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David G Hunter - One of the best experts on this subject based on the ideXlab platform.
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the role of botulinum toxin in the treatment of strabismus
Seminars in Ophthalmology, 2019Co-Authors: Anna G Escuder, David G HunterAbstract:Purpose: To perform a systematic review of the application of botulinum toxin A (BTA) in the management of strabismus in the adult and pediatric populations. Materials and methods: A systematic literature search was performed using the Medline database. Results: In 1989, with the FDA approval of botulinum toxin (onabotulinum toxin A, or BTA) for the treatment of strabismus, patients were provided with an alternative to surgical recession. In this review, we discuss the uses of BTA in the treatment of acute onset comitant Esotropia or smaller angle Esotropia and as an adjunct to surgery for larger angle Esotropia or sixth nerve palsy. Its uses are also explored in intermittent exotropia and vertical strabismus, including thyroid-associated orbitopathy, fourth nerve palsies, and other orbital pathology. Discussion: Despite its transient kinetics, BTA can have permanent effects on ocular alignment, promoting binocularity and reduction of diplopia, and can serve as a primary treatment or a muscle sparing option in patients at risk of anterior segment ischemia or need for future surgeries.
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long term surgical outcomes for large angle infantile Esotropia
American Journal of Ophthalmology, 2018Co-Authors: Hedva Chiu, Michael J Wan, Ankoor S Shah, David G HunterAbstract: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. Study Population: Children with large-angle (≥55 prism diopters) infantile Esotropia. Intervention: Surgical treatment of infantile Esotropia. Main Outcome Measure: Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment). Results A total of 88 patients with large-angle infantile Esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus muscle recessions in 70 patients, botulinum toxin–augmented surgery in 15 patients, and 3-muscle surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent Esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin–augmented surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up. Conclusions The overall success rate for treatment of large-angle infantile Esotropia was poor in this cohort, with most failures owing to recurrent or residual Esotropia. Botulinum toxin–augmented surgery was associated with a higher success rate at final follow-up.
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superior rectus transposition vs medial rectus recession for treatment of esotropic duane syndrome
JAMA Ophthalmology, 2014Co-Authors: Shiqiang Yang, David G Hunter, Sarah Mackinnon, Linda R DagiAbstract:Importance Superior rectus transposition (SRT) with or without medial rectus recession (MRc) has been introduced as an alternative to MRc alone for treatment of esotropic Duane syndrome; however, the effectiveness of these procedures has not been compared previously. Objective To compare the safety and efficacy of MRc and SRT in treatment of Duane syndrome. Design, Setting, and Participants Retrospective medical record review of all patients with esotropic Duane syndrome who underwent surgical treatment from January 1, 2006, through December 31, 2012, in a multispecialty, hospital-based pediatric ophthalmology/adult strabismus practice at Boston Children’s Hospital. Patients in the SRT group underwent SRT with or without MRc; those in the non-SRT group underwent unilateral or bilateral MRc. Exposures Surgical treatment of esotropic Duane syndrome. Main Outcomes and Measures Binocular alignment, ocular ductions, head position, stereopsis, and fundus torsion were recorded before surgery and at the 2-month and final postoperative visits. We also evaluated postoperative drift. Results The medical record review identified 36 patients who underwent 37 procedures, including 19 in the SRT group (13 SRT + MRc and 6 SRT alone) and 18 in the non-SRT group (11 unilateral MRc and 7 bilateral medial rectus resession). Mean MRc was smaller when performed with SRT (3.3 vs 5.3 mm;P = .004). Although the initial deviation was larger in the SRT group, both groups had a similar improvement in Esotropia and head turn. Abduction improved by at least 1 unit in 15 of 19 patients in the SRT group (79%) vs 5 of 18 in the non-SRT group (28%). In 24 patients followed up for more than 6 months, mean Esotropia decreased from 8.2 to 6.1 prism diopters (Δ) in the SRT group (n = 12) but increased from 7.2 to 10.9Δ in the non-SRT group (n = 12). Conclusions and Relevance The combination of SRT and MRc was more effective than MRc or bilateral medial rectus resession at improving abduction while allowing for a smaller recession to align the eyes and eliminate a compensatory head posture. Although any surgery on the vertical rectus muscles should in theory increase the risk for vertical or torsional complications, to date this theory has not been borne out in our patients. Patients treated with SRT appear to have a reduced likelihood of long-term undercorrection. We therefore recommend SRT with adjustable MRc for treatment of Duane syndrome in patients with larger amounts of Esotropia.
