Concomitant Exotropia Research Articles

Differences in the corrective effects of vertical transposition accompanied by recession-resection of the horizontal rectus muscles for complicated vertical deviation.

To investigate whether the corrective effect differs between upward and downward transpositions or between exotropia and esotropia in vertical transposition accompanied by horizontal rectus muscle recession-resection. This prospective study investigated 41 patients with concomitant exotropia or esotropia with small-angle vertical deviation who underwent unilateral vertical transposition accompanied by horizontal rectus muscle recession-resection and were followed up for 1 year postoperatively. We analysed the vertical deviation corrective effect, defined as the corrective amount per displacement distance (°/tendon width [TW]). We compared the corrective effects between upward and downward transpositions and between exotropia and esotropia. Additionally, we investigated the correlation between the corrective effect and the studied parameters. The 1-year vertical corrective effect was 5.2 ± 4.6° (9.0 ± 8.1 prism dioptres [Δ])/TW. The 1-year vertical corrective effect of upward transposition (7.9 ± 4.0° [13.8 ± 7.0Δ]/TW) was higher than that of the downward transposition (3.9 ± 4.4° [6.8 ± 7.7Δ]/TW, P = 0.009). In contrast, upward and downward transposition did not differ between exotropia and esotropia (P = 0.62). Multivariate analyses revealed that the 1-year vertical corrective effect correlated with the vertical transposition direction (upward or downward) and preoperative vertical deviation but did not correlate with the disease type (exotropia or esotropia). The 1-year motor success (vertical deviation ≤ 5Δ) rate was 89%. The vertical corrective effect of vertical transposition accompanied by horizontal rectus muscle recession-resection is greater in upward transposition than in downward transposition; however, it does not differ between exotropia and esotropia.

The causal effect of obesity on concomitant exotropia: A lifecourse Mendelian randomization study.

Obesity is now a significant global public health issue. Limited understanding exists regarding the association between obesity and concomitant exotropia. Our objective was to identify the causal relationship between lifecourse obesity, including birth weight, childhood body mass index (BMI), and adult BMI, and the risk of concomitant exotropia. We used a two-sample Mendelian randomization (MR) strategy to examine the causal relationship with inverse-variance weighted method as the primary MR analysis. We carried out sensitivity analyses to evaluate the accuracy and robustness of our findings. Also, we performed reverse-direction MR analysis to eliminate the possibility of reverse causality. Childhood BMI, as opposed to birth weight or adult BMI, had a significant impact on the risk of concomitant exotropia (odds ratio = 1.40, 95% confidence interval (CI): 1.08-1.81, P = .01). This significance persisted even after accounting for birth weight and adult BMI using multivariable MR analysis (odds ratio = 1.35, 95% CI: 1.04-1.75, P = .02). There was no significant heterogeneity or pleiotropy observed in sensitivity analyses (P > .05). Multivariable MR analysis further confirmed the absence of pleiotropic effects of some risk factors including prematurity, maternal smoking around birth and refractive error. Reverse causality did not affect the causal relationship (beta = -0.0244, 95% CI: -0.0545 to 0.0056, P = .11). Genetic predisposition to higher childhood BMI was found to be causally linked to an increased risk of concomitant exotropia.

The Comparison of Long-term Surgical Results for Sensory Exotropia and Comitant Exotropia

Purpose: To compare the long-term surgical outcomes of patients with sensory and concomitant exotropia and to define the factors associated with successful surgical outcomes in those with sensory exotropia.Methods: The medical records of patients with sensory exotropia who underwent operations and were followed-up for at least 2 years were retrospectively reviewed. We enrolled patients exhibiting only best-corrected visual acuities ≤ 20/100 of the operated eyes. Surgical success was defined as a final distance deviation < 10 prism diopters (PD) with the eye in the primary position. Twenty-eight patients operated upon to treat sensory exotropia and 28 who underwent operations to treat concomitant exotropia who did not differ in terms of the gaze deviation angle were matched in terms of age, sex, and the preoperative distance and near distributions; their surgical outcomes were compared. Factors affecting such outcomes were identified using a multivariate Cox’s proportional hazards model.Results: The mean follow-up times were 91.7 ± 45.8 months in the sensory and 42.6 ± 27.7 months in the concomitant exotropia groups. The cumulative probabilities of surgical success 2 years after surgery were 74.5% in the sensory and 74.4% in the intermittent exotropia groups, thus not significantly different (<i>p</i> = 0.988). The Cox’s proportional hazard model showed that a greater difference between the preoperative distant and near deviations was associated with recurrence (<i>p</i> = 0.091).Conclusions: The long-term surgical outcomes of patients with sensory and concomitant exotropia were comparable. A high-level near-distance disparity increased the risk of recurrence.

