What's new AAPOS 2008 - The Private Eye Clinic

The effect of topical tetracaine eyedrops on the emergence behavior and pain
relief after strabismus surgery.
Anninger W, Forbes B, et al.
J AAPOS 2007; 11: 273-76.
The authors performed a double masked randomized controlled trial of 88 patients from
one to 12 years of age undergoing strabismus surgery. They had three groups
randomized to receive either saline drops before and after surgery, saving drugs before
and tetracaine 1% after surgery, and tetracaine drops before and after surgery. They
masked observers then assessed each patient in the Post anesthesia care unit. They
found that postoperative strabismus surgery pain was lessened by the use of
preoperative and pre-and postoperative tetracaine drops.
Management of nonresolving consecutive exotropia following botulinum toxin
treatment of childhood esotropia.
Jaime Tejedor MD PhD, José Rodriguez MD
Arch Ophthalmol 2007;125(9):1210-1213
Retrospective medical records review; 2445 patients treated with botulinum toxin
bimedial injection; patients operated on after 1 year of consecutive exotropia were
selected. A total of 5 children with acquired esotropia and 2 with infantile esotropia were
included. A high dose of toxin per injection might increase the risk of consecutive
exotropia. Preoperative mean exotropic deviation was 15.42 prism diopters, and
stereoacuity was not measurable before surgery. Postoperative mean deviation was 6
PD, and mean stereoacuity was 447.14 arc seconds. In 2 patients, suppression of the
nondominant eye was detected. Three children had poor stereoacuity.
Conclusion: Surgery for exotropia following botulinum toxin injection in children is
effective from a motor and sensory point of view.
A 10-year overview of double elevator muscle weakening procedures.
Richard Saunders MD, Stacey Kruger MD, Joel Lall-Trail MD, Philip Rust PhD
Arch Ophthalmol 2007;125:634-638
Observational case series; 10-year period; consecutive patients who underwent bilateral
5- to 11-mm superior rectus muscle recessions combined with an IO muscle recession,
myectomy, or anterior transposition. Effects on ocular rotations and eyelid position were
recorded for 37 patients (69 eyes) who were followed up for at least 6 months
postoperatively.
Supraduction deficiency was significantly associated with transposition of the IO muscle
anterior to the inferior rectus muscle insertion compared with the standard IO muscle
recession and IO muscle myectomy. Y-pattern exotropia occurred more frequently after
transposition of the IO muscle anterior to the inferior rectus muscle insertion than other
weakening procedures.
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