Superior oblique tuck: evaluation of surgical outcomes.

PURPOSE: To report the surgical outcomes of the superior oblique tuck procedure in the management of superior oblique palsies performed at a single centre over a 25-year period. METHODS: A retrospective study of superior oblique tuck performed as a primary and secondary procedure by a single surgeon over a 25-year period between 1992 and 2016. We evaluated patient demographics, the angle of deviation pre- and post-surgery in prism dioptres (PD), amount of muscle tuck surgery performed (mm), complications (iatrogenic Brown's Syndrome) and improvement of diplopia post-operatively. RESULTS: 162 eyes from 162 patients were identified. Gender = 108 male patients (66.67%). Mean age at the time of surgery = 45.94 years; laterality = 85 left eyes (52.47%). 110 patients (67.90%) = congenital superior oblique palsy. Mean post-op follow-up time = 7.5 months. Mean pre-operative angle of deviation = 15.88 PD (range = 4-35 PD); mean post-operative angle of deviation = 5.09 PD (range = 0-20 PD; p < 0.0001). 157 patients (96.91%) displayed a reduction in angle of deviation post-operatively. Overall mean reduction in the angle of deviation = 10.79 PD (range = 0-34 PD). Mean amount of muscle tucking = 9.75 mm (range = 3-20 mm). 24 patients (14.82%) experienced post-operative iatrogenic Brown's syndrome but only two of these required further corrective surgery. 138 patients (85.19%) experienced improvement of diplopia post-operatively. Overall, 54 patients (33.33%) required additional extraocular muscle surgery to reduce diplopia further. CONCLUSIONS: This large series of superior oblique tuck procedures performed over a 25-year period, displays excellent surgical outcomes with regards to reduction of the angle of deviation, diplopia and limited complications.

Single Injection of Bupivacaine for Correction of Strabismus.

A retrospective review of 30 patients with eso/exodeviations less than 20 prism diopters (PD) who underwent one injection of BPX into their medial/lateral rectus was carried out. Preoperative deviations were recorded in PD, using the alternate prism cover test. Postoperative angles at 1 and 3 months were measured in the same manner. 11 out of 30 patients achieved an acceptable outcome and required no further intervention. The mean angle of deviation for near in all patients reduced significantly by 3.1 PD and 2.1 PD at 1 and 3 months. The mean angle of deviation for distance in all patients also decreased significantly by 2.3 PD and 1.9 PD at 1 and 3 months. In conclusion, single injection of BPX in a heterogeneous group of patients with horizontal strabismus caused a mild improvement and a qualitative success rate of 37%.

Treatment of "heavy eye syndrome" using simple loop myopexy.

PURPOSE: To describe our results using a technique modified from that described by Yokoyama in 1991 for treating heavy eye syndrome with high myopia by restoring the normal anatomical relationship of superior rectus and lateral rectus. We perform a simple loop myopexy between superior rectus and lateral rectus without concurrent muscle splitting, medial rectus recession, or scleral fixation. METHODS: Retrospective analysis of records of all patients with heavy eye syndrome who underwent our modified simple loop myopexy procedure between 2005 and 2008. Pre- and postoperative orthoptic measurements were recorded and analyzed. Surgical complications were noted. Success was deemed patient satisfaction. RESULTS: A total of 5 patients were identified who underwent the procedure for heavy eye syndrome. All patients requested surgery for aesthetically unacceptable strabismus. The mean preoperative horizontal deviation was 13(Delta) esotropia and the mean vertical deviation was 21.8(Delta) hypotropia. The mean postoperative horizontal deviation was 0(Delta) and vertical deviation was 4.4(Delta) hypotropia. Thus there were large improvements in both the vertical (17.4(Delta)) and the horizontal deviations (13(Delta)) following surgery. There were no surgical complications. Follow-up was 6 months. All patients have aesthetically acceptable deviations and have been discharged from care. CONCLUSIONS: A simple loop myopexy can be an effective treatment in these difficult patients. We encourage a staged approach to these patients, with simple myopexy being the first line of approach.

The psychosocial aspects of strabismus: correlation between the AS-20 and DAS59 quality-of-life questionnaires.

PURPOSE: To compare two quality-of-life (QoL) scales and subscales: the Derriford Appearance Scale 59 (DAS59) and the Adult Strabismus-20 (AS-20) scale in a series of strabismic and nonstrabismic patients and to illustrate the differences in results between strabismic and nonstrabismic patients. METHODS: The DAS59 is a self-report QoL questionnaire generating an assessment of distress caused by problems of appearance. The AS-20 is a newly developed strabismus specific QoL scale. A prospective, noninterventional study of a series of consecutive adult patients undergoing strabismus surgery and a control group was performed. Patients were given both questionnaires to complete before surgery. The underlying condition, previous number of surgeries, and deviation measurements were recorded. RESULTS: Thirty-four patients and 30 controls correctly completed both questionnaires. In the strabismus group, the mean AS-20 score was 50.5. The mean DAS59 score was 122.5 (out of 269). There is strong correlation between the scales (r = -0.813; 95% CI, -0.90 to -0.66; p < 0.0001). In the control group, the AS-20 score was 98.8 and the DAS59, 84.4, with both showing significant differences to the strabismic group (t = 12.9 [p < 0.0001] and t = -4.642 [p < 0.0001], respectively). CONCLUSIONS: The AS-20 shows strong correlation to the widely used DAS59. Strabismus patients show significantly more psychosocial distress than controls. The AS-20 is specific to strabismus patients and the result is not influenced by any other systemic factors that can impinge on the more general DAS59 scale.