Comparison of outcomes of unilateral lateral rectus recession for exotropia between first and second operations

Purpose

To compare the outcomes of unilateral lateral rectus recession between the first operation and second operation for exotropia.

Methods

Thirty-two patients who underwent unilateral lateral rectus recession for exotropia of 15 to 20 prism diopters (PD) were investigated. The follow-up period was at least 6 months. We classified 17 patients without a surgical history for exotropia (first operation group) and 15 patients with a previous procedure (second operation group). Surgical success was defined as an exodeviation or esodeviation of less than 10 PD at the primary position. Postoperative deviation angles and success rates were compared between the two groups.

Results

There were no significant differences in the age, gender, visual acuity (logarithm of the minimal angle of resolution), preoperative deviation, and amount of recession between the two groups. Postoperative deviations were -1.7 ± 5.5:1.3 ± 5.1 PD at one day, 4.3 ± 3.8:5.6 ± 5.1 PD at 1 month, 4.3 ± 4.3:3.0 ± 8.1 PD at 3 months, and 5.0 ± 4.3:4.5 ± 7.2 PD at 6 months post-operation, and there was no statistically significant difference between the two study groups. Surgical success rate were 95.2:100% at one day, 95.2:92.9% at 1 month, 90.5:85.7% at 3 months, and 90.0:92.9% a 6 months post-operation.

Conclusions

In patients with exotropia of 15 to 20 PD, no significant difference was found in terms of the postoperative deviation angle and the surgical success rate between the first operation and the second operation groups. Unilateral lateral rectus recession can lead to similar results in 15 to 20 PD exotropia for the first operation or recurrent exotropia.     

探讨倾斜水平直肌止端在V型外斜中的应用

目的 探讨水平肌的斜行重置对外斜视V征的治疗效果.方法 对11例不合并斜肌异常或斜肌亢进+1的外斜视V征患者经水平肌的斜行重置治疗后,观察其术前与术后的眼位、眼肌功能、双眼视功能等.结果 所有患者V征消失,双眼球运动无障碍,无旋转不适,5例有双眼视功能改善.结论 选择合适的病例(不合并斜肌异常或斜肌亢进+1的V征),水平肌的斜行重置矫正V征是有效的术式.     

间歇性外斜视手术前后交叉视差和非交叉视差立体视觉的临床研究

目的探讨间歇性外斜视患者手术前后近零视差、交叉视差及非交叉视差的临床变化规律。方法将100例间歇性外斜视患者分为4组,使用立体视觉检查图检测手术前后的近零视差、交叉视差及非交叉视差,使用同视机测定远融合范围和远立体视,分析、比较检查结果。结果在全部患者中,手术前后均无近零视差仅与非交叉视差共存者和交叉视差仅与非交叉视差共存者,也无交叉视差、非交叉视差独立存在者。4组患者术后近零视差、交叉视差、非交叉视差、远融合范围及远立体视均较术前明显改善,差异有统计学意义（P〈0．01）。手术前后远融合范围4组患者比较,差异均无统计学意义（P〉0．05）。术后远立体视4组患者比较,差异有统计学意义（P〈0．01）,1组和2组患者远立体视的重建均优于3组和4组。结论（1）间歇性外斜视患者近零视差立体视锐度、交叉视差和非交叉视差立体感知度不健全,损伤次序依次为非交叉视差、交叉视差、近零视差,重建顺序与之相反。（2）非交叉视差立体感知度严重受损或消失,也应视为间歇性外斜视的手术指征,此时应立即进行手术治疗,以利双眼视功能的重建。     

大角度基本型外斜视主眼与非主眼手术的疗效比较

目的：探讨治疗大角度基本型外斜视的最佳手术方法。方法：分别对斜视度数≥60的基本型外斜视患者41例,使用主眼手术和非主眼手术两种方法治疗,同时记录,比较手术后患者的视力,眼位,双眼单视功能,注视等情况,以及平均手术量和手术次数等,并进行统计学分析。结果：两组患者术后双眼正位者均为39例,手术欠矫者均为2例,无过矫者;两组患者术后注视情况均好转;主眼手术组非主眼裸眼视力提高＞2行者多于非主眼手术组,差异有显著意义（P＜0．05）;术后Ⅰ,Ⅲ级视功能者主眼手术组多于非主眼手术组,差异有显著意义（P＜0．05）,主眼手术组平均手术量和手术次数明显低于非主眼手术组,两组比较差异有非常显著意义（P＜0．01）;主眼手术组眼外肌1mm手术量可矫正的平均斜视度数明显大于非主眼手术组,两组比较差异有非常显著意义（P＜0．01）。结论：治疗大角度基本型外斜视患者,主眼手术方法疗效好,损伤轻,值得推广使用;尤其以需在全麻下进行手术的儿童患者更具有临床意义。     

婴幼儿外斜视临床相关因素分析

目的探讨婴幼儿外斜视临床相关因素。方法回顾1996.1～2003.1在我院就诊的外斜视病人,选择4月龄～1周岁前被小儿眼科医生确诊的、无眼部器质性病变的外斜视。询问孕产期异常,有无家族史、外伤或神经系统疾病。检查斜视角、眼球运动以及立体视功能。手术者记录手术年龄、随访期限及立体视功能。结果共23人符合本研究标准。其中间歇性5人(21.7%)、恒定性18人(78.3%)。外斜度≤25△者2人(8.7%),>25△者21人(91.3%),平均斜度为49.7△(25～70△)。5/23人(22.7%)具有立体视功能,这5人中4人为间歇性,1人为小角度恒定性外斜视。阳性家族史者3人(13%),孕产期及全身其它异常8人(34.8%)。伴其它非器质性眼部异常者6人(26.1%)。行手术治疗的15人,术后眼位恢复良好(-16～+10△之间),但只5人具有立体视功能,术前表现为间歇性的3人术后均有一定的立体视。结论婴幼儿外斜视与早产、神经系统和一些其它非器质性眼部异常有关。患儿的双眼视功能低下,临床医生应努力进行早期矫正眼位以恢复一定的双眼视功能,尤其对于间歇性者。     

