Plication as an alternative to resection in horizontal strabismus: A randomized clinical trial.

PURPOSE: Resections and plications tighten recti although the latter are less traumatic, potentially reversible, quicker, and vascularity preserving. To compare inflammation, scarring, and alignment in horizontal strabismus, operated uniocularly by either resections or plications (with recessions): recession and resection (R&R) or recession and plication (R&P) groups. This was a prospective, patient and assessor blind, randomized trial. METHODS: All consenting strabismus patients qualifying for the first-time uniocular horizontal rectus surgeries underwent detailed ocular examination and were randomized into standard R&R or R&P groups. For the latter, we folded the tendon-muscle strap the desired amount using 6-0 polyglactin, suturing it to its insertion, entailing no disinsertion. We compared the groups for inflammatory grades (individually for congestion, chemosis, discharge, foreign-body sensation, and drop intolerance and aggregated to a total inflammatory score (TIS), scar visibility (SV) at 1 m, and successful alignment (≤10 prism diopter of orthotropia). We used Mann-Whitney and Fisher's exact tests, with significance at P ≤ 0.05. RESULTS: We randomized 40 patients: 22 to R&R and 18 to R&P. The groups were comparable in age, strabismus onset and duration, and strabismus amount. The inflammatory scores, both individual and TIS, were comparable at all time-points: all P > 0.05. SV proportions were not significantly different: 16/22 in R&R versus 9/18 in R&P; P = 0.19. There were no significant differences in success rates: 14/22 versus 10/18, P = 0.74. CONCLUSION: Our study shows that plication is similarly effective as resection, when combined with recession in horizontal strabismus, and should be resorted to more frequently.

Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population.

PURPOSE: Ophthalmic complications in diabetes such as retinopathy, cataract, and infections have been extensively studied. Recently, attention has been drawn toward ocular surface changes in diabetes mellitus (DM). This study has been carried out to investigate the tear film and ocular surface abnormalities in type II DM patients. MATERIALS AND METHODS: A total of 83 participants (130 eyes) were enrolled: 53 diabetics (80 eyes) and 30 healthy controls (50 eyes). Of the 53 diabetics, 24 patients (42 eyes) had some diabetic retinopathy. The tear film and ocular surface were evaluated using Schirmer test, tear film break-up time (TBUT), keratoepitheliopathy score (KES), Rose Bengal Staining (RBS) test, and conjunctival impression cytology. RESULTS: When compared with the healthy controls, diabetics showed significantly reduced Schirmer, TBUT measurements and the higher grades of KES and RBS test (P < 0.001). Impression cytology analysis showed goblet cell loss and conjunctival squamous metaplasia in diabetics. CONCLUSION: Tear film abnormality is a significant feature of diabetic ocular surface diseases. These abnormalities are likely on account of poor quality and function of tears, combined with the subnormal ocular surface. Therefore, all diabetic patients especially those with evidence of retinopathy changes should undergo routine early examination and follow-up of tear function and ocular surface parameters.

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.

Bilateral persistent hyperplastic primary vitreous: a close mimic of retinoblastoma.

Bilateral persistent hyperplastic primary vitreous (PHPV) is a rare disorder of eye. It is one of the most important differential diagnoses of retinoblastoma, hence early and accurate diagnosis is important. We here report a case of an 11-month-old child which was referred to ocular OPD with complaints of bilateral leukocoria. Examination revealed greyish-white masses posterior to both lenses, raising the clinical suspicion of retinoblastoma. Ultrasonography demonstrated echogenic masses extending from the posterior surface of the lens to the optic disc with reduced axial lengths. These masses demonstrated flow on color Doppler evaluation. CT scan revealed hyperdense masses behind the lens without any evidence of intralesional calcification. Clinical features and imaging findings point towards the diagnosis of bilateral PHPV. PHPV is a developmental disorder of the globe in which the hyaloid vasculature fails to regress normally. While unilateral PHPV is common, bilateral PHPV is a rare entity. It is one of the most important conditions mimicking retinoblastoma; hence early and accurate diagnosis is required. Ophthalmological examination is still the best way to confirm the diagnosis. However, if the diagnosis remain unclear, further evaluation using ultrasonography, Color Doppler, and CT scan is useful.