Comparison of clinical efficacy effect between anisometropia amblyopia and strabismus amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the effect of comprehensive treatment in children with anisometropia and strabismus amblyopia.<p>METHODS: Prospective study. Forty-six individuals(mean age 9±3 years old, 26 males, 20 females)with previously untreated monocular amblyopia were recruited in our hospital from July 2018 to January 2020. There were 23 patients with strabismus monocular amblyopia(mean age 9±3 years old, 12 males, 11 females)and 23 patients with anisometropia monocular amblyopia(mean age 9±3 years old, 14 males, 9 females). The best corrected visual acuity(Tumbling E Chart)and stereopsis(Titmus)were measured before and after a 6mo period of comprehensive treatment(refractive correction, patching and precision eyesight training). The differences of monocular visual benefits(visual acuity)and binocular visual benefits(stereopsis)between two groups before and after treatment were compared. <p>RESULTS: Before treatment, there was no significant difference of best corrected visual acuity between anisometropia amblyopia and strabismus amblyopia(<i>t</i>= -0.475, <i>P</i>>0.05), but the stereopsis of strabismus amblyopia was significantly lower than that of anisometropia amblyopia(<i>t</i>= -3.919, <i>P</i><0.001). After 2mo treatment, there was a significant difference in best corrected visual acuity benefits between anisometropia amblyopia and strabismus amblyopia(<i>t</i>= -2.946, <i>P</i><0.01), but there was no significant difference in stereopsis benefits between anisometropia amblyopia and strabismus amblyopia(<i>t</i>=1.305, <i>P</i>>0.05). After 6mo treatment, there was a significant difference in visual acuity benefits between anisometropia amblyopia and strabismus amblyopia(<i>t</i>= -2.353, <i>P</i><0.05), and there was also a significant difference in stereopsis benefits between anisometropia amblyopia and strabismus amblyopia(<i>t</i>=2.218, <i>P</i><0.05). However, the stereopsis of strabismus amblyopia was still lower than that of anisometropia amblyopia at 6mo(<i>t</i>=-2.760, <i>P</i><0.01).<p>CONCLUSION: We conclude that the stereopsis of patients with strabismus amblyopia is more severe than those with anisometropic amblyopia before treatment under the same visual acuity. The visual acuity of patients with anisometropic amblyopia recovers faster than patients with strabismus amblyopia through treatment. While the stereopsis of patients with strabismus amblyopia recovers faster than patients with anisometropic amblyopia, but the level of stereopsis with strabismus amblyopia is still lower than that of patients with anisometropic amblyopia.

Systematic review and Meta-analysis of safety of Sanfu acupoint herbal patching in randomized controlled trial / 中国中药杂志

In order to systematically evaluate the safety of Sanfu acupoint herbal patching, CNKI, SinoMed, VIP, Wanfang, PubMed, Medline, EMbase, and Cochrane Library were searched in accordance with PICOS principles, with a time limit from database establishment to December 2019. Meta-analysis was used for a single-group rate analysis and a weighted combination of these two groups on rates of adverse reactions. A total of 9 articles meeting the inclusion criteria were included in the analysis, involving 2 119 patients. The single-group rate Meta-analysis showed that the adverse reactions incidence was 9% in the treatment group(OR=0.10,95%CI[0.06, 0.19], P<0.000 01), and 9% in the control group(OR=0.10, 95%CI[0.07, 0.13], P<0.000 01). In combined statistics of all samples OR=1.81, 95%CI[1.04, 3.15], P=0.04, the incidence of adverse reactions in the treatment group was slightly higher than that of the control group. In the subgroup analysis, the incidence of adverse reactions in terms of both single-group rate and weighed rate in the treatment group was higher than that in the control group in the asthma subgroup, rhinitis subgroup, ≥18 years old subgroup, and application time 2 h subgroup, with statistically significant differences(P<0.05). The results of the Meta-analysis and systematic review suggested that the incidence of adverse reactions in clinical use of the Sanfu acupoints herbal patching was relatively low. The main types of adverse reactions were skin ulcers, blisters and other skin symptoms. The symptoms were relatively mild, which could be relieved by drug withdrawal or symptomatic treatment. It shows that the safety of the Sanfu acupoint herbal patching was relatively high, and the occurrence of adverse reactions was related to the original disease and age, mainly in asthma and rhinitis or patients over 40 years old. Affected by clinical heterogeneity, the conclusions of the application time subgroup need to be further improved.

