Binocular visual function in congenital esotropia after bilateral medial rectus recession with loop suture

Predictive factors of stereopsis outcomes following strabismus surgery

Purpose:

To determine the predictive factors of post-operative stereopsis in patients with strabismus.

Method:

In this retrospective study, records of patients who received surgical treatment for strabismus were reviewed. All types of strabismus were included. Pre- and post-treatment stereoacuity were measured using the Titmus Stereo Fly test, and predictive factors of stereopsis were evaluated.

Results:

A total of 194 patients (132 females and 62 males) with a mean age of 14.8 ± 8.4 years were included. There was a statistically significant improvement in stereopsis following surgery (p value < 0.001). Patients with a higher amount of deviation at baseline had poorer stereopsis on the final examination (p value < 0.001). Stereopsis improvement was more prominent in the pure horizontal strabismus group, compared to combined horizontal and vertical deviations. Baseline and the final stereopsis were higher in the “exotropia” group as compared to the “esotropia” group (p value = 0.003 and 0.0155, respectively); however, the within group change of stereopsis was not significantly different between these two groups (p value = 0.144). Post surgical residual deviation was associated with a poorer stereopsis (p value = 0.002, r = 0.251). A longer duration of strabismus before surgery was associated with poorer final stereopsis levels (p value = 0.026). The presence of amblyopia before surgery was associated with poorer stereopsis on last examination (p value < 0.001 for both correlations).

Conclusion:

Based on the result of this study, final stereopsis after strabismus surgery could be affected by the type, duration, and the amount of deviation before surgery, amblyopia, and post operative ocular deviation.

Cerebral Palsy for the Pediatric Eye Care Team Part III: Diagnosis and Management of Associated Visual and Sensory Disorders

INTRODUCTION

Cerebral palsy (CP) is a term used to describe a spectrum of deficits of muscle tone and posture resulting from damage to the developing nervous system. Though considered a motor disorder, CP can be associated with disorders of the sensory visual pathway. This paper, the final in a series of three articles, will present frequency, diagnosis, and management of the visual and binocular vision deficits associated with CP. Topics for discussion will include the prevalence and etiology of decreased acuity, the effect of CP on sensory and motor fusion, and the response to treatment for these sensory deficits.

METHODS

A retrospective chart review of all cases of cerebral palsy referred to the St. Louis Children's Hospital Eye Center was done. Detailed data on the sensory and motor deficits documented in these children was collected. Also recorded was the management strategy and response to treatment.

RESULTS

Of the 131 cases reviewed (mean age 5.2 years at presentation), 46% had decreased vision in at least one eye due to amblyopia (24%), optic nerve abnormality (16%), cortical visual impairment (14%), or a combination. Forty-nine (37%) had significant refractive error. Sixty-four percent of those with significant refractive error responded to spectacle correction. Forty-three percent of those with amblyopia responded to conventional therapies. Of the nonstrabismic patients, 89% demonstrated sensory fusion, 90% had stereopsis, and 91% had motor fusion. No patient lacking fusion or stereopsis prior to strabismus surgery gained these abilities with realignment of the eyes.

CONCLUSION

While children with CP are capable of age-appropriate acuity and binocular vision, they are at increased risk for sensory visual deficits. These deficits are not the direct result of CP itself, but either share a common underlying cause, or occur as sequelae to the strabismus that is prevalent in CP. Most importantly, some sensory deficits may respond to standard treatment methods.