Cyclic Esotropia: a Case Report

In this case report, two cases with diagnosis of cyclic esotropia are presented. Both patients complained of periodic alternative inside eye deviation with an interval of one day. Para- clinical tests including magnetic resonance imaging (MRI) of the brain and electroretinogram (ERG) were normal and no neurological abnormality or paralysis was detected. Patients were observed in two consecutive days to confirm the diagnosis of cyclic esotropia. Both patients underwent bilateral medial rectus recession surgery as routinely performed for non- cyclic esotropic patients, and the postoperative orthotropia with the best corrected visual acuity (BCVA) of 20/20 was obtained in both cases. In conclusion surgical and non-surgical treatments can be used for cyclic esotropia similar to what is routinely performed for non- cyclic strabismic patients. Successful therapeutic outcomes might be obtained in such patients achieving normal binocular fusion in several days with no ocular deviation. Keywords: Cyclic; Esotropia; Treatment

Acute Acquired Comitant Esotropia in Adults; a Case Report

Purpose:  The aim of this manuscript was to report the clinical characteristics of two patients suffering from acute acquired comitant esotropia presented in adulthood.Case report: Both patients reported intermittent diplopia especially during car driving before their diplopia becoming constant. They had 20/20 uncorrected visual acuity and a cyclorefraction of + 0.50 D with normal extraocular function except very mild lateral rectus underaction (< 1) in their both eyes. In alternate prism cover test, the manifest esotropia of 25 - 30 Δ was measured at both far and near distances. They did not show any signs of neurological disorders such as marked extraocular underaction or different esotropia on lateral gazes compared with esotropia in primary position. No abnormality was found on electromyography, visual field measurements and magnetic resonance imaging for both cases.Conclusion: Based on our clinical assessment, hereditary causes, mild lateral rectus underaction or inability to compensate esotropia due to decreased divergence amplitude and fusion could be considered as the probable risk factors for acute acquired comitant esotropia in adults, although the actual etiology of this disease has not been determined.Keywords: Acquired; Esotropia; Acute; Etiology; Adult; Risk factor

Side Effects of the COVID-19 Vaccination among the Personnel of Negah Eye Hospital, Tehran, Iran

Purpose: To investigate the complications of coronavirus vaccination among the personnel of Negah Eye Hospital, Tehran, Iran. Patients and Methods: In this questionnaire-based survey we collected demographic characteristics as well as local and general vaccine complications among the personnel of Negah Eye Hospital, Tehran, Iran, including gastrointestinal, cardiac, pulmonary and ocular complications between June and August 2021. Results: In this study, all personnel (n = 259) were evaluated. The mean age of participants was 42.58 ± 11.98 years. It was observed that 70.3 %, 24.7 %, and 5.0 % were vaccinated with AstraZeneca, Sputnik, and Baharat vaccines, respectively. Cases who were vaccinated with the first dose of AstraZeneca showed higher rate of fever (P < 0.001), chills (P < 0.001), muscle pain (P = 0.001), joint pain (P = 0.004), confusion (P = 0.002), drowsiness (P < 0.001), nausea (P = 0.014), and injection site pain (P = 0.005) compared to other types of vaccination. Post-injection complications mostly declined after the second dose. The most frequent complications secondary to vaccination were observed among younger and female participants (P < 0.05). Conclusion: Complications were significantly higher after the first dose of AstraZeneca compared to Sputnik, and Bharat vaccines. Vaccine complications were higher after the first dose which remarkably decreased after the second dose of vaccination. Younger and female cases were in more risk of complication compared to older and male patients

The Effect of Refractive Error Correction on Stereopsis

Purpose: The present study aimed to assess the effect of refractive error (RE) correction on stereopsis. Materials and Methods: A total of 62 participants underwent comprehensive ophthalmic examinations, which included measurements of visual acuity, RE, stereopsis, ocular alignment, as well as examinations of the anterior and posterior ocular segments. Stereopsis was evaluated using the TNO random dot stereogram booklet at a distance of 33cm, both with and without RE correction. The results were then compared to evaluate the impact of RE correction on stereopsis. Results: Our findings revealed that correcting one diopter of the spherical and spherical equivalent components of RE led to a significant improvement in stereopsis, with improvements of 30.884 and 30.373 seconds of arc, respectively (P = 0.001). However, the correction of other components of RE did not demonstrate a statistically significant effect on improving stereopsis. Additionally, we found no significant correlation between different types and severities of refractive errors and stereopsis. Conclusion: Correcting the spherical and spherical equivalent components of refractive error may enhance stereopsis across various types of refractive errors

