Survival analysis of 365 patients with exotropia after surgery

PURPOSE: Few reports have included large numbers of exotropia patients. Thus, we undertook this study to perform a survival analysis of over 350 patients with exotropia and to determine which factors might affect the outcome of exotropia surgery. METHODS: The clinical records of 365 patients who underwent exotropia surgery by one surgeon were retrospectively reviewed. Preoperative patient characteristics, surgical procedures performed, and early postoperative ocular alignment were evaluated as potential risk factors of surgical outcome using survival analysis. RESULTS: The estimated median time from surgery to recurrence was 48.3 months. None of the characteristics or procedures were found to be significantly associated with surgical outcome. The likelihood of a good postoperative surgical outcome was highest with an initial postoperative alignment of more than 10 prism diopters of esotropia (P<0.001). CONCLUSIONS: Early postoperative overcorrection was the only predictor of a successful long-term outcome after exotropia surgery.     

Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia

Purpose

The purpose of this study is to evaluate prognostic factors, specifically age, at the time of surgery, for recurrence after bilateral lateral rectus recession (BLR) in patients with intermittent exotropia.

Methods

Medical records of 511 subjects who underwent BLR procedures between the ages of 3 and 10 years with more than 12 months of follow-up were retrospectively reviewed. Patients'' surgical outcomes with a deviation of less than 10 prism diopters (PD) exotropia and less than 5 PD esotropia were defined as a success. Outcomes with more than 11 PD exotropia were designated as recurrences, and those with esotropia of more than 5 PD after 3 months of surgery were noted as overcorrection. Prognostic factors for recurrence were analyzed by multivariate logistic regression test.

Results

Of the 511 subjects, 371 had successful surgical outcomes and 129 had recurrences, whereas 11 were found to be overcorrected. Age at surgery and immediate postoperative alignment proved to be significant factors influencing a favorable outcome by multivariate logistic regression analysis (P<0.05). However, gender, photophobia, age at onset, spherical equivalent (SE) refractive error, astigmatism, SE anisometropia, and preoperative deviation size were not significantly predictive of success (P>0.05).

Conclusion

In BLR procedures, increasing patient age at surgery was associated with lower recurrence rates.     

Effect of refractive surgery on binocular vision and ocular alignment in patients with manifest or intermittent strabismus

OBJECTIVE: To evaluate the effect of refractive surgery on binocular vision and ocular alignment in patients with manifest or intermittent strabismus, with or without vertical component. SETTING: University Hospital Antwerp, Edegem, Belgium. Patients and methods: 13 patients (22 eyes) with strabismus underwent refractive surgery. Five of these patients presented with an esotropia and four of them with a small vertical deviation. Five patients had a manifest exotropia, of whom two presented with a small vertical deviation. Two patients had an intermittent exotropia with binocular vision, of whom one patient had a vertical deviation. One patient had a hypertropia with a dissociated vertical deviation. RESULTS: Ocular alignment and binocular function remained unchanged postoperatively in all except two patients with high anisometropia who experienced an improvement in binocular function. In these patients, the preoperative manifest deviation became intermittent or latent after surgery, allowing fusion and stereopsis. Vertical deviation was found preoperatively in 8 of the 13 patients. This vertical deviation remained unchanged postoperatively, but improved in one patient with anisometropia. CONCLUSION: Preoperative intermittent or manifest strabismus is not a contraindication for refractive surgery provided some specific recommendations are taken into account, such as an adequate preoperative orthoptic examination and aiming at emmetropia for both eyes.     

