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AIM: To analyze the strabismus surgery situation of adolescents and children in Yunnan province.METHODS: A retrospective analysis was conducted on medical records data of 3 068 adolescents and children who received strabismus surgery at Affiliated Hospital of Yunnan University from January 2017 to December 2021. The analysis included gender, constituent ratio of age, distribution of strabismus types and combination with other ocular diseases, etc.RESULTS: Among the included patients, 52.12% were males, and 47.88% were females. Preschool patients(1 to 6 years old)accounted for 32.89%, primary pupils(7 to 12 years old)accounted for 45.89% and high school students(13 to 18 years old)accounted for 21.22%. Exotropia accounted for 63.17% of the total strabismus, of which intermittent exotropia was the most common type. Esotropia accounted for 19.69%, and concomitant esotropia was the most common type. The special type of strabismus accounted for 17.14%, and A-V syndrome and dissociative vertical deviation(DVD)were the most common types. Strabismus combined with ametropia accounted for 61.02% and amblyopia accounted for 10.89%. A few patients also combined with other eye diseases.CONCLUSION: In Yunnan province, intermittent exotropia was the most common type of strabismus among adolescents and children. Some patients combined with other ocular diseases.
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AIM: To investigate the role of visual perception training on the recovery of visual function at all levels and the improvement of perceptual eye position in children with intermittent exotropia(IXT).METHODS: Prospective clinical study. A total of 74 patients with IXT who received corrective surgery for strabismus in the Ophthalmology Department of the First People's Hospital of Lanzhou City from January to June 2022 were collected and followed up for 3mo. The patients were randomly divided into 2 groups at 1d after surgery: 35 patients in the training group received binocular visual perception training, and 39 patients in the control group did not receive visual training. The changes of visual function and perceived eye position at all levels were observed at 1d and 3mo after operation.RESULTS: There were 24 patients(69%)with simultaneous perception in the training group at 1d after surgery and 34 patients(97%)with recovered visual function at 3mo after surgery, which was significantly higher than 1d after surgery(P=0.002). Furthermore, there were 22 cases(56%)of fusion function in the control group at 3mo after surgery, 13 cases(33%)of far stereopsis, 20 cases(51%)of dynamic stereopsis and 17 cases(44%)of static fine stereopsis. In the training group, there were 31 cases(89%)of fusion function, 25 cases(71%)of far stereopsis, 30 cases(86%)of dynamic stereopsis and 27 cases(77%)of static fine stereopsis, which were significantly higher than those in the control group(all P<0.05). The degree of perceived eye displacement in the training group decreased more significantly than that in the control group(all P<0.05).CONCLUSION: Postoperative visual perceptual training in children with IXT can promote recovery of visual function at all levels, improve perceptual eye position and enhance the control of eye position at the perceptual level of the brain.
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AIM: To investigate the effect of wearing an orthokeratology lens on postoperative binocular vision rebuilding in patients with intermittent exotropia combined with myopic refractive error.METHODS: Prospective control study. A total of 60 patients(120 eyes)with intermittent exotropia and myopia who underwent surgical treatment in our hospital from June 2019 to December 2020 were selected. Patients who wore orthokeratology lenses or monofocal frame glasses after surgery were divided into a treatment group(group A)and a control group(group B)according to the wishes of patients and their families, with 30 cases(60 eyes)in each group, and they were followed-up for 6mo. The third level visual function and Titmus near stereoscopic visual function of the two groups of patients were observed before and 6mo after surgery.RESULTS: There was no statistical significance in all observation indicators between group A and group B before surgery(P>0.05). After 6mo of surgery, patients with intermittent exotropia achieved significant improvement in binocular visual function and corrected eye position. Group A was superior to group B in terms of fusion range and near stereoscopic visual function(P<0.05). There was no statistical significance between the two groups in terms of simultaneous vision and stereoscopic visual function(P>0.05).CONCLUSION: The binocular visual function of patients with intermittent exotropia after surgery has significantly improved. Wearing orthokeratology lenses can effectively improve binocular visual function in patients with intermittent exotropia combined with myopia after surgery.
