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Uwai Y, Nabekura T. A safety signal for congenital strabismus associated with valproic acid: A pharmacovigilance analysis utilizing the FDA Adverse Event Reporting System database. Congenit Anom (Kyoto) 2024; 64:207-214. [PMID: 39082936 DOI: 10.1111/cga.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 09/03/2024]
Abstract
This pharmacovigilance study investigated the relationship between antiepileptic drugs and congenital strabismus, utilizing the FDA Adverse Event Report System database between 2014 and 2023. Out of 28 347 889 reports of adverse events in 10 937 764 cases, we identified 1104 reports of strabismus and 67 of congenital strabismus. Valproic acid was the most frequently implicated primary suspect drug (95 and 14 cases, respectively). Ninety-five reports involved transplacental valproic acid exposure, yielding an information component (IC) of 7.06 (IC-2 × standard deviation: 5.50). A multivariate analysis showed that transplacental exposure to valproic acid correlated with strabismus (adjusted odds ratio: 8.47, 95% CI: 6.74-10.65). We revealed a robust safety signal linking valproic acid to congenital strabismus.
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Affiliation(s)
- Yuichi Uwai
- School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
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2
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Koçkar A, Dizdar Yiğit D, Gürez C, İnal A, Çelik S, Yılmaz T, Hüseyinhan Z, Gökyiğit B. Effect of refractive errors on the results of botulinum neurotoxin administration in patients with infantile esotropia. Int Ophthalmol 2024; 44:67. [PMID: 38347246 DOI: 10.1007/s10792-024-02960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/04/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE To investigate the effect of refractive errors on the results of patients followed up with infantile esotropia (IE) and treated with botulinum neurotoxin (BNT) injection. METHODS The files of patients with IE who presented to the ophthalmology pediatric ophthalmology unit and underwent BNT injection into both medial rectus muscles between 2019 and 2021 were reviewed retrospectively. Sixty eyes of 30 patients were included in the study. Patients with additional systemic or ocular diseases and those with a history of ocular surgery were excluded. Distance and near deviations were measured (with the prism cover test or Krimsky method) before and at the first, third, and sixth months after BNT injection. RESULTS In Group 1 (n = 20) with a spherical equivalent of + 2.0 diopters (D) or less, the mean near and distance deviation value was both 36.8 ± 12.7 prism diopter (PD) before injection. In Group 2 (n = 10) with a spherical equivalent of above + 2.0 D, the near deviation was measured as 35.0 ± 7.1 PD and distance deviation as 31.8 ± 7.9. At six months after BNT injection, the near and distance deviation values were 20.6 ± 12.3 and 20.6 ± 11.6 PD, respectively in Group 1 and 10.1 ± 10.3 and 8.8 ± 10.8 PD, respectively in Group 2. The change in deviation did not statistically significantly differ between the groups (p > 0.05), but the distance and near deviation values were lower in Group 2 at sixth months after BNT injection. CONCLUSIONS BNT injection is a preferred method in IE. Higher hypermetropic values seem to increase the success of BNT injection.
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Affiliation(s)
- Alev Koçkar
- Ophthalmology Department, Ümraniye Training and Research Hospital, Istanbul, Turkey.
| | - Didem Dizdar Yiğit
- Ophthalmology Department, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ceren Gürez
- Ophthalmology Department, İstanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Aslı İnal
- Ophthalmology Department, İstanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Selcen Çelik
- Ophthalmology Department, İstanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Tolga Yılmaz
- Ophthalmology Department, İstanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Zahid Hüseyinhan
- Ophthalmology Department, İstanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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3
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Beğendi D, Duranoğlu Y. Comparison of the results of the modified and classical bi-medial hang-back recession in infantile esotropia. Int Ophthalmol 2023; 43:4011-4018. [PMID: 37410297 DOI: 10.1007/s10792-023-02805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Bi-medial rectus recession, which can also be performed using a hang-back technique, is one of the surgical treatment options for infantile esotropia (IE). This study has modified the surgical approach, with outcomes compared to the traditional hang-back technique. METHODS The bi-medial recession was performed with a modified hang-back technique in 120 IE patients and with a traditional hang-back technique in 88 cases. Surgical outcomes were reviewed and compared retrospectively. RESULTS The patients in the two groups were compared in terms of surgery time, inferior oblique weakening surgery, and the presence of refractive error. The differences between pre-operative and postoperative first-month, sixth-month, and first-year degrees were statistically significant (p < 0.001). CONCLUSIONS This modified novel technique aims to avoid unwanted muscle movement in the horizontal and vertical axes and a gap in the middle of the recessed muscle, as seen in the traditional hang-back technique. Further, the modified technique resulted in less over- and under-correction as well as alphabetic pattern deviation.