Factors affecting the surgical outcome of primary exotropia

AIMS: To identify the predictors for motor outcome and response to surgical treatment of primary exotropia. SETTING: Taunton and Somerset Hospital, Somerset, United Kingdom. STUDY TYPE: Retrospective analysis of the surgical treatment of primary exotropia performed in our department over a period of 12 years from April 1991 to May 2003. METHODS: Case-notes of the patients who had surgical treatment for primary exotropia for the specified period were identified by a hospital computer database (MDI coding). All case-notes were reviewed and the following data were recorded and used for statistical analysis: age at the time of surgery, type and severity of exotropia, presence of amblyopia, AV pattern and vertical deviation, the level of stereopsis, type of surgery, and motor and cosmetic results. The surgical outcome was determined as good motor outcome if tropia was within 10 PD of orthotropia. The response to surgery was derived from the difference between the preoperative and postoperative angle of deviation for distance per amount of muscle surgery in millimetres. RESULTS: A total of 124 cases were included in the study. Good motor outcome was achieved in 83 (67%) cases. There was a positive correlation between the preoperative angle of deviation at distance and dose response to surgery (r = 0.6 and p < 0.001) and a negative correlation between average corrected visual acuity and response (r = -0.21 and p = 0.025). There was a statistically significant negative relationship between preoperative stereopsis and response to surgery (p = 0.02). CONCLUSIONS: Surgical treatment for exotropia is effective and the dose response is correlated to the preoperative angle of deviation and average visual acuity. Poor or no preoperative stereopsis was associated with better response to surgery.     

The clinical course of consecutive esotropia after surgical correction

PURPOSE: To investigate the clinical course in patients who underwent surgical correction of consecutive esotropia. METHODS: The medical records of 13 patients who underwent surgical correction of consecutive esotropia were reviewed retrospectively. The authors investigated the deviation and surgical method at the time of exotropia surgery. During the follow up period, the authors also studied incidence of amblyopia development, the effect of occlusion therapy, surgical methods for consecutive esotropia, and postoperative change of deviation. RESULTS: The average exodeviation was 27.1 prism diopter (PD). Bilateral lateral rectus muscle recession was performed in all patients. In all patients, alternate occlusion was tried from 2 weeks after development of consecutive esotropia. However, there was no effect on 7 patients. None of the patients developed amblyopia. Surgery for consecutive esotropia was performed on the average 15.3 months after exotropia surgery. The average esodeviation was 21.1PD. Medial rectus muscle recession was performed in 10 patients and lateral rectus muscle advancement in 3 patients. The average deviation of the subject group immediately after surgery was 1.2PD esodeviation, 0.9PD esodeviation one month after surgery, 2.4PD exodeviation 6 months after surgery, and 4.7PD exodeviation at the last follow up, and it showed a tendency to progress to exodeviation as the follow up period increased. Ten patients (76.9%) showed deviation within 8PD at the last follow up. CONCLUSIONS: The success rate of surgical correction for consecutive esotropia was a favorable outcome. But, careful decisions of the surgical method and amount is needed because the conversion of exodeviation during long-term follow-up is possible.     

Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre (PD)] were retrospectively reviewed. Two groups of patients were identified; Group I (21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A (BTA) injection into the recessed muscles and group II (30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group I (47.6%) and 20 patients in group II (66.7%) achieved esotropia/esophoria <5 PD or exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant (P=0.1) but there was a statistically significant higher rate of undercorrection in group I (P=0.03). On the other hand, 3 patients in group I (14.3%) and 5 patients in group II (16.7%) had improved stereopsis; this difference in the sensory outcome was not statistically significant (P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate (P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilateral medial rectus resection in the correction of large angle intermittent exotropia. The surgical success rate in BTA augmented surgery group is observed to be higher in patients with preoperative smaller angle of deviation and in patients with good stereoacuity.     

Results of combined divergence operation in intermittent exotropia in 120 children

