双眼外直肌倾斜后徙术治疗集合不足型间歇性外斜视的疗效

目的：探讨双眼外直肌倾斜后徙术治疗集合不足型间歇性外斜视的疗效及安全性。

方法：选取2017-10/2019-11在我院就诊的集合不足型间歇性外斜视患者29例行双眼外直肌倾斜后徙术治疗,术后随访6mo,观察斜视度的变化、手术正位率、双眼视功能及并发症情况。

结果：本组患者术前看近斜视度-41.72±3.35PD,看远斜视度-23.28±9.75PD,看近-看远斜视度差值16.90±2.47PD,术后6mo分别为-5.97±4.85、-2.66±4.78、3.28±1.10PD,手术总体正位率76%。术后6mo,Ⅰ、Ⅱ级视功能恢复比例均较术前提高(P<0.05),远立体视、近立体视恢复较术前均无显著差异(P>0.05)。所有患者术后均未出现A-V综合征、眼球运动受限、限制性斜视、垂直斜视、旋转复视等并发症,部分患者术后出现短暂水平复视,均在术后2～3wk内消失。

结论：双眼外直肌倾斜后徙术能减少看近、看远斜视度及看近-看远斜视度差值,未发现明显并发症,是一种安全有效的治疗集合不足型间歇性外斜视的手术方式。     

集合不足型外斜视手术治疗及双眼视觉重建的相关研究

目的:观察集合不足型外斜视术后双眼视功能的恢复及眼位回退情况。方法:对83例行单眼外直肌后徙联合内直肌缩短的集合不足型外斜视患者手术前后的眼位、双眼视功能、进行回顾性总结和分析。斜视手术以单眼外直肌后徙联合内直肌缩短为主设计。术前有一级视功能患者如术后欠矫则进一步在同视机下行双眼融合功能训练。术后随访6～12(平均8)mo。结果:术前视远平均外斜度为-35.6△(-15△～80△),视近平均外斜度为-56.5△(-30△～-95△);术后视远平均外斜度为-6.5△(+11△～-19△),视近平均外斜度为-13.2△(+9△～-20△),术后视远视近斜视度与术前视远视近斜视度的比较差异有统计学意义(P=0.000),术前双眼视功能和术后双眼视功能比较差异有显著性,术后远期视远视近外斜度的差值明显降低,平均斜视度差值从术前的19△下降到术后的5.5△(P=0.000)。结论:集合不足型外斜视患者行单眼外直肌后徙联合内直肌缩短;术后如双眼视功能进一步恢复则术后远期效果较好,回退率较低。     

双眼外直肌后徙与单眼一退一截两种术式治疗基本型间歇性外斜视疗效比较的Meta分析

目的：评价双眼外直肌后徙与单眼一退一截手术对基本型间歇性外斜视手术疗效。

方法：电子检索1970-01/2018-01的PubMed数据库、EMBASE、Cochrane library、Web of Science、Clinical Trial，中国生物医学文献数据库、万方医学网。纳入比较双眼外直肌后徙与单眼一退一截手术对基本型间歇性外斜视手术疗效的随机对照研究。由两名评价员独立收集数据并对所得数据及试验质量进行评价，采用STATA14版进行统计分析。

结果：共有5项试验、529例患者符合纳入标准。Meta分析结果提示：与单眼一退一截手术相比，双眼外直肌后徙术术后远期正位率(RR：0.85； 95% CI：0.72～0.99，P=0.043)、术后欠矫(RR：3.975； 95% CI：2.097～7.537， P<0.01)方面差异有统计学意义，远期术后正位率Meta分析的P值随着纳入文献增多逐渐接近0.05。而在术后过矫(RR：0.336； 95% CI：0.049～2.294， P=0.266)差异无统计学意义。