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prevalence of systemic and ocular disease in infantile exotropia comparison with infantile Esotropia
Ophthalmology, 1999Co-Authors: David G Hunter, Forrest J EllisAbstract:Abstract Objective Exotropia in infancy is believed to be associated with an increased prevalence of neurologic, ocular, and craniofacial abnormalities; however, the prevalence of coexisting ocular and systemic disease in these patients is unknown. In this study, the prevalence of ocular disease and systemic illness was determined in patients diagnosed with exotropia in infancy. Design Observational comparative case series. Participants Medical records of 70 patients diagnosed with exotropia in the first year of life were reviewed and compared with records of 136 patients diagnosed with Esotropia before 1 year of age. Intervention Patients with no disorders (other than latent nystagmus, dissociated vertical deviation, or oblique muscle overaction) were grouped as "simple" strabismus. Patients with systemic disorders (including prematurity, neurologic disease, and genetic disease) and patients with ocular disorders (including congenital nystagmus, other strabismus, ptosis, and any condition associated with loss of vision [except amblyopia]) were grouped as "complex" strabismus. Main outcome measures Prevalence of coexisting systemic and ocular disorders. The demographics, strabismus measurements, and types of coexisting disease in the simple and complex groups were compared. Results A high percentage of both exotropia (67%) and Esotropia (49%) patients had a coexisting ocular or systemic abnormality. Exotropia patients with a constant strabismus were more likely to have coexisting ocular or systemic disease than those with an intermittent strabismus. Smaller angles of exotropia or Esotropia were associated with a higher likelihood of coexisting ocular or systemic diseases. Systemic disorders were found more frequently than ocular disorders in both the exotropia and Esotropia groups. In 25% of all patients referred for evaluation of strabismus, an additional ocular or systemic abnormality was discovered by the ophthalmologist. Conclusion Patients presenting to a university hospital-based practice in the first year of life with exotropia were more likely than those presenting with Esotropia to have coexisting ocular and systemic disease. Both groups had a notably high prevalence of associated disorders. The percentages measured in this population may not be applicable to other practices because of referral bias. However, clinicians should consider that children presenting with infantile exotropia and Esotropia appear to be at risk for coexisting ocular or systemic disease.
Brian G Mohney - One of the best experts on this subject based on the ideXlab platform.
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strabismus in childhood eyelid ptosis
American Journal of Ophthalmology, 2014Co-Authors: Gregory J Griepentrog, Brian G MohneyAbstract:Purpose To report the prevalence and causes of strabismus in children with eyelid ptosis diagnosed in a well-defined population over a 40-year period. Design Retrospective, population-based cohort study. Methods We retrospectively reviewed the charts of 107 patients ( Results Strabismus was diagnosed in 20 (18.7%) of the 107 patients with childhood ptosis. Of the 81 patients, 8 (9.9%) were diagnosed with simple congenital ptosis and had strabismus, of which there were 4 (4.9%) cases of exotropia and 4 (4.9%) cases of Esotropia. There were no cases of isolated vertical deviation. Conclusions Strabismus occurred in 1 of 5 children diagnosed with any form of childhood ptosis in this population-based cohort. Strabismus affected approximately 1 of 10 patients diagnosed with simple congenital ptosis, and a predominance of isolated horizontal deviations was equally divided between Esotropia and exotropia.
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postoperative outcomes in children with intermittent exotropia from a population based cohort
Journal of Aapos, 2009Co-Authors: Noha S Ekdawi, Kevin J Nusz, Nancy N Diehl, Brian G MohneyAbstract:Purpose To describe the long-term surgical outcomes in a population-based cohort of children with intermittent exotropia. Methods The medical records of all children ( Results Of 184 patients with intermittent exotropia, 61 (33%) underwent surgery at a mean age of 7.6 years (range, 3.2 to 23 years). Twelve of the 61 children (19.7%) underwent a second surgery (10 for recurrent exotropia and 2 for consecutive Esotropia), and no patient received 3 or more surgeries during a mean follow-up of 10 years from the first surgery. The final postoperative measurements were recorded in 56 of 61 patients (92%) at a mean of 7.4 years (range, 0 to 18 years) after the first surgery: 31 of the 56 (55%) were within 9 Δ of orthotropia at distance and 25 of 55 (45%) had better than 60 seconds of stereopsis. The Kaplan-Meier rate of developing ≥10 Δ of misalignment after the first surgery was 54% by 5 years, 76% by 10 years, and 86% by 15 years. Conclusions In this population-based study of surgery in children with intermittent exotropia, although only 1 in 5 received a second surgery, after a mean follow-up of 8 years, approximately half were successfully aligned and 45% had high-grade stereopsis.
