles/degree) were presented to the patient (30 minutes a day, twice a week). Plates with SF equal to the two lines better than the measured corrected distance visual acuity (CDVA) were chosen. During the training, the non-amblyopic eye was occluded. The standard occlusion therapy protocols were performed in the occlusion therapy group. The CDVA for all patients was measured at baseline and then at one, two, and three months after the treatment.</p><p><strong>Results: </strong>The mean age of patients in CAM and occlusion therapy groups was 7.0 ± 2.1 and 6.9 ± 1.9 years, respectively (<i>p</i> = .721). There was no significant difference in the mean CDVA between CAM and occlusion therapy groups after one (0.30 ± 0.16 vs. 0.25 ± 0.14, <i>p</i> = .079), two (0.15 ± 0.10 vs. 0.15 ± 0.11, <i>p</i> = .732) and three months (0.05 ± 0.08 and 0.05 ± 0.06, <i>p</i> = .919) from baseline. However, the mean amount of CDVA increased significantly in each follow-up in both groups (all <i>p</i> < .001). Regarding the amblyopia type and severity, the mean improvement of CDVA from baseline in the anisometropic patients and in moderate amblyopia was significantly higher in the CAM group than the occlusion group after two and three months (<i>p</i> < .05).</p><p><strong>Discussion: </strong>CAM and conventional occlusion therapies significantly improved CDVA in children with amblyopia, and the difference was not significant; therefore, they could be used as alternatives. CAM therapy requires cost and time for the amblyopic patient and parents. Thus, it can be considered as a second treatment option in amblyopic patients, especially anisometropic type and moderate amblyopia, with poor compliance to patching.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"123-138"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794041","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":"Occlusion therapy for amblyopia, a historical report from 9th century Persian scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE).","authors":"Narges Tajik, Mohammad Reza Talebnejad, Mojtaba Heydari","doi":"10.1080/09273972.2024.2366392","DOIUrl":"10.1080/09273972.2024.2366392","url":null,"abstract":"<p><strong>Introduction: </strong>This study reevaluates the historical origins of occlusion therapy for amblyopia, focusing on the contributions of the 9th-century Islamic scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE).</p><p><strong>Methods: </strong>The investigation delved into al-Tabari's writings, particularly \"Firdous al-Hikma,\" to extract insights into his approach to addressing reduced vision in one eye.Additionally, the study examined subsequent advancements in occlusion therapy by scholars such as Thabit ibn Qurrah and Rhazes, building upon al-Tabari'sfoundational work.</p><p><strong>Results: </strong>Al-Tabari's reports contain significant insights into occlusion therapy for amblyopia, predating commonly attributed origins of the treatment. Within \"Firdous al-Hikma,\" he outlines methods for addressing reduced vision, advocating for the covering of the healthier eye to promote the function of the weaker eye. These findings highlight the pioneering efforts of al-Tabari and his contemporaries in the Islamic civilization and challenge the conventional narrative surrounding the history of occlusion therapy. Subsequent advancements by scholars such as Thabit ibn Qurrah and Rhazes expanded upon al-Tabari's work, advocating for similar therapeutic approaches within the Islamic civilization. Their contributions further solidified the practice of occlusion therapy, laying the groundwork for its continued evolution and refinement in subsequent centuries.</p><p><strong>Discussion: </strong>Al-Tabari's contributions to occlusion therapy underscore the rich heritage of scientific inquiry in theIslamic civilization during the medieval period. This historical perspective sheds light on the diverse contributions to medical knowledge and practice outside of Western contexts and emphasizes the importance of recognizing and honoring these contributions in the broader history of medicine.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"217-221"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318944","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":"Nasal loop myopexy for management of exotropia-hypotropia complex associated with high myopia.","authors":"Neelam Pawar, Praveena Shyam, Meenakshi Ravindran","doi":"10.1080/09273972.2024.2367697","DOIUrl":"10.1080/09273972.2024.2367697","url":null,"abstract":"<p><strong>Introduction: </strong>Exotropia-hypotropia complex is an uncommon phenomenon associated with high myopia. However, some literature reports cases of the exotropia-hypotropia complex where residual hypotropia is managed through a secondary surgery following the conventional recession-resection of the lateral rectus (LR) and medial rectus (MR). Nasal Loop myopexy as a primary surgical procedure for the management of exotropia-hypotropia complex has been rarely reported in the literature.