Reoperation in Horizontal Strabismus and its Related Risk Factors

This study was performed to determine the surgical outcomes and the related risk factors of second operation in patients with residual horizontal deviations. In this interventional case series study, a total of 119 patients with a history of reoperation were included (39 exotropia and 80 esotropia). Cases with consecutive strabismus, muscular palsy, systemic disease, lack of ocular fixation, and those, who had vertical deviation and Dissociated Vertical Deviation (DVD)>5 Prism Diopters (pd) were excluded. Medial Rectus (MR) resection in residual Exotropia (XT) and Lateral Rectus (LR) resection in residual Esotropia (ET) were performed. Unilateral or bilateral operations were considered if the preoperative residual deviation was < 20 pd or > 20 pd, respectively. Success of the reoperation was considered if the postoperative angle of deviation was ≤ 10 pd. Unilateral and bilateral MR resection was performed in 26% and 74% of patients with XT, respectively, with greater dose response in unilateral cases (2.8 versus 2.6 mm/pd). Successful surgical outcomes were observed in 94.9% of patients with XT. Unilateral and bilateral LR resection was also performed in patients with residual ET, each in 50% of patients. Unilateral cases showed greater dose-response compared to bilateral ones (2.6 versus 2 mm/pd) and successful surgical outcomes were observed in 83.8% of patients with ET. No variable was found as a risk factor of reoperation in both groups. In conclusion, both LR and MR resection are easy and predictable surgical approaches with high success rate in patients with residual ET and XT. Generally, MR resection is more effective than LR resection. Unilateral operation is less recommended in the residual exotropic group, due to its lower success compared to the bilateral operation. Unfortunately, none of the mentioned variables were found to be the risk factor of reoperation in the sampled patients.Â

Risk Factors Associated with Keratoconus in an Iranian Population

Purpose: To determine associated factors for keratoconus (KCN) in the Iranian population. Methods: In this retrospective case-control study, 100 KCN patients and 200 age- and sex-matched individuals, who were either candidates for photorefractive keratectomy or healthy referrals from the Torfeh Eye Hospital, were included as the case and control groups, respectively. KCN patients were all registered at the Iranian National Registry of Keratoconus (KCNReg®). Demographic characteristics, patients’ symptoms and their habits, as well as systemic and ocular disorders were documented. Clinical examinations included best corrected visual acuity (BCVA) and refractive error measurements, biomicroscopic examination, and corneal imaging. Results: In this case group, the frequency of mild, moderate, and severe KCN was 38%, 28%, and 34%, respectively. Parental consanguinity (odds ratio [OR] = 1.758, P = 0.029), positive familial history in patients’ first degree (OR = 12.533, P < 0.001) and second degree (OR = 7.52, P < 0.001) relatives, vernal keratoconjunctivitis (OR = 7.510, P = 0.003), severe eye rubbing (OR = 10.625, P < 0.001), and systemic diseases including migraine, hypertension, and thyroid disease (OR = 6.828, P = 0.021) were found as associated factors for KCN. Lesser frequency of KCN was observed in patients with Fars ethnicity (OR = 0.583, P = 0.042), with higher levels of wealth indices (OR = 0.31, P < 0.001) and higher levels of education (OR = 0.18, P = 0.024). Conclusion: Severe eye rubbing, vernal keratoconjunctivitis, parental consanguinity and positive familial history of KCN, low socioeconomic status, and low levels of education were significantly associated with KCN in our study population

Vision Therapy/Orthoptics among Three to Seven Year Old Children

Background: Vision Therapy/Orthoptics(VT/O) is a package of treatments that enables patients to achieve the maximum level of visual performance.The aim was to determine the effect of three months vision therapy/orthoptics on best corrected visual acuity (BCVA), fusion, stereopsis and ocular alignment in 3-7 year old children.Materials and Methods: In this randomized clinical trial study, 80 children with amblyopia and/or non-paralytic horizontal deviations were randomly divided into intervention and control groups. Intervention group was treated by vision therapy/orthoptics for three months. These modalities included patch, red filter, sector patch, over minus lens, prism and synoptophore exercises. Controls were treated by only patching for the same period. Pre and post-treatment BCVA, fusion, stereopsis and alignment were compared. Visual performance was classified as excellent (BCVA≥20/30, deviation≤10pd and stereopsis≤70sec/are), acceptable (BCVA≥20/30, deviation ≤10pd and stereopsis 70 to 3000sec/are) and unsatisfactory (BCVA<20/30, deviation>10pd and no stereopsis).Results: A total of 80 cases (56 girls and 24 boys) with the mean age of 5.6±1.4 years entered the study. Although more improvement of fusion and stereopsis was seen in the intervention group (P<0.001 for both groups), there was no significant differences in BCVA and alignment between two groups. Also the difference of visual performance was not statistically significant between two groups, whereas the improvement was significant in each group (P<0.001, for both groups).Conclusion: Vision therapy/orthoptics treatment can be effective for improving sensory status in 3 to 7 year old children with amblyopia and/or strabismus. Further studies with larger sample sizes and focusing on accommodation and fusional amplitude are warranted

