Design and Efficacy of Surgery for Horizontal Idiopathic Nystagmus with Abnormal Head Posture and Strabismus

The design and efficacy of surgery for horizontal idiopathic nystagmus （HIN） with abnormal head posture and strabismus were investigated. Different surgical procedures were selected according to the angle of head turn in 44 cases of HIN with abnormal head posture and strabismus. For patients with a head turn of 15° or less, the Anderson procedure was used; the yoke muscles were recessed upon slow-phase. For patients with a head turn between 15° and 25°, the surgery was designed as a Kestenbaum 5-4-4-5 procedure. For patients with a head turn of 25° or more, the surgery was designed as a Parks 5-8-6-7 procedure. The surgery to correct the abnormal head posture was performed on the fixating eye while that to correct the deviation was then performed on the non-fixating eye at the same time. The amount of surgery of the horizontal rectus muscles on the nonfixating eye was sum of the angle of head turn and the degree of deviation, which was calculated as follows： recession/resection amount of medial and lateral rectis/2×5=angle of head turn±degree of deviation. The results showed as follows： （1） Visual acuity： the visual acuity in the primary ocular position increased two lines or more in 35 patients, accounting for 79.55%. Nine patients had no or only one-line improvement, accounting for 20.45% of the entire study population; （2） The degree of deviation in the primary ocular position： 37 cases had a normal primary ocular position or the degree of deviation ≤8△ after surgery, accounting for 84.09%. Six patients had a residual degree of deviation of 8△―15△, accounting for 13.64%. One patient had a residual degree of deviation 〉20△, accounting for 2.27% of the patients examined; （3） Abnormal head posture： 34 patients had a normal head posture or a head turn of less than 5°, accounting for 72.27%. Eight patients had a residual head turn of 5°―15°, accounting for 18.18%. Two patients had a head turn of 15°― 25°, accounting for 4.55%. It was concluded that different surgical procedures based on the angle of head turn and the relationship between deviation and null zone can eliminate anomalous head posture, correct deviation, and improve vision acuity in the primary ocular position simultaneously.

Retinal vessels caliber changes after strabismus surgery：results of 6mo follow-up

AIM：To evaluate the effect of strabismus surgery on retinal vessels calibers with digital color fundus photographs.METHODS：Two hundred consecutive strabismus patients underwent surgery,and 118 patients（female/male,55/63） who finished 6-month follow-up were finally included in this study.Optic disc-centered digital color fundus photographs of both eyes of all patients were taken prior to surgery and 6mo post surgery.The retinal vascular caliber of 116 operated eyes were measured using the computer program IVAN.The operated eyes were divided into 3 groups according to the surgical methods,recession of one muscle,one muscle recession and one muscle folding,one muscle resection and one muscle recession.The effect of number of altered muscles on retinal vessels was analyzed using statistic software SPSS 16.0.RESULTS：The mean age was 12.4±8.6y.Averaged central retinal artery equivalent（CRAE） of all patients was 120.31 ±23.02 μm preoperatively,and 122.87 ±15.93 μm six months after surgery.Averaged central retinal vein equivalent（CRVE） was 171.11 ±31.73 μm preoperatively and175.02±21.00 μm postoperatively.There was no significant difference of averaged CRAE（P=0.22） or CRVE（P=0.19）before and after operation.Averaged arteriole to venule ratio（AVR） was 0.71 ±0.07 before surgery and 0.70±0.07 after surgery.Comparison of preoperative and postoperative retinal vessels calibers among different surgical groups did not show significant differences.Also,there was no advantage of rectus muscle folding to muscle resection.CONCLUSION：Up to 6mo after strabismus surgery,the retinal vascular calibers were not altered.No more than two muscles in one surgery are safe for retinal perfusion.

