Atropine
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Reverse amblyopia: 2 case reports In a case series, two girls aged 2.6-years and 3.2-years were described, who experienced reverse amblyopia following administration of atropine for amblyopia in the USA. Case-1: The 2.6-year-old girl presented with a large angle esotropia and amblyopia of right eye. She was initially diagnosed with esotropia 1 year earlier. She had a left eye fixation preference, and spectacle correction was prescribed at that time. But she did not wear the glasses. During the current presentation, she had an esotropia. Her best-corrected visual acuity was 20/70 in right eye and 20/30 in left eye. She had a strong left eye fixation preference. Daily 1-4 drops of atropine (1%) penalisation was started for the right eye amblyopia. She has not adhered with spectacle wear. Four days later, she was noted with a fixation switch to the right eye and self-discontinued the atropine. Six weeks later during a follow-up examination, she had a right eye fixation preference. Her bestcorrected visual acuity was 20/50 in the right eye and less than 20/500 in the left eye. MRI of brain and orbits was normal except for a Chiari I malformation. Thus, a diagnosis of atropine induced reverse amblyopia (left eye) was established. The atropine was stopped formally and patching of the right eye initiated, but her adherence to the treatment was limited. Four months later, best-corrected visual acuity of left eye improved partially to 20/200 ,and she was hospitalised and underwent surgery for residual esotropia in the left eye. After 3 years her best corrected visual acuity was 20/20 in the right eye and 20/60 in the left eye. Case-2: The 3.2-year-old girl presented with an 8 month history of intermittent crossing of the eyes that worsened over time. On examination, she had an esotropia, with a strong right eye fixation preference. Uncorrected visual acuity was 20/50 in left eye and 20/20 in the right eye. Full hyperopic correction was prescribed and amblyopia of left eye treatment was initiated. She initially attempted to patch the right eye for 2 weeks; however, she did not wear neither the patch nor spectacles. Therefore, 1-4 drops of atropine penalisation was started for the left eye amblyopia. After a single dose of atropine [dose not stated], her parents noted a fixation switch to the left eye and self-discontinued the atropine. She did not return for follow-up, however three months later she presented with a strong left eye fixation preference. Best-corrected visual acuity in left eye remained at 20/50, whereas it reduced to less than 20/400 in the right eye. MRI of the brain and orbits was normal. Therefore, she was diagnosed with atropine induced reverse amblyopia (right eye). Atropine was discontinued formally and left eye patching was initiated, but her treatment adherence was limited. After 3 months, best-corrected visual acuity in the right eye remained at 5/400. Later, she was hospitalised and underwent bilateral medial rectus recessions for persistent esotropia. Two months following the surgery, her visu
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