Subsequent strabismus surgeries in patients with no prior medical records

Comparison of the swept-source anterior segment optical coherence tomography and wide-field ultrasound biomicroscopy for imaging previously operated horizontal extraocular muscles

PURPOSE

To assess the feasibility and accuracy of determining extraocular muscle insertion distance from the limbus of previously operated extraocular muscles with the swept-source anterior segment optical coherence tomography (AS-OCT) compared with wide-field ultrasound biomicroscope (UBM).

METHODS

Patients with a history of previous strabismus surgery for whom additional strabismus surgery was planned were enrolled. The insertion distance was measured by AS-OCT and UBM before reoperation and compared to the caliper measurement at the time of surgery. Observers taking measurements were masked to patient data. Patient comfort for both machines was graded on a scale of 1-10 and timing of both imaging procedures was recorded.

RESULTS

Thirteen previously operated muscles of 6 subjects (age 20.3 ± 4.4 years; range, 11-25) were imaged. The muscle insertion could be identified in 12 cases on AS-OCT and 10 cases on UBM. The difference between the imaging result and the caliper reading was ≤1 mm in 9 cases on AS-OCT and 5 cases on the UBM (69% vs 38%; P = 0.03). The maximum insertion distance on AS-OCT was 13.8 mm; on UBM, 10.4 mm. AS-OCT had a higher grade than UBM for patient comfort (P = 0.0005) and speed (P = 0.001).

CONCLUSIONS

In our cohort, AS-OCT identified the muscle insertion distance more accurately than UBM. AS-OCT measurements were judged more comfortable to the patient, and images were acquired faster. In large recessions, wide-field UBM yields suboptimal results compared with AS-OCT.

Comparison Between Parental Observations and Clinical Evaluation Findings in Korean Pediatric Patients With Intermittent Exotropia

PURPOSE

To compare parental observations with the clinical evaluation findings in pediatric patients with intermittent exotropia and evaluate the clinical factors associated with the parental observations.

METHODS

This prospective study included either one or both parents of pediatric patients with intermittent exotropia who visited the clinic between January and May 2019. The parental observations were assessed through a questionnaire that included questions on the age of onset, usually deviated eye, degree of awareness, and frequency of exotropia. These findings were compared with those of the clinical evaluations, including the amount of ocular deviation and level of control.

RESULTS

A total of 100 parents (mean age: 39.7 years; 78 women) of 95 pediatric patients (mean age: 8.2 years; 47 girls) with intermittent exotropia participated in the study. The parental observation and clinical evaluation findings on the usually deviated eye showed good concordance (74%). The degree of parental awareness did not show any association with the amount of deviation. However, it showed a statistically significant increase associated with the worsening level of distance control (P = .04). The parental observations of the frequency of exotropia significantly increased with the worsening of the level of near (P = .037) and overall (P = .019) control.

CONCLUSIONS

Parental observations are more likely to correlate with the level of control than with the amount of ocular deviation in pediatric patients with intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 2020;57(3):199-203.].