Molteno implants are gaining wide acceptance for refractory glaucoma In both children and adults. Such surgery led to vertical strabismus In three patients. Two children developed an inability to elevate the globe after Molteno implants were placed superiorly. One adult, whose Molteno Implant was placed interiorly, could not fully depress the globe postoperatlvely, and experienced vertical diplopia. This complication of Molteno implants was explored using forced auction testing and surgery. We feel a likely explanation for this Is a Faden or posterior fixation suture effect induced by scarring under the rectus muscle. Patients undergoing this surgery should be counseled about possible postoperative diplopia, an especially devastating complication when the implant is placed inferiorly.

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Purpose: To evaluate the surgical and functional outcomes in children with congenital Zika syndrome who underwent strabismus surgery. Methods: This prospective case series included children with congenital Zika syndrome who presented with horizontal infantile strabismus and underwent strabismus surgery. Ocular motility and visual fields were assessed preoperatively and postoperatively. Visual fields were considered normal if they exceeded 70 degrees in the temporal meridian. Postoperatively, parents and caregivers answered a questionnaire that assessed their child's behavioral improvements. A final ocular alignment within ±10 prism diopters (PD) and expansion of the visual fields were considered satisfactory motor surgical results at 6 months postoperatively. Results: Five children (3 girls [60%]) with congenital Zika syndrome (age: 36.4 ± 0.9 months) were included in this study. All children (100%) presented with moderate to severe visual impairment and 4 (80%) presented with funduscopic abnormalities. Preoperatively, 4 children (80%) had infantile esotropia (mean preoperative angle of deviation: 41.3 ± 6.3 PD) and 1 (20%) had infantile exotropia measuring 65 PD. The postoperative outcomes demonstrated ocular alignment in 4 children (80%) at the 6-month follow-up visit. Expansion of the temporal visual field was observed in 7 eyes (70%) of 4 children (80%). Four caregivers (80%) reported behavioral improvement in daily activities, and all caregivers (100%) reported improved peripheral target detection and socialization skills. Conclusions: Strabismus surgery can be an effective procedure for treating horizontal strabismus in children with congenital Zika syndrome because it can improve ocular alignment, expand the visual field, and improve the child's social, functional, and behavioral skills. [ J Pediatr Ophthalmol Strabismus . 2020;57(3):169–175.]

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