Preoperative Angle Of Deviation Research Articles

Efficacy of augmented-dosed surgery versus botulinum toxin A injection for acute acquired concomitant esotropia: a 2-year follow-up

Background/aimsThis study aims to evaluate the clinical efficacy of botulinum toxin type A (BTXA) injection and augmented-dosed surgery in the treatment of acute acquired concomitant esotropia (AACE), and explore potential...

Effect of 4-week preoperative prism adaptation in preventing postoperative residual esotropia.

Preoperative prism adaptation (PPA) simulates postoperative status and possibly can predict postoperative undercorrection before surgery in esotropia. The present study aimed to assess the effect of 4-week PPA in preventing postoperative residual esotropia. Seventy-five (75) esotropes who had undergone surgery at a single strabismus center were retrospectively enrolled. They included 25 basic, 31 acute comitant, 10 partially accommodative, and 9 recurrent esotropia patients. The preoperative deviation angle, which had been determined using the alternating prism and cover test, was fully corrected with press-on prisms 4 weeks before surgery. If there was an increase of 5 PD or more of esodeviation, the prisms were changed accordingly at 2 weeks. The deviation angle measured at 4 weeks was determined as the surgical target angle. Patients were then divided into increase (≥ 5 PD increase of angle during 4-week PPA) and non-increase groups. Success was defined as either esodeviation of 8 PD or under or exodeviation of 5 PD or under at distance at postoperative 6 months. The increase group included 44 patients (58.7%). The mean deviation angle before PPA was 27.4 PD, and after the 4-week PPA, there was an average increase of 9.4 PD. The success rate was 90.9% in the increase group and 96.8% in the non-increase group (p = 0.316). There were no intergroup differences in preoperative clinical characteristics, esotropia types, postoperative deviation angle or postoperative near stereopsis (p > 0.05). The results of this study indicated a beneficial effect of 4-week PPA in esotropia of various types, specifically by uncovering the hidden esodeviation in the increase group and simulating the postoperative alignment in both the increase and the non-increase groups.

Revisiting the surgical table: An analysis of surgical dose-response in Asian exotropia

BackgroundPrevious research on the factors associated with surgical dose-response in strabismus surgery for exotropia has yielded inconsistent results. This study determined the factors influencing surgical dose-response in exotropia patients who underwent recession and resection (R&R). MethodsExotropia patients who underwent unilateral R&R at the National Taiwan University Hospital between 2006 and 2021 were evaluated. Deviation-angle differences in prism diopters (PD) were measured preoperatively and at 1 month postoperatively. Surgical dose-response (PD/mm) was defined as the difference in deviation angle (in PD) divided by the surgical dose in millimeters. Linear and non-linear regression models were used to evaluate the influence of variables including age, sex, axial length, and preoperative deviation on surgical dose-response. ResultsOverall, 295 patients (162 children; 133 adults) were included. Average surgical dose-response in the pediatric and adult groups was 2.82 ± 0.60 PD/mm and 3.02 ± 0.62 PD/mm, respectively. Male sex was negatively correlated with surgical dose-response in children. The surgical dose-response was larger in adults with longer axial length (>25.64 mm) and patients with larger preoperative deviation (>42.6 PD and >38.7 PD in pediatric and adult groups, respectively). Surgical dose-responses peaked at 35.1 years. ConclusionAge, axial length, and preoperative deviation have a nonlinear effect on surgical dose-responses in exotropia patients undergoing R&R. Surgical dose-responses were larger in patients in young adulthood, with longer axial length and larger preoperative deviation angle. A table with fitted values for surgical dose-response based on age, axial length, and preoperative deviation was established for clinical reference.

Postoperative outcome and influencing factors of strabismus surgery in infants aged 1-6years.

