Comparison of outcome of inferior oblique weakening procedures, myectomy and anterior transposition, from western India

Context: Inferior oblique (IO) weakening is one of the commonest surgical procedures on the oblique muscles. Purpose: To compare the results of two IO weakening procedures, myectomy, and anterior transposition, done for IO over-action and dissociated vertical deviation (DVD). Setting and design: Tertiary eye-care center. Retrospective review Materials and Methods: Patients operated for IO over-action and DVD were studied. All patients had undergone a comprehensive ocular examination with full orthoptic evaluation and cycloplegic refraction. In the anterior transposition of IO, the IO muscle was recessed from its insertion and placed lateral to the insertion of the inferior rectus. In myectomy, the IO tendon was cut at two sites 5 mm apart and the cut ends cauterized and left free. The outcome measure was pre and post-operative IO action measurement. Statistical analysis: T-test. Results: Eighty six children (128 eyes) underwent IO weakening procedures, 81 (62.4%) were myectomy and 47 (36.2%) were anterior transpositions. The average age was 8.9 years (standard deviation, SD 3.51), 53 (61.6%) were girls. Twenty-three had DVD and 42 patients had bilateral IO surgeries. Thirty-eight (44.2%) had esotropia and 47 (54.6%) had exotropia co-existent; one had only primary IO over-action. The pre-and post-operative IO over-action was 1.61 and 0.59 for myectomy and 1.61 and 0.29 for anterior transposition, respectively. On comparing the pre- vs post-IO action, P < 0.001 for both techniques, but post-operative anterior transposition versus myectomy had P = 0.156 by the t-test. Conclusion: Both techniques were effective and the difference between the two techniques was not statistically significant

Visual outcome and impact on quality of life after surgeries differ in children operated for unilateral and bilateral cataract (Pune study 2011)

Background: We compared vision and quality of life (VQL) of children aged 5-15 years and operated for unilateral and bilateral cataract between 2008 and 2010 in western India. Materials and Methods: In this cohort study, ophthalmologists assessed vision, anterior and posterior segment of eyes with cataract. Children completed a functional vision questionnaire (LVP-FVQ). Follow up at 6 months after surgery included the best corrected visual acuity (BCVA), FVQ and eye assessment. The improvement of BCVA and quality of life were compared in group of unilateral and bilateral cataract. Result: A total of 20 (70%) bilateral and 7 (39%) unilateral cataract were operated within 1 month of detection. All 48 eyes with bilateral cataract were congenital and 12 (67%) unilateral cataract were traumatic. Among bilateral group, 27 eyes [56.2% (95% confidence interval (CI) 44.4-72.2)] and in unilateral group 11 eyes [61.1% (95% CI 38.6-83.6)] had vision ≥ 20/60 at 6 months follow up. The visual gain was significantly higher in children who were operated between 1 month and 1 year of detection (adjusted Odds ratio (OR) = 15.6 P = 0.03). Positive impact on VQL in bilateral group was noted in 50%, 27%, and 13% children for subscale of distant vision, near vision, and field of vision, respectively. There was positive impact in these subscales among children with unilateral cataract. Thirty percent eyes with bilateral cataract and 22% of eyes with unilateral cataract improved their vision. Surgery within 1 month of cataract was significant predictor of improved vision (OR = 16.6 P = 0.02). Conclusion: Vision and VQL improved in children with unilateral and bilateral cataract. However, it was better 6 months following surgery in children with bilateral cataract than in children with unilateral cataract