AIM:To summarize publication trends in the field of strabismus over the past 30y and predict future research hotspots.METHODS:A total of 2915 English-language articles and reviews on strabismus,published between 1993 ...AIM:To summarize publication trends in the field of strabismus over the past 30y and predict future research hotspots.METHODS:A total of 2915 English-language articles and reviews on strabismus,published between 1993 and 2022,were retrieved from the Web of Science Core Collection.Bibliometric analyses were performed using VOSviewer and CiteSpace software to explore publication trends,as well as the contributions and collaborative networks of countriesegions,authors,institutions,and journals.RESULTS:The annual number of publications on strabismus showed a consistent upward trend.The United States(USA)maintained a leading position in this research field while Republic of Korea and China emerged as rapidly advancing contributors over the last decade.The University of California,Los Angeles ranked as the most productive institution,and Jonathan M.Holmes from USA was the most productive author.Journal of AAPOS was the leading journal with the most strabismus publications,whereas the two most highly cited articles were both published in Ophthalmology.Co-occurrence analysis identified pivotal keywords and burst terms,including intermittent exotropia(IXT),acute acquired comitant esotropia(AACE),functional magnetic resonance imaging(fMRI),and surgical treatment,which were confirmed as predominant and frontier topics.CONCLUSION:This study provides a comprehensive bibliometric analysis of strabismus research,revealing the evolution of research hotspots over the past 30y and outlining several cutting-edge directions for future investigation.展开更多
Recent advances in the surgical management of restrictive strabismus caused by thyroid-associated orbitopathy(TAO)demonstrate a clear trend toward precision and individualization.This review synthesizes current litera...Recent advances in the surgical management of restrictive strabismus caused by thyroid-associated orbitopathy(TAO)demonstrate a clear trend toward precision and individualization.This review synthesizes current literature,highlighting innovations in preoperative evaluation,surgical techniques,and outcome assessment over the past decade.Preoperative assessment has evolved from clinical observation alone to a comprehensive model incorporating serological markers and highresolution imaging,significantly improving the accuracy of surgical timing decisions.Surgical techniques have been refined to address a range of complex scenarios,enhancing predictability,success rates while reducing reoperation rates.Outcome measures now prioritize functional vision and patient-reported outcomes alongside ocular alignment.Furthermore,emerging therapies,including biologics,offer novel non-surgical options for active-phase disease management and perioperative care.Based on the evidence synthesized herein,the field is moving toward a more personalized approach;however,high-level prospective trials evaluating surgical strategies remain limited.Surgeons are encouraged to base decisions on comprehensive assessments to optimize functional and quality-of-life outcomes.Future directions may involve the integrating evolving biologic therapies with advanced data analytics,an approach that holds promise for further personalization.展开更多
AIM:To compare visual motor integration(VMI)in non-amblyopic children with and without horizontal strabismus.METHODS:VMI,visual perception,and motor coordination were evaluated in non-amblyopic children aged 6 to 17 y...AIM:To compare visual motor integration(VMI)in non-amblyopic children with and without horizontal strabismus.METHODS:VMI,visual perception,and motor coordination were evaluated in non-amblyopic children aged 6 to 17 years old using the Beery-Buktenica Developmental Test of Visual-Motor Integration(Beery-VMI),together with its supplementary Developmental Tests of Visual Perception and Motor Coordination.RESULTS:Forty-five non-amblyopic children with horizontal strabismus(23 males,22 females;mean age:126.0±33mo)and 45 children without strabismus(22 males,23 females;mean age:126.2±34mo)were enrolled.Children with horizontal strabismus exhibited significantly lower mean Beery-VMI scores(P<0.001),visual perception scores(P<0.001),and motor coordination scores(P<0.001)compared with controls,even after adjustment for confounding variables including sex,age,regular sports participation,number of siblings,and stereopsis.CONCLUSION:Non-amblyopic children with horizontal strabismus demonstrate significantly poorer performance in Beery-VMI,visual perception,and motor coordination compared with children without strabismus.展开更多
AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patient...AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patients who were determined to be surgical candidates.The patients’cohort were divided into two groups based on the presence or absence of strabismus.Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups.RESULTS:A total of 76 patients with TED were enrolled,including 58 males(76.3%)with a mean age of 52.68±10.45y.The 55 patients(male:female=2:1)were found to have TED with strabismus,while the remaining 21 patients(male:female=4:1)had TED without strabismus.There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus(OR=4.1,P=0.018)and they showed higher prevalence of proptosis(95.2%)than the TED strabismus group(63.6%,P0.05).The most common types of strabismus were hypotropia(36%)and esotropia(29%),respectively.CONCLUSION:Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction,but a higher incidence of compensatory AHP.Identifying these differences may aid in risk stratification and early intervention for TED patients,particularly those at risk for restrictive strabismus.展开更多
In this study,we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery.We enrolled 18 stereo-deficient patients with intermittent exotropia before and...In this study,we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery.We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery,along with 18 healthy controls.Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli.Compared with controls,preoperative patients showed hypoactivation in higher-level dorsal(visual and parietal)areas and ventral visual areas.Pre-and postoperative activation did not significantly differ in patients overall;patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus.Worse stereopsis and fusional control were correlated with preoperative hypoactivation,suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia.The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis.Thus,additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.展开更多
AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus...AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus surger y were enrolled prospectively. Retinal vessel diameters on color fundus photographs were assessed before and 1, 7 d, 6 mo after surgery, using a computerassisted quantitative assessment software. To evaluate the retinal vascular caliber changes, retinal vascular diameters were calculated by means of the Parr–Hubbard formula as the central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE). The arteriovenous ratio(AVR) was calculated as CRAE divided by CRVE. RESULTS: A total of 154 eyes of 104 consecutive patients were included. Compared with the data before surgery(121.55±24.67), the mean CRAE(131.18±28.29) significantly increased 1 d af ter surger y(P=0.003), but went back to baseline level at 7 d(118.89±30.35, P=0.15), and 6 mo(123.22±15.32, P=0.60), so did the AVR(P<0.001, P=0.08, P=0.07). As for the mean CRVE, there was no significant difference between those four time points(172.43±33.25, 175.57±36.98, 174.03±40.18, 174.86±20.46, P=1.00). CONCLUSION: Strabismus surgery on both lateral and media rectus muscles, or single media rectus muscle may increase retinal blood flow during the early postoperative period, but would return to normal later. The number of transected anterior ciliary arteries rather might be the main cause of retinal hemodynamic changes early after strabismus surgery.展开更多
AIM: To identify the potentially pathogenic gene variants that contributes to the etiology of strabismus. METHODS: A Chinese pedigree with strabismus was collected and the exomes of two affected individuals were seq...AIM: To identify the potentially pathogenic gene variants that contributes to the etiology of strabismus. METHODS: A Chinese pedigree with strabismus was collected and the exomes of two affected individuals were sequenced using the next-generation sequencing technology. The resulting variants from exome sequencing were filtered by subsequent bioinformatics methods and the candidate mutation was verified as heterozygous in the affected proposita and her mother by sanger sequencing. RESULTS: Whole exome sequencing and filtering identified a nonsynonymous mutation Co434G-T transition in paired box 3 (PAX3) in the two affected individuals, which were predicted to be deleterious by more than 4 bioinformatics programs. This altered amino acid residue was located in the conserved PAX domain of PAX3. This gene encodes a member of the PAX family of transcription factors, which play critical roles during fetal development. Mutations in PAX3 were associated with Waardenburg syndrome with strabismus. CONCLUSION: Our results report that the c.434G-T mutation (p.R145L) in PAX3 may contribute to strabismus, expanding our understanding of the causally relevant genes for this disorder.展开更多
AIM:To evaluate the effect of strabismus surgery on retinal vessels calibers with digital color fundus photographs.METHODS:Two hundred consecutive strabismus patients underwent surgery,and 118 patients(female/male,...AIM:To evaluate the effect of strabismus surgery on retinal vessels calibers with digital color fundus photographs.METHODS:Two hundred consecutive strabismus patients underwent surgery,and 118 patients(female/male,55/63) who finished 6-month follow-up were finally included in this study.Optic disc-centered digital color fundus photographs of both eyes of all patients were taken prior to surgery and 6mo post surgery.The retinal vascular caliber of 116 operated eyes were measured using the computer program IVAN.The operated eyes were divided into 3 groups according to the surgical methods,recession of one muscle,one muscle recession and one muscle folding,one muscle resection and one muscle recession.The effect of number of altered muscles on retinal vessels was analyzed using statistic software SPSS 16.0.RESULTS:The mean age was 12.4±8.6y.Averaged central retinal artery equivalent(CRAE) of all patients was 120.31 ±23.02 μm preoperatively,and 122.87 ±15.93 μm six months after surgery.Averaged central retinal vein equivalent(CRVE) was 171.11 ±31.73 μm preoperatively and175.02±21.00 μm postoperatively.There was no significant difference of averaged CRAE(P=0.22) or CRVE(P=0.19)before and after operation.Averaged arteriole to venule ratio(AVR) was 0.71 ±0.07 before surgery and 0.70±0.07 after surgery.Comparison of preoperative and postoperative retinal vessels calibers among different surgical groups did not show significant differences.Also,there was no advantage of rectus muscle folding to muscle resection.CONCLUSION:Up to 6mo after strabismus surgery,the retinal vascular calibers were not altered.No more than two muscles in one surgery are safe for retinal perfusion.展开更多
AIM:To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation.METHODS:The medical records of 122 patients,aged1.5mo to 9y,who had undergone c...AIM:To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation.METHODS:The medical records of 122 patients,aged1.5mo to 9y,who had undergone cataract extraction with primary intraocular lens implantation between January1993 and August 2011 were reviewed.Fourteen patients(17 eyes)with strabismus before cataract surgery were excluded.Patients were divided into those with congenital bilateral cataracts(64 patients,128 eyes)and those with unilateral cataracts(44 patients,44 eyes).The associations between the development of strabismus and age at cataract surgery,pre-and post-cataract extraction corrected distance visual acuity(CDVA),interocular CDVA difference,nystagmus,surgical method,and secondary cataract were evaluated.RESULTS:Factors significantly associated with the development of strabismus included age at cataract surgery(≤1y),preoperative mean CDVA≤20/100,presence of nystagmus in the bilateral cataract group and postoperative interocular CDVA difference】20/70 in the unilateral group.Postoperative CDVA≤20/100 and preservation of posterior capsule,and presence of secondary cataract were significant factors in both groups.CONCLUSION:Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus,especially when they underwent surgery at age≤1y,and they have nystagmus,large postoperative interocular CDVA difference,poor preoperative and postoperative CDVA,preservation of the posterior capsule,or secondary cataract.展开更多
