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Paralytic strabismus in adults and the risk for mental health disorders
e44 of intraventricular hemorrhage (P 5 1.000), development of septicemia (P 5 1.00) and respiratory distress syndrome (P 5 0.767). Results: We included 26 infants in the treatment group and 18 infants in the control. The mean gestational age for the treatment group was 24.85 weeks 1.71 and 25.28 weeks 1.31 for the control (P 5 0.374). The mean birth weight for the treatment group was 0.677 kg 0.20 and 0.71 kg 0.11 for the control (P 5 0.575). The mean magnesium level was 2.585 0.540 in the treatment group and 2.171 0.590 for the control group (P 5 0.03). The magnesium level tended to drop significantly over time in the treatment group when compared to the control group (P 5 0.050). Discussion: The serum magnesium level was higher in the treatment group, but tended to drop significantly when compared to the control group. Conclusions: The serum magnesium level may play an important role in the development and severity of retinopathy of prematurity. 146 Pediatric corneal topography: feasibility and findings in three pediatric risk groups. Rebecca Neustein, James B. Randleman, Phoebe D. Lenhart Introduction: While global consensus exists for the definition of progressive keratoconus in adults, the best ways of identifying children at risk have not been established. The present study investigated the utility of 3 corneal screening devices in 3 groups of children. Methods:IRB approved, prospective cohort study of patients with trisomy 21 (group 1), first-degree relative with keratoconus/significant refractive error (group 2), or control (group 3) enrolled at Emory Eye Center. Informed consent was obtained before testing with Pentacam, Orbscan, and Ocular Response Analyzer (ORA). Ability to complete tests, quality of test results, and corneal parameters obtained for each eye were recorded. A 1-way ANOVA test compared results between the 3 groups. Results: Fifty-four patients age 7-17 years (mean, 11.74) were enrolled July 2014-July 2016. Number of patients in and percentage of tests completed for groups 1, 2, and 3 respectively: 12, 55%; 21, 87%; 21, 88%. Pentacam values by group: central corneal thickness (CCT) 524, 543, 542 P 5 0.36; thinnest point (TP) 498, 536, 534 P 5 0.03; corneal front mean keratometry 44.94, 43.17, 43.22 P 5 0.01; quality score 1.42, 0.22, 0.04 P \ 0.0001. Orbscan: CCT 493, 551, 550 P 5 0.01; TP 451, 536, 538 P \ 0.0001. ORA: corneal hysteresis 10.6, 12.1, 11.6 P 5 0.124; corneal resistance factor 9.9, 11.8, 11.6 P 5 0.03; waveform score 5.6, 7.6, 7.3 P \ 0.0001. Discussion: Children with trisomy 21 completed fewer tests reliably, had thinner corneas, and lower corneal resistance factors than children in groups 2 and 3. Conclusions: Corneal tests used to evaluate adults for keratoconus may not be reliable for the evaluation of certain high-risk pediatric patients. 147 Paralytic strabismus in adults and the risk for mental health disorders. Brian G. Mohney, Kristin D. Nguyen, Nancy N. Diehl Introduction: Children and adults with some forms of strabismus have recently been shown to be at an increased risk of developing mental illness. The purpose of this study was to determine if adults with paralytic strabismus are similarly at risk. Methods: The medical records of all patients (n 5 302) diagnosed as adults with a new-onset, paralytic strabismus in a defined population
Volume 21 Number 4 / August 2017 from January 1, 1985, through December 31, 2004, were retrospectively reviewed. Each case was compared with a sex- and birthdate-matched nonstrabismic control. Results: Although the entire cohort of strabismic adults was no more likely than controls to also have a diagnosis of mental illness (P 5 0.14), depressive disorders (P 5 0.003), sleep-wake disorders (P \ 0.001), and neurocognitive disorders (P 5 0.022) were more common among strabismic adults compared to controls. Similarly, while each subset of paralytic strabismus was not associated with an increased risk of mental illness, oculomotor palsy, abducens palsy, and INO were found to have more sleep-wake disorders compared to controls (P 5 0.002, P 5 0.002, P 5 0.021, resp.) while trochlear nerve palsies were more likely to have depressive disorders (P 5 0.043). Discussion: Mental illness is prevalent among adults with and without strabismus, with mental illness more often preceding the diagnosis of strabismus. However, adults with some forms of strabismus are significantly more likely to have sleep-wake disorders and depression, which generally occurred following the diagnosis of strabismus. Conclusions: Mental health disorders are common among adults with and without strabismus. The specific disorders of neurocognition, depression, and sleep-wake cycles appear to be elevated among strabismic adults compared to controls. 