BACKGROUND: Intermittent exotropia is the most frequent indication for surgical correction of exodeviations in childhood. Overcorrection with prolongated or persistent consecutive esotropia can impair binocular vision particularly in early childhood. We wanted to investigate this potential risk and the dose/effect relation of recess-resect surgery on children. PATIENTS AND METHODS: 120 children up to ten years of age underwent recess-resect surgery for intermittent exotropia in our clinic from 1991 to 1999 (< 2% of the surgical cases). The cycloplegic refraction was spectacle corrected with a reduction of 0.5 dpt. Preoperatively, a diagnostic occlusion was performed for three days. The amount of surgery was calculated using our dosage schedules based on effects one week postoperatively. The squint angles as measured by the alternate prism and cover test at 5 m and 0.3 m pre- and 3 months postoperatively and the binocular functions as measured by the Bagolini striated glasses, Titmus, Randot, TNO, or Lang tests were evaluated. RESULTS: (Medians) Squint angles in primary position were: preoperative: distance (5 m)--15 degrees, near (0.3 m)--16 degrees; postoperative (n = 104); distance--4 degrees, near--3 degrees. Effectivity of surgery: distance: 1.3 degrees/mm, near 1.4 degrees/mm. Consecutive esotropia requiring surgical correction occurred in 1 child. Second surgery for intermittent exotropia in the years 1991 to 1999 was necessary in 5 children. Binocular functions (n = 95): Preoperative = postoperative: 61%, postoperative > preoperative 21%, postoperative < preoperative 18%. The diagnostic occlusion was helpful to differentiate "pseudo-divergence excess type" from "divergence excess type" exotropia. The average deviation did not increase under the diagnostic occlusion. The effectivity of surgery (degree/mm) in the children group was lower than in a compared group of older patients (> 10 years) with intermittent exotropia. CONCLUSION: Using our own dosage schedules and surgical technique, residual exodeviations are common after recess-resect surgery in childhood. The risk of consecutive esotropia or persistent impairment of binocular vision is low.     

Full tendon transposition augmented with posterior intermuscular suture and recession--resection surgery

PURPOSE: To report an effect of the full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery, for the patient with monocular elevation deficiency (MED) and large exotropia. METHODS: Interventional case report. Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was performed for a 26-year-old male patient had monocular elevation deficiency (MED) and large exotropia. RESULTS: Preoperative angle of deviation was 56 prism diopters (PD) hypotropia and 45 PD right exotropia, compared with 18 PD left hypertropia and 10 PD right esotropia postoperatively. Essotropia persisted after 2.5 years, however, and so the right medial rectus was recessed after removal of the previous posterior intermuscular suture. At a three-year follow-up after the second surgery, alignment was straight in the primary position at near and far distances. CONCLUSIONS: Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was effective for a patient with MED associated with significant horizontal deviation, and a second operation was easily performed when overcorrection occurred.     

视感知觉检查系统对共同性外斜视术后立体视功能重建的相关预测因素

目的：引入视感知觉可塑性评分检查训练系统,评价该检测方法在临床应用中预测共同性外斜视术 后立体视恢复状况的准确度以及灵敏度和特异度。方法：前瞻性临床研究。连续收集2017年1─9月 在北京同仁医院诊断为共同性外斜视且进行手术治疗的患者136例,在术后1周接受视感知觉可塑 性评分检查。采用秩相关分析手术年龄、病程时长、术前斜视角度、术后1周斜视角度等因素与可 塑性评分相关性。所有患者均从术后1周开始进行视感知觉训练,分别于术后1、3、6个月进行远、 近立体视功能检测,制作ROC曲线,评价可塑性评分对术后不同时间点远、近立体视功能恢复预测 的准确度及灵敏度和特异度。采用Delong test将可塑性评分以及传统临床指标对半年立体视功能的 恢复状况的预测效能进行比较。结果：间歇性外斜视患者109例（80.2%）,恒定性外斜视27例（19.9%）。 可塑性评分分别与年龄、术前斜视度、斜视病程、外斜视类型、术后1周斜视度相关（r=-0.3、-0.2、 -0.3、0.4、-0.3,均P<0.05）。可塑性评分在术后半年内不同时间点对立体视功能均具有预测能力, 其中对术后6个月远、近立体视功能恢复正常均具有中等程度的预测意义,曲线下面积（AUC）均 >0.7,P<0.001。传统临床指标中,术前近立体视功能对术后半年近立体视功能有较低的预测能力 （AUC=0.63<0.7,P=0.009）;术前看远斜视角度对术后6个月远、近立体视功能能否完全恢复正常具 有较低的预测能力（AUC=0.66<0.7,P=0.02）,但这些指标与可塑性评分的预测能力相比,差异无统 计学意义（Z=1.2、1.4,P>0.05）。结论：视感知觉检查训练系统中,可塑性评分可以有效地预测共同 性外斜视患者术后远、近立体视功能的恢复状况,为术后患者制定进一步的诊疗策略提供依据。     

Effect of a Visual Perceptual Evaluation System on Predicting Stereopsis Function Rehabilitation after Concomitant Exotropia Surgery