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AIM: To investigate the status of stereoscopic reconstruction in adults with intermittent exotropia after surgery, and analyze related influencing factors.METHODS: A retrospective study was conducted among 196 adults with intermittent exotropia who were admitted to our hospital from January 2019 to January 2021. All patients underwent strabismus surgery, and their preoperative and postoperative data were collected.RESULTS: Near and distal stereo visual function was not found in all the included 196 patients before surgery. The reconstruction rates of near stereo visual function and distal stereo visual function were 52.6%(103/196)and 50.5%(99/196), respectively. There were significant differences in surgical age, age of onset, course of disease, and postoperative level of horizontal strabismus between patients with near stereoscopic reconstruction(103 cases)and those without reconstruction(93 cases; P<0.001). Multivariate Logistic regression analysis showed that age of onset, course of disease, and postoperative level of horizontal strabismus were factors influencing near stereo visual function reconstruction(P<0.05). The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)values of age of onset, course of disease and postoperative level of horizontal strabismus to predict near stereo visual function reconstruction were 0.757, 0.737 and 0.727, respectively(P<0.001). There were significant differences in surgical age, age of onset, course of disease, and postoperative level of horizontal strabismus between patients with distal stereoscopic reconstruction(99 cases)and those without reconstruction(97 cases; P<0.001). Multivariate Logistic regression analysis showed that age of onset and course of disease were factors influencing distal stereo visual function reconstruction(P<0.05). ROC curve showed that the AUC values of age of onset and course of disease to predict distal stereo visual function reconstruction were 0.672 and 0.821, respectively(P<0.001).CONCLUSION: Stereoscopic reconstruction in adults with intermittent exotropia after surgery is affected by many factors, such as age of onset and course of disease. The influencing factors of near stereo visual function reconstruction and distal stereo visual function reconstruction are different, which deserves attention.
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Intermittent exotropia(IXT)is a common ophthalmic disease with high incidence, variable deviation, and varying degrees of impaired binocular visual function. The defect of binocular visual function is related to the changes of visual cortex. IXT involves the functional changes of many brain regions, including the cortical areas related to binocular fusion. After correcting the eye position, the abnormal changes of cerebral cortex still exist in some patients with IXT, and the recovery of binocular vision is still difficult. In order to solve these problems, visual perception training is gradually applied to the postoperative reconstruction of binocular visual function in patients with IXT. Visual perception training repairs the visual cortex from the brain level, improving the ability of the visual cortex to process information by constantly stimulating the visual center, thus repairing the visual central function, so that patients can obtain good binocular visual function, stabilize the eye position and reduce recurrence. This article reviews the mechanism of binocular visual impairment and the role of visual perception training in the treatment of IXT. It is hoped to provide more evidence for visual perception training to reconstruct postoperative binocular visual function and reduce the recurrence rate in patients with IXT.
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In this study, we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery. We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery, along with 18 healthy controls. Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli. Compared with controls, preoperative patients showed hypoactivation in higher-level dorsal (visual and parietal) areas and ventral visual areas. Pre- and postoperative activation did not significantly differ in patients overall; patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus. Worse stereopsis and fusional control were correlated with preoperative hypoactivation, suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia. The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis. Thus, additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.
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Humans , Exotropia/surgery , Depth Perception/physiology , Strabismus/surgery , Oculomotor Muscles/surgeryABSTRACT
Purpose: To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current study is carried on how FVT affects the duration of treatment, sensory fusion, and exotropic drift. Methods: This was a retrospective study for the medical record of 11 patients with consecutive esotropia after IXT surgery of 543 patients over the period of 5 year, with mean surgery age of 9.5 (range: 4–33 y). FVT was planned after minimum 6 weeks of surgery and was considered for maximum 24 weeks. Patients underwent a combination of office-based and home-based FVT. Successful outcome of therapy was considered where diplopia resolves in free space and achieves sensory fusion, stereopsis with no manifest deviation. Results: Record of 543 patients who had horizontal muscle surgery for IXT were identified and reviewed. Records of 11 patients who showed consecutive esotropia of 10 prism diopter (PD) or more with normal retinal correspondence, with or without diplopia complaint, after 6 week of surgery and had undergone vision therapy management were reviewed. A successful outcome of binocular single vision with good sensory and motor fusion with no manifest deviation or prism requirement was achieved with in the mean duration of 4.8 month of therapy. With a mean duration of 4 weeks of therapy, the mean angle of deviation reduced by 53% for distance (17 PD to 8 PD) and 27% for near (11 PD to 8 PD) and mean stereopsis improvement by 80% with 94% patients demonstrating sensory fusion on Bagolini test and 94% of patients having no symptoms of diplopia or squint. Conclusion: With nonsurgical management involving refractive error correction, FVT, and prism, consecutive esotropia was resolved in 74% cases. Management of consecutive esotropia with FVT can result in satisfactory sensory fusion and successful motor alignment.