Dear Editor,cleral penetration during strabismus surgery was k3 first reported over 50 years ago[1].Early manuscripts reported the incidence of this complication around 10%[1].However,more recent studies suggest that ...Dear Editor,cleral penetration during strabismus surgery was k3 first reported over 50 years ago[1].Early manuscripts reported the incidence of this complication around 10%[1].However,more recent studies suggest that this rate may have decreased[2-3].展开更多
Objectives:To translate the Child Intermittent Exotropia Questionnaire(Child-IXTQ)from English to Chinese and to evaluate its reliability and validity in Chinese childhood strabismus patients.Method:A consecutive samp...Objectives:To translate the Child Intermittent Exotropia Questionnaire(Child-IXTQ)from English to Chinese and to evaluate its reliability and validity in Chinese childhood strabismus patients.Method:A consecutive sample of 143 child strabismus patients was recruited from the Department of Ophthalmology at a medical center in Southwest China.In addition,100 visually normal adults and 100 patients with other eye diseases were recruited.The Brislin translation model was followed to develop the Chinese version of Child-IXTQ.Reliability was established using Cronbach's a and test-retest.Validity was established encompassing content validity,construct validity,convergent validity,criterion-related validity and discriminative validity.Results:The correlation coefficients between each item score with the total score ranged from 0.370 to 0.813.Two subscales were extracted by principal component analysis,with a content validity of 0.91.The correlation coefficients between two factor scores with the total score were 0.709 and 0.939.Criterion-related validity was estimated by the correlating the Child-IXTQ with the PedsQL 4.0,and the correlation coefficient was 0.522.In addition,the Child-IXTQ discriminated accurately between strabismus patients and normal children,or children with other eye diseases that possessed good discriminative validity.Cronbach's a coefficient for the internal consistency was 0.907 and the test-retest reliability was 0.962.Conclusions:Our study indicates that the Child-IXTQ is a reliable and valid instrument for assessing the health-related quality of life among children with strabismus.展开更多
The design and efficacy of surgery for horizontal idiopathic nystagmus (HIN) with abnormal head posture and strabismus were investigated. Different surgical procedures were selected according to the angle of head tu...The design and efficacy of surgery for horizontal idiopathic nystagmus (HIN) with abnormal head posture and strabismus were investigated. Different surgical procedures were selected according to the angle of head turn in 44 cases of HIN with abnormal head posture and strabismus. For patients with a head turn of 15° or less, the Anderson procedure was used; the yoke muscles were recessed upon slow-phase. For patients with a head turn between 15° and 25°, the surgery was designed as a Kestenbaum 5-4-4-5 procedure. For patients with a head turn of 25° or more, the surgery was designed as a Parks 5-8-6-7 procedure. The surgery to correct the abnormal head posture was performed on the fixating eye while that to correct the deviation was then performed on the non-fixating eye at the same time. The amount of surgery of the horizontal rectus muscles on the nonfixating eye was sum of the angle of head turn and the degree of deviation, which was calculated as follows: recessionesection amount of medial and lateral rectis/2×5=angle of head turn±degree of deviation. The results showed as follows: (1) Visual acuity: the visual acuity in the primary ocular position increased two lines or more in 35 patients, accounting for 79.55%. Nine patients had no or only one-line improvement, accounting for 20.45% of the entire study population; (2) The degree of deviation in the primary ocular position: 37 cases had a normal primary ocular position or the degree of deviation ≤8△ after surgery, accounting for 84.09%. Six patients had a residual degree of deviation of 8△―15△, accounting for 13.64%. One patient had a residual degree of deviation 〉20△, accounting for 2.27% of the patients examined; (3) Abnormal head posture: 34 patients had a normal head posture or a head turn of less than 5°, accounting for 72.27%. Eight patients had a residual head turn of 5°―15°, accounting for 18.18%. Two patients had a head turn of 15°― 25°, accounting for 4.55%. It was concluded that different surgical procedures based on the angle of head turn and the relationship between deviation and null zone can eliminate anomalous head posture, correct deviation, and improve vision acuity in the primary ocular position simultaneously.展开更多
BACKGROUND Pitt-Hopkins syndrome(PTHS;MIM#610954)is a rare genetic neurological disorder.Myopia and strabismus have been reported in approximately 50%of PTHS patients.No studies have reported details about the require...BACKGROUND Pitt-Hopkins syndrome(PTHS;MIM#610954)is a rare genetic neurological disorder.Myopia and strabismus have been reported in approximately 50%of PTHS patients.No studies have reported details about the required surgery for PTHS with strabismus and early-onset myopia.Here,we retrospectively reviewed the surgical management of two patients with PTHS combined with strabismus and/or early-onset myopia.CASE SUMMARY A 5-year-old girl presented with congenital esotropia and left eye myopia,and the second girl was a 5-year-old girl who presented with intermittent exotropia.Genetic testing performed on both patients showed a mutation in transcription factor 4,which is a diagnostic marker of PTHS.The first girl underwent bilateral medial rectus recession combined with posterior scleral reinforcement(PSR)in the left eye and the second patient underwent bilateral lateral rectus recession strabismus surgery.We made key innovations in surgical timing and strategy,and the results were satisfactory.The combination of strabismus and PSR surgery is an innovative strategy for patients with both strabismus and early-onset myopia.CONCLUSION Early treatment of strabismus and myopia positively influence motor development and should be included in rehabilitation programs for patients with PTHS.展开更多
