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.

Current situation and analysis of convergence insufficiency of primary school students in Nanchong / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the prevalence of convergence insufficiency(CI)of primary school children in Nanchong and to analysis its relationship with age, gender and myopia in a school screening study.<p>METHODS: A cross-sectional screening study was used to select students in grades three, four, and five of three primary schools in the urban area of Nanchong from April to June in 2019. They were all performed relevant eye examinations, including slit lamp, fundus examination, vision acuity, refraction, distance and near heterophoria with alternate cover test, near point of convergence(NPC), and near positive and negative fusional vergences. A questionnaire of convergence insufficiency symptom survey(CISS-15)was performed for each participant, and a score of ≥21 was considered as a positive symptom.<p>RESULTS: Of the 4123 students, 2876 students participated in the study. And the data was analyzed using 2571 participants. The average age of the participants was 9.33±0.02(7 to 13)years. The prevalence of <i>CI</i> was 12.4%, and analysis of variance showed no gender difference(χ2=0.479, <i>P</i>=0.489). The <i>CI</i> prevalence among primary third, fourth, and fifth grade students were 12.4%, 11.3% and 13.5%, respectively, and there was no statistically significant difference in the prevalence of <i>CI </i>between grades(χ2=1.97,<i> P</i>=0.374). The prevalence of myopia among students in the third, fourth and fifth grades was 15.1%, 24.0% and 34.5%, respectively, and the difference in the prevalence of myopia between grades was statistically significant(χ2=86.47, <i>P</i><0.01). Of the 641 myopic students, 240(37.4%)were diagnosed as <i>CI</i>, while the <i>CI</i> prevalence of non-myopic students was 4.15%. The difference between the two groups was statistically significant(χ2=489.54,<i> P</i><0.01).<p>CONCLUSION: This study shows that the overall prevalence of convergence insufficiency of primary school students in Nanchong was 12.4%, which was higher than most previous studies. The prevalence of convergence insufficiency in myopic students was significantly higher than that in non-myopic students. There was no statistical difference in the prevalence of convergence insufficiency between different grades and genders.

The Effectiveness Of The Dot Card Therapy Towards Convergence Insufficiency Patients Among Young Adults

@#Convergence insufficiency is a common binocular vision disorder. It has been reported that the frequency of this anomaly has reached as high as 6% among school children and young adults and may affect their quality of life and near work performance. One of the treatment modalities is the Dot Card therapy. However, there is scarce research report on the effectiveness of the Dot Card therapy. Hence, this study was conducted to compare the effectiveness of the therapy given to convergence insufficiency patients among young adults. A total of 33 university students (age range=22.55±1.66 years) with convergence insufficiency problems participated in this study. Convergence insufficiency symptoms based on the Convergence Insufficiency Symptom Survey (CISS) and binocular vision components such as near point of convergence, fusional vergence and phoria were measured before and after the Dot Card therapy was given to each participant. All participants were reviewed after 2 weeks and 4 weeks. The results indicated that participants demonstrated statistically and clinically significant changes and improvement in symptom from CISS score (22.30 to 15.30, p<0.001), NPC (11.08 cm to 6.50 cm, p<0.001) and PFV at near (13.82Δ to 18.36Δ, p=0.035) at the end of 4-week visit. Participants’ near phoria were improved (2.12 exo to 1.79 exo, p=0.369) even though it is not statistically and clinically significant. The convergence insufficiency patients have achieved significant improvements in symptoms and near point of convergence both statistically and clinically, within one month of the Dot Card therapy treatment.

Differential diagnosis and treatment for three types of binocular vision dysfunctions / 国际眼科杂志(Guoji Yanke Zazhi)

·Convergence insufficiency, basic exophoria and pseudo convergence insufficiency are three common reason for visual dysfunction. It's difficult for optometrist to differential diagnosis because of the similar signs and symptoms. Comprehensive analysis of distance &near eye position, accommodation, AC/A ratio and negative/positive relative accommodation ( NRA/PRA ) may help optometrist to make an accurate diagnosis and treatment strategy, which may relax asthenopia and maintain normal binocular vision.

