Orbital cellulitis complicating strabismus surgery: a case report and review of the literature.

Orbital cellulitis is a rarely reported, but potentially vision- and life-threatening complication after strabismus surgery. To date, only seven cases of orbital cellulitis complicating strabismus surgery have been reported in the world literature, and only two cases were reported in adult patients, both occurring more than 100 years ago. We describe a case of unilateral orbital cellulitis after bilateral strabismus surgery in an adult. Early diagnosis (aided by computed tomography) and aggressive intravenous antibiotic therapy resulted in a favorable visual outcome. Diagnosis and management are discussed, and this case is compared with previous cases in the literature.     

Orbital Cellulitis after Faden Operation on the Medial Rectus

Background Orbital cellulitis after strabismus surgery is uncommon, may cause blindness and may lead to death. Very few cases have been described in detail due to the low incidence of this complication. Methods We report the first case of orbital cellulitis following Faden operation on the medial rectus muscle. We believe that the infection was due to asymptomatic ethmoid sinusitis. Our case is compared with other cases previously reported. Results A two-year-old boy was surgically treated for residual esotropia after two botulinum toxin A injections. Two days after surgery, signs of orbital cellulitis developed in his right orbit. CT-scan disclosed right ethmoid sinusitis that spread to the orbit after surgery. After intravenous antibiotic treatment, the infection resolved with full restoration of visual acuity and ocular motility. Conclusion Despite adequate measures to prevent infection, orbital cellulitis may complicate strabismus surgery. Patients must be instructed to recognize early symptoms of this severe infection and call the surgeon immediately. Diagnosis may be confirmed by CT-scanning of the orbits. Prompt treatment with intravenous antibiotics usually leads to full recovery.     

Orbital cellulitis following surgery of strabismus

The authors report a case of orbital cellulitis after strabismus surgery. Diagnosis was confirmed by computerized tomography. Subsequent therapy and follow-up are discussed. Attention is drawn to the importance of this syndrome.     

Infected conjunctival pyogenic granuloma at strabismus surgery site mimicking conjunctival abscess

We present a rare case of infected pyogenic conjunctival granuloma mimicking a conjunctival abscess as complication of strabismus surgery in a Saudi girl with exotropia. Despite administration of local antibiotics following strabismus surgery, a patient presented with localised redness and discharge after three weeks. The patient was afebrile with no signs of pre-septal or orbital cellulitis. After culture (Staphylococcus aureus) sensitivity testing the patient was prescribed oral Amoxicillin and Clavulanate and reviewed under general anaesthesia. A 55?mm² conjunctival pyogenic granuloma was noted. A punch biopsy specimen indicated inflammatory and histiocytic cells. The addition of steroid to the medical therapy resulted in a quiet eye after three weeks.     

Blinding orbital cellulitis: a complication of strabismus surgery

A 56-year-old healthy man underwent left medial rectus recession and lateral rectus resection for esotropia. The next day he developed severe left periocular pain with decreased vision, an afferent pupillary defect, periorbital edema, limited ocular motility, and proptosis. Computed tomography showed fat stranding and less than 90 degrees of posterior globe tenting. Despite intravenous antibiotics to treat orbital cellulitis, and a lateral canthotomy and cantholysis to decompress the orbit, visual acuity worsened to no light perception. The patient underwent emergent orbital decompression including release of the superior and inferior septum and outfracturing of the orbital floor and medial wall; however, there was no recovery of vision. Blinding orbital cellulitis is a rare complication after strabismus surgery. Despite poor prognosis, prompt diagnosis and aggressive treatment may maximize visual potential.     

Needle sterility during strabismus surgery.

BACKGROUND: Infection after strabismus surgery is uncommon and its cause remains unanswered. The source of the bacteria and the manner in which it enters the eye is often unknown. Most pediatric ophthalmologists now use 5% povidone-iodine to reduce the bacterial population before surgery. The needles used during strabismus surgery may be a source of bacterial contamination. METHODS: One hundred six needles were cultured after their use in strabismus surgery. RESULTS: Sixteen of 106 needles (15.1%) and 15 of 61 cases (24.6%) were culture positive. The organisms recovered closely resembled indigenous bacterial flora. CONCLUSION: This study suggests that the needles used during strabismus surgery may be the source of bacteria that can lead to infections after strabismus surgery.     

