International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Three horizontal muscle squint surgery for large angle infantile esotropia

Background: To report the long-term outcome of a series of 49 patients who underwent three horizontal muscle squint surgery for large angle infantile esotropia. Methods: The patient records were retrospectively reviewed of 49 (24 girls [49%], 25 boys) consecutive patients with infantile esotropia of angle greater than or equal to60 Delta, who had undergone three horizontal muscle surgery performed by one surgeon (author GG). Surgery consisted of bilateral medial rectus recession combined with graded unilateral lateral rectus resection. Surgeries were carried out over a 6-year period with a mean follow-up period of 32.9 months (3.7-71.8 months). Results: Using Kaplan-Meier life-table analysis, cumulative surgical success (orthotropia +/-10 Delta) was 93.9% at 1 week, 91.8% at 2 and 6 months, 87.7% at 12 and 18 months, 79.9% at 2 years, 77.1% at 3, 4 and 5 years, and 70.6% at 6 years. The mean preoperative deviation was 68.7 Delta. The mean age at surgery was 12.9 months. The failure rate was independent of preoperative deviation. Prevalence of residual esotropia (>10 Delta) varied from 2.0% at 1 week to 17.0% at 6 years. Similarly the prevalence of consecutive exotropia (>10 Delta) varied from 4.0% at 1 week to 12.4% at 6 years. Conclusion: Operating in a graded fashion on three horizontal muscles in children with large angle infantile esotropia has a high success rate, even over long-term follow up. Based on the study's results, amounts of surgery for a given angle of strabismus are proposed

Amblyopia And Sensory Features At Initial Presentation of Brown Syndrome: An Issue to Recognize

Purpose To investigate the frequency of amblyopia and sensory features at initial presentation in patients who had unilateral congenital Brown syndrome (BS) and to identify the potential risk factors for amblyopia in BS. Methods The study conducted with patients who had unilateral congenital BS. Patient demographics, visual acuity, refractive errors, amount of horizontal and vertical deviations, abnormal head position, fusion, and stereopsis were all reviewed. The main outcome measure was the frequency of amblyopia at initial presentation. Results The review identified 44 patients with BS (median age 5 years). The frequency of amblyopia was 15.9% (seven patients) in BS at initial presentation. Patient age (P = 0.297), ocular alignment at primary position (P = 0.693), anisometropia (P = 0.184), and stereoacuity (P = 0.061) were found to have no significant relation with amblyopia. The main associated risk factor was the absence of sensory fusion (P = 0.013). Conclusions Amblyopia may be encountered among patients with BS, and may be related to binocularity of the patient. Its recognition may be a critical step during the treatment planning and may determine presumably the success of future therapies. Eye (2013) 27, 515-518; doi:10.1038/eye.2012.306; published online 1 February 2013Wo