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Binocular vision problems after refractive surgery
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
D.J.M. Godts, M.J. Tassignon, L. Gobin
The third patient is a 40-year-old woman complaining of intermittent diplopia after LASIK for hyperopia of her left eye. She reported a history of intermittent esotropia since childhood. Postoperative best-corrected visual acuity was 20/20 in the right eye with +1.50 and 20/63 in the left eye with +1.25 (−3.50 × 150°) in the left eye. With the prism cover test, performed with glasses, an esotropia of 18 PD was found at near vision and of 10 PD at distance vision. Without glasses the esodeviation increased up to 25 PD at near and to 18 PD at distance. The diagnosis of partial accommodative esotropia was made. Ocular motility showed a V pattern with over action of the left inferior oblique muscle. The objective angle of strabismus was +7° and the subjective angle was -1° measured with the Synoptophore. These results are suggestive for an abnormal retinal correspondence with peripheral fusion on the subjective angle of strabismus. Suppression of the left eye was present in free space. Accommodation measured with the RAF test was 5D in both eyes, which is low but acceptable considering patient’s age. Fundus examination showed an extreme extorsion of both maculae. Bielschowsky head-tilt-test was negative.
A Rare Case of Bilateral Incomplete Duane’s Syndrome with Synkinesis of the Levator and Lateral Rectus
Published in Neuro-Ophthalmology, 2022
Sühan Tomaç, Enes Uyar, Erdogan Yasar
In primary gaze, the upper eyelids were in the normal position. Ocular motility examination revealed orthotropia in the primary position at both near and distance by the cover test. Only a slight intermittent exohypertropia was observed in upgaze. No limitation on ocular movements was noted, but an upshoot of the left eye was observed in adduction. Bilateral globe retraction with narrowing of the palpebral fissure was observed in adduction – see Figure 1a, b. Bilateral eyelid retraction occurred with abduction and infra-abduction. Complete ptosis was observed occasionally in adduction – see Figure 1c, d, while complete ptosis was always present in infra-adduction bilaterally. The findings were more apparent in the left eye. The Bielschowsky head tilt test was negative, and no extorsion or intorsion in each eye was observed. Her intra-ocular pressures, as measured in the sitting position using a Tono-pen-AVIA (Reichert Technologies, USA), of the right and left eyes were 15 and 14 mmHg, respectively, in primary position, whereas they were 20 and 18 mmHg, respectively, on full adduction.
Strabismus patterns after cataract surgery in adults
Published in Strabismus, 2021
Mirjam Johanna Rossel-Zemkouo, Richard Bergholz, Daniel J Salchow
This retrospective chart review at the Department of Ophthalmology of the Charité – Universitätsmedizin Berlin included 40 consecutive patients who presented between December 2014 and July 2016 with binocular diplopia noted within 1 week after uncomplicated cataract surgery. Data collected included refractive error, best corrected visual acuity (BCVA), slitlamp biomicroscopy, dilated funduscopy, and binocular function (stereopsis, Bagolini striated glasses). Ocular alignment (cover test and alternate cover and prism test at 5 m and 33 cm) and ocular motility were noted. Bielschowsky head-tilt test, and, if available, results of the Harms tangent screen were evaluated. The patient's medical history was reviewed for previous or concurrent ophthalmologic, systemic, and neurological disorders. Details on the type of anesthesia and complications during the cataract surgery were gathered from the operative report or by telephone consultation with the surgeon or, if not available, by history from the patient.
The efficacy of superior rectus recession with simultaneous inferior oblique disinsertion on superior oblique palsy with superior rectus contracture
Published in Strabismus, 2019
Seyhan B. Özkan, Ayse Ipek Akyuz Unsal, Derya Buran Kagnici
The retrospective review of the patients who were operated for SOP revealed that the percentage of SR recession was 11.03% (95% CI 6.4–17.3) (16 patients). In the overall group of patients with SOP, the percentage of presumed congenitals and acquired ones were 68.75% and 31.25%, respectively. Among the patients who were operated for SOP, the results of 15 patients (10.34%, 95% CI 5.9–16.4) with SR overaction/contracture syndrome were evaluated excluding the one with adherence syndrome.25 The etiology of SOP with SR contracture was presumed congenital in 12 cases (80%, 95% CI 51.9–95.6) and posttraumatic in 3 cases (20%, 95% CI 4.3–48.1). The pre- and postoperative findings are listed in detail in Tables 1 and 2. Preoperative diplopia was observed in five cases (33.33%, 95% CI 11.8–61.6) which was torsional in one bilateral case and vertical in four cases. Preoperative abnormal head posture was observed in 12 cases (80%, 95% CI 51.9–95.6). The Bielschowsky head-tilt test was positive in 14 patients with an average of 16.07 ± 7.68 PD difference between 2 sides. In the affected eye, mean IO overaction was 1.87 ± 1.13 (0–3), the mean SO underaction was 1.53 ± 1.13 (0–4), and IR underaction was 1.0 ± 1.07 (0–4). The mean pseudo SO overaction was 0.27 ± 0.46 in the contralateral eye. The preoperative mean vertical deviation in primary position was 23.0 ± 5.03 PD (16–35 PD). The mean vertical deviation was 14.47 ± 8.06 PD (0–25 PD) and 18.47 ± 8.98 PD (3–35 PD) on upgaze and downgaze, respectively. The vertical deviation in the field of IO was 21.87 ± 9.22 PD (9–37 PD). In forced duction test, mild SO tendon laxity was found in 6 cases and tight SR was found in 15 cases. In the patient group, forced duction test for SR contracture was found positive in all cases with clinically suspected SR contracture. SR recession (3–6.5 mm) with a mean value of 4.86 ± 1.18 mm was performed on adjustable sutures in 12 adult patients. The amount of the recessions was increased 1–2 mm on adjustment in four patients (case 2, 3, 6, and 15) and only one of them was overcorrected (case 15). The amount of the recessions was not so accurate because of the postoperative adjustment procedure in bow-tie technique. In 12 patients (80%), postoperative mean vertical deviation in primary position was 1.41 ± 1.88 (0–4 PD) (p = 0.005). The final mean vertical deviation for all patients including both successful and unsuccessful ones is −3.0 ± 4.3 PD (0–16). The mean vertical deviation for unsuccessful cases is 9.33 ± 5.77 PD. Table 2 lists the results for first day, first week, first month, and third month for all of the patients. Cases 1, 6, and 8 were found to have associated exodeviations ranging between 16 and 20 PD and all resolved after adjustable LR recession.