ABSTRACT
ABSTRACT Purpose: To report the outcomes in patients undergoing surgical correction of intermittent exotropia and to compare the age at surgery to motor and sensory success. Methods: This was a retrospective cohort study. The results of patients with intermittent exotropia treated with surgery over a 4-year period were reviewed. Patients were divided into two groups based on age at first surgery (<4 years vs. ≥4 years), and motor and sensory outcomes were compared between the two groups. Results: One hundred thirty-six patients were evaluated, with 67 and 51 patients undergoing surgery before and after the age of 4 years, respectively. The mean age at surgery was 6.8 ± 2.6 years. The reoperation rate for the patients who underwent surgery before 4 years of age was 48% versus 42% for the ones who underwent surgery after this age (p=0.93). Postoperative stereopsis showed an inverse linear association with age at surgery (p<0.001). For each month younger at the time of surgery, there was 0.69 s of arc worsening in the Titmus test. Conversely, when we separately analyzed the patients in whom the first postoperative alignment was esotropic vs. orthophoric/exotropic, we found no correlation between the immediate postoperative alignment in the first week and sensory outcome at the last visit. Conclusions: When indicated, patients with intermittent exotropia can be operated upon safely under 4 years of age, and may even present better motor results than older patients. Postoperative stereoacuity in younger children revealed to be worse than in older children; however, this result is unlikely to be due to inadequate age for surgery, but rather, immaturity for performing the stereopsis test.
RESUMO Objetivo: Descrever os resultados em pacientes submetidos à correção cirúrgica de exotropia intermitente e comparar o sucesso motor e sensorial em relação à idade na cirurgia. Métodos: Estudo tipo coorte retrospectivo. Os resultados cirúrgicos de pacientes com exotropia intermitente foram avaliados em um período de 4 anos. Os pacientes foram divididos em 2 grupos de acordo com a idade na primeira cirurgia (antes ou após os 4 anos de idade) e foram comparados quanto aos resultados motores e sensoriais. Results: 136 pacientes foram avaliados, 67 operados antes dos 4 anos e 51 operados após esta idade. A idade média na cirurgia foi de 6,8 ± 2,6 anos. A taxa de reoperação em pacientes operados antes dos 4 anos foi de 48% versus 42% naqueles operados mais tarde (p=0,93). A estereopsia pós-operatória mostrou uma associação linear inversa com a idade na cirurgia (p<0,001). Para cada mês mais jovem na idade da cirurgia, houve uma piora de 0,69 segundos de arco no teste de Titmus. Por outro lado, não foi encontrada correlação entre o alinhamento pós-operatório na primeira semana e o resultado sensorial na última visita, quando avaliamos separadamente os pacientes que se apresentaram com esotropia ou orto/exotropia na primeira semana pós-cirúrgica. Conclusão: Havendo critério para cirurgia, os pacientes com exotropia intermitente podem ser operados com segurança antes dos 4 anos de idade, e podem muitas vezes apresentar um melhor resultado motor do que os pacientes operados mais tarde. A estereopsia pós-operatória em crianças mais jovens foi pior, mais provavelmente por imaturidade ao realizar o teste do que por idade inadequada na cirurgia.
Subject(s)
Humans , Female , Infant, Newborn , Infant , Child, Preschool , Child , Ophthalmologic Surgical Procedures/methods , Exotropia/surgery , Visual Acuity , Chronic Disease , Retrospective Studies , Cohort Studies , Age Factors , Treatment OutcomeABSTRACT
Objective To observe the sedative and analgesic effects of local anesthesia with midazolam and sufent-anil for patients in ophthalmologic plastic surgery. Methods A total of 160 patients (ASA I-II) were randomly divided into two group using a random number table, 80 cases in each group, groupⅠ: local anesthesia and groupⅡ: local anesthesia with midazolam (0.05 mg/kg) and sufentanil (0.1μg/kg). Values of bispectral index (BIS), systolic blood pressure (SBP), dia-stolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), oxyhemoglobin saturation(SpO2) and visual analogue scale (VAS) were recorded after patients entered into the operating room, during the time of injection of local anesthesia, at the beginning of the procedure, 20 min after the surgery and after operation. It was also recorded including hypoxemia, ap-noea, restlessness, nausea and vomiting and the duration of surgery. Results There were no significant differences in age, gender, weight and duration of surgery between two groups of patients. There was a significantly lower BIS value before inject-ing local anesthesia, at the beginning of the surgery and 20 min after the surgery compared with that of time point that pa-tients entered into the operating room in groupⅡ(P<0.05). In groupⅠthere were significantly higher values of SBP, DBP and HR during the injection of local anesthesia, at the beginning of the procedure, 20 min after the beginning of the proce-dure and after the surgery than those of time point that patients entered into the operating room;the value of RR was signifi-cantly increased during the injection of local anesthesia, at the beginning of the procedure and 20 min after the beginning of the procedure than that of time point that patients entered into the operating room (P<0.05). Compared with before anesthe-sia induction, values of SBP, DBP, HR and RR were significantly decreased in groupⅡ(P<0.05). There were significantly lower levels of SBP, DBP, HR and RR during the local anesthesia injection to the time after surgery in groupⅡthan those of groupⅠ. The value of VAS was significantly higher during the time of injection of local anesthesia and during the surgery in groupⅠthan that of groupⅡ(P<0.05). There were 15 patients with restlessness in group I, which were higher than those of groupⅡ(3 patients with restlessness). There were 3 patients with nausea and 3 patients with anoxemia and no apnea in group Ⅱ. Conclusion The conscious sedation with midazolam and sufentanil is an effective anesthetic technique for patients in ophthalmo-logic plastic surgery.