结论：双眼外直肌后徙术相比于单眼一退一截手术对基本型间歇性外斜视手术成功率略低，术后欠矫较明显。     

改良外斜视矫正术治疗儿童小度数集合不足型间歇性外斜视的临床观察

目的研究改良的外斜视矫正手术治疗儿童小度数集合不足型间歇性外斜视的手术疗效。方法 31例视近斜视度在20^△~30^△的集合不足型间歇性外斜视行改良的外斜视矫正手术,分别观察手术前后视远和视近的斜视度、视远和视近的斜视度的差值、术后的正位率、A-V型斜视、眼球运动以及立体视的变化。随访时间6~12个月。结果术后视近和视远的斜视度平均比较(t=8.72,P<0.05)和(t=3.46,P<0.05),视远和视近的斜视度的差值比较(t=5.75,P<0.05),平均立体视锐度为361.2"(t=3.25,P<0.05),正位率83.9%(26/31),术后没有出现A-V型斜视和眼球运动受限。结论对于小度数集合不足型间歇性外斜视,改良的外斜视矫正手术在减小视远和视近的斜视度,降低视远和视近的斜视度的差值,恢复立体视,提高术后的正位率均安全有效。     

不同类型斜视手术前后远近立体视的变化

目的：探讨斜视类型对术后远、近立体视恢复的影响。

方法：选取72例不同类型斜视患者,按斜视类型分为四组：组1为非调节性内斜视,组2为间歇性外斜视,组3为恒定性外斜视,组4为外斜V征伴下斜肌亢进。手术前后分别应用同视机检查远立体视。采用颜少明编绘的《立体视觉检查图》检查近立体视锐度。记录并分析术前、术后第7d,1、3、6mo的各项检查数据。

结果：斜视患者72例术后远、近立体视的恢复较术前有明显改善,其差异有统计学意义(P<0.05)。间歇性外斜视组术后远、近立体视的恢复优于非调节性内斜视组、恒定性外斜视组及外斜V征伴下斜肌亢进组,其差异有统计学意义(P<0.05)。非调节性内斜视组、恒定性外斜视组和外斜V征伴下斜肌亢进组术后不同时期远、近立体视的恢复差异无统计学意义(P>0.05)。远立体视(0例)比近立体视(19例,26%)的损害更严重,术后近立体视(51例,71%)的恢复明显优于远立体视(17例,24%),术后1mo远、近立体视恢复效果明显。

结论：不同斜视类型对术后远、近立体视恢复的影响存在差异,间歇性外斜视术后远、近立体视的恢复效果最佳。非调节性内斜视、恒定性外斜视和外斜V征伴下斜肌亢进对术后远、近立体视的恢复影响一致。斜视患者远立体视损害较重,术后近立体视恢复明显优于远立体视。     

间歇性外斜视患者分型对眼位控制能力的影响

目的:分析间歇性外斜视患者分型对眼位控制能力的影响.方法:选取我院2014-06/2016-07收治的50例行斜视手术治疗的间歇性外斜视患者作为研究对象,依据所有患者视近与视远斜视度数差值将其分为基本型24例(视近斜视角与视远斜视角基本相等或相差≤15△)、分离过强型17例(视远斜视角≥视近斜视角15△)、集合不足型9例(视近斜视角≥视远斜视角15△)三组,采用注视33cm视标(视近)、注视6m视标(视远)、注视户外视标、1h遮盖试验四种检测方法对其眼位控制能力进行比较.结果:基本型间歇性外斜视患者注视33cm视标、注视6m视标、注视户外视标、1h遮盖试验四种检测结果分别为55.10±1.62、45.32±1.21、64.85±1.77、68.33±1.66PD,分离过强型间歇性外斜视患者检测结果为50.23±1.88、67.46±1.17、76.95±1.64、78.15±1.56PD,集合不足型间歇性外斜视患者检测结果为50.98±1.29、33.48±1.40、43.65±1.49、54.64±1.12PD,组间差异具有统计学意义(P＜0.05).结论:间歇性外斜视患者分型对眼位控制能力存在着显著的影响关系,确定其分型将有助于提高斜视手术治疗效果.     