</p><p><strong>Methods: </strong>A 24-year-old male with unilateral high myopia presented with a large angle exotropia-hypotropia complex with limitation of elevation in abduction in his left eye. His ocular deviation was successfully managed through a nasal loop myopexy of the superior rectus (SR) and MR using a non-absorbable suture, combined with large LR recession and MR resection.</p><p><strong>Results: </strong>Postoperatively, the patient had satisfactory ocular alignment with improved hypotropia and normal elevation in abduction, contributing to enhanced binocular vision and better cosmesis.</p><p><strong>Discussion: </strong>Managing the exotropia-hypotropia complex in the context of high myopia demands a comprehensive approach that addresses both vertical and horizontal deviations. The surgical strategy employed in this case, which included loop myopexy of SR and MR along with LR recession and MR resection, achieved positive outcomes regarding alignment, elevation, and binocular vision. The case supports variations in muscle path and the potential benefits of tailored surgical strategies for complex strabismus cases associated with high myopia.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"206-209"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555947","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":"Relationships between fusional convergence, suppression depth, and exotropia control in intermittent exotropia.","authors":"Ken Kakeue, Miharu Mihara, Hinano Ataka, Ryoi Tamura, Atsushi Hayashi","doi":"10.1080/09273972.2024.2362202","DOIUrl":"10.1080/09273972.2024.2362202","url":null,"abstract":"<p><p><i>Purpose</i>: To assess the correlation between the contribution rates of fusional convergence from the dominant and non-dominant eye and suppression depth and exotropia control. <i>Study design</i>: Cross-sectional prospective study. <i>Methods</i>: The fusional convergence of 25 participants with intermittent exotropia (mean age 10.8 ± 3.4; range 6-18 years) was measured with an eye-tracking system. The contribution rate was defined based on the amplitude of fusional convergence during refusion relative to the exo-deviation angle. The suppression depth was assessed, and exotropia control was evaluated using the intermittent exotropia Office Control Score. We analyzed the correlations between the contribution rate from the dominant and non-dominant eyes and the suppression depth or control score. <i>Results</i>: There was a negative correlation between the dominant eye's contribution rate and the suppression depth in both eyes (<i>r</i> =  -0.85, 95% confidence interval [CI]: -0.97 to - 0.20 in the fixated dominant eye and <i>r</i> =  -0.91, 95%CI: -0.95 to - 0.40 in the fixated non-dominant eye). There was a negative correlation between the dominant eye's contribution rate and the control score at a 4-meter distance (<i>r</i> =  -0.53, 95%CI: -0.76 to - 0.17). <i>Conclusion</i>: Suppression in intermittent exotropia patients could affect the fusional convergence in the dominant eye.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"139-148"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297275","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":"Divergence excess and basic exotropia types of intermittent exotropia: a major review. Part 2: non-surgical and surgical treatment options.","authors":"Martin Ming-Leung Ma, Mitchell Scheiman","doi":"10.1080/09273972.2023.2291056","DOIUrl":"10.1080/09273972.2023.2291056","url":null,"abstract":"<p><strong>Introduction: </strong>Currently, there is no consensus regarding the management of intermittent exotropia (IXT), which includes both surgical and non-surgical treatment options. Nonsurgical management of IXT has been suggested and includes watchful observation, patching, overminus lenses, prism, and vision therapy/orthoptics. While a significant portion of IXT patients are treated by surgery, it is reported that there is a substantial tendency for reoperation or recurrence of IXT. This paper provides a comprehensive review of non-surgical and surgical treatment options for the IXT.</p><p><strong>Methods: </strong>Search strategies involving combination of keywords including intermittent exotropia, divergence excess, basic exotropia, refractive error, glasses, spectacles, natural history, untreated, observe, occlusion, patch, overminus, overcorrecting minus, prism, vision therapy, orthoptic, anti-suppression, fusion exercise, and surgery were used in Medline. All English articles from 01/01/1900 to 01/09/2020 were reviewed. The reference list of the identified articles was also checked for additional relevant articles. Studies focused on animal models or strabismus associated with neurologic disorders or injury were excluded. The following filters were used for surgical management due to the abundance of reports: full text, randomized controlled trial, review, in the last 5 years.