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Affiliation(s)
- Diğdem Beğendi
- Department of Ophthalmology, Faculty of Medicine, Demiroğlu-Bilim University, Istanbul, Turkey
| | - Yaşar Duranoğlu
- Department of Ophthalmology, Faculty of Medicine, Akdeniz University, 07050, Antalya, Turkey.
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Guo J, Chen Y, Liu W, Huang L, Hu D, Lv Y, Kang H, Li N, Peng Y. Alterations of large-scale functional network connectivity in patients with infantile esotropia before and after surgery. Brain Behav 2023; 13:e3154. [PMID: 37433043 PMCID: PMC10454265 DOI: 10.1002/brb3.3154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Growing evidences have indicated neurodevelopmental disorders in infantile esotropia (IE). However, few studies have analyzed the characteristics of large-scale functional networks of IE patients or their postoperative network-level alterations. METHODS Here, individuals with IE (n = 32) and healthy subjects (n = 30) accomplished the baseline clinical examinations and resting-state MRI scans. A total of 17 IE patients also underwent corrective surgeries and completed the longitudinal clinical assessments and resting-state MRI scans. Linear mixed effects models were applied for cross-sectional and longitudinal network-level analyses. Correlation analysis was performed to assess the relationship between longitudinal functional connectivity (FC) alterations and baseline clinical variables. RESULTS In cross-sectional analyses, network-level FC were apparently aberrant in IE patients compared to controls. In longitudinal analyses, intra- and internetwork connectivity were observed with significant alterations in postoperative IE patients compared to the preoperative counterparts. Longitudinal FC changes are negatively correlated to the age at surgery in IE. CONCLUSIONS Obviously, altered network-level FC benefiting from the corrective surgery serves as the neurobiological substrate of the observed improvement of stereovision, visuomotor coordination, and emotional management in postoperative IE patients. Corrective surgery should be performed as early as possible to obtain more benefits for IE in brain function recovery.
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Affiliation(s)
- Jianlin Guo
- Department of Radiology, MOE Key Laboratory of Major Diseases in ChildrenBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingP. R. China
| | - Yuanyuan Chen
- Tianjin International Joint Research Center for Neural EngineeringAcademy of Medical Engineering and Translational Medicine, Tianjin UniversityTianjinP. R. China
| | - Wen Liu
- Department of OphthalmologyBeijing Children's HospitalCapital Medical University, National Center for Children's HealthBeijingP. R. China
| | - Lijuan Huang
- Department of OphthalmologyBeijing Children's HospitalCapital Medical University, National Center for Children's HealthBeijingP. R. China
- Department of OphthalmologySecond Affiliated Hospital of Fujian Medical UniversityQuanzhouP. R. China
| | - Di Hu
- Department of Radiology, MOE Key Laboratory of Major Diseases in ChildrenBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingP. R. China
| | - Yanqiu Lv
- Department of Radiology, MOE Key Laboratory of Major Diseases in ChildrenBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingP. R. China
| | - Huiying Kang
- Department of Radiology, MOE Key Laboratory of Major Diseases in ChildrenBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingP. R. China
| | - Ningdong Li
- Department of OphthalmologyBeijing Children's HospitalCapital Medical University, National Center for Children's HealthBeijingP. R. China
- Key laboratory of Major Diseases in ChildrenMinistry of EducationBeijingP. R. China
| | - Yun Peng
- Department of Radiology, MOE Key Laboratory of Major Diseases in ChildrenBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingP. R. China
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Bhate M, Flaherty M, Martin FJ. Timing of surgery in essential infantile esotropia - What more do we know since the turn of the century? Indian J Ophthalmol 2022; 70:386-395. [PMID: 35086202 PMCID: PMC9023972 DOI: 10.4103/ijo.ijo_1129_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 11/17/2022] Open
Abstract
This review summarizes the results and interpretations of studies pertaining to the long-standing debate regarding the timing of surgery in infantile esotropia, more recently referred to as essential infantile esotropia. A systematic search of studies from the year 2000 onward pertaining to the timing of surgery in infantile esotropia as listed in PubMed, Google Scholar, and the Cochrane database was performed. Appropriate cross-references from the articles were also included. Data collected included demographics, presentation, time of surgery, complications, and outcomes. Very early surgery, that is, within 6 months of the onset of infantile esotropia, offers significant advantages in terms of the quality of stereopsis and binocular vision as well as promoting the development of cortical visual processing, thereby benefiting cortical development in human infants. However, the postoperative alignment was not found to be significantly different in the very early, early, or late surgery groups. The reduction in the incidence of manifest dissociated vertical deviation postoperatively in the very early surgery group also showed measurable benefits. The results of this recent literature review demonstrated that very early surgery, within 6 months of misalignment, showed demonstrable benefits in essential infantile esotropia.
