The reliability of the angle of deviation measurement from the Photo-Hirschberg tests and Krimsky tests

Tengtrisorn, Supaporn; Tungsattayathitthan, A.; Phatthalung, S. Na; Singha, Penny; Rattanalert, Narisa; Bhurachokviwat, S.; Chouyjan, S.

doi:10.1371/journal.pone.0258744

Cited by 3 publications

(1 citation statement)

References 10 publications

(13 reference statements)

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“…The prism and alternate cover tests were used to measure the angle of deviation in the primary position and in different gaze positions at 30 cm and 6 m with and without glasses, if present, and the target angle for surgery was midway between distant and near deviations. The Krimsky method was used in patients with poor fixation [ 21 ]. The ductions and versions in 6 cardinal positions of gaze of all patients were assessed [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Early and delayed suture adjustments after adjustable suture strabismus surgery: a randomized controlled trial

Abdelmonem¹,

Awadein²,

Genidy³

et al. 2023

Med Hypothesis Discov Innov Ophthalmol

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Background: Adjustable sutures increase the success rate of strabismus surgery. However, the optimal timing of postoperative suture adjustment remains controversial. This trial was aimed at comparing the surgical outcomes and pain scores of early or 2 – 4 h and delayed or 24 h postoperative suture adjustment in adult patients undergoing strabismus surgery. Methods: An open-label, prospective, randomized, comparative interventional study was performed in consecutive adult patients scheduled for eye muscle surgery. Patients were randomized into two groups: the early group, with suture adjustment 2 – 4 h postoperatively, and the delayed group, with suture adjustment 24 h postoperatively. Subjective pain scores during the adjustment were also analyzed. The angles of misalignment at 1 and 3 months and the success rate at 3 months postoperatively were compared. Results: Forty-five (90%) patients completed the follow-up, including 23 (92%) in the early adjustment group and 22 (88%) in the delayed adjustment group, with a mean (standard deviation) age of 25.6 (9.5) years and a male-to-female ratio of 46.7:53.3. Thirty patients (66.7%) had exotropia, and 15 (33.3%) patients had esotropia. Both groups had comparable baseline characteristics (all P > 0.05). The mean pain scores during adjustment did not differ significantly between groups (P > 0.05). The postoperative angles of alignment were comparable between the groups before suture adjustment and at the 1- and 3-month follow-ups (all P > 0.05). The success rate in the early adjustment group was slightly higher (87.0% versus 63.6%), but the difference was not statistically significant (P > 0.05). The success rate was comparable between the groups in patients with esotropia or exotropia (both P > 0.05). Conclusions: Although the early adjustment group had a slightly higher success rate, the difference was not significant. Both groups had comparable subjective pain scores during adjustment. Future clinical trials should be performed different time intervals for postoperative suture adjustment, and subjective and objective outcomes, such as diplopia and stereopsis, should be compared between patients with a first strabismus surgery and those who underwent reoperation. This could better resolve the persistent controversy related to the optimal time for suture adjustment.

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Section: Methodsmentioning

confidence: 99%

Early and delayed suture adjustments after adjustable suture strabismus surgery: a randomized controlled trial

Abdelmonem¹,

Awadein²,

Genidy³

et al. 2023

Med Hypothesis Discov Innov Ophthalmol

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A Smartphone-Based Large-Scale Screening System for Efficient Strabismus Detectio

Wang,

Jin,

Xiu

et al. 2024

Preprint

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To compare horizontal strabismus deviation as assessed from photographs with that in the strabismus clinic using the prism bar

Bose,

Amitava,

Gupta

et al. 2024

Indian Journal of Ophthalmology

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Purpose: To compare the deviation in cases of horizontal strabismus as assessed from photographs with the measurements as obtained in the strabismus clinic. Methods: After obtaining informed consent, we recruited subjects with manifest horizontal strabismus. We took a frontal flash photograph from a distance of 50 cm using smart-phone-based cameras with the flash light vertically aligned with the lens. After projecting the photograph on a laptop and using a vernier caliper, we measured the horizontal corneal diameter of the non-strabismic eye and the decentration of reflex in the strabismic eye taking limbus as the reference point. We converted these values to degrees by using a conversion factor of 7.5°/mm and further to prism diopters (PD) by the standard mathematical formula 100*tanθ. Results: We included 74 subjects aged between 5 and 40 years with manifest horizontal deviation from 20 to 85 PD. We found a statistically significant correlation of 82.6% (P value < 0.001) between the clinic and photographic measurements. Agreement analysis suggested that the photographic measurements measured on average 7 PD less (95% confidence interval: 4.6 to 9.2) than clinical measurements along all values of misalignment, although the difference between the two methods decreased as the quantum of deviation increased. Linear regression revealed an r2 of 68% and provided a predictive equation to derive clinic equivalent measurements from photographic estimates. Conclusion: We believe our simple method provides robust evidence that a photographic estimation can provide the basic information of the size of the deviation to plan possible surgeries, especially in situations of a tele-consultation. This is an easy approach to both understand and master and should form the armamentarium of most orthopticians and strabismologists.

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The reliability of the angle of deviation measurement from the Photo-Hirschberg tests and Krimsky tests

Cited by 3 publications

References 10 publications

Early and delayed suture adjustments after adjustable suture strabismus surgery: a randomized controlled trial

Early and delayed suture adjustments after adjustable suture strabismus surgery: a randomized controlled trial

A Smartphone-Based Large-Scale Screening System for Efficient Strabismus Detectio

To compare horizontal strabismus deviation as assessed from photographs with that in the strabismus clinic using the prism bar

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