AIM:To evaluate the characteristics of exotropia(XT)and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery.METHODS:The medical records of all p...AIM:To evaluate the characteristics of exotropia(XT)and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery.METHODS:The medical records of all patients that were diagnosed with XT and underwent strabismus surgery in 13 major government hospitals in Thailand;from January 2012 to December 2019,were retrospectively reviewed.Univariable and multivariable logistic regression were performed to identify factors related to binocular vision.RESULTS:Data of five hundred and thirty-seven patients were analyzed.Two hundred and twenty-six patients were men(42.1%).The median age of onset was 3 years old[Interquartile range(IQR):1,8].The median age at diagnosis was 9.21 years old(IQR;4.64,21.06).intermittent exotropia[X(T)]was the most common type(52.1%);19.5%of the patients had amblyopia.For refractive error,spherical equivalent refraction on right eye(RE)and left eye(LE)were-0.53±2.45 diopters(D)(range-14.88 to+10 D)and-0.48±2.37 D(range-19.50 to+7.75 D),respectively.The mean angle of deviation at distance and near before surgery were 42.06±14.91 prism diopters(PD)and 40.81±16.09 PD,respectively.Follow-up time after first operation was 2.48±2.27y.Four hundred sixtytwo patients(86%)needed only one operation and 299(55.6%)patients had bilateral lateral rectus recession.At final visit,the mean angles of deviation at distance and near decreased to 5.76±8.96 PD and 5.01±8.73 PD,respectively.After surgery,two hundred seventy-three patients(50.8%)were evaluated for binocular function,but the others did not have result.From multivariable logistic regression in 273 patients,the factors related to better binocular function were type of XT which was X(T)[adjusted odds ratio(aOR)10.35;95%CI:4.73,22.66]compared to constant XT,without amblyopia(aOR 3.97;95%CI:1.84,8.53),underwent only single operation compared with more than 1 operation(aOR 3.80,95%CI:1.58,9.16),the angle of deviation at near in last visit less than 10 PD better than 10–30 PD with aOR 0.42(95%CI:0.18,0.96)and type of refraction revealed isometropia better than anisometropia with aOR 4.13(95%CI:1.19,14.32).CONCLUSION:The surgical outcomes of XT within one operation in Thailand is 86%.The factors related to achieve binocular function includes type of XT as X(T),without amblyopia,angle of deviation at final visit less than 10 PD,isometropia type of refraction and underwent only one surgical correction.展开更多
AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who u...AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.展开更多
AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ab...AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ability of intermittent exotropia(IXT)patients in three conditions:natural 2D optotype viewing,2D optotype viewing with polarized glasses,and 3D optotype viewing with polarized glasses.Recording with a smartphone,we captured videos to analyze the accurate time of spontaneous exodeviation and subsequent realignment before and after breaking fusion.Additionally,the correlation of stereopsis were also analyzed.RESULTS:A total of 48 patients(age range:4-33y;54.17%male)participated in the study.When viewing 3D optotypes with polarized glasses,their median control scores were 1(interquartile range,0-4)at distance and 0(0-1)at near.These scores were significantly better than those observed under natural viewing conditions,which were 2.5(1-5)at a distance and 1(0-3)at near(Friedman test,P=0.049).Furthermore,those subjects who exhibited exophoria(realignment within 2 seconds)while viewing 3D optotypes with polarized glasses were more likely to have measurable stereo vision(Kendall’sτb=-0.344,P=0.018).CONCLUSION:IXT patients exhibit enhanced control ability when using polarized glasses to view 3D optotypes,notably improving realignment capabilities.This expands our understanding of current tests and offers a potentially sensitive method for assessing IXT severity.展开更多
Introduction: exotropia is a deviation outside the visual axes. In children, an association with ametropia is often observed, however, that with hyperopia is rare. The objective of this study was to highlight the part...Introduction: exotropia is a deviation outside the visual axes. In children, an association with ametropia is often observed, however, that with hyperopia is rare. The objective of this study was to highlight the particularities of the management of exotropia associated with hyperopia in children. Subjects and Methods: this was a retrospective study over 78 months including all children aged 0 to 15 years, treated for exotropia associated with hyperopia. Results: we found 20 cases of exotropia with hyperopia, or 57.15% of exotropia. The mean age was 4.3 years and the sex ratio was 0.82. Hyperopia was mild in 30 eyes (75%), moderate in 9 eyes (22.5%) and high in 2.5% of eyes. Over a one-year follow-up, 10 children (50%) had regular follow-up, including 6 with full hyperopic correction and 4 with partial hyperopic correction. After full hyperopic correction, one child had a resolution of his exotropia;2 had a decrease in the angle of deviation and 3 had no improvement of their exotropia. Among the 4 with partial hyperopic correction children, 2 had a resolution of their exotropia. Strabismus surgery was planned in 3 children after iso-acuity. Conclusion: the association of exotropia and hyperopia poses a management problem. The total correction or not of hyperopia is discussed according to several authors.展开更多
AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literatur...AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence rate.RESULTS: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [<2 y, OR 0.56(0.33-0.94) for success rate; OR 2.11(1.17, 3.81) for undercorrection rate]. However, BLR achieved a higher success rate [OR 2.49(1.61, 3.86)] and a lower undercorrection rate [OR 0.40(0.23, 0.71)], compared to that of R&R at a long-term followup(>2 y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85(0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37(0.18, 0.74)] and a lower undercorrection [OR 3.50(1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T)(20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08(0.65, 1.79)] and undercorrection rate [OR 0.89(0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic typeIX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.展开更多
AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underw...AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success[≤5 prism diopters(PD)esophoria(E)to≤10 PD exophoria(X)on the postoperative sixth month]were enrolled in this study.Their consecutive survival on the postoperative first year,second year and third year and at the last visit of fourth year or more,and the factors that might affect their survival,were analyzed.The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group(≤5 PD E to≤10 PD X)and the failure group(】5 PD esodeviation or】10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%,92.89%,83.70%and 50.49%on the postoperative first,second and third years and fourth year or more,respectively.None of the clinical factors was determined to have affected the survival.The amount of the exodrift was largest(2.29 PD)between the first year and the second year,and smallest(1.47 PD)between the fourth year and the last visit.Sixty-three patients had their final visit after the postoperative fourth year,and 29 of them were in the failure group.Twentyfive patients in the failure group had an intermittent exotropia(IXT)of【20 PD with good to fair distant fusion;two had an IXT of【20 PD with poor distant fusion;one had an IXT of≥20 PD with fair distant fusion;and another had delayed-onset consecutive esotropia.The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group(2.81 PD vs 5.86 PD,P=0.012).The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift,but the amount of the exodrift decreases with long-term follow-up.The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients.A smaller deviation on the postoperative sixth month is associated with long-term survival.展开更多
AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retro...AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.展开更多
AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in...AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparityonly components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests,respectively. Patients with a long disease course(>1 y) had worse dynamic stereopsis than those with a short disease course(<1 y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparityonly, or the motion-only test components(all P>0.05, Chisquare test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.展开更多
Objective： To investigate the time and postoperative binocular vision of strabismus surgery for children with intermittent exotropia （X（T））. Methods： A retrospective investigation was conducted in 80 child patie...Objective： To investigate the time and postoperative binocular vision of strabismus surgery for children with intermittent exotropia （X（T））. Methods： A retrospective investigation was conducted in 80 child patients with intermittent exotropia. Pre- and postoperative angles of deviation fixating at near （33 cm） and distant targets （6 m） were measured with the prolonged alternate cover testing. The binocular function was assessed with synoptophore. Twenty-one patients took the postoperative synoptophore exercise. Results： （1） A week after surgery, 96.2% of the 80 patients had binocular normotopia, while a year after surgery, 91.3% of the 80 patients had binocular normotopia; （2） Preoperatively, 58 patients had near stereoacuity, while postoperatively, 72 patients achieved near stereoacuity （P〈0.05）; （3） Preoperatively, 64 patients had Grade Ⅰ for the synoptophore evaluation and postoperatively, 76 patients achieved Grade Ⅰ. Meanwhile, 55 patients had Grade Ⅱ preoperatively and 72 achieved Grade Ⅱ postoperatively. For Grade Ⅲ, there were 49 patients preoperatively and 64 patients postoperatively （P〈0.05）; （4） Patients of 5-8 years old had a significantly better recovery rate of binocular vision than those of 9-18 years old （P〈0.05）; （5） Patients taking postoperative synoptophore exercise had a better binocular vision than those taking no exercise （P〈0.05）. Conclusions： （1） Strabismus surgery can help to preserve or restore the binocular vision for intermittent exotropia; （2） Receiving the surgery at young ages may develop better postoperative binocular vision; （3） The postoperative synoptophore exercise can help to restore the binocular vision.展开更多
AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Kno...AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Knowledge Infrastructure were searched prior to December 16,2019.From this broad database search,we performed some Meta-analysis including eleven independent studies,to further evaluate the outcome(s)when comparing early versus late surgery for IXT.The boundaries between early and late surgery and the surgery methods were not inconsistent,so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches.The pooled odds ratios(ORs)and the 95%confidence interval(CI)were estimated according to the random-effects model for high heterogeneity between studies.RESULTS:Eleven retrospective studies were included in this Meta-analysis.No significant difference between early and late surgery was observed for IXT patients(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final follow-up)=1.48,95%CI 0.94-2.31,P=0.09).However,sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable.Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession(BLR)subgroup for the final follow-up(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=2.25,95%CI 1.36-3.74,P=0.00).CONCLUSION:Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.展开更多
AIM： To compare a group of patients with consecutive exotropia with patients who had ≤ 10 prism diopters （PD） esotropia or no deviation postoperatively in terms of probable clinical risk factors for the developmen...AIM： To compare a group of patients with consecutive exotropia with patients who had ≤ 10 prism diopters （PD） esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. METHODS： The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. RESULTS： The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 （P=0.634）. There was no significant difference of preoperative near and distant deviations among two groups （P =0.835, 0.928 respectively）. The mean amount of medial rectus recession and lateral rectus resection was similar in both groups （P=0.412, 0.648 respectively）. Convergence insufficiency and neurological diseases were more frequent in group 1 （P-0.007, 0.045）. Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios （OR）： 5.75 （1.04-31.93）]. CONCLUSION： Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors.展开更多
AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic reson...AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic resonance imaging（f MRI） data.METHODS： Totally, 32 CEs（25 males and 7 females） and 32 healthy control subjects（HCs）（25 males and 7 females） were enrolled in the study and underwent the MRI scanning. Two-sample t-test was used to examine differences in FC maps between the CE patients and HCs. RESULTS： The CE patients showed significantly less FC between the left brodmann area（BA17） and left lingual gyrus/cerebellum posterior lobe, right middle occipital gyrus, left precentral gyrus/postcentral gyrus and right inferior parietal lobule/postcentral gyrus. Meanwhile, CE patients showed significantly less FC between right BA17 and right middle occipital gyrus（BA19, 37）.CONCLUSION： Our findings show that CE involves abnormal FC in primary visual cortex in many regions, which may underlie the pathologic mechanism of impaired fusion and stereoscopic vision in CEs.展开更多
AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHOD...AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHODS： This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2 y. The results were evaluated at 2 y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1 wk was used to evaluate relationship with long-term outcome. The longterm outcome was classified into 3 groups： successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters（PD） and exodeviation 10 PD.RESULTS： Forty-two patients were enrolled. The mean age at surgery was 26 y（range, 15-49 y）. The median follow-up period was 30 mo（range, 24-108 mo）. Successful outcome was found in 81% of patients at 2 y and in 71% at the final visit. Overcorrection at 1 wk postoperatively was associated with a successful outcome at 2 y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome（RR=2.2）. The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2 y.CONCLUSION： Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1 wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.展开更多
AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for...AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test,and had moderate to good strabismus control.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.展开更多
AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral re...AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.展开更多
AIM: To study the quality of life of adult patients with intermittent exotropia(IXT) in China and analyze the factors affecting the quality of life in IXT patients.METHODS: Total y 109 cases of normal eye(control grou...AIM: To study the quality of life of adult patients with intermittent exotropia(IXT) in China and analyze the factors affecting the quality of life in IXT patients.METHODS: Total y 109 cases of normal eye(control group), 77 cases of IXT(IXT group) and 115 cases of strabismus control group(except IXT) were collected. The quality of life of the patients was assessed by Chinese version of adult strabismus patient’s quality of life scale(CAS-20). The differences of general characteristics, visual function and quality of life were analyzed, and the effects of individual factors and visual function