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Bilateral posterior tenectomy of the superior oblique muscle for the treatment of A-pattern strabismus

Ranka, Milan P; Liu, Grace T; Nam, Julie N; Lustig, Marc J; Schwartz, Shirah R; Hall, Lisabeth S; Furlan, Louis E; Ceisler, Emily J; Steele, Mark A
PURPOSE: To evaluate the efficacy of bilateral posterior superior oblique tenectomy for the treatment of A-pattern strabismus due to superior oblique overaction regardless of the magnitude of the pattern. METHODS: The medical records of patients with A-pattern esotropia or exotropia in the presence of superior oblique overaction who underwent combined horizontal muscle surgery along with bilateral superior oblique posterior 7/8 tenectomy from 2003 to 2013 were retrospectively reviewed. Patients with at least 3 months' follow-up were included. RESULTS: A total of 73 patients were included. Of these, 46 had esotropia; 27, exotropia. The preoperative A-pattern deviation for the study population was 19.6Delta +/- 11.4Delta (range, 10-60), with a final postoperative patten collapse of 18.2 +/- 3.6. Superior oblique overaction was 2.3 +/- 0.7 preoperatively and 0.3 +/- 0.7 postoperatively. Overall, 87.7% of patients had a successful collapse of their pattern to <10Delta following the initial bilateral superior oblique posterior tenectomy, with an additional 4.1% following a second procedure. Of patients with a pattern deviation of <25Delta, 87.9% had successful collapse of the pattern following 1 surgery, and 86.7% of patients who had a pattern of >/=25Delta had successful collapse. Postoperatively, 7 patients demonstrated mild inferior oblique overaction. No surgical complications were noted. CONCLUSIONS: A uniform dose of bilateral posterior 7/8 tenectomy surgery successfully collapses A-pattern deviations of all magnitudes.
PMID: 25262558
ISSN: 1091-8531
CID: 1259922

"Double vision" as a presenting symptom in adults without acquired or long-standing strabismus

Shippman, Sara; Heiser, Larisa; Cohen, Kenneth R; Hall, Lisabeth
Background: Evaluation of adults with a symptom of acquired double vision is a challenging diagnostic problem. This retrospective report reviews a series of adult patients who presented with a symptom of 'double vision' but did not have diplopia related to a recently acquired or decompensated strabismus. The symptom of double vision was related mainly to blurred vision and often was not true binocular diplopia. Methods: This is a retrospective study of medical records. Results: 261 patients, age 40 years or older referred for a recent onset symptom of double vision were reviewed. Sixty-seven patients were included in the study. These patients presented with no findings that indicate a recent onset of incomitance or breakdown of a long-standing strabismus. The patients were divided into five groups with common etiologies and their findings were analysized. Group 1 (17 patients) had symptoms of double vision due to monocular blur without diplopia. Group 2 (21 patients) had symptoms of double vision related to monocular blur that caused a dissociation of a small phoria. Group 3 (10 patients) had symptoms of double vision related to superimposition of images due to a distorted image. Group 4 (13 patients) had symptoms of double vision related to convergence insufficiency. Group 5 (6 patients) had symptoms of double vision related to an induced tropia secondary to anisometropia correction. Options for treatment include improving vision and having the patient understand the nature of the problem. Conclusion: 'Double vision' does not mean the same thing to the patient and the examiner. The examiner must distinguish true diplopia from other symptoms and be able to demonstrate this to the patient. Treatment is directed to the specific type of problem, but improvement of vision resolves the large majority of these complaints. Examination and treatment techniques are discussed
PMID: 21149183
ISSN: 0065-955x
CID: 119217

Dynamic visual acuity: its place in ophthalmology?

Shippman, Sara; Heiser, Larisa; Cohen, Kenneth R; Hall, Lisabeth S
Introduction and Purpose: To detect if dynamic visual acuity can be useful in the evaluation of a patient with vague asthenopic complaints including dizziness. Method: A review of the vestibular system and the vestibular ocular reflex as it relates to dynamic visual acuity. Results: Ten patients with asthenopic symptoms and convergence insufficiency were tested with dynamic visual acuity. None were found to have a positive test despite a complaint of dizziness, indicating the lack of vestibular involvement. Conclusion: Testing for dynamic visual acuity may be useful in the examination of patients with vague complaints of dizziness. Patients who presents with vague asthenopic complaints often include dizziness. Dynamic visual acuity may be helpful in diagnosing vestibular problems so appropriate referral can be made
PMID: 21149123
ISSN: 0065-955x
CID: 119218

Development of primary axial myopic anisometropia

Shippman, Sara; Heiser, Larisa; Hall, Lisabeth S; Cohen, Kenneth R
Assessment of refractive errors is an integral part of the treatment of ophthalmic problems. This is especially important in pediatric patients for early diagnosis of strabismus and amblyopia. In anisometropic amblyopia, careful monitoring of the refractive error is necessary. The following case history describes a patient who developed myopic axial anisometropia at age one. It suggests that the development of myopic axial anisometropia may be different than our present understanding. We reviewed the literature and found no description of the onset of myopic axial anisometropia
PMID: 21149080
ISSN: 0065-955x
CID: 119219

Visual outcomes in children with bilateral retinoblastoma

Hall LS; Ceisler E; Abramson DH
BACKGROUND: Retinoblastoma is the most common primary intraocular tumor of childhood. Although studies have explored trends in retinoblastoma management and prognosis, few have addressed visual outcome. METHODS: A retrospective chart review was performed on children in whom bilateral retinoblastoma was diagnosed at New York Hospital-Cornell Medical College. A total of 74 children were included in the study. All children underwent radiation to the eyes that were studied. Fundus drawings done at the time of diagnosis were evaluated to determine the location of tumors on presentation and the Reese-Ellsworth classification. Visual outcome was classified into 3 groups: group 1 represented visual acuity of 20/20 to 20/40; group 2, 20/50 to 20/400, and group 3, <20/400. RESULTS: A total of 74 children were studied. Forty-six (62%) underwent enucleation of 1 eye. The visual acuity of the remaining 102 eyes was divided into groups 1, 2, and 3. Fifty-eight percent of these eyes were in group 1, 31% in group 2, and 9% in group 3. Two percent underwent subsequent enucleation after treatment. The tumors were analyzed on the basis of Reese-Ellsworth classification, location, size, and distance from the macula. Excluding Reese-Ellsworth group VB, there was no correlation between Reese-Ellsworth classification and final visual outcome. Tumors involving the macula were in 7 (78%) of 9 eyes with poor visual outcome (group 3), and 16 (33%) of 48 eyes with excellent vision (group 1) had macular tumors. Paradoxically, 2 (22%) of 9 eyes in group 3 did not have tumors involving the macula. CONCLUSIONS: Children with retinoblastoma now have an excellent prognosis for life. Although correlated with tumor location, visual outcome is not always easily predicted on the basis of the initial presentation. Final acuity is excellent in most cases but may be influenced by multiple factors that must be considered when caring for these children and families
PMID: 10428586
ISSN: 1091-8531
CID: 36211


ISSN: 0146-0404
CID: 103671