Tactics and timing of surgical treatment in a child with congenital essential esotropia: clinical case

Purpose. To evalute the effective of the proposed volume of surgical treatment for the progressive course of infant esotropia. Material and мethods. A premature baby with congenital esotropia, which was diagnosed at the sith month of life. The patient was assigned a spectacle correction taking into account the par of ametropia and constant alternating occlusion. In connection with the subsequent increase in horizontal esodeviation and the appearance of a paretic component, a bilateral recession of the internal rectus muscle by 5mm was carried out in combination with an injection of Botox in a volume of 2.0. IU. Results and discussion. After the first stage of surgical treatment, a stable decrease of horizontal esodeviation and an increase of the amount of abduction were achieved. Conclusion. Bilateral combined weakening of medial rectus muscles (classical recession and chemorecession) allows to achieve predicted good results in case of large strabismus angles, combined with limi of abduction. Key words: congenital esotropia, chemodenervation, chemorecession.

Strabismus in Generations and Among Siblings

Introduction: Strabismus has been observed among family members in involved families. The study was conducted to document manifest strabismus running in generations and among siblings of strabismic patients. Methods: It was a hospital based prospective study conducted from May to November 2017. Strabismic patients with ocular deviation visiting Department of Paediatric Ophthalmology and strabismus were enrolled using specially designed proforma. Detailed ocular examinations were done and family history obtained regarding the presence of strabismus. Family tree was drawn for those with positive family history. Results: A total of 78 participants completed the study with 48.7% males. Family history of strabismus was present in 56.4%. Strabismus was present in two generations in 45.45%, in three generations in 18.2%, 1st and 3rd generation in 18.2%, 1st, 2nd and 4th generation in 4.5% and among siblings only in 13.6%. Among those with positive family history, exotropia was present in 75% and esotropia in 25%. Among exotropes, manifest deviation was present in 47.7% and intermittent exotropia in 27.3%. Among esotropes, congenital esotropia was present in 9% and accommodative esotropia in 16%. First degree relatives were affected in 45.45% of strabismic patients among which 55% had manifest exotropia, 20% had intermittent exotropia, 15% had accommodative esotropia and 10% had congenital esotropia. Conclusions: Strabismus was found in different generations in 56.4% strabismic patients. Two generations were involved in 45.45%, three generations in 18.2%, 1st and 3rd generation in 18.2%, 1st, 2nd and 4th generation in 4.5% and siblings only in 13.6%. Genetic factors appear to be significant in strabismus in Nepalese population and it requires to be substantiated with further larger studies.

Retrospective review of ocular alignment after large-angle congenital esotropia surgery

Objective: The study’s aims were to evaluate the success of bimedial rectus recession as a primary surgical procedure for patients with congenital esotropia; describe the demographic data of the study group; and compare surgical success with patient age at the time of surgery.Method: A retrospective review of 52 patients with congenital esotropia ≥ 50∆ (prism dioptres) was conducted. All patients underwent bimedial rectus recession and were followed-up postoperatively for a minimum of 6 months.Results: The study period was from January 1992 to September 2003. Fifty-two patients were included in the study group. The pre-operative angle of deviation ranged from 50∆–85∆. Patient ages ranged from 15 months to 22 years, with a mean of 5.3 years and a median of 4 years. The gender distribution was 42% male (n = 20) and 58% female (n = 28). Surgery was successful (within 10∆ of orthophoria) in 77% (n = 40), a partial success (10∆–20∆ from orthophoria) in 17% (n = 9) and a failure (> 20∆ from orthophoria) in 6% (n = 3). No statistically significant relationship was found between surgical success and patient age at the time of surgery.Conclusion: The study confirmed that bilateral medial rectus recession, performed as a primary procedure for patients with large-angle (> 50∆) congenital esotropia, has a high success rate. This finding corresponds with the outcomes of similar international studies.