Surgical Treatment Of Intermittent Exotropia Research Articles

Timely Surgery in Intermittent Exotropia

ABSTRACT Introduction Surgical treatment of intermittent exotropia is indicated when periods of monocular deviation become longer or control over deviation deteriorates. However, there is no consensus on the ideal age to perform surgery in patients with intermittent exotropia. Purpose To evaluate ocular alignment and sensory results at 12 months of follow-up, in patients who received surgical treatment for intermittent exotropia at ≤4 years or >4 years. Methods A retrospective, observational, analytical, and comparative cohort study was carried out, which included 97 patients treated surgically for X(T), divided into two groups, ≤4 years and >4 years. The motor and sensory results of the patients were evaluated on the first day, 1 month and 12 months of postoperative follow-up. Results In this study, no statistically significant differences were observed in ocular alignment and postoperative sensory results at 1 year of follow-up between both groups. Conclusion Age is not a variable that influences surgical results in patients with intermittent exotropia. Instead of early or delayed surgery, we propose to use the term “timely surgery.”

How to Better Treat Patients with Intermittent Exotropia: A Review of Surgical Treatment of Intermittent Exotropia.

Intermittent exotropia (X(T)) is the most common form of strabismus, especially in Asians. Treatment of X(T) includes occlusion, overminus lens, and surgery, of which, surgery is the mainstay of treatment. Commonly performed surgical procedures for X(T) are bilateral lateral rectus muscle recession or unilateral lateral rectus recession with medial rectus resection; however, it is unclear which of the two surgeries is more effective. The purpose of this review is to provide an insight on the surgical treatment of X(T). Randomized controlled trials, comparative observational studies, and case series with a large number of patients as well as a long follow-up period of over a year were included.

Long term surgical outcomes of unilateral recession-resection versus bilateral lateral rectus recession in basic-type intermittent exotropia in children

The long-term results of surgical treatment of intermittent exotropia (X(T)) according to the type of surgery are controversial. We conducted a retrospective cohort study to compare the long-term results between unilateral recession-resection (RR) and bilateral lateral rectus recession (BLR) with an average follow-up of 9.5 years in children with basic-type X(T). Patients with basic-type X(T), who underwent RR (RR group) or BLR (BLR group) and were followed-up for more than 5 years postoperatively, were analyzed. Of the 560 patients, 363 patients received BLR and 197 patients underwent RR. There was no significant difference in the success rates between the two groups until postoperative 3 years. At an average of 9.5 ± 2.6 years after surgery, the success rate of the RR group was significantly higher than that of the BLR group starting from the fourth post-operative year until the last follow-up examination (64.5% vs 43.3%, P < 0.001). By multivariate analysis, preoperative hyperopia of more than + 2.00 diopters, younger age of onset, younger age at surgery, larger exodeviation at near than at distance of > 5 prism diopters, and the type of surgery (BLR) were risk factors of recurrence. In conclusion, RR was more successful than BLR with a lower recurrence rate in the long-term follow-up of patients with basic-type X(T).

Commentary on Concerns in the Surgical Treatment of Intermittent Exotropia

Commentary on Concerns in the Surgical Treatment of Intermittent Exotropia

Concerns in the surgical treatment of intermittent exotropia

Management of intermittent exotropia raises several concerns, regarding the indication for surgery, timing of the surgery, and the type of surgical procedure. This article attempts to highlight the controversial aspects of surgical management of intermittent exotropia and the consensus, in light of current evidence.

The Role of Stereopsis and Binocular Fusion in Surgical Treatment of Intermittent Exotropia

Background/Aims: The purpose of this study is to identify the appropriate timing for surgical treatment of intermittent exotropia (XT) in the pediatric population by examining several parameters that may contribute to surgical planning. Methods: A retrospective chart review was conducted on patients between the ages of 3 and 17 years undergoing surgical management for intermittent XT. Preoperative and postoperative data regarding age, past medical history, visual acuity, stereopsis, magnitude of deviation and control was recorded. Medical records were reviewed and analyzed to determine if preoperative control of near misalignment, stereopsis, or presence of amblyopia may play a role in surgical outcome. Results: Ninety-five patients met inclusion criteria. Mean age was 6.71 years. Mean follow up period was 10.79 months. At least 140 sec arc of stereopsis using Titmus testing was present in 39.5% of patients preoperatively, while 55.8% of patients had less than 140 sec arc preoperatively, indicative of poor fusion at near. 47.2% of patients had good control of the near misalignment preoperatively, while 52.7% of patients had fair to poor control preoperatively. There was no statistically significant difference in surgical outcomes when comparing preoperative level of control of misalignment at near (P=0.2284) and stereopsis (P=0.2537). Presence of amblyopia preoperatively also had no association with surgical outcome (P=1.00). Conclusion: The use of worsening stereopsis and/or alignment control at near as parameters to determine the appropriate time for surgical intervention does not predict improved outcomes in patients with intermittent XT.