Objective: To evaluate the accuracy, sensitivity and specificity of the plasticity score in examinations of visual perception and training systems in the clinical application for predicting the recovery of stereopsis in patients with concomitant exotropia. Methods: This was a prospective clinical study. A total of 136 patients with concomitant exotropia were continuously recruited and underwent surgery in Beijing Tongren Hospital from January 2017 to September 2017. Of these, there were 109(80.2%) cases of intermittent exotropia and 27(19.9%) cases of constant exotropia. One week after the surgery, all patients underwent visual perception plasticity testing. Spearman correlation was used to analyze the correlation between the type of exotropia, age at surgery, duration of strabismus, deviation angle of preoperative strabismus, deviation angle of strabismus one week after surgery, and plasticity score. All patients underwent visual perception training one week after surgery for 6 months. The far stereopsis and near stereopsis acuity tests were performed 1 month, 3 months, and 6 months after surgery, and the ROC curve was plotted to evaluate the accuracy, sensitivity and specificity of the plasticity score in predicting stereopsis after concomitant exotropia surgery. The Delong test was used to compare the predictive efficacy of the plasticity score and traditional clinical indicators on the recovery of stereopsis function 6 months after surgery. Results: The plasticity score was correlated with age preoperative deviation angle, the course of strabismus, strabismus type and deviation angle one week after surgery (r was -0.3, -0.2, -0.3, 0.4, -0.3, P<0.05, respectively). The plasticity score can predict far and near stereopsis at different time points during the 6 month interval after surgery. There was a moderate predictive significance for both far and near stereopsis six months after surgery (AUC>0.7, P<0.001). For the traditional clinical indicators, preoperative near stereopsis had a low degree of predictive significance for near stereopsis 6 months after surgery (AUC=0.63<0.7, P=0.009), but there was no significant difference when compared with the plasticity score (Z=1.2, P=0.06). The preoperative far deviation angle had a low predictive significance for the complete recovery of both near and far stereopsis 6 months after surgery (AUC=0.66<0.7, P=0.02), but there was no significant difference of degree of predictive significance between the deviation angle and plasticity score (Z=1.4, P=0.15). Conclusions: The plasticity score can effectively predict the recovery of far and near stereopsis in patients with concomitant exotropia after surgery, and provide the basis for further diagnosis and treatment strategies for patients after surgery.     

Prognostic factors for successful surgical outcome with preoperative prism adaptation test in patients with superior oblique palsy.

PURPOSE: This study evaluated the surgical outcome of patients managed with preoperative prism adaptation test (PAT) and investigated prognostic factors for successful motor alignment in adult patients with superior oblique palsy. METHODS: Prospective study of preoperative PAT was performed. Fifty-seven patients with superior oblique palsy, aged 16 to 81 years, participated in this study. Patients were assigned to surgery with the target angle based on either the original angle or the prism compensated angle. When the amount of neutralizing prism exceeded 4delta or more compared to the original angle of deviation, the patient was defined as having prism compensation, and the target angle for surgery was based on the amount of neutralizing prism. The motor success rate was compared between the 2 groups at the 3-month postoperative follow-up. RESULTS: The prism responders group showed a superior outcome compared to that of the prism non-responders group (77% successful outcome compared with 46%, p = 0.0397). The presence of prism compensation and the amount of vertical deviation were significant prognostic factors for successful motor alignment. CONCLUSION: Preoperative PAT is a useful prognostic indicator of successful surgical outcome in patients with superior oblique palsy.     

Changes in deviation following correction of hyperopia in children with fully refractive accommodative esotropia

Changes in deviation may occur following the correction of hyperopia in children with accommodative esotropia. We analyzed possible factors involving the development of changes in deviation. We examined 49 children (23 boys and 26 girls) who had fully refractive accommodative esotropia at the age of 3 or 4 years. All children wore glasses to correct the fully cycloplegic refractive errors. At the age of 10 or 11 years, 28 (57.1%) of these children had good alignment, 12 (24.5%) developed partial accommodative esotropia and 9 (18.4%) developed consecutive exotropia. The age at onset of esotropia, age at initial visit, and refraction, deviation and presence of stereopsis, as determined by the Titmus test using a fly at the initial visit, were similar among the three groups. In the consecutive exotropia group, amblyopia at the initial visit was significantly higher (89%) than that of the good alignment group (50%). The age at the start of the correction, and the refraction, amblyopia and presence of fusion (10 or 11 years) were almost equal among the three groups. We conclude that some children with fully refractive accommodative esotropia associated with amblyopia at the age of 3 or 4 years may be predisposed to developing consecutive exotropia.     