白内障术中局部注射麻醉导致的术后斜视及治疗

目的 在白内障手术中因球后或球周麻醉时药物可能导致眼外肌毒性而产生术后斜视及治疗.方法 对5例局部麻醉白内障术后患者,均于术后第一天去除眼罩时发现复视.于白内障术后3个月后在全麻下行受累肌肉的后徙及可调节缝线手术.结果 白内障术中局部注射布比卡因导致的眼肌麻痹于术后即发复视并持续存在.在观察病例中2例上直肌受累、3例下直肌受累.4例左眼,1例右眼.在受累肌肉行足量的肌肉后徙并可调节缝线,术后大部分注视方向复视消失,眼位调正.结论 白内障术后斜视应当注意到术中局麻药物肌肉毒性所致的斜视.早期由于肌肉麻痹产生复视,后期由于肌肉纤维化和(或)肥大产生与初始复视相反方向的复视.对受累肌肉的足量后徙和可调节缝线可以获得满意的术后效果.     

The fat adherence syndrome and strabismus after retina surgery

The etiology of persistent strabismus after retina surgery has been poorly understood. Seven patients with acquired restrictive strabismus after retina surgery were surgically explored for the cause of the strabismus. In each case, the fat adherence syndrome was identified as playing a significant role in causing the restriction. In four patients, restriction secondary to the fat adherence syndrome was the sole cause of the strabismus. Other contributing causes included a misplaced muscle in two patients and a sponge under a muscle in one patient. Our conclusion is that the fat adherence syndrome is an important cause of restrictive strabismus after retina surgery and that this complication can be minimized by avoiding surgical maneuvers that violate Tenon's capsule and expose extraconal fat.     

Giant orbital cysts after strabismus surgery

PURPOSE: To describe a rarely reported complication of strabismus surgery. DESIGN: Observational case series. METHODS: A review of four eyes in three patients with orbital cysts following strabismus surgery. RESULTS: Each patient had either a symptomatic strabismus or visible mass that brought them to medical attention many years, often decades after surgery (mean 34 years). All had some degree of incomitancy. During surgery, all cysts were found to be associated with the involved rectus muscle. CONCLUSIONS: Orbital cysts are a rarely recognized complication of strabismus surgery. However, it should be considered in the differential of orbital cysts after strabismus surgery because of the risk of muscle damage during surgical excision.     

眼外肌注射肉毒毒素及布比卡因治疗斜视

斜视的眼外肌药物注射疗法相比于斜视矫正手术具有更加安全、微创、麻醉时间短、术后疼痛轻、患者易于接受等优点。目前应用最广泛的减弱眼外肌力量的药物为肉毒毒素，其对小角度斜视、鼻内窥镜术后斜视、斜视矫正手术的辅助治疗等有重要作用；有效地增强肌肉力量的药物为布比卡因，其对小角度的共同性斜视、非陈旧性麻痹性斜视早期有治疗作用；肉毒素及布比卡因联合注射可对中等角度的水平共同性斜视、非陈旧性麻痹性斜视早期有较好治疗效果。（国际眼科纵览， 2018,  42:   169-174）     

儿童斜视矫正术后的立体视觉

本文报告１６８例儿童斜视术后有６０例获得立体视觉，功能治愈率达３５．７％。结果表明：斜视儿童术后立体视恢复与手术年龄、斜视度大小和术后眼位矫正程度等因素密切相关（Ｐ＜０．０１）。作者认为，手术时机的最佳选择取决于斜视类型和儿童初诊年龄。手术正位率是立体视重建和恢复的必不可少的因素。     

共同性斜视术后复视的临床观察

目的：观察共同性斜视术后复视发生率及消失时间。方法：对456例共同性斜视术后行复视检查,分析术后复视发生率及消失时间。结果：共同性斜视术后复视发生率为665,消失时间3天－60天,平均11．6天,术后复视及消失时间与斜视类型、术后眼位、视网膜对应及隔合范围有关,与手术年龄无关,但手术年龄大者术后复视较难耐受,且消退时间较长。结论：共同性斜视术后复视发生率较高,但持续不退者极少。     

