Cases Of Exotropia Research Articles

Incidence, Risk Factors and Management of Postoperative Complications in Horizontal Strabismus Surgery

ABSTRACT Objective To report the incidence, risk factors and management of postoperative complications after horizontal strabismus surgery. Design Retrospective Cohort study. Participants The study assessed 1,273 patients with 1,035 cases of exotropia and 238 cases of esotropia, with a minimum 18-month follow-up. Methods Retrospective review of strabismus operation patients’ medical records included baseline demographics, age at surgery, pre/postoperative visual acuity, and deviation. Complications were categorized as surgical site (infection, scarring, cyst, granuloma, ischemia) and strabismus-related (recurrence, diplopia), with analysis of incidence, risk factors, and management. Results Among surgical site complications, the incidence of infection, pyogenic granuloma, and anterior segment ischemia were similar between the exotropia (0.3%, 0.3%, 0.2%) and esotropia (0.8%, 0%, 0.4%) groups (p = .221, 0.406, 0.515). In contrast, the esotropia group presented a higher risk of conjunctival inclusion cyst and conjunctival scar than the exotropia group, with incidences of 5.0% vs 2.2% and 6.3% vs 1.3%, respectively (p = .004, <0.001). Regarding strabismus complications, the incidence of early recurrence was not significant between the two groups, with 10.0% in the exotropia group and 10.5% in the esotropia group (p = .553). Older age and poor initial visual acuity were associated with early recurrence (p < .001). The esotropia group had a higher risk of persistent diplopia than the exotropia group, with incidences of 4.2% vs 2.0%, respectively (p = .003). Conclusion Esotropia carries a higher risk of conjunctival inclusion cysts, conjunctival scarring, and persistent diplopia compared to the exotropia group, while both groups exhibit similar rates of early recurrence and other surgical site complications.

Evaluation of clinical characteristics and risk factors of strabismus cases.

Strabismus, defined as the misalignment of the eyes, is a common disorder that is usually diagnosed in childhood. Strabismus is an important health problem with both functional and psychosocial effects on children. In this study, we aimed to determine the clinical features and risk factors of patients diagnosed with strabismus and followed up in our clinic. The data of pediatric patients who were followed up in our strabismus clinic between February 2016 and September 2022 were retrospectively reviewed. The patients' detailed ophthalmological and strabismus examination findings and anamnesis findings concerning the etiology of strabismus were recorded. A total of 391 patients were enrolled in the study. The mean age of the patients was 8.66±4.7 years. Of the patients, 207 (52.9%) had esotropia, 172 (43.99%) had exotropia, and 12 (3.07%) had vertical deviation, with the mean ages of these groups being calculated as (7.27±4.1), (10.45±4.8), and (7.16±4.7) years, respectively. Amblyopia was present in 54 (26.09%) of the 207 esotropia cases, 27 (15.70%) of the 172 exotropia cases. Esotropia is more likely than exotropia to be related to amblyopia, according to our research. Of all the patients, 97 (24.81%) had a family history of strabismus, 38 (9.7%) had a history of preterm birth, 39 (10.0%) had a history of neonatal care unit stay, 38 (9.7%) had epilepsy, 4 (1%) had a history of trauma, and 14 (3.6%) had an additional eye disease. Detection of risk factors such as family history, preterm birth, length of stay in the neonatal care unit and epilepsy that may be associated with strabismus can help identify high-risk children for early diagnosis and treatment.

Transplante autólogo de músculo ocular extrínseco para tratamento cirúrgico de estrabismos sensoriais grandes

We report 13 cases of large angle sensory strabismus treated with autologous graft of extraocular muscle. Recession-resection procedure of the horizontal rectus muscles was performed, and the flap from the resected muscle was sutured to the weakened muscle as an autologous expander. Six cases of exotropia and seven of esotropia, with mean prism diopter deviation of 75 (range of 70-90). There was significant improvement in the postoperative deviation, and mean prism diopter of 10.07 (range of no deviation to [...]