Consecutive exotropia after surgical treatment of childhood esotropia: a 40‐year follow‐up study

Purpose: To determine the incidence of consecutive exotropia (XT) following successful surgical correction of childhood esotropia (ET) and identify factors associated with its development. Material and Methods: This is a retrospective study of 85 patients with ET, aged 2–24 , who underwent strabismus surgery by a single surgeon between 1958 and 1969 in Sweden, until they were successfully aligned to ET within 10 prism dioptre, after primary or reoperation(s). The charts of these patients were reviewed, and data regarding age at onset of strabismus, surgery performed and outcome were recorded. The patients were recalled for a complete orthoptic examination in 2001–2003. Results: The incidence of consecutive XT in this cohort was 21% (18/85). Patients who had undergone multiple surgeries had a higher risk of developing consecutive XT compared to those successfully aligned with one surgery (p = 0.00036). Restriction of adduction and convergence postoperatively was associated with a high risk of consecutive XT (p = 0.0437). The incidence of consecutive XT did not vary with the level of visual acuity in the operated eye (p = 0.6428). Age of onset, age at surgery and amount of surgery did not appear to influence the risk for developing consecutive XT (p > 0.05). Conclusion: This 40‐year postoperative follow‐up of patients with childhood ET who underwent strabismus surgery by a single surgeon in Sweden showed that multiple surgeries and presence of postoperative adduction deficit were the most important factors influencing the incidence of consecutive XT after surgery. Presence of uncorrected amblyopia did not alter the prognosis for long‐term development of consecutive XT.     

影响成人间歇性外斜视术后立体视功能重建情况分析

目的:调查成人间歇性外斜视术后立体视功能重建情况,并分析影响患者立体视功能重建的相关因素。方法:回顾性研究。选择2019-01/2021-01我院收治间歇性外斜视成人患者196例,所有患者均行斜视矫正手术,收集患者术前一般资料和术后患者立体视功能重建情况。结果:纳入患者196例术前均无近远立体视觉功能,术后近立体视觉功能重建率为52.6%(103/196),远立体视功能重建率为50.5%(99/196)。近立体视功能重建(103例)与未重建患者(93例)手术年龄、发病年龄、病程、术后水平斜视量等因素比较存在统计学意义(P<0.001);多因素Logistic回归分析显示发病年龄、病程、术后水平斜视量是影响近立体视功能重建的因素(P<0.05);受试者操作特征(ROC)曲线显示,发病年龄、病程、术后水平斜视量用于预测患者近立体视功能重建曲线下面积(AUC)分别为0.757、0.737、0.727(P<0.001)。远立体视功能重建(99例)与未重建患者(97例)在手术年龄、发病年龄、病程、术后水平斜视量比较存在统计学意义(P<0.001),多因素Logistic回...     

Prognostic factors for recurrence with unilateral recess-resect procedure in patients with intermittent exotropia

Purpose

To evaluate the prognostic factors, particularly age at the time of surgery, for recurrence after unilateral medial rectus resection and lateral rectus recession (R&R) procedures in patients with intermittent exotropia, or X(T).

Methods

Medical records of 489 subjects who received unilateral R&R procedures with more than 12 months of follow-up were reviewed. The patients'' surgical outcomes with a deviation of less than 10 prism diopters (PD) of exotropia and less than 5 PD of esotropia were defined as a success. Outcomes with more than 11 PD of exotropia were designated as recurrences, and those with esotropia of more than 5 PD after 3 months of operation were noted as overcorrection. The prognostic factors for recurrence were analyzed by the multivariate logistic regression test.