To evaluate the postoperative outcome of strabismus surgery performed in children aged 1-6 years by investigating the change of the preoperative angle of deviation (AOD), elevation in adduction, best-corrected visual acuity (BCVA) and refractive error. Retrospective chart review of 62 children who received strabismus surgery between January 2018 and December 2021 at the Department of Ophthalmology and Optometry of the Medical University of Vienna. Age, sex, type of strabismus, AOD, BCVA, refractive error and visual acuity were evaluated with respect to the postoperative outcome. Mean follow-up was 13.55 ± 11.38 months with a mean age of 3.94 ± 1.97 years (range: 1.0-6.0) at time of surgery. 74.19% of patients (n = 46) had isolated or combined esotropia, 12.90% (n = 8) had isolated or combined exotropia and 12.90% (n = 8) had isolated strabismus sursoadductorius. Mean preoperative AOD of 15.69 ± 16.91°/15.02 ± 14.88° (near/distance) decreased to 4.00 ± 9.18°/4.83 ± 7.32° (near/distance) at final follow-up (p < 0.001). BCVA improved from 0.26 ± 0.26/0.25 ± 0.23 (left/right) to 0.21 ± 0.25/0.20 ± 0.23 (left/right) (p = 0.038). There was no significant change regarding refractive error (p = 0.109) or elevation in adduction (p = 0.212). Success rate which was defined as a residual AOD of less than 10° was 74.19% (n = 46). In 3.23% (n = 2) retreatment was necessary. Strabismus surgery in infants was shown to have a satisfactory outcome with a low retreatment rate. Surgical success rate was not linked to age, sex, type of strabismus or the preoperative parameters AOD, refractive error and visual acuity in this study.

Acquired comitant esotropias – comparison of surgical outcomes of accommodative vs non-accommodative types

ABSTRACT Purpose: To compare the motor and sensory outcomes of strabismus surgery and the factors affecting surgical success in acquired acute non-accomodative esotropia (ANAET) and partially accommodative refractive esotropia (pARET). Methods: A retrospective chart review of patients with ANAET and pARET who underwent unilateral or bilateral horizontal rectus muscle surgery between January 2020 and December 2021 was conducted. Patients with postoperative follow-up of at least six weeks were included. Patients with pattern deviation, lateral incomitance, and near-distance disparity were excluded. Motor success was defined as a postoperative deviation within eight prism diopters of orthophoria. Sensory success was defined as presence of binocular single vision (BSV) for both distance and near (Worth four dot test). The effect of factors like age at onset, age at surgery, amblyopia before surgery, duration of squint before treatment, presence or absence and magnitude of vertical deviation, preoperative angle of deviation, and spherical equivalent on the motor and sensory success in each group were analyzed and compared. Results: 38 patients with ANAET and 33 patients with pARET were included. The mean age of onset of esotropia was 8.55 ± 4.65 years and 4.39 ± 2.27 years (p < .001) and the mean age at surgery was 10.62 ± 4.99 years and 7.89 ± 2.84 years (p = .006) in the ANAET and the pARET group respectively. The mean duration of the final follow-up was 38.51 weeks in the ANAET and 48.68 weeks in the pARET group (p = .089). Patients were successfully aligned for both distance and near in 81.5% of patients in the ANAET and 78.9% of patients in the pARET group at the final follow-up (p. 0.775). A BSV for both distance and near at the final follow-up was seen in 81.2% vs 66.6% of patients in the ANAET and the pARET group respectively (p = .25). A good near stereoacuity (<120 arcsecs) was seen in 60.6% and 41.9% of the ANAET and the pARET groups respectively (p = .175). The percentage of patients in the ANAET group who had orthophoria, any esodeviation, and any exodeviation for distance at the final follow-up was 63.1%, 34.2% and, 2.6%. The percentage of patients in the pARET group in similar categories was 36.3%, 42.4% and, 21.2%. None of the demographic and preoperative factors were found to affect the surgical outcomes in the two groups. Conclusions: The motor and sensory outcomes were similar in the two groups. A higher proportion of ANAET patients remained orthophoric during the follow-up. The patients in the pARET group showed a tendency toward exodrift.