Anterior segment optical coherence tomography (AS-OCT) finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anter...Anterior segment optical coherence tomography (AS-OCT) finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery. We discuss two cases of operated strabismus surgery where AS-OCT imaging helped in identifying the operated eye and/or extra ocular muscles (EOM) and thus proved instrumental in planning and management.展开更多
Purpose:To investigate the effect of proparacaine hydrochloride eye drops on emergence agitation after general anaesthesia for paediatric strabismus surgery.Methods:Paediatric patients(3-12 years-old)receiving strabis...Purpose:To investigate the effect of proparacaine hydrochloride eye drops on emergence agitation after general anaesthesia for paediatric strabismus surgery.Methods:Paediatric patients(3-12 years-old)receiving strabismus surgery were randomly assigned to receive 1-2 drops of isotonic saline(n=129)or proparacaine hydrochloride(n=129)after surgery.The incidence and degree of emergence agitation were recorded and compared between groups.Results:A significantly lower occurrence of emergence agitation was observed with proparacaine hydrochloride drops compared to isotonic saline(12.4% vs.31.8%;p<0.05).Conclusion:Proparacaine hydrochloride eye drops reduce the incidence of emergence agitation after general anaesthesia for paediatric strabismus surgery.展开更多
Dear Editor,In this work, we evaluated a special case. Acquired progressive restrictive strabismus is very rare in the infants. We have been accessed to literatures and found only 5 infants had been reported. So, we r...Dear Editor,In this work, we evaluated a special case. Acquired progressive restrictive strabismus is very rare in the infants. We have been accessed to literatures and found only 5 infants had been reported. So, we report a case of progressive restrictive strabismus in a 4-month-old infant and using an anterior orbitotomy approach for the strabismus surgery.展开更多
Strabismus and amblyopia are common ophthalmologic developmental diseases caused by abnormal visual experiences. However, the underlying pathogenesis and visual defects are still not fully understood. Most studies hav...Strabismus and amblyopia are common ophthalmologic developmental diseases caused by abnormal visual experiences. However, the underlying pathogenesis and visual defects are still not fully understood. Most studies have used experimental interference to establish diseaseassociated animal models, while ignoring the natural pathophysiological mechanisms. This study was designed to investigate whether natural strabismus and amblyopia are associated with abnormal neurological defects. We screened one natural strabismic monkey(Macaca fascicularis) and one natural amblyopic monkey from hundreds of monkeys, and retrospectively analyzed one human strabismus case. Neuroimaging, behavioral,neurophysiological, neurostructural, and genovariation features were systematically evaluated using magnetic resonance imaging(MRI), behavioral tasks, flash visual evoked potentials(FVEP),electroretinogram(ERG), optical coherence tomography(OCT), and whole-genome sequencing(WGS), respectively. Results showed that the strabismic patient and natural strabismic and amblyopic monkeys exhibited similar abnormal asymmetries in brain structure, i.e., ipsilateral impaired right hemisphere. Visual behavior, visual function, retinal structure, and fundus of the monkeys were impaired. Aberrant asymmetry in binocular visual function and structure between the strabismic and amblyopic monkeys was closely related, with greater impairment of the left visual pathway.Several similar known mutant genes for strabismus and amblyopia were also identified. In conclusion,natural strabismus and amblyopia are accompanied by abnormal asymmetries of the visual system,especially visual neurophysiological and neurostructural defects. Our results suggest that future therapeutic and mechanistic studies should consider defects and asymmetries throughout the entire visual system.展开更多
Strabismus significantly impacts human health as a prevalent ophthalmic condition.Early detection of strabismus is crucial for effective treatment and prognosis.Traditional deep learning models for strabismus detectio...Strabismus significantly impacts human health as a prevalent ophthalmic condition.Early detection of strabismus is crucial for effective treatment and prognosis.Traditional deep learning models for strabismus detection often fail to estimate prediction certainty precisely.This paper employed a Bayesian deep learning algorithm with knowledge distillation,improving the model's performance and uncertainty estimation ability.Trained on 6807 images from two tertiary hospitals,the model showed significantly higher diagnostic accuracy than traditional deep-learning models.Experimental results revealed that knowledge distillation enhanced the Bayesian model’s performance and uncertainty estimation ability.These findings underscore the combined benefits of using Bayesian deep learning algorithms and knowledge distillation,which improve the reliability and accuracy of strabismus diagnostic predictions.展开更多
:Strabismus is a medical condition that is defined as the lack of coordination between the eyes.When Strabismus is detected at an early age,the chances of curing it are higher.The methods used to detect strabismus and...:Strabismus is a medical condition that is defined as the lack of coordination between the eyes.When Strabismus is detected at an early age,the chances of curing it are higher.The methods used to detect strabismus and measure its degree of deviation are complex and time-consuming,and they always require the presence of a physician.In this paper,we present a method of detecting strabismus and measuring its degree of deviation using videos of the patient’s eye region under a cover test.Our method involves extracting features from a set of training videos(training corpora)and using them to build a classifier.A decision tree(ID3)is built using labeled cases from actual strabismus diagnosis.Patterns are extracted from the corresponding videos of patients,and an association between the extracted features and actual diagnoses is established.Matching Rules from the correlation plot are used to predict diagnoses for future patients.The classifier was tested using a set of testing videos(testing corpora).The results showed 95.9%accuracy,4.1%were light cases and could not be detected correctly from the videos,half of them were false positive and the other half was false negative.展开更多
基金Supported by National Natural Science Foundation of China(No.82020108006,No.81730025).
