Publications by authors named "Kanwar Mohan"

31 Publications

Comparison Between the Deviations After 1 and 24 Hours of Diagnostic Occlusion for Basic and Divergence Excess Types of Intermittent Exotropia.

J Pediatr Ophthalmol Strabismus 2021 Aug 1:1-5. Epub 2021 Aug 1.

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 the 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. .
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http://dx.doi.org/10.3928/01913913-20210610-02DOI Listing
August 2021

Long-term Motor and Sensory Outcomes After Unilateral Lateral Rectus Recession-Medial Rectus Resection for Basic Intermittent Exotropia.

J Pediatr Ophthalmol Strabismus 2020 Sep;57(5):326-332

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.].
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http://dx.doi.org/10.3928/01913913-20200731-01DOI Listing
September 2020

Long-term motor and sensory outcomes after surgery for the nonaccommodative component of partially refractive accommodative esotropia.

J AAPOS 2018 Oct 12;22(5):356-360. Epub 2018 Sep 12.

Department of Statistics, Panjab University, Chandigarh, India.

Purpose: To report long-term motor and sensory outcomes after surgery for the nonaccommodative component of partially refractive accommodative esotropia (PRAET).

Methods: The medical records of consecutive patients ≤11 years old operated for the nonaccommodative component of PRAET and followed postoperatively for at least 10 years were retrospectively reviewed.

Results: A total of 47 patients were included (median age, 3.0 years). The mean postoperative follow-up was 12.15 ± 2.05 years (range, 10.00-17.50 years). Overall, 23 patients (49%) had surgical success; 10 (21%), decompensation; and 7 (15%), esotropia with a high ratio of accommodative convergence to accommodation (AC/A) or consecutive exotropia. The median age at surgery, mean cycloplegic refraction, median near and distance deviation, presence of binocular vision, and amblyopia did not predict decompensation, a high AC/A ratio esotropia, and consecutive exotropia. Eight patients (18%) achieved stereopsis. Patients with an older age at onset (2.87 ± 1.31 years) and a shorter duration of strabismus (≤4 years) achieved better stereopsis.

Conclusions: Nearly half of our patients with PRAET achieved a successful ocular alignment after surgery for the nonaccommodative component. Some developed decompensation, a high AC/A ratio esotropia, or consecutive exotropia. Few patients achieved stereopsis. Older age at onset and a shorter duration of strabismus predicted a better stereopsis outcome.
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http://dx.doi.org/10.1016/j.jaapos.2018.06.006DOI Listing
October 2018

Long-term treatment results of accommodative esotropia.

J AAPOS 2014 Jun;18(3):261-5

Cornea Centre, Chandigarh, India.

Purpose: To report the long-term ocular alignment outcomes of patients with accommodative esotropia.

Methods: The medical records of consecutive patients ≤12 year of age diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10(Δ) with full hyperopic correction) and followed for at least 10 years were retrospectively reviewed.

Results: A total of 107 patients were included (mean age, 4.81 ± 2.64 years). The mean follow-up period was 12.02 ± 2.25 years (range, 10-21 years). At the first examination performed 10 years after spectacle correction (mean, 10.2 years), 85 patients (79%) had orthophoria or esotropia ≤10(Δ) at both near and distance fixation, 14 (13%) had consecutive exotropia, 5 (5%) had decompensation and 3 (3%) had esotropia with a high ratio of accommodative convergence to accommodation (AC/A). The mean time interval between presentation and prescription of full hyperopic correction, initial cycloplegic refraction, and presence of amblyopia was not associated with consecutive exotropia, decompensation, or a high AC/A ratio esotropia.

Conclusions: Whereas most patients with refractive accommodative esotropia maintained normal long-term ocular motility with spectacle treatment, some developed consecutive exotropia, nonaccommodative esotropia, or esotropia with a high AC/A ratio.
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http://dx.doi.org/10.1016/j.jaapos.2014.01.018DOI Listing
June 2014

Pseudomonas aeruginosa endophthalmitis masquerading as chronic uveitis.

Indian J Ophthalmol 2014 May;62(5):662-3

Dr. Ashok Sharma's Cornea Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4103/0301-4738.133529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065534PMC
May 2014

Post penetrating keratoplasty glaucoma: cumulative effect of quantifiable risk factors.

