Curative effect of slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe curative effect and safety of slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia.<p>METHODS:This study included 29 patients who underwent slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia in our hospital between October 2017 and November 2019 with a follow-up of 6mo, the deviation, the surgical success rate, the binocular vision function and the complications were observed.<p>RESULTS:In our study, the mean near deviations, the mean distance deviations and the near-distance deviation differences reduced from -41.72±3.35PD, -23.28±9.75PD and 16.90±2.47PD before surgery to -5.97±4.85PD, -2.66±4.78PD, 3.28±1.10PD 6mo after surgery, the surgical success rate was 76%. The Grades I and Ⅱ binocular vision function improved 6mo after surgery(<i>P</i><0.05), the distance stereopsis and the near stereopsis were not statistically significant(<i>P</i>>0.05). None of the patients developed A-V pattern, limitation of eye movement, restrictive strabismus, vertical strabismus, and rotated diplopia, some patients had transient horizontal diplopia, which disappeared within 2-3wk after surgery.<p>CONCLUSION:Slanted bilateral lateral rectus recession may successfully reduce the near exodeviations, the distance exodeviations and the near-distance deviations difference without obvious complications, proved to be a safe and effective procedure for the treatment of convergence insufficiency-type intermittent exotropia.

The Effect of Bilateral Medial Rectus Resection for Recurrent Intermittent Exotropia

PURPOSE: The purpose of this study was to investigate the effect of bilateral medial rectus muscle resection on the treatment of recurrent intermittent exotropia. METHODS: A retrospective chart analysis was conducted for 25 patients who underwent bilateral medial rectus resection for recurrent exotropia over 20 prism diopters (PD) between January 2009 and August 2015. The medial rectus was resected from 4.0 to 6.5 mm by 0.5 mm according to the deviation angle. The postoperative angle of deviation was checked at 1 day, 1 week, 3 months, 6 months, and 1 year postoperatively to investigate the amount of corrected deviation per resected muscle. RESULTS: The average preoperative deviation angle was 27.20 ± 5.02 PD exodeviation and the mean resection was 5.10 ± 0.79 mm of the medial rectus. The postoperative angle deviation was 10.68 ± 5.50 PD esodeviation at 1 day. The incidence of esodeviation tended to decrease over time. At 1 year, the postoperative angle deviation was 1.16 ± 7.54 PD esodeviation. The overcorrection rate was 84% at 1 day postoperatively but decreased to 24% at 1 year with a success rate of 68%. The corrected deviation angle per millimeter was 7.53 ± 1.22, 7.75 ± 2.16, 6.27 ± 1.74, 5.50 ± 1.54, and 5.56 ± 1.58 PD/mm at 1 day, 1 week, 3 months, 6 months, and 1 year after surgery, respectively. The dose effect per millimeter decreased over time. The corrected deviated angle per millimeter remained constant regardless of the amount of medial rectus muscle resection at 1 year postoperatively(p=0.939). CONCLUSIONS: Bilateral medial rectus resection for recurrent exotropia over 20 PD tended to overcorrect at first; however, after 1 year, the mean angle of deviation was 1.16 ± 7.54 PD esodeviation. Bilateral medial rectus resection is an effective surgical method for the treatment of recurrent exotropia over 20 PD.

Comparison between Modified Bilateral Lateral Rectus Recession and Augmented Unilateral Recession-resection for Convergence Insufficiency Exotropia

PURPOSE: To compare the surgical outcomes between modified bilateral lateral rectus muscle (BLR) recession and augmented unilateral recession-resection (R&R) for the convergence insufficiency intermittent exotropia (IXT). METHODS: 37 patients with convergence insufficiency IXT were divided into two groups: 13 patients (underwent BLR recession) and 24 patients (underwent unilateral R&R). Success was defined as within 10 prism diopters (PD) at distance and near, and within 10 PD of the difference between them at postoperative 12 months. RESULTS: After the patch test, the preoperative distance deviation angle in the BLR group was 29.9 ± 8.4 PD, and the near deviation angle was 42.3 ± 9.7 PD; the difference between them was 12.5 ± 3.2 PD. In the R&R group, the preoperative distance deviation angle was 26.7 ± 5.8 PD, and the near deviation angle was 41.5 ± 7.4 PD; the difference between them was 14.8 ± 4.3 PD (p = 0.235, p = 0.987, and p = 0.123). At the 12-month follow-up in the BLR group, the distance angle was 3.8 ± 5.1 PD, and the near deviation angle was 4.9 ± 6.1 PD; the difference between them was 2.9 ± 5.9 PD. In the R&R group, the postoperative distance deviation angle was 4.7 ± 6.1 PD, and the near deviation angle was 7.9 ± 6.6 PD; the difference between them was 3.65 ± 5.1 PD (p = 0.708, p = 0.162, and p = 0.632, respectively). The surgical success rate did not differ significantly between groups at 12 months postoperatively (76.9%: BLR group and 70.8%: R&R group; p = 0.690). CONCLUSIONS: Modified BLR recession showed a similar surgical success rate to augmented unilateral R&R, and was effective in reducing both distance and near exodeviation, and in decreasing the difference between distance and near deviation in convergence insufficiency IXT.