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Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children’s Eye Care Centre, L.V.Prasad Eye Institute, Hyderabad, India
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6
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Why bilateral medial rectus recession fails? Factors associated with early repeated surgery. Int Ophthalmol 2019; 40:59-66. [DOI: 10.1007/s10792-019-01152-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/09/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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Li B, Sharan S. Post-operative analysis of pediatric esotropia associated with high hypermetropia. BMC Ophthalmol 2019; 19:140. [PMID: 31262252 PMCID: PMC6604460 DOI: 10.1186/s12886-019-1149-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background To describe clinical features, evaluation, surgical management and outcomes in children with esotropia associated with high hypermetropia. Methods Medical records of healthy children who received strabismus surgery for accommodative esotropia with hypermetropia larger than spherical equivalence of + 4.0 diopters from 2009 to 2015, were reviewed. Results A total of 47 patients were identified. The average age was 2.9 years old. The average spherical equivalence of cycloplegic refraction was + 6.0 diopters (D). All patients presented with large angle esotropia with spectacle correction. Average age of esotropia onset was 1.3 years. Average time between the onset of esotropia to spectacle correction was 7.2 months. Average duration between onset of constant esotropia to strabismus surgery was 28.1 months. Average duration between spectacle correction to strabismus surgery was 21.8 months. Post-operatively, 74.5% of patients achieved ocular alignment within 10 prism diopters (PD) of orthotropia. Overall, 66.0% patients developed sensory fusion. For patients who achieved surgical success, 71.4% developed sensory fusion, compared at 50.0% for patients who were over- or under-corrected (p = 0.18). For patients who received hyperopic spectacles within 6 months of esotropia onset, 92.3% developed sensory fusion, compared with 54.5% for patients who received hyperopic spectacles at 6 month or later after esotropia onset (p = 0.02). Conclusions Strabismus surgery for esotropia with high hypermetropia has high rate of surgical success with low rate of under- or over-correction. There is a trend toward higher rate of sensory fusion for patients with surgical success. Shorter time interval between esotropia onset and receiving hyperopic spectacles is associated with higher rate of sensory fusion development.
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Affiliation(s)
- Bo Li
- Department of Ophthalmology, Ivey Eye Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. .,Division of Ophthalmology, St Joseph's Health Care London, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
| | - Sapna Sharan
- Department of Ophthalmology, Ivey Eye Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Al Jabri S, Kirkham J, Rowe FJ. Development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures. BMC Ophthalmol 2019; 19:47. [PMID: 30736755 PMCID: PMC6368710 DOI: 10.1186/s12886-019-1055-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Core Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS. METHODS A review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non-systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points. RESULTS A total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common "visual or motility" outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements. CONCLUSION This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS.
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Affiliation(s)
- Samia Al Jabri
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
| | - Jamie Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
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9
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Lee HJ, Kim JA, Kim SJ, Yu YS. Relation between preoperative hyperopia and surgical outcome in infantile esotropia. Int J Ophthalmol 2018; 11:1963-1967. [PMID: 30588431 DOI: 10.18240/ijo.2018.12.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 02/07/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the relation between preoperative hyperopia and surgical outcomes of infantile esotropia in patients younger than 24 months of age. METHODS Medical records of patients who underwent bilateral medial rectus muscle recession for infantile esotropia between November 1, 2002 and December 1, 2011 were retrospectively reviewed. Patients were divided into two groups according to the degree of preoperative hyperopia. Group I had less than +3.0 diopter (D) of hyperopia and group II had between +3.0 and +5.0 D of hyperopia. Postoperative alignments were evaluated 1wk, 3, 6mo, and 1y after surgery. Following the 1-year postoperative visit, patients were monitored yearly. Relationships between preoperative factors including hyperopia and postoperative outcomes were evaluated. RESULTS Forty-six patients were included, with 33 patients in group I and 13 patients in group II. The preoperative mean refractive error was +0.88 D in group I and +3.45 D in group II. Surgical outcomes were not significantly different between groups at any postoperative time point examined. Cumulative probability of surgical success, prevalence of inferior oblique overaction, dissociated vertical deviation, and re-operation rate were not significantly different between groups. CONCLUSION Preoperative moderate hyperopia (less than +5.0 D) did not affect the surgical outcome of infantile esotropia. Therefore, the surgical correction of esotropia should be considered when the angle of esodeviation is unchanged following hyperopia correction, even in children with moderate hyperopia.
