Strabismus surgery before versus after completion of amblyopia therapy in children (original) (raw)
Related papers
The Effect of Amblyopia Therapy on Ocular Alignment
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2005
We sought to describe the change in ocular alignment at 2 years after treatment of amblyopia in children younger than 7 years of age at enrollment. Methods: A randomized clinical trial of patching versus atropine for 6 months followed by standard clinical care for 18 months was conducted in 357 children with anisometropic, strabismic, or combined amblyopia (20/40-20/100) whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment was evaluated at enrollment and after 2 years of follow-up. Results: At enrollment when tested at distance fixation, 161 (45%) children were orthotropic, 91 (25%) had a microtropia (1-8Δ), and 105 (29%) had a heterotropia >8Δ. Of the 161 patients with no strabismus, similar proportions of patients initially assigned to the patching and atropine groups developed new strabismus by 2 years (18% vs. 16%, P = 0.84). Of these cases of new strabismus, only 2 patients in the patching group and 3 patients in the atropine group developed a deviation that was greater than 8Δ. Microtropia at enrollment progressed to a deviation greater than 8Δ with similar frequency in both treatment groups (13% vs. 15%, P = 1.00). Of the 105 patients with strabismus greater than 8Δ at enrollment, 13% of those in the patching group and 16% of those in the atropine group improved to orthotropia without strabismus surgery. Strabismus surgery was performed in 32 patients during the 2-year study period. Conclusions: Patients who had amblyopia treatment with patching or atropine for 6 months followed by standard clinical care were found to have similar rates of deterioration and improvement of ocular alignment. When parents begin amblyopia treatment for children without strabismus, they should be warned of the possibility of development of strabismus, although it is most often a small angle deviation. Strabismus resolved after amblyopia therapy in some cases.
Cureus, 2022
Introduction: The purpose of the present study was to determine the factors that affect the outcome of strabismus surgery in terms of improvement in stereopsis and binocularity. Methods: Data were collected prospectively from patients with childhood-onset, concomitant, constant strabismus greater than 30 prism diopters (PD) with postoperative alignment within 10 PD. Pre- and postoperative stereopsis and binocularity testing were performed using the Titmus fly test, random dot test, Bagolini striated glass test, and Worth four dot test at one, four, and 12 weeks postoperatively. Results: A total of 73 patients (55% males and 45% females) who underwent surgery at our center were studied. The mean age at the time of surgery was 16 ± 7.7 years (range: 5-35 years). We found that factors such as age of strabismus onset, type of deviation, and amblyopia had a statistically significant influence on the postoperative surgical outcome. A statistically insignificant relationship was noted with...
Ocular alignment and results of strabismus surgery in neurologically impaired children
International journal of ophthalmology, 2012
To evaluate ocular alignment and surgical results of strabismus surgery in neurologically impaired children. Files of 33 neurologically impaired squint children were evaluated. Twelve patients had cerebral palsy(CP), 4 had CP with mental retardation, therest had mental-motor retardation of unknown cause. Cycloplegic refractions, type and angle of strabismus, surgeries performed were recorded. Mean follow-up was 34.0±16.5 months. Twenty-three patients had esodeviation, the remaining had exodeviation. In 19 patients, angle of deviations measured at different visits were highly variable. Twelve patients with stable angle of deviations or with unstable but high angle deviations had horizontal muscle surgery. Mean horizontal deviation decreased from 43.75±10,69 D to 12.83±8.38 D with surgery. In neurologically impaired strabismic children, surgery is effective in patients with stable deviations or unstable but high angle deviations. Decision for surgery should be made after a long follow...
Clinical Features and Outcome of Strabismus Surgery in Children
International Journal of Science and Research (IJSR), 2016
Pediatric strabismus must be treated early to maximize the potential for binocular vision and decrease the risk of amblyopia. Treatment goals include good vision in each eye and straight eyes. The aim of this study was to describe the outcome of strabismus surgery. The study was conducted at University Hospital Center "Mother Theresa" in Tirana, Albania over the period 2014-2015 including one hundred patients. The mean age of patients was 11.9 (±3.2) years, with a range 1 to 22 years. 44% were females and 56% males. Abnormal head posture was present in 11% of patients. Extra ocular movements were full in 65.5% right eyes and 26.5% left eyes. Regarding the distribution of patients according to visual acuity, 74% had visual acuity 6/6-6/18, 16% had visual acuity of <6/60 and 10% had visual acuity of 6/24-6/60 prior to surgery. Surgery in children with esotropia should be performed as early as possible to preserve stereopsis.
Strabismus in Cases of Cataract in Pediatric Age Group
Open Journal of Ophthalmology, 2013
Purpose: To investigate the epidemiology of strabismus in cases of pediatric cataracts. To assess visual outcome following orthoptic treatment for amblyopia in cases of cataracts in the pediatric age group. Methods: This was a retrospective cohort study. We investigated a consecutive series of pediatric patients with congenital, developing, or traumatic cataracts who underwent surgery between January 1999 and April 2012 at our center. Patient demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. Results: In total, 1331 eyes of 1043 children were included: unilateral cataracts were present in 785 (59%) eyes. There were 605 (45.5%) traumatic and 726 (54.5%) non-traumatic cases. Ages at surgery ranged from 1 to 215 months. All eyes were examined for ocular alignment; 66 (5%) were found to manifest strabismus. Deviation was significantly associated with age at intervention (p < 0.001), sensory nystagmus (p < 0.001), and etiology of cataracts (p < 0.001). We found significant differences in visual outcome following amblyopia therapy (p < 0.001). Conclusions: Surgical treatment with intraocular lens implantation in children with congenital, developmental, or traumatic cataracts is effective for visual rehabilitation. Orthoptic treatment made a significant difference in visual outcome (p < 0.001).
