Effect of perioperative synoptophore training on postoperative restoration of visual function in patients with constant exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of perioperative synoptophore scintillation training on postoperative restoration of binocular visual function in patients with constant exotropia.<p>METHODS: We retrospectively reviewed 68(136 eyes)patients with constant exotropia, who successfully underwent surgical ophthalmological treatment from January 2017 to March 2021. Patients were divided into group A(n=35 cases, 70 eyes)and group B(n=33 cases, 66 eyes)according to whether or not they received perioperative synoptophore scintillation training. Group A included 19 males(38 eyes)and 16 females(32 eyes)(mean age: 29.34±12.72 years). Group B included 13 males(26 eyes)and 20 females(40 eyes)(mean age: 30.12±8.75 years). One month postoperatively, the patients were examined with a synoptophore, and the restoration of simultaneous vision, fusion function, and stereoscopic function were compared between the two groups.<p>RESULTS: There were no significant differences in age, sex, and preoperative far and near deviations between the two groups(P>0.05). Postoperatively, the restoration rates of simultaneous vision, fusion function, and stereoacuity were 54%, 54%, and 43% in group A, respectively. And 27%, 27%, and 15% in group B, respectively. Statistically, there were respectively significant differences between the two groups(χ2=5.117, 5.117, 6.280; all P<0.05).<p>CONCLUSION: Perioperative synoptophore scintillation training can effectively improve the binocular vision function of adult patients and older children(>12 years)with constant exotropia without binocular vision function and enhance the therapeutic effect of surgery.

Surgical Outcomes of Intermittent Exotropia According to the Constancy

PURPOSE: To investigate how the constancy of intermittent exotropia affects postoperative motor and sensory outcomes. METHODS: A retrospective analysis was conducted of 44 patients with intermittent exotropia (IXT group) and 16 patients with constant exotropia with a previous history of intermittent exotropia (CXT group). All patients were followed up for more than 1 year postoperatively. Successful postoperative motor alignment was defined as within 8 prism diopters of exo- or esotropia at 6 meters and 33 centimeters. Successful sensory outcome (bifixation) was considered as stereoacuity < or =60 seconds of arc. The influence of constancy, age at surgery, duration of strabismus, preoperative gross stereopsis, preoperative distant deviation, and preoperative distant fusion to surgical outcomes were evaluated using logistic regression analysis. RESULTS: Mean age at surgery and follow-up periods was 9.34 years and 37.8 months in the IXT group, and 10.19 years and 45.7 months in the CXT group. Successful motor alignment rates of the IXT and CXT groups were 65.9% and 48.3%, respectively. Postoperative bifixation rates of the IXT and CXT groups were 70.5% and 12.5%, respectively. The IXT group showed significantly better successful sensory outcome (p = 0.000), but no significant difference in motor outcome (p = 0.121). Constancy and preoperative distant fusion were associated with post-operative bifixation in univariate regression analysis (p = 0.001, 0.025, respectively). However, only the constancy was strongly associated with successful sensory outcome in multivariate regression analysis with an odds ratio of 20.138 (p = 0.008). CONCLUSIONS: Surgical correction of intermittent exotropia during the intermittent period showed better sensory outcome than in constant deviation period.

Clinical Findings of Constant Exotropia Developed from Intermittent Exotropia

PURPOSE: To investigate clinical characteristics of constant exotropia patients with a previous history of intermittent exotropia. METHODS: Constant exotropia patients (CXT) with a previous history of intermittency, and intermittent exotropia patients (X [T]) who had undergone surgery for exotropia were included in the present study. Patching therapy of the fixating eye was performed for all patients. Surgical results, the effect of patching, lateral incomitancy, and suppression were retrospectively reviewed and compared between the 2 groups. RESULTS: The number of CXT was 51 and X (T) was 84. The angles of deviation at the initial visit and at surgery were significantly larger in CXT. After 3 months of patching therapy, there was no difference between the 2 groups in the reduction of distant angle of deviation. However, the reduction of near angle of deviation was 0.29 +/- 5.44 in CXT and 4.42 +/- 6.26 Delta in X (T), which was significantly different (p = 0.04). Lateral incomitancy was observed in 7.8% of CXT and 34.5% of X (T) (p < 0.001). The angles of deviation at the final visit and surgical success rate were not different between the groups. Preoperative suppression at distant was found in 100% of CXT and 88.7% of X (T), and postoperative suppression was in 17.6% and 18.3%, respectively. CONCLUSIONS: The surgical success rate and postoperative suppression were not different between constant exotropia and intermittent exotropia. However, the frequency of lateral incomitancy and the response to the patching therapy was lower in constant exotropia.

