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Suzuki Y, Aoki T, Tomita A, Mitsukawa T, Hama Y, Yamada M. Slanted and Standard Lateral Rectus Recession Procedures for Convergence Insufficiency-Type Intermittent Exotropia in Children: A Retrospective Cohort Study. Clin Ophthalmol 2024; 18:2453-2460. [PMID: 39228766 PMCID: PMC11370759 DOI: 10.2147/opth.s471172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/19/2024] [Indexed: 09/05/2024] Open
Abstract
Purpose To evaluate the efficacy and safety of slanted bilateral lateral rectus recession (BLR-rec) for treating convergence insufficiency-type intermittent exotropia (CI-IXT) in children. Methods In this retrospective cohort study, 26 patients aged <16 years with CI-IXT who underwent BLR-rec between August 2016 and July 2021 with six months of follow-up data post-surgery were classified into slanted BLR-rec group (n = 14) and standard BLR-rec group (n = 12; equal-length recession of the upper and lower horns of the LR muscle). Surgical outcomes were compared between the groups. Results In the slanted and standard groups, the preoperative distance exodeviation was 27.9 ± 5.5 and 30.8 ± 10.0 prism diopter (PD) (p = 0.63), near exodeviation was 41.1 ± 5.6 and 42.9 ± 9.2 PD (p = 0.75), and difference between near and distance deviation (N-D deviation difference) was 13.2 ± 3.2 and 12.1 ± 3.3 PD (p = 0.30), respectively. The ratio of postoperative and preoperative N-D deviation difference was compared between the slanted BLR and standard BLR groups at six months postoperatively. The results revealed that the ratio for slanted-BLR was 0.44 ± 0.19, and for standard-BLR was 0.84 ± 0.24. In the standard group, stereoacuity remained unchanged post-surgery compared to that pre-surgery, while the slanted group showed significant improvement (p < 0.05, Wilcoxon signed-rank test). Conclusion Compared with the standard BLR-rec procedure, the slanted BLR-rec procedure reduced N-D deviation differences in CI-IXT, positively impacting gross stereopsis.
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Affiliation(s)
- Yumi Suzuki
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Takafumi Aoki
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Akane Tomita
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Tadahiro Mitsukawa
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yukiko Hama
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Masakazu Yamada
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Hwang JM. How to Better Treat Patients with Intermittent Exotropia: A Review of Surgical Treatment of Intermittent Exotropia. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:550-564. [PMID: 36220643 DOI: 10.3341/kjo.2022.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Tellioglu A, Ocak OB, Inal A, Gurez C, Celik S, Ozkan Tellioglu D, Gokyigit B. Treatment of convergence insufficiency type intermittent exotropia with bupivacaine injection to the medial rectus combined with lateral rectus recession. J AAPOS 2022; 26:249.e1-249.e5. [PMID: 36115598 DOI: 10.1016/j.jaapos.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the outcomes of combined bupivacaine HCL (BPX) injection in the medial rectus (MR) muscle with recession of the lateral rectus muscle in the treatment of convergence insufficiency-type intermittent exotropia (CI-IXT). METHODS The medical records of patients who underwent combined injection-recession treatment from January 2019 to January 2020 for CI-IXT were reviewed retrospectively along with a group of age-matched controls with IXT without CI who underwent only unilateral LR recession during the same period. The following data were extracted from the record: age at surgery, average follow-up period, angle of deviation at distance and near and the difference between them before and after surgical procedure, correction of near and distance deviations, and recession dosage. Successful outcome was defined as a distance deviation in primary gaze between ≤10Δ of exophoria/tropia and ≤5Δ of esophoria/tropia. RESULTS A total of 10 patients and 20 controls were included. Average follow-up was 13.9 ± 3.67 months in the BPX group and 15.9 ± 3.61 months in the control group (P = 0.17). Postoperative distance deviation measured 8.30Δ ± 5.88Δ in the BPX group and 14.67Δ ± 9.83Δ in the control group (P = 0.80). Distance-near differences were significantly reduced in the CI-IXT group receiving BPX, by a mean of 6.60Δ, from a preoperative mean of 10.50Δ ± 3.65Δ to 3.90Δ ± 3.26Δ (P < 0.01). CONCLUSIONS BPX injection combined with unilateral lateral rectus recession yields outcomes comparable to bilateral lateral rectus recession for distance deviations, and results in reduction of the distance-near difference in the angle of exotropia.
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Affiliation(s)
- Adem Tellioglu
- University of Health Sciences Beyoğlu Eye Research and Training Hospital, İstanbul, Turkey.
| | - Osman Bulut Ocak
- University of Health Sciences Beyoğlu Eye Research and Training Hospital, İstanbul, Turkey
| | - Aslı Inal
- University of Health Sciences Beyoğlu Eye Research and Training Hospital, İstanbul, Turkey
| | - Ceren Gurez
- University of Health Sciences Beyoğlu Eye Research and Training Hospital, İstanbul, Turkey
| | - Selcen Celik
- University of Health Sciences Beyoğlu Eye Research and Training Hospital, İstanbul, Turkey
| | - Derya Ozkan Tellioglu
- University of Health Sciences Beyoğlu Eye Research and Training Hospital, İstanbul, Turkey
| | - Birsen Gokyigit
- University of Health Sciences Beyoğlu Eye Research and Training Hospital, İstanbul, Turkey
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Kim SJ, Jeon H, Choi HY. Comparison between Down Transposition and Slanted Surgery for Bilateral Lateral Rectus Recession in Convergence Insufficiency-Type Exotropia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.9.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We compared bilateral lateral rectus recession with down transposition and slanted bilateral lateral rectus recession as surgical methods for convergence insufficiency-type exotropia.Methods: We included patients who underwent bilateral lateral rectus recession with down transposition or slanted bilateral lateral rectus recession for convergence insufficiency-type exotropia from January 2012 to January 2021 and observed them for more than 1 year. We retrospectively analyzed sex, age, preoperative best-corrected visual acuity, spherical equivalent, axial length, amount of surgery, and deviation angle before surgery and after surgery (immediately, 1 week, 6 months, and 1 year). We also examined surgical success and stereopsis before surgery and after 6 months and 1 year.Results: The down transposition group included 45 patients and the slanted group included 40. The deviation angle of distance, deviation angle of near and the near-distance disparity (NDD) all decreased in the down transposition group and slanted group 1 year after surgery (1.96 ± 8.77 prism diopter [PD] and 4.60 ± 4.99 PD, respectively; 5.53 ± 9.09 PD and 9.03 ± 9.09 PD, respectively; and 3.58 ± 5.26 PD and 4.43 ± 5.32 PD, respectively). Surgical success after 1 year was 55.6% in the down transposition group and 52.5% in the slanted group, and there was no significant difference between the two groups.Conclusions: In convergence insufficiency-type exotropia, both bilateral lateral rectus recession with down transposition and slanted bilateral lateral rectus recession were effective to correct the deviation angle of near, distance, and NDD. Both are suitable primary surgical methods for convergence insufficiency-type exotropia.
