PurposeTo compare the success rates of botulinum toxin (BTX) injection and conventional strabismus surgery in treating residual esotropia. MethodsThis retrospective cohort study included patients with residual esotropia of >15[Δ] following strabismus surgery treated at a single instituion from 2015 to 2023. Patients were categorized into two groups based on intervention type: the surgery group and the BTX group. The success rate was defined as an angle of deviation of <10[Δ] of esotropia during the last follow-up, at least 3 months after the last intervention. ResultsA total of 41 patients were included: 20 in the surgery group and 21 in the BTX group. No statistically significant differences were observed between the groups in terms of age, sex, spherical equivalent, amblyopia, diagnosis, or preintervention angle of deviation. Mean preintervention angles of deviation were 25.40[Δ] ± 9.36[Δ] in the surgical group and 25.14[Δ] ± 6.76[Δ] in the BTX group, which decreased to 10.45[Δ] ± 9.36[Δ] and 11.52[Δ] ± 13.11[Δ], respectively, after treatment, with no statistically significant difference (P = 0.555). The success rates were 47.6% in the BTX group and 60% in the surgery group (P = 0.427). Exotropia developed in a single patient in each group. Dissociated vertical deviation developed in 2 patients from the surgical group and 1 patient from the BTX group. In the surgical group, 2 patients developed hypertropia; in the BTX group, 4 patients. ConclusionsBTX is comparable to conventional surgery and can be considered in the management of residual esotropia.

Pediatric endophthalmitis is a rare but vision-threatening condition, most commonly associated with trauma worldwide. A case of delayed-onset postoperative Staphylococcus warneri endophthalmitis was identified in a 7-year-old boy with Marfan syndrome after scleral-sutured Akreos AO60 intraocular lens (IOL) implantation. After lensectomy, pars plana vitrectomy, and Gore-Tex-fixated IOL placement with intraoperative moxifloxacin, early postoperative examinations were unremarkable. At postoperative day 59, the patient developed progressive vision loss with white, spherical deposits coating the IOL and hazy fundus view. Despite initially mild inflammation treated with topical corticosteroids, the condition progressed to anterior chamber inflammation with biofilm-like refractile deposits involving the IOL and scleral sutures, prompting vitreous tap, intravitreal vancomycin and ceftazidime, and membrane peeling. Cultures grew rare S. warneri. After transient improvement, recurrent endophthalmitis with vitritis necessitated vitrectomy with IOL and Gore-Tex suture explantation and adjunctive systemic antibiotics. The patient underwent repeat scleral-sutured IOL implantation 4 months later, and best-corrected visual acuity improved to 20/40, with no apparent recurrence of endophthalmitis at 6 months following explantation of the initial scleral-sutured IOL.

A 7-year-old boy with a history of Duane retraction syndrome was found to have an anomalous orbital band arising from the right lateral rectus muscle. Surgical removal of this band to correct exotropia resulted in postoperative optic neuropathy and hypoesthesia in the distribution of the superior branch of the trigeminal nerve. This case demonstrates a rare complication of orbital surgery in patients with Duane retraction syndrome. It serves as a reminder to evaluate patients with congenital cranial dysinnervation disorders for additional structural defects and consider orbital imaging in patients with atypical pattern restrictive strabismus.

We present a series of 3 patients with partial oculomotor nerve palsy who underwent a modified augmented transposition procedure, reported here for the first time, which effectively improved both horizontal and vertical deviations. This procedure consists of resections of both superior rectus and medial rectus muscles, followed by transpositions of the medial rectus muscle superiorly and the superior rectus muscle nasally to join in the superonasal quadrant. This technique avoids operation on three or more extraocular muscles, which is typically required to achieve orthotropia in primary position for oculomotor nerve palsies, consequently reducing the risk of anterior segment ischemia postoperatively.

Gyrate atrophy (GA) is a rare autosomal recessive disease caused by a defect in the enzyme ornithine aminotransferase (OAT). We report a case of a 4-year-old boy with GA of the choroid and retina. Following initiation of an arginine-restricted diet and targeted supplementation, there was rapid improvement in his cystoid macular edema (CME) and foveoschisis. We also report clinical and imaging findings from his 2-year-old sister, who carries the same genetic variant. This report highlights the potential for early metabolic intervention to produce rapid anatomical improvement in GA-associated CME. Further studies are needed to determine which mutations respond better to specific treatments.