Quantitative analysis of binocular alignment by Hess screen testing in surgery for superior oblique palsy.

Mixed Reality Glasses Image Translocation for Binocular Diplopia.

This prototype MRG image translocation software was helpful to 69% of patients with binocular diplopia, but limited by large angle strabismus because of the limited instrument field of view.

Analysis of Convergence and Divergence Using an Eye Tracker in Acquired Comitant Esotropia

Purpose To quantitatively evaluate vergence-related eye movements in acquired comitant esotropia (ACE) using video-based eye tracking and to characterize abnormal movement patterns and their postoperative changes. Methods We studied 46 patients with ACE (mean age, 24.3 years) who underwent unilateral or bilateral medial rectus recession. Binocular gaze was recorded at 300 Hz (Tobii Pro Spectrum) while participants alternately fixated every 5 seconds on a near target (30 cm) and a far target (60 cm). Stable amplitude was the difference between the mean near- and far-target gaze angles in the 3- to 4-second period after each target step. Eye movements were classified as conjugate or vergence according to the direction of stable amplitude in each eye. Saccadic onset, offset, and postsaccadic stabilization metrics were extracted. Statistical analyses included logistic regression and Wilcoxon signed-rank tests. Results Despite vergence stimulation, 26 patients (56.5%) exhibited conjugate movements, whereas 20 patients (43.5%) showed vergence movements. Conjugate movements were associated with a larger absolute stable amplitude of the fixating eye, larger absolute saccadic amplitudes in both eyes, and a smaller interocular difference in saccadic amplitude (fixating – non-fixating; all P < 0.05). In addition, interocular differences were observed in stabilization time and amplitude, particularly in the vergence group. Postoperatively, conjugate movements decreased markedly, as 81.8% of patients (18/22) demonstrated vergence movements at 1 month, and 92.3% (12/13) at ≥3 months. Conclusions Video-based eye tracking revealed frequent conjugate movements during vergence stimulation in ACE. After medial rectus recession surgery, vergence responses increased substantially, suggesting restoration of coordinated binocular motor control.

Surgical outcomes of Scott 2:1 recession-resection adjustable technique for incomitant strabismus.

BACKGROUND Surgical management of incomitant strabismus, characterized by gaze-dependent misalignment, is challenging. The Scott procedure, which involves the combined recession-resection of the same extraocular rectus muscle, avoids posterior scleral suturing beyond the globe's equator and allows for postoperative adjustment. However, long-term outcomes and optimal surgical dosing remain unclear. This study is the largest series to date that reports outcomes of a 2:1 same-muscle recession-resection dosing strategy. METHODS A retrospective chart review (January 2014 to August 2024) identified patients with ≥5Δ difference between primary and diplopic gazes who underwent a 2:1 Scott procedure. All procedures were performed by a single surgeon at a tertiary referral center. RESULTS Thirty-five patients met inclusion criteria, including 16 (46%) with prior strabismus surgery. The inferior rectus muscle was most commonly treated (n = 16), followed by the medial rectus (n = 11), lateral rectus (n = 8), and superior rectus (n = 2) muscles. The amount of recession and resection was 5.3 ± 1 mm and 2.5 ± 0.5 mm, respectively. Preoperative incomitance improved from 9.5Δ ± 6Δ to 1Δ ± 2Δ (P < 0.0001) in 34 of 35 patients (97%). Improvement in incomitance was comparable across rectus muscles (P = 0.5) and between small and large (<10Δ and ≥10Δ) preoperative incomitance (P = 0.48). Four patients (12.5%) required reoperation, with no increased reoperation risk related to strabismus surgical history or degree of preoperative deviation/incomitance. CONCLUSIONS In this patient cohort, the 2:1 dosage for same-muscle recession-resection demonstrated significant improvement in incomitance across various rectus muscles, preoperative deviations, and history of strabismus surgery. This approach provides surgeons with a straightforward and pragmatic means to manage incomitant strabismus.

NON-SURGICAL CORRECTION OF LONG-STANDING CONCOMITANT STRABISMUS

Superior Oblique Palsy: Characteristics and Treatment Outcomes.

PURPOSE To evaluate the characteristics, prognostic factors, and treatment outcomes in patients with superior oblique (SO) palsy. METHODS A retrospective review was conducted on patients diagnosed with SO palsy at King Chulalongkorn Memorial Hospital from January 2012 to October 2022. Patient demographics, etiology, preoperative strabismus evaluations, treatment approaches, and surgical outcomes were analyzed. Motor and sensory success criteria were ocular deviation ≤5 PD vertically, ≤10 PD horizontally, and the resolution of diplopia. RESULTS Among 57 patients, 43 (75.4%) had acquired SO palsy, most commonly due to ischemia (50.9%). Unilateral involvement was observed in 48 patients (84.2%), while 9 (15.8%) had bilateral SO palsy. Congenital cases had higher odds of requiring surgery (OR 30, 95% CI [3.55-253.86]; p < .001) compared to acquired cases that resolved spontaneously. Among 26 surgeries, inferior oblique (IO) myectomy was the most common (57.7%). Motor and sensory successes were achieved in 84.6% and 50% of cases respectively. Vertical deviation improved from 13 (6-20) to 0 (0-3) PD (p < .001) at distance and from 13 (6-20) PD to 0 (0-3) PD (p < .001) at near. Postoperative drift toward overcorrection was noted at both distance (-4 [-5 to -2] PD; p < .001) and near (-4 [-8 to -1] PD; p = .002) but stabilized by 12 months. The Harada-Ito procedure reduced extorsion in bilateral cases from 25 (22-30) to 5 (0-10) degrees (p < .001), correcting 10 (7.5-11) degrees for each operated eye (p = .02). CONCLUSIONS SO palsy management requires individualized treatment. Congenital cases were more likely to require surgery. IO myectomy is effective for vertical deviations ≤15 PD, while larger misalignments need combined procedures. The Harada-Ito procedure corrected 10 (7.5-11) degrees of extorsion for each operated eye in bilateral SO palsy. Aiming for early small residual hypertropia is advisable due to postoperative drift to overcorrection, particularly in congenital cases with large fusional amplitudes.

Real-world effectiveness of a binocular, dual-mechanism therapy in severe amblyopia: analysis from the PUPiL Registry.

Luminopia demonstrated significant improvements in Registry patients with severe amblyopia, particularly in treatment-naive patients, supporting its use as a viable treatment option that may address key limitations of traditional approaches.