Effects of Surgical Assistant's Level of Resident Training on Surgical Treatment of Intermittent Exotropia: Operation Time and Surgical Outcomes.

PurposeTo evaluate the effects of the surgical assistant's level of resident training on operation time and surgical outcome in the surgical treatment of intermittent exotropia.MethodsThis study included 456 patients with intermittent exotropia who underwent lateral rectus recession and medial rectus resection and were followed up for 24 months after surgery. The patients were divided into two groups according to the surgical assistant's level of resident training: group F (surgery assisted by a first-year resident [n = 198]) and group S (surgery assisted by a second-, third-, or fourth-year resident [n = 258]). The operation time and surgical outcomes (postoperative exodeviation and the number of patients who underwent a second operation) were compared between the two groups.ResultsThe average operation times in groups F and S were 36.54 ± 7.4 and 37.34 ± 9.94 minutes, respectively (p = 0.33). Immediate postoperative exodeviation was higher in group F (0.79 ± 3.82 prism diopters) than in group S (0.38 ± 3.75 prism diopters). However, repeated-measures analysis of variance revealed no significant difference in exodeviation between the two groups during the 24-month follow-up period (p = 0.45). A second operation was performed in 29.3% (58 / 198) of the patients in group F, and in 32.2% (83 / 258) of those in group S (p = 0.51).ConclusionsNo significant difference in operation time was observed when we compared the effects of the level of resident training in the surgical treatment of intermittent exotropia. Although the immediate postoperative exodeviation was higher in patients who had undergone surgery assisted by a first-year resident, the surgical outcome during the 24-month follow-up was not significantly different.

This issue of ACTA, printed and electronic

The cover illustration shows a variety of orbital implants that have been used following enucleation. This is discussed by Mourits et al in this issue of ACTA. Prins et al. in the Netherlands review the use of MRI imaging of the brain in eye disease. Structural changes in the visual pathways of the brain are seen in glaucoma, AMD and other eye diseases and might suggest a general neurological disorder. Yassin in Saudi Arabia reviews bleb-related infections following glaucoma filtering surgery. The prognosis is usually good if the infection is limited to the bleb but poor when endophthalmitis develops. de Vries et al. in the Netherlands report that the relatively few patients require glaucoma drainage surgery following vitreoretinal surgery. These patients were more likely to have history of glaucoma, many vitreoretinal operations and silicon oil. Tryggvason et al. in Norway, Iceland and USA examined the hearing of patients with glaucoma and/or exfoliation syndrome. Many individuals have hearing loss, and this was associated with age and male gender but not with glaucoma or exfoliation syndrome. Jonas et al. in Germany report thinning of Bruch's membrane in patients in secondary high axial myopia caused by congenital glaucoma. Timlin et al. in London recommend anterior segment OCT for diagnostic examination of lacrimal puncta. Ringvold and Reubsaet in Norway found that acetylcholine affects corneal epithelial cells in vitro and influences iron channels. Mourits et al. in the Netherlands evaluate complications from different types of orbital implants following enucleation for retinoblastoma. They recommend acrylic implants. Klingenstein et al. in Germany and USA examine microcirculation patterns and suggest that these may guide in differentiating uveal nevi from malignant melanomas. Munch et al. in Denmark and Austria validate the Radner reading chart for reading acuity and speed in a Danish cohort. Breukink et al. in the Netherlands recommend half-dose photodynamic therapy and subthreshold diode micropulse laser for chronic central serous chorioretinopathy. Haas et al. in Austria found no difference in pain during intravitreal injections with 27 and 30 gauge needles. However, 30 gauge needles were preferred by the surgeons. Segal et al. in Israel found an association between anxiety levels and perceived pain during intravitreal injections. Norn documents the history of ophthalmology in Denmark up to 1865. The following articles are published electronically only. They are accessible on www.actaophthalmologica.com, where you can find all published articles of ACTA from the beginning. Kim and Choi in Korea found that early postoperative overcorrection was associated with success in surgical treatment of intermittent exotropia. Creuzot-Garcher et al. in France examined elderly people over 75 years old and found visual impairment (visual acuity <0.3) in 2.3% and increasing to 5.6% in patients over 85 years old. Lee et al. in Korea associated the location of retinal nerve fibre layer defects with peripapillary atrophy in glaucoma patients. Kiliç et al. in Turkey found exfoliation syndrome in 5.7% of a Turkish population and this was associated with advancing age and male gender. Hayes et al. in UK recommend a modification of iontophoresis technique for riboflavin penetration into corneal stroma for cross-linking. Prakash et al. in the United Arab Emirates discuss the differences between central and non-central keratoconus in terms of corneal topography. GamalElDin et al. in Egypt recommend big-bubble technique for Descemet's endothelial grafts. Agrawal et al. in UK and Singapore propose a classification for semi-automated laser flare readings in uveitis. Gupta et al. in Singapore suggest that the visibility of choroidal–scleral interface on OCT images influences choroidal thickness measurements. Fernández-Vigo et al. in Spain found the variation in anterior chamber depth to be associated with age, sex, spherical error, corneal diameter and anterior chamber angle. Njikam et al. in Kenya, Cameroon and Germany report on the epidemiology of diabetic retinopathy in Cameroon. Sansom et al. in UK found an association between systolic blood pressure and ocular perfusion pressure with subfoveal choroidal thickness. Vannozzi et al. in Italy report cytomegalovirus retinitis in a patient who received a dexamethasone implant. Barteselli et al. in Italy and USA report transient structural abnormalities of the retina following intravitreal ocriplasmin injection. Suh and Kee in Korea examined long-term outcome of patients with congenital glaucoma and found that many need reoperation. Mulder et al. in the Netherlands and Belgium suggest shallowing of the anterior chamber to protect the crystalline lens during vitrectomy. Kessel et al. in Denmark discuss early results from preoperative scoring of cataract patients. Mazeikaite et al. in Lithuania and USA report elevated levels of antiphospholipid antibodies in patients with pseudoexfoliation syndrome. Alberti and la Cour in Denmark compare treatment of macular holes with vitrectomy and ocriplasmin. More macular holes are closed after vitrectomy but visual acuity outcomes are similar. Cennamo et al. in Italy recommend transpupillary thermotherapy for choroidal haemangioma. I hope you find This Issue of ACTA informative and interesting.

