云南省青少年儿童斜视手术回顾性分析

目的:分析云南省青少年儿童斜视手术情况。方法:回顾性分析2017-01/2021-12于云南大学附属医院行斜视手术的青少年儿童患者3 068例的病历资料,分析纳入患者的性别和年龄构成、斜视类型分布、合并其它眼部疾病等情况。结果:纳入患者中男性占52.12%,女性占47.88%;学龄前(1～6岁)患者占32.89%,小学生(7～12岁)占45.89%,中学生(13～18岁)占21.22%;外斜视占63.17%,其中以间歇性外斜视最常见,内斜视占19.69%,其中以共同性内斜视最常见,特殊类型斜视占17.14%,其中以A-V综合征和分离性垂直斜视(DVD)最常见;合并屈光不正者占61.02%,合并弱视者占10.89%,少数患者还合并其他眼部疾病。结论:云南省青少年儿童斜视类型以间歇性外斜视最普遍,部分患者合并其他眼部疾病。     

中国东北某医院2014─2017年间斜视住院患者斜视类型分布变化

目的：根据中国东北地区某医院眼科收集的数据,评估所有年龄阶段斜视住院患者的斜视类型和数量变化趋势。方法：回顾性分析2014年1月至2017年12月在哈尔滨医科大学附属第一医院眼科住院的斜视患者3 661例的资料。收集患者基本信息、斜视类型以及各种斜视的数量等信息,并观察分析斜视类型分布及斜视数量的变化趋势。组间数据比较采用方差分析、χ2 检验或Fisher确切概率法。 结果：最终纳入3 555例患者,年龄为1～79岁（15.5±11.6）岁,其中3 536例患者行斜视手术治疗。患者数量呈逐年递增趋势,且在每年1、2月份及7、8月份大致达到峰值（χ2 =956.67,P<0.001）。外斜视患者数量（71.8%）明显多于内斜视患者数量（16.0%）,差异有统计学意义（χ2 =31.41,P<0.001）, 其中间歇性外斜视是最常见的斜视类型。非调节性内斜视（77.6%）是所有内斜视中最常见的斜视类型。其他特殊类型斜视虽然患者数量较少,但依然有小幅度的上升趋势。在所有年龄阶段患者中, 12岁以下的患者最常见,占总数的56.0%,其中外斜视（71.5%）是最主要的斜视类型。结论：中国东北地区某医院2014─2017年外斜视患者比内斜视患者更常见,且外斜视患者的比例逐年增加,其中间歇性外斜视是最主要的斜视类型。此外12岁以下患者是最常见的患病人群。     

知觉性内/外斜视与视力障碍发病年龄关系的研究

目的 研究知觉性内斜视或外斜视的发生与视力障碍发病年龄的关系。方法 回顾性分析169例知觉性斜视的临床资料,包括视力障碍的发病年龄、病因和知觉性斜视的类型等。结果 169例知觉性斜视中34例先天性视力障碍(20％),其中20例(59％)发生知觉性内斜视,14例(41％)发生知觉性外斜视;135例(80％)获得性视力障碍,其中21例(16％)发生知觉性内斜视;114例(84％)发生知觉性外斜视。两组间有显著性差异,x~2=27.67,P<0.01。86例视力障碍(51％)因白内障所致,其中无晶状体者64例(74％)。结论 先天性视力障碍(发病年龄≤6个月)主要发生知觉性内斜视,获得性视力障碍(发病年龄>6个月)主要发生知觉性外斜视。白内障是导致知觉性斜视最常见的原因。     

Comparison of Surgical Success for Infantile Esotropia and Strabismus Associated with Neurological Impairment

Purpose: Surgery for strabismus associated with neurological impairment is assumed to have unsatisfactory results in comparison with other strabismus cases. The aim of this study is to compare the surgical success rates of infantile esotropia (IE) and strabismus associated with neurological impairment.

Methods: The records of 103 patients that received operations for IE and strabismus associated with neurological impairment between January 1994 and May 2014 were reviewed retrospectively. The angles of deviation and surgical success rates were evaluated at preoperative, 1-month postoperative, and 24-month postoperative visits.