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Jang YK, Bae SH, Choi DG. Surgical outcomes of unilateral lateral rectus recession versus recess-resect in children with convergence insufficiency type intermittent exotropia. Sci Rep 2022; 12:8591. [PMID: 35597850 PMCID: PMC9124180 DOI: 10.1038/s41598-022-12664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
To determine the efficacy of unilateral lateral rectus recession (ULR) for convergence insufficiency-type intermittent exotropia (CI-type IXT), we compared surgical outcomes following ULR and recess‒resect (RR) procedures for CI-type IXT. In this retrospective study, medical records of 57 children who underwent ULR (n = 30) or RR (n = 27) for CI-type IXT of less than 25 PD at distance with a postoperative follow-up of 6 months or more were reviewed. Surgical success was defined as an alignment between 10 PD exodeviation and 5 PD esodeviation at distance and near fixation. The postoperative exodeviation showed no significant difference between the two groups at the last follow-up. A significant reduction in the mean near-distance difference was achieved postoperatively in both groups: from 5.4 PD preoperatively to 2.5 at last follow-up after ULR, and from 8.2 to 2.4 after RR (both p = 0.001). However, this difference between ULR and RR was not statistically significant (p > 0.05). The success rate at the last follow-up was 63.3% for ULR and 70.4% for RR (p = 0.574). ULR was found to be an effective treatment for CI-type IXT, with similar surgical outcomes to RR.
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Affiliation(s)
- Yoon Kyung Jang
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 665 Shiheongdae-ro, Seoul, 07442, South Korea
| | - Seok Hyun Bae
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 665 Shiheongdae-ro, Seoul, 07442, South Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 665 Shiheongdae-ro, Seoul, 07442, South Korea.
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Li Y, Lin H. Slanted recession on bilateral lateral rectus for the treatment of intermittent Exotropia with convergence insufficiency. BMC Ophthalmol 2022; 22:134. [PMID: 35331195 PMCID: PMC8951717 DOI: 10.1186/s12886-022-02367-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/21/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of slanted bilateral lateral rectus recession (S-BLRc) for the treatment of convergence insufficiency-type intermittent exotropia (CI-IXT) in children and to probe the relationship of the slanted amount and surgical outcomes. Methods Retrospective study. Fifty-eight patients with CI-IXT, aged 4 to 10 years old, underwent S-BLRc procedures. According to the different slanted amount between the upper and lower poles of lateral rectus, all the patients were grouped: Group A (slanting 1 mm, n = 22), Group B (slanting 1.5 mm, n = 18) and Group C (slanting 2 mm, n = 18). The successful surgical outcome was defined as deviation in the primary position ranging from exotropia< 8△ to esotropia< 5△ both at near and at distant as well as the near-distance difference (NDD) < 5△. We analyzed and compared the preoperative and postoperative data including deviations both at near and at distance, NDD, objective torsion, horizontal deviation at up and down gaze, lateral incomitance, binocular vision and surgical success rate among three groups. Results The average deviations were significantly decreased from − 37.1△ ± 4.2△ (−,exotropia) to − 1.4△ ± 4.6△ at near (P < 0.05) and from − 25.8△ ± 3.7△ to − 0.1 ± 4.1△ at distance (P < 0.05). The postoperative NDD on average was significantly reduced from 10.0△ to 1.8△ in Group A (P < 0.05), from 11.2△ to 0.8△ in Group B (P < 0.05) and from 13.3△ to 0.9△ in Group C (P < 0.05). There was a significant difference in the mean corrections of NDD among the three groups (8.2△ in group A, 10.3△ in group B and 12.4△ in group C respectively, P < 0,05). All the patients attained various improvement of stereopsis after surgery. None had torsional diplopia, A-V pattern and lateral incomitance after strabismic surgery. Totally, the surgical success rate was 89.7% in our series at the 6- to 8-month follow-up. Conclusions Slanted bilateral lateral rectus recession is an effective and safe procedure for the treatment of CI-IXT in children. S-BLRc can successfully collapse exotropia both at distance and at near, decrease NDD and benefit to gain binocular vision. The correction of NDD was associated with the slanted amount.
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Affiliation(s)
- Yueping Li
- Tianjin Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, Tianjin, 300020, China.
| | - Huiyu Lin
- QuanZhou Women's and Children's Hospital, Quanzhou, 362000, China
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Ren M, Wang Q, Wang L. Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study. BMC Ophthalmol 2020; 20:287. [PMID: 32664882 PMCID: PMC7362399 DOI: 10.1186/s12886-020-01562-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background The present study sought to investigate the efficiency and safety of slanted bilateral lateral rectus recession for the treatment of convergence insufficiency-type intermittent exotropia. Methods This retrospective study included 34 patients who underwent slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia in Shandong Provincial Hospital affiliated to Shandong First Medical University between September 2013 and October 2015 with a minimum follow-up of 6 months. A successful surgical alignment was defined as + 5 (positive for esotropia) to − 10 (negative for exotropia) prism diopters (PD) of orthotropia in the primary position while viewing distant or near targets and a near-distance deviation difference ≤ 8PD. Results The mean age of the patients at surgery was 7.09 ± 3.80 years (range, 3 to 18 years). The mean distance deviations were − 26.09 ± 6.5 PD (range, − 15 to − 35 PD) and the mean near deviations, − 37.21 ± 6.3 PD (range, − 25 to − 45 PD) preoperatively. The mean recession amount of upper pole of the lateral rectus was 5.97 mm (range, 4.0 to 7.5 mm) and that of lower pole of the lateral rectus, 7.49 mm (range, 6.0 to 8.5 mm). At a mean follow-up of 15.0 months (range, 6 to 37 months), the surgical success rate was 70.6% (24/34), the under-correction rate was 17.6% (6/34), and the overcorrection rate was 11.8% (4/34). The mean near-distance deviation difference was significantly reduced from 11.12 ± 2.06 PD (range, 10 to 15 PD) preoperatively to 2.47 ± 3.04 PD (range, 0 to 10 PD) postoperatively (P < 0.001). Each millimeter of difference between the upper and lower poles of the lateral rectus recession was associated with an improvement of 5.65 PD in the near-distance deviation difference. At the final follow up, a near-distance deviation difference of ≤8PD was found in 32 (94.1%) patients. None of the patients developed A-V pattern, torsional diplopia, or restricted abduction of the eyes. Conclusions Slanted bilateral lateral rectus recession may successfully reduce the distance and near exodeviations and the near-distance deviation difference, thus was proved to be an effective and safe procedure for the treatment of convergence insufficiency-type intermittent exotropia.
