Sensory Exotropia Research Articles

Persistent Fetal Vasculature with Pediatric Cataract, Microcornea, Sensory Exotropia and Mental Retardation: A Case Report

Introduction : Persistent Fetal Vasculature (PFV) is a congenital, nonhereditary ocular malformation that frequently involves the lens. PFV is most frequently unilateral. The classical presentation is leukocoria, microphthalmia, and cataract.
 Case Illustration : A 16-year-old boy patient with mental retardation, came with chief complaint blurred vision and white appearance on the RE, noticed for 1 month ago. Visual acuity of the RE was LPBP and the LE was 6/120. There was microcornea on both eyes with diameter 8 mm. Lens opacity and exotropia with XT 30 0 on the RE. IOP on both eyes was normal. Funduscopic on the RE was negative and LE there was tigroid retina. Ultrasonography of the RE was echogenic with minimal after movement and low to moderate spikes. Planning for this patient were RE lens extraction with IOL. After that evaluate for the posterior segment.
 Discussion : Progressive cataract formation often occurs, sometimes leading to a complete cataract. Strabismus associated with a unilateral cataract. The most important was differentiating PFV from retinoblastoma. In patients with poor view of the fundus, ultrasonography should be performed. Retinal or optic nerve abnormalities cannot be definitively ruled out, however, until the posterior pole can be visualized directly. The opacity in the affected eye should be cleared to allow visual development and to save the eye from complications of untreated PFV.
 Conclusion : It is important to obtain a detailed history of the child’s growth, development, systemic disorders, family history, and need further comprehensive examination and multidiscipline consultation to establish the diagnose.

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.

Cirugía monocular de 4 músculos extraoculares para la exotropía monocular de gran ángulo

IntroductionRecurrent exotropia is common following surgery for monocular large angle constant sensory exotropia. Surgery is usually limited to operations on the affected eye. Simultaneous oblique weakening surgery may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting forces. We report the results of simultaneous oblique muscle weakening procedures combined with ipsilateral horizontal rectus muscle surgery constant monocular exotropia greater than 35 prism diopters (PD). MethodsRetrospective case series of patients who underwent unilateral lateral rectus recession combined with medial rectus muscle resection and simultaneous weakening of both ipsilateral oblique muscles. Primary outcome measure was ocular alignment in primary position. ResultsTwelve eyes of 12 patients were included. The mean preoperative exotropia improved from 57.9±15.1 (range 35–80; median 60PD) to 3.3±5.5 (range 0–16; median 0PD) postoperatively (p<0.005). Two (66%) patients with a pre-existing vertical deviation had resolution of their vertical misalignment postoperatively. At the last postoperative follow up 92% of the patients had an exodeviation of 10PD or less (range 0–16PD median 0PD), and 7 (58%) measured near and distance orthotropia. Postoperative abduction measured −0.6±1 (0 to −3) and adduction −0.4±0.7 (0 to −2). ConclusionWeakening the ipsilateral oblique muscles may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting vectorial forces when operating for a large angle monocular exotropia. As an additional potential advantage, oblique muscle surgery may be used simultaneously to address associated vertical deviations.

Surgical outcomes in sensory exotropia

To determine success rates over time for strabismus surgery for sensory exotropia and to determine factors associated with successful outcomes. We retrospectively reviewed medical records of patients with sensory exotropia (best-corrected visual acuity ≤20/200 in the affected eye) who underwent strabismus surgery between May 2009 and December 2019. Patients with paralytic/restrictive exotropia and patients who did not follow up postoperatively were excluded. Surgical success was defined as exotropia of ≤10Δ or esotropia of ≤6Δ. Cox-proportional hazard models were used to evaluate covariate relationships with surgical outcome (α = 0.05). A total of 94 patients (64% female) were included. Mean patient age was 27.2 years (range, 3-69). Mean follow-up was 2.35 ± 2.77 years. The mean preoperative near deviation was 39Δ ± 14.8Δ of manifest or intermittent exotropia. Successful alignment was achieved in 51 of 83 patients (61%) at 1 month, 19 of 32 (59%) at 1 year, and 8 of 16 (50%) at 5 years. We found a significant correlation (P value = 0.0476) between success and smaller surgical doses in patients that underwent one- and two-muscle surgeries. In our study cohort of 94 patients, 50% of patients still had satisfactory ocular alignment at 5 years.