Correction of exotropia and improved adduction by fixation of the anterior encircling fascia to the medial rectus insertion site following myectomy of the four horizontal rectus muscles for infantile nystagmus

Myectomy of the four horizontal rectus muscles for infantile nystagmus syndrome without a null point may improve visual acuity and quality of life. Exotropia and adduction loss are complications of this procedure, although abduction is typically preserved. We investigated whether adduction loss may be rescued by reestablishing the attachment of the anterior intermuscular septum (AIMS) to the globe at the medial rectus insertion. We present 2 cases of exotropia and adduction loss following myectomy and transposition surgery, where the nasal AIMS and the medial rectus insertion site were joined with nonabsorbable polyester suture. Both patients experienced improvements in eye alignment and adduction. Based on radiologic observations of the posterior displacement of the pulley, or posterior intermuscular septum (PIMS), with medial rectus contraction, we hypothesize that adduction and alignment were improved by providing an anterior site of action for the posterior movement of the PIMS.

The effects of simultaneous operation on dissociated vertical deviation with horizontal and torsional strabismus.

To investigate the therapeutic effects of simultaneous horizontal and vertical operations on dissociated vertical deviation (DVD) associated with other deviations. Forty-five cases of DVD with horizontal and torsional strabismus underwent combined operation were collected retrospectively. All clinical records were analyzed. All patients were followed up for 6 to 24mo. Wilcoxon signed-ranks test was performed to evaluate the changes of vertical and horizontal deviation. χ 2 test was used to evaluate the changes of binocular visual function. Forty-five cases included 36 patients with intermittent exotropia and binocular inferior oblique overaction (IOOA), 5 patients with concomitant esotropia and binocular IOOA, 4 patients with intermittent exotropia and monocular superior oblique palsy. The superior rectus recession (SRR) combined with horizontal rectus recession and the myectomy of inferior oblique or anterior transposition were operated simultaneously to correct all types of strabismus. There were 43 cases who achieved normal eye position in vertical direction, while 2 cases were with undercorrection of 5Δ to 6Δ. In patients with horizontal strabismus, 2 cases of exotropia were with overcorrection of 6Δ to 8Δ, 1 case of esotropia was with undercorrection of 6Δ, and 1 case of monocular superior oblique palsy with compensatory head posture was not significantly improved. The binocular visual function of most patients recovered after operation. The difference of the binocular visual function and eye position were significant compared with that before operation (P<0.05). The simultaneous operation on DVD with horizontal and torsional strabismus is successful.

Outcomes of bilateral lateral rectus recession in treatment of recurrent exotropia after bilateral medial rectus resection.

To report the results of bilateral lateral rectus muscle recession for recurrent exotropia in cases where the primary surgery was a bilateral medial rectus resection. Retrospective chart review of 15 subjects who completed 6 months of follow-up. Data collected included patients' demographics and pre- and post-operative measurements of ocular alignment and motility. Surgical nomogram used was the same nomogram we use for primary cases of exotropia. At 6-month follow-up, 73.3% of cases had a successful surgical outcome (defined as 8 PD of esotropia to 10 PD of exotropia). In addition, recession of lateral rectus muscles against the previously resected medial recti did not result in a significant increase in the limitation of abduction. Bilateral lateral rectus recession using standard surgical tables is a safe and effective method for treating recurrent exotropia following bilateral medial rectus resection. Even large primary resections up to 12 mm do not seem to affect the results of bilateral lateral rectus recession.

The accuracy of wide-field ultrasound biomicroscopy in localizing extraocular rectus muscle insertions in strabismus reoperations

To compare the accuracy of widefield ultrasound biomicroscopy (UBM) with mechanical intraoperative measurements of the distance between rectus muscle insertions and the corneal limbus in strabismus reoperations. Subjects with a history of horizontal rectus muscle surgery who required further surgery on horizontal rectus muscle(s) were recruited prospectively. All widefield UBM measurements were carried out under topical anesthesia using a 50 MHz linear probe without immersion cup and external caliper. The insertion angle distance was measured using the caliper tool of the UBM device; the actual muscle insertion distance from the limbus was considered to be the measured distance plus 1 mm. The distance from muscle insertion to the limbus was also measured intraoperatively. The results of UBM and surgical measurements were compared. A total of 28 subjects were recruited, and 53 horizontal muscles (30 medial rectus, and 23lateral rectus muscles) were included. The longest distance of the muscle insertion from limbus detectable on UBM was 13 mm for the medial rectus muscle and 15 mm for the lateral rectus muscle. In 38 muscles (71.7%) UBM and surgical measurements were within 1 mm of each other. Only in 1 muscle (1.9%) was the difference between measurements >2 mm (2.3mm). The intraclass correlation coefficient was 0.87, demonstrating excellent agreement between measurements. Limit of agreement analysis demonstrated better agreement between measurements of medial rectus muscles and in consecutive exotropia cases. This study demonstrated good agreement between intraoperative and widefield UBM measurements of the muscle insertion-limbus distance in our patient cohort.

