Surgery For Esotropia Research Articles

Surgical Treatment of Strabismus in Children With Developmental Delay: A Review of the Literature and Results of Personal Experience.

To review the current literature, to provide a foundation of knowledge on strabismus surgery in patients with developmental delay, and to present results from the authors' personal experience. The following terms were searched on PubMed: strabismus surgery, mental delay, developmental delay, Down syndrome, Angelman syndrome, cerebral palsy, hydrocephalus, Williams syndrome, fragile X syndrome, and fetal alcohol syndrome. Surgical outcomes were analyzed and discussed; only English articles were included. Medical records of 183 patients with developmental delay who underwent strabismus correction surgery from 2001 to 2020 were examined and discussed. Articles were reviewed and analyzed, categorized based on the disease. The authors' experience included 183 patients with various diseases or syndromes: 44 Down syndrome, 40 fetal alcohol syndrome, 36 Williams syndrome, 9 fragile X syndrome, 12 Angel-man syndrome, 11 Cohen syndrome, and 31 cerebral palsy. Surgical results at 3 and 18 months of follow-up were analyzed. Regarding esotropia surgery, 83.9% had a deviation of less than 8 prism diopters at 3 months and 53.8% at 18 months of follow-up. Hypocorrection was seen in 7.7% and 3.5% and hypercorrection was observed in 8.4% and 52.7% at 3 and 18 months, respectively. For exotropia, 60% had a deviation of less than 8 prism diopters at 3 months and 22.5% at 18 months. Hypocorrection occurred in 35% and 75%, whereas hypercorrection was found in 5% and 2.5%, respectively. A higher prevalence of strabismus was found in these patients and the surgical outcomes were more difficult to predict. Patients with esotropia were more hypercorrected, whereas those with exotropia were more hyporcorrected. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

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.

SURGICAL MANAGEMENT IN ESOTROPIA AT CIPTO MANGUNKUSUMO HOSPITAL: A 4-YEAR OBSERVATION ON CHARACTERISTIC AND RESULT

Introduction: Esotropia, although have low prevalence in Indonesia, give significant impacts on its sufferer, and due to the wide range of types creates numerous options for surgery without much consensus. Success rates of the surgery also varied depends on many factors. This study aims to evaluate clinical characteristics, success rate in esotropia surgery, and factors that may influence the outcome. Methods: A retrospective descriptive study based on secondary data from medical records of child and adult esotropia patients who underwent surgery from January 2018 to December 2021. Result: Of 68 patients included in the study, 60.2% were adults. More than half of patients have an onset before 7 years of age, though amblyopia only affects 29.4% of patients. Squinted-eye was the chief complaint in most patients (76.5%). One-third of patients had basic type esotropia and 59.7% had large preoperative deviation. Unilateral procedure was done in 50% of patients. The surgery success rate reached 65% with good stability on 8 months of follow-up. Better results were seen in congenital and basic type esotropia than in other types. Although none of the believed influenced factors affecting outcome were significant statistically, duration <5 years and preoperative deviation <50 PD had a higher success rate of 75% and 84.6%. Conclusion: Esotropia surgery in Cipto Mangunkusumo hospital were performed majorly in adults with large pre-operative deviations, mostly by unilateral procedure of recession and resection. The surgeries yield good results and stability, with shorter duration and smaller preoperative deviation giving higher success rates.

A Comparative Analysis of Surgical Outcomes for Infantile Esotropia With and Without Prior Botulinum Toxin A Injection.