Clinical Course and Outcome of Infantile Exotropia

PURPOSE: To evaluate the clinical course and surgical outcome of infantile exotropia with large and constant angle, as defined by the onset of exotropia before 6 months. METHODS: We reviewed the records of 11 patients who were diagnosed with infantile exotropia and received surgery between July 1987 and December 2003. Age at onset and surgery, visual acuity, refractive error, pre- and post-operative angle of strabismus, and binocular sensory status after surgery were evaluated for each patient. RESULTS: The mean age at onset, diagnosis, and first surgery was 2.3 months (range, birth to 5 months), 14.9 months (range, 4 to 33 months), and 36.3 months (range, 11 to 45 months), respectively. The mean size of preoperative exodeviation was 57.3 prism diopters (PD) (range, 40 to 100 PD). Six patients (54.5%) required reoperation to correct residual or recurred exotropia, oblique dysfunction, and/or DVD. Two (18.2%) of the six required a third operation. Sensory tests including Lang test were performed in seven patients but all failed in Lang test and showed no fusion even with successful surgical treatment. CONCLUSIONS: Infantile exotropia should be observed for a long period and needs proper reoperation because it may be frequently associated with residual or recurred exotropia, oblique dysfunction, and/or DVD after initial operation. However, improvement of binocular function can rarely be expected even with successful surgical alignment.

Surgical Results in Constant Exotropia According to Fixation Patterns

Surgical results of 59 patients with constant exodeviation having at least 2 months of follow-up were reviewed. Fifty nine cases of constant exodeviation were classified by fixation patterns into alternating exotropia 38 cases and monocular exotropia 21 cases. The final surgical results and success rates were compared between the 2 groups and were analyzed according to the length of postoperative follow-up period. The surgical results were as follows: in alternating exotropia, 63.2% was satisfactory, 28.9% undercorrected and 7.9% overcorrected, in monocular exotropia, 85.7% was satisfactory, 9.5% undercorrected and 4.8% overcorrected. The mean follow-up period was 5.3 months in alternating exotropia and 5.9 months in monocular exotropia. Final surgical results were not affected by the length of postoperative follow-up period in alternating exotropia. However, in monocular exotropia, there was a strong tendency to become exotropic with a long term follow-up period(2-17 months). We suggest that the fixation patterns could have an influence on postoperative stability in exodeviation.

Surgical Results in Constant Exotropia According to Fixation Patterns

Surgical results of 59 patients with constant exodeviation having at least 2 months of follow-up were reviewed. Fifty nine cases of constant exodeviation were classified by fixation patterns into alternating exotropia 38 cases and monocular exotropia 21 cases The final surgical results and success rates were compared between the 2 groups and were analyzed according to the length of postoperative follow-up period. The surgical results were as follows: in alternating exotropia, 63.2% was satisfactory, 28.9% undercorrected and 7.9% overcorrected, in monocular exotropia, 85.7% was satisfactory, 9.5% undercorrected and 4.8% overcorrected. The mean follow-up period was 5.3 months in alternating exotropia and 5.9 months in monocular exotropia. Final surgical results were not affected by the length of postoperative follow-up period in alternating exotropia. However, in monocular exotropia, there was a strong tendency to become exotropic with a long term follow-up period (2-17 months). We suggest that the fixation patterns could have an influence on postoperative stability in exodeviation.