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Purpose: To compare the clinically significant (5 prism diopters [PD] or greater) changes in deviations after 1 and 24 hours of diagnostic monocular occlusion specifically for basic and divergence excess types of intermittent exotropia. Methods: In this prospective study, diagnostic monocular occlusion was performed at 1 and 24 hours before surgery in patients with intermittent exotropia. A change of 5 PD or greater in near and distance deviation after occlusion was considered clinically significant and used as the cut-off point for analysis. The mean clinically significant changes between the deviations after 1 and 24 hours of occlusion in patients with basic and divergence excess types of intermittent exotropia were compared. Results: A total of 21 patients with basic type and 20 patients with divergence excess type intermittent exotropia were included. No statistically significant differences were found for the mean near and distance deviations, the number of patients who had a clinically significant (5 PD or greater) increase, or the magnitude of increase in near and distance deviations after 1 hour versus 24 hours of diagnostic occlusion in patients with both types of intermittent exotropia. Conclusions: Diagnostic monocular occlusion for 1 hour is sufficient in patients with basic and divergence excess types of intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 2022;59(1):41–45.]

Purpose: To report long-term motor and sensory outcomes after unilateral lateral rectus recession–medial rectus resection for basic intermittent exotropia. Methods: The medical records of patients who had undergone unilateral lateral rectus recession–medial rectus resection for basic intermittent exotropia and were observed postoperatively for a minimum of 10 years were reviewed retrospectively. Results: A total of 41 patients were included (mean age: 6.07 ± 2.96 years; range: 3 to 17 years). The mean postoperative follow-up was 13.28 ± 3.27 years (range: 10 to 23 years). Overall, 19 patients (46%) had surgical success at their most recent follow-up visit. Age at onset of strabismus, age at surgery, strabismus duration, preoperative size of near and distance deviation, presence of stereopsis, and initial postoperative overcorrection did not predict motor outcome after surgery. Twenty-five patients (74%) achieved stereopsis. None of the 4 patients without binocular single vision preoperatively achieved stereopsis, compared to 3 of 7 patients (43%) with peripheral binocular single vision (P = .02). Five of 7 patients (71%) with a preoperative stereoacuity of 120 to 240 seconds of arc improved to 60 seconds of arc. Age at surgery did not predict stereopsis. Patients with a strabismus duration of 5 years or less achieved a better stereopsis. Conclusions: Fewer than half of the patients with basic intermittent exotropia achieved a successful long-term surgical outcome. Age at surgery, strabismus duration, preoperative stereopsis, and an initial postoperative overcorrection did not predict motor outcome. A pre-operative absence of binocular single vision indicated a poor prognosis for stereopsis. A shorter duration of strabismus predicted a better stereopsis after surgery. [J Pediatr Ophthalmol Strabismus. 2020;57(5):326–332.]

To find the optimal dosage of cyclopentolate 1% for cycloplegic refraction in hypermetropes with brown irides, we investigated the difference in cycloplegic auto-refractions obtained after one, two, and three instillations in the same patient. The mean hypermetropia found after three instillations was statistically significantly more compared to that found after one instillation. There was no statistically significant difference in the mean hypermetropia between two and three instillations. There was no significant effect of gender, age, and the presence and type of horizontal deviation. These observations suggest that two drops of cyclopentolate 1% 10 min apart are sufficient for cycloplegic refraction in hypermetropes.

Purpose To report long-term motor and sensory outcomes after unilateral lateral rectus recession–medial rectus resection for infantile constant exotropia. Methods The medical records of patients who had undergone unilateral lateral rectus recession–medial rectus resection for infantile constant exotropia who were followed up postoperatively for a minimum of 4 years were reviewed retrospectively. Results A total of 20 patients were included. The mean age at surgery was 3.21 ± 1.54 years (range: 1.25 to 6.00 years). The mean duration of exodeviation was 2.99 ± 1.61 years (range: 9 months to 6 years). The mean angle of exodeviation was 70.1 ± 20.9 prism diopters (PD) (range: 35 to 90 PD). The median postoperative follow-up was 9.1 years (range: 4 to 24 years). Overall, 12 patients (60%) had surgical success at their last follow-up visit. Age at first surgery, cycloplegic refraction, strabismus duration, preoperative angle of deviation, presence of amblyopia, and the number of exotropia surgeries did not predict motor outcome after surgery. At the last follow-up visit, 20% of patients had residual exotropia and 15% had recurrent exotropia. Peripheral binocular single vision was achieved in 25% of patients and stereopsis in none. Age at first surgery, strabismus duration, and surgical outcome had no effect on sensory outcome. Conclusions In this study, 60% of patients achieved a successful long-term motor outcome and 25% achieved peripheral binocular single vision after unilateral recession-resection for infantile constant exotropia. Stereopsis outcome was nil. Age at surgery and duration of strabismus had no effect on motor and sensory outcomes. [J Pediatr Ophthalmol Strabismus. 2025;62(3):203–210.]