To compare the surgical outcomes in patients who had a failed botulinum toxin A injection before surgery versus those who had surgery as primary treatment (primary surgery) for infantile esotropia. The files of patients who had strabismus surgery in the Strabismus Unit of Beyoglu Eye Training and Research Hospital between January 2012 and March 2022 were reviewed. This study included 104 eyes of 52 patients with infantile esotropia. The angle of deviation before and 1, 3, and 6 months after botulinum toxin A injection or surgery, complications, pattern deviations, family history, abnormal head position, history of prematurity, intensive care unit admission, and consanguineous marriage were noted. A successful outcome was defined as ocular alignment of 10 prism diopters (PD) or less. The study population consisted of 52 patients: 27 (52%) boys and 25 (48%) girls. In the botulinum toxin A group (n = 26), the mean age at admission was 14.0 ± 6.8 months, whereas the mean preoperative near and far angle of deviation were 41.92 ± 12.2 and 41.3 ± 13.0 PD, respectively. The mean age at the time of surgery was 40.6 ± 18.1 months. In the primary surgery group (n = 26), the mean age at admission was 34.0 ± 15.9 months. The mean preoperative near and far angle of deviation were 37.3 ± 8.0 and 35.3 ± 10.5 PD, respectively. The mean age at the time of surgery was 48.1 ± 18.5 months. The success rates 6 months after treatment in the botulinum toxin A group and the primary surgery group were 76.9% and 88.5% in near (P > .05) and 80.8% and 88.5% in far (P > .05), respectively. Three patients had transient ptosis and one had consecutive exotropia after botulinum toxin A injection. In infantile esotropia treatment, strabismus surgery after failed botulinum toxin A injection compared to primary surgery has statistically comparable surgical success rates. [J Pediatr Ophthalmol Strabismus. 2024;61(4):245-251.].

What to expect from primary inferior oblique overaction after esotropia surgery

BackgroundOverelevation in adduction is common in patients with primary esotropia. This study evaluates the variation in ocular motility pattern in patients with primary inferior oblique (IO) muscle overaction after esotropia surgery.MethodsThe medical records of consecutive patients who underwent surgery for infantile, partially accommodative, and basic esotropia over eleven years and had at least one year of follow-up were reviewed. Patients with primary inferior oblique muscle overaction (IOOA) presented at baseline or during follow-up were selected and divided according to the first surgery performed concurrently with horizontal rectus surgery: without IO recession (NO-recess), with unilateral IO recession (UNIL-recess), and with bilateral IO recession (BIL-recess). The success (version normalisation or at least 2 points upgrade in severity scale [0–4] in the operated eye), recurrence rates, and the evolution of the non-operated IO muscles were evaluated.ResultsOne hundred and ten patients were included – 53 NO-recess, 26 UNIL-recess, and 31 BIL-recess. Medial rectus muscle posterior fixation sutures surgery (PFS) was performed in 88.2% of patients for esotropia. A recession with graded anterior transposition was the weakening IO procedure. In the NO-recess group, 28 (52.8%) patients normalised their mild IOOA after PFS surgery alone. In the UNI-recess group, the success rate was 88.5%, with 16 (61.5%) patients showing worsened IO muscle of the fellow eye, which prompted additional surgery in 10 patients. In the BIL-recess group, all 31 patients improved the adduction pattern of the operated eye for an 80.6% success rate (6 improved marginally).ConclusionGraded anterior transposition of the inferior oblique muscle effectively normalises versions. However, it’s frequent for a contralateral overaction to become manifest after unilateral IO surgery.

Revisiting Posterior Fixation Sutures Surgery: Unveiling Novel Approaches for Primary Management of Diverse Esotropia Cases.

Strabismus, specifically esotropia, presents a significant challenge in ophthalmic surgery, while several treatment options exist. This study aims to evaluate the results of posterior fixation sutures (PFS) on the medial rectus as a primary approach for some types of esotropia. The medical records of consecutive patients who underwent surgery for esotropia over 11years and had at least 1year of follow-up were reviewed retrospectively. Patients were classified into one of three types of deviation: infantile (IE), partially accommodative (PAE) and basic (BE) esotropias. An alignment within 16 prism diopters (PD) of orthotropia was a successful outcome. A total of 404 patients were included: 67IE, 180 PAE and 157 BE. Before surgery, a deviation greater than 30PD was present in 88.1% and 80.1%, and a deviation greater than 50PD was present in 66.5% and 52.9% of patients (near and distance, respectively). In the BE group, PFS was the baseline surgery in a smaller number of cases (75%) compared to the other two groups (versus 86.6% [IE] and 88.3% [PAE], p = 0.002). The need for an additional procedure was significantly higher in the infantile esotropia group (44.8% vs. 18.9% and 24.8%, p < 0.001). Final surgical success was achieved in 95.3% of all patients. Orthotropia was achieved in 19.4% (IE), 29.6% (PAE) and 25.5% (BE) of cases. PFS of the medial rectus without recession proved successful as a first-line procedure for esotropia in the subtypes of patients evaluated in this study.