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common forms of childhood strabismus in an incidence cohort
American Journal of Ophthalmology, 2007Co-Authors: Brian G MohneyAbstract:Purpose To report the prevalent forms of childhood strabismus. Design Retrospective, population-based cohort study. Methods The medical records of all Olmsted County, Minnesota, residents younger than 19 years diagnosed with Esotropia, exotropia, or hypertropia from January 1, 1985 through December 31, 1994, were reviewed. Results Six hundred twenty-seven new cases of childhood strabismus were identified during the 10-year study period, including 380 (60.1%) with Esotropia, 205 (32.7%) with exotropia, and 42 (6.7%) with hypertropia. The five most common forms of strabismus included accommodative Esotropia (27.9%), intermittent exotropia (16.9%), acquired nonaccommodative Esotropia (10.2%), Esotropia in children with an abnormal central nervous system (7.0%), and convergence insufficiency (6.4%). Conclusions This study provides population-based data on the most prevalent forms of childhood strabismus. Accommodative Esotropia, intermittent exotropia, and acquired nonaccommodative Esotropia were the predominant forms of strabismus in this Western population.
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common forms of childhood Esotropia
Ophthalmology, 2001Co-Authors: Brian G MohneyAbstract:Abstract Objective To determine the most common forms of childhood Esotropia. Design Prospective, consecutive, observational case series. Participants All esotropic children younger than 11 years of age from a predominantly rural Appalachian region evaluated from August 1, 1995 through July 31, 1998. Methods Demographic and clinical data were collected for all patients. Main outcome measures The percentage ratio of the various forms of childhood Esotropia. Results Two hundred twenty-one consecutive children without prior surgical treatment were evaluated for Esotropia. One hundred seventeen (52.9%) of the 221 children had some form of accommodative Esotropia, 38 (17.2%) were associated with congenital or acquired abnormalities of the central nervous system, 23 (10.4%) displayed acquired nonaccommodative Esotropia, 15 (6.8%) resulted from ocular sensory defects, 12 (5.4%) had confirmed congenital Esotropia, seven (3.2%) had paralytic Esotropia, and an unverified age at onset prevented an accurate categorization in the remaining nine (4.1%). Conclusions Children with accommodative Esotropia accounted for more than half of the study patients and were diagnosed nearly 10 times more frequently than children with congenital Esotropia. Esotropic patients with central nervous system defects or with an acquired nonaccommodative deviation were also more common than children with congenital Esotropia. Children with congenital Esotropia or with a paralytic or sensory cause of their deviation were relatively uncommon.
Ramesh Kekunnaya - One of the best experts on this subject based on the ideXlab platform.
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duane minus duane sine retraction and duane sine limitation possible incomplete forms of duane retraction syndrome
Eye, 2020Co-Authors: Ahmed Awadein, Shaimaa A Arfeen, Pratik Chougule, Ramesh KekunnayaAbstract:To report ocular motility patterns that mimic, but do not fulfil the full clinical picture of Duane retraction syndrome (DRS) and to describe their clinical features and surgical management. This is a retrospective case series study conducted on patients with DRS, mimicking non-comitant exotropia or Esotropia and a face turn. Patients were included only if they lacked either globe retraction on adduction (sine retraction) or limitation of adduction or abduction on ductions (sine limitation not >0.5). Any overshoots or pattern strabismus was recorded. The ocular motility and alignment, details of surgery and their surgical outcomes were analysed. Twenty-one patients were identified; 13 in the sine retraction and 8 in the sine limitation group. All patients presented with a compensatory face turn. Overshoots were present in 10 (77%) and 7 patients (88%) in the sine retraction and sine limitation groups, respectively. Forced duction test showed tightness of the ipsilateral medial and the ipsilateral lateral rectus muscle in esotropic (n = 3) and exotropic patients (n = 18), respectively. Orthotropia was achieved in 82% of patients following ipsilateral medial or lateral rectus muscle recession. There is a subset of patients who present with motility pattern similar to DRS but lack its complete diagnostic criteria. The presence of a face turn, overshoots on adduction or an ipsilateral tightness of the affected muscle should make one consider DRS sine retraction/sine limitation. The patients in our study responded well to lines of management similar to those of DRS.