Results: Forty-five patients received operations for strabismus associated with neurological impairment (25 patients with esotropia and 20 patients with exotropia) and 58 patients for IE. Mean preoperative angles of deviation in cases with neurological impairment were 42 prism diopters (PD) for esotropia, 44.7 PD for exotropia, and 44.4 PD for IE. One patient from each group had consecutive deviation at first visit, and at last visit, 3 patients with neurological impairment and 5 patients with IE had consecutive deviations. Surgical success rates at the end of the second year were 52% for esotropia and 50% for exotropia in patients with neurological impairment and 56.8% for IE cases.

Conclusion: This study was unable to find the differences between surgical success rates in IE and strabismus associated with neurological impairment.     

Comitant Horizontal Strabismus in South African Black and Mixed Race Children—A Clinic-based Study

Purpose: To examine the types of comitant horizontal strabismus in children belonging to the two largest ethnic groups of the Western Cape, South Africa.

Methods: Retrospective review of 2371 children presenting with comitant horizontal strabismus to a single, large, pediatric tertiary referral center in Cape Town, South Africa, between 1997 and 2007.

Results: 81% of children were of mixed race and 19% were black. The overall esotropia:exotropia ratio was 73:27. For black children this was 85:15 and for mixed race, 71:29. The overwhelming majority of black children had congenital esotropias (74%), whereas accommodative esotropia was rare (9%). In mixed race children, esotopias were more equally divided between congenital (46%) and accommodative types (35%). Exotropias were uncommon in black children, and were mainly constant (61%). Intermittent exotropias predominated in mixed race children (55%).

Conclusion: Congenital esotropia remains common in South African black children, and of the few who presented with exotropia, most had constant type. Accommodative esotropias were more prevalent in South African mixed race children, but in smaller proportions than in other studies. Exotropias were mostly intermittent in this ethnic group, and showed a similar profile to that in white American children.     

Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis

ABSTRACT

Purpose: Despite the importance of information on the prevalence of strabismus, which can be effective in planning preventive and curative services, no study has addressed its prevalence comprehensively. In this study, a systematic search was done to estimate the regional and global prevalence of strabismus in different age and sex groups and factors affecting prevalence heterogeneity.

Methods: A comprehensive and systematic search was done in different international databases, including Web of Science, Scopus, PubMed, Embase, etc. to find published articles on the total prevalence of strabismus and the prevalence of exotropia and esotropia. A binomial distribution was used to calculate the prevalence and 95% confidence interval (CI). The Cochran’s Q-test and I² were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The Begg’s test was administered to investigate publication bias and finally, a meta-regression method was applied to determine the factors affecting the heterogeneity among studies.

Results: Of 7980 articles, 56 articles with a total sample size of 229,396 were analyzed. Many of these articles (n = 14) were from the Regional Office for the Americas. The estimated of pooled prevalence (95% CI) of any strabismus, exotropia, and esotropia was 1.93% (1.64–2.21), 1.23% (1.00–1.46), and 0.77% (0.59–0.95), respectively. The heterogeneity in prevalence of strabismus and its subtypes according to I² was above 95% (p value <.001 for all). Age had a direct effect on heterogeneity in the prevalence of exotropia (b: 3.491; p: 0.002). Moreover, WHO region had a significant direct effect on heterogeneity in the prevalence of strabismus (b: 0.482; p < .001) and esotropia (b: 0.168; p: 0.027), and publication year had a significant direct effect on heterogeneity in the prevalence of exotropia (b: 0.059; p: 0.045). Sample size and publication year did not have any association with strabismus nor with other variables. There was no publication bias according to the Begg’s test.

Conclusion: The prevalence of strabismus varies widely in the world. As for factors affecting heterogeneity in the prevalence of strabismus, the results showed that age affected heterogeneity in the prevalence of exotropia, WHO region affected heterogeneity in the prevalence of strabismus and esotropia, and publication year affected heterogeneity in the prevalence of exotropia. Information about the global prevalence of strabismus can help health care planners design interventions and prioritize resource allocation.     

Botulinum Toxin Treatment in Patients Up to 3 Years of Age Who Have Esotropic Duane Retraction Syndrome

ABSTRACT

Purpose: To report the results of botulinum toxin (BOTOX®, Allergan) type A (BTA) bilateral injection in the treatment of Duane retraction syndrome (DRS) type 1 in patients aged up to 3 years.