斜视手术前后双眼视觉的临床研究

目的探讨斜视对双眼视觉的影响及不同双眼视检查方法的评价。方法89例共同性斜视分为间歇性外斜、恒定性外斜及恒定性内斜3组。定量测量斜视度；检查双眼视觉状态及视网膜对应情况；测定远近立体视锐度。并观察斜视手术前及手术后1周、1月的斜视度、双眼视觉状态及远、近立体视锐度变化。结果3组术后双眼视功能较术前均有明显改善（P〈0．05），术后1周与1月双眼视功能的差异无统计学意义（P〉0．05）；恒定性斜视术后立体视恢复好于间歇性外斜视，且近立体视恢复好于表视；立体视检查非随机点画片（Titmus与Optec3500）与随机点画片（TNO）检查结果的差异有统计学意义（P〈0．05）；线状镜较Worth四点检测阳性率高；大于9岁患者术后双眼视觉较术前增加32％。结论斜视手术是恢复、重建双眼视觉的有效方法，不同检测方法结果不一致，需综合考虑。     

Infected epithelial inclusion cyst mimicking subconjunctival abscess after strabismus surgery.

Presumed subconjunctival abscess has been reported as a rare postoperative complication of strabismus surgery.(1-2) We report the case of a child who initially was diagnosed with subconjuctival abscess after strabismus surgery for whom histopathology demonstrated an infected epithelial inclusion cyst. We suggest that previous reports of presumed subconjunctival abscess after strabismus surgery also may have been caused by a similar mechanism.     

Binocular diplopia following vision restoration in patients with keratoconus and sensory strabismus

PURPOSE: To report the phenomenon of newly-noted binocular diplopia following vision improvement in patients with sensory strabismus secondary to keratoconus, and to document the effect of strabismus surgery on this diplopia. METHODS: Retrospective institutional case series [1982--2005] of records coded with keratoconus and strabismus. Keratoconus patients with visual acuity that could not be improved, childhood strabismus, known reason for acquired strabismus (other than decreased vision from kerataconus), decreased vision from other ocular disease, monocular diplopia, failure of strabismus surgery, and/or less than six months follow-up after strabismus surgery were excluded. RESULTS: Although 103 medical records were identified, only seven met the strict inclusion criteria. All seven patients presented with gradual reduction in vision (not due to their strabismus), and none initially complained of diplopia. After intervention to improve visual acuity, six complained of constant binocular diplopia. This diplopia resolved after successful strabismus surgery. Postoperative Worth four-dot testing demonstrated suppression. CONCLUSIONS: Binocular diplopia, noted after intervention to improve visual acuity in our patients with strabismus secondary to long-standing uncorrected keratoconus, resolved after successful surgical alignment. Our patients may have developed suppression from uncorrected keratoconus before their sensory strabismus occurred.     

共同性斜视手术前后脱抑制治疗的初步观察

目的 探讨共同性斜视手术前后应用增视能软件脱抑制治疗的临床效果.设计回顾性病例系列研究.研究对象55例共同性斜视患者.方法 应用增视能软件术前术后进行脱抑制治疗,应用同视机检查双眼视功能.主要指标术前术后脱抑制患者所占的百分比.结果 术前成功脱抑制者46例（83.6%）;术后经脱抑制治疗,同视机检查获得双眼视功能者52例（94.5%）.术前脱抑制治疗后主、客观斜视角不等者占83.0%;术后脱抑制治疗后主、客观斜视角不等者占29.4%.术前术后脱抑制训练后均无复视出现.结论 共同性斜视术前术后脱抑制治疗有效.术前脱抑制治疗后用同视机可查到潜在的知觉融合及运动融合功能,可预测术后双眼视功能的重建.     

Strabismus surgery for large-angle cyclotorsion after macular translocation surgery.