Unilateral four muscle surgery for extra-large monocular exotropia

IntroductionRecurrent exotropia is common following surgery for monocular large angle constant sensory exotropia. Surgery is usually limited to operations on the affected eye. Simultaneous oblique weakening surgery may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting forces. We report the results of simultaneous oblique muscle weakening procedures combined with ipsilateral horizontal rectus muscle surgery constant monocular exotropia greater than 35 prism diopters (PD). MethodsRetrospective case series of patients who underwent unilateral lateral rectus recession combined with medial rectus muscle resection and simultaneous weakening of both ipsilateral oblique muscles. Primary outcome measure was ocular alignment in primary position. ResultsTwelve eyes of 12 patients were included. The mean preoperative exotropia improved from 57.9 ± 15.1 (range 35–80; median 60 PD) to 3.3 ± 5.5 (range 0–16; median 0 PD) postoperatively (p < 0.005). Two of 3 patients with a pre-existing vertical deviation had resolution of their vertical misalignment postoperatively. At the last postoperative follow up 92% of the patients had an exodeviation of 10 PD or less (range 0–16 PD median 0 PD), and 7 (58%) measured near and distance orthotropia. Postoperative abduction measured −0.6 ± 1 (0 to −3) and adduction −0.4 ± 0.7 (0 to −2). ConclusionWeakening the ipsilateral oblique muscles may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting vectorial forces when operating for a large angle monocular exotropia. As an additional potential advantage, oblique muscle surgery may be used simultaneously to address associated vertical deviations.

Surgical Outcomes for Sensory Exotropia in a Tertiary Hospital in Manila, Philippines

Surgical Outcomes for Sensory Exotropia in a Tertiary Hospital in Manila, Philippines

Unilateral surgery for pediatric sensory exotropia: clinical characteristics and surgical results

BackgroundTo delineate the clinical characteristics and surgical outcomes of large angle sensory exotropia in pediatric patients.MethodsThe medical records of 54 large angle exotropia ≥40 PD patients aged from 1 to 18 years who were operated on between 2018 and 2021 and were followed up for 1 year were reviewed and contacted. Clinical characteristics and surgical outcomes were analyzed retrospectively. Patients were divided into two groups, group S patients had supermaximum recession resection and group E had augmented recession by lateral rectus muscle elongation with an autograft from the resected medial rectus muscle in the same eye. The clinical characteristics and results of both groups were compared.ResultsThe mean age of the studied patients with sensory exodeviation at the time of surgery was 8.3 ± 4.2 years. Mean of the duration of exotropia was 6.9 ± 2.2 years, and the mean of postoperative follow-up was 14.3 ± 4.2 months. Surgical success was achieved in 73.07% of group S and 82.14% of group E. Recurrence was more common with anterior segment pathology. Larger post-operative distant angles were strongly related to poorer visual acuities P = 0.001 and not related to the age of onset or the duration. Narrowing of the palpebral fissure improved in both groups at the last follow up P = 0.336. The limitation of abduction in both groups improved in the last follow up P = 0.145.ConclusionThe outcome of monocular surgery for sensory exotropia in children is satisfactory with no significant differences in results between lateral rectus muscle tendon autograft elongation technique and supermaximum recession resection. Recurrence is more common with anterior segment pathology. Larger post-operative distant angle of deviation is strongly related to poorer visual acuity.Clinical trial registrationThis study was retrospectively registered at clinicaltrials.gov (ID: NCT04286945) on 25-2-2020.

Unilateral four-muscle surgery for large monocular constant sensory exotropia

Recurrent exotropia is common following horizontal rectus muscle surgery for monocular constant sensory exotropia. Surgery is limited to avoid operating on the better-seeing eye. Simultaneous oblique weakening surgery may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting oblique force. We report the results of simultaneous inferior and superior oblique muscle weakening procedures combined with horizontal muscle recession/resection for large angle constant monocular sensory exotropia greater than 35Δ.

True muscle transplantation in sensory exotropia – A case series

Management of sensory exotropias is often challenging. In this study, patients who had sensory exotropia &gt;70 prism diopter (PD) were treated with true muscle transplantation. A total of 10 patients with vision &lt;3/60 in one eye were included in the study. All patients underwent transplantation of the medial rectus to the lateral rectus along with a recess–resect procedure. The mean preoperative deviation was 77.5 ± 7.5 PD and postoperative deviation was 6.8 ± 3.2 PD at 1 year. No limitation of movements or lateral incomitance was noted. Thus, this procedure seems to be effective in treating large-angle sensory exodeviations.

Binocular summation in comitant exotropia: Change after surgery.

Purpose:To assess the change in binocular summation (BiS) in comitant exotropia (XT) after strabismus surgery.Methods:This is a prospective study on 20 patients who underwent surgery for comitant XT over a one year period. Patients with sensory exotropia and nystagmus were excluded. Best-corrected visual acuity (VA) and contrast sensitivity (CS) of both eyes separately and together (binocularly) were recorded. BiS score was calculated as binocular score minus better eye score. BiS score at the end of 3 months was compared with the preoperative data.Results:The mean ± SD of BiS score increased from 2.95 ± 0.88 to 4.55 ± 0.68 (P-value < 0.0001) for VA (on ETDRS letters) and from 2.75 ± 0.44 to 4.5 ± 0.76 (P-value < 0.001 for CS (on Pelli–Robson chart) after surgery.Conclusion:There is significant improvement in BiS in XT after strabismus surgery. Authors recommend its inclusion in evaluation of functional outcome of XT surgery.

