Botulinum toxin A in surgically overcorrected and undercorrected strabismus.

OBJECTIVE: To evaluate the effectiveness and safety of botulinum toxin A injection in treating overcorrected and undercorrected strabismus after unsatisfactory postoperative alignment. MATERIAL AND METHOD: The authors reviewed the outcomes of 20 patients aged 5 to 56 years (mean 29.1 years) who had botulinum toxin A injection following their unsatisfactory operation. The motor outcomes (percentage of successful motor outcome and percentage change in deviation) were recorded at 1 month, 3 months, 6 months, I year 2 years, 3 years, and 4 years after botulinum toxin injection. RESULTS: The mean pre-botulinum toxin injection angle of deviation was 20.6 prism dioptors (PD). Six of 20 (30%) patients maintained the successful position for the average of 2.66 years (range 1-4 years) with single injection. The mean percentage change of the deviation was 87.50%, 87.93 %, 73.05 % at 1, 2, and 3-year visit respectively. In 3 of 5 (60%) patients of consecutive esotropia, 4 of 8 (50%) residual esotropia, 1 of 4 (25%) of consecutive exotropia and 1 of 3 (33.33%) of residual exotropia had successful motor alignment at 6 month visit. There was no scleral perforation, visual loss, or retrobulbar hemorrhage from the injection treatment in the present study. CONCLUSION: Botulinum toxin A injection appears to be a safe and effective treatment for overcorrected and undercorrected strabismus after unsatisfactory surgery. It is very effective in rapid elimination postoperative diplopia. When the result is not adequate or the effect does not last long, repeat the injection or reoperation can be chose to perform later.

Eye health in the priests and novices in central Bangkok.

BACKGROUND: Early detection and proper management of eye diseases in priests and novices is cost effective, and minimize serious ocular damage and permanent loss of vision. Therefore, the Department of Ophthalmology, Priest Hospital set-up an eye examination project for the priests and novices who came for physical examination. The laboratory test was part of the Sustained and Holistic Healthcare Program for Priests and Novices as Commemoration of His Majesty the King's 60 Years of Accession to the Throne. OBJECTIVE: To evaluate eye health status and screening for refractive error in priests and novices and to provide free spectacles and eye health education to fulfill the criteria of voluntary Buddhist eye health workers. MATERIAL AND METHOD: Between February and June 2006, the Department of Ophthalmology, Priest Hospital conducted eye examination for the priests and novices in 28 temples in central Bangkok. The priest and novices with refractive error and abnormal eye examination received appointment for repeated refraction and complete eye examination in Priest Hospital. RESULTS: Six hundred forty nine priests and novices had complete eye examination. Normal visual acuity (Snellen VA 20/20) was found in 355 (54.69%) cases. The most common eye diseases were refractive error with 294 cases (45.30%), cataract with 41 cases (6.32%), glaucoma with 10 cases (1.54%) and vitreoretinal diseases, which included diabetic retinopathy, age related macular degeneration and branch retinal venous occlusion with eight cases (1.23%). Three novices had amblyopia (0.46%). CONCLUSION: Most of the priests and novices in central Bangkok had good eye health. Half of the eye problems were refractive errors. Since most of other eye diseases reported in priests were associated with aging and systemic diseases as hypertension, diabetes, and ischemic heart disease, regular ophthalmic examination should be provided in this risk group. Eye health education should be provided for sustainable eye health development as voluntary eye health workers in Buddhism.

Diabetic retinopathy in Priest Hospital.

BACKGROUND: Diabetic retinopathy (DR) is common complication of DM and is one of the leading causes of visual loss in working age population in developed and developing countries. The known risk of retinopathy is directly related to the degree and duration of hyperglycemia. Priests are one of the disadvantageous groups because they cannot select their food and have poor access to health care. These two reasons are suspected to be causes of high prevalence of DM and DR in the priests. OBJECTIVES: To perform complete eye examinations and take fundus pictures at DR screening to estimate the prevalence of DR in the priests and to perform appropriate treatment. MATERIAL AND METHODS: Retrospective review of the medical records of the priests and novices who had diabetes in Priest Hospital between October 2005 and September 2007 was done. Appointment for crosssectional DR screening for those who never had an eye exam and to complete DR treatment. RESULTS: Four hundred and fourteen diabetic priests and novices were enrolled in the study with the mean age was 61.65 years. Only 297 (71.74 %) of the diabetic priests had a visual acuity measurement previously. DR screening program was done in 176 priests. The result revealed that 123 priests had no DR (69.89 %), 33 (18.75%) had non-proliferative DR (NPDR), 20 (11.36%) had proliferative DR (PDR), and 11 (6.25% or 33.33% of NPDR) had clinically significant macula edema (CSME). From the previously diagnosed patients, 15 (28.3%) had Laser treatment performed and 2 (3.77%) had pars plana vitrectomy (PPV). CONCLUSION: Although Priest Hospital sent DR screening postcards to diabetic priests twice, only 176 (42.51%) priests came, and of those, 53 (30.11%) had DR. There is poor co-operation from the priests because of their lack of medical knowledge about DM complication and DR. The priest who came for the appointment were concerned with their health therefore, they had low prevalence of DR with moderate glycemic control. DR in the priests led to low vision (11.83%) and blindness (5.92%). For the priests, adherence to clinical guidelines for glycemic and BP control was low, even in a well-developed health care system with free ophthalmic care access because they cannot select their food and have poor transportation services to health care facilities.

Guidelines for prescribing optical correction in children.

As the eye grows, the axial length increases while the cornea and lens flatten. High refractive errors which are common in the neonatal period, reduce rapidly during the first year of life through the process called emmetropization. The possibility that long-term full- time glasses wear may impede emmetropization must be considered. Hyperopia greater than 5.00 diopters (D) in young children is associated with an increased risk of amblyopia and strabismus, therefore optical correction should be prescribed. When hyperopia is associated with esotropia, full correction of the cycloplegic refractive error should be prescribed. Myopia greater than 8.00 D and astigmatism greater than 2.50 D are common causes of isometropic amblyopia. Patients with hyperopic anisometropia with as little as l D difference between the eyes may develop amblyopia while the difference should reach 3-4 D for myopic anisometropia to develop amblyopia. Full cycloplegic refractive difference between two eyes should be given to the anisometropic child in spite of age, strabismus and degree of anisometropia. Myopia control is the attempt to slow the rate of progression of myopia such as cycloplegic agents, plus lenses at near, and rigid contact lenses.