Study on the postoperative visual function recovery of children with concomitant exotropia based on an augmented reality plasticity model.

This study aimed to investigate the clinical application effect of an augmented reality (AR) plasticity model on the postoperative visual function recovery of children with concomitant exotropia. Between September 2019 and October 2021, 28 patients with concomitant exotropia who visited Shenzhen Children's Hospital (9 male and 19 female) were enrolled in this study. The average age of the patients was 6.4 ± 1.8 years. Postoperative rehabilitation training was conducted using a personalized AR binocular visual perception plasticity model developed based on the patient's examination results. After 1 month, 3 months, and 6 months of training, the patients returned to the hospital for examinations of perceptual eye position, static zero-order stereopsis, dynamic first-order fine stereopsis, and dynamic second-order coarse stereopsis to compare the changes in eye position control and stereovision function. After 6 months of eye position training, the horizontal perception eye position of the 28 patients was significantly lower than that before training. The difference in eye position at the first and third months compared with that before training was not statistically significant (1st month: z = -2.255, p = 0.024 > 0.017; 3rd month: z = -2.277, p = 0.023 > 0.017; 6th month: z = -3.051, p = 0.002 < 0.017). The difference in vertical perceptual eye position after training compared with that before training was not statistically significant (1st month: z = -0.252, p = 0.801 > 0.017; 3rd month: z = -1.189, p = 0.234 > 0.017; 6th month: z = -2.225, p = 0.026 > 0.017). The difference in 0.8-m static zero-order stereopsis before and after training was not statistically significant (1st month: z = -2.111, p = 0.035 > 0.017; 3rd month: z = -1.097, p = 0.273 > 0.017; 6th month: z = -1.653, p = 0.098 > 0.017). The 1.5-m static zero-order stereopsis was improved after 1 month, 3 months, and 6 months of training compared with that before training (1st month: z = -3.134, p = 0.002 < 0.017; 3rd month: z = -2.835, p = 0.005 < 0.017; 6th month: z = -3.096, p = 0.002 < 0.017). Dynamic first-order fine stereopsis and dynamic second-order coarse stereopsis were measured in the 28 patients before and after training. Patients 1 and 18 had no dynamic first-order fine stereopsis before training, but both regained dynamic stereopsis after 1 month, 3 months, and 6 months of training. Patient 16 had no dynamic first-order fine stereopsis or dynamic second-order coarse stereopsis before training, but first-order and second-order stereopsis had been reconstructed after 1 month, 3 months, and 6 months of training. Concomitant exotropia surgery improved the basic problem of eye position at the ocular muscle level, but the patient's perceptual eye position and visual function defects at the brain visual level remained. This might partly explain the poor postoperative clinical effect. The AR plasticity model can improve patients' horizontal perceptual eye position and multi-dimensional stereoscopic function, and its clinical effect warrants further study.

A multimodal MRI study of functional and structural changes in concomitant exotropia.