The Relationship of Depression with Sleep Quality in Psychology Students of Unika Atma Jaya University During the Covid-19 Pandemic

Exotropia sensory is unilateral divergence as a sequel to vision loss or long-standing poor vision. Characterized by large angles, comitant strabismic, increased gradually. Surgical characteristic treatment success are final deviation less than 10 prism diopters at distance in the primary position. Large deviation requires operating on three or four horizontal muscle and operating only for poor vision. This research aims to report the exotropia sensory patients and the result of surgical treatment for sensory exotropia by examiningthe outcomes of the surgical treatment. This is a prospective descriptive study conducted from January 2018 to December 2020 at Dr.M.Djamil hospital, Padang. A total of 12 patients included in this study. Detailed history regarding the complaint, developmental history was taken. Patients were thoroughly evaluated for visual acuity, through anterior segment evaluation using slit lamp, and fundus examination, and finding the deviation of the eye by doing hisberg test and prisma krimsky near and distance test. The result of surgical treatment evaluated by examine Hirsberg test and prisma krimsky test. A total of 12 patient were included, of whom 6 cases (50%) are man and woman 6 cases (50%), and the patients are 21-30 age year old about 33,33%. From the etiology, retinal abnormalities are the most causes of the exotropia with 4 cases (33,33%). The patient are management by surgical and with monocular reses-resect hang back surgery. From 6-month follow up, the patient was satisfactory cosmetic result with orthotropia 85,71%. The patient exotropia sensory are 21-30 years old. The most common cause of sensory strabismus was retinal abnormalities, and the long-term outcome of surgery for sensory exotropia was satisfactory.

Surgical outcomes of strabismus surgery in sensory exotropia

Surgical outcomes of strabismus surgery in sensory exotropia

Efficacy of Botulinum Toxin Injection in Exotropia Treatment.

PURPOSE:Botulinum toxin (Botox) therapy is a well-known option for strabismus management and is often used in managing esotropia. Exotropia is also a common type of strabismus; however, the effectiveness of Botox in improving exotropia is still ambiguous. In this study, we report our experience in using Botox to manage the various types of exotropia.METHODS:A retrospective cohort study was conducted at King Khaled Eye Specialist Hospital Riyadh, Saudi Arabia. Medical records of patients with exotropia who received Botox from 2014 to March 2020 were reviewed. The main success indicator was a remaining angle of less than 10 prism diopters (PD).RESULTS:A total of 97 cases were reviewed, with 57 (58.8%) males and 40 (41.2%) females. The age ranged from 2 months to 40 years. The most prevalent diagnosis was sensory exotropia. Overall, 28 patients (28.9 %) and 49 patients (50.5%) achieved an angle of deviation within 10 PD and within 20 PD, respectively. Female patients had a better response to Botox than males, with 32.5% of them achieving an angle of deviation within 10 PD and 60% achieving an angle of deviation within 20 PD. We found that the change in the angle of deviation increased as the Botox dose was increased.CONCLUSION:Botox represents a possible safe alternative to surgery in the management of some exotropia types. The success rate differs by type, with basic exotropia scoring the highest. The presence of poor vision and amblyopia leads to a significantly lower success rate.

True muscle transplantation surgery for large angle exotropia

Managing large-angle exotropia (&gt;70 PD) can be challenging with the various techniques available. In this case series, we present “True Muscle Transplantation"––a simple technique––to manage large-angle sensory exotropia as a possible alternative. Seven patients (four women and three men) of mean age 39.71 ± 17.38 years with sensory large-angle exotropia (&gt;70 PD) underwent proposed surgery after detailed preoperative workup. The stump resected from MR was transplanted to LR and recessed. The mean preoperative deviation of 77.14 ± 4.52 PD base-in reduced to mean postoperative angle of 4.71 ± 4.42 PD at 6 months with good ocular alignment, no lateral incommittance, and no limitation of ductions in all patients. Stable results were maintained beyond 6 months. True Muscle Transplantation, therefore, has the potential of being a possible alternative.