Use Of Paper Patching And Tincture Ferri Perchloride For Day Care Management Of Tympanic Membrane Perforation

INTRODUCTION: Perforation of tympanic membrane constitutes a major portion of patients attending ENT OPD for which they are advised surgical procedures. Most of the cases with small perforations can be managed by doing OPD procedure of cautery patching and hence surgical procedure can be avoided. METHODS: The study was conducted in the tertiary hospital from August 2018 to July 2019. The patients were selected on the basis of the inclusion criteria after doing clinical examination, and audiometry. All the patients underwent cautery patching with tincture ferri perchloride and patch placed. The patients were followed up weekly till the perforation was completely closed or uptill 3 months. RESULTS: Total of 65 patients was included in the study. Most common etiology of perforation was inflammatory involving anteroinferior quadrant as most common etiology with success achieved in 56 patients. CONCLUSION: patients with small central dry perforation of tympanic membrane, cautery patching using tincture ferri per chloride and paper patching gives good results comparing to the surgical procedure, while ablating the morbidity and psychological trauma of the surgery.

Simplified updates on the pathophysiology and recent developments in the treatment of amblyopia: A review

Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.

Clinical evaluation for atropine penalization in treatment of moderate and severe anisometropic amblyopia / 中华实验眼科杂志

Objective@#To evaluate the effect of atropine penalization for treatment of moderate and severe anisometropic amblyopia.@*Methods@#Retrospective cohort study was performed.Eighty moderate and severe anisometropic amblyopia pediatric patients aged 4-7 years old were enrolled from December 2011 to November 2017 in Tianjin Eye Hospital and Beijing Children's Hospital.The subjects were divided into atropine penalization group and patching group according to the treatment, with 25 cases of moderate amblyopia and 15 cases of severe amblyopia in each group.The best corrected visual acuity (BCVA) of amblyopia in atropine penalization group and patching group before treatment, 2 months, 4 months, 6 months and 8 months after treatment were compared.The binocular visual function of each group was compared before and after treatment.The compliance and complications were also recorded.This study adhered to the Declaration of Helsinki, and was approved by the Ethics Committee of Tianjin Eye Hospital (2016-42) and Beijing Children's Hospital (2019-k-33).@*Results@#There were significant differences in BVCA between the two groups before and after treatment in cases with moderate amblyopia (Fgroup=3.104, P=0.032; Ftime=4.342, P=0.013); The BCVA of atropine penalization group was better than that of patching group at 2, 4, 6 and 8 months after treatment, the differences were statistically significant (all at P<0.05). There were significant differences in BCVA between the two groups before and after treatment in cases with severe amblyopia (Fgroup=3.149, P=0.016; Ftime=5.094, P=0.024); The BCVA of atropine penalization group was better than that of patching group at 2, 4, 6 and 8 months after treatment, the differences were statistically significant (all at P<0.05). The effective rates of stereopsis reconstruction in atropine penalization group were significantly higher than those in patching group in both moderate and severe amblyopia cases, and the differences were statistically significant (both at P<0.05). The compliance rate of moderate amblyopia in atropine penalization group was 96% (24/25), which was significantly higher than 76% (19/25) in patching group, the difference was statistically significant (χ2=4.153, P=0.042). The compliance rate of severe amblyopia in atropine penalization group was 100% (15/15), which was also significantly higher than 67% (10/15) in patching group, the difference was statistically significant (χ2=6.000, P=0.014). During the follow-up period, there were 4 cases with photophobia in the atropine penalization group.No adverse reaction was observed in the patching group.@*Conclusions@#Compared with patching, atropine penalization is an effective method in treatment of moderate and severe amblyopia, with the advantage in rapid improvement of visual acuity, stereopsis recovery and compliance of treatment.Atropine penalization is worthy for clinical application.

