Evaluation of single-stage adjustable strabismus surgery under conscious sedation.

PURPOSE: To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia. MATERIALS AND METHODS: Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients' experience of the surgery (by questionnaire) were also compared. RESULTS: Mean preoperative deviation for distance in Groups I, II, III was -41.67 prism diopter (pd) +/-9.0, -38.93 pd +/-11.05 and -41.87 pd +/-8.91 ( P =0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd +/-11.71, +35.47 pd +/-10.86 and +42.80 pd +/-10.71 respectively which was significantly different between Group III and Group I ( P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable ( P =0. 5) in all groups. Intraoperative pain ( P < 0.001) and time taken for surgery ( P < 0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups ( P = 0.5). CONCLUSIONS: SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.

Current profile of secondary glaucomas.

PURPOSE: To study the current profile of secondary glaucomas for their incidence and to identify risk factors. Materials and Methods: In this retrospective chart review, 2997 patients newly diagnosed and referred with glaucoma to our tertiary glaucoma center in the year 2005 were included. Evaluation of all cases was done on the basis of a detailed history and recorded examination including vision, intraocular pressure (IOP), anterior segment examination, gonioscopy and fundus evaluation by glaucoma specialists. Demographic data, etiology of secondary glaucoma, and any other significant findings were noted. RESULTS: Of 2997 referred patients, 2650 had glaucoma or were glaucoma suspects. Of all glaucoma patients or glaucoma suspects, 579 patients (21.84%) had secondary glaucoma. Age distribution was as follows: 25% were between 0-20 years; 27% were between 21-40 years; 30% were between 41-60 years and 18% were > 60 years. The male female ratio was 2.2. Frequent causes of secondary glaucoma were post - vitrectomy 14%, trauma 13%, corneo-iridic scar 12%, aphakia 11%, neovascular glaucoma 9%. Post-vitrectomy glaucoma eyes had vitreous substitutes in 83% cases of which 66% eyes had retained silicone oil for more than three months. Vision <or=20/200 was present in 63% eyes, 57% eyes had baseline IOP > 30 mm Hg. Of all traumatic glaucoma patients, 71% cases were < 30 years of age. Fifty per cent had baseline IOP of> 30 mm Hg and vision <or=20/200. CONCLUSIONS: Most patients with secondary glaucoma have poor vision (<or=20/200) with high IOP and advanced fundus changes at presentation.

Evaluation of distance and near stereoacuity and fusional vergence in intermittent exotropia.

Aim: To evaluate the role of distance and near stereoacuity and fusional vergence in patients with intermittent exotropia [X(T)] and their change after surgery. Materials and Methods: This prospective interventional institution-based clinical study included 31 cases of X(T) requiring surgery and 33 age, sex-matched controls. All subjects underwent complete orthoptic assessment including near stereopsis (Randot stereogram) and distance stereopsis by polaroid stereo-projector apparatus using special paired slides and fusional vergence assessment at distance and near prism bar at baseline and one week, one month, three months and six months after surgery in X(T). Results: The successful surgical alignment rate was 74.2%. Preoperatively, cases demonstrated significantly poor distance and near stereoacuity, compared to controls ( P P Conclusion: Early detection of abnormal stereoacuity (near and if possible distance) and near fusional vergence amplitudes may help to decide proper timing of surgery in X(T).