Comparison of myopia prevalence among normal, exophoria and intermittent exotropia children / 眼科新进展

Objective To discuss the difference of myopia prevalence and spherical equivalent among normal,exophoria and intermittent exotropia children.Methods The children aged between 6 years old to14 years old were divided into 3 groups of orthophoria (n =151),exophoria (n =180) and intermittent exotropia (n =168) based on the result of cover-uncover test.Intermittent exotropia group was divided into three types of basic,convergence insufficiency and divergence excess.Diopter values were retrospectively reviewed,and results were recorded with the average data after the objective optometry of cycloplegia.Results Myopia prevalence of intermittent exotropia of different ages was higher than normal and exophoria (all P ＜ 0.05),but no difference between exophoria and normal (all P ＞ 0.05).There were statistical significant differences in overall prevalence among three groups (intermittent exotropia and orthophoria:P =0.000,intermittent exotropia and exophoria:P =0.000,orthophoria and exophoria:P =0.034).Average spherical equivalent was (0.08 ± 0.99) D in orthophoric group,(-0.16 ± 1.16)D in exophoric group and (-1.23 ± 1.57)D in intermittent exotropic group,there was statistical difference among three groups (P =0.000).The differences were also statistical significant between orthophoria group and exophoria group (P =0.015),intermittent exotropia group and orthophoria group (P =0.000),exophoria group and intermittent exotropia group (P =0.000).In the group of intermittent exotropia,average spherical equivalent was (-1.68 ± 1.61) D in convergence insufficient group,(-1.14 ± 1.44) D in basic group and (-0.85 ± 1.50) D in divergence excessive group,there was statistical difference among three groups (P =0.000).The spherical equivalent in convergence insufficient group was lower than the basic group (P =0.000)and divergence excessive group (P =0.041).Conclusion The myopia prevalence and degree of intermittent exotropia are all higher than normal and exophoria in children.

A Case of Cyclic Exotropia in a Pediatric Patient

PURPOSE: To report a case of cyclic exotropia in a pediatric patient. CASE SUMMARY: There was a pediatric exotropia patient with large variation of prism diopter on alternate cover test at each visits. Not large enough for going through the surgery, she was recommended for the regular check-ups. Sometimes, she was orthophoria and some other times, distinct exotropia. After a few times of follow up, she showed 25-prism diopter exotropia on alternate cover test. The surgery was scheduled and she was admitted after 2 weeks. At the preoperative evaluation, she was orthophoria. She was discharged without having the surgery. To evaluate daily eyeball deviation status, the parents were asked to write a daily note on patient's eye condition. For 3-months, daily strabismus note was thoroughly reviewed and alternate cover test was performed monthly. Patch test was performed twice, and results were 10 and 12 prism diopter exotropia, each. Analyzing the note, a cycle of being the orthophoria and exotropia was noted. With the cycle of 72-hours, she was diagnosed with cyclic exotropia and the surgery was re-scheduled. Ulnilateral lateral rectus recession was performed. Without undercorrection or recurrence, she has been stayed stable over two years of follow up period.

Sensory Status in Patients Showing Orthophoria After Strabismus Surgery in Exotropes

PURPOSE: The purpose of this study is to evaluate sensory function and stereoacuity in patients showing orthophoria after surgery in exotropes, and to elucidate factors influencing postoperative improved sensory status METHODS: We prospectively studied 45 patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes. Three tests (Worth-4-dot test, Bagolini striated lens test and Titmus test) were performed at pre and postoperative period. We studied the effect of different variables (age at surgery, visual acuity, angle of deviation, Bagolini striated lens test, Titmus test, anisometropia, and fusional status) with suspected clinical influence on the sensory and motor outcomes. RESULTS: In Worth-4-dot test, 34 patients (75.6%) showed improvement after surgery. Thirty-three patients (73.3%) and 35 patients (77.8%) showed improvement respectively in the Bagolini striated lens test and Titmus test. Thirty-eight patients showed improvement in 2 or more tests after surgery and 7 patients showed no change. Of patients showing preoperative abnormal response in each test, 21 patients (65.6%) in Worth-4-dot test, 14 patients (53.8%) in Bagolini striated lens test, and 22 patients (68.8%) in Titmus test showed normal response at postoperative 6 months. Of 3 tests and other factors, Bagolini striated lens test was the only factor predicting postoperative sensory recovery (x2=4.18, P<0.05). CONCLUSIONS: In patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes, Bagolini striated lens test was the only meaningful factor predicting postoperative sensory recovery

