Motor and Sensory Outcomes of Infantile Exotropia: A 10-Year Study (2008–2017)

Purpose@#We aimed to determine the long-term motor and sensory outcomes of patients with infantile exotropia. @*Methods@#In this longitudinal retrospective (historical cohort) study, the records of 76 patients with infantile exotropia were Studied. Subjects with constant exotropia manifesting before the age of 1 year who were at least 5 years old at recruitment time between 2008 and 2017 were included. @*Results@#The medical records of 26 patients were excluded due to not participating in follow-up examinations or having incomplete records. In total, 54 infantile exotropic patients (51.9% male) with a mean age of 11.1 ± 6.8 years and follow-up of 4.99 ± 3.58 years were studied. Postoperative sensory outcomes (central stereopsis [3,000 sec/arc]) were observed in 38.9%, 38.9%, and 21.2% of patients, respectively. In terms of postoperative motor outcomes, 69%, 24%, and 7% were achieved as orthophoria, residual exotropia, and consecutive esotropia, respectively. Patients with a higher surgical age (p = 0.022) and better visual acuity (p = 0.004) had significantly better sensory outcomes, while higher preoperative deviation resulted in more suppression (p = 0.039, rs = 0.218). @*Conclusions@#With rates of 69% for motor success and 78.8% for sensory success, surgical outcomes of infantile exotropic patients seems to be favorable. Further studies are recommended to verify our findings.

Macular Thickness in Moderate to Severe Amblyopia

PURPOSE: To compare the macular retinal thickness of moderately to severely amblyopic eyes with non-amblyopic eyes as controls. METHODS: This case control study was conducted on 56 children aged 4 to 10 years old (64.3% female subjects). Twenty-eight children had unilateral amblyopia (28 amblyopic eyes as cases and 28 normal fellow eyes as internal controls) and 28 children had normal visual acuity in both eyes and were considered as external controls (n = 56 eyes). Among our cases, 14 had strabismic amblyopia and 14 had anisometropic amblyopia. Macular retinal thickness was measured using optical coherence tomography at the center and in 1-, 3-, and 6-mm rings. RESULTS: Best-corrected visual acuity of the amblyopic eyes was less than that of the internal and external controls, and the best-corrected visual acuity of their fellow eyes was also less than that of the external controls. Thickness of the central macula and a 1-mm ring area in the amblyopic eyes was higher than that of both internal and external controls. Difference of central macular thickness ≥20 µm between two eyes of the amblyopic children was significantly more than non-amblyopic subjects. CONCLUSIONS: Based on the results of this study, the macular retinal thickness was significantly higher in moderate to severe amblyopic eyes compared to their fellow eyes and external controls. This might be due to macular developmental disorders in amblyopic eyes. Therefore, optical coherence tomography imaging is recommended if subtle macular abnormalities are suspected in moderate to severe amblyopic eyes.

Vision therapy/orthoptics among three to seven year old children

Vision Therapy/Orthoptics [VT/O] is a package of treatments that enables patients to achieve the maximum level of visual performance. The aim was to determine the effect of three months vision therapy/orthoptics on best corrected visual acuity [BCVA], fusion, stereopsis and ocular alignment in 3-7 year old children. In this randomized clinical trial study, 80 children with amblyopia and/or nonparalytic horizontal deviations were randomly divided into intervention and control groups. Intervention group was treated by vision therapy/orthoptics for three months. These modalities included patch, red filter, sector patch, over minus lens, prism and synoptophore exercises. Controls were treated by only patching for the same period. Pre and post-treatment BCVA, fusion, stereopsis and alignment were compared. Visual performance was classified as excellent [BCVA >/= 20/30, deviation /= 20/30, deviation 10pd and no stereopsis]. A total of 80 cases [56 girls and 24 boys] with the mean age of 5.6 +/- 1.4 years entered the study. Although more improvement of fusion and stereopsis was seen in the intervention group [P<0.001 for both groups], there was no significant differences in BCVA and alignment between two groups. Also the difference of visual performance was not statistically significant between two groups, whereas the improvement was significant in each group [P<0.001, for both groups]. Vision therapy/orthoptics treatment can be effective for improving sensory status in 3 to 7 year old children with amblyopia and/or strabismus. Further studies with larger sample sizes and focusing on accommodation and fusional amplitude are warranted