Congenital dysplasia involving both medial and inferior recti: clinical features and surgical outcomes

AIM: To investigate the clinical features and surgical outcomes of congenital dysplasia involving both inferior recti (IR) and medial recti (MR) muscles. METHODS: A retrospective review was conducted including cases of simultaneous congenital dysplasia of IR and MR that were diagnosed and surgically treated at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China, from July 2009 to November 2019. Ocular motility, ocular alignment at distance (6 m) and near (33 cm) by prism alternating cover test and stereoacuity were assessed in all patients before and after surgery. RESULTS: A total of five patients (four males and one female; three with right eye and two with left eye congenital dysplasia) were included in this review. The patients ranged in age from 10 to 42y (21±13.4y). The main clinical findings were hypertropia and exotropia of the affected eye, along with motility limitations in adduction and depression. Lateral rectus (LR) recession/transposition combined with IR resection was performed in one case. Two scheduled surgeries were performed in four cases, with one involving superior rectus recession and IR resection and the others LR recession and MR resection. Mean±SD pre-surgical exotropia of 51.0±31.11 prism diopter (PD) and hypertropia of 29.20±7.12 PD in the primary position were decreased to 3.6±12.90 and 3.2±10.09 PD, respectively, at two years after surgery, with a success rate of 60% and an under-correction rate of 40%. CONCLUSION: The main clinical features associated with simultaneous MR/IR congenital dysplasia are hypertropia and exotropia of the affected eye along with motility limitations in adduction and depression. Scheduled two-stage surgeries achieved a success rate of 60%.

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Surgical outcomes of acute acquired comitant esotropia of adulthood

BMC Ophthalmology ◽

10.1186/s12886-020-01793-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dae Hyun Kim ◽

Ha Jeong Noh

Keyword(s):

Success Rate ◽

Surgical Outcomes ◽

Medical Records ◽

Large Angle ◽

Sudden Onset ◽

Prism Diopter ◽

Factors Affecting ◽

The Mean ◽

Motor Outcomes

Abstract Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.

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The efficacy of superior oblique posterior tenectomy in the treatment of A-pattern exotropia without ocular intorsion: A retrospective study

10.21203/rs.2.14556/v2 ◽

2019 ◽

Author(s):

Yan Wei ◽

Ling-Yan Dong ◽

Xiao-li Kang ◽

Pei-quan Zhao

Keyword(s):

Rectus Muscle ◽

Ocular Motility ◽

Ocular Torsion ◽

Primary Position ◽

Horizontal Alignment ◽

Pattern Deviation ◽

The Mean ◽

Fundus Photographs ◽

Cover Test ◽

Superior Oblique

Abstract Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aims to evaluate the surgical results of the bilateral superior oblique posterior tenectomy procedure to treat A-pattern strabismus patients who had bilateral superior oblique overaction without objective ocular intorsion. Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tentomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenectomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical and horizontal alignment change and the superior oblique posterior tenectomy procedure. Conclusions: Superior oblique posterior tenectomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical and horizontal deviation, as well as the ocular torsion. It is an effective procedure to treat the mild to moderate superior oblique overaction (SOOA)-associated A pattern strabismus without ocular intorsion.

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The efficacy of superior oblique posterior tenotomy in the treatment of A-pattern strabismus without ocular intorsion: A retrospective study

10.21203/rs.2.14556/v1 ◽

2019 ◽

Author(s):

Yan Wei ◽

Ling-Yan Dong ◽

Xiao-li Kang

Keyword(s):

Rectus Muscle ◽

Ocular Motility ◽

Ocular Torsion ◽

Primary Position ◽

Horizontal Alignment ◽

Pattern Deviation ◽

The Mean ◽

Fundus Photographs ◽

Cover Test ◽

Superior Oblique

Abstract Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aim to evaluate the surgical results of superior oblique posterior tenotomy procedures to treat A-pattern strabismus patients who had bilateral superior oblique overaction without ocular objective intorsion.Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tenotomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenotomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical and horizontal alignment change and the superior oblique posterior tenotomy procedure. Conclusions: Superior oblique posterior tenotomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical and horizontal deviation, as well as the ocular torsion. So it is an effective procedure to treat the mild to moderate superior oblique overaction (SOOA)-associated A pattern strabismus without ocular intorsion.

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Astigmatism Characteristics and Surgical Outcomes in Younger Children With Severe Congenital Ptosis After Frontalis Suspension Surgery

10.21203/rs.3.rs-1149813/v1 ◽

2021 ◽

Author(s):

Yilan Tan ◽

Xilang Wang ◽

Jing Tang ◽

Jianbo Xiang ◽

Lijuan Tao ◽

...