Indian J Ophthalmol 2014 May;62(5):590-5

Dr. Ashok Sharma's Cornea Centre, Chandigarh, India.

Purpose: To ascertain the incidence, identify risk factors and calculate cumulative effect of risk factors in patients developing glaucoma following optical penetrating keratoplasty.

Materials And Methods: We carried out retrospective analysis of 445 patients, those underwent optical PK and had a minimum follow up of 6 m. Data on post-operative intra-ocular pressure (IOP) recorded at 3, 6, 9, 12 and 18 m or more was analyzed. Various risk factors including age, sex, indications for penetrating keratoplasty, pre-existing glaucoma and type of surgical procedures performed were analyzed by using univariate analysis and logistic regression technique.

Results: Ninety (21%) of eyes developed post-PK glaucoma. On applying logistic regression, age, sex, indication of surgery, pre-existing glaucoma were found to be significant risk factors for the development of post-PK glaucoma (P < 0.05). Using logistic regression equation the cumulative risk of developing post-PK glaucoma in an individual patient can be calculated.

Conclusions: Male patients, aged more than 40 years, having opaque grafts as an indication and with pre-existing glaucoma were found to be higher risk of developing post-PK glaucoma. Patients at higher cumulative risk for development of post-PK glaucoma may be closely monitored during follow-up.
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http://dx.doi.org/10.4103/0301-4738.129790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065511PMC
May 2014

Alopecia following oral acyclovir for the treatment of herpes simplex keratitis.

Middle East Afr J Ophthalmol 2014 Jan-Mar;21(1):95-7

Cornea Service, University of Maryland, Maryland, MD, USA.

The authors report acyclovir-induced alopecia in a patient treated for herpetic keratouveitis. A 32-years-old female was diagnosed with herpetic keratouveitis. She was placed on prednisolone acetate (1%) suspension four times a day, atropine sulfate (1%) thrice a day, and oral acyclovir 400 mg twice-daily. Three weeks following oral acylovir, keratouveitis improved, but she developed alopecia without any drug eruptions. Oral acyclovir was discontinued. Three months later, alopecia completely resolved. Alopecia may be considered a possible complication following oral acyclovir.
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http://dx.doi.org/10.4103/0974-9233.124131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959052PMC
June 2014

Repositioning of pedicle conjunctival flap performed for refractory corneal ulcer.

Middle East Afr J Ophthalmol 2014 Jan-Mar;21(1):89-91

Cornea Service, University of Maryland, Maryland, MD, USA.

A 50-year-old male was referred with a previous history of conjunctival flap (CF) for a nonhealing fungal corneal ulcer with extreme corneal thinning in the right eye. The peritomy for the CF extended from 6:30 to 9:30 clock h on the cornea. The CF was disengaged, peritomy area deepithelialized, and CF was repositioned. He later underwent penetrating keratoplasty and achieved 20/40 best corrected visual acuity. The authors present a new concept for surgically repositioning CF s to the original site immediately after healing of the corneal ulcer.
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http://dx.doi.org/10.4103/0974-9233.124118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959050PMC
June 2014

Scleral Patch Graft Augmented Cyanoacrylate Tissue Adhesive for Treatment of Moderate-Sized Noninfectious Corneal Perforations (3.5-4.5 mm).

Cornea 2013 Oct;32(10):1326-30

*Cornea Centre, Chandigarh, India; †Squint Centre, Chandigarh, India; ‡Cornea Service, Eye Consultants of Maryland, Owings Mills, MD; and §Department of Ophthalmology, University of Maryland, Baltimore, MD.

Purposes: To describe a new technique of scleral tissue augmented cyanoacrylate tissue adhesive (CTA) application and to evaluate its efficacy in noninfectious corneal perforations that measure between 3.5 and 4.5 mm.

Methods: Retrospective noncomparative case series included 16 consecutive patients diagnosed with moderate-sized corneal perforations measuring 3.5 to 4.5 mm who were treated with scleral patch graft augmented glue application. A partial-thickness scleral patch equal to the size of corneal perforation was placed in the corneal perforation site. After the area was sufficiently dried, CTA was applied on the interface of the host cornea and scleral patch. The ability of the scleral patch graft with CTA to seal the perforation and allow complete wound healing was considered a successful outcome.

