Comparison of squint angle measured by right angle prism and isosceles angle prism / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the differences in squint angle measured by right angle prism and isosceles angle prism.METHODS: Case control study. A total of 176 cases of concomitant strabismus admitted to our hospital from June 2021 to April 2022 were selected, among which 79 cases were concomitant esotropia and 97 cases were concomitant exotropia. The squint angle of all patients was measured respectively by alternating cover right angle prism and isosceles angle prism.RESULT: For patients with concomitant esotropia, the right angle prism degree was 49.167△±13.573△ and the isosceles angle prism degree was 38.250△±10.756△ (P<0.01), with a difference of 10.917△±3.752△; the measurement of right angle prism converted to circular degree was 19.096°±2.456°, and the isosceles angle prism value was 20.847°±5.364°(P<0.05), with a difference of 2.443°±2.702°. For patients with concomitant exotropia, the right angle prism degree was 51.875△±13.567△, and the isosceles angle prism degree was 40.492△±11.753△ (P<0.01), with a difference of 11.383△±4.783△; the measurement of right angle prism converted to circular degree was 19.589°±2.521°, and the isosceles angle prism value was 21.947°±5.864°(P<0.01), with a difference of 3.200°±3.077°. There was no significant statistical difference in the differences of the two prism degree and the circular degree for concomitant esotropia and concomitant exotropia(P>0.05).CONCLUSIONS: The squint angle measured by different shaped prisms is different. The degree measured by right angle prism is larger than that by isosceles angle prism.

Pattern of Ocular Morbidity in School Going Children

We wanted to determine the prevalence of ocular morbidity among school going children between ages of 6 and 16 yrs. in public schools of urban and rural areas of Kanpur city and study its pattern. METHODSA cross-sectional prospective study was done among a total of 2105 school going children (rural - 956 and urban -1149), 6-16 years of age in rural and urban areas of Kanpur city. A comprehensive ocular examination was done with the help of torch light, slit lamp and +90 D and direct ophthalmoscope to examine the anterior & posterior segment pathologies. RESULTSOcular morbidity in the rural population was 817 (no. of diagnosed cases) of which 43.30 % were in rural areas of which 63.52 % were males. 35.07 % were in urban areas of which 57.81 % were males. The most common type of ocular morbidity in rural population was refractive error (15.9 %), followed by vitamin A deficiency (12.86 %), blepharitis (5.43 %), squint (3.66 %), amblyopia (2.87 %), stye (2.40 %), ptosis (1.67%), colour blindness (1.15 %), and posterior segment pathologies (0.19 %).in urban areas, the most common cause was refractive error (26.19 %), followed by squint (2.78 %), amblyopia (1.91 %), vitamin A deficiency (1.91 %), blepharitis (1.83 %), colour blindness (1.21 %), stye (0.70 %), ptosis (0.35 %) and posterior segment pathologies (0.08 %). The difference was statistically extremely significant with p = 0.0001. CONCLUSIONSRefractive error was the most common ocular morbidity in both urban and rural areas, but Vitamin A deficiency and blepharitis were more common in rural areas. In rural areas malnutrition seems to be the major cause of ocular morbidity while more use of gadgets and less outdoor activity seems to play vital role in urban areas.

Benign abducens nerve palsy: diagnosis by exclusion

Of all the cranial nerves, the abducens nerve has the longest intracranial course hence is most common cranial nerve to be affected secondary to any potentially devastating intracranial cause. It can indicate significant underlying pathology. Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. Most of the time it will be unilateral but bilateral involvement is also well known. It can recurrent without any underlying identifiable pathology. The 6th nerve palsy is considered as benign after ruling out all possible causes. Benign causes account for just 9 to 14% of all 6th nerve palsies in children. Most of the time benign 6th nerve palsy occurs after viral infection or vaccination as an immunological reaction. In our case patient had history of pentavalent vaccination 1 month back. After thorough investigation and ruling out all possible causes it was attributed to post vaccination immunological reaction. which resolved spontaneously over 4months.

A unique solution to improve an amblyopic child’s adherence to patching

Amblyopia should be treated in early ages to have better outcomes. Stimulation of suppressed eye and depriving light stimulus to the good eye is the main principal of the amblyopia treatment. Adherence to the patching for the treatment of amblyopia in children remains challenging. This could be due to poor cooperation of child or ill-fitting patch. Younger children can be motivated to mimic cartoon figures to improve their adherence to patching. Amblyopia treatment is a team work of parents and optometrist who not only select the mode of management but improve the acceptance of child for patching.  We present a child with mild anisometropia and hypermetropia-induced esotropia and amblyopia who was non-compliant to patching. An innovative idea by the parents using a Ninja Turtle patch on the prescribed spectacle was very well accepted by the child and both esotropia and amblyopia improved within four months of the patching treatment. The vision in the affected eye improved from 20/200 to 20/20 with refractive error correction and patching. We share this low-cost child-friendly patching technique that parents invented that can be used to improve adherence to patching by young children during amblyopia therapy. This parent’s innovation enabled to improve adherence and thus address amblyopia in patched eye and regain vision.

