The Effect of Preoperative Occlusion Therapy on Long-term Outcome after Surgery for Early-onset Exotropia.

PURPOSE: To investigate the effect of preoperative part-time occlusion therapy on long-term surgical success in early-onset exotropia. METHODS: The medical records of patients who underwent surgery for exotropia with onset before the first year of age and who were followed for ≥3 years were reviewed. Patients were divided into two groups according to the degree of compliance with part-time occlusion therapy: the good compliance group (>50% adherence rate) and the poor compliance group (≤50% adherence rate). Surgical success was defined as orthophoria to exodeviation less than 10 prism diopters both at distance and near. The level of postoperative stereopsis was compared between the two study groups among total enrolled patients and among those with constant exotropia. RESULTS: Of the 51 patients, 26 were assigned to the good compliance group and the remaining 25 patients to the poor compliance group. The surgical success rate was significantly higher in the good compliance group than in the poor compliance group (80.8% vs. 52.0%, p = 0.040). Among 24 constant exotropia patients (12 patients for each group), the success rate was insignificantly higher in the good compliance group than in the poor compliance group (75.0% vs. 58.3%, p = 0.448). The good compliance group had a better level of stereopsis than the poor compliance group (p = 0.045 for all 44 patients, p = 0.020 for 19 patients with constant exotropia). CONCLUSIONS: Preoperative part-time occlusion therapy was useful for improving the surgical outcome of early-onset exotropia and postoperative stereopsis.

The impact of intermittent exotropia and surgery for intermittent exotropia on myopic progression among early school-aged children with myopia.

AIM: To investigate the relationship between myopic progression and intermittent exotropia, and the impact of surgery for exotropia on myopic progression in early school-aged children (from 7 years to 12 years of age). METHODS: Medical records of early school-aged patients with myopia were reviewed. Patients were divided into three groups; (A) Patients with intermittent exotropia and myopia at presentation and who underwent bilateral lateral rectus muscle recession for exotropia when 7-12 years old; (B) Patients with intermittent exotropia and myopia at presentation and who were merely observed for exotropia; and (C) Patients with myopia and straight ocular alignment. Main outcome measurements were the simple rate of myopic progression per year, the preoperative and postoperative rates of refractive growth with regards to the logarithmic age model in Group A, and the rate of high myopia development at the end of the early school period. RESULTS: The rates of myopic progression were -0.43±0.14 dioptre (D) per year in Group A, -0.49±0.17 D/year in Group B and -0.42±0.24 D/year in Group C. There was no significant difference in the rate of myopic progression among three groups. There was no significant intergroup difference in the preoperative and postoperative rates of refractive growth in Group A. There were no significant intergroup differences in the rates of high myopia development among three groups. CONCLUSIONS: Whether patients with intermittent exotropia underwent surgical correction for intermittent exotropia did not influence the rate of myopic progression. There was no significant difference in the rate of myopic progression between patients with accompanying intermittent exotropia and myopia and those with myopia alone.

Intracameral illuminator-assisted advanced cataract surgery combined with 23-gauge vitrectomy in eyes with poor red reflex.

PURPOSE: To evaluate the efficacy and outcomes of intracameral illuminator-assisted advanced cataract surgery combined with 23-gauge vitrectomy in eyes with a poor red reflex. SETTING: Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea. DESIGN: Interventional case series. METHODS: Surgeon-controlled intracameral illumination was used for visualization during combined cataract surgery and 23-gauge vitrectomy. The main outcome measures were causes of the poor red reflex, value of the intracameral illuminator in specific cataract steps, and intraoperative and postoperative complications. RESULTS: The study comprised 17 patients (17 eyes). The main causes of a poor red reflex were vitreous hemorrhage in 8 eyes, vitreous opacity in 6 eyes, and corneal opacity, bullous retinal detachment, and globe deviation in 1 eye each. Horizontal or oblique intracameral illumination minimized the amount of corneal scatter and reflection of the illuminating light and provided high-quality intraoperative lens images in most surgical steps. In addition, excellent visibility of the lens capsules facilitated the removal of almost all lens epithelial cells from the capsular bag. In all eyes, completion of the capsulorhexis and in-the-bag implantation of an intraocular lens were accomplished. In 1 eye, a radial anterior capsule tear occurred during irrigation/aspiration. Postoperatively, the rate of anterior capsule opacification was 11.8% (2/17 eyes) and of posterior capsule opacification, 23.5% (4/17 eyes). CONCLUSIONS: Surgeon-controlled intracameral illumination provided excellent imaging and almost 360-degree visualization of the lens capsule structures. This capability can be used for challenging cataract surgery combined with vitrectomy in eyes with a poor red reflex. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.