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AIM:To evaluate the effects of intermittent exotropia(IXT)on the quality of life of children and their parents using the Chinese version of intermittent exotropia questionnaires(CIXTQ).METHODS: The scores of CIXTQ were collected from IXT children and the same number of age-matched control children in department of ophthalmology, Nanjing Children's Hospital from June 2020 to June 2021. They were the Chinese version of intermittent exotropia questionnaires scores(CIXTQ, for children to assess their health related quality of life), the parental proxy CIXTQ(pp-CIXTQ, for parents to assess children's life quality)scores and the parent CIXTQ(p-CIXTQ, for parents to assess their life quality)scores. To explore: 1)The differences in the CIXTQ, pp-CIXTQ and p-CIXTQ scores between IXT children and the normal children; 2)The relationship between the CIXTQ and pp-CIXTQ scores in IXT children; 3)The factors affecting the quality of life in children with IXT.RESULTS: A total of 156 patients with IXT and 156 age-matched normal children were included. CIXTQ scores in the children with IXT group was lower than that in the control group(t=-12.915, P<0.001). In IXT group, there was no difference observed in CIXTQ or pp-CIXTQ scores(t=-0.718, P=0.473). As suggested by item-level analysis, children in the IXT group were more concerned about how others think of them and their vision, whereas parents were more concerned about whether the child needs surgery, and whether the permanent damage of strabism caused to the eyes of their children and whether strabismus affects their social life.CONCLUSION: The CIXTQ performed better in distinguishing the children with IXT and those with normal condition, and it can accurately predict the impact of IXT on children, and benefit to make personalized treatment regimens.
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@#AIM: To investigate the binocular accommodative amplitude(AMP)and accommodative facility(AF), near point of convergence(NPC), accommodative convergence/accomodation ratio(AC/A), positive relative convergence(PRC)of intermittent exotropia(IXT)children, according to the convergence insufficiency type, basic type, divergence excess type, and to compare with the normal children, investigating the differences of regulation and collection function.<p>METHODS: Totally 40 IXT children were divided into three groups according to the different types of the IXT patients, the convergence insufficiency group(12 children), the basic group(18 children)and the divergence excess group(10 children). And the 20 non-exotropia children were set up as the control group. AMP was measured with improved push-up test, and AF was measured with turning over convex and concave lens test. NPC was measured with push-up test. AC/A ratio were measured with the lens gradient method. PRC was measured with BO prism. The binocular accommodative and convergence function of four groups were compared.<p>RESULTS: The difference of AMP, AF, NPC, AC/A ratio and PRC among four groups was significant difference(<i>P</i><0.05), and we did the further pair wise comparisons. AMP of the IXT group was less than the control group, and AMP of the convergence insufficiency group was the least; AF of the convergence insufficiency group was less than the basic group and the control group; NPC of the convergence insufficiency group was the largest; AC/A ratio of the convergence insufficiency group and the basic group was lower than the other two groups; PRC of the IXT group was less than the control group when fixating at near target of 33cm, and the mean of the convergence insufficiency group was the least; PRC of the IXT group was less than the control group when fixating at far target of 6mo(<i>P</i><0.05).<p>CONCLUSION: There are differences in the ocular function of accommodation and convergence in different types of IXT children, and the function of the convergence insufficiency IXT is the worst. The binocular accommodative and convergence function of IXT children is worse than non-exotropia children.
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@#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.