Systemic evaluation of the risk of reoperations in pediatric populations with exotropia and esotropia: nested case–control study

The study aimed to assess the risk of reoperations for strabismus in the pediatric population and to identify high-risk groups. This was a nationwide population-based study that used data from the Korean National Health Claims Database from 2008 to 2020. Two major cohorts were established based on initial strabismus: age-, sex-, and recruitment year-matched controls were randomly selected. Patients aged ≤ 9 years who underwent initial strabismus surgery for exotropia and esotropia were included, resulting in a total of 24,816 patients included to this study. The cumulative incidence of reoperations was 843 per 10,000 persons for exotropia, 1559 per 10,000 persons for esotropia. To assess the significant exposure factors, conditional logistic regression was performed to obtain odds ratio (OR) in each cohort. In patients with exotropia, the OR of reoperations was 4.26 times higher when the initial surgery is performed at younger age (earlier than 3-year-old) and 6.49 times higher when only one eye underwent than two eye. Similarly, in patients with esotropia, younger age (6.57 times) and unilateral surgery (7.20 times) were identified as common factors that increase the risk of reoperations. Based on the findings, special attention is recommended for patients younger than 3 years, especially those performed unilateral surgery as initial intervention in practical settings.

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.

Surgical Outcomes of Consecutive Exotropia – A Retrospective Analysis from a Tertiary Eye Hospital

Purpose: To determine the surgical outcomes of medial rectus advancement alone or in combination with lateral rectus recession in the management of patients with consecutive exotropia. Materials and Methods: A retrospective analysis of 20 patients who underwent surgical correction for consecutive exotropia (XT) between January 2019 and June 2022 was conducted. Patients underwent either medial rectus advancement (Group 1) or combined medial rectus advancement and lateral rectus recession (Group 2). Patients were followed up for a minimum period of 1 month postoperatively, and the correction obtained per mm of muscle operated was analysed. Results: Twenty patients (8 females, 12 males) were enrolled in the study. The mean age at primary surgery for esotropia was 6.25 ± 4.67 years, and the mean age at surgery for XT was 23.1 ± 9.47 years. At the present surgery for XT, the mean distance deviation was 43.05 ± 13.79 prism diopter (PD) of exotropia and the mean near deviation was 43.55 ± 15.21 PD of exotropia. Group 1 consisted of five patients, and Group 2 consisted of 15 patients. Postoperatively, the mean distance deviation was 7.6 ± 6.21 PD (range: 6 PD esophoria–18 PD XT) and the mean near deviation was 7.0 ± 6.07 PD (range: 6 PD esophoria–20 PD XT). The mean correction obtained postoperatively was 36.0 ± 12.49 PD. The mean correction obtained per mm of muscle operated was 3.45 ± 0.61 PD. Conclusion: Medial rectus muscle advancement with or without lateral rectus recession is an effective surgical method for the treatment of XT, and the mean correction obtained per mm of muscle operated was 3.45 ± 0.61 PD. Careful history taking, analysing previous surgery details, preoperative planning, and intraoperative exploration of muscles are important for managing eyes with XT.

Clinical Profile, Neuroimaging Characteristics, and Surgical Outcomes of Patients With Acute Acquired Non-accommodative Comitant Esotropia.

