Journal Reading Muhammad Baqir-Strabismus.pptx

Journal Reading Strabismus, Strabismus atau mata juling adalah kondisi ketidaksejajaran mata yang menyebabkan mata mengarah ke arah yang berbeda. Strabismus dapat terjadi pada anak-anak atau orang dewasa, namun sebagian besar kasus terjadi pada masa kanak-kanak

1. Outcomes of symmetric bilateral medial rectus recession in large-angle esotropic Duane syndrome Muhammad Baqir* Consultant: dr. Linda Trisna, Sp.M, Subsp. POS Source: Nabie R, Manouchehri V, Azad B. Eur J Ophthalmol. 2021 Sep;31(5):2647-2650. doi: 10.1177/1120672120968731. MEDICAL STAFF GROUP OF OPHTHALMOLOGY MEDICAL FACULTY OF SRIWIJAYA UNIVERSITY M OHAMMAD HOESIN GENERAL HOSPITAL PALEMBANG 20 24 Journal Reading

2. Clinical manifestations of Duane Retraction Syndrome (DRS) are multiple and various. The cause of this diversity relates to the pathophysiology of the disease, where the nucleus of abducens nerve can either be completely absent or hypoplastic. In this syndrome, the lateral rectus receives a wide range of stimuli from different branches of the oculomotor nerve, leading to co-contraction between the medial and lateral rectus muscles in adduction. INTRODUCTION

3. To choose the best surgical technique, strabismus surgeons need to consider the type and size of the primary position deviation and abnormal head posture (AHP), the magnitude of ocular motor restriction, and the severity of globe retraction and over-shoots.

4. To evaluate the efficacy of symmetric bilateral medial rectus recession in large-angle esotropic Duane retraction syndrome (DRS) with moderate to severe globe retraction. PURPOSE

5. Retrospective study 30 patients who underwent symmetric bilateral medial rectus recession were reviewed Population Study Design Location Date Nikookari Eye Center (a tertiary eye care center) in Tabriz, Iran, between October 2013 and February 2019. METHOD

6. RESULT

7. RESULT Table 1 shows pre- and post-operative clinical measurements. The mean preoperative primary position esotropia measured 28.9 ± 9.1 pd (range: 20–45 pd) in distance and 25.7 ± 7.2 pd in near (range: 16–45 pd), which decreased to 4.9 ± 6.1 pd (range: 0–25 pd) in distance and 3.9 ± 8.8 pd (range: 0–25 pd) in near postoperatively. The mean corrective effect of surgery was 23.7 ± 8.9 pd (range: 3–40 pd). The mean bilateral medial rectus recession was 4.9 ± 0.9mm (range: 3–6mm). Considering the mean total amount of medial rectus recession for each patient (9.8mm) and the mean corrective effect of surgery (23.7 pd), a dose-response ratio of 2.4 was calculated.

8. DISCUSSION The present study reports the results of symmetric bilateral medial rectus recession in esotropic Duane patients with deviations equal to or greater than 20 pd with moderate to severe globe retraction. The success rate of 76.7% showed that the above mentioned method was an effective surgical option in reducing and eliminating primary position deviation and AHP in these patients.

9. Consecutive exotropia was not seen in any patient, and all of the failed group had residual esotropia. Globe retraction decreased in most patients. Vertical deviation was not induced and no patient complained about diplopia. Previous studies in this field have aroused controversy over the efficacy of bilateral medial rectus recession in unilateral esotropic DRS. Both symmetric and asymmetric weakening of the contralateral medial rectus muscle have been recommended for large-angle esotropia in Duane syndrome.

10. LIMITATION The retrospective design, the lack of measuring convergence amplitude and binocular visual field

11. CONCLUSSION In the large-angle esotropic DRS patients with moderate to severe globe retraction, symmetric bilateral medial rectus recession, can be conducted to successfully resolve primary position deviation and abnormal head posture.

12. CRITICAL APPRAISAL

13. Yes it was, the two groups similar and recruited from the same population Were the two groups similar and recruited from the same population?

14. Yes it was, the exposures measured similarly to assign people to both exposed and unexposed groups Were the exposures measured similarly to assign people to both exposed and unexposed groups?

15. Yes it was, the exposure measured in a valid and reliable way Was the exposure measured in a valid and reliable way?

16. No, it was not, there were no explanation about cofounding factors Were confounding factors identified?

17. Yes it was, the outcomes measured in a valid and reliable way Were the outcomes measured in a valid and reliable way?

18. Yes it was, less than 3 months of follow up were excluded. Was the follow up time reported and sufficient to be long enough for outcomes to occur?

19. Yes it was, SPSS 23.0 for Windows (IBM, Inc., Chicago, IL) was used for the analysis. Was appropriate statistical analysis used?

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