Purpose: To report long-term ocular alignment and sensory outcomes after medial rectus recession for high accommodative convergence/accommodation (AC/A) ratio esotropia. Methods: The medical records of consecutive patients who had undergone unilateral or bilateral medial rectus recession for high AC/A ratio esotropia and were observed postoperatively for a minimum of 5 years were reviewed retrospectively. Results: A total of 34 patients were included. Twenty-three patients (68%) used bifocals preoperatively. The mean age at surgery was 11.5 ± 4.4 years (range: 2.5 to 19.0 years). The mean postoperative follow-up was 7.5 ± 2.3 years (range: 5.0 to 15.25 years). Overall, 21 patients (62%) had surgical success at their last follow-up visit. Age at surgery, preoperative angle of distance and near deviation, distance-near disparity, and preoperative bifocal wear did not predict motor outcome after surgery. Preoperative presence of peripheral binocular single vision was a significant favorable factor for surgical success. At the last follow-up visit, 21% of patients had a recurrence of high AC/A ratio esotropia and 9% each had consecutive exotropia (intermittent [3%] and constant [6%]) and basic esotropia. Peripheral binocular single vision was achieved in 64% of patients and stereopsis in 28%. Bifocal segment was eliminated postoperatively in 70% of patients. Conclusions: Nearly two-thirds of patients with high AC/A ratio esotropia achieved a successful long-term motor outcome and peripheral binocular single vision, and nearly one-fourth achieved stereopsis. Recurrence of high AC/A ratio esotropia occurred in some patients, and consecutive exotropia and basic esotropia in a few. Bifocal segment was eliminated postoperatively in 70% of patients. [J Pediatr Ophthalmol Strabismus. 2024;61(5):344–350.]

Purpose: To report long-term motor and sensory outcomes after unilateral medial rectus recession–lateral rectus resection for infantile esotropia. Methods: The medical records of patients who had undergone unilateral medial rectus recession–lateral rectus resection for infantile esotropia and were followed up postoperatively for a minimum of 10 years were reviewed retrospectively. Results: A total of 100 patients were included. The mean age at surgery was 2.9 ± 2.2 years (range: 2.5 months to 9.0 years). The mean postoperative follow-up was 15.7 ± 4.4 years (range:10.0 to 27.5 years). Overall, 54 patients (54%) had surgical success at their last follow-up visit. Age at first surgery, strabismus duration, degree of hyperopia, preoperative size of deviation, presence of dissociated vertical deviation, inferior oblique overaction, or both dissociated vertical deviation and inferior oblique overaction, and the number of esotropia surgeries did not predict motor outcome after surgery. Consecutive exotropia developed in 43% of patients (constant in 18% and intermittent in 25%). Residual and recurrent esotropia occurred in 20% and 21% of patients, respectively. Refractive accommodative esotropia developed in 17% of patients and there was a high accommodation convergence/accommodation ratio esotropia in 2%. Peripheral binocular single vision was achieved in 54% of patients and stereopsis in 1%. Patients with 1.5 years or less of strabismus duration had better chances of achieving peripheral binocular single vision. Conclusions: Nearly half of the patients with infantile esotropia achieved a successful long-term motor outcome and peripheral binocular single vision. Consecutive exotropia occurred frequently. Recurrent esotropia and refractive accommodative esotropia developed in some patients, and a high accommodation convergence/accommodation ratio esotropia in a few. Stereopsis outcome was extremely poor. [J Pediatr Ophthalmol Strabismus. 2024;61(2):106–113.]