Hyperopic refractive errors as a prognostic factor in intermittent exotropia surgery.

Purpose: To evaluate and compare surgical outcomes with respect to refractive errors in strabismus surgery for the treatment of intermittent exotropia (IXT). The medical records of patients with IXT who were treated by one surgeon from January 2005 and June 2011 were reviewed. Three hundred and thirty-three IXT patients were included and divided into three groups according to preoperative refractive error: IXT with hyperopia (group I), IXT with emmetropia (group II), and IXT with myopia (group III). The surgical outcomes with respect to sensory and motor criteria were compared among the three groups. The surgical success rates according to motor criteria and sensory and motor criteria combined were higher in groups I (29 patients) and III (124 patients) than in group II (180 patients) at postoperative 3 and 6 months and at the last follow-up. Stereopsis was significantly better in groups II and III than in group I preoperatively (P=0.002 by one-way analysis of variance test); however, the difference was not significant postoperatively. Twenty patients in group I (69.0%) were prescribed undercorrected hyperopic spectacles postoperatively, while only 22 patients in group III (17.7%) were prescribed spectacles with more myopic power than their refractive errors. In the surgical treatment of IXT, hyperopia was not an indicator of poor prognosis. Taking into consideration the age effect, follow-up period after IXT surgery, and stereopsis improvement, hyperopic refractive error is rather a good prognostic factor.

Long-term outcome following bilateral lateral rectus recession for intermittent exotropia