Current Management of Childhood Amblyopia

Amblyopia is defined as the reduction of best-corrected visual acuity of one or both eyes caused by conditions that affect normal visual development. The basic strategy to treat amblyopia is to obtain a clear retinal image in each eye and correct ocular dominance through forced use of the amblyopic eye. Treatment modalities include correcting any underlying organic disease, prescribing appropriate optical correction, and providing occlusion/penalization therapy for the non-amblyopic eye. Given the success of amblyopia treatment declines with increasing age, the detection and management of amblyopia should begin as early as possible during the sensitive period for visual development. Proper management of amblyopia during childhood can reduce the overall prevalence and severity of visual loss. This study aims to provide an update for the management of childhood amblyopia to provide better visual outcomes.

Characteristics of Patients Who Are Not Responsive to Alternate Patching for Overcorrected Intermittent Exotropia

PURPOSE: To compare the characteristics of patients with surgically overcorrected intermittent exotropia treated with alternate patching. METHODS: The medical records of 51 patients who underwent bilateral lateral rectus muscle recession for intermittent exotropia and required alternate patching to correct postoperative overcorrection were retrospectively reviewed. Patients with postoperative esodeviation ≥18 prism diopters (PD) were started on alternate patching on postoperative day 1, whereas those with postoperative esodeviation of 10 to 17 PD were started after 2 weeks. Postoperative esodeviation <10 PD was considered as slight intentional overcorrection after exotropia surgery. Patients not responsive to alternate patching treatment were defined as those with postoperative esodeviation ≥10 PD after 3 months of treatment. Sex, family history, age, refractive error, amblyopia, stereopsis, suppression, type of exotropia, surgical method, preoperative and postoperative angle of deviation, and start time of alternate patching were compared. RESULTS: Among 51 patients, 29 patients responded to alternate patching and 22 patients did not respond. Female sex (p = 0.04), larger preoperative exodeviation at distance (p = 0.04), late onset of postoperative maximal esodeviation (p < 0.01), larger postoperative maximal esodeviation at near (p = 0.02), and late initiation of alternate patching (p = 0.01) were associated with patients in the non-responsive group. Although postoperative angle of deviation was similar for 2 weeks, the angle of postoperative esodeviation was significantly larger in the non-responsive group than in the responsive group, beginning at 1 month postoperatively. CONCLUSIONS: Female sex, large preoperative exodeviation, late initiation of alternate patching, and large esodeviation 1-month postoperative predisposed patients to be resistant to alternate patching for postoperative overcorrection.

Clinical Observation of Treating Functional Constipation with Spleen-kidney Yang ;Deficiency Syndrome by TCM Hot Patching Guanyuan / 中国中医药信息杂志

Objective To evaluate the clinical efficacy of treating functional constipation with spleen-kidney yang deficiency syndrome by TCM hot patching Guanyuan. Methods Totally 61 patients with functional constipation with spleen-kidney yang deficiency syndrome were randomly divided into treatment group (31 patients) and control group (30 patients). Treatment group was given TCM hot patching, heated to 45 ℃, sticking to Guanyuan (RN4), eight hours, one time a day. The control group was treated with polyethylene glycol 4000 powder, 10 g for each time, twice a day, one time for morning and one time for evening. One course lasted for 15 d, 4 courses in total, with six-month follow-up. The improvement of the symptoms, such as difficulty in defecation, interval of defecation, texture of stool, time of defecation, feeling of defecation, weakness of waist and knees, coldness of limbs and so on, were ovserved. The clinical efficacy was evaluated and adverse reaction and recurrence rate were observed. Results After treatment, the symptoms of constipation scores in both groups were significantly improved compared with those before the treatment (P0.05);the incidence of adverse reaction was 6.5%(2/31) in the treatment group, and 16.7%(5/30) in the control group, with statistical significance (P<0.05). In the follow-up of 2, 4 and 6 months, the relapse rates were 0, 3.6%, and 7.1% for the treatment group, and 7.7%, 38.5% and 50.0% for the control group. Relapse rates of 4 and 6 months of treatment group was significantly lower than the control group (P<0.05). Conclusion TCM hot patching Guanyuan has good efficacy for functional constipation with spleen-kidney yang deficiency syndrome, with few adverse reactions and low relapse rate.

