Duane Retraction Syndrome: The Role of Botulinum Toxin A Injection in Adults and Its Impact on Quality of Life in an Indian Population.

PURPOSE: To evaluate the role of botulinum toxin A in the treatment of adults with Duane retraction syndrome and its impact on quality of life. METHODS: A total of 25 adults with unilateral Duane retraction syndrome were selected for this interventional case series. Botulinum toxin was injected in the appropriate horizontal recti. The parameters assessed were ocular deviation (▵), overshoots, and abnormal head posture. Patients were followed up at 1 day, 10 days, and 3 months after the injection. The outcome was categorized on the basis of deviation/abnormal head posture/overshoots as: (1) significant improvement (< 8 prism diopters [PD]/< 5 degrees/≤ grade 1); (2) partial improvement (8 to 20 PD/5 to 15 degrees/≤ grade 2); and (3) no improvement (> 20 PD/> 15 degrees/≥ grade 3). Patients with partial/significant improvement were considered to have a favorable outcome. The impact on quality of life was assessed using the Adult Strabismus-20 Questionnaire scores 10 days after injection. RESULTS: There was a significant reduction in ocular deviation in esotropic and exotropic Duane retraction syndrome at 10 days (P = .001) and 3 months (P = .04) after botulinum toxin injection. The abnormal head posture improved from 11.58 ± 7.43 to 7.86 ± 6.25 degrees at 10 days. Botulinum toxin had a positive impact on the Adult Strabismus-20 Questionnaire scores, which significantly improved (P < .05) at 10 days. A favorable outcome was noted in 21 patients at 10 days but only 4 patients at 3 months. Three patients developed ptosis and 1 patient with orthotropic Duane retraction syndrome developed transient exotropia. CONCLUSIONS: In adults with Duane retraction syndrome, botulinum toxin can have a useful diagnostic role by providing insight to patients and setting realistic expectations. It can identify patients likely to benefit from further treatment and also has a positive impact on quality of life. [J Pediatr Ophthalmol Strabismus. 2023;60(1):46-51.].

Comparative Study of Bilateral Versus Unilateral Strabismus Surgery in the Management of Lateral Incomitance in Intermittent Exotropia.

PURPOSE: To evaluate and compare bilateral asymmetric lateral rectus recession versus unilateral resection-recession surgery in the management of lateral incomitance in intermittent exotropia. METHODS: A prospective randomized interventional comparative study was conducted consisting of 80 patients with intermittent exotropia (older than 7 years) having significant lateral incomitance. They were equally divided into two groups by a sealed envelope system. The bilateral group underwent bilateral asymmetric lateral rectus recession and the unilateral group underwent unilateral lateral rectus recession and medial rectus resection based on post-patch deviation. Parameters assessed were change in horizontal deviation, change in lateral incomitance, binocularity, motility limitation, and complications, if any. Surgical outcome was considered successful if the primary deviation was within ±8 prism diopters (PD) and lateral incomitance was less than 5 PD. RESULTS: The mean lateral incomitance preoperatively and postoperatively was 8.3 ± 1.6 and 2.8 ± 2.4 PD in the bilateral group and 8.9 ± 1.4 and 3.7 ± 2.5 PD in the unilateral group, respectively. There was no statistically significant difference in the postoperative lateral incomitance between the two groups (P = .25), but a statistically significant difference was observed between preoperative and postoperative lateral incomitance in each group (P < .0001). CONCLUSIONS: Both procedures are equally efficacious in achieving acceptable ocular alignment and improving significant lateral incomitance in patients with intermittent exotropia with deviations between 15 and 35 PD without causing significant motility limitation. [J Pediatr Ophthalmol Strabismus. 2023;60(4):277-281.].

Tolosa-Hunt Syndrome: A Review of Diagnostic Criteria and Unresolved Issues.

PURPOSE: To review the diagnostic criteria for Tolosa-Hunt syndrome (THS) and utility of recent modifications. METHODS: We searched PubMed for keywords Tolosa Hunt and magnetic resonance imaging. We compared the three editions of International Classification of Headache Disorders and isolated case reports and case series with the assessment of cavernous internal carotid artery (ICA) caliber to find the prevalence of vascular anomalies. We also evaluated cases of THS with the involvement of extracavernous structures and the possible role of idiopathic hypertrophic pachymeningitis (HP). Cases diagnosed falsely as THS were also reviewed for the presence of atypical features and relevance of criterion D. We assessed nonconforming cases (those with normal neuroimaging benign THS) and idiopathic inflammatory orbital pseudotumor (IIPO). RESULTS: Vascular abnormalities were found in 36.36% of THS cases. Benign THS may also show changes in ICA caliber. Evidence suggestive of idiopathic HP could be found in 57% of cases with the involvement of extracavernous structures, such as facial nerve and pituitary gland. Both THS and IIPO are steroid-responsive pathologies with similar clinical and radiological features. False-positive diagnosis of THS results from early labeling, based solely on clinical features and symptom resolution after steroid therapy. CONCLUSIONS: Benign THS may be a result of limitation of resolution of available neuroimaging technique or early testing. Early and late vascular changes can be seen in both THS and its benign variant; some of them are not innocuous. THS may be considered a type of focal idiopathic HP. IIPO may represent an anterior variant of THS. In the absence of histopathological diagnosis, steroid-induced resolution of symptoms should be confirmed radiologically and followed-up.

