Download esa2016_brochure - 38th Meeting of European Strabismological

38TH MEETING
OF THE EUROPEAN
STRABISMOLOGICAL
ASSOCIATION
Hotel Hungaria City Center - Budapest, Hungary
28TH SEPTEMBER - 1ST OCTOBER 2016
FINAL PROGRAMME
TABLE OF CONTENTS
Welcome Message from the ESA President .................................................................................... 04
Welcome Message from the Head of the Local Organizing Committee ............................................ 05
Committees .................................................................................................................................. 06
General Information ....................................................................................................................... 07
Pre-Meetings................................................................................................................................. 10
Programme at a Glance ................................................................................................................. 11
Scientific Programme .................................................................................................................... 13
Index of Posters ............................................................................................................................ 21
Abstracts of Free Papers ............................................................................................................... 27
Abstracts of Rapid Fire Posters ...................................................................................................... 53
Abstracts of Posters ...................................................................................................................... 61
Authors Index .............................................................................................................................. 102
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WELCOME MESSAGE
FROM THE ESA PRESIDENT
Dear friends and colleagues,
It is my great pleasure to welcome you
to the 38th Annual Congress of the
European Strabismological Association in
Budapest. We have assembled an exciting
scientific programme of Symposia, a
Round Table, Early Course and our usual
Difficult Cases session. We have also had
a record number of submissions for free
papers and posters, which are getting
particular attention. We look forward to some interesting discussions.
But Budapest is also a beautiful city with its two parts, Buda and Pest,
which sit on either side of the River Danube and were united in 1873. It
is steeped in history from Celtic times onwards and has an impressive
medieval castle across the river on the Buda side, which is well worth a
visit. There are also many beautiful streets and buildings from the time
of the Austro-Hungarian Empire. There are also interesting buildings
from the more recent past, including an underground hospital. And
don’t miss our Gala Dinner, which will be a cruise along the Danube,
with wonderful views of the City on both banks. Have an enjoyable
congress.
John Sloper
President,
European Strabismological Association
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WELCOME MESSAGE
FROM THE LOCAL ORGANIZER
OF THE 38th ESA MEETING
Dear Colleagues,
On behalf of the Local Organizing
Committee, it is a great pleasure to invite
you to take part in the 38th Congress of the
European Strabismological Association
to be held in Budapest, Hungary, from the
28th September to the 1st October 2016.
We experienced, how extraordinary
interesting and successful was the
2015’s meeting in Venice, Italy for
ophthalmologists, optometrists and residents from Europe and all over
the world!
Conferences are becoming more and more informative, even
sometimes to the extreme. While giving overview on all important and
new aspects of strabismus, ESA provides a platform where there is
time for discussion. Experts discuss their experiences and that way,
dissemination of knowledge is easier. The better, easier and more
effective treatments can be spread all over the world.
The congress venue this year is Best Western Hotel Hungaria, situated
in the heart of Budapest’s city. As a conference center, it provides an
auditorium equipped with technical facilities of the highest standard.
An experienced professional staff (Tensi Congress) will help participants
with all details.
Your particular work is welcome, it will enrich the world of strabismus
science so do not hesitate to present it to colleagues all over the
world. Moreover, it gives you the possibility to international evaluation
of the results.
We hope that this year’s meeting will be a fruitful one for all participants.
We cordially invite you to the beautiful city of Budapest and hope to
make the 38th ESA Congress a memorable experience for you!
Krisztina Knézy
President,
Hungarian Society of Paediatric Ophthalmologists and Strabologists
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COMMITTEES OF THE 38TH ESA MEETING
ESA COUNCIL 2016
ORGANIZING SECRETARIAT
John Sloper, (UK) • President
Branislav Stanković, (SERBIA) • Vice President
Dominique Thouvenin, (FRANCE) • Vice President
Vincent Paris, (BELGIUM) • Vice President
Heimo Steffen, (GERMANY) • Secretary/Treasurer
Giovanni Battista Marcon, (ITALY)
Laura Lindbergh, (FINLAND)
Sule Zylan, (TURKEY)
Daniela Cioplean, (ROMANIA) • Proceedings Editor
Krisztina Knezy, (Hungary, co-opted)
Pedro Meneres, (Portugal, co-opted)
TENSI LTD.
Komjádi Béla u. 1.
1023 Budapest, Hungary
Tel.: +36 1 345 1567
E-mail: [email protected]
Web: www.esa2016.hu
SCIENTIFIC COMMITTEE
Branislav Stankovic, (Serbia, Chair)
Dominique Thouvenin (France)
John Sloper (UK)
Krisztina Knézy (Hungary)
LOCAL ORGANIZING COMMITTEE
Krisztina Knézy, Budapest – Head
Valéria Gaál, Pécs
Piroska Garger, Budapest
Erika Maka, Budapest
Otto Maneschg, Budapest
Annamária Nagy, Debrecen
Prof. Zoltán Zsolt Nagy, Budapest
Zsuzsanna Récsán, Budapest
Csilla Serfőző, Budapest
Nicolette Sohár, Szeged
Anna Soproni, Budapest
Prof. Ildikó Süveges, Budapest
Anna Szamosi, Budapest
Andrea Szigeti, Budapest
Katalin Virágos Kis, Gyula
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GENERAL INFORMATION
TIME ZONE
Budapest is in the Central European Time (CET) zone. In the winter months this means clocks are set at GMT + 1
hour, and in the summer (March to the end of October) GMT + 2 hours.
CLIMATE
The climate of Budapest is humid continental with warm or very warm summers. The spring months (March and
April) see variable conditions, with a rapid increase in the average temperature (around 10-12 ˚C). The weather in
late March and April is often very agreeable during the day and fresh at night. Budapest’s long summer, lasting from
May until mid-September is warm or very warm. Budapest has as much summer sunshine as many Mediterranean
resorts. Sudden heavy showers also occur, particularly in May and June.
ELECTRICITY
Voltage in Hungary is 230V/50Hz, and plugs are of the two-pin continental type (Europlug Type C, Type F).
TELEPHONE
The international code for Hungary is 36; the area code for Budapest is 1.
CURRENCIES
The Hungarian currency is the Forint (Ft). All visitors are advised to exchange currency only at accredited places. The
majority of banks have 24-hour ATM’s some of which can also exchange foreign currency. Some places will accept
payment in Euro, however this is at the discretion of the venue.
TAXES
In most cases standard Value Added Tax (VAT) in 2016 is payable at a rate of 27%.
There is a reduced rate of 18%, relating to hotels and basic food and a 5% rate that relates mainly to products and
services such as books and medicines.
TAXI
Yellow taxis can be flagged down from the kerbside and taxi ranks are located in several locations in the city, and at
the airport. The average taxi fare from the airport to the city is approximately 30 EUR (10.000 Ft). CONGRESS INFORMATION
Congress Secretariat and Registration desk is located in Hotel Hungária, right in the hotel lobby. You can contact us
and register personally during the opening hours as following times:
Wednesday
28th September
8:30 – 20:00
Thursday
29th September
7:30 – 20:00
Friday
30th September
7:30 – 14:00
Saturday
1 October
8:00 – 17:00
st
LANGUAGE
The official language of the congress is English.
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GENERAL INFORMATION
PARTICIPANTS’ IDENTIFICATION
All participants are required to wear their name badge during the whole congress. This badge provides you access to
the scientific sessions, the exhibition, the lunches, coffee breaks, the welcome cocktail and the welcome reception.
Please note, we cannot replace lost badges.
In addition to registering for the conference and collecting your badges please visit the registration desk for information
on accommodation and tours (if you have booked through the registration process or would like to book tours onsite)
and information on local amenities.
CONTINUING MEDICAL EDUCATION
The 38th Meeting of the European Strabismological Association is designated for a maximum of 15 hours of European
external CME credits by the European Accreditation Council for Continuing Medical Education (EACCME). Each
medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.
ROOM ALLOCATION AND PRESENTATION FACILITIES
The plenary room for the scientific session is on the Hotel Hungária’s conference level on the first floor.
The speaker preview room (Slide-check room) is located in Amfora room close to the Registration Desk, in the hotel
lobby. Opening times are the same as Congress Secretariat.
Presenters who have not submitted their slides in advance should take their final presentation (USB key / pendrive)
to the speaker preview room (Slide-check room) no later than 2 hours prior to their presentation also confirm their
audiovisual requirements. The speaker preview room will be staffed with technicians who can assist with any
compatibility or formatting issues.
EXHIBITION
We are pleased to welcome exhibitors at the ESA2016 Congress in Budapest. You can find their booths on the Hotel
Hungária’s conference level, in the poster area. The exhibition is open throughout the scientific hours.
POSTERS AREA AND SESSION
The posters area is located on the Hotel Hungária’s conference level. The poster set-up is available from 8:30 on 28th
September and the posters area can be visited during the whole congress. Posters must be removed by 17:00 on
1st October. The poster size shall be 90 cm × 120 cm in portrait format.
The poster boards are signed with your poster numbers that please check in the programme book before hanging
up. We ensure hostesses to help you, please look for them in red T-shirts on the conference level. Posters authors
are asked to be present at their posters and be available for discussion during the poster sessions.
GUIDELINES FOR ORAL PRESENTATION
Presenters of free papers have 8 minutes plus 2 minutes for questions. Rapid fire poster presenters have Title plus 3
slides and 3 minutes talk with 2 minutes for questions.
WI-FI AREA
Complimentary Wi-Fi can be accessed throughout the Hotel Hungária’s conference level and in the rooms on all
conference days by entering the details that you have at the registration desk.
NON-SMOKING POLICY
Smoking is prohibited inside of the building. At the entrance of the Hotel Hungária is signed the smoking area.
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GENERAL INFORMATION
CLOAKROOM
We ask you not to take coats or large bags into the conference hall. Please use the free cloakroom just outside the
main hall.
PHOTOGRAPHY AND FILMING
Please note that an official photographer will be present during the conference to capture delegate and presenter
experience. Participants are also entitled to take photographs and recordings at the conference but may not name
other participants featuring in such recordings without their consent or violate the personal rights of such participants.
COFFEE BREAKS AND LUNCHES
Coffee, tea, soft drinks, mineral water and cakes and also fruits are provided in coffee breaks as scheduled in the
scientific programme. Coffee break is located in front of the plenary room.
Buffet lunches will be served on 29th, 30th September and 1st October in the Beatrix Restaurant on the Hotel Hungária’s
ground floor that is also included in the registration fee.
SOCIAL EVENTS
Welcome cocktail
Venue: Hotel Hungária’s conference level
Date:
Wednesday, 28th September 2016
Start time: 18:30
End time: 20:00
Price per person: included in the registration fee
Dress code: Casual Smart
Welcome Reception
Venue: Hotel Hungária, Beatrix Restaurant
Date:
Thursday, 29th September 2016
Start time: 18:00
End time: 21:00
Price per person: included in the registration fee
Dress code: Casual Smart
Gala dinner
Venue: Date:
Start time: End time: Meeting time:
Meeting point: Price per person:
Dress code: Cruise on the River Danube
Friday, 30th September 2016
18:30
22:00
18:00
Hotel Hungária, Lobby
€110. Tickets available from the Registration desk
Casual Smart
The ESA 2016 Gala Dinner will be held on Friday 30th September from 18:30 – 22:00 on the Táltos Cruise boat sailing
on the River Danube. Tickets for this event can be purchased for EUR 110 through the online registration system and
at the registration desk if still available no later than 28th September. The dinner will be a served menu, drinks and
entertainment, providing you with the perfect opportunity to socialise with friends and colleagues. Upon arrival you
will be asked to present your ticket to a member of staff so please remember to bring it with you.
Transfer buses for the Gala Dinner will leave from the entrance of Hotel Hungária between 18:05 – 18:15. After the
Gala Dinner, a shuttle service to the Hotel Hungária will be provided.
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PRE-MEETINGS
WEDNESDAY 28TH SEPTEMBER
Pre-meeting venue: IMPERIAL room (1st floor)
10:00 – 12:00 OCE EDUCATION WORKSHOP
Part one: Invited speakers
Introduction of first OCE pre-education workshop
Ingrid van Wijnen-Segeren, Chair OCE Education committee, University of Applied sciences Utrecht, Netherlands
Integration of research in the Orthoptic curriculum
Craig Murray, University of Liverpool, United Kingdom
Practical tips on how to use presentation techniques interactively, e.g. for case presentations,
questions & answers etc.
Oliver Ehrt, Ludwig-Maximilians-University, Germany
Evidence Based Practice in Bachelors Education Orthoptics at University of Applied Sciences Utrecht
Mari Gutter, University of Applied sciences Utrecht, Netherlands
Part two: Free papers
A bachelor degree in Orthoptics to meet increasing demand for public health to eye care in an African Island
- Saint Vincent in Cape Verde
Carla Costa Lança, Lisbon School of Health Technology, Lisbon, Portugal
Clinical reasoning at the orthoptics department of HU University of applied sciences
Marijke Luijten, University of Applied sciences Utrecht, Netherlands
Public engagement in the development of a student-led learning resource on visual impairment
Anne Bjerre, University of Sheffield, United Kingdom
12:30 – 16:30 INTERACTIVE STRABISMUS COURSE
Course Faculty
Prof. Oliver Ehrt (MD), Ludwig-Maximilians-University, Muenchen, Germany
Dr. Fiona Rowe (Orthoptist), University of Liverpool, Liverpool, United Kingdom
Dr. Dominique Thouvenin (MD), University Hospital Purpan & Clinique Saint Nicolas, Toulouse, France
This interactive pre-conference workshop is aimed at those relatively new to strabismology, who have some experience,
and are starting to attend ESA meetings.
The intention of the workshop is to introduce the participants to:
• different terminology across Europe
• different approaches to assessment and management of strabismus across Europe
• case discussions
• ... and plenty of time to answer questions and have discussion.
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PROGRAMME AT A GLANCE
Wednesday
28th September
Thursday
29th September
8:00
8:30
9:00
Registration and Poster
Set-up
9:30
Opening Ceremony
11:00
Coffee Break and
Poster Exhibition
Session IV.
Neurological
ESA Lecture
11:30
12:00
12:30
8:00
8:30
ESA Orthoptic Symposium
Session III.
Stereo and Binocular
Function
OCE Orthoptic Education
Workshop
Saturday
1st October
Early Course
Quality of Life
Session I.
Amblyopia and Screening
10:00
10:30
Friday
30th September
Session V.
Surgery
Coffee Break
Coffee Break and
Poster Exhibition
Round table discussion
Inferior Oblique Overaction
Session VI.
Surgery II
Symposium:
Management of diplopia in
inflammatory orbital disease
John Lee (Rapid Fire)
Poster Session
Lunch
Lunch
About 2017 ESA meeting
ESA Business Meeting
13:00
14:00
Interactive Strabismus
Course
ISA Symposium
Current concepts in strabismus
Session VII.
Varia I
Session II.
Intermittent Exotropia and
Cyclovertical
15:30
16:00
16:30
Coffee Break
Session VIII.
Varia II
Coffee Break and
Poster Exhibition
ESA Council Meeting
17:30
Lunch
Session:
A case I have learnt from
15:00
17:00
9:30
10:00
10:30
11:00
11:30
12:00
12:30
13:00
13:30
14:30
9:00
Symposium:
Amblyopia
Closing Ceremony
13:30
14:00
14:30
15:00
15:30
16:00
16:30
17:00
17:30
18:00
18:00
18:30
18:30
19:00
19:30
20:00
20:30
Welcome Reception
19:00
Welcome Cocktail
19:30
Gala Dinner
20:00
20:30
21:00
21:00
21:30
21:30
22:00
22:00
22:30
22:30
23:00
23:00
SCIENTIFIC
PROGRAMME
SCIENTIFIC PROGRAMME
WEDNESDAY 28TH
SEPTEMBER
THURSDAY 29TH
SEPTEMBER
08:30 - 20:00
Poster Set Up, Registration
08:30 - 09:00
Opening Ceremony
10:00 - 12:00
OCE Orthoptic Education Workshop
09:00 - 10:00
13:00 - 16:30
Interactive Strabismus Course
16:30 - 18:30
ESA Council Meeting
SESSION I: AMBLYOPIA AND SCREENING
Chair: Huibert Simonsz
Moderator: John Sloper
18:30 - 20:00
Welcome Cocktail
Amblyopia epidemiology in a pediatric
population referred to a Portuguese tertiary
care center
Lages, VM; Coelho, João; Miranda, Vasco;
Malheiro, Luísa; Parreira, Ricardo; Menéres,
Pedro
Centro Hospitalar do Porto Oftalmologia,
PORTUGAL
Amblyopia risk factors screening project
implementation in Portugal
Dias, David A; Casal, Inês; Miranda, Vasco;
Parreira, Ricardo; Menéres, Pedro
Centro Hospitalar do Porto, PORTUGAL
Amblyopia with eccentric fixation: Is inverse
occlusion still an option?
Godts, Daisy
Antwerp University Hospital Ophthalmology,
BELGIUM
Intractable diplopia in adults with
strabismus and history of anti-suppression
therapy
Loba, Piotr; Simiera, Justyna; BroniarczykLoba, Anna
Department of Ophthalmology Medical
University of Lodz, POLAND
Evaluation of the biprism test in early
childhood
Serfozo, Csilla; Soproni, Anna
Heim Pal Children’s Hospital, Ophthalmological
Private Practice, HUNGARY
Cost-optimized childhood vision and
hearing screening programmes in all
countries in Europe
Simonsz, Huibert J.; Sloot, Frea; EUSCREEN,
FOUNDATION
Erasmus
Medical
Center
Rotterdam,
NETHERLANDS
13
SCIENTIFIC PROGRAMME
10:00 - 11:00
Coffee Break and Poster Exhibition
11:00 - 12:00
ESA Lecture: Topical anesthesia in
strabismus surgery
Rosario Gómez de Liaño
Hospital Clinico Universitario San Carlo, Madrid,
SPAIN
Introduced by Branislav Stanković
12:00 - 13:00
SYMPOSIUM: MANAGEMENT OF DIPLOPIA IN
INFLAMMATORY ORBITAL DISEASE
Chair: Anja Eckstein
Moderator: John Sloper
Management of diplopia in lymphoplasmacytic infiltrates of the orbit
Olivier Galatoire
Fondation Rotschild, Paris, FRANCE
Effects of Orbital Decompression on Eye
Alignment
Olav H. Haugen
Haukeland University Hospital, Bergen,
NORWAY
Strabismus Surgery in Thyroid Eye Disease
- A Practical Guide
Gill Adams
Moorfields Eye Hospital, London, UK
Tendon elongation with Tutopatch for large
deviations in Graves orbitopathy
Michael Schittkowski
University Hospital, Göttingen, GERMANY
Options of corrections for vertical squint in
GO. Inferior rectus, superior rectus, obliques
or all together?
Anja Eckstein
University Clinic, Essen, GERMANY
13:00 - 14:00
Lunch
14:00 - 15:00
ISA SYMPOSIUM: CURRENT CONCEPTS IN
STRABISMUS
Moderator: Frank Martin
Extraocular muscle compartmentalisation
in strabismus
Joseph Demer
SteinEye, Los Angeles, USA
Mandatory indications of imaging in
strabismus
Seyhan B. Özkan
Adnan Menderes University Medical School
Department of Ophtalmology, Aydin, TURKEY
Adjustable sutures in children
David Guyton
Johns Hopkins Wilmer Eye Institute, Baltimore,
USA
14
Predicting masked bilateral congenital SO
palsy in young children
David Plager
Indiana University, Indianapolis, IN, USA
15:00 - 16:30
SESSION II: INTERMITTENT EXOTROPIA AND
CYCLOVERTICAL
Chair: Alejandro Armesto
Moderator: Heimo Steffen
The Clinical Course Of Intermittent Exotropia
Vladutiu, Cristina; Rusu, Oana; Rusu, Raluca M;
Sevan, Simona A
SC Rojo Business Group SRL Cluj Hospital,
ROMANIA
Correlation of distance stereoacuity with
Newcastle control scores in intermittant
exotropia
Oto, Sibel; Yüce, Aslıhan; Akca Bayar, Sezin
Baskent
University
Hospital
Pediatric
Ophthalmology, TURKEY
Myopic Shift During Control Of The Deviation
In Intermittent Exotropia: A Study With The
Plusoptix 12r Photoscreener
Schiavi, Costantino; Tassi, Filippo; Di Croce,
Valentina
DIMES, Department of Experimental, Diagnostic
and Specialty Medicine, University of Bologna
Ophthalmic Unit, St. Orsola-Malpighi Teaching
Hospital, ITALY
Inferior Oblique Recession is enough
for Unilateral Long-standing Congenital
Superior Oblique Palsy?
Ciubotaru, Andreea; Iosub, Ionela Geanina;
Macau, Mihaela; Hopinca, Andreea
Infosan Eye Clinic, ROMANIA
Cyclocheck – a new web-based software for
the assessment of objective cyclodeviation
Simiera, Justyna; Broniarczyk-Loba, Anna;
Loba, Piotr
Medical University of Lodz Department
of Binocular Vision Pathophysiology and
Strabismus, POLAND
Effect of „graded” recession of
inferior oblique muscle in strabismus
sursoadductorius
Maneschg, Otto A.; Knézy, Krisztina; Maka,
Erika; Volek, Éva; Nagy, Zoltán Z
Semmelweis University Dep. of Ophthalmology,
HUNGARY
Superior oblique trochlear injuries: clinical
features and strabismus treatment
Armesto, Alejandro l; Ugrin, Maria C
Hospital Aleman Ophthalmology, ARGENTINA
SCIENTIFIC PROGRAMME
Botulinum Toxin Injection Of Superior
Rectus Muscle in Superior Oblique Palsy
With Large Vertical Deviation
Ozkan, Seyhan B.; Balica, Faruk
Adnan Menderes University Medical School
Department of Ophthalmology, TURKEY
Harada-Ito without dissection or muscle
splitting
Stavis, Monte I
Pediatric Ophthalmology of Houston, UNITED
STATES
16:30 - 17:00
Coffee Break
17:00 - 18:00
SYMPOSIUM: AMBLYOPIA
Chair: John J. Sloper
Binocular treatment for amblyopia
Jonathan M. Holmes
Mayo Clinic, Rochester, MN, USA
Eye hand co-ordination in amblyopia
Simon Grant
City University, London, UK
Reading and Eye Movements in Amblyopia
Frank Proudlock
University Eye Clinic, Leicester, UK
Posture and balance in amblyopia and
strabismus
Anna Dickman
Institute of Ophthalmology, Catholic University,
Rome, ITALY
18:00 - 20:00
Welcome Reception
FRIDAY 30TH
SEPTEMBER
08:00 – 09:00 EARLY COURSE: QUALITY OF LIFE
Moderator: Dominique Thouvenin
How to build a questionnaire
Giovanni B. Marcon
Casa di Cura Città di Udine, Udine, ITALY
Refraction (glasses, CL, refractive surgery),
strabismus and QOL
Christine Costet
Nice, FRANCE
Videos: Living with a strabismus
Alain Pechereau
University Eye Clinic, Nantes, FRANCE
Adult strabismus and QOL
Gill Adams
Moorfields Eye Hospital, London, UK
QOL in childhood strabismus and
amblyopia
Jonathan M. Holmes
Mayo Clinic, Rochester, MN, USA
09:00 – 10:00 SESSION III: STEREO AND BINOCULAR
FUNCTION
Chair: Helen Davis
Moderator: Sule Ziylan
Changes in stereoacuity and aniseikonia
following LASIK in binocular and monocular
cases
Mravicic, Ivana; Bohac, Maja; Selma, Lukacevic;
Marija, Anticic; Patel, Sudi; Gabric, Nikica
University eye hospital Svjetlost, CROATIA
Cyclofusion and Target Orientation
Davis, Helen; Donnachie, Alice; Buckley, David
University of Sheffield, UNITED KINGDOM
Long term outcome of high versus very high
hypermetropic children
Ziylan, Sule; Gokce, Berna; Parlakgunes,
Zeynep
Yeditepe University School of Medicine, Istanbul
Pediatric Ophthalmology and Strabismus,
TURKEY
Acute acquired comitant esotropia classification and factors influencing regain
of stereopsis after surgery
Hesgaard, Helena Buch; Vinding, Troels; La
Cour, Morten; Holst, Inger Copenhagen Eye & Strabismus clinic & affiliated
with Rigshospitalet – Glostrup, DENMARK
Stereoacuity in Pediatric Blowout fractures
in the Copenhagen region in a 10 year period
with 5 year follow-up
Saunte, Jon Peiter; Torp-Pedersen, Tobias;
Wolsing, Lone
Ophthalmology Department, Rigshospitalet Glostrup, University of Copenhagen, DENMARK
15
SCIENTIFIC PROGRAMME
Interhemispheric connections in human
binocularity
Ten Tusscher, Marcel P; Houtman, Anne Cees
University Hospital Vrije Universiteit Brussel
Ophthalmology, BELGIUM
10:00 – 10:40 SESSION IV: NEUROLOGICAL
Chair: Mike Brodsky
Moderator: Laura Lindberg
Strabismus indicates severity of motor
impairment in cerebral palsy (CP)
Chaudhuri, Zia; Nagpal, Manisha; Jain,
Rajesh Lady Hardinge Medical College & Associated
Hospitals, University of Delhi, Department of
Genetics, University of Delhi South Campus,
PGIMER, Dr RML Hospital, INDIA
The challenge of diagnosing myasthenia in
neuro-ophthalmology
Drimtzias, Evangelos; Hoole, Janicek;
Simmons, Ian G
St James University Hospital, UNITED KINGDOM
Incidence Of Ocular Motility Disorders
Following Stroke
Rowe, Fiona J; Hepworth, Lauren; Hanna,
Kerry; Howard, Claire
University of Liverpool Health Services
Research, UNITED KINGDOM
Parinaud Syndrome or Nuclear Third Nerve
Palsy?
Spielmann, Alain C; Gravier, Nicolas
Ravinelle Centre, FRANCE
10:40 – 11:10 Coffee Break
11:10 – 12:10 ROUND TABLE DISCUSSION:
OBLIQUE OVERACTION
Moderator: Dominique Thouvenin
INFERIOR
Panelists:
Vincent Paris, University Hospital, Liege,
BELGIUM; Oliver Ehrt, University Hospital
Munich, GERMANY; Daniela Cioplean, Oftapro
Ophthalmology Clinic, Bucharest, ROMANIA;
Pierre Lebranchu, University of Nantes,
FRANCE; François Kaeser, Jules Gonin
Hospital, Lausanne, SWITZERLAND; Miho Sato,
Hamamatsu University School of Medicine,
JAPAN; David Plager, Indiana University,
Indianapolis, IN, USA; Ian Marsh, Aintree
University, Hospital, Liverpool, UK
16
12:10 – 13:10 JOHN LEE (RAPID FIRE) POSTER SESSION
Moderator: Jan-Tjeerd de Faber
Limbus-insertion distance of extraocular
rectus muscles using Spectral domain
optical coherence tomography and
correlation study
Rosario Gómez de Liaño Hospital
Universitario
San
Carlos,
Ophthalmology Motility Unit, Madrid, SPAIN
Oculomotor findings in Joubert syndrome
Gravier, Nicolas M.; Aubert-Brenugat, Valerie
Polyclinique de l’Atlantique ophthalmology,
FRANCE
The effect of previous orbital radiotherapy
on results of strabismus surgery in patients
with thyroid eye disease
Kang, Hyun Goo; Yoon, Jin Sook; Han, SeungHan; Han, Jinu; Lee, Jong Bok
Gangnam Severance Hospital, Yonsei University
Ophthalmology, SOUTH KOREA
Reliability of a new method for measuring
single visual field and uniocular fields of
fixation
Alarcón Tomás, María; Gómez de Liaño
Sanchez, Rosario; Dupré Peláez, Mauro; Garcia
Garcia, Miguel
Hospital Puerta de Hierro Majadahonda, SPAIN
The PrismPeriscopePat. Pend. – a new abductor
fixation device prototype – provides better
access for inspection of the temporal fundus
in children with large angle esotropia
Saunte, Jon Peiter; Bonne, Max
Ophthalmology Department, Rigshospitalet Glostrup, University of Copenhagen, DENMARK
Retinal Nerve Fibre Layer and Macular
Thicknesses in Adults with Hyperopic
Anisometropic Amblyopia
Yakar, Konuralp; Kan, Emrah; Alan, Aydın; Alp,
Mehmet Hanifi; Ceylan, Tolga
Ataturk State Hospital Ophthalmology, TURKEY
SCIENTIFIC PROGRAMME
Holographic Presentation: Seeking Publicity
or New Opportunities of a Research and
Practice Report
Plisov, Igor L.; Chernykh, Valeriy V.; Larionova,
Yuliya A.; Vaulin, Michael A.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI
of the Ministry of Health Care of the Russian
Federation, Novosibirsk, RUSSIA
Statistical analysis of Lang 1 stereo test for
the diagnosis of microesotropia in children
Piantanida, Andrea C.; Spera, Manuela; Nobili,
Roberta; Gerosa, Giulia
Centro Oculistico Lariano, ITALY
Correlation between age of onset of diplopia
and CAG-repeats in patients with spino
cerebellar degeneration type 3 (SCA3)
Pott, Jan Willem R; Wasmann, Rosemarie A;
Olie, Lisette; Rijpman, Kristie; de Vries, Jeroen J
University
Medical
Centre
Groningen
Ophthalmology, NETHERLANDS
Pediatric strabismus: primary care referral
efficacy, epidemiology and prognosis in a
portuguese tertiary referral center
Coelho, Joao; Lages, Vania; Carneiro, Ines;
Miranda, Vasco; Parreira, Ricardo; Meneres,
Pedro
Department of Ophthalmology - Centro
Hospitalar do Porto, PORTUGAL
Machado-Joseph disease
Saunte, Jon Peiter; Bonne, Max
Ophthalmology Department, Rigshospitalet Glostrup, University of Copenhagen, DENMARK
Strabismus and binocular summation in
pediatric population
Skunca Heman, Jelena; Malenica Ravlic, Maja;
Tadic, Raseljka; Lovric, Tena; Vatavuk, Zoran
KBC Sestre Milosrdnice, CROATIA
Free afternoon
18:30 – 22:30 Gala Dinner – Cruising on the Danube by night
SATURDAY 1ST
OCTOBER
08:30 – 09:30 ESA ORTHOPTIC SYMPOSIUM: THE CONTRIBUTION OF ORTHOPTISTS TO THE CARE OF
ELDERLY PATIENTS
Chair: Chris Timms, Department of Orthoptics,
Moorfields Eye Hospital, London, UK
Binocular vision anomalies associated with
age-related ocular pathology
Daisy Godts
BELGIUM
Problems with binocular vision in patients
with Parkinson’s disease
Dominika Bujak
POLAND
Strabismus and ocular motor defects in
stroke patients
Fiona Rowe
UNITED KINGDOM
Age-related distance esotropia
Chris Timms
UNITED KINGDOM
09:30 – 10:30 SESSION V: SURGERY
Chair: Seyhan B. Özkan
Moderator: Rosario Gómez de Liano
Short tag noose adjustable sutures – in
adults and children – how many needs
adjustment – and when?
Loenkvist, Claes S; Saunte, Jon Peiter
Rigshospitalet - Glostrup, DENMARK
The contribution of suture adjustment to the
outcome of strabismus surgery for adults
with symptomatic intermittent exotropia
Raoof, Naz; Sloper, John
Strabismus and Paediatric Service, Moorfields
Eye Hospital, London, UNITED KINGDOM
The success rates of adjustable suture
surgery in horizontal strabismus
Ziylan, Sule; Gokce, Berna; Parlakgunes,
Zeynep
Yeditepe University School of Medicine, Istanbul
Pediatric Ophthalmology and Strabismus,
TURKEY
17
SCIENTIFIC PROGRAMME
Y-splitting of the lateral rectus for treatment
of upshoot and downshoot in Duane’s
retraction syndrome
El Adawy, Ibrahim T
Mansoura Ophthalmic Center, Mansoura
University, EGYPT
Lateral splitting technique for complete
third nerve paralysis
Goberville, Mitra; Guepratte, Nathalie; Krivosic,
Valerie
Centre Ophtalmologique Lauriston, FRANCE
Long term results of Ysplit lateral rectus
transposition to the medial rectus area in
complete third nerve palsy
Gokyigit, Birsen; Akar, serpil; Aygit, Ebru D; Inal,
Asli; Ocak, Osman B
Beyoglu Education and Training Eye Hospital,
TURKEY
10:30 – 11:30 Coffee Break and Poster Exhibition
11:30 – 12:10 SESSION VI: SURGERY II
Chair: Michael Gräf
Moderator: Giovanni Marcon
Anderson procedure for nystagmus-related
head-turn – decreasing long-term effect
Gräf, Michael; Lorenz, Birgit
University of Giessen Department of
Ophthalmology, GERMANY
18
12:10 – 12:20 About 2017 ESA meeting
12:20 – 13:00 ESA Business Meeting
13:00 – 14:00 Lunch
14:00 – 15:00 SESSION: A CASE I HAVE LEARNT FROM
Chair: Branislav Stanković
Participants:
Sule Ziylan, Yeditepe University Medical
Faculty, Istanbul, TURKEY; Brian G. Mohney,
Mayo Clinic, Rochester, USA; Laura Lindberg,
Helsinki University Hospital, FINLAND; Hermann
Schworm, Herzog Carl Theodor Eye Hospital,
Munich, GERMANY; Galton Vasconcelos,
Federal Universtiy of Minas Gerais, BRAZIL
15:00 – 15:40 SESSION VII: VARIA I
Chair: Brian G. Mohney
Moderator: Krisztina Knézy
An Optokinetic Clue to the Pathogenesis of
Crossed Fixation in Infantile Esotropia
Brodsky, Michael C.; Klaehn, Lindsay
Mayo Clinic, Rochester, USA
Strabismus Digitalization for Better
Evaluation
Hakim, Ossama
Magrabi Eye Hospital Paediatric Ophthalmology,
UNITED ARAB EMIRATES
Success modification of Sinskey operation
for the treatment of nystagmus patients
who had not null point
Gokyigit, Birsen; Ocak, Osman B; Inal, Asli;
Aygit, Ebru D.; Basarir, Berna
Beyoglu Education and Training Eye Hospital,
TURKEY
Changes in corneal topography and
refractive error after various extraocular
muscles surgery
Akar, Serpil; Gokyigit, Birsen; Aygit, Ebru
Demet; Pinarci, Eylem Yaman; Bayar, Sezin
Akca; Oto, Sibel
Baskent University, Medicine Faculty,
Ophthalmology Department, Istanbul Pediatric
Ophthalmology and Strabismus, TURKEY
Slanted Medial Rectus Recessions for the
treatment of Convergence Excess Esotropia;
a quantitative analysis
La Roche, G Robert; Tremblay, François; Gravier,
Nicolas
Dalhousie University Ophthalmology and Visual
Sciences, CANADA
May Magnetic Resonance Imaging of the
Orbit play a role in refractory strabismus?
Marcon, Giovanni B; Pittino, Raffaele
Strabismological and Diplopia Centre, Bassano
del Grappa, ITALY
Post-surgical Recurrences of Strabismus in
Sagging Eye Syndrome (SES)
Chaudhuri, Zia; Demer, Joseph L
Lady Hardinge Medical College & Associated
Hospitals, University of Delhi, Department of
Genetics, University of Delhi South Campus,
PGIMER, Dr RML Hospital, New Delhi, INDIA
15:40 – 16:10 Coffee Break
SCIENTIFIC PROGRAMME
16:10 – 17:00 SESSION VIII: VARIA II
Chair: Zia Chaudhuri
Moderator: Pedro Meneres
Pedigree analysis of concomitant horizontal
strabismus in north India
Chaudhuri, Zia; John, Jibin; Aneja, Satinder;
Thelma, B K
Lady Hardinge Medical College & Associated
Hospitals, University of Delhi, Department of
Genetics, University of Delhi South Campus,
PGIMER, Dr RML Hospital, New Delhi, INDIA
Profile and distribution of strabismus in
craniosynostosis
Chaudhuri, Zia; Puncholothu, Akila K; Sharma,
Ajay
Lady Hardinge Medical College & Associated
Hospitals, University of Delhi, Department of
Genetics, University of Delhi South Campus,
PGIMER, Dr RML Hospital, New Delhi, INDIA
Strabismus Incidence in a Danish
Population-Based Cohort
Torp-Pedersen, Tobias E; Boyd, Heather A;
Skotte, Line; Haargaard, Birgitte; Wohlfahrt,
Jan; Holmes, Jonathan M; Melbye, Mads
Rigshospitalet Glostrup Dept. of Ophthalmology,
DENMARK
How well do we detect superior oblique
involvement in restrictive strabismus from
thyroid eye disease?
Del Porto, Lana; Hinds, Anne-Marie; Adams,
Gillian
Moorfields Eye Hospital Strabismus and
Paediatrics, UNITED KINGDOM
Management of patients in a combined
thyroid eye disease clinic: Can the
Amsterdam Declaration aims be met in a
secondary care centre?
