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Purpose@#To investigate the effect of botulinum A toxin (BTXA) chemodenervation in paralytic strabismus patients without surgical correction. @*Methods@#A retrospective chart review of 51 patients who were diagnosed as paralytic strabismus and underwent BTXA chemodenervation was performed. The patients were divided into four groups according to the cause of paralytic strabismus of vasculopathy, neoplasm, trauma, and idiopathic. They were also divided into two groups of early and late treatment according to the initiation time of BTXA chemodenervation after the onset of strabismus (3 months), and of the initial strabismus type of exotropia and esotropia. We investigated the changes of angle of deviation and diplopia after BTXA chemodenervation. @*Results@#The average deviation of angles decreased by 25.2 prism diopter (PD) (35.1 to 9.9 PD) in total patients, and the overall success rate was 64.7% (33 by 51), and the there was no statistically significant difference in success rate between each group divided by the cause of paralytic strabismus. According to the treatment timing, the deviation of the angle decreased by 28.0 PD (36.8 to 8.8 PD) in the early treatment group, and 21.3 PD (33.5 to 12.2 PD) in late treatment group at the time of the last postinjective follow-up. According to the initial strabismus type, the average angle of deviation decreased by 20.3 PD (35.6 to 15.3 PD) in exotropia group by cranial nerve 3 palsy, and 24.4 PD (32.5 to 8.1 PD) in esotropia by cranial nerve 6 palsy. @*Conclusions@#BTXA chemodenervation reduced the angle of deviation and the number of patients with diplopia regardless of the cause of paralytic strabismus. Early BTXA chemodenervation can be considered as the first treatment of choice in paralytic strabismus, especially in esotropia patients.
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Purpose@#To investigate the postoperative changes in diplopia and evaluate factors that affect diplopia after isolated inferior orbital wall fracture. @*Methods@#A retrospective study was conducted on 200 patients who underwent reconstruction surgery for isolated inferior orbital wall fracture between March 2001 and December 2020. Diplopia was categorized into peripheral, central, and full-degree types based on the history and binocular single vision. The natural course of diplopia was analyzed pre-operatively and at 1 day, 6 weeks, and 6 months postoperatively. We analyzed the orbital computed tomography images to determine fracture size (small, medium, or large), fracture site (anterior, middle, posterior, or mixed), extraocular muscle (EOM) size (swelling or deformity), EOM site (incarcerated or prolapsed), and EOM tenting. @*Results@#Diplopia was seen in 144 out of 200 patients (72.0%) before surgery; peripheral diplopia was seen in 57 patients (39.6%), central diplopia in 46 (24.3%), and full-degree diplopia in 20 (13.9%). Pre-operative diplopia differed according to the pre-operative limitation of range of motion (LOM) (p < 0.001) and EOM site (p = 0.022). Pre-operative diplopia type differed according to the LOM direction (p = 0.018) and EOM size (p = 0.020). Diplopia persisted in 33 patients (16.5%) 6 months after the surgery. Recovery was faster in patients with peripheral diplopia compared to those with central or full-degree diplopia. @*Conclusions@#The presence of diplopia was associated with the pre-operative LOM and EOM site but the type of diplopia was associated with LOM direction and EOM size. These factors can be used to predict the progression of diplopia in patients with isolated inferior orbital wall fracture.
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Purpose@#To evaluate the postoperative stereopsis changes in strabismus patients over 10 years of age after surgical correction. @*Methods@#We reviewed, retrospectively, the medical records of 193 patients (99 men and 94 women) who underwent strabismus surgery from March 2002 to August 2019 at our hospital. Patients were classified into an exotropia group, an esotropia group, or a combined strabismus group (having horizontal and vertical strabismus simultaneously), according to their strabismus type. These groups were further divided into three groups based on pre-operative stereopsis findings classified as poor (above 4,000 seconds [s] of arc), fair (between 4,000 to 100 s of arc), or good (below 100 s of arc). The stereopsis conditions before and after surgery were compared. @*Results@#Overall, the stereopsis of patients over 10 years of age who underwent surgery improved from 2.45 ± 0.69 logarcsec to 2.85 ± 0.58 logarcsec (p < 0.001) after surgery regardless of strabismus type. Stereopsis in exotropia patients was 2.33 ± 0.71 logarcsec before surgery and improved to 2.15 ± 0.56 logarcsec (p < 0.001) after surgery. Stereopsis in esotropia patients was 0.85 ± 0.58 logarcsec before surgery and 2.48 ± 0.11 logarcsec after surgery (p = 0.002). Stereopsis of combined strabismus patients was 2.44 ± 0.76 logarcsec before surgery versus 2.20 ± 0.54 logarcsec after surgery (p = 0.133). The degree of stereopsis improvement was highest for the esotropia, group followed by the combined strabismus, and exotropia groups. @*Conclusions@#Surgical correction of various types of strabismus may be helpful for binocular function in patients over 10 years of age.
ABSTRACT
Purpose@#To evaluate the postoperative stereopsis changes in strabismus patients over 10 years of age after surgical correction. @*Methods@#We reviewed, retrospectively, the medical records of 193 patients (99 men and 94 women) who underwent strabismus surgery from March 2002 to August 2019 at our hospital. Patients were classified into an exotropia group, an esotropia group, or a combined strabismus group (having horizontal and vertical strabismus simultaneously), according to their strabismus type. These groups were further divided into three groups based on pre-operative stereopsis findings classified as poor (above 4,000 seconds [s] of arc), fair (between 4,000 to 100 s of arc), or good (below 100 s of arc). The stereopsis conditions before and after surgery were compared. @*Results@#Overall, the stereopsis of patients over 10 years of age who underwent surgery improved from 2.45 ± 0.69 logarcsec to 2.85 ± 0.58 logarcsec (p < 0.001) after surgery regardless of strabismus type. Stereopsis in exotropia patients was 2.33 ± 0.71 logarcsec before surgery and improved to 2.15 ± 0.56 logarcsec (p < 0.001) after surgery. Stereopsis in esotropia patients was 0.85 ± 0.58 logarcsec before surgery and 2.48 ± 0.11 logarcsec after surgery (p = 0.002). Stereopsis of combined strabismus patients was 2.44 ± 0.76 logarcsec before surgery versus 2.20 ± 0.54 logarcsec after surgery (p = 0.133). The degree of stereopsis improvement was highest for the esotropia, group followed by the combined strabismus, and exotropia groups. @*Conclusions@#Surgical correction of various types of strabismus may be helpful for binocular function in patients over 10 years of age.
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PURPOSE: This study evaluated the clinical outcomes of transcanalicular laser-assisted dacryocystorhinostomy (TCL-DCR) using a diode laser in patients with nasolacrimal duct obstruction (NLDO). METHODS: A total of 71 patients (76 eyes) who underwent TCL-DCR between May 2004 and April 2010 were analyzed. The functional and anatomic success rates were evaluated and the causes of failure were analyzed. RESULTS: The anatomic and functional success rates in primary TCL-DCR were 73.9% (51 of 69 eyes) and 62.3% (43 of 69), respectively. The causes of failure were membranous obstruction in 50.0% of the cases, granuloma formation in 38.9%, synechia formation in 5.6%, and canalicular stenosis in 5.6%. The anatomic and functional success rates were both 42.9% (3 of 7eyes) after TCL-DCR revision. CONCLUSIONS: The success rate of TCL-DCR is relatively comparable to that of conventional surgery. Additionally, the advantages of the procedure are its minimal invasiveness and convenience in an outpatient setting, suggesting that TCL-DCR may be an effective procedure for primary and secondary NLDO.