PURPOSE: We report the results of a new strabismus surgical procedure to address the large-angle cyclotorsion induced by macular translocation surgery for severe age-related macular degeneration. METHODS: The strabismus surgery described is a modification of earlier-described surgery(1) and was performed for symptomatic incyclotorsion measuring 20 degrees or more (by Maddox rod testing) after macular translocation. Surgery included superior oblique tenotomy and inferior oblique advancement, with transposition of the lateral and medial recti to the insertions of the superior and inferior recti, respectively, in the affected eyes. Minimum follow-up time was 6 weeks. RESULTS: Fifteen patients (15 eyes) had macular translocation surgery with incyclotorsion of 20 degrees or more. Mean incyclotorsion after macular translocation (36.1 +/- 9.4 degrees; range, 20-55) was reduced to 1.5 +/- 6.4 degrees after strabismus surgery (P <.0001), with 2 overcorrections and no surgical complications. Mean follow-up time was 24.8 +/- 13.4 weeks. All patients showed a hypertropia of the fellow eye. The mean pre-op hypertropia of 22 +/- 8 PD was reduced to 3 +/- 9 PD after strabismus surgery (P <.0001). The mean exotropia was minimally altered by strabismus surgery (21 +/- 10 PD pre vs 17 +/- 8 PD postop). All patients were symptomatic prior to strabismus surgery: 4 of 15 patients with "tilt" (objects appearing subjectively rotated with respect to their true orientation); 2 of 15 patients with diplopia; and 9 of 15 patients with both. Postoperatively, 7 patients had residual milder symptoms: tilt, 2 patients; diplopia, 3 patients; and both, 2 patients. Two patients required additional muscle surgery (on the fellow eye) for persistent symptoms. No patient showed binocular function (stereopsis or motor fusion) after macular translocation, either before or following strabismus surgery for cyclotorsion. CONCLUSION: The strabismus surgery described is effective at reducing the large degree of cyclotorsion (>or= 20 degrees) often resulting from macular translocation surgery, but does not allow reestablishment of binocular function.     

Prognostic factors for strabismus surgery after cataract surgery

PURPOSE: To evaluate the clinical features of strabismus that present after cataract surgery and determine the motor and sensory results after surgical correction of the strabismus. SETTING: Department of Ophthalmology, the Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. METHODS: Thirty-one patients who had strabismus surgery after cataract surgery between January 1996 and June 2004 were included in the study. The clinical features of strabismus and the factors contributing to successful strabismus surgery results were retrospectively analyzed. Sensory functional tests were performed postoperatively. RESULTS: Fifteen patients (48.4%) had exotropia. The types of cataract included traumatic (35.5%), congenital (32.3%), and senile (25.8%). Prolonged deviation was the statistically significant factor contributing to final alignment (P = .023). Fourteen of 31 patients had stereoacuity measurement; all achieved a stereoacuity of 3000 seconds of arc. Five of the 14 patients (35.7%) had better than 200 seconds of arc. CONCLUSIONS: The anatomical results and sensory function of the patients were generally good. When appropriate, surgical intervention to treat strabismus after cataract surgery should be offered, and this is important for restoration of fusion.     

Anterior segment ischemia after surgery on 2 vertical rectus muscles augmented with lateral fixation sutures.

Anterior segment ischemia is a rare but potentially serious complication of strabismus surgery. Anterior ischemia typically occurs after surgery on 3 or 4 rectus muscles. Advanced age, dysthyroid ophthalmopathy, and a history of previous strabismus surgery are known risk factors for this complication. This report reviews the case of a healthy 50-year-old patient who developed anterior segment ischemia after surgery on 2 rectus muscles.     

我国斜视显微手术的探索

随着手术显微镜引进眼科手术,开启了眼科显微手术时代,开创了现代白内障手术和玻璃体手术新纪元.当眼科显微手术时代走过了半个世纪后,国际上还是倡导戴2～3倍放大镜做斜视手术.显微手术仅仅是内眼手术的专利吗?我国斜视显微手术的最早报告见于20世纪90年代初,探索在显微镜下实施直肌睫状血管分离术,其后未见跟进.本世纪以来,一些日常做内眼显微手术的专家和一些显微手术训练基础好的青年骨干坚持探索斜视显微手术.在这个过程中,中华医学会斜视与小儿眼科学组积极引导探索其健康发展,努力发掘显微手术在斜视矫正术中的积极意义,并探索提高手术质量.2011年6月在济南召开的第14届全国斜视与小儿眼科学术会议对这一问题又进行了热烈交流和讨论.本文结合发展现状,总结了斜视显微手术的目的和意义,提出了健康发展斜视显微手术的措施与建议.