Changes in Types of Recurrent Intermittent Exotropia after Surgical Correction of Basic Type Intermittent Exotropia

PURPOSE: To report the surgical outcomes and changes in types of recurrent exotropia after surgical correction of basic type intermittent exotropia. METHODS: We retrospectively analyzed the medical records of 91 patients who underwent reoperations for recurrent exotropia after primary surgical correction, and who visited our hospital for a period of at least one year after the reoperation. When distant deviation was >30 prism diopters (PD), we defined convergence insufficiency type (CI type) if the difference of the deviation angle was >10 PD and basic type exotropia if the difference was 33% of the distant deviation angle. RESULTS: The types of recurrent exotropia were similar to those of the preoperative condition in 68 patients (74.7%), and newly emergent CI type was observed in 23 patients (25.3%). With regard to the incidence of CI type, bilateral lateral rectus recession was more common than unilateral lateral rectus recession after primary surgery and medial rectus resection and unilateral lateral rectus recession, but the difference was not significant (p = 0.615). Recurrent CI type exotropia was observed 6 months after primary surgery (p 0.05). There was no significant difference in the success of reoperations between the two groups (p > 0.05). CONCLUSIONS: The types of recurrent exotropia after surgical correction of primary basic type intermittent exotropia differed from those of preoperative exotropia, which was not related to various factors before surgery. Recurrent exotropia was successfully treated by appropriately selected reoperations, regardless of the type of exotropia.

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.

The Surgical Outcome and Stereopsis between Pseudodivergence Excess Type and Convergence Insufficiency Type

PURPOSE: To compare the surgical outcomes and stereopsis between pseudodivergence excess type and convergence insufficiency type in intermittent exotropia. METHODS: In a retrospective comparative analysis of 42 eyes, 18 eyes that were of the convergence insufficiency type (group 1) and 24 eyes that were or the pseudodivergence excess type (group 2) were analyzed. Recession-resection was performed in the same eye. Success was defined to be within ±8 PD after 12 months postoperatively; more than ±8 PD was defined as recurrence. Stereopsis was measured by the Titmus test. RESULTS: After the patch test, the mean preoperative near angle in group 1 was 35.56 ± 6.62 PD and the far angle was 23.06 ± 6.22 PD. In group 2, the mean preoperative near angle was 26.92 ± 6.30 PD and the far angle was 28.29 ± 7.41 PD. The group 1 postoperative (12 months) mean near angle was 6.89 ± 8.46 PD and the far angle was 6.11 ± 7.90 PD. In group 2, the mean postoperative near angle was 1.75 ± 2.85 PD and the far angle was 3.42 ± 3.98 PD. The success rate of group 1 was 50% and the success rate of group 2 was 83.3%. The success rate of both group were statistically significant differences (p = 0.021). The postoperative (12 months) mean of near stereopsis for group 1 was 588 ± 1,124 seconds, and group 2 was 101.25 ± 102 seconds. There were no statistically differences in postoperative (12 months) stereopsis. CONCLUSIONS: The success rate of the pseudodivergence excess type was significantly higher than in the convergence insufficiency type.

Cambios del estado oculomotor en pacientes de 18 a 25 años diagnosticados con insuficiencia de convergencia (IC) de la Universidad El Bosque, tras el tratamiento sugerido de ortóptica durante tres meses, 2013 / Oculomotor status changes in patients 18 to 25 years diagnosed with convergence insufficiency (CI) of the universidad el bosque, after orthoptics suggested treatment for three months, 2013

Estudio de casos prospectivo longitudinal, cuyo propósito es valorar los cambios de las condiciones binoculares, en pacientes diagnosticados con insuficiencia de convergencia, tras el tratamiento sugerido de ortóptica durante tres meses, con el fin de establecer el porcentaje de mejoría. Durante el desarrollo de esta investigación, se establecieron como criterios de inclusión: exoforia (X´) en visión próxima <20 Dioptrías prismáticas (Dpt), reservas fusiónales positivas (RFP) <15 Dpt, amplitud de acomodación baja (AA), punto próximo de convergencia (PPC) ≥6cm, acomodación relativa positiva (ARP) <2.50 y edades entre 18-25 años. Un total de 7 pacientes fueron incluidos; quienes firmaron el consentimiento informado. Inicialmente se valoró el estado oculomotor de cada paciente y respondieron la encuesta de síntomas pre-tratamiento; posteriormente fueron instruidos para realizar ejerciciosy/o terapia visual diarios en casa por 30 minutos. Una vez, finalizado el tratamiento, se tomaron medidas, las cuales evidenciaron cambios significativos en el PPC con luz ruptura/ recuperación (p = 0.0022) / (p = 0.0017); PPC con objeto real ruptura/ recuperación (p = 0.0040) / (p= 0.0017); reservas fusiónales positivas en visión próxima ruptura/ recobro (p = 0.0017) / (p = 0.0027). El 100% de los pacientes presentaron una ruptura ≤6cm y una recuperación de 7 ±3,6 cm en el PPC con luz; con objeto real el 71,4% presento una ruptura ≤ 6cm y una recuperación de 9 ±1,2 cm; las RFP incrementaron en el 85,7% siendo esta ≥15Δ en ruptura y una recuperación ≥15Δ en el 71,4% y en la encuesta el 48% de los pacientes reportaron mejoría de sus síntomas. Con lo anterior, se puede concluir que el tratamiento sugerido de ortoptica, presentó cambios y mejoras significativas de los signos clínicos los cuales se acompañan de una reducción de síntomas, los que permiten mejoras en la calidad de vida de los jóvenes universitarios y el restablecimiento de las condiciones binoculares.