The present prospective study aimed to investigate the structural and functional changes in patients with concomitant exotropia using multimodal MRI. A total of 11 adult patients with concomitant exotropia (5 males and 6 females) and 11 healthy adult individuals (5 males and 6 females) were recruited and examined using multimodal MRI techniques. Near and distance exotropia deviation angles were measured. The structrual changes were evaluated using the gray matter volume. Functional reorganization was assessed using the amplitude of low-frequency fluctuation, regional homogeneity and resting-state functional connectivity (FC) on MRI. No significant differences could be found in terms of sex, age or body mass index between the two groups. However, the near and distance exotropia angles were significantly higer in the concomitant exotropia group compared with those in the normal control group (P<0.001). Compared with those in normal individuals, the bilateral thalamus, right middle temporal gyrus (MTG) and right cuneus had significantly reduced gray matter volumes in the concomitant exotropia group (false discovery rate corrected, P<0.05). Reduced FC was found between the bilateral thalamus and the bilateral precuneus, between the right MTG and the right medial superior frontal gyrus in addition to the right precuneus, and between the right cuneus and the right primary sensorimotor cortex (P<0.05, Gaussian random-field corrected) in the concomitant exotropia group compared with that in the normal individuals. In conclusion, the present study indicated that structural and functional reorganization occurs in specific brain regions of patients with concomitant exotropia. These reorganized areas appeared to mainly involve the subcortical structures and related cortices that process visual information.

Occurrence of Dry Eye Disease in Patients With Concomitant Strabismus: A Preliminary Cross-sectional Analysis.

To determine the effects of strabismus on dry eye parameters. In this cross-sectional study, the preliminary assessment of ocular parameters related to dry eye disease was performed in patients with untreated concomitant strabismus. In total, 204 patients with concomitant strabismus and 125 volunteers without strabismus (4 to 30 years old, 170 male and 159 female) were enrolled. The Ocular Surface Disease Index questionnaire (OSDI) was administered, and ocular surface was examined using the Oculus Keratograph 5M (Oculus Optikgeräte GmbH) to collect data on tear film break-up time (TBUT), ocular redness index (based on bulbar conjunctival blood vessel engorgement), and meibomian gland atrophy. Subgroup analysis was performed based on strabismus type (concomitant exotropia, concomitant esotropia, and non-strabismus); age (juvenile versus adults age > 18 years); and 5- to 10-year and 10- to 20-year strabismus course, according to an age of 12 years. Concomitant exotropia and esotropia were reported in 134 and 70 patients, respectively. A total of 125 healthy volunteers were recruited. The three groups showed significant differences in the ocular redness index (right eye: P = .012, left eye: P = .018). In contrast, other parameters were not significantly different. Similarly, no statistical differences in ocular surface indicators were observed when patients were divided by age (P > .05 for all) and the 5- to 10-year and 10- to 20-year strabismus course. The meibomian gland showed varying degrees of atrophy in both the strabismus and non-strabismus groups. Strabismus does not affect tear film stability with age in this cohort with constant strabismus up to 30 years, indicating that strabismus may not increase the risk of dry eye disease. [J Pediatr Ophthalmol Strabismus. 2024;61(1):30-37.].

Evaluation of retinal microvasculature in exotropia with abnormal binocular vision by optical coherence tomography angiography

BackgroundTo explore the retinal microvasculature in large-angle concomitant exotropia patients with abnormal binocular vision using optical coherence tomography angiography (OCTA) analysis.MethodsOCTA images of 52 healthy and 100 strabismic eyes were analyzed to quantify the retinal thickness (RT), superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone (FAZ). Paired t-tests were performed to compare differences between the two groups, the dominant eye and the deviated eye in the exotropia group, respectively. A p-value < 0.01 was considered significant.ResultsThe mean angle of deviation was 79.38 [± 25.64] (prism diopters, PD). There were significant differences in the DCP in deviated eyes between the exotropia group and the control group (fovea: p = 0.007; temporal: p = 0.014; nasal: p = 0.028; inferior: p = 0.013). The temporal SCP in the exotropia group was significantly higher than in the control group in deviated eyes (p = 0.020). No significant difference was found between dominant eyes and strabismic eyes (p > 0.01).ConclusionsThe study showed that OCTA revealed subnormal DCP in patients with large-angle exotropia and abnormal binocularity which may be related to retinal suppression. Changes in the macular microvasculature may provide valuable insights into the development of strabismus. Further studies are needed to determine the clinical relevance of this finding.Trial registrationThis trial is registered as ChiCTR2100052577 at www.Chictr.org.cn.