间歇性外斜视儿童手术前后双眼单视功能的临床分析

目的：对间歇性外斜视儿童手术前后双眼单视功能进行临床分析,为间歇性外斜视的手术治疗提供理论依据。

方法：选取对象为2016-01/2017-01于我院斜视与小儿眼科治疗的间歇性外斜视儿童患者40例,40例患者中手术眼为64眼。所有患者均采用斜视矫正手术治疗,术后随访6wk,比较治疗前后存在Ⅰ、Ⅱ、Ⅲ级视功能人数比例,采用视近、视远WORTH四孔灯分别对患者术前和术后2、6wk的中央及周边融合情况进行比较,采用颜少明颜氏随机点立体图(stereoscopic test charts,STC)评价术前和术后2、6wk近立体视,采用同视机画片对患者术前、术后2、6wk的远立体视进行评估。

结果：视功能Ⅰ、Ⅱ、Ⅲ级术前人数分别为26例(65%)、9例(22.5%)、5例(12.5%),术后2wk分别为10例(25%)、17例(42.5%)、13例(32.5%),术后6wk分别为8例(20%)、18例(45%)、14例(35%),术前与术后2、6wk比较差异具有统计学意义(P<0.05),术后2wk和6wk比较差异无统计学意义(P>0.05); WORTH 四孔灯检查结果显示术前中央融合人数比例显著低于术后2、6wk,术后6wk中央融合人数显著高于术后2wk人数,差异具有统计学意义(P<0.05); 术后2、6wk周边融合人数显著高于术前,差异具有统计学意义(P<0.05),术后2、6wk比较差异无统计学意义(P>0.05); 术后2、6wk近立体视较术前显著改善,差异具有统计学意义(P<0.05),术后2、6wk比较差异无统计学意义(P>0.05); 术后2、6wk远立体视人数比例分别为24例(60%)与39例(97.5%),较术前6例(15%)显著改善,差异具有统计学意义(P<0.05),术后2、6wk比较差异无统计学意义(P>0.05)。

结论：间歇性外斜视儿童行矫正手术能显著改善双眼单视功能,挽救患者的远、近立体视以及中央融合功能。     

外直肌截除术治疗分开不足的临床观察

目的：观察外直肌截除术治疗分开不足的临床效果。

方法：回顾性分析2011-02/2017-10在我院就诊的37例分开不足型患者。临床表现为看远内斜视伴同侧复视，视近为内隐斜视无复视，单眼、双眼运动正常。术前作屈光、斜视度、近立体视、负向融合力检查，然后行单眼或双眼外直肌截除手术。

结果：所有病例术后复视消失，术后1a复查时复视无复发。术前远距内斜视度为+15^△～+28^△(平均18.4^△±5.7^△)，近距内斜视度为+5^△～+16^△(平均10.3^△±3.6^△)，远距近距斜视度差异值为8.1^△±2.3^△； 术后1wk远距斜视度-5.4^△±1.5^△，近距斜视度-7.2^△±1.6^△，差异值为1.8^△±0.6^△； 术后1a远距斜视度-1.9^△±1.2^△，近距斜视度-3.4^△±1.4^△，差异值为1.5^△±0.8^△。术后1wk，1a的远近距斜视度较术前明显减小(P<0.05)，术后1wk，1a的远近距斜视度比较有差异(P<0.05)，患者术前的远近距斜视度之差值与术后1wk，1a的远近距斜视度之差值比较有差异(P<0.05)。术前远距负向融合力为3^△～9^△(平均5.1^△±1.8^△)，近距负向融合力为15^△～24^△(平均19.4^△±3.2^△)。术后1wk远近距负向融合力分别为10.1^△±3.3^△、19.7^△±4.1^△，术后1a远近距负向融合力分别为11.2^△±3.6^△、20.2^△±4.8^△。患者术前与术后1wk的远距负向融合力比较有差异(q=4.551， P=0.013)，术后1wk与术后1a比较无差异(q=0.713，P=0.115)。患者近距融合力术前与术后1wk，1a比较无差异(P>0.05)。

