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.

Clinical Features Associated with the Direction of Deviation in Sensory Strabismus

PURPOSE: To assess the clinical features associated with the direction of deviation in sensory strabismus and postoperative stability of strabismus angles. METHODS: The authors retrospectively reviewed the medical records of 98 patients diagnosed with sensory strabismus who were treated surgically. Among the factors analyzed were sex, age, direction of strabismus, preoperative visual acuity, age at onset of visual loss, cause of primary sensory deficit, refractive error, age at operation, deviation angle at 1 and 6 months postoperatively and after at least 5 years. RESULTS: At baseline, 20 patients (20.4%) had esotropia and 78 (79.6%) had exotropia. Common causes of primary sensory deficit were corneal opacity (25.5%), vitreoretinal disorder (23.5%), and congenital cataracts (16.3%). The proportion of esotropia increased significantly as the refractive error of the sound eye became more hyperopic. The older the patients were when they lost their vision, the higher the proportion of exotropia. Patients with longer duration of vision loss were more likely to have a larger deviation angle with exotropia, but the association was not significant with esotropia. CONCLUSIONS: Patients with sensory strabismus tend to develop exotropia. Refractive error of the sound eye and age at onset of vision loss were associated with the direction of strabismus. Despite poor sensory fusion even after surgery, more than 50% of patients maintained a stable eye position.

Results of Re-operation on the Deviated Eye in Patients with Sensory Heterotropia

PURPOSE: To evaluate the result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after surgery. METHODS: The medical records of 11 patients who had received second strabismus operation on the deviated eye due to recurred, consecutive or undercorrected sensory strabismus were studied retrospectively. RESULTS: Among the 11 patients, five patients were operated for recurred exotropia after surgery of sensory exotropia (group 1), two for consecutive exotropia after surgery of sensory esotropia (group 2), and four for undercorrected esotropia after surgery of sensory esotropia (group 3). Re-operation was performed 19.2+/-12.6 years after the first operation and the mean preoperative deviation before re-operation was 30.0+/-8.66 prism diopters (PD), 32.5+/-10.6PD, and 32.5+/-8.66PD, respectively. In all cases, a small amount of recession or resection compared with the usual surgical dosage was applied in re-operation on the deviated eye. The mean follow-up period after re-operation was 12.3+/-14.2 (1-48 months). Among the 11 patients, postoperative deviations less than 10PD were achieved postoperatively in 8 (72.7%) at 1 month and of the 8 patients with follow-up data beyond 6 months, 5 (62.5%) showed orthotropia within 10PD at 6 months or later. CONCLUSIONS: The surgical result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after the first surgery was satisfactory in spite of the reduced amount of surgical correction compared with the surgical dosage recommended for the non-operated eye.

Results of Re-operation on the Deviated Eye in Patients with Sensory Heterotropia

PURPOSE: To evaluate the result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after surgery. METHODS: The medical records of 11 patients who had received second strabismus operation on the deviated eye due to recurred, consecutive or undercorrected sensory strabismus were studied retrospectively. RESULTS: Among the 11 patients, five patients were operated for recurred exotropia after surgery of sensory exotropia (group 1), two for consecutive exotropia after surgery of sensory esotropia (group 2), and four for undercorrected esotropia after surgery of sensory esotropia (group 3). Re-operation was performed 19.2+/-12.6 years after the first operation and the mean preoperative deviation before re-operation was 30.0+/-8.66 prism diopters (PD), 32.5+/-10.6PD, and 32.5+/-8.66PD, respectively. In all cases, a small amount of recession or resection compared with the usual surgical dosage was applied in re-operation on the deviated eye. The mean follow-up period after re-operation was 12.3+/-14.2 (1-48 months). Among the 11 patients, postoperative deviations less than 10PD were achieved postoperatively in 8 (72.7%) at 1 month and of the 8 patients with follow-up data beyond 6 months, 5 (62.5%) showed orthotropia within 10PD at 6 months or later. CONCLUSIONS: The surgical result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after the first surgery was satisfactory in spite of the reduced amount of surgical correction compared with the surgical dosage recommended for the non-operated eye.