</p><p><strong>Results: </strong>Appropriate optical correction of refractive error is generally the starting point for all management approaches, but there is a lack of randomized clinical trial data regarding this treatment modality. Randomized clinical trial data indicate that both observation and occlusion are reasonable management options for children 3-10 years old, and there were insufficient data to recommend occlusion for children 12-35 months old. While overminus lenses were found to improve the control of IXT when assessed wearing overminus spectacles, this improvement did not persist after the treatment ended. The result of the only randomized clinical trial on the effectiveness of base-in prism indicated that this treatment is no more effective than nonprism spectacles for improving control. A recent randomized clinical trial showed that vision therapy/orthoptics is effective in improving the control of IXT when compared to observation alone. Surgery was found to alter a number of clinical characteristics of IXT, including reducing the distance and near angle of deviation, reducing photophobia, improving health-related quality of life, stereopsis, and the Newcastle Control Score. However, there are no randomized clinical trial data comparing surgery with a control group such as placebo or a no treatment observation group.</p><p><strong>Discussion: </strong>Rigorously designed clinical trials to investigate the effectiveness of non-surgical and surgical treatments for intermittent exotropia are needed.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"159-194"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472422","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":"Secondary IOL implantation for an aphakic patient with congenital cataract living in Bonin Islands; follow-up study.","authors":"Misae Ito, Kimiya Shimizu, Tetsuya Ikeda","doi":"10.1080/09273972.2024.2367068","DOIUrl":"10.1080/09273972.2024.2367068","url":null,"abstract":"<p><p><i>Introduction</i>: We previously reported a case of a patient with bilateral congenital cataract identified in the Ogasawara village, Bonin Islands, Japan, on a visit by an ophthalmologist and describe its course over 17 years from initial surgery. Here, we report on a secondary intraocular lens (IOL) implantation that was subsequently performed at 22 years and 5 months of age. <i>Methods</i>: After cataract surgery at 7 months, the aphakic patient began amblyopia treatment using extended-wear soft contact lenses (SCLs). After 10 years of age, SCLs were chosen to achieve crossed monovision considering the cosmetic appearance when facing other people. At 22 years of age, a secondary IOL implantation was performed. Secondary implant in the patient considered appearance and postoperative vision without glasses, we selected the crossed monovision method using a monofocal IOL. The postoperative targeted refraction for the right (non-dominant eye) and left eyes (dominant eye) planed - 0.33D and - 2.25D, respectively. <i>Results</i>: At 3 months after surgery, the corrected distance visual acuity (CDVA) with IOLs for the right and left eyes was 20/16 and 20/60, respectively, and the binocular visual acuity was 20/16 for distant vision and 20/25 for near vision. The CDVA for the right eye was: 20/13 × IOL = sph-0.25D and that for the left eye was: 20/13 × IOL = sph -1.75D D/cyl -0.50D/Ax170°. Although the exotropia was complicated by dissociated horizontal deviation and dissociated vertical deviation, there were no significant changes in ocular position before and after surgery. The patient was satisfied with achieving independence from spectacles and SCLs. <i>Conclusion</i>: The use of the crossed monovision method with monofocal IOLs in this patient and defective binocular function created a visual environment with no inconvenience in everyday life after secondary IOL implantation. In terms of secondary implant after amblyopia treatment, the IOL type or postoperative targeted refraction must be chosen to maintain or improve the visual environment obtained with the amblyopia treatment.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"202-205"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555948","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 effect of strabismus surgery on the dynamic balance in children with strabismus.","authors":"Serpil Hülya Çapar, Emin Karaman, Eyyup Kara, Olgu Çapar, Sibel Ahmet, Halide Cetin Kara, Akın Çakır, Birsen Gökyiğit, Ahmet Ataş","doi":"10.1080/09273972.2024.2367070","DOIUrl":"10.1080/09273972.2024.2367070","url":null,"abstract":"<p><p><i>Purpose</i>: To evaluate the effect of strabismus surgery on dynamic balance by using computerized dynamic posturography in children with strabismus. <i>Methods</i>: This study was designed as a prospective observational study. Hearing tests and complete ophthalmological examinations were performed for all subjects. Patients with moderate and severe amblyopia, hearing loss at any level, and/or any suspicion of balance impairment were excluded from the study. Postural stability evaluation was performed by computerized dynamic posturography including sensory organization test, adaptation test, and rhythmic weight shift test. All tests were applied preoperatively and in the postoperative 1st and 3rd months, respectively. <i>Results</i>: Fifteen female and twelve male pre-adolescents aged between 7 and 12 (9.67 ± 1.62 years) were included in the current study. In the sensory organization test, the preoperative visual ratio percentages (73.19 ± 14.95%) improved statistically significantly at the postoperative 1st and 3rd months (78.59 ± 16.21% and 81.44 ± 14.18; <i>p</i> = .026, <i>p</i> = .021, respectively). The preoperative toes up (110.66 ± 33,48) and toes down (81.46 ± 28.36) adaptation tests improved statistically significantly in the postoperative 3rd month (88.74 ± 20.94 and 63.36 ± 16.03; <i>p</i> < .001, <i>p</i> = .001, respectively). In the Rhythmic Weight Shift test, the postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the preoperative directional control (forward-backward) value (67.76 ± 11.38%) (<i>p</i> = .011). The postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the postoperative 1st-month directional control (forward-backward) value (68.43 ± 14.00%) (<i>p</i> = .028). <i>Conclusion</i>: Surgical treatment resulted in an improvement in the maintenance of dynamic balance in children with strabismus.