on quality of life of patients with IXT were analyzed.RESULTS: The IXT group had a high proportion of patients with family history, low proportion of patients with amblyopia compared with strabismus control group. The proportion with normal near and far stereopsis of IXT group were lower than that of normal control group. The best corrected visual acuity of IXT group was higher than that of strabismus control group, but lower than the control group. In addition, the median strabismus degree in IXT group was higher than that in other strabismus control group. The median psychosocial scores and median visual function scores of the IXT group was lower than that of the normal control group, but not different from strabismus control group. Occupation status, course of disease, far stereopsis and near stereopsis significantly affected the quality of life in IXT patients.CONCLUSION: Adult IXT patients in China have a certain proportion of family history and lower quality of life, The main factors affecting the quality of life of IXT patients is stereopsis, course of disease and occupation status.展开更多
To evaluate the phacoemulsification and intraocular lens implantation in patients with sensory exotropia subsequent to senile cataract. The authors prospectively studied the role of phacoemulsification and intraocular...To evaluate the phacoemulsification and intraocular lens implantation in patients with sensory exotropia subsequent to senile cataract. The authors prospectively studied the role of phacoemulsification and intraocular lens implantation on 25 patients by observing visual acuity, ocular alignment, binocular vision and diplopia pre-, 1 month post- and 3 months post-operation. The patients underwent follow-up for three months. Postoperatively, one patient had a corrected visual acuity of 20/50, and 24 patients had 20/40 or better. The ocular alignment, binocular vision and diplopia were resolved spontaneously. Phacoemulsification and intraocular lens implantation performed together is effective on sensory exotropia subsequent to senile cataract.展开更多
AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the result...AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre(PD)] were retrospectively reviewed. Two groups of patients were identified;Group Ⅰ(21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A(BTA) injection into the recessed muscles and group Ⅱ(30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group Ⅰ(47.6%) and 20 patients in group Ⅱ(66.7%) achieved esotropia/esophoria <5 PD or exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant(P=0.1) but there was a statistically significant higher rate of undercorrection in group Ⅰ(P=0.03). On the other hand, 3 patients in group Ⅰ(14.3%) and 5 patients in group Ⅱ(16.7%) had improved stereopsis;this difference in the sensory outcome was not statistically significant(P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate(P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilateral medial rectus resection in the correction of large angle intermittent exotropia. The surgical success rate in BTA augmented surgery group is observed to be higher in patients with preoperative smaller angle of deviation and in patients with good stereoacuity.展开更多
AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent ...AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent bilateral lateral rectus muscle recession for IXT between 4 and 12 years old were reviewed retrospectively. They were categorized based on the surgical results;successful correction group(n=36) and overcorrection group(esotropia ≥10 PD at 3 mo postoperatively, n=18). Using CGT-2000 test for CS was performed binocularly, and subjective reports of photophobia was investigated preoperatively and at 3 mo postoperatively. Objective photophobia was defined as a significant decrease in CS in the presence of glare.RESULTS: Preoperatively, there was no difference in CS between the groups. Postoperatively, under mesopic conditions, significant improvement of CS was observed at 6.3°, 4°, and 2.5° in the successful correction group and at 6.3° and 4° in the overcorrection group, regardless of glare. Under photopic conditions, at all visual angles except 0.64°, improvement in CS was noted in both groups while CS worsened significantly at 0.64° in the overcorrection group postoperatively. At all visual angles under photopic conditions postoperatively, regardless of glare, CS in the overcorrected group was significantly worse than that in the successful correction group, and CS was significantly decreased by addition of glare in both groups. All patients except one(96.4%) in the successful correction group and 8 patients(61.5%) in overcorrection group showed improvement of photophobia postoperatively, which correlated with CS under photopic conditions(P=0.001, 0.03).CONCLUSION: After surgery for IXT, CS under photopic conditions improve at all visual angles except 0.64°, while CS is significantly worse in the overcorrection group postoperatively at 0.64°. Subjective photophobia havesignificant correlation with CS under photopic conditions, and may be used as an objective indicator of photophobia.展开更多
I am Dr. Heeyoung Choi, from the Department of Ophthalmology of Pusan National University Hospital,Busan, Korea. I write to present a case report of abnormal medial rectus insertion presenting exotropia.
