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Strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis
Wendy E Adams1, Jacqueline A Leavitt, Jonathan M Holmes
1Department of Ophthalmology Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Summary
Surgery for bilateral internuclear ophthalmoplegia with exotropia in multiple sclerosis patients effectively restored single vision. This intervention significantly improved quality of life for individuals experiencing disabling double vision.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Internuclear ophthalmoplegia (INO) affects up to 40% of multiple sclerosis (MS) patients.
- Bilateral INO with exotropia in MS presents management challenges due to the disease's uncertain progression.
- Diplopia from INO significantly impairs patient quality of life, necessitating treatment consideration.
Observation:
- Three MS patients with BINO and exotropia experienced disabling diplopia.
- Surgical intervention involved bilateral medial rectus resections with adjustable lateral rectus recession(s).
- Preoperative exotropia ranged from 40-64 prism diopters (PD) at distance and 50-70 PD at near.
Findings:
- Post-surgery, patients achieved alignment within 10-18 PD exotropia at distance, anticipating drift.
- At 6 months, all patients achieved orthotropia at distance and near, with single vision.
- Two-year follow-up showed sustained single vision in primary position and for reading, with one patient needing prism.
Implications:
- Surgical correction of BINO with exotropia is a beneficial option for MS patients.
- This surgical approach can effectively alleviate disabling diplopia and improve visual function.
- Consideration of surgical intervention is warranted for symptomatic MS patients with BINO and exotropia.
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