Reena Gupta

Abstract

Material and Methods: The study was conducted at Pediatric Ophthalmology and Strabismus clinic at our tertiary care institute PGIMS, Rohtak. Patients who developed consecutive tropia after squint surgery for horizontal strabismus from April 2015 to August 2016 were enrolled. Continued esodeviation after surgery for exotropia was termed as consecutive esotropia and post-operative exodeviation present even 2 weeks after surgery for esotropia was termed as consecutive exotropia. The patients were followed up for at least 3 months. Ocular movements, preoperative deviation (PBCT), presence of vertical deviation, DVD, A-V patterns was noted, AC/A ratio, sensory status by Worth Four Dot Test and Titmus test. Immediate post-operative deviation was measured. Follow-up was done at 2 weeks, 6 weeks, 3 months and 6 months. Results: There were a total of 92 patients who underwent squint surgeries for horizontal strabismus. 12 patients developed consecutive squint. Out of 12 patients, 10 patients developed consecutive exotropia and 2 patients developed consecutive esotropia. The mean pre-operative deviation of resolved cases in both the groups was 458.16PD for near and 42.58.66PD for distance and the mean pre-operative deviation of unresolved cases in both the groups was 39.1610.68PD for near and 38.336.83PD for distance. Discussion: In our study, the incidence of consecutive squint was 13%. Out of which 10.86% had consecutive exotropia and 2.17% had consecutive esotropia. The patients who developed consecutive squint had infantile esotropia, infantile exotropia, partially accommodative esotropia and non- accommodative acquired esotropia. Amongst consecutive exotropias group, 40% cases resolved while in consecutive esotropia group, 50% resolved. Conclusion: Consecutive squint is a complication of squint surgery which can develop immediately after surgery or years later. Taking care of the errors during measurement of pre-operative deviation improves the success of surgical outcomes. Keywords: Consecutive squint, Horizontal strabismus, DVD, Esodeviation, Exodeviation, Consecutive esotropia, Consecutive exotropia.

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Abstract

Material and Methods: The study was conducted at Pediatric Ophthalmology and strabismus clinic at our tertiary care institute PGIMS, Rohtak. The study was a descriptive pilot study which was conducted between January 2017 to April 2019. All patients who reported to pediatric ophthalmology and strabismus clinic, PGIMS, Rohtak, diagnosed as Congenital fibrosis of EOM, Duane’s retraction syndrome, Mobius syndrome, Congenital strabismus with abnormal vertical movements, MEDs and variants of Dysinnervational disorders were included in our study. Results: In the study a total of 25 cases were taken with 22 cases having a follow up of 6 months, with 71% cases being females and rest being males, 27% cases had bilateral involvement, 32% had left and 41% had right eye involvement. 56% had strabismic amblyopia, 11% had anisometropic and rest had visual axis obscuration. 10 cases from the total were treated with surgery and 4 were managed conservatively, a follow up of >6 months was taken and results were noted. Discussion: Of the multiple observations made through this study some of the most important ones were that patients with CFEOM have variable angle strabismus mainly Exotropia with hypertropia , Muscle hypoplasia with displaced scleral insertions were seen, two staged surgical correction of remnant muscles resulted in good ocular alignment, AHP was frequently present, there was association of CCDD’s with complex strabismus, predominant vertical ocular motility defects helped as a tool for diagnosing variants of CCDD’s, cosmetic alignment with correction of face turn helped a long way in restoring self confidence of patients, Congenital MED with innervational pathology was included and Knapp’s procedure has proved to be effective in treating strabismus, AHP, ocular elevation. Conclusion: Classification and unification of congenital disorders of ocular motility continues to evolve and unlock the complexity of mechanism of etiopathogenesis of CCDD, and advanced imaging is opening new doors of managing these cases successfully each day, further research in genetic basis of this disease complex can yield us better results in future. Keywords: Misinnervation, Upshoot, Abnormal head posture, Globe retraction, Ocular misalignment.

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