Postoperative Eye Position Research Articles

Clinical features of Helveston syndrome and discussion of individualized surgical design.

Reasonable personalized surgical design can achieve good treatment results for Helveston syndrome in one surgery, reducing the psychological and economic burden on patients. This article aims to explore the clinical characteristics of Helveston syndrome and the clinical effectiveness and feasibility of individualized surgical design. In this retrospective case series study, 28 patients who underwent strabismus correction for Helveston syndrome at the Affiliated Hospital of Yunnan University from June 2018 to December 2020 with complete follow-up data were enrolled. Preoperatively, all patients received standard assessment of vision, intraocular pressure, slit lamp, fundus and refractive status, excluding other eye diseases, as well as detailed special examination of strabismus. These patients were divided into two groups according to the surgical modality: the horizontal muscle surgery alone group and the horizontal muscle surgery combined with superior oblique muscle surgery (combined surgery) group. We used SPSS software for data analysis and compared the postoperative eye position, eye movement, success rate, and reoperation rate between these two groups. Clinical measurement data were compared and analyzed with Fisher's exact test for count data, the t-test for normally distributed measurement data, and the Mann-Whitney U test for non-normally distributed measurement data. P<0.05 was considered statistically significant. This study included a total of 28 patients with Helveston syndrome, including 20 males and 8 females. The average age at the time of surgery is 12.04 ± 8.67 years (range, 4-43 years). The postoperative A-pattern degree was significantly greater in the group undergoing horizontal muscle surgery alone [6.23±1.31 prism diopters (PD); range, 0-10 PD] than in the group undergoing combined surgery (0.53±0.32 PD; range, 0-4 PD; P=0.002). Superior oblique muscle overactivity was significantly reduced in the combined surgery group (0.20±0.11+; range, 0-1+) compared to the horizontal muscle surgery alone group (1.31±0.26+; range, 0-2+; P=0.002). However, there was no significant difference in success rate or reoperation rate between the two groups. Additionally, after combining the recession of the superior rectus muscle with the horizontal muscle, the number of A-pattern degrees was greatly reduced. Helveston syndrome can be improved using a personalized surgical design according to the degree of external strabismus A-pattern, superior oblique muscle overaction, and dissociated vertical deviation (DVD) degree, which improves the success rate of single surgery.

Clinical Manifestations, Diagnosis, and Surgery of Inferior Oblique Muscle Ectopia.

Objectives To summarize the clinical manifestations, diagnosis, treatment, and prognosis for inferior oblique muscle ectopia (IO-E). Subjects and Methods. Patients diagnosed with IO-E during strabismus surgery from March 2017 to September 2018 were included in this retrospective, cross-sectional study. All patients received preoperative Krimsky test, synoptophore, cycloplegia refraction, fundus torsion, and other strabismus-related specific tests. The anatomic variations of IO-E were always discovered during surgical procedure. Postoperative eye position and binocular visual function (BVF) were all reviewed in early days after operation. Results A total of 7 patients were enrolled in this study with an average age of 6.4 ± 3.8 yrs. They all presented with significant exotropia and unilateral (or bilateral) overelevation in adduction (OEA). No compensatory head position was detected. Some of them had vertical deviation, V pattern, or excyclotropia, which were indicated by fundus torsion. Monocular or binocular IO-E was distinguished during the surgery, and it could be classified into two types according to its anatomic features. In surgery, the ectopic IO muscle bundle was restored, and different IO weakening methods were employed. Meanwhile, the horizontal deviation was also corrected according to the preoperative examination. Eyes of all patients were properly aligned in the primary position after surgery. Varying degrees of BVF appeared in 3 cases. Conclusions IO-E is a rare congenital dysplasia variation of the extraocular muscle, which could appear as inferior oblique overaction. It is difficult to diagnose before surgery, and weakening the overactive ectopic inferior oblique was required for better prognosis if this condition was confirmed during surgery.