Methods: We studied the results of BTA bilateral injection in eight consecutive patients with DRS type 1 and esotropia in primary gaze. Average follow-up was 74?±?71 months. The main variables analyzed were horizontal and vertical deviation and face turn. Patients were anesthetized with nitrous oxide (N₂O). A mean dosage of 5.6?±?1.8?IU (range 2.5–7.5?IU) of botulinum toxin diluted in 0.9% saline solution was injected under electromyography control in each medial rectus muscle.

Results: Seven patients had one affected eye and one patient had bilateral involvement. The mean preoperative esotropia was 32?±?10 prism diopters (PD). Three patients (37.5%) had also a vertical deviation. All patients had face turn ranging between 15° and 45° before BTA injection. In the last follow-up, 4 patients were orthotropic (50%), 1 (12.5%) had 3 PD exotropia and 3 (37.5%) had esotropia averaging 25 PD mean. The 3 esotropic patients needed surgical correction. Vertical strabismus improved in 3 patients achieving complete resolution in one of these patients. Two patients, without vertical strabismus before the BTA injection, developed a 5-PD vertical deviation, one of them required surgery. Face turn improved in all patients.

Conclusion: Botulinum toxin injection is an alternative treatment for patients with DRS type 1 presents esotropia and face turn in children up to 3 years of age.     

Results of re-operation on the deviated eye in patients with sensory heterotropia

Purpose

To evaluate the result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after surgery.

Methods

The medical records of 11 patients who had received second strabismus operation on the deviated eye due to recurred, consecutive or undercorrected sensory strabismus were studied retrospectively.

Results

Among the 11 patients, five patients were operated for recurred exotropia after surgery of sensory exotropia (group 1), two for consecutive exotropia after surgery of sensory esotropia (group 2), and four for undercorrected esotropia after surgery of sensory esotropia (group 3). Re-operation was performed 19.2±12.6 years after the first operation and the mean preoperative deviation before re-operation was 30.0±8.66 prism diopters (PD), 32.5±10.6PD, and 32.5±8.66PD, respectively. In all cases, a small amount of recession or resection compared with the usual surgical dosage was applied in re-operation on the deviated eye. The mean follow-up period after re-operation was 12.3±14.2 (1-48 months). Among the 11 patients, postoperative deviations less than 10PD were achieved postoperatively in 8 (72.7%) at 1 month and of the 8 patients with follow-up data beyond 6 months, 5 (62.5%) showed orthotropia within 10PD at 6 months or later.

Conclusions

The surgical result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after the first surgery was satisfactory in spite of the reduced amount of surgical correction compared with the surgical dosage recommended for the non-operated eye.     

儿童外斜视术后继发性内斜视的手术效果短期观察

目的 探讨儿童外斜视术后继发性内斜视的特点及原因,评价手术治疗效果。设计 回顾性病例系列。研究对象 17例外斜视术后继发性内斜视并再次手术的患儿。方法 总结17例患者既往外斜视手术方法和特点,外斜视术后出现内斜视时间、术后处理、继发性内斜视手术方式以及手术中探查发现。选择间歇性外斜视50例作为对照组,以探讨继发性内斜视的原因。主要指标 第一次手术外斜视的类型、手术方法、术后处理,继发性内斜视出现的时间。第二次手术探查发现、是否合并其他类型的斜视、手术方式以及手术后眼位。结果 17例患者合并垂直斜视9例（52.9%）,其合并中V征2例,合并DVD 4例;而对照组合并垂直斜视者9例（18.0%）,两者比较差异有统计学意义（X2=6.33,P=0.01）。继发性内斜视出现时间为术后1~12个月,平均2个月。继发性内斜视患者16例为恒定性内斜视,1例为不典型周期性内斜视;17例中外展受限10例,手术探查发现肌肉滑脱2例,粘连综合征3例,3例术后进行缝线调整。17例患者治愈14例（82.3 %）,2例过矫,1例欠矫。结论 继发性内斜视平均在外斜视术后2个月出现,外展受限、粘连综合征、肌肉滑脱以及合并垂直斜视为继发性内斜视可能的病因,合并垂直斜视的复合斜视在手术后更容易出现继发性内斜视。（眼科, 2013, 22： 327-331）     

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。     

Plusoptix S08 sensitivity in detecting strabismus as amblyogenic risk factor

Abstract

Purpose: To evaluate the sensitivity of photoscreener Plusoptix S08 in screening strabismus.