Macular pucker, an atypical clinical presentation of ocular toxoplasmosis: a case report

BackgroundOcular toxoplasmosis caused by Toxoplasma gondii is an infectious disease which is widely distributed around the world and can present with various clinic manifestations. We are here reporting an unusual case presented with epiretinal membrane (ERM), i.e., macular pucker.Case presentationA 16-year old male patient visited our outpatient clinic complaining of decreased vision for about 8 years in his left eye. The best-corrected visual acuity (BCVA) was 20/20 OD and 20/400 OS. There was sensory exotropia in his left eye. No inflammatory cells or flare were found in his anterior chamber or vitreous cavity OU. An ERM involving his left macular area was found on his dilated fundus exam, which was confirmed by Optical Coherence Tomography (OCT). The ERM was found to involve his left macular area with his foveal ellipsoid zone absent. The right eye was found to be within normal limit.After a thorough discussion with the patient and his parents about treatment options and surgical benefits, risks and alternatives, we performed vitrectomy, peeled off the ERM and collected the vitreous sample for parasite testing during the procedure. Patient’s blood also was drawn for serological testing. Vitreous sample analysis and serological tests confirmed ocular toxoplasmosis OS as his final diagnosis. Unfortunately, the BCVA of this patient was not improved after the surgery, but the exotropia disappeared.ConclusionERM is an unusual clinical presentation of ocular toxoplasmosis. We may add Toxoplasma gondii infection as a differential diagnosis when encountering ERM cases.

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

Surgery in a Patient with Sensory Exotropia with an Abnormally Attached Lateral Rectus Muscle

Surgery in a Patient with Sensory Exotropia with an Abnormally Attached Lateral Rectus Muscle

Spontaneous consecutive sensory esotropia: a case series

We present the first case series of patients with no systemic neurologic disease who experienced a spontaneous conversion from an initial exotropia to a sensory esotropia in the absence of strabismus surgery or chemodenervation. The patients in this series all were exotropic in the first 2years of life, with the strabismic eye having decreased vision due to unilateral ocular pathology. All patients demonstrated spontaneous conversion to esotropia between 4 and 8years of age and thereafter clinically demonstrated a high ratio of accommodative convergence to accommodation. There was no discernible relationship between refractive error and the pattern of spontaneous esotropia. The existence of this rare entity may support delayed surgical correction of strabismus in patients with sensory exotropia.

Triple procedure for coexistent aphakia, squint, and iris defect: single-stage strabismus correction, glued IOL, and single-pass 4-throw pupilloplasty

Posttraumatic aphakia is a serious deterrent to visual rehabilitation that usually follows sensory exotropia, thereby mandating urgent surgical intervention. In addition, abnormal iris configuration and iris defects postocular trauma can lead to amblyopia and glare and require surgical correction. However, in individuals where such multiple posttraumatic extraocular and intraocular abnormalities coexist, confusion remains about whether to perform sequential or concomitant surgeries. In these situations, an unusual triple technique consisting of strabismus correction, glued scleral fixation of intraocular lens, and single-pass 4-throw pupilloplasty is a useful cost-effective method of single-stage visual and cosmetic rehabilitation. However, it requires collaboration of experienced surgeons form multiple ophthalmic subspecialties.

Unilateral recession and resection surgery with adjustable suture in adult sensory exotropia: long-term success and exotropic drift

ABSTRACT This retro-prospective study aimed to evaluate the correlation between initial postoperative deviation and long-term outcome of unilateral recession and resection surgery with adjustable suture in adult sensory exotropia, factors associated with long-term outcome, exotropic drift, and time to failure following surgery. We included adult patients (age ≥18 years) with sensory exotropia who underwent unilateral lateral rectus recession with adjustable suture and medial rectus resection with at least 2-year follow-up. Preoperative and postoperative data was collected. Either Krimsky or alternate and prism cover testing was used to measure the angle of deviation depending on patients’ fixation ability. Glasses with full refractive correction were worn if they can provide better visual acuity. Exodeviation at near fixation was used in statistical analysis. A total of 38 patients (mean age at surgery 32 ± 13 years) were included. Median preoperative exotropia was 45 PD (IQR 40–55, range 25–70) and median initial postoperative deviation was esotropia 8 PD (IQR 0–11, range from exotropia 8 to esotropia 30). Mean follow-up time was 5 ± 2.5 years (range 2–10). Motor success, defined as a deviation within 10 PD of orthotropia, was found in 50% and 42% of patients at 2-year and last follow-up. Initial postoperative deviation and amount of lateral rectus recession were significantly associated with long-term outcome (p = .006 and 0.029). Patients with initial moderate and minimal overcorrection had higher success rates (67% and 62%) than patients with initial orthotropia or undercorrection (10%) (p = .002). Median overall rate of exotropic drift was 8 PD/year (IQR 6–13, range from esotropic drift 8 to exotropic drift 26). Time to failure in nonsuccess group was 24 months (IQR 21–24, range 2–24). In conclusion, unilateral recession and resection surgery with adjustable suture in adult sensory exotropia achieved 50% success at 2 years. Initial postoperative moderate overcorrection results provide the highest chance for long-term success. The majority of patients developed exotropic drift with time and time to failure was 2 years.