The Effects of Binocular Visual Function Training after Concomitant Exotropia Surgery

Purpose This study investigated the effect and long-term efficacy of binocular visual function training after concomitant exotropia surgery. Methods A total of 92 patients who underwent concomitant exotropia surgery were randomly divided into group A (the training group) (n = 54), who received binocular four-dimensional (4D) visual function training after surgery, and group B (control group) (n = 38). The patients in group A received personalized 4D visual function training 2 weeks after surgery and were followed up for 12 months. The eye position, distant and near stereo acuity, respectively, and postoperative efficacy were compared with those of the patients in group B. Results The normal eye position rate in group A was higher than in group B at the end of the overall follow-up period (p < .05), and the near stereo acuity rate was higher than the distant stereo acuity rate in both groups A and B at 2 weeks after surgery and at the end of follow up. The distant and near stereo acuity rates of the patients in group A were higher than those in group B (p < .05) at the end of the follow-up period, and the distant stereo acuity of group A was significantly improved (p < .05). The functional complete and incomplete response rates of group A were significantly higher than those of group B at the end of the follow-up period (p < .05). Conclusions Four-dimensional visual function training for patients after concomitant exotropia surgery could facilitate the recovery of postoperative binocular visual function, as well as prevent the recurrence of exotropia after surgery.

Novel variants identified in a three‑generation family with concomitant exotropia

Concomitant exotropia is a condition where there is a misalignment between both eyes, which is more prevalent in Asians than in Caucasians. It is an eye disease related to the neural development of binocular vision and eye movement control. Studies have indicated that genetic factors contribute to the development of concomitant exotropia; however, the underlying mutations have not been thoroughly investigated to date. In the present study, whole-exome sequencing was performed in a three-generation family with concomitant exotropia. In the proband and the proband's father, bioinformatics analyses identified a duplication of the genomic region spanning genes PCDHA1-7 and a heterozygous mutation c.3775G>A (p.A1259T) of the COL3A1 gene, which is located in the conserved COLFI domain and leads to decreased stability of the encoded protein product. Furthermore, a deletion of amino acid S165 in the gene NCOA7 was discovered in the family members, including the proband, the proband's mother and maternal grandfather. S165 was predicted to be a conserved phosphokinase site of CK1/VRK and CK1/CK1. The genes in which these variants reside are all involved in cortical neuronal development. The present study reveals novel variants of concomitant exotropia and suggests that aberrant cortical neuronal development may contribute to the origin of concomitant strabismus.

Analysis of the Changes and Possible Reasons in Aberrations before and after Surgery in Patients with Concomitant Exotropia.

