Purpose: Large-angle horizontal ocular deviations will commonly require bilateral surgery to correct the primary ocular deviation. However, considering the need for full correction with one surgical procedure and patients’ reluctance to be operated on the good eye, such large horizontal ocular deviations may be managed with true muscle transplantation. The authors present a case series of patients who underwent this procedure and develop a surgical table to guide management. Methods: Patients with horizontal Squints measuring 80 prism diopters (PD) or larger in all age groups who underwent extraocular muscle transplantation surgery between January 2019 and June 2022 in Nigeria were included. Preoperative deviation of the Squint, sensory evaluation, surgical dosage, and outcomes were documented. Part of the resected muscle was transplanted to give additional recession in the antagonist muscle. Success was defined as deviation corrected by 60% or more or postoperative ocular alignment within 10 PD or less, six weeks postoperatively. Results: Fourteen patients with extra-large-angle strabismus were operated. Male/female ratio was 0.6:1. Mean preoperative deviation of 89.6 ± 9.3 collapsed to 6.6 ± 1.8 PD at six weeks and continued to improve to a mean deviation of 2.5 PD at six months postoperatively. When the subgroup of patients who were <18 years were analyzed, the outcome was equally successful; preoperative deviation of 89.4 PD collapsed to 1.4 PD, six months postoperatively. There were equal success rates when those with sensory strabismus were compared with those with binocular vision; preoperative deviation of 92.5 PD in the sensory group and 88.5 PD in the binocular group collapsed to 5.9 PD and 1 PD, respectively, six months after surgery. Conclusion: A viable alternative for treating extra-large-angle strabismus in adults and children in developing countries was described with good postoperative outcome. In addition, a new expanded surgical dosage table for muscle transplantation surgery corrections of up to 130 PD was developed.

Family studies suggest that there is a strong genetic component to the etiology of comitant strabismus. Seven cases of a family in three consecutive generations found to have isolated comitant exotropia. This pattern of inheritance is highly suggestive of an autosomal-dominant mode with complete penetrance which is an unreported finding in this entity.

Spinal muscular atrophies (SMAs) represent a rare group of inherited disorders that cause progressive degeneration of the anterior horn cells of the spinal cord. The exact cause of the degeneration is unknown. Loss of these cells results in a progressive lower motor neuron disease that has no sensory involvement and that is manifested as hypotonia, weakness, and progressive paralysis. Kugelberg Welander spinal muscular atrophy (also known as Wohlfart-Kugelberg-Welander syndrome or mild SMA) is a milder form of SMA, with symptoms typically presenting after age 18 months. Here in we report a case of anesthetic management of a patient with Kugelberg Welander disease who was refered for Squint surgery and also we reviewed some other cases of SMA patients receiving different types of anesthesia.

Profound bradycardia during eye surgery is a potentially serious event. In clinical practice oculocardiac reflex (OCR) is most often encountered during Squint surgery. The objective of this study was to assess the occurrence of OCR and prove the effect of ketamine as an induction drug and anticholinergic premedication (atropine) to prevent OCR. This study comprised 90 patients (aged 4-10 years) operated for Squint surgery under general anesthesia. Patients were divided into three groups. Using block randomization, each patient enrolled in one of the three groups based on organized random table prepared by statistician.Group K received ketamine as an induction drug, Group A was premedicated with intravenous injection of atropine and Group C did not receive any premedication. Patients were monitored during operation for any bradycardia or dysrhythmias. The observed data showed occurrence of 63% OCR in Group C as compared to 43% in group A and only 20% in Group K. Current study showed that induction with ketamine in the patients of Squint surgery under general anesthesia definitely obtunds OCR and prevents any untoward effects of dysrhythmias during eye surgery.