Surgical outcomes of plication versus resection in basic type of intermittent exotropia.

OBJECTIVES: To compare the surgical outcomes of plication versus resection in basic type of intermittent exotropia. DESIGN: Prospective interventional study. PARTICIPANTS: 60 patients above 6 years of age with diagnosis of basic type of intermittent exotropia. METHODS: A randomized study was conducted in 60 patients above 6 years of age with diagnosis of basic type of intermittent exotropia. They were equally divided in two groups by computer generated random number table. Group A underwent recession and plication (RP) and group B underwent recession and resection (RR) based on post patch deviation with constant 8 mm lateral rectus recession in both groups. Parameters assessed were postoperative alignment, cosmetic outcome, improvement in binocularity & stereoacuity and dose effect. Successful outcome was defined as post patch deviation ≤ 10 Prism diopters (PD) of exophoria/exotropia to < 5 PD of esophoria/esotropia at 12 months follow up. RESULTS: The mean preoperative and postoperative deviation was 44.67 ± 4.5 PD and 10.13 ± 3.6 PD respectively in group A and 43.17 ± 4.8 PD and 9.40 ± 3.3 PD respectively in group B (p = 0.423). The exodrift at 12 months follow up was 4.4 ± 2.8 PD in group A and 4.67 ± 3.29 PD in group B. There was statistically no significant difference in outcomes between the two groups. Mean effect of MR plication at last follow up was 5.91 PD/mm and MR resection was 5.5 PD/mm (p = 0.877). CONCLUSION: Both procedures achieved acceptable ocular alignment and had a comparable dose effect. Plication has certain added advantages over resection hence may be preferred as an alternate tightening procedure.

Effects of correlations and temperature on the electronic structures and related physical properties of FeSi and CoSi: a comprehensive study.

Here, we report detailed investigations of the temperature dependent (100-800 K) electronic structures of FeSi and CoSi by using a DFT+DMFT method where self-consistently calculated values of U and J are used. The calculated spectral functions are found to provide fairly good representation for the experimentally observed photoemission spectra for both the compounds. For FeSi, the density of states (DOS) closer to the Fermi level are found to increase with the increase in temperature up to 450 K and then they decrease, whereas, for CoSi DOS continuously decrease with an increase in temperature. The electronic states of FeSi are greatly influenced by electronic correlations while they are moderately influenced in CoSi. From momentum resolved spectral functions, the excitations have shown enhanced broadening with temperature rise in FeSi whereas an opposite behavior is observed in CoSi. In FeSi, the maximum effect of temperature on the lifetime of [Formula: see text] quasiparticles states is observed where it first decreases to 400 K and then increases, and finally becomes almost infinite at 800 K. The temperature dependent behavior of DOS and quasiparticle lifetime help us in understanding the experimentally observed electrical resistivity and Seebeck coefficient for these compounds. The calculated effective magnetic moment [Formula: see text] for Fe (∼2.5 [Formula: see text], which is closer to the experimental value) is temperature independent. The electronic structures of these compounds are showing the existence of mixed configurations with [Formula: see text] and [Formula: see text] for FeSi and CoSi, respectively. Average electrons in the d orbitals are found as ∼6.5 and ∼7.7 for FeSi and CoSi, respectively, with charge fluctuations [Formula: see text] 0.9 are obtained for both materials. This suggests that both the compounds are lying in the intermediate coupling regime of electronic correlations.

A case of atypical ophthalmoplegia after Chikungunya fever.

PURPOSE: This study aims to report an unusual case of bilateral diffuse ophthalmoplegia with levator sparing, in a patient after an episode of Chikungunya fever. METHODS: Case report of a five-year-old girl with inability to move both eyes along with decreased near vision. RESULT AND CONCLUSION: Bilateral external ophthalmoplegia has been described as a part of the spectrum of ocular manifestations of this arbovirus-associated fever. This is the first report of its kind in a pediatric patient. In addition, there was evidence of internal ophthalmoplegia as well. Recognition of this rare clinical presentation can help avoid misdiagnosis as Guillain-Barré syndrome or its ocular variant, namely Miller Fisher Syndrome.

Aniridic Glaucoma: Long-term Visual Outcomes and Phenotypic Associations.