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Consecutive cyclic Esotropia – A case report
'Medknow', 2019Co-Authors: Niranjan K Pehere, Usha B Kommineni, Ramesh KekunnayaAbstract:Cyclic Esotropia, a rare condition of obscure etiology characterized by regularly alternating periods of Esotropia and orthophoria. We present a case of a 7-year-old boy who underwent surgical correction for intermittent exotropia elsewhere and developed Esotropia with cyclic pattern post-operatively. Initially the cycle was of half-day orthophoria and half-day Esotropia, which later became one full day of Esotropia and one day of orthophoria. During re-surgery, right lateral rectus was found to have a stretched scar which was resected and then advanced and medial rectus was recessed. Post-surgery the child was orthophoric without cyclic pattern
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duane retraction syndrome causes effects and management strategies
Clinical Ophthalmology, 2017Co-Authors: Ramesh Kekunnaya, Mithila NegalurAbstract:Duane retraction syndrome (DRS) is a congenital eye movement anomaly characterized by variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or down-shoot. The etiopathogenesis of this condition can be explained by a spectrum of mechanical, innervational, neurologic and genetic abnormalities occurring independently or which influence each other giving rise to patterns of clinical presentations along with a complex set of ocular and systemic anomalies. Huber type I DRS is the most common form of DRS with an earlier presentation, while Huber type II is the least common presentation. Usually, patients with unilateral type I Duane syndrome have Esotropia more frequently than exotropia, those with type II have exotropia and those with type III have Esotropia and exotropia occurring equally common. Cases of bilateral DRS may have variable presentation depending upon the type of presentation in each eye. As regards its management, DRS classification based on primary position deviation as esotropic, exotropic or orthotropic is more relevant than Huber's classification before planning surgery. Surgical approach to these patients is challenging and must be individualized based on the amount of ocular deviation, abnormal head position, associated globe retraction and overshoots.
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a high prevalence of exotropia in patients with duane retraction syndrome in a tertiary eye care center in south india
Journal of Pediatric Ophthalmology & Strabismus, 2017Co-Authors: Manjushree Bhate, Virender Sachdeva, Ramesh KekunnayaAbstract:Purpose To determine the prevalence and clinical characteristics of patients with Duane retraction syndrome presenting with exotropia in a tertiary eye care center. Methods Medical records of 140 patients with Duane retraction syndrome and exotropia (of the total 441 patients with Duane retraction syndrome) seen from 2000 to 2009 were reviewed. Characteristics studied included age at presentation, gender, laterality, manifest primary position, abnormal head posture, ocular motility, and overshoots. Data were collected regarding associated ocular or systemic abnormalities and amblyopia. Results The mean age of the patients at presentation was 16.96 ± 15.09 years (range: 1 to 70 years). Of the 140 patients with Duane retraction syndrome and exotropia, 59 (42%) were male. Unilateral type I Duane retraction syndrome accounted for 118 (84.2%), type II for 7 (5%), and type III for 10 (7.1%) patients, whereas 5 (3.6%) had Duane retraction syndrome and bilateral exotropia. Duane retraction syndrome was seen in the left eye, right eye, and both eyes in 97 (69%), 37 (26%), and 6 (4%) patients, respectively. Exotropia ranged from 10 to 60 prism diopters. An abnormal head posture was noted in 101 (72%) and upshoot in 26 (18.6%) patients. Reported ocular and systemic abnormalities in these patients included cataract (6), aniridia (1), nasolacrimal duct block (1), and retinal breaks (1). Conclusions This is an exclusive study on a large series of patients with Duane retraction syndrome and exotropia. Almost one-third of patients with Duane retraction syndrome patients might have exotropia. Although patients with Duane retraction syndrome and exotropia had clinical characteristics and associations similar to those with Duane retraction syndrome and Esotropia, there was an increased propensity for overshoots and face turn opposite to the affected eye, which the authors hypothesize to be due to a tight or short lateral rectus muscle. [J Pediatr Ophthalmol Strabismus. 2017;54(2):117-122.].
