Nonsurgical Consecutive Exotropia Following Childhood Esotropia: A Multicentered Study.

Purpose: Nonsurgical consecutive exotropia (NCX) occurs when an esotropia (ET) spontaneously converts to exotropia (XT) without surgical intervention. Although NCX is considered to occur in early-onset accommodative ET with high hyperopia, consensus on causation is lacking. We report the clinical characteristics of NCX and assess the response to conservative management.

Comparison of Unilateral Versus Bilateral Lateral Rectus Recession for Small Angle Intermittent Exotropia: Outcomes and Surgical Dose-Responses.

Purpose: To compare the surgical outcomes of unilateral lateral rectus recession to bilateral lateral rectus recession for small angle intermittent exotropia.

Methods: This was a retrospective cohort study of pediatric patients with an intermittent exotropia between 16 and 20 prism diopters (PD) who underwent unilateral lateral rectus recession or bilateral lateral rectus recession at a single tertiary care pediatric hospital. The primary outcome was success (exotropia < 10 PD of esotropia < 5 PD, no decrease in stereopsis > 0.

Ocular motility disturbances after glaucoma drainage device implantation for paediatric glaucoma: a cross-sectional study.

Aim: To grade extraocular motility in the field of action of each extraocular muscle following superotemporal glaucoma drainage device (GDD) implantation in a paediatric population and to investigate which drainage device (Ahmed vs Baerveldt) yields less extraocular motility disturbance.

Methods: Cross-sectional study of children with a GDD implanted consecutively by a single surgeon who underwent ocular motility examination by two masked orthoptists. Ductions in the cardinal positions were graded.

Endophthalmitis after strabismus surgery: incidence and outcome in relation to age, operated eye muscle, surgical technique, scleral perforation and immune state.

Purpose: Identify risk factors for endophthalmitis after strabismus surgery (EASS) and relate these to incidence and outcome.

Methods: Ophthalmologists, who had operated, diagnosed or treated EASS, completed a case record form with 71 questions in six domains: Preoperative, Surgery, Perforation, Postoperative, Outcome and Experts' opinion. To estimate the age-specific incidence per number of strabismus operations in the Netherlands during 1994-2013, the age distribution of Dutch cases was compared with the age-specific rates of strabismus surgery in the Dutch Registry of Strabismus Operations and with population data.

Population trends in adult strabismus surgery.

Objective: To review the trends in adult strabismus procedures in Ontario from 2000-2013.

Design: Population-based, retrospective data analysis.

Participants: All patients 18 years or older who underwent a strabismus related procedure in Ontario and all ophthalmologists who performed these procedures from 2000-2013.

What Did They Know Then? A Journey Among the Giants of the Past.

Dr. Richard Scobee has the honorary title "The Father of American Orthoptics." In addition to his numerous accomplishments in his academic career, he had hobbies that included collecting historical stamps.

Idiopathic Enlargement of the Extraocular Muscles in Young Patients: A Case Series.

Purpose: To describe a case series of enlarged extraocular muscles in young patients.

Design: Retrospective interventional case series.

Methods: Study involves 6 young patients who presented with atypical restrictive strabismus and reduced eye movements.

The Effect of Achieving Immediate Target Angle on Success of Strabismus Surgery in Children.

Purpose: To determine if achieving the ideal postoperative target range increases the long-term success of pediatric strabismus surgery.

Design: Interventional case series.

Methods: Children below 12 years old with horizontal strabismus who underwent surgical correction by recession, resection, advancement, or a combination of both between 1996 and 2011 were included.

Cyclic strabismus in adults.

Cyclic strabismus is a rare condition that usually occurs in children and is characterized by alternating intervals of straight and strabismic eyes. In adults with the condition, strabismus surgery often eliminates the cycles. We report a case of adult-onset cyclic esotropia that was converted into a cyclic exotropia.

The accuracy of anterior segment optical coherence tomography (AS-OCT) in localizing extraocular rectus muscles insertions.

Purpose: To evaluate the accuracy of the anterior segment optical coherence tomography (AS-OCT) in measuring the distance from the limbus to the insertion of primary and previously operated rectus muscles in children.

Methods: In this prospective, double masked, observational study the distance of the extraocular muscle insertion from the limbus measured by AS-OCT preoperatively was compared to intraoperative measurement using the surgical calipers. Consecutive patients 4-18 years of age undergoing primary or repeat strabismus surgery on horizontal or vertical rectus muscles between September 2013 and May 2014 were included.

Achieving postoperative target range increases success of strabismus surgery in adults: a case for adjustable sutures?

Background/aims: To evaluate the role of achieving immediate target angles on the success of strabismus surgery.