The Effect of Amblyopia Treatment with Patching on Ocular Alignment

PURPOSE: To evaluate the effect of patching on ocular alignment in children with unilateral amblyopia. METHODS: We evaluated the change in ocular alignment during and after patching in patients who had started amblyopia treatment with patching, and analyzed the aspects of change according to the cause and severity of amblyopia, type and magnitude of deviation, type of refractive error, and age at initiation. A change of eight prism diopters (PD) or more in horizontal deviation, or two PD or more in vertical deviation was considered significant. RESULTS: A total of 209 patients were enrolled; 135 had amblyopia associated with anisometropia, 50 with strabismus, 19 with combined cause, and 5 with deprivation. After patching, there was no change in distant deviation in 177 patients (84.7%), while a decrease was noted in 23 patients (11.0%) and an increase in nine patients (4.3%). The angle of deviation decreased in 7.4% of anisometropic amblyopia, 20.0% of strabismic amblyopia, 10.5% of combined amblyopia, and 20.0% of deprivation amblyopia. The angle of deviation increased in 4.4% of anisometropic amblyopia, 5.3% of combined amblyopia, and 40.0% of deprivation amblyopia. The angle of deviation decreased in 24.2% of exodeviation, and 21.6% of esodeviation, but there was no change in vertical deviation among the studied patients. The angle of deviation decreased in 31.9% of patients with deviation greater than 8 PD. The change did not differ according to severity of amblyopia, type of refractive error, or age. Among the successes, decrease in deviation was more common until they achieved equal visual acuity between both eyes, while the increase during tapering of patching. CONCLUSIONS: Change in ocular alignment may occur after patching in some patients with amblyopia, and seems to be more frequent in cases associated with horizontal deviation greater than 8 PD.

Surgical Outcome of Large and Giant Duodenal Ulcers Perforations.

Duodenal Ulcer perforations be it large or giant, is frequently encountered surgical emergency in clinical practice. Its quiet prevalent in tropical and sub tropical countries like ours and accounts for high number of hospital admissions. It's a treatable surgical disease with good clinical outcome but has potential for mobidity and mortality in the event of delayed treatment. Despite the advances made in surgical therapy the diagnosis of Large and Giant duodenal perforations is quiet difficult and the management is highly demanding.In our study of 30 patients, we report our expereince of Cellan-Jones omental patching with feeding jujenostomy in cases of large duodenal ulcer perforations and also the experience of treating giant duodenal ulcer perforations with jujenal serosal patching with feeding jujenostomy and with Anterectomy plus Bilroth-II in selective cases.

Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia

PURPOSE: We compared the results of daily patching and alternate-day patching to treat amblyopia. METHODS: Patients with difference in the visual acuity (VA) between the eyes of at least two lines were prescribed spectacles according to the result of cycloplegic refraction. After 4 months, 45 patients with confirmed amblyopia were randomly assigned to daily patching or alternate-day patching group. Patients were patched daily in the daily patching group (n = 24), and patched every other day in another group. The patching time was 2-6 hours according to the VA of the amblyopic eye. The parents were asked to mark on a calendar whether their child performed occlusion or not. The main outcome measure was the mean VA of amblyopic eye and compliance of occlusion after 1, 3, 6 and 9 months. The success of treatment was defined if difference of VA between the eyes was less than or equal to 1 line. RESULTS: There was no significant difference between the two groups in age, type of amblyopia, VA of the amblyopic eye and total treatment duration. VA of the amblyopic eye was significantly improved at 1 month after occlusion in both groups. At the final visit in both groups, the number of improved VA lines in the amblyopic eye (3.8 lines:3.7 lines, p = 0.754), the final success rate (50.0%:81.0%, p = 0.060) and the compliance of occlusion (94.5%:96.3%, p = 0.803) were not different significantly, but VA of the amblyopic eye (0.2 log MAR:0.1 log MAR, p = 0.042) was better in the alternate-day patching group than that in another group. CONCLUSIONS: There was no difference in the number of improved VA lines in the amblyopic eye, nor were there differences in success rate and compliance of occlusion between the two groups. The final VA was better in the alternate-day patching group than another group. Therefore, the alternate-day patching method is another possible option for the treatment of amblyopia.

