Pattern strabismus and torsion needs special surgical attention

Kekunnaya, Ramesh; Mendonca, Teena Mariet; Sachdeva, Virender

doi:10.1038/eye.2014.270

Cited by 26 publications

(23 citation statements)

References 23 publications

(15 reference statements)

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“…4 Around 12-87% of strabismus patients have an "A" or "V" pattern. 1,2,4 The mechanism of pattern strabismus is still unclear. Many theories have been put forward regarding its etiology.…”

Section: Discussionmentioning

confidence: 99%

“…Best-corrected visual acuity was documented and refractive correction was given to patients prior to the surgery. The preoperative angle of deviation was assessed by the prism cover test with the refractive correction in place, for both near and distance in primary gaze position, as well as in 25° of upgaze (chin down) and 35° of down gaze (chin up) 1 , right and left gaze, and head tilt in cases of paralytic strabismus. In certain cases of sensory strabismus with poor fixation, the Krimsky test was used for analysis of the angle or a pen torch was used as a target for near and distance.…”

Section: Methodsmentioning

confidence: 99%

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Types of Pattern Strabismus and Their Surgical Outcomes after Adjustable Strabismus Surgery

Nadeem

2020

pak J Ophthalmol

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Purpose: To study the different types of pattern strabismus and their surgical outcomes after adjustable strabismus surgery. Study Design: Prospective, interventional study. Place and Duration of Study: Eye department, Fauji Foundation Hospital, Rawalpindi (June, 2016 to March, 2019). Methods: A total of 40 consecutive patients with pattern strabismus were included in the study. After complete orthoptic assessment, the patients underwent either rectus muscle transposition or oblique muscle surgery, by adjustable squint surgery. The pre-operative evaluation of different strabismus patterns, deviations, and post-operative results were measured and analyzed. The amount of postoperative pattern change was measured at 6 weeks postoperatively, to assess the success of the surgeries. Results: Out of 40 patients, 33 were females and 7 were males. The age ranged from 7 to 69 years (mean 18.05 ± 9.6). All patients were operated by using adjustable suture technique. “V” pattern was seen in 26 cases (65%) and “A” pattern was seen in 12 (30%) cases. The mean preoperative pattern was 13.2 ± 8.09 PD (prism diopters), and the mean postoperative pattern was 2.05 ± 2.96 PD. Surgical success was defined as the amount of pattern collapse at 6 weeks, the period at which a stable alignment was achieved. The difference between the preoperative and postoperative pattern deviation was statistically significant (p = 0.000). Correction of the pattern was seen in 92.5% of patients at average follow up of 50.87 ± 14.02 days. Conclusions: Pattern Strabismus can be corrected by varying rectus muscle transpositions or oblique muscle surgery during routine adjustable strabismus surgery. Key Words: Strabismus, V pattern, A pattern, Y pattern, X pattern, lambda pattern, muscle transposition.

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“…4 Around 12-87% of strabismus patients have an "A" or "V" pattern. 1,2,4 The mechanism of pattern strabismus is still unclear. Many theories have been put forward regarding its etiology.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Types of Pattern Strabismus and Their Surgical Outcomes after Adjustable Strabismus Surgery

Nadeem

2020

pak J Ophthalmol

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“…Refractive correction was given to the patients before surgery. The prism cover test (PCT) was used to assess the preoperative angle of deviation with the refractive correction in place, for both near and distance in primary gaze position, as well as in 25° of upgaze (chin down) and 35° of downgaze (chin up) 8 , right and left gaze, and head tilt in case of paralytic strabismus. In certain cases of sensory strabismus with poor fixation, the Krimsky test was used for analysis of the angle or a pen torch used as a target for near and distance.…”