Quinn, Annika S; Benzimra, James; Dujardin,
Leticia R; Quinn, Anthony G; Vaidya, Bijay
Royal Devon & Exeter Hospital, UNITED
KINGDOM
17:00
Closing Ceremony
19
INDEX
POSTERS
POSTERS
P01
Endothelial cell density following extraocular
muscle surgery
Akar, Serpil; Gokyigit, Birsen; Kirandi, Ece; Bayar, Sezin
Akca; Oto, Sibel
Baskent University, Medicine Faculty, Ophthalmology
Department, Istanbul Pediatric Ophthalmology and
Strabismus, TURKEY
P02
Outcomes of 3 hours part-time occlusion treatment
combined with near activities among children with
unilateral amblyopia
Alotaibi, Abdullah; Fawazi, Samah M.; Alenazy, Badriah
R; Abu-Amero, Khaled K
King Saud University, SAUDI ARABIA
P03
P04
P05
P06
P07
P08
Effect of rolipram on visual cortical plasticity and
behavioral effect on vision, spatial and visual
memory in amblyopia model in adult rats
Altintas, Ozgul; Celik, Onur Sinan; Eraldemir, Fatma
Ceyla; Mutlu, Oguz; Kum, Tugba
Acibadem University Department of Ophthalmology,
TURKEY
Success of Strabismus Surgery in Adult Patients
Atalay, Hatice T.; Özsaygılı, Cemal; C Özmen, Mehmet;
Yüksel, Erdem; Bilgihan, Kamil
Gazi University School of Medicine Pediatric
Ophthalmology and Strabismus, TURKEY
Management of Duane retraction syndrome with
prismatic glasses
Aygit, Ebru Demet; Kocaman, Murat; Ínal, Asli; Gokyigit,
Birsen; Taskapili, Muhittin
Beyoglu Eye Training and Research Hospital
STRABİSMUS, TURKEY
New technology of postoperative fusion
rehabilitation in patients with congenital strabismus
Aznauryan, Igor; Balasanyan, Victoria; Aznauryan, Erik;
Agagulyan, Satenik
Association of Pediatric Ophthalmology Clinics, RUSSIA
Determination of cycloplegic refraction of children
by retinoscopy and refractometer PlusoptixA09®
under atropin or cyclopentolate induced cycloplegia
Berkes, Szilvia
University of Szeged Department of Ophthalmology,
HUNGARY
AK/A ratio, fusion and stereovision in patients with
constant and intermittent divergent strabismus
Boichuk, Iryna M.; Aloui, Tarak
Filatov Institute of Eye Diseases and Tissue therapy Lab.
of Binocular Vision disorders, UKRAINE
P09
Oculomotor and other of ophthalmic disorders in
children with oculocutaneous albinism
Carneiro, Inês; Malheiro, Luisa; Maia, Sofia; Miranda,
Vasco; Parreira, Ricardo; Menéres, Pedro
Hospital Santo António - Centro Hospitalar do Porto,
PORTUGAL
P10
Ocular manifestations in Botulism – case report
Casal, Inês; Maia, Sofia; Miranda, Vasco; Parreira,
Ricardo; Garrido, Cristina; Menéres, Pedro
Centro Hospitalar do Porto, PORTUGAL
P11
The association of epibulbar dermoid and type
1 Duane syndome in a patient with Goldenhar
syndrome: A clinical case report
Celik, Tuba
Bulent Ecevit University Faculty of Medicine Department
of Ophthalmology, TURKEY
P12
Outcomes after the surgery for acquired
nonaccommodative esotropia
Choi, Dong Gyu; Moon, Nam Ju; Kim, Eunbi
Kangnam Sacred Heart Hospital, College of Medicine
Hallym University Department of Ophthalmology, SOUTH
KOREA
P13
ADHD and convergence inufficiency-does a
connection really exist
Dawidowsky, Barbara; Klobučar, Aleksandra
Children’s Hospital Zagreb Dpt of neurosurgery,
otorhynolaryngology and ophthalmology, CROATIA
P14
A case of monocular elevation deficiency treated
by innervational surgery on the yolk muscles of the
sound eye
Eltoukhi, Elsayed Mohamed; Ismail, Mohamed
Research Institute of Ophthalmology Pediatric
Ophthalmology and strabismus, EGYPT
P15
Ocular Neuromyotonia: A Case Series and
Recommendations
England, Laura C; Williams, Lindsi C
Central Manchester University Hospitals, UNITED
KINGDOM
P16
The Frequency and Causes of Abnormal Head
Position: An Ophthalmology Clinic Based Review
Erkan Turan, Kadriye; Taylan Sekeroglu, Hande; Kilic,
Meltem; Sanac, Ali Sefik
Hacettepe University Faculty of Medicine Department Of
Ophthalmology, TURKEY
21
POSTERS
P17
P18
P19
P26
Myastenia Gravis at Childhood: Two Cases
Inal, Asli; Ocak, Osman Bulut; Gokyigit, Birsen; Aygit,
Ebru Demet; Basgil Pasaoglu, Isil; Fazil, Korhan
Beyoglu Eye Research and Training Hospital, TURKEY
P27
Laser corneal refractive surgery for the treatment
of refractive accommodative esotropia : 15 years
experience
Farahi, Azadeh; Hashemi, Hassan
Noor Eye Hospital, IRAN
Electrophysiological examinations in childhood
Janossy, Agnes; Sohar, Nicolette; Bereg, Edit; Janaky,
Marta
Department of Ophthalmology, University of Szeged,
HUNGARY
P28
Comparative study between Synoptophore and
videoculograph Gazelab
Fernández Agrafojo, Dora; Martín, Pedro; Morales, Hari
Research center and eye surgery INOF. Teknon Medical
Center, SPAIN
Retrospective analysis of divergent strabusmus
surgery in children in last eight years
Jarc Vidmar, Martina; Rahne, Ingrid; Kosec, Dragica
Eye Hospital, University Medical Centre Ljubljana Dpt for
Ortoptics and Strabology, SLOVENIA
P29
Effect of squint surgeries on the corneal higher
order aberrations
Juhász, Éva; Fodor, Magdolna; Knézy, Krisztina; Maka,
Erika; Maneschg, Otto; Sényi, Katalin; Szamosi, Anna;
Szigeti, Andrea; Tóth, Georgina; Kun, Lídia; Kiss, Huba;
Nagy, Zoltán Zsolt
Semmelweis University, HUNGARY
P30
Correlation between strabismus and severity of
periventricular leukomalacia
Jung, Jaeho; Jeon, Hyeshin; Choi, Hee-Young
Pusan National University Ophthalmology, SOUTH
KOREA
P31
Localizing extraocular rectus muscles insertions
by using anterior segment optical coherence
tomography
Kang, Hyun Goo; Choi, Eun Young; Han, So Young; Han,
Jinu; Han, Sueng-Han
Gangnam Severance Hospital, Yonsei University
Ophthalmology, SOUTH KOREA
P32
The Impact of Graded Inferior Oblique Recession on
the Outcome of Unilateral Recess-resection Surgery
in the Same Eye
Kim, Mirae; Kim, Won-Jae; Kim, Myung-Mi
Yeungnam University College of Medicine, SOUTH
KOREA
P33
A Case of Unilateral Trochlear Nerve Palsy Secondary
to Herpetic Uveitis in Herpes Zoster Ophthalmicus
Kim, Su Jin; Lee, Sang Gon; Lee, Seung UK
Gyeong Sang National University Department of
Ophthalmology, SOUTH KOREA
Why and When to Prefer Botulinum Toxin Injection
in Children?
Erkan Turan, Kadriye; Taylan Sekeroglu, Hande; Sanac,
Ali Sefik; Agin, Abdullah
Hacettepe University Faculty of Medicine Department Of
Ophthalmology, TURKEY
P20
Reverse Yokoyama procedure for high myopic
exodeviation
Gokyigit, Birsen; Aygit, Ebru D; Inal, Asli; Ocak, Osman
B; Akar, Serpil
Beyoglu education and training eye hospital, TURKEY
P21
Limbus-insertion distance of extraocular rectus
muscles using Spectral domain optical coherence
tomography and correlation study
Gomez de Liano, Rosario; Fernández-Vigo, José I;
Ventura, Néstor; Morales, Laura; De Pablo, Lucía
Hospital Universitario San Carlos Ophthalmology Motility
Unit, SPAIN
P22
Paralytic Strabismus in Indian Population
Grover, Renu
Icare Eye Hospital, Noida, INDIA
P23
Reduced Esodeviation without Correction; A
Indicator for Tapering Hyperopia in Refractive
Accommodative Esotropia
Ha, Suk-Gyu; Suh, Young-Woo; Cho, Yoonae A.; Kim,
Seung-Hyun
Korea University College of Medicine, Seoul, Republic
of Korea Department of Ophthalmology, SOUTH KOREA
P24
P25
22
Preferences and compliances data for Amblyz liquid
crystal occlusion glasses in amblyopes
Heo, Hwan; Park, Yong Seok
Chonnam National University Medical School
Department of Ophthalmology, SOUTH KOREA
Visual Acuity Assessment in Children With Three
Different Charts
Inal, Asli; Ocak, Osman Bulut; Gokyigit, Birsen; Aygit,
Ebru Demet; Yurttaser Ocak, Serap; Inal, Berkay
Beyoglu Eye Research and Training Hospital, TURKEY
POSTERS
P34
The Analysis of Axial Length-Disc Area Ratio and
Peripapillary Retinal Nerve Fiber Layer Thickness in
Amblyopic Eyes
Kim, Su Jin; Park, Changeum; Lee, Seung UK
Gyeong Sang National University Department of
Ophthalmology, SOUTH KOREA
P41
Vertical squint as initial manifestation of fibrous
dysplasia
Maka, Erika; Garami, Miklos; Rudas, Gabor; Czirjak,
Sandor; Nagy, Zoltan Zsolt
Semmelweis University Department of Ophthalmology,
HUNGARY
P35
Dorsal midbrain syndrome. A diagnostic challenge
Knézy, Krisztina; Tátrai, Erika; Pek, Anita; Skaliczky,
Zoltan; Maka, Erika; Nagy, Zoltán Zsolt DSc
Semmelweis University Department of Ophthalmology,
HUNGARY
P42
Sensorial
Infantile
Nystagmus
Syndrome:
prevalence of oculomotor and refractive disorders
Malheiro, Luisa; Carneiro, Ines; Maia, Sofia; Miranda,
Vasco; Parreira, Ricardo; Menéres, Pedro
Centro Hospitalar do Porto, PORTUGAL
P36
Correlations between the position of horizontal
extraocular muscles insertion and the biometrical
data of the eye
Kun, Lidia; Fodor, Magdolna; Juhász, Éva; Kiss, Huba;
Knézy, Krisztina; Maka, Erika; Maneschg, Otto; Sényi,
Katalin; Szamosi, Anna; Szigeti, Andrea; Tóth, Georgina;
Nagy, Zoltán Zsolt
Semmelweis University, Department of Ophthalmology,
HUNGARY
P43
Eye position under general anesthesia in orthophoric
children
Manoli, Pierre; Auckburraly, Mehran; Lebranchu,
Pierre; Pechereau, Alain; Gain, Philippe; Thuret, Gilles;
Jullienne, Remy
Saint-Etienne University Hospital, FRANCE
P44
Effect of squint surgeries on the blood-aqueous
barrier
Mihályi, Dorottya; Fodor, Magdolna; Kiss, Huba; Knézy,
Krisztina; Kun, Lídia; Maka, Erika; Maneschg, Ottó;
Sényi, Katalin; Szamosi, Anna; Szigeti, Andrea; Tóth,
Georgina; Nagy, Zoltán Zsolt
Semmelweis University, Budapest, HUNGARY
P45
Ocular muscles from strabism undergo autophagy
Nagy, Annamária; Szatmári-Tóth, Mária; Berta, András;
Facskó, Andrea; Petrovski, Goran
Department of Ophthalmology, Faculty of Medicine,
University of Debrecen, HUNGARY
P46
Epidemiology of Infantile Nystagmus Syndrome
Ocak, Osman Bulut; Inal, Asli; Gokyigit, Birsen; Aygit,
Ebru Demet; Yilmaz, Tolga; Ozturker, Can
Beyoglu Eye Research and Training Hospital, TURKEY
P47
Bimedial Rectus Recession Surgery with Down
Syndrome Patients
Ocak, Osman Bulut; Inal, Asli; Gokyigit, Birsen; Aygit,
Ebru Demet; Ozcelik, Ferah; Satana, Banu
Beyoglu Eye Research and Training Hospital, TURKEY
P48
Lea Gratings: differences between observers when
carrying out evaluation of the visual acuity in
children under 30 months
Ocak, Osman Bulut; Inal, Asli; Gokyigit, Birsen; Aygit,
Ebru Demet; Ozturk Karabulut, Gamze; Basarir, Berna
Beyoglu Eye Research and Training Hospital, TURKEY
P37
The case of successful surgical treatment of
atypical form of vertical strabismus
Kuzhda, Iryna; Serdiuchenko, Vira; Kaminskyy, Yuriy;
Pityk, Olena
Ivano-Frankivsk Regional Childrens Clinical Hospital
Ophthalmology, UKRAINE
P38
Factors associated with tolerance of partial
spectacle correction in hyperopic children
Kyung, Sungeun
Dankook University Ophthalmology, SOUTH KOREA
P39
Efficiency of the Pediatric Autorefractometer
Plusoptix A-09 During the Ophthalmic Examination
of the Early Age Children
Lamiya Hasanzade, Nigar Gurbanova, Dursun
Mustafayeva, Jamila Shafieva, Aziza Amirova
Azerbaijan Institute of Postgraduate Education after A.
ALiev, Baku, AZERBAIJAN
P40
Relationship between thyrotropin receptor antibody
and stability of strabismus in thyroid- associated
ophthalmopathy
Lee, Yeonhee; Kim, Min-su
Chungnam National University Hospital Department of
Ophthalmology, SOUTH KOREA
23
POSTERS
P49
Surgical Outcome Depending on the Amount of
Hyperopia in patients with Infantile Esotropia
PAIK(BAEK), Hae Jung; Yim, Hae bin
Gachon University Ophthalmology, SOUTH KOREA
P57
Treatment of primary gaze diplopia in patients with
endocrine orbitopathy
Rahne, Ingrid; Kosec, Dragica
University Eye Hospital Ljubljana, SLOVENIA
P50
Exophoria/exotropia in adults with diplopia after
refractive surgery: do we always need to manage it
with muscles surgery?
Piantanida, Andrea C.; Spera, Manuela; Nobili, Roberta;
Gerosa, Giulia
Centro Oculistico Lariano, ITALY
P58
Pituitary apoplexy presenting as isolated bilateral
oculomotor nerve palsy : Case report
Ryu, Won Yeol; An, Seoung Hyun; Song, Young Jin
Department of Ophthalmology, Dong-A Medical Center
College of Medicine, Dong-A University Strabismus,
SOUTH KOREA
P51
The System of Treatment and Rehabilitation
Measures in Patients with Paretic Strabismus
Plisov, Igor L.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
Novosibirsk, RUSSIA
P59
Revitalvision treatment in patients affected by
nystagmus
Sabetti, Lelio; BIANCHI, FEDERICA
University of L’Aquila, ITALY
P60
Semi-structured observations of eye screening and
the procedure of revision of the vision screening
guideline in the Netherlands
Sami, Aya; Karaman, Hatice; Sloot, Frea; Simonsz, Herb
Erasmus Medical Center Ophthalmology, NETHERLANDS
P61
Strabismus after orbital endoscopic decompression
in patients with thyroid orbitopathy
Samsel, Agnieszka; Jabłońska, Anna; Białas-Niedziela,
Dorota; Krzeski, Antoni; Kęcik, Dariusz
Children’s Hospital, Warsaw Department Of
Ophthalmology, POLAND
P62
Atypical Case of Ocular Myasthenia Gravis
Sari, Ayca; Dinc, Erdem; Okuyaz, Cetin; Ecel, Mahmut
Mersin University Medical School Dept. of
Ophthalmology, TURKEY
P63
Minimal exposition of test-object recognitrion in
children with emmetropia, anomalies of refraction,
and amblyopia
Serdiuchenko, Vira; Zheliznyk, Mariia
The Filatov Instirute of Eye Diseases and Tissue Therapy
Ophthalmology, UKRAINE
P64
Some clinical features of oculomotor disturbances
at A-V-X syndromes
Serdiuchenko, Vira; Yemchenko, Victor
The Filatov Instirute of Eye Diseases and Tissue Therapy
Ophthalmology, UKRAINE
P65
Electrophysiological examinations for objective
evaluation of the binocularity and the deviation of
the visual axis in young children with strabismus
Sohar, Nicolette; JAnossy, Agnes; Janaky, Marta
University of Szeged Department of Ophthalmology,
HUNGARY
P52
P53
Induced Hypertrophy of Extraocular Muscles After
the Administration of Synthetic Peptides into Them
Plisov, Igor L.; Atamanov, Vasiliy V.; Chernyavskaya,
Mariya A.; Toporkov, Igor A.; Mamulat, Darya R.;
Antsiferova, Natalya G.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI
of the Ministry of Health Care of the Russian
Federation, Novosibirsk, RUSSIA
Botulinum Toxin in the treatment of strabismus in
children – our experience
Podedworny-Chustecka, Agnieszka; Jakubaszek,
Aleksandra; Bukala-Mroczek, Anna; Szala, Ewa;
Samsel, Agnieszka
Szpital Dziecięcy, Warszawa, POLAND
P54
The surgical results of correcting esotropia
strabismus with inferior oblique hyperfunction
Polyanskaya, Elena; Kashenko, Tamara Pavlovna
The S. Fyodorov Eye Microsurgery Federal State
Institution, RUSSIA
P55
Paralysis of N. Oculomotorius: Our Experience of
Surgical Treatment
Puzyrevskiy, Konstantin G.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
RUSSIA
P56
Heavy Eye Syndrome: Our Experience of Surgical
Treatment
Puzyrevskiy, Konstantin G.; Plisov, Igor L.; Antsiferova,
Natalya G.; Mamulat, Darya R.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
RUSSIA
24
POSTERS
P66
Similarity of therapeutic mechanism between Y-Split
procedure and posterior fixation for correcting upand downshoots on adduction in Duane syndrome
Suh, Young-Woo; Choi, Soo-Youn; Jang, Sungmin; Ha,
Suk-Gyu; Kim, Seoung-Hyun; Cho, Yoonae, A.
Korea University College of Medicine Department of
Ophthalmology, SOUTH KOREA
P67
Is there any correlation between inferior oblique
overaction and astigmatism?
Sultan, Pinar; Gurkan, Sedat; Eltutar, Kadir; Erkul, Sezin
O.; Osmanbasoglu, Ozen A; Ozdemir, Fatma E
Istanbul Training and Research Hospital Ophthalmology,
TURKEY
P68
P69
Atypical presentation of chronic progressive
external ophthalmoplegia
Szigeti, Andrea; Maka, Erika; Vamos, Rita; Toth,
Jeannette; Fodor, Magdolna; Hargitai, Janos; Szamosi,
Anna; Nagy, Zoltán Zsolt
Semmelweis University, Department of Ophthalmology,
HUNGARY
Anterior and nasal transposition of the inferior
oblique muscles
Teodorescu, Luminita; Velcea, Irina
OFTALMIX SOP Ophthalmology Clinic, București,
ROMANIA
P70
The influence of anti-VEGF treatment on binocular
vision in patients with age-related macular
degeneration
Uzdrowska, Marta; Bilińska, Ewa; Broniarczyk-Loba,
Anna
Medical University of Lodz Department of Binocular
Vision Pathophysiology and Strabismus, POLAND
P71
Prevalence of oculomotor abnormalities in patients
seen at a university- based hospital low vision
service in Brazil
Vasconcelos, Galton Carvalho; Fernandes, Luciene
Chaves; Moura, Sarah Rogeria Martins; Lima, Ana Luiza
Avelar Morais
Universidade Federal de Minas Gerais (UFMG)
Ophthalmology and ENT department, BRAZIL
P72
Case report: Management of restrictive squint and
amblyopia in Moebius syndrome
Volek, Éva; Maneschg, Otto A; Knézy, Krisztina; Maka,
Erika; Nagy, Zoltán Zs
Semmelweis University Dep.of Ophthalmology,
HUNGARY
P73
Two-staged
unilateral
Surgical
correction
for Large exotropia in Bilateral internuclear
ophthalmoplegia(INO) : Case report
Yun, Jun Myeong; Yim, Hye Bin; Lee, Kee Il; Paik, Hae
Jung
Department of Ophthalmology, The Catholic University
of Korea Incheon St. Mary’s Hospital Department of
Ophthalmology, SOUTH KOREA
P74
Are We Overlooking Masked Bilateral Congenital
Superior Oblique Palsy in Children and Is It Easy to
Diagnose Before Surgery?
Erkan Turan, Kadriye; Taylan Sekeroglu, Hande; Sanac,
Ali Sefik
Hacettepe University Faculty of Medicine Department Of
Ophthalmology, TURKEY
P75
Differences of Fundus Torsion between Congenital
and Acquired Unilateral Superior Oblique Palsy
Kim, Dae Hee, MD1, Kim, Hyuna, MD2, Lim, Hyun Taek,
MD, PhD2
1. Department of Ophthalmology, Seonam University,
College of Medicine, Myongji Hospital, Goyang-si,
Gyeonggi-do, Korea
2. Department of Ophthalmology, University of Ulsan
College of Medicine, Asan Medical Center, Seoul, Korea
P76
Analysis on a new scale for assessing the level of
control in intermittent exotropia based on objective
findings
Hyuna Kim, MD, Dae Hee Kim, MD, Hyosook Ahn, MD,
PhD, Hyun Taek Lim, MD, PhD
Department of Ophthalmology, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, South
Korea
25
ABSTRACTS
FREE PAPERS
THURSDAY, 29TH SEPTEMBER
01
02
AMBLYOPIA EPIDEMIOLOGY IN A PEDIATRIC
POPULATION REFERRED TO A PORTUGUESE
TERTIARY CARE CENTER
Lages, VM; Coelho, João; Miranda, Vasco; Malheiro,
Luísa; Parreira, Ricardo; Menéres, Pedro
Centro Hospitalar do Porto Oftalmologia, PORTUGAL
AMBLYOPIA RISK FACTORS SCREENING
PROJECT IMPEMENTATION IN PORTUGAL
Dias, David A; Casal, Inês; Miranda, Vasco; Parreira,
Ricardo; Menéres, Pedro
Centro Hospitalar do Porto, PORTUGAL
Purpose: To analyze the causes of amblyopia and amblyopic risk
factors in a pediatric population referred by primary care health
providers to a terciary care center.
Methods: Retrospective review of the medical files of all 10 years
old or under patients referred to the pediatric ophthalmology consult
for the first time between July 2011 and February 2013.
Results: In a total of 1205 patients, 298 (24,7%) were referred
due to suspected reduction of visual acuity (RVA), which was
confirmed in only 167 (13,9%) patients. 226 patients referred for
other reasons also had RVA. A total of 393 children had RVA, of
which 90 (22,9%) had associated amblyopia: 56,7% due to purely
refractive amblyopia, 17,8% due to purely strabismic amblyopia,
22,2% due to both refractive and strabismic amblyopia and 3,3%
due to visual deprivation amblyopia. The mean age at diagnosis of
amblyopia was at 5,3 years old. Of all the patients reviewed, 12,9%
were found to have potentially amblyogenic refractive errors.
Conclusions: The fact that most of the patients with RVA were
not referred due to suspected RVA and the late age of diagnosis of
amblyopia strongly support the implementation of a photorefractive
screening program.
Purpose: Amblyopia is the most common cause of monocular
vision loss in children, and treatment outcomes tend to be better
with earlier detection and earlier treatment. However, finding
a cost-effective method and the optimum screening intervals to
appropriately screen amblyopia is still a matter of debate and study.
We present the design and implementation of an amblyopia risk
factors screening project in a large based Portuguese population.
Methods: Two referral centers will be enrolled, they will assess all
children aged 2 under their direct referral area. At this age, the cut-off
defined for referral were: more than 1 Diopter (D) of anisometropia,
more than 1.5D of astigmatism, more than 2D of myopia and more
than 1.5D of hyperopia. All asymmetric eye alignment results are
referred too. The results are reported to a reading platform that
will allow the ophthalmologist to see all exams, and provide timely
appointment with a complete ophthalmologic assessment for those
who need. This is a pilot project conducted by the Ministry of Health
together with the Portuguese Society of Ophthalmology and the
results will be audited to become a screening procedure for the
general population.
Results: Approximately 5,249 children will be screened. We
estimate to have a referral rate of 6%. The results will be evaluated
and compared with the conventional ophthalmologic screening to
assess its sensitivity, specificity and cost-effectiveness.
Conclusion: This screening program may be highly relevant to
eradicate untreated amblyopia from our population. The results
may lead to the implementation of this project to the whole country.
27
ABSTRACTS: FREE PAPERS
03
04
AMBLYOPIA WITH ECCENTRIC FIXATION: IS
INVERSE OCCLUSION STILL AN OPTION?
Godts, Daisy
Antwerp University Hospital Ophthalmology, BELGIUM
INTRACTABLE DIPLOPIA IN ADULTS WITH
STRABISMUS
AND
HISTORY
OF
ANTISUPPRESSION THERAPY
Loba, Piotr; Simiera, Justyna; Broniarczyk-Loba, Anna
Departament of Ophthalmology Medical University of
Lodz, POLAND
Purpose: To present our treatment protocol for patients with
strabismus or mixed amblyopia with eccentric fixation.
Material and methods: Eleven consecutive patients, aged 3.5 to
5 with strabismus (3) or mixed (8) amblyopia and eccentric fixation
were included in this study.
All patients underwent occlusion therapy of the dominant eye for at
least 6 months with minor improvement of visual acuity (VA) despite
good compliance (VA ranged from 20/800 to 20/63). Seven patients
had total inverse occlusion of the amblyopic eye for 4 weeks and
4 patients for 8 weeks before the eccentric point lost fixation and
fixation became wandering. No binocular viewing was allowed. The
dominant eye was then occluded day and night and a red filter was
placed before the amblyopic eye to stimulate foveal fixation. In 9
patients the fixation became central and occlusion of the dominant
eye was continued without red filter. All children continued full time
occlusion until no further improvement of VA was noticed after 2
consecutive visits despite good compliance.
Results: In 9 children the VA improved to at least 20/32 in the
amblyopic eye, the VA of the dominant eye did not change.
Conclusion: Inverse occlusion is still a valuable option if
conventional occlusion proves to be insufficient to improve VA in
amblyopic eyes with eccentric fixation. Full time inverse occlusion
should be done until the eccentric point looses fixation. This should
be followed with full time occlusion of the dominant eye. Placing a
red filter before the amblyopic eye may also be helpful the stimulate
foveal fixation.
Intractable diplopia is usually encountered following surgery for
long-standing or consecutive strabismus. Nevertheless it might also
be elicited by antisupression therapy. In Poland intensive pleoptic
excercises were very popular in the past, therefore intractable
diplopia is presently a relatively common finding.
Purpose: The aim of this study is to try to establish predisposing
factors for intractable diplopia based on a retrospective case
analysis.
Material and Methods: A retrospective analysis of patients
referred to the Strabismus Outpatient Clinic in the period of 4
years. Inclusion criteria were as follows: age 12 years and above ,
constant diplopia that could not be attributed to any kind of acquired
strabismus and could not be improved with prisms, history of
antisupression therapy, strabismus since childhood. Medical charts
of all patients were reviewed.
Results: 12 cases of intractable diplopia were identified (7 male,
mean age 34 years). Six cases were esotropic and 6 exotropic all of
the latter consecutive. Moderate to deep amblyopia was present in
9 cases. Eight patients had hyperopic anisometropia which wasn’t
fully corrected in childhood and history of monofixation syndrome.
Four patients had multiple strabismus surgeries, 5 single procedure
and 3 had none. Diplopia perception ranged from shadowy image
in the periphery to doubling of the contours of the fixation target.
In 5 cases the second image was so bothersome that they sought
treatment.
Conclusions: Factors that appear to be associated with intractable
diplopia that results from intensive antisupression therapy are:
uncorrected anisometropia, monofixation syndrome, no fusion
potential, delayed treatment commencement.
28
THURSDAY, 29TH SEPTEMBER
05
06
EVALUATION OF THE BIPRISM TEST IN EARLY
CHILDHOOD
Serfozo, Csilla; Soproni, Anna
Heim Pal Children’s Hospital, Ophthalmological Private
Practice, HUNGARY
COST-OPTIMIZED CHILDHOOD VISION AND
HEARING SCREENING PROGRAMMES IN ALL
COUNTRIES IN EUROPE
Simonsz, Huibert J.; Sloot, Frea; EUSCREEN
FOUNDATION
Erasmus Medical Center Rotterdam, NETHERLANDS
Purpose: To study the correlation between the biprism test (BPT)
and later visual acuity (VA) in a screening setting among children,
whose eyes did not seem to be strabismic.
Methods: BPT results of 353 children (0- 8 years, average 4.6;
51% male) were retrospectively collected from 2010. The strabism
of included patients was not obvious at their first examination.
Every patient presented later to a second visit (average age: 33.64
months) when VA was measured (VA under 0.8 was regarded as
abnormal). Chi-square test was used to compare the results of the
two measurements.
Results: In the absence of co-operation BPT could not be taken
in 18.44% under 4 years of age (3-27 months, average: 13.05
months, 50% male).
22 right eyes and 29 left eyes of 353 patients were found abnormal
with BPT; VA was abnormal in 34 right eyes and 39 left eyes. The
result of a later VA acuity could be predicted with previous BPT in
a statistically significant (p<0.05) extent (0.0007 right eye, 0.0305
left eye). The negative and positive predictive values of BPT were
84% and 42%, respectively.
Conclusion: BPT is a rapid and inexpensive examination easy to
perform. BPT correlates well with later VA. BPT is able to relatively
precisely identify children with good vision even in very young age.
The positive predictive value of the test was lower in this study,
which may be partly explained by the smaller size of the group of
patients with non-obvious strabism.
Herb Simonsz & Frea Sloot for the EUSCREEN Study Group
Communicative skills at young age are crucial for health,
employment and quality of life in later life. Screening for vision and
hearing disorders in children, followed by early treatment, have
shown to be highly effective. Early detection and treatment of a
lazy eye prevents lifelong visual impairment. Early detection and
treatment of hearing impairment prevents delayed speech and
language development. EU-directive 16620/11 gives priority to
these programmes, since they may impact tens of thousands of
children and their parents.
Across Europe inequity exists in the provision of childhood vision
and hearing screening programmes (VAHSPs). High- Income
Countries have VAHSPs, but they vary with regard to age and
frequency of testing, tests used, uptake, screening professionals,
referral pathway and funding. This makes it difficult for healthcare
providers and policy makers in Low- to Middle-Income Countries to
decide what VAHSP to implement and how.
In this study, cost-optimised, evidence-based VAHSPs will be
implemented two European countries, based on collated evidence
from existing VAHSPs in Europe. Data on VAHSPs, demography,
administration, general screening, screening professions, uptake
and treatment availability is currently gathered in an established
network of professionals in 41 European countries and will be used
in a disease/health system modelling framework to predict benefits
and cost in the most optimal health system, taking regional diversity
and organisational and resource requirements into account.
Model-developed VAHSPs will be tested in the county of Cluj in
Romania for vision, and in three counties in Albania for hearing
screening. A generic strategy for implementation will be developed
by detailed tracking, and from identified requirements, facilitators
and barriers. The decision-analytic modelling framework and the
strategy for implementation will be packed into a transferable
TOOLKIT that will assist healthcare providers and policy makers
worldwide in their decisions to introduce or modify VAHSPs, and
increase effectiveness, efficiency and equity of child healthcare.
29
ABSTRACTS: FREE PAPERS
07
08
THE CLINICAL COURSE OF INTERMITTENT
EXOTROPIA
VLADUTIU, CRISTINA; Rusu, Oana; Rusu, Raluca M;
Sevan, Simona A
SC Rojo Business Group SRL Cluj Hospital, ROMANIA
CORRELATION OF DISTANCE STEREOACUITY
WITH NEWCASTLE CONTROL SCORES IN
INTERMITTANT EXOTROPIA
OTO, Sibel; Yüce, Aslıhan; Akca Bayar, Sezin
Baskent University Hospital Pediatric Ophthalmology,
TURKEY
Purpose: To briefly look into the natural history of intermittent
exotropia.
Methods: One hundred fifty patients with intermittent exotropia
were included in the study. In 65 of the cases the strabismus was
managed conservatively by overcorrecting minus lens therapy and
orthoptics. One hundred four patients underwent surgical treatment.
Postoperatively, examinations were performed on the second day,
after 2 months, 1 year, 3 years, 6 years and more than 6 years
from the surgery. According to the postoperative angle of deviation,
patients were divided into 4 groups: orthophoria, residual exotropia
over 6 PD and under 6 PD, consecutive esotropia.
Results: Forty-six of the patients with a conservative approach
showed improved control of exotropia and did not require surgery.
The majority of the 104 patients who received surgical treatment
achieved immediate postoperative orthotropia or under 6 PD
exotropia (38 and 49, respectively). The most substantial alteration
in ocular alignment was encountered in the 2 month-postoperative
period. Accordingly, the number of patients with orthotropia lowered
significantly (p=0.002), while that of those with over 6 PD exotropia
increased (p = 0.007). Subsequent checkups (at 1 and 3 years) did
not reveal statistically significant variations. Few patients presented
for examinations after 6 years, therefore a statistical analysis would
be irrelevant.
Conclusions: The majority of patients with intermittent exotropia
require surgery. Residual deviation is present in most cases
postoperatively, but overall there is an improvement in the control
of the exotropia. Most alterations in ocular alignment occur in the
2-month postoperative period.
30
Aim: Distance stereoacuity has been reported to be a reliable
assessment of control of intermittant exotropia (IXT). In this study
distance stereoacuity values were compared with revised Newcastle
Home and Clinic control scores in patients with IXT.
Methods: Patients(n=22) with IXT, age ≥6 years and without
amblyopia were included. Home and office-based control were
graded on a 0 to 3 scale. Complete orthoptic examination was
performed and distance stereopsis was measured by Distance
Randot (DR) test.
Results: All patients had a history of deviation <50% of time fixing
in distance and very good near stereopsis values. There was poor
correlation between parental report of home control and office
control (r=0.27 p=0.225). Distance stereoacuity thresholds were
not correlated with home (r=-0.386 p=0.076) or office (r=0.255
p=0.252) control scores.
Conclusion: There was poor correlation between the DR test and
Newcastle control scores consistent with previous studies. This
result may be due to homogeneity of our study group.
THURSDAY, 29TH SEPTEMBER
09
MYOPIC SHIFT DURING CONTROL OF THE
DEVIATION IN INTERMITTENT EXOTROPIA:
A STUDY WITH THE PLUSOPTIX 12R
PHOTOSCREENER
Schiavi, Costantino; Tassi, Filippo; Di Croce, Valentina
DIMES, Department of Experimental, Diagnostic and
Specialty Medicine, University of Bologna Ophthalmic
Unit, St. Orsola-Malpighi Teaching Hospital, ITALY
Purpose: To assess refraction changes under binocular viewing
conditions during the control of the deviation for near fixation in
intermittent exotropia (XT) patients.
Methods: 20 (XT) patients aged 4 to 26 years were enrolled in the
study. The four patterns of divergent strabismus were present in the
study group: divergence excess, basic exodeviation, convergence
insufficiency, and simulated divergence excess. All the patient
exibited random dot stereopsis. The refraction and pupillary diameter
were measured by infrared video retinoscopy and pupillometry with
the Plusoptix A12 photoscreener (Nuernberg, Germany) under either
monocular and binocular viewing conditions at 1 meter distance.
The accommodation convergence to accommodation (AC/A) ratio
was measured in all patients with the gradient method.
Results: A myopic shift (mean 0.44, SD 0.422) was recorded under
binocular viewing conditions during the control of the deviation. No
hyperopic shift was detected turning from monocular to binocular
viewing conditions in any patient. No change in pupil diameter was
recorded passing from monocular to binocular fixation. The mean
AC/A ratio resulted 5.61. When considering the sub-groups, it
ranged from 8.7 in the divergence excess group, to 5.6 in the basic
exodeviation group and 3.4 in the convergence insufficiency group.
Conclusions: The myopic shift occurring under binocular viewing
conditions during the control of the deviation at near fixation could
be explained by the increased vergence demand in (XT) patients.
Fusional vergence through convergence accommodation to
convergence ratio rather than accommodation through AC/A ratio
seems to be the main compensatory mechanism for the deviation
in (XT).
31
ABSTRACTS: FREE PAPERS
10
11
INFERIOR OBLIQUE RECESSION IS ENOUGH FOR
UNILATERAL LONG-STANDING CONGENITAL
SUPERIOR OBLIQUE PALSY?
Ciubotaru A, Iosub I, Măcău M, Hopincă A
Infosan Eye Clinic, Bucharest, ROMANIA
CYCLOCHECK – A NEW WEB-BASED SOFTWARE
FOR THE ASSESSMENT OF OBJECTIVE
CYCLODEVIATION
Simiera, Justyna; Broniarczyk-Loba, Anna; Loba, Piotr
Medical University of Lodz Department of Binocular
Vision Pathophysiology and Strabismus, POLAND
Purpose: to review the results and techniques of surgical treatment
of unilateral congenital superior oblique palsy(CSOP) in adults.
Methods: We retrospectively evaluated 47 adults undergoing
surgery for unilateral CSOP in our clinic (2006-2016). The patients
were divided in 2 groups: Group 1-34 patients with preoperative
vertical deviation (VD) in primary position (PP) less than 30 prism
diopters (PD), in which we performed a graded inferior oblique
recession (8mm,10mm or maximal) and Group 2 -13 patients with
preoperative VD in PP greater than 30 PD, in which we performed
a maximal inferior oblique recession combined with recession of
contralateral inferior rectus muscle, according to the amount of
vertical deviation. Horizontal and vertical deviations in five positions
of gaze and head posture were assessed pre- and postoperatively.
In 21 patients, we measured cyclodeviation with Harms’tangent
screen.
Results: In Group 1,VD in PP and in adduction were reduced from
median 10 PD and 25 PD to 1PD and 3PD respectively. In Group
2, VD in PP and in adduction were reduced from median 34 PD
and 36 PD to 6PD and 8PD respectively. All patients improved their
abnormal head posture after reoperation.78% of patients have first
heard the diagnosis of CSOP in our clinic, even 92% of them had
more than 3 eye examinations during life.
Conclusion: Isolated inferior oblique muscle recession is an
effective treatment option for CSOP up to 30 PD of vertical deviation
in PP. Two-muscle surgery should be reserved for patients with
larger vertical deviations.