Observation on the curative effects of two surgical methods for basic intermittent exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the differences between unilateral recess-resection (R & R) and bilateral lateral rectus recession (BLR-rec) in the treatment of basic intermittent exotropia.METHODS: A retrospective analysis of treatment of basic intermittent exotropia in 89 patients,in which 49 cases underwent unilateral recess-resection,40 cases underwent bilateral lateral rectus recession of external rectus retroperitoneal surgery January 2013 to January 2015 in our hospital.The stereopsis and strabismus were observed in 1d,1,6mo,1 and 2a after operation.RESULTS: There was no significant difference in the success rate and oblique degree between the two groups after 1d,1,6mo,1 and 2a (all P>0.05),but the success rate of the operation was reducing as time passed.After 2d of the operation,the drift of the R & R group was 12.10±5.74PD and the drift of the BLR-rec group was 7.78±4.21PD,the difference was statistically significant (P=0.021).The R & R group was more likely to cause lateral slanting than BLR-rec group.Two groups of patients with nearly stereopsis were both significantly improved,there was no significant difference between the two groups in the two groups (x2=4.530,P=0.210).CONCLUSION: The long-term stability of BLR-rec is superior to R & R.

Comparison between 20 and 25 Prism Diopters in Bilateral Rectus Muscle Recession for Intermittent Exotropia

PURPOSE: To compare the outcomes of bilateral lateral rectus recession between 20 and 25 prism diopters (PD) for intermittent exotropia. METHODS: A retrospective study was performed with a total of 584 patients who underwent surgery for intermittent exotropia and were followed up for more than 12 months. The patients were classified into either the 20 PD group (5 mm bilateral rectus muscle recession [BLR]) or the 25 PD group (6 mm BLR). Successful postoperative motor alignment was defined as within 10 PD of exotropia and 4 PD of esotropia. RESULTS: Cumulative probabilities of surgical success rates for 24 months were 77.9% in the 20 PD group and 54.8% in the 25 PD group, respectively (p < 0.001). Postoperative deviations in recurrence patients were 13.41 +/- 3.64 PD and 14.66 +/- 3.87 PD (p = 0.062) at postoperative 12 months. CONCLUSIONS: All patients with relatively small angle of exodeviation such as 20 PD had a higher success rate and small postoperative exodaviation at 12 months. Therefore, surgery could be considered when the eye is exodeviated with a relatively small angle. However, in the group with the exotropic drift, approximately 2/3 of the preoperative angle of deviation is measured with similar outcomes between preoperative and postoperative angles of deviation.

Change of Strabismus Angle and Deviation After Unilateral or Bilateral Lateral Rectus Recession in Exotropia

PURPOSE: To compare the changes in strabismus angle and deviation between two groups: a bilateral lateral rectus recession (Group 1) and a unilateral lateral rectus recession in exotropia (Group 2). METHODS: A retrospective survey was conducted on 198 patients who had received exotropia surgery in our ophthalmology clinic from September 2003 to April 2007. A total of 116 patients were in Group 1, and 82 patients were in Group 2. RESULTS: The average deviations of the first postoperative month and the first postoperative year were -1.96 D +/- 4.75, 2.5 D +/- 7.82 for Group 1 and 0.77 D +/- 2.87, 5.94 D +/- 3.38 for Group 2. Revealing statistical significance between the 2 Groups: Group 1 had 30 failure cases (25.9%) and their 1 postoperative year average deviation was 5.42 D +/- 13.97, while Group 2 showed 24 failure cases (29.3%) and their 1-postoperative-year average deviation was 13.0-79 +/- 3.04. Group 1 had less strabismus angle and a greater standard deviation than Group 2, as Group 1 had more overcorrection. Among the 30 failure cases of Group 1, 9 were overcorrected and 21 were undercorrected, but all 24 failure cases in Group 2 were undercorrected. CONCLUSIONS: The strabismus angle after lateral rectus recession showed a wider variation and a larger difference in bilateral lateral rectus recession than in the unilateral lateral rectus recession.