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Divergence excess (DE) can be described clinically as exotropia at far greater than the near deviation by at least 10 prism dioptres (PD). We are reporting a rare case of 25-year-old female visited in the eye department for a routine eye check-up with a history of decreased vision in one eye. On examination, it was detected as a case of unilateral amblyopia with intermittent exotropia of true divergence excess with high accommodative-convergence over accommodation (AC/A) ratio. The patient was asymptomatic from exo-deviation due to the presence of binocular vision and good fusional reserve. The patient was started on active conventional vision therapy along with occlusion therapy. Post 16 weeks of constant therapy, a vision assessment with complete squint assessment along with binocular vision tests were performed. The result interprets to support the use of active conventional vision therapy as an integral part of the clinical treatment of amblyopia and intermittent exotropia. The rate of recovery of several monocular functions monitored during the vision therapy period provides the evidence of neural plasticity at multiple sites in the visual pathway in this adult amblyope. Therefore, if an ordered plan is being followed for the management of the patient of unilateral amblyopia and divergence excess, it can yield long-lasting improvement in visual acuity and binocular functions of any age.
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PURPOSE: To investigate how the effect of bilateral rectus muscle recession changed by analyzing the effect/dose ratio of surgery according to the preoperative angle deviation.METHODS: We retrospectively studied the medical records of patients from January 2007 to March 2014 who underwent bilateral lateral rectus muscle recession and who visited our hospital for at least 2 years after surgery. We classified the patients into two groups: the preoperative large angle deviation group (35 prism diopters [PD] or more) and the small angle deviation group (20 PD or less). We observed exodrift patterns by measuring distant and near angle deviation according to the preoperative and postoperative times. The effect/dose ratio of recession was calculated at each visit. Surgical success was defined as an alignment between 10 PD of exodeviation and 5 PD of esodeviation, both at distance and at near.RESULTS: Among 165 patients, 84 patients were in the large angle deviation group and 81 patients were in the small angle deviation group. Preoperative angle deviation of the large angle deviation group was 39.34 ± 5.13 PD (range: 35–55 PD) and the small angle deviation group was 19.49 ± 1.62 PD (range: 18-20 PD) (p < 0.001). At postoperative 1 day, the alignments of eyes of the two groups were −8.32 ± 9.31 PD and −13.11 ± 6.94 PD; p < 0.001, respectively. At the date of the final follow-up, the alignments of eyes of the two groups were 4.63 ± 8.94 PD and 1.22 ± 8.01 PD; p = 0.011, respectively, and the effect/dose ratios were 2.25 ± 0.62 PD/mm and 1.94 ± 0.78 PD/mm, respectively, which meant that the effect of correction for the large angle deviation group was larger than that of the small angle deviation group (p = 0.005). Both groups showed postoperative exodrift patterns and similar success rates (75.0% and 80.2%, respectively), which showed no significant difference (p = 0.268).CONCLUSIONS: The small angle deviation group showed a larger effect of correction and high exodrift pattern at the postoperative initial time and the large angle deviation group showed a smaller effect of correction and low exodrift pattern at the postoperative initial time. The preoperative angles of deviation and the operative success rates were not related.
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@#AIM: To investigate the recovery of binocular vision in patients with intermittent exotropia of different age.<p>METHODS: Totally 172 patients with intermittent exotropia who underwent strabismus correction in our department from January 2016 to January 2018 were selected, including 95 males and 77 females, aged from 3 to 32 years, with an average age of 11.4±1.5 years. All patients with intermittent exotropia were basic type. According to the age of operation, the patients were divided into two groups: the group of less than 9 years old(90 cases)and the group of more than 9 years old(82 cases).The preoperative, 1d, 7d, 1mo and 3mo after operation were observed. The function of binocular vision was examined by synoptophore and myopia was examined by Titmus.<p>RESULTS: A comparison of simultaneous vision: at the same time, the visual function, fusion function, fusion range, far stereo, near stereo recovery effect of patients ≤9 years group was better than that of patients >9 years group. The difference was statistically significant(<i>P</i><0.05). <p>CONCLUSION:Suggested surgical treatment of intermittent exotropia before 9 years old. Early operation is conducive to better improvement of binocular vision after surgery.