32
Purpose: Detection and precise measurement of torsional deviation
can be clinically essential in the diagnosis and management of
certain forms of cyclovertical strabismus. A fundus photography with
determination of the disc-foveal angle (DFA) is currently regarded as
the gold standard for assessing objective cyclodeviation, however
it has not yet been routinely used in strabismological practice due
to the lack of objective and repeatable measurement methods. The
purpose of this study is to present a new free web-based software
(www.cyclocheck.com) designed for the measurement of the DFA
and to evaluate its accuracy.
Methods: 32 subjects, (18 orthotropic and 14 strabismic) were
enrolled in the study. Digital fundus photographs of both eyes with
Centervue DRS non-mydriatic fundus camera were performed in
all cases. Four separate measurements were made for each eye
and the DFA was calculated independently by two observers, to
determine reproducibility and repeatability of the technique. The
results were statistically analysed using Krippendorff’s Alpha
Coefficient (p<0.001).
Results: The inter-observer agreement was 0.99 (0.95 for
orthotropic and 1.0 for strabismic subjects). Reproducibility between
patients with easily or poorly detectable foveal reflex or optic disc
outlines were 0.99 and 0.95 respectively. Repeatability for the first
and the second observer were 0.98 and 0.99 respectively.
Conclusions: The proposed method of assessing ocular torsion
can be performed quickly and easily in daily practice. The results
indicate that this free web-based software provides reliable
and accurate measurements of the DFA and thus objective
cyclodeviation in both orthotropic and strabismic patients.
THURSDAY, 29TH SEPTEMBER
12
13
EFFECT
OF
„GRADED’
RECESSION
OF
INFERIOR OBLIQUE MUSCLE IN STRABISMUS
SURSOADDUCTORIUS
Maneschg, Otto A.; Knézy, Krisztina; Maka, Erika;
Volek, Éva; Nagy, Zoltán Z
Semmelweis University Dep. of Ophthalmology, HUNGARY
SUPERIOR OBLIQUE TROCHLEAR INJURIES:
CLINICAL
FEATURES
AND
STRABISMUS
TREATMENT
Armesto, Alejandro l; Ugrin, Maria C
Hospital Aleman Ophthalmology, ARGENTINA
Purpose: Retrospective semiquantitative analysis of clinical
results after graded recession in inferior oblique overaction (IOO) in
strabismus sursoadductorius.
Methods: During a period of 4 years (2012-2015) we operated 43
patients (mean age 12.3 ± 7.1 SD) with inferior oblique overaction
(IOO) with recession (8 mm, 10 mm or maximal) of the inferior
oblique muscle sceduling the procedure depending of vertical
deviation (VD) in maximal adduction. Maximal recession (14 - 15
mm) included an anteroposition to the lateral aspect of the insertion
of the inferior rectus. We analyzed the dose-response relation of
graded recession and evaluated the squint angle in five positions of
gaze by prisms and Maddox cross examination preoperatively and
postoperative 1 week, 1 month and 3 months after surgery. We also
examined BCVA, binocular single vision and other complications
after surgery.
Results: 31 patients had a normal binocular single vision. The
mean effect of the operation on VD in 25° adduction increased
from 5.5 ° with 8mm recession to 13.1 ° with maximal recession.
In 3 patients postoperatively vertical deviation was over 10 ° and
reoperation was needed during a follow up of 5 – 12 months.
Conclusions: Graded recession of inferior oblique muscle is a
suitable proposed procedure in patients with marked strabismus
sursoadductorius. The rate of functional undercorrection is low and
there is low risk from general anesthesia or significant postoperative
limitation of elevation.
Introduction: Trochlear damage has been described following
orbital roof fracture, orbital penetrating trauma, dog bite, sinus
surgery and cosmetic blepharoplasty of the upper lids. We present
a series of 5 patients with superior oblique disfunction due to
trochlear damage of different causes.
Materials and Methods: Five patients sought treatment for
vertical binocular diplopia. Four of them had a history of orbital
trauma, three following blunt trauma and one after a cosmetic
rhinoplasty. The fifth patient had Wegener´s disease. A complete
ophthalmological evaluation and orbital imaging have been
performed in all patients. Three patients had undergone strabismus
surgery and one have been treated with prisms.
Results: Three of our patients had a history of trauma in the area
of the superior oblique pulley and one had a fracture of the base
of the nose, intentionally performed by the plastic surgeon for a
cosmetic rhinoplasty, that progressed up to the trochlear fossa. The
fifth patient had an active Wegener´s disease in the area of the SO
pulley that was accurately disclosed in a PET scan. The trochlear
lesions in the penetrating injuries patients went unnoticed when
first treated elsewhere, and were diagnosed only when examined
for diplopia. Three patients had a trochlear detachment and two
had inflammation in the area of the trochlear fossa. Two patients
had superior oblique underaction with elevation deficit in adduction
(secondary Brown syndrome), and three had SO underaction
with inferior oblique overaction. In onee patient the trochlea was
surgically reattached, but ocular misalignement persisted. Three
were successfully treated with surgery, one had a residual SO
underaction despite a SO tuck performed elsewhere, and the
Wegener´s patient did well with prisms.
Conclusions: Strabismus due to trochlear injury is difficult to treat.
Trochlear detachment leads to SO underaction and inflammation
in the trochlear fossa may lead to intense scarring and limitation
to elevation in adduction. Thus, same side hypertropia when
depressing the eye in adduction is often combined with hypotropia
when attempting elevation in adduction. Trochlear reattachment is
difficult and frequently frustrating and surgery on the extraocular
muscles is necessary. A SO tuck of the affected muscle associated
with a contralateral inferior rectus posterior myoscleropexy can
help to relieve diplopia.
33
ABSTRACTS: FREE PAPERS
14
BOTULINUM TOXIN INJECTION OF SUPERIOR
RECTUS MUSCLE IN SUPERIOR OBLIQUE PALSY
WITH LARGE VERTICAL DEVIATION
Seyhan B. Özkan, Faruk Balıca
Adnan Menderes University Medical School Department
of Ophthalmology, Aydin, TURKEY
Purpose: In superior oblique (SO) palsy with large vertical
deviation, inferior oblique (IO) weakening alone is not sufficient to
correct the deviation. Secondary contracture of superior rectus (SR)
muscle may develop in long standing cases which requires superior
rectus recession in addition to IO weakening. The trouble with that
combined surgery is the risk of overcorrection. In an attempt to
weaken the SR muscle without having the overcorrection risk we
combined IO weakening with ipsilateral SR botulinum toxin injection.
Methods: Three cases with SO palsy at 5, 26 and 35 years of
age are presented. All of the patients underwent IO disinsertion
in combination with 5 units of botulinum toxin injection into the
ipsilateral SR muscle per operatively. Follow up was between 1217 months.
Results: The preoperative vertical angle of deviation was 25, 28
and 30 prism diopters. All of the patients had the clinical signs
of secondary superior rectus contracture. Post operative angle of
deviation ranged between 0-4 prism diopters at the final visit. One
of the patients developed ptosis that resolved in four weeks time.
Conclusions: In SO palsy with large angle of deviation with
secondary SR contracture, weakening the SR muscle with botulinum
toxin in combination with surgical weakening of IO muscle seems to
be a safe and effective method in long term. However the patients
must be warned about the possibility of transient ptosis.
34
THURSDAY, 29TH SEPTEMBER
15
HARADA-ITO MODIFICATION: PLICATION OF
ANTERIOR FIBERS OF SUPERIOR OBLIQUE
WITHOUT DISSECTION OR MUSCLE SPLITTING
Stavis, Monte I
Pediatric Ophthalmology of Houston, UNITED STATES
Introduction: The Harada-Ito procedure tightens the split lower
third of the superior oblique to correct excyclotorsion without
causing much change in depression and abduction. A modification
is described in which the muscle is NOT split.
Methods: The superior oblique is hooked. Laxity and position are
noted. A permanent 6-0 mersilene suture is tied with a square
knot on ONLY 1 ½ mm of the lower part of the superior oblique
between 2-4 mm back from the anterior insertion. The muscle is
NOT DISSECTED FREE of the superior rectus and is NOT SPLIT. The
needle is placed into the sclera where the muscle feels taught but
not tight, usually 2-3mm anterior and 2-3mm lateral, cinched up,
and tied. In patients with large excyclotorsion and NO UPSHOOT
IN ADDUCTION, an inferior oblique 2/3 partial Z tenotomy was
performed first. UPSHOOT in adduction is treated with inferior
oblique recession. If significant excyclotorsion remains after inferior
oblique surgery, as determined by indirect ophthalmoscopy, this
Harada-Ito modification is performed. Torsion is reevaluated.
Results: This procedure was performed in 23 eyes of 15 patients.
Follow up was 1 to 24 months. A few patients developed a +1/2 to
1+ depression in adduction. One eye was reoperated. Correction of
excylotorsion regressed slightly.
Discussion: This Harada-Ito modification is easier and safer to
perform, and allows better quantification of intraoperative tension.
Significant tightening of the posterior fibers did not occur.
Conclusion: Modified non-muscle splitting Harada-Ito has many
advantages and no disadvantages when compared to the classic
or Fells modification.
Harada M, Ito Y. Visual correction of cyclotropia. Jpn J Ophthalmol.
1964;8:88–96. Fells, P. Management of paralytic strabismus.
British Journal of Ophthalmology (1974) 58: 255-265.
35
ABSTRACTS: FREE PAPERS
16
CHANGES IN STEREOACUITY AND ANISEIKONIA
FOLLOWING LASIK IN BINOCULAR AND
MONOCULAR CASES
Mravicic, Ivana; bohac, maja; Selma, Lukacevic; Marija,
Anticic; Patel, Sudi; Gabric, Nikica
University eye hospital Svjetlost, CROATIA
Purpose: To determine the significance of any changes in the
magnitude of aniseikonia, stereoacuity at both distance and near
following unremarkable Laser in Situ Keratomileusis (LASIK) at one
year postop.
Methods: All patients underwent unremarkable LASIK using
Schwind Amaris 750S laser platforms. Patients were included as
follows group I,monocular myopes II,binocular myopes III,binocular
hyperopes IV,binocular astigmats V,binocular anisometropes.
An age and gender matched control was also included (group
VI). Aniseikonia and stereoacuity (RanDot) were evaluated at 6m
using polarised chart (CSO, Vision Chart CVC03 v2.0.0, Firenze,
Italy). Near stereoacuity was measured using Titmus Fly test (Vision
Assessment Corporation, Elk Grove, Illinois,USA). Measurements
were recorded at pre-and 1 year postop. Data were collected
under the same ambient conditions at all times and analysed using
appropriate non-parametric statistical tests (p<0.05 was regarded
as significant).
Results: Reporting the major findings were as follows
I, (n=20) aniseikonia reduced, stereoacuity improved at distance
and near.
II, (n=20) aniseikonia reduced, stereoacuity improved at distance.
III, (n=18) aniseikonia reduced, stereoacuity improved at distance
and near.
IV, (n=20) there was no significant changes in aniseikonia or
stereoacuity.
V, (n=20) aniseikonia reduced, stereoacuity improved at distance
and near.
VI, (n=20) remained unchanged.
Conclusions: Binocular vision improved in monocular and
anisometric cases as expected. Also, as expected, binocular vision
did not improve in binocular astigmats. Surprisingly, binocular
status did improve in the myopic and hyperopic cases. This could
be associated with changes in ocular aberrations or other factors.
LASIK has a tendency to elevate binocular function.
36
17
CYCLOFUSION AND TARGET ORIENTATION
Davis, Helen; Donnachie, Alice; Buckley, David
University of Sheffield, UNITED KINGDOM
Purpose: To evaluate whether the orientation of a target would
alter the amount of excyclofusion achieved. If so was this similar
with the stimulus presented on a computer as compared to the
synoptophore.
Methods: Thirty six participants aged between 18 and 30 years
were tested. All had a visual acuity of 0.200 LogMAR or better
in each eye and stereoacuity of at least 85 seconds of arc as
measured by the Frisby Near Stereotest. Twenty four participants
were presented with a stimulus on the computer which consisted
of lines in either a vertical or horizontal orientation. The use of
shutter glasses allowed fusion of the lines and for the image in
front of the left eye to be intorted in increments of 0.5 degrees.
The other 12 participants fused the after image line slides in the
synoptophore. Both were placed in the same orientation either
vertical or horizontal and fused before the image in front of the left
eye was gradually intorted. In both cases break point and recovery
point were recoreded.
Results: Cyclofusional amplitudes were larger when tested on the
synoptophore than when tested on the computer. The break point
was significantly larger (p<0.05) when the participant viewed the
vertical stimuli in both testing conditions.
Conclusions: The horizontal disparity created by cyclotorsion of
the vertical stimuli allows for much greater fusional amplitudes
than the vertical disparity created by the horizontal stimuli. This may
account for some variability of control in acquired oblique muscle
palsies.
FRIDAY, 30TH SEPTEMBER
18
19
LONG TERM OUTCOME OF HIGH VERSUS VERY
HIGH HYPERMETROPIC CHILDREN
Ziylan, Sule; Gokce, Berna; Parlakgunes, Zeynep
Yeditepe University school of medicine,Istanbul
Pediatric Ophthalmology and Strabismus, TURKEY
ACUTE ACQUIRED COMITANT ESOTROPIA CLASSIFICATION AND FACTORS INFLUENCING
REGAIN OF STEREOPSIS AFTER SURGERY
Hesgaard, Helena Buch; Vinding, Troels; La Cour,
Morten; Holst, Inger
Copenhagen Eye & Strabismus clinic / & affiliated with
Rigshopsitalet – Glostrup, DENMARK
Purpose: To evaluate the long-term outcome of high hypermetropic
children , comparing the groups of 5.00-8.00 D and ≥8.00 D, by
means of visual acuity, stereopsis and strabismus.
Methods: We retrospectively reviewed the data of patients having
≥5D of hypermetropia without anisometropia (≤1.5D). Data were
collected on the magnitude of spherical equivalent hypermetropia,
best corrected visual acuity (VA) with Snellen or Tumbling E charts,
stereopsis and strabismus. Patients were divided into two groups
as 5-8D(group1) and ≥8D(group2) spherical equivalent hyperopia.
Results of two groups were analyzed according to improvement of
visual acuity, stereopsis and strabismus.
Results: A total of 73 children met the criteria. The mean followup was 54.8 months. Visual acuity between the first and the last
examination was increased significantly in both groups (p1 and
p2=0 ) . Improvement of stereopsis was significantly higher in
both groups (p=0,037 ,p=0,042 respectively). The comparison of
the improvement of visual acuity and stereopsis between the two
groups (both left and right eyse) was not statistically significant.
In addition to this, there was no statistically significant difference
between the two groups in terms of the development of strabismus.
Conclusion: Visual acuity and stereopsis of children with high
hyperopia improved satisfactorily with spectacle correction and .
There is no statistical difference on the development of strabismus
between two groups having spherical equivalence of 5.00 to 8.00 D
or more than 8.00 D at the first exam and the last exam.
Purpose: To elucidate the etiologic factors for acute acquired
comitant esotropia (AACE) in childhood and study factors influencing
regain of stereopsis after strabismus surgery for AACE.
Material and Methods: Retrospective analysis of children referred
with AACE from May 2000 to March 2013. All children underwent
complete pre- and postoperative ophthalmological and orthoptic
examinations.
Results: We reviewed the charts of 48 children. Seven causespecific types of AACE were identified. Intracranial disease
was present in 6%, and 4 risk factors were identified to guide
clinicians when to perform brain imaging. A total of 24 of the 48
children with AACE underwent strabismus surgery within the 13
year study period. All children were aligned within 8Δ or less of
orthotropia at near (1/3 m) postoperatively. At the 6 week postoperative examination 4 of the 24 children (16.7%) had regained
normal stereopsis (TNO 60”). At the long-term follow-up, additional
7 children (29.2%) had regained normal stereopsis. Of the 24
children, 11 (45.8%) regained normal stereopsis, 4 (17.0%)
regained moderate degree of stereopsis (TNO 120” – 1980”), 6
(25.0%) had simultaneous perception with Bagolini lenses, while
3 children (12.5%) demonstrated suppression. Accordingly, 62.5%
(15/24) of the children who underwent surgery regained some
degree of stereopsis postoperatively. These children were older at
AACE onset (P=0.05 Fishers exact; P=0.01 t-test). Additionally,
there was an insignificant trend towards shorter delay of surgery
(P=0.08) and presence of fusion preoperatively (P=0.1) among
those who regained normal stereopsis compared to those who did
not regain stereopsis postoperatively.
Conclusion: Findings of seven cause-specific types of AACE
suggest classification of AACE of childhood. The potential for
regain of stereopsis was large among children with AACE. The
reemergence of stereopsis may take several months, and depends
on age at onset. Delay of surgery among children younger than 6
years may worsen the prognosis for regain of stereopsis.
37
ABSTRACTS: FREE PAPERS
20
21
STEREOACUITY IN PEDIATRIC BLOWOUT
FRACTURES IN THE COPENHAGEN REGION IN A
10 YEAR PERIOD WITH 5 YEAR FOLLOW-UP
Saunte, Jon Peiter; Torp-Pedersen, Tobias; Wolsing, Lone
Ophthalmology Department, Rigshospitalet, Glostrup,
Copenhagen University Hospital, DENMARK
INTERHEMISPHERIC CONNECTIONS IN HUMAN
BINOCULARITY
Marcel ten Tusscher, Anne Cees Houtman
University
Hospital
Vrije
Universiteit
Brussel
Ophthalmology, BELGIUM
Introduction: Pediatric “white-eyed” blowout fractures can be
difficult to diagnose. Little information on long time results after
orbital fractures in the pediatric population exists. We describe
the results of a 5 year follow-up study of children as measured by
persisting diplopia and stereoacuity level.
Purpose: To evaluate any persisting diplopia and stereoacuity in
pediatric patients with orbital fractures.
Methods: A diagnose search in a 10 year period in Copenhagen,
Denmark, revealed 13 patients under the age of 16 with orbital
fractures,who were offered an orthoptic re-evaluation. Stereoacuity
at near and diplopia any was noted.
Results: 9 patients had an eye-exam. One with unilateral traumatic
optic neuropathy and –LP was excluded.1 girl and 7 boys were
included, mean age 9 years (4-15y), follow-up-time mean 64
months (30-169). 0 of 8 had diplopia in primary position, 4 had
diplopia in down-gaze, and 6 had diplopia in up-gaze. 7 of 8 had
stereoacuity of 60 seconds of arc (”) or better, one had 240”.
Conclusions: Pediatric orbital fractures can due to entrapment of
orbital contents in the fracture line cause damage to the extraocular
musculature and adnex tissue. In a group of 8 childen, at 5 year
follow-up orthoptic evaluation after a white-eyed- pediatric orbital
fractures, the stereo acuity was found normal in 7 of 8 patients, but
persisting diplopia was found in 6 of 8 patients in up gaze, and in
4 in down gaze.
38
Aim: Partial chiasmal decussation is a prerequisite for binocular
vision in man. The role of the corpus callosum (CC) in human
binocular development is largely unknown. Besides visual field
unification the corpus callosum is implicated in central stereopsis
and disparity detection. Individuals with agenesis of the corpus
callosum may show normal stereopsis and disparity vergence. We
set out to study interhemispherical pathways.
Methods: Diffusion Tensor Imaging (DTI) of the interhemispheric
connections of the primary and secondary visual areas (V1, V2)
and grey matter analysis in 9 normal volunteers, in 4 subjects with
infantile esotropia (IE), and in one man with callosal agenesis with
normal binocularity.
Results: DTI showed interhemispheric connection through the
corpus callosum in all subjects. Fibers connecting the right V1
were more abundant in 2 subjects with IE and greatly reduced
in 2 others. All 4 showed abnormal fiber morphology. Anomalous
tracts through the anterior commissure linking the occipital cortices
bilaterally were shown in the subject with callosal agenesis.
Conclusion: In all subjects areas V1 and V2 are connected to the
contralateral V1 and V2 via interhemispheric fibers. Subjects with
IE showed abnormal numbers of transcallosal fibers connecting the
right V1 and a different fiber pattern. Callosal agenesis may result in
restructuring of the interhemispheric fibers. An alternative binocular
pathway may be established via the anterior commissure. This
study demonstrates that the CC has an important role in normal
binocular development.
FRIDAY, 30TH SEPTEMBER
22
23
STRABISMUS INDICATES SEVERITY OF MOTOR
IMPAIRMENT IN CEREBRAL PALSY (CP)
Chaudhuri, Zia; Nagpal, Manisha; Jain, Rajesh
Lady Hardinge Medical College & Associated Hospitals,
University of Delhi, Department of Genetics, University
of Delhi South Campus, PGIMER, Dr RML Hospital,
INDIA
THE CHALLENGE OF DIAGNOSING MYASTHENIA
IN NEURO-OPHTHALMOLOGY
Drimtzias, Evangelos; Hoole, Janice K; Simmons, Ian G
ST James University Hospital, UNITED KINGDOM
Background: CP is functionally classified by the gross motor
function classification system (GMFCS), manual ability classification
system (MACS) and motor syndrome / topographical type as per
the European classification. The purpose of the study was to assess
the relevance of ocular misalignment as an easily observable
ophthalmic parameter that could be assessed with these functional
motor classifications as a marker for more severe motor impairment,
necessitating more stringent care.
Methods: An observational, cross-sectional–design prospective
study was conducted by morphological and functional assessment
by GMFCS, MACS, Vineland Adaptive Behavior Scales (VABS)
and the European classification alongwith a complete ophthalmic
assessment on a representative cohort of 100 children with CP
between 4 to 18 years of age with mean age (6.85 ± 2.92 years),
(M: F:: 57:43), referred from a pediatric neurology clinic in a tertiary
care pediatric hospital.
Results: Strabismus (58%) and refractive errors (92%) were
found to be the most common ophthalmic anomalies. Both
GMFCS and MACS scales showed higher prevalence of squint and
refractive errors in the severely impaired groups as compared to
mildly impaired groups. By the European classification, spastic
quadriplegics had higher prevalence of squint and refractive errors
than spastic diplegics & hemiplegics. The VABS score assessing
adaptive levels of functioning of these children demonstrated
significantly reduction with increased levels of severity of CP as per
both functional and topographical scales.
Purpose: Myasthenia affecting the eyes continues to be a
challenging diagnosis to make. Confirmatory tests may fail to
positively identify the clinical suspicion. The purpose of this study
is to identify clinical signs which can be of diagnostic value in
establishing the diagnosis.
Methods: Clinical data of nineteen patients who presented with
symptoms suspicious of myasthenia were reviewed retrospectively.
Subjects underwent orthoptic assessment, ophthalmic examination,
laboratory testing and neurology review.
Results: Median age at diagnosis was 55 years (range: 29 –
77 years). Variable diplopia was the most common symptom at
presentation accounting for 61% of the cases. Approximately one
third of the patients had a history of unilateral/bilateral fatiguing
ptosis. Inferior rectus underaction and variable motility were the
most commonly reported signs on clinical examination. Myasthenia
was confirmed in 10 patients, ocular in 5 and general in 5. Five
subjects remain undiagnosed in the long-term. Chronic fatigue
syndrome, diabetic fourth nerve palsy and migraine were diagnosed
in the rest of the cohort. Positive acetylcholine receptor antibodies
were found in half of the patients diagnosed with ocular myasthenia
and in 75% of those with the generalized form. Ice-pack test was
positive in two thirds of the group. Fatiguing ptosis and variable
diplopia were found to be strong predictors of final diagnosis.
Inferior rectus underaction was present in 70% of myasthenics
but that and the ice-pack test were not statistically significant as
diagnostic indicators.
Conclusion: Clinical signs and symptoms are of prognostic value
in establishing diagnosis. A multidisciplinary team approach is
required.
Conclusions: Strabismus is indeed an easily observable ophthalmic
parameter that indicates more severe motor impairment in CP by
different functional, topographical and adaptive scales.
39
ABSTRACTS: FREE PAPERS
24
INCIDENCE OF OCULAR MOTILITY DISORDERS
FOLLOWING STROKE
Fiona J Rowe, Lauren Hepworth, Kerry Hanna, Claire
Howard
Department of Health Services Research, University of
Liverpool, UK
Purpose: To report annual incidence of ocular motility disorders in
an acute adult stroke population.
Methods: A prospective, epidemiology study was conducted from
1.6.14 to 30.6.15 across 3 stroke units. All patients were assessed
on the stroke unit. Patients who could not be assessed were coded
for reasons why. Assessment included visual acuity, visual fields,
ocular alignment, ocular motility, visual inattention and visual
perception.
Results: There was no significant difference across recruiting
sites for general demographics so data were pooled. There were
51% males and 49% females, mean age of 73.4 (SD 13.8) years,
87% ischaemic strokes. 1289 patients were recruited: 144 died
before assessment and 148 could never be assessed. Overall 997
patients were assessed and diagnosed. Over half were assessed
within 3 days. 574 could not be assessed at baseline so were
reviewed at visit 1 (median 3 days later). Two thirds were assessed
with diagnosis within 1 month and the majority within 2 months.
251/997 (25.2%) had normal eye exams. 746/997 (74.8%) had
visual impairment: 63% with impaired central vision, 43.8% with
ocular motility disorders, 28.7% with visual field loss, 27.8% with
visual inattention and 3.8% with visual perceptual disorders. Ocular
motility disorders comprised acquired strabismus, gaze palsy,
cranial nerve palsy, vergence impairment and nystagmus.
Conclusions: The incidence of post-stroke visual impairment
in adult stroke survivors is 75% with an incidence of 44% for
ocular motility disorders. This is higher than previous reports, and
highlights the need for integration of visual assessment as a core
post-stroke assessment.
40
FRIDAY, 30TH SEPTEMBER
25
PARINAUD SYNDROME OR NUCLEAR THIRD
NERVE PALSY?
SPIELMANN, Alain C; Gravier, Nicolas
Ravinelle Centre, FRANCE
Purpose: An acquired elevation palsy (Parinaud syndrome), due
to a damage of the midbrain tectum is usually not associated with
hypotropia. Two cases with elevation palsy and hypotropia were
studied to discuss an associated damage of the superior rectus
sub-nucleus, and to show how clinical examination can help
differentiate both.
Method: Five cases of acquired elevation palsy were studied.
Two cases with elevation palsy and hypotropia were compared
with three other cases without hypotropia. The patients had
clinical examination, Lancaster chart, fundus photographs, video
recordings of ocular motility and MRI of the brain. Similarities and
differences were looked for.
Results: The clinical features in the 2 cases with hypotropia
were: elevation palsy in both eye with retraction of the superior
lids, vertical diplopia, absence of nystagmus and absence of
convergence spasm. The Lancaster chart showed a palsy of the
superior rectus in the hypotropic eye. The MRI was normal in
both cases. One of these patients was operated on, making the
diplopia disappear (adjustable resection of the superior rectus). The
underlying neuronal circuitry will be discussed to determine the site
of the lesion.
Conclusion: It is believed that the 2 patients with hypotropia and
elevation palsy had a damage of both the superior rectus subnucleus and the midbrain tectum, as an elective lesion of the subnucleus should not be enough to explain all the clinical features.
The lesion might be too small to be detected by MRI.
41
ABSTRACTS: FREE PAPERS
26
27
SHORT TAG NOOSE ADJUSTABLE SUTURES – IN
ADULTS AND CHILDREN – HOW MANY NEEDS
ADJUSTMENT – AND WHEN?
Loenkvist, Claes S; Saunte, Jon Peiter
Rigshospitalet - Glostrup, DENMARK
THE CONTRIBUTION OF SUTURE ADJUSTMENT
TO
THE
OUTCOME
OF
STRABISMUS
SURGERY FOR ADULTS WITH SYMPTOMATIC
INTERMITTENT EXOTROPIA.
Raoof, Naz; Sloper, John
Strabismus and Paediatric Service, Moorfields Eye
Hospital, London, UNITED KINGDOM
First author email: [email protected]
Affiliations: Ophthalmology Department, Rigshospitalet, Glostrup,
Copenhagen University Hospital, Nordre Ringvej 56, 2600
Copenhagen, Denmark
Introduction: Adjustable sutures whith hidden knots under
conjuctiva provides a flexible tool for the strabismus surgeon,
and with application of the short tag noose suture (stnt), delayed
adjustment is possible. Stnt provides the surgeon a second chance
to reach target deviation, especially useful in patients with paralytic
or restrictive strabismus, or in re-operations.
Purpose: To evaluate outcomes in frequency of performed
adjustment and alignment in patients where stnt was applied –
and to evaluate benefits and risks of delayed adjustment in specific
cases.
Methods: All patients who underwent strabismus surgery in one
University Hospital by three strabismus surgeons during an 8 month
period are registrered with a minimum of 6 w follow-up time are
evaluated. Stnt cases are analyzed, and delayed time (days) and
frequency (%) of adjustment is registrered. All complications are
reported.
Results: Of a total of 345 strabismus surgeries, 96 (28%) patients
(m/f-ratio:49/47, age 6-81y, 6 under age 15y) had stnt placed on
one or more muscles. 27 (28%) needed adjustment, performed up
to 5 days after the surgery. One 73- year old woman with thyroid
eye disease suffered from a delayed infection and mild scleritis
initated 5 weeks after surgery, which responded well to topical
antibiotic and systemic sterioid treatment.
Conclusions: In pediatric and adult strabismus, stnt provides an
extra chance to reach the target deviation and is found to be safe
to perform. Delayed adjustment allows the surgeon to plan surgery
adjustment in a time slot available in the department.
42
Introduction: Although comparisons have been made for overall
success rates of strabismus surgery with and without adjustable
sutures 1-3, we have found no description of the difference made
to individual patient outcomes by post-operative suture adjustment.
Methods: A retrospective chart analysis was performed for 14
consecutive adult patients who underwent unilateral medial rectus
resection and lateral rectus recession under general anaesthesia for
symptomatic intermittent exotropia. All surgery was performed by,
or under the immediate supervision of, one surgeon. Adjustments
were performed under topical anaesthesia by the same surgeon 6
to 8 hours after surgery, assisted by an experienced orthoptist, who
measured the distance angle in primary position before and after
adjustment using the alternate prism cover test. Eye movements
were also examined, with particular reference to lateral incomitance
and diplopia in side-gaze.
Results: Sutures were adjusted for 9 of 14 patients. For those
not requiring adjustment, the mean pre-operative distance angle
was 39 p.d. base-in. Immediately following surgery their mean
distance angle was 5.6 p.d. base-in, increasing to 9.6 p.d. base-in
at 3 months after surgery. For those who were adjusted, the mean
pre-operative distance angle was 40 p.d. base-in. Immediately
following surgery their mean distance angle was 6.1 p.d. base-out
adjusted to 3.8 p.d. base-in. Three months after surgery the mean
had increased to 8.8 p.d. base-in.
Discussion: The use of adjustable sutures allowed the use of larger
surgical dosages knowing that symptomatic overcorrections could
be corrected at adjustment and lateral gaze diplopia minimised.
Conclusion: Suture adjustment improved surgical outcomes for
these patients.
References: 1. Zhang MS, Hutchinson AK, Drack AV, Cleveland,
J, Lambert, S. Improved ocular alignment with adjustable sutures in
adults undergoing strabismus surgery. Ophthalmology 2012; 119:
396-402.; 2. Mireskandari K, Cotesta M, Schofield J, Kraft SP. Utility
of adjustable sutures in primary strabismus surgery and re-operations.
Ophthalmology 2012; 119: 629-33.; 3. Libermann L, Hatt SR, Leske,
DA, Holmes JM. Adjustment versus no adjustment when using
adjustable sutures in strabismus surgery. J. AAPOS 2013; 17: 38-42.
SATURDAY, 1ST OCTOBER
28
29
THE SUCCESS RATES OF ADJUSTABLE SUTURE
SURGERY IN HORIZONTAL STRABISMUS
Ziylan, Sule; Gokce, Berna; Parlakgunes, Zeynep
Yeditepe University school of medicine, Istanbul
Pediatric Ophthalmology and Strabismus, TURKEY
Y-SPLITTING OF THE LATERAL RECTUS FOR
TREATMENT OF UPSHOOT AND DOWNSHOOT
AND DOWNSHOOT IN DUANE’S RETRACTION
SYNDROME
El Adawy, Ibrahim T
Mansoura Ophthalmic Center, Mansoura University,
EGYPT
Purpose: To detect success of surgical results of adjustable suture
surgery for strabismus.
Methods: This retrospective study is performed in patients who
underwent adjustable suture surgery in our clinic between April
2008 to January 2016. All patients had horizontal strabismus
(16 patients had esotropia and 28 patients had exotropia).
Restrictive and paralytic strabismus were excluded. Postoperative
suture adjustment was performed 8 or 24 hours after surgery.
The angle of deviation was measured before surgery, before and
after adjustment, and at the final follow-up examination. Surgical
success was set to a range between orthotropia and a deviation of
up to 10 PD for both ET and XT.
Results: The total number of patients was 44, including 22
(%50) female and 22 (%50) male. Mean age of the patients was
33,6±14,5 (ranged 15 to 64) years. The follow-up period was
6-80 ( mean 16.5 ) months. Suture position was not changed in
28 (63.6%) patients. Knot pushed back in 6(13.6%) patients and
pulled forward in 10(22.7%) patients. Surgical success achieved
in 37(84%) patients. Only one patient was scheduled for a second
surgery.
Purpose: To evaluate the efficacy of Y-splitting of the lateral rectus
to eliminate upshoot & downshoot in Duane’s retraction syndrome
(DRS).
Methods: Cases with DRS presented with upshot or downshoot
were treated (among the other surgical plan) with Y-splitting of the
lateral rectus.
Results: Thirty five cases of DRS presented with upshot &
downshoot were included in the study; Y-splitting of the lateral rectus
was done in all cases. All cases showed marked improvement with
elimination of upshoots & downshoots.
Conclusion: Y-splitting of the lateral rectus is very effective in
treatment of upshoots or downshoots in DRS.
Conclusions: It is most likelye to achieve a high level of success
with adjustable suture surgery .Almost all of the patients were
satisfied from the results. It should be preferred in appropriate
cases especially who has undergone multiple surgeries before .
43
ABSTRACTS: FREE PAPERS
30
31
LATERAL
SPLITTING
TECHNIQUE
FOR
COMPLETE THIRD NERVE PARALYSIS
Goberville, mitra; Guepratte, Nathalie; Krivosic, Valerie
Centre Ophtalmologique Lauriston, FRANCE
LONG TERM RESULTS OF YSPLIT LATERAL
RECTUS TRANSPOSITON TO THE MEDIAL
RECTUS AREA IN COMPLETE THIRD NERVE
PALSY
Gokyigit, Birsen; Akar, serpil; Aygit, Ebru D; Inal, Asli;
Ocak, Osman B
Beyoglu education and training eye hospital, TURKEY
Purpose: Complete N.III palsy is very challenging for the strabismus
surgeon as the eye is blocked in abduction and vertical muscles
are also paralysed making vertical transposition usually ineffective.
Splitting of the lateral rectus, described by Kaufmann in 1990 can
be helpful in these cases. This study aims to analyse the results
and one complication of this surgery which is transitory retinal
detachment and its mechanisms.
Method: 5 eyes of 4 patients with complete N. III palsy underwent
a lateral splitting surgery between 2010 and 2016. In 3 cases, the
lateral splitting was the first and only procedure. In 1 case (2 eyes)
maximal recession/ resection surgery had been performed before
with a recurrence of a major deviation.
Results: In all cases the preoperative horizontal deviation was more
than 50 pd with total paralysis of abduction and vertical movements.
In 4/5 cases the final deviation was less than 12 pd with limitation
of all the movements of the eye and a very small excursion capacity.
In one case, a central retinal detachment occurred after surgery
with spontaneous resolution after two weeks. The mechanism of
these detachments is probably related to vascular modifications
created by the muscle sheets on their path.
Conclusion: The lateral splitting seems to give good and steady
results in correcting deviation in severe complete N III palsy. Several
cases of transitory retinal detachments were reported.
44
Purpose: Y split medial transposition of lateral rectus operation
has nearly perfect restoration of ocular motility in primary position
for complete third nerve palsy cases. The aim of this study to
evaluate the long term results of operated cases for their visual
acuity change, ocular motility stability and complications.
Methods: Retrospective screen of patients’ records and last control
visit performed to 13 patients who underwent operation at least 24
months ego. Pre and postoperative DATA evaluated by SPSS for
Windows program.
Results: Except for 3,all other patients’ visual acuity found similar
with their preoperative values. When visual acuity improved in 2
young patients (because of strict ambliopia treatment), one patient
lost 1 line Snellen because of retina problem just following the
operation. Patients’ ocular motilities were found stable after third
month control visit. Only one case had transient retina problem.
Conclusion: Y split medial transposition of lateral rectus operation
found safe with stable results for long term follow-up for complete
third nerve palsy.
SATURDAY, 1ST OCTOBER
32
33
ANDERSON PROCEDURE FOR NYSTAGMUSRELATED HEAD-TURN – DECREASING LONGTERM EFFECT
Michael Gräf, Birgit Lorenz
Department of Ophthalmology, Justus-Liebig-University
Giessen, GERMANY
SUCCESS MODIFICATON OF SINSKEY OPERATION
FOR THE TREATMENT OF NYSTAGMUS PATIENTS
WHO HAD NOT NULL POINT
Gokyigit, Birsen; Ocak, Osman B; Inal, Asli; Aygit, Ebru
D.; Basarir, Berna
Beyoglu Education and Training Eye Hospital, TURKEY
Purpose: The major goal of extraocular muscle surgery for
nystagmus is to reduce abnormal head posture. The Anderson
procedure (AP) shifts the eccentric null zone to the primary gaze
position by bilateral recession of the yoke muscles opposite to
the abnormal head-turn (AHT). There are only few studies on the
effectiveness of the AP. We report on our cumulative experience
with the AP.
