Outcomes of a simplified, fixed surgical dosage calculation for uncomplicated, horizontal, concomitant strabismus in adults

Purpose: The aim of this study was to evaluate the outcomes of a simplified, fixed surgical dosage calculation for uncomplicated, horizontal, concomitant strabismus in adults. Methods: Outcomes analysis of a fixed?dose calculation method for uncomplicated, horizontal, concomitant strabismus in adults (?18 years) wherein 1?mm recession/resection equals 2 PD for lateral rectus and 3 PD for medial rectus. This was a retrospective case series. Results: The mean age of the patients was 28.50 � 8.43 years, the mean amount of preoperative deviation was 35.16 � 9.97 PD, the mean expected correction was 36.26 � 9.49 PD, and the mean correction achieved was 35.92 � 10.74 PD. There were 22 monocular exotropias, six monocular esotropias, eight alternate divergent squints, and two alternate convergent squints. There were 20 cases of sensory strabismus (54.28%). There was no statistically significant difference between the expected correction and correction achieved (P = 0.519), meaning that our fixed?dose calculation method was effective. Thirty?five out of 38 patients had successful outcomes as per our criteria of less than 10?PD deviations from straight in primary position. Therefore, the success rate achieved by this procedure was 92.10%. There was no statistically significant correlation between age and the amount of deviation (P = 0.611). Conclusion: Our case series had a high postoperative success rate in terms of motor alignment. It is hoped that this simplified, fixed?dosage calculation method would help the numerous novice strabismus surgeons, make their starting steps easier and give them the confidence to do strabismus surgeries. They can modify the dosages later as per their own experiences

Clinical Features of Patients over the Age of 60 Years Who Have Undergone Strabismus Surgery

PURPOSE: In recent years, there has been an increase in the number of strabismus operations performed on patients aged 60 years and over. This study aims to establish the characteristics and outcomes of old age strabismus. METHODS: Patients aged 60 years and over who underwent strabismus surgery between January 2011 and December 2015 were included in this study. The purpose of surgery, type of strabismus, etiology, postoperative recurrence, prevalence of general and ocular complications, and postoperative diplopia rate were reviewed. RESULTS: Ninety-eight patients aged 60 years or older were identified, and 58.2% of patients had strabismus surgery to improve diplopia, while 41.8% chose surgery for cosmetic purposes. Esotropia was the most common type of strabismus found in 40.8% of the patients, and horizontal-vertical combined type was the second highest at 29.6%. The etiology of strabismus was similarly high in both the restrictive pattern (31.6%) and neuro-paralytic pattern (30.6%). The recurrence rate after strabismus surgery was 4.1%, and the reoperation rate was 3.1%. The remnant diplopia rate after surgery in patients with diplopia was 15.8%, and the diplopia occurring rate in patients who underwent surgery for cosmetic purposes was 4.9%. No severe ocular complications such as anterior segment syndrome or eyeball rupture occurred. Anesthesia related problems did not occur in any of the patients who underwent general anesthesia. CONCLUSIONS: Strabismus in patients aged 60 years and over is an effective and safe way to improve diplopia and cosmetic status by restoring ocular alignment.

Cirugía de estrabismo en adultos: resultados motores y sensoriales / Strabismus surgery in adults: sensory and motor results

Objetivo: determinar los resultados quirúrgicos y la obtención de fusión y estereopsis en adultos operados de estrabismo adquirido y si el tiempo transcurrido entre la aparición de la desviación y la cirugía influyó en la obtención de fusión y estereopsis. Métodos: se realizó una investigación descriptiva, de corte longitudinal y prospectivo, en adultos operados de estrabismo adquirido, quienes acudieron a la consulta de Oftalmología Pediátrica y Estrabismo del Instituto Cubano de Oftalmología Ramón Pando Ferrer de enero a diciembre del año 2013. Se analizaron las variables edad, sexo, edad de inicio del estrabismo, tiempo de evolución, diagnóstico, sentido de la desviación, agudeza visual, síntomas y signos, alineamiento ocular, fusión y estereopsis posoperatoria. Resultados: las causas más frecuentes fueron la parálisis o paresias de músculos extraoculares y la exotropía, ambas con 37,7 por ciento. El 34 por ciento de los casos sobrepasaban los tres años de evolución. Se logró el alineamiento ocular y la fusión en el 73,6 por ciento, y se recuperó la estereopsis en el 52,8 por cientot. El 90,9 por ciento de los pacientes que estuvieron desviados menos de un año alcanzaron fusión y estereopsis. Conclusiones: la cirugía de estrabismo de adulto permite recuperar el alineamiento ocular, la fusión y la estereopsis, con más posibilidades de recuperación funcional cuando se realiza con menor tiempo de evolución(AU)