Effectiveness of the addition of citicoline to patching in the treatment of amblyopia around visual maturity: A randomized controlled trial.

Aim: To study the effectiveness of the addition of citicoline to patching in the treatment of amblyopia in the age group of 4‑13 years. Materials and Methods: A randomized controlled trial, which included patients who were randomly divided into two groups. Both the groups received patching therapy till plateau was achieved in phase 1 of the study. Then in phase 2, group I received citicoline plus patching and group II continued to receive only patching. Outcome Measures: Outcome was measured by the visual acuity in logMAR every month in phase 1 till plateau was achieved and then for 12 months in phase 2. Results: No significant difference was found in the mean visual acuities in these two groups in phase 1 till plateau was reached. In phase 2, for the initial four months, there was no significant difference in the visual acuities in these two groups, at the respective intervals. However, five months onward, up to 12 months, there was a significant difference in the visual acuities in these groups.The result was the same in younger patients (< seven years of age) as well as in older patients (> seven years of age). In phase 2, the mean proportional improvement in group I was significantly more than that in group II, at two months and onward, at the respective intervals. Conclusion: The improvement in visual acuity with citicoline plus patching was significantly more than that with patching alone, in one year of treatment.

Visual outcomes of Amblyopia Therapy

Objective@#To determine the visual outcome of amblyopia treatment and describe the relationship between age of onset and consult, compliance as measured by a patch diary, amblyopia subtype, and severity with the final visual outcome.@*Methods@#Thirty-two consecutive, newly-diagnosed cases of amblyopia, aged 3-8 years on initial consult, with no history of prior amblyopia treatment, were included. Patching was done based on current AAO recommendations and patients were followed up monthly for 6 months. Treatment success was defined as best corrected visual acuity (BCVA) better than 20/30 (0.17LogMAR), or a 3-line improvement from baseline, or stable isoacuity for at least 3 months. Treatment failure was defined as no improvement of BCVA after 3 months of occlusion therapy or a regression of 2 lines. Descriptive and correlation statistics were performed comparing age of onset and consult, amblyopia subtype, severity, and compliance with the main outcome measure of BCVA at 6 months. @*Results@#Sixteen (50%) attained treatment success. Patients seen earlier (age 2-5 years) had higher rates of success (75%) than those seen later (age 6-8 years) (35%). A moderately strong negative correlation (r=-0.48, p=0.01) existed between severity of amblyopia and final BCVA at 6 months. overall compliance to patching was 88±18%, with good compliance in the success group (92%) compared to fair compliance in the failure group (84%) and a moderate correlation between compliance and BCVA (r=0.37, p=0.05). @*Conclusion@#Treatment success was related to severity, compliance, and younger age of treatment. In the presence of good compliance, severity was a strong prognostic variable.

The Clinical Features With Recurrence of Amblyopia After Cessation of Amblyopic Treatment

PURPOSE: To identify the clinical features with recurrence of amblyopia after cessation of amblyopic treatment. METHODS: Amblyopic children followed up at least 1 year after successful treatment were evaluated. A recurrence of amblyopia was defined as a reduction of more than 2 levels in visual acuity (VA) of the amblyopic eye after cessation of treatment. The age and VA of the amblyopic eye at the start and during follow-up, type of amblyopia, type and duration of treatment, weaning and stereopsis on cessation of treatment were analyzed. RESULTS: Amblyopia recurred in 5 out of 82 patients with successful treatment, and the period of recurrence varied from 7 to 31 months after cessation of treatment. Two out of 5 recurred patients had only patching therapy and the other 3 patients had atropine penalization after patching therapy. The weaning was performed in the 5 recurred patients at cessation of treatment. There was no remarkable clinical factor associated with recurrence of amblyopia. CONCLUSIONS: The recurrence rate was 6% after cessation of amblyopic treatment and there was no factor associated with recurrence of amblyopia. Therefore, regular follow-up may be required after successful treatment for amblyopia.

