Outcomes of intermittent exotropia surgery.

PURPOSE: To study the epidemiological and clinical characteristics of intermittent exotropia and to describe our therapeutic choices as well as their results and prognostic factors. MATERIALS AND METHODS: This was a retrospective study including 57 cases of intermittent exotropia. All patients underwent a complete ophthalmological examination with a sensory-motor assessment. Surgery was performed by the same surgeon, and the vertical component was addressed surgically at the same time as the exotropia. Statistical analysis was performed using SPSS software version 21.0. RESULTS: Our patients were classified as basic exotropia in 46 cases (80.7%), divergence excess in eight cases (14.1%), and convergence insufficiency in three cases (5.2%). Amblyopia was found in 26% of cases. The preoperative maximum angle of deviation was 36.5DP±9.1DS and a vertical component was found in 16 patients (28%). The most common was V pattern (8 patients). The mean age at the time of surgery was 14.8 years old. After a single surgery, we obtained motor success in 78.9% of the patients. Three patients were re-operated, with an overall motor success of 84.2%. CONCLUSIONS: Motor and sensory success may be achieved in intermittent exotropia. Rigorous, early management is necessary, even if tropic episodes are still rare. The rate of early consultation among children is still low in our country; thus, a national strabismus screening program must be established to obtain the best results.

Outcomes of surgery in patients with sensory exotropia.

INTRODUCTION: Sensory exotropia is often due to profound amblyopia. Surgery essentially aims to improve aesthetic appearance and quality of life. Our goal was to discuss clinical features of sensory exotropia as well as surgical indications and outcomes. METHODS: Medical records of 43 patients who underwent sensory exotropia surgery were retrospectively reviewed. Each patient had an ophthalmological examination and a complete sensorimotor assessment. All surgeries were performed by the same surgeon. We studied the influence of certain prognostic factors on motility outcomes, such as age of onset of strabismus, gender, delay of surgical management, degree of amblyopia, angle of deviation, and amount of recession/resection. RESULTS: The mean follow-up was 2.3 years. All of our patients had severe amblyopia. An abnormal retinal correspondence with no fusion or stereopsis was noted in all subjects. The mean angle of deviation was 44.5 PD±12.4 SD preoperatively. The alignment success rate after a single procedure was 65.1%. Eight patients developed recurrent exotropia and were reoperated, with a final alignment success rate of 74.4%. CONCLUSIONS: Sensory exotropia is characterized by a large angle of deviation and an altered sensory status. The overall goal of surgery is to improve the patient's aesthetics and quality of life by treating the maximum angle of deviation. Surgical outcomes are often satisfactory for the patients, but certain complications may occur, such as diplopia, enopthalmos, and recurrences.

Oculomotor palsy in diabetics.

INTRODUCTION: Oculomotor palsy is one of the most frequent neuro-ophthalmologic complications of diabetic patients. It generates less interest in the literature than the other ocular manifestations. Our goal was to study the clinical, epidemiological, therapeutic and prognostic characteristics of oculomotor palsy in the diabetic. METHODS: This is a retrospective study of 24 diabetic patients with oculomotor palsy. The ophthalmological examination emphasized ocular motility. We performed an orthoptic assessment and a Hess-Lancaster test. Neuro-imaging was ordered in case of IIIrd and IVth nerve involvement, bilateral involvement, multiple ocular cranial nerve palsy or associated optic neuropathy. Treatment consisted of glucose management and alternating monocular occlusion or prisms for the diplopia. Data were entered and analyzed on SPSS 11.5 software. RESULTS: The mean age of the patients was 58.5±11.9 years. Binocular diplopia was the main symptom. The oculomotor palsy involved the VIth nerve in 50% of cases and was bilateral in two cases. Three patients also had an optic neuropathy. The mean duration of diabetes was 11.7±11 years; poorly controlled diabetes was found in 75% of cases and an association with diabetic retinopathy was noted in 56% of cases. CONCLUSIONS: Long-standing uncontrolled type 2 diabetes, hypertension, coronary artery disease, left ventricular hypertrophy, and elevated hematocrit are the most common risk factors. The VIth nerve is commonly involved. Certain characteristics of the pupillary light reflex can help to differentiate an ischemic insult from an aneurysmal injury to the IIIrd nerve.