Objective The objective is to observe the changes in aberrations before and after surgery in patients with common horizontal strabismus and to analyze the possible reasons for the changes. Methods Forty eyes of 40 cases with concomitant exotropia who underwent strabismus correction at the Ophthalmology Department of Nantong University Hospital from October 2020 to July 2021 were included in this study, all of whom underwent unilateral lateral rectus recession combined with a medial rectus resection in the same eye. Aberration parameters were measured 1 day before surgery and 1 week, 1 month, 3 months, and 6 months after surgery. Differences in the indicators at each time period were compared by analysis of variance (ANOVA) of repeated measures data for a single factor, and data were analyzed using SPSS 25.0 statistical application software. Results 5 mm pupil diameter: the preoperative and postoperative RMS of total aberration showed statistically significant difference (P < 0.01). Postoperation test (Bonferroni method) and preoperative comparison at each period after surgery showed statistically significant differences between 6 months after surgery (P=0.002) and preoperative comparison. The preoperative and postoperative comparison of RMS in LOAs was statistically significant (P < 0.01); postoperative test (Bonferroni method) and preoperative comparison showed that there were statistically significant differences between 1 week (P=0.033) and 6 months (P=0.002) after operation. The difference of RMS of defocus before and after operation was statistically significant (P < 0.01); postoperation test (Bonferroni method) and preoperative comparison showed that there was statistically significant difference between 6 months after operation (P=0.007) and preoperative comparison. There was statistically significant difference in preoperative and postoperative RMS of HOAs (P=0.013). Postoperative test (Bonferroni method) and preoperative comparison showed that there was statistically significant difference 6 months after surgery (P=0.03). The RMS of secondary astigmatism showed a statistically significant difference before and after operation (P=0.001), and the postoperation test (Bonferroni method) showed a statistically significant difference 6 months after operation (P=0.002). In 5 mm pupil diameter, the preoperative and postoperative RMS of total aberration showed statistically significant difference (P < 0.01), postoperative test (Bonferroni method) was used to compare each period after surgery with that before surgery, and there were statistically significant differences between 1 week after surgery (P=0.034), 3 months after surgery (P=0.033), and 6 months after surgery (P=0.003). The preoperative and postoperative comparison of RMS in LOAs was statistically significant (P < 0.01), postoperative test (Bonferroni method) was used to compare each period after surgery with that before surgery, and there were statistically significant differences between 1 week after surgery (P=0.04), 3 months after surgery (P=0.034), and 6 months after surgery (P=0.004). The difference of RMS of defocus before and after surgery was statistically significant (P=0.002), and the comparison between postoperation test (Bonferroni method) and preoperation showed that the difference was statistically significant 6 months after surgery (P=0.027). The RMS of astigmatism showed statistically significant difference before and after operation (P=0.002), and the postoperation test (Bonferroni method) showed statistically significant difference between 6 months after operation (P=0.009) and before operation. Conclusion We found that horizontal rectus surgery had a transient effect on LOAs and almost no effect on HOAs. Long-term follow-up is recommended after strabismus surgery to observe eye position and binocular visual function. Because of the high prevalence of strabismus in adolescents, long-term observation of the eye axis and aberration is recommended.

Analysis of Improvement Time and Influencing Factors of Diplopia after Intermittent Exotropia in Children.

Analysis of Improvement Time and Influencing Factors of Diplopia after Intermittent Exotropia in Children.

Inter-eye Differences in Ocular Biometric Parameters of Concomitant Exotropia.

Purpose: To evaluate the ocular biometric parameters in patients with constant and intermittent exotropia by the measurement of swept-source optical coherence tomography (SS-OCT) optical biometer OA-2000 and comparing it with the normal control subjects.Design: Cross-sectional case-control study.Participants: Fifty-five constant and 24 intermittent patients with exotropia with central fixation and 77 orthotropic normal control participants aged 4–18 years old.Methods: Non-contact and high-resolution optical biometric OA-2000 measurements were conducted under uniform ambient light conditions. The statistical analysis included intraclass correlation coefficient (ICC), Bland-Altman plot, and independent t-tests.Main Outcome Measures: Spherical equivalent (SE), ocular biological parameters such as pupil diameter (PD), anterior chamber depth (ACD), lens thickness (LT), and axial lengths (AL). The absolute values of inter-eye differences for SE, PD, ACD, LT, and AL were recorded as AnisoSE, AnisoPD, AnisoACD, AnisoLT, and AnisoAL, respectively.Results: AnisoSE (0.878 vs. 0.577, P = 0.019), AnisoAL (0.395 vs. 0.208, P = 0.001), AnisoACD (0.060 vs. 0.032, P < 0.001), AnisoLT (0.060 vs. 0.031, P = 0.002), and AnisoPD (0.557 vs. 0.340, P = 0.002) were significantly larger in concomitant patients with exotropia. The SE, AL, ACD, LT, and PD showed excellent binocular correlation with ICC values that ranged from 0.943 to 0.987 in control participants and from 0.767 to 0.955 in concomitant exotropia patients. Bland-Altman plots showed the wider range of agreement in patients with concomitant exotropia than the control participants (SE: 5.0288 vs. 3.3258; AL: 2.2146 vs. 1.3172; ACD:0.3243 vs. 0.1682; PD: 2.4691 vs. 1.9241; and LT:0.3723 vs 0.1858).Conclusion: Patients with concomitant exotropia showed larger inter-eye differences in SE, ACD, LT, PD, and AL. Advice should be given to suspicious children to avoid or delay the development of concomitant exotropia.