Results

Of the 489 subjects, 209 had successful surgical outcomes and 280 had recurrences, whereas overcorrection was not found. Mean age at operation was 8.9±6.5 years, mean preoperative distant X(T) size was 32.9±6.0 PD, and mean follow-up period was 27.5±17.9 months. On the basis of the survival analysis in which survival represented time of recurrence, the mean duration was 31.2±1.7months. Age at onset, age at surgery, and immediate postoperative alignment proved to be significant factors influencing a favorable outcome by multivariate logistic regression analysis (P<0.05). However, gender, family history, and preoperative deviation size were not significantly predictive of success (P>0.05).

Conclusion

In unilateral R&R procedures, increasing patient age at the time of surgery was associated with lower recurrence rates. Recurrence rates also increased with the immediate postoperative angle and with the postoperative angle of deviation at 1, 3, 6, and 12 months.     

Efficacy and toxic effect associated with subretinal tissue plasminogen activator injection in treating submacular hemorrhage

AIM: To review the demographics, clinical manifestations, and surgical experiences of patients with congenital ocular counter-roll, whose treatments were performed exclusively by ophthalmologists. METHODS: A retrospective review was conducted consisting of patients who received strabismus surgery between 2017 to 2019. Patients with obvious ocular counter-roll were included. RESULTS: A total of 7008 patients who received strabismus surgery, 28 (12 males, 16 females) were diagnosed as congenital ocular counter-roll, accounting for 0.40%. All patients were initially misdiagnosed: 21 patients were misdiagnosed as superior oblique palsy (SOP), 3 as inferior oblique overaction, 2 as dissociated vertical deviation (DVD), 1 as superior oblique overaction with A-pattern exotropia, and 1 as medial rectus palsy. The mean±SD age was 12.4±9.4y (range 2.5-36y). The most common clinical findings included ocular counter-roll, vertical deviation or vertical deviation combined with outward deviation and head tilt. At follow-up, an excellent surgical result was achieved in 20 patients. Preoperative horizontal deviation of 26±24 PD and vertical deviation of 18±12 PD were reduced to 0±12 PD (P=0.0001) and 3±4 PD (P=0.001), respectively. CONCLUSION: Congenital ocular counter-roll is a rare supranuclear vertical strabismus caused by congenital abnormalities involving vestibule-ocular reflex pathways. In addition to ocular counter-roll, the most salient clinical features included, but were not limited to, hyperdeviation, outward deviation, overelevation in adduction and head tilt.     

Clinical characteristics of sibling patients with comitant strabismus

AIM: To investigate the clinical characteristics of sibling patients with comitant strabismus. METHODS: Sibling patients who were diagnosed with comitant strabismus from January 2005 to December 2014 were retrospectively reviewed. Factors including age, sex, types of strabismus, refractive errors, angle of deviation, and coexistence of other strabismus were analyzed. RESULTS: A total of 62 patients (31 pairs of siblings) were included. Of these, 26 pairs had intermittent exotropia, 3 had accommodative esotropia, and 2 had infantile esotropia. There were no pairs with different subtypes of strabismus. The age at first visit was 3.7±2.6y and the mean follow-up period was 30.5±24.1mo. In siblings with intermittent exotropia, there was no difference in age of onset, age at operation, or refractive errors between the first and second-born children. The 20 (77%) pairs of siblings with exotropia showed more than 80% concordance of maximum angle of deviation during follow-up. In the 9 pairs in which both siblings had an operation, the final angle of deviation after the operation was 8.2±8.1 prism diopters (PD) in first-born children and 8.6±6.5 PD in second-born children. CONCLUSION: The subtypes of strabismus are the same in all pairs of siblings and clinical characteristics of strabismus are similar between the first and second-born children. This similarity could be an indicator for the diagnosis of second-born children. Further prospective study including a larger number of sibling patients is needed.     

Re-recession of the lateral rectus muscles in patients with recurrent exotropia.

PURPOSE: We undertook a retrospective evaluation of changes in deviation and ocular motility after surgical rerecession of the lateral rectus (LR) muscles as a treatment for recurrent exotropia (XT). METHODS: We describe 16 consecutive patients (age 6 to 35 years; median, 10 years; 13 children and 3 adults) with an average amount of recurrent alignment, amount of rerecession, distance from insertion to the limbus, postoperative alignment, and versions. RESULTS: In most cases, bilateral LR muscles were rerecessed to a distance of 15 mm from the limbus, but in 5 cases with larger amount of deviation, these muscles were rerecessed to 17 mm from the limbus. A relation was found between the amount of rerecession and change in far alignment in prism diopters (r=0.46, P=0.07), but not for near deviation. The success rate (esotropia相似文献   

Prognostic factors predicting the surgical outcome of bilateral lateral rectus recession surgery for patients with infantile exotropia

Purpose

To determine the presurgery factors affecting early and long-term favorable outcomes of bilateral lateral rectus recession surgery for infantile exotropia.