结论：外直肌截除术治疗分开不足可有效降低术后的远近距斜视度差，消除患者的复视症状，改善患者术后的近立体视锐度及远距负向融合力。     

眼位对间歇性外斜视患者远近立体视的影响

目的：分析眼位变化对间歇性外斜视患者远近立体视的影响。 方法：采用Clement Clarke International同视机检测远立体视,选用随机点画片。采用Titmus立体图检测近方立体视。对40例间歇性外斜视患者术前及术后1wk分别进行远近立体视测定,对所得结果进行分析。 结果：术前近立体视存在比率要高于远立体视存在比率。术前近立体视锐度分布情况与正常人不同。术后远近立体视均有不同程度改善。差异有统计学意义。 结论：间歇性外斜视患者存在不同程度的远近立体视。间歇性外斜视患者立体视的损害表现为远立体视丧失,近立体视锐度下降。大部分间歇性外斜视患者虽然存在近立体视,但立体视锐度要低于正常。眼位矫正对于近立体视改善及远近立体视重建有重要作用。间歇性外斜视患者手术时机的选择应参考远近立体视检查结果。     

内直肌缩短治疗共同性外斜视手术的效果分析

目的:探讨双眼或单眼内直肌缩短术或联合外直肌后退术治疗集合不足型共同性外斜视的疗效。方法:收集行双眼或单眼内直肌缩短术或联合外直肌后退术的集合不足型共同性外斜视患者181例,术前及术后1wk;2,6mo均行常规的眼科检查、斜视角测量、眼球运动及同视机检查,分别对眼位、视功能等结果进行统计学分析。结果:术后1wk;2,6mo,患者正位率分别为80.1%,83.7%和81.3%,眼位同术前相比有明显改善(P<0.01),术后双眼视功能同术前相比无明显恢复(P>0.05)。结论:对于集合不足型共同性外斜视,行双眼或单眼内直肌缩短术可获得较满意的效果。     

Surgical outcomes of symmetric and asymmetric surgery for intermittent exotropia with postoperative large early overcorrection

Purpose

To compare surgical outcomes between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus resection (RR) for intermittent exotropia with overcorrection of 20 prism diopter (PD) or more on postoperative day 1.

Methods

A retrospective chart review identified 319 patients who underwent either BLR or RR for primary surgical treatment of intermittent exotropia between July 2008 and June 2011. The patients with basic type intermittent exotropia and overcorrection of 20 PD or more, at either near or distance, on postoperative day 1 and had more than 6 months of follow-up were included. Patients with simultaneous vertical and/or oblique muscle surgery and those with paralytic or restrictive strabismus were excluded. The pre- and post-operative deviation, visual acuity, and near stereoacuity were analyzed.

Results

Twenty-four patients were included. The mean postoperative day 1 alignment was 21.5 ± 6.2 PD esotropia at distance, and 13.8 ± 8.0 PD at near. Fourteen patients underwent BLR and 10 underwent RR. Three patients were wearing the base out prism below 15 PD at the last follow-up. The mean duration from the surgery to esotropia below 10 PD was 2.9 ± 1.1 weeks and 8.0 ± 7.1 weeks in the BLR and RR groups, respectively (p = 0.030). All three recurrent patients underwent RR. None of the patients completely lost stereoacuity, postoperatively.

Conclusions

In basic type intermittent exotropia with overcorrection of 20 PD or more on postoperative day 1, the overcorrection resolved faster and recurrence rates were lower in BLR group than in the RR group. Consecutive esotropia over 15 PD did not occur in both groups.     

Unilateral recession-resection in children with exotropia of the convergence insufficiency type

PURPOSE: The surgical success rates for intermittent exotropia of the convergence insufficiency type have been reported to be variable, and most were studied retrospectively in adults. The purpose of this study was to evaluate prospectively the long-term surgical results of unilateral lateral rectus (LR) muscle recession and medial rectus (MR) muscle resection in children with intermittent exotropia of the convergence insufficiency type. METHODS: A total of 14 children with intermittent exotropia greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. The amounts of resection and recession were based on near and distance deviation, respectively. Minimum follow-up was 1 year (mean 26.6 months; range, 12-68 months) after surgery. The paired t-test was used to compare preoperative and postoperative measurements of the angle of deviation at distance and near, near-distance difference. RESULTS: Significant postoperative reduction was achieved in terms of mean distance exodeviation, from 22.5 PD to 9.1 PD (P=0.000), and mean near exodeviation from 33.8 PD to 13.6 PD (P=0.000). Mean near-distance difference reduced from 11.3 PD preoperatively to 4.6 PD postoperatively (P=0.000). Fresnel prism was used temporarily to treat postoperative esotropia in only one patient for postoperative 6 months. CONCLUSIONS: Unilateral surgery biased to MR strengthening more than LR weakening in children with intermittent exotropia of the convergence insufficiency type, was found to successfully reduce both distance and near deviation and to collapse near-distance differences with a low risk of long-term postoperative esotropia.     