Prospective longitudinal study of cases, the purpose is evaluate the changes in binocular conditions, in patients diagnosed with convergence insufficiency after orthoptic suggested treatment for three months, with the objective of determine the percentage of improvement. During the development of this investigation, were established as inclusion criteria: exophoria (X) in near vision <20 prism diopters (DPT), positive fusional reserves (RFP) <15 Dpt, low amplitude accommodation (AA), next point Convergence (CPP) ≥6cm, positive relative accommodation (PRA) low and ages 18-25 years. A total of 7 patients were included; They signed the informed consent. Initially the oculomotor status of each patient were evaluated and respondents survey of pretreatment symptoms; then they were instructed to perform exercises and / or vision therapy daily at home for 30 minutes.. Once treatment is completed, measures were taken, which showed significant changes in the PPC with break light / recovery (p = 0.0022) / (p = 0.0017); PPC real object breakdown / recovery (p = 0.0040) / (p = 0.0017); positive fusional reserves near sighted ness breakdown / recovery (p = 0.0017) / (p = 0.0027). 100% of patients had a breakdown and recovery ≤6cm 7 ± 3.6 cm in the PPC with light; real object with 71.4% showed a break ≤ 6cm and a recovery of 9 ± 1.2 cm; RFPs increased by 85.7% this being ≥15Δ in breaking ≥15Δ recovery and 71.4% in the survey and 48% of patients reported improvement in their symptoms. With this, one can conclude that the treatment suggested orthotopic, introduced significant changes and improvements in the clinical signs which are accompanied by a reduction in symptoms, which allow improvements in the quality of life in college students and restoring binocular conditions.

Clinical Manifestations and Prognosis of Convergence Insufficiency after Craniofacial Trauma

PURPOSE: To evaluate the clinical manifestation and prognosis of convergence insufficiency after craniofacial trauma. METHODS: Twelve patients injured by craniofacial trauma were analyzed for the cause of trauma, ocular and accompanied non-ocular symptoms, presence of loss of consciousness, presence of craniofacial fracture and intracranial hemorrhage, treatment modality for ocular symptoms, change in strabismic angle and near point of convergence (NPC) after treatment and prognosis using clinical records from April 2008 to December 2014. RESULTS: Traffic accidents (8 patients) were the leading cause of trauma. Near diplopia (11 patients) was the leading type of ocular symptom and other following symptoms included headache, asthenopia and reading difficulty. Ten patients experienced loss of consciousness and craniofacial fracture and intracranial hemorrhage were observed in 7 patients. Intracranial hemorrhage and craniofacial fracture occurred in 3 patients and only 1 patient had neither intracranial hemorrhage nor craniofacial fracture. All 12 patients performed orthoptic exercises, but no improvement of near strabismic angle, NPC and ocular symptoms was observed. However, 4 patients who received surgery demonstrated improvement in near strabismic angle, NPC and ocular symptoms. CONCLUSIONS: Convergence insufficiency after craniofacial trauma occurred by relatively strong traumatic force and had a poor outcome in non-surgical methods such as orthoptic exercise. Surgery was an effective treatment method rather than orthoptic exercise.