Spectacles are routinely prescribed by the ophthalmologist and dispensed by the opticians. We investigated how frequently the spectacles are not dispensed as prescribed and whether the frequency of inaccurate spectacles would decrease if the patients, at the time of collecting spectacles, ask the optician to verify that the spectacles have been dispensed accurately. We found inaccurate spectacles in about one-third of our patients and incorrect spherocylinders more frequently with an error in the spherical element and cylinder axis. These inaccuracies decreased significantly when patients while collecting spectacles, asked the optician to verify the accuracy of the spectacles dispensed. It is suggested that while prescribing spectacles, the patients should be made aware of the possibility of dispensing errors. To decrease the frequency of incorrect spectacles, the patients while collecting spectacles, should ask the optician to check whether the spectacles have been dispensed accurately.

Purpose: To evaluate short-term and long-term status of monocular eye closure in sunlight after surgical treatment of intermittent exotropia. Methods: The medical records of consecutive patients 4 years and older who underwent surgery for intermittent exotropia with monocular eye closure in sunlight were reviewed retrospectively. Monocular eye closure status on short-term and long-term postoperative follow-up was analyzed to determine whether the status on short-term follow-up remained or changed on long-term follow-up. Results: A total of 37 patients were included (mean age: 10.64 ± 6.05 years). Thirteen patients (35%) were postoperatively observed for 6 months or less (short-term) and 24 (65%) for a mean 7.12 ± 2.89 years (long-term). Monocular eye closure disappeared in 16 patients (43%) and persisted in 21 (57%) on short-term follow-up. There was no significant difference in eye closure status between short-term and long-term follow-up in 24 patients. Eight of 9 patients (89%) with disappearance of eye closure on short-term follow-up maintained this status on long-term follow-up and 1 patient (11%) had reappearance of eye closure. Eleven of 15 patients (73%) with persistence of eye closure on short-term follow-up maintained this status on long-term follow-up and 4 (27%) had disappearance of eye closure. Three patients had a fluctuation in eye closure status during long-term follow-up. Conclusions: Monocular eye closure disappeared in nearly 40% of patients on short-term follow-up and in 50% on long-term follow-up after surgery for intermittent exotropia. Monocular eye closure status on short-term follow-up remained on long-term follow-up in most patients and changed in a few patients. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX–XX.]

Purpose: To compare improvement in long-term stereoacuity between patients with refractive accommodative esotropia (RAET) with initial subnormal stereopsis (between 120 and 1,980 arcsec of stereoacuity) and nil stereopsis. Methods: The medical records of patients 4 years and older who had RAET with initial subnormal stereopsis and nil stereopsis and a minimum follow-up period of 5 years were retrospectively reviewed. Improvement in stereoacuity at the last follow-up visit and the factors that could influence it were compared between the initial subnormal stereopsis and the nil stereopsis groups. Results: A total of 79 patients (mean age: 6.3 ± 1.9 years) were included: 31 patients with initial subnormal stereopsis and 48 patients with nil stereopsis. The mean follow-up time was 11.7 ± 1.8 years (range: 5 to 21 years). At the last follow-up visit, a statistically significantly greater number of patients with initial subnormal stereopsis demonstrated improvement in stereoacuity and also achieved 60 arcsec of stereoacuity compared with those with nil stereopsis. Age at onset, duration of esodeviation, mean hyperopia, amblyopia, anisometropia, and follow-up duration were not significantly different between the initial subnormal stereopsis and the nil stereopsis groups. The initial mean near and distance deviations with hyperopic correction were significantly smaller in patients with initial subnormal stereopsis. A significantly greater number of patients with initial sub-normal stereopsis had fusion at distance. Conclusions: Patients with RAET with initial subnormal stereopsis have greater chances of stereoacuity improvement and recovery of 60 arcsec of stereoacuity than those with nil stereopsis. Patients who initially have nil stereopsis may develop normal stereoacuity. Smaller initial deviations with hyperopic correction and fusion at distance indicate a favorable prognosis for stereoacuity improvement. [J Pediatr Ophthalmol Strabismus. 2022;59(4):248–253.]

The rate of KOH positivity in fungal keratitis is around 30-34% (32%). [...] in clinical practice of 100 cases of corneal ulcers, only 16 cases may be KOH positive.