Medial rectus resection(s) with adjustable suture for intermittent exotropia of the convergence insufficiency type.

BACKGROUND: The surgical results for intermittent exotropia of the convergence insufficiency type have been reported to be of varying success. The purpose of this study is to evaluate the surgical results of medial rectus muscle (MR) resection(s) with adjustable suture for this condition. METHODS: Twenty-one consecutive patients with intermittent exotropia of the convergence insufficiency type were included in this retrospective study. All patients had a history of prolonged difficulties at near work unrelieved by nonsurgical treatment. Unilateral or bilateral MR resection(s) were done with the adjustable suture, which was tied at the first postoperative day. The target angle was an esotropia of 10 to 20 PD at distance and an esotropia of 5 to 10 PD at near. Postoperatively Fresnel prisms were used temporarily in patients manifesting a consecutive esotropia with diplopia at distance. Postoperative follow-up period was between 6 months and 24 months with a mean of 9.1 months. RESULTS: MR resection(s) with the adjustable suture reduced the mean exodeviation at near from 25.7 to 3 PD. It also reduced the exodeviation at distance from 11.4 to -2 PD (esodeviation). The mean near-distance difference was collapsed from 14.3 PD preoperatively to 5 PD postoperatively. CONCLUSIONS: MR resection(s) with adjustable suture combined with intentional postoperative aggressive overcorrection and the use of Fresnel prisms is useful in intermittent exotropia of the convergence insufficiency type. The intentional overcorrection during the immediate postoperative period at distance and near is required to prevent long-term undercorrection.     

Efficacy of Botulinum Toxin in the treatment of Intermittent Exotropia

Background: Multiple surgical interventions are burden to patients with intermittent exotropia (IXT) due to a high recurrence rate. This study was designed to evaluate the efficacy of botulinum toxin injection in the treatment of intermittent exotropia (IXT).

Method: A total of 21 patients with IXT, who had a far deviation of less than 40 prism diopters (PD), were enrolled. All cases were followed for at least 6 months with non-surgical management and had decremented fusional control (increasing 3 or more scores in Newcastle Control Score [NCS]). Botulinum toxin was injected (10 units Dysport) to both lateral rectus muscles. Fusional control, sensory and motor status were evaluated at 1 day, 1 week, and 1, 3, and 6 months after injection to compare with the pre-injection values.

Results: Fusional control (based on NCS) showed a significant improvement during 6-month follow-up. Mean NCS was 4.4?±?0.8 SD before botulinum toxin injection and 1.4?±?0.4 SD after 6 months (p?Conclusion: Botulinum toxin injection to lateral rectus muscles seems to be a promising procedure in the management of fusional control, far and near deviations in patients with intermittent exotropia in short time.     

Y-splitting medial rectus muscle and recession in treatment for convergence excess esotropia