An Overview for Concomitant Exotropia Management: Review Article

Background: A common type of strabismus known as concomitant exotropia (XT) occurs when mismatched eyes deviate outward and the angle of deviation is the same regardless of which eye is fixed. Among ophthalmologists, there is no agreement on non-surgical treatment options for XT. For those who suffer from strabismus, surgery is an option for correcting their visual axis and restoring their ability to see in both eyes simultaneously. Instead, then severing the muscle, muscle plication involves folding the muscle around itself and stitching it in place, essentially shortening and tightening the muscle. Muscle plication has been found to reduce the risk of anterior segment ischemia by protecting the anterior ciliary arteries. Objective: To hallmark the new guidelines options of concomitant exotropia management. Conclusion: Muscle-tightening techniques such as excision, plication, advancement, and transposition have been documented in the literature. Technical simplicity, the ability to reverse it, shorter operating times, reduced surgical trauma, and the preservation of anterior ciliary arteries are only a few of the many advantages of plication.

Single stage Large LR recession with or without MR resection and its motor outcomes in Concomitant Exotropia

Exotropia is a manifest outward deviation of the visual axes, which is either constantly or intermittently present. Untreated, poorly controlled intermittent exotropia later progresses to constant exotropia. Sensory exotropia is unilateral divergent misalignment of the eyes, resulting from loss of vision or long-standing poor vision in an eye. In sensory exotropia the angles are characteristically large, ranging from 30 to 100 prism dioptres (PD) and increases gradually over time as long as the cause of visual deficit remains active. Treatment is directed to re-establish the normal ocular alignment and binocular vision[1]. The preferred treatment for manifest exotropia is surgery[2]. Large angle constant exotropia negatively impacts the way the patients see themselves and are perceived by others. The benefits of surgical treatment of exotropia in adults is well proven, both psychologically and visually. The surgical treatment for largeangle exotropia has been a subject of sufficient debate. A variety of surgical plans have been described including two, three or four horizontal rectus muscles recession and resections with or without adjustable suture technique.[3] In more recent studies, the management of large-angle exotropia falls into two surgical approaches. Large bilateral lateral rectus recession is done when the acuity is good in each eye and indicated for true divergent excess type. For basic exodeviation R-R procedure is done popularly. Before embarking on surgical plan we do post occlusion test and identify the clinical type. If one eye is amblyopic, a maximal or supramaximal unilateral recess- resect procedure is performed. Records of previous studies have shown that monocular surgery had shown good results for exotropia of &lt; 60 PD. But for exotropia of &gt; 60 PD, monocular surgery was not so effective (4). In previous studies mild to moderate LR recessions were described but our study involves maximum recession on LR. In previous studies large LR recessions were reported to have complications like Lid changes and palpebral aperture widening. This study was done to evaluate the outcome of single stage, unilateral large LR recession with or without MR resection for constant exotropia

MRI study of rectus extraocular muscles in concomitant exotropia with small angle vertical deviation

Objective: To observe the changes of four pulley locations of extraocular rectus muscles and rectus muscle volumes, as well as superior and inferior part ratio of horizontal rectus muscles, in concomitant exotropia with small-angle vertical deviation in primary gaze. Methods: Cross-sectional study. Data was collected from January 2018 to December 2019 in Tianjin Eye Hospital. The pulley position changes and volumes of four extraocular rectus muscles in the coronal position of patients who had concomitant exotropia without vertical deviation (group A) or with small-angle vertical deviation in primary gaze (<5 prism diopter; group B) and normal controls (group C) were observed using MRI, and the changes of the volume ratio of the superior and inferior parts of the horizontal rectus muscle were calculated. One way analysis of variance and Kruskal-Wallis test were used for statistical analysis. Results: There were 19 patients (38 eyes; 10 males, 9 females) aged (30±7) years in group A, ten patients (20 eyes; 4 males, 6 females) aged (27±6) years in group B, and 20 healthy volunteers (40 eyes) in group C. Age and gender distribution were matched among the three groups (all P>0.05). Among the three groups, the pulley locations of the four extraocular rectus muscles were not significantly different (all P>0.05). The medial rectus muscle volume in groups A [(358.6±44.9) mm3; t=6.405, P<0.01] and B [(334.7±35.6) mm3; t=6.025, P<0.01] was significantly smaller than group C [(437.5±49.3) mm3]. There was no statistically significant difference in the superior and inferior muscle volume ratio of the lateral rectus in three groups (all P>0.05), while the ratio in group B was more dispersive. Conclusions: The pulley location changes of four extraocular rectus muscles of patients with concomitant exotropia and small-angle vertical deviation in primary gaze are not significant, but the medial rectus volume in patients who had concomitant exotropia with vertical deviation or not is significantly smaller. The dispersive superior and inferior muscle volume ratio of the horizontal rectus muscles may be related to the small angle of vertical deviation in clinical examinations. (Chin J Ophthalmol, 2021, 57: 223-227).