摘要AIM:To summarize publication trends in the field of strabismus over the past 30y and predict future research hotspots.METHODS:A total of 2915 English-language articles and reviews on strabismus,published between 1993 and 2022,were retrieved from the Web of Science Core Collection.Bibliometric analyses were performed using VOSviewer and CiteSpace software to explore publication trends,as well as the contributions and collaborative networks of countriesegions,authors,institutions,and journals.RESULTS:The annual number of publications on strabismus showed a consistent upward trend.The United States(USA)maintained a leading position in this research field while Republic of Korea and China emerged as rapidly advancing contributors over the last decade.The University of California,Los Angeles ranked as the most productive institution,and Jonathan M.Holmes from USA was the most productive author.Journal of AAPOS was the leading journal with the most strabismus publications,whereas the two most highly cited articles were both published in Ophthalmology.Co-occurrence analysis identified pivotal keywords and burst terms,including intermittent exotropia(IXT),acute acquired comitant esotropia(AACE),functional magnetic resonance imaging(fMRI),and surgical treatment,which were confirmed as predominant and frontier topics.CONCLUSION:This study provides a comprehensive bibliometric analysis of strabismus research,revealing the evolution of research hotspots over the past 30y and outlining several cutting-edge directions for future investigation.
基金supported by Science and Technology Program of Guangzhou,China(SL2023A03J00480)the National Natural Science Foundation of China(82371099)+1 种基金Clinical High-tech and Major Technology Projects in Guangzhou(2024P-GX13)General Program of Natural Science Foundation of Guangdong Province(2026A1515011922).
摘要Recent advances in the surgical management of restrictive strabismus caused by thyroid-associated orbitopathy(TAO)demonstrate a clear trend toward precision and individualization.This review synthesizes current literature,highlighting innovations in preoperative evaluation,surgical techniques,and outcome assessment over the past decade.Preoperative assessment has evolved from clinical observation alone to a comprehensive model incorporating serological markers and highresolution imaging,significantly improving the accuracy of surgical timing decisions.Surgical techniques have been refined to address a range of complex scenarios,enhancing predictability,success rates while reducing reoperation rates.Outcome measures now prioritize functional vision and patient-reported outcomes alongside ocular alignment.Furthermore,emerging therapies,including biologics,offer novel non-surgical options for active-phase disease management and perioperative care.Based on the evidence synthesized herein,the field is moving toward a more personalized approach;however,high-level prospective trials evaluating surgical strategies remain limited.Surgeons are encouraged to base decisions on comprehensive assessments to optimize functional and quality-of-life outcomes.Future directions may involve the integrating evolving biologic therapies with advanced data analytics,an approach that holds promise for further personalization.
摘要AIM:To compare visual motor integration(VMI)in non-amblyopic children with and without horizontal strabismus.METHODS:VMI,visual perception,and motor coordination were evaluated in non-amblyopic children aged 6 to 17 years old using the Beery-Buktenica Developmental Test of Visual-Motor Integration(Beery-VMI),together with its supplementary Developmental Tests of Visual Perception and Motor Coordination.RESULTS:Forty-five non-amblyopic children with horizontal strabismus(23 males,22 females;mean age:126.0±33mo)and 45 children without strabismus(22 males,23 females;mean age:126.2±34mo)were enrolled.Children with horizontal strabismus exhibited significantly lower mean Beery-VMI scores(P<0.001),visual perception scores(P<0.001),and motor coordination scores(P<0.001)compared with controls,even after adjustment for confounding variables including sex,age,regular sports participation,number of siblings,and stereopsis.CONCLUSION:Non-amblyopic children with horizontal strabismus demonstrate significantly poorer performance in Beery-VMI,visual perception,and motor coordination compared with children without strabismus.
摘要AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patients who were determined to be surgical candidates.The patients’cohort were divided into two groups based on the presence or absence of strabismus.Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups.RESULTS:A total of 76 patients with TED were enrolled,including 58 males(76.3%)with a mean age of 52.68±10.45y.The 55 patients(male:female=2:1)were found to have TED with strabismus,while the remaining 21 patients(male:female=4:1)had TED without strabismus.There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus(OR=4.1,P=0.018)and they showed higher prevalence of proptosis(95.2%)than the TED strabismus group(63.6%,P0.05).The most common types of strabismus were hypotropia(36%)and esotropia(29%),respectively.CONCLUSION:Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction,but a higher incidence of compensatory AHP.Identifying these differences may aid in risk stratification and early intervention for TED patients,particularly those at risk for restrictive strabismus.
基金supported by the National Natural Science Foundation of China(82271117,8201001029 and 81730025)Shanghai 2022 Science and Technology Innovation Action Plan(22ZR1410200).