Methods: Eighty-three consecutive patients were examined by a single expert to determine the type and amount of the deviation. Then photoscreening was done for all the patients via Plusoptix S08 photoscreener (Plusoptix GmbH, Nuremberg, Germany) on the same day, using the default software for referring the patients.

Results: The age range was between 6 months and 40 years. The overall sensitivity of the device to detect strabismus is 70%; it was 25% for exophoria, 67% for esotropia, 73% for exotropia, and 89% in patients who had mixed strabismus. Regarding degree of deviation, sensitivity was 46% in deviations less than 30 prism diopters (PD) and rises while the degree of deviation increases.

Conclusions: Our research shows that Plusoptix should not be used solely in evaluating strabismus because its sensitivity decreases significantly specially in esotropic patients with less than 30 PD deviations.     

胰岛素样生长因子-1在斜视儿童眼外肌及血清中的表达

目的: 探讨正常眼位及斜视儿童眼外肌、血清中胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)的表达差异,以期进一步认识斜视发病机制与IGF-1的相关性。方法: 根据患儿的眼位情况及斜视类型分组:共同性内斜视组67例86眼,共同性外斜视组129例183眼,正常眼位组23例23眼,运用免疫组织化学、免疫印迹及ELISA法分别检测各组儿童眼外肌及血清中IGF-1的含量,并行统计学分析。结果: (1)免疫组织化学检测结果显示:IGF-1在眼外肌细胞中主要表达在胞浆,细胞外基质中有少量的表达。正常眼位组眼外肌中IGF-1含量明显多于共同性内斜视组及共同性外斜视组(P<0.05)。(2)免疫印迹法检测结果显示:正常眼位组与共同性内斜视组、共同性外斜视组相比较,眼外肌中IGF-1含量明显增多(P<0.05)。(3)正常眼位组、共同性内斜视组、共同性外斜视组儿童血清中IGF-1含量的差异无统计学意义(P>0.05)。结论: 共同性内斜及共同性外斜等儿童常见单纯眼位异常的发生,可能与眼球血供中IGF-1含量的多少相关性不大,其影响在于控制眼球运动的眼外肌局部IGF-1含量的多少,提示应用IGF-1在眼外肌局部注射对于治疗斜视等眼外肌相关疾病具有潜在的应用前景。     

Ruxandra Sireteanu (1945–2008)

Purpose: Large-angle strabismus is a gray zone for surgeons with various advocates for one, two-, three-, or even four-muscle surgeries. Very frequently, reoperations are required in these cases in order to achieve a successful outcome. In this article, the authors evaluate the outcome of concomitant large-angle strabismus after a single surgical procedure.

Methods: A retrospective analysis of all operated cases of concomitant large-angle strabismus (50 prism diopters or more) during a 1.5-year period was performed from patient’s case files. A successful outcome of surgery was defined as deviation within 10 prism diopters of orthophoria/tropia for both distance and near.

Results: Fifty patients met the inclusion criteria. The overall success rate was 60%, with the esotropia group having a higher success rate (68.75%) than the exotropia group (44.45%). Ten patients underwent recess-resect procedure, 20 had bimedial rectus recession, and 3 had bilateral lateral rectus recession, while 17 patients had surgery on 3 horizontal rectus muscles. Thirty-three patients had two-muscle surgery with a success rate of 57.58%, while 17 patients had three-muscle surgery with a success rate of 64.71%, the difference being statistically insignificant. There was no statistically significant difference between the various age groups analyzed for overall success rate, suggesting that age group is not a factor for positive outcome in large-angle strabismus surgery. A total of 12 patients were amblyopic at the time of strabismus surgery and they had a success rate of 33.33%, which was much poorer than the success rate (68.42%) of the remaining 38 patients who did not have amblyopia at the time of surgery.

Conclusions: A good surgical outcome can be obtained in large-angle strabismus with a single surgical procedure, though a randomized controlled study needs to be done to establish whether three-muscle surgeries give better results than two-muscle surgeries.     