High Level of Inflammatory Cytokines in the Tears: A Bridge of Patients with Concomitant Exotropia and Dry Eye.

Concomitant exotropia have obvious symptoms of eye discomfort in adults, and the presence of ocular surface inflammation in patients may be important mediators between concomitant exotropia and dry eye. Oculus Keratograph eye comprehensive analyzer was performed to detect noninvasive tear break time, noninvasive tear height, and eye red index, while the ocular surface disease index and schirmer I testing were made. The levels of IL-6, IL-10, IL-17A, IL-12P70, INF-γ, and TNF-α were detected in tears in patients with concomitant exotropia and healthy controls matched by age and gender through the Simoa technology. IL-6 was significantly higher in patients with concomitant exotropia (4.683 ± 1.329) pg/mL than that in normal group (1.455 ± 0.391) pg/mL, p = 0.0304. TNF-α was also significantly higher in patients (0.2095 ± 0.0703) pg/mL than normal group (0.0513 ± 0.0149) pg/mL, p = 0.0397. The levels of inflammatory factors in strabismic patients vs. normal controls were as follows: IL-17A (0.1551 pg/mL︰0.0793 pg/mL), IL-10 (0.3358 pg/mL︰0.0513 pg/mL), IL-12p70 (0.0253 pg/mL︰0.0099 pg/mL), and INF-γ (0.0284 pg/mL︰0.009 pg/mL) were detected, and the median of them in concomitant strabismus was 1.96-6.55-fold as much as the control group. High levels of inflammatory cytokines in tears of patients with concomitant exotropia, which may be a potentially factor promoted the occurrence of dry eye in the patients with concomitant exotropia.

Disrupted neural signals in patients with concomitant exotropia.

Decreased binocular and oculomotor function in strabismics has recently been considered as cortical in origin. This study aimed to investigate functional abnormalities using a frequency-specific neuroimaging method in patients with concomitant exotropia (XT), and to demonstrate the clinical implications. Resting-state functional magnetic resonance imaging data were collected in 26 XT patients and 26 matched controls. To evaluate the local spontaneous neural activity, the amplitude of low frequency fluctuations (ALFF) was calculated in the typical frequency band (0.01-0.08Hz) as well as five narrowly-defined frequency bands (slow-6: 0-0.01Hz, slow-5: 0.01-0.027Hz, slow-4: 0.027-0.073Hz, slow-3: 0.073-0.167Hz, and slow-2: 0.167-0.25Hz), respectively. Patients with XT showed decreased ALFF in the bilateral parieto-occipital sulcus (POS), and increased ALFF in the bilateral thalamus within the typical frequency band. Frequency-dependent ALFF alterations were found in the higher visual areas such as the right lateral occipital complex (LOC). Furthermore, ALFF in the right LOC in the slow-5 band was positively correlated with fusion control score (r=0.70, p<0.0001) and binocular function score (r=0.67, p=0.0002). Regression analyses showed that early age of onset remained the only significant explanatory factor for ALFF reduction in the right POS in the typically-measured frequency band (also referred to as the typical frequency band) (Odds ratio, 0.038; 95% confidence interval, 0.001 to 0.075). Our findings provide spatial information regarding the functionally disrupted regions in XT. Moreover, the frequency-dependent ALLF alteration in the right LOC might reflect a potential plastic capacity in binocular function, which could be a potential objective index for evaluating disease severity.