AIM: To evaluate the surgical outcome of medial rectus (MR) recession with Y-splitting procedure in treatment of esotropia with convergence excess. METHODS: Medical records were retrospectively reviewed for those patients who underwent surgical treatment for their convergence excess esotropia (CEET) between January 2018 and December 2020. Refractive error was examined by the equipment of the VS100 (Welch Allyn). The surgical approach was bilateral MR recession with Y-splitting. The amount of recession was calculated according to the deviation angle at distance. Ocular movement and ocular alignment at distance and near were evaluated pre- and post-operatively. Binocular sensory status was evaluated by the Bagolini striated glasses at near and distance, and by stereoacuity assessment at near using the Titmus test. RESULTS: Six patients with CEET were included in this study. Four of them were hyperopia and two of them were myopia. A mean of eso-deviation angle at distance had been changed from 27.3±13.02 prism diopters (PD) preoperatively to 1.83±1.60 PD postoperatively (P<0.05), while a mean of eso-deviation angle at near had been changed from 50.00±20.74 PD preoperatively to 6.83±0.98 PD postoperatively (P<0.05). Patients had obtained binocular vision postoperatively. CONCLUSION: The surgical approach of Y-splitting MR and recession is effective in treatment of CEET.     

对小度数集合不足型间歇性外斜视手术疗效分析

目的 探讨单纯单眼内直肌截除术和2.5～3.0mm单眼外直肌后徙+单眼内直肌截除术对视近时斜视度在15△～25△之间的小度数集合不足型间歇性外斜视的手术疗效.方法 对10例患者行2.5～3.0mm单眼外直肌后徙+单眼内直肌截除术(A组),15例患者行单纯单眼内直肌截除术(B组),术后分别比较两组患者视远和视近的斜视度以及视远和视近的斜视度的差值,并比较两组患者术后的正位率、恢复双眼视例数和恢复近立体视例数.术后随访6至12个月.结果 两组术前和术后视远和视近的斜视度以及视远和视近的斜视度的差值比较经t检验差异均有统计学意义(t=1.73～9.73,P＜0.05),A、B两组术后正位率、术后恢复双眼视的例数和恢复立体视例数经x2检验差异具有统计学意义(x2=3.84～5.11,P＜0.05).结论 (1)2.5～3.0mm单眼外直肌后徙+内直肌截除术和单纯单眼内直肌截除术治疗视近时斜视度15△～25△的小度数集合不足型间歇性外斜视均有效.(2)在缩小视近和视远斜视度的差值、术后正位率、恢复双眼视和立体视功能方面,2.5～3.0mm单眼外直肌后徙+内直肌截除术优于单纯单眼内直肌截除术.

Abstract：

Objective To evaluate the surgical results of unilateral medial rectus muscle resection and 2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection for the intermittent exotropia of the convergence insufficiency type with small-diopter exodeviation of 15 △ to 25 △ at near.Methods Ten cases received 2.5mm-3.0mm unilateral lateral muscle resection with unilateral medial rectus muscle resection (group A),15 cases received unilateral medial rectus muscle resection (group B).The distance and near deviations and differences in the deviations were compared separately for the two groups;besides,the positioning rates,number of patients with restoration of binocular and stereoscopic visions were compared in the two groups after surgery.They were followed-up for 6 to 12 months after surgery.Results There was statistically significant difference (t =1.73-9.73,P ＜0.05) in the angle at near and distance,the angle near-distance difference.There also was statistically significant difference (x2=3.84-5.11,P ＜0.05) in the orthophoria rate,biocular vision recovery,stereopsis recovery after operation were compared between group A and B.Conclusions Both of the unilateral medial rectus muscle resection and 2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection are an effect surgical treatment for the intermittent exotropia of the convergence insufficiency type with small-diopter exodeviation of 15△ to 25△ at near.2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection is superior to unilateral medial rectus muscle resection in reducing the angle difference of near-diatance,orthophoria rate,biocular vision recovery,stereopsis recovery.     

Retroequatorial myopexy combined with bimedial recession for near-distance disparity esotropia

