Developmental evaluation in congenital esotropia.

Eleven patients with congenital esotropia were tested with the Bayley Scales of Infant Development (BSID) before surgery and at two and six months after surgery. Eight patients completed all three tests and no obvious changes were found between the first and last test. Of the eight patients, two were considered developmentally normal by the BSID; three had significantly delayed mental and motor scores; one showed significant mental delay; and one had motor delay. Medial rectus muscle recessions were done bilaterally on all patients. Four required a second operation. Orthophoria was obtained in six patients.     

Accommodative esotropia following surgical treatment of infantile esotropia: frequency and risk factors

Purpose: We aimed to examine the frequency of and risk factors for the development of accommodative esotropia following surgical treatment for infantile esotropia. Methods: A total of 29 children were recruited. Potential risk factors for the development of accommodative esotropia included: sex; angle of deviation at initial and final visits; cycloplegic refractive error at initial and final visits; increase in hyperopia; amblyopia; amblyopia treatment; age at surgical treatment; pre‐ and postoperative latent nystagmus; dissociated vertical deviation or inferior oblique muscle overaction; additional surgical procedures; unstable alignment, and binocular sensory status. Results: Overall, 14 (48.2%) of 29 children developed accommodative esotropia during the 36‐ to 132‐month postoperative follow‐up period. Twelve (85.7%) of the 14 patients developed refractive accommodative esotropia and two developed non‐refractive accommodative esotropia. The onset of accommodative esotropia occurred at a mean of 8.8 months (range 6–24 months) after the initial surgical alignment. This corresponded to a mean age of onset for accommodative esotropia of 43.2 months. We determined that, among children with infantile esotropia, those who had hyperopia of ≥ 3.0 D and increasing hyperopia after surgery and those who did not develop dissociated vertical deviation during the follow‐up period were more likely to develop accommodative esotropia. Conclusions: Children who have the established risk factors should be followed closely for the development of accommodative esotropia. The treatment of these children with appropriate glasses may prevent the development of adverse effects of accommodative esotropia on sensory and motor functions.     

Check ligaments: surgical effects in infantile esotropia

In a prospective randomized study, we compared the results of surgical treatment of 25 patients with infantile esotropia, using bilateral medial rectus muscle recession of a graded amount without severing the check ligaments, to results obtained with a similar group of 23 patients in whom check ligaments were severed at the time of bimedial surgery. No significant difference could be found in the immediate postoperative and 6-month postoperative ocular alignment of the two groups.     

Accommodative esotropia following surgical correction of congenital esotropia,frequency and characteristics

This study was undertaken to look at the development of accommodative esotropia, which occurs following the surgical correction of congenital esotropia. A restrospective review was done on all congenital esotropia patients operated on by one of the authors from 1974 through mid-1984. The criterion of a minimum of 3 years postsurgical follow-up was met by 101 patients. Of these patients, 52 developed accommodative esotropia, 25 within 3 months of surgery and 27 from 3 to 60 months after surgery. The average preoperative refractive error in the early group was +3.90 and +1.95 in the later group. The average time to develop accommodative esotropia in this group with later onset was 27 months following the initial surgery. It would appear that if the preoperative refractive error is +3.00 or more, and especially if the preoperative deviation responds to spectacles with a reduction of 15 prism diopters or more, then it is very likely that glasses will be required for accommodative esotropia very soon following surgery. There appear to be no clues as to which patients will need glasses later for accommodative esotropia.Dedicated to Dr. G.K. von Noorden on the occasion of his 60th birthday     

The relationship between nystagmus and surgical outcome in congenital esotropia.

PURPOSE: Congenital esotropia is often associated with congenital nystagmus. This study examines the relationship between the presence of nystagmus and surgical outcome in the treatment of patients with congenital esotropia. METHODS: In this institutional retrospective study, we reviewed the charts of 200 consecutive patients who underwent surgical correction for congenital esotropia between 1991 and 1995. Preoperative clinical characteristics and subsequent need for additional strabismus surgery for a residual or consecutive deviation were noted. Minimum follow-up was 6 months after the original operation. RESULTS: Of the 84 patients who met the inclusion criteria, 15 patients (18%) had latent or manifest latent nystagmus, and 69 patients (82%) had no nystagmus. Eight of the 15 patients with nystagmus had or required reoperation according to our criteria (53%). Nineteen of the 69 patients (28%) without nystagmus had or required reoperation (P =.155). CONCLUSIONS: Nystagmus, when associated with congenital esotropia, may increase the risk of requiring additional strabismus surgery for residual or consecutive deviations. Appropriate and complete preoperative counseling of patients with congenital esotropia who also have nystagmus should include this increased risk.     

Changes in the functional binocular status of older children and adults with previously untreated infantile esotropia following late surgical realignment.

