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The relationship between magnitude of anisometropia and amblyopia depth
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Abstracts
Volume 11 Number 1 February 2007
cle was measured before and after severing the frenulum. Results: For the first group, the anterior edge of the SO tendon moved 5.9 ⫹ 0.2, 8.0 ⫹ 0.2, 9.8 ⫹ 0.3, 10.5 ⫹ 0.2, and 11.5 ⫹ 0.3 mm for superior rectus suspension distances of 6, 8, 10, 12, 14 mm, respectively. After severing the frenulum, the superior oblique tendon moved less (0.3 ⫹ 0.5, 0.6 ⫹ 0.5, 0.7 ⫹ 0.3, 1.0 ⫹ 0.4, 1.2 ⫹ 0.6 mm). For the second group, the mean recession distance of the superior oblique tendon insertion after disinsertion, before and after stripping the frenulum, was 2.4 ⫹ 0.3 and 8.5 ⫹ 0.6 mm, respectively ( paired t-test ⫽ 0.001). Discussion: The frenulum constrains recession of the superior oblique tendon after disinsertion and pulls the tendon posteriorly as the superior rectus is recessed. Conclusion: The relative location of the SR muscle and the SO tendon is influenced by a fascial connection between them. This may have important surgical implications.
any abnormalities or complications occurring during the first 2 months after the strabismus surgery. Abnormalities were defined as any unusual amount of discharge, pain, swelling, or redness. Results: Complete documentation was found for 1502 patients. Single-dose povidone-iodine prophylaxis was used in 950 cases (63%) and a topical antibiotic/steroid combination was used in 552 cases (37%). Of the 1502 cases, possible infection occurred in 43 patients (2.86%). Of the 43 possible infections, 17 (3.08%) occurred in 552 patients on an antibiotic/steroid combination and 26 (2.74%) occurred in the 950 patients treated with singledose povidone-iodine prophylaxis. This difference was not statistically significant ( p ⫽ 0.7008). No cases of orbital cellulitis or endophthalmitis occurred in either group. Conclusions: Singledose povidone-iodine is a safe and inexpensive alternative to postoperative antibiotic/steroid prophylaxis in routine strabismus surgery.
Treatment outcomes following toddler photoscreening. Valerie Kirk, Michelle M. Clausen, Mary Diane Armitage, Robert W. Arnold Background: If we can get reliable objective refractive screening in infants, is it any better than waiting for preschool acuity screening? Conventional vision screening and PEDIG amblyopia studies rely on the ability to attain monocular acuity cooperation, whereas objective screening for amblyopiagenic factors can be done at much younger ages. Donahue just reported that such early intervention can be better. Methods: The IRB-approved Alaska Blind Child Discovery (ABCD) has community photoscreened with 85% PPV, 5.7% referral in over 21,000 children since 1996. All those “positive” interpreted images for “toddlers” (less than 48 months) followed until older than 6 years were reviewed for treatment compliance and success. Results: ABCD interpreted 410 toddlers as “positive” who were now older than 6 years. The positive-predictive value using AAPOS criteria was 87%. Of children photoscreened before age 2 (36%) and compliant with treatment, none had eventual acuity worse than 20/ 32, whereas the 64% aged 2.1 to 4.0 years at age of photoscreening, 23% did not achieve best corrected acuity better than 20/32. Conclusions: To our knowledge, ABCD and Tennessee Lion’s are the only venerable, ongoing state efforts from which outcome of amblyopia treatment endpoint can be currently assessed for community-screened infants and toddlers; we concur with the increased value of objective screening in toddlers.
The relationship between magnitude of anisometropia and amblyopia depth. Alejandro Leon, Sean P. Donahue, David G. Morrison, Robert L. Estes, Chun Li Introduction: Anisometropia is a significant cause of amblyopia. The relationship between anisometropia depth and amblyopia magnitude is not well characterized since previous studies only included patients identified because of their amblyopia. We analyzed results from anisometropic patients identified with photoscreening to eliminate this selection bias. Methods: Retrospective review of 721 charts of anisometropic children identified over a 6-year period. Visual acuity, cycloplegic refraction data, and age were used for analysis. Amblyopia was defined as two or more lines decrease in visual acuity. Patients with anisometropia greater than 1 D difference were included. We grouped anisometropia greater than 1 and less than 2 D as mild, 2 to 4 D as moderate, and greater than 4 D as severe. Results: Amblyopia prevalence and depth both increased with greater anisometropia ( p ⬍ 0.001). Patient age and anisometropia magnitude impacted amblyopia severity ( p ⬍ 0.001). There was no correlation between age and depth of anisometropia ( p ⫽ 0.65). Prevalence of four or more lines amblyopia was 14.3, 37.6, and 51.2% in the mild, moderate, and severe anisometropia patients, respectively. Discussion: Patients with deeper anisometropia have greater magnitude of amblyopia. Visual screening should aim to detect patients with highest magnitude of refractive error.