Consideraciones actuales en la insuficiencia de convergencia / Current considerations about convergence insufficiency

La insuficiencia de convergencia es un problema común de coordinación muscular en el cual los ojos tienden a desviarse hacia afuera exoforia con la lectura o cuando se realizan actividades de cerca. Los síntomas más característicos son los astenópicos. Es una de las causas más frecuentes de disconfort ocular. Se diagnostica cuando la exoforia es mayor de cerca y el paciente tiene uno o ambos de los siguientes signos: un punto próximo de convergencia remoto y/o reserva fusional positiva reducida. No existe un consenso para su diagnóstico y tratamiento, aunque muchos coinciden en que la terapia visual y la aplicación de los adelantos técnicos donde los programas de computación juegan un papel importante logran una pronta mejoría en estos pacientes

Convergence insufficiency is a common eye muscle coordination problem in which the eyes tend to drift outward (exophoria) when reading or doing some work at near distance. The most frequent symptoms are the asthenopics. Convergence insufficiency is one of the most common causes of ocular discomfort. The diagnosis is based on exophoria greater at near distance, a remote near point of convergence and decreased convergence amplitudes. There is not any consensus whatsoever about diagnosis and treatment, although many agree on the fact that the visual therapy and the application of technical advances - computer software packages play an important role - manage to attain rapid visual improvement in these patients

The Ratio of Accommodative-Convergence to Accommodation in Patients with Intermittent Exotropia

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with pseudodivergence excess type and convergence insufficiency type of intermittent exotropia [X(T)], and to compare with a normal group. METHODS: A total of 55 subjects were divided into 3 groups: pseudodivergence excess type, convergence insufficiency type, and normal group. Age, gender, and refractive error of patients were examined. The deviation angle was measured at near and distance by using a prism cover test, followed by an interpupillary distance measurement. The AC/A ratio was calculated using a heterophoria and a gradient method. RESULTS: There was no statistically significant difference in age, gender, and the refractive errors among the 3 groups. The mean value of AC/A ratio using the heterophoria method was 9.50 in pseudodivergence excess type patients, 2.59 in convergence insufficiency type patients, and 5.47 in the normal group. Using the gradient method, the mean value of AC/A ratio was 1.47, 0.03, and 2.08 in each group, respectively. There was no statistically significant difference in mean values between patients with pseudodivergence excess type and the normal group, except when obtained using the gradient method (p = 0.43). CONCLUSIONS: A distinct difference in AC/A ratio existed when computed by the heterophoria method between patients with pseudodivergence excess type or convergence insufficiency type and the normal group. In the gradient method, however, the ratios of convergence insufficiency type patients were lower compared to the normal group, indicating the gradient method is more accurate than the heterophoria method.

The Ratio of Accommodative-Convergence to Accommodation in Patients with Intermittent Exotropia

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with pseudodivergence excess type and convergence insufficiency type of intermittent exotropia [X(T)], and to compare with a normal group. METHODS: A total of 55 subjects were divided into 3 groups: pseudodivergence excess type, convergence insufficiency type, and normal group. Age, gender, and refractive error of patients were examined. The deviation angle was measured at near and distance by using a prism cover test, followed by an interpupillary distance measurement. The AC/A ratio was calculated using a heterophoria and a gradient method. RESULTS: There was no statistically significant difference in age, gender, and the refractive errors among the 3 groups. The mean value of AC/A ratio using the heterophoria method was 9.50 in pseudodivergence excess type patients, 2.59 in convergence insufficiency type patients, and 5.47 in the normal group. Using the gradient method, the mean value of AC/A ratio was 1.47, 0.03, and 2.08 in each group, respectively. There was no statistically significant difference in mean values between patients with pseudodivergence excess type and the normal group, except when obtained using the gradient method (p = 0.43). CONCLUSIONS: A distinct difference in AC/A ratio existed when computed by the heterophoria method between patients with pseudodivergence excess type or convergence insufficiency type and the normal group. In the gradient method, however, the ratios of convergence insufficiency type patients were lower compared to the normal group, indicating the gradient method is more accurate than the heterophoria method.