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"149-158"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421854","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":"Clinical spectrum and its association with recovery patterns in patients with acquired isolated ocular motor nerve palsies - an observational study.","authors":"Disha Agarwal, Nirupama Kasturi, Subashini Kaliaperumal","doi":"10.1080/09273972.2024.2363396","DOIUrl":"10.1080/09273972.2024.2363396","url":null,"abstract":"<p><p><i>Purpose:</i> To study the clinical spectrum and recovery patterns in patients of acquired isolated ocular motor nerve palsies (OMNPs). <i>Methods:</i> Patients above 5 years of age with various etiologies of OMNPs were included. Demographic and ocular details were recorded, and a squint assessment was performed. Recovery patterns at 3 and 6 months were noted. <i>Results:</i> OMNP was more common in adults, in the order VI > III > IV nerve. Ischemic cause (35%) was followed by idiopathic (26.3%). III nerve palsies were all unilateral, of which all ischemic palsies were pupil-sparing. By 6 months, >50 patients showing complete recovery had ischemic and idiopathic palsies. Smaller baseline deviation correlated with better recovery. <i>Conclusion:</i> Acquired isolated OMNPs are mostly ischemia-related, with >80% of cases fully recovering by 6 months. VI nerve palsy of ischemic or idiopathic etiology and small baseline deviation were associated with self-recovery.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"210-216"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555945","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":"An atypical case of bilateral optic neuritis after strabismus surgery under general anesthesia.","authors":"Himani Pal, Anupam Singh, Sandhya Shrestha, Indar Kumar Sharawat, Prateek Kumar Panda, Barun Kumar","doi":"10.1080/09273972.2024.2324166","DOIUrl":"10.1080/09273972.2024.2324166","url":null,"abstract":"<p><strong>Introduction: </strong>Strabismus surgery under general anesthesia is a common procedure with rare complications in the form of hemorrhage, infection, slipped muscle, lost muscle, scleral perforation, and anterior segment ischemia. We report a unique case of bilateral optic neuritis following squint surgery under general anesthesia in a 15-year-old girl.</p><p><strong>Methods: </strong>A 15-year-old girl presented with accommodative esotropia with V pattern. She underwent uneventful bilateral inferior oblique recession surgery under general anesthesia with Propofol 60 mg, Atracurium 30 mg, and Fentanyl 70 mcg. On the first post-operative day, the patient had an acute onset of temporal headache which was non-radiating. She responded to supportive treatment and was discharged. However, on the 7th postoperative day, she presented with a constant severe headache in the bitemporal region (left > right) for 3 days. She also experienced a painless diminution of vision for 2 days. There was no vomiting, fever, loose stools, diplopia, difficulty in breathing, peripheral sensation loss, generalized weakness, or bowel/bladder incontinence.</p><p><strong>Results: </strong>The best corrected visual acuity was 6/9 in right eye, and 6/9p in left eye with a relative afferent pupillary defect (RAPD) in the left eye. Both optic discs appeared hyperemic with blurred margins. Magnetic resonance imaging (MRI) of the brain and orbit showed hyperintensity along the intraorbital and intracanalicular parts of bilateral optic nerves on T2 weighted image suggesting bilateral optic neuritis. She received intravenous methylprednisolone pulse therapy followed by oral steroids and responded to the medical treatment with improvement in vision but developed steroid-induced glaucoma requiring medical management over several weeks.</p><p><strong>Discussion: </strong>Neuro-ophthalmic complication in the form of non-arteritic ischemic optic neuropathy has been reported after various ophthalmic surgeries, but bilateral optic neuritis has not been reported to date. This possibility should be kept in mind if any patient presents with similar symptoms. This report also highlights IOP monitoring in pediatric patients receiving systemic steroids to prevent loss of vision due to steroid-induced glaucoma.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"102-107"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144554","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}