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Affiliation(s)
- Haeng Jin Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Jeong-Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 110-744, South Korea.,Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul 110-744, South Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 110-744, South Korea.,Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul 110-744, South Korea
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O'Connor AR, Tidbury LP. Stereopsis: are we assessing it in enough depth? Clin Exp Optom 2018; 101:485-494. [PMID: 29377291 PMCID: PMC6033147 DOI: 10.1111/cxo.12655] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 01/17/2023] Open
Abstract
The assessment of stereoacuity is an integral part of the ophthalmic assessment, with the responses used to inform clinical management decisions. Stereoacuity impacts on many aspects of life, but there are discrepancies reported where people without measurable stereoacuity report appreciating 3-D vision. This could be due, in part, to the presentation of the stimuli. A literature review was undertaken to evaluate current assessment techniques, how they relate to patient outcomes, identify the limitations of current tests and discuss how they could be improved. Recent evidence has been collated on currently available tests, used commonly within vision clinics, with normative data provided allowing responses to the tests to be interpreted. The relevance of the results is evaluated in relation to a range of outcomes, where a reduced level of stereopsis has a negative impact on the ability of an individual to perform many tasks, and can lead to an increase in difficulty interacting in the world. Current tests are limited in the aspects of stereoacuity they assess and their ability to precisely measure stereopsis. The world is not static, yet clinical tests are limited to measuring static stereoacuity, even though higher grades of depth perception can be identified in the presence of changing depth. Presentation methods of stereoacuity tests have remained similar over time, with a limited number of disparity levels assessed. New assessment methods are becoming available that include automated staircase testing to present multiple levels of disparity using digital technology. Current clinical tests are limited in their presentation, and are poor at detecting/measuring stereoacuity in those with limited stereopsis. Given the relevance of the stereoacuity measurement to management choices and functional outcomes, new testing methods would be beneficial to fully assess stereoacuity, both static and dynamic.
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Affiliation(s)
- Anna R O'Connor
- Directorate of Orthoptics and Vision ScienceUniversity of LiverpoolLiverpoolUK
| | - Laurence P Tidbury
- Directorate of Orthoptics and Vision ScienceUniversity of LiverpoolLiverpoolUK
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Solebo AL, Austin AM, Theodorou M, Timms C, Hancox J, Adams GGW. Botulinum toxin chemodenervation for childhood strabismus in England: National and local patterns of practice. PLoS One 2018; 13:e0199074. [PMID: 29902283 PMCID: PMC6001959 DOI: 10.1371/journal.pone.0199074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/31/2018] [Indexed: 12/05/2022] Open
Abstract
Background Botulinum toxin injection chemodenervation is a well-established intervention for adult strabismus, and has also been recognised as an effective alternative to routine incisional surgery for paediatric disease. We aimed to investigate the temporal patterns of practice, indications and outcomes of chemodenervation for paediatric strabismus at national and tertiary centre level. Methods Retrospective study using routinely collected patient data: Hospital Episode Statistics (HES) data were used to identify children undergoing non-incisional strabismus procedures in England from 2007 to 2016. Single–centre retrospective data on children undergoing botulinum toxin injections (Dysport® 2.5 units/ 0.1ml) as an isolated intervention (not involving incisional procedures) was undertaken to identify indications and outcomes. Successful outcome was defined as deviation <11 prism dioptres (PD). Results Between 2007 and 2016, there was no increase in the proportion of childhood strabismus involving non-incisional procedures. Amongst 150 children undergoing chemodenervation for strabismus within the tertiary centre, the most common diagnoses were acute onset esotropia (n = 34), infantile esotropia (n = 16) and consecutive exotropia (n = 15). Median age at injection was 8.5 years (range 0.9–15 years), and median follow up 12 months (6 months—11 years). Success rates differed by diagnosis, from 66% (non or partially accommodative esotropia) to 0% (congenital cranial disorders). Adverse events were seen in 62/150, 41%, most commonly transient ptosis (39%, n = 58). Overcorrection was seen in 14/119, 13%. Mild subconjunctival haemorrhage (n = 2) was the only other adverse event. Conclusions Botulinum toxin for childhood strabismus has an acceptable safety profile, and considerable potential therapeutic benefit. However, nationally there has been no increased uptake of chemodenervation non-incisional procedures. Further prospective studies are necessary to understand the predictors of outcome within the separate clinical subgroups, to guide clinical decision making.
