Browsing by Subject "strabismus surgery"

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    Postoperative infection following strabismus surgery: case series and increased incidence in a single large referral center
    (Elsevier, 2019) House, Robert J.; Rotruck, Jill C.; Enyedi, Laura B.; Wallace, David K.; Saleh, Ezzeldin; Freedman, Sharon F.; Ophthalmology, School of Medicine
    Purpose To identify and analyze cases of postoperative infection following strabismus surgery at a large referral center and to report the incidence, risk factors, and outcomes. Methods An electronic database search identified strabismus procedures at Duke Eye Center from July 1996 to October 2017. Diagnosis codes for periocular infections were used to further identify patients with possible infections following strabismus surgery. Results Of 9,111 strabismus surgeries, 13 (0.14%) met criteria for probable infection, all occurring since October 2012 (0/6580 before vs 13/2531 [0.51%] after; P < 0.0001). Mean age of infection cases was 11.4 years; 11 patients (85%) were under 18 years of age. Associated previous diagnoses were genetic abnormalities with associated developmental delay (n = 5 [38%]), previous skin or ear infection (n = 4 [31%]), and acute or chronic rhinitis (n = 3 [23%]). Infection site cultures revealed methicillin-resistant Staphylococcus aureus (n = 3 [23%]), methicillin-sensitive S. aureus (n = 3 [23%]), and Streptococcus pyogenes/group-A Streptococcus (n = 2 [15%]). Only 1 case had bilateral infection. Infection remained extraocular in all cases, but one eye lost light perception secondary to optic atrophy. No common surgeon/procedure/preparation-related risks were identified. Conclusions A unifying explanation for the increase in post–strabismus surgery infections at Duke Eye Center was not identified. Potential risk factors include age <18 years, developmental delay, immune compromise, preceding nonocular infection, and bacterial colonization.
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    A prospective study of treatments for adult-onset divergence insufficiency–type esotropia
    (Elsevier, 2021-08) Crouch, Eric R.; Dean, Trevano W.; Kraker, Raymond T.; Miller, Aaron M.; Kraus, Courtney L.; Gunton, Kammi B.; Repka, Michael X.; Marsh, Justin D.; Del Monte, Monte A.; Luke, Paula A.; Peragallo, Jason H.; Lee, Katherine A.; Wheeler, Maynard B.; Daley, Timothy J.; Wallace, David K.; Cotter, Susan A.; Holmes, Jonathan M.; Ophthalmology, School of Medicine
    Purpose To describe 10-week and 12-month outcomes following treatment for divergence insufficiency–type esotropia in adults. Methods In this prospective observational study, 110 adults with divergence insufficiency–type esotropia, with a distance esodeviation measuring 2Δ to 30Δ and at least 25% larger at distance than near, and binocular diplopia present at least “sometimes” at distance, were enrolled at 28 sites when initiating new treatment. Surgery, prism, or divergence exercises/therapy were chosen at the investigator’s discretion. Diplopia was assessed at enrollment and at 10-week and 12-month outcome examinations using a standardized diplopia questionnaire (DQ). Success was defined as DQ responses of “rarely” or “never” when looking straight ahead in the distance, with no alternative treatment initiated. Results Of the 110 participants, 32 (29%) were prescribed base-out prism; none had received prior treatment for esotropia. Success criteria were met by 22 of 30 at 10 weeks (73%; 95% CI, 54%-88%) and by 16 of 26 at 12 months (62%; 95% CI, 41%-80%). For the 76 (68%) who underwent strabismus surgery (82% of whom had been previously treated with prism), success criteria were met by 69 of 74 at 10 weeks (93%; 95% CI, 85%-98%) and by 57 of 72 at 12 months (79%; 95% CI, 68%-88%). Conclusions In this study cohort, both base-out prism as initial therapy and strabismus surgery (usually following prism) were successful in treating diplopia for most adults with divergence insufficiency–type esotropia when assessed during the first year of follow-up.