BACKGROUND: Most studies of infantile esotropia concern patients diagnosed in infancy and treated throughout childhood. This prospective study addresses changes in the functional binocular status of older children and adults with previously untreated infantile esotropia, following late surgical realignment. SUBJECTS AND METHODS: Seventeen patients aged 8 years or more with a history of untreated esotropia occurring within the first 6 months of life were included in this study. All had monocular optokinetic asymmetry, a visual acuity of 20/30 or better in the worse eye, and binocular function assesment preoperatively and postoperatively. All were surgically aligned within 8(Delta) of orthotropia. None had neurologic disease. RESULTS: Preoperatively, all 17 patients demonstrated a monocular response to Bagolini lenses, while postoperatively 15 (88%) of the 17 demonstrated binocular function with Bagolini lenses (in that they could constantly perceive the major part of both arms of the X generated by the Bagolini lenses) and 13/17 (76%) demonstrated an increase in the binocular field. All 17 had no sensory fusion, either preoperatively or postoperatively, when tested with the Worth 4-Dot test or synoptophore, and no stereopsis with the Titmus stereo test. CONCLUSIONS: Older children and adults with previously untreated infantile esotropia derive some functional benefits following late surgical realignment. The degree of binocular function may be lower than that achieved in patients aligned before 24 months of age.     

先天性内斜视的临床表现和手术治疗

目的了解先天性内斜视的临床特征和手术治疗方法及疗效。方法回顾分析2000年10月至2003年12月我院斜视住院病人中132例先天性内斜视病例的临床资料及治疗结果。所有病例接受三棱镜、眼球运动检查,大龄合作患儿同时行同视机、线状镜等检查。手术方法以对称性双眼内直肌后退为主,斜视度较大者同时行一眼外直肌缩短,如果有垂直斜视先行垂直肌肉手术矫正。术后随访时间6～48个月,平均24个月。结果先天性内斜视多数患者就诊年龄在1岁以后,弱视发生率较小,内斜视度较大,多在40△～60△之间,眼外肌功能多表现为双眼运动时内直肌功能过强。本组资料中113例患者手术后达到临床治愈,一次手术临床治愈率86.3%。结论先天性内斜视多为双眼交替性,斜视度较大,需要手术治疗,一旦明确诊断,应尽早手术,可获得满意效果。     

儿童部分调节性内斜视的手术探讨

目的探讨儿童部分调节性内斜视的手术时机，手术量。方法对35例部分词节性内斜视的患儿戴全矫眼镜半年以后，手术矫治与调节因素无关的非调节因素所致的内斜视。手术量按裸眼和戴镜后斜视度的平均值设计。结果35例中．眼位矫正满意32例占91．43％，良好3例占8．57％；功能治愈有立体视19例占54．29％。结论儿童部分调节性内斜视，其由解剖因素所致的斜视需手术矫正。当患儿戴全矫眼镜半年眼位仍不能恢复正位时，可尽早手术矫治其残存的内斜度，手术量按裸眼与戴镜平均斜视度设计，术后由于调节因素所致内斜仍需配镜矫正。     

固定性内斜视的手术治疗观察

目的 探讨固定性内斜视的手术方法及治疗效果。方法 对10例固定性内斜视采用内直肌肌腱完全断腱,外直肌缩短联合眶缘骨膜固定术,且将跟球固定于过矫5°。结果 出院时10例中6例眼位正位,1例残留有5°内斜,3例仍过矫5°。随访1年后,9例为正位,1例欠矫。结论 固定性内斜视,采用内直肌断腱、外直肌缩短并眶缘骨膜固定联合手术,眼位过矫5°～10°。一年随访观察效果满意。     

Etiology and surgical management of horizontal pontine gaze palsy with ipsilateral esotropia.

INTRODUCTION: An esotropia ipsilateral to a horizontal pontine gaze palsy has been infrequently reported. We discuss the etiology and review the surgical management of this ocular motility defect. METHODS: Four patients with radiographically documented dorsal pontine lesions and persistent horizontal gaze palsy with esotropia ipsilateral to the gaze palsy were treated. In each patient, the esotropia was present in attempted primary gaze, producing symptomatic diplopia. An anomalous face turn was required to attain single binocular vision. RESULTS: All 4 patients underwent surgical correction to alleviate the anomalous head position and diplopia. Bilateral, asymmetric surgery was required to achieve a long-term successful result. Single binocular vision in the primary position with elimination or marked improvement of the compensatory head posture was initially achieved in all 4 patients. One patient, who had not undergone asymmetric strabismus surgery to reconcile incomitance produced by the esotropia, rapidly developed a residual esotropia. CONCLUSIONS: Ophthalmologists should recognize that concurrent esotropia may occur in patients with horizontal pontine gaze palsy. Single binocular vision in the primary position, an expanded binocular visual field, and alleviation of a compensatory head position are achievable with strabismus surgery.     

