ABSTRACT
BACKGROUND: Strabismus means ocular misalignment. It is also one of the most prevalent types of amblyopia and the leading cause of pediatric visual impairment. OBJECTIVE: This study aims to determine the frequency of different types of strabismus and the associated refractive errors and amblyopia in patients younger than 16 years of age. This study also aims to compare the age at presentation and gender between the geographic locations and between different strabismus types. MATERIALS AND METHODS: A cross-sectional retrospective study was done using the archives of Beirut Eye and ENT specialist hospital between January 2014 and December 2018. Lebanese pediatric patients aged <16 years having strabismus were included in this study. RESULTS: There was a total of 787 pediatric patients with strabismus, 62.6% of cases had esotropia (ET) and 30.2% exotropia (XT), with ET/XT: 2.07/1. Mt Lebanon had the highest number of cases, whereas Nabatieh was the only governorate with reversed ET/XT ratio. Most patients were diagnosed at the age of 1-5 years, with ET being the most common diagnosis, while XT was mostly found in patients aged 11-15. Hyperopia was the most common (55.4%) refractive error detected in our cohort of strabismus patients, followed by myopia and simple astigmatism. Amblyopia was found in 18.9% of cases, where Nabatieh had the highest count. CONCLUSION: Strabismus pattern was investigated for the first time across Lebanon to shed the light on the crucial role of early ophthalmologic examination, to detect early refractive error and strabismus, and to prevent amblyopia.
ABSTRACT
We aimed to assess age-related changes in corneal topographic indices, keratometry and visual acuity after sequential intracorneal ring segment implantation (ICRS) and crosslinking (CXL). This was a retrospective matched case-control series including 26 eyes of patients ≤18 years as cases and 26 eyes of adult patients as controls. All eyes received ICRS+CXL for progressive keratoconus. Eyes were matched regarding the keratoconus parameters and the treatment (type, number and thickness of ICRS). Data was analyzed for refractive and topographic values (uncorrected and corrected distance visual acuity (UDVA; CDVA) sphere; cylinder; spherical equivalent; maximum keratometry (Kmax); flat keratometry (Kflat); steep keratometry (Ksteep); all 7 pentacam topographic indices) preoperatively and one year postoperatively. Preoperatively, there was no significant difference for any refractive, clinical or topographic parameters between the groups except for index of vertical asymmetry. After one year, children had a significantly higher improvement in Ksteep (3.05D) than adults (2.10D; P=0.036) and a trend to significance for Kflat (2.7D compared to 1.78D, respectively; P=0.081). UDVA improved by 4.3 ETDRS lines in children compared to 3.3 ETDRS lines in adults and CDVA improved by 1.7 ETDRS lines in children compared to 1.2 ETDRS lines in adults, but with no statistical significance. The effects on keratometry indicated that corneal response after ICRS and CXL for keratoconus is more pronounced in young patients than adults. This assumption is also supported by functional improvement and by the fact that a few eyes (5) of some very young patients (<13years) showed highly remarkable improvements after surgery (higher than any adult eye).
ABSTRACT
BACKGROUND/AIMS: To study peripapillary retinal nerve fibre layer (RNFL) and macular thickness in amblyopia using high-definition spectral-domain optical coherence tomography (SD-OCT) and to compare the results with available literature using the time-domain modality. METHODS: This was a prospective institutional study of patients ≥ 6 years of age with unilateral amblyopia (strabismic or anisometropic) and non-amblyopic anisometropia. RNFL and macular thicknesses were measured using SD-OCT and compared between fellow eyes. RESULTS: The mean age was 20 (± 12) years; 45 patients had amblyopia: 14 strabismic and 31 anisometropic. 20 patients had non-amblyopic anisometropia. The mean macular thickness was significantly increased in the amblyopic (273.8 µm) vs fellow eyes (257.9 µm), p=0.001. This difference remained significant in the anisometropic group (p=0.002) but not the strabismic group. The mean RNFL thickness was similar in amblyopic (95.4 µm) and fellow eyes (94.0 µm). Similar results were obtained regardless of the level of visual acuity, age or refractive error. In the control group of non-amblyopic anisometropia, the interocular difference did not reach statistical significance. CONCLUSIONS: Central macular thickness was significantly increased in anisometropic amblyopia using SD-OCT. Anisometropia alone did not produce such a difference, which points to a possible correlation between amblyopia and the development of the retinal layers.