Clinical Characteristics and Outcomes after Augmented Medial Rectus Muscle Recession in Patients with Acute Acquired Comitant Esotropia

Purpose: To analyze the clinical characteristics of patients with acute acquired comitant esotropia, evaluate the outcomes of augmented medial rectus muscle recession, and propose indicators for determining the appropriate surgical dosage.Methods: Data of patients with acute acquired esotropia who underwent medial rectus recession between 2016 and 2022 were retrospectively analyzed. The amount of medial rectus muscle recession was 1-2 mm greater than for other types of esotropia. Surgical success was assessed by reference to the angle of deviation and diplopia status 6 months after surgery. We investigated the amount of additional recession required for favorable surgical outcomes, the characteristics of groups that required augmentation, and changes in surgical amount according to the deviation angle.Results: A total of 38 patients were included; the average refractive error was -3.79 ± 3.11 diopters (D). Patient age at the time of surgery was 25.6 ± 18.2 years and the preoperative deviation angle was 38.1 ± 11.5 prism diopters (PD). The amount of medial rectus muscle recession was 6.25 ± 1.4 mm, i.e., 1.2 ± 1.0 mm greater than during other surgeries. The average augmentation was 24.1 ± 18.8%. The motor surgical success rate was 92.1% and the sensory success rate was 97.4%. The required augmentation was 26.9% for those with angles of deviation &lt; 30 PD, 25.5% for patients with angles between 30 and 40 PD, and 20.0% for those with angles &gt; 40 PD. Patients who required augmentation &gt; 25% were older, and the surgical effect was greater as the angle of deviation increased.Conclusions: To ensure successful surgical outcomes of patients with acute acquired comitant esotropia, it is essential to increase the amount of medial rectus recession compared to that during other surgeries; the average augmentation was 24% in this study.

Refractive Profile of Surgical Patients with Intermittent Exotropia: A Large-Sample Cross-Sectional Study in Southern China

Purpose To describe the refractive profile of surgical patients with intermittent exotropia (IXT) residing in southern China. Methods Medical records of patients who received strabismus surgery between June 2014 and August 2020 were retrospectively reviewed. Clinical data, including age, sex, refractive errors, preoperative angle of deviation, types of exotropia, accommodative convergence to accommodation ratio (AC/A ratio) and stereopsis, were investigated. Results A total of 2250 patients were included, and 93.6% of patients were younger than 30 years of age. The mean angle of exodeviation was 37.0 ± 14.7 prism degree (PD) and 37.5 ± 15.8 PD at distance and near, respectively. Mean spherical equivalent refraction (SER) values were -0.7 ± 2.4 D and −0.8 ± 2.5 D in the dominant eye and nondominant eye, respectively. Significant differences in SER were observed between the dominant eye and nondominant eye among children at 6 years old or younger. The percentage of myopia increased from 11.0% in children (≤6 years old) to 77.9% in teenagers (13-18 years of age). Significant positive associations between the magnitude of exodeviation and the magnitude of myopia were observed (p < 0.0001). Patients with convergence insufficiency type IXT (p < 0.0001) or AC/A < 2 (p < 0.05) showed a greater magnitude of myopia. The mild hyperopia group included a larger proportion of subjects showing a certain degree of stereopsis (p < 0.05). Conclusions Myopia was present in more than half of our patients (51.2%), which is much higher than the percentage in the general population of southern China. Patients with convergence insufficiency, an AC/A ratio < 2, or a larger angle of deviation tended to have a greater magnitude of myopia.

Results of Unilateral Lateral Rectus Recession Surgery in 15 - 30 PD Intermittent Exotropia.