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@#AIM: To investigate the changes of visual function and multifocal visual evoked potential in children with strabismus after intermittent exotropia operation.<p>METHODS: Totally 91 children with intermittent exotropia from January 2014 to December 2017 were enrolled in the study. All children were treated with surgery. The changes of visual function before and after operation were observed, and the level of multifocal visual evoked potential before and after operation were detected. <p>RESULTS: The total effective rate was 88% at one week after operation, 86% at 6mo after operation, the mean preoperative strabismus was-38.12△, and the mean postoperative strabismus was-5.8△. At 6mo after operation, the number of children with simultaneous vision, fusion and distant stereopsis decreased significantly as compared with that before operation(<i>P</i><0.01). The orthopedic rate was 68% at 6mo after operation, and the majority of the patients with all or only one or two grade visual function before the operation were positive, which was significantly higher than that of the patients who lost it after operation(<i>P</i><0.05). From before operation to 6mo after operation, the amplitude response density of the characteristic peak and the latency of the nasal and temporal retinas in the fourth and sixth rings of the children were significantly increased, while the latent period of the inferior retina was significantly decreased(<i>P</i><0.05).<p>CONCLUSION: Intermittent exotropia operation can effectively improve the visual function of children and promote the recovery of eye position in children, and the level of multifocal visual evoked potential in children after operation is also improved to some extent. The clinical effect is outstanding, and it is worth popularizing and applying.
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@#AIM: To explore the influence factors of the mid-long-term postoperative eye position of patients with intermittent exotropia(IXT).<p>METHODS: Retrospective analysis was performed on the clinical data of 78 patients with intermittent exotropia admitted to the ophthalmology department of our hospital during 2017-01/2018-08. Data of patients with strabismus type,operation age, preoperative binocular vision function and the eye position of preoperative and postoperative day one were collected, to explore the influence factors of the mid-long-term postoperative eye position.<p>RESULTS: The result display that 47 cases(60%)had positive eye position in the mid-long-term after operation. There were 43 cases of insufficient collection type, 18 cases(42%)cured in eye position. The operation was successful in 26 of the 31 cases(84%)of basic type; 3 of 4(75%)divergence excess type were successful after operation. The results of univariate analysis showed that the difference of strabismus type and preoperative eye position between the two groups was statistically significant(<i>P</i><0.05). Multivariate logistic regression analysis showed that type of strabismus(<i>OR</i>: 5.769, 95% <i>CI</i>: 1.790-18.595), was independent influencing factors of the eyes position in the mid-long-term after operation(<i>P</i><0.05).<p>CONCLUSION:The strabismus type was independent predictors of the eyes position in the mid-long-term after operation, which should be paid more attention in clinical practice.
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@#AIM:To investigate the effect of visual training on the reconstruction of visual function in children with intermittent exotropia. <p>METHODS: A total of 94 children with intermittent exotropia diagnosed in our hospital from August 2016 to January 2019 were selected and 94 eyes were affected. According to whether the postoperative visual training was divided into two groups, 47 patients(47 affected eyes)were not visually trained after operation and were included in the control group; 47 patients(47 affected eyes)were visually trained 2wk after operation and were included in the observation group. Follow-up for 6mo was performed to observe the recovery of visual function and eye position regression.<p>RESULTS: Six months after surgery, the proportion of children in the observation group with simultaneous visual function(89%), fusion function(85%)and stereoscopic function(40%)was significantly higher than that in the control group(53%, 47%, 19%), and the orthotopic rate of children in the observation group was significantly higher than that in the control group(91% <i>vs</i> 66%).<p>CONCLUSION: The binocular visual function training after intermittent exotropia in children can promote the recovery of binocular visual function and reduce the risk of postoperative eye position regression.