Keyword(s):

Survival Analysis ◽

Success Rate ◽

Surgical Outcomes ◽

Gradual Decrease ◽

Congenital Ptosis ◽

Younger Patients ◽

Kaplan Meier ◽

Before And After ◽

Frontalis Suspension ◽

Fellow Eyes

Abstract Background: To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery.Methods: We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children‘s Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure.Results: Degree of astigmatism in ptotic and fellow eyes was -1.45±0.59 D and -0.66±0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3% and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9% and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8% to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence. Conclusion: Frontalis suspension surgery can effectively and safely correct congenital ptosis in younger patients, which may ameliorate the development of amblyopic astigmatism.

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The efficacy of superior oblique posterior tenotomy in the treatment of A-pattern strabismus without ocular intorsion: A retrospective study

10.21203/rs.2.14556/v3 ◽

2020 ◽

Author(s):

Yan Wei ◽

Ling-Yan Dong ◽

Pei-quan Zhao ◽

Xiao-li Kang

Keyword(s):

Rectus Muscle ◽

Ocular Motility ◽

Ocular Torsion ◽

Vertical Alignment ◽

Primary Position ◽

Pattern Deviation ◽

The Mean ◽

Fundus Photographs ◽

Cover Test ◽

Superior Oblique

Abstract Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aims to evaluate the surgical results of the bilateral superior oblique posterior tenectomy procedure to treat A-pattern strabismus patients who had bilateral superior oblique overaction without objective ocular intorsion. Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tenectomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenectomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical alignment change and the superior oblique posterior tenectomy procedure. Conclusions: Superior oblique posterior tenectomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical deviation, as well as the ocular torsion. It is an effective procedure to treat the mild to moderate superior oblique overaction associated A pattern strabismus without ocular intorsion.

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Surgical outcomes of acute acquired comitant esotropia of adulthood

10.21203/rs.3.rs-20552/v1 ◽

2020 ◽

Author(s):

Dae Hyun Kim ◽

Ha Jeong Noh

Keyword(s):

Success Rate ◽

Surgical Outcomes ◽

Medical Records ◽

Prism Diopter ◽

Factors Affecting ◽

Motor Outcome ◽

The Mean ◽

Motor Outcomes ◽

Type Of Surgery

Abstract Background: To analyze the surgical outcomes for adult patients diagnosed with acute acquired comitant esotropia (AACE). Methods: Medical records of 21 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥60 sec/arc. Results: The preoperative mean esodeviation angles were 33.0 ± 11.6 PD at distance and 32.6 ± 10.8 PD at near. The mean period of postoperative follow up was 8.1 ± 4.5 months (range 3–8 months). The postoperative mean esodeviation angles at final follow-up time were 4.1 ± 5.7 PD at distance and 3.9 ± 5.6 PD at near. The surgical motor success rate at final follow-up was 76.2% (16/21). The sensory success rate at final follow-up was 55.5% (11/21). The factor affecting the motor outcome was the type of surgery ( p < 0.05). The factor affecting sensory outcome was postoperative follow-up time ( p < 0.05). Conclusions: Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.

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SAT-LB41 Surgery Outcomes for Patients With Primary Aldosteronism Who Show Normal-Appearing Adrenals on Computed Tomography but Unilateral Disease on Adrenal Venous Sampling

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2009 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Daisuke Aono ◽

Takuya Higashitani ◽

Yuta Hayakawa ◽

Sho Yamamoto ◽

Koki Taniguchi ◽

...

Keyword(s):

Computed Tomography ◽

Success Rate ◽

Clinical Features ◽

Primary Aldosteronism ◽

Surgical Outcomes ◽

Clinical Characteristics ◽

Venous Sampling ◽

Bilateral Group ◽

Unilateral Disease ◽

Unilateral Group

Abstract Background: The primary aldosteronism (PA) subtype is usually confirmed by computed tomography (CT) and adrenal venous sampling (AVS). However, the subtype diagnosis by AVS is not necessarily consistent with the subtype diagnosis by CT. Patients with PA who show normal-appearing adrenals on CT but unilateral disease on AVS (CT-negative and AVS-unilateral group) are often found. However, few studies have focused on them, despite a discrepancy between CT and AVS subtype diagnosis. Objective: The aim of this study was to evaluate the clinical features of CT-negative and AVS-unilateral group and assess whether they obtain benefits from surgery. Methods: We retrospectively analyzed 362 consecutive patients with PA who underwent both CT and adrenocorticotropic hormone (ACTH)-unstimulated AVS at Kanazawa University Hospital. First, the patients were divided into normal-appearing adrenals, bilateral adrenal nodules, or unilateral adrenal nodules based on CT findings. Second, they were classified as having unilateral or bilateral disease based on ACTH-unstimulated AVS. The criterion for successful selective catheterization was selectivity index >2 and unilateral aldosterone overproduction was confirmed by lateralized index ≥2. Among the group with normal appearing-adrenals on CT, we examined preoperative clinical characteristics between those with unilateral disease on AVS and those with bilateral disease on AVS. In addition, we compared surgical outcomes of CT-negative and AVS-unilateral group with those of CT-unilateral and AVS-ipsilateral group (patients with unilateral lesions on CT and ipsilateral disease on AVS). The Surgical outcomes for unilateral PA were evaluated according to the criteria of the Primary Aldosteronism Surgical Outcome study. Results: The success rate of AVS in patients with normal-appearing adrenals on CT was 88% (167/190). Furthermore, the discordance rate between CT and AVS in patients with normal-appearing adrenals on CT was 36% (60/167). There were no significant differences in preoperative clinical characteristics between the CT-negative and AVS-unilateral group (n=60) and the CT-negative and AVS-bilateral group (n=107). After surgery, the CT-negative and AVS-unilateral group (n=14) had a lower complete biochemical success rate than the CT-unilateral and AVS-ipsilateral group (n=30) (43% vs. 80%, p=0.02), but clinical and biochemical benefits (the complete and partial success combined) were not significantly different between them (71% vs. 93% (p=0.07) and 71% vs. 90% (p=0.13), respectively). Conclusion: The clinical features of CT-negative and AVS-unilateral group were significantly similar to those of CT-negative and AVS-bilateral group. They benefited from surgery, and AVS should be performed for patients who pursue surgical management when the CT findings suggest normal-appearing adrenals.