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Affiliation(s)
- Meiyu Ren
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong Province, China
| | - Lihua Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong Province, China.
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Abstract
Recent reports confirm innervational compartments of select rectus extraocular muscles as well as the superior oblique.1 Histopathological and orbital imaging studies demonstrate well defined compartmental innervation of the horizontal rectus muscles with less differentiation in the vertical rectus muscles. Acquired vertical misalignment not associated with cyclovertical muscle dysfunction has been associated with horizontal rectus muscle compartment dysfunction. Pattern and other forms of strabismus have been associated with segmental or compartmental abnormal innervation of the extraocular muscles. Taking advantage of segmental function and innervation, selective weakening and strengthening procedures have been used to treat patients with incomitant near/distance disparities, incomitant vertical and torsional strabismus, and patients with A- and V-pattern strabismus.
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Affiliation(s)
- Stacy L Pineles
- Stein Eye Institute, University of California Los Angeles , Los Angeles, California.,Department of Ophthalmology, University of California Los Angeles , Los Angeles, California
| | - Melinda Y Chang
- Department of Ophthalmology, Vison Center at Children's Hospital Los Angeles , Los Angeles, California.,Roski Eye Institute, University of Southern California , Los Angeles, California
| | - Federico G Velez
- Duke Eye Center, Duke University , Durham, North Carolina.,Doheny Eye Institute, University of California Los Angeles , Los Angeles, California
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Chun BY, Oh JH, Choi HJ. Comparison of surgical outcomes of slanted procedure for exotropia with convergence insufficiency according to their response to preoperative monocular occlusion. Sci Rep 2020; 10:7261. [PMID: 32350350 PMCID: PMC7190736 DOI: 10.1038/s41598-020-64251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/14/2020] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this prospective study was to compare surgical outcomes of slanted bilateral lateral rectus (LR) recession for intermittent exotropia (IXT) with convergence insufficiency (CI) according to their response to preoperative monocular occlusion. This prospective study included 55 children who underwent slanted bilateral LR recession for IXT with CI. Patients were divided into two groups according to their response to preoperative monocular occlusion for 2 hours. The True CI group was defined as having near-distance differences of ≥10 PD before and after occlusion; the Masked CI group as having near-distance differences of <10 PD and ≥10 PD prior to and after occlusion. Slanted procedure reduced distance and near exodeviations from 32.1 PD and 43.0 PD to 3.5 PD and 4.4 PD, and collapsed near-distance differences from 10.9 PD to 1.0 PD at 3 years postoperatively. Cumulative probabilities of surgical success were 76%, and the mean recurrence was 50 months at 3 years postoperatively; the True CI and Masked CI groups showed cumulative success rates of 89% and 55%, respectively (p = 0.0052). Patients in the True CI group demonstrated surgical outcomes superior to those demonstrated by patients in the Masked CI group after slanted bilateral LR recession.
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Kwon JM, Lee SJ. Long-term Results of Slanted Recession of Bilateral Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:353-358. [PMID: 31389211 PMCID: PMC6685829 DOI: 10.3341/kjo.2019.0031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/21/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the long-term efficacy of slanted lateral rectus recession in children for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency. METHODS The medical records of 53 patients with convergence insufficiency intermittent exotropia who underwent slanted bilateral lateral rectus recession performed by a single surgeon and received follow-up for more than 12 months were retrospectively analyzed. Deviation angles at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively and on the last visit were reviewed. Surgical success was defined as postoperative residual distance and near deviation angles ≤8 prism diopters and a difference between the near and distance angles ≤8 prism diopters. RESULTS The mean duration of follow-up was 24 months (range, 12 to 61 months). On the last visit, the residual deviation angles were ≤8 prism diopters in 75.5% for distance, 62.3% for near, and 81.1% for the near-distance difference. Surgical success was achieved in 31 (58.5%) patients, and none of them manifested limitations in eye movements or diplopia at the last follow-up visit. CONCLUSIONS Slanted lateral rectus recession is an effective surgical method for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency.
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Affiliation(s)
- Ji Min Kwon
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Soo Jung Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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Rajavi Z, Feizi M, Aliasghar Nabavi S, Sabbaghi H, Behradfar N, Mehdi Yaseri MS, Faghihi M, Abdi S. Slanted versus Augmented Recession for Horizontal Strabismus. J Ophthalmic Vis Res 2019; 14:465-473. [PMID: 31875102 PMCID: PMC6825697 DOI: 10.18502/jovr.v14i4.5453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/17/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the surgical outcomes of slanted versus augmented recession in patients with horizontal strabismus. Methods In this randomized clinical trial, a total of 100 esotropic (ET) and exotropic (XT) patients with a high AC/A ratio which was defined as a difference of ≥ 10 prism diopters (pd) between the distance and near deviations were included if the patients had a distance deviation ≥ 15 pd. Patients were randomly assigned into the slanted (n = 26 in ET and n = 24 in XT group) and augmented recession groups (n = 25 in ET and n = 25 in XT group). In the slanted group, recession was performed on the superior and inferior poles of the muscle based on the distance and near deviations, respectively, while in the augmented recession group, the muscles were recessed 1.00 or 1.50 mm more than the standard amount according to the distance and near difference between 10 and 20 pd or > 20 pd, respectively. Results The mean age was 9.8 ± 9.6 years and 63% were female. There was a significant postoperative reduction of difference in convergence excess in ET cases compared to patients who underwent the augmented recession procedure (12.65 ± 6.16 vs 8.64 ± 6.1 pd, P = 0.014). Among our XT groups, there was no significant difference in postoperative reduction in the XT angle in the slanted group compared with the augmented group (P > 0.05). Conclusion Slanted recession is recommended in convergence excess ET patients. In XT patients, either slanted or augmented recession may be chosen according to the priority and experience of the surgeon.
