A 9-year-old healthy boy presents for follow-up with a 7-year history of esotropia (ET). When first evaluated at 2 years of age, he had a manifest deviation of 30 ET with a strong fixation preference for the left eye. Cycloplegic refraction was +4.00 right and +2.50 + 0.50 x 90 left. At this time, he was diagnosed with refractive-accommodative esotropia (RAET), anisometropia, and probable amblyopia of the right eye. Treatment was initiated with full-time wearing of full-plus glasses. When visual acuity testing was possible at 4 years of age, his acuity measured 20/125 right and 20/40 left. Therefore, part-time occlusion of the left eye 3-4 hours daily was started for amblyopia of the right eye. At 6 years of age, his visual acuity measured 20/125 right and 20/80 left and he was then diagnosed with bilateral amblyopia. Amblyopia occlusion therapy was discontinued at 8 years of age, with visual acuities measuring 20/100 right and 20/70 left.
Now, at 9 years of age, visual acuity with correction is 20/200 right and 20/60 left. Cycloplegic refraction measures +5.00 sphere right and +3.75 + 2.00 x 80 left. Ocular motility is normal but alternate cover testing reveals a small residual strabismus of 10 E(T) with distance fixation and 6 E(T) with near fixation. Fundus photos taken at the most recent examination are shown below.
Great
Cybersight is a great platform
The macular should have been checked earlier when there was decrease in VA after 2yrs.
What can be done at this time? Can the macular be improved?
Dear Dr. Adetunde Anifaleye,
Thank you for your question. On behalf of our medical advisor, we are copying the response below:
“Treatment options consist of topical carbonic anhydrase inhibitors such as 2% dorzolamide 2-3 times per day. This has been shown to decrease the subretinal fluid in the schisis cavities and improve visual acuity in some patients.
https://consultqd.clevelandclinic.org/long-term-topical-dorzolamide-improves-visual-acuity-in-juvenile-x-linked-retinoschisis/”
Should there be any further questions, please do reach out to us at [email protected].
Macular dystrophies
Good case
Interesting. Very educative
Very interested cases . Keep forward!
Very informative
Why did you wait this long to make a diagnosis of macular disease? Still incompete is the diagnosis. Do electro diagnostic tests, should have done at the earliest opportunity. I will do genetic testing as well.
Occlusion therapy for each eye during 2 months with light therapy. This child has fixation mistake on both eyes.
Also, in addition to the asterisk in the macula, an incorrect topography of the macula relative to the optic nerve is visualized)
If the treatment of amblyopia does not give results within 4 months, then it is necessary to either change tactics or conduct a more detailed examination.
Once I had almost same case, I was wondering what was the wrong? Why the child’s vision and motility did not show any improvement? That’s why it is really important to use atropine drops in order to reveal all latent hypermetrope for some unexplained cases, besides I significantly recommend for digital amblyopia therapy for binocular amblyopia in order to improve it faster.
The fundus photograph and the lack of improvement with the glasses and management given over the years actually shows there’s more to just the refractive aspect of the case . The reason I would go for OCT for further investigation especially around the macular region.
Tnx for such a wonderful cases!
Interesting one
Thank you very much,very educative.
A very interesting case.
Informative case study
Very instructive case. Thank you
Wonderful
İnteresting question.
Interesting
Good case👍
It’s so important to see the fundi in every strabismus patient!
Yes
Yes
Great case, with structural and functional components
Yes
Good case
Bert good case, examination of mácula should bem allways a point um ambliopia cases
Yes
Very productive.
Oct est obligatoire pour eliminer une amblyopie organique
Informative
Wow this is very informative, i have had similar cases before but i couldn’t really place my diagnosis.
From Nigeria
Good
This was very informative and interesting.
Interesting case
Es muy instructivo e interesante.
Informative question
Thankyou 👍🏾
The question is information
Interesting
This is so informative and mind refreshing too. Helpful for inquisitive thinking and knowledge enriching studies. Thanks and keep it coming…
Very Nice
Very educative.
I love this
Thanks for sharing a nice case
very informative, please keep posting such things.
Wow
Nice presentation of the scenario..wish more like these
Educative… please keep sending this
Thank you for up dating my knowledge
Keep me updated
BE – OCT to rule out HMD
Good informative quiz
Yes ..pt has macular disease
Yes
Looks more likely macular dystrophy
Good
Good topic
Interesting
Retinoschisis presenting as constant or intermittent Strabismus with refractive error is not uncommon
Macular star spoke like pattern may consistent with X link retinoschisis
What happened to the macula?
Interesting case. I have been enlightened. Thank you so much.
ok
Surprised VA could not be measured until 4yo – fixation behavior of the strabismus at thr very least can inform the need for occlusion therapy (although unlikely to have made any difference in this patient)