Artifact of Worth Four Dot Test in Strabismic Patients

It is the purpose of this study to evaluate fusional status of 49 strabismic patients who showed orthophoria less than 10 prism diopters (PD) after surgery under alternate prism and cover test. We undertook the Worth 4-dot(W4D) test twice, reversing the position of the red/green glasses between the eyes for the second trial. Bagolini test was also performed in 31 of 49 cases. Nineteen of 49 case(18.4%) showed different results on the W4D test with red/green glasses after reversal at near or distance, either changing fusional status or changing laterality of suppression. Four of 31 cases (18.0%) showed different status of fusion or suppression between W4D and Bagolini tests. We think that it repeating test twice, with the red/green glass reversed between trials, and with combination of Bagolini test, provides better reliability of W4D test.

Clinical Feature and Factors of Operative Result on Infantile Esotropia

We present the retrospective study to identify the clinical characteristics and the results of surgical correction for 50 patients with diagnosis of infantile esotropia at Soonchunhyang Chunan University Hospital from January 1990 to August 1994. The following results were obtained. Of 50 patients, 29(58%) patients were male and 21(42%)patients were female. Initial visit was most common between age of 2 and 3 years. 14% of patients were seen at age of 2 years or less. Average initial visit was 5.16 years. Esotropia was noted most commonly 2 to 4 month after birth in 23 patients(46%). Preoperative deviation angle was over 30PD in 88% of patients, and preoperative cycloplegic refraction showed +2.0D-O in 62%. The prevalence of associated findings such as amblyopia, dissociated vertical deviation(DVD), inferior oblique muscle overaction, and nystagmus were 32%, 14%, 38%, 4% by sequence. Surgical correction was performed before age of 2 year if noted at initial visit. The average age of surgical correction was 5.42 years. Bilateral medial rectus muscle recessions were performed in 30%, Unilateral resection and recession were performed in 35 patients(70%), Orthophoria(within +10 prism diopters) was achieved in 58% of the patients postoperatively. In 16% of patients residual esotropia of more than 20PD remained, which required further operation. These patients had average preoparative esotropia of 51PD and amblopia and inferior oblique overaction were seen in 87.5% preoperatively. We found that the two variables of amblyopia and inferior oblique muscle overaction lead to less satisfactory outcomes(P<0.01). Since amblyopia and inferior oblique muscle overaciton were seen more commonly in those patients that required reoperation. The average follow up time was 9.4 months.

Early Surgery for Infantile Esotropia

It is known that early surgery between 6 and 24 months of age obtains better binocularity in infantile esotropia. We selected 59 patients who had infantile esotropia with onset before 6 months of age and underwent surgery at 10 years of age or less. Stereopsis was tested in 51 patients after surgery. Thirty four patients(66.7%) showed gross stereopsis. The patients who underwent surgery at 2 years of age or less, developed gross stereopsis in 80.8%. The patients who had their eyes aligned their eyes between 2 and 4 years of age, gross stereopsis was demonstrated in 64.3%, white the patients underwent surgery more than 4 years of age developed gross stereopsis in 36.3%. The younger the patients at the time of surgery, the greater the percentage of gross stereopsis was shown(p0.05). This study revealed that early surgery, before 2 years of age, yields better outcome for sensory fusion and good alignment.

Surgical Results of Intermittent Exotropia

To study the results of surgically treated intermittent exotropia, 62 consecutive patients have been followed up for over 6 months. Initial postoperative alignments in all cases were between 10 PD esodeviation and 10 PD exodeviation. Six months after surgery, 85.5% of initial postoperative alignment within 10 PD to either side remained satisfactory, as did 85% of initial orthophoria. Persisting overcorrections without fusion occurred in 1.6%, while under corrections of 15 PD or more occurred in 3.2%. A satisfactory result could be obtained through alignment of 0 +/- 10 PD immediately after operation.