To evaluate the surgical outcomes of unilateral lateral rectus muscle recession (ULR) with low surgical dosage in patients with intermittent exotropia (IXT) of 15 - 30 prism dioptres (PD). We retrospectively analysed 92 eyes of 92 patients who underwent ULR surgery with the diagnosis of IXT of 15 - 30 PD at distance fixation between January 2017 and June 2019. ULR surgery of 6.5 mm was performed for exotropia of 15 - 20 PD, 7.5 mm for that of 20 - 25 PD, and 8.5 mm for that of 25 - 30 PD and postoperative results were evaluated at the 1st week, 1st month, 6th month, and the 2nd year. Orthophoria or IXT less than 10 PD was accepted as successful. The mean preoperative deviation angle at distance was 22.3 ± 4.4 PD. Mean postoperative deviation angles at distance were 2.5 ± 1.7, 3.9 ± 2.4, 6.5 ± 3.0, and 8.7 ± 3.1 at 1 week, 1 month, 6 months, and 2 years, respectively. The surgical success rate of ULR was 100, 96.7, 84.7, and 77.1% at the 1st week, 1st month, 6th month, and the 2nd year, respectively. In the long-term results, there were no complications such as lateral gaze incomitance, overcorrection, or deterioration in stereopsis. Using the ULR technique, we were able to obtain effective surgical results in IXT with less surgical dosage and without any serious complications. ULR surgery can be used as an effective method in patients with IXT of 15 - 30 PD.

Evaluation of the efficacy of botulinum toxin injection for the treatment of infantile esotropia.

The purpose of this study was to investigate the outcomes and complications of botulinum toxin injection (BTX) as the primary treatment of infantile esotropia (IET). We included patients with IET who underwent BTX from 2015 to 2020. IET was defined as esotropia present before 12 months of age, with no significant refractive error, or limitation of rotations. We defined success as a postoperative angle of 0-10 prism diopters (PD). Sixty-three patients met our inclusion criteria (38 male patients [60.3%]). The mean age was 18 ± 8 months (range: 10-26), onset 6 ± 4 months (range: 2-10), and follow-up of 29 ± 25 months (range: 4-54). Amblyopia was present in 45 patients (71.4%). Number of BTX was, 1 in 42 (66.7%), 2 in 17 (27%), 3 in 4 (4.8%), and 4 in 1 (1.6%). The 1st BTX mean dose was 7 ± 3 international unit (range: 4-10) and a mean duration of 4 ± 1 min (range: 3-5). The mean preoperative angle of deviation was 42.30 ± 13.73 PD. The mean postoperative angle of deviation was 16.07 ± 16.15 PD (P = 0.0001). At the final follow-up, BTX was successful in 32 (51%) (success after 1st BTX 33.3%, 2nd BTX 46.03%, and 3rd BTX 50.79%). Twelve patients (19%) had undergone surgery due to the failure of BTX. Postoperative observations included transient ptosis 29 (49.2%), transient exotropia 36 (57.14%), inferior oblique overaction 13 (20.6%), vertical deviation 8 (12.7%), and persistent ptosis 1 (1.6%). The success rate of BTX for IET was 51%. BTX can be offered as an alternative to surgery to those who cannot undergo prolonged anesthesia or where accurate measurements could not be obtained.

One-Unit Osteotomy to Correct Deviated Bony Dorsum.

