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Neurology and neurosurgery
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Most cases of convergent squint are due to disturbances of vision, such as hypermetropia, which require treatment with glasses or topical myotics. Aligning the squinting eye by surgery will not restore vision. The majority of patients respond to treatment with glasses, although some may require surgery for a residual squint. Retinoblastoma and congenital glaucoma cause visual disturbance which leads to convergent squint. A divergent squint has better prognosis than convergent squint. When due to esotropia it is alternating and vision is likely to develop equally in both eyes.
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.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Infantile esotropia (Fig. 7.63) develops before the age of 6 months with a large and stable angle, crossfixation (child uses right eye to look to left and vice versa as the eyes are so convergent) and normal refraction for age. Non-accommodative esotropia: esotropia after 6 months of age with normal refraction.Refractive accommodative esotropia: onset is usually between 2 and 3 years, associated with hypermetropia (long-sightedness).Non-refractive accommodative esotropia: onset after 6 months but before 3 years. No significant refractive error but excessive convergence for near (called high accommodative convergence: accommodation ratio – AC/A ratio).Sensory esotropia: due to reduction in vision, with one eye much worse than the other, which disrupts fusion – e.g. in unilateral cataract.Convergent spasm: intermittent esotropia with pseudomyopia and miosis due to accommodative spasm, which may be seen after trauma or due to a posterior fossa tumour but usually has a functional element.
Prism adaptation response and surgical outcomes of acquired nonaccommodative comitant esotropia
Published in Strabismus, 2023
Noriko Nishikawa, Yuriya Kawaguchi, Rui Fushitsu
The PAT is a test which uses a Fresnel prism lens to neutralize the deviation to determine the maximum angle of deviation (prism-adapted angle) and to estimate fusional potential. The terminology for response to prisms varies among studies; however, recent reports often referred to them separately as sensory state and angular change, i.e., responder or non-responder with or without fusion13 and prism builder or prism non-builder with or without angle increase after prism adaptation.14,15 Previous studies have shown that surgery based on the prism-adapted angle demonstrated better surgical outcomes than that based on the alternate prism cover test (APCT) angle, and prism responders showed more favorable motor and sensory outcomes than non- responders.7,8 The conventional method requires an adaptation period of several weeks wearing Fresnel prism glasses and has been applied mainly to pediatric patients with acquired esotropia, including partially accommodative esotropia. Later, a short PAT, which is a method of prism adaptation during only outpatient clinic hours, was developed and reported.16–18
Selected Ophthalmological Features in Children with Septo-Optic Dysplasia and Optic Nerve Hypoplasia
Published in Neuro-Ophthalmology, 2022
Michael S. Salman, Shakhawat Hossain, Elizabeth Carson, Chelsea A. Ruth, Ian H. Clark
Strabismus is common in patients with SOD/ONH and its prevalence varies from 13.8% to 92.5% (Table 4). It was very commonly seen in our cohort, likely reflecting the high prevalence of patients with asymmetrical bilateral and unilateral ONH, as documented previously.28 Untreated childhood manifest strabismus is a common cause of amblyopia and should therefore be identified and treated. Superimposed amblyopia may also occur secondary to anisometropia, or other refractive errors, so these should also be addressed.1,31 Both esotropia and exotropia were common, but BCVA of the worse eye on last clinic visit was more impaired in patients with esotropia. Esotropia has been reported to occur more commonly in patients with early onset visual loss;32 this would be associated with a worse visual outcome and higher risk of additional visual loss through suppression and amblyopia.
Congenital anomalies of inferior rectus and its surgical outcomes
Published in Strabismus, 2022
Jenil Sheth, Aparajita Shinde, Ramesh Kekunnaya
A 21-year-old male presented to the clinic with a constant nonprogressive upward deviation of the right eye since birth. External examination showed mild right-sided hemifacial flattening. On further evaluation, the right eye had anisometropic amblyopia due to higher with-the-rule astigmatism (Re: −2.00DC x 180 vs LE: −0.25DC x 180). Anterior and posterior segment examination was normal. Motility examination showed −2 limitation of infraduction in the right eye that worsened in abduction (Figure 3a,b). The prism bar cover test (PBCT) revealed 40 PD right hypertropia with 20 PD of esotropia. The MRI orbit showed the absence of IR in all coronal sections in the right orbit (Figure 3c). Intraoperative FDT showed that the SR was 4+ tight in the right eye. Inferior rectus and its ciliary vessels were not to be found at least 6 mm beyond its apparent insertion. Right-eye SR recession of 6 mm with IOANT to 6.5 mm posterior to limbus and 4-mm medial rectus recession were performed. At a 6-month follow-up visit, the patient had satisfactory outcomes with 10 PD of esotropia with marked improvement in motility in the right eye (Figure 3d). There were no signs of anterior segment ischemia in follow-up visits.