Efectividad de la cirugía monocular en la exotropía sensorial de gran ángulo / Effectiveness of the surgery monocular in the sensorial exotropia of great angle

La exotropía sensorial se define como una desviación ocular divergente unilateral o bilateral, dada por anomalías oculares congénitas o adquiridas; es más frecuente en adultos. El objetivo de la cirugía de estrabismo en el adulto es restablecer la visión binocular, reduciendo la diplopía y al lograr el alineamiento ocular, mejorar su estética, por lo que antes de realizar la cirugía se debe tratar la causa que provoca la baja visión. El procedimiento quirúrgico de elección es la cirugía monocular, pero si la desviación es grande se realizará cirugía binocular. Se presenta una paciente femenino de 25 años de edad portadora de lentes de contacto por miopía elevada del ojo derecho (9,00 -0.75 x 105º con 0,2 de agudeza visual mejor corregida), exotropía de más de 25º por Hirschberg, limitación de aducción del ojo derecho y por método de oclusor y prismas a 6 metros sin cristales y con sus lentes de contacto, ambos ojos 50 ∆ b interna, no estereopsia y suprime ojo derecho. Por todas las ventajas que presenta la cirugía monocular, se decidió realizarla en el ojo derecho, se colocó anestesia local peribulbar, se realizó recesión amplia del recto lateral a 12 mm y se realizó 8 mm de resección del recto medial; en el postoperatorio se logró 10 ∆ b interna y por momentos ortotropia; refirió diplopía post quirúrgica que resolvió espontáneamente. Los resultados quirúrgicos en la exotropía sensorial son menos alentadores ya que con el tiempo pueden evolucionar hacia la hipercorrección o hacia la recurrencia(AU)

Sensory exotropía is defined as a unilateral or bilateral divergent ocular deviation, given by congenital or acquired ocular anomalies, and is more frequent in adults. The objective of the strabismus surgery in adults is to reestablish binocular vision, reduce diplopía, improve ocular alignment and enhance quality of life; before performing surgery the cause of low vision should be treated. The preferred surgical procedure is a monocular approach, but if there is a large deviation a binocular procedure should be performed. The case presented Is a 25 year-old female with high myopia of the right eye (-9.00 -0.75 x 105º with 0.2 of best corrected visual acuity), exotropía of more than 25º for Hirschberg, limitation of aducción of the right eye and with both the oclusor method and prisms to 6 meters without glasses and with her contact lenses, both eyes have 50∆ of internal base, no estereopsia and suppression of the right eye. For its advantages a monocular approach (of the right eye) was preferred, with peribulbar anesthesia: recession to 12mm of the lateral rectus combined with 8 mm of resection of the medial rectus; in the postoperative she presented a 10∆ intern base deviation and for moments ortotropia; she referred diplopia that solved spontaneously. The surgical results in sensory exotropía are less encouraging since they have higher hypercorrection and recurrence rates(AU)

Outcome of monocular surgery for horizontal strabismus in Hyderabad.

BACKGROUND AND OBJECTIVE: Squint surgery is frequently performed successfully in Hyderabad. However, no study in any detail has been performed on the outcome of monocular surgery for horizontal squint in the region. This study aims to determine the results of monocular surgery for horizontal trabismus. DESIGN: Retrospective/observational study. SUBJECTS AND METHODS: The study was conducted on patients aged under 45 years, presenting with horizontal strabismus and undergoing monocular squint surgery. Anterior segment slit lamp examination, and if possible, posterior segment examination with 90 diopter (D) and 78 D fundoscopes was performed. Angle of deviation was measured. Patients were divided into two groups (esotropia and exotropia). Investigations were performed. Surgery was done under general anesthesia. A second surgical procedure was performed after six months for any residual deviations. RESULTS: After squint surgery, patients in group 1 (79%) and in group 2 (73.3%) had residual deviation of less than 15 prism diopters (PD). The preoperative deviations of 60 PD or less illustrated excellent domino effects with residual deviation of fewer than 15 PD. Three patients with successive deviation underwent a second surgery with excellent outcomes. CONCLUSION: Few extraocular muscles can be prevented due to monocular squint surgery when multiple surgeries are needed.