Postoperative povidine-iodine prophylaxis in strabismus surgery. Natalie Marie Koederitz, Daniel E. Neely, David A. Plager, Blair Boehmer, Derek Sprunger, Naval Sondhi Introduction: While antibiotic/steroid combinations are routinely administered during the first week after strabismus surgery; they are costly, inconvenient, and may be unnecessary. The purpose of this study was to evaluate the safety and efficacy of single-dose 5% povidone-iodine drops as a prophylaxis against postoperative infection in extraocular muscle surgery. Methods: Retrospective chart review was performed of 1752 patients undergoing strabismus surgery from January 2002 to June 2006. Patients received either a single application of 5% povidoneiodine solution to the operative eye(s) at the conclusion of the surgical procedure or they received a standard week-long course of topical antibiotic/steroid. If treated with only the single dose of povidone-iodine, patients did not receive any additional postoperative antibiotics or steroids. Postoperative records, including office visits and telephone logs, were then reviewed to identify
Dissociated vertical deviation in patients with intermittent exotropia. Hyun Taek Lim, David R. Smith, Stephen P. Kraft, J. Raymond Buncic Introduction: Dissociated vertical deviation (DVD) is a unique ocular motor disorder regarded as a marker of early disruption of normal binocular interactions. Although it is commonly associated with infantile esotropia, DVD may also occur in patients with intermittent exotropia [X(T )] in whom binocular functions are relatively normal. The purpose of our study was to describe the clinical characteristics of DVD in patients with X(T ). Methods: Retrospective medical record review (1996 to 2005) for patients with a diagnosis of X(T ) with concurrent DVD was performed. Data collected included age of onset, strabismus measurements, response of DVD to Bielschowsky head tilt test (BHTT ), degree of stereopsis, and amblyopia status. Results: Fifty children (mean age: 8.0 ⫾ 2.5 years) were identified. Mean age of strabismus onset was 12.7 ⫾ 6.0 months. Mean amount of exodeviation and DVD in primary position was 25.4 ⫾ 5.8 and 9.7 ⫾ 3.8⌬, respectively.
Journal of AAPOS
Abstracts
Volume 11 Number 1 February 2007
cle was measured before and after severing the frenulum. Results: For the first group, the anterior edge of the SO tendon moved 5.9 ⫹ 0.2, 8.0 ⫹ 0.2, 9.8 ⫹ 0.3, 10.5 ⫹ 0.2, and 11.5 ⫹ 0.3 mm for superior rectus suspension distances of 6, 8, 10, 12, 14 mm, respectively. After severing the frenulum, the superior oblique tendon moved less (0.3 ⫹ 0.5, 0.6 ⫹ 0.5, 0.7 ⫹ 0.3, 1.0 ⫹ 0.4, 1.2 ⫹ 0.6 mm). For the second group, the mean recession distance of the superior oblique tendon insertion after disinsertion, before and after stripping the frenulum, was 2.4 ⫹ 0.3 and 8.5 ⫹ 0.6 mm, respectively ( paired t-test ⫽ 0.001). Discussion: The frenulum constrains recession of the superior oblique tendon after disinsertion and pulls the tendon posteriorly as the superior rectus is recessed. Conclusion: The relative location of the SR muscle and the SO tendon is influenced by a fascial connection between them. This may have important surgical implications.
any abnormalities or complications occurring during the first 2 months after the strabismus surgery. Abnormalities were defined as any unusual amount of discharge, pain, swelling, or redness. Results: Complete documentation was found for 1502 patients. Single-dose povidone-iodine prophylaxis was used in 950 cases (63%) and a topical antibiotic/steroid combination was used in 552 cases (37%). Of the 1502 cases, possible infection occurred in 43 patients (2.86%). Of the 43 possible infections, 17 (3.08%) occurred in 552 patients on an antibiotic/steroid combination and 26 (2.74%) occurred in the 950 patients treated with singledose povidone-iodine prophylaxis. This difference was not statistically significant ( p ⫽ 0.7008). No cases of orbital cellulitis or endophthalmitis occurred in either group. Conclusions: Singledose povidone-iodine is a safe and inexpensive alternative to postoperative antibiotic/steroid prophylaxis in routine strabismus surgery.