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Affiliation(s)
- Ameenat Lola Solebo
- Department of Strabismus and Paediatric Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, National Institute of Health Research, Biomedical Research Centre, London, United Kingdom
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Ulverscroft Vision Research Group, London, United Kingdom
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, United Kingdom
| | - Anne-Marie Austin
- Department of Strabismus and Paediatric Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, National Institute of Health Research, Biomedical Research Centre, London, United Kingdom
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, United Kingdom
| | - Maria Theodorou
- Department of Strabismus and Paediatric Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, National Institute of Health Research, Biomedical Research Centre, London, United Kingdom
| | - Chris Timms
- Department of Strabismus and Paediatric Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, National Institute of Health Research, Biomedical Research Centre, London, United Kingdom
| | - Joanne Hancox
- Department of Strabismus and Paediatric Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, National Institute of Health Research, Biomedical Research Centre, London, United Kingdom
| | - Gillian G. W. Adams
- Department of Strabismus and Paediatric Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, National Institute of Health Research, Biomedical Research Centre, London, United Kingdom
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, United Kingdom
- * E-mail:
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Rajavi Z, Sabbaghi H, Torkian P, Behradfar N, Yaseri M, Feizi M, Faghihi M, Sheibani K. The relationship between abduction deficit and reoperation among patients with infantile esotropia. Int J Ophthalmol 2018; 11:478-483. [PMID: 29600183 DOI: 10.18240/ijo.2018.03.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/25/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the relationship between abduction deficit and reoperation among patients with infantile esotropia (IET). METHODS The records of 216 patients (432 eyes) with IET who underwent surgery, from 2010 to 2015 were studied. Patients with IET whose deviation appeared before 6mo of age and had stable preoperative deviation in two examinations with at least 2wk apart and a minimum 3mo postoperative follow up were included. Cases with early onset accommodative esotropia, congenital cataract, retinopathy of prematurity (ROP), manifest nystagmus, fundus lesions, neurologic and ophthalmic anomalies, 6th nerve palsy and Duane's syndrome were excluded. Preoperative abduction deficit was considered from -1 to -3 grading scale. Three months after surgery, children were classified into no-need reoperation [deviation≤15 prism diopters (PD)], and need-reoperation groups (deviation>15 PD). RESULTS In this retrospective study, 117 female and 99 male patients with the mean surgical age of 4.7±6.4y were included. Reoperation rate was 33.3% and 16.0% in IET patients with and without abduction deficit, respectively in patients who had a history of late surgery. Abduction deficit increased the odds of reoperation by 82% [OR=1.82, 95% confidence interval (CI) =1.05 to 3.19, P=0.003] in patients who had a history of late surgery (>2 years old, P=0.021). Abduction deficit was improved significantly after operation (P<0.001). CONCLUSION Based on our results, abduction deficit can be considered as a risk factor of reoperation in IET patients who are operated at the age of more than 2y.
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Affiliation(s)
- Zhale Rajavi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1666673111, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1666673111, Iran.,Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran 1616913111, Iran
| | - Pooya Torkian
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Narges Behradfar
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran 1616913111, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Mohadeseh Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1666673111, Iran.,Torfeh Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1149847514, Iran
| | - Mohammad Faghihi
- Torfeh Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1149847514, Iran
| | - Kourosh Sheibani
- Basir Eye Health Research Center, Basir Eye Clinic, Tehran 1418643113, Iran
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Magli A, Carelli R, Chiariello Vecchio E, Esposito F, Rombetto L, Esposito Veneruso P. Essential infantile esotropia with inferior oblique hyperfunction: long term follow-up of 6 muscles approach. Int J Ophthalmol 2016; 9:1802-1807. [PMID: 28003983 DOI: 10.18240/ijo.2016.12.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate long term follow-up (10y) of 6 muscle surgical approach in essential infantile esotropia (EIE). METHODS A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique (IO) hyperfunction and lateral rectus (LR) pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach: bilateral medial recti (MR) recession (4-5 mm), bilateral LR resection (lower than 7 mm) and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥+30 prism diopters (PD) and IO hyperfunction were selected from larger cohort of patients (n=213, 103 females and 110 males) after excluding patients with: angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package (version 9.1, SAS Institute Inc., Cary, NC, USA). RESULTS Ten years follow up data analysis showed the following percentage of orthotropic patients: (0 PD): 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant (P<0.01), increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction (P=0.04). CONCLUSION Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.