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comparison of augmented superior rectus transposition with medial rectus recession for surgical management of esotropic duane retraction syndrome
Journal of Aapos, 2015Co-Authors: Shailja Tibrewal, Virender Sachdeva, Mohammed Hasnat Ali, Ramesh KekunnayaAbstract:Background Medial rectus recession (MRc) and vertical rectus transpositions are procedures used to treat esotropic Duane retraction syndrome. Recently superior rectus transposition (SRT) combined with MRc has also been shown to improve primary alignment and abduction. The purpose of this study is to compare the results of augmented (ie, with scleral fixation) SRT with or without MRc with either unilateral or bilateral MRc for treatment of esotropic Duane syndrome. Methods The medical records of patients who underwent surgery for esotropic Duane syndrome between May 2007 and February 2013 were retrospectively reviewed. Success was defined as alignment within 8 Δ of orthotropia and abnormal head posture of Results There were 8 patients in the SRT group (6 of whom had additional ipsilateral MRc) and 13 in the MRc group (6 unilateral and 7 bilateral). In the SRT group, the mean preoperative deviation was 20 Δ of Esotropia; the mean postoperative deviation, 3 Δ . In the MRc group, the mean preoperative deviation was 24 Δ of Esotropia; the mean postoperative deviation, 4 Δ . The success rate was 87% in the SRT group; 77%, in MRc group ( P = 0.98). Mean abduction limitation improved from −3.6 to −2.4 units in the SRT group and from −3.6 to −3.3 units in the MRc group ( P = 0.003). Induced vertical deviation or subjective torsion was not seen. Three patients in each group developed adduction limitation postoperatively. Conclusions Although both the procedures successfully correct Esotropia in Duane syndrome, SRT with or without MRc has the additional advantage of improving abduction.
Joseph L. Demer - One of the best experts on this subject based on the ideXlab platform.
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consecutive exotropia why does it happen and can medial rectus advancement correct it
Journal of Aapos, 2014Co-Authors: Bhambi Uellyn Gesitede A Leon, Joseph L. DemerAbstract:Purpose To investigate whether consecutive exotropia following medial rectus muscle recession is associated with muscle slippage and to assess the effectiveness of treating the condition with medial rectus advancement. Methods The records of patients with consecutive exotropia after medial rectus recession were reviewed to determine medial rectus muscle insertion location at the time of advancement surgery. Measurements before and after medial rectus advancement were compared. Success was defined as alignment within 10 Δ of orthotropia. The dose effect of medial rectus advancement was determined by nonlinear regression. Results A total of 20 patients were included. The mean age (± standard deviation) at time of surgery was 19 ± 19 years (range, 1.1-65.4). The mean preoperative exotropia was 28 Δ ± 16 Δ (range, 12 Δ -60 Δ ). Medial rectus slippage of 2.5 ± 1.7 mm (range, 1.0–5.0 mm) was found in 14 patients (36%) who had previously undergone medial rectus recession. Surgery corrected about 4 Δ of exotropia per mm total medial rectus advancement. Although 95% of patients were aligned successfully immediately after surgery, averaging 2 Δ ± 4 Δ Esotropia, there was significant late exodrift, averaging 17 Δ at final follow-up. At final follow-up, 1.6 ± 1.8 (range, 0.10-6.2) years after surgery, 50% of patients maintained alignment within 10 Δ of orthotropia (mean, 3 Δ ± 4 Δ exotropia); the rest experienced recurrent exotropia of 25 Δ ± 8 Δ . Conclusions Medial rectus slippage is common in consecutive exotropia. Medial rectus advancement effectively treated consecutive exotropia, whether or not there was muscle slippage. It is however, associated with late exodrift; hence patients should be warned about potential for further XT recurrence.
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Surgical outcomes following rectus muscle plication: a potentially reversible, vessel-sparing alternative to resection.