Retinal vascular diameter changes assessed with a computer-assisted software after strabismus surgery

AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus surger y were enrolled prospectively. Retinal vessel diameters on color fundus photographs were assessed before and 1, 7 d, 6 mo after surgery, using a computerassisted quantitative assessment software. To evaluate the retinal vascular caliber changes, retinal vascular diameters were calculated by means of the Parr–Hubbard formula as the central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE). The arteriovenous ratio(AVR) was calculated as CRAE divided by CRVE. RESULTS: A total of 154 eyes of 104 consecutive patients were included. Compared with the data before surgery(121.55±24.67), the mean CRAE(131.18±28.29) significantly increased 1 d af ter surger y(P=0.003), but went back to baseline level at 7 d(118.89±30.35, P=0.15), and 6 mo(123.22±15.32, P=0.60), so did the AVR(P<0.001, P=0.08, P=0.07). As for the mean CRVE, there was no significant difference between those four time points(172.43±33.25, 175.57±36.98, 174.03±40.18, 174.86±20.46, P=1.00). CONCLUSION: Strabismus surgery on both lateral and media rectus muscles, or single media rectus muscle may increase retinal blood flow during the early postoperative period, but would return to normal later. The number of transected anterior ciliary arteries rather might be the main cause of retinal hemodynamic changes early after strabismus surgery.

Long-term chorioretinal changes following strabismus surgery——possible occult needle penetration

Dear Editor,cleral penetration during strabismus surgery was k3 first reported over 50 years ago[1].Early manuscripts reported the incidence of this complication around 10%[1].However,more recent studies suggest that this rate may have decreased[2-3].

Reliability of a computerized system for strabismus screening

AIM:To evaluate the reliability of Photo-Hirschberg screening for global strabismus performed by non-specialized personnel.METHODS:Participants at three sites were enrolled.One person at each site was trained in visual acuity measurement and use of the computerized system.Visual acuity was measured,and strabismus testing was performed using two flash photographs.All data from the three primary observers were sent to an experienced assistant researcher,who was blinded to the primary results,for re-evaluation.The primary and re-evaluation results of the Photo-Hirschberg screenings using weighted kappa for agreement were compared.RESULTS:The study included 181 participants(88 males and 93 females)and the results for primary and re-evaluation screenings were corresponded.Ten participants with contrasting results presented with unclear corneal light reflex.Sensitivity and specificity were 100%[95%confidence interval(CI):29.0%-100%]and 99.4%(95%CI:96.6%-100%),respectively,based on the Agresti test of the primary evaluation,considering the re-evaluated classification as true.CONCLUSION:The computerized system can be used for primary strabismus screening by non-specialized personnel,with 98.8%agreement with specialists.However,it cannot be used as a substitute for professional examination.

Anterior segment optical coherence tomography for identifying muscle status in strabismus surgery

Anterior segment optical coherence tomography （AS-OCT） finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery. We discuss two cases of operated strabismus surgery where AS-OCT imaging helped in identifying the operated eye and/or extra ocular muscles （EOM） and thus proved instrumental in planning and management.

Strabismus Detection Based on Uncertainty Estimation and Knowledge Distillation

Strabismus significantly impacts human health as a prevalent ophthalmic condition.Early detection of strabismus is crucial for effective treatment and prognosis.Traditional deep learning models for strabismus detection often fail to estimate prediction certainty precisely.This paper employed a Bayesian deep learning algorithm with knowledge distillation,improving the model's performance and uncertainty estimation ability.Trained on 6807 images from two tertiary hospitals,the model showed significantly higher diagnostic accuracy than traditional deep-learning models.Experimental results revealed that knowledge distillation enhanced the Bayesian model’s performance and uncertainty estimation ability.These findings underscore the combined benefits of using Bayesian deep learning algorithms and knowledge distillation,which improve the reliability and accuracy of strabismus diagnostic predictions.