Patients and methods

A retrospective study of 50 patients with infantile exotropia (both constant-type and intermittent-type exotropia with onset before 1 year of age) who had bilateral lateral rectus recession surgery correction with more than 1 year follow up. Presurgery data were obtained and evaluated by use of multiple regression analysis.

Results

Smaller presurgery distance deviation (p = 0.042), older age at surgery (p = 0.025), longer interval between onset and surgery (p = 0.020), and more myopic refractive error (p = 0.007) were associated with successful outcome at 6 weeks, but none was correlated with successful outcome at 1 year. Among all data, presurgery distance deviation was the only significant determinant (multiple regression analysis, p = 0.021) for successful outcome at 6 weeks. Presurgery distance deviation (β = 0.952, p < 0.001) was correlated with the distant angle of deviation 6 weeks (β = 0.952, p < 0.001) and 1 year (β = 0.394, p = 0.006) postsurgery.

Conclusions

Smaller presurgery deviation was found to be associated with more favorable surgical outcome.     

双眼外直肌倾斜后徙术治疗儿童集合不足型外斜视

目的：评价双眼外直肌倾斜后徙术（S-BLRc）治疗儿童集合不足型间歇性外斜视（CI-IXT）的有效性和安全性。方法：回顾性病例对照研究。收集2019年8月至2020年7月于天津市眼科医院收治的集合不足型外斜视儿童患者58例，年龄4～10岁。根据S-BLRc外直肌上、下缘止点后徙量的差异分为 3组：A组（1 mm，22例）、B组（1.5 mm，18例）和C组（2 mm，18例）。比较各组术前和术后6个月时的看近、看远斜视度，近远斜视度差（NDD），眼底客观旋转角，上转和下转25°时斜视度差，调节性集合与调节比值（AC/A），立体视及手术成功率，屈光状态。手术成功的标准：看近、看远的斜视度， 外斜视<-8△，内斜视<+5△；NDD<5△。术前和术后数据采用配对t检验进行比较。组间数据采用单 因素方差分析进行比较。立体视觉和手术成功率采用Fisher精确检验法分析。结果：术后6个月，看近、 远的斜视度分别由-37.1△±4.2△、-25.8△±3.7△下降至-1.4△±4.6△、-0.1△±4.1△，手术前后的差异具有统计学意义（t=45.72，P<0.001；t=32.54，P<0.001）。各组术后NDD（A组1.8△±1.9△，B组 0.8△±2.1△，C组0.9△±2.5△ ）均较术前（A组10.0△±0△，B组11.2△±1.5△，C组13.3△±2.2△ ）显著降低， 手术前后差异具有统计学意义（t=20.3，P<0.001；t=17.2，P<0.001；t=13.6，P<0.001）；NDD平均改善量分别为8.2△±1.9△、10.3△±2.5△、12.4△±3.9△，3组间差异有统计学意义（F=10.80，P<0.001）。 纳入的患者术前AC/A均值为（1.55±0.73）△/D，术后AC/A均值为（1.53±0.74）△/D，术前术后比较 差异没有统计学意义。所有患者术后立体视觉均有不同程度的改善。术后无旋转性复视、A-V型斜视。 手术前后各组间的球镜度、散光轴位比较差异无统计学意义，而右眼和左眼散光度在术后6个月随 访时与术前比较差异有统计学意义（t=5.06，P<0.001；t=5.32，P<0.001）。术后6～9个月随访时的手术成功率为89.7%，3组的成功率比较差异无统计学意义。结论：S-BLRc是治疗儿童CI-IXT的一种 安全有效的手术矫正方法，有效矫正看近、看远外斜视，降低NDD，有利于双眼视觉改善。NDD的 改善量与外直肌上、下缘的倾斜量有关。