双眼视觉训练对间歇性外斜视儿童术后立体视觉恢复的影响

目的 探讨双眼视觉训练对间歇性外斜视儿童术后立体视觉恢复的影响。方法 选取2019年8月至2020年8月在南方医科大学顺德医院接受治疗的间歇性外斜视病儿140例（280眼）作为研究对象,参照随机数字表法将入组病儿分为对照组、观察组各70例。两组病儿均于全麻下行眼位矫正手术治疗,对照组病儿术后未行针对性视觉训练,观察组病儿术后2周开始进行双眼视觉训练、持续训练6个月。术后6个月,对比两组病儿的术后眼位情况、立体视觉情况,使用多因素logistics回归模型分析间歇性外斜视儿童术后立体视觉恢复的影响因素。结果 术后6月,观察组病儿的术后眼正位63例,多于对照组病儿的45例（P<0.05）;观察组病儿的无立体视觉比例为12.86%,低于对照组病儿的27.14%(P<0.05)。术后无立体视觉、术后有立体视觉病儿的性别、家族史、术前斜视度、术前立体视觉的分布差异无统计学意义（P>0.05）;年龄、病程时间、术后双眼视觉训练的分布差异有统计学意义（P<0.05）。多因素logistics回归分析结果显示：年龄<9周岁、病程≥1年是间歇性外斜视病儿术后无立体视觉的独立...     

间歇性外斜视手术前后立体视的临床研究

目的 探讨手术治疗间歇性外斜视的最佳时机,以期为手术时机的选择提供科学依据.方法 对36例间歇性外斜视患者术前及术后半年远近立体视进行测定,并分析.结果 术前有近立体视者30例（83.3％,30/36）,有远立体视者7例（19.4％,7/36）,两者比较差异有统计学意义（P＜0.05）,术前有近立体视者30例（83.3％,30/36）,术后半年有近立体视者35例（97.2％,35/36）,两者比较差异有统计学意义（P＜0.05）.术前有远立体视者7例（19.4％,7/36）,术后半年有远立体视者14例（38.9％,14/36）,两者比较差异有统计学意义（P＜0.05）.结论 远立体视功能的损害可以作为间歇性外斜视患者手术时机的参考指标,手术对远近立体视功能的恢复有益.     

Symptoms in Children with Intermittent Exotropia and Their Impact on Health-Related Quality of Life

Purpose: In childhood intermittent XT, the frequency and type of symptoms have not been rigorously studied. We aimed to identify specific symptoms in children with intermittent XT, their frequency, and effects on health-related quality of life (HRQOL).

Methods: 35 children (5-13 years) with intermittent XT without previous surgery were enrolled in a prospective cohort study. Specific symptoms were identified from a previous study involving child and parent interviews and formulated as a 22-item symptom questionnaire. A frequency Likert-type rating scale was used and a response of “sometimes” or more was considered consistent with having the symptom. All 35 children, along with one parent for each child, also completed the patient-derived intermittent XT HRQOL questionnaire (IXTQ) with Child, Proxy, and Parent components. The frequency of symptoms was calculated, and the relationship between individual symptom question scores and Child, Proxy, and Parent HRQOL scores, was evaluated in multivariate linear regression analyses.

Results: The mean number of specific symptoms was 7 (range 2 to 19). The most frequently reported were: rubbing the eye (29 [83%] of 35), problems with eyes in the sun, and the eyes feeling tired (each 22, 63%). Lower (worse) Child IXTQ HRQOL scores were associated with symptoms of difficulty focusing eyes (P=0.0007), double vision (P=0.007), eyes hurting (P=0.006), and problems with eyes in the sun (P=0.06). There were weak associations between Proxy IXTQ and Parent IXTQ scores and child symptoms. Overall, 7 symptom questions were associated with reduced HRQOL in multivariate models.

Conclusion: Children with intermittent XT frequently experience symptoms, some of which impact the child’s HRQOL. Formal assessment of symptoms may aid understanding of the effects of intermittent XT on an individual child, and could use just the 7 symptom questions associated with reduced HRQOL.     

An Overview of the Korean Intermittent Exotropia Multicenter Study by the Korean Association for Pediatric Ophthalmology and Strabismus

The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.     

Traducción y adaptación transcultural de la escala AS-20 para medir la calidad de vida en adultos con estrabismo en Colombia,prueba piloto

BackgroundStrabismus generates a negative psychosocial impact on adult patients, affecting aspects such as self-perception and quality of life. There is no scale in Colombian Spanish that measures these impacts.ObjectiveTo carry out the translation and cross-cultural adaptation of the AS-20 instrument into Colombian Spanish, for measuring the quality of life in adult patients with strabismus in Colombia.Materials and methodsPilot test of a cross-sectional study for the translation, reverse translation, and cross-cultural adaptation of the AS-20 instrument from its original language, English, to Colombian Spanish, in adult patients with strabismus in Bogotá, Colombia.ResultsSixteen patients were assessed. The age range was between 18 and 68 years with a mean age of 41 years. The scale was answered in an average time of 10.62 min. Difficulty was reported in 3 individuals for understanding 2 items (questions 8 and 14), which were resolved.ConclusionThe translation and pilot test of AS-20 scale into Colombian Spanish was carried out, identifying and solving translational difficulties. It is the first step in the cross-cultural adaptation process. Based on the results, the validation and cross-cultural adaptation can be completed in a future study.