Long-term outcomes of single monocular resection–recession in adult sensory strabismus and factors affecting the postoperative drift

Purpose: The purpose of our study was to analyze the clinical characteristics and outcome of horizontal strabismus surgery in patients having sensory strabismus and to analyze the factors that affect the postoperative drift in these patients over a follow?up of three years. Methods: This was a retrospective case series. Patients aged ?18 years, having low vision (visual acuity ?20/60) in one eye, and undergoing horizontal strabismus surgery (standard recess–resect procedures) in the same eye were recruited. All patients were advised patching of the good eye six weeks prior and continued for six weeks post strabismus surgery. We excluded patients who had paralytic disorders, motility defects, or those with chronic systemic conditions. Patients with a minimum follow?up of three years were recruited. Results: The study included 56 patients whose mean age was 22.9 ± 4.93 years. Exotropia (n = 38; 67.8%) was more common than esotropia (n = 18; 32.1%). Preoperative visual acuity was 1.1 ± 0.85 (range perception of light to 6/18p). The cause of low vision was amblyopia (n = 30; 53.5%) followed by trauma (n = 22; 39.2%). The mean preoperative distance deviation was 57.7 ± 15.5 PD in the primary position (range: 20–65 PD). The success rate of exotropia (78.9%) was more than esotropia (52.9%) at three years. Two patients with esotropia were overcorrected. All patients with exotropia showed an exotropic drift with time. Conclusion: The motor alignment after a single recession– resection procedure was satisfactory at the long?term in our cohort of sensory strabismus. The duration or extent of visual impairment had no relation to the postoperative outcome.

Short-term effect of unilateral recession-resection procedure for intermittent exotropia with insufficient collection / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect and binocular alignment of unilateral recession-resection(R-R)procedure in patients with insufficient convergence intermittent exotropia(IXT).<p>METHODS: Totally 45 patients with insufficient convergence IXT were operated with unilateral R-R procedure. Binocular alignment was accessed 1d postoperative and 2wk postoperative. Statistical analysis was performed on squint at different time points.<p>RESULTS: All 45 patients with insufficient convergence IXT were operated with unilateral R-R procedure. On the 1st day after surgery, an overcorrection of 8.27±7.17PD at distance and 2.40±8.86PD at near were seen. On the 2wk after surgery. An under correction of 1.18±6.98PD at distance and 4.36±7.83PD at near were seen. Within 2wk after surgery, the average exo-drift at distance was 9.45±6.40PD, and at near was 6.77±7.92PD. There was statistically significant difference between exo-drift at distance and near, and a positive correlation was discovered. The difference of near-distance squint at postoperative(3.18±5.60PD)was significantly lower than that of preoperative(7.65±6.55PD), and there was a positive correlation between them.<p>CONCLUSION: Unilateral R-R procedure is appropriate for patients with insufficient convergence IXT. An appropriate increase of medial rectus strengthening can reduce postoperative near-distance squint difference and does not change the tension of medial rectus and lateral rectus. There was a synchronized exo-drift both at distance and near. The postoperative exo-drift at distance was 10PD and we believe a 10PD overcorrection shortly after operation may be beneficial to the long-term binocular alignment.

Binocular lateral rectus recession versus monocular recess-resect procedure for basic intermittent exotropia:a Meta analysis of randomized controlled trials / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the curative effect between monocular lateral rectus recession(BLR)and Binocular recession resection(R & R)for basic intermittent exotropia.<p>METHODS:A literature review using the MEDLINE, EMBASE, The Cochrane Library, Web of Science, Clinical Trial, CBM, Wanfang Databases and paper collections of conferences was performed. Randomized controlled trials comparing the effects of BLR and R & R for basic intermittent exotropia with a duration of follow-up at least half a year were eligible for inclusion. The methodologic quality of included studies was evaluated independently by 2 authors. Statistical analysis was performed by using the STATA 14 software(StataCorp Texas USA).<p>RESULTS:Five prospective random controlled clinical trials involving 529 patients were included. Compared with R & R procedure,the BLR procedure group showed lower successful rate(<i>RR</i>:0.85; 95% <i>CI</i>:0.72-0.99; <i>P</i>=0.043)and postoperative undercorrection(<i>RR</i>:3.975; 95% <i>CI</i>:2.097-7.537; <i>P</i><0.01). The <i>P</i> value of long-term postoperative corrected rate in Meta analysis was decreased near to 0.05 when the included references increased. There was no significant difference in overcorrection rate between the BLR and R & R procedures(<i>RR</i>:0.336; 95% <i>CI</i>:0.049-2.294; <i>P</i>=0.266).<p>CONCLUSION:Current evidences suggested that BLR procedure is related to lower successful and higher undercorrection rates for basic intermittent exotropia compared to conventional R & R procedure.