The prevalence and types of strabismus, and average of stereopsis in Japanese adults.

Few studies report the prevalence and types of strabismus, or average of stereopsis in Japanese adults. We performed ophthalmological evaluation including motility and stereopsis during medical examinations at cooperative companies. We studies 1214 volunteers. The average age was 41.2±12.6 (range 20-86)years. Examinations were carried out using their customary eyewear, evaluating alternate prism cover test (APCT), and Titmus stereo test (TST). The mean horizontal angle at near distance (1/3m) was 8.1±6.0 Prism Diopter (PD), and vertical angle was 0.09±1.0PD. The total number of cases who had intermittent or constant tropia was 44 (3.6%), and the ratio of exotopia to esotropia (XT:ET ratio) was 18.5:1. The mean horizontal angle at far distance (5m) was 3.9±3.7PD, and vertical angle was 0.09±1.7PD. The total number of cases who had intermittent or constant tropia was 21 (1.7%), and the XT:ET ratio was 7:1. The average TST was 50.1±1.6arcsec. 7.3% (n=89) of the cases did not reach 100arcsec. We report detailed strabismus and stereopsis in Japanese adults. The XT:ET ratio was 18.5:1 in near distance, 7:1 in far distance. In our study, more than 60% of the cases of exotropia were convergence insufficiency type, and this may be a characteristic in Japanese adults.

Cerrahi Sonrası Başarılı Primer Ekzotropya Olgularında Doz-Cevap Sonuçları

Cerrahi Sonrası Başarılı Primer Ekzotropya Olgularında Doz-Cevap Sonuçları

A Case of Exotropia with Convergence Insufficiency due to Right Parieto-occipital Lobe Hemorrhage

A Case of Exotropia with Convergence Insufficiency due to Right Parieto-occipital Lobe Hemorrhage

Strabismus in Childhood Eyelid Ptosis

To report the prevalence and causes of strabismus in children with eyelid ptosis diagnosed in a well-defined population over a 40-year period. Retrospective, population-based cohort study. We retrospectively reviewed the charts of 107 patients (<19 years) for the prevalence and causes of strabismus in children who were diagnosed with childhood eyelid ptosis as residents of Olmsted County, Minnesota, from January 1, 1965, through December 31, 2004. Strabismus was diagnosed in 20 (18.7%) of the 107 patients with childhood ptosis. Of the 81 patients, 8 (9.9%) were diagnosed with simple congenital ptosis and had strabismus, of which there were 4 (4.9%) cases of exotropia and 4 (4.9%) cases of esotropia. There were no cases of isolated vertical deviation. Strabismus occurred in 1 of 5 children diagnosed with any form of childhood ptosis in this population-based cohort. Strabismus affected approximately 1 of 10 patients diagnosed with simple congenital ptosis, and a predominance of isolated horizontal deviations was equally divided between esotropia and exotropia.