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Visual Effects of Deep Brain Stimulation in a Patient with Parkinson’s Disease

Vision Development & Rehabilitation ◽

10.31707/vdr2019.5.3.p158 ◽

2019 ◽

pp. 158-173

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Visual System ◽

Brain Stimulation ◽

Neurodegenerative Disorder ◽

Initial Examination ◽

Before And After ◽

Deep Brain ◽

Cover Test

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder caused by a dopamine deficiency that presents with motor symptoms. Visual disorders can occur concomitantly but are frequently overlooked. Deep brain stimulation (DBS) has been an effective treatment to improve tremors, stiffness and overall mobility, but little is known about its effects on the visual system. Case Report: A 75-year-old Caucasian male with PD presented with longstanding binocular diplopia. On baseline examination, the best-corrected visual acuity was 20/25 in each eye. On observation, he had noticeable tremors with an unsteady gait. Distance alternating cover test showed exophoria with a right hyperphoria. Near alternating cover test revealed a significantly larger exophoria accompanied by a reduced near point of convergence. Additional testing with a 24-2 Humphrey visual field and optical coherence tomography (OCT) of the nerve and macula were unremarkable. The patient underwent DBS implantation five weeks after initial examination, and the device was activated four weeks thereafter. At follow up, the patient still complained of intermittent diplopia. There was no significant change in the manifest refraction or prism correction. On observation, the patient had remarkably improved tremors with a steady gait. All parameters measured were unchanged. The patient was evaluated again seven months after device activation. Although vergence ranges at all distances were improved, the patient was still symptomatic for intermittent diplopia. OCT scans of the optic nerve showed borderline but symmetric thinning in each eye. All other parameters measured were unchanged. Conclusion: The case found no significant changes on ophthalmic examination after DBS implantation and activation in a patient with PD. To the best of the authors’ knowledge, there are no other cases in the literature that investigated the effects of DBS on the visual system pathway in a patient with PD before and after DBS implantation and activation.

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Obesity management through Ayurveda - A Case Study

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i4.9377 ◽

2017 ◽

Vol 2 (4) ◽

Author(s):

Dheeraj Kumar Tyagi ◽

Shivakumar .

Keyword(s):

Clinical Findings ◽

Dietary Habit ◽

Unhealthy Lifestyle ◽

Lifestyle Management ◽

Before And After ◽

Effect Of Treatment ◽

And Control

Lifestyle disorders are one of the biggest threats for the population living unhealthy lifestyle. Sthoulya (Obesity) is one such disorder which creates lot of physical as well as mental disorder to the sufferer. Due to changing lifestyle, comforts and dietary habit lots of individuals changed their life totally. Obesity is a growing disease in developed and developing countries. Prevalence is drastically hike in past few years. Ayurveda, the science of life with which we can manage and control lots of lifestyle disorders. Focusing on dietary and lifestyle management along with treatment, we can overcome the hazards of obesity which is growing in a uncontrolled manner. The available data is based on the clinical findings only. Aim and objective: To assess the effect of “Guru Cha Atarpanam Chikitsa” in the management of Sthoulya. Setting: Swastharakshana evam Yoga, OPD and IPD, SDMCAH, Hassan. Method: Udwarthana, Parisheka, Shamana Aushadhis, Ahara, and Vihara was followed within the treatment duration and effect of treatment was assessed before and after treatment, advised for follow up. Results: The treatment adopted is effective in the management of Sthoulya and to improve the quality of life.

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Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽

10.1186/s12893-020-01027-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yoshikazu Nagase ◽

Shinya Matsuzaki ◽

Masayuki Endo ◽

Takeya Hara ◽

Aiko Okada ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Cesarean Delivery ◽

Clinical Features ◽

Surgical Outcomes ◽

Multivariate Regression ◽

Placenta Previa ◽

Control Group ◽

Intraoperative Blood Loss ◽

Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

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