Purpose: Maximal subtotal extirpation of the horizontal rectus
muscles for the treatment of nystagmus cases with no null point
introduced by Sinskey in 2002. But following the operation patients
were had serious exo-deviations.
The aim of the study is to introduce a modification of the Sinskey
operation and evaluate the visual and ocular motility restoration with
normal appearance outcomes of maximal excision of the horizontal
rectus muscles in nystagmus patients.
Methods: The AP was performed in 17 consecutive orthotropes
with idiopathic or sensory defect associated infantile nystagmus
and AHT. Medians and ranges (min – max) were: age at surgery,
8 years (4–44); AHT during a visual acuity task, 30 deg (20–40);
equal recessions on the yoke muscles opposite to the AHT of
12 mm (10–14). One patient received augmentation by bovine
pericard grafts of effectively 5 mm and 6 mm, respectively after
initial recessions of 12 mm O.U.
Material and Method: Sinskey operation performed on 9 cases
with un-attached 10mm non-absorbable 6/0 suture on stumps.
Postoperative severe exo-deviation treated either advancement
of medial rectus or vertical recti muscle union procedures. a
modification .A complete eye examination was performed pre- and
postoperatively for all cases. Patients’ pre and postoperative DATA
evaluated by SPSS® 16 for Windows program.
Results: At follow-up 3 months after surgery (after augmentation
in one case), AHT was reduced to 5 deg (0–20). Success rates
(head turn ≤10 deg and ≤15 deg) were 88% and 94%. After 6-30
months (9 patients) the residual AHT was 15 deg (0–20) due to
increased AHT in 4 patients. Success rates were 44% and 56%. No
over-effect and adverse side-effects were observed.
Results: All patients had reduction of their normal and abnormal
horizontal eye movement and improvement of their objective and/
or subjective visual acuity. Postoperative severe exo-deviation was
completely recovered after second operation in 4 cases. There were
no anterior segment ischemia and need further operations least 6
month follow-up.
Conclusions: The “high-dosage” Anderson procedure significantly
reduced AHT. Large recessions of at least some 12 mm on the yoke
muscles appear essential to achieve the desired effect. The initially
high success rates decreased during the long term follow up.
Conclusion: Modified Sinskey operation and vertical recti muscle
union procedure for consecutive deviation were found safe and
effective procedures for nystagmus patients who had no null points.
45
ABSTRACTS: FREE PAPERS
34
35
SLANTED MEDIAL RECTUS RECESSIONS FOR
THE TREATMENT OF CONVERGENCE EXCESS
ESOTROPIA; A QUANTITATIVE ANALYSIS
La Roche, G Robert; Tremblay, François; Gravier, Nicolas
Dalhousie University Ophthalmology and Visual Sciences,
CANADA
POST-SURGICAL RECURRENCES OF STRABISMUS IN SAGGING EYE SYNDROME (SES)
Chaudhuri, Zia; Demer, Joseph L
Lady Hardinge Medical College & Associated Hospitals,
University of Delhi, Department of Genetics, University
of Delhi South Campus, PGIMER, Dr RML Hospital,
New Delhi, INDIA
We report a quantitative analysis of the effect of slanted medial
rectus recessions as a treatment of Convergent Excess Esotropia
in children. This retrospective review of 30 cases operated in
two centres is serving as a pilot study demonstrating the validity
and feasibility of a multicentre trial on this simple yet seemingly
effective technique.
There have been numerous surgical approaches described for
convergence excess esotropia. Many, if not most, have significant
drawbacks. In 2012, Ellis et al reported on favourable and stable
results of a slanted recession technique. The basic and simple
principle of this approach describes recessing both medial recti
with selective re-implantation to the sclera of the upper and lower
poles of the muscles based on the near and distance measurements
respectively. Clark and Demer have presented work showing the
probable physiological rational for a differential action of the upper
vs lower half of the recti, helping to explain the increased effect on
a near deviation of the selective larger recession of the lower pole
of a medial rectus.
We have analysed quantitatively the results of 30 cases where
bilateral slanted medial recti recessions was used to treat
convergence excess in children at two independent centres.
An excellent overall result showed an average alignment to
orthotropia for distance (from an average 17∆ ET pre-op) while
the decrease of the convergence excess was 80% of the original
angle (average residual angle of 6,5∆ Esotropia post-operatively).
Analysis of the correlation between the amount of convergence
corrected and the slant of reinsertion defined as the augmentation
of recession at the lower pole of the muscle insertion relative to the
top was 0,34 with no interference by the upper pole recession. This
correlation increases in cases of non accommodative convergence
excess and seems to remain constant for all amounts of slant used.
We feel these promising results of an independent analysis since
Ellis’s report warrant a larger study to confirm the therapeutic value
of slanted medial rectus recession in convergence excess esotropia.
46
Purpose: Strabismus due to SES, occurring due to age-related
connective tissue involution, is now an established cause of acute
or chronic diplopia in the geriatric population. High suspicion of
the condition results in early recognition and often obviates need
for extensive neurological investigations, and enables surgical
correction of the strabismus.
Methods: This retrospective study reviewed results of surgical
procedures performed on 93 patients (40 males) of average age
68±12 years, who had small angle strabismus due to SES, during
the 20-year period 1994-2014.
Results: In central gaze, mean pre-operative esotropia was
4.2±7.5 PD, while mean hypertropia was 4.7±5.9 PD. Surgeries
comprised medial rectus (MR) recession; lateral rectus (LR)
resection; plication, imbrication and superior transposition of the LR
to the superior rectus (SR) for esotropia; and graded vertical rectus
tenotomies (GVRT) and vertical muscle recessions for hypertropia.
Mean post-operative immediate and long-term deviation after
316±678 months average follow-up was 0.2±1.2 PD and 1.1±2.7
PD respectively for horizontal strabismus and 0.00 PD and 1.1±2.7
PD respectively for vertical strabismus. There was recurrence of
strabismus seen in 9 cases, possibly because of progressive
involutional changes.
Conclusions: Irrespective of surgical procedures performed,
progressive connective tissue involution in SES may occasionally
result in symptomatic recurrences of the small angle strabismus
within two years in about 10% of patients. This risk should be
disclosed pre-operatively.
SATURDAY, 1ST OCTOBER
36
37
AN OPTOKINETIC CLUE TO THE PATHOGENESIS
OF CROSSED FIXATION IN INFANTILE ESOTROPIA
Brodsky, Michael C.; Klaehn, Lindsay
Mayo Clinic, Rochester, USA
STRABISMUS DIGITALIZATION FOR BETTER
EVALUTATION
Hakim, Ossama
Magrabi Eye Hospital Paediatric Ophthalmology,
UNITED ARAB EMIRATES
Purpose: To elucidate the pathophysiology of crossed fixation in
infantile esotropia.
Methods: Clinical examination of three patients with infantile
esotropia during presentation of optokinetic targets that periodically
reverse their horizontal direction of movement.
Results: When viewing a horizontally-rotating optokinetic drum
under binocular viewing conditions, all patients spontaneously
fixed with the eye exposed to nasalward optokinetic motion. When
the horizontal direction of optokinetic target was reversed so that
the contralateral eye was receiving nasalward optokinetic input, a
spontaneous fixation shift occurred after 5-10 seconds.
Conclusion: Peripheral monocular nasotemporal optokinetic
asymmetry provides a stronger fixation stimulus than foveal
proximity. Horizontal optokinetic asymmetry may underlie the
phenomenon of crossed fixation in infantile esotropia. In infantile
esotropia, both nasal retinas become frontally-directed, which
restores bidirectional motion detection under binocular conditions.
Purpose: Can we evaluate inferior oblique over-action in a better
way? and how this can affect our surgical outcome?
Methods: Thirty patients of horizontal strabismus with IOOA, but
no extraocular muscle palsy, were included in our study. For fifteen
patients, IOOA was determined by measuring the hypertropia of the
adducting eye using vertical prisms during extreme dextroversion
and levoversion.
For the other fifteen patients, IOOA was measured using a
computerized, Videoculographic monitoring system that is mounted
over patient’s head (Gazelab machine).
For the two groups, IOOA was graded as trace: 0-9 PD, Grade
1:10-19 PD, Grade 2:20-29 PD, Grade 3:30-39 PD, Grade 4:40
and above PD. Only patients with IOOA of 10 PD or more were
operated for inferior oblique weakening procedure. patients were
aged between 5 and 15 years where 10 were males and 20 were
females.
Results: For the first group, eight patients were qualified for
unilateral inferior oblique overaction but on follow up, inferior
oblique overaction was shown for five of the seven unilaterally
weakened inferior oblique muscle, which required inferior oblique
weakening for these patients, as a second stage procedure.
For the second group, twelve of the patients were eligible for
inferior oblique weakening procedure and on follow up non of the
three unilaterally weakened inferior oblique muscle required further
inferior oblique weakening procedure.
Conclusion: Digitalizing our measuring technique for extraocular
muscle deviation can provide us with a better preoperative
assessment, surgical planning, postoperative evaluation and
surgical outcome of our extraocular muscle interventions.
47
ABSTRACTS: FREE PAPERS
38
39
CHANGES
IN
CORNEAL
TOPOGRAPHY
AND REFRACTIVE ERROR AFTER VARIOUS
EXTRAOCULAR MUSCLES SURGERY
Akar, Serpil; Gokyigit, Birsen; Aygit, Ebru Demet;
Pinarci, Eylem Yaman; Bayar, Sezin Akça; Oto, Sibel
Baskent University, Medicine Faculty, Ophthalmology
Department, Istanbul Pediatric Ophthalmology and
Strabismus, TURKEY
MAY MAGNETIC RESONANCE IMAGING OF
THE ORBIT PLAY A ROLE IN REFRACTORY
STRABISMUS?
Marcon, Giovanni B; Pittino, Raffaele
Strabismological and Diplopia Centre, Bassano del
Grappa, ITALY
Purpose: To investigate the short-term effect of various extraocular
muscles surgery on refractive error and corneal topography
measurements.
Method: Consecutive patients who underwent various extraocular
muscles surgery from July 2013 to March 2015 were prospectively
studied. In this study, 163 eyes of 151 patients were evaluated in
7 groups;
(1) inferior oblique weakening, (2) medial rectus(MR) recession and
lateral rectus resection(LR), (3) LR recession and MR resection, (4)
LR recession, (4) MR recession and (5) MR recession and Faden
operation surgery. Refractive error; corneal measurements and
anterior chamber depth (Orb Scan II) were measured before and at
1 week and 1 month after surgery. Patients who could not maintain
reliable fixation and those with sensory strabismus or a history of
eye surgery were excluded. Pre- and postoperative measurements
were compared by analysis of variance.
Results: Overall, patients manifested statistically significant
changes in spherical and cylindrical equivalent, mean simulated
keratometry (Sim K) astigmatism value, mean corneal power at
3.0 mm and 5.0 mm zones, astigmatic power, irregularity values
and anterior chamber depht at 1 week after surgery (P < 0.05).
Changes became progressively smaller during the first month after
surgery, although significant changes in cylindrical equivalent and
corneal power at 3.0 mm and 5.0 mm zones persisted at 1 month.
Conclusion: Extraocular muscle surgery resulted in short-term
changes in refractive error and corneal measurement in this cohort.
The etiology of the refractive change is unknown but could be due
to alterations in muscle tension that affect corneal remodeling,
segmental interruption of the ciliary body circulation affecting the
lens curvature, postoperative tissue edema, and/or other postsurgical
factors. The decrease in change after 1 month may be due to the
effects of compensation by other quadrants of the eye or resolution
of the surgical induced tissue damage. Change in the tension of 1
muscle produces a significant change in the entire corneal surface,
which illustrates the interaction and interdependence all corneal
positions have with respect to each other. Longer follow-up is
necessary to ascertain clinical significance.
48
Purpose: to evaluate the usefulness of MR Imaging of the orbit
and the extraocular muscles for exploring the underlying pathologic
conditions in patients who did not benefit from strabismus surgery.
Methods: Three patients, two with vertical deviation (one clinically
suspected IV cranial nerve palsy, one suspected monocular
elevation deficiency) operated by inferior rectus recession and one
with horizontal deviation (clinically suspected myopic esotropia)
operated by bimedial rectus recession didn’t benefit from surgery
(no significant change in deviation). MR Imaging of the orbit by 1.5
Tesla scanner with head coil and fixation targets was performed
post-operatively to clarify the diagnosis.
Results: in these 3 patients MR Imaging of the orbit and of the
extraocular muscles revealed supernumerary extraocular muscles
that were responsible of the motility alteration. No further surgery
was performed in these patients.
Conclusions: MR Imaging of the orbit may play a role in identifying
the underlying alteration when patients don’t benefit from surgery.
It may also help in preventing further unnecessary surgery in
selected cases.
SATURDAY, 1ST OCTOBER
40
41
PEDIGREE ANALYSIS OF CONCOMITANT
HORIZONTAL STRABISMUS IN NOTH INDIA
Chaudhuri, Zia; John, Jibin; Aneja, Satinder; Thelma, B K
Lady Hardinge Medical College & Associated Hospitals,
University of Delhi, Department of Genetics, University
of Delhi South Campus, PGIMER, Dr RML Hospital,
New Delhi, INDIA
PROFILE AND DISTRIBUTION OF STRABISMUS
IN CRANIOSYSNOSTOSIS
Chaudhuri, Zia; Puncholothu, Akila K; Sharma, Ajay
Lady Hardinge Medical College & Associated Hospitals,
University of Delhi, Department of Genetics, University
of Delhi South Campus, PGIMER, Dr RML Hospital,
New Delhi, INDIA
Purpose: Familial inheritance of common forms of strabismus
like esotropia and exotropia is noted, genetic components of
which remain unidentified. The most significant finding so far has
been localization of the recessive STBMS1 locus on chromosome
7p22.1. Recently next generation sequencing (NGS) technology
has emerged as a powerful tool in discovery genomics and a large
number of novel disease causing variants are being reported,
particularly for monogenic disorders. In this study, we aimed to
recruit informative families for subsequent genetic analysis for
disease causing variant identification.
Purpose: Craniosynostosis may give rise to strabismus due to
heterotopy of extraocular muscle (EOM) pulleys, muscle force
imbalance due to orbital dystopia and absent or anomalous EOMs.
We aimed to study the profile and distribution of strabismus in
craniosynostosis, to enable understanding of the pathogenesis of
this condition, thus aiding management.
Methods: All consecutive families with two or more affected
subjects with strabismus were prospectively recruited at the
ophthalmic outpatients department (OPD) of our institution from
August 2014 to April 2016. Detailed phenotypic evaluation and
pedigree documentation was performed.
Results: Of the 26 recruited families of north Indian origin
recruited, nine were purely exotropic and 17 were esotropic. While
vertical transmission was observed in all families with exotropia, six
with esotropia had affected members across one generation, two
were consanguineous and two were twin families.
Conclusions: Families with clear-cut mode of inheritance recruited
in this study may provide a valuable resource to unravel the genetic
determinants of this common disorder of early childhood, with high
ophthalmic morbidity.
Method: 53 patients (31 males) with craniosynostosis of average
age 4.5 years at presentation were prospectively evaluated over a
period of 24 months for the distribution and profile of associated
strabismus. The cranial shapes were phenotypically classified
as trigonocephaly (metopic suture stenosis, 13), brachycephaly
(bicoronal and / or lambdoid suture stenosis, 20), scaphocephaly
(sagittal suture stenosis, 9), plagiocephaly (unilateral coronal and /
or lambdoid suture stenosis, 5) and oxycephaly (stenosis of coronal,
lambdoid and sagittal suture producing a tower skull, 6).
Results: 31/53 (58.5%) patients comprising all with plagiocephaly
(5), none with trigonocephaly (13), 17/20 (85%) with brachycephaly,
6/9 (67%) with scaphocephaly and 3/6 (50%) with plagiocephaly had
strabismus. This difference in distribution of strabismus in different
types of craniosynostosis was significant (p< 0.005, chi-square).
27/31 (87%) patients demonstrated exodeviation associated with
pattern strabismus (5), dissociated strabismus (1), nystagmus (1)
and hyperdeviations (5, all patients with plagiocephaly) while 4
patients had esodeviation.
Conclusion: The profile and distribution of strabismus in
craniosynostosis indicates a neuroanatomical rather than neural
basis. Preoperative high resolution orbital imaging could help
localize the position of abnormally placed / absent EOMs, thus
aiding customized sequential management comprising remodelling
of skull shape, orbital dystopia and associated strabismus.
49
ABSTRACTS: FREE PAPERS
42
43
STRABISMUS INCIDENCE IN A DANISH
POPULATION-BASED COHORT
Torp-Pedersen, Tobias E; Boyd, Heather A; Skotte,
Line; Haargaard, Birgitte; Wohlfahrt, Jan; Holmes,
Jonathan M; Melbye, Mads
Rigshospitalet Glostrup Dept. of Ophthalmology, DENMARK
FACTORS ASSOCIATED WITH TOLERANCE
OF PARTIAL SPECTACLE CORRECTION IN
HYPEROPIC CHILDREN
Del Porto, Lana; Hinds, Anne-Marie; Adams, Gillian
Moorfields Eye Hospital Strabismus and Paediatrics,
UNITED KINGDOM
Objective: To determine incidence and age distrubtion of
strabismus, overall and by subtype, in Danish children.
Purpose: To compare the effect of spectacle correction in
hyperopic children between full and partial spectacle correction of
hyperopia and investigate the factors associated with tolerance of
partial spectacle correction in hyperopic children.
Design: Prospective population-based cohort study.
Participants: 96,842 children in the Danish National Birth Cohort.
Methods: Children from the Danish National Birth Cohort evaluated
for strabismus were identified through national registers. Their
ophthalmologic records were collected from hospital ophthalmology
departments and ophthalmologists in private practice, and
strabismus diagnoses were classified by orthoptists. Estimation of
incidence was performed using survival analysis.
Main results: Overall, 1,309 cases of strabismus were identified
in a cohort of 96,842 children born in Denmark in the period 1996
to 2003. We found an overall cumulative strabismus incidence of
2.56% at
age 7 years. The overall incidence was similar in boys and girls.
The distribution of major strabismus subtypes was (percent of
cases, n): congenital esotropia (16.5%, 216); fully accommodative
esotropia (13.5%, 177); partially accommodative esotropia (19.3%,
252); exotropia (13.8%, 181). The esotropia:exotropia ratio was
5.4:1. Age-specific incidence curves for congenital esotropia, fully
accommodative esotropia, partially accommodative esotropia, and
all exotropia were of significantly different shapes, with median age
at detection being 0.0, 32.0, 26.1, and 16.6 months, respectively,
for the four subtypes.
Conclusions: In a national, population-based cohort study, we
found a cumulative incidence of strabismus of 256 cases per
10,000 children at age 7 and an esotropia:exotropia ratio of 5.4:1.
The most prevalent subtype was partially accommodative esotropia,
followed by congenital esotropia. The
age-specific incidence curves for strabismus subtypes were
significantly different, indicating etiological differences
50
Methods: A retrospective cohort study was performed by a search
of the hospital database of child patients with prescribing glasses
more than 1.5D hyperopia. Patients were classified into two groups
by cycloplegic refraction: 1) under-correction of hyperopia: at least
more than 0.5 diopter from cycloplegic photorefraction, 2) full
correction of hyperopia, according to two different practitioners.
A total of 72 patients were followed at least 1 years. The main
outcome measure was the comparison in spherical equivalent
refractive errors of spectacle glasses in both groups after more
than one year of follow-up with age at first visit, initial spherical
equivalent refractive errors, strabismus, amblyopia, astigmatism, or
anisometropia.
Results: There was statistical significantly difference in the factors
which can tolerate hyperopia reduction, like no anisometropia,
hyperopia less than 4 D, or astigmatism less than 1 D. The linear
regression analysis scatterplot indicated that initial spherical
equivalent refraction errors were little correlation with hyperopia
reduction rate in partial correction group. (n:36; r2:0.036; P
value:0.304) and full correction group
Conclusion: The partially corrected spectacle glasses may have
benefit in patient with no anisometropia, less than 1 diopter
astigmatigm, and less than 4diopter hyperopia in terms of tolerance
of hyperopic reduction.
SATURDAY, 1ST OCTOBER
44
MANAGEMENT OF PATIENTS IN A COMBINED
THYROID EYE DISEASE CLINIC: CAN THE
AMSTERDAM DECLARATION AIMS BE MET IN A
SECONDARY CARE CENTRE?
Quinn, Annika S; Benzimra, James; Dujardin, Leticia R;
Quinn, Anthony G; Vaidya, Bijay
Royal Devon & Exeter Hospital, UNITED KINGDOM
Purpose: Early diagnosis & treatment of thyroid eye disease (TED)
improves outcomes. Previous studies highlighted delays in diagnosis
& referral to specialist centres. Amsterdam Declaration (2009) aims
to halve time from presentation to diagnosis & diagnosis to referral
to a centre of excellence. A recent study from EUGOGO tertiary
centres suggests a trend for earlier referral (Perros, 2015). It is
unknown whether similar improvements occur in secondary care
hospitals.
We studied trends in referral to a UK secondary care specialist TED
clinic since Amsterdam Declaration.
Methods: We previously audited our specialist TED clinic from
2004-8 (Benzimra, 2014). We prospectively re-audited TED clinic
after Amsterdam Declaration (2010-15). We compared patient
characteristics & time to referral.
Results: During 2010-15, 129 patients were referred to clinic; 115
(89%) had TED (98 females, median age 55 yrs; range 13-88 yrs;
35 current smokers). Compared to 2004-8 cohort, current cohort
had shorter duration of eye symptoms (median 5.5 vs 12 months)
and larger proportion of patients with mild disease (EUGOGO
severity score mild, moderate-to-severe and sight-threatening:
66%, 34% and 0 vs 52%, 45% and 3%; p-value=0.04). Recent
cohort had clinical activity score (CAS) ≥3/7 (26% vs. 18% in
2004-8). 89 (77%) were biochemically euthyroid at first visit. 69
(60%) required follow-up appointments in the TED clinic; of these,
34 (49%) received either immunosuppressive or surgical treatment.
16 (40%) of current smokers either decreased or stopped smoking
by last visit to clinic.
Conclusion: Access to secondary care TED specialist clinic is
improving since Amsterdam Declaration.
51
ABSTRACTS
RAPID FIRE POSTERS
ABSTRACTS: RAPID FIRE
01RFS
02RFS
LIMBUS-INSERTION
DISTANCE
OF
EXTRAOCULAR RECTUS MUSCLES USING
SPECTRAL DOMAIN OPTICAL COHERENCE
TOMOGRAPHY AND CORRELATION STUDY
Rosario Gómez de Liaño
Hospital Universitario San Carlos, Ophthalmology
Motility Unit, Madrid, SPAIN
OCULOMOTOR
FINDINGS
IN
JOUBERT
SYNDROME
Gravier, Nicolas M.; Aubert-Brenugat, Valerie
Polyclinique de l’Atlantique ophthalmology, FRANCE
Purpose: to determine the insertion distance of the horizontal
rectus muscles to the limbus using Spectral Domain optical
coherence tomography (SD-OCT), and to evaluate whether there
exists any correlation between the insertion distance and gender,
age or axial length.
Methods: Cross-sectional study of 187 right eyes of healthy
subjects. The gender and age were collected, and axial length was
measured using an optical biometer. SD-OCT images were used
to measure the distance from the horizontal rectus insertion to
the limbus. The intraclass correlation coefficient (ICC) was used to
assess the reproducibility of the measurements, and a multivariate
model was adjusted to analyze whether gender, age and axial
length could have an impact on insertion distance.
Results: Mean age was 43.7 ±22.1 years (range 6-85); 69% were
women. 25 patients were children. Mean axial length was 23.9
±1.6 mm (range: 20.4-29.3). Mean rectus insertion distance to
the limbus was 6.47 ±0.52 mm (range 5.2-7.6) for lateral rectus,
and 5.22 ±0.51 mm (range 4.1-6.1) for medial rectus. ICC was
>0.87 for intra and interobserver reproducibility, showing excellent
agreement. The insertion-limbus distance was influenced by
gender, being greater in men (P=0.040 for lateral rectus; P=0.036
for medial rectus). However, there was no correlation between this
distance and axial length or age (P>0.156).
Purpose: Joubert syndrome is a rare congenital malformation
of the brainstem and cerebellar vermis. Diagnosis is based on
clinical (hypotonia, breathing disorder, developmental delay) and
neuroradiologic findings (cerebellar hypoplasia). Among ophthalmic
problems, the aim of this presentation is to analyze eye movements
anomalies.
Methods: we analyze videos oculomotor features of 9 patients
presenting a Joubert syndrome.
Results: All patients had eye movement anomalies. 5 patients had
an isolated saccades apraxia, 1 had a saccades apraxia associated
with an esotropia, 2 had a see-saw nystagmus, 1 a jerk nystagmus.
The origin of the oculomotor apraxia is not well known. A possible
cause is a defect in the initiation of the quick phase of the optokinetic
nystagmus. The origin of see-saw nystagmus may be a deficiency
of crossed connections involving either visual pathways (chiasmatic
anomalies), or neural structure in the brainstem that control eye
movements (Interstitial Nucleus of Cajal)
Conclusion: Characteristic eye movement disorders in Joubert
syndrome are the oculomotor saccades apraxia and see-saw
nystagmus.
Conclusions: This study determined that SD-OCT is an effective
technique in measuring the insertion distance of the horizontal
rectus muscles to the limbus. The length of this distance was greater
in men, however, age and axial length seem to be independent.
53
ABSTRACTS: RAPID FIRE
03RFS
04RFS
THE
EFFECT
OF
PREVIOUS
ORBITAL
RADIOTHERAPY ON RESULTS OF STRABISMUS
SURGERY IN PATIENTS WITH THYROID EYE
DISEASE
Hyun Goo Kang, MD,1 Jong Bok Lee, MD,2 Jin Sook
Yoon, MD,1 Sueng-Han Han, MD,1 Jinu Han, MD,1
1
Institute of Vision Research, Severance Hospital,
Department of Ophthalmology, Yonsei University
College of Medicine
2
Kong Eye Center
RELIABILITY OF A NEW METHOD FOR
MEASURING SINGLE VISUAL FIELD AND
UNIOCULAR FIELDS OF FIXATION
Alarcón Tomás, María; Gómez de Liaño Sanchez,
Rosario; Dupré Peláez, Mauro; Garcia Garcia, Miguel
Hospital Puerta de Hierro Majadahonda, SPAIN
Purpose: To evaluate the effect of previous orbital radiotherapy
on the success of strabismus surgery in patients with thyroid eye
disease (TED).
Methods: We conducted a cross sectional study with 40 healthy
subjects to asses reliability of a modified Weiss screen to measure
SVF and UFOF. Measurements were taken twice by the same
observer and by two different observers in 8 of those patients to
assess intraobserver and interobserver reproductibility. We also
conducted a pilot study with nine of this patients to compare de
modified screen with de Goldmann perimeter.
Methods: The retrospective chart review of patients who underwent
strabismus surgery for TED were conducted. Patients were divided
into two group according to whether they had previously undergone
radiotherapy. Success was defined as no diplopia in primary and
downgaze. The effect of strabismus surgery on the amount of
protopsis was also evaluated.
Results: A total of 102 patients with TED were included. Among
these, 26 (25.5%) patients had undergone orbital radiotherapy
before strabismus surgery and 76 patients had not. The two
groups did not differ in terms of the average angle of preoperative
horizontal, vertical deviations, the average number of extraocular
muscles that underwent surgery, and the average number of
strabismus surgery. The postoperative exophthalmometric value
decreased an average 0.2 mm in the radiotherapy group and 0.3
mm in the non-radiotherapy group. The success rate of the surgery
was 88.5% in patients who had previous radiotherapy and 68.4%
in patients who had not (P = 0.046).
Conclusions: Previous orbital radiotherapy had significant effect
on the outcomes of strabismus surgery in patients with TED.
Therefore, radiotherapy should be considered in patients with TED
who had diplopia.
54
Purpose: To evaluate the reliability of uniocular fields of fixation
(UFOF) and single visual field (SVF) with a modified screen in
healthy subjects.
Results: Measurement were analyzed considering pairs of data
by axis. Results for both eyes were comparable in vertical and
horizontal axis. SVF and UFOF measurements had very high
reproductibility interobserver and intraobserver with a CCI of 0.86
and 0.78. When comparing Goldmann versus modified screen we
found a negative correlation between the tests with overestimation
of measurements in Goldmann
Conclusions: SVF is an important parameter when evaluating
motility in patients with restriction and it correlates well with
functionality and quality of life. Due to the fact that Goldmann
perimeter is tending to disappear, new methods to assess SVF and
UFOF are needed. The modified screen test is reliable, reproducible,
easy to perform and does not require a trained technician.
ABSTRACTS: RAPID FIRE
05RFS
06RFS
THE PRISMPERISCOPE (PAT. PEND.) – A NEW
ABDUCTOR FIXATION DEVICE PROTOTYPE –
PROVIDES BETTER ACCESS FOR INSPECTION
OF THE TEMPORAL FUNDUS IN CHILDREN WITH
LARGE ANGLE ESOTROPIA
Jon Peiter Saunte, Max Bonne
Ophthalmology Department, Rigshospitalet, Glostrup,
Copenhagen University Hospital, DENMARK
RETINAL NERVE FIBRE LAYER AND MACULAR
THICKNESSES IN ADULTS WITH HYPEROPIC
ANISOMETROPIC AMBLYOPIA
Yakar, Konuralp; Kan, Emrah; Alan, Aydın; Alp, Mehmet
Hanifi; ceylan, tolga
Ataturk State Hospital Ophthalmology, TURKEY
Purpose: To demonstrate a new fixation device prototype to
improve access for eye exam in small children or uncooperative
adult patients.
Methods: Presentation of the PrismPeriscopePat. Pend. (PP), a
periscope with two mirrors and an integrated base-out prism. The
patient is allowed to fixate through the handheld PP at a cartoon,
thus the other eye is abducted and available for examination. PP
can be used in front of both eyes alternatively, driving the nonfixation eye in abduction, and by holding the PP in a vertical position,
the non-fixating eye is driven in up- or down-gaze; the superior or
inferior part of fundus then available for examination.
Results: The PP prototype was tested during 6 months in a clinical
setting. In children or mentally disabled patients with large angle
Esotropia (ET) it was proven helpful in the examination of the cornea
and fundus, especially by allowing examination of the temporal part
of retina in esotropic eyes, thus avoiding need for eye-exam under
general anesthesia in 3 children.
Conclusions: Examination of the anterior segment and fundus
in children with large angle ET can be challenging. The invented
prototype of PrismPeriscope provides better access for examination
of anterior segment and fundus in these children, thus saving time
in the clinic and in some cases avoiding further eye exams under
general anesthesia.
Purpose: The aim of this study to compare the macular and retinal
nerve fibre layer (RNFL) thicknesses and optic nerves of eyes with
reducedvision due to anisometropia with the contralateral healthy
eyes in adults using optical coherence tomography (OCT).
Methods: Macular and RNFL thicknesses, optic nerve disc
area,cup area, and horizontal vertical cup-to-disc ratios obtained
using a NIDEK RS-3000 SLO spectral domain OCT device were
compared between the amblyopic and fellow eyes in 30 adults with
anisometropic amblyopia 18–55 years old who were seen in our
clinic with unilateral poor vision.
Results: The mean macular thickness was 266.90 ± 23.22 mm in
the amblyopic eyes and 263.90 ±22.84 mm in the fellow eyes, and
the mean RNFL thickness was 111.90 ± 12.9 and 109.70 ± 9.42
mm, respectively. The two thicknesses did not differ significantly
between the amblyopic and fellow eyes. There were also no
significant differences between the eyes in disc area, cup area, and
horizontal-vertical cup/disc ratios.
Conclusions: There does not seem to be a difference in macular
thickness, peripapillary RNFL, or optic disc structures between the
amblyopic and fellow eyes in adults.
55
ABSTRACTS: RAPID FIRE
07RFS
HOLOGRAPHIC
PRESENTATION:
SEEKING
PUBLICITY OR NEW OPPORTUNITIES OF A
RESEARCH AND PRACTICE REPORT
Plisov, Igor L.; Chernykh, Valeriy V.; Larionova, Yuliya A.;
Vaulin, Michael A.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
Novosibirsk, RUSSIA
Purpose: To create a new format for a strabismological conference
with the use of a holographic cube for a possibility of interactive
participation of the speaker in the presentation.
Methods: Successful attempt of presenting reports in a holocube
became a peculiar feature of the conference which was held
in November 2015 in Novosibirsk. Reports of Novosibirsk
strabismologists were presented with elements of pseudo
holographic animation and a possibility for the speakers to
interactively participate in the demonstration of dynamic slides.
Results: Out of 28 reports, 7 were presented in the format
of holographic presentations with interactive participation of
the speakers, 2 – only as holographic presentations. Other
presentations were adjusted to the requirements of presentation
demonstration in a holocube, 2 of them – in the online mode. The
new demonstration format made it possible to represent anatomy
and physiology of the oculomotor system in health and in disease in
the form of 3D animation, to show diagnostic algorithms, symptoms
and syndromes, to show particular aspects of surgery.
The secret of novel conferencing was not revealed to the invited
strabismologists and the audience till the conference started. But
the online audience of the conference included 402 territorial
centers from 19 towns in Russia and 5 other countries. The
conference was assessed positively in 100% of comments.
Conclusions: Successful holding of the conference with the use
of a holographic cube was the first step to prospective creation of
interactive presentations and academic programs with a possibility
to manage those using gestures and 7D technologies.
56
ABSTRACTS: RAPID FIRE
08RFS
STATISTICAL ANALYSIS OF LANG 1 STEREO TEST
FOR THE DIAGNOSIS OF MICROESOTROPIA IN
CHILDREN
Piantanida, Andrea C.; Spera, Manuela; Nobili, Roberta;
Gerosa, Giulia
Centro Oculistico Lariano, ITALY
Purpose: We have examined the most common and used test
to detect microesotropia in daily practice: Lang I stereo-test. The
aim of our study was to analyze it statistically to detect its real
effectiveness.
Methods: We considered 294 patients whose age range from 3
to15 years. Children less than 3 years of age were excluded from the
study since it was not possible to detect any answer. All underwent a
full orthoptic and ophthalmological examination. “Paliaga 8 diopters
base- in test” was considered the “gold standard” diagnostic test.
Results: Among all the patients, 269 ( 91.5%) were considered
normal (without strabismus) and 25 (8,5%) were considered
affected (whit strabismus). The authors founded a specificity of
99% and a sensitivity of 85%. We could also calculate the positive
predictive value (92%) and the negative predictive value (99%) of
the test. Likelihood ratio was detected to evaluate the efficacy of the
tests in daily practice and it corresponds to 85,19.
Conclusions: Lang I stereo-test is a simple test whit a high
specificity and a good sensitivity. Positive and negative predictive
values correspond to a test with a good reliability in young children.
Likelihood ratio stress the importance of Lang I stereo test in
diagnosing microesotropia in children elder than 3 years. We stress
the importance to involve children aged more than three to have
a good reliability of this test in practice to detect microesotropic
patients. Younger children should be monitored with other tests
with good statistical evaluation according to age.
57
ABSTRACTS: RAPID FIRE
09RFS
10RFS
CORRELATION BETWEEN AGE OF ONSET OF
DIPLOPIA AND CAG-REPEATS IN PATIENTS
WITH SPINO CEREBELLAR DEGENERATION
TYPE 3 (SCA3)
Pott, Jan Willem R; Wasmann, Rosemarie A; Olie,
Lisette; Rijpman, Kristie; de Vries, Jeroen J
University Medical Centre Groningen Ophthalmology,
NETHERLANDS
PEDIATRIC STRABISMUS: PRIMARY CARE
REFERRAL EFFICACY, EPIDEMIOOGY AND
PROGNOSIS IN A PORTUGUESE TERTIARY
REFERRAL CENTER
Coelho, João; Lages, Vânia; Carneiro, Inês; Miranda,
Vasco; Parreira, Ricardo; Menéres, Pedro
Department of Ophthalmology - Centro Hospitalar do
Porto, PORTUGAL
Purpose: About half of the patients with SCA3 will develop diplopia
due to divergence paralyses. SCA3 is a dominantly inherited
cerebellar ataxia. Patients have a CAG repeat expansions in the
ataxin-3 gene. There is a strong correlation between the number
of CAG repeats in the gene and neurological disease severity and
disease onset. We examined if there was a correlation between
CAG repeats and onset of diplopia in patients with SCA3.
Purpose: to characterize the strabismus subtypes, age of diagnosis,
associated amblyogenic factors and prevalence of amblyopia in
children referred to a tertiary referral center in Porto – Portugal.
Methods: The age of onset of diplopia in 44 patients with SCA3
was retrospectively determined from medical records. Diagnosis of
SCA3 was confirmed in all patients by genetic testing. Pearson’s
correlation was calculated.
Results: The mean onset of neurological symptoms in the 44
SCA3 patients was 38.2 years (range 16-55yrs). The mean onset
of diplopia was 43.8 years (range 21-67yrs). The CAG repeats of
SCA3 patients with diplopia ranged between 61 and 77 repeats
(median 68 repeats). There was a strong correlation between the
number of CAG repeats and age of onset of neurological symptoms
(r = -0,742) and onset of diplopia (r = -0,546).
Conclusions: There is a strong correlation between number of CAG
repeats and age of onset of diplopia in SCA3 patients. This strong
genotype/phenotype correlation implies that the neurodegenerative
processes in SCA3 are directly involved in the cause of divergence
paralysis type of diplopia.
58
Methods: Retrospective review of the medical files of patients with
10 years or less referred to the pediatric ophthalmology consult for
the first time between July 2011 and February 2013.
RESULTS: A total of 1205 patients were referred during this period.