PURPOSE: The aim of this study was to evaluate long-term visual outcomes in patients with aniridic glaucoma. DESIGN: Retrospective noncomparative observational case series. MATERIALS AND METHODS: A review of medical records of 128 eyes of 64 consecutive patients with aniridic glaucoma, diagnosed after the age of 5 years was analyzed. The parameters studied included age at presentation, family history, baseline intraocular pressure (IOP), type and the number of surgical interventions, and associated comorbidities. PRIMARY OUTCOME MEASURE: Best corrected visual acuity (BCVA) in the better eye. RESULTS: Mean age at presentation was 15.86±10.11 years (range, 5 to 47 y). The average follow-up was 7.69±4.98 years (range, 1 to 17 y). At the final follow up only 18 patients had BCVA better than 6\60 and only 5 patients had BCVA of >6/18. Seventeen of the 64 (26.5%) patients developed phthisis in 1 eye. The final visual outcomes were not associated with age at presentation (P=0.64) or sex (P=0.76); however, those with a higher baseline IOP (P=0.017), those with familial aniridia (P=0.037), and those who underwent more number of surgical interventions had poorer visual outcomes (P=0.004). Kaplan-Meier analysis demonstrated the probability of bilateral blindness to be 69.8% and 97.6% at 5 and 10 years, respectively. CONCLUSIONS: Long-term visual outcomes after therapy among aniridic glaucoma patients remain poor. Higher baseline IOP, the presence of familial aniridia, and a history of greater number of surgical interventions are associated with poorer long-term visual outcomes.

Clearance of cervical human papillomavirus infection by topical application of curcumin and curcumin containing polyherbal cream: a phase II randomized controlled study.

Curcumin and curcumin containing polyherbal preparations have demonstrated anti-microbial and anti- viral properties in pre-clinical studies. Till date no therapeutic intervention has been proved to be effective and safe in clearing established cervical human papillomavirus (HPV) infection. The present study evaluated the efficacy of Basant polyherbal vaginal cream (containing extracts of curcumin, reetha, amla and aloe vera) and of curcumin vaginal capsules to eliminate HPV infection from cervix. Women were screened by Pap smear and HPV DNA test by PCR. HPV positive women without high grade cervical neoplasias (N=287) were randomized to four intervention arms to be treated with vaginal Basant cream, vaginal placebo cream, curcumin vaginal capsules and placebo vaginal capsules respectively. All subjects were instructed to use one application of the assigned formulation daily for 30 consecutive days except during menstruation and recalled within seven days of the last application for repeat HPV test, cytology and colposcopy. HPV clearance rate in Basant arm (87.7%) was significantly higher than the combined placebo arms (73.3%). Curcumin caused higher rate of clearance (81.3%) than placebo though the difference was not statistically significant. Vaginal irritation and itching, mostly mild to moderate, was significantly higher after Basant application. No serious adverse events were noted.

Effect of glaucoma on the quality of life of young patients.

PURPOSE: To evaluate the quality of life (QOL) of juvenile-onset primary open-angle glaucoma (JOAG) patients by using a utility-based assessment. METHODS: QOL using time-tradeoff utility values was analyzed in 70 JOAG patients and compared with 108 adult-onset POAG patients. The relationships of utility values to parameters like age at diagnosis, visual acuity, mean deviation, number of medications and surgery, duration of the disease, level of education, and socioeconomic status were assessed. RESULTS: The mean age at diagnosis of JOAG patients was 26 ± 9.8 years, whereas that of the adult onset POAG patients was 62 ± 11.2 years. Overall, there was a decrease in utility values with increasing age (r = -0.3; P < 0.001). The mean utility score among JOAG patients was (0.80 ± 0.18) significantly greater than among adult POAG patients (0.64 ± 0.28; P < 0.001). The differences in utility scores between JOAG and adult POAG patients were significant when adjusted for differences in better eye visual acuity, mean deviation, and the presence of systemic comorbidity among adults (P = 0.02). Among JOAG patients, those needing topical antiglaucoma medications and those with visual acuity worse than 6/12 in the better eye had lower utility values (P = 0.008 and P = 0.002, respectively). CONCLUSIONS: Utility values among glaucoma patients in the juvenile age group are better than those of adult POAG patients. Decreasing vision in the better eye and having to use medication decrease the utility scores among young patients with glaucoma.

Bilateral lens subluxation in a case of lipoid proteinosis.

We report a patient who presented with pain, redness, and diminution of vision in the right eye and low vision in the left eye. Ophthalmologic examination showed characteristic eyelid lesions, anterior dislocation of the crystalline lens in the right eye, and nasal subluxation in the left eye. The patient's voice was hoarse, and he had skin lesions. After histopathologic examination of the skin biopsy, lipoid proteinosis (LP) was diagnosed. Bilateral pars plana lensectomy was performed. The ophthalmic manifestations of LP are discussed.

Automated vitrector-assisted optical iridectomy: customized iridectomy.

An automated vitrector was used to create an optical iridectomy in 15 eyes of 15 patients with leucomatous corneal opacities. The optical iridectomy was performed successfully through a standard 1.2 mm incision in all eyes. No intraoperative complications were observed, and there was no case of iatrogenic cataract formation. The median best corrected visual acuity improved from 1/60 (range light perception to 6/60) preoperatively to 6/24 (range 6/60 to 6/12) at the last follow-up (mean 28 days). An automated vitrector can be successfully used to create an optical iridectomy in eyes with leucomatous corneal opacities. This technique was safe and could be performed through a small surgical incision.