Effectiveness of Home-Based Pencil Push-ups (HBPP) for Patients with Symptomatic Convergence Insufficiency

PURPOSE: To report the effectiveness of home-based pencil push-ups (HBPP) therapy for patients with symptomatic convergence insufficiency. METHODS: Data was collected prospectively on 16 patients who were diagnosed with convergence insufficiency beginning in January 2009. The study group was composed of ten male and six female patients. The duration of symptoms, refractive error, distant and near deviation angles, and near point of convergence (NPC) prior to and after 12 weeks of HBPP therapy were measured in all patients. RESULTS: The mean age of the patients was 19.3 years. The mean deviation angle of exophoria was 3 prism diopters (PD) at distant and 11.2 PD at near. The mean value of NPC prior to HBPP therapy was 36.3 cm; however, the near point of accommodation was within the normal range. After 12 weeks of HBPP therapy, the mean deviation angle of exophoria decreased to orthophoric at distant and 4 PD at near. The mean value of NPC decreased to 14.4 cm. CONCLUSIONS: Twelve weeks of HBPP therapy appears to be an easy, cost-free and effective therapy for patients with symptomatic convergence insufficiency.

The Binocular Performance of Convergence Insufficiency / Jurnal Sains Kesihatan Malaysia

Convergence insufficiency (CI) is a binocular anomaly associated with difficulty of the two eyes to converge during near vision. This study investigated the performance of binocular vision in subjects with CI. The performance of binocular vision that comprised of distant binocular visual acuity (VA), near binocular VA and stereoacuity of subjects with CI were compared with normals. Thirty subjects with CI of mean age 17.33 ±5.49 year-old and 30 normal subjects of mean age 18.77 ± 6.08 year-old with visual acuity of VA 6/6 or better, spherical refractive error of no more than ± 4.00 DS, astigmatism no more than 2.00 DC, non-strabismic and never had vision therapy, with good general and ocular health were recruited for the study. The monocular VA of the right eye, monocular VA of the left eye, binocular VA and stereoacuity of the two groups of subjects were measured and the data were compared. Results of the study showed significant differences in the distance binocular VA (t = 2.31, p < 0.05), near binocular VA (t = 0.89, p < 0.05) and stereoacuity (Z = -2.81, p < 0.01) between CI and normal subjects. The study concludes that subjects with CI experienced reduced performances distance binocular VA, near binocular VA and stereoacuity compared with normal subjects.

Convergence Insufficiency in Patients Visiting Eye OPD with Headache.

The present study was undertaken to find out the incidence of convergence insufficiency in patients presenting in eye OPD with chief complaints of headache. Only patients with normal visual acuity and fundus picture were included in this study. All the 100 patients included in this study were subjected to detailed orthoptic examination which included tests for near point of convergence by RAF, Maddox rod tests and synaptophore examination. It was found that a substantial number of patients had convergence insufficiency and maximum no. of such patients (49%) were in the age group of 20-40 years. The sudy highlights the importance of ortoptic examination in all patients of strain and headache.

Monocular Slanted Lateral Rectus Recession for Exotropia with Convergence Insufficiency

PURPOSE: To evaluate the efficacy of monocular slanted lateral rectus (LR) muscle recession for exotropia with convergence insufficiency. METHODS: Twenty five patients with exotropia greater at near than at versus far distance by > or =10 prism diopters (PD), were divided into two groups: 15 patients who underwent monocular slanted LR recession (study group), and 10 patients who underwent monocular standard LR recession (control group). In the study group, the lower horn of the LR was recessed according to near deviation, the upper horn was recessed according to distance deviation. In the control group, monocular LR was recessed according to distance deviation. The postoperative ocular alignment at distance and near, and the difference between them, were measured and compared retrospectively. The criteria for successful outcome were postoperative residual deviation at near and distance, and the difference of 8 PD or less between the two. RESULTS: The mean distance deviation showed a significant postoperative reduction in both groups (P<0.001, P<0.001). The mean near deviation showed a significant postoperative reduction in both groups (P<0.001, P<0.001). The mean difference between near and distance deviation showed a significant postoperative reduction only in the study group (P<0.001, P=0.175). Successful outcome was obtained in 13 our of 15 (86.7%) patients in the study group, in 2 out of 10 (20%) patients in the control group. None of the study patients had postoperative diplopia. CONCLUSIONS: Monocular slanted lateral rectus recession is effective in reducing both distant and near exodeviation and in collapsing the difference between distance and near deviation them at postoperative 4 months.

