Physical therapy exercises for improving intermittent exotropia control post-strabismus surgery: A randomized controlled study

Background

Exotropia control is deteriorated by post-strabismus surgery in many cases. Improving this control is considered as an important factor for success of the strabismus surgery like ocular motor alignment.

Objective

To determine the therapeutic effect of postoperative eye exercises on exodeviation eye control after the strabismus surgery.

Methods

Forty patients suffering from intermittent exotropia after strabismus surgery were randomly divided into experimental group and control groups. Both groups received the usual medical care, while the experimental group received different types of eye exercises using physiotherapy modalities in 24 sessions over three months (two sessions a week). The measurement of exotropia control for near target and far target using the office-based scale was done before and after the treatment.

Results

There was a significant improvement in near eye control post-treatment (0 . 45 ± 0 . 61 ) in the experimental group compared with control group (3 . 65 ± 0 . 88 ) as the mean difference was -3.20 and 95% CI of the difference between them was -3.645--2.755 with P < 0 . 01 . Also, far eye control improved post-treatment in the experimental group (0 . 75 ± 0 . 64 ) compared with control group (4 . 00 ± 0 . 86 ) with mean difference of -3.250 and 95% CI of the difference between them was -3.727--2.773 with P < 0 . 01 .

Conclusions

For patients with intermittent exotropia who had undergone strabismus surgery, the addition of physiotherapy exercises for the eye provided significant improvements in exotropia control for near target and far target.

Extra Ocular Muscle Fenestration as a Weakening Maneuver for Surgical Management of Strabismus: A Randomized Pilot Clinical Trial

Purpose

This study aimed to evaluate the efficacy and safety of fenestration in comparison to the classic muscle recession as a weakening maneuver to horizontal and vertical extra ocular muscles in the surgical management of strabismus.

Patients and Methods

This is a pilot single blind parallel group randomized controlled trial with 1:1 allocation ratio. Male or female patients aged 1- to 60-years-old who were admitted to the Pediatric Ophthalmology and Strabismus Department for surgical correction of horizontal or vertical strabismus. Patients were randomly allocated by the envelop method to either group 1 (muscle fenestration, N=9) or group 2 (classic muscle recession, N=9). All participants were assessed at the first post operative day, at one week, and one month after the surgery for the outcomes.

Results

Postoperative ocular alignment evaluated at the first day, one week, and one month following the operation showed comparable results with no significant differences between both groups (p>0.05). The median postoperative pain score evaluated at the first day following the operation was significantly higher in fenestration group than recession group (the medians were 2.0 and 1.0, respectively, p=0.014). Alternatively, the medians of the pain score were equal in both groups at one week and one month postoperatively (p>0.999). One patient in the fenestration group developed progressive subconjunctival hemorrhage. In contrast, there was no postoperative complications in the recession group (p>0.999).

Conclusion

Efficacy and safety of muscle fenestration for correcting horizontal or vertical strabismus was comparable to the classic muscle recession.

Evaluation of Artisan aphakic intraocular lens in cases of pediatric aphakia with insufficient capsular support

PURPOSE

To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support.

METHODS

In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth <3 mm, central endothelial cell density (CECD) <2500 cells/mm(²), uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively.

RESULTS

A total of 25 aphakic eyes of 18 patients (mean age, 7.86 ± 3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 ± 0.36; for patients with subluxation, 0.7 ± 0.26. Values improved at 1 year to 0.38 ± 0.15 (P < 0.002) and 0.3 ± 0.2 (P < 0.0001), respectively. One year after surgery the CECD (2892.64 ± 441.79 cells/mm(²)) was significantly reduced from the preoperative and 1 month postoperative values (3573.36 ± 468.9 cells/mm(2), 3081 ± 495 cells/mm(²); P < 0.0001, P < 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%).

CONCLUSIONS

Artisan IOL implantation for pediatric aphakia achieved a good visual outcome.