Application Value of Topical Aneasthesia in Children Strabismus Surgery

Purpose:Comparison of topical vs general aneasthesia for strabismus surgery. Methods: Preoperative patients (aged 6～12 years) were divided into two study groups: the topical aneasthesia group (n=22), and the general aneasthesia group (n=21). The study groups were compared on the following measures:.analgesic effect, surgical correction effect, eye-heart reflex, preoperative preparation time. and operation time, using t-tests or X2 tests where appropriate. Results:.Compared with the general aneasthesia group, the topical aneasthesia group gained better surgical correction results(P<0.05), had a lower rate of eye-heart reflex (P<0.05), and had a shorter preoperative preparation time (P<0.001). No significant difference was observed between the groups in terms of the analgesic effect or operation time (P>0.05). Conclusion:Topical aneasthesia represents a safe and effective alternative to general aneasthesia for strabismus surgery in children.

Reduced emergence agitation with proparacaine hydrochloride eye drops after general anaesthesia for paediatric strabismus surgery

Purpose:To investigate the effect of proparacaine hydrochloride eye drops on emergence agitation after general anaesthesia for paediatric strabismus surgery.Methods:Paediatric patients(3-12 years-old)receiving strabismus surgery were randomly assigned to receive 1-2 drops of isotonic saline(n=129)or proparacaine hydrochloride(n=129)after surgery.The incidence and degree of emergence agitation were recorded and compared between groups.Results:A significantly lower occurrence of emergence agitation was observed with proparacaine hydrochloride drops compared to isotonic saline(12.4% vs.31.8%;p<0.05).Conclusion:Proparacaine hydrochloride eye drops reduce the incidence of emergence agitation after general anaesthesia for paediatric strabismus surgery.

Effect of Diplopia on Daily Life and Evaluation of Nursing Measures Following Strabismus Surgery

Purpose: To investigate the effect of diplopia on the daily life of patients after strabismus surgery and to explore appropriate nursing care measures.Methods:.A total of 200 patients who developed postoperative diplopia underwent telephone follow-up to evaluate the influence of diplopia on their daily lives..SPSS 19.0 statistical software was utilized for data analysis.Results: Postoperative diplopia affected patients' physical activity(49%), attention(39.2%), work and study(24.5%),emotions.(19.5%),.and housework performance.(17%),whereas it did not influence the quality of sleep. Potential risk factors associated with diplopia, such as duration of diplopia,gender, and age, were analyzed by uni- and multivariate regression analysis. Quality of life was significantly and negatively correlated with the duration of diplopia, but not correlated with gender or age.Conclusion:.Postoperative diplopia affects the quality of life in partial patients..The nursing staff should provide nursing care, health education, and explicit instructions to the patients after discharge. In addition, nursing care should be sustained by subsequent telephone follow-up.

Corneal Topographical Changes Following Strabismus Surgery

Purpose:To study corneal topographical changes after strabismus surgery.Methods:Computer-aided corneal topography was used in 43 strabismus patients(45 eyes)one or two days prior to and six or seven ays after strabismus surgery.The spherical and cylindrical equivalents were calculated based on the simulated keratometry.Results:After the surgery,only the changes at 3mm in the inferior quadrant were statistically significant.The changes at 3mm in the rest quadrants and the changes at 7mm were no significant.Significant changes in spherical equivalent were found post-operatively.neither the horizontal nor the verical meridional equivalent showed significant changes after surgery.Conclusions:The results of corneal topographical changes following strabismus surgery in our preliminary study indicated the little effect of strabismus surgery on corneal curvature and corneal astigmatism.

The Suh Muscle Hook: A New Muscle Hook for Tight Extraocular Muscles during Strabismus Surgery

Purpose: To introduce an advanced muscle hook to decrease risks and create more feasible extraocular muscle surgeries for physicians. Case Report: Tight extraocular muscles during strabismus surgery could be extremely challenging even in experienced hands due to restricted globe rotation, limited view, and lack of muscle elasticity. Although a variety of surgical instruments have been introduced through the years, traditional muscle hooks such as the Jameson hook are largely unchanged and are bulky and cumbersome. Using the traditional muscle hook under situations such as pediatric strabismus surgery with smaller eyes and extraocular muscles may increase the risk of perforating the globe or even rupturing the muscles. We developed the “Suh muscle hook”, which has a 0.55 mm wide grooved track in a 1.1 mm wide horizontal bar, a semi-sharp dissecting tip, and a 30-degree bending near the handle accommodating for nasal bridge to better facilitate surgeons dealing with tight extraocular muscles and minimize risks during strabismus surgery.