Graded anterior transposition of the inferior oblique muscle for V-pattern strabismus

To evaluate the efficacy of bilateral graded anterior transposition of the inferior oblique muscle for the correction of V-pattern strabismus associated with inferior oblique overaction. Medical records of patients who underwent graded anterior transposition of the inferior oblique muscle for bilateral primary inferior oblique overaction associated with V-pattern strabismus were reviewed. The surgical technique entailed recessing and anteriorly transposing the inferior oblique muscle to various locations along the temporal border of the inferior rectus muscle. The amount of anterior transposition was determined by both the severity of the overaction and the extent of the V pattern. We analyzed the changes in inferior oblique muscle overaction and V-pattern strabismus and the frequency of limited elevation after surgery. The record review identified 69 patients (138 eyes) who met inclusion criteria. V-pattern esotropia was present in 44 patients (64%) and V-pattern exotropia in 25 (36%). Full correction or undercorrection to <10(Δ) of V pattern was achieved in 82% of esotropia cases and 80% of exotropia cases. Response to surgery was influenced by the severity of the preoperative inferior oblique muscle overaction and the extent of the preoperative V pattern. The grading of the anterior transposition was not a significant independent predictor of surgical response. No patient suffered limitation of elevation postoperatively. Anterior transposition of the inferior oblique muscles corrected V-pattern strabismus and reduced inferior oblique muscle overaction without creating limitation of elevation; however, it is unclear whether grading the transposition contribute to the success of the procedure.

Defectos refractivos en una población infantil escolarizada en Bogotá DC

Objetivo: describir la frecuencia y distribución de los diferentes tipos de errores refractivos en una población infantil escolarizada de Bogotá DC. Metodología: estudio de corte transversal que incluyó niños escolares de un colegio de Bogotá DC hasta segundo grado de primaria, cuyos padres o acudientes firmaron el consentimiento informado: La valoración fue realizada por residentes de oftalmología y optómetras del Hospital de San José, con ayuda de un autor refractómetro para buscar la prevalencia de defectos refractivos. Resultados: se analizaron 109 niños entre 4 y 9 años, encontrándose la mayoría entre 6 y 7 años. El defecto refractivo esférico más frecuente fue astigmatismo (15,1%), seguido por hipermetropía (13,8%) y miopía (2,3%). Hubo sospecha de ambliopía (agudeza visual corregida peor de 20/40) en el 2 1,5% de la población. El 11% presentó estrabismo, encontrando 9 casos de exotropia y 3 de endotropia. Conclusiones: se encontró un alto porcentaje de niños con disminución de la agudeza visual, siendo muy pocos los que han recibido una valoración oftalmológica u optométrica previas a pesar de ser obligatorias en el país. Se insiste en la necesidad de vigilar el cumplimiento estricto de los programas gubernamentales de salud visual en Bogotá DC y en el resto del país.

Characteristics of divergence excess type intermittent exotropia in Asian children

Exotropia is twice as common as esotropia in Asian children, with divergence excess intermittent exotropia contributing more than one half of exotropia cases. In this study, distance-near relationships and ratios of accommodative convergence to accommodation (AC/A) are compared using different measurement methods in Asian children with divergence excess intermittent exotropia. Children with intermittent exotropia and a distance deviation exceeding the near by at least 10(Δ) were consecutively recruited. After prism cover test measurements at 6 m and 33 cm, AC/A ratios were calculated using the heterophoria method and the gradient method with -2.0 D and +3.0 D lenses at 6 m and 33 cm, respectively. AC/A ratios were recalculated after 1 hour of monocular patching. A total of 42 children (mean age, 6.9 years; range, 3-16 years) were included. The mean difference between distance and near deviation was 22(Δ) before occlusion and 14(Δ) after (P < 0.001). Approximately one third had a distance-near difference <10(Δ) after occlusion. With the heterophoria method, 100% of patients had high AC/A ratios before occlusion, with 71% continuing to have high AC/A ratios after. With the gradient method, 52% of patients had high AC/A ratios before occlusion, with 68% of this subgroup continuing to have high AC/A ratios after. Pseudo-divergence excess was found in one third of the subjects. More children were diagnosed with high AC/A ratios using the heterophoria method than with the gradient method. Without monocular occlusion, approximately one third of the children with normal AC/A ratios may be mistaken to have high AC/A ratios when measured with either method. Identification of high AC/A ratio exotropic patients is critical due to the risk of developing consecutive esotropia at near after strabismus surgery.