Prevalence of systemic and ocular disease in infantile exotropia: comparison with infantile esotropia.

OBJECTIVE: Exotropia in infancy is believed to be associated with an increased prevalence of neurologic, ocular, and craniofacial abnormalities; however, the prevalence of coexisting ocular and systemic disease in these patients is unknown. In this study, the prevalence of ocular disease and systemic illness was determined in patients diagnosed with exotropia in infancy. DESIGN: Observational comparative case series. PARTICIPANTS: Medical records of 70 patients diagnosed with exotropia in the first year of life were reviewed and compared with records of 136 patients diagnosed with esotropia before 1 year of age. INTERVENTION: Patients with no disorders (other than latent nystagmus, dissociated vertical deviation, or oblique muscle overaction) were grouped as "simple" strabismus. Patients with systemic disorders (including prematurity, neurologic disease, and genetic disease) and patients with ocular disorders (including congenital nystagmus, other strabismus, ptosis, and any condition associated with loss of vision [except amblyopia]) were grouped as "complex" strabismus. MAIN OUTCOME MEASURES: Prevalence of coexisting systemic and ocular disorders. The demographics, strabismus measurements, and types of coexisting disease in the simple and complex groups were compared. RESULTS: A high percentage of both exotropia (67%) and esotropia (49%) patients had a coexisting ocular or systemic abnormality. Exotropia patients with a constant strabismus were more likely to have coexisting ocular or systemic disease than those with an intermittent strabismus. Smaller angles of exotropia or esotropia were associated with a higher likelihood of coexisting ocular or systemic diseases. Systemic disorders were found more frequently than ocular disorders in both the exotropia and esotropia groups. In 25% of all patients referred for evaluation of strabismus, an additional ocular or systemic abnormality was discovered by the ophthalmologist. CONCLUSION: Patients presenting to a university hospital-based practice in the first year of life with exotropia were more likely than those presenting with esotropia to have coexisting ocular and systemic disease. Both groups had a notably high prevalence of associated disorders. The percentages measured in this population may not be applicable to other practices because of referral bias. However, clinicians should consider that children presenting with infantile exotropia and esotropia appear to be at risk for coexisting ocular or systemic disease.     

A study of heredity as a risk factor in strabismus

AIMS: Inheritance is recognised to have a part in the aetiology of strabismus but previous studies have not adequately distinguished between different types of strabismus leading to wide variations in reported findings. The aim of this study was to investigate the importance of heredity in different types of strabismus. METHODS: The parents of children attending for treatment of strabismus over a one-month period were interviewed to identify relatives with a history of strabismus. A complete three-generation pedigree was established for 96 index cases who were classified into four groups: infantile esotropia (26 cases), accommodative esotropia (49 cases), anisometropic esotropia (15 cases), and exotropia (six cases). RESULTS: Forty-three of a total of 165 (26.1%) first degree relatives of patients with hypermetropic accommodative esotropia were affected. In contrast, 15 of a total of 101 (14.9%) first degree relatives of patients with infantile esotropia, eight of a total of 66 (12.1%) first degree relatives of patients with anisometropic esotropia, and one of a total of 25 (4%) first degree relatives of patients with exotropia were affected. Analysing the data using logistic regression with a random term for family showed a significantly higher proportion of affected first degree relatives in the accommodative group than in any of the other three diagnostic groups. CONCLUSION: A history of strabismus appears to be more common in hypermetropic accommodative esotropia than in infantile esotropia, anisometropic esotropia or exotropia. More detailed investigation of the role of heredity in the aetiology of accommodative esotropia is needed.     

Manejo del estrabismo asociado al glaucoma de la infancia: serie de casos

ObjectiveTo evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results.MethodsThe clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied.ResultsFour patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs.ConclusionStrabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed.     