Methods: We performed a retrospective cohort study of all patients over 12 years old undergoing strabismus surgery with either adjustable or non-adjustable sutures. Target angle for patients with esotropia and vertical deviation was within 4 prism dioptres (PD) of orthotropia and for patients with exotropia between orthotropia and 8 PD of esotropia.

Outcomes of three different vertical rectus muscle transposition procedures for complete abducens nerve palsy.

Purpose: To compare the efficacy of three different vertical rectus muscle transposition (VRT) techniques performed as a sole procedure to correct ocular alignment and improve abduction in cases of complete abducens nerve palsy.

Methods: The medical records of patients with complete abducens nerve palsy who underwent one of three different VRT procedures without simultaneous medial rectus weakening over a period of 20 years were retrospectively reviewed. The following procedures were used: full-tendon transposition (FTT), FTT with 4 mm resections before reinsertion (FTTR), and FTT with myopexy sutures (FTTM).

Surgical management of strabismus in Duane retraction syndrome.

While Duane retraction syndrome (DRS) is relatively common, surgical management of the associated strabismus can be challenging because of the lack of abduction/adduction, the variable severity of muscle contracture, and the variety of clinical presentations. In this workshop a panel of experienced surgeons provide their perspective and practical tips on the management of strabismus in patients with DRS.

Localising rectus muscle insertions using high frequency wide-field ultrasound biomicroscopy.

Aim: The ultrasound biomicroscope (UBM) can accurately locate an extraocular muscle (EOM) insertion. The authors compared the accuracy of the Sonomed UBM (SUBM), a new 'wide-field ultrasound biomicroscope', with the older model Humphrey UBM (HUBM) in localising EOM insertions and compared their ranges of detection of muscle insertions.

Methods: Prospective, double-masked, observational study of 27 patients undergoing primary (n=40 muscles) or repeat (n=10 muscles) horizontal or vertical rectus muscle surgery.

Utility of adjustable sutures in primary strabismus surgery and reoperations.

Purpose: To evaluate the success of adjustable suture (AS) and nonadjustable suture (NAS) strabismus surgery in primary procedures and reoperations.

Design: Retrospective case series.

Participants: Four hundred four patients older than 12 years who underwent strabismus surgery over a 13-year period.

Long-term efficacy of botulinum a toxin for blepharospasm and hemifacial spasm.

Objective: To determine whether the duration of relief from symptoms in patients with essential blepharospasm (EB) or hemifacial spasm (HFS) who receive serial treatments with botulinum toxin type A (BtA) changes over the long-term.

Methods: Retrospective longitudinal comparative analysis. The main outcome measure is the mean duration of relief from symptoms after an injection with BtA.

Lateral rectus resection strabismus surgery in unilateral duane syndrome with esotropia and limited abduction.

Background: Resection of the lateral rectus in Duane retraction syndrome (DRS) with esotropia (ET) and limited abduction can be a useful component of surgical planning in specific circumstances, when combined with medial rectus (MR) recession. This article reports the results of a prospective series of patients for whom this approach was used successfully.

Methods: Seven patients were treated, aged 3 to 52 years, with uniltaeral DRS with the following features: 1) ET at least 25 PD; 2) "mild" retraction on adduction; 3) clinically normal adduction; 4) significantly limited abduction; 5) no or mild upshoots/downshoots; and 6) positive forced duction to abduction at surgery.

Evaluation of vertical rectus muscles using ultrasound biomicroscopy.

Purpose: To evaluate the accuracy of ultrasound biomicroscopy (UBM) in measuring the distance (in mm) from limbus to the insertion of vertical rectus muscles (superior rectus and inferior rectus compared with the "gold standard" surgical caliper at the time of surgery.

Methods: Prospective, masked, observational study of 31 vertical rectus muscle insertions in which we compared the measurements from the limbus as measured by 50 MHz UBM, either preoperatively or at the time of anesthesia, with that measured by surgical caliper intraoperatively. Measurements (UBM and surgical) were evaluated by two different observers and analyzed using the Bland-Altman method.

Dissociated vertical deviation in patients with intermittent exotropia.

Purpose: To determine whether the age of strabismus onset and the degree of stereopsis are related to the development of dissociated vertical deviation (DVD) in patients with intermittent exotropia and to describe the characteristics of DVD in patients with intermittent exotropia and DVD.

Methods: Retrospective record review of patients with (1) intermittent exotropia with DVD; (2) infantile esotropia with DVD; and (3) intermittent exotropia without DVD. Age of strabismus onset, stereopsis, strabismus measurements, and the response of DVD to the Bielschowsky head-tilt test were compared among the three groups.