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Affiliation(s)
- Zhale Rajavi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Feizi
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayed Aliasghar Nabavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Behradfar
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M S Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Faghihi
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Abdi
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cho KH, Kim J, Choi DG, Lee JY. Do the primary surgical options for basic-type exotropia cause differences in distance-near discrepancy of recurrent exotropia after surgery? PLoS One 2019; 14:e0221268. [PMID: 31425519 PMCID: PMC6699689 DOI: 10.1371/journal.pone.0221268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/04/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Most ophthalmologists appear to have no distinct preference between unilateral recess-resect (R&R) and bilateral lateral rectus (BLR) recessions to treat basic-type exotropia. This study aimed to determine whether differences in distance-near discrepancy and resultant exotropia types of recurrent exotropia following surgery for primary basic-type exotropia exist between the two surgical options. Methods Ninety-three patients with recurrent exotropia following BLR recessions for basic-type exotropia (BLR group) and 95 following R&R for basic-type exotropia (R&R group) were included in this retrospective study. The exotropia types in recurrent exotropia were classified into three types according to distance-near discrepancy: basic, divergence-excess, and convergence-insufficiency. The BLR and R&R groups were compared. Results After surgery for basic-type exotropia, the type composition changed differently in each group (p < 0.001). The basic-type of primary exotropia was more often maintained in recurrent exotropia in the R&R group than in the BLR group. The incidence of postoperative convergence-insufficiency type exotropia in the BLR group was 28.0% and 8.4% in the R&R group (p = 0.001). Postoperative near stereopsis and fusion control grade of distance deviation did not differ between the two groups (p > 0.05). Conclusions Convergence-insufficiency type recurrent exotropia occurred more frequently after BLR recessions than after R&R for basic-type exotropia. The high rate of secondary convergence-insufficiency type exotropia after BLR recessions should be considered when clinicians select a surgical option to treat exotropia.
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Affiliation(s)
- Kwan Hyuk Cho
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Jinsoo Kim
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Joo Yeon Lee
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
- * E-mail: ,
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Chun BY, Freire MV, Cestari DM. Surgical Responses and Outcomes of Bilateral Medial Rectus Recession in Esotropia With Spinocerebellar Ataxia. J Pediatr Ophthalmol Strabismus 2019; 56:266-270. [PMID: 31322719 DOI: 10.3928/01913913-20190514-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/09/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the surgical responses and outcomes of bilateral medial rectus (BMR) recession in esotropic patients with spinocerebellar ataxia (SCA) and to compare the results with normal controls. METHODS The medical records of patients with SCA who underwent strabismus surgery for esotropia between 2006 and 2015 were reviewed retrospectively. Five esotropic patients with SCA (SCA group) and 10 esotropic patients without neurologic disorders (control group) who underwent BMR recession were included. Success rates, surgical responses, and the amount of preoperative and postoperative distance-near disparity were evaluated and compared between the groups. RESULTS The mean preoperative esodeviation was not different between the SCA and control groups (20 vs 17.3 prism diopters [PD], P = .214). However, patients with SCA showed significant undercorrection compared with controls 1 week postoperatively (4.8 vs 1.0 PD, P = .048) and at the final follow-up (6.8 vs 1.8 PD, P = .032). The surgical success rates for the SCA and control groups were 40% and 80%, respectively (P = .095). Patients with SCA demonstrated a significantly reduced surgical response compared with controls (3.15 vs 3.87 PD/mm, P = .004), and a greater amount of postoperative distance-near disparity than controls (8.0 vs 1.1 PD, P = .001). CONCLUSIONS A significant undercorrection was observed following BMR recession in esotropic patients with SCA. Accordingly, the authors recommend a slight overcorrection of 5 to 10 PD or adding a slanting procedure when planning strabismus surgery for this distinct group of patients. [J Pediatr Ophthalmol Strabismus. 2019;56(4):266-270.].
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Wang X, Zhang W, Chen B, Liao M, Liu L. Comparison of bilateral medial rectus plication and resection for the treatment of convergence insufficiency-type intermittent exotropia. Acta Ophthalmol 2019; 97:e448-e453. [PMID: 30740923 DOI: 10.1111/aos.14056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/19/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare the clinical outcomes of bilateral medial rectus plication and resection for the treatment of convergence insufficiency (CI)-type intermittent exotropia (IXT). METHODS Fifty-five patients with CI-type IXT were included in this prospective study and were followed for 6 months. The patients were randomized into two groups: the bilateral medial rectus plication (BMRP) group (n = 27) and the bilateral medial rectus resection (BMRR) group (n = 28). The eye examinations of each patient were carried out before the surgery and at 1 day and 1, 3 and 6 months postoperatively. The success rate, angle of deviation, stereoacuity, operative time and postoperative conjunctival swelling and redness score were analysed. RESULTS The mean deviation at distance at 1 day postoperatively was +6.6 ± 5.6 prism dioptres (PD) in the BMRP group, which was lower than the value of +10.8 ± 9.3 PD observed in the BMRR group (p = 0.046). There was more overcorrection in the BMRR group at first day after surgery. However, there were no significant differences in deviations or success rates were observed between the two groups at 1, 3 and 6 months after surgery (p > 0.05). The operative time in the BMRP (12.9 ± 1.4 min) group was shorter than that in the BMRR (14.7 ± 1.4 min) group (p < 0.001). Postoperative conjunctival swelling and redness were milder in the BMRP group than in the BMRR group (p < 0.001). CONCLUSION The BMRP surgery could be an alternative procedure to BMRR for the treatment of CI-type IXT with less immediate postoperative overcorrection and simpler, safer, less traumatic characteristics.
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Affiliation(s)
- Xi Wang
- Department of Ophthalmology West China Hospital Sichuan University Chengdu China
| | - Wenqiu Zhang
- Department of Ophthalmology West China Hospital Sichuan University Chengdu China
| | - Bingjie Chen
- Department of Ophthalmology West China Hospital Sichuan University Chengdu China
| | - Meng Liao
- Department of Ophthalmology West China Hospital Sichuan University Chengdu China
| | - Longqian Liu
- Department of Ophthalmology West China Hospital Sichuan University Chengdu China
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Chougule P, Kekunnaya R. Surgical management of intermittent exotropia: do we have an answer for all? BMJ Open Ophthalmol 2019; 4:e000243. [PMID: 30997406 PMCID: PMC6440598 DOI: 10.1136/bmjophth-2018-000243] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/20/2018] [Accepted: 12/28/2018] [Indexed: 12/11/2022] Open
Abstract
Intermittent exotropia (X(T)) is one of the most common form of strabismus with surgery being the mainstay of treatment. The main goal of surgery is to preserve binocular vision and stereopsis and to prevent its further loss. The decision to operate is mainly based on four aspects: increasing angle of exodeviation, deteriorating control of X(T), decrease in stereopsis for near or distance and quality of life. Bilateral lateral rectus muscle recession and unilateral lateral rectus recession with medial rectus resection, are the two most common surgical procedures performed and have been studied extensively in basic, divergence excess and convergence insufficiency types of X(T). However, there is no consensus over the relative efficacy of the two procedures in terms of postoperative alignment, residual or recurrent exotropia and consecutive esotropia with widely variable results, which can be attributed to poor understanding of the natural course of the disease. Multiple demographic, clinical and anatomic features that may influence the surgical outcomes have been studied to explain this variability. Moreover, most of the evidence regarding surgical outcomes of X(T) is from retrospective studies and the ongoing randomised prospective trials can shed light on long-term efficacy of these procedures. The goal of this review is to give a comprehensive overview of the outcomes of various surgical techniques in the management of different types of X(T), the preoperative and postoperative factors that may affect the surgical outcomes and to discuss the dilemmas faced by the treating surgeons including the effective management of overcorrection and undercorrection.
