The Surgical Outcome of Intermittent Exotropia with Good Binocular Function

PURPOSE: We investigated the success rate of surgery and binocular function after surgery in intermittent exotropia with good preoperative binocular function. METHODS: Thirty-eight intermittent exotropia patients who had good stereopsis of 40 seconds according to the Titmus test, showed fusion by Worth-4-dot test preoperatively, and had at least 1 year of postoperative follow-up were included in the present study. The age at operation, angle of exodeviation, visual acuity, stereopsis with Titmus test and fusional status with Worth-4-dot test after surgery were analyzed. A surgical success was defined as postoperative angle of deviation less than 10 prism diopter (PD). RESULTS: The patient mean age at the time of the operation was 7.9 years. The mean preoperative angle of exodeviation was 25.5 PD at far distance and 27.5 PD at near distance. The mean follow-up time was 22.9 months. The success rate of surgery was 81.6% at 6 months, 68.4% at 1 year and 60.5% on the last visit. Seventeen patients (44.7%) had stereopsis of 40 seconds and showed fusion at far and near distance after surgery. The stereopsis was worse than 100 seconds in 2 patients (5.3%), and fusion was maintained at only near distance in 15 patients (39.5%). In 7 patients (18.4%), the stereopsis decreased to 200 seconds or worse, or there was no fusion after surgery. CONCLUSIONS: The recurrence of exodeviation was a major cause of the surgical failure in the intermittent exotropia with good preoperative binocular function. Moreover, binocular function may decrease postoperatively in intermittent exotropia with good preoperative binocular function, so careful follow-up may be required to maintain this function.

Clinical Manifestations of Inferior Oblique Overaction in Patients with Horizontal Strabismus

PURPOSE: To investigate the clinical manifestations of and the surgical success rates in patients with horizontal strabismus and inferior oblique overaction (IOOA). METHODS: The patients included in the present study had received myectomy for correction of IOOA and had at least 3 months of follow-up. The patients were divided into 2 groups; patients who received myectomy and surgery for horizontal strabismus simultaneously (combined group, 74 eyes of 49 patients) and patients who received myectomy only (myectomy group, 29 eyes of 24 patients). Chief complaints, head tilt, bilaterality of IOOA, ocular torsion, and the surgical success rates were analyzed. RESULTS: In the combined group, 51% of the chief complaints were horizontal deviation, and in the myectomy group 42% were upward deviation and 29% were head tilt. Objective head tilt was 29% in the combined group and 54% in the myectomy group and the difference was significant. There was no significant difference statistically in the success rate of myectomy. CONCLUSIONS: The frequency of symptoms associated with IOOA in the combined group was lower than in the myectomy group. Therefore, preoperative examination regarding IOOA should be carefully performed in patients who are planning a horizontal strabismus surgery because there was no difference in surgical success rate between the 2 groups, the association with horizontal strabismus may have no effect on the surgical results of IOOA.

Clinical Manifestation after Surgical Correction of Consecutive Esotropia

PURPOSE: To report the clinical outcome of patients with consecutive esotropia (ET) in the pre- and post-operative periods and at the last postoperative visit. METHODS: The present study included 12 patients who underwent surgery for the correction of consecutive ET. The angle of deviation, duration of consecutive ET, and surgical and non-surgical methods for correction of consecutive ET were investigated. The sensory status was evaluated before the surgery of exotropia (XT), during consecutive ET and after the surgery for consecutive ET. RESULTS: The average angle of deviation before the surgery of XT was 27.5 PD and 3 patients had lateral incomittancy. Alternate occlusion treatment was performed in all patients, and 10 patients wore Fresnel prisms. The average angle of deviation of consecutive ET was 24.3 PD. After an average of 30 months postoperative consecutive ET, 9 patients were orthotropic or had deviation within 8 PD, 2 patients had 15 PD ET, and 1 patient had 20 PD XT. There were 3 patients whose stereopsis was aggravated and 1 patient had poorer fusion during consecutive ET, and recovered after the surgery for consecutive ET. No patients had a decrease in visual acuity. CONCLUSIONS: As a result of alternate occlusion and Fresnel prisms during consecutive ET after surgery of XT, the incidence of aggravation in binocularity was low, and the cases with aggravated binocularity were recovered after surgical correction of consecutive ET. The surgical success rate was 75% in consecutive ET.