148 Outcomes of strabismus surgery following retinal detachment surgery. Lindsay D. Rothfield, Carla J. Osigian, Kara M. Cavuoto, Oriel Spierer, Hilda Capo Introduction: Strabismus and diplopia following retinal detachment (RD) surgery occur in 3.8%-25% of cases. Anatomical success rates of strabismus surgery range from 47%-80%. Diplopia is alleviated in up to 60% of cases. Our study reports factors associated with successful motor and sensory surgical outcomes of strabismus surgery after RD repair. Methods: Retrospective review of medical records. Results: A total of 25 patients were included; 22 had scleral buckle procedures with or without vitrectomy and 3 had only vitrectomy. 88% had surgery in the eye with RD repair. There were no intraoperative or postoperative complications. No cases required scleral buckle removal. Motor surgical success rate (defined as horizontal of \10D, vertical of \4D) was 76% after 1.05 0.2 surgeries. Motor success rate was higher with preoperative horizontal deviations \25D (P 5 0.02). 60% patients had persistent diplopia postoperatively. Of these, 9 patients had diplopia despite successful motor outcome, but visual acuity, number of previous retina surgeries, macular involvement, and preoperative deviation were not significantly correlated with diplopia persistence. Discussion: Motor surgical success can be achieved in the majority of patients undergoing strabismus surgery after RD surgery without need of scleral buckle removal. However, persistence of diplopia postoperatively is frequent, even after successful anatomical outcomes. Conclusions: Smaller preoperative horizontal deviations are associated with better surgical outcomes. Postoperative binocular disturbances are common in spite of good motor alignment, and do not seem to be statistically associated with visual acuity, macular involvement, preoperative deviations or number of retina surgeries.
Journal of AAPOS
Volume 21 Number 4 / August 2017 from January 1, 1985, through December 31, 2004, were retrospectively reviewed. Each case was compared with a sex- and birthdate-matched nonstrabismic control. Results: Although the entire cohort of strabismic adults was no more likely than controls to also have a diagnosis of mental illness (P 5 0.14), depressive disorders (P 5 0.003), sleep-wake disorders (P \ 0.001), and neurocognitive disorders (P 5 0.022) were more common among strabismic adults compared to controls. Similarly, while each subset of paralytic strabismus was not associated with an increased risk of mental illness, oculomotor palsy, abducens palsy, and INO were found to have more sleep-wake disorders compared to controls (P 5 0.002, P 5 0.002, P 5 0.021, resp.) while trochlear nerve palsies were more likely to have depressive disorders (P 5 0.043). Discussion: Mental illness is prevalent among adults with and without strabismus, with mental illness more often preceding the diagnosis of strabismus. However, adults with some forms of strabismus are significantly more likely to have sleep-wake disorders and depression, which generally occurred following the diagnosis of strabismus. Conclusions: Mental health disorders are common among adults with and without strabismus. The specific disorders of neurocognition, depression, and sleep-wake cycles appear to be elevated among strabismic adults compared to controls. 148 Outcomes of strabismus surgery following retinal detachment surgery. Lindsay D. Rothfield, Carla J. Osigian, Kara M. Cavuoto, Oriel Spierer, Hilda Capo Introduction: Strabismus and diplopia following retinal detachment (RD) surgery occur in 3.8%-25% of cases. Anatomical success rates of strabismus surgery range from 47%-80%. Diplopia is alleviated in up to 60% of cases. Our study reports factors associated with successful motor and sensory surgical outcomes of strabismus surgery after RD repair. Methods: Retrospective review of medical records. Results: A total of 25 patients were included; 22 had scleral buckle procedures with or without vitrectomy and 3 had only vitrectomy. 88% had surgery in the eye with RD repair. There were no intraoperative or postoperative complications. No cases required scleral buckle removal. Motor surgical success rate (defined as horizontal of \10D, vertical of \4D) was 76% after 1.05 0.2 surgeries. Motor success rate was higher with preoperative horizontal deviations \25D (P 5 0.02). 60% patients had persistent diplopia postoperatively. Of these, 9 patients had diplopia despite successful motor outcome, but visual acuity, number of previous retina surgeries, macular involvement, and preoperative deviation were not significantly correlated with diplopia persistence. Discussion: Motor surgical success can be achieved in the majority of patients undergoing strabismus surgery after RD surgery without need of scleral buckle removal. However, persistence of diplopia postoperatively is frequent, even after successful anatomical outcomes. Conclusions: Smaller preoperative horizontal deviations are associated with better surgical outcomes. Postoperative binocular disturbances are common in spite of good motor alignment, and do not seem to be statistically associated with visual acuity, macular involvement, preoperative deviations or number of retina surgeries.
Journal of AAPOS