Clinical observation of external rectus muscle amputation in the treatment of divergence insufficiency / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the clinical effect of external rectus muscle amputation in the treatment of divergence insufficiency. <p>METHODS: A retrospective analysis of 37 cases of insufficiency in our hospital from February 2011 to October 2017. The clinical manifestations were hyperopic esotropia with ipsilateral diplopia, myopia implicit esotropia without diplopia, and the monocular and binocular movements were normal. Preoperative refractive, strabismus, near stereopsis, negative fusion force examination, and then single or double external rectus muscle surgery.<p>RESULTS: Double vision disappeared after all cases, and there was no recurrence in diplopia after one year of follow-up. The preoperative long-term internal strabismus was +15△-+28△, with an average of 18.4△±5.7△, the near-internal strabismus was +5△-+16△, the average was 10.3△±3.6△, The difference value of long distance and short distance strabismus was 8.1△±2.3△; one week after surgery, the distance strabismus was -5.4△±1.5△, the near-distance squint was -7.2△±1.6△, the difference value was 1.8△±0.6△; the one year postoperative strabismus was -1.9△±1.2△, the close squint was -3.4△±1.4△, the difference value was 1.5△±0.8△. The long-distance strabismus one week after operation and one year after operation was significantly lower than that before operation(<i>P</i><0.05). The difference of distance and strabismus between one week and one year after operation was statistically significant. Preoperative the difference between near and far squint one week and one year after operation was statistically significant(<i>P</i><0.05). The difference was statistically significant between the preoperative and postoperative one week. The difference was statistically significant 1 week after surgery and 1 year after surgery. The long-distance negative fusion force before surgery was 3△-9△, with an average of 5.1△±1.8△, and the near-negative fusion force was 15△-24△, with an average of 19.4△±3.2△. The long-near negative fusion force was 10.1△±3.3△, 19.7△±4.1△ at 1wk after operation, and the long-distance negative fusion force was 11.2△±3.6△, 20.2△±4.8△ for one year after operation. There was a statistically significant difference between the patients with preoperative and one week postoperative negative fusion(<i>q</i>=4.551, <i>P</i>=0.013). There was no significant difference between the one week and one year after surgery(<i>q</i>=0.713, <i>P</i>=0.115).There was no significant difference in the patients' brachytherapy before and after one week and one year after operation(<i>P</i>>0.05).<p>CONCLUSION: Divergence insufficiency of external rectus muscle surgery can effectively reduce the difference of long-distance strabismus after surgery, eliminate the symptoms of diplopia in patients, and improve the near stereoscopic sharpness and long-distance negative fusion force.

Clinical study on camera-assisted measurement for measuring squint angle of concomitant strabismus / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate camera-assisted measurement in evaluating the accuracy of Hirschberg Test in measuring squint angle of concomitant strabismus.<p>METHODS:The clinical data of 105 patients with concomitant strabismus who were admitted to the hospital during the period from January 2016 to January 2018 were collected. After admission, they were given traditional Hirschberg Test and picture Hirschberg Test for squint angle examination.Taking the prism cover test as golden standard, the deviation values between squint angle measured by golden standard and those measured by the traditional Hirschberg Test and the picture Hirschberg Test were recorded.The influence of Kappa angle on the deviation value was analyzed.The application value of camera-assisted measurement in squint angle of concomitant strabismus was analyzed.<p>RESULTS:There was a significant difference in the value of squint angle measured by traditional Hirschberg Test, picture Hirschberg Test and prism cover test test(<i>P</i><0.05), and the squint angle measured byprism cover test test was higher than that of picture Hirschberg Test method(<i>P</i><0.05), and the angle in picture Hirschberg Test method was higher than that in traditional Hirschberg Test method(<i>P</i><0.05), and the consistency of picture Hirschberg Test method and prism cover test test in measuring squint angle was higher than that of Traditional Hirschberg Test method(<i>P</i><0.05).There were significant differences in the deviation values of squint angle measured by traditional Hirschberg Test among the 4 examiners(<i>P</i><0.05).The deviation values of all examiners measured by traditional Hirschberg Test were higher than those by picture Hirschberg Test(<i>P</i><0.05).The deviation degree of picture Hirschberg Test was lower than that of traditional Hirschberg Test in terms of the examination of squint angle in patients with positive and negative Kappa angle(<i>P</i><0.05).<p>CONCLUSION: The deviation of camera-assisted measurement picture Hirschberg Test is lower than that of traditional Hirschberg Test for the measurement of squint angle of concomitant strabismus, and it is more suitable for young patients who cannot cooperate with.