Objective: to describe the surgical results and the fusion and stereopsis achieved in adults operated on for acquired strabismus, and to determine whether the time elapsed from the emergence of deviation to the time of surgery had an effect on fusion and stereopsis. Methods: prospective, longitudinal and descriptive research conducted in adults operated on for acquired strabismus, who had been seen at the Pediatric Ophthalmology and Strabismus service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to December 2013. The analyzed variables were age, sex, the age at the onset of strabismus, time of progression, diagnosis, deviation angle, visual acuity, symptoms and signs, eye alignment and postoperative fusion and stereopsis. Results: the most frequent causes were extra ocular muscle palsy or paresis and exotropia, both accounting for 37.7 percent of cases. Over three years of progression was observed in 34 percent of patients. Eye alignment and fusion occurred in 73.6 percent whereas stereopsis was recovered in 52.8 percent of patients. In the study group, 90.9 percent of patients with deviation angle for less than one year reached fusion and stereopsis. Conclusions: strabismus surgery in adults allows recovering eye alignment, fusion and stereopsis, and the possibilities of functional recovery increase when the time of progression of disease is shorter(AU)

Quality of life in adults with strabismus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the quality of life in adults with strabismus and evaluate the improvement in quality of life after treatment. METHODS: In this prospective study, forty-five adults with a diagnosis of strabismus conform to the inclusion and exclusion standard were selected in our hospital from October 2013 to May 2014, as experimental group and 45 normal adults were enrolled as control group. A Chinese Adult Strabismus-20 questionnaire was used to evaluate the differences of quality of life between patients with strabismus and normal adults, and to evaluate the differences of quality of life in patients with strabismus preoperative and 6mo postoperative. RESULTS:The scores of quality of life in adult patients with strabismus preoperative and 6mo postoperative were statistically significant lower than those of normal adults (P CONCLUSION: Strabismus can decrease the quality of life in psychosocial and visual functional for adults and the surgical treatment can improve quality of life in patients with strabismus.

Gain beyond cosmesis: Demonstration of psychosocial and functional gains following successful strabismus surgery using the adult strabismus questionnaire adult strabismus 20.

Background: Strabismus adversely affects psychosocial and functional aspects; while its correction impacts positively. Aim: The aim was to evaluate the gains in scores: Overall scores (OASs), psychosocial subscale scores (PSSs) and functional subscale scores (FSSs) following successful surgical alignment. Settings and Design: We evaluated changed scores in the adult strabismus 20 (AS-20) questionnaire, administered before and after successful surgery. Materials and Methods: Thirty adults horizontal strabismics, were administered the AS‑20, at baseline, and at 6‑week and 3‑month. Group‑wise analysis was carried out based on gender, strabismus type (esotropia [ET] or exotropia [XT]), back‑ground and amblyopia. Statistical Analysis: We used Wilcoxon, and Mann-Whitney U‑tests. Significance was set at P ≤ 0.05. Results: At baseline, there were no significant differences within the groups, except that those with amblyopia significantly scored less than nonamblyopes in OAS (median scores: 53.8 vs. 71.3; P = 0.009) and FSS (56.3 vs. 85.3; P = 0.009). OAS, PSS and FSS showed significant gains at 6‑week and 3‑month (all Wilcoxon P < 0.001). Compared with males, females showed significantly more gain at 3‑month (OAS: 37.9 vs. 28.7; P = 0.02), on account of PSS gain (49.6 vs. 37.5; P = 0.01). The ET performed better than XT only on the FSS at 6‑week (28.7 vs. 15.0; P = 0.02). Vis‑à‑vis the nonamblyopes, the amblyopes showed significantly more benefit at 6‑week alone (OAS: 18.7 vs. 28.7; P = 0.04), largely due to gains in PSS. Conclusions: Successful strabismus surgery has demonstrated significant gains in psychosocial, functional and overall functions. There is some evidence that gains may be more in females; with a trend to better outcomes in ET and amblyopes up to 6‑week.