摘要In this study,we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery.We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery,along with 18 healthy controls.Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli.Compared with controls,preoperative patients showed hypoactivation in higher-level dorsal(visual and parietal)areas and ventral visual areas.Pre-and postoperative activation did not significantly differ in patients overall;patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus.Worse stereopsis and fusional control were correlated with preoperative hypoactivation,suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia.The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis.Thus,additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.
基金Supported by the Project for Collaboration Between Basis and Clinic of Capital Medical University(No.14JL04)。
摘要AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus surger y were enrolled prospectively. Retinal vessel diameters on color fundus photographs were assessed before and 1, 7 d, 6 mo after surgery, using a computerassisted quantitative assessment software. To evaluate the retinal vascular caliber changes, retinal vascular diameters were calculated by means of the Parr–Hubbard formula as the central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE). The arteriovenous ratio(AVR) was calculated as CRAE divided by CRVE. RESULTS: A total of 154 eyes of 104 consecutive patients were included. Compared with the data before surgery(121.55±24.67), the mean CRAE(131.18±28.29) significantly increased 1 d af ter surger y(P=0.003), but went back to baseline level at 7 d(118.89±30.35, P=0.15), and 6 mo(123.22±15.32, P=0.60), so did the AVR(P<0.001, P=0.08, P=0.07). As for the mean CRVE, there was no significant difference between those four time points(172.43±33.25, 175.57±36.98, 174.03±40.18, 174.86±20.46, P=1.00). CONCLUSION: Strabismus surgery on both lateral and media rectus muscles, or single media rectus muscle may increase retinal blood flow during the early postoperative period, but would return to normal later. The number of transected anterior ciliary arteries rather might be the main cause of retinal hemodynamic changes early after strabismus surgery.
摘要AIM: To identify the potentially pathogenic gene variants that contributes to the etiology of strabismus. METHODS: A Chinese pedigree with strabismus was collected and the exomes of two affected individuals were sequenced using the next-generation sequencing technology. The resulting variants from exome sequencing were filtered by subsequent bioinformatics methods and the candidate mutation was verified as heterozygous in the affected proposita and her mother by sanger sequencing. RESULTS: Whole exome sequencing and filtering identified a nonsynonymous mutation Co434G-T transition in paired box 3 (PAX3) in the two affected individuals, which were predicted to be deleterious by more than 4 bioinformatics programs. This altered amino acid residue was located in the conserved PAX domain of PAX3. This gene encodes a member of the PAX family of transcription factors, which play critical roles during fetal development. Mutations in PAX3 were associated with Waardenburg syndrome with strabismus. CONCLUSION: Our results report that the c.434G-T mutation (p.R145L) in PAX3 may contribute to strabismus, expanding our understanding of the causally relevant genes for this disorder.
基金Supported by Funds for Clinical-Basic Research Cooperation of Capital Medical University(No.14JL04)Beijing Municipal Science&Technology Commission(No.Z141107002514030)
摘要AIM:To evaluate the effect of strabismus surgery on retinal vessels calibers with digital color fundus photographs.METHODS:Two hundred consecutive strabismus patients underwent surgery,and 118 patients(female/male,55/63) who finished 6-month follow-up were finally included in this study.Optic disc-centered digital color fundus photographs of both eyes of all patients were taken prior to surgery and 6mo post surgery.The retinal vascular caliber of 116 operated eyes were measured using the computer program IVAN.The operated eyes were divided into 3 groups according to the surgical methods,recession of one muscle,one muscle recession and one muscle folding,one muscle resection and one muscle recession.The effect of number of altered muscles on retinal vessels was analyzed using statistic software SPSS 16.0.RESULTS:The mean age was 12.4±8.6y.Averaged central retinal artery equivalent(CRAE) of all patients was 120.31 ±23.02 μm preoperatively,and 122.87 ±15.93 μm six months after surgery.Averaged central retinal vein equivalent(CRVE) was 171.11 ±31.73 μm preoperatively and175.02±21.00 μm postoperatively.There was no significant difference of averaged CRAE(P=0.22) or CRVE(P=0.19)before and after operation.Averaged arteriole to venule ratio(AVR) was 0.71 ±0.07 before surgery and 0.70±0.07 after surgery.Comparison of preoperative and postoperative retinal vessels calibers among different surgical groups did not show significant differences.Also,there was no advantage of rectus muscle folding to muscle resection.CONCLUSION:Up to 6mo after strabismus surgery,the retinal vascular calibers were not altered.No more than two muscles in one surgery are safe for retinal perfusion.
摘要AIM:To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation.METHODS:The medical records of 122 patients,aged1.5mo to 9y,who had undergone cataract extraction with primary intraocular lens implantation between January1993 and August 2011 were reviewed.Fourteen patients(17 eyes)with strabismus before cataract surgery were excluded.Patients were divided into those with congenital bilateral cataracts(64 patients,128 eyes)and those with unilateral cataracts(44 patients,44 eyes).The associations between the development of strabismus and age at cataract surgery,pre-and post-cataract extraction corrected distance visual acuity(CDVA),interocular CDVA difference,nystagmus,surgical method,and secondary cataract were evaluated.RESULTS:Factors significantly associated with the development of strabismus included age at cataract surgery(≤1y),preoperative mean CDVA≤20/100,presence of nystagmus in the bilateral cataract group and postoperative interocular CDVA difference】20/70 in the unilateral group.Postoperative CDVA≤20/100 and preservation of posterior capsule,and presence of secondary cataract were significant factors in both groups.CONCLUSION:Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus,especially when they underwent surgery at age≤1y,and they have nystagmus,large postoperative interocular CDVA difference,poor preoperative and postoperative CDVA,preservation of the posterior capsule,or secondary cataract.