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Affiliation(s)
- Pratik Chougule
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
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Clark RA, Demer JL. Magnetic Resonance Imaging of the Globe-Tendon Interface for Extraocular Muscles: Is There an "Arc of Contact"? Am J Ophthalmol 2018; 194:170-181. [PMID: 30030978 PMCID: PMC6420818 DOI: 10.1016/j.ajo.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/09/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine if the "arc of contact" is an accurate approximation of the globe-tendon interface for the biomechanical modeling of extraocular muscle (EOM) force transfer onto the globe. METHODS At a single academic institution, 18 normal and 14 strabismic subjects were prospectively recruited for surface-coil enhanced magnetic resonance imaging at 312- or 390-μm resolution in axial planes for horizontal EOMs (23 subjects, 26 orbits) and sagittal planes for vertical EOMs (13 subjects, 22 orbits) during large ipsiversive ductions. The measured angle at insertion and the predicted angle assuming an "arc of contact" were compared using paired t tests. RESULTS For normal EOMs, the measured angle at insertion was significantly greater than predicted assuming an "arc of contact" for the medial rectus (MR) (5.0 ± 4.8 degrees vs 0.0 ± 0.0 degrees, P = .03), lateral rectus (LR) (4.9 ± 3.0 degrees vs 0.0 ± 0.0 degrees, P = .02), inferior rectus (7.4 ± 4.8 degrees vs 1.2 ± 2.6 degrees, P = .00003), and superior rectus (0.6 ± 1.1 degrees vs 0.0 ± 0.0 degrees, P = .04). In strabismic subjects, the measured angle was significantly greater for the MR in abducens palsy (9.9 ± 4.3 degrees vs 0.5 ± 0.7 degrees, P = .0007) and after MR resection (9.0 ± 6.9 degrees vs 1.2 ± 2.4 degrees, P = .02), but not after LR recession (2.9 vs 0.0 degrees). Single subjects had comparable angles after MR recession, but markedly different angles after MR and LR posterior fixation. CONCLUSIONS Contrary to the "arc of contact" biomechanical model, normal and postsurgical EOMs are significantly non-tangent to the globe at their scleral insertions. The "arc of contact" should be replaced in biomechanical modeling by the experimentally measured angles at tendon insertions. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Robert A Clark
- Department of Ophthalmology, David Geffen Medical School, University of California, Los Angeles, Los Angeles, California, USA.
| | - Joseph L Demer
- Department of Ophthalmology, David Geffen Medical School, University of California, Los Angeles, Los Angeles, California, USA; Department of Neurology, David Geffen Medical School, University of California, Los Angeles, Los Angeles, California, USA; Department of Neuroscience, David Geffen Medical School, University of California, Los Angeles, Los Angeles, California, USA; Biomedical Engineering Interdepartmental Programs, David Geffen Medical School, University of California, Los Angeles, Los Angeles, California, USA
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Abstract
Normal orbital anatomy plays a foundational role in stabilizing binocular eye movements. Abnormal orbital anatomy, contrariwise, destabilizes binocular eye alignment by introducing eccentric and unbalanced EOM forces. These abnormalities can be categorized into five broad etiologies: (1) orbital structural disorders; (2) globe size disorders; (3) degenerative disorders; (4) innervational disorders; and (5) trauma. Orbital imaging provides important diagnostic information on EOM path and innervational status, but only if performed properly. The three critical elements are (1) maximize the field of view by focusing on the orbit of interest; (2) control gaze, ideally imaging in primary position; and (3) image perpendicular (direct coronals) and parallel (axial for horizontal, sagittal for vertical) to the EOM(s) of interest. Images should be analyzed systematically by comparing EOM size and location between orbits and with established normative values. The single most critical image is the most anterior direct coronal plane that contains both globe and clearly defined EOM cross sections. EOM positional abnormalities in this plane establish the diagnosis for the first three categories of orbital abnormalities. Innervational abnormalities are best evaluated in the mid-orbit; asymmetry in mid-orbital EOM size and shape defines or confirms innervational disorders like complete or partial cranial nerve palsies.
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Kim MH, Song SH, Yum HR. Comparison between Modified Bilateral Lateral Rectus Recession and Augmented Unilateral Recession-resection for Convergence Insufficiency Exotropia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.1.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Hwan Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Seok Hyeon Song
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Hae Ri Yum
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
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Surgical outcomes of three different surgical techniques for treatment of convergence insufficiency intermittent exotropia. Eye (Lond) 2017; 32:693-700. [PMID: 29271419 DOI: 10.1038/eye.2017.259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/16/2017] [Indexed: 02/01/2023] Open
Abstract
PurposeTo determine the outcomes of three different techniques of strabismus surgery in patients with convergence insufficiency intermittent exotropia (CI-X(T)).Patients and methodsSixty-seven patients with CI-X(T) with near-distance disparity (NDD) ≥10 prism diopter (PD) were included in this 1-year follow-up prospective study and were randomly divided into three groups: slanted bilateral LR recession (S-BLR) group in which 22 patients underwent bilateral slanting recession of the lateral rectus (LR) muscle, the I-RR group with 23 patients who underwent improved unilateral medial rectus (MR) resection and LR recession with the amounts of resection and recession biased to near and distance deviation, respectively, and the A-BLR group with 22 patients who underwent bilateral augmented LR recession based on the near deviation. A successful outcome at distant and near was defined as exodeviation between 10 PD of exophoria/tropia and 5 PD of esophoria/tropia. Cumulative probabilities of success, preoperative and postoperative distant, near deviations, and NDD among groups were analyzed and compared.ResultsThe success rate of distant exodeviation, near exodeviation, and NDD in the three groups after 1 year was statistically insignificant (P=0.054, 0.233, and 0.142, respectively). At the 1 year follow-up, vertical pattern strabismus (V and A patterns) was a feature of the S-BLR group, whereas the rate of postoperative overcorrection and undercorrection was significant in the A-BLR and I-RR groups, respectively.ConclusionThe success rate of correction of distant exodeviation, near exodeviation, and NDD was statistically indifferent among the three groups. However, each procedure has its specific postoperative concerns, which should be considered before implementing in patients with CI-X(T).