Abstract Background: Bilateral lateral rectus recession is the most common surgical treatment of intermittent exotropia in children. Success rates in previous studies differ because longer follow-up periods may change success rate as the eyes drift out with time. Initial overcorrection was thought to be appropriate management, but the preferred initial postoperative deviation has not been well quantified. Objective: To study long-term outcomes (≥3 years) of bilateral lateral rectus recession for intermittent exotropia and to evaluate factors influencing long-term success. Methods: This retrospective descriptive study reviews patients with intermittent exotropia who underwent bilateral lateral rectus recession with a minimum follow up of 3 years. Long-term motor outcome was classified as good (within 8 prism diopters (PD) of esodeviation and 10 PD of exodeviation), acceptable (exodeviation 11-20 PD), and poor (esotropia &gt;8 PD or exotropia &gt;20 PD). Stereoacuity testing pre- and postoperatively was used to evaluate sensory outcome. Correlation between long-term outcome and various pre- and postoperative factors were analyzed. Results: A total of 59 patients met the selective inclusion criteria. The mean age at time of surgery was 7.1 years with a mean follow-up time of 4.5 years. At the time of the last visit, 69% (41 patients) had good outcomes, 24% (14 patients) had acceptable outcomes, and 7% (4 patients) had poor outcomes. Initial postoperative ocular deviation significantly correlated with long-term outcome (P &lt; 0.05). Mean initial postoperative ocular deviation of patients with good outcome was esodeviation 12.7 PD (range ortho to esodeviation 25 PD). In 45 patients whose stereoacuity could be assessed, 58% (26 patients) had stereoacuity improvement. Conclusion: Good long-term motor outcome can be achieved in 69% of patients following bilateral lateral rectus recession for intermittent exotropia. Initial postoperative ocular deviation correlated with long-term motor success.

Surgical outcomes of symmetric and asymmetric surgery for intermittent exotropia with postoperative large early overcorrection

To compare surgical outcomes between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus resection (RR) for intermittent exotropia with overcorrection of 20 prism diopter (PD) or more on postoperative day 1. A retrospective chart review identified 319 patients who underwent either BLR or RR for primary surgical treatment of intermittent exotropia between July 2008 and June 2011. The patients with basic type intermittent exotropia and overcorrection of 20 PD or more, at either near or distance, on postoperative day 1 and had more than 6 months of follow-up were included. Patients with simultaneous vertical and/or oblique muscle surgery and those with paralytic or restrictive strabismus were excluded. The pre- and post-operative deviation, visual acuity, and near stereoacuity were analyzed. Twenty-four patients were included. The mean postoperative day 1 alignment was 21.5 ± 6.2 PD esotropia at distance, and 13.8 ± 8.0 PD at near. Fourteen patients underwent BLR and 10 underwent RR. Three patients were wearing the base out prism below 15 PD at the last follow-up. The mean duration from the surgery to esotropia below 10 PD was 2.9 ± 1.1 weeks and 8.0 ± 7.1 weeks in the BLR and RR groups, respectively (p = 0.030). All three recurrent patients underwent RR. None of the patients completely lost stereoacuity, postoperatively. In basic type intermittent exotropia with overcorrection of 20 PD or more on postoperative day 1, the overcorrection resolved faster and recurrence rates were lower in BLR group than in the RR group. Consecutive esotropia over 15 PD did not occur in both groups.

The surgical treatment of intermittent exotropia

Objective To investigate the surgical juncture and effect in intermittent exotropia. Meth-ods The surgical decision was made by the guidelines of 1 mm lateral reetus resection equal to 2-3 prism diop-ters and 1 mm of medical rectus resection equal to 4-5 prism diopters. Examine binocular single vision with syn-optophore and stereoacuity with Titmus. According to the rat of AC/A and binocular vision. 66 cases received surgery which included single lateral rectus recession in 3 cases, both lateral rectus recession in 8 cases, single medial rectus resection in 3 cases, single lateral rectus recession combined medial rectus resection in 35 cases, both medial rectus resection combined with single lateral rectus recession in 1 case,both lateral rectus recession combined single medial rectus resection in 16cases. Local anesthesin was used in 41 cases, and general anesthe-sia used in 38cases. Results Cases(58) got ocular alignment after suraery. Conclusion For the treatment of intermittent exotropia juncture and reasonable scheme of sugery is benifical to the binocular single vision recov-ery. Key words: Intermittent exotropia; Surgical; Binocular single vision

北里大学病院における間けつ性外斜視手術の施行年齢と手術効果の検討

北里大学病院における間けつ性外斜視手術の施行年齢と手術効果の検討

Surgical Treatment of Intermittent Exotropia

Surgical Treatment of Intermittent Exotropia

The Surgical Treatment of Intermittent Exotropia

A group of 38 cases of intermittent exotropia was examined. All operations were performed by the same surgeon. The follow-up period averaged 21 months. These patients were evaluated and treated, when necessary, by preoperative orthoptics. The records were analyzed for such characteristics as onset, duration, family history, visual acuity and refraction. These patients were classified into the following types of exotropia: primary (divergence excess), convergence insufficiency, and combined. The basic physiology of this condition is discussed. The progressive nature of this entity is demonstrated. The choice of operation depended upon the presence or absence of a significant deviation at near. In the postoperative evaluation, the absence of a tropia was the criteria for adequate surgical correction. Only 26 patients (68%) were adequately corrected.