Results: The corneal perforation healed in 14 eyes (87.5%), with a mean of 5.65 weeks (range, 5-9 weeks). One eye (6.25%) developed microperforation that required additional CTA to seal the wound. Three eyes (18.75%) required reapplication of the scleral patch graft and CTA. The 2 eyes (12.50%) that failed scleral patch with CTA were successfully treated with tectonic penetrating keratoplasties. In all 5 eyes (100%), the corneal perforations as a result of Mooren ulcer healed in a mean 5.80 weeks (range, 5-7 weeks). One patient developed retinal detachment with proliferative vitreoretinopathy and cataract after trauma.

Conclusions: Scleral patch graft augmented CTA technique is a successful alternative treatment method to emergent penetrating keratoplasty for corneal perforations that measure 3.5 to 4.5 mm.
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http://dx.doi.org/10.1097/ICO.0b013e31829cb625DOI Listing
October 2013

A comparison of ocular alignment success of hang-back versus conventional bilateral lateral rectus muscle recession for true divergence excess intermittent exotropia.

J AAPOS 2013 Feb 23;17(1):29-33. Epub 2013 Jan 23.

Squint Centre, Chandigarh, India.

Purpose: To assess whether hang-back or conventional bilateral lateral rectus muscle recessions were more successful in achieving a satisfactory postoperative ocular alignment in patients with true divergence excess intermittent exotropia.

Methods: The medical records of consecutive patients with true divergence excess intermittent exotropia who underwent bilateral lateral rectus muscle recession using hang-back or conventional techniques were retrospectively analyzed. All surgeries were performed by a single surgeon using the same standard table of surgical dosage. We compared the preoperative characteristics and motor surgical outcomes between the two groups. Success was defined as alignment within 10(Δ) of intermittent exotropias at distance and near. Any amount of postoperative esotropia was considered a failure.

Results: A total of 42 patients were included: 13 in the hang-back group and 29 in the conventional group. The mean age at surgery, mean preoperative deviation at near and distance, mean amount of lateral rectus muscle recession, and mean follow-up duration were not statistically significantly different between groups. At the most recent follow-up, the conventional group had a significantly greater success rate (≤10(Δ) of intermittent exotropia) than the hang-back group (83% vs 31%, P = 0.0009). There was no statistically significant difference in the mean amount of lateral rectus recession between patients with successful and unsuccessful surgical outcomes in both groups.

Conclusions: Within the limitations of this study, conventional bilateral lateral rectus recessions were more effective than hang-back recessions in achieving a successful postoperative alignment in patients with true divergence excess intermittent exotropia.
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http://dx.doi.org/10.1016/j.jaapos.2012.09.014DOI Listing
February 2013

How often are spectacle lenses not dispensed as prescribed?

Indian J Ophthalmol 2012 Nov-Dec;60(6):553-5

Squint Centre, Chandigarh, India.

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.
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http://dx.doi.org/10.4103/0301-4738.103796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545135PMC
November 2013

Persistent corneal edema after collagen cross-linking for keratoconus.

Am J Ophthalmol 2012 Dec 7;154(6):922-926.e1. Epub 2012 Sep 7.

Cornea Centre, Chandigarh, India.

Purpose: To present a new complication of persistent corneal edema after collagen cross-linking (CXL) in keratoconus patients.

Design: Retrospective case series of postoperative corneal edema after CXL.

Methods: study population: All patients who underwent CXL treatment with subsequent corneal edema. Patients with stromal haze were excluded. intervention: The CXL treatments used the Dresden protocol with corneal thickness of more than 400 μm after epithelium was removed. main outcome measure: The resolution of corneal edema after surgery.

Results: Postoperative corneal edema was identified in 10 (2.9%) of 350 patients who were followed up for a mean of 14 ± 4 months. The edema started on postoperative day 1 (10/10) and increased for 3 weeks. Additional findings included: deep vascularization (2 eyes; 20%), iris atrophy (6 eyes; 60%), pigment dispersion (5 eyes; 50%), persistent epithelial defect (3 eyes; 30%), and infectious keratitis (1 eye; 10%). Specular microscopy was unsuccessful, but the fellow untreated eyes had normal endothelial counts. Intraocular pressure and lenticular evaluations were normal. Corneal edema improved in 4 patients and resolved in 1 patient. In these 5 patients, the logarithm of the minimal angle of resolution best-corrected visual acuity was 0.5 ± 0.18. Penetrating keratoplasty was offered to 5 patients when improvement plateaued at 3 months, but only 2 patients underwent penetrating keratoplasty.