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Cho KH, Kim HW, Choi DG, Lee JY. Type of the recurrent exotropia after bilateral rectus recession for intermittent exotropia. BMC Ophthalmol 2016; 16:97. [PMID: 27391365 PMCID: PMC4938985 DOI: 10.1186/s12886-016-0270-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 06/08/2016] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to investigate the type of exotropia (XT) based on the distance-near (D/N) difference in recurrent XT after bilateral lateral rectus (BLR) recession to treat intermittent XT (IXT) to look into the possibility of secondary convergence insufficiency (CI)-type strabismus. Methods A total of 121 patients with recurrent XT after BLR recession for basic-type and divergence excess (DE)-type IXT were retrospectively enrolled at a single institution. The distributions in the XT types were compared according to the D/N difference between primary and recurrent XT. Results Preoperatively, the population comprised 14 divergence excess (DE) types and 107 basic types. After the BLR recession, the XT-type composition changed to 59 basic types, 33 CI types, and 29 DE types. In one of the 14 preoperatively identified DE-type XT cases, the XT type changed to CI type, it changed to basic type in four cases, and the remaining nine cases showed no change in the DE type. The 107 preoperatively identified basic-type XT cases postoperatively became 55 basic-type, 32 CI-type, and 20 DE-type recurrent XT cases, and their postoperative distance XT control grades and near stereoacuity values did not significantly differ. Conclusion The XT type composition changed after the BLR recession. The XT types in recurrent XT after BLR recession showed an increasing proportion of CI-type. We suspect that an individual fusion mechanism might also influence the XT-type in recurrent XT in view of the somewhat increased DE-type in recurrent XT.
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Affiliation(s)
- Kwan Hyuk Cho
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do, 431-070, South Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hee Weon Kim
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do, 431-070, South Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Joo Yeon Lee
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do, 431-070, South Korea.
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Comment on “Early Results of Slanted Recession of the Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency”. J Ophthalmol 2016; 2016:8236314. [PMID: 27057350 PMCID: PMC4808542 DOI: 10.1155/2016/8236314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/18/2016] [Indexed: 11/25/2022] Open
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Early results of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. J Ophthalmol 2015; 2015:380467. [PMID: 25688298 PMCID: PMC4321669 DOI: 10.1155/2015/380467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. This prospective study included 31 patients who underwent slanted lateral rectus recession for intermittent exotropia with convergence insufficiency between June 2010 and June 2012. Following parameters were recorded and analyzed: patient sex, age, preoperative and postoperative near and distance ocular alignment, and changes in stereopsis. The mean age of the patients was 9.2 years. The preoperative mean deviation angle was 32.4 PD at distance and 43.4 PD at near. After 6 months, slanted lateral rectus recession reduced the deviation angles to 2 PD at distance and 3.4 PD at near. In addition, the mean difference between distance and near deviation angles was significantly reduced from 11 PD to 1.4 PD at 6 months postoperatively. Slanted lateral rectus recession for intermittent exotropia with convergence insufficiency in children successfully reduced the distance and near exodeviations and the near-distance difference without increasing the risk of long-term postoperative esotropia or diplopia.
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Bayramlar H, Ünlü C, Dag Y. Slanted medial rectus recession is effective in the treatment of convergence excess esotropia. J Pediatr Ophthalmol Strabismus 2014; 51:337-40. [PMID: 25068768 DOI: 10.3928/01913913-20140723-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the surgical outcomes of slanted medial rectus recession in patients diagnosed as having convergence excess esotropia. METHODS Bilateral slanted recession of medial rectus muscles was performed in 16 patients with convergence excess esotropia. The lower margins of medial rectus muscles were recessed 1 to 2 mm more than the upper margins. Changes in near-distance disparity of the deviations were recorded. RESULTS The mean preoperative near-distance disparity of 20.3±6.5 prism diopters (PD) decreased to 4.37±5.6 PD postoperatively. The amount of collapse was significant (mean: 16 PD; P<.005). Near-distance disparity of 10 PD or less was obtained in 14 patients after surgery (87.5%), except 2 patients who had 16 PD of disparity. The authors did not encounter overcorrection except in 1 patient in whom minimal exophoria at distance and near with the glasses was observed and reduced the prescription. CONCLUSIONS Bilateral slanted medial rectus muscle recession procedure effectively decreases the disparity between near and distance deviations in patients with convergence excess esotropia.
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Luan YN, Wang LH. Advances in surgery procedures for convergence insufficiency-type intermittent exotropia. World J Ophthalmol 2014; 4:71-74. [DOI: 10.5318/wjo.v4.i3.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/24/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Intermittent exotropia with convergence insufficiency is defined as a greater exodeviation measured at near than at distance of at least 10 prism diopters and it is harmful to binocular vision at earlier time. This paper mainly introduces three operation patterns including lateral rectus recession(s) with or without a slanting procedure, unilateral lateral rectus recession with medial rectus resection, and medial rectus resection(s) with or without a slanting procedure.
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25
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Wang B, Wang L, Wang Q, Ren M. Comparison of different surgery procedures for convergence insufficiency-type intermittent exotropia in children. Br J Ophthalmol 2014; 98:1409-13. [DOI: 10.1136/bjophthalmol-2013-304442] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Snir M, Dotan A, Friling R, Ron-Kella Y, Goldenberg-Cohen N, Stiebel-Kalish H. Contralateral lateral rectus muscle recession in patients with Duane retraction syndrome type 3. Eye (Lond) 2014; 28:279-84. [PMID: 24310235 PMCID: PMC3965804 DOI: 10.1038/eye.2013.260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 10/30/2013] [Indexed: 11/08/2022] Open
Abstract
AIMS The aim of this study was to evaluate the motor, sensory, functional, and head posture results of recession of the lateral rectus muscle contralateral to the involved eye in patients with exotropic Duane retraction syndrome (DRS) type 3. METHODS This was a retrospective, longitudinal, observational study of a consecutive clinical case series. Of the 11 patients with DRS type 3 operated on at a tertiary medical center from 1977 to 2012, 8 underwent recession of the lateral rectus muscle contralateral to the involved eye (with combined Y-splitting of ipsilateral lateral rectus muscle in 3 of them). Full ophthalmic, orthoptic, and neurological examination was performed before and after surgery. Main outcome measures included intragroup changes in motor misalignment, abnormal head turn, ocular upshoot, and stereopsis. RESULTS Mean patient age was 8.75±3.1 years at surgery. Mean exodeviation for distance was -17.3±3.5 prism diopters (PD) preoperatively and -4.0±6.1 PD postoperatively; corresponding values for near were -23.1±7.2 PD and -5.9±8.7 PD. Motor deviation improved by 77% for distance (P=0.017) and 74.5% for near (P=0.01). In 7/8 patients, the postoperative residual exodeviation (distance and near) was <8.0 PD. There was an 80% improvement in head turn, from 15.3±4° before surgery to 3.1±5.0° after (P=0.01). Stereopsis improved significantly in 6/8 patients. Findings remained stable during follow-up (mean duration 35.9±50.8 months, range 5-132 months). CONCLUSIONS Contralateral lateral rectus muscle recession appears to be a promising technique for the treatment of moderate unilateral DRS type 3, with patients showing significant motor and functional improvement and a decrease in head turn.