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.

Postoperative Recovery of Stereopsis in Longstanding Adult Constant-Horizontal Strabismus

PURPOSE: To evaluate postoperative binocularity after surgical correction of longstanding constant-horizontal adult strabismus without both stereopsis and previous surgery. METHODS: Subjects included 43 adults over 18 years of age, who had constant-horizontal strabismus for more than 10 years without previous surgery and stereopsis. The patients were composed of 30 exotropes and 13 esotropes. Patients with a corrected visual acuity less than 20/40 in the deviating eye were excluded. After correcting for refractive error, the angle of deviation was measured, and pre- and postoperative stereopsis was assessed with the Titmus fly test and Randot stereo test. The relationship between duration of deviation and recovery of stereopsis or obtained stereoacuity were evaluated. RESULTS: The mean preoperative angle of deviation was 49.8+/-12.56 PD in exotropes and 34.7+/-12.41 PD in esotropes. All patients showed suppression of the deviating eye at distance and near before surgery. Postoperatively all patients showed orthophoria within +/-8 PD. Stereopsis was obtained in 80% of exotropes and in 30.8% of esotropes. The mean postoperative stereoacuity was 449.2+/-815.29 seconds of arc (sec) in exotropes and 1000+/-1336.66 sec in esotropes. However, there was no significant relationship between the duration of deviation and the obtained stereoacuity (p>0.05), or between the duration of deviation and the recovery of stereopsis (p>0.05). CONCLUSIONS: Adults with longstanding constant-horizontal strabismus more than 10 years obtained stereopsis with good quality after surgical correction. The recovery of stereopsis was much better in exotropes than in esotropes. Recovery was not influenced by the duration of deviation.

Long-standing Adult Horizontal Strabismus with Early Childhood Onset

Management of infantile and early childhood onset strabismus should be completed during early childhood to gain better binocular function and vision. The author experienced 38 adult patients who had horizontal strabismus without any adequate treatment lasting over 14 years with onset before 6 years of age. They showed large angle of deviation and deep amblyopia. After surgery, stereopsis was never developed in all of the 14 congenital strabismic patients, whereas 30% of the 24 patients with acquired onset showed gross stereopsis. There was abnormal muscular contracture requiring adjustable stutre. All of the patients showed abnormal character psychologically. This study revealed that the lunger the duration of misalignment, the greater the chance of deep amblyopia large angle of deviation, abnormal sensory and motor adaptation, psychological influence, and ahnormal muscular contracture. Therefore early initiation of therapy during early childhood should be emphasized.

Long-standing Adult Horizontal Strabismus with Early Childhood Onset

Management of infantile and early childhood onset strabismus should be completed during early childhood to gain better binocular function and vision. The author experiencep 38 adult patients who had horizontal strabismus without any adequate treatment lasting over 14 years with onset before 6 years of age. They showed large angle of deviation and deep amblyopia. After surgery, stereopsis was never developed in all of the 14 congenital strabismic patients, whereas 30% of the 24 patients with acquired onset showed gross stereopsis. There was abnormal muscular contracture requiring adjustable stutre. All of the patients showed abnormal character psychologically. This study revealed that the longer the duration of misalignment, the greater the chance of deep amblyopia, large angle of deviation, abnormal sensory and motor adaptation, psychological influence, and abnormal muscular contracture. Therefore early initiation of therapy during early childhood should be emphasized.