Ocular alignment and results of strabismus surgery in neurologically impaired children

AIM:To evaluate ocular alignment and surgical results of strabismus surgery in neurologically impaired children.· METHODS:Files of 33 neurologically impaired squint children were evaluated.Twelve patients had cerebral palsy(CP),4 had CP with mental retardation,therest had mental-motor retardation of unknown cause.Cycloplegic refractions,type and angle of strabismus,surgeries performed were recorded.· RESULTS:Mean follow-up was 34.0±16.5 months.Twenty-three patients had esodeviation,the remaining had exodeviation.In 19 patients,angle of deviations measured at different visits were highly variable.Twelve patients with stable angle of deviations or with unstable but high angle deviations had horizontal muscle surgery.Mean horizontal deviation decreased from 43.75±10,69 D to 12.83±8.38D with surgery.· CONCLUSION:In neurologically impaired strabismic children,surgery is effective in patients with stable deviations or unstable but high angle deviations.Decision for surgery should be made after a long follow up period.

Perioperative care following strabismus surgery for the patient with severe congenital neutropenia

A 10-year-old girl presented with esotropia. She had 35 prism diopters of esodeviation at far and near with left inferior oblique muscle overaction (+3). Cycloplegic refraction was +0.5D OD and +0.75D OS, and visual acuity was 20/25 in each eye. The patient was being treated with G-CSF (Leufokine?) due to her severe congenital neutropenia (WBC 3350, neutrophil 7.3%, and ANC 170/ul). Despite of low ANCs, we decided to perform a surgery because the patient and her parents strongly wanted it. Prophylactic topical antibiotics (Cravit?, levofloxacin 0.5%) were applied four times a day for three days prior to the surgery. We sterilized the periocular skin with povidone-iodine 10% and placed povidone-iodine 5% drops in the cul-de-sac preoperatively. Strabismus surgery was performed. After surgery, profuse irrigation with the entire bottle of topical antibiotics (Vigamox?, moxifloxacin hydrochloride 0.5%) was performed for each eye. We prescribed topical and highly potent systemic antibiotics for 1 week. This is the first case report to describe the successful perioperative antisepsis care following strabismus surgery for a patient with severe congenital neutropenia. Prevention of postoperative infection in granulocytopenic patients could be achieved using antibiotic agents which provide the greatest spectrum of coverage against both Gram-positive and Gram-negative infections.

Consecutive Exotropia after Convergent Strabismus Surgery—Surgical Treatment

Purpose: In this study the results of consecutive exotropia surgical treatment by using different surgical technics are presented. Methods: This study included 34 patients, aged 21 to 47 years (mean 27.9), who underwent medial rectus muscle advancement alone or in combination with medial rectus resection and/or lateral rectus recession. The mean interval between original surgery and surgery for consecutive exotropia was 8.5 years (range: 5.5 years to 14 years). Most of patients had 2 and more prior surgeries (73.5%) sold by an adduction deficit (47.06%). Results: The overall mean preoperative exodeviation was 35.12 ± 10.13 PD. Satisfactory alignment (within 10 PD of orthophoria) was achieved in 20 patients (58.8%) at 10 days after surgery and 24 patients (70.5%) at final 6-month follow-up. The most common surgical procedures were unilateral MR advancement and LR recession—47%. Conclusion: Medial rectus advancement is an effective method of surgical treatment, especially in cases with adduction limitation, but the risk of the eyelid fissure narrowing in cases of MRM advancement more than 5 mm associated with resection is present. In our opinion for reducing this risk in cases of XT with big angle of deviation, performing a smaller amount of advancement associated with recession of LRM can prevent the development of a such complication.