Purpose: In cases of esotropia combined with a high AC/A ratio, partly accommodative convergence excess or with nonaccommodative convergence excess, two methods of surgical therapy are possible: recession of the medial recti (Parks) and retroequatorial myopexy (Cüppers). Our aim was to answer the question whether retroequatorial myopexy alone and in combination with bimedial recession are appropriate methods of reducing the strabismic angle at near and distant fixation to values under 10 PD and near-distance disparity to less than 10 PD to form the basis for single binocular vision without bifocals. Patients and methods: Eighty-three patients, aged 2–14 years (39 boys and 44 girls), were included in the study: 37 children (group A) with early-onset near-distance esotropia of 14–48 PD for distance and 26–65 PD for near objects and 46 children (group B) with acquired near-distance esotropia of 8–45 PD for distance and 26–70 PD for near objects. Inclusion criteria were a near-distanced disparity of at least 10 PD (range 10–33 PD), a follow-up of at least 3 months (median 5 months, range 3–69 months), retinoscopy in cycloplegia and full refractive correction. The amount of conventional surgery was chiefly based on the distance angle of esotropia. The myopexy was placed 12, 13 and 14 mm behind the insertion of the medial rectus. Results: In 73 of 83 patients (88 %) we were able to reduce the strabismic angle for distance and near fixation to less than 10 PD and in 73 cases even under 5 PD. In 77 of 83 patients (93 %) the near-distance disparity was reduced to less than 10 PD and in 72 patients (87 %) even under 5 PD. Postoperatively, 9 children had bifocals, but 3 of them have meanwhile discarded them. Two cases were slightly ocvercorrected and 1 case undercorrected. Seventy children (84 %) attained grade of binocularity. Conclusion: Retroequatorial myopexy (fadenoperation) alone and combined with bimedial recession is an effective procedure in treating esotropia with abnormal near-distance disparity.      

Insuficiencia de convergencia con diplopía: tratamiento quirúrgico en adultos

ObjectiveTo study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia.MethodsThe study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up.ResultsA central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (± SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (± 2.9) pd and distance preoperative deviation: 6.88 (± 4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months.ConclusionCentral mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.     

Relationship between motor alignment at postoperative day 1 and at year 1 after symmetric and asymmetric surgery in intermittent exotropia

PURPOSE: To evaluate the relationship between the motor alignment at postoperative day 1 and at year 1 following bilateral lateral rectus recession (BLR, symmetric surgery) and unilateral lateral rectus recession-medial rectus resection (R&R, asymmetric surgery) for the treatment of intermittent exotropia, X(T). METHODS: Forty-six patients with basic or pseudo-divergence excess type of X(T) underwent BLR and 57 patients underwent R&R. The motor alignment at postoperative day 1 was classified as overcorrected by 11-20 prism diopters (PD), overcorrected by 1-10 PD, orthotropic, or undercorrected by 1-10 PD of exotropia. RESULTS: There was a statistically significant relationship between the alignment at postoperative day 1 and at year 1 following both R&R and BLR surgery (r = 0.74, r = 0.51, respectively, P <.05). Patients overcorrected by 1-20 PD had a significantly higher success rate than those undercorrected by 1-10 PD on postoperative day 1 (P <.05). For R&R, a postoperative day 1 alignment of 1-10 PD resulted in the highest success rate of 73.7%. For BLR, a postoperative day 1 alignment of 11-20 PD showed the highest success rate of 76.9%. There were no significant differences in the success, undercorrection and overcorrection rates between the two surgical procedures after a 1-year postoperative period. CONCLUSIONS: The alignment at postoperative day 1 can be a predictive factor of the surgical outcome in X(T). A postoperative day 1 overcorrection of 11-20 PD following BLR surgery and an overcorrection of 1-10 PD following R&R can lead to good results.     

Marginal myotomy of the medial rectus with lateral rectus resection as a secondary procedure for esotropia

Between 1964 and 1982, 89 marginal myotomies were performed, 70 on the medial rectus with lateral rectus resection as a combined secondary procedure for esotropia. Successful realignment was attained in 51% of the cases (for both distance and near measurements); undercorrection occurred in 34% (either distance or near), and overcorrection in 14% (either distance or near). Further operation was required in 17%, of which 4% were for overcorrection. Initial postoperative alignment was maintained at subsequent follow-up. The degree of change in deviation did not correlate with the degree of resection of the lateral rectus or the degree of medial rectus myotomy. Marginal myotomy of the medial rectus with lateral rectus resection is a useful procedure that should be part of the repertoire of all strabismus surgeons.Dedicated to Dr. G.K. von Noorden on the occasion of his 60th birthday