Retroceso bilateral de rectos laterales comparado con retroceso/resección unilateral para el tratamiento de la exotropia intermitente básica / Bilateral lateral rectus recession versus unilateral recession/resection for basic intermittent exotropia

Resumen INTRODUCCIÓN: En determinadas circunstancias clínicas, la exotropia intermitente básica requiere resolución quirúrgica. Existen dos técnicas para ello: el retroceso bilateral de rectos laterales y el retroceso/resección unilateral. Aunque el retroceso bilateral es la técnica más utilizada, no está claro cuál de estas técnicas tiene mejores resultados. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron siete estudios primarios, de los cuales tres son ensayos aleatorizados. Concluimos que el retroceso/resección unilateral podría tener un mayor éxito quirúrgico y probablemente disminuiría la tasa de subcorrección/recurrencia, cuando se le compara al retroceso bilateral de rectos laterales.

Abstract INTRODUCTION: Intermittent exotropia requires surgical resolution under some clinical circumstances. The main techniques are bilateral lateral rectus recession and unilateral recess/resection. Although bilateral recession is the most widely used, it is not clear whether it leads to better results. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including seven studies overall, of which three were randomized trials. We concluded unilateral recess/resection might achieve greater surgical success and probably decrease the rate of undercorrection/recurrence when compared to bilateral lateral rectus recession.

Recession-Resection Surgery Augmented with Botulinum Toxin A Chemodenervation for Paralytic Horizontal Strabismus

In this case series study, we assessed the effects of recession-resection surgery augmented with botulinum toxin A chemodenervation for patients with chronic paralytic horizontal strabismus. In addition, we compared these effects with those of full tendon transposition (FTT) augmented with posterior intermuscular suture (PIMS). Ten patients who underwent strabismus surgery due to paralytic horizontal strabismus were retrospectively reviewed. They received a recession-resection surgery augmented with botulinum toxin A chemodenervation (type I surgery) or a FTT augmented with PIMS (type II surgery). The preoperative angle of deviation (AOD) and postoperative improvement in AOD were compared according to the type of procedure. The preoperative AOD was 60.00 +/- 28.50 prism diopters (PD) for type I surgery and 68.00 +/- 27.06 PD for type II (p = 0.421). Improvement in AOD was 53.20 +/- 25.01 PD for type I surgery and 44.20 +/- 18.74 PD for type II (p = 0.548). Recession-resection surgery augmented with botulinum toxin A chemodenervation is a concise and effective procedure for treating paralytic horizontal strabismus.

Unilateral Recession-Resection Versus Re-resection of Medial Rectus in Recurrent Intermittent Exotropia

PURPOSE: To compare the surgical outcomes of recession-resection (R&R) on the contralateral eye and medial rectus re-resection surgery for recurrent intermittent exotropia in patients who previously underwent unilateral recess-resection. METHODS: A retrospective analysis was performed on patients who underwent either R&R on the contralateral eye or medial rectus re-resection surgery for recurrent intermittent exotropia who had unilateral R&R previously with a minimum follow-up period of at least 12 months. RESULTS: Thirty-nine patients underwent contralateral R&R surgery and 13 patients underwent medial rectus re-resection surgery. The satisfactory surgical result was considered between -5 (prism diopters, PD) and +10PD. The success rate of the contralateral R&R group and medial rectus re-resection group was 84.6% and 100% (p=0.317) at postoperative 1 week, 79.5% and 46.2% (p=0.034) at postoperative 6 months, 69.2% and 38.5% (p=0.048) at postoperative 12 months, and 51.3% and 7.7% (p=0.006) at the last follow-up visit. CONCLUSIONS: The long-term surgical outcome of R&R surgery on the contralateral eye for the patients with recurrent intermittent exotropia who previously underwent unilateral R&R surgery was significantly better than medial rectus re-resection.