A Rare Complication of MRSA Lid Abscess and Orbital Abscess Following Strabismus Surgery in a Child

Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was freeof pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known.

Analysis of Influencing Factors of Stereopsis and Eye Position Changes before and after Intermittent Exotropia Surgery / 中国医科大学学报

Objective To investigate the influencing factors of stereopsis and ocular position changes before and after intermittent exotropia sur-gery. Methods A total of 70 cases diagnosed with intermittent exotropia(squint angle>15△and0.05). There was no statistical difference in the recovery rate of stereopsis and the orthostatic rate of eyes between the groups of 45△and more than 45△. Conclusion Intermittent exotropia surgery can effectively improve the stereopsis and eye po-sition,and the outcomes of surgery are related to the age of surgery. The recovery rate of stereopsis is higher in the patients with intermittent exotro-pia during the visual development period. Regardless of the size of the angle of squint ,early surgery is benefit to the recovery of stereopsis.

Analysis of diversity between synoptophore and triple prism strabismometry / 国际眼科杂志(Guoji Yanke Zazhi)

? AIM: To investigate the differences between synoptophore and triple prism strabismometry and its possible cause.?METHODS: There were 347 patients with horizontal concomitant strabismus involved, in which 76 patients were esotropia, 37 patients were male while 39 were female, with average age of 13. 27 ± 7. 77 years old. There were 271 patients with exotropia, 131 cases were male while 140 were female, with average age of 15. 43 ± 8. 42 years old. All the patients were examined by synoptophore and prism plus shaded strabismometry in a long distance of 6m. Datas were analyzed by SPSS 17. 0.?RESULTS:In the exotropia patients, the conversions of circular degree(°) and prism degree(△) were:1°=0. 29△ ~1. 78△, which was statistically significant with intermittent strabismus (P=0. 001). While in the esotropia patients, the conversions were:1°=2. 01△ ~2. 15△.?CONCLUSION: The diversity between the two methods is enlarged with the increase of squint angle for exotropia patients. While in esotropia patients, the diversity decreased with the increase of squint angle. Synoptophore equipped with +7. 00D, defects of the triple prism itself and proximal convergence during exam may be the reasons for the diversity.

Ocular morbidity among school aged children in Indian scenario.

Background: Vision is the most important special sense in human being. Normal vision is essential for normal physical, mental, psychological development and education. About 30% of blind population of India lose their eyesight before the age of 20 years and many of them are under 5 when they become blind. Methods: The present study is a cross sectional study of children aged 6 to 15 years from Schools in the rural area within 30 kilometers surrounding Khammam, India during september 2012 to March 2014. Results: Conjunctival abnormalities had the highest prevalence rate (4.36%) followed by Refractive errors (2.04%), Lid Abnormalities (1.35%), Corneal Abnormalities (1.02%), Squint (0.70%), Posterior segment abnormalities (0.51%), Amblyopia (0.32%), Colour vision abnormalities (0.28%) and lens abnormalities (0.23%). Conclusion: Our study is one of the few studies to be conducted in this rural setup. This Study gives us benchmark data for comparing future studies in Khammam district and also helps in providing valuable information for proper planning and conduction of future school based health programs.

Rectus and oblique muscles of eyeball: a morphometric study of Indian population / 대한해부학회지

During the strengthening and weakening procedures of intraocular muscles, distance of insertion from the sclerocorneal junction is an important determinant in the identification of muscles. During repositioning of the aponeurosis of the muscles, it is desired that the width should not change in order to avoid diversion of forces. Available anatomic studies on insertions of extraocular muscles are few, date back to early twentieth century and have been conducted on mostly white population. The present study is an attempt to document the insertions of recti and oblique muscles in Indian population. Forty eyeballs were removed from orbit. Insertion of recti and obliqui were cleaned and eyeballs were perfused with normal saline to regain the volume (hence shape and size) before recording observations. Insertion of recti and obliqui muscles were observed under various study parameters. The distance of insertion of recti from the limbus were found to be 7.3 mm, 8.06 mm, 8.71 mm, and 8.74 mm for medial, inferior, lateral, and superior rectus, respectively. The superior oblique was aponeurotic and found to be more variable in mode of insertion as compared to inferior oblique which had a fleshy and relatively constant insertion. The observations on insertion of recti and obliqui as obtained in present study differ from earlier studies to the tune of 1-1.5 mm. This may be attributed to adoption of method of reperfusion of eyeball before recording observations thus maintaining size close to in vivo. The observations are expected to be closer to actual.

The perceived personality traits of adults with digitally induced large angle strabismus and the impact of its correction.