A 4 year retrospective survey of strabismus surgery in Tongren Eye Centre Beijing

Purpose: To investigate the distribution pattern of the strabismus surgery undertaken at an eye centre in Beijing, China. Methods: A retrospective analysis was conducted including the data of all strabismus surgeries performed in Beijing Tongren hospital for the 4 year period from 2003 to 2006. The proportions of different surgery types and their association with patients’ age and gender were analyzed. Result: During the study period, 8997 strabismus surgeries were performed. The number of the surgeries increased progressively each year from 1507 in 2003 to 2769 in 2006 (p < 0.05). Intermittent exotropia was the most common of all strabismus surgeries (27.9%). Superior oblique palsy was the most common type among the paralytic strabismus surgeries. The proportions of different types of strabismus showed no significant change between successive years. Among the patients, the number of surgeries performed in the population aged 0–12 years was significantly higher than other age groups and increased from 35.37% in 2003 to 42.80% in 2006 (p < 0.05). Conclusion: There has been a continuous increase in the number of strabismus operations in our eye centre in Beijing, and this pattern is especially obvious in children. The distribution of surgery type remained relatively constant each year. Surgery for intermittent exotropia is the most common type of procedure.     

The Management of Strabismus in Patients with Chronic Progressive External Ophthalmoplegia

Aims: To describe the clinical profiles and results of surgical and non-surgical interventions in a large cohort of patients with strabismus associated with chronic progressive external ophthalmoplegia (CPEO).

Methods: A retrospective case note review was conducted of all patients with a clinical diagnosis of CPEO referred to our institution’s strabismus department in the United Kingdom between 1990 and 2008.

Results: The total number of patients in this series was 28 (12 male, 16 female). The main presenting symptoms were diplopia (14) or cosmetically objectionable strabismus (11). Three had symptoms unrelated to strabismus and were excluded from further analysis. The most common strabismus findings were large angle exotropias (mean 47 prism diopters), half of which had associated vertical deviations. Strabismus management consisted of prisms (3), occlusion (3), botulinum toxin (7), and surgery (8). Two patients were offered surgery but were deemed unfit for general anesthesia, and a further 2 declined surgery or defaulted follow-up. Three had no active treatment for strabismus. The most effective procedure for exotropia was maximal, bilateral lateral rectus recessions (8?mm or 17?mm from the limbus) with medial rectus resections (7?mm) using adjustable sutures. Patients who had less than maximal horizontal muscle surgery were inevitably undercorrected, even in the early postoperative period. Long-term stability of measurements was rarely achieved, with either progressive increase in the angle of exotropia, or with new onset vertical deviations.

Conclusions: In selected patients with CPEO and exotropia, maximal bilateral surgery significantly improves ocular alignment and may relieve symptoms of diplopia, but due to the progressive nature of the disease, strabismus often recurs. Toxin can be invaluable in maintaining a satisfactory ocular alignment in patients with residual or progressive exotropias, who have undergone maximal horizontal rectus muscle surgery or multiple previous strabismus procedures.     

Causes,background, and characteristics of binocular diplopia in the elderly

Purpose

We evaluated the background and characteristics of elderly patients with binocular diplopia including diseases caused by abnormalities in orbital pulleys.

Study design

Retrospective.

Methods

The participants were 236 patients aged 60 years or older who visited Kitasato University Hospital complaining of binocular diplopia. We classified strabismus by types and investigated the causes for each group. We diagnosed orbital pulley disorders using magnetic resonance imaging (MRI). Patients with orbital pulley disorders exhibited esotropia and/or vertical strabismus and did not present with cranial nerve palsy, systemic illness, or ocular injury.

Results

Classification of strabismus types was: exotropia (24.2%); esotropia (25.0%); vertical strabismus (30.1%), combined strabismus (20.8%). There were 50.9% cases of strabismus associated with vertical deviation. The causes of disease in each group were as follows: in the exotropia group, 50.9% convergence insufficiency exotropia, 21.1% basic exotropia; in the esotropia group: 35.6% orbital pulley disorder 33.9% sixth cranial nerve palsy; in the vertical strabismus group: 32.4% forth cranial nerve palsy, 31.0% orbital pulley disorder; in the combined strabismus group: 28.6% orbital pulley disorder, 28.6% forth cranial nerve palsy.

Conclusions

About half of the elderly patients with binocular diplopia exhibited vertical deviation. In addition, binocular diplopia was often caused by orbital pulley disorders. It is the first epidemiological study focusing on orbital pulley disorders diagnosed on the basis of MRI.