Clinical Characteristics of Exodeviation

PURPOSE: In order to evaluate the incidence and clinical characteristics of exodeviation according to the Kushner's classification. METHODS: We prospectively studied the 820 patients with exodeviation from 1998 to 2003. One hundred thirty patients with systemic abnormalities, eye disease except exodeviation, or histories of previous strabismus operations were excluded. Best-corrected visual acuity, alternate prism cover test or Krimsky test, duction/ versions, funduscopy, and cycloplegic refraction were performed in every patient, and Bielschowsky phenomenon, Worth 4 dot test and Titmus stereotest, in possible patients. We categorized exodeviations according to the Kushner's classification. RESULTS: Of the remaining 690 patients with exodeviation, 318 were male and 372 were female. Age of onset of exodeviation was 3.9 years. Basic exodeviation was most common (76.5%), and followed by tenacious proximal fusion (7.1%), convergence insufficiency (2.8%), proximal convergence (0.6%), pseudo-convergence insufficiency (0.6%) and high AC/A ratio (0.4%). Binocular fusion both at near and at distance was observed in 30% (148 patients) of the patients. The incidence of amblyopia and dissociated vertical deviation was 13.9% and 8.5%, respectively. Bielschowsky phenomenon was observed mostly in patients with early-onset exodeviation. CONCLUSIONS: Basic exodeviation was most commonly observed, followed by tenacious proximal fusion and convergence insufficiency. Patients with exodeviation showed an onset age of 3.9 years and accompanied by an amblyopia and dissociated vertical deviation in 14% and 5%, respectively. One third of the patients showed binocular fusion.

Unilateral Resection-Recession Based on Near/Distance Deviation in Children with Exotropia of the Convergence Insufficiency Type

PURPOSE: The purpose of this study was to evaluate prospectively the long-term surgical results of unilateral lateral rectus (LR) muscle recession and medial rectus (MR) muscle resection in children with convergence insufficiency exotropia (XT). METHODS: This prospective study included 14 children with an angle of XT greater at near than at distance by 10 prism diopters (PD) or more. The amounts of resection and recession were based on near and distance deviation, respectively. Minimum follow-up was one year (mean, 26.6+/-19.4 months) after surgery. RESULTS: Significant postoperative reduction was achieved in mean distance exodeviation from 22.5 PD to 9.1 PD (p=0.000), and in mean near exodeviation from 33.8 PD to 13.6 PD (p=0.000). The mean near-distance difference decreased from 11.3 PD preoperatively to 4.6 PD postoperatively (p=0.000). A Fresnel prism was used temporarily to treat postoperative esotropia in only one patient for 6 months postoperatively. CONCLUSIONS: Unilateral surgery biased more to MR strengthening than to LR weakening in children with convergence insufficiency XT, was found to successfully reduce both distance and near deviation and to collapse near-distance differences with a low risk of long-term postoperative esotropia.

The Prospective Comparison of Surgical Outcomes in Convergence Insufficiency Exotropia

PURPOSE: The surgical results for exotropia with convergence insufficiency have been reported to be unsatisfactory and there was a risk of creating diplopia due to postoperative esotropia at distance. The purpose of this study is to determine the effective surgical method in convergence insufficiency exotropia. METHODS: Two surgical procedures were alternately performed in patients with convergence insufficiency exotropia. Minimum follow-up was 6 months after surgery. In the bimedial resection (BMR) group (n=9), bilateral medial recti (MR) resections were performed with slanted procedure where the upper MR margin was resected to correct the distance deviation and the lower margin was resected to correct the near deviation. The recession and resection (R and R) group (n=15) involved MR resection and lateral rectus recession where the amounts of resection and recession were based on the near and distance deviation, respectively. RESULTS: At an average last follow-up of 22 months, a significant reduction in the distance and near angle of deviation, as well as in the difference between the distance and near deviation, was shown in the R and R group as compared with the BMR group (p<0.05). Fresnel prism was used to treat postoperative diplopia in only one patient of the R and R group. CONCLUSIONS: The surgical method of the R and R group appeared to produce a more favorable result than that of the BMR group without the risk of long-term postoperative diplopia at distance in convergence insufficiency exotropia.

A Case of Angled tuck of the Medial Recti: A New surgical approach to Convergence Insufficiency

Patients with convergence insufficiency were complaint from diplopia and asthenopia at near Most patients respond well to orthoptic therapy, glasses, prism. In the case of patient unresponsive to conventional non-surgical orthoptic treatment, surgery remained controversial due to recurrence of symptoms reported following conventional bilateral medial rectus resection. To overcome these problems, an angled tuck of the medial recti was performed. Strengthening of the lower margin of the medial recti, by tucking them more than these of the upper margin results in a same aligment of the eye for near and distance deviation and relief of symptoms.