To report the clinical presentations, neuroimaging findings, and surgical outcomes in patients with acute acquired non-accommodative comitant esotropia (AACE). A retrospective review of records of all patients diagnosed as having AACE between January 2011 and December 2019 across three tertiary eye care centers was done. Cases with AACE onset after age 1 year were included. Patients were divided into two groups based on age of onset of esotropia: childhood (16 years or younger) and adult (older than 16 years). Surgical success was defined as postoperative horizontal deviation of 8 prism diopters (PD) or less at the last follow-up visit. A total of 338 patients (220 males and 119 females; mean age at presentation: 12.60 ± 9.8 years) met the study criteria. The mean age at onset of esotropia in the childhood and adult onset groups was 3.61 ± 1.1 and 26.6 ± 8.7 years, respectively. There were significantly more individuals with myopia (30%) in the adult onset group compared to the childhood onset group (6%) (P = .004). Thirty-seven (16%) had positive neuroimaging findings (16.4% adult onset vs 9.4% childhood onset). A total of 148 (44%) patients underwent surgery for esotropia, and the overall success rate was 73%. Mean preoperative esotropia was comparable in either group (P = .20), but surgical success was better in the adult onset group (75.6% vs 66.3% in the childhood onset group). Mean duration of follow-up postoperatively was 13.6 ± 12 months. Two-thirds of the patients had childhood onset of AACE. Intracranial pathology was found in 1 of 6 patients. Surgical success was better in the adult onset group, which was not influenced by preoperative esotropia, neuroimaging findings, or refractive status, but was dependent on age at onset of esotropia and duration between onset and intervention. [J Pediatr Ophthalmol Strabismus. 2023;60(3):218-225.].

One-step triple surgery for large esotropia in Chinese patients with chronic sixth nerve palsy

The aim of this study is to evaluate the effect of a one-step triple surgery comprising inferior rectus belly transposition, augmented superior rectus transposition and medial rectus recession (IRBT-aSRT-MRc), in the management of large-angle esotropia in Chinese patients with chronic six nerve palsy.

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.

A retrospective study of strabismus surgery in a tertiary eye hospital in the Chaoshan area in China from 2014 to 2020

BackgroundTo investigate the distribution pattern of strabismus surgery at an eye center in southern China.MethodsThe data of all patients who underwent strabismus surgery at the Joint Shantou International Eye Center of Shantou University /Chinese University of Hong Kong from 2014 to 2020 were retrospectively analyzed. The type of strabismus and its relationship with age and sex were analyzed, and the trend in the number of strabismus surgeries was observed.ResultsThe data of 4640 patients included a total of 5,282 surgeries.Exotropia surgery was the most common, accounting for 54.0% of all strabismus surgeries, which tended to increase over time, but not significantly (P = 0.109). Constant exotropia was the most common exotropia, but its proportion decreased year by year. The next most common was intermittent exotropia. The percentage of surgeries for intermittent exotropia increased from 2016 to 2020. Surgery for esotropia accounted for 22.1% of all strabismus surgeries and became significantly less common from 2016 to 2020 (P < 0.01). Among patients with intermittent or constant exotropia, the proportion of patients younger than 12 years who underwent surgical intervention increased yearly, while this proportion amoung patients older 12 years old with constant exotropia decreased yearly.ConclusionAmong exotropia surgeries, surgery for constant exotropia was the most common but decreased in prevalence annually. Children under 12 years old were the most affected population.

Three-muscle surgery for large-angle esotropia in chronic sixth nerve palsy: comparison of two approaches

AimsTo report the effect of two three-muscle surgeries, inferior rectus belly transposition plus augmented superior rectus transposition plus medial rectus recession (ISM) and modified vertical rectus belly transposition plus medial...

