Ocular lichen planus as a cause of recurrent restrictive strabismus.

We report the case of an 80-year-old man with restrictive strabismus in lateral gaze following multiple oculoplastic procedures for idiopathic epiphora. Despite excellent initial response to nasal conjunctival recession with lysis of adhesions and a miminal recession of the medial rectus muscle, the patient suffered recurrence of diplopia associated with limitation of abduction due to aggressive, deep, subconjunctival scarring. Given the history of oral lichen planus (LP), the patient was diagnosed with ocular involvement of LP.

A Comparison of Chemodnervation to Incisional Surgery for Acute, Acquired, Comitant Esotropia: An International Study.

Purpose: To compare the efficacy of botulinum toxin injections to strabismus surgery in children with acute, acquired, comitant esotropia (ACE), and to investigate factors predicting success.

Design: International, multi-center nonrandomized comparative study METHODS: Setting: Cloud-based survey.

Study Population: Children aged 2 to 17 years who underwent a single surgical intervention for ACE.

Strabismus Surgery in Orthophoric Patients With Symptomatic, Asymmetric Vertical or Horizontal Incomitance.

Purpose: To report the indications, operative strategies, and surgical outcomes of patients who undergo vertical and horizontal rectus muscle surgery for incomitant strabismus despite being orthophoric in primary gaze.

Design: Retrospective, interventional case series.

Methods: The setting for this study was an academic practice at Boston Children's Hospital.

Subthreshold Amblyopia: Characterization of a New Cohort.

Purpose: Published studies of amblyopia include only patients with visual acuity (VA) worse than 20/40 in one or both eyes. The purpose of this study is to evaluate patients diagnosed and treated as amblyopic despite not meeting traditional VA criteria for amblyopia.

Design: Retrospective clinical cohort study.

A decline in the strabismus surgical experience of ophthalmology residents in the United States from 2010 to 2019.

Subspecialty exposure during residency can influence the future pursuit of fellowship training. In this study, we compared the trends in strabismus surgical experience reported by graduating ophthalmology residents in the United States with other categories of ophthalmic surgery. Over the 10-year period (2010-2019), there was a decline in the total number of strabismus procedures performed during residency by ophthalmology residents graduating in a given year (1.

Carbon footprint of the 2021 and 2022 AAPOS annual meetings.

The COVID-19 pandemic necessitated a virtual annual meeting of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) in 2021, thus eliminating carbon emissions from travel to and from the planned meeting venue in Boston, Massachusetts. We found that the reduced carbon footprint of the virtual meeting saved 1,282 metric tonnes of CO emissions compared with estimated CO emissions for travel if the meeting had taken place in person, or 880 metric tonnes relative to the projected emissions associated with the in-person 2022 annual meeting in Scottsdale, Arizona. An entirely virtual or hybrid AAPOS meeting would reduce its environmental footprint and increase the opportunity for national and international participation and education.

Adjustable Suture Technique Is Associated with Fewer Strabismus Reoperations in the Intelligent Research in Sight Registry.

Purpose: To compare the reoperation rates after strabismus surgery with and without the adjustable suture technique.

Design: Retrospective cohort study.

Participants: Patients 18 years of age or older in the Intelligent Research in Sight (IRIS®) Registry who underwent strabismus surgery between January 1, 2013, and December 31, 2018.

Comparison of fellowship match opportunities and results across pediatric surgical subspecialities.

There is a nationwide shortage of pediatric ophthalmologists, with trends in fellowship applicants foreshadowing a continued reduction in the number of active pediatric ophthalmologists in the years ahead. In this study, we investigated whether similar fellowship applicant shortages exist in other pediatric surgical subspecialties. We compared the match statistics of six pediatric surgical fellowships from 2015 to 2020.

Effect of Sequential and Simultaneous Patching Regimens in Unilateral Amblyopia.

Purpose: Many clinicians treat unilateral amblyopia with glasses alone and initiate patching when needed; others start glasses and patching simultaneously. In this study, we reviewed the outcomes of the two approaches at our institution.

Design: Retrospective nonrandomized clinical trial.

Botulinum Toxin Injection of the Inferior Oblique Muscles for V-Pattern Strabismus and Primary Position Hypertropia.

Purpose: To evaluate outcomes of botulinum toxin (BTX) injection of the inferior oblique (IO) muscle.

Design: Retrospective case series.

Methods: Setting: Single center, ophthalmology department at Boston Children's Hospital.

Evaluation of the blinq vision scanner for detection of amblyopia and strabismus.

Purpose: To report the results of a clinical study designed to evaluate the accuracy of the blinq pediatric vision scanner, which detects amblyopia and strabismus directly by means of retinal polarization scanning, unlike other vision screening devices, which infer possible disease based on detection of refractive risk factors.