379 (31,5%) were referred for strabismus, which was diagnosed in
only 143 (37,7%) children. 51 patients referred for other motives
were also diagnosed with strabismus (25% of all strabismus
patients). No gender differences were noted. The mean age of
diagnosis was 54 months. 54,1% of pediatric strabismus cases
presented with esotropia, 30.9% with exotropia and 15,0% of
deviations were associated with vertical or horizontal syndromes.
Amblyopia was present in 24.7% of children with strabismus and
classified as strabismic amblyopia in 37,5%. The prevalence of
potentially amblyogenic refractive errors was 28,8%. 20.1% of
strabismus patients were submitted to surgery.
Conclusions: Strabismus is a diagnostic challenge in children.
An early screening and referral by primary health care providers is
essential in order to adequately treat strabismus and the frequently
associated amblyopia. The fact that one fourth of all diagnosis
were not referred due to strabismus, the late age of diagnosis, the
high prevalence of amblyopia and the low prevalence of divergent
squints indicate a need to improve primary care referral efficacy.
ABSTRACTS: RAPID FIRE
11RFS
12RFS
MACHADO-JOSEPH DISEASE
Dias, David A; Menéres, Pedro; Miranda, Vasco;
Parreira, Ricardo
Centro Hospitalar do Porto, PORTUGAL
STRABISMUS AND BINOCULAR SUMMATION IN
PEDIATRIC POPULATION
SKUNCA HEMAN, JELENA; Malenica Ravlic, Maja;
Tadic, Raseljka; Lovric, Tena; Vatavuk, Zoran
KBC SESTRE MILOSRDNICE, CROATIA
Purpose: Machado–Joseph disease, also known as Machado–
Joseph Azorean disease or Spinocerebellar ataxia type 3, is a rare
autosomal dominantly inherited neurodegenerative disease that
causes progressive cerebellar ataxia, which results in a lack of
muscle control and coordination of the upper and lower extremities
and may present with ophthalmologic symptoms like involuntary
eye movements, diplopia or ophthalmoplegia. The authors aim to
describe a clinical case of a patient with Machado–Joseph disease
followed in Ophthalmologic consultation.
Methods: Clinical case followed in Ophthalmologic consultation
between 2011 and 2015
Results: 46-year-old female patient diagnosed with MachadoJoseph disease followed in Neurologic consultation since
2005. In 2010 she presents with diplopia and is referred to an
ophthalmologic consultation in 2011. Ophthalmologic examination
revealed: an esotropia of 10 prism dioptres (PD) at distance fixation
and an exotropia of 6 PD at near fixation (greater in supraversion);
little fusional amplitude; nystagmus in dextro and levoversion;
best corrected visual acuity was 10/10 in both eyes (refraction:
OD -1.00; OE -0.75); no morphologic abnormalities were found at
biomicroscopy and fundoscopic examination. Spectacles correction
with 4+4 PD base out in each eye, for distance fixation, and 2+2
PD base out, for reading, were prescribed. Since, the patient has
remained stable. Results from optical coherence tomography,
magnetic resonance imaging and synoptophore will be displayed.
Conclusions: It is important for the ophthalmologist to
be familiarized with some rare pathologies that may have
ophthalmologic symptoms
Purpose: To characterize the relationship between strabismus and
binocular summation (BiS) in pediatric subjects.
Methods: This prospective study included 10 esotropic, 10
exotropic, 10 esophoric, 10 exophoric and 30 age-matched control
subjects. Participants were recruited from the office if they were
diagnosed as having horizontal latent or manifest strabismus without
amblyopia. Exclusion criteria included age younger than 6 or older
than 16 years, current amblyopia or any other eye or neurologic
disease. Age-matched control participants were included only if
they had no history of eye disease other than refractive error. A BiS
score was measured using Early Treatment Diabetic Retinopathy
Study (ETDRS) high contrast visual acuity protocol, ETDRS lowcontrast acuity (2.2% and 1.1% contrast levels) and Pelli-Robson
contrast sensitivity chart for each eye individually and binocularly.
BiS was calculated as the ratio between binocular and better-eye
individual scores. Binocular alignment was measured at near and
distance using cover/uncover and alternate prism cover testing.
Results: 70 subjects were examined with age range, 6-16 years
and no gender predominance. There was no difference between
groups in BiS for high contrast visual acuity, for low-contrast acuity
at level of 2.2% (p>0.05) and Pelli-Robson contrast sensitivity.
They showed a mean BiS ratio of 1 or greater, indicating binocular
summation. Mean BiS was significantly lower in the manifest
strabismic patients than control for low-contrast acuity at level of
1.1% (p<0.05).
Conclusions: Manifest strabismus is associated with diminished
BiS for low-contrast acuity charts at level of 1.1% in pediatric
subjects without amblyopia.
59
ABSTRACTS
POSTERS
ABSTRACTS: POSTERS
P01
P02
ENDOTHELIAL CELL DENSITY FOLLOWING
EXTRAOCULAR MUSCLE SURGERY
Akar, Serpil; Gokyigit, Birsen; Kirandi, Ece; Bayar, Sezin
Akca; Oto, Sibel
Baskent University, Medicine Faculty, Ophthalmology
Department, Istanbul Pediatric Ophthalmology and
Strabismus, TURKEY
OUTCOMES
OF
3
HOURS
PART-TIME
OCCLUSION TREATMENT COMBINED WITH
NEAR ACTIVITIES AMONG CHILDREN WITH
UNILATERAL AMBLYOPIA
Alotaibi, Abdullah; Fawazi, Samah M.; Alenazy, Badriah
R; Abu-Amero, Khaled K
King Saud University, SAUDI ARABIA
Purpose: The aim of this study was to report the effect of eye
muscle surgery on the oxygen supply of the anterior segment of the
eye by determination of the corneal endothelial cell density.
Objectives: To evaluate the outcome of part-time occlusion therapy
with or without near activities in monocular amblyopic patients.
Methods: We investigated preoperative and postoperative corneal
endothelial cell density of 129 cases underwent extraocular muscle
surgery. They had primary surgery on two horizontal recti muscles
(49 cases), primary surgery on one horizontal recti muscle(46
cases), primary surgery on two vertical recti muscles (16 cases)
and revision surgery on two horizontal recti muscles of one eye
(18 cases). Mean age at surgery was 32.8 +/- 13.3 (15 to 71)
years. Mean follow-up time 6.1 +/- 2.2 (3 to 14) months. The
quantification of the corneal endothelial cell density was carried out
with the specular microscope (KONAN Cellcheck CC-7000; KONAN
Medical, Inc., Hyogo, Japan).
Results: In all eyes no significant difference in pre- and
postoperative corneal endothelial cell density was encountered:
2399 cell/mm2 vs. 2375 cell/mm2 (p=0.795). In addition,there
was no difference in the subgroup of revision surgery and primary
surgery on two vertical recti muscles: (p=0.677, p=0.206).
Conclusion: On the basis of corneal endothelial cell density there
was no indication of a chronically decreased oxygen supply of the
anterior segment after eye muscle surgery.
Methods: One hundred and thirty patients who prescribed daily
occlusion therapy (part-time occlusion) were followed-up for 12
weeks period. Original Articles The study was carried out in the
Pediatric Ophthalmology and Orthoptics Clinics of King Abdul-Aziz
University Hospital, Riyadh, Saudi Arabia for the period from January
2010 to November 2010. Sixty-five patients were recommended to
do the 3 hours of near visual activities (such as reading a book
during patching) while the other 65 patients were not advised to
do any near activity. Main outcome measures were best corrected
visual acuity (VA) for both groups and line improvement.
Results:The total line of VA improvement from baseline by an
average of 6.7 ± 2.37 line log MAR (logarithm of the minimum
angle of resolution) unit in the group of patching with near activities
and by average of 5.3 ± 2.04 line log MAR, unit in the group of
patching without near activities. All type of amblyopia (strabismic,
anisometropic, and mixed type of amblyopia) has improved
significantly after patching with near activities. Both moderate and
severe amblyopia has improved significantly in the group of near
activities compared to the group without near activities.
Conclusion: Performing near activities while patching in treatment
of anisometropic, stabismic, or combined amblyopia improves the
VA outcome more than patching alone.
61
ABSTRACTS: POSTERS
P03
P04
EFFECT OF ROLIPRAM ON VISUAL CORTICAL
PLASTICITY AND BEHAVIORAL EFFECT ON
VISION, SPATIAL AND VISUAL MEMORY IN
AMBLYOPIA MODEL IN ADULT RATS
Altintas, Ozgul; Celik, Onur Sinan; Eraldemir, Fatma
Ceyla; Mutlu, Oguz; Kum, Tugba
Acibadem University Department of Ophthalmology,
TURKEY
SUCCESS OF STRABISMUS SURGERY IN ADULT
PATIENTS
Atalay, Hatice T.; Özsaygılı, Cemal; C Özmen, Mehmet;
Yüksel, Erdem; Bilgihan, Kamil
Gazi University School of Medicine Pediatric
Ophthalmology and Strabismus, TURKEY
Purpose: To investigate the effects of rolipram, on the visual cortical
plasticity, vision, spatial and visual memory in adult, monocularly
deprived rats.
Methods: A total of 60 Wistar-Albino type male rates were
involved in the study .We subjected half of the rats to a
monocular deprivation (MD) model at postnatal day 21 until
postnatal day 45. Animals divided into the groups as;control
group,amblyop group,control+vehicle group,amblyop+vehicle
group,control+rolipram group,amblyop+rolipram group.Rolipram
and vehicle applied intraperitoneally. For behavioral testing we
used; Elevated Plus Maze Test, Morris Water Maze Test, New Object
Recognition Test, Evaluation of locomotor activity and anxiety test.
BDNF and CREB levels in visual cortex were studied by ELISA
method after decapitation.
Results: İn Morris water maze test; at the end of 4th session,
escape latency was significantly shortened in amblyopic+rolipram
group compared to amblyopic group alone .During blank trial which
was performed at 6th day,ıt was observed that time spent in platform
quadrant was significantly extended in amblyopic+rolipram group
compared to amblyopic group alone.Mean distance to platform
was significantly decreased in amblyopic+rolipram group when
compared to amblyopic group alone. Ratio index was significantly
increased in amblyopic+rolipram group compared to amblyopic
group alone.It was observed that rolipram treatment reversed
the BDNF decrease in amblyopic group.When CREB results were
assessed, treatment almost reversed the decrease in amblyopic
group to the control level; but, this result could not reach to
statistically significance.
Conclusions: We observed that rolipram provided a biochemical
and behavioral improvement on vision in adult, monocular-deprived
rats.
62
Introduction: A common misconception among patients and
ophthalmologists has been that strabismus in adults is difficult or
impossible to treat surgically, and that strabismus surgery will not
yield improvement of visual function or symptoms in adults with
strabismus. We investigated the success of strabismus surgery in
our visually mature (age ≥ 9 years) patients.
Methods: The medical records of all patients of age ≥ 9 years
between January 2012 and April 2015 were reviewed. Pre and
postoperative diplopia, stereopsis, deviation measurements and
complications of patients which undergone strabismus surgery
were recorded. The surgical success was defined as less than 10
PD horizontally and less than 5 PD vertically.
Results: 117 patients were enrolled. 89 of 117 patients undergone
surgery. The mean age of the patients was 24.3 ± 15.7 (9-83)
years. The mean follow-up duration was 11.5 months. In 77 of 89
cases (86.5%) the surgery was successful. No complications were
noted apart from the two cases of scleral penetration. 23 of 26
patients who had diplopia preoperatively (88.5%) had no diplopia
in postoperative period. The mean stereopsis was 489 sec of arc
in the preoperatively and improved to 470 sec of arc after surgery.
Discussion: In patients who had completed visual maturation,
strabismus surgery improves motor alignment, eliminates diplopia
and provides some level of improvement in binocularity depending
on the age of onset or the strabismus.
Conclusion: Surgical treatment of adults with strabismus is safe
and effective.
ABSTRACTS: POSTERS
P05
P06
MANAGEMENT
OF
DUANE
RETRACTION
SYNDROME WITH PRISMATIC GLASSES
AYGIT, EBRU DEMET; KOCAMAZ, MURAT; İNAL, ASLI;
GÖKYİGİT, BİRSEN; TASKAPILI, MUHITTIN
Beyoglu Eye Training and Research Hospital
STRABİSMUS, TURKEY
NEW TECHNOLOGY OF POSTOPERATIVE
FUSION REHABILITATION IN PATIENTS WITH
CONGENITAL STRABISMUS
Aznauryan, Igor; Balasanyan, Victoria; Aznauryan, Erik;
Agagulyan, Satenik
Association of Pediatric Ophthalmology Clinics, RUSSIA
Purpose: To report the results of using prismatic glasses for Duane
retraction syndrome (DRS). We studied the results of management
with prismatic lenses in DRS patients.
Purpose: to estimate efficiency of the sensory fusion recovery using
LCD glasses with electronically controlled intermittent occlusion.
Methods: Data were obtained from the records of patients who
were evaluated during 2000 in the Strabismus Department of
Beyoglu Eye Training and Research Hospital. The average follow-up
was 12.2 ± 17.7 months. In all cases, two main variables were
evaluated: horizontal deviation in the primary position and face
turn. Prismatic glasses were provided to patients according to the
degree of shift in the primary position.
Results: The mean age of patients was 11.2 years. An analysis
was performed on the data collected from 12 cases; 7 patients
were females (58.3%) and 5 were males (41.7%). 11 (91.7%)
cases were type I DRS. All 12 patients had abnormal head posture
(face turn) and an angle of mean deviation 10 PD (prism dioptri)
in two cases. After the 3-month ocular misalignment eliminated
with prismatic glasses in 2 patients and abnormal head posture
disappeared completely in five patients (41.7%).
Conclusion: Treatment is individualized on a case-by-case basis.
Prismatic glasses are useful for eliminating abnormal head posture
and ocular misalignment in selected cases with DRS patients.
Keywords: Duane retraction syndrome, abnormal head posture,
strabismus, treatment with prismatic glasses
Methods: There were retrospectively analyzed 41 cards of patients
with no sensory fusion who wear LCD glasses. The average age of
the patients was 5,7 ± 1,9. All patients have hyperopic refraction.
5 patients (12.2%) have corrected visual acuity from 0.1 to 0.4
(in worse seeing eye), 11 patients (26.8%) from 0.5 to 0.7, 22
patients (53.7%) from 0.8 to 1.0, and in 3 patients (7.3%) visual
acuity could not be verified due to the young age. All patients before
wearing glasses have been operated for esotropia. Patients wear
the glasses with optimal correction for 8 hours per day.
The first group of 14 patients (34.15%) was under observation 12
months, the second group of 8 patients (19.5%) - 9 months. 1
patient (2.44%) was followed up 6 months, 4 patients (9.76%) - 3
months. 14 patients (34.15%) were under observation less than 3
months.
Results: Sensor fusion has recovered at 12 patients in the first
group (85.7%) and at all patients in the second group (100%).
Binocular vision has recovered at 5 patients (33.3%) in the first
group, and at 2 patients (25.0%) in the second group.
Conclusion: LCD glasses is an effective mean of recovering
sensory fusion and binocular function in patients with operated
esotropia.
63
ABSTRACTS: POSTERS
P07
P08
DETERMINATION OF CYCLOPLEGIC REFRACTION OF CHILDREN BY RETINOSCOPY AND
REFRACTOMETER PLUSOPTIXA09® UNDER ATROPIN OR CYCLOPENTOLATE INDUCED CYCLOPLEGIA
Berkes, Szilvia
University of Szeged Department of Ophthalmology,
HUNGARY
AK/A RATIO, FUSION AND STEREOVISION IN
PATIENTS WITH CONSTANT AND INTERMITTENT
DIVERGENT STRABISMUS
Boichuk, Iryna M.; Aloui, Tarak
Filatov Institute of Eye Diseases and Tissue therapy
Lab. of Binocular Vision disorders, UKRAINE
Purpose: Due to obligate cycloplegia and lacking cooperation,
the measurement of the refractive error in pediatric population is
still challenging. Using hand-held refractometer, both the required
time and the disturbing, accommodative stimuli can be reduced
significantly.
Aim: To compare the data obtained from standard retinoscopy and
Plusoptix A09® hand-held refractometer.
Methods: 40 children (age range: 1-15 years) were enlisted in the
comparative analysis. The cycloplegia was induced applying either
atropine 0.5% for patients aged 1 to 7 years (Group ”A”, n=21) or
cyclopentolate 0.5% (Humapent®) for patients between 4 and 15
years of age (Group “H”, n=19). Refractions were determined by
both traditional retinoscopy and Plusoptix A09® refractometer and
the differences were calculated accordingly.
Results: Spherical equivalent values measured by retinoscopy
in groups “A” and “H” were +2.7 ± 1.8 D and +1.4 ± 2.0 D,
respectively. Although in Group “A” the mean difference between
the refractometer’s results from the retinoscopic values was
moderate (+0.2 D), their standard deviation was still high (± 0.8 D).
In contrast, in Group “H” the values measured by autorefractometry
exceeded those determined by retinoscopy (+0.6 D ± 0.8 D; p =
0.11) in general, but the differences proved not to be significant
(p=0.11). It must be noted that the differences between retinoscopic
and refractometric values showed correlation between right and left
eyes individually (Group “A”, r = 0.72; Group “H”, r = 0.77).
Conclusions: The measured differences between retinoscopy and
Plusoptix A09® do not enable Plusoptix A09® to be a standalone
alternative of traditional retinoscopy. Following cyclopentolateinduced cycloplegia, the observed lower dioptric values of glasscorrections determined by retinoscopy emerge the possibility of an
incomplete cycloplegic effect of cyclopentolate.
64
Purpose: To determine AK/A ratio, fusion and stereovision in
patients with constant and intermittent divergent strabismus.
Material and methods: 59 patients (33 with constant – I and 26
with intermittent exotropia – II) 10-21 y.o. were observed. Angle of
deviation for far and near distance in both groups was as following:
in the I (36,6 ± 2,8 and 16,6 ± 2,5) dptrs and (26,6 ± 2,8 and
12,0± 2,3) dptrs in the II group, p>0,05. In addition to conventional
eye examination the nearest point of convergence using proximetry,
AK/A ratio by the method of heterophoria, fusional reserves by
synoptophore and stereovision for near by test Lang II stereotest
for far distance by Huvitz CCP 3100 were determined in patients/
Results: It was found that in cases with the permanent form of
strabismus low values of AK/A are more common (53,5%) than in
intermittent (38%). Fusion is significantly more common in patients
of II group (II) of divergent strabismus (53,8%) in comparison with
the I (24,4%), p=0.001. Only 25% of patients showed stereoacuity
for near (200 - 600 arc sec) and 75% did not show stereovision in
the II group. No stereovision was determined in the I group. Values
of convergence correlated with AK/A ratio (r=0,87)
Conclusion: It was established that patients with intermittent
form of exophoria has low values of AK/A (53,5%) which may be
associated with weakness of accommodative convergence in these
patients.
Fusion is significantly more common in patients with intermittent
form of divergent strabismus (53,8%) in comparison with a
constant (24,4%),p=0.001. Only 25% of patients of II group
showed stereoacuity for near (200 - 600 arc sec).
ABSTRACTS: POSTERS
P09
P10
OCULOMOTOR AND OTHER OF OPHTHALMIC
DISORDERS IN CHILDREN WITH OCULOCUTANEOUS ALBINISM
Carneiro, Inês; Malheiro, Luisa; Maia, Sofia; Miranda,
Vasco; Parreira, Ricardo; Menéres, Pedro
Hospital Santo António - Centro Hospitalar do Porto,
PORTUGAL
OCULAR MANIFESTATIONS IN BOTULISM –
CASE REPORT
Casal, Inês; Maia, Sofia; Miranda, Vasco; Parreira,
Ricardo; Garrido, Cristina; Menéres, Pedro
Centro Hospitalar do Porto, PORTUGAL
Purpose: Oculocutaneous albinism (OCA) comprises a group of
heterogeneous disorders of melanin synthesis that cause various
ocular alterations and remarkable visual morbidity. This study aims
to evaluate the spectrum of oculomotor and visual disorders in
children with OCA.
Methods: Cross-sectional descriptive review of all children with
OCA referred to a low vision clinic in a tertiary hospital, between
November 2014 and April 2016. Demographic and ophthalmological
examination data were obtained from each patient.
Results: The group of patients (n = 8, 6 males), included 3
children with Hermansky Pudlak syndrome. The mean age was
14.75 years (range 9-17 years). Both refractive and non-refractive
ophthalmic disorders were present in 100% of patients. All patients
had a decreased best corrected visual acuity (mean: 20/100).
Non-refractive disorders included sensorial infantile nystagmus
syndrome, iris transillumination, retinal pigment epithelium
hypopigmentation and foveal aplasia / hypoplasia in 100% of
cases. Almost 88% had associated strabismus (50% with esotropia,
37.5% with exotropia, and 50% had coexistent alphabetic patterns).
Severe photophobia requiring chromatic filters was present in 50%
of cases. Anomalous head position was present in 37.5% of all
patients. Clinically significant ametropias were present in 87.5%
(50% with myopic astigmatism and 37.5% with hypermetropic
astigmatism) but only 12.5% had a significant anisometropia.
Approximately 38% already had intraocular hypertension but none
had yet developed glaucomatous optic neuropathy.
Purpose: to present the case of an adolescent with Botulism B and
ophthalmoparesis.
Methods: clinical case description.
Results: 14 year-old female admitted to paediatric department
with diarrhea, abdominal pain, diplopia with right eye abduction
deficit, photophobia with bilateral mydriasis, no pupillary light
contraction and no accommodation. Remaining neurological
examination was normal. Blood tests were negative for
inflammatory and infectious diseases; lumbar puncture showed no
alterations and head-brain CT scan showed sinusitis. On the 3rd
day she presented with worsening fatigue, diplopia and pain on
extreme gaze positions, asymmetric facial movements, imbalance
and ataxia - methylprednisolone was initiated. On the 5th day best
corrected visual acuity was 10/10 bilaterally (far) and Jaeger 5
(near); horizontal and vertical diplopia were present as well as 4
rectus muscle and inferior oblique paresis of the right eye, superior
and lateral rectus paresis of the left eye and right eye superior
eyelid ptosis. MRI; Electromyography and nerve-conduction study
were normal. Test for botulinum toxin was positive for Toxin B and
antitoxin was administered. Progressive improvement was noted
and 4 months after antitoxin she had no diplopia in primary position
of gaze, diplopia in latero and inferoversions, and no pupillary light
contraction.
Conclusions: Botulism diagnosis is difficult and often confused
with acute gastroenteritis, poisoning, myasthenia gravis, GuillainBarre syndrome/Miller-Fisher like, among others. In the presence
of gastrointestinal symptoms with intraocular and extraocular
ophthalmoplegias, botulism should be suspected.
Conclusions: Oculomotor and refractive disorders are extremely
prevalent in OCA. Strabismus and nystagmus management,
refractive correction, photophobia minimization and glaucoma
screening are essential to improve the visual prognosis of these
patients.
65
ABSTRACTS: POSTERS
P11
THE ASSOCIATION OF EPIBULBAR DERMOID
AND TYPE 1 DUANE SYNDOME IN A PATIENT
WITH GOLDENHAR SYNDROME: A CLINICAL
CASE REPORT
Celik, Tuba
Bulent Ecevit University Faculty of Medicine Department
of Ophthalmology, TURKEY
Goldenhar Syndrome is a rare congenital anomaly involving
defective development of the structures derived from the first and
second branchial arch. Duane Retraction Syndrome is a congenital
strabismus syndrome occurring in isolated or syndromic forms.
Type I duane syndrome is a congenital ocular motility disorder
characterized by limitation of abduction with normal adduction
accounts for 85% of all Duane Retraction Syndrome cases. Here we
reported a case of Goldenhar Syndrome in a 12 year-old male patient
with the features of accessory tragus, preauricular apendages and
epibulbar dermoid with the association of Type I Duane Syndrome.
The patient admitted with complaint of left sided swelling of bulbar
conjunctiva since birth. The swelling had increased minimally for
a few years. On examination, right sided preauricular appendages
along the line joining the tragus and the angle of the mouth and
lateral cleft-like extension of right corner of the mouth was noted.
(Figure 1-2) The oral cavity examination revealed normal. Ocular
examination demonstrated the presence of pink-yellowish region
on the lower temporal aspect of the right bulbar conjunctiva and
yellowish, hairy, soft dermoid with 6 mm x10 mm size on the lower
temporal aspect of the left bulbar conjunctiva. (Figure 3) Extra
ocular movements of left eye showed limitation of abduction and
normal adduction. (Figure 4) The right eye did not constitute any
ocular motility disorder. Refractive status, fundus examination and
intraocular pressure of the both eyes were normal.The patient was
underwent surgery for excision of the mass. It was observed that
the posterior extension of the fatty mass has no adherence with
the lateral rectus muscle. Histolo¬gical examination of the mass
confirmed the diagnosis an epibulbar dermoid. The patient’s mental
and physical development was normal. He had no deafness and
any acoustic problems. There were no associate anomalies of the
vertebra. We diagnosed the patient as a case of GS on the basis
of accessory tragus, preauricular appendages, epibulbar dermoid
and type I DS. Genetic consultation of the patient was suggested.
A multidisciplinary approach is required to manage the associated
anomalies. Reconstruction surgeries can be done for the anomalies
of eyes, ears, cleft palate and mandibular hypoplasia. Epibulbar
dermoids should be surgically excised. Children with DS should
have eye examination to treat the refractive error or ambliyopia.
The prognosis of GS is generally good in exception of any systemic
associations as heart defects.
66
ABSTRACTS: POSTERS
P12
P13
OUTCOMES AFTER THE SURGERY FOR ACQUIRED NONACCOMMODATIVE ESOTROPIA
Dong Gyu, Choi; Moon, Nam Ju; Kim, Eunbi
Kangnam Sacred Heart Hospital, College of Medicine
Hallym University Department of Ophthalmology,
SOUTH KOREA
ADHD AND CONVERGENCE INSUFFICIENCYDOES A CONNECTION REALLY EXIST
Dawidowsky, Barbara; Klobučar, Aleksandra
Children’s Hospital Zagreb Dpt of neurosurgery,
otorhynolaryngology and ophthalmology, CROATIA
Purpose: To analyze the surgical outcomes for patients diagnosed
with acquired nonaccommodative esotropia (ANAET)
Aim: to evaluate the relationship between CI (convergence
insufficiency) and children diagnosed with ADHD. To estimate the
improvement of convergence and binocular vision after orthoptic
treatment as well as improvement of simptoms of ADHD.
Design: Retrospective, cohort study
Methods: In this study, the medical records of 39 patients who had
undergone for ANAET surgery with a postoperative follow-up period
of 6 months or more were reviewed. The main outcome measures
were postoperative esodeviation angle, final success rate, and
factors affecting surgical outcome (sex, age at onset, age at
surgery, refractive error, symptom duration, amblyopia, stereopsis,
dominance of fixation, accompanying strabismus, preoperative
follow-up period, and type of surgery). Surgical success was
considered to be an alignment within 10 prism diopters (PD).
Results: The mean postoperative follow-up period was 58.1 ±
58.9 months (6-201 months). The preoperative mean esodeviation
angles were 36.5 ± 13.4 PD at far and 37.9 ± 16.6 PD at near.
The postoperative mean esodeviation angles at far were as follows:
3.9 PD at 1 day, 4.4 PD at 1 month, 4.2 PD at 3 months, 5.1 PD
at 6 months, 4.6 PD at 1 year, and 5.3 PD at final follow-up. There
was no statistically significant difference in angle of esodeviation
between the initial postoperative period (1 day to 6 months) and
the final follow-up day (p>0.05). The surgical success rate at final
follow-up was 71.8% (28/39). Among the 11 patients for whom the
surgery failed, 8 (20.5%) showed esotropia and 3 (7.7%) exotropia
of more than 10 PD. Seven patients (18.0%) underwent reoperation
(5 for esotropia and 2 for exotropia). Among the affecting factors,
only dissociated vertical deviation (DVD) possibly influenced surgical
success.
Conclusion: The surgical outcome in patients with ANAET was
relatively favorable: the final success rate was 71.8%, and DVD
was the only possible affecting factor.
Patients and methods: 60 children with ADHD ( diagnosed by
children psychiatrist with DSM V classification) underwent a detailed
ophthalmologic exam as part of their evaluation. We noticed that
children diagnosed with ADHD had a high incidence of convergence
insufficiency and problems with maintaining binocular vision at
near. The symptoms of these two conditions can overlap and both
can interfere with reading and learning abilities. Children often
suffer of disturbance in reading and writing, frontal headaches,
short attention span, blurred and double vision, pain in periocular
region, red eyes and double vision.
Our main aim is to evaluate the relationship between ADHD and
CI, measure CI and binocular vision before and after the treatment
and state whether improving convergence in patients with ADHD
simultaneously improves their symptoms in working at near.
Results: almost all of the ADHD patients ( 86%) had convergence
insufficiency and troubles with maintaining binocular vision. After
orthoptic therapy combined of home exercises and office based
therapy at synoptophore, significant improvement in convergence
and binocular vision has been noted, as well as improvement
in working at near distance and reading abilities (estimated by
questionnaire given to parents and children before and after the
therapy).
Conclusion: further investigation of attention degree is needed to
evaluate the exact impact of improved convergence and binocularity
on the level of attention
67
ABSTRACTS: POSTERS
P14
A CASE OF MONOCULAR ELEVATION DEFICIENCY TREATED BY INNERVATIONAL SURGERY ON
THE YOLK MUSCLES OF THE SOUND EYE
Eltoukhi, Elsayed Mohamed; Ismail, Mohamed
Research Institute of Ophthalmology Pediatric
Ophthalmology and strabismus, EGYPT
4 year old girl presented by left monocular elevation deficiency .
Intra-operative forced duction test of the affected eye was negative
. Anterior and nasal transposition of the inferior oblique of the
affected eye and combined by 3 mm recession of the superior
rectus muscle . Post-operative alignment in the primary position
was excellent and in other gazes was satisfactory . Inervational
surgery is very useful in many forms of paralytic and or restrictive
strabismus. Further studies are needed
68
ABSTRACTS: POSTERS
P15
P16
OCULAR NEUROMYOTONIA: A CASE SERIES
AND RECOMMENDATIONS
England, Laura C; Williams, Lindsi C
Central Manchester University Hospitals, UNITED
KINGDOM
THE FREQUENCY AND CAUSES OF ABNORMAL
HEAD POSITION: AN OPHTHALMOLOGY CLINIC
BASED REVIEW
Erkan Turan, Kadriye; Taylan Sekeroglu, Hande; Kilic,
Meltem; Sanac, Ali Sefik
Hacettepe University Faculty of Medicine Department
Of Ophthalmology, TURKEY
Purpose: Ocular neuromyotonia is a rare but distinctive neurogenic
disorder of ocular motility, characterised by episodic involuntary
contractures of one or more of the extraocular muscles. We present
a series of five patients with this condition and compare signs,
symptoms and management. We highlight the need for specific
assessment of ocular motility in order to manifest the features of
this condition.
Methods: Patients diagnosed with ocular neuromyotonia between
2008 and 2015 were identified from orthoptic databases. Case
notes and clinical correspondence were retrospectively reviewed.
Results: Four females and one male with ocular neuromyotonia
were identified with a mean±SD presenting age of 51±14 years.
80% of cases had received previous radiotherapy, 60% had
received previous chemotherapy and 60% were hypothyroid. 80%
presented with intermittent diplopia and 20% with intermittent
blurring. Ocular neuromyotonia was seen in: four lateral recti; two
medial recti and one superior oblique muscle. The neuromyotonia
was always initiated by eye movement away from primary position;
in 60% of cases it was only seen if eccentric gaze was sustained.
Carbamazepine was effective in two patients and Gabapentin was
effective in one patient.
Conclusion: Ocular neuromyotonia should be considered as a
differential diagnosis for patients presenting with recurrent, transient
diplopia, especially when there is a history of radiotherapy. When
the diagnosis is being considered, it is vital to sustain eccentric
gaze on ocular motility testing to manifest the neuromyotonia.
Purpose: To determine the frequency of abnormal head position
(AHP) in patients presented to an ophthalmology clinic for any
ophthalmological complaint and to identify the underlying causes.
Methods: Medical records of the patients presented with any
ophthalmological symptoms for 6-month period were prospectively
evaluated. Two thousand seven hundred and ten patients
(1492 female, 1218 male) aged between 6 months to 91 years
were included in the study. Each patient underwent complete
ophthalmologic evaluation including orthoptic examination.
Results: Of the 2710 patients, 30 (1.1%) (7 female, 23 male)
had AHP. The mean age was 14.62±17.45 (6 months to 60 years)
years. Twenty four (80%) patients were younger than 16 years.
Initial complaint was ocular misalignment in 18 (60%) patients, AHP
in 4 (13.3%) patients, abnormal ocular movements in 4 (13.3%)
patients, double vision in 3 (10%) patients, droppy eyelid in 1 (3.3%)
patient. Comitant strabismus, nystagmus, Duane’s Syndrome were
the most common causes of AHP. Other diagnosis were unilateral
fourth nerve palsy, sixth nerve palsy, Brown Syndrome, congenital
muscular torticollis, ptosis and blow-out orbital fracture.
Conclusion: Leading underlying causes of AHP in patients
presented to an ophthalmology clinic were found to be ocular and
treatable. It’s worthy of note that only a minority of these patients
indicated AHP as the main presenting complaint. It should be
kept in mind that any abnormal head position observed during
ophthalmological examination should be further investigated
because the underlying pathology may cause treatable morbidity or
rarely mortality such in case of acute cranial nerve palsy.
69
ABSTRACTS: POSTERS
P17
P18
WHY AND WHEN TO PREFER BOTULINUM TOXIN
INJECTION IN CHILDREN?
Erkan Turan, Kadriye; Taylan Sekeroglu, Hande; Sanac,
Ali Sefik; Agin, Abdullah
Hacettepe University Faculty of Medicine Department
Of Ophthalmology, TURKEY
LASER CORNEAL REFRACTIVE SURGERY FOR
THE TREATMENT OF REFRACTIVE ACCOMMODATIVE ESOTROPIA : 15 YEARS EXPERIENCE
Farahi, Azadeh; Hashemi, Hassan
Noor Eye Hospital, IRAN
Purpose: To investigate the indications and outcomes of botulinum
toxin injection in children with strabismus.
Purpose: To evaluate the result of laser insitu keratomileusis(LASIK)
and photorefractive keratotomy(PRK) in partly and fully
accommodative esotropia in adolescence and adult patients.
Methods: The medical records of children who underwent
botulinum toxin injection for strabismus were reviewed. Eighteen
patients (13 boys, 5 girls) with a mean age of 9.08±5.93 (6 months
to 17 years) years were enrolled in the study. The main indication
and diagnosis, initial and final deviation at primary position and the
presence of abnormal head position were all evaluated.
Setting: Noor Ophthalmology Research Center, Noor Eye Hospital.
Results: All patients received monocular injection. The mean followup period was 2.78±0.94 months for the first postinjection visit
and 21.64±15.23 months for the last visit. The mean preinjection
and final postinjection deviation was 31.44±23.88 prism diopters
(PD) and 14.23±14.87 PD. The most common diagnosis was sixth
nerve palsy (6 patients) followed by Duane’s Syndrome (4 patients).
Other diagnoses were consecutive exotropia, sensory strabismus,
acquired exotropia-exotropia. The leading indications for botulinum
toxin injections were the presence of abnormal head position,
diplopia and ocular misalignment at primary position. Fourteen
patients had one, 4 patients had more than one injection. Five
patients underwent strabismus surgery due to inadequate response
to injection. No complication related to injection was observed.
Results: Mean age of the patients was 25.5 years (range 11 to 46
years), 5 patients were younger than 18 years and 21 patients were
women. The mean preoperative uncorrected and corrected angle
of deviation was 28.35 and 14.2 prism diopter (PD) of esotropia
respectively, which changed to 6.4 PD without correction postoperatively. Three patients with partially accommodative esotropia
underwent strabismus surgery 6 months after refractive surgery.
Minimum follow up was 6 months.
Conclusions: Botulinum toxin injection may be preferred in
pediatric age group particularly with extraocular muscle palsy,
diplopia and concomitant deviation either to provide ocular
alignment prior to surgery or to prevent the detrimental effect of
diplopia on binocularity. The intervention seems to be safe and
repeatable in children even though in particular cases surgery is
still an irreplaceable treatment option.
70
Method: In this interventional case series study we performed
LASIK in 54 eyes of 27 patients and PRK in 4 eyes of 2 patients.
Preoperative and postoperative visual acuity, refractive spherical
equivalent, stereopsis and ocular alignment were recorded.
Conclusion: Excimer laser refractive surgery is a promising
alternative treatment for patients with refractive accommodative
esotropia.
ABSTRACTS: POSTERS
P19
P20
COMPARATIVE STUDY BETWEEN SYNOPTOPHORE AND VIDEOCULOGRAPH GAZELAB
Fernández Agrafojo, Dora; Martín, Pedro; Morales, Hari
Research center and eye surgery INOF. Teknon Medical
Center, SPAIN
REVERSE YOKOYAMA PROCEDURE FOR HIGH
MYOPIC EXODEVIATION
Gokyigit, Birsen; Aygit, Ebru D; Inal, Asli; Ocak, Osman
B; Akar, Serpil
Beyoglu education and training eye hospital, TURKEY
Purpose: The purpose of our study is to compare the strabismus
angle measurements obtained with synoptophore and with the
videoculography Gazelab®, and evaluate management of the
videoculography in obtaining measures of the deviation.
Purpose: To introduce and evaluate reverse Yokoyama procedure
in two cases who had high myopic exo-deviation.
Methods: The measurements were performed with both
instruments in a group of 20 strabic patients in five diagnostic
positions of gaze (primary position, dextroversion, levoversion,
supraversion and infraversion).
Results: The obtained results have statistically no significant
differences in the precision of the obtained mesurements between
Gazelab and Synoptophore, except in infraversion.