A crooked nose is frequently caused by nasal bony vault deviation, and proper management of the bony vault is an integral part of rhinoplasty. Conventional osteotomy to correct a deviated nose favors simultaneous medial and lateral osteotomies, which allows the free independent movement of each nasal bone. However, patient satisfaction with deviated nose surgery is sometimes low. In the present study, we introduce a one-unit osteotomy procedure that combines bilateral and root osteotomies with unilateral triangular bony wedge resection to allow symmetry of both nasal bones. Twenty consecutive patients who presented with bony vault deviation and underwent one-unit osteotomy were enrolled in this retrospective single-center study. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire was used to evaluate each patient's functional outcome. The angle of bony vault deviation before and after one-unit osteotomy was measured using a protractor and compared with the. of 14 patients who had undergone conventional osteotomy. The improvement in dorsal deviation was evaluated using facial photography preoperatively and 3 months postoperatively. NOSE values improved from 8.4±6.4 to 4.1±4.2 (P =0.021). The angle of bony vault deviation improved from 6.9°±2.2° to 2.1°±1.2° (P <0.001) in one-unit osteotomy and from 7.3°±4.0° to 2.7°±1.2° (P =0.001) in conventional osteotomy. The preoperative deviation angle improved by 70.3% in one-unit osteotomy compared with 56.6% in conventional osteotomy, which was a significant difference (P =0.033). The mean grade of the postoperative esthetic outcomes for the remaining deviation was 1.6±0.5, which was similar to that in the conventional osteotomy group. One-unit osteotomy is a relatively simple procedure that balances the width of both lateral walls by removing excessive bony fragments from the wider bony wall and providing better structural integrity. This technique improves functional outcomes and has equivalent esthetic. to those of the traditional procedure.

Epidemiological and Clinical Characteristics of Patients Operated for Strabismus at the Yaounde Central Hospital

Purpose: to describe the epidemiological and clinical characteristics of patients operated for strabismus. Methods: records of patients operated for strabismus between 2014 and 2022 at the Yaounde Central Hospital were included in this cross-sectional study. Data collected included: age at onset, age at the time of surgery, sex, type of strabismus, preoperative angle of deviation at distance, number of eyes and muscles operated. Significance level was set at p &lt;0.05. Results: 84 patients were included. There were 57 (67.9%) exotropias and 27 (32.1%) esotropias. Females were predominant, with no significant difference between exotropias and esotropias (70.4% in esotropias and 70.2% in exotropias). Early-onset strabismus was present in 88.9% of esotropias and in 57.9% of exotropias (p=0.0055). The mean age at the time of surgery was respectively 8.6 ± 8.6 years and 18.8±13.9 years for esotropias and exotropias. (p=0.00001). The mean pre-operative angle was 41.1 ± 9.5 prism diopters (PD) in esotropias and 40.2 ± 12.6 PD in exotropias. Surgery was done in both eyes in 82.1% of cases and at least on 2 muscles in 90.5% of cases. Conclusion: surgery for esotropia is carried out in late childhood and that for exotropia in late adolescence. Efforts geared towards sensitizing the public in view of early management of strabismus need to be made.

Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia.

To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre (PD)] were retrospectively reviewed. Two groups of patients were identified; Group I (21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A (BTA) injection into the recessed muscles and group II (30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. By the end of the first postoperative year, 10 patients in group I (47.6%) and 20 patients in group II (66.7%) achieved esotropia/esophoria <5 PD or exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant (P=0.1) but there was a statistically significant higher rate of undercorrection in group I (P=0.03). On the other hand, 3 patients in group I (14.3%) and 5 patients in group II (16.7%) had improved stereopsis; this difference in the sensory outcome was not statistically significant (P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate (P=0.004, 0.01 respectively). BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilateral medial rectus resection in the correction of large angle intermittent exotropia. The surgical success rate in BTA augmented surgery group is observed to be higher in patients with preoperative smaller angle of deviation and in patients with good stereoacuity.