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 Recession-Resection in 25 PD Intermittent Exotropia

PURPOSE: It is the purpose of this paper to study the long-term results of surgically treated intermittent exotropia of 25 prism diopters (PD) of preoperative deviation. METHODS: We analyzed and compared 364 patients (376 cases) with at least 6 months of postoperative follow-up. Two surgical methods were done : 6 mm bilateral recession of lateral rectus muscle in 190 patients (190 cases) and unilateral 4 mm recession of lateral rectus muscle combined with 3 mm resection of medial rectus muscle in 174 patients (186 cases). RESULTS: The average age of operation was 6.2 years, ranging from 3 to 16 years, and the follow-up period after surgery ranged 6 to 128 months (mean 27.3 months). The satisfactory surgical result defined as orthophoria and deviation between 5 PD esodeviation and 10 PD exodeviation. The final success rates were 75.3% in bilateral recession group and 64.5% in unilateral recession-resection group. This difference in success rates between the two groups was statistically significant (P=0.023), and the age at operation did not influence the surgical results. Those cases who were over-corrected 6 to 10 PD had a higher success rate and there was a statistically significant relationship between alignment immediately after surgery and on the final postoperative day in the two surgical groups (P=0.0001). CONCLUSIONS: The outcome of the bilateral recession is better than that of the unilateral recession-resection for correction of 25 PD intermittent exotropia in any age group.

The Changes of Refractive Error and Corneal Astigmatism after Horizontal Strabismus Surgery

We performed a prospective study of evaluating preoperative and postoperative refractive error and corneal curvature in cycloplegic refraction and keratometry in 25 eyes of 25 patients undergoing horizontal recession and resection procedure. At 4 months after operation, the change of refractive error by cycloplegic refraction was +0.12D in average in horizontal meridian, which was a significant shift toward 'with-the-rule astigmatism' direction(p0.05). In horizontal meridian, the with-the-rule astigmatic changes of +0.5D or more were present in 7 eyes(28%) and the against-the-rule astigmatic changes of -0.5D or more were present only in 2 eyes(8%). In vertical meridian, we found that 3 eyes(12%) had the changes of +0.5D or more and 6 eyes(24%) had the changes of -0.5D or more. The change of corneal curvature in keratometry amounted to average -0.50D in horizontal meridian(that means the flattening of cornea)(p0.05) at postoperative 4 months, showing the results similar to those of cycloplegic refraction. Futhermore, the astigmatic change by cycloplegic refraction and keratometry at postoperative 2 weeks and 1 month were similar to those at postoperative 4 months. These data suggest that there may be significant changes in astigmatism(more commonly in with-the-rule astigmatism) after strabismus surgery, and this astigmatic change appears due to the corneal change resulting from the variation in the force that the muscles exert on the globe.

Horizontal Incornitancy After Monocular Recession-Resection Surgery

Horizontal incomitancy is a difference of deviation angle between right and left gaze and monocular recession-resection operation may cause horizontal incomitancy. We reviewed 85 patients of intermittent exotropia without oblique dysfunction and vertical deviation who underwent monocular recession-resection operation. The preoperative horizontal in comitancy was 1.0 delta in average with a range of 0 delta to 5 delta. The postoperative horizontal incomitancy after 7 months (mean) was 4.8 delta in average with a range of 0 delta to 17 delta. The postoperative remained deviation and horizontal incomitancy were significanty smaller in the group of patients who had fusion with worth 4-dot test (p

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

To treat intermittent exotropia, bilateral recession or monocular recession-resection can be chosen. Thirty one cases of intermittent exotropia with preoperative exoangle 25 delta were treated with 8mm bilateral recession (15 cases) and 5.5mm recession of lateral rectus muscle combined with 5mm resection of medial rectus muscle (16 cases). The final surgical results were compared between the 2 groups. The surgical results were as follows: in bilateral recession group, 33.3% was satisfactory, 60.0% undercorrected, and 6.7% overcorrected with 13.7 months of follow-up in average, in monocular recession-resection group, 50.0% was satisfactory, 18.8% undercorrected, and 31.3% overcorrected with 13.0 months of follow-up in average. Monocular recession-resection procedure had better satisfactory result than that of bilateral recession procedure. The author agrees the opmion that recession-resection produces a more permanent result than recession alone because the resection of the medial rectus muscle locks the eye in better alignment, preserving the benefit of the recessed lateral rectus muscle.