Perinatal risk factors for strabismus

Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype. Orthoptists reviewed ophthalmological records for Danish National Birth Cohort (DNBC) children examined for strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for strabismus overall and by strabismus subtype, respectively. Among 96,842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for strabismus. Ophthalmological records were available for 5655 of these children, of whom 1321 were diagnosed with strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had congenital abnormality. Although not associated with esotropia, delivery by Caesarean section was associated with exotropia (relative risk = 1.65; 95% confidence interval 1.16-2.34). After adjustment for birth weight, Apgar score at 5 min, multiple gestation and parental ages were not associated with strabismus overall. Congenital abnormalities, low birth weight, prematurity and large head circumference were independent risk factors for strabismus. Differences in risk factors for esotropia and exotropia suggest that strabismus subtypes may have different underlying aetiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital abnormality.

Clinical Audit of Horizontal Strabismus Surgery in Children in Maharashtra, India

Background: The study aimed to audit the results of horizontal strabismus surgery in the hospital’s pediatric ophthalmology department in Maharashtra, India.Method: Medical records of strabismus surgeries done over 3 years were collated. Preoperative visual acuity, deviation, refraction, and orthoptic evaluation were noted as well as post-operative residual deviation and patient satisfaction. Post-operative residual deviation ≤ 10Δ was considered good outcome, 11–20Δ borderline, and > 20Δ was considered poor outcome. The surgeons were briefed about their results periodically and the cause of poor outcomes discussed.Result: Between March 2004 and December 2007, 529 children were operated upon, of whom 461 (87.1%) completed the 6-week follow-up. Average age was 9 years 7 months (range 1–19 years). 260/461 (56.3%) patients had good, 100/461 (21.6%) borderline, and 101/461 (21.9%) had poor outcome. 133/231 (57.6%) cases of esotropia and 127/230 (55.2%) cases of exotropia had a good outcome, while the poor outcome was 50/231 (21.6%) and 51/230 (22.1%), respectively. Bilateral medial rectus recession for esotropia had 25/56 (44.6%) good outcome and 15/56 (26.7%) poor outcome, while recess-resect procedures (R/R) for esotropia had 108/175 (61.7%) good and 35/175 (20%) poor outcome (p = 0.062). Bilateral lateral rectus recession for exotropia had 30/56 (53.6%) good and 12/56 (21.4%) had poor outcome, while for recess-resect procedures for exotropia it was 97/174 (55.7%) good and 39/174 (22.4%) poor outcome (p = 0.97). The result did not significantly change over 3 years. 433/461 (93.9%) expressed satisfaction about the surgery on 6-week follow-up. Large pre-operative deviations and amblyopic eyes accounted for 63/101 (62.3%) cases of poor outcome. Fifty-seven patients recorded an improvement in stereopsis.Conclusion: Recess-resect procedures had better outcome as compared to bilateral recess procedures, but it was not statistically significant. Clinical audit helped maintain and improve good outcome over the 3 years.

Vision of Strabismic Children in Ilorin, Nigeria

Objective: This study was conducted to evaluate the visual pattern of strabismic children. Methods: A cross-sectional survey was carried out among primary school children in Ilorin South Local Government Area. A cluster random sampling technique was used to select the subjects for this study. The pattern of vision of children found to have ocular misalignment was studied. Results: A total of 7288 school children were screened and this yielded 22 cases of esotropia and 10 cases of exotropia. Their ages ranged from 2 to 16 years; 78.1% of the study group had normal vision; 3.1% had low vision and another 3.1% was blind. Eight-two per cent (82%) of the children with esotropia had normal vision, while 4.5% were blind; 70% of the children with exotropia had normal vision; 10% of exotropics had low vision. Twenty-five per cent(25%) of the strabismic population was amblyopic, and the majority of the cases of amblyopia (62.5%) were associated with esotropia. The prevalence of strabismic amblyopia was found to be 0.11%. Conclusion: The majority of strabismic children had normal vision. The prevalence of low vision and blindness was low. The prevalence of strabismic amblyopia was also low in the study population and most of it was associated with esotropia. Keywords : esotropia, exotropia, amblyopia, children, Nigeria Nigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 12-15