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@#AIM: To investigate the influence of orthokeratology on ocular surface and visual quality of intermittent exotropia with myopia. <p>METHODS: Totally 60 patients(120 eyes)with intermittent exotropia and spherical equivalent ranging from -0.75 to -5.50D were numbered and divided into study group and control group according to random number table, which included 30 cases(60 eyes)of patients in each group. Two groups patients were intervened by orthopaedic training with prism for at least half of a year. In addition, the study group matched the night wearing corneal plastic lenses through the standardization of corneal plastic matching process, and observed continuously for at least half of a year. The before and after treatment strabismus, naked eye vision, best corrected visual acuity, fluoresce-in staining tear film rupture time(FBUT), diopter and visual quality between the two groups were compared. The rate of adverse reactions and complications between the two groups was compared to evaluate the safety. <p>RESULTS: There was no significant difference in all before intervention indexes between the two groups(<i>P</i> > 0.05). Compared with that those of before intervention, in both groups, after treatment strabismus decreased, naked vision, best corrected vision and FBUT increased, diopter values reduced, and the proportion of patients with excellent visual quality increased. And the after treatment naked visual acuity, best corrected visual acuity, FBUT, diopter and visual quality in the study group were better than those in the control group(<i>P</i><0.05). There was no significant difference in therate of adverse reactions and complications such as orbital and orbital pain, eye distention, headache, palpebral conjunctival vascular congestion between the two groups(13% <i>vs</i> 10%, <i>P</i>=1.000). <p>CONCLUSION: On the basis of triangular prism orthophotic training, the wearing of orthopaedic keratoplasty lenses can improve the tear film, refraction and visual quality of intermittent exotropia patients, and its safety is good, which is worthy of clinical application.
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PURPOSE: To measure and analyze ocular deviations between dominant and non-dominant eyes using video-oculography (VOG) in intermittent exotropia. METHODS: Fourteen subjects who were diagnosed with intermittent exotropia from July 2017 to July 2018 with age of 5 or more, visual acuity of 20/30 or better and corrected visual acuity of 20/25 or more and difference in vision of both eyes of 1 line or less on Snellen optotype were included. The subjects were asked to fixate on a black-on-white optotype at 1 m, which subtended a visual angle of 50 minutes of arc. The video files and data about ocular deviations were obtained using VOG with alternate cover test. We analyzed angles of ocular deviations in dominant and non-dominant eyes. RESULTS: Among the 14 subjects in this study, the mean age were 7.6 ± 1.7 (range 5–9 years). Seven of 14 subjects had the right eye dominance. Six of the 14 subjects were men. There was no significant difference of ocular deviations between the dominant and non-dominant eyes in VOG (p = 0.167). Additionally, there was no significant difference of the values of VOG when one eye was exodeviated or re-fixated (p = 0.244), when both eyes were deviated, and when both eyes were re-fixated (p = 0.195, 0.637). CONCLUSIONS: In this study, there was no significant difference of ocular deviations between the dominant and non-dominant eyes, between when an eye was exodeviated or fixated using VOG. Therefore, it may not be a problem even if alternate prism cover test is performed in any eye in intermittent exotropia of more than 50 prism diopter without amblyopia or refraction abnormality that could affect the uncorrected visual acuity.
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Humans , Male , Amblyopia , Dominance, Ocular , Exotropia , Strabismus , Visual AcuityABSTRACT
PURPOSE: To investigate the recovery period of overcorrection and related factors after surgery in pediatric patients with basic intermittent exotropia (XT). METHODS: Retrospective chart reviews of the medical records of patients who underwent bilateral lateral rectus recession for basic XT were analyzed. Preoperative age, sex, angle of deviation (prism diopters [PD]), and suppression at distance were measured. Patients were observed every week when the angle of deviation was > 2 PD of overcorrection at postoperative day 1. Recovery of overcorrection was defined as improvement of overcorrection with orthotropia. Patients were divided into two groups according to age: younger (group 1) and older (group 2) than 10 years of age. Success was defined as an angle of deviation between 10 PD of exodeviation and 5 PD of esodeviation at the final visit. RESULTS: A total of 88 patients were included. At postoperative day 1, the angle of deviation at distance was −6.9 ± 2.2 PD, and the near angle of deviation was −6.9 ± 2.4 PD. Esodeviation presented as a minus value. The recovery period of overcorrection was 1.9 ± 3.9 weeks and the success rate was 80.7% (71 patients). The success rates of group 1 and group 2 were not statistically significant (p = 0.51). The recovery period of overcorrection in group 2 (2.7 ± 5.9 weeks) was significantly longer than in group 1 (1.8 ± 3.4 weeks) (p = 0.02). CONCLUSIONS: In pediatric adolescents with basic XT, the surgical success rates did not differ significantly according to age, but recovery of overcorrection after strabismus surgery took longer in patients ≥ 10 years of age.
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Adolescent , Humans , Esotropia , Exotropia , Medical Records , Retrospective Studies , StrabismusABSTRACT
@#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.