Conclusions: Taking into account the comfort and speed for the
clinical use, we can say that preparation and positioning of the
patient is easier with Synoptophore, even though GazeLab gives us
a new perspective in the dynamic evaluation of the strabic patients,
and its objective measurement of cyclotorsions. We consider that
Gazelab can be a great instrument for examining strabic patients,
giving a better impression because it implements new technologies
in the optometric and ophthalmologic practice.
Methods: Two cases’ who underwent reverse Yokoyama operation
records evaluated retrospectively. Operation technique:Fallowing
limbal conjunctival insicion medial rectus and inferior rectus jointed
6/0 nonabsorbable suture behind of approximately 11-12 mm of
their insertion.
Results: Case 1 and case 2 axial lenghth were 31.02 mm and
29.11 mm respectively.Deviation were >45pd exodeviation with
14pd hyperdeviation in case 1 and 55pd exodeviation with 16pd
hyperdeviation in case 2 preoperatively.Deviations were 15pd
exodeviation in case 1 and ortho position in case 2 without vertical
deviation in primary position postoperatively.
Conclusion: Reverse Yokoyama procedure found effective for
surgical treatement of high myopic exo-hyperdeviation
71
ABSTRACTS: POSTERS
P21
P22
LIMBUS-INSERTION
DISTANCE
OF
EXTRAOCULAR RECTUS MUSCLES USING
SPECTRAL DOMAIN OPTICAL COHERENCE
TOMOGRAPHY AND CORRELATION STUDY
Gomez-de-Liano, Rosario; Fernández-Vigo, José I;
Ventura, Néstor; Morales, Laura; De Pablo, Lucía
Hospital Universitario San Carlos Ophthalmology
Motility Unit, SPAIN
PARALYTIC STRABISMUS IN INDIAN POPULATION
Grover, Renu
Icare Eye Hospital, Noida, INDIA
Purpose: to determine the insertion distance of the horizontal
rectus muscles to the limbus using Spectral Domain optical
coherence tomography (SD-OCT), and to evaluate whether there
exists any correlation between the insertion distance and gender,
age or axial length.
Methods: Cross-sectional study of 187 right eyes of healthy
subjects. The gender and age were collected, and axial length was
measured using an optical biometer. SD-OCT images were used
to measure the distance from the horizontal rectus insertion to
the limbus. The intraclass correlation coefficient (ICC) was used to
assess the reproducibility of the measurements, and a multivariate
model was adjusted to analyze whether gender, age and axial
length could have an impact on insertion distance.
Results: Mean age was 43.7 ±22.1 years (range 6-85); 69% were
women. 25 patients were children. Mean axial length was 23.9
±1.6 mm (range: 20.4-29.3). Mean rectus insertion distance to
the limbus was 6.47 ±0.52 mm (range 5.2-7.6) for lateral rectus,
and 5.22 ±0.51 mm (range 4.1-6.1) for medial rectus. ICC was
>0.87 for intra and interobserver reproducibility, showing excellent
agreement. The insertion-limbus distance was influenced by
gender, being greater in men (P=0.040 for lateral rectus; P=0.036
for medial rectus). However, there was no correlation between this
distance and axial length or age (P>0.156).
Conclusions: This study determined that SD-OCT is an effective
technique in measuring the insertion distance of the horizontal
rectus muscles to the limbus. The length of this distance was greater
in men, however, age and axial length seem to be independent.
72
Purpose: The Purpose of this study was to evaluate the
Incidence,Types and Causes of Paralytic Stabismus in patients
presenting at a Tertiary Eye Centre in the North of India.
Methods: It was a Prospective study,conducted over a period of
One year,beginning March 2015 to March 2016.The Age Group
of patients ranged from 3 years to 80 years.History taking,Cover
Test,Abnormal Head Posture,Extraocular movements,Hess
Charting and Diplopia Charting –were done-wherever possible.Any
Comorbidity,if present, was noted.This Study was conducted in the
Paediatric Ophthalmology /StrabismusDepartment at a tertiary eye
Centre in the North of India.
Results: Superior Oblique Palsy was the most Commonly found
Palsy –followed by Sixth Nerve palsy.The most common cause
was Found to be Ischaemic-specially in the Elderly age group.In
the younger age group,Viral infections followed by trauma were
the commonly found causes.In 54% cases,the cause however
remained inconclusive.
Conclusion: Paralytic Strabismus accounts for about 51% of
the total strabismus cases presenting at the Strabismus clinic.
Superior Oblique Palsy the most commonly occurring Cranial
Nerve Palsy ,specially in the elderly age group,Ischaemia being the
most common cause.A large number of cases remain of unknown
aetiology,the Viral aetiology seemingly on the rise.
ABSTRACTS: POSTERS
P23
P24
REDUCED ESODEVIATION WITHOUT CORRECTION; A INDICATOR FOR TAPERING HYPEROPIA
IN REFRACTIVE ACCOMMODATIVE ESOTROPIA
Ha, Suk-Gyu; Suh, Young-Woo; Cho, Yoonae A.; Kim,
Seung-Hyun
Korea University College of Medicine, Seoul, Republic of
Korea Department of Ophthalmology, SOUTH KOREA
PREFERENCES AND COMPLIANCES DATA
FOR AMBLYZ LIQUID CRYSTAL OCCLUSION
GLASSES IN AMBLYOPES
Heo, Hwan; Park, Yong Seok
Chonnam National University Medical School
Department of Ophthalmology, SOUTH KOREA
Purpose: To investigate clinical characteristics for the prescription
of tapering hyperopic correction in patients with refractive
accommodative esotropia (RAET) treated with spectacles.
Methods: Fifty-nine patients with RAET were enrolled in this study.
During follow up period, after prescribing a reduction of hyperopic
correction, the clinical features were analyzed. Within the range that
can sustain stereoacuity and corrected visual acuity, patients were
prescribed for tapering hyperopic correction by 0.25 diopters (D)
interval, up to a maximum of 1 D. At visit, visual acuity and angle of
deviation with spectacle correction, esodeviation without spectacle
correction, decreased amount of esodeviation without correction,
stereoacuity were measured. The parameters were compared at
final visit, and the correlations between them were analyzed.
Results: The follow up period was 1.1 years and the mean age
at initiation of tapering was 6.1 ± 2.9 years. The mean baseline
refractive error at the time of diagnosis was 4.6 D. The esodeviation
without correction decreased from 14.6 prism diopters (PD) (range,
6 - 45) to 4.6 PD (range, 0 - 20) at final visit. None of the other
measured values changed significantly at final visit (all, p>0.05).
The prescribed amount of decreased hyperopia was positively
correlated with the reduced esodeviation without correction and the
baseline hyperopia (p = 0.03, 0.04, respectively).
Conclusions: Esodeviation without correction should be
considered when tapering hyperopia for patients with refractive
accommodative esotropia. Because esodeviation without correction
can be conveniently measured at the time of prescribing hyperopic
correction, it may be used as a clinical indicator for tapering
hyperopia with RAET.
Purpose: To evaluate the preferences and compliances data for
Amblyz liquid crystal occlusion glasses in amblyopes.
Methods: We evaluated 15 patients between 3 and 8 years of
age who had previously used adhesive patches for monocular
amblyopia and were now wearing Amblyz occlusion glasses.
Patients wore Amblyz glasses between 4 hours and all day for
1 month. We evaluated patient preference, compliance, price
satisfaction and advantages and disadvantages in comparison with
adhesive patches.
Results: Of the 15 patients evaluated, 14 (93.3%) completed the
1-month study period answered the patient questionnaire. One
patient (6.7%) wore Amblyz occlusion glasses for only 3 days, he
tried to take off the glasses due to a severely amblyopic eye. Patient
preferences and level of satisfaction with Amblyz occlusion glasses
varied regardless of visual acuity of the amblyopic eye. There were
4 patients (26.7%) who were very satisfied with the glasses. Patient
satisfaction level was low for price and moderate for the size of the
glasses. The advantages of Amblyz occlusion glasses were that they
did not cause skin irritation, required no hourly parental monitoring,
and ensure more convenient patching of the patient during daily
activities. Conversely, the disadvantages were the high price and
their weight in comparison with conventional optical glasses.
Conclusions: Despite their high price and extra weight, Amblyz
occlusion glasses can compensate for the drawbacks of adhesive
patch therapy. Since preference and compliance may vary among
amblyopes, they can opt to wear Amblyz occlusion glasses if they
exhibit good compliance during test period.
73
ABSTRACTS: POSTERS
P25
P26
VISUAL ACUITY ASSESSMENT IN CHILDREN
WITH THREE DIFFERENT CHARTS
Inal, Asli; Ocak, Osman Bulut; Gokyigit, Birsen; Aygit,
Ebru Demet; Yurttaser Ocak, Serap; Inal, Berkay
Beyoglu Eye Research and Training Hospital, TURKEY
MYASTENIA GRAVIS AT CHILDHOOD: TWO
CASES
Inal, Asli; Ocak, Osman Bulut; Gokyigit, Birsen; Aygit,
Ebru Demet; Basgil Pasaoglu, Isil; Fazil, Korhan
Beyoglu Eye Research and Training Hospital, TURKEY
Purpose: Familial inheritance of common forms of strabismus
like esotropia and exotropia is noted, genetic components of
which remain unidentified. The most significant finding so far has
been localization of the recessive STBMS1 locus on chromosome
7p22.1. Recently next generation sequencing (NGS) technology
has emerged as a powerful tool in discovery genomics and a large
number of novel disease causing variants are being reported,
particularly for monogenic disorders. In this study, we aimed to
recruit informative families for subsequent genetic analysis for
disease causing variant identification.
Background: CP is functionally classified by the gross motor
function classification system (GMFCS), manual ability classification
system (MACS) and motor syndrome / topographical type as per
the European classification. The purpose of the study was to assess
the relevance of ocular misalignment as an easily observable
ophthalmic parameter that could be assessed with these functional
motor classifications as a marker for more severe motor impairment,
necessitating more stringent care.
Methods: All consecutive families with two or more affected
subjects with strabismus were prospectively recruited at the
ophthalmic outpatients department (OPD) of our institution from
August 2014 to April 2016. Detailed phenotypic evaluation and
pedigree documentation was performed.
Results: Of the 26 recruited families of north Indian origin
recruited, nine were purely exotropic and 17 were esotropic. While
vertical transmission was observed in all families with exotropia, six
with esotropia had affected members across one generation, two
were consanguineous and two were twin families.
Conclusions: Families with clear-cut mode of inheritance recruited
in this study may provide a valuable resource to unravel the genetic
determinants of this common disorder of early childhood, with high
ophthalmic morbidity.
Methods: An observational, cross-sectional–design prospective
study was conducted by morphological and functional assessment
by GMFCS, MACS, Vineland Adaptive Behavior Scales (VABS)
and the European classification alongwith a complete ophthalmic
assessment on a representative cohort of 100 children with CP
between 4 to 18 years of age with mean age (6.85 ± 2.92 years),
(M: F:: 57:43), referred from a pediatric neurology clinic in a tertiary
care pediatric hospital.
Results: Strabismus (58%) and refractive errors (92%) were
found to be the most common ophthalmic anomalies. Both
GMFCS and MACS scales showed higher prevalence of squint and
refractive errors in the severely impaired groups as compared to
mildly impaired groups. By the European classification, spastic
quadriplegics had higher prevalence of squint and refractive errors
than spastic diplegics & hemiplegics. The VABS score assessing
adaptive levels of functioning of these children demonstrated
significantly reduction with increased levels of severity of CP as per
both functional and topographical scales.
Conclusions: Strabismus is indeed an easily observable ophthalmic
parameter that indicates more severe motor impairment in CP by
different functional, topographical and adaptive scales.
74
ABSTRACTS: POSTERS
P27
P28
ELECTROPHYSIOLOGICAL EXAMINATIONS IN
CHILDHOOD
Agnes Janossy¹ , Nicolette Sohar¹ , Edit Bereg² , Marta
Janaky¹
¹Department of Ophthalmology, University of Szeged,
²Department of Pediatrics University of Szeged
RETROSPECTIVE ANALYSIS OF DIVERGENT
STRABISMUS SURGERY IN CHILDREN IN LAST
EIGHT YEARS
Jarc Vidmar, Martina; Rahne, Ingrid; Kosec, Dragica
Eye Hospital, University Medical Centre Ljubljana Dpt
for Ortoptics and Strabology, SLOVENIA
Purpose: Our aim was to investigate not only the severity of
visual loss in childhood, but to underline the support in differential
diagnosis.
Purpose: Retrospective analysis of strabismus surgery done by
dr. Jarc-Vidmar in children with divergent strabismus in last eight
years at University Eye Clinic in Ljubljana.
Patients: Every year generally 100-150 children are sent to our
laboratory due to any kind of visual disturbances. According to the
symptoms, visual evoked potentials (VEP), pattern ERGs (PERG)
and standard ERGs were recorded according to the international
standards (ISCEV). For ERGs, DTL electrode was used which was
well tolerated by children.
Patients and methods: 20 children (12M, 8F) were operated for
divergent squinting in last eight years. Types of surgical techniques
and results were compared and analysed.
Results: Individual cases are presented to prove the value of these
examinations:
Case1: VEP and PERG alterations in a child with juvenile multiple
sclerosis with left eye proved the involvement of the optic nerve.
Case 2: VEP alteration with normal PERG was caused by papillitis.
Case 3: VEP and PERG were abnormal: neuromyelitis optica was
the final diagnosis.
Case 4: Intracranial tumor was suspected after the performed
examination instead of optic neuritis; the child was operated within
one week and resulted in full recovery of vision.
Case 5: Binocular stimulation of VEPs showed existence of binocular
facilitation.
Case 6: Normal VEPs and PERGs could exclude the organic
background of visual disturbances.
Conclusion: Electrophysiological examinations are valuable tool
in objective evaluation of the severity of visual disturbance and
support to determine the final diagnosis.
Results: The children were operated at the mean age of 9,2 ±3,9
years (range: 3-17 years), the average squint angle before surgery
was -15,5±8,5 degrees. Children were corrected with glasses for
refractive error measured in cycloplegia, most had hypermetropia
or hypermetropic astigmatism, only three were myopic. Surgical
techniques used were: bilateral lateral rectus muscle recessions
(6 children), recessions of one lateral rectus muscle (12 children),
unilateral medial rectus muscle resection and lateral rectus muscle
recessions of the same eye (2 children). Average squint angle at
one week after surgery was -6,5±6,0 degrees, at last visit at follow
up it was -7,0±6 degrees. No patient had normal fusion before
operation, five patients gained normal fusion after operation, visual
acuity at last visit was 0,9 ± 0,1.
Conclusions: In the last 8 years there were 20 children operated
for divergent squinting. In most children unilateral lateral rectus
muscle recessions was used. There was small and stable squint
angle at follow up visits, five patients gained normal fusion after
the operation.
75
ABSTRACTS: POSTERS
P29
P30
EFFECT OF SQUINT SURGERIES ON THE
CORNEAL HIGHER ORDER ABERRATIONS
Juhász, Éva; Fodor, Magdolna; Knézy, Krisztina; Maka,
Erika; Maneschg, Otto; Sényi, Katalin; Szamosi, Anna;
Szigeti, Andrea; Tóth, Georgina; Kun, Lídia; Kiss, Huba;
Nagy, Zoltán Zsolt
Semmelweis University, HUNGARY
CORRELATION
BETWEEN
STRABISMUS
AND
SEVERITY
OF
PERIVENTRICULAR
LEUKOMALACIA
Jung, Jaeho; Jeon, Hyeshin; Choi, Hee-Young
Pusan National University Ophthalmology, SOUTH
KOREA
Purpose: to evaluate the effect of squint surgeries on the corneal
higher order aberrations.
Material and methods: 44 eyes of 24 patients were enrolled
in our study who underwent different kinds of squint operation
(weakening and strengthening procedures) at the Department of
Ophthalmology, Semmelweis University between January and
April, 2016. Patients were screened before and 10 days after the
surgeries regarding wavefront aberrations by using OPD-scan
(Nidek Technologies, Gamagori, Japan®). Corneal higher order
aberration data (RMS-HOA corneal) were analyzed in 6.0 mm
diameter zone representing mesopic conditions.
Results: There was a statistically significant increase between
pre- and postoperatively measured RMS-HOA corneal data in
the 6.0 mm diameter (mean±standard deviationpreoperative=
1.798±1.021,
mean±standard
deviationpostoperative=
2.144±1.269, p=0.0044; Wilcoxon-test).
Conclusions: According to our results squint surgeries have an
effect on corneal higher order aberrations, but to detect its exact
reasons more evaluations are needed. Longer follow-up period
would be necessary in order to test higher order aberrations by
changing over time.
Importance: Although strabismus is commonly associated with
periventricular leukomalacia (PVL), its clinical features are not well
established.
Objective: To investigate the correlation between strabismus and
magnetic resonance imaging (MRI) findings in children with PVL.
Design: Cross-sectional study.
Setting: The severity of PVL was graded based on the MRI findings
of the patients. The MRI findings were retrospectively analyzed
to establish the presence of lesions invading specific locations.
All of the patients underwent complete ophthalmic examination.
Strabismus was characterized in terms of direction, intermittency,
and angle of deviation.
Participants: The study included 73 consecutive patients who
visited the Department of Ophthalmology and were diagnosed with
PVL.
Main outcomes and measures: The prevalence and the
characteristics of strabismus and their correlation with the grade
of PVL were investigated.
Results: The perinatal characteristics did not differ between
different grades of PVL. Refractive errors, found in 56 (76.7%)
patients, did not differ between the grades of PVL either. Strabismus
was observed in 38 (52.1%) patients, and its prevalence increased
with the stage of the disorder; 20 patients had exotropia. Constant
strabismus was found more frequently in patients with higher grade
PVL. However, the direction and angle of deviation did not differ
depending on the grade of PVL.
Conclusions and relevance: The prevalence of strabismus
increased with the severity of PVL and was higher among patients
with PVL than among healthy individuals. We believe that the
severity of PVL might be related to ocular misalignment. Early
ophthalmic evaluation is necessary in children with PVL, especially
in those with higher grades of the disease.
76
ABSTRACTS: POSTERS
P31
P32
LOCALIZING EXTRAOCULAR RECTUS MUSCLES
INSERTIONS BY USING ANTERIOR SEGMENT
OPTICAL COHERENCE TOMOGRAPHY
Kang, Hyun Goo; Choi, Eun Young; Han, So Young;
Han, Jinu; Han, Sueng-Han
Gangnam Severance Hospital, Yonsei University
Ophthalmology, SOUTH KOREA
THE IMPACT OF GRADED INFERIOR OBLIQUE
RECESSION ON THE OUTCOME OF UNILATERAL
RECESS-RESECTION SURGERY IN THE SAME
EYE
Kim, Mirae; Kim, Won-Jae; Kim, Myung-Mi
Yeungnam University College of Medicine, SOUTH
KOREA
Purpose: To determine whether anterior segment optical coherence
tomography (AS-OCT) can accurately predict the location of muscle
insertions when compared to actual intraoperative measurements.
Purpose: To evaluate the effects of graded inferior oblique
recession when combined with unilateral recess-resection surgery
in the same eye on the horizontal alignment after surgery to correct
intermittent exotropia
Methods: A total of 25 muscles from 19 patients undergoing
correction of horizontal strabismus (including 3 muscle undergoing
reoperation) between December 2015 to April 2016 were
included in this prospective, double masked, observational study.
Preoperatively, distance from both scleral spur (SP) and angle
recess (AR) to muscle cleft was calculated by AS-OCT (Cornea/
Anterior Segment OCT SS-1000, Tomey Corp., Nagoya, Japan).
These values were compared to distances measured with the
surgical caliper from limbus to the anterior side of the insertion site.
Results: Distances measured by AS-OCT from the SP and AR
compared to surgical caliper measurements revealed good reliability
of 0.92 (95% CI, 0.85-0.96)(p<0.0001) and 0.91 (95% CI, 0.830.95)(p<0.0001), respectively. AS-OCT measurements from the SP
and AR were 66.70% and 61.50% within the clinically acceptable
1mm range of intraoperative measurements. Applying simple linear
regression between SP-derived values and caliper-measurements
allowed for adjusted preoperative values that are 89.47% within
the clinically acceptable range (p<0.001).
Conclusions: AS-OCT can accurately predict extraocular muscle
distances preoperatively with reliability. It may be a useful tool for
preoperative planning in cases of primary or previously operated
cases undergoing strabismus surgery.
Method: The medical records of patients who underwent unilateral
recess-resection surgery and had a follow-up of more than 1
year were retrospectively reviewed. The patients were divided into
two groups: Group A included patients who underwent combined
graded inferior oblique recession in the same eye (n=62) and
group B included patients who underwent an isolated procedure
(n=107). Baseline demographics, clinical features, success rate
and the angle of distance horizontal deviation at 1 week and 1, 3,
and 12-months postoperatively were compared.
Result: There were no significant differences in baseline
demographics and preoperative angles of deviation between group
A and B. The proportion of patients who passed Lang stereotest
(550 seconds of arc) was significantly lower in group A (67.9% VS
89.3%, p=0.001). No significant intergroup difference in the angle
of deviation was observed at any postoperative time point and the
success rate at postoperative 1 year did not differ between groups.
Conclusion: Combined graded inferior oblique recession
procedures did not significantly influence the horizontal alignment
after unilateral recess-resection surgery in the same eye. Therefore,
there is no need to revise the surgical amount of unilateral recessresection surgery.
77
ABSTRACTS: POSTERS
P33
P34
A CASE OF UNILATERAL TROCHLEAR NERVE
PALSY SECONDARY TO HERPETIC UVEITIS IN
HERPES ZOSTER OPHTHALMICUS
Kim, Su Jin; Lee, Sang Gon; Lee, Seung UK
Gyeong Sang National University Department of
Ophthalmology, SOUTH KOREA
THE ANALYSIS OF AXIAL LENGTH-DISC AREA
RATIO AND PERIPAPILLARY RETINAL NERVE
FIBER LAYER THICKNESS IN AMBLYOPIC EYES
Kim, Su Jin; Park, Changeum; Lee, Seung UK
Gyeong Sang National University Department of
Ophthalmology, SOUTH KOREA
Purpose: To report a case of unilateral trochlear nerve palsy
secondary to herpetic uveitis in herpes zoster ophthalmicus.
Purpose: To compare the retinal nerve fiber layer(RNFL) thickness
and characteristics of optic nerve head (ONH) parameters in
amblyopic and fellow eyes in patients with amblyopia using spectral
domain optical coherence tomography(SD-OCT).
Case summary: A 67-year-old man presented with binocular
diplopia of 4 days duration. He has been diagnosed with herpes
zoster ophthalmicus and taking antiviral agents and steroid for
4 days. Anterior chamber reaction was seen in left eye on slit
lamp examination and extorsion of left eye was seen on fundus
examination. He was diagnosed with trochlear nerve palsy based
on prism cover test showing hypertropia in left eye and limitation
of infraduction in the adducted position in left eye. He was treated
with antiviral agents and steroid and complete resolution of
ophthalmoplegia occured after 2 months of treatment.
Conclusions: Unilateral trochlear nerve palsy secondary to
herpetic uveitis can occur in herpes zoster ophthalmicus and can
be improved with antiviral agents and steroid.
Key word: Herpes zoster ophthalmicus, Trochlear nerve palsy,
Herpetic uveitis
Methods: 52 patients with 104 eyes were included in this study;
the distribution of patients was 23 patients with anisometropic
amblyopia, 15 patients with bilateral refractive amblyopia, and 15
patients with non-amblyopia. The circumpapillary retinal nerve fiber
layer thickness, and ONH parameters(rim volume, cup volume,
rim area, sup-to-disc area ration) were obtained by SD-OCT. Axial
lengths were determined by IOL master.
Result: The amblyopic eyes were significantly more hyperopic
than the fellow eyes(p<0001). Among the ONH parameters, the
optic disc area was significantly larger and the average C/D ratio
and cup volume were smaller in the amblyopic eyes than in the
fellow eyes(P<0.05). Axial length/optic disc area ratio and retinal
area/optic disc rim area were larger in amblyopic eyes than the
fellow eyes(p<0.05). The circumpapillary retinal nerve fiber layer
thickness was not significantly different between two groups.
Conclusions: We found significant differences in optic disc area,
average C/D ratio, cup volume, axial length/optic disc area and
retinal area/optic disc rim area between amblyopic and fellow eyes.
Keywords : Anisometropic amblyopia, Peripapillary retinal nerve
fiber layer thickness, ONH parameters, Axial length/optic disc area
78
ABSTRACTS: POSTERS
P35
DORSAL MIDBRAIN SYNDROME. A DIAGNOSTIC
CHALLENGE.
Knézy, Krisztina; Tátrai, Erika; Pek, Anita; Skaliczky,
Zoltan; Maka, Erika; Nagy, Zoltán Zsolt DSc
Semmelweis University Department of Ophthalmology,
HUNGARY
Aim: to present the diagnostic steps and differential diagnostic
considerations in a case of a patient who presented to us with
diffuse visual complaints.
Patient: 25 years old female patient presented to our Clinic to
obtain third opinion. She started to experience progressive bilateral
deterioration of vision for some months. A medium degree myopia
was the only eye problem she ever had. History revealed ventriculoperitoneal shunt-implantation during infancy due to hydrocephalus.
MRI brain already performed excluded space occupying lesion.
Methods: Routine ophthalmological examination was carried out,
comprising Goldmann perimetry and Hess chart. Follow-up cranial
imaging was also carried out.
Results: Best corrected visual acuity was 1,0 bilaterally, but
refraction showed a -1,5 D sph myopic shift on both eyes. Otherwise
anterior and posterior segments were normal. Kinetic perimetry
was normal while Hess chart suggested bilateral abducent nerve
damage. We could find a severe limitation in voluntary upgaze and
retraction nystagmus on attempt of voluntary upgaze. Spontaneous
repeated upper lid retraction could be observed (Collier’s sign).
We concluded dorsal midbrain syndrome based on the results
mentioned above and assumed shunt-malfunction in the
background. Shunt revision surgery was carried out a month later
and complaints resolved in a few weeks with the exception of
accomodation spasm.
Conclusion: In case of ill-defined complaints we should always
carry out complete neuroophthalmologic examination. Checking
eye movements is crucial. In shunt patients we always have to take
into consideration malfunction of the device.
79
ABSTRACTS: POSTERS
P36
P37
CORRELATIONS BETWEEN THE POSITION
OF HORIZONTAL EXTRAOCULAR MUSCLES
INSERTION AND THE BIOMETRICAL DATA OF
THE EYE
Kun, Lidia; Fodor, Magdolna; Juhász, Éva; Kiss, Huba;
Knézy, Krisztina; Maka, Erika; Maneschg, Otto; Sényi,
Katalin; Szamosi, Anna; Szigeti, Andrea; Tóth, Georgina;
Nagy, Zoltán Zsolt
Semmelweis University, Department of Ophthalmology,
HUNGARY
THE CASE OF SUCCESSFUL SURGICAL
TREATMENT OF ATYPICAL FORM OF VERTICAL
STRABISMUS
Kuzhda, Iryna; Serdiuchenko, Vira; Kaminskyy, Yuriy;
Pityk, Olena
Ivano-Frankivsk Regional Childrens Clinical Hospital
Ophthalmology, UKRAINE
Purpose: To investigate whether the position of the medial
(MRM) and lateral rectus muscles (LRM) has any correlation with
biometrical data of the eye.
Methods: 64 eyes of 32 healthy volunteers underwent anterior
segment optical coherence tomography (AS-OCT) (DRI OCT Triton,
Swept source OCT, Topcon), and optical biometry measurements
(Lenstar LS 900, Haag-Streit Diagnostics). AS-OCT was performed
in lateral gaze position, the scanning plane was oriented parallel
to the long axis of the muscles. The insertion distances were
measured between the scleral spur (SS) and the end of the gap
between sclera and the muscle. Axial length (AL), white to white
distance (WTW), and anterior chamber depth (ACD) was determined
with optical biometry. Regression analysis was used to evaluate the
association between the insertion distances and ocular parameters.
Results: The mean distance between SS and LRM insertion
was 6.333 (SD±0.7038) mm, and MRM insertion was 5.276
(SD±0.936) mm. The distance between SS and LRM insertion
showed positive correlation with the AL (r=0.32647; p=0.0084).
The distance between SS and MRM has no correlation with AL,
and correlated slight but not significant with the ACD (r=0.22636;
p=0.074). This can be explained with the higher variability of MRM
insertion, or lower reproducibility of measurements in case of MRM.
The other biometrical data showed no correlation with the position
of horizontal extraocular muscles.
Conclusion: Our data showed the extraocular muscle position
determined with AS-OCT can be associated with other biometrical
measurements of the eye. Further standardized investigations are
needed to determine the clinical significance of this results.
80
Purpose: Vertical strabismus is one of rare types of strabismus.
Sometimes it is combined with eso- or exotropia. It is not
accommodative strabismus. In majority cases it developes because
of congenital changes of eye muscles, especially of vertically
motors (inferior or superior oblique muscles, superior or inferior
rectus muscles). We cannot use spectacles or orthoptic treatment
for such category of strabismic patients. So, the only possibility
of medical care in such cases is surgery. But in many cases of
vertical strabismus the surgeon must decide what type of surgical
treatment to use in concrete patient. Sometimes it is hard to do.
Methods: The patient with atypical form of vertical strabismus
was surgically treated by combined operation (great recession and
anteriotransposition of inferior oblique muscle combined with great
recession of superior rectus muscle). The patient also suffers from
hard neurological and traumatological problems. He was operated
before by traumatologist because of hard congenital pathology of
the spine.
Results: The result of surgery was satisfactory. Orthotropia
in primary position was achieved. Also, better eye movements
in downgase were achieved. Also, we achieved decreasing of
abnormal head posture and decreasing of ptosis of upper eyelid.
Positive and satisfactory cosmetic effect was obtained after surgery.
Increasing of visual acuity from 0,1 to 0,2 was attained. As a result,
better conditions to treat disbinocular amblyopia were achieved.
Such level of best corrected visual acuity gives the possibility to
develop fusion and binocular functions.
The patient and his family were consulted by psychiatrist also and
psychoeducation was recommended.
So, in such complicated cases of strabismus we must use all
our knowledge and understanding about functions of extraocular
muscles in order to make decision what muscles to operate in order
to achieve satisfactory functional and cosmetic result of surgery.
Such patients need consulting of neurologist and psychiatrist (if
they agree) in order to proceed treatment.
ABSTRACTS: POSTERS
P38
P39
FACTORS ASSOCIATED WITH TOLERANCE
OF PARTIAL SPECTACLE CORRECTION IN
HYPEROPIC CHILDREN
Kyung, Sungeun
Dankook University Ophthalmology, SOUTH KOREA
EFFICIENCY
OF
THE
PEDIATRIC
AUTOREFRACTOMETER
PLUSOPTIX
A-09
DURING THE OPHTHALMIC EXAMINATION OF
THE EARLY AGE CHILDREN
Lamiya Hasanzade, Nigar Gurbanova, Dursun
Mustafayeva, Jamila Shafieva, Aziza Amirova
Azerbaijan Institute of Postgraduate Education after A.
ALiev, Baku, AZERBAIJAN
Purpose: To compare the effect of spectacle correction in
hyperopic children between full and partial spectacle correction of
hyperopia and investigate the factors associated with tolerance of
partial spectacle correction in hyperopic children.
Methods: A retrospective cohort study was performed by a search
of the hospital database of child patients with prescribing glasses
more than 1.5D hyperopia. Patients were classified into two groups
by cycloplegic refraction: 1) under-correction of hyperopia: at least
more than 0.5 diopter from cycloplegic photorefraction, 2) full
correction of hyperopia, according to two different practitioners.
A total of 72 patients were followed at least 1 years. The main
outcome measure was the comparison in spherical equivalent
refractive errors of spectacle glasses in both groups after more
than one year of follow-up with age at first visit, initial spherical
equivalent refractive errors, strabismus, amblyopia, astigmatism, or
anisometropia.
Results: There was statistical significantly difference in the factors
which can tolerate hyperopia reduction, like no anisometropia,
hyperopia less than 4 D, or astigmatism less than 1 D. The linear
regression analysis scatterplot indicated that initial spherical
equivalent refraction errors were little correlation with hyperopia
reduction rate in partial correction group. (n:36; r2:0.036; P
value:0.304) and full correction group.
Conclusion: The partially corrected spectacle glasses may have
benefit in patient with no anisometropia, less than 1 diopter
astigmatigm, and less than 4diopter hyperopia in terms of tolerance
of hyperopic reduction.
Aim: evaluation of the diagnostic possibilities of pediatric
autorefractometer Plusoptix A-09 in the early age children.
Material and methods: 82 children (164 eyes) at the age of 6
months-3 years of old were examined.At the age of 1 year – 18
children,2 years - 26 children,3 years – 38 children. The examination
was performed on the pediatric autorefractometer Plusoptix A-09
with the narrow pupil.The results of autorefractometry were
compared with the data of sciascopi having been conducted in the
conditions of mydriasis medicamentosus.
Results: In the children of first year of life the total coincidence of
results of the compared examination methods was 50%.In 16,6 of
cases the autorefractometry exceeded the indices of sciascopy on
0,5 and in 27,7% - lowered it on 0,5D or 1,0D (2,7%). In the children
of the age of 2 years of old the total coincidence of sciascopy and
autorefractometry results was 67,3%.In 13,4% and 7,6% of cases
autorefractometry exceeded the sciascopy indices on 0,5D and in
3,6% - on 1,0D. In the group of children at the age of 3 years
the coincidence of results of compared refractometry methods
was 61,8%.In 26,3% of cases autorefractometry exceeded the
sciascopy indices on 0,5D (15,0%) and 1,0D (11,3%) but in 13,2%
of cases-lowered it on 0,5D (11,0%)and 1,0D(2,2%) accordingly.
Conclusion: Pediatric autorefractometry is a convenient,rapid and
sufficiently exact method of definition of clinical refraction of the
early age childrens eyes.
81
ABSTRACTS: POSTERS
P40
P41
RELATIONSHIP
BETWEEN
THYROTROPIN
RECEPTOR ANTIBODY AND STABILITY OF
STRABISMUS IN THYROID- ASSOCIATED
OPHTHALMOPATHY
Lee, Yeonhee; Kim, Min-su
Chungnam National University Hospital Department of
Ophthalmology, SOUTH KOREA
VERTICAL SQUINT AS INITIAL MANIFESTATION
OF FIBROUS DYSPLASIA
Maka, Erika; Garami, Miklos; Rudas, Gabor; Czirjak,
Sandor; Nagy, Zoltan Zsolt
Semmelweis University Department of Ophthalmology,
HUNGARY
Relationship between thyrotropin receptor antibody and stability of
strabismus in thyroid- associated ophthalmopathy
Purpose: To investigate relationship between thyrotropin
receptor antibody and stability of strabismus in thyroid-associated
ophthalmopathy(TAO) during its natural course.
Design: Observational case series
Participants: 25 patients who have strabismus associated with
TAO for more than 6 months and available thyrotropin binding
inhibiting immunoglobulin(TBII) data.
Methods: To test statistical relationship between changes of
deviation angle and levels of TBII, we created the test periods.
Each test periods had a level of TBII and change of deviation angle
for 6 months from the day the TBII was measured on. Fifty-five
test periods were included after overlapping test periods in same
patients were excluded. The relationships between change of
deviation angle and level of TBII in each test periods were tested
with Pearson’s correlation coefficient. A change in deviation angle
more than 10 prism diopter for 6 months was defined as the
significant change.
Main Outcome Measures: Ocular alignment, and TBII.
Results: The levels of TBII showed statistically significant correlation
with the changes of deviation angle(r=0.361, p=0.007, Pearson’s
correlation coefficient). All of test periods that have normal level of
TBII did not show significant changes in deviation angle. All of test
periods that showed significant changes in deviation angle had a
high level of TBII.
Conclusion: Thyrotropin receptor antibody is a useful parameter
for predicting stability of strabismus in TAO.
82
Case report: We report vertical squint as an initial manifestation of
fibrous dysplasia in a 14-month-old boy.
This boy was born at 32nd gestational week. His birth weight
was 1480 grams. According to our national guidelines, regular
ophthalmological exams were carried out. The vertical squint
was recognised when the boy started to open his eyes. Part-time
occlusion therapy was recommended in other institute.
On first ophthalmological examination in our unit, he fixed with both
eyes but could follow only with left eye. We found right hypotropia
in the primary position. The right eye couldn’t move at all. Neither
enophthalmos nor proptosis were presented. Pupillary reactions
were normal. Hypermetropy of the right eye was recognised.
Anterior and posterior segments were normal.
We planned to make a large recession of the right inferior rectus
muscles, but we couldn’t do that.
Orbital magnetic resonance imaging revealed a mass in the
right paranasal sinuses (maxillary, ethmoidal, sphenoidal) with
involvement of the lower and medial walls of the orbit.
Histopathological examination of this tumour disclosed fibrous
dysplasia. Incomplet excision was performed.
This is a rare condition. Orbital MRI can be useful in differential
diagnosis of restrictive vertical squint in childhood.
ABSTRACTS: POSTERS
P42
P43
SENSORIAL INFANTILE NYSTAGMUS SYNDROME: PREVALENCE OF OCULOMOTOR AND
REFRACTIVE DISORDERS
Malheiro, Luisa; Carneiro, Ines; Maia, Sofia; Miranda,
Vasco; Parreira, Ricardo; Menéres, Pedro
Centro Hospitalar do Porto, PORTUGAL
EYE POSITION UNDER GENERAL ANESTHESIA
IN ORTHOPHORIC CHILDREN
Manoli, Pierre; Auckburraly, Mehran; Lebranchu,
Pierre; Pechereau, Alain; Gain, Philippe; Thuret, Gilles;
Jullienne, Remy
Saint-Etienne University Hospital, FRANCE
Purpose: Sensorial infantile nystagmus syndrome (SINS) has
a multitude of different etiologies and frequently coexists with
oculomotor and refractive disorders that worsen the visual
impairment. This study aims to review the prevalence of oculomotor
and refractive disorders in children with this syndrome
Purpose: The aim of this study is to evaluate the effect of general
anesthesia with muscle relaxant on the horizontal ocular deviation
in orthophoric children.
