What's new AAPOS 2008 - The Private Eye Clinic

STRABISMUS
Causes and outcomes for patients presenting with diplopia to an eye casualty
department.
Comer RM, Dawson E, Plant G, Acheson JF, Lee JP.
Eye. 2007 Mar;21(3):413-8
Patients presenting with diplopia as a principal symptom, who were referred to the
Orthoptic Department from Moorfields Eye Casualty over a 12-month period, were
retrospectively investigated. One hundred and seventy-one patients were identified with
complete records in 165 cases. There were 99 men and 66 women with an age range of
5-88 years. Monocular diplopia accounted for 19 cases (11.5%), whereas 146 patients
(88.5%) had binocular diplopia. Cranial nerve palsies were the most common cause of
binocular diplopia accounting for 98 (67%) of cases. Isolated sixth nerve palsy was the
largest diagnostic group (n=45). Microvascular disease (hypertension or diabetes
mellitus, or both) was present in 59% of patients with cranial nerve palsies, and of this
group, 87% resolved spontaneously by 5 months rising to 95% by 12 months. Causes
of binocular diplopia other than cranial nerve palsies included thyroid eye disease,
myasthenia gravis, myositis, superior oblique myokymia and previous strabismus
surgery. Patients with clinically isolated single cranial nerve palsies associated with
diabetes or hypertension are likely to recover spontaneously within 5 months and
initially require observation only. However, patients with unexplained binocular diplopia
and those who progress or fail to recover should be investigated to establish the
underlying aetiology and managed as appropriate.
New approach for treating vertical strabismus: decentered intraocular lenses.
Nishimoto H, Shimizu K, Ishikawa H, Uozato H.
J Cataract Refract Surg. 2007 Jun;33(6):993-8.
PURPOSE: To evaluate a new surgical procedure that uses a decentered intraocular
lens (IOL) to correct vertical strabismus in cataract patients.
METHODS: Six patients (11 eyes) with vertical strabismus had small-incision cataract
surgery. The continuous curvilinear capsulorhexis was decentered, and the
asymmetrical span of the IOL haptics located on the side to be bent was inserted after
phacoemulsification and aspiration. Some relaxing incisions were made in the anterior
capsule. Postoperatively, the alternate prism cover test was used to assess changes in
ocular position. In addition, the EAS-1000 (Nidek) and KR-9000PW (Topcon) were used
to evaluate IOL decentration, tilt, and aberrations.
RESULTS: The mean age of the patients was 66 years (range 58 to 77 years). The
mean preoperative vertical strabismus was 7.3 prism diopters (PD) (range 4 to 12 PD).
Two years after surgery, the mean angle of vertical deviation was 1.3 PD (range 0 to 5
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