Ophthalmic disturbances in children with sensorineural hearing loss

Co-incidence of sensorineural hearing loss and ophthalmic abnormalities has a tremendous influence on development of children. This study was done to determine the nature and prevalence of ophthalmic disturbances in children with congenital sensorineural hearing loss. In a descriptive cross-sectional study, complete ophthalmologic examinations such as assessment of visual acuity, cycloplegic refraction, ocular motility examination, slit lamp examination and indirect funduscopy on 50 children with sensorineural hearing loss (determined by ABR), were performed. Thirty-two percent of cases had at least one kind of ophthalmic disturbances. Refractive errors were the most common abnormalities (28%), including astigmatism (12%), myopia and astigmatism (8%), and hyperopia (8%). Three (6%) cases had ocular motility disturbance including one case of esotropia, one case of exophoria and one case of exotropia. Twenty-four percent of cases had retinal abnormalities, including suspected Rubella retinopathy (6%), pigmentary changes suspect to retinitis pigmentosa (4%), optic nerve hypoplasia (4%), and finally poor fovea reflex (10%).

Diagnostic occlusion test in intermittent exotropia

We sought to determine the ideal length of time to use the diagnostic occlusion test (DOT) in the evaluation of patients with intermittent exotropia. Eighty-two consecutive intermittent exotropia patients were prospectively evaluated. After the routine ophthalmic examination, the DOT was applied for 1, 3, and 24 hours. The mean distance and near deviations, obtained with the DOTs, were compared, and the DOT periods at which deviations were stabilized were determined. The Nonparametric Tukey HSD test was used for statistical analysis. Before occlusion, the mean distance exotropia was 28.4 +/- 14.5, and the mean near exotropia was 25.7 +/- 15.5. After 1 hour of DOT, the exotropia measured 30.0 +/- 14.8 (p = 0.023) and 31.2 +/- 14.0 (p = 0.000), respectively. A clinically and statistically significant difference was not found after 3-hour and 24-hour DOT at either distance or near. Although the distance deviation stabilized after the 1-hour DOT and the near deviation was stabilized after the 3-hour DOT in intermittent exotropia cases, the change of mean near deviation between 1 and 3 hours was clinically negligible. The 1 hour DOT was at least as effective as the 3- and 24-hour DOT in most cases. Therefore, we recommend that the 1 hour DOT is sufficient for clinical applications.

Intérêt de l’IRM cérébrale dans les exotropies précoces

Primary exotropia is a divergent strabismus that appears from the first day of life to the second year. It can be isolated or associated with a pathological context requiring cerebral imaging to determine diagnosis and prognosis. The objective of this study was to report the sensorimotor state and the result of MRI in infantile exotropia. Forty-seven children with primary exotropia had a complete ophthalmologic assessment (visual acuity, binocular vision, refraction with cycloplegia, eye fundus) and cerebral MRI (average age, 16 months). Deviation was classified into four categories<4 degrees, > or =4<10 degrees, > or =10<20 degrees, > or =20 degrees. MRI results were classified into seven categories: white matter abnormalities (gliosis, delay of maturation, periventricular leukomalacia, aspecific hyperintense signal, and necroses); Virchow-Robin enlargement space and enlarged subarachnoid space; gray matter abnormalities (necroses, cerebral atrophy, occipital cortex, basal ganglia); ventriculomegaly; thin corpus callosum; cerebellar injury; and tumor. There was a statistically significant increase in the rate of pathological MRI as the angle deviation increased: 76.6% of patients had a pathological ophthalmologic exam (amblyopia, ptosis, head posture, Duane's syndrome, cataract, albinism, or pigmentary retinopathy). We found 38% nystagmus and 38% optic nerve hypoplasia. There was a real pathological context in 61.7% of the exotropia cases: 27.7% prematurity, 31.9% fetal distress, 21.3% facial dysmorphy (plagiocephaly), 12.8% psychomotor delay, and 14.9% epilepsy. Only three children had isolated exotropia. Thirty-four cerebral MRI (72.3%) were not normal. In pathological MRI, there was 61.8% white matter injury, 41.2% gray matter injury, and 17.6% thin corpus callosum. This study demonstrates the fundamental contribution of cerebral MRI in infantile exotropia. The greater the deviation, the more abnormal the MRI results are. The pathological context and ophthalmological abnormalities are important in infantile exotropia.