Long-term results of augmented unilateral lateral rectus muscle recession for dissociated horizontal deviation.

We report the long-term surgical results of augmented lateral rectus muscle (LR) recession for dissociated horizontal deviation (DHD) without concomitant exotropia (XT) or esotropia (ET). This retrospective review included patients with DHD without XT or ET who underwent augmented LR recession and were followed-up for ≥12 months. Each patient’s medical records were evaluated to identify their demographics, preoperative angle of deviation, surgical procedure, success rate, and reoperation rate. A total of 11 patients with DHD were included (median patient age at surgery, 6 years; interquartile range [IQR], 5 to 10 years). Four patients (36.4%) had a history of infantile ET while three patients (27.3%) had a history of unilateral cataract surgery for congenital cataract. The median preoperative angle of DHD in the unilateral eye was 20 prism diopters (PD) (IQR, 15 to 25 PD). The median amount of LR recession was 8.0 mm (IQR, 7.5 to 8.0 mm). Three patients (27.3%) underwent simultaneous surgery for dissociated vertical deviation. At the final examination after a median follow-up period of 32 months (IQR, 24 to 58 months), 10 patients (91%) showed successful alignment. The long-term successful alignment rate after augmented LR recession for DHD was good; thus, application of this technique is appropriate in patients with DHD.

Prevalence of the thoracic scoliosis in children and adolescents candidates for strabismus surgery: results from a 1935-patient cross-sectional study in China.

No study so far has paid attention to strabismus-related spinal imbalance. This study aimed to determine the epidemiology of thoracic scoliosis in children and adolescents with strabismus and investigate the association of two diseases. A cross-sectional study. Study group consists of 1935 consecutive candidates for strabismus surgery (4-18years); Control group consists of the age- and sex-matched patients with respiratory diseases. All subjects underwent a screening program based on chest plain radiographs using the Cobb method. Their demographic information, clinical variables and results of Cobb angle were recorded and analyzed. A significantly higher prevalence of thoracic scoliosis (289/1935, 14.94% versus 58/1935, 3.00%) was found in study group compared with control group. Among strabismic patients, the coronal thoracic scoliosis curve mainly distributed in right and in main thoracic (198/289) and in the curves 10°-19° (224/289); Age range 7-9years (103/1935), female (179/1935) and concomitant exotropia patients (159/851) were more likely to have thoracic scoliosis. According to the logistic regression, thoracic scoliosis had no significant association with age, BMI, duration of illness and onset age (p > 0.05). However, gender, BCVA, type of strabismus and degree of strabismus showed a significant relationship with the prevalence of thoracic scoliosis (p < 0.05). With a pooled prevalence of 14.94%, strabismus patients showed a great higher risk of developing thoracic scoliosis. Screening for scoliosis in strabismus patients can be helpful to discover a high prevalence of potential coronal scoliosis. More attention should be paid to ophthalmological problems in patients with scoliosis. These slides can be retrieved under Electronic Supplementary Material.

Intermediate filaments in the medial rectus muscles in patients with concomitant exotropia

PurposeDistribution of intermediate filament (IF) proteins in normal extraocular muscles (EOMs) showed that the EOMs differ significantly from the other muscles in the body with respect to their IFs composition, including desmin and nestin. The aim of the present study was to investigate the pathological changes in the medial rectus (MR) in patients with concomitant exotropia (XT).MethodsForty-six MR muscle samples from 46 patients with XT were analyzed pathologically and processed for immunohistochemistry with specific antibodies against desmin and nestin.ResultsAlthough most of MR muscles remained normal structures relatively, they presented high expression of desmin, and in contrast, nestin was absent in a large proportion of the MR muscles.ConclusionDesmin, which is downregulated in normal EOMs, had high expression in MR muscles of patients with XT. Nestin, which is present in a high proportion of normal EOMs, was downregulated in MR muscles of patients with XT.