Effect of monocular fixation in binocular field (MFBF) on amblyopia - a pilot study comparing it with patching.

54 children with anisometropic amblyopia of ages 4-15 years were included in the study - 24 children in the patching and 30 children in the MFBF group. The study ran for a period of 6 months with BCVA assessed at each visit of follow up.In the patching group, visual acuity (VA) gain was 0.37 ± 0.26 log Mar over the course of 6 months with continuous improvement in vision across the three time points (0.20 log mar in the first month, 0.11 log Mar from month1 to 3 and 0.06 log Mar from months 3 to 6).In the Amb I Net group, visual acuity gain was 0.54 ± 0.38 log Mar over the same course of time. A continuous improvement in vision was also noted, with gains of 0.16 in the first month, 0.19 from month 1 to 3 and 0.19 from month 3 to 6. The difference in log Mar gains in VA was not statistically significant between the treatment arms and the final VA was similar (0.25 log Mar for patching and 0.18 log Mar for Amb I net). However, clinically the patching group showed 3 log MAR lines, whereas the MFBF group showed 5 log MAR lines of vision improvement at the end of therapy.MFBF was not superior to patching as far as efficacy is concerned in anisometropic amblyopia. However, the combination of more game options to sustain interest, a shorter duration of therapy over the course of a week and software directed compliance monitoring system favors the Amb I Net system from both patient and parental perspective. Amb I Net also negated discomfort, social stigma, and parental monitoring needed with patching regimens. It can be considered as a good alternative to patching in reluctant/non - compliant children with anisometropic amblyopia. This is the first large cohort study based on this therapy.

Modified Faden operation -A new surgical technique.

Faden operation was first described in 1912. It weakens the muscle in its field of action without much slackening and alteration in the primary position. When combined with recession the weakening effect is more. It is a useful surgery in esotropia with high accommodative convergence, nystagmus blockage syndrome, dissociated vertical deviation, Duane's retraction syndrome with up or downshoots, and in sixth nerve paresis, where it is performed on the contralateral normal yoke muscle to increase the field of binocular vision. The conventional procedure is cumbersome due to small working space, entanglement of sutures, and posterior location of Faden site which is not easily accessible. We have modified the Faden operation by using a single 5-0 double-armed polyester suture, which is much easier and simpler to perform, and have done it in a series of small angle esotropias combined with recession. This paper demonstrates the surgical technique so that this surgery can be performed with ease by more surgeons.

Combined lateral rectus augmented transposition and inferior rectus recession for monocular elevation deficiency.

We report the case of a 21-year-old woman who presented with a drooping right upper eyelid and smaller-appearing right eye, evident since birth. Her visual acuity was 20/30 in the right eye and 20/20 in the left eye. In primary gaze she had a hypotropia of 25Δ, with a marked elevation limitation and associated true upper lid ptosis of 3 mm. Under local anesthesia, the lateral rectus muscle was transposed to the superior rectus muscle and was augmented by a nonabsorbable suture attaching the superior rectus muscle and lateral rectus muscle 8 mm posterior to the insertion, accompanied by an inferior rectus recession. One year after surgery she was orthophoric in primary position and showed improvement in elevation. The surgical procedure can be performed at the same time as the inferior rectus recession and reduces the risk of anterior segment ischemia.