AB075.Population trends in adult strabismus surgery

Background:To review the trends in adult strabismus procedures in Ontario from 2000-2014.Methods:A population based,retrospective data analysis was conducted.Ontario Health Insurance Plan billing claims for strabismus procedures were collected and subdivided by number of muscles repaired,the use of adjustable sutures and repeat procedures,adjusted by the total adult population.The number of Ophthalmologists performing adult strabismus surgery was also analyzed,subdivided by high volume and low volume surgeons.Results:From 2000-2014,per 100,000 adult population,the number of total strabismus surgeries in Ontario increased 29.1%;single muscle surgery increased 25.0%,two muscle surgery increased 46.3%,and three or more muscle surgeries increased 8.3%.During the study period,strabismus procedures using adjustable sutures increased 26.1%and repeat procedures increased 65.1%.The number of surgeons performing adult strabismus surgery decreased 21.7%from 2000-2014.In 2014,88.4%of surgeries were performed by 29.8%of all of surgeons who performed adult strabismus surgery.Conclusions:From 2000-2014,more strabismus surgery was performed in adults by fewer surgeons from 2000-2014.The number of adult strabismus surgeries in Ontario increased since 2000,including procedures using adjustable sutures and repeat procedures.These changes may be due to increases in healthcare funding and an increased awareness of the functional and psychosocial benefits of strabismus surgery.

Preservation and Observation of Anterior Ciliary Vessels in Rectus Muscles during Strabismus Surgery

Purpose:To observe the form and number of the anterior ciliary vessels(ACV)in rectus muscles.To train technician in preservation an d obsevation of ACV,so preservation can be done in caes with a rish of anterior segment ischemia(ASI).Methods:Curved foreign knife,iris hook,plastic rubber band and standard operat-ing loupes(3x)or microscope were used in the surgery on 34cases of comitant strabismus and 18cases of paralytic strabismus.Results:The ACVs per muscle in medial,lateral,superior,inferior rectus were3.08,3.26,3.50and3.50respectively in 89muscles of 52surgical strabismus cas-es.All ACVs in 16rectus muscles and 90out of 220ACVs in 73rectus muscles were too small ortoo short to be dissected.The sucess rate of ACV preservation was91.5%(119/130).105out of 130vessels were saved using loupe magnifica-tion and 14pit pf130vessels were saved under operating microscope.Conclusions:The number of ACVinrectus muscles are more than 2in our obser-vation cases.The ACVpreservation has the clinical value of allowing us toper-form muscle sugery on three or more rectus muscles simultaneously and get fonal surgical results more earlier after acv in each muscle are dissected and preserved otherwinse staged surgery are needed.The each strabismus surgeon must knov this technique.

A Preliminary Report of 40 Cases of Strabismus Microsurgery

Objective: To improve the qaulity of strabismus surgery and to find out the role ofmicrosurgery in the field of strabismus.Methods: We performed separation and preservation of anterior ciliary vessels (ACV),adjustable sutures, routine rectus recession, and oblique muscle surgeries undermicroscope in 13 cases of comitant strabismus, 19 cases of A-V syndrome and 8 cases ofparalytic strabismus. Results: Surgeries were performed in a very clear field under microscope. Wesuccessfully did vascular microdissection and ACV preservation. Also with the use ofmicroscope, various kinds of strabismus microsurgery videos were recorded.Conclusions: Microscopic technique can be used to enhance the quality and accuracy ofstrabismus surgery and to reduce surgical damage, postoperative inflammatory reactionand scar formation. All kinds of strabismus surgery , especially, oblique muscles andcomplex paralytic operations can be performed under microscope.

Fatal risk in hysteroscopic surgery that should not be overlooked:Uterine artery pseudoaneurysm

This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm(UAP),as well as an analysis of UAP etiology.This finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic procedures.The patient underwent timely relevant examinations to confirm the diagnosis,allowing for crucial time required for her treatment.In this study,the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility,suggesting that the selection and imple-mentation of dilatation catheters are some of the predisposing factors for UAP.In conclusion,this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment,offering valuable in-sights for the clinical diagnosis and management of UAP.

Cauda equina syndrome with urinary retention as a postoperative complication of lumbar spine surgery:A case report

BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.