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Affiliation(s)
- Adriano Magli
- Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy
| | - Roberta Carelli
- Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy
| | | | | | - Luca Rombetto
- Department of Ophthalmology, University Federico II, Naples 80131, Italy
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Magli A, Rombetto L, Matarazzo F, Carelli R. Infantile esotropia: risk factors associated with reoperation. Clin Ophthalmol 2016; 10:2079-2083. [PMID: 27799735 PMCID: PMC5077265 DOI: 10.2147/opth.s116103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to identify clinical and demographic factors associated with misalignment after first surgery performed on children affected by infantile esotropia to evaluate the reoperation rate. A retrospective study was carried out, analyzing data from 525 children who underwent bilateral medial recti recession, bilateral lateral recti resection, and inferior oblique recession and anteroposition by the same surgeon (AM). Postoperative evaluation included assessment of motor alignment at approximately 3 months, 6 months, 1 year, and 5 years. Statistical analysis was performed with a logistical regression model in which the dependent variable was the presence/absence of reoperation. We found that late surgery (after 3 years of age) and a family history of strabismus are associated with a higher risk of reoperation, while some clinical factors, including some classically associated with worst motor outcome as preoperative angle, dissociated vertical deviation, and amblyopia, did not influence the incidence of reoperation in infantile esotropia. Male patients and patients with hyperopia in preoperative examinations have a significantly decreased reoperation rate.
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Affiliation(s)
- Adriano Magli
- Department of Ophthalmology, Orthoptics and Pediatric Ophthalmology, University of Salerno, Salerno
| | - Luca Rombetto
- Department of Ophthalmology, Federico II University, Naples, Italy
| | | | - Roberta Carelli
- Department of Ophthalmology, Orthoptics and Pediatric Ophthalmology, University of Salerno, Salerno
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Magli A, Carelli R, Esposito F, Bruzzese D. Essential Infantile Esotropia: Postoperative Sensory Outcomes of Strabismus Surgery. Semin Ophthalmol 2016; 32:663-671. [PMID: 27367798 DOI: 10.3109/08820538.2016.1157614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The optimum age for Essential Infantile Esotropia surgery is a controversial subject. Sensory status was evaluated in patients who underwent surgery at different ages in a retrospective study. The setting of the study is the ophthalmology department of a teaching hospital. METHODS Different clinical characters were analyzed pre- and postoperatively; nine different surgeries were performed. A total of 188 patients presented valid postoperative sensorial data, divided in two groups: surgery at ≤2 years (n=69) or >2 years (n=119). Sensory status was dichotomized in binocular single vision (BSV) and exclusion. Univariate differences were assessed with the chi-square test (or Fisher exact test). To identify the independent role of factors associated with the sensory status, all variables showing in univariate analyses a significant association (p<0.05) with the outcome variable were entered into a multivariate logistic regression model. All statistical tests were two-sided. RESULTS Multivariate analysis confirmed that children operated >2 years were 0.4 times less likely to obtain BSV compared with children operated at ≤2 years (AOR. 0.38, 95% C.I. 0.17-0.89, p=0.025). Patients operated on by OO MR rec.+ OO LR res. + OO IO rec.-ap. (intervention type 6) were about 11 times more likely to have BSV than those by OO rec.MR + unilateral res. LR (operation type 2); AOR.: 10.67, 95% C.I.: 1.34 - 85.29, p=0.026). Twenty-nine patients (12.1%) operated at ≤2 years of age underwent a reoperation, compared to 33 (8.6%) who underwent surgery after two years (p>0.05). CONCLUSIONS Our findings suggest to perform EIE surgery between age 1 and 2 and, when indicated, to prefer a six-muscle approach in order to achieve a better sensory function.
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Affiliation(s)
- Adriano Magli
- a University of Salerno , Pediatric Eye Department , Salerno , Italy
| | - Roberta Carelli
- a University of Salerno , Pediatric Eye Department , Salerno , Italy
| | | | - Dario Bruzzese
- c University of Naples Federico II , Department of Preventive Medical Science , Naples , Italy
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Is there anything new in strabismus? Curr Opin Ophthalmol 2015. [PMID: 26196096 DOI: 10.1097/icu.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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