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Affiliation(s)
- M Snir
- Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Dotan
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - R Friling
- Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Ron-Kella
- Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - N Goldenberg-Cohen
- Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Stiebel-Kalish
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Ophthalmology Unit, Rabin Medical Center, Petach Tikva, Israel
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Song IJ, Lee SG. The Effect of Bilateral Slanted Lateral Rectus Recession in Exotropia with Near-Far Disparity. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.2.311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- In Je Song
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sul Gee Lee
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Yang HK, Hwang JM. Surgical outcomes in convergence insufficiency-type exotropia. Ophthalmology 2011; 118:1512-7. [PMID: 21474185 DOI: 10.1016/j.ophtha.2011.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 11/30/2010] [Accepted: 01/03/2011] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the efficacy of different types of strabismus surgeries in patients with convergence insufficiency (CI)-type exotropia, according to their response to diagnostic monocular occlusion. DESIGN Retrospective cohort study. PARTICIPANTS Sixty-five patients with CI-type exotropia with near-distance differences of ≥10 prism diopters (PD) who underwent strabismus surgery. METHODS Patients were divided into 3 groups according to their response to monocular occlusion: (1) true-CI group: near-distance differences ≥10 PD before and after occlusion; (2) masked-CI group: near-distance differences <10 PD before occlusion and ≥10 PD after occlusion; and (3) pseudo-CI group: near-distance differences ≥10 PD before occlusion and <10 PD after occlusion. Either bilateral lateral rectus recession based on near measurements with 1 mm augmentation (BLR) or unilateral medial rectus resection based on the near deviation with lateral rectus recession based on the distant deviation (RR) was performed. MAIN OUTCOME MEASURES Cumulative probabilities of success, near-distance differences of exodeviation, rate of recurrence per person-year, and risk factors of recurrence. RESULTS There were 24 children in the true-CI group, 19 children in the masked-CI group, and 22 children in the pseudo-CI group. The cumulative probabilities of success at 2 years after BLR versus RR were 61% versus 100% in the true-CI group, 58% versus 100% in the masked-CI group, and 77% versus 71% in the pseudo-CI group. The RR procedure was significantly more successful than the BLR procedure in the true-CI and masked-CI groups. CONCLUSIONS Successful outcome in CI-type exotropia was closely related to the patients' response to monocular occlusion. In patients with CI-type exotropia maintained after monocular occlusion, unilateral resection-recession based on near-distance measurements is recommended. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Augmented medial rectus recession, medial rectus recession plus Faden, and slanted medial rectus recession for convergence excess esotropia. Eur J Ophthalmol 2010; 21:119-24. [PMID: 20658460 DOI: 10.5301/ejo.2010.5225] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of 3 different surgical techniques for convergence excess esotropia: augmented medial rectus recession, medial rectus recession plus Faden, and slanted medial rectus recession. METHODS Twenty-nine patients with convergence excess esotropia were divided into 3 groups. Group A included 9 patients treated with medial rectus muscle recession augmented with 1-2 mm more of the standard recession. Group B included 10 patients treated with standard recession plus Faden. Group C included 10 patients treated with slanted medial rectus recession. Surgical success was defined as esotropia (ET) 10 prism diopters (Δ) or less at distance and near with collapse of distance/near disparity. RESULTS Satisfactory alignment with elimination of bifocal correction was noted in group A (66.6%). In groups B and C, the results were 70%. Group A patients had a mean reduction in distance/near disparity from 15.5±1.5Δ prism diopters preoperatively to 4.7±2.5Δ prism diopters postoperatively, while in group B the preoperative distance/near disparity was 16.5±1.8Δ prism diopters and decreased to 3.8±3.1Δ prism diopters postoperatively, and group C also showed reduction in distance/near disparity from 18.1±1.6Δ prism diopters preoperatively to 4.5±3.6Δ prism diopters postoperatively. There were no statistically significant differences among the 3 groups. CONCLUSIONS The 3 procedures are effective surgical options to treat convergence excess esotropia with acceptable motor outcomes.
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A comparative study of medial rectus slanting recession versus recession with downward transposition for correction of V-pattern esotropia. J AAPOS 2010; 14:127-31. [PMID: 20451854 DOI: 10.1016/j.jaapos.2009.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 11/14/2009] [Accepted: 11/23/2009] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the effect of medial rectus slanting recession versus medial rectus recession with downward transposition for correction of V-pattern esotropia without significant oblique muscle dysfunction. METHODS A total of 18 patients having V-pattern esotropia, without significant oblique muscle dysfunction were included in this randomized, prospective study. These were divided equally into 2 groups. The SLANT group underwent bilateral medial rectus muscle slanting recession: the lower pole of the medial rectus muscle was recessed a larger amount than the upper pole on the basis of the angles of esotropia in upgaze and downgaze, respectively. The TRANS group underwent bilateral medial rectus recession according to the angle of esotropia in the primary position, with half-tendon width downward transposition. Patients were followed for at least 6 months. RESULTS Postoperatively, esotropia in the primary position was corrected to within 10Delta of orthotropia in 8 of 9 patients in the SLANT group and 7 of 9 patients in the TRANS group. All uncorrected patients showed a residual esotropia. All studied patients showed collapse of V-pattern esotropia to less than 10Delta difference between upgaze and downgaze. The mean V-pattern collapse was from 31.1Delta to 5.33Delta (25.8Delta) in the SLANT group and from 27.8Delta to 5.6Delta (22.2Delta) in the TRANS group. The difference between both groups was insignificant (p = 0.17). Both techniques significantly collapsed the esodeviation and V pattern (p < 0.05). CONCLUSIONS Both slanting medial rectus recession and medial rectus recession with downward transposition corrected V-pattern esotropia, with no clinically or statistically significant differences in success rate.