Methods: Demographic and ophthalmological examination data
were obtained from children with SINS referred to a low vision clinic
in a tertiary hospital, between October 2013 and April 2016.
Results: A total of 49 children (27 female) were included. The
mean age was 9 years (range 2 months-18 years). Cone-rod
retinal dystrophy was the disorder most frequently associated with
SINS (n=13) followed by optic neuropathy (n=7), oculocutaneous
albinism and microphtalmia (n=6), congenital cataracts (n=5),
premature retinopathy (n=3), aniridia and isolated foveal aplasia
(n=2). Retinoblastoma, iris and retina coloboma, septo-optic
dysplasia, congenital toxoplasmosis and posterior polymorphous
corneal dystrophy were recorded only once. Almost 79% had
associated strabismus (44% with esotropia, 56% with exotropia and
13% had coexistent alphabetic patterns). Anomalous head position
was present in 25% of patients. All patients had a decreased best
corrected visual acuity of both eyes (mean: 20/200). Clinically
significant ametropias were present in 82% of patients: 29% of
the eyes with myopia, 16% with hypermetropia, 27% with myopic
astigmatism, 13% with hypermetropic astigmatism and 15% with
mixed astigmatism. Impaired psychomotor development coexisted
in one third of all patients.
Methods: Children aged 4 to 16 years requiring a nonophthalmological surgical procedure under general anesthesia with
neuromuscular blockade were included. Prior ophthalmological
examination excluded any oculomotor disorder. Horizontal ocular
deviation was measured by the Hirschberg photographic method
by comparing pictures taken in the awakened state to those taken
under general anesthesia. Monitoring of anesthesia was performed
by the Bispectral index (BIS) and muscle relaxation by the train of
four (TOF).
Results: 33 patients were included. Mean age was 8 (+/-4) years
and 67.7% were male. The mean horizontal ocular deviation after
general anesthesia with neuromuscular blockade was -0.2 diopters
(SD: 9.7). Median was -0.7 diopters. 72.7% of patients had an
ocular deviation of less than 7.5 diopters with a normal distribution.
Conclusions: Our results show that contrary to popular belief, eye
position under general anesthesia in children without strabismus is
not divergent but very close to orthophoria.
Conclusions: Despite being associated with very different
predisposing pathologies, SINS is very frequently associated with
strabismus and refractive errors which contribute to the overall
visual morbidity.
83
ABSTRACTS: POSTERS
P44
P45
EFFECT OF SQUINT SURGERIES ON THE BLOODAQUEOUS BARRIER
Mihályi, Dorottya; Fodor, Magdolna; Kiss, Huba; Knézy,
Krisztina; Kun, Lídia; Maka, Erika; Maneschg, Ottó;
Sényi, Katalin; Szamosi, Anna; Szigeti, Andrea; Tóth,
Georgina; Nagy, Zoltán Zsolt
Semmelweis University, Budapest, HUNGARY
OCULAR MUSCLES FROM STRABISM UNDERGO
AUTOPHAGY
Nagy, Annamária; Szatmári-Tóth, Mária; Berta, András;
Facskó, Andrea; Petrovski, Goran
Department of Ophthalmology, Faculty of Medicine,
University of Debrecen, HUNGARY
Purpose: to evaluate the influence of strabismus surgery on the
blood-aqueous barrier through anterior segment ischaemia.
Material and methods: 32 eyes of 26 patients (mean age:
35.4±12.7 years, male/female: 1/1,36) were enrolled in our study
who underwent different kinds of squint operation (weakening and
strengthening procedures) at the Department of Ophthalmology,
Semmelweis University between January and April, 2016. Exclusion
criteria: uveitis, haematological deseases in the medical history,
simultaneous surgery on more than 2 rectus muscles. Patients were
screened before the surgery and 1 and 10 days postoperatively
regarding anterior-chamber flare by using Kowa FM-600 Laser
Flare meter.
Results: There were not statistically significant differences
between pre- and postoperatively measured anteriorchamber flare values (mean±SDpreoperative=4.25±2.01
photon count/ms, mean±SDpostoperative1day = 4.34±1.62,
mean±SDpostoperative10day=3.84±1.30, p>0.05 Wilcoxontest).
Conclusions: According to our results strabismus surgery did not
have influence on the blood-aqueous barrier. Although our patients’
mean age was low, it would be interesting to examine patients of
the cardiovascular risk group (elderly patients with atherosclerosis),
or patients with thyroid associated orbitopathy, or patients after
several squint surgeries, even on more than 2 muscles.
84
Purpose: To examine the presence of autophagy - a selfdegradative intracellular mechanism, in ocular muscles obtained
from strabism.
Materials and Methods: Ocular muscles from strabism patients
were obtained from surgery after obtaining signed informed consent
(3 donors) and from control cadaver eyes (3 donors) according to the
Guidelines of the Helsinki Declaration. Immunofluorescent staining
of fixed strabism muscles undergoing atrophy was performed
against a marker for autophagy (LC3) and further confirmed by
Western blotting for LC3 and p62/SQSTM1.
Results: Atrophic muscles from strabism contained significantly
higher expression of the autophagy marker LC3 (hallmarked
by higher number and size of fluorescently positive autophagic
vacuoles) compared to the controls. These findings could be
confirmed by Western blotting for LC3 and related to a decreased
p62 expression as usually found in autophagy activation.
Conclusions: This is the first time a presence of autophagy
is shown in strabism muscles. Whether autophagy has a prosurvival or death role in muscle atrophy needs further studies to
be undertaken.
ABSTRACTS: POSTERS
P46
P47
EPIDEMIOLOGY OF INFANTILE NYSTAGMUS
SYNDROME
Ocak, Osman Bulut; Inal, Asli; Gokyigit, Birsen; Aygit,
Ebru Demet; Yilmaz, Tolga; Ozturker, Can
Beyoglu Eye Research and Training Hospital, TURKEY
BIMEDIAL RECTUS RECESSION SURGERY WITH
DOWN SYNDROME PATIENTS
Ocak, Osman Bulut; Inal, Asli; Gokyigit, Birsen; Aygit,
Ebru Demet; Ozcelik, Ferah; Satana, Banu
Beyoglu Eye Research and Training Hospital, TURKEY
Purpose: To evaluate the epidemiological features of İnfantile
Nystagmus Syndrome (INS)
Purpose: To compare the effectiveness of bimedial rectus
recession surgery on the patients with Down syndrome and on the
patients who has normal neurological development.
Material method: We evaluated the datas from 51 patients with
INS who were referred between September 2015 - April 2016
retrospectively. The ethiology of INS, precense of strabismus and
abnormal head posture (AHP), applied operations were recorded.
Results: 32 (%62.74) of the patients were male and 19(%37.26)
patients were female. Their ages were between 1 – 31 years (mean
age 9.60 ± 7.43). 27 ( %52.94 ) of the patients were idiopatic, 5
(%9.80) patients were with oculo-cutaneous albinism, 4 (%7.84)
patients were with ocular albinism, 2 (%3.92) patients had retinal
disorders, 3 (%5.88) patients had congenital cataract, 6 (%11.76)
patients had norological disorders and 4(%7.84) patients had
optic disc anomalies. 21 (%41.2) patients had strabismus and 27
(%52.9) patients had AHP. We operated 15 patients. The operations
were for strabismus or AHP and 1 patient was operated for decrease
of nystagmus amplitude.
Conclusions: The examination of INS patients must be detailed
and the presence of strabismus and AHP should be carefully
evaluated.
Material and method: We evaluate the patients with Down
syndrome who underwent bimedial rectus recession surgery
for esotropia between april 2005 and april 2014 retrospectively.
Control group was selected from the age-matched patients with
normal neurological development who underwent the same surgical
procedure. Ocular alignment was measured with Krimsky test or
prism cover test. Surgical success was defined as within 10 prism
dioptri (PD) of orthotropia 6 months after surgery. We compared
case and control groups in terms of preoperative and postoprative
esodeviation angle at 6 months follow-up, surgical doses of
bimedial rectus recession and postoperative surgical success.
Results: Eleven patients with Down Syndrome ( age range 2 – 17)
and 22 control subjects were included. Their ages were between
2 – 17 years. The groups did not differ in either preoperative (Down
syndrome group 37.73±8.42 PD, control group 35.91±7.65
PD) and postoperative deviation angle (Down syndrome group
5.45±11.83 PD, control group 2.36±7.13 PD), surgical doses
of bimedial rectus recession surgery (Down syndrome group
4.68±0.40 mm, control group 4.78±0.38 mm). Surgical success
was achieved in 9 patients with Down syndrome (% 81.8), and in
20 of control patients at 6 months follow-up. There was significant
difference between preoperative and postoperative deviation in
both groups (p<0.05).
Conclusion: Surgical success between esotropia patients who
underwent bimedial rectus recession surgery with or without Down
Syndrome was similar.
Key Words: Bimedial rectus recession surgery, Down syndrome,
esotropia
85
ABSTRACTS: POSTERS
P48
P49
LEA GRATINGS: DIFFERENCES BETWEEN
OBSERVERS WHEN CARRYING OUT EVALUATION
OF THE VISUAL ACUITY IN CHILDREN UNDER 30
MONTHS
Ocak, Osman Bulut; Inal, Asli; Gokyigit, Birsen; Aygit,
Ebru Demet; Ozturk Karabulut, Gamze; Basarir, Berna
Beyoglu Eye Research and Training Hospital, TURKEY
SURGICAL OUTCOME DEPENDING ON THE
AMOUNT OF HYPEROPIA IN PATIENTS WITH
INFANTILE ESOTROPIA
PAIK(BAEK), Hae Jung; Yim, Hae bin
Gachon University Ophthalmology, SOUTH KOREA
Purpose: To study the visual acuity and inter-observer variability
of visual acuity measurements by means of Lea gratings charts in
children under 30 months.
Methods: We evaluated the visual acuity with Lea gratings charts
of 182 eyes of 91 patients ages between 6 to 30 months ( mean
age 16,62 ± 6.94 months). The visual acuity measurements were
obtained by two different doctors and the results obtained were
compared. For statistical analyses we used SPSS® 22 for Windows.
Results: The mean visual acuity levels were 2.59±2.30 and
2.60±2.30 of the right eyes and 2.96±2.39 and 2.98±2.38
of the left eyes obtained by doctor 1 and doctor 2 respectively.
The correlation between measurements of two doctors were
significantly high (p<0.001).
Conclusions: Lea gratings charts can be used for evaluation of
the visual acuity in children under 30 months by different doctors
without any significant differencess being found between them.
Purpose: To analyze surgical outcome depending on the amount of
hyperopia in patients with infantile esotropia
Methods: This study retrospectively examined 80 patients with
infantile esotropia who underwent both medial rectus recession
from January 2007 to December 2011 before 36months old and at
least 36 months of follow-up. The patients were divided into groups
according to the degree of hyperopia ≥ +3.0D (High hyperopia,
HH, n=59 patients) and ≤ +3.0D (Non high hyperopia, NH, n=21
patients). Clinical characteristics analyzed included surgical success
rate, dose-response relationship at 3months and 3years follow-up.
Results: There were no statistically significant differences
between the groups with initial preoperative alignment (p=0.450),
Surgical success rate(NH: 69.5% (41/59), HH: 71.4% (15/21),
p=0.837), Under-correction rate(NH: 23.7% (14/59), HH: 9.5%
(2/21), p=0.191) and Over-correction rate(NH: 6.8% (4/59), HH:
19.1%(4/21), p=0.138). There was a tendency towards larger
dose-response relationship with higher hyperopia (NH: 3.9PD/
mm, HH: 4.3PD/mm) at 3months post-op follow-up, but it was not
significant (p=0.105). Dose-response relationship was significantly
higher in high hyperopia group than non high hyperopia (NH 3.9PD/
mm, HH 4.9PD/mm) at 3years post op follow-up (p=0.010). There
was no statistically significant difference between the groups with
amblyopia (p=0.146).
Conclusions: Surgical success rate of infantile esotropia may be
not associated with amount of hyperopia. There was no association
between dose-response relationship and amount of hyperopia at
post-op 3months follow-up, but high dose-response relationship
in high hyperopia group at post-op 3years follow-up. Therefore the
conventional amount of recession or resection of muscles should
be modified in high hyperopic (≥ +3.0D) infantile esotropia, and
long term post-op follow-up is necessary.
Key Words: Infantile esotropia, Refractive error, High hyperopia,
Medial rectus recession, Dose-response relationship
86
ABSTRACTS: POSTERS
P50
P51
EXOPHORIA/EXOTROPIA IN ADULTS WITH
DIPLOPIA AFTER REFRACTIVE SURGERY: DO WE
ALWAYS NEED TO MANAGE IT WITH MUSCLES
SURGERY?
Piantanida, Andrea C.; Spera, Manuela; Nobili, Roberta;
Gerosa, Giulia
Centro Oculistico Lariano, ITALY
THE
SYSTEM
OF
TREATMENT
AND
REHABILITATION MEASURES IN PATIENTS WITH
PARETIC STRABISMUS
Plisov, Igor L.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
Novosibirsk, RUSSIA
Purpose: To stress the importance of the orthoptic check in
patients with latent strabismus before performing refractive surgery
and to consider early cataract surgery with consecutive “desired”
myopia as a solution in diplopia to manage divergent strabismus.
Purpose: A system of complex functional treatment of patients
with paretic strabismus was developed and introduced in clinics.
Methods: An 40 years old woman came at our observation referring
for frequent diplopia increasing during time. She underwent laser
refractive surgery for myopia (RE – 2.00 sf dioptres, LE – 8.00
sf. diopters) few years before. Her actual visual acuity was - 0,1
LogMar in the right eye and 0,2 LogMar. In both eyes she had an
initial opacity of the posterior capsule. At our orthoptic check she
was exoforic/exotropic (for far -4^, for near -12^) with intermittent
cross diplopia, even if she had normal fusional vergences. We
decided to perform an early cataract surgery to restore a myopic
refraction to control divergence.
Results: After surgery the patient had a better control of the
exophoria, she didn’t refer for subjective diplopia anymore. At the
orthoptic check she was ortophoric for far and slight exoforic for
near (-8^)
Conclusions: Non muscular diplopia in adults after refractive
surgery is one of the most challenging problem to manage. An
orthoptic examination should be mandatory before refractrive
surgery in order to quantify latent strabismus and its control by the
patient. Early catarct surgery restoring myopic refraction may be an
important therapeutic aid alternative to muscle surgery in selective
cases.
Methods: Prismatic correction was prescribed as an independent
method (92 patients) and for the correction of residual deviation
after extraocular muscle chemodenervation or surgical treatment
(20 patients). A method of orthoptic treatment using synoptophore
was developed; it is adjusted to incomitant oculomotor system.
In the cases, when the above methods did not make it possible
to efficiently improve the functions of affected muscles,
chemodenervation was done.
Results: In 95 patients (84.8%), prismatic correction made
it possible to eliminate diplopia in the problematic direction of
gaze (DG). In 17 patients (15.2%), diplopia was reduced. In 22
cases (23.9%), functional recovery was achieved. In all cases
of primary (10 patients) or stage (5 patients) treatment using
synoptophore the patients were released from diplopia in the
direct DG. In 70 patients (94.6%), positive results were achieved
after chemodenervation of ipsilateral antagonist: functionality
of the affected muscles was increased from degree 1.5±1.1 to
3.4±0.8, primary deviation was decreased from 17.96±8.31° to
3.01±3.14°. In 55 patients (74.3%), orthophoria was achieved
in the direct DG. Chemodenervation of ipsilateral antagonist and
contralateral synergist was performed in 28 patients: functionality
was increased from degree 1.14±1.02 to 3±0.86, deviation was
decreased from 19.14±7.31° to 4.23±3.43°. In 42.9% patients,
functional recovery was achieved.
Conclusions: The system of active functional treatment made it
possible to achieve recovery in 48.5% patients. In the remaining
cases, the volume of the required surgical treatment was decreased.
87
ABSTRACTS: POSTERS
P52
P53
INDUCED HYPERTROPHY OF EXTRAOCULAR
MUSCLES AFTER THE ADMINISTRATION OF
SYNTHETIC PEPTIDES INTO THEM
Plisov, Igor L.; Atamanov, Vasiliy V.; Chernyavskaya,
Mariya A.; Toporkov, Igor A.; Mamulat, Darya R.;
Antsiferova, Natalya G.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
Novosibirsk, RUSSIA
BOTULINUM TOXIN IN THE TREATMENT OF
STRABISMUS IN CHILDREN – OUR EXPERIENCE
Podedworny-Chustecka, Agnieszka; Jakubaszek,
Aleksandra; Bukala-Mroczek, Anna; Szala, Ewa;
Samsel, Agnieszka
Szpital Dziecięcy, Warszawa, POLAND
Purpose: The purpose of the research was to conduct morphometric
study of extraocular eye structures in rabbits after the introduction
of synthetic peptides into them.
Methods: A retrospective analysis was performed on a series
of children with horizontal strabismus treated with BTXA into the
lateral or medial rectus muscle. A case series included a total
of 131 patients aged from 5 months to 17 years. The average
age at the time of application was 2,2 years. Type A botulinum
toxin (Dysport) injection in medial rectus muscles was used for
concomitant esotropia treatment, esotropia due to VI nerve paralysis
or paresis (114 cases). In 17 cases with exotropia BTA was injected
in lateral rectus muscles. The incidence of adverse effects was also
evaluated. The follow-up was 12 months.
Methods: Morphometric research of m. rectus lateralis (MRL), m.
levator palpebrae (MLP) and m. orbicularis oculi (MOO) was done
in 10 experimental rabbits after the administration of synthetic
peptides into the periorbital area.
Results: During microscopy in the study group, the thickness of
MRL and MOO muscular fibers was 30% bigger, of MLP – 56%
bigger as compared with the values of this parameter in the control
group, which was due to muscle fiber hypertrophy. The hypertrophy
had a non-uniform character in respect of the fiber length and
was more expressed in the middle sections. It may be assumed
that muscle fiber hypertrophy happens to a greater degree due to
sarcoplasmic hypertrophy. Myofibrillar hypertrophy was registered
only in certain MLP fibers. The most expressed differences in the
compared groups were observed when assessing angiogenesis
processes. The number of vessels in intramuscular space of muscle
increased mainly due to hyperplastic processes with the formation
of newly formed vessels of the microvasculature, exceeding the
values of the similar parameter in the control group by 52.4%,
which testifies to expressed stimulation of early angiogenesis with
an increase in capillarization and improvement of trophic processes.
Conclusions: Administration of synthetic peptides into muscle
activates reparative processes expressed in heterogeneous
hypertrophy of muscular fibers; activation of fibrogenesis with
increased number density of fibroblasts; increased reactivity of the
vessel component with neoangiogenesis activation.
88
Purpose: To evaluate clinical results and complications from
botulinum toxin (BTXA) for strabismus treatment.
Results: The ocular deviation was reduced by an average of 45% in
convergent concomitant strabismus, 23% in incomitant esotropia,
40% in concomitant exotropia, 75% in consecutive exotropia after
esotropia surgery. Improvement in eyes mobility was observed in
93% of patients. Complications included: transient ptosis, vertical
deviation, diplopia and subconjunctival hemorrhages.
Conclusions: BTXA is an efficacious treatment for esotropia
in children. The technique is simple, well tolerated, and has no
systemic side effects.
ABSTRACTS: POSTERS
P54
P55
THE SURGICAL RESULTS OF CORRECTING
ESOTROPIA STRABISMUS WITH INFERIOR
OBLIQUE HYPERFUNCTION
Polyanskaya, Elena; Kashenko, Tamara Pavlovna
The S. Fyodorov Eye Microsurgery Federal State
Institution, RUSSIA
PARALYSIS OF N. OCULOMOTORIUS: OUR
EXPERIENCE OF SURGICAL TREATMENT
Puzyrevskiy, Konstantin G.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
RUSSIA
Purpose: The definition of tactics and volume of surgical
intervention at the combined forms of strabismus is an important
task.
Purpose: To analyze clinical and functional results of new surgical
treatment of patients with n. oculomotorius palsy.
Methods: The study group included 61 patients with a mean
age of 5,2 years. All patients had esotropia of varying severity
with increasing hypertropia in adduction, amid hyperfunction of
the inferior oblique muscle. All patients underwent one-stage
elimination of the horizontal component of the deviation by the
recession and resection of the horizontal muscles, as well as the
recession of the inferior oblique muscle. The mean follow-up was 3
years (range, 1 to 5 years).
Results: In result of simultaneous surgery orthotropy in the
early postoperative period reached 92%. In 5 patients eliminated
residual esotropia in terms from 6 months to 1 year. Hypertropy
was not in the primary gaze position and adduction. Forced position
of the head is eliminated in 78% of cases. All patients received
functional treatment (orthoptics) and constant spectacle correction.
In the long-term period of 6 to 12 months, orthotropy persisted
in 90% of patients achieved binocular vision in 35% of patients.
Overcorrection was not noted in any patient.
Methods: The group under study included 4 patients. The main
stage of operative therapy implied union of the superior and
medial rectus muscles with fixation to sclera closer to limbus: in
three cases – according to the Puzyrevskiy technique. In all cases,
weakening lateral rectus muscle and oblique superior muscle.
Results: The average value of exotropia was reliably decreased
from 32.63±12.02° to 9.5±2.21°, hypotropia – from
13.35±3.32° to 5.25±2.12°. The adduction volume was increased
from -12.33±1.09° to 5.5±2.24°, the elevation volume – from 14.17±2.23° to 4.07±3.14°.
Conclusions: The proposed technique is an effective method of
surgical treatment in addition to the weakening of the lateral rectus
and superior oblique muscles.
Conclusions: The one-stage surgery with combined horizontal
vertical strabismus is an effective treatment, reducing the stages
of surgical correction of strabismus. The recession of inferior
oblique muscle is the effective method of operation in high oblique
hyperfunction.
89
ABSTRACTS: POSTERS
P56
P57
HEAVY EYE SYNDROME: OUR EXPERIENCE OF
SURGICAL TREATMENT
Puzyrevskiy, Konstantin G.; Plisov, Igor L.; Antsiferova,
Natalya G.; Mamulat, Darya R.
S.N. Fyodorov IRTC “Eye Microsurgery” FSAI of the
Ministry of Health Care of the Russian Federation,
RUSSIA
TREATMENT OF PRIMARY GAZE DIPLOPIA IN
PATIENTS WITH ENDOCRINE ORBITOPATHY
Rahne, Ingrid; Kosec, Dragica
University Eye Hospital Ljubljana, SLOVENIA
Purpose: To analyze clinical and functional results of surgical
treatment of patients with the heavy eye syndrome.
Methods: The group under study included 5 patients. The main
stage of operative therapy implied union of the superior and
lateral rectus muscles: in two cases – according to the Yokoyama
technique, in three cases – according to the Puzyrevskiy technique
(with fixation of the united superior and lateral rectus to sclera
closer to limbus). In all cases, maximum recession of the ipsilateral
medial rectus. In the cases with positive traction test (4 patients),
in the attempt to rotate the eye up, the action of the inferior rectus
was weakened using tendon-sclera-plasty. In one case (after the
first stage without tendon-sclera-plasty of the inferior rectus),
hypertropia occurred, that is why median tucking of the inferior
rectus was done as a second stage.
Results: The average value of esotropia was reliably decreased
from 36.67±14.02° to 7.50±3.27°, hypotropia – from
11.67±5.32° to 3.50±3.02°. The abduction volume was increased
from -8.33±13.29° to 22.50±12.94°, the elevation volume – from
-5.67±3.33° to 16.17±6.34°.
Absence of diplopia with relative cosmetic orthoposition was
explained by asymmetric decrease in visual functions as a result
of worsening of optical medium transparency and chorioretinal
dystrophic changes.
Conclusions: The main efficient technique for surgical treatment
is the union of superior and lateral rectus muscles – elimination of
the defect in para-orbital tissues through which the eye dislocates.
In the case of tension of medial and inferior rectus muscles, the
volume of surgical intervention is supplemented with reducing their
action.
90
Purpose: The aim of this study is to present the results of
treatment in patients with endocrine orbitopathy (EO) and primary
gaze diplopia in University Eye hospital Ljubljana.
Methods: Retrospective analysis of patients with EO and primary
gaze diplopia from 2001-2016, treated in University Eye hospital
Ljubljana. Treatment methods were: surgical, nonsurgical and
combined treatment. The statistical analysis includes clinical
assessment of disorders in the motility, angle of deviation, binocular
functions, treatment modality and patient’s subjective assessment
of diplopia improvement after the treatment.
Results: There were 33 patients with diplopia (29 women and
4 men). Prior to the treatment 20 patients presented with limited
elevation (14 unilateral, 6 bilateral), 4 patients with bilaterally
limited abduction, 2 with combined limitation of abduction and
elevation, 3 patient with unilaterally limited depression and 1 the
patient with combined limitation of elevation in one and depression
in the other eye; in 3 patients motility clinically was not limited.
In 78% of patients angle of deviation reduced. 64% of patients
had some of binocular functions after treatment. 52% of patients
were treated with surgery, 27% with prismatic correction, 21% had
other ways of treatment. A single image in the primary position was
achieved in 78% of patients with prismatic correction and in 76,5%
of the surgically treated patients.
Conclusion: Treatment of primary gaze diplopia as a result of EO
is a complex and lengthy process, which requires a combination of
different treatment modalities, experienced surgeon and individual
adjustment of the treatment in an individual patient.
ABSTRACTS: POSTERS
P58
PITUITARY
APOPLEXY
PRESENTING
AS
ISOLATED BILATERAL OCULOMOTOR NERVE
PALSY: CASE REPORT
Ryu, Won Yeol; An, Seoung Hyun; Song, Young Jin
Department of Ophthalmology, Dong-A Medical Center
College of Medicine, Dong-A University Strabismus,
SOUTH KOREA
Purpose: To report a case of pituitary apoplexy presenting as
isolated bilateral oculomotor nerve palsy which was improved after
surgical management.
Methods: A 46-year-old man presented with bilateral ptosis
and headache for 6 days. Ophthalmic examination revealed the
complete limitation of adduction, supraduction, and infraduction
with complete ptosis on the both side. The patient was was
diagnosed as isolated bilateral oculomotor nerve palsy. In addition,
magnetic resonance imaging demonstrated a pituitary gland cystic
lesion which was diagnosed as pituitary apoplexy.
Results: The patient was admitted to the department of
neurosurgery and received intravenous methylprednisolone 1.0
g for 7 days. He underwent navigation guided transsphenoidal
approach surgery. Oculomotor nerve palsy improved partially on the
second postoperative day and completely improved in the fourth
month after operation.
Conclusion: This is a rare case of pituitary apoplexy that presented
with isolated bilateral oculomotor nerve palsy, bilateral ptosis and
vision loss. A full recovery was achieved after navigation guided
transsphenoidal approach surgery.
P59
REVITALVISION TREATMENT
AFFECTED BY NYSTAGMUS
Sabetti, Lelio; BIANCHI, FEDERICA
University of L’Aquila, ITALY
IN
PATIENTS
Purpose: To evaluate the efficacy of the RevitalVision training
in enhancing Best Corrected Visual Acuity (BCVA) and Contrast
Sensitivity (CS) in a group of patients affected by nystagmus.
Materials and methods: 12 patients, ranging in age from 10 to
45 years (median age 25.8), 9 males and 3 females with nystagmus
and low vision. Median binocular BCVA was 0.46 LogMar. Initial
binocular median CS was 1.12 Log CS and stereopsis mean was
275 arc7sec. Patients presented a stable refraction for at least
1 year before inclusion. Strabismic deviation was below 8Dp.
Patients who were not able to pass the calibration of RV, who
suffered from diabetes, epilepsy, migraine, concentration problems,
diplopia, and pregnant women, were excluded from the study. Each
patient followed a protocol according to the following schedule: T0
baseline/enrolment including the recording of the following data:
BCVA at both distance and near, Reading speed (words per minute),
Eyesight examination, Stereo test (random dot test II), extraocular
movement, cover test at near and distance, contrast sensitivity
measurement using the Pelli Robson charts; T1 after 10 sessions;
T2 after 20 sessions; T3 at the end of treatment of 50 sessions,
reaching and stabilization of plateau. At each stage, the following
data were measured: BCVA at both distance and near, CS and
stereo test. Following a series of precautions (e.g., a distance of
1 m from the screen, dark room, absence of distracting elements),
patients accomplished their personalized exercises at home on
their own computer on alternate days with no interruption for a
period longer than 15 days.
Results: At the end of the treatment, median binocular sensitivity
contrast was 1.67 logCS, median binocular BCVA was 0.27 logMar
and stereopsis mean was 255 arc/sec. Three patients interrupted
the training. All patients reported subjective improvement in their
functional vision.
Conclusions: The functional training using RevitalVision appears
to be a valid method of functional visual enhancement also in
patients with a high visual impairment.
91
ABSTRACTS: POSTERS
P60
P61
SEMI-STRUCTURED OBSERVATIONS OF EYE
SCREENING AND THE PROCEDURE OF REVISION
OF THE VISION SCREENING GUIDELINE IN THE
NETHERLANDS
Sami, Aya; Karaman, Hatice; Sloot, Frea; Simonsz, Herb
Erasmus Medical Center Ophthalmology, NETHERLANDS
STRABISMUS AFTER ORBITAL ENDOSCOPIC
DECOMPRESSION IN PATIENTS WITH THYROID
ORBITOPATHY
Samsel, Agnieszka; Jabłońska, Anna; Białas-Niedziela,
Dorota; Krzeski, Antoni; Kęcik, Dariusz
Children’s Hospital, Warsaw Department Of
Ophthalmology, POLAND
Across Europe, inequity exists in the provision of childhood vision
screening. Most European countries have screening programmes,
but they vary with regard to age and frequency of testing, tests used,
uptake, screening professionals, referral pathway and funding.
In the Netherlands, screening physicians and nurses screen all
children, with 98-99% coverage, at Child Health Care Centers, for
all kinds of developmental disorders and diseases. This is a very
efficient system: One minute of examination time of all 180,000
children born in the Netherlands costs € 400,000 (2003 data).
Visual acuity has been measured at age 3 - 5 since the 60s.
The children are also examined at the age of 1 and 3 months for
congenital eye disorders. In the 80s several examinations have
been added between the ages of 6 and 24 months: inspection of
the eyes, pupillary reflexes, Hirschberg test, cover test, motility and
pursuit movements.
During our (AS & HK) bachelor study of orthoptics, we assessed the
quality of the eye screening tests with semi-structured observations
of Youth Health Care doctors screening children during a total of
100 days. In general, visual acuity was measured well, but pupillary
reflexes and the orthoptic tests were not performed with sufficient
quality in many cases due to various reasons.
Since April 1st, we now participate in the revision of the national
guideline for vision screening in the Netherlands. We cannot report
on the results of that revision, but will report on the procedure that
is being followed and on the assistance that being is given to this
process by the first author (AS) as a research-orthoptist.
92
Aim: The aim of the study was to evaluate the incidence of eye
motility problems and diplopia in patients with thyroid orbitopathy
after endoscopic orbital decompression.
Material and method: (9 males, 15 females) ( 42 orbits), aged
31-76years, underwent endoscopic orbital decompression in
the period between November 2011 and January 2016. In 15
patients orbitopathy was active, in 9 - inactive. Orbital endoscopic
decompression was performed due to dysthyroid optic neuropathy
(DON) in 18 patients, proptosis - in 6 patients. The follow-up was
from 3 to 48 months. Eye motility and diplopia before and after
operation and treatment options for diplopia were analysed.
Results: Constant diplopia in the primary position preoperatively
was observed in 7 (29%) patients.
After the operation new onset diplopia in the primary gaze was
seen in 7 (29%) patients, worsening of diplopia to constant was
noted in 6 ( 25%) patients, with significant increase of esotropia. 9
patients underwent strabismus surgery (7 with diplopia worsening
or occuring after decompression), 4 patients needed prism glasses
for diplopia. Partial or complete resolving of diplopia was observed
in 4 cases.
Conclusions: Strabismus with diplopia after endoscopic orbital
decompression is a significant problem. In most of cases with
diplopia subsequent eye muscle surgery is required.
ABSTRACTS: POSTERS
P62
P63
ATYPICAL CASE OF OCULAR MYASTHENIA
GRAVIS
Sari, Ayca; Dinc, Erdem; Okuyaz, Cetin; Ecel, Mahmut
Mersin University Medical School Dept. of
Ophthalmology, TURKEY
MINIMAL
EXPOSITION
OF
TEST-OBJECT
RECOGNITION IN CHILDREN WITH EMMETROPIA,
ANOMALIES OF REFRACTION, AND AMBLYOPIA
Serdiuchenko, Vira; Zheliznyk, Mariia
The Filatov Instirute of Eye Diseases and Tissue Therapy
Ophthalmology, UKRAINE
Purpose: To discuss an unusual case of childhood ocular Myasthenia
Gravis presented with bilateral total external ophthalmoplegia.
Method: A 5.5 years old boy complaining diplopia, dizziness and
unsteady gait for 3 days was referred to our clinic with a possible
diagnosis of intracranial tumor. The ophthalmological examination
was remarkable for bilateral cranial 3rd, 4th and 6th nerve palsies
with left ptosis and mydriasis. The best corrected visual acuity was
20/32 in the right eye and 20/25 in the left eye. The anterior and
posterior segment findings were normal. He did not complain about
fatique, difficulty in swallowing or motor weakness.
Results: Cranial magnetic resonance imaging (MRI) was normal.
His neurological examination and blood tests resulted in the
diagnosis of Ocular Myasthenia Gravis (OMG). His eye movements
dramatically responded to oral Acetylcholinesterase inhibitors. His
complaints and clinical findings regressed completely in the 5th
day of the treatment. He had no relapse of symptoms during the 6
months follow up.
Conclusion: Ocular myasthenia gravis is the majority of
childhood MG cases and solely effects eye muscles, causing
diplopia, strabismus, ptosis or ophthalmoplegia. Total bilateral
ophthalmoplegia is quite a rare type of presentation and brain
stem tumors, vascular malformations should be excluded initially.
As almost half of the cases possibly will progress to generalized
form of MG and early treatment is essential for the prognosis; it is
important to be aware that any atypical extraocular eye movements
might occur as a result of MG.
Purpose: To investigate the minimal exposition of test-object
recognition (METOR) in children with emmetropia, anomalies of
refraction and amblyopia.
Methods: METOR was investigated in 127 children 7-13 y/o (23
children with emmetropia and normal visual acuity (VA), 48 - with
anomalies of refraction and normal VA with correction, 56 - with
different kinds of amblyopia). The investigation was conducted with
help of special electronic device. Test-object (ring of Landolt), with
size 8 angle minutes, with one of 8 different directions of rupture,
was showed in different expositions, from 1 millisecond (ms), with
step 1 ms.
Results: The value of METOR in monocular and binocular
investigation was accordingly: in emmetropia – 7,8±1,1 ms and
6,0±0,8 ms, in hyperopia 1,5-4,5 D – 14,9±1,3 ms and 11,8±1,1
ms, in myopia 1,0-4,0 D – 7,9±1,0 ms and 6,9±1,0 ms. The value
of METOR in 21 patients with refractive amblyopia and hyperopia
(VA with correction 0,3-0,7) equalized 130,0±17,4 ms in
monocular and 56,0±8,9 ms in binocular investigation. Monocular
METOR in 13 patients with anisometropic amblyopia and hyperopia
(VA with correction 0,4-0,8) was equal 50,5±8,6 ms. In 22 children
with dysbinocular amblyopia (VA 0,2-0,35) monocular METOR was
112,5±15,8 ms.
Conclusion: It was revealed the tendency to diminution of
binocular METOR in comparison with monocular METOR in children
with emmetropia, with anomalies of refraction and normal VA,
with refractive amblyopia without strabismus. It was established
prolonged time of test-objects recognition in children with different
kinds of amblyopia.
93
ABSTRACTS: POSTERS
P64
P65
SOME CLINICAL FEATURES OF OCULOMOTOR
DISTURBANCES AT A-V-X SYNDROMES
Serdiuchenko, Vira; Yemchenko, Victor
The Filatov Instirute of Eye Diseases and Tissue Therapy
Ophthalmology, UKRAINE
ELECTROPHYSIOLOGICAL EXAMINATIONS FOR
OBJECTIVE EVALUATION OF THE BINOCULARITY
AND THE DEVIATION OF THE VISUAL AXIS IN
YOUNG CHILDREN WITH STRABISMUS
Sohar, Nicolette; JAnossy, Agnes; Janaky, Marta
University of Szeged Department of Ophthalmology,
HUNGARY
Aim: To investigate the clinical features of oculomotor disturbances
at A-V-X syndromes.
Methods: We observed 560 patients with A-V-X syndromes
aged 2 - 21 y /o . Methods : viso and refractometry, motility eye
examination, measurement of the angle of strabismus in different
directions , ophthalmoscopy.
Results: A,V and X syndromes respectively occurred at a frequency
of 14.3%, 83% and 2.7%. The value of the syndrome is defined by
the difference between the values of the deviation when patient look
up and down. When A syndrome is the most common value of 15˚
and 20˚ ( respectively 22.2% and 31.5%), and V- syndrome - also
the value of 15˚ and 20˚ ( respectively 36.6% and 23.3%), when X
syndrome - 20˚, 25˚ and 30˚ ( by 26.7%). The majority of patients
(92.2%) had A-V-X syndrome associated with horizontal deviation.