基金Supported in part by the National Institute of Health,Bethesda,Maryland(No.P30-EY014801)An unrestricted grant to the University of Miami from Research to Prevent Blindness,New York,USA.
摘要Dear Editor,cleral penetration during strabismus surgery was k3 first reported over 50 years ago[1].Early manuscripts reported the incidence of this complication around 10%[1].However,more recent studies suggest that this rate may have decreased[2-3].
基金This study was funded by the Clinical Care Technology Innovation Fund(201202)for projects at the Southwest Hospital.
摘要Objectives:To translate the Child Intermittent Exotropia Questionnaire(Child-IXTQ)from English to Chinese and to evaluate its reliability and validity in Chinese childhood strabismus patients.Method:A consecutive sample of 143 child strabismus patients was recruited from the Department of Ophthalmology at a medical center in Southwest China.In addition,100 visually normal adults and 100 patients with other eye diseases were recruited.The Brislin translation model was followed to develop the Chinese version of Child-IXTQ.Reliability was established using Cronbach's a and test-retest.Validity was established encompassing content validity,construct validity,convergent validity,criterion-related validity and discriminative validity.Results:The correlation coefficients between each item score with the total score ranged from 0.370 to 0.813.Two subscales were extracted by principal component analysis,with a content validity of 0.91.The correlation coefficients between two factor scores with the total score were 0.709 and 0.939.Criterion-related validity was estimated by the correlating the Child-IXTQ with the PedsQL 4.0,and the correlation coefficient was 0.522.In addition,the Child-IXTQ discriminated accurately between strabismus patients and normal children,or children with other eye diseases that possessed good discriminative validity.Cronbach's a coefficient for the internal consistency was 0.907 and the test-retest reliability was 0.962.Conclusions:Our study indicates that the Child-IXTQ is a reliable and valid instrument for assessing the health-related quality of life among children with strabismus.
摘要The design and efficacy of surgery for horizontal idiopathic nystagmus (HIN) with abnormal head posture and strabismus were investigated. Different surgical procedures were selected according to the angle of head turn in 44 cases of HIN with abnormal head posture and strabismus. For patients with a head turn of 15° or less, the Anderson procedure was used; the yoke muscles were recessed upon slow-phase. For patients with a head turn between 15° and 25°, the surgery was designed as a Kestenbaum 5-4-4-5 procedure. For patients with a head turn of 25° or more, the surgery was designed as a Parks 5-8-6-7 procedure. The surgery to correct the abnormal head posture was performed on the fixating eye while that to correct the deviation was then performed on the non-fixating eye at the same time. The amount of surgery of the horizontal rectus muscles on the nonfixating eye was sum of the angle of head turn and the degree of deviation, which was calculated as follows: recessionesection amount of medial and lateral rectis/2×5=angle of head turn±degree of deviation. The results showed as follows: (1) Visual acuity: the visual acuity in the primary ocular position increased two lines or more in 35 patients, accounting for 79.55%. Nine patients had no or only one-line improvement, accounting for 20.45% of the entire study population; (2) The degree of deviation in the primary ocular position: 37 cases had a normal primary ocular position or the degree of deviation ≤8△ after surgery, accounting for 84.09%. Six patients had a residual degree of deviation of 8△―15△, accounting for 13.64%. One patient had a residual degree of deviation 〉20△, accounting for 2.27% of the patients examined; (3) Abnormal head posture: 34 patients had a normal head posture or a head turn of less than 5°, accounting for 72.27%. Eight patients had a residual head turn of 5°―15°, accounting for 18.18%. Two patients had a head turn of 15°― 25°, accounting for 4.55%. It was concluded that different surgical procedures based on the angle of head turn and the relationship between deviation and null zone can eliminate anomalous head posture, correct deviation, and improve vision acuity in the primary ocular position simultaneously.
摘要BACKGROUND Pitt-Hopkins syndrome(PTHS;MIM#610954)is a rare genetic neurological disorder.Myopia and strabismus have been reported in approximately 50%of PTHS patients.No studies have reported details about the required surgery for PTHS with strabismus and early-onset myopia.Here,we retrospectively reviewed the surgical management of two patients with PTHS combined with strabismus and/or early-onset myopia.CASE SUMMARY A 5-year-old girl presented with congenital esotropia and left eye myopia,and the second girl was a 5-year-old girl who presented with intermittent exotropia.Genetic testing performed on both patients showed a mutation in transcription factor 4,which is a diagnostic marker of PTHS.The first girl underwent bilateral medial rectus recession combined with posterior scleral reinforcement(PSR)in the left eye and the second patient underwent bilateral lateral rectus recession strabismus surgery.We made key innovations in surgical timing and strategy,and the results were satisfactory.The combination of strabismus and PSR surgery is an innovative strategy for patients with both strabismus and early-onset myopia.CONCLUSION Early treatment of strabismus and myopia positively influence motor development and should be included in rehabilitation programs for patients with PTHS.