Clinical Analysis of Sensory Strabismus with Organic Amblyopia in Children

PURPOSE: To study the clinical characteristics of pediatric sensory strabismus in Korean children. METHODS: A retrospective analysis was performed on 71 patients with the diagnosis of sensory strabismus before the age of 16 years. Patients with strabismic amblyopia or anisometropic amblyopia were excluded from consideration. The age at onset of vision loss, diagnosis, type of strabismus, deviated angle, etiologic factors leading to vision loss, and visual acuity of the deviated eye were recorded. The surgical results were analyzed in the case of strabismus surgery for sensory strabismus. RESULTS: The mean age at the onset of vision loss was 4.6 years and the mean age at diagnosis was 7.5 years. Forty-one patients (58%) had congenital vision loss and the most common cause of vision loss was optic nerve disease in 35 (49%). Exotropia developed in 58 (82%), and patients with severely impaired visual acuity were more likely to develop exotropia (P=0.054). The age at the onset of vision loss and the age at diagnosis in esotropia were younger than in exotropia (P=0.049, P=0.047, respectively). Twenty-five (78%) of 32 patients who had undergonewere strabismus surgery had ocular alignment within 10 prism diopters of orthophoria. The frequency of consecutive exotropia was 40% in surgery for esotropia. CONCLUSIONS: Children with organic amblyopia tend to develop sensory exotropia. We considered that the age at initial vision loss and the severity of vision loss could play a role in determining the direction of deviation. The surgical results were favorable, but we should pay attention to the development of consecutive exotropia in surgery for esotropia.

The Clinical Consideration of Sensory Strabismus

PURPOSE: To evaluate the factors influencing the direction of sensory strabismus and the consequent surgical outcomes. METHODS: We retrospectively reviewed the medical records of 150 sensory strabismus patients who had undergone surgery. Consisting of 38 esotropes and 112 exotropes. Parameters considered were the cause of vision loss, the age at vision loss, the refractive error of the sound eye, the interorbital distance in the posteroanterior view of the orbit, the deviation angle at postoperative 6 months and 1 year. Patients were excluded if the cause of vision loss was strabismic amblyopia. RESULTS: The major causative factors of sensory strabismus were corneal opacity (26.7%) followed in frequency by cataract (22.7%), and optic nerve disorder (15.3%). The age at vision loss, the refractive error of the sound eye, and the inner and outer interorbital distance were statistically significant among the considered factors in determining the direction of sensory strabismus. At postoperative 6 months, 69.3% of the patients maintained the alignment within 10 PD of orthotropia and 70.4% at 1 year. CONCLUSIONS: We considered that the age at vision loss, the refractive error of the sound eye, and the inner and outer interorbital distance could play a role in determining the direction of sensory strabismus. In spite of the deficit of sensory fusion, the surgical outcomes of sensory strabismus remained favorable at 1 year after surgery.

Clinical Analysis of Sensory Strabismus

PURPOSE: This study was carried out for the clinical analysis of deviation axis of sensory strabismus METHODS: We retrospectively reviewed the medical records of 100 patients who had been diagnosed with sensory strabismus and undergone surgery. Etiology, age at onset of vision loss, duration of vision loss, refraction in sound eye, angle of deviation according to sensory esotropia and exotropia were analyzed. RESULTS: The most common etiology was corneal opacity which occurred in 17 patients (17.0%). Fifteen patients had esotropia and 85 patients exotropia. Esotropia was commonly developed in congenital origin (9 patients, 60%) and under the age of 5 years (12 patients, 80%). Exotropia was commonly developed in acquired origin (68 patients, 80%) and over the age of 6 years (53 patients, 62.4%) (P=0.003). When the refraction in sound eye was hyperopia, esotropia developed in 3 patients (18.8%) and exotropia in 13 patients (81.2%). When the refraction in sound eye was myopia, esotroia developed in 12 patients (14.3%) and exotropia in 72 patients (85.7%). But there was no statistical significance (P=0.445). CONCLUSIONS: Type of horizontal strabismus in sensory strabismus was significantly related to the age at onset of vision loss, but not to the refraction in sound eye.

Clinical Analysis of Sensory Strabismus with Fundus Abnormalities in Children and the Effectiveness of Occlusion Therapy

Fifty-nine children (75 eyes) with organic amblyopia were investigated to know the distribution and incidence of the optic nerve or retinal lesion, the type of sensory strabismus, and the effect of occlusion therapy in organicamblyopia. Optic nerve lesion was found more frequently than retinal lesion as causes of organic amblyopia. Among these optic nerve lesions, optic nerve hypoplasia and tilted disc were most frequently found, and in the retinal lesion, ROP (retinopathy of prematurity: macular dragging), foveal dysplasia, and myopic degeneration were frequent.Thirty-nine of 59 children with organic amblyopia (66%)showed strabismus and 74.4% of them had horizontal deviation; 17 eyes had esotropia, and 12 eyes exotropia. No vertical eyeball deviation was found. Myopic anisometropia was accompanied in 19 cases. Better visual outcome was obtained after occlusion therapy in cases with tilted disc and ROP according to the degree of these lesions. However, there was no improvement in other cases. Authors suggest that fundus examination should be included in the routine ophthalmologic examination in chlidren with strabismus.