Workshop 9

Mar 04, 2017 by AAPOS editor in  Workshop

Strabismus Surgery in Complex Neurologic Disease: Surgical Strategy and Outcomes

Gena Heidary, MD, PhD; Stacy Pineles, MD; Jason Peragallo, MD;
Mitchell Strominger, MD; Jane Edmond, MD; Linda Dagi, MD

Boston Children’s Hospital
Boston, MA

Purpose/Relevance:  Strabismus occurs frequently in children and adults in the setting of neurologic disease such as brain tumor or cortical visual impairment.1-3  The purpose of this workshop is to discuss and evaluate the approach to strabismus surgery in patients who harbor complex neurologic disease.  We seek to highlight important considerations with respect to surgical strategy and discuss surgical outcomes in the context of these neurologic conditions.

Target Audience:  Pediatric ophthalmologists and neuro-ophthalmologists

Current Practice:  Ophthalmologists may not be familiar with the ophthalmic symptoms/signs suggestive of CNS disease, the significant morbidity of oculomotor dysfunction secondary to CNS disease, and the current literature regarding oculomotor outcomes in this context.

Best Practice:  Ophthalmologists should recognize the clinical signs and the types of strabismus that are associated with these CNS conditions and be familiar with the pearls and pitfalls of strabismus management in the context of complex neurologic disease.

Expected Outcomes:  The attendee will be empowered to recognize clinical signs suggestive of specific CNS diseases that affect oculomotor function and the pattern(s) of strabismus associated with these disease processes.  The clinician will become aware of evidence based ocular motility outcomes for these patients thereby enhancing clinical management.

Format:  Panel with case presentations, didactic lectures and question/answer period

Summary:  The workshop will focus on the following topics: dorsal midbrain syndrome, internuclear ophthalmoplegia, strabismus after treatment of posterior fossa tumors, pediatric myasthenia gravis, ocular neuromyotonia, and cortical visual impairment.  Each topic will be led by one of the authors with a case presentation followed by a didactic talk.  The talk will include a brief review of pertinent clinical findings associated with the condition, a discussion of surgical strategy/decision making, and any relevant literature regarding oculomotor outcomes in the context of each topic.

References:  1. Shalev and Repka.  Ophthalmol. 2000; 107:1880-1883.
2. Peragallo JH, Velez FG, Demer JL, Pineles SL. J Neuroophthalmol. 2013 Mar;33(1):40-4. doi: 10.1097/WNO.0b013e318280d630.
3. Binder NR, Kruglyakova J, Borchert MS.  JAAPOS. 2016; 2016 Apr;20(2):121-5. doi: 10.1016/j.jaapos.

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