Conclusions: CXL is a safe and effective procedure with few known side effects. This case series reports the possibility of corneal endothelial damage with visually significant corneal edema after CXL treatment. Based on the extent of endothelial damage, patients may require penetrating keratoplasty.
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http://dx.doi.org/10.1016/j.ajo.2012.06.005DOI Listing
December 2012

Development of refractive accommodative esotropia in children initially diagnosed with pseudoesotropia.

J AAPOS 2012 Jun;16(3):266-8

Squint Centre, Chandigarh, India.

Purpose: To determine the clinical characteristics of children with pseudoesotropia who later develop refractive accommodative esotropia.

Methods: We retrospectively reviewed the records of consecutive patients diagnosed with pseudoesotropia from 2003 to 2010. Inclusion criteria included age 3 years or younger at the time of diagnosis, history of strabismus, verifiable positive or negative family history of strabismus, hypermetropia detected with atropine refraction, prism and cover test measurements performed with and without refractive correction at follow-up visits, and a minimum follow-up of 1 year.

Results: A total of 51 children met inclusion criteria (average age, 1.48 ± 0.79 years; range, 3-36 months; mean follow-up, 2.9 years). Refractive accommodative esotropia developed in 15.7% of the children at a mean age of 2.78 ± 1.06 years. It developed in 53.9% of the children with pseudoesotropia who had >1.50 D of hypermetropia compared to 2.6% of those who had ≤ 1.50 D hypermetropia (P = 0.0001). A positive family history of strabismus (P = 0.193) and initial age at presentation with pseudoesotropia (P = 0.571) were not predisposing factors.

Conclusions: Children aged ≤ 3 years diagnosed with pseudoesotropia should undergo cycloplegic refraction. If >1.50 D hypermetropia is detected, patients should be monitored for the development of refractive accommodative esotropia.
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http://dx.doi.org/10.1016/j.jaapos.2012.01.003DOI Listing
June 2012

Optimal dosage of cyclopentolate 1% for cycloplegic refraction in hypermetropes with brown irides.

Indian J Ophthalmol 2011 Nov-Dec;59(6):514-6

Squint Centre, Chandigarh, India.

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.
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http://dx.doi.org/10.4103/0301-4738.86329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214430PMC
February 2012

Differences in epidemiological and clinical characteristics between various types of Duane retraction syndrome in 331 patients.

J AAPOS 2008 Dec 23;12(6):576-80. Epub 2008 Aug 23.

Squint Centre, Chandigarh, India.

Purpose: To determine the differences in various epidemiologic and clinical characteristics among types I, II, and III of unilateral Duane syndrome and between unilateral and bilateral Duane syndrome.

Methods: A retrospective chart review of 331 patients with the Duane syndrome (291 unilateral and 40 bilateral) was performed. Various characteristics studied included sex, age at presentation, laterality, manifest primary position horizontal deviation, upshoot and downshoot, amblyopia, and associated ocular and systemic abnormalities.

Results: Unilateral types I and III Duane syndrome were more common in the left eye and in female patients, whereas type II had no such predilection. The mean age at presentation was significantly greater in type III patients. Type I patients had an almost-equal frequency of esotropia and exotropia, type II had exotropia, and type III had exotropia more commonly than esotropia. The upshoots and downshoots were more common in types II and III. There was no difference in amblyopia among various types of Duane syndrome. Associated ocular abnormalities were more common in types I and III, and systemic abnormalities were more common in type I. A manifest primary position horizontal deviation was more common in bilateral Duane syndrome. Exotropia was more common in unilateral cases, whereas esotropia was more common in bilateral cases.

Conclusion: Unilateral types I, II, and III Duane syndrome differ in the mean age at presentation, primary position horizontal deviation, upshoot and downshoot, and associated ocular and systemic abnormalities. Bilateral Duane syndrome differs from the unilateral only in the primary position horizontal deviation.
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http://dx.doi.org/10.1016/j.jaapos.2008.04.015DOI Listing
December 2008

Unilateral lateral rectus muscle recession and medial rectus muscle resection with or without advancement for postoperative consecutive exotropia.

