Bilateral medical rectus advancement versus bilateral lateral rectus recession for consecutive exotropia

To compare bilateral medial rectus advancement [BMRA] and bilateral lateral rectus recession [BLRR] for the treatment of consecutive exotropia. This randomized clinical trial was performed on 14 patients with consecutive exotropia. Inclusion criteria were history of bilateral medial rectus recession, exotropia of 20 PD or more with far-near discrepancy < 10 PD. Exclusion criteria consisted of more than once medial rectus recession, restricted adduction, history of operation on the lateral rectus, positive forced duction test of the lateral rectus, concomitant neurologic disorders and follow-up less than 6 months' duration. Seven patients underwent BMRA and 7 patients underwent BLRR. Mean age was 11.4 +/- 6.9 [range 5 to 21] years in the BMRA group and 13.7 +/- 7.1 [range 5-22] years in the BLRR group [P=0.44]. Two patients in the BMRA group and 3 subjects in the BLRR group were amblyopic. Mean preoperative exotropia was 27.8 +/- 6.3 PD and 39.2 +/- 14.8 PD [P=0.09] which was reduced to 4.2 +/- 2.3 PD and 3.4 +/- 2.2 PD [P=0.94] in the BMRA and BLRR groups respectively. Successful alignment was achieved in 71.4% and 85.7% of cases in the BMRA and BLRR groups respectively [P=0.94]. All amblyopic patients achieved successful alignment postoperatively. Bilateral medial rectus advancement and bilateral lateral rectus recession are comparable in efficacy for treatment of consecutive exotropia

Causes of blindness and severe visual impairment in children in schools for the blind in east azerbaijan state

To determine the anatomical site and underlying causes of blindness and severe visual impairment [BL/SVI], in schools for the blind in East Azerbaijan state with determining potentially preventable and treatable causes. Between October 2003 and November 2004 a total of 124 students attending three schools for the blind in East Azerbaijan state were examined clinically and data reported using the WHO/PEL childhood blindness assessment form. Most of the students [91.9%] were blind. The major causes of BL/SVI in our study were: Retinal dystrophy [mainly early onset retinitis pigmentosa] in 34.7% of participents; cataract and aphakia in 14.5%; corneal scar/haze in 15.4% and microphthalmus in 13.7%. The retina was the major anatomical site of visual loss [41.1%] followed by the whole globe [23.4%], lens [14.5%], cornea [15.3%] and optic nerve [5.6%]. A relatively high proportion of childhood blindness in East Azerbaijan state has avoidable causes. Most cases of corneal scars and phthisis can be prevented, and cataract is potentially treatable condition