JAMA Ophthalmology, 2014Co-Authors: Zia Chaudhuri, Joseph L. DemerAbstract:Importance Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection. Objective To compare the surgical dose effect of plication with that of resection. Design, Setting, and Participants Retrospective comparison of surgical outcomes in an academic pediatric ophthalmology and strabismus practice from July 25, 2005, through March 28, 2013, with a mean follow-up of 137 days for plication and 1243 days for resection. A single surgeon performed all procedures. Twenty-two consecutive patients underwent bilateral horizontal rectus plication or plication combined with antagonist recession (13 with Esotropia and 9 with exotropia; mean [SD] age, 38 [21] years). Thirty-one consecutive patients underwent bilateral resection or resection combined with antagonist recession (12 with Esotropia and 19 with exotropia; mean [SD] age, 28 [24] years). Six patients underwent vertical rectus plication. Exposures Rectus resection or plication performed by folding the anterior tendon posteriorly under the muscle margins oversewn to the poles of the scleral insertion, avoiding the anterior ciliary arteries. Main Outcomes and Measures Postoperative binocular alignment at the first postoperative and last available examinations. Results Lateral rectus plication (mean [SD], 6.5 [2.2] mm) and resection (6.6 [1.6] mm) were performed for similar magnitudes of Esotropia (27.9 [13.4] prism diopters [PD] for plication, 29.0 [15.2] PD for resection; P = .44). Mean (SD) initial correction by lateral rectus plication was 5.17 (0.29) PD/mm, slightly less than the 95% CI (5.51-7.75 PD/mm) for resection (6.63 [0.50] PD/mm). Medial rectus plication (mean [SD], 4.9 [0.9] mm) vs resection (5.1 [1.1] mm) was performed for similar magnitudes of exotropia (32.8 [14.2] PD for plication, 31.2 [15.6] PD for resection; P = .33). Mean (SD) initial correction by medial rectus plication (7.10 [1.65] PD/mm) was within the 95% CI (4.65-9.87 PD/mm) for resection (7.26 [1.23] PD/mm). Initial and late effects were similar. Ciliary circulation observed at surgery remained patent after plication. Plication was cosmetically acceptable and did not produce conspicuous tissue elevations. Conclusions and Relevance Horizontal rectus muscle plication is a rapidly performed, technically simple surgical procedure to strengthen the rectus muscles, with an equivalent (per millimeter) in surgical effect to that of medial rectus resection for treatment of Esotropia and exotropia. Plication diminishes surgical trauma and does not intentionally sacrifice ciliary circulation, with the potential for reversal by suture release in the first postoperative days.
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muscle path length in horizontal strabismus
Journal of Aapos, 2014Co-Authors: Ronen Rabinowitz, Joseph L. DemerAbstract:Background Sarcomere adaptation has been proposed as a mechanism for the adjustment of rectus muscle length in regulating binocular alignment. The purpose of this study was to investigate whether horizontal rectus muscle paths have abnormal lengths in subjects with intermittent or alternating strabismus. Methods High-resolution, surface coil magnetic resonance imaging was obtained in 2 mm thick axial planes in strabismic patients who had not undergone prior surgery and normal control subjects. The lengths of horizontal rectus muscle paths were measured digitally in central gaze for the fixating eye only and compared. Results A total of 12 strabismic subjects and 13 controls were included: 8 subjects had Esotropia averaging 30 Δ , and 4 had exotropia averaging 47 Δ . The sample had 80% power to detect muscle path length changes of at least the typical surgical doses appropriate to strabismus surgery for correction of the mean deviations in each group, had such changes existed. Mean (± standard deviation) medial rectus path length was 35.0 ± 4.1 mm in controls, not significantly different from 36.3 ± 1.7 mm in exotropia ( P = 0.56) or 35.8 ± 2.9 mm in Esotropia ( P = 0.62). Mean lateral rectus path length in controls was 35.7 ± 4.0 mm, not significantly different from the values of 39.6 ± 3.8 mm in exotropia ( P = 0.09) and 37.8 ± 3.3 ( P = 0.19) mm in Esotropia. Conclusions Horizontal rectus muscle path lengths are not significantly abnormal in commonly encountered intermittent or alternating Esotropia and exotropia.