Job Satisfaction among Ophthalmologists in Iran

Purpose: To estimate the level of job satisfaction among ophthalmologists in Iran and determine the associated factors that may impact their overall job satisfaction. Methods: In this cross-sectional study, 181 ophthalmologists (79.0% male) were interviewed by the Warr-Cook-Wall questionnaire with 7-point-Likert scale, which transformed responses from a 0 (most dissatisfied) to 100 (most satisfied). Questionnaires were randomly distributed among registered ophthalmologists at the 29th Annual Congress of the Iranian Society of Ophthalmology in November 2019. Satisfaction under each scale was considered as a score of >60% of the total score. Results: A total of 181 ophthalmologists with a mean age of 47.8 ± 12.1 years and 16 ± 12 years of practice participated in the present study. They were mostly satisfied with their job as a whole (88.1%, mean score: 60.6 ± 20.7) and dissatisfied with their income (55.9%, mean score: 47.6 ± 20.3). High levels of job satisfaction were found among ophthalmologists with longer duration of practice (P < 0.001) while lower levels of satisfaction were identified among those who worked in academic centers (P = 0.004). Conclusion: In this study, high levels of job satisfaction were found among ophthalmologists with longer duration of practice while low levels of satisfaction were identified among ophthalmologists who worked in academic centers. The factors of salary and working hours accounted for the least levels of job satisfaction

Reoperation in Horizontal Strabismus and its Related Risk Factors

This study was performed to determine the surgical outcomes and the related risk factors of second operation in patients with residual horizontal deviations. In this interventional case series study, a total of 119 patients with a history of reoperation were included (39 exotropia and 80 esotropia). Cases with consecutive strabismus, muscular palsy, systemic disease, lack of ocular fixation, and those, who had vertical deviation and Dissociated Vertical Deviation (DVD)>5 Prism Diopters (pd) were excluded. Medial Rectus (MR) resection in residual Exotropia (XT) and Lateral Rectus (LR) resection in residual Esotropia (ET) were performed. Unilateral or bilateral operations were considered if the preoperative residual deviation was < 20 pd or > 20 pd, respectively. Success of the reoperation was considered if the postoperative angle of deviation was ≤ 10 pd. Unilateral and bilateral MR resection was performed in 26% and 74% of patients with XT, respectively, with greater dose response in unilateral cases (2.8 versus 2.6 mm/pd). Successful surgical outcomes were observed in 94.9% of patients with XT. Unilateral and bilateral LR resection was also performed in patients with residual ET, each in 50% of patients. Unilateral cases showed greater dose-response compared to bilateral ones (2.6 versus 2 mm/pd) and successful surgical outcomes were observed in 83.8% of patients with ET. No variable was found as a risk factor of reoperation in both groups. In conclusion, both LR and MR resection are easy and predictable surgical approaches with high success rate in patients with residual ET and XT. Generally, MR resection is more effective than LR resection. Unilateral operation is less recommended in the residual exotropic group, due to its lower success compared to the bilateral operation. Unfortunately, none of the mentioned variables were found to be the risk factor of reoperation in the sampled patients.

Slanted versus Augmented Recession for Horizontal Strabismus

Purpose: To compare the surgical outcomes of slanted versus augmented recession in patients with horizontal strabismus. Methods: In this randomized clinical trial, a total of 100 esotropic (ET) and exotropic (XT) patients with a high AC/A ratio which was defined as a difference of ≥ 10 prism diopters (pd) between the distance and near deviations were included if the patients had a distance deviation ≥ 15 pd. Patients were randomly assigned into the slanted (n = 26 in ET and n = 24 in XT group) and augmented recession groups (n = 25 in ET and n = 25 in XT group). In the slanted group, recession was performed on the superior and inferior poles of the muscle based on the distance and near deviations, respectively, while in the augmented recession group, the muscles were recessed 1.00 or 1.50 mm more than the standard amount according to the distance and near difference between 10 and 20 pd or > 20 pd, respectively. Results: The mean age was 9.8 ± 9.6 years and 63% were female. There was a significant postoperative reduction of difference in convergence excess in ET cases compared to patients who underwent the augmented recession procedure (12.65 ± 6.16 vs 8.64 ± 6.1 pd, P = 0.014). Among our XT groups, there was no significant difference in postoperative reduction in the XT angle in the slanted group compared with the augmented group (P > 0.05). Conclusion: Slanted recession is recommended in convergence excess ET patients. In XT patients, either slanted or augmented recession may be chosen according to the priority and experience of the surgeon