Comparison of Results of 2-Hour, 6-Hour and Full-Time Patching Regimens in Treatment of Monocular Amblyopia

PURPOSE: To compare effects of a 2-hour, 6-hour, and full-time patching regimens in monocular amblyopia patients under 10 years of age. METHODS: This study recruited monocular amblyopia patients under 10 years of age. The patients were divided into a 2-hour patching group (group A, n=34), a 6-hour patching group (group B, n=33), and a full time patching group (group C, n=28) according to the patching time. A prospective analysis was then performed. The ages at the start of treatment, differences of corrected visual acuity between the 2 eyes and severity of the 3 groups were compared and analyzed. On the final evaluation, 'success' was defined when the difference of corrected visual acuity between the 2 eyes converted into logMAR was less than 0.1. RESULTS: The ages at the start of treatment in group A, B, C were 5.61, 5.48 and 5.71 years, respectively. The best corrected visual acuity of an amblyopic eye converted into logMAR changed to 0.13 after treatment in group A, to 0.16 in group B and to 0.19 in group C. Although visual acuity after the treatment was increased significantly compared to the beginning of treatment in all 3 groups, the final visual acuity showed no statistically significant difference among the 3 groups. Because the occlusion therapy success rates were 70.6%, 69.7% and 64.3% for groups A, B and C, respectively, there was no statistically significant difference. CONCLUSIONS: In the 2-hour, 6-hour, and full-time patching regimens, all patients showed a significant improvement in visual acuity although their success rates were not significantly different. Therefore, the part-time patching therapy favored by patients and parents is effective for the first treatment of amblyopia.

Microsurgicai techniques in amniotic membrane patching for mild to moderate ocular surface burns / 中华显微外科杂志

Objective To evaluate the use of amniotic membrane patches for mild or moderate eye burns at the stage of acute burns and the involved microsurgical techniques.Methods Thirty-four eyes with corneal burns of Ⅱ to Ⅲ degree in which may have partial limbal necrosis were accepted amniotic membrane patching (21 eyes) or pharmaceutical treatment (13 eyes).Four amniotic patches were procured and examined by transmitting electronic microscope when the exposed corneal surface became re-epithelialization after amniotic membrane inching.Results Amniotic patches became partially melting or prolapsed 5-10 (11± 2) days after surgery.The uncovered corneal surface showed quickly re-epithehalized.There were a few thin fibrovascular membrane invaded onto corneal surface in the patients with more than a half limbal necrosis.Postoperative visual acuity increased 1 to 6 (3.3 ± 1.2) lines.The electronic findings showed that most of the infiltrated polymorphonuclear neutrophils in the anmiotic patches became apoptosis.Corneal melting presented in four of 13 eyes who received only drug treatment and lamellar keratoplasty was then performed.The other eyes manifested pseudo-pterygium or symblepharon at different extent.Conclusion Amniotic,patches may reduce the inflammation of burned cornea and corneal neovascularization,accelerate re-epithelialization of corneal surface,even improve the rehabilitation of burned limbal stem cells.

Clinical Course of Patients With Delayed Consecutive Esotropia After Exotropia Surgery

PURPOSE: To report the characteristics and therapeutic results of patients with delayed consecutive esotropia after undergoing surgery for exotropia. METHODS: Ten patients with delayed consecutive esotropia of more than 10 prism diopters (PD) after orthotropia was obtained postoperatively were included in this study. The authors investigated the clinical characteristics, the deviated angle at postoperative day one, the duration between surgery and orthotropia, the duration between surgery and delayed esotropia, the angle of esotropia, and the result of treatment in delayed consecutive esotropia. RESULTS: The average of the preoperative angle of exodeviation was 30PD at distance and 31PD at near. The patients underwent surgery for exotropia at a mean age of 5.3 years, and one day postoperatively, the angle of esodeviation was 12PD at distance and 10PD at near. All 10 patients demonstrated orthotropia at 0.9 months after surgery. However, esotropia of 21PD occurred 4 months after surgery for all patients. Six of the 10 patients demonstrated orthotropia or 10PD or less at the last visit after patching therapy or fitting for Fresnel prism glasses. The remaining four patients did not improve or showed aggravated esotropia with a doubled-angle of esotropia. CONCLUSIONS: In patients with orthotropia after exotropia surgery, delayed consecutive esotropia can occur, and the prognosis of non-surgical treatment is relatively poor.