Frequency of Refractive Error and Amblyopia in Strabismus in Pediatric Age Group
2021
Objective: To see the frequency and compare the type of refractive error and strabismus in amblyopic versus non amblyopic children. Study Design: Comparative cross sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan to Jul 2019. Methodology: The sample population comprised of 250 patients of new or previously diagnosed children with refractive error and strabismus presenting at children eye outdoor patient department of armed forces institute of ophthalmology. Strabismus was diagnosed by the consultant eye specialist on the basis of heterotropia at near or distance fixation. Amblyopia and refracttive error was assessed by a trained optometrist. Patients were classified into amblyopia and non- amblyopia groups. The type of squint and refractive error was noted down along with demographic details. Chi square test was used to assess thesignificance of association between various categorical variables. Results: A total of 250 parti...
Effect of Ocular Alignment on Emmetropization in Children <10 Years With Amblyopia
American Journal of Ophthalmology, 2012
Purpose-To determine whether change in refractive error is associated with ocular alignment in 105 children 3 to <7 years of age who previously participated in a randomized trial comparing atropine and patching for moderate amblyopia. Methods-One hundred five children 3 to <7 years of age previously participated in a randomized trial comparing atropine with patching for moderate amblyopia. Cycloplegic refraction was measured at baseline and 10 years of age. Ocular alignment at baseline was categorized as orthotropic, microtropic (1-8Δ horizontal tropia), or heterotropic (>8Δ horizontal tropia). Multivariate regression models evaluated whether change in spherical equivalent refractive error was associated with alignment category, after adjusting for age, baseline spherical equivalent refractive error, and type of amblyopia treatment. Results-Between enrollment and the age 10-year exam there was a decrease in spherical equivalent refractive error from hyperopia to less hyperopia (amblyopic eye: -0.65D, 95%CI -0.85, -0.46; fellow eye: -0.39D, 95%CI -0.58, -0.20). A greater decrease in amblyopic eye refractive error was associated with better ocular alignment category (p=0.004), with the greatest
Background Current treatments for amblyopia in children, occlusion and pharmacological blurring, have had limited success, with less than two- thirds of children achieving good visual acuity of at least 0.20 logMAR in the amblyopic eye, limited improvement of stereopsis, and poor compliance. A new treatment approach, based on the dichoptic presentation of movies or computer games (images presented separately to each eye), may yield better results, as it aims to balance the input of visual information from each eye to the brain. Compliance may also improve with these more child-friendly treatment procedures. Objectives To determine whether binocular treatments in children aged three to eight years with unilateral amblyopia result in better visual outcomes than conventional occlusion or pharmacological blurring treatment. Search methods We searched the Cochrane Eyes and Vision Group Trials Register (last date of searches: 14 April 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to April 2015), EMBASE (January 1980 to April 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) In- ternational Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. Selection criteria Two review authors independently screened the results of the search in order to identify studies that met the inclusion criteria of the review: randomised controlled trials (RCTs) that enrolled participants between the ages of three and eight years old with unilateral amblyopia, defined as best-corrected visual acuity (BCVA) worse than 0.200 logMAR in the amblyopic eye, and BCVA 0.200 logMAR or better in the fellow eye, in the presence of an amblyogenic risk factor such as anisometropia, strabismus, or both. Prior to enrolment, participants were to have undergone a cycloplegic refraction and comprehensive ophthalmic examination including fundal examination.In addition, participants had to have completed a period of optical treatment, if indicated, and BCVA in the amblyopic eye had to remain unchanged on two consecutive assessments despite reportedly good compliance with glasses wearing. Participants were not to have received any treatment other than optical treatment prior to enrolment. We planned to include any type of binocular viewing intervention; these could be delivered on different devices including computer monitors viewed with LCD shutter glasses or hand- held screens including mobile phone screens with lenticular prism overlay. Control groups were to have received standard amblyopia treatment; this could include occlusion or pharmacological blurring of the better-seeing eye. We planned to include full-time (all waking hours) and part-time (between 1 and 12 hours a day) occlusion regimens. Data collection and analysis We planned to use standard methodological procedures expected by The Cochrane Collaboration. We had planned to meta-analyse the primary outcome, that is mean distance BCVA in the amblyopic eye at 12 months after the cessation of treatment. Main results We could identify no RCTs in this subject area. Authors’ conclusions Further research is required to allow decisions about implementation of binocular treatments for amblyopia in clinical practice. Currently there are no clinical trials offering standardised evidence of the safety and effectiveness of binocular treatments, but results from non- controlled cohort studies are encouraging. Future research should be conducted in the form of RCTs, using acknowledged methods of visual acuity and stereoacuity assessment with known reproducibility. Other important outcome measures include outcomes reported by users, compliance with treatment, and recurrence of amblyopia after cessation of treatment.