Methods: Subjects 1-20 years of age were prospectively enrolled in this cross-sectional diagnostic accuracy study with planned enrollment of 200. All enrolled subjects were tested by individuals masked to the diagnosis, followed by complete ophthalmologic examination by pediatric ophthalmologists masked to the screening result.

Identifying Characteristics Predictive of Lost-to-Follow-Up Status in Amblyopia.

Purpose: To identify demographic and disease-related characteristics predictive of Lost-to-Follow-Up (LTFU) status in amblyopia treatment and create a risk model for predicting LTFU status.

Design: Retrospective cohort study METHODS: Setting: Single-center, ophthalmology department at Boston Children's Hospital (BCH).

Patients: 2037 patients treated for amblyopia at BCH between 2010 and 2014.

Self-grading effect of inferior oblique myectomy and recession.

Purpose: To evaluate the outcomes of inferior oblique (IO) weakening surgery, whether recession or myectomy, and to assess the dose-response relationship and correlation with angle of preoperative hypertropia.

Methods: The medical records of all patients with vertical deviation in primary gaze who underwent unilateral IO-weakening surgery, either recession or myectomy, at Boston Children's Hospital over an 8-year period with a minimum postoperative follow-up of 1 month were reviewed retrospectively. Outcome measures were effect of IO weakening surgery on vertical deviation in primary gaze and its correlation with the preoperative angle of hyperdeviation.

Severe reverse amblyopia with atropine penalization.

We report 2 cases of refractory reverse amblyopia that developed after instillation of 1-4 drops of atropine. Risk factors appear to include age <4, large-angle esotropia, and lack of adherence to spectacle wear.

Effect of Primary Occlusion Therapy in Asymmetric, Bilateral Amblyopia.

Purpose: Many bilateral amblyopia patients have asymmetric visual acuity (VA). There is no standard treatment for these patients, and outcomes have not been well described. Our goal is to compare VA outcomes in this group based on timing of occlusion therapy.

Anomalous superior oblique muscles and tendons in congenital fibrosis of the extraocular muscles.

Purpose: To evaluate the finding of anomalous superior oblique muscles in congenital fibrosis of the extraocular muscles (CFEOM), a feature not previously emphasized in this condition.

Methods: The medical records of all patients clinically or genetically diagnosed with CFEOM at Boston Children's Hospital between 2010 and 2018 were reviewed retrospectively. Those who underwent strabismus surgery during the study period were included in the analysis.

Outcomes of strabismus surgery in genetically confirmed congenital fibrosis of the extraocular muscles.

Purpose: To detail surgical strategy and strabismus outcomes in a genetically defined cohort of patients with congenital fibrosis of the extraocular muscles (CFEOM).

Methods: A total of 13 patients with genetically confirmed CFEOM (via genetic testing for mutations in KIF21A, PHOX2A, and TUBB3) were retrospectively identified after undergoing strabismus surgery at Boston Children's Hospital and surgical outcomes were compared.

Results: Age at first surgery ranged from 11 months to 63 years, with an average of 3 strabismus procedures per patient.

Transposition procedures in Duane retraction syndrome.

Duane retraction syndrome, or Duane syndrome (DS), is one of several congenital cranial dysinnervation disorders. Patients present with limited horizontal eye movement(s) and globe retraction with eyelid fissure narrowing on attempted adduction due to co-contraction of the lateral and medial rectus muscles in one or both eyes. Various surgical approaches have been proposed to improve binocular alignment, reduce head turn, and minimize undesirable up- or downshoots in DS.

Anomalous Vertical Deviations in Attempted Abduction Occur in the Majority of Patients With Esotropic Duane Syndrome.

Purpose: To describe a phenomenon, depression in attempted abduction, not previously recognized as a feature of Duane syndrome (DS).

Design: Retrospective, observational case series.

Methods: Setting: Institutional practice.

Congenital muscular dystrophy-dystroglycanopathy, type A, featuring bilateral retinal dysplasia and vertical angle kappa.

Muscular dystrophy-dystroglycanopathy type A (MDDGA3), one of a group of diseases collectively known as congenital muscular dystrophies, is an alpha-dystroglycanopathy with characteristic brain and ocular abnormalities. We report the case of a 9-month-old boy with developmental delay whose family sought evaluation for esotropia. Subsequent examination, imaging, and testing revealed significant motor and cognitive delay, marked weakness with appendicular spasticity, and a diffuse brain malformation.

Long-term Surgical Outcomes for Large-angle Infantile Esotropia.

Purpose: To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia.

Design: Multicenter, nonrandomized clinical study.

Methods: Setting: Two tertiary-care pediatric hospitals.