Modified Y- split and recession of medial rectus muscles in convergence excess esotropia

Purpose: The convergence excess esotropia (CEET) is defined when near esotropia is greater than the distance by at least 10 PD while the eye is corrected with the full cycloplegic refraction. The purpose of this study is to evaluate the effect of a modified technique of Y- split recession of the medial rectus muscles on CEET. Methods: This was a retrospective study on patients diagnosed with CEET. The surgery included longitudinally dividing the medial rectus muscles into two equal halves and re-attaching them in a recessed and one-tendon width apart position. Success was defined as a residual distance and near esotropia of less than 10 PD and a distance-near disparity of less than 5 PD. Results: Fourteen patients, including 8 (57.1%) females, were enrolled with a mean age of 7.1 ± 2.9 years. The mean follow-up period was 28.6 ± 12.1 months. The mean preoperative distance and near esotropia was 31 ± 10 and 45 ± 11.3 PD respectively that decreased to 2.4 ± 3 and 3.6 ± 3.8 PD at the final visit ( p < 0.001). The Mean distance-near disparity of esotropia was 14 ± 4.5 PD before the operation that decreased to 1.3 ± 1.8 PD at the final visit ( p < 0.001). The motor success rate was 78.6%, bifocal glasses were no more required in 92.9% of patients, and stereopsis improved in 35.7% of patients after the surgery. Conclusion: Bilateral modified Y- split and recession of the medial rectus muscle is an effective technique for the treatment of CEET with persistent outcomes in the long-term follow-up.

P2781How to bridge residual distance to target low-density-lipoprotein cholesterol in stroke patients after initial statin therapy?

Background Current guidelines recommend intensive low-density-lipoprotein cholesterol (LDL-C) lowering to target LDL-C <1.8mmol/L after ischemic stroke (IS). Residual distance to LDL-C target can help select further treatment options after initial statin therapy. Purpose We aimed to evaluate residual distance to target LDL-C and the proportion of IS patients who are projected to reach target LDL-C by different statin and non-statin lipid lowering strategies. Methods We retrospectively analyzed 5,025 patients admitted with IS or transient ischemic attack who survived 1 year from an academic institution in Hong Kong between Jan 2005 and Sep 2017. Patients were divided into (i) high potency (HP-S; rosuvastatin ≥20mg, atorvastatin ≥40mg or simvastatin ≥80mg); (ii) non-high potency (NHP-S; other statin doses) statin users and (iii) no statin therapy. We calculated the mean distance and percentage LDL-C reduction required to reach target LDL-C. We assumed up-titration from NHP-S to HP-S would further reduce LDL-C by 5–15%; addition of ezetimibe 15–25%; up-titrate to HP-S plus ezetimibe 20–40% and combine statin with proprotein convertase subtilsin-kexin type 9 inhibitor (PCSK-9) 40–60%. Results Of 5,025 patients (56.3% males, mean age 69.1±11.5 years), 62.4% (3134/5025) had LDL-C ≥1.8mmol/L at 12-months after index stroke with 16.7% (839/5025), 80.9% (4064/5025) and 2.4% (122/5025) of patients on no statin, NHP-S and HP-S, respectively. 58.1% (2362/4064) of NHP-S and 60.7% (74/122) of HP-S users did not reach LDL-C target. Among these patients, the mean LDL-C was 2.5±0.6 and 2.8±1.0mmol/L; mean residual distance to target 0.7±0.6 and 1.0±1.0mmol/L; and mean percentage LDL-C reduction required to reach target LDL-C goal was 23.3±15.1% and 29.5±18.1%, respectively. The proportion of NHP-S users projected to reach target LDL-C is 34.9% (824/2362) by up-titrating/switching to HP-S, 57.2% (n=1352/2362) by addition of ezetimibe, 84.5% (n=1997/2362) by up-titration to HP-S plus ezetimibe and 98.6% (2330/2362) with PCSK-9 inhibitor (Figure 1). The proportion of HP-S users projected to reach target LDL-C is 43.2% (32/74) by addition of ezetimibe and 94.6% (70/74) with PCSK-9 inhibitor (Figure 1). Conclusion The use of high-potency statin is low and more than 50% of statin users did not reach target LDL-C at 12-months after index stroke. Combined up-titration to high-potency statin plus addition of ezetimibe is expected to bridge residual distance to target LDL-C in majority of stroke patients. Acknowledgement/Funding Supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme (Asia) Ltd.