Effect of bimedial recession on near-distance disparity in esotropia.

BACKGROUND: Esotropia may be associated with a difference in the deviation at near and distance fixation termed near-distance disparity (NDD). Convention suggests patients with NDD may benefit more from bilateral medial rectus recessions (BMR) as opposed to a unilateral recession/resection (RR). The aim of this study is to establish the effect of BMR for the treatment of esotropia on both the near and distance deviation and NDD. METHODS: Retrospective patient records search from 2011 to 2021. INCLUSION CRITERIA: comitant esotropia, first surgery, equal and normal vision with free alternation. EXCLUSION CRITERIA: incomitant, neurological or restrictive strabismus, previous surgery, clinically significant amblyopia. RESULTS: 49 patients met the inclusion criteria. 19 patients were female; the average age was 17 years. Following surgery, the average near deviation reduced from 39PD base out (BO) to 11PD BO. The average distance deviation reduced from 33PD to 9PD. Average preoperative NDD was 12 PD. NDD resolved in 15 out of 18 patients with NDD (83%). The average PD gain per mm of recession was 2.7 for near and 2.2 for distance. CONCLUSIONS: BMR is an effective surgical treatment for esotropia and has a greater effect on near deviation than distance. It is also an effective and simple technique for lesser degrees of NDD. BMR has several advantages over RR: no tissue loss, readily reversible, the scars are easier to hide and it avoids potential motility limitations due to leash effects following resection.

Anisocoria in an intubated patient with COVID-19.

The effects of COVID-19 on the eye are still widely unknown. We describe a case of a patient who was intubated and proned in the intensive care unit (ICU) for COVID-19 and developed unilateral anisocoria. CT venogram excluded a cavernous sinus thrombosis. MRI of the head showed microhaemorrhages in the midbrain where the pupil reflex nuclei are located. After the patient was stepped down from ICU, intraocular pressure (IOP) was found to be raised in that eye. A diagnosis of subacute closed angle glaucoma was made. It is important for clinicians to rule out thrombotic causes in patients who develop acute anisocoria. It is also crucial to measure IOP in patients who develop ophthalmic pathology and have been proned for extended periods.

Visual loss from dermal fillers.

BACKGROUND: An increasing number of people are undergoing non-surgical aesthetic procedures, especially injections of botulinum toxin and dermal fillers. While toxin injections have lower rates of complications, profound and serious consequences can arise with the use of dermal fillers. CASE: A 29-year-old woman presented to the eye casualty department with sudden visual loss, ptosis and ophthalmoplegia after having had non-surgical rhinoplasty in a beauty salon in West London. The filler was administered by a healthcare professional not registered with the General Medical Council (GMC) or similar governing body. DISCUSSION: Despite prompt measures on arrival at our service, the symptoms of visual loss, ptosis and ophthalmoplegia persisted. Attempts from the patient and medical services to report the incident (to trading standards and the police) were to no avail. CONCLUSION: This case highlights the poor treatment response to filler-related ophthalmic complications. It is also evident that in the United Kingdom, there appears to be poor regulation in the use of these products, a lack of clear guidelines for the management of their complications and finally no recourse for patients to challenge practitioners who lack medical registration and are not held accountable.

COVID-19: The Role of the Ophthalmologist in ICU.

Coronavirus disease 2019 (COVID-19) pandemic has had a devastating impact on patient lives. COVID-19 impacts the respiratory system and this leads to acute respiratory distress syndrome (ARDS), which increases the likelihood of intensive care unit (ICU) admission. Patients admitted to ICU are at increased risk of developing ophthalmological complications due to the systemic effects of COVID-19 along with the side effects of the mechanical ventilators and the regular proning that patients are exposed to. This article presents an overview of sight-impairing ophthalmic conditions seen in COVID-19 patients admitted to ICU admissions. The article provides a brief commentary on the clinical signs and examinations that intensive care nurses and doctors have to be vigilant of before escalating the patient care to the Ophthalmic team.

Eye injuries in children - incidence and outcomes: An observational study at a dedicated children's eye casualty.

PURPOSE: Trauma is an important cause of visual loss in children and may affect their quality of life. Prevention and legislation can reduce the incidence of trauma, and appropriate and timely treatment can improve prognosis. We aimed to describe incidence of eye injuries in children and the adherence to national and local management guidelines. METHODS: Retrospective service evaluation at a tertiary hospital (Moorfields Eye Hospital, London, UK) which operates a dedicated children's eye casualty. The electronic patient administration system and electronic patient record system (Openeyes) were used to identify children who presented with eye injuries between January 2015 and December 2015. RESULTS: Of 2397 first-time attendances to our children's casualty, 508 were for injuries (estimated incidence 21.1%, 95% confidence interval: 19.5%-22.7%). Mean age at presentation was 7.51 (standard deviation: 7.97) years; boys were more commonly affected than girls (69%). The most common injury was corneal abrasion, followed by blunt and chemical injury; severe injuries such as penetrating trauma were rare. Injuries were sustained mostly during play or sports. Two children sustained permanent loss of vision in the affected eye. CONCLUSION: Our findings are comparable to other published reports. Adherence to management guidelines is high, but documentation of advice given to families can be improved. Regular training of staff and collaboration with organisations outside the hospital can increase awareness of eye injuries in children.

Fornix-based incision for strabismus surgery: the Parks technique revisited.

The authors revisit the fornix incision for strabismus surgery. This technique, first developed by Parks in 1968, has key advantages over the limbal incision and ought to be used and taught more commonly. A modified version of this approach is described, illustrated with a demonstration video.

Nonlinear coupling in the human motor system.

The synchronous discharge of neuronal assemblies is thought to facilitate communication between areas within distributed networks in the human brain. This oscillatory activity is especially interesting, given the pathological modulation of specific frequencies in diseases affecting the motor system. Many studies investigating oscillatory activity have focused on same frequency, or linear, coupling between areas of a network. In this study, our aim was to establish a functional architecture in the human motor system responsible for induced responses as measured in normal subjects with magnetoencephalography. Specifically, we looked for evidence for additional nonlinear (between-frequency) coupling among neuronal sources and, in particular, whether nonlinearities were found predominantly in connections within areas (intrinsic), between areas (extrinsic) or both. We modeled the event-related modulation of spectral responses during a simple hand-grip using dynamic casual modeling. We compared models with and without nonlinear connections under conditions of symmetric and asymmetric interhemispheric connectivity. Bayesian model comparison suggested that the task-dependent motor network was asymmetric during right hand movements. Furthermore, it revealed very strong evidence for nonlinear coupling between sources in this distributed network, but interactions among frequencies within a source appeared linear in nature. Our results provide empirical evidence for nonlinear coupling among distributed neuronal sources in the motor system and that these play an important role in modulating spectral responses under normal conditions.