摘要Anterior segment optical coherence tomography (AS-OCT) finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery. We discuss two cases of operated strabismus surgery where AS-OCT imaging helped in identifying the operated eye and/or extra ocular muscles (EOM) and thus proved instrumental in planning and management.
摘要Purpose:To investigate the effect of proparacaine hydrochloride eye drops on emergence agitation after general anaesthesia for paediatric strabismus surgery.Methods:Paediatric patients(3-12 years-old)receiving strabismus surgery were randomly assigned to receive 1-2 drops of isotonic saline(n=129)or proparacaine hydrochloride(n=129)after surgery.The incidence and degree of emergence agitation were recorded and compared between groups.Results:A significantly lower occurrence of emergence agitation was observed with proparacaine hydrochloride drops compared to isotonic saline(12.4% vs.31.8%;p<0.05).Conclusion:Proparacaine hydrochloride eye drops reduce the incidence of emergence agitation after general anaesthesia for paediatric strabismus surgery.
摘要Dear Editor,In this work, we evaluated a special case. Acquired progressive restrictive strabismus is very rare in the infants. We have been accessed to literatures and found only 5 infants had been reported. So, we report a case of progressive restrictive strabismus in a 4-month-old infant and using an anterior orbitotomy approach for the strabismus surgery.
基金supported by the National Natural Science Foundation of China(81870682,81961128021,81670885)National Key R&D Program of China(2022YEF0203200,2021ZD0200103,2018YFA0108300)+2 种基金Guangdong Provincial Key R&D Programs(2018B030335001,2018B030337001)Local Innovative and Research Teams Project of Guangdong(2017BT01S138)Science and Technology Program of Guangzhou(202007030011,202007030010)。
摘要Strabismus and amblyopia are common ophthalmologic developmental diseases caused by abnormal visual experiences. However, the underlying pathogenesis and visual defects are still not fully understood. Most studies have used experimental interference to establish diseaseassociated animal models, while ignoring the natural pathophysiological mechanisms. This study was designed to investigate whether natural strabismus and amblyopia are associated with abnormal neurological defects. We screened one natural strabismic monkey(Macaca fascicularis) and one natural amblyopic monkey from hundreds of monkeys, and retrospectively analyzed one human strabismus case. Neuroimaging, behavioral,neurophysiological, neurostructural, and genovariation features were systematically evaluated using magnetic resonance imaging(MRI), behavioral tasks, flash visual evoked potentials(FVEP),electroretinogram(ERG), optical coherence tomography(OCT), and whole-genome sequencing(WGS), respectively. Results showed that the strabismic patient and natural strabismic and amblyopic monkeys exhibited similar abnormal asymmetries in brain structure, i.e., ipsilateral impaired right hemisphere. Visual behavior, visual function, retinal structure, and fundus of the monkeys were impaired. Aberrant asymmetry in binocular visual function and structure between the strabismic and amblyopic monkeys was closely related, with greater impairment of the left visual pathway.Several similar known mutant genes for strabismus and amblyopia were also identified. In conclusion,natural strabismus and amblyopia are accompanied by abnormal asymmetries of the visual system,especially visual neurophysiological and neurostructural defects. Our results suggest that future therapeutic and mechanistic studies should consider defects and asymmetries throughout the entire visual system.
基金supported in part by the Guangdong Natu-ral Science Foundation(No.2022A1515011396)in part by the National Key R and D Program of China(No.2021ZD0111502)in part by the Science Research Startup Foundation of Shantou University(No.NTF20021)。
摘要Strabismus significantly impacts human health as a prevalent ophthalmic condition.Early detection of strabismus is crucial for effective treatment and prognosis.Traditional deep learning models for strabismus detection often fail to estimate prediction certainty precisely.This paper employed a Bayesian deep learning algorithm with knowledge distillation,improving the model's performance and uncertainty estimation ability.Trained on 6807 images from two tertiary hospitals,the model showed significantly higher diagnostic accuracy than traditional deep-learning models.Experimental results revealed that knowledge distillation enhanced the Bayesian model’s performance and uncertainty estimation ability.These findings underscore the combined benefits of using Bayesian deep learning algorithms and knowledge distillation,which improve the reliability and accuracy of strabismus diagnostic predictions.
基金funded by the Deanship of Scientific Research at Princess Nourah bint Abdulrahman University,through the Research Funding Program(Grand No.FRP-1440-32).
摘要:Strabismus is a medical condition that is defined as the lack of coordination between the eyes.When Strabismus is detected at an early age,the chances of curing it are higher.The methods used to detect strabismus and measure its degree of deviation are complex and time-consuming,and they always require the presence of a physician.In this paper,we present a method of detecting strabismus and measuring its degree of deviation using videos of the patient’s eye region under a cover test.Our method involves extracting features from a set of training videos(training corpora)and using them to build a classifier.A decision tree(ID3)is built using labeled cases from actual strabismus diagnosis.Patterns are extracted from the corresponding videos of patients,and an association between the extracted features and actual diagnoses is established.Matching Rules from the correlation plot are used to predict diagnoses for future patients.The classifier was tested using a set of testing videos(testing corpora).The results showed 95.9%accuracy,4.1%were light cases and could not be detected correctly from the videos,half of them were false positive and the other half was false negative.