Relevant factors of successful surgery in the basic type of intermittent exotropia

Objective To explore the relevant factors of functionally healing the basic type of intermittent exotropia. Methods A prospective observation study was designed.One hundred and thirty-two cases with basic type of intermittent exotropia in Tianjin Eye Hospital from August 2015 to March 2016.Pre- and post-operation examinations to each patient, including the tests of ocular alignment, Worth four-dot test at 2 m and 33 cm, Titmus, functional visual analyzer (FVA), Frisby Davis distance (FD2) were used to explore the influencing factors of postoperative eye position and stereoscopic reconstruction, and to find the cutoff point of surgery.This study followed the Declaration of Helsinki.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital (No.YKLL-2015-8-21). Written informed consent was obtained from each patient or guardian prior to entering study cohort. Results At 6 months postoperatively, there were 84 cases of orthopedic position, 4 cases of overcorrection and 44 cases of undercorrection.The success rate was 63.6%.The deviation at day 1 and peripheral fusion function were statistically significant to postoperative eye position (b=-0.093, P=0.037; b=0.725, P=0.017). The area under the receiver operating characteristic (ROC) curve was 0.645, which showed that the result of Worth four-dot test at 33 cm had lower diagnostic value.Seventy-two cases with eye position between 0 and + 10 PD at 1 day postoperatively were all successful in eye position at 6 months postoperatively.The postoperative eye position was the influencing factor for postoperative distance stereo with FVA (χ2=4.036, P=0.045). The age of onset and the preoperative distance stereoacuity with FD2 were the influencing factors of postoperative distance stereo reconstruction (b=-0.213, P=0.023; b=0.021, P=0.036). The area under the ROC curve of the age of onset and the preoperative distance stereoacuity with FD2 was 0.257 and 0.752, respectively.The former had no diagnostic value, and the latter had a medium diagnostic value.The best cutoff point was 22.5″ with FD2 at 6 m. Conclusions Success rate of postoperative eye position is affected by the postoperative deviation at day 1.The optimal deviation at post-operation day 1 is 0-10 PD.Postoperative distance stereopsis is improved well and the surgery should be done before the distance stereoacuity is decreased to 22.5″ with FD2 at 6 m. Key words: Exotropia/surgery; Oculomotor muscles/surgery; Binocular vision; Stereopsis

Analysis of the surgical efficacy for sensory exotropia

Objective To analyse the long-term efficacy of strabotomy surgery for sensory exotropia. Methods Thirty-three cases of sensory exotropia from Jan. 2011 to Dec. 2015 who underwent monocular strabismus surgery were retrospectively analyzed. All cases were randomly divided into two groups: over corrected group postoperative, 5△-10△ esotropia after surgery, 15 cases, and orthophoria group postoperative, 18 cases. Results The follow-up time was 12-52 months. At last follow-up, orthophoria occurred in 26 cases(78.79%), under-corrected in 7 cases(21.21%), and none was over-corrected. The postoperative orthophoria rate of over corrected group was higher than that of orthophoria group. The difference was statistically significant (P 0.05). Conclusion Strabismus surgery for the treatment of sensory exotropia is a effective method with high satisfaction. The patients with immediate mild over correction after surgery have good postoperative eye position. The patients with preoperative smaller-angle strabismus have good postoperative eye position. BCVA of squinting eye has no effect on postoperative eye position. Key words: Exotropia, sensory; Strabismus surgery; Efficacy, long-term

The effect of surgical methods and postoperative eye position on the quality of life in patients with intermittent exotropia

Objective: To evaluate the effects of different surgical methods and postoperative eye positions on the quality of life of children with intermittent exotropia (IXT) and their parents 3 months following strabismus surgery. Methods: Clinical observation. One-hundred and eighty children aged 2 to 17 years with IXT who received surgical treatment were recruited. One parent of each child was investigated by using 2 kinds of the Chinese version of the Intermittent Exotropia Questionnaires (CIXTQ) within 1 weeks before and at 3 months after surgery: the parent proxy scale (for parents to assess children's health related quality of life (HRQoL)) and the parent scale (containing functional, psychosocial and surgery subscales; for parents to assess their HRQoL). One hundred and eighty children were divided into different groups according to the surgical. Methods Monocular surgery group, binocular surgery group and eye position after 3 months: undercorrection group, successful group, overcorrection group, to explore: (1) the change of scores before and after surgery. (2) the difference of score changes after surgery between monocular and binocular surgery groups. (3) the difference of score changes after surgery between different postoperative eye position groups. Results: Significant improvement in median scores was seen from pre-operation to 3months post-operatively for all the proxy scale (t=-9.585, P<0.001), the functional (t=-11.361, P<0.001), psychosocial (t=-10.856, P<0.001) and surgery subscale (t=-11.622, P< 0.001) of parent scale. The change values from pre-operation to 3months post-operatively were not significantly different between monocular and binocular surgery groups for all the proxy scale (t=0.242, P=0.330), the functional (t=0.462, P=0.050), psychosocial (t=0.781, P=0.582) and surgery subscale (t=0.009, P=0.355) of parent scale, but significantly different between undercorrection, successful and overcorrection groups for the proxy scale (F=21.527, P<0.001), the functional (F=54.236, P<0.001), psychosocial (F=41.784, P<0.001) and surgery subscale (F=31.943, P<0.001). The scores of proxy scale and 3 parent subscales were all significantly improved (t=-13.639 to -6.059, P<0.05) after operation in both the undercorrection and successful groups, while significantly decreased in the overcorrection group (t=1.350-4.391, P<0.05). Conclusions: HRQoL can be improved significantly in both the undercorrection and successful groups, while decreased in the overcorrection group. (Chin J Ophthalmol, 2017, 53: 924-930).