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functional magnetic resonance imaging of horizontal rectus muscles in Esotropia
Journal of Aapos, 2013Co-Authors: Kirsta Schoeff, Zia Chaudhuri, Joseph L. DemerAbstract:Purpose Monkey neurophysiology suggests that changes in neural drive rather than extraocular muscle structure underlie sensory-induced strabismus. If this is true, then extraocular muscle structure should be normal. We used magnetic resonance imaging to measure horizontal rectus muscle size and contractility to determine whether muscle structure is a factor in human concomitant Esotropia. Methods High-resolution, quasicoronal plane magnetic resonance imaging was performed in target-controlled central gaze, abduction, and adduction in 13 orthotropic controls (mean age, 38 ± 19 years) and 12 adults (mean age, 52 ± 16 years) who had concomitant Esotropia averaging 28 Δ ± 18 Δ at distance. Thyroid ophthalmopathy was excluded. Horizontal rectus muscle cross sections were determined in 6 contiguous, 2-mm-thick midorbital image planes. Contractility was computed in each plane as the difference in cross section from contraction to relaxation. Results Medial rectus muscle cross sections in multiple planes averaged up to 39% larger in esotropic patients than in controls ( P P P Conclusions Medial rectus muscle size is supernormal and lateral rectus muscle size is not subnormal in concomitant Esotropia. This finding indicates that human concomitant Esotropia is associated with peripheral muscular abnormality.
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decreased postoperative drift in intermittent exotropia associated with a and v patterns
Journal of Aapos, 2009Co-Authors: Stacy L Pineles, Arthur L Rosenbaum, Joseph L. DemerAbstract:Introduction Few data exist concerning postoperative drift in patients with intermittent exotropia who have coexistent A or V patterns. In addition, the impacts of pattern collapse and surgical method on postoperative drift have not been well addressed. Methods We retrospectively reviewed the records of 132 patients who had surgery for intermittent exotropia and had ≥6 months' follow-up. Mean postoperative drift in 66 patients with pattern exotropia was compared with a nonpattern (comitant) group matched for surgeon, age, surgical method, and initial deviation. Postoperative drift was calculated by subtracting the deviation at postoperative day 1 from that at approximately 6 weeks, 6 months, 9 months, and >1 year. Results Pattern and comitant groups were similar in mean ± SD age (15 ± 17 years), follow-up (2.3 ± 2 years), preoperative exotropia (23 Δ ± 11 Δ ), initial postoperative deviation (1 Δ ± 5 Δ Esotropia), and surgical technique. Patients with pattern intermittent exotropia showed significantly ( p p Conclusion Postoperative drift in patients with A- or V-pattern intermittent exotropia is consistently less than in comitant exotropia, particularly if the pattern persists postoperatively and if the exotropia is undercorrected. Therefore, surgeons should consider smaller early overcorrections in pattern than comitant intermittent exotropia. Lesser postoperative drift in pattern exotropia may suggest differing underlying causes of pattern vs nonpattern exotropia.
Nada Al Tassan - One of the best experts on this subject based on the ideXlab platform.
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Infantile Esotropia could be oligogenic and allelic with Duane retraction syndrome.
Molecular vision, 2011Co-Authors: Arif O. Khan, Jameela Shinwari, Latifa Al Sharif, Dania S. Khalil, Saeed Al-gehedan, Nada Al TassanAbstract:Purpose: To describe phenotyping and linkage analysis results for available members from a consanguineous nuclear family with hereditary congenital strabismus. Methods: Both parents and all 12 children underwent clinical examination. Available affected and several unaffected family members had venous blood sampling for DNA extraction and 10K single nucleotide polymorphism (SNP) genotyping (Affymetrix Gene Chip® Human). Multipoint logarithm of the odds (LOD) score calculations were performed assuming an autosomal recessive mode of inheritance with 100% penetrance and disease allele frequency of 0.01%. Results: Three children had non-syndromic large-angle infantile Esotropia without significant hyperopia. A fourth child had left esotropic Duane retraction syndrome. A fifth child who had Esotropia in the setting of prematurity and childhood poliomyelitis was excluded from the analysis. A sixth child had keratoconus and was excluded. Both parents and the remaining 6 children had no significant orthoptic or ophthalmic findings. Using linkage analysis including the 4 esotropic children, disease loci were mapped to regions on chromosomes 3p26.3–26.2 and 6q24.2–25.1 using multipoint linkage analysis with LOD scores of 3.18 and 3.25 respectively. Linkage to these regions persisted when the esotropic Duane retraction syndrome patient was excluded from the linkage analysis (LOD scores of 2.00 and 2.32, respectively). Conclusions: Non-syndromic infantile Esotropia could be related to susceptibility loci on chromosomal regions 3p26.3– 26.2 and 6q24.2–25.1 and may share alleles that underlie Duane retraction syndrome.