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Park JS, Lee SJ, Roh YB, Choi HY. Monocular Slanted Lateral Rectus Recession for Exotropia with Convergence Insufficiency. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.8.1112-1118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Sung Park
- Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea
| | | | | | - Hee Young Choi
- Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea
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Choi MY, Hyung SM, Hwang JM. Unilateral recession-resection in children with exotropia of the convergence insufficiency type. Eye (Lond) 2005; 21:344-7. [PMID: 16327792 DOI: 10.1038/sj.eye.6702197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The surgical success rates for intermittent exotropia of the convergence insufficiency type have been reported to be variable, and most were studied retrospectively in adults. The purpose of this study was to evaluate prospectively the long-term surgical results of unilateral lateral rectus (LR) muscle recession and medial rectus (MR) muscle resection in children with intermittent exotropia of the convergence insufficiency type. METHODS A total of 14 children with intermittent exotropia greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. The amounts of resection and recession were based on near and distance deviation, respectively. Minimum follow-up was 1 year (mean 26.6 months; range, 12-68 months) after surgery. The paired t-test was used to compare preoperative and postoperative measurements of the angle of deviation at distance and near, near-distance difference. RESULTS Significant postoperative reduction was achieved in terms of mean distance exodeviation, from 22.5 PD to 9.1 PD (P=0.000), and mean near exodeviation from 33.8 PD to 13.6 PD (P=0.000). Mean near-distance difference reduced from 11.3 PD preoperatively to 4.6 PD postoperatively (P=0.000). Fresnel prism was used temporarily to treat postoperative esotropia in only one patient for postoperative 6 months. CONCLUSIONS Unilateral surgery biased to MR strengthening more than LR weakening in children with intermittent exotropia of the convergence insufficiency type, was found to successfully reduce both distance and near deviation and to collapse near-distance differences with a low risk of long-term postoperative esotropia.
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Affiliation(s)
- M Y Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
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Choi MY, Hwang JM. The long-term result of slanted medial rectus resection in exotropia of the convergence insufficiency type. Eye (Lond) 2005; 20:1279-83. [PMID: 16151478 DOI: 10.1038/sj.eye.6702095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the long-term results of slanted medial rectus (MR) resection for intermittent exotropia (X(T)) of the convergence insufficiency type. METHODS In all, 10 patients with an X(T) greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. Patients received slanted bilateral MR resection. The upper edge of the MR was resected according to the distance exodeviation and the lower edge of the MR was resected according to near exodeviation. The postoperative follow-up period was between 6 and 62 months with a mean of 38.9 months. The paired t-test was used to compare: mean distance angle of deviation preoperatively and postoperatively; mean near angle of deviation preoperatively and postoperatively; and mean near-distance exodeviation difference preoperatively and postoperatively. RESULTS Bilateral slanted MR resections reduced mean exodeviation at distance from 23.0+/-7.2 to 16.3+/-5.4 PD (P=0.03); mean exodeviation at near from 34.3+/-7.7 to 24.6+/-6.9 PD (P=0.01); and mean near-distance difference from 11.4+/-2.6 to 8.3+/-3.5 PD (P=0.04). At the final follow-up examination, all patients demonstrated an exodeviation of 10 PD or more at distance and near, and the exodeviation difference between distance and near deviation was within 10 PD in five of the 10 patients. Three patients had an esodeviation at distance after surgery, but all resolved within 4 weeks. CONCLUSIONS Bilateral slanted MR resections in patients with X(T) of the convergence insufficiency type resulted in undercorrection in all patients.
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Affiliation(s)
- M Y Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea. mychoi@ chungbuk.ac.kr
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Snir M, Kremer I, Weinberger D, Sherf I, Axer-Siegel R. Decompensation of Exodeviation After Corneal Refractive Surgery for Moderate to High Myopia. Ophthalmic Surg Lasers Imaging Retina 2003. [DOI: 10.3928/1542-8877-20030901-04] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Choi DG, Rosenbaum AL. Medial rectus resection(s) with adjustable suture for intermittent exotropia of the convergence insufficiency type. J AAPOS 2001; 5:13-7. [PMID: 11182666 DOI: 10.1067/mpa.2001.111137] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The surgical results for intermittent exotropia of the convergence insufficiency type have been reported to be of varying success. The purpose of this study is to evaluate the surgical results of medial rectus muscle (MR) resection(s) with adjustable suture for this condition. METHODS Twenty-one consecutive patients with intermittent exotropia of the convergence insufficiency type were included in this retrospective study. All patients had a history of prolonged difficulties at near work unrelieved by nonsurgical treatment. Unilateral or bilateral MR resection(s) were done with the adjustable suture, which was tied at the first postoperative day. The target angle was an esotropia of 10 to 20 PD at distance and an esotropia of 5 to 10 PD at near. Postoperatively Fresnel prisms were used temporarily in patients manifesting a consecutive esotropia with diplopia at distance. Postoperative follow-up period was between 6 months and 24 months with a mean of 9.1 months. RESULTS MR resection(s) with the adjustable suture reduced the mean exodeviation at near from 25.7 to 3 PD. It also reduced the exodeviation at distance from 11.4 to -2 PD (esodeviation). The mean near-distance difference was collapsed from 14.3 PD preoperatively to 5 PD postoperatively. CONCLUSIONS MR resection(s) with adjustable suture combined with intentional postoperative aggressive overcorrection and the use of Fresnel prisms is useful in intermittent exotropia of the convergence insufficiency type. The intentional overcorrection during the immediate postoperative period at distance and near is required to prevent long-term undercorrection.
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Affiliation(s)
- D G Choi
- Department of Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, California 90095-7001, USA
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Abstract
In the past year experimental studies have analyzed the ease with which specific sutures can be adjusted, have investigated ways to prevent adhesions in animal models, and have studied variations of the inferior oblique at the surgical capture site. Our knowledge of rectus extraocular muscle pulleys continues to improve, and the value of botulinum toxin type A in the treatment of several conditions has been further documented. New surgical techniques include slanted recessions of the lateral rectus muscles, combined monocular resection and bilateral anterior transposition of the inferior oblique, and intraoperative use of acetylcholine during inferior oblique myectomy. Favorable results have been reported after clinically important modifications to the superior oblique muscle silicone expander and anterior transposition of the inferior oblique procedures, as well as after bilateral inferior rectus muscle recession in dysthyroid ophthalmopathy. Conjunctival inclusion cysts, anterior segment ischemia despite microvascular dissection, and corneal topographic changes are reported as complications occurring after strabismus surgery. Recent publications discussing these issues are reviewed here.
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Affiliation(s)
- T Murray
- Department of Ophthalmology, University of Cape Town Medical School, South Africa.
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