The Swan incision: an underutilized conjunctival approach to strabismus surgery.

BACKGROUND: The Swan incision is an easy-to-learn yet underutilized approach to strabismus surgery. We compare the Swan approach to the limbal and the fornix approaches and report the results of a survey of surgeons who had previously learned the technique. METHODS: We distributed a survey to former fellows of the senior author (NBM) to determine which approaches to strabismus surgery they have continued to use. For comparison, we also distributed our survey to other strabismus surgeons practicing in the greater New York area. RESULTS: Surgeons in both groups reported using all three approaches. However, while 60% of those trained by NBM reported still utilizing the Swan approach, only 13% of other strabismus surgeons did. Those who utilize the Swan approach report employing it for both primary and secondary cases. CONCLUSIONS: Our survey results indicate that surgeons who employ the Swan approach as described here are satisfied with the results. The Swan incision provides an effective surgical approach to the muscles in strabismus surgery.

Complication and Management of Optic Nerve Edema Resulting From Nasal Transposition of the Split Lateral Rectus Muscle.

A 9-year-old boy with partial third nerve palsy underwent medial transposition of the left lateral rectus muscle and left inferior oblique myectomy. He developed optic nerve compression, which improved after a superior oblique tenotomy. A primary superior oblique tenotomy or a maximum lateral rectus muscle split may help avoid this complication. [J Pediatr Ophthalmol Strabismus. 2021;58(3):e12-e15.].

Update on Orthokeratology in Managing Progressive Myopia in Children: Efficacy, Mechanisms, and Concerns.

Myopia is an important public health issue, and high myopia may lead to severe complications if left untreated. Orthokeratology lenses, worn overnight to reshape the cornea, are one of many recent modalities used to slow down the progression of myopia in children. This treatment has been proven successful, as evidenced by decreased spherical refractive error and axial length relative to the control at interval follow-up ranging from 6 months to 5 years. In this systematic review, the authors collected published controlled studies that analyzed the efficacy of orthokeratology lens wear and calculated longitudinal relative changes in axial length, revealing a weighted average of -45.1% change in axial length at the 2-year follow-up. The exact mechanism by which orthokeratology lenses reduce myopia progression is unknown, but research shows that the corneal reshaping decreases peripheral hyperopic defocus and therefore increases peripheral myopic defocus to likely reduce stimuli for axial elongation and subsequent development of myopia. Use of orthokeratology lenses is generally safe, but cases of associated infectious keratitis may have a higher incidence of virulent organisms such as Pseudomonas, Acanthamoeba, and antibacterial-resistant strains of Staphylococcus, partially due to the required overnight use of these lenses. Orthokeratology is regarded as one of the most effective non-pharmacologic measures to slow progression of myopia in children and, with regular follow-up to ensure safety, continues to be one of the most effective treatments for myopia management around the world. [J Pediatr Ophthalmol Strabismus. 2017;54(3):142-148.].

The Greater Metropolitan Medical Alumni Council (GMMAC): the realization of a need.

OBJECTIVE: The greater New York metropolitan area includes 8 medical schools. Their alumni association (AA) presidents formed a council 6 years ago, meeting 3 times a year to share ideas and identify best practices to solve mutual problems challenging students and alumni. METHODS: A survey of the 8 medical AAs was conducted; all responded, and the results constitute the data in this report. RESULTS: Mean AA membership was 2509 or 33% of mean alumni populations (7489). Two AAs conferred membership at graduation; hence, 100% of alumni were AA members. Omitting these 2 AAs reduced mean participation to 1722 or 23%. Alumni association support staff averaged 3.8 persons (range, 1-7 persons). The 2 most frequently cited AA challenges were membership and fund-raising. All AAs had annual or biennial reunions and considered the reunion to be a major commitment of resources. Despite this commitment, mean reunion attendance was only 242 alumni (range, 40-500 alumni) or 7.3% of alumni in anniversary years (5-year intervals). The mean number of alumni who contributed annually to their alma mater through its AA was 1936 alumni (range, 500-3500 alumni), or 26% (range, 5%-47%). Medical AAs reported mean assets of $2,755,000 (range, $6475-$11,000,000). The mean AA budget was $298,750, of which 65% (range, 13%-100%) was devoted to "medical student support". The most frequently cited student activities were "career night" (100%), "white coat ceremonies" (63%), medical equipment (stethoscopes, etc, 50%), and alumni host programs (38%). Eleven additional medical student activities received financial support from the 8 AAs in varying proportions. CONCLUSIONS: Each AA in the Greater Metropolitan Medical Alumni Council has derived significant benefit from the application of best practices to its individual problem set. In particular, a nascent AA developed significant momentum in its formation and development by its participation in the Greater Metropolitan Medical Alumni Council. Additionally, these data provide a foundation for the development of best practices within medical school AA for optimizing support of student programs and alumni participation. Stronger AAs will translate into enhanced support of educational programs for medical students. We urge formation of similar medical AA organizations in other metropolitan areas.

Strabismus in craniosynostosis.

Strabismus is common in craniosynostosis, with rates from 39% to 90.9% in Crouzon, Apert, Pfeiffer, and Saethre-Chotzen syndromes. This article reviews the epidemiology of strabismus in these disorders and discusses competing theories of the mechanism, including absent muscles, excyclorotation of muscles, and instability of muscle pulleys. The authors then review options for surgical treatment of the often complex ocular misalignment in these disorders.

Treatment of periocular capillary hemangiomas.

PURPOSE: To report the results of a survey of the members of the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) regarding the treatment of periocular capillary hemangiomas. METHODS: A survey was delivered to the 600 members of AAPOS. Surveys were returned via facsimile. Results were collected in a computerized spreadsheet and then tabulated and analyzed. RESULTS: Of the 600 AAPOS members, 225 responded to the survey. The results showed that intralesional steroid injection is the most commonly used treatment modality for periorbital capillary hemangiomas. Oral steroids and excision were also commonly used in the treatment of these lesions. CONCLUSIONS: Further controlled studies are needed to determine which treatment modality offers the most benefit and least risk. More standardization based on these studies is necessary to improve treatment of periocular capillary hemangiomas.