Conventional surgery versus botulinum toxin injection for the management of esotropia in children with Down syndrome

To compare the success rates of strabismus surgery and botulinum toxin injection (BTX) in treating esotropia in patients with Down syndrome (DS). This multicenter retrospective cohort study included all consecutive patients having DS with esotropia between 2014 and 2021 at King Abdullah Specialist Children Hospital, King Abdullah International Medical Research Center, and King Khaled Eye Specialist Hospital, Saudi Arabia. We divided the patients into two groups according to interventions. Success was defined as angle of deviation of <10Δ at final visit. A total of 53 patients were included: 23 in the surgery group and 30 in the BTX group. There were no significant differences between groups with regard to age, sex, diagnosis, spherical equivalent, and preoperative deviation angle. Before the intervention, the median angle of deviation was 30.0Δ (IQR, 30Δ-45Δ) in the surgery group and 37.5Δ (IQR, 28.8Δ-50.0Δ) in the BTX group (P = 0.802). Postoperatively, the median (IQR) deviation angle was 0.0Δ (0.0Δ-16.0Δ) in the surgery group and 22.5Δ (6.75Δ-30.0Δ) in the BTX group (P = 0.006). The success rate in the surgery and BTX groups was 65% and 30%, respectively (P = 0.011). Two patients developed dissociated vertical deviation in the surgery group. One patient presented consecutive exotropia and one inferior oblique overaction in the BTX group. In this study, conventional surgery showed a higher success rate than BTX in the management of esotropia.

Bilateral Medial Rectus Advancement versus Unilateral Medial Rectus Advancement with Lateral Rectus Recession for Surgical Management of Large Angle Consecutive Exotropia without Adduction Deficit.

PurposeTo compare the postoperative eye alignment in patients who underwent bilateral medial rectus advancement with those who underwent unilateral medial rectus advancement plus ipsilateral lateral rectus recession in the case of large angle consecutive exotropia without adduction deficit.MethodsThirty-four patients with large angle consecutive exotropia that developed after infantile esotropia surgery were included in this retrospective study. Nineteen patients underwent bilateral medial rectus muscle advancement (group I) and 15 underwent unilateral medial rectus muscle advancement with ipsilateral lateral rectus muscle recession (group II). The follow-up periods were at least 12 months. Postoperative eye alignment was assessed and orthotropia within 10 prism diopters was considered a successful result.ResultsThe mean age of patients was 9.45±2.71 years in group I and 9.93±2.05 years in group II. Sixty percent of patients were female in group II and 57.89% in group I. In group I, the mean preoperative angle of deviation was 56.26±3.78 PD at distance and 53.11±3.49 PD at near. In group II, patients had a mean preoperative angle of deviation of 56±3.38 and 52.47±2.77 PD at distance and near, respectively. At the end of the follow-up period, the success rate was 52.63% in group I and 73.33% in group II (p = 0.22). The mean of the dose-effect relationship in group I was 2.62±1.35 PD/mm while in group II it was 2.36±0.84 PD/mm (p = 0.52).ConclusionIn patients with large angle consecutive exotropia, unilateral medial rectus advancement combined with ipsilateral lateral rectus recession produced better postoperative eye alignment than bilateral medial rectus advancement. Group I had a higher dose-effect relationship than group II.

Medial rectus recession versus lateral rectus advancement in surgical correction of consecutive esotropia