Efficacy of Spectacles before Amblyopia Treatment in Anisometropic Amblyopia

PURPOSE: To identify the efficacy of spectacle wearing for 4 months before amblyopia treatment in children with anisometropic amblyopia. METHODS: The patients with anisometropic amblyopia without strabismus were selected for the present study. The patients were divided into 2 groups; patients who began amblyopia treatment while simultaneously wearing glasses (Group A, 16 patients) and patients who began amblyopia treatment after wearing spectacles for 4 months (Group B, 17 patients). Intermittent atropine penalization or part-time occlusion was provided for amblyopia treatment. Age and best-corrected visual acuity at the start and cessation of treatment, type of amblyopia, treatment method and duration of treatment were analyzed. RESULTS: There were no statistical differences among age, best-corrected visual acuity of the amblyopic and better eyes, type of amblyopia, or treatment method between the 2 groups. In Group B, visual acuity of the amblyopic and better eyes improved after 4 months of spectacle wearing. At the last visit, there were no statistical differences of visual acuity in the amblyopic eye between the 2 groups. In children with resolution of amblyopia, the treatment duration of Group A (15 patients) was 17.3 months, longer than the 4.7 months in Group B (13 patients) (p = 0.003). CONCLUSIONS: Wearing spectacles for 4 months prior to amblyopia treatment may be an effective method of shortening the treatment duration.

Clinical Manifestation of Patients with Accommodative Esotropia for 10 Years

PURPOSE: To analyze the clinical features of patients who successfully discontinued correction with hyperopic glasses for refractive accommodative esotropia during a 10 year follow-up. METHODS: The authors of the present study analyzed 29 patients followed-up for a minimum of 10 years after diagnosis of accommodative esotropia. The patients were divided into 2 groups: patients who successfully discontinued correction with hyperopic glasses (10 patients, Group A), and patients who required constant use of hyperopic glasses (19 patients, Group B). The age at first visit, refractive error, deviated angle without correction, stereopsis, and follow-up duration were compared between the 2 groups. RESULTS: The mean age at first visit for all patients was 3.03 +/- 1.46 years, and the follow-up duration was 11.3 +/- 1.51 years. Patients in Group A discontinued the use of hyperopic glasses after 10.26 +/- 2.08 years. There were no statistical differences in mean age at first visit, deviated angle without correction, stereopsis, follow-up duration, or the amount of change in hyperopia. The initial amount of hyperopia in Group A was 3.81 +/- 1.54 D, significantly lower than the 5.12 +/- 1.37 D in Group B. CONCLUSIONS: After a 10 year follow-up of accommodative esotropia, 34% of the patients discontinued the use of hyperopic glasses, and the hyperopic amount at initial visit was statistically lower than that of patients who required constant use of hyperopic glasses.

Re-Elevation of Intraocular Pressure after Peripheral Laser Iridotomy in Patients with Closed Angle

PURPOSE: To investigate the long-term effects of maintenance of intraocular pressure (IOP) after peripheral laser iridotomy (PLI) in patients with closed angle. METHODS: The patients who received PLI were assessed and divided into 2 groups. There were 38 patients (41 eyes) with a history or ocular findings of acute angle-closure attack in Group A, and 54 patients (70 eyes) who underwent prophylactic PLI in Group B. IOP over 18 mm Hg was considered to be re-elevated. The number of patients with re-elevated IOP and the duration until the re-elevation was investigated. RESULTS: The amount of IOP elevation immediately after PLI at 6, 24, and 48 months was 0.9, 2.5, and 2.6 mm Hg in Group A, and 0.1, 0.5, 0.5 mm Hg in Group B, respectively. The IOP re-elevation rate was 26.8, 40.0, and 51.4% at 6, 24, and 48 months in Group A and 8.6, 27.2, and 30.4% in Group B with statistically significant difference (p = 0.02, log-rank test). CONCLUSIONS: Close, long-term observation for patients who receive PLI is recommended because there is a high risk of IOP re-elevation within 1 year after PLI. After prophylactic PLI, IOP was maintained under 18 mm Hg for a longer period than after acute angle-closure attack, thus performing preventive PLI should be considered.