Clinical Characteristics and Related Factors of Surgical Outcome in Patient who Underwent LR Recession After the age of 10 years

PURPOSE: To identify clinical characteristics and preoperative factors that influence the surgical results of an intermittent exotropia patient who underwent lateral rectus recession after the age of 10 years. METHODS: A retrospective study was performed based on the medical records of 45 patients who underwent unilateral lateral rectus recession or bilateral lateral rectus recession for intermittent exotropia after the age of 10 years and who had undergone at least three months of postoperative follow-up. The authors investigated the clinical characteristics and factors associated with surgical success according to gender, age at surgery, fusion ability, preoperative angle of deviation, preoperative difference between near and far angles of deviation, vertical deviation, spherical equivalent of refractive error, Randot stereo test and postoperative angle of deviation at one week, one month, and three months. The postoperative deviation change according to the time between groups who underwent surgery before and after 10 years of age for intermittent exotropia was also compared. RESULTS: Surgical success was defined as a final deviation of less than 10 prism diopters. Patients without vertical deviation had a better surgical outcome than did patients with vertical deviation (p=0.022). There was no significant difference in the postoperative deviation changes between groups who underwent surgery for intermittent exotropia before 10 years and after 10 years of age. CONCLUSIONS: Among the many preoperative influencing factors, vertical deviation showed a significant difference in postoperative improvement after intermittent exotropia surgery undergone after the age of 10 years. There was no difference in the aspects of surgical success between surgeries for intermittent exotropia before and after the age of 10 years.

Effects of Bilateral Lateral Rectus Recession and Unilateral Recession-Resection in Large Angle Exotropia

PURPOSE: To evaluate the effect of bilateral lateral rectus recession and of unilateral rectus recession and resection in the patients who showed large angle exotropia. METHODS: Sixty-five patients who underwent either bilateral lateral rectus recession or unilateral recession-resection and who were followed up for more than 1 year between 1996 to 2001 at Chonnam University Hospital, were reviewed. The effect of bilateral lateral recession and unilateral recession-resection was compared according to preoperative angle of deviation. Successful outcome was defined as esotropia

Comparison of Surgical Results Between Bilateral Recession and Unilateral Resection-Recession in Intermittent Exotropia

PURPOSE: The purpose of this study is to compare the postoperative results of surgery for 60 patients with intermittent exotropia (20-30PD). METHODS: They were classified into two groups: one group with bilateral lateral rectus recession (n=34) and another group with unilateral medial rectus resection and lateral rectus recession (n=26). We assessed the postoperative results by comparing the deviation at postoperative 1 year to those at 1day, 1week, 1month, and 6months after surgery. RESULTS: The stisfactory result defined as orthophoria and deviation between 10PD esodeviation and 10PD exodeviation. The postoperative success rates are as follows: 65% in the bilateral rectus recession group and 62% in the unilateral lateral rectus muscle recession and medial rectus resection group. In the bilateral lateral rectus recession group, postoperative 1 day alignment of 11-15PD esodeviation showed the success rate of 83%. In the unilateral medial rectus resection and lateral rectus recession group, postoperative 1 day alignment of 1-5PD esodeviation resulted in the success rate of 80%. CONCLUSIONS: The initial postoperative esodevation of 11-15PD in bilateral lateral rectus recession and esodeviation of 1-5PD in unilateral medial rectus resection and lateral rectus recession can lead to good results. Postoperative 1 year surgical results for exotropia of moderate degree could be predicted from angle of deviation at postoperative 6 months, regardless of the type of surgery.

Comparison of Surgical Results between Bilateral and Unilateral Lateral Rectus Recession in 20~25 Prism Diopters Intermittent Exotropia

PURPOSE: To compare the postoperative results of unilateral lateral rectus recession with bilateral lateral rectus recession between 20 prism diopters (PD) and 25 PD intermittent exotropia for basic type. METHODS: We analyzed retrospectively the data of 27 patients underwent unilateral lateral rectus recession and 38 patients underwent bilateral lateral rectus recession with 20 PD and 25 PD intermittent exotropia for basic type from June 1996 to May 2000 at the Department of Ophthalmology of Chonnam National University Hospital. RESULTS: There were 10 cases (37.0%) in unilateral group and 8 cases (21.1%) in bilateral group showing undercorrection in the amount of deviation more than 10 PD and 2 cases (5.3%) in bilateral group showing overcorrection in the amount of deviation more than 10 PD, and there was no overcorrection in unilateral group. There was a tendency of recurrence of exotropia during the first postoperative month, but the alignment after 1 month postoperative was not much different from the alignment at the last follow-up. The mean amount of correction after surgery was 13.78+/-7.65 PD (Mean+/-SD) in unilateral group and 20.32+/-8.37 PD (Mean+/-SD) in bilateral group (P=0.002). Success rate was 73.6% in bilateral group, better than 63.0% in unilateral group although there was no statistically significant difference (p>0.05). CONCLUSIONS: The undercorrection rate of bilateral lateral rectus recession is less than that of unilateral lateral rectus recession and more satisfactory surgical outcome was obtained in bilateral lateral rectus recession; therefore bilateral lateral rectus recession can lead to good result in 20~25 PD intermittent exotropia for basic type.