Background Following surgery to address intermittent exodeviation, consecutive esotropia (ET), in which postoperative ET continues for more than 6 months, may arise. Both lateral rectus advancement (LRA) and medial rectus recession (MRR) are effective in correction of consecutive ET. Purpose The aim of this study was to compare the results of LRA and MRR in correction of consecutive ET (within 40 PD) following bilateral lateral rectus recession for treatment of intermittent exotropia. Patients and methods This was a randomized double-blind controlled trial that included 30 patients who were divided into two groups: group 1 (LRA group, 15 patients) and group 2 (MRR group, 15 patients). Unilateral or bilateral LRA or MRR was done according to the preoperative angle of deviation. All patients had preoperative ocular examination, which included history taking, visual acuity testing, slit-lamp examination, fundus examination, preoperative angle of deviation at near and far using the Krimsky method, stereopsis using the Titmus test, and suppression using the Worth 4-dot test. The patients were followed up at 1, 3, and 6 months after surgery. Results There was no statistically significant difference between the two groups in the preoperative angle of deviation (P=0.213). In group 1, the mean preoperative angle of consecutive ET was 29.0±6.14 PD, which improved to 0.87±3.56 PD 6 months after surgery, with a statistically significant difference (P<0.001). In group 2, the mean preoperative angle of consecutive ET was 25.47±8.81 PD and improved to 1.67±4.58 PD 6 months after surgery, with a statistically significant difference (P<0.001). However, there was no statistically significant difference between the two groups in the postoperative angle of deviation (P=0.562). Six months postoperatively, there were two (13.3%) undercorrected cases and one (6.7%) overcorrected case, with a success rate of 80% in group 1, whereas in group 2, there were two (13.3%) undercorrected cases and two (13.3%) overcorrected cases, with a success rate of 73.4%, with no statistically significant difference between the two groups in the success rate (P=0.66). In group 1, the mean preoperative stereoacuity value was 291.7±206.5, which improved significantly postoperatively to 140±35.71 (P=0.005). Similarly, in group 2, the mean preoperative stereoacuity value was 506.7±810.5 and improved significantly postoperatively to 150±46.41, (P=0.003). Conclusion Both LRA and MRR were effective in the correction of consecutive ET.

Esotropia management: outcomes and prognostic factors

AbstractPurposeWe aimed to study the epidemiological and the clinical characteristics of esotropia, to report the results of the medico‐surgical management, and to analyze the various factors that may influence the postoperative prognosis.MethodsMedical records of 130 patients who underwent esotropia surgery between 2000 and 2015 were retrospectively reviewed. Ophthalmological examination and complete sensorimotor assessment were performed for each patient. All surgeries were made by the same surgeon. We operated simultaneously on the horizontal and vertical elements. Total optical correction and amblyopia treatment were started before surgery. We studied the influence of certain prognostic factors on motor outcome, such as strabismus type, age at the onset, delay of surgical management, degree of amblyopia, preoperative deviation angle, and a vertical syndrome presence.ResultsThe mean age was 8 ± 4.20 years. Our patients had infantile esotropia in 52.3% of cases. The age of strabismus onset was 2 years ± 2.2 years on average. Our patients had amblyopia in 70.7% of cases. A bilateral medial rectus muscle recession was performed in half of our patients with an associated Faden operation in 46.2%. We obtained a motor success rate of 85.38% after a single operation and a global success rate of 91.54%. A stable fusion and stereoscopic vision were present in only 4.6% of cases preoperatively and 6.92% of cases postoperatively. Surgical dosage and postoperative day 1 angle were significantly associated with motor outcome (p = 0.009 and p &lt; 0.001).ConclusionsEsotropia represents 83.3% of all strabismus. The infantile esotropia group had the worst motor and sensory status. Concerning the surgical protocol, the vertical syndrome is often operated on the same time as the horizontal deviation. Bilateral medial rectus muscle recession is the most practiced surgery. Unilateral surgery of recession/plication is indicated for deviations between 30 and 45 diopters and in the case of amblyopia. Bilateral surgery on 3 horizontal muscles is indicated in deviations of more than 45 diopters. Faden operation is indicated in angle variability of more than 15 diopters. The success rate for convergent strabismus varies between 48 to 90%.

