Inferior Oblique Recession with 5 mm Loop to Correct Vertical Deviation and Inferior Oblique Overaction Secondary to Superior Oblique Palsy

Purpose: To evaluate the effect of augmented inferior oblique recession (recession +5 mm loop) on the vertical deviation in primary position (PP) and the inferior oblique overaction (IOOA) in patients with unilateral congenital or acquired superior oblique palsy.Patients and methods: The medical records of patients who underwent unilateral inferior oblique recession with 5 mm loop during 2012 and 2019 were retrospectively reviewed. All patients had small to moderate manifest or intermittent hypertropia in PP and overaction of the inferior oblique muscle of +2 or +3 in lateral gaze. Patients who had combined inferior rectus surgery of the contralateral eye or who had previous vertical muscle surgery were excluded.Results: A total of 26 patients were included. Of these, three patients had combined horizontal muscle surgery. In 22 patients, the superior oblique palsy was congenital or longstanding, in 4 it was acquired and stable for more than 9 months. The mean preoperative vertical deviation in PP at distance and near was 14.7Δ and 11.2Δ, respectively. The mean postoperative vertical deviation was 5.7Δ and 4.1Δ after a mean follow-up of 19 months. The IOOA improved in all patients, 16 patients had an improvement of +2 and 10 patients had an improvement of +1.Conclusion: Inferior oblique recession with a 5 mm loop is a simple and quick technique to correct small to moderate hypertropia in primary position and inferior oblique overaction in contralateral gaze in patients with congenital, longstanding or acquired superior oblique palsy without risk of overcorrection.

Treatment of non-idiopathic clubfeet with the Ponseti method: a systematic review

PURPOSE

Although non-idiopathic clubfeet were long thought to be resistant to non-surgical treatment methods, more studies documenting results on treatment of these feet with the Ponseti method are being published. The goal of this systematic review is to summarize current evidence on treatment of non-idiopathic clubfeet using the Ponseti method.

METHODS

PubMed and Limo were searched, reference lists of eligible studies were screened and studies that met the inclusion criteria were included. Data on average number of casts, Achilles tendon tenotomy (ATT), initial correction, recurrence, successful treatment at final follow-up and complications were pooled. The Methodological Index for Non-Randomized Studies was used to assess the methodological quality of the selected studies.

RESULTS

In all, 11 studies were included, yielding a total of 374 non-idiopathic and 801 idiopathic clubfeet. Non-idiopathic clubfeet required more casts (7.2 versus 5.4) and had a higher rate of ATT (89.4% versus 75.7%). Furthermore, these feet had a higher recurrence rate (43.3% versus 11.5%) and a lower rate of successful treatment at final follow-up (69.3% versus 95.0%). Complications were found in 20.3% of the non--idiopathic cohort. When comparing results between clubfeet associated with myelomeningocele and arthrogryposis, the first group presented with a lower number of casts (5.4 -versus 7.2) and a higher rate of successful treatment at final follow-up (81.8% versus 58.2%).

CONCLUSION

The Ponseti method is a valuable and non-invasive option in the primary treatment of non-idiopathic clubfeet in young children. Studies with longer follow-up are necessary to evaluate its long-term effect.

LEVEL OF EVIDENCE

Level III - systematic review of Level-III studies.This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and -Meta-Analyses).

Does Self-Licensing Benefit Self-Regulation Over Time? An Ecological Momentary Assessment Study of Food Temptations

Self-licensing, employing reasons to justify indulgence, may help resolve the conflict between immediate temptations and long-term goals in favor of the former. It was hypothesized that this conflict-resolving potential of self-licensing may benefit self-regulation over time. With a momentary assessment design, we examined how self-licensing affects self-regulatory ability and the capacity to deal with subsequent self-regulatory conflicts. One hundred thirty-six female participants filled out surveys eight times per day for one week. Food temptation strength, conflict, resistance, and enactment were assessed, as well as license opportunity and perceived self-regulatory ability. When self-licensing opportunity was high (vs. low), a weaker association between temptation strength and conflict was observed. High license opportunity was associated with higher perceived self-regulatory ability for instances of low degrees of temptation enactment and predicted better handling of subsequent conflict after high degrees of prior temptation enactment. These results suggest that self-licensing can support self-regulation after initial failure.

Oops I Did it Again: Examining Self-Licensing Effects in a Subsequent Self-Regulation Dilemma

BACKGROUND

Previous studies have mainly examined the immediate effects of self-licensing on self-regulation failure. The present vignette studies examined what happens when a second self-regulation dilemma is encountered.

METHODS

In Studies 1 (N = 52) and 2 (N = 166), participants read a vignette in which the protagonist chooses to buy a treat while being on a diet, which was preceded by a license (License condition) or not (Control condition). The self-reported likelihood of indulging again when a second dilemma was presented in the same situation served as the dependent variable. Study 2 included measures of self-regulatory ability (motivation and self-efficacy) and also presented the dilemma in a new situation.

RESULTS

Study 1 showed that participants were more likely to indulge again after an initial indulgent choice with a license. This was replicated in Study 2, which also showed that self-licensing had no effect on goal re-engagement in a new situation. A marginally significant positive effect of self-licensing was found for self-efficacy.

CONCLUSIONS

The results obtained suggest that self-licensing negatively affects goal re-engagement in the same situation, but not in a new situation. Whether self-licensing maintains or increases feelings of self-efficacy needs to be validated in future studies.