J AAPOS 2006 Jun;10(3):220-4

Squint Centre, Chandigarh, India.

Purpose: To evaluate the effectiveness of unilateral lateral rectus muscle recession and medial rectus muscle resection with or without advancement in treating postoperative consecutive exotropia.

Methods: We performed a retrospective review on 31 patients with consecutive exotropia who were treated with unilateral lateral rectus muscle recession and medial rectus muscle resection (17 patients) or unilateral lateral rectus muscle recession and medial rectus muscle partial resection combined with advancement (14 patients). All patients had exotropia with a less than 10 prism diopters (PD) distance near-disparity. The characteristics studied before surgery included type of esotropia surgery, detection of amblyopia, presence of an "A" or "V" pattern, dissociated vertical deviation, limitation of adduction, deviation angle measurement, and forced duction testing. Ocular alignment and status of adduction postoperatively at the last follow-up were recorded.

Results: Nineteen patients (61.3%) had amblyopia, 17 patients (54.8%) had limitation of adduction, 8 patients (25.8%) had dissociated vertical deviation, and 5 patients (16.1%) had an "A" or "V" pattern. The mean preoperative exodeviation was 47.3 PD. Overall 21 (67.7%) of 31 patients achieved a successful postoperative result (alignment within 10 PD of orthophoria). There was no significant difference in successful alignment in patients treated with unilateral medial rectus muscle resection compared with those treated with unilateral medial rectus muscle partial resection combined with advancement. There was no influence of amblyopia on the result. Twelve (70.6%) of the 17 patients with limited adduction preoperatively showed normalization of adduction postoperatively.

Conclusions: Unilateral lateral rectus muscle recession and medial rectus muscle resection with or without advancement is an effective alternative for treating postoperative consecutive exotropia.
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http://dx.doi.org/10.1016/j.jaapos.2006.01.182DOI Listing
June 2006

Extraocular muscle cysticercosis: clinical presentations and outcome of treatment.

J Pediatr Ophthalmol Strabismus 2005 Jan-Feb;42(1):28-33

Squint Clinic, Grewal Eye Institute, Chandigarh, India.

Purpose: To report various clinical presentations and treatment outcomes in a series of patients with extraocular muscle cysticercosis.

Methods: This retrospective study reviewed the charts of 43 patients diagnosed with extraocular muscle cysticercosis with computed tomography and orbital B-scan ultrasonography between January 1991 and December 2002. Clinical presentation, results of investigations, treatment, and outcome were recorded.

Results: The superior rectus was the most commonly affected extraocular muscle. Restricted ocular motility was present in 88% of patients, and inflammatory signs were noted in the involved quadrant in 70% of patients. Eleven patients were treated with oral albendazole alone and 31 patients were treated with oral albendazole and prednisolone. Four extraocular muscle cysts were excised surgically, and five extruded spontaneously. Inflammatory signs subsided in all patients, and residual restriction of ocular motility was seen in 16 (50%) of 32 patients at a mean follow-up of 5 months. Type of treatment made no significant difference in the ocular motility outcome.

Conclusions: Extraocular muscle cysticercosis should be considered in patients who present with restricted ocular motility and inflammatory signs. The direction of motility restriction does not indicate the muscle involved. Residual restriction of ocular motility is common despite the addition of corticosteroids to albendazole therapy.
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http://dx.doi.org/10.3928/01913913-20050101-04DOI Listing
April 2005

Congenital unilateral adduction associated with jaw movement: a rare variant of trigemino-oculomotor synkinesis.

J Pediatr Ophthalmol Strabismus 2004 May-Jun;41(3):174-6

Squint Clinic, Grewal Eye Institute Chandigarh, India.

A 21-year-old man had abnormal adducting movements of his left eye on mastication. This suggested an anomalous innervation of the medial rectus muscle from the motor branch of the trigeminal nerve that innervated the external pterygoid muscle.
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http://dx.doi.org/10.3928/0191-3913-20040501-11DOI Listing
July 2004

Cyclic "V" esotropia.

J Pediatr Ophthalmol Strabismus 2004 Mar-Apr;41(2):122-5

Squint Clinic, Grewal Eye Institute, Chandigarh, India.