Purpose: To ascertain the effect of digitally induced large angle strabismus and its correction on social bias against strabismic adults. Subjects and Methods: This prospective, observational study included 10 orthotropic subjects whose face photographs were digitally altered to produce esotropia, exotropia, and hypertropia. Three batches of non‑medical professionals, each consisting of 14 subjects, adjudged personality traits of the altered face photographs on a 10‑item questionnaire. The same evaluators effected the appraisal of the orthotropic photographs. The personality score of the strabismic photograph of a subject was compared with its own orthotropic photograph. Results: The 10 subjects whose photographs were digitally modified were of the same age (21 years) and had equal gender distribution. The evaluation of the photographs was performed by 42 evaluators aged 38.3 ± 14.9 years, of whom 21 were males. Different personality traits were rated negatively in the strabismic photographs. The statistically significant negative impact was apparent on more number of personality traits for esotropia (7 out of 10) as compared to exotropia (4 out of 10) or hypertropia (3 out of 10). Rating of the strabismic photographs was significantly lower by female evaluators (P = 0.006). However, there was no difference whether the subject evaluating the photograph of the strabismic individual was of the same gender or the opposite gender. Internal consistency of the questionnaire was excellent (Cronbach’s Alpha = 0.81). Conclusion: There was a significant negative impact of strabismus on the perceived personality traits of the digitally altered face photographs of the adults when compared to their orthotropic photograph.

Feed back of the parents and / or relatives witnessing a squint surgery of their ward in the operation theater.

The aim of the study was to know the response of the relatives attending the squint surgery of their ward. A trained secretary administered an eight item questionnaire by live / telephonic interview. Of the 44 attendees, two left the Operation Theater before completion of the surgery. Mean age of the patients was 7.2 years ± 7.8 and that of the attendees was 36.1 years ± 8.5. Forty patients had a surgery under general anesthesia and four under local anesthesia. Eleven (25%) attendees experienced an increase in anxiety. Thirty-six (82%) attendees reported increased transparency, 38 (86%) reported increased confidence, and 43 (98%) reported increased awareness. None found any disadvantage. Twenty-seven (61%) recommended this practice for all and 16 (36%) recommended the practice selectively. The internal validity of the questionnaire was fair (Cronbach's Alpha = 0.6). It was concluded that the presence of relatives in the Operation Theater during the surgery could bring in more transparency, accountability, confidence, awareness, and trust.

Comparison of psychosocial and emotional consequences of childhood strabismus on the families from rural and urban India.

Purpose: To compare the psychosocial consequences of horizontal comitant strabismus in children between the families of urban and rural India. Materials and Methods: In this cohort study, an eight-question quality-of-life instrument was administered by trained staff to the guardians of strabismic children from rural and urban areas by a live interview. Results: This study included 93 strabismic-children aged 4-16 years of which 52 were females. Forty-one had esodeviation and 52 had exodeviation. Seventy per cent parents were extremely distressed due to squint, 65% were extremely distressed due to people's remarks, 65% were extremely worried, 55% children were extremely distressed due to people's remarks, 57% children were severely ostracized, 38% had severe difficulty in communication and 50% had difficulty to cope; 64% parents were not advised a corrective surgery. The difference between families from rural and urban areas, or whether a male child was affected or a female child or for an esodeviation or an exodeviation was statistically not significant. The questionnaire had a good internal consistency (Cronbach's Alpha = 0.71). Conclusions: There was a significant negative psychosocial and emotional impact of childhood strabismus that was not affected by the rural or urban location of the family or the gender of the strabismic child or type of the deviation. The quality-of-life instrument can be used as part of the clinical examination for strabismic children.

Refractive errors in concomitant tropias

1. Refractive errors are influential, but not essential factors in the development of squint. Hypermetropia is commonly found in cases of convergent conmitant squint; myopia, in the divergent type2. Concomitant convergent squint beings usually before the age of six years. In such cases, the fusion sense is apt to be deteriorated. In cases of squint that develops after this age, the defective fusion sense is capable of being re-educated3. Orthoptic exercises, if timely instituted, are one of the most effective treatments to correct squint. it is seldome successful if it is done after seven years of age in squints which started in early life4. Surgical intervention may restore ocular parallelism, partially or totally, and the results obtained may improve greatly if orthoptic training is given before and after surgery, especially as regards binocular vision. But, if the fusion sense is markedly deteriorated or lost, the effect of surgery is purely cosmetic. (Summary and Conclusion)

The Change of the Squint Angle Under General Anesthesia Using Pancronium Bromide(Myoblock(R))

The use of succinylcholine chloride(Anectin(R)) prior to intubation, can cause increased contracture of ocular muscles. Therefore the authors studied the change of the squint angle under general anesthesia using pancronium bromide (Myoblock(R)) in 81 horizontal strabismus patients who had no neurologic disease and mechanical restrictions of eye movement. We used the alternative cover test and Krimsky method to measure the eye position under general anesthesia.