The Surgical Outcome of Bilateral Lateral Rectus Recession in Large Angle Exotropia

To evaluate the results of bilateral recession in large angle exotropia we examined medical records of 73 patients who had exotropia larger than 35PD and underwent bilateral lateral rectus recession. The mean of follow-up period was 16months. Successful alignment, defined as a final alignment of orthophoria, esotropia less than 5PD or exotropia less than 10PD was achieved in 44 patients(60.3%). There were no differences in age, refractive error, preoperative angle of deviation, prevalence of amblyopia, the presence and concurrent correction of vertical or cyclodeviation, the development of diplopia and the duration of follow-up period between the successful alignment group and failure group. The esodeviation on postoperative one-day tended to ensure a more satisfactory result, but it was not statistically significant. There were no statistically significant differences in stereoacuity and postoperative angle of deviation among the different fusional ability groups. The stereoacuity and postoperative angle of deviation did not show a positive correlation. However, on the two separate examinations of the stereoacuity and fusional ability, the latter results showed improvement in both parameters. This result suggests that the correction of exodeviation may play a role in improving binocular visual function in patients with large angle exotropia.

Surgical Results in Basic Exotropia of Moderate Degree

The purpose of this study is to assess the postoperative stability for exotropia by comparing the deviation at postoperative 2 years to those at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery in children with basic exotropia of between 25 and 30 prism diopters. They were classified into two groups:one group[n=20]with unilateral lateral rectus recession and medial rectus resection, and another group[n=15] with bilateral lateral rectus recession. There was no difference in age at the time of surgery or preoperative angle of deviation between the two groups. Exodrift occurred according to an increase in follow-up and maximal correlation between postoperative 6 months and 2 years in both groups[r=0.85, r=0.81, respectively, p>0.05]was noted. Success rates at postoperative 2 years were 65%and 60%, respectively[p>0.05]. In conclusion, long-term surgical results for exotropia of moderate degree and basic type could be predicted from angle of deviation at postoperative 6 months, regardless of the type of surgery.

Comparison of Surgical Results by Initial Postoperative Alignment Following Bilateral Lateral Rectus Recession and Unilateral Lateral Rectus Recession-Medial Rectus Resection in Intermittent Exotropes

We attempted to predict the success, undercorrection, overcorrection rate at postoperative 1 year by examining alignment at postoperative 1 day and find out the relationship between alignment of postoperative 1 day and 1year. Forty-six patients with intermittent exotropia underwent bilateral lateral rectus recession at Keimyung university, Dongsan medical center and fifty-seven patients underwent unilateral medial rectus resection and lateral rectus recession at Catholic university, St.Mary`s hospital. The alignment at postoperative 1 day was classified as the overcorrected with 11-20PD, the overcorrected with 1-10PD,the orthotropia, and the undercorrected with residual exotropia of 1-10PD. There was a statistically significant relationship between alignment at postoperative 1 day and 1 year in unilateral medial rectus resection and lateral rectus recession and bilateral lateral rectus recession (r=0.74, r=0.51, p<0.05). Those patients who were overcorrected 1-20PD had a significantly higher success rate than those undercorrected 1-10PD at postoperative 1 day (p<0.05). In the unilateral medial rectus resection and lateral rectus recession group,postoperative 1 day alignment of 1-10PD resulted in the highest success rate of 73.7%. In the bilateral lateral rectus recession group,postoperative 1 day alignment of 11-20PD showed the highest success rate of 76.9%. There were no significant differences in the success rate,undercorrection rate, and overcorrection rate between the two kinds of surgery at postoperative 1 year. As a result, the alignment at postoperative 1 day can be one of the predictive factors of future surgical outcome. The initial postoperative overcorrection of 11-20PD in bilateral lateral rectus recession and overcorrection of 1-10PD in unilateral medial rectus resection and lateral rectus recession can lead to good results.