Relation between preoperative hyperopia and surgical outcome in infantile esotropia

AIM: To evaluate the relation between preoperative hyperopia and surgical outcomes of infantile esotropia in patients younger than 24 months of age. METHODS: Medical records of patients who underwent bilateral medial rectus muscle recession for infantile esotropia between November 1, 2002 and December 1, 2011 were retrospectively reviewed. Patients were divided into two groups according to the degree of preoperative hyperopia. Group I had less than +3.0 diopter (D) of hyperopia and group II had between +3.0 and +5.0 D of hyperopia. Postoperative alignments were evaluated 1wk, 3, 6mo, and 1y after surgery. Following the 1-year postoperative visit, patients were monitored yearly. Relationships between preoperative factors including hyperopia and postoperative outcomes were evaluated. RESULTS: Forty-six patients were included, with 33 patients in group I and 13 patients in group II. The preoperative mean refractive error was +0.88 D in group I and +3.45 D in group II. Surgical outcomes were not significantly different between groups at any postoperative time point examined. Cumulative probability of surgical success, prevalence of inferior oblique overaction, dissociated vertical deviation, and re-operation rate were not significantly different between groups. CONCLUSION: Preoperative moderate hyperopia (less than +5.0 D) did not affect the surgical outcome of infantile esotropia. Therefore, the surgical correction of esotropia should be considered when the angle of esodeviation is unchanged following hyperopia correction, even in children with moderate hyperopia.     

周期性内斜视的屈光状态与临床治疗

目的 探讨周期性内斜视的屈光状态与治疗方法。方法 对２４例周期性内斜视者用１％阿托品液散瞳验光检验屈光度。斜视日与正位日用三棱镜测量斜视度,用同视机检验双眼立体视觉。手术量按斜视日最大斜视角有设计。结果 轻度、中度远视２３例。斜视日均有复视。正位日均有双眼立体视觉,斜视矫正术后２３例在斜视日与非斜视日眼位均矫正有正常的立体视觉。结果 为获得正常的双眼立体视功能,应在周期性期间及早手术。手术量控斜视     

A randomized comparison of prism adaptation and augmented surgery in the surgical management of esotropia associated with hypermetropia: one-year surgical outcomes.

OBJECTIVE: To compare motor and sensory 1-year surgical outcomes in patients with hypermetropic esotropia, managed with either augmented surgery based on the average of the near deviation with and without correction or preoperative prism adaptation. METHODS: Forty-three patients with hypermetropic esotropia without distance-near disparity entered a randomized prospective evaluation of augmented surgery (group A, 27 patients) versus prism adaptation (group P, 16 patients). The formula for augmenting the amount of the rectus muscle recession was based on the average of the near deviation with and without correction in group A and the prism-adapted angle of deviation in group P. During prism adaptation, 9 of 16 patients in group P responded to prism. Motor and sensory outcomes of the Worth 4-dot test at 6 and 0.33 m and the Titmus stereotest were evaluated 1, 3, 6, and 12 months after surgery. RESULTS: Postoperative deviations of 8 PD or less at distance were achieved in 24 of 27 patients (89%) of group A and in 7 of the remaining 8 patients (88%) of prism responders and in all 7 prism nonresponders (100%) in group P. No significant difference existed between groups A and P, as well as between the prism responders and prism nonresponders in group P in terms of near and distance deviation 1 year after surgery. The sensory outcomes improved over time in group A and prism responders. CONCLUSION: There were no significant differences in the surgical outcomes between each group. However, the small sample size may limit the power to detect any statistically significant differences.     

Results of surgical treatment of alphabetical syndromes in esotropia. Apropos of 98 cases

The authors report the results of 98 cases of esotropia treated by global surgery. They treated 72 "V" syndromes, 22 "A" syndromes and 4 cases without vertical incommitance but presenting visible hyperactivities of the oblique muscles. The alphabetical variations have been treated by weakening of the oblique muscles and sometimes have been treated by weakening of the oblique muscles and sometimes of the vertical recti which are part of the same torsional couple (inferior oblique - inferior rectus in the "V" syndrome, superior oblique - superior rectus in the "A" syndrome). Post-operative improvement has been obtained in 76% of the cases for the "V" syndrome and in 63% of the cases for the "A" syndrome. The surgery of the oblique muscle must be done according to the importance of the incommitance. The arc-technique permits these adjustments. Some pronounced "X" syndromes appear in the post-operative period. All anomalies found during motility examination should be surgically corrected.     

Objective evaluation of experimental ocular irritation.

After topically administered nitrogen mustard the irritative effect on the pupil, intraocular pressure, protein concentration of the aqueous humor and on the vessels of the iris and conjunctiva was quantified. The protein level in aqueous was determined by refractometry. The degree of hyperemia of conjunctiva and iris was determined by measuring the amount of Evans blue dye present in the tissue minutes after intravenous administration. A reproducible relationship was obtained using these methods to evaluate the degree of irritation produced by nitrogen mustard.