Rectus muscle transplantation combined with Jensen procedure for the correction of special strabismus

Objective To evaluate the efficacy of the combined surgery of rectus muscle transplantation and Jensen procedure in the correction of special types of paralytic strabismus. Methods Partial transplantation of the superior and inferior rectus were performed on the horizontal strabismus, while partial transplantation of the medial and lateral rectus were performed on the vertical strabismus. There were two stages in the combined surgery. On the first stage, recession operation of the antagonist muscles associated to the paralyzed or dysplastic muscle was performed. On the second stage, Jensen procedure was performed by combining the transplanted muscle and the paralyzed or dysplastic rectus on the basis of partial rectus transplantation. Results The postoperative eye position was finely corrected and the ocular movement was significantly improved. Besides, part of visual functions were improved, and the complication of anterior segment ischemia wasn't been observed. Conclusion This combined operation not only corrects the eye position of large angle strabismus, but also improves the ocular movement, as well as the binocular visual functions. Key words: Strabismus, paralytic, special type; Rectus muscle transplantation, partial; Jensen procedure; Combined surgery

Rectus Muscle Posterior Tenon Fixation as an Inactivation Procedure

To report a surgical technique and the results of rectus muscle posterior Tenon fixation as an inactivation procedure for treatment of Duane syndrome, restrictive strabismus, and long-standing paralytic strabismus, which conventionally require large rectus muscle recession. Prospective, interventional case series. Three eyes in three Duane syndrome patients, one eye in one myopic strabismus fixus patient, one eye in one complete third nerve palsy patient, and one eye in complete sixth nerve palsy patient underwent rectus muscle inactivation by disinsertion and posterior Tenon fixation of its insertion. The main outcome measures were the postoperative eye position in all patients, the presence of upshoot or downshoot on adduction, and, in Duane syndrome patients only, the height of the palpebral fissure. In Duane syndrome patients, the upshoot and the downshoot were improved markedly, and the height of the palpebral fissure was increased on adduction after the operation as compared with before the operation; the other patients had improved ocular alignment after surgery. We believe that rectus muscle inactivation by fixation of its insertion to posterior Tenon is an effective and less invasive technique for achieving profound weakening of a rectus muscle compared with periosteal fixation of the rectus muscle.

Clinical features and surgical treatment of congenital ocular muscle palsy characterized with double elevator dysfunction

To investigate the clinical features of congenital ocular elevator muscle palsy and to evaluate the efficacy of surgical treatment. Pre- and post-operative eye position, superior rectus muscle and inferior oblique muscle function, clinical features were examined and analyzed in 11 patients with congenital double elevator palsy of ocular muscles. When fixated with the nonparetic eye, ten of 11 patients showed hypotropia and pseudoblepharoptosis in the primary position; One of 11 patients fixated with the paretic eye and showed hypotropia in the primary position. All cases were a monocular elevation deficiency in abduction and adduction, and showed pseudoblepharoptosis. In ten patients fixated with the nonparetic eye, two of 10 were undergone inferior rectus recession on paretic eyes; six of 10 were undergone inferior rectus recession and superior oblique tenectomy on paretic eyes; two of 10 were applied inferior rectus recession and superior oblique tenectomy on paretic eyes, superior rectus recession was performed on healthy eyes in six months postoperation. The patient fixated with the paretic -eye were undergone superior rectus recession and inferior oblique tenectomy on healthy eyes. Seven patients with exotropia had lateral rectus muscle surgery performed at the time of their vertical operation. Strabismus were complete corrected in 81.8% (9/11) of patients in our study and 18.2% (2/11) of patients were partial corrected. The functions of superior rectus muscle and inferior oblique muscle were not corrected. Nine patients showed complete correction of the psuedoptosis, one patient showed partial correction of the psuedoptosis, one patient did not showed any improvement of the pseudoptosis. We conclude that superior rectus muscle and inferior oblique muscle insufficiency are the primary factors in the etiology of congenital double ocular elevator palsy. Vertical rectus recession and superior oblique tenectomy on paretic eyes is an effective way of surgical treatment the disease.