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Session: Poster session A

Postoperative Binocular Visual Field Assessment Using a Personalized Computerized Kinetic Perimetry

Júlio BRISSOS1, Guilherme ALMEIDA1, Rafaela CORREIA1, Marta LOURO1, Cristina SANTOS1, Raquel SELDON1, Gabriela VARANDAS1

1ULS São José, Lisboa, Portugal


  • Surgical outcome of diplopia caused by paretic and restrictive strabismus is often accessed by a binocular visual field (BVF) using the Goldmann perimeter. However, Goldmann perimeters are being replaced by automated perimeters for assessment of patients with glaucoma and neuro-ophthalmic conditions. We propose to apply a postoperative evaluation method to BVF in patients diagnosed with fourth cranial nerve palsy (IVCNP) and thyroid eye disease (TED) using a computerized kinetic perimetry.

  • Retrospective study. Patients with IVCNP and TED older than 18 years old and submitted to strabismus surgery were included. We excluded patients with previous strabismus surgery and absence of fusion. The BFV was performed after surgery through a personalized kinetic perimetry software on Octopus 900, Haag Streit® (vectors with a radiant direction, pointing from the center to the periphery, stimuli III4e; angular velocity of 5º/s). Thereafter, the Binocular Single Vision (BSV) Score was calculated as proposed by Sullivan et al (1992). We defined good surgical outcome: BSV Score > 50% and heterophoria in the primary position; moderate outcome: BSV Score 1-50% but with correctable diplopia with prisms or head tilt; poor outcome: BSV Score = 0% and/or intractable diplopia.

  • 13 patients were included: 6 with IVCNP and 7 with TED. 10 patients achieved good outcome, 2 patients had moderate outcome and 1 patient had poor outcome. Mean BVS was 64.7 ± 25.6. IVCNP subgroup analysis revealed mean postoperative vertical deviation of 3.0 ± 3.5 DP, -1.0 ± 2.5 DP of horizontal deviation and mean BVS Score was 67.8 ± 24.9. TED subgroup presented mean postoperative vertical deviation of 2.7 ± 5.5 DP, +2.4 ± 2.6 DP of horizontal deviation and mean BVS Score was 62 ± 27.6.

  • BVF evaluation allows us to quantify surgical outcome in patients with diplopia consequent to IVCNP and TED. This method may be applied to binocular diplopia from other causes and further studies are needed to validate this tool.