Factors influencing surgical success in concomitant horizontal strabismus

Objective: To identify the factors affecting surgical success in patients who underwent horizontal concomitant strabismus surgery.&#x0D; Materials and Methods: Medical records of 143 patients who underwent concomitant horizontal strabismus surgery and who were followed up at least 6 months at Ordu University, Faculty of Medicine, Department of Ophthalmology between January 2015 and December 2020 were reviewed retrospectively. Surgical success was defined as postoperative orthophoria or deviation angle of 10 prism diopters (PD) or less at 6 months after surgery.&#x0D; Results: 101 (70.63%) patients with esotropia and 42 (29.37%) patients with exotropia were operated. The mean follow-up period was 18.54 ± 17.51 months, the mean distance and near preoperative deviation were 46.94 ± 11.62 PD and 47.29 ± 11.81 PD, respectively. The surgical success was 83.92% in all patients, 87.13% in esotropic patients, and 76.19% in exotropic patients. Additional surgery was performed in 8 (5.59%) patients with &gt;20 PD residual strabismus in the following year. Preoperative distance and near deviations were found to be significantly related with surgical success (p=0.020 and p=0.026). As the preoperative deviation decreases, the surgical success increases significantly. The deviation type, age at onset, age at the time of surgery, the interval between diagnosis and surgery, gender, or preoperative amblyopia were not significantly related to surgical success (p&gt;0.05).&#x0D; Conclusion: The surgical success was found to be high following concomitant horizontal strabismus surgery. Since the preoperative deviation angle is the significant factor determining surgical success, preoperative evaluations should be done carefully. Patients and their parents should also be warned about the probability of additional surgery.

Extraocular muscle resection, recession length and surgery outcome modelling in strabismus treatment: a pilot study

BackgroundMany surgical formulas have been developed and proposed based on the experience of surgeons to improve the predictability of strabismus surgery. However, the consent among strabismus surgeons regarding the dose...

Effect of the base-out recovery point as the surgical target for acute acquired comitant esotropia.

To evaluate the treatment efficacy of the preoperative base-out recovery point as the surgical target angle for acute acquired comitant esotropia. Prospective study. Twenty-two patients with acute acquired comitant esotropia (AACE) underwent strabismus surgery based on the target angle of the preoperative base-out recovery point. The postoperative deviation, positive fusional vergence, and negative fusional vergence were evaluated and compared with those of 23 normal individuals. The mean follow-up period was 18.68 ± 19.48months. At the last follow-up, 19 (86.4%) of 22 subjects had orthophoria, whereas 3 (13.6%) had minimal esophoria. The postoperative angle of deviation was significantly smaller than the preoperative angle of deviation at near (P < 0.001) and distance (P < 0.001). Postoperative sensory fusion was significantly better than preoperative fusion at near (P < 0.001) and distance (P < 0.001). The postoperative stereoacuity improved significantly after the surgery at near (P < 0.001) and distance (P < 0.001). Compared with the controls, the convergence and divergence amplitudes in the AACE patients were similar at distance (P > 0.05) but were still narrower at near (P < 0.001). Good alignment and binocular balance were obtained with the surgical target angle of the base-out recovery point in AACE.

Clinical factors affecting the rate of exodrift after surgery in patients with basic intermittent exotropia

We investigated the period of postoperative exodrift during follow-up and clinical factors that affect the rate of exodrift after surgery in the patients with intermittent exotropia (IXT). A retrospective review of medical records of patients with exodrift who underwent bilateral rectus recession for IXT was performed. Exodrift was defined as angle of deviation greater than 10 prism diopters (PD) at distance and near. The median survival period of postoperative exodrift was analyzed using Kaplan Meier survival analysis. The patients were divided into two groups according to the median period of postoperative exodrift (early and late group). The weighted Cox’s proportional hazards regression analysis to investigate the risk factors that affect rate of postoperative exodrift was performed. A total of 108 patients was included. The preoperative angle of deviation at distance and near were 30.3 ± 7.2 PD and 29.5 ± 8.6 PD, respectively. The median survival period of postoperative exodrift was 24 months (range, 6–48 months).The angle of deviation at postoperative day 1 in early and late group were − 3.8 ± 5.5 PD (range, − 16–8 PD) and − 7.7 ± 4.6 PD (range, − 16–4 PD) (p < 0.01). Minus value means esodeviation. In regression analysis, the angle of deviation at postoperative day 1 was the significantly related with rate of exodrift (p < 0.01). The median period of exodrift after surgery was 24 months, angle of deviation at postoperative day 1 could affect the rate of exodrift in patients with IXT.