Background: Adjustable sutures increase the success rate of strabismus surgery. However, the optimal timing of postoperative suture adjustment remains controversial. This trial was aimed at comparing the surgical outcomes and pain scores of early or 2 –,4 h and delayed or 24 h postoperative suture adjustment in adult patients undergoing strabismus surgery. Methods: An open-label, prospective, randomized, comparative interventional study was performed in consecutive adult patients scheduled for eye muscle surgery. Patients were randomized into two groups: the early group, with suture adjustment 2 –,4 h postoperatively, and the delayed group, with suture adjustment 24 h postoperatively. Subjective pain scores during the adjustment were also analyzed. The angles of misalignment at 1 and 3 months and the success rate at 3 months postoperatively were compared. Results: Forty-five (90%) patients completed the follow-up, including 23 (92%) in the early adjustment group and 22 (88%) in the delayed adjustment group, with a mean (standard deviation) age of 25. 6 (9. 5) years and a male-to-female ratio of 46. 7: 53. 3. Thirty patients (66. 7%) had exotropia, and 15 (33. 3%) patients had esotropia. Both groups had comparable baseline characteristics (all P > 0. 05). The mean pain scores during adjustment did not differ significantly between groups (P > 0. 05). The postoperative angles of alignment were comparable between the groups before suture adjustment and at the 1-and 3-month follow-ups (all P > 0. 05). The success rate in the early adjustment group was slightly higher (87. 0% versus 63. 6%), but the difference was not statistically significant (P > 0. 05). The success rate was comparable between the groups in patients with esotropia or exotropia (both P > 0. 05). Conclusions: Although the early adjustment group had a slightly higher success rate, the difference was not significant. Both groups had comparable subjective pain scores during adjustment, final motor alignment, or success rate. Future clinical trials should be performed different time intervals for postoperative suture adjustment, and subjective and objective outcomes, such as diplopia and stereopsis, should be compared between patients with a first strabismus surgery and those who underwent reoperation. This could better resolve the persistent controversy related to the optimal time for suture adjustment.

Background: Strengthening of extraocular muscles is a conventional procedure in the management of strabismus. Plication may be an alternative strengthening technique, and is less invasive than resection. This study compared plication and resection, each combined with antagonist muscle recession, in terms of success rates and changes in ocular deviation in the management of horizontal strabismus. Methods: This retrospective study recruited individuals with horizontal strabismus who underwent plication (group I) or resection (group II) coupled with antagonist muscle recession. All participants underwent a detailed baseline eye and ocular motility evaluation. Demographic and clinical data were collected, including age, sex, type of preoperative strabismus (exotropia or esotropia), baseline visual acuity, mean follow-up duration, laterality of operated eye, surgical doses of correction (resection, plication, or recession) in millimeters, preoperative strabismus magnitude in prism diopters (PD), and postoperative strabismus magnitude in PD. Successful postoperative deviation was defined as less than or equal to 10 PD. At final follow-up, the success rates and degrees of change in angle of deviation were recorded. Results: Forty-four patients were enrolled: 19 patients in group I (plication) and 25 patients in group II (resection). The groups had comparable ages, sex ratios, types of strabismus, and preoperative and postoperative angles of deviation (all P > 0. 05). Despite comparable success rates between groups (73. 7% in group I versus 64. 0% in group II, P > 0. 05), the difference (9. 7%) was marginally close to the predefined clinically meaningful difference of 10%. In the esotropia subgroup, despite comparable alignment between the plication and resection groups (P > 0. 05), the difference was clinically meaningful (17. 3%), and both groups had higher success rates in the esotropia subtype than in the exotropia subtype. The rate of over-or undercorrection was not statistically or clinically different in the total and in each subtype of strabismus (all P > 0. 05). Success rates for unilateral and bilateral cases were similar between groups (both P > 0. 05). Changes in angle of deviation were similar for individuals with esotropia and exotropia between groups (both P > 0. 05). Conclusions: In esotropic and exotropic strabismus, plication and resection procedures combined with antagonist recession were similarly effective. However, further randomized, large-scale, longitudinal studies with clinical and subjective evaluations could provide practical evidence on the suitability of the plication procedure in managing various types of strabismus.