TL;DR
The case of a 15-year-old boy with esotropia and functional suppression scotoma, also known as binocular haploscopic suppression, which interferes with binocular vision restoration and reduces the effectiveness of diploptic treatment is presented.
Surgical correction of longstanding childhood exotropia in adults has traditionally been regarded as a cosmetic procedure with limited potential for restoring binocular vision. However, published evidence suggests that functional improvement, including recovery of stereopsis in selected patients, may also be achieved. This critical review evaluates the available evidence regarding postoperative binocular vision, stereopsis, sensory fusion, and health-related quality of life (HRQOL). The strengths and limitations of the published studies, together with factors influencing surgical outcomes, are critically discussed. Although the available evidence is limited by relatively small study populations and methodological heterogeneity, most studies report improvements in ocular alignment, binocular function, and quality of life following successful surgery. The findings suggest that adult strabismus surgery may provide functional as well as cosmetic benefits. Further well-designed studies are needed to strengthen the evidence base.
Luminopia demonstrated significant improvements in Registry patients with severe amblyopia, particularly in treatment-naive patients, supporting its use as a viable treatment option that may address key limitations of traditional approaches.
PURPOSE To describe a specific pattern of esotropia observed in myopic patients occurring exclusively while wearing refractive correction despite a normal accommodative convergence / accommodation (AC/A) ratio and to evaluate the efficacy of its management. METHODS This is a retrospective study which included children and young adults with high myopia who presented with esotropia with spectacles or contact lenses correction only, and orthophoria or near orthophoria without optical correction. AC/A ratio was measured using gradient method. Ductions and versions were evaluated. The angles of deviations were measured with and without optical correction, for both distance and near. Magnetic resonance imaging of the extraocular muscles was performed. The target angle for surgical correction was the preoperative angle of esotropia at distance with spectacle correction, and the changes in the angles of deviation after surgery were evaluated. RESULTS Nine patients were identified. The mean age at presentation was 13.6 ± 5.2 years; 6 patients were females (66.7%). The mean angle of esotropia with optical correction was 44 ± 5 PD for distance and 43 ± 4 PD for near. The mean angle of esotropia for near without optical correction was 4 ± 3 PD. Mean spherical equivalent was -10.6 ± 1.8 Diopters. All patients underwent bilateral medial rectus muscle recession. Mean medial muscle recession was 6.9 ± 0.4 mm. Mean follow up was 8 ± 4 months. Successful outcome was achieved in 8 patients, one patient had residual esotropia of 25 PD. None of the patients developed exotropia without glasses after surgery. CONCLUSION Esotropia in myopic patients may appear only with optical correction, including glasses or contact lenses. The exact cause of the absence of esotropia without optical correction cannot be confirmed but cannot be attributed to a high AC/A ratio. These patients benefit from bilateral medial rectus recession similar to those who have esotropia without optical correction, without carrying the risk of overcorrection without spectacles or contact lenses.
Highlights What are the main findings? Long-term ocular alignment was successfully achieved in approximately two-thirds of children with cerebral palsy following individualized interventional treatment. Consecutive exotropia occurred exclusively after treatment of esotropia, whereas residual deviation was significantly more common after exotropia treatment. What are the implications of the main findings? Children with cerebral palsy require long-term postoperative follow-up because ocular alignment may change substantially over time. Individualized treatment strategies, including strabismus surgery with or without Botulinum toxin A, can provide satisfactory long-term outcomes, although postoperative alignment instability remains an important clinical challenge. Abstract Background/Objectives: To evaluate the long-term outcomes of strabismus treatment in children with cerebral palsy (CP) and to investigate factors associated with postoperative alignment success and the development of consecutive strabismus. Methods: The retrospective, single-center study included 73 children with CP and strabismus who were followed from January 2015 to December 2024. Demographic characteristics, ophthalmological findings, treatment methods, and postoperative outcomes were assessed. Ocular deviation was measured through prism and alternate cover testing or a modified Krimsky test, and surgical success was defined as a final deviation of ≤10 prism diopters (PD). Patients were assessed at the patient level. Comparisons between exotropic and esotropic patients and between patients who had consecutive exotropia and those who had successful alignment were made using appropriate statistical tests. Results: Study participants included 55 patients with esotropia (75.3%) and 18 patients with exotropia (24.7%). The mean follow-up period was 32.6 ± 7.18 months. A successful ocular alignment was achieved in 32 of 46 patients (69.6%) with esotropia and in 10 of 17 patients (58.8%) with exotropia following surgical treatment and/or BTA. Consecutive exotropia developed exclusively in patients initially treated for esotropia (39.1% vs. 0%, p = 0.001). Patients with consecutive exotropia underwent surgery at a younger age and had larger preoperative deviation angles than those who had successful alignment, but these differences were not statistically significant. Conclusions: Strabismus treatment provides satisfactory long-term motor alignment in many children with cerebral palsy. However, consecutive exotropia following esotropia surgery remains a common postoperative condition and is the principal source of alignment instability in this population. Younger surgical age and larger preoperative deviations were more common among patients with consecutive exotropia, but no statistically significant associations between the evaluated clinical variables and consecutive exotropia were identified in the exploratory univariate analyses.
SMILE with micro-monovision had an impact on accommodative function in the early postoperative stage in myopic patients with presbyopia, and patients exhibited good distance and near vision, maintained binocular visual functions, and reported high subjective satisfaction.