In case of A-syndrome eso - and exodeviation observed respectively
in 43.8% and 48.8% of cases; X syndrome - respectively 40% and
33.3%; at V- syndrome esotropia predominated (74.6%). Related
vertical deviation investigated in 19.3% of cases ( hypertropia 13% of patients , hypotropia - at 6.3%). Cyclotropia was detected in
35.9% of patients ( excyclotropia at 30.1%, incyclotropia - at 5.8%).
Muscle dysfunction of cyclovertical action 1-4 degrees (vertical
deviation change at eye moving horizontally) were quite frequent
at A, V, and X syndromes; the most frequent muscle dysfunction
were oblique muscles: the inferior oblique - respectively , at 31.9%,
64.2%, 93.3% of patients , the superior oblique - respectively , at
81.2%, 50.8%, 96.7%.
Conclusion: A-V-X syndromes - difficult oculomotor disturbances,
requiring an individual approach to the rehabilitation of these
patients.
94
Purpose: Objective evaluation of the function of the visual
pathways, the level of binocularity, and the deviation of strabismus in
young children with strabismus with the help of electrophysiological
examination methods.
Methods: After establishing the orthoptic status of twenty children
aged between 0-18years of age, electrophysiological tests were
ordered for the determination of the anatomical or functional
causes of the abnormal visual loss.
Ater 2 years of age monocular and binocular visual evoked potential
(VEP)s were tested for the detection of the level of binocular
facilitation. Cooperative children (above 3-4 years) were tested
monocularly and binocularly by multifocal electroretinography (ERG)
s, multifocal (mfERG) for excluding the central macular functional
loss and for the objective determination of the deviation of the
visual axis.
All electrophysiological examinations were done according to
the ISCEV stardards. The mfERG s were detected through DTL
electrodes.
Results: Among the examined children ten had strabismus caused
by organic lesion of the strabismic eye. Existence of some binocular
facilitation would be the basis of the continuation of the orthoptic
treatment (in eight chidren). The monocular and binocular mfERG
helped the exact determination of the deviation of the strabismic
eye for the successful surgery (ten children).
Conclusions: Electrophysiological examinations may help in
reaching success in the orthoptic treatment in very young children,
too.
ABSTRACTS: POSTERS
P66
P67
SIMILARITY OF THERAPEUTIC MECHANISM
BETWEEN
Y-SPLIT
PROCEDURE
AND
POSTERIOR FIXATION FOR CORRECTING UPAND DOWNSHOOTS ON ADDUCTION IN DUANE
SYNDROME
Suh, Young-Woo; Choi, Soo-Youn; Jang, Sungmin; Ha,
Suk-Gyu; Kim, Seoung-Hyun; Cho, Yoonae, A.
Korea University College of Medicine Department of
Ophthalmology, SOUTH KOREA
IS THERE ANY CORRELATION BETWEEN
INFERIOR
OBLİQUE
OVERACTION
AND
ASTIGMATISM?
Sultan, Pinar; Gurkan, Sedat; Eltutar, Kadir; Erkul, Sezin
O.; Osmanbasoglu, Ozen A; Ozdemir, Fatma E
Istanbul Training and Research Hospital Ophthalmology,
TURKEY
Purpose: The Y-split procedure and posterior fixation suture in the
lateral rectus muscle are effective for correcting up- and downshoots
in Duane syndrome. Although mechanisms of the 2 procedures are
different, it can become similar when adhesion occurs after Y-split
procedure. This study was performed to investigate the amount of
adhesion after Y-split procedure in the rectus muscle.
Methods: Twenty-four eyes of 12 rabbits were included. The Y-spit
procedure was performed in the superior rectus muscle (SR) of
right eye. The central portion of the SR was split up to 10 mm from
the insertion. The nasal and temporal muscle halves were sutured
at the nasal and temporal ends of the SR insertion respectively. In
the left eye, posterior fixation suture at 10 mm from insertion was
performed. The amount of adhesion was evaluated 6 weeks after
surgery.
Results: The SR was attached to the sclera 9.18±0.62 mm from
insertion after posterior fixation suture. The Y-split procedure also
showed adhesion especially around split area and the length of
adhesion was 7.33±0.33 mm from insertion. Although the range
of adhesion was more posterior after posterior fixation suture,
(P=0.002) the amount of adhesion after Y-split procedure was
also larger than conventional rectus muscle surgery. After Y-split
procedure, the proximal end of Y was adhered to the sclera in most
cases.
Conclusions: A large amount of adhesion including the proximal
end of Y occurred after the Y-spit procedure. The therapeutic
mechanism of Y-split procedure changes into that of posterior
fixation suture when the entire nasal and temporal halves adhere to
the sclera. Additional effort to reduce adhesion would be necessary
for Y-split procedure.
Purpose: The purpose of this study was to investigate the
correlation between inferior oblique muscle overaction grade and
astigmatism
Methods: Clinical data from the records of 30 patients with inferior
oblique overaction were searched retrospectively. All patients were
given a detailed eye examination including the anterior and posterior
segments. The refractive errors of all eyes were measured in a quiet
room using table-top refractometer. We analyzed the demographics,
characteristics of the patients and refraction (cylindrical and axis)
.The axis component was converted into a vector representation
for analysis.
Patients were divided into two groups: those having unilateral
inferior oblique overaction (unilateral inferior oblique group) and
those having bilateral asimetrical inferior oblique overaction
(bilateral inferior oblique group). In unilateral inferior oblique group
each eye astigmatism values compared according to the inferior
oblique muscle overaction and in bilateral inferior oblique group
according to the degree of inferior oblique muscle overaction.
Results: Sixty eyes of thirty patients with an average age of
12.09±5.77 years (range, 4-25 years) were included. There was
no significant correlation between astigmatism and the inferior
oblique overaction grade for both groups.
Conclusions: According to this study inferior oblique muscle
overaction did not increase astigmatism along the axis of the
overacting muscle so it can be speculated that a mechanical force
exerted by the inferior oblique muscle didn’t cause astigmatism.
95
ABSTRACTS: POSTERS
P68
ATYPICAL
PRESENTATION
OF
CHRONIC
PROGRESSIVE EXTERNAL OPHTHALMOPLEGIA
Szigeti, Andrea; Maka, Erika; Vamos, Rita; Toth,
Jeannette; Fodor, Magdolna; Hargitai, Janos; Szamosi,
Anna; Nagy, Zoltán Zsolt
Semmelweis University, Department of Ophthalmology,
HUNGARY
Purpose: Chronic progressive external ophthalmoplegia (CPEO) is
a rare mitochondrial myopathy characterized by slowly progressive
paralysis of the extraocular muscles. Patients usually experience
bilateral ptosis before developing symmetric, multidirectional
external ophthalmoplegia.
Case report: A 33-year-old woman with a 12-year history of slowly
progressive paralysis of the extraocular muscles and exotropia
was referred to our institute. Every action of extraocular muscles
was reduced in both eyes. She could not adduct and elevate and
there was only a slight abduction and depression function in both
eyes. The patient had no ptosis, neither exophthalmus. BCVA was
20/20 in both eyes. Slit lamp examination was normal. Dilated
funduscopic examination revealed slight pigment disturbance at the
retinal periphery. Visual field tests were normal. Electroretinography
showed lower borderline scotopic b-wave amplitudes. Laboratory
tests showed increased lactic acid and creatine phosphokinase
values. Brain and orbital magnetic resonance scans were normal.
Tensilon test excluded myasthenia gravis. We considered the
case as CPEO clinically, and mitochondrial DNA analysis revealed
a „common deletion” (nucleotid 8679-13447) of mtDNA. We
performed resection of the medial rectus muscle on both sides.
Histopathology showed an abnormal accumulation of enlarged
mitochondria in the sarcolemma (so called „ragged red fibres”)
with modified Mallory staining, which was further sustained by
immunohistochemistry with antimitrochondrial antibody.
Conclusions: Slowly progressive paralysis of the extraocular
muscles in CPEO, although rarely, may develop without preliminary
ptosis. In atypical cases the differential diagnosis is based on
mutation analysis of mtDNA and demonstration of abnormal
accumulation of enlarged mitochondria by histology and
immunohistochemistry.
96
ABSTRACTS: POSTERS
P69
ANTERIOR AND NASAL TRANSPOSITION OF THE
INFERIOR OBLIQUE MUSCLES
Teodorescu, Luminita; Velcea, Irina
OFTALMIX SOP Ophthalmology Clinic, București,
ROMANIA
Introduction: Anterior transposition of the inferior oblique (IOAT)
muscle has been used for the treatment of inferior oblique
overaction (IOOA) associated with dissociated vertical deviation
(DVD). One risk of this surgical procedure is that it may cause an
anti-elevation syndrome (AES), especially after “spread-out” or
“bunch up” technique. Also, in patients with IOOA +3 and DVD,
IOAT reduces the magnitude of DVD but IOOA may persist. Stager
D.R. suggested that placing the new IO muscle insertion nasal and
posterior to the nasal border of the IR rectus muscle: anterior and
nasal transposition (IOANT), will convert the IO muscle from an
extorter and elevator in adduction to an intorter and tonic depressor
in adduction. Also, IOANT was proposed as primary surgery in
patients with absent SO muscles.
Methods: 7 patients with IOOA and DVD, 1 patient with superior
oblique (SO) palsy, 1 case of absent SO muscle underwent ANTIO:
the anterior fibers of the IO muscle were inserted 2 mm nasal and
2 mm posterior to the nasal border of the inferior rectus muscle.
Results: DVD decreased from a mean value of 19,21 PD to 6,56
PD; in the case of absent SO muscle hypertropia decrease from 25
PD to 0. However, a poor result was noted in a patient with SO palsy
and large hypertropia.
Conclusions: IOANT converts the IO muscle into an intorter
and tonic depressor. In our patients it significantly reduced DVD
magnitude and globe elevation in adduction. This procedure seems
particularly useful in cases of absent SO muscle.
97
ABSTRACTS: POSTERS
P70
P71
THE INFLUENCE OF ANTI-VEGF TREATMENT ON
BINOCULAR VISION IN PATIENTS WITH AGERELATED MACULAR DEGENERATION
Uzdrowska, Marta1; Bilińska, Ewa2; Broniarczyk-Loba,
Anna1
1
Department of Binocular Vision Pathophysiology and
Strabismus, Medical University of Lodz, Lodz, POLAND
2
Department of Ophthalmology, University Hospital
No.1, Medical University of Lodz, Lodz, POLAND
PREVALENCE OF OCULOMOTOR ABNORMALITIES
IN PATIENTS SEEN AT A UNIVERSITY- BASED
HOSPITAL LOW VISION SERVICE IN BRAZIL
Vasconcelos, Galton Carvalho; Fernandes, Luciene
Chaves; Moura, Sarah Rogeria Martins; Lima, Ana
Luiza Avelar Morais
Universidade Federal de Minas Gerais (UFMG)
Ophthalmology and ENT department, BRAZIL
Purpose: The aim of this research was to assess the quality of
binocular vision in patients with age-related macular degeneration
(ARMD), as well as to evaluate the influence of treatment on
binocularity in these patients and on their subjective assessment
of life quality.
Method: Subjective assessment of visual acuity, simultaneous
perception, fusion and stereopsis was conducted before anti-VEGF
treatment and after the third intravitreal injection in a group of
patients with neovascular ARMD.
Results: The results of the study present two subgroups of
patients: a bigger one with partially preserved binocular vision
and a smaller one with suppression. After the treatment the
general number of patients with partially preserved binocular
vision increased. However, some patients with supression gained
at least simultaneous perception after the treatment, whereas
some patients with partially preserved binocular vision lost it after
the therapy. Improvement of visual acuity in the treated eye was
equivalent neither to improvement of binocular vision quality, nor to
subjective quality of life in patients after the therapy.
Conclusion: Impairment of central vision in ARMD does not
influence all levels of binocular vision in patients. The anti-VEGF
therapy has a significant impact on binocular vision status in treated
patients. However, changes in binocularity cannot be predicted solely
on the basis of visual acuity before and after treatment. Therefore
a standard vision examination in patients treated with anti-VEGF
agents should be extended by binocular vision evaluation. This
could help in arranging rehabilitation for these patients and might
improve their quality of life.
98
Purpose: To assess the prevalence and characteristics of
oculomotor abnormalities in patients with low vision, a crosssectional study was performed in 24 selected patients of the low
vision sector at Hospital São Geraldo HC, UFMG, from June to
December 2014. In addition to routine eye examination, all patients
underwent motor evaluation of strabismus. Deviations were
characterized as Esotropia, Exotropia and Hipertropia, measured
by Krimsky and classified according to their magnitude in small,
medium and large angles. The type of fixation was identified using
a visuscope and classified as central or eccentric.
Results: 24 patients met the inclusion criteria: age varied from
8-64 years old, 66.6% we’re female. 17 patients had strabismus
(70.8%), 11 with exotropia (45.8%), 6 with esotropia (25.0%) and
3 (12.5%) vertical deviations associated to horizontal component
As for the deviation angle, 76.5% were small to moderate and
23.5% had greater or equal deviation than 40 PD. The presence
of nystagmus was observed in 14 patients (58.3%). Only 4 (12.1%
had centric fixation located in the fovea.
Conclusion: The prevalence of strabismus and nystagmus in
patients with low vision was high, Exotropia being more frequent
than exotropia. Most patients showed eccentric fixation. Thus, we
consider highly relevant to include careful oculomotor examination
in the evaluation of low vision patients, before prescribing glasses
and/or adding low vision aids, which may help in better functional
response understanding in visual rehabilitation.
ABSTRACTS: POSTERS
P72
P73
CASE REPORT: MANAGEMENT OF RESTRICTIVE
SQUINT AND AMBLYOPIA IN MOEBIUS
SYNDROME
Volek, Éva; Maneschg, Otto A; Knézy, Krisztina; Maka,
Erika; Nagy, Zoltán Zs
Semmelweis University Dep.of Ophthalmology,
HUNGARY
TWO-STAGED
UNILATERAL
SURGICAL
CORRECTION
FOR
LARGE
EXOTROPIA
IN
BILATERAL
INTERNUCLEAR
OPHTHALMOPLEGIA(INO): CASE REPORT
Hye Bin Yim1, MD, Jun Myeong Yun1, MD, Kee Il Lee1,
MD, Hae Jung Paik2, MD
Department of Ophthalmology, The Catholic University
of Korea Incheon St. Mary’s Hospital, SOUTH KOREA1,
Department of Ophthalmology, Gachon University Gil
Medical Center, Incheon, SOUTH KOREA2
Purpose: case report.
Methods: We report a 5-year-old girl affected by Moebius
syndrome with absolute amotility of both eyes, persistent esotropic
strabismus fixus and amblyopia. From early childhood she got
amblyogenic treatment and at the age of 5, she underwent a
squint surgery. We evaluated and analyzed BCVA (best corrected
visual acuity), binocularity, motility of the eyes and the squint angle
pre- and postoperatively in a follow up time of 1 week, 1 month, 3
months and 1 year.
Results: From the age of 6 months she was regularly observed and
in timeframes of 3 months got an adequate alternated amblyogenic
treatment with eye patches. BCVA reached at the age of 3 years
1.0 on both eyes and remained stable during all the follow up time.
Binocular vision could not be restored. One week after surgery,
squint deviation was significantly reduced, the deviation angle was
estimated by Krimsky test, it was under 5º and remained stable
during the follow up time. Horizontal motility of the eyes improved
slightly, but vertical movements were still reduced.
Conclusions: Surgical management of restrictive squint in
Moebius syndrome represents a difficult treatment challenge, but
accurate operative procedures and amblyogenic treatment would
improve vision and patient’s quality of life.
Purpose: To evaluate the result of strabismus surgery in patient
with exotropia from bilateral INO in acute pons infarction.
Case: 65 years old male patient who had a history of acute cerebral
infarction in left postero-lateral pons visited out-patient clinic. After
infarction, constant diplopia developed especially in horizontal gaze.
Pre-operative alignment by APCT showed exotropia with 90 prism
diopters(PD) on the left eye at both distant and near fixation. He had
-4 graded adductive limitation on the both eye (from -1 to -4, -1
indicating minimal limitation and -4 indicating marked limitation).
Convergence power was minimally impaired and there was jerky
nystagmus in abducting eye. Initially, the patient underwent medial
rectus(MR) resection of 7 mm and a lateral rectus(LR) hang-back
recession of 10 mm on the left eye. After surgery, exotropia on the
right eye turned to be more prominent. Alignment by APCT was 45
PD on the right eye, adductive movement limitation was graded as
-1 on the left eye. 3 months later, He underwent MR resection of
6 mm and LR hang-back recession of 8 mm on the right eye. 3
months after two-staged operation, the patient showed no diplopia,
improved abducting nystagmus and measured nearly orthotropic
at distant and near fixation. Limitation of adductive movement was
graded as -1 on the both eye.
Conclusion: Our result suggests that two-staged unilateral
recession-resection surgery should be considered in patients with
large exotropia in bilateral INO
99
ABSTRACTS: POSTERS
P74
P075
ARE WE OVERLOOKING MASKED BILATERAL
CONGENITAL SUPERIOR OBLIQUE PALSY
IN CHILDREN AND IS IT EASY TO DIAGNOSE
BEFORE SURGERY?
Erkan Turan, Kadriye; Taylan Sekeroglu, Hande; Sanac,
Ali Sefik
Hacettepe University Faculty of Medicine Department
Of Ophthalmology, TURKEY
DIFFERENCES OF FUNDUS TORSION BETWEEN
CONGENITAL AND ACQUIRED UNILATERAL
SUPERIOR OBLIQUE PALSY
Kim, Dae Hee, Kim, Hyuna, Lim, Hyun Taek
1. Department of Ophthalmology, Seonam University,
College of Medicine, Myongji Hospital, Goyang-si,
Gyeonggi-do, Korea
2. Department of Ophthalmology, University of Ulsan
College of Medicine, Asan Medical Center, Seoul, Korea
Purpose: To determine the frequency of patients who had
subsequent contralateral inferior oblique overaction (IOOA) after
strabismus surgery for unilateral congenital superior oblique palsy
and to identify suggestive clinical features for masked bilateral
fourth nerve palsy.
Methods: The medical records of children who underwent inferior
oblique tenotomy as a single procedure for unilateral superior
oblique palsy were all reviewed. Diagnosis was based on evaluation
of ocular misalignment in 9 diagnostic gaze positions and presence
of abnormal head position.
Results: The study was conducted with 29 children (15 girls,
14 boys). All patients had unilateral (IOOA) and superior oblique
underaction. Eleven patients (37.9%) had hyperdeviation with
esodeviation of the affected eye while others (62.1%) had
hyperdeviation and exodeviation. The mean age at surgery was
6.66±1.87 (4 to 10) years. The mean horizontal-vertical deviations
and the amount of IOOA were decreased postoperatively (p<0.001
for all). Of the 29 patients, 22 had no residual IOOA, 2 had IOOA,
5 had inferior oblique underaction (IOUA) on the operated eye
at last visit. Three patients (10.3%) had contralateral IOOA and
hyperdeviation at last visit, one of whom had IOUA on the operated
eye. There was no difference on preoperative features between
patients with or without subsequent contralateral IOOA.
Conclusion: Bilateral superior oblique palsy may be overlooked and
should always be kept in mind in cases with unilateral pathology.
Particular care in testing and higher index of suspicion are required
to detect bilaterality especially for children.
100
Presenting Author
Kim, Dae Hee, MD
E-mail: [email protected]
Purpose: To investigate the differences of fundus torsion between
congenital and acquired unilateral superior oblique palsy. (USOP)
Methods: The retrospective review of medical records and fundus
photographs for a total of 157 patients diagnosed with USOP was
performed. Quantitative (disc-fovea angle; DFA) and qualitative data
(extorsion only in the paretic eye, only in the fellow eye and in both
eyes / no extorsion) of fundus torsion was collected. Comparison
between congenital and acquired USOP was performed.
Results: Ninety patients had congenital, and another 67 patients
had acquired etiology. In the paretic eyes, the size of DFA showed
no significant difference between the two groups. In the non-paretic
fellow eyes, by contrast, the size of DFA was significantly larger
in congenital than acquired USOP group. In addition, regarding
the frequency of the fundus extorsion in these fellow eyes, the
congenital group disclosed it more frequently than the acquired
group.
Conclusion: The patients with congenital USOP showed more
frequent fundus extorsion in the non-paretic fellow eyes than those
with acquired USOP. Significant differences were found between
congenital and acquired superior oblique palsy in terms of the
amount as well as the frequency of fundus torsion in the nonparetic fellow eyes, although that is not the case in the paretic eyes.
Fundus torsional data may be helpful in discriminating congenital
and acquired USOP.
ABSTRACTS: POSTERS
P76
ANALYSIS ON A NEW SCALE FOR ASSESSING
THE LEVEL OF CONTROL IN INTERMITTENT
EXOTROPIA BASED ON OBJECTIVE FINDINGS
Hyuna Kim, MD, Dae Hee Kim, MD, Hyosook Ahn, MD,
PhD, Hyun Taek Lim, MD, PhD
Department of Ophthalmology, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, South
Korea
Purpose: To prospectively evaluate a new scale for assessing the
level of control in children with intermittent exotropia based on
objective findings, consists of 2 sessions of determining whether
exotropia was manifested or not for 10 seconds.
Methods: A total of 10 children with intermittent exotropia were
evaluated by a new scale to assess the level of control for both
distance and near fixation. Each examination was recorded and
rated individually by 6 ophthalmologists using computer-based
assessment program. The distance score (0 to 4) was combined
with the near score (0 to 4) to yield an overall control score from 0
to 8. The inter-observer reliability of 6 raters was evaluated.
Results: The mean age of enrolled patients was 6.0 ± 2.8 years
and mean deviation was 23.8 ± 7.3 prism diopters (PD) at distance,
24.1 ± 7.5 PD at near. The median score at distance (3) was worse
than at near (1). A bimodal distribution was presented in overall
control score (median of 4). Inter-observer agreement at distance
and near were moderate (Kappa= 0.481 and Kappa=0.551
respectively).
Conclusions: This new scale for assessing control in children
with intermittent exotropia is a reliable method which can be easily
applied, requires only 1 minute for each patient in the office setting.
101
AUTHORS INDEX
Name
Page
A
Abu-Amero, Khaled K
Adams, Gill
Agagulyan, Satenik
Agin, Abdullah
Ahn, Hyosook
Akar, Serpil
Akca Bayar, Sezin
Alan, Aydin
Alarcón Tomás, María
Alenazy, Badriah R
Alotaibi, Abdullah
Aloui, Tarak
Alp, Mehmet Hanifi
Altintas, Ozgul
Amirova, Aziza
An, Seoung Hyun
Anticic, Marija
Antsiferova, Natalya G
Armesto, Alejandro I
Atalay, Hatice T
Atamanov, Vasiliy V
Aubert-Brenugat, Valerie
Auckburraly, Mehran
Aygit, Ebru D
Aznauryan, Erik
Aznauryan, Igor
21, 61
14, 15, 19, 50
21, 63
22, 70
25, 101
18, 18, 21, 22, 44, 48,
61, 71
14, 21, 30, 61
16, 55
16, 54
21, 61
21, 61
21, 64
16, 55
21, 62
23, 81
24, 91
15, 36
24, 88, 90
14, 33
21, 62
24, 88
16, 53
23, 83
18, 21, 22, 23, 44, 45,
48, 63, 71, 74, 85, 86
21, 63
21, 63
B
Balasanyan, Victoria
Balica, Faruk
Basarir, Berna
Basgil Pasaoglu, Isil
Bayar, Sezin Akca
Benzimra, James
Bereg, Edit
Berkes, Szilvia
Berta, András
Bialas-Niedziela, Dorota
Bianchi, Federica
Bilgihan, Kamil
Bilinska, Ewa
Bohac, Maja
Boichuk, Iryna M
102
21, 63
15, 34
18, 23, 45, 86
22, 74
18, 48
19, 51
22, 75
21, 64
23, 84
24, 92
24, 91
21, 62
25, 98
15, 36
21, 64
Name
Page
Bonne, Max
Boyd, Heather A
Brodsky, Michael C
Broniarczyk-Loba, Anna
Buckley, David
Bujak, Dominika
Bukala-Mroczek, Anna
16, 17, 55
19, 50
18, 47
13, 14, 25, 28, 32, 98
15, 36
17
24, 88
C
C Özmen, Mehmet
Carneiro, Ines
Casal, Ines
Celik, Onur Sinan
Celik, Tuba
Ceylan, Tolga
Chaudhuri, Zia
Chernyavskaya, Mariya A
Chernykh, Valeriy V
Cho, Yoonae A
Choi, Dong Gyu
Choi, Eun Young
Choi, Hee-Young
Choi, Soo-Youn
Cioplean, Daniela
Ciubotaru, Andreea
Coelho, Joao
Costet, Christine
Czirjak, Sandor
21, 62
17, 21, 23, 58, 65, 83
13, 27, 65
21, 62
21, 66
16, 55
16, 18, 19, 39, 46, 49
24, 88
17, 56
22, 25, 73, 95
21, 67
22, 77
22, 76
25, 95
16
14, 32
13, 17, 27, 58
15
23, 82
D
Davis, Helen
Dawidowsky, Barbara
De Pablo, Lucía
de Vries, Jeroen J
Del Porto, Lana
Demer, Joseph
Di Croce, Valentina
Dias, David A
Dickman, Anna
Dinc, Erdem
Donnachie, Alice
Drimtzias, Evangelos
Dujardin, Leticia R
Dupré Peláez, Mauro
15, 36
21, 67
22, 72
17, 58
19, 50
14, 18, 46
14, 31
13, 27, 59
15
24, 93
15, 36
16, 39
19, 51
16, 54
AUTHORS INDEX
Name
Page
E
Ecel, Mahmut
Eckstein, Anja
Ehrt, Oliver
El Adawy, Ibrahim T
Eltoukhi, Elsayed Mohamed
Eltutar, Kadir
England, Laura C
Eraldemir, Fatma Ceyla
Erkan Turan, Kadriye
Erkul, Sezin O
23, 84
22, 70
21, 61
22, 74
25, 98
22, 71
22, 72
22, 23, 25, 76, 80,
84, 96
Gomez de Liano, Rosario
Graf, Michael
Grant, Simon
Gravier, Nicolas
Grover, Renu
Guepratte, Nathalie
Gurbanova, Nigar
Gurkan, Sedat
Guyton, David
Ha, Suk-Gyu
Haargaard, Brigitte
Hakim, Ossama
Han, Jinu
Han, Seung-Han
Han, So Young
Hanna, Kerry
Hargitai, Janos
Hasanzade, Lamiya
Hashemi, Hassan
Haugen, Olav H
Heo, Hwan
Hepworth, Lauren
Hesgaard, Helena Buch
Hinds, Anne-Marie
Holmes, Jonathan M
Holst, Inger
Hoole, Janicek
Hopinca, Andreea
Houtman, Anne Cees
Howard, Claire
22, 25, 73, 95
19, 50
18, 47
16, 22, 54, 77
16, 22, 54, 77
22, 77
16, 40
25, 96
23, 81
22, 70
14
22, 73
16, 40
15, 37
19, 50
15, 19, 50
15, 37
16, 39
14, 32
16, 38
16, 40
I
G
Gabric, Nikica
Gain, Philippe
Galatoire, Oliver
Garami, Miklós
Garcia Garcia, Miguel
Garrido, Cristina
Gerosa, Giulia
Goberville, Mitra
Godts, Daisy
Gokce, Berna
Gokyigit, Birsen
Page
H
24, 93
14
16
18, 43
21, 68
25, 95
21, 69
21, 62
21, 22, 25, 69, 70, 100
25, 95
F
Facskó, Andrea
Farahi, Azadeh
Fawazi, Samah M
Fazil, Korhan
Fernandes, Luciene Chaves
Fernández Agrafojo, Dora
Fernández-Vigo, José I
Fodor, Magdolna
Name
15, 36
23, 83
14
23, 82
16, 54
21, 65
17, 24, 57, 87
18, 44
13, 17, 28
15, 17, 37, 43
18, 18, 21, 22, 22, 23,
44, 45, 48, 61, 63, 71,
74, 85, 86
14, 16, 16, 22, 53,
54, 72
18, 45
15
16, 16, 18, 41, 46, 53
22, 72
18, 44
23, 81
25, 95
14
Inal, Asli
Inal, Berkay
Iosub, Ionela Geanina
Ismail, Mohamed
18, 21, 22, 22, 23, 44,
45, 63, 71, 74, 85, 86
22, 74
14, 32
21, 68
J
Jablonska, Anna
Jain, Rajesh
Jakubaszek, Aleksandra
Janaky, Marta
Jang, Sungmin
Janossy, Agnes
Jarc Vidmar, Martina
Jeon, Hyeshin
Jibin, John
Juhász, Éva
Jullienne, Remy
Jung, Jaeho
24, 92
16, 39
24, 88
22, 24, 75, 94
25, 95
22, 24, 75, 94
22, 75
22, 76
19, 49
22, 23, 76, 80
23, 83
22, 76
103
AUTHORS INDEX
Name
Page
K
Kaeser, Francois
Kaminskyy, Yuriy
Kan, Emrah
Kang, Hyun Goo
Karaman, Hatice
Kashenko, Tamara Pavlovna
Kecik, Dariusz
Kilic, Meltem
Kim, Dae Hee
Kim, Eunbi
Kim, Hyuna
Kim, Min-Su
Kim, Mirae
Kim, Myung-Mi
Kim, Seung-Hyun
Kim, Su Jin
Kim, Won-Jae
Kirandi, Ece
Kiss, Huba
Klaehn, Lindsay
Klobucar, Aleksandra
Knézy, Krisztina
Kocamaz, Murat
Kosec, Dragica
Krivosic, Valerie
Krzeski, Antoni
Kum, Tugba
Kun, Lídia
Kuzhda, Iryna
Kyung, Sungeun
16
23, 80
16, 55
16, 22, 54, 77
24, 92
24, 89
24, 92
21, 69
25, 25, 100, 101
21, 67
25, 25, 100, 101
23, 82
22, 77
22, 77
22, 25, 73, 95
22, 23, 78
22, 77
21, 61
22, 23, 76, 80, 84
18, 47
21, 67
14, 22, 23, 23, 25, 33,
76, 79, 80, 84, 99
21, 63
22, 24, 75, 90
18, 44
24, 92
21, 62
22, 23, 23, 76, 80, 84
23, 80
23, 81
L
La Cour, Morten
La Roche, G Robert
Lages, Vania
Larionova, Yuliya A
Lebranchu, Pierre
Lee, Kee II
Lee, Sang Gon
Lee, Seung UK
Lee, Yeonhee
Lim, Hyun Taek
Lima, Ana Luiza Avelar Morais
Lindberg, Laura
104
15, 37
18, 46
13, 17, 27, 58
17, 56
16, 23, 83
25, 99
22, 78
22, 23, 78
23, 82
25, 101
25, 98
18
Name
Page
Loba, Piotr
Loenkvist, Claes S
Lorenz, Birgit
Lovric, Tena
Lukacevic, Selma
13, 14, 28, 32
17, 42
18, 45
17, 59
15, 36
M
Macau, Mihaela
Maia, Sofia
Maka, Erika
Malenica Ravlic, Maja
Malheiro, Luisa
Mamulat, Darya R
Maneschg, Otto A
Manoli, Pierre
Marcon, Giovanni B
Marsh, Ian
Martín, Pedro
Melbye, Mads
Menéres, Pedro
Mihályi, Dorottya
Miranda, Vasco
Mohney, Brian G
Moon, Nam Ju
Morales, Hari
Morales, Laura
Moura, Sarah Rogeria Martins
Mravicic, Ivana
Mustafayeva, Dursun
Mutlu, Oguz
14, 32
21, 23, 65, 83
14, 22, 23, 23, 25, 33,
76, 79, 80, 82, 84,
96, 99
17, 59
13, 21, 23, 27, 65, 83
24, 88, 90
14, 22, 23, 25, 33, 76,
80, 84, 99
23, 83
15, 18, 48
16
22, 71
19, 50
13, 17, 21, 23, 27, 58,
59, 65, 83
23, 84
13, 17, 21, 23, 27, 58,
59, 65, 83
18
21, 67
22, 71
22, 72
25, 98
15, 36
23, 81
21, 62
N
Nagpal, Manisha
Nagy, Annamária
Nagy, Zoltán Zsolt
Nobili, Roberta
16, 39
23, 84
14, 22, 23, 25, 33, 76,
79, 80, 82, 84, 96, 99
17, 24, 57, 87
O
Ocak, Osman B
Okuyaz, Cetin
Olie, Lisette
18, 22, 23, 44, 45, 71,
74, 85, 86
24, 93
17, 58
AUTHORS INDEX
Name
Page
Osmanbasoglu, Ozen A
Oto, Sibel
Ozcelik, Ferah
Ozdemir, Fatma E
Ozturk Karabulut, Gamze
Özkan, Seyhan B
Özsaygili, Cemal
25, 95
14, 18, 21, 30, 48, 61
23, 85
25, 95
23, 86
14, 15, 34
21, 62
P
Paik(Baek), Hae Jung
Paris, Vincent
Park, Changeum
Park, Yong Seok
Parlakgunes, Zeynep
Parreira, Ricardo
Pechereau, Alain
Pék, Anita
Petrovski, Goran
Piantanida, Andrea C
Pinarci, Eylem Yaman
Pittino, Raffaele
Pityk, Olena
Plager, David
Plisov, Igor L
Podedworny-Chustecka,
Agnieszka
Polyanskaya, Elena
Pott, Jan Willem R
Proudlock, Frank
Puncholothu, Akila K
Puzyrevskiy, Konstantin G
24, 25, 86, 99
16
23, 78
22, 73
15, 17, 37, 43
13, 17, 21, 23, 27, 58,
59, 65, 83
15, 23, 83
23, 79
23, 84
17, 24, 57, 87
18, 48
18, 48
23, 80
14, 16
17, 24, 24, 56, 87,
88, 90
24, 88
24, 89
17, 58
15
19, 49
24, 89, 90
Q
Quinn, Annika S
Quinn, Anthony G
19, 51
19, 51
R
Rahne, Ingrid
Raoof, Naz
Rijpman, Kristie
Rowe, Fiona J
Rudas, Gábor
Rusu, Oana
Rusu, Reluca M
Ryu, Won Yeol
22, 24, 75, 90
17, 42
17, 58
16, 17, 40
23, 82
14, 30
14, 30
24, 91
Name
Page
S
Sabetti, Lelio
Sami, Aya
Samsel, Agnieszka
Sanac, Ali Sefik
Sari, Ayca
Satana, Banu
Satinder, Aneja
Sato, Miho
Saunte, Jon Peiter
Schiavi, Costantino
Schittkowski, Michael
Schworm, Hermann
Sényi, Katalin
Serdiuchenko, Vira
Serfozo, Csilla
Sevan, Simona A
Shafieva, Jamila
Sharma, Ajay
Simiera, Justyna
Simmons, Ian G
Simonsz, Herb
Simonsz, Huibert J
Skaliczky, Zoltán
Skotte, Line
Skunca Heman, Jelena
Sloot, Frea
Sloper, John
Sohar, Nicolette
Song, Young Jin
Soproni, Anna
Spera, Manuela
Spielmann, Alain C
Stavis, Monte I
Sudi, Patel
Suh, Young-Woo
Sultan, Pinar
Szala, Ewa
Szamosi, Anna
Szatmári-Tóth, Mária
Szigeti, Andrea
24, 91
24, 92
24, 24, 88, 92
21, 22, 25, 69, 70, 100
24, 93
23, 85
19, 49
16
15, 16, 17, 17, 38,
42, 55
14, 31
14
18
22, 23, 76, 80, 84
23, 24, 80, 93, 94
13, 29
14, 30
23, 81
19, 49
13, 14, 28, 32
16, 39
24, 92
13, 29
23, 79
19, 50
17, 59
13, 24, 29, 92
17, 42
22, 24, 75, 94
24, 91
13, 29
17, 24, 57, 87
16, 41
15, 35
15, 36
22, 25, 73, 95
25, 95
24, 88
22, 23, 25, 76, 80,
84, 96
23, 84
22, 23, 25, 76, 80,
84, 96
105
AUTHORS INDEX
Name
Page
T
Tadic, Raseljka
Taskapili, Muhittin
Tassi, Filippo
Tátrai, Erika
Taylan Sekeroglu, Hande
Ten Tusscher, Marcel P
Teodorescu, Luminita
Thelma, B K
Thuret, Gilles
Timms, Chris
Toporkov, Igor A
Torp-Pedersen, Tobias
Tóth, Georgina
Toth, Jeannette
Tremblay, Francois
14, 33
25, 98
V
Vaidya, Bijay
Vamos, Rita
Vasconcelos, Galton
Vatavuk, Zoran
Vaulin, Michael A
Velcea, Irina
Ventura, Néstor
Vinding, Troels
Vladutiu, Cristina
Volek, Éva
19, 51
25, 96
18, 25, 98
17, 59
17, 56
25, 97
22, 72
15, 37
14, 30
14, 25, 33, 99
W
Wasmann, Rosemarie
Williams, Lindsi C
Wohlfahrt, Jan
Wolsing, Lone
106
Page
Y
17, 59
21, 63
14, 31
23, 79
21, 22, 25, 69, 70, 100
16, 38
25, 97
19, 49
23, 83
17
24, 88
15, 19, 38, 50
22, 23, 76, 80, 84
25, 96
18, 46
U
Ugrin, Maria C
Uzdrowska, Marta
Name
17, 58
21, 69
19, 50
15, 38
Yakar, Konuralp
Yemchenko, Victor
Yim, Hae Bin
Yoon, Jin Sook
Yun, Jun Myeong
Yurttaser Ocak, Serap
Yüce, Aslihan
Yüksel, Erdem
16, 55
24, 94
24, 25, 86, 99
16, 54
25, 99
22, 74
14, 30
21, 62
Z
Zheliznyk, Mariia
Ziylan, Sule
24, 93
15, 17, 18, 37, 43
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