A young girl had cyclic esotropia with cyclic inferior oblique overaction and "V" pattern. A recession-resection surgery of the horizontal rectus muscles and recession of the inferior oblique muscles cured the cyclic esotropia as well as the inferior oblique overaction and V pattern.
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http://dx.doi.org/10.3928/0191-3913-20040301-16DOI Listing
June 2004

Successful occlusion therapy for amblyopia in 11- to 15-year-old children.

J Pediatr Ophthalmol Strabismus 2004 Mar-Apr;41(2):89-95

Squint Clinic, Grewal Eye Institute, Chandigarh, India.

Purpose: To investigate the effectiveness of full-time occlusion therapy in treating amblyopia in 11- to 15-year-old children and to determine its lasting results.

Patients And Methods: Fifty-five compliant children 11 to 15 years old who had amblyopia were treated with full-time (during all waking hours) occlusion of their good eye until no further improvement in the visual acuity of their amblyopic eye was observed on 3 consecutive monthly follow-up examinations. After this, part-time (4 hours per day) occlusion therapy was used randomly in 24 of 55 patients for 3 to 6 months for maintenance of the final visual acuity. Snellen visual acuity and its logMAR equivalent were recorded before treatment, at the cessation of full-time occlusion therapy, and on the most recent examination.

Results: All 55 of the patients had improved visual acuity after treatment. The mean improvement was 0.46 logMAR unit (4.6 Snellen lines). Thirty-two of the patients had a mean follow-up of 17.6 months after the cessation of full-time and maintenance occlusion therapy. Twenty-nine (91%) of the 32 patients maintained improved visual acuity, whereas 3 (9%) exhibited a regression in visual acuity. Maintenance occlusion therapy did not have a significant stabilizing effect on the improved visual acuity.

Conclusion: Compliant, full-time occlusion effectively improves acuity in children 11 to 15 years old who have amblyopia due to strabismus, anisometropia, or both. Most older patients have lasting improvement with or without maintenance patching.
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http://dx.doi.org/10.3928/0191-3913-20040301-08DOI Listing
June 2004

Large pedunculated congenital corneal dermoid in association with eyelid coloboma.

J Pediatr Ophthalmol Strabismus 2004 Jan-Feb;41(1):53-5

Grewal Eye Institute, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.3928/0191-3913-20040101-12DOI Listing
March 2004

Fibrin glue for conjunctival closure in strabismus surgery.

J Pediatr Ophthalmol Strabismus 2003 May-Jun;40(3):158-60

Squint Clinic, Grewal Eye Institute, Chandigarh, India.

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August 2003

Factors predicting upshoots and downshoots in Duane's retraction syndrome.

J Pediatr Ophthalmol Strabismus 2003 May-Jun;40(3):147-51

Squint Clinic, Grewal Eye Institute, Chandigarh, India.

Purpose: Factors predicting mechanical and innervational types of upshoots and downshoots in Duane's retraction syndrome were evaluated.

Methods: This retrospective study evaluated upshoots and downshoots in 196 patients (222 eyes) with Duane's retraction syndrome seen between January 1990 and July 2001. On the basis of the clinical characteristics, upshoots and downshoots were classified as mechanical type, innervational type, or both. Factors potentially predicting the upshoot-downshoot phenomenon that were studied included patient age, type of Duane's retraction syndrome, horizontal strabismus, and vertical tropia in the primary position of gaze.

Results: Upshoots and downshoots were present in 39% of the eyes. The mechanical type was more common than the innervational type (26% vs 12%). Overall, upshoots and downshoots were statistically significantly more common in type III Duane's retraction syndrome, with exotropia, and with vertical tropia in primary position. Patient age had no correlation with upshoots or downshoots. Both types of upshoots and downshoots were significantly more common in type III Duane's retraction syndrome. A statistically significant association was found between exotropia and the mechanical type, and between vertical tropia in primary position and the innervational type.

Conclusions: All patients with type III Duane's retraction syndrome, exotropia, and vertical tropia in the primary position of gaze should be examined for upshoots and downshoots. One should look specifically for the mechanical type when there is exotropia and for the innervational type when there is a large vertical tropia in the primary position of gaze.
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August 2003

Acute concomitant esotropia.

J Pediatr Ophthalmol Strabismus 2002 Sep-Oct;39(5):304-6

Squint Clinic, Grewal Eye Institute, Chandigarh, India.

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February 2003
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