Clinical Analysis of Anisometropic Amblyopia with Monocular Vision 0.1 or Worse

PURPOSE: To analyze the results of treatment in pure anisometrpic amblyopia with unilateral visual acuity of 0.1 or worse. METHODS: The major eligibility criteria included pure anisometropic amblyopia with age <10 years, best-corrected visual acuity 0.1 or worse in the worse eye and 0.5 or better in the good eye after the wearing of optimal spectacle correction for a minimum of 4 weeks, and the minimum follow-up was 6 months. Twenty-one patients were selected and we analyzed the age at the amblyopia treatment, the type and degree of anisometropia, and the final visual acuity after treatment for visual improvement. Successful treatment was defined as a final visual acuity of 0.3 or more. RESULTS: The mean age at treatment was 5.2 years. The types of anisometropia were hypermetropic in 14 patients, astigmatic in 4, and myopic in 3. The mean duration of treatment of amblyopia was 16 months, and 13 of 21 children with pure anisometropic amblyopia achieved 0.3 or better. The age at treatment was younger and the compliance rate was higher in the success group than in the failure group. CONCLUSIONS: The most common type was hyperopic in the pure anisomteropic amblyopia. Compliance and age at treatment were significantly related to best visual acuity attained in pure anisometropic amblyopia with unilateral visual acuity of 0.1 or worse.

The Influence of Part-time Patching Therapy on Types of Intermittent Exotropia

PURPOSE: To evaluate the influence of part-time patching therapy on the types of intermittent exotropia. METHODS: Forty-four children with basic type intermittent exotropia and 26 with convergence insufficiency type, aged 4 to 12 years, were evaluated. At initial examination, the deviating angles were obtained at distant and near with the alternate prism cover test after correcting for refractive errors. The types of intermittent exotropia were classified based on the reference values of distant-near difference as follow. In the patients with distant angle more than 30 PD, the reference value of distant-near difference was 10 PD, whereas in the patients with distance angle less than 30 PD, the value was one third of the distant angle. Three-hour per day patching of the non-deviating eye was performed for 3 months, and the change in the types of intermittent exotropia was investigated. RESULTS: At initial examination, mean deviating angles (PD) were 27.1 +/- 7.46 PD at distant, and 30.6 +/- 7.92 PD at near. After 3 months with 3-hours patching, the deviating angles were both reduced significantly to 25.9 +/- 9.10 PD at distant and 21.4 +/- 11.00 PD at near (p=0.005, <0.001 respectively). Fourteen patients (32%) of basic type were transformed to pseudodivergence excess type. Among the patients with basic type who showed no change in type, 9 (20%) showed a reduction of angles at both near and distant. Among the patients with convergence insufficiency type, 18 (69%) were converted to basic type and 2 (7%) to pseudodivergence excess type. CONCLUSIONS: Three-hour patching therapy converted the basic and convergence insufficiency type to the pseudodivergence excess and basic type in more than half of the intermittent exotropes.

The Efficacy of Intermittent Atropine Penalization in Amblyopic Children Who Have Failed Patching Therapy

PURPOSE: The purpose of this study is to assess the effect of intermittent atropine penalization (AP) in amblyopic children who have failed patching therapy. METHODS: Twenty-one amblyopic (visual acuity in the amblyopic eye >or= 0.3) children (mean age, 7.8 years) who had failed patching therapy were treated with intermittent AP consisting of one drop of atropine 1% in the sound eye, twice per week. The visual acuity was analyzed in the cases of at least 3-month follow-up after intermittent AP. Treatment success was defined as an improvement in final visual acuity of 2 lines more than baseline visual acuity in the amblyopic eye. RESULTS: The cause of amblyopia in the 21 cases was strabismus in 10 and anisometropia in 11. The mean visual acuities (logMAR) of the amblyopic eye were +0.28 before AP and +0.07 after AP. Of the 21 patients, success was achieved in 17 (84.2%), and their mean treatment duration was 7.5 months. The compliance rate with intermittent AP was 90.1%. CONCLUSIONS: Intermittent AP could be considered for amblyopic children (visual acuity in the amblyopic eye >or= 0.3) who have failed patching therapy.