Supramaximal Horizontal Rectus Recession–Resection Surgery for Complete Unilateral Abducens Nerve Palsy

PurposeTo review the surgical procedures and outcomes of supramaximal horizontal rectus recession–resection surgery for abduction deficiency and esotropia resulting from complete unilateral abducens nerve palsy.MethodsA total of 36 consecutive cases diagnosed as complete abducens nerve palsy, receiving supramaximal medial rectus recession (8.5 ± 1.4 mm, range: 6–10) combined with a supramaximal lateral rectus resection (11.1 ± 1.7 mm, range: 8–14) as performed over the period from 2017 to 2020, were reviewed retrospectively. All surgeries were performed by a single surgeon. Pre- and post-operative ocular motility, ocular alignment, forced duction test, binocular vision, abnormal head posture, and surgical complications were assessed.ResultsOf these 36 cases, 23 (63.8%) were followed up for greater than 2 months (Mean ± SD = 8.4 ± 6.0, range: 2–24) after surgery and the collected data was presented. Mean ± SD age of these patients was 41.7 ± 14.4 (range: 12–67) years with 73.9% being female. Trauma (52.2%, 12/23) and cerebral lesions (21.7%, 5/23) were the primary etiologies for this condition. Esodeviation in primary position improved from 55.5 ± 27.2 prism diopters (PD) (range: +25 to +123) to 0.04 ± 7.3 PD (range: −18 to +12) as assessed on their last visit. Pre-operative abduction deficits of −5.6 ± 1.0 (range: −8 to −4) reduced to −2.4 ± 1.4 (range: −4 to 0) post-operatively. The mean dose-effect coefficient of 2.80 ± 1.20 PD/mm (range: 1.07–6.05) was positively correlated with pre-operative esodeviation. Rates of overcorrection and ortho were 69.6 and 26.1%, respectively, on the first day after surgery, while on their last visit the respective levels were 4.3 and 82.6%.ConclusionSupramaximal horizontal rectus recession–resection surgery is an effective treatment method for complete abduction deficiency. The dose-effect was positively correlated with pre-operative esodeviation. Overcorrection on the first day post-operatively is required for a long-term satisfactory surgical outcome.

Timing of surgery in essential infantile esotropia - What more do we know since the turn of the century?

This review summarizes the results and interpretations of studies pertaining to the long-standing debate regarding the timing of surgery in infantile esotropia, more recently referred to as essential infantile esotropia. A systematic search of studies from the year 2000 onward pertaining to the timing of surgery in infantile esotropia as listed in PubMed, Google Scholar, and the Cochrane database was performed. Appropriate cross-references from the articles were also included. Data collected included demographics, presentation, time of surgery, complications, and outcomes. Very early surgery, that is, within 6 months of the onset of infantile esotropia, offers significant advantages in terms of the quality of stereopsis and binocular vision as well as promoting the development of cortical visual processing, thereby benefiting cortical development in human infants. However, the postoperative alignment was not found to be significantly different in the very early, early, or late surgery groups. The reduction in the incidence of manifest dissociated vertical deviation postoperatively in the very early surgery group also showed measurable benefits. The results of this recent literature review demonstrated that very early surgery, within 6 months of misalignment, showed demonstrable benefits in essential infantile esotropia.

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%.

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...

Management of Consecutive Exotropia.

Purpose:To determine the clinical characteristics and surgical outcomes of medial rectus (MR) advancement with or without lateral rectus (LR) recession in patients with consecutive exotropia.Methods:This interventional case series was performed on patients with consecutive exotropia of more than 15 prism diopters (PD) at least 6 months after the esotropia surgery. All patients were operated using either unilateral or bilateral MR muscle advancement with or without simultaneous LR recession. Ocular deviation at far and near distances, adduction limitation, and exoshift were investigated at the follow-ups of 1 week, as well as 1, 3, and 6 months after the surgery. Operation was considered successful when the postoperative far deviation was <10 PD.Results:Thirty patients were evaluated. The mean amount of MR advancement was 5.69 ± 1.33 mm with the mean dose response of 4.7 ± 3.3 and 4.55 ± 4.01 PD at 3 and 6-month follow-ups, respectively. Success rate was reduced from 93% at week 1 to 73% at month 6 due to postoperative exodrift, especially during the first 3 months. Preoperative exotropia was the only contributing factor in our study.Conclusions:MR advancement was an effective surgical method for consecutive exotropia correction, especially in cases with MR underaction. Bilateral MR advancement and/or LR recession are suggested in cases with higher preoperative exodeviation. The presence of postoperative exodrift indicates longer follow-ups for patients.