Treatment outcomes following toddler photoscreening. Valerie Kirk, Michelle M. Clausen, Mary Diane Armitage, Robert W. Arnold Background: If we can get reliable objective refractive screening in infants, is it any better than waiting for preschool acuity screening? Conventional vision screening and PEDIG amblyopia studies rely on the ability to attain monocular acuity cooperation, whereas objective screening for amblyopiagenic factors can be done at much younger ages. Donahue just reported that such early intervention can be better. Methods: The IRB-approved Alaska Blind Child Discovery (ABCD) has community photoscreened with 85% PPV, 5.7% referral in over 21,000 children since 1996. All those “positive” interpreted images for “toddlers” (less than 48 months) followed until older than 6 years were reviewed for treatment compliance and success. Results: ABCD interpreted 410 toddlers as “positive” who were now older than 6 years. The positive-predictive value using AAPOS criteria was 87%. Of children photoscreened before age 2 (36%) and compliant with treatment, none had eventual acuity worse than 20/ 32, whereas the 64% aged 2.1 to 4.0 years at age of photoscreening, 23% did not achieve best corrected acuity better than 20/32. Conclusions: To our knowledge, ABCD and Tennessee Lion’s are the only venerable, ongoing state efforts from which outcome of amblyopia treatment endpoint can be currently assessed for community-screened infants and toddlers; we concur with the increased value of objective screening in toddlers.
The relationship between magnitude of anisometropia and amblyopia depth. Alejandro Leon, Sean P. Donahue, David G. Morrison, Robert L. Estes, Chun Li Introduction: Anisometropia is a significant cause of amblyopia. The relationship between anisometropia depth and amblyopia magnitude is not well characterized since previous studies only included patients identified because of their amblyopia. We analyzed results from anisometropic patients identified with photoscreening to eliminate this selection bias. Methods: Retrospective review of 721 charts of anisometropic children identified over a 6-year period. Visual acuity, cycloplegic refraction data, and age were used for analysis. Amblyopia was defined as two or more lines decrease in visual acuity. Patients with anisometropia greater than 1 D difference were included. We grouped anisometropia greater than 1 and less than 2 D as mild, 2 to 4 D as moderate, and greater than 4 D as severe. Results: Amblyopia prevalence and depth both increased with greater anisometropia ( p ⬍ 0.001). Patient age and anisometropia magnitude impacted amblyopia severity ( p ⬍ 0.001). There was no correlation between age and depth of anisometropia ( p ⫽ 0.65). Prevalence of four or more lines amblyopia was 14.3, 37.6, and 51.2% in the mild, moderate, and severe anisometropia patients, respectively. Discussion: Patients with deeper anisometropia have greater magnitude of amblyopia. Visual screening should aim to detect patients with highest magnitude of refractive error.
Postoperative povidine-iodine prophylaxis in strabismus surgery. Natalie Marie Koederitz, Daniel E. Neely, David A. Plager, Blair Boehmer, Derek Sprunger, Naval Sondhi Introduction: While antibiotic/steroid combinations are routinely administered during the first week after strabismus surgery; they are costly, inconvenient, and may be unnecessary. The purpose of this study was to evaluate the safety and efficacy of single-dose 5% povidone-iodine drops as a prophylaxis against postoperative infection in extraocular muscle surgery. Methods: Retrospective chart review was performed of 1752 patients undergoing strabismus surgery from January 2002 to June 2006. Patients received either a single application of 5% povidoneiodine solution to the operative eye(s) at the conclusion of the surgical procedure or they received a standard week-long course of topical antibiotic/steroid. If treated with only the single dose of povidone-iodine, patients did not receive any additional postoperative antibiotics or steroids. Postoperative records, including office visits and telephone logs, were then reviewed to identify
Dissociated vertical deviation in patients with intermittent exotropia. Hyun Taek Lim, David R. Smith, Stephen P. Kraft, J. Raymond Buncic Introduction: Dissociated vertical deviation (DVD) is a unique ocular motor disorder regarded as a marker of early disruption of normal binocular interactions. Although it is commonly associated with infantile esotropia, DVD may also occur in patients with intermittent exotropia [X(T )] in whom binocular functions are relatively normal. The purpose of our study was to describe the clinical characteristics of DVD in patients with X(T ). Methods: Retrospective medical record review (1996 to 2005) for patients with a diagnosis of X(T ) with concurrent DVD was performed. Data collected included age of onset, strabismus measurements, response of DVD to Bielschowsky head tilt test (BHTT ), degree of stereopsis, and amblyopia status. Results: Fifty children (mean age: 8.0 ⫾ 2.5 years) were identified. Mean age of strabismus onset was 12.7 ⫾ 6.0 months. Mean amount of exodeviation and DVD in primary position was 25.4 ⫾ 5.8 and 9.7 ⫾ 3.8⌬, respectively.
Journal of AAPOS