Section: Methodsmentioning

confidence: 99%

Pain Score in Adjustable Strabismus Surgery

Nadeem¹

2020

pak J Ophthalmol

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Purpose: To assess the pain experienced by patients at the time of suture adjustment using topical proparacaine hydrochloride 0.5% anesthesia, in adjustable suture strabismus surgery. Study Design: Prospective, interventional study. Place and Duration of Study: Eye department of Fauji Foundation Hospital, Rawalpindi from May, 2017 to March, 2019. Material and Methods: A prospective study was carried out to assess the pain experience of patients undergoing suture adjustment under topical proparacaine hydrochloride 0.5% anesthesia, during routine adjustable squint surgery. All surgeries were performed under general anesthesia with suture adjustment done 1 hour or more after surgery when the effects of general anesthesia had worn off. Horizontal and vertical muscle recessions and resections were included along with inferior oblique surgeries, and transposition procedures. The patients were given the ‘Wong-Baker FACES® Pain rating Scale’; along with a ‘Numeric Pain Rating Scale’ from 0 to 10 (0 signifying ‘no pain’ and 10 signifying ‘worst possible pain’) on a proforma. The response of the patients was noted. Results: Thirty three patients who underwent adjustable strabismus surgery were included in this study. The mean age was 19.1 ± 11.1 years. The average number of muscles operated upon for each patient were 2.87 ± 1.08. The patients’ response to the ‘Wong-Baker FACES® Pain rating Scale’ ranged from 0 to 8, with a mean of 2.03 ± 1.81 SD. On the ‘Numeric Pain Rating Scale’ a similar response was obtained with a mean of 2.0 ± 1.82 SD. Augmentation of anesthesia was not needed in any patient. Conclusion: Adjustment of sutures under topical proparacaine hydrochloride 0.5% anesthesia after strabismus surgery is a practical, comfortable and safe procedure.

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“…This has been deemed the A or V pattern [ 1 ]. The A pattern generally indicates a difference of exodeviation between upgaze and downgaze of more than 10 prism diopters (PD), and the V pattern, more than 15 PD [ 2 ]. Whereas these patterns are often the result of oblique muscle overaction or palsy, they also can be caused by ectopic muscle courses with ectopic pulleys, rotated orbit associated with craniofacial abnormalities, or nerve disdirection [ 1 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of horizontal rectus surgery for the correction of intermittent exotropia on sub-A or sub-V pattern

et al. 2017

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We evaluated effect of horizontal rectus surgery on sub-A or sub-V pattern intermittent exotropia. We enrolled patients with sub-A or sub-V pattern intermittent exotropia. The sub-A pattern was diagnosed when the eyes diverged less than 10 prism diopters (PD) from upgaze to downgaze, and sub-V pattern when the divergence was 14 PD or less from downgaze to upgaze. Patients had undergone horizontal rectus surgery without vertical transposition of horizontal rectus muscle or oblique muscle weakening. The patients were divided into two groups: sub-A pattern (group A) and sub-V pattern (group V). The outcome measures were change of amount of pattern and rate of collapse of pattern postoperatively. The amount of pattern (vertical incomitance) was amount of difference in exodeviation between upgaze and downgaze. Collapse of pattern was defined as disappearance of difference in exodeviation between upgaze and downgaze. In groups A and V, preoperative amounts of pattern were 4.9 PD and 6.8 PD, respectively. A significant reduction in amount of pattern was observed in both groups throughout the follow-up period (p<0.05). At postoperative 6 months, the amounts of pattern were 1.0 PD and 1.2 PD and the extents of reduction in amount of pattern were 4.4 PD and 5.9 PD. The rates of collapse of pattern at postoperative 6 months were 77.8 and 60.0%, respectively. In the patients with sub-A or sub-V pattern exotropia, horizontal rectus surgery without vertical transposition or oblique muscle weakening can successfully collapse the pattern.

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Pattern strabismus and torsion needs special surgical attention

Cited by 26 publications

References 23 publications

Types of Pattern Strabismus and Their Surgical Outcomes after Adjustable Strabismus Surgery

Types of Pattern Strabismus and Their Surgical Outcomes after Adjustable Strabismus Surgery

Pain Score in Adjustable Strabismus Surgery

Effect of horizontal rectus surgery for the correction of intermittent exotropia on sub-A or sub-V pattern

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