文摘AIM:To evaluate the characteristics of exotropia(XT)and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery.METHODS:The medical records of all patients that were diagnosed with XT and underwent strabismus surgery in 13 major government hospitals in Thailand;from January 2012 to December 2019,were retrospectively reviewed.Univariable and multivariable logistic regression were performed to identify factors related to binocular vision.RESULTS:Data of five hundred and thirty-seven patients were analyzed.Two hundred and twenty-six patients were men(42.1%).The median age of onset was 3 years old[Interquartile range(IQR):1,8].The median age at diagnosis was 9.21 years old(IQR;4.64,21.06).intermittent exotropia[X(T)]was the most common type(52.1%);19.5%of the patients had amblyopia.For refractive error,spherical equivalent refraction on right eye(RE)and left eye(LE)were-0.53±2.45 diopters(D)(range-14.88 to+10 D)and-0.48±2.37 D(range-19.50 to+7.75 D),respectively.The mean angle of deviation at distance and near before surgery were 42.06±14.91 prism diopters(PD)and 40.81±16.09 PD,respectively.Follow-up time after first operation was 2.48±2.27y.Four hundred sixtytwo patients(86%)needed only one operation and 299(55.6%)patients had bilateral lateral rectus recession.At final visit,the mean angles of deviation at distance and near decreased to 5.76±8.96 PD and 5.01±8.73 PD,respectively.After surgery,two hundred seventy-three patients(50.8%)were evaluated for binocular function,but the others did not have result.From multivariable logistic regression in 273 patients,the factors related to better binocular function were type of XT which was X(T)[adjusted odds ratio(aOR)10.35;95%CI:4.73,22.66]compared to constant XT,without amblyopia(aOR 3.97;95%CI:1.84,8.53),underwent only single operation compared with more than 1 operation(aOR 3.80,95%CI:1.58,9.16),the angle of deviation at near in last visit less than 10 PD better than 10–30 PD with aOR 0.42(95%CI:0.18,0.96)and type of refraction revealed isometropia better than anisometropia with aOR 4.13(95%CI:1.19,14.32).CONCLUSION:The surgical outcomes of XT within one operation in Thailand is 86%.The factors related to achieve binocular function includes type of XT as X(T),without amblyopia,angle of deviation at final visit less than 10 PD,isometropia type of refraction and underwent only one surgical correction.
文摘AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.
基金Supported by the National Natural Science Foundation of China(No.82070995,No.82301256)Youth S&T Talent Support Programme of Guangdong Provincial Association for Science and Technology.
文摘AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ability of intermittent exotropia(IXT)patients in three conditions:natural 2D optotype viewing,2D optotype viewing with polarized glasses,and 3D optotype viewing with polarized glasses.Recording with a smartphone,we captured videos to analyze the accurate time of spontaneous exodeviation and subsequent realignment before and after breaking fusion.Additionally,the correlation of stereopsis were also analyzed.RESULTS:A total of 48 patients(age range:4-33y;54.17%male)participated in the study.When viewing 3D optotypes with polarized glasses,their median control scores were 1(interquartile range,0-4)at distance and 0(0-1)at near.These scores were significantly better than those observed under natural viewing conditions,which were 2.5(1-5)at a distance and 1(0-3)at near(Friedman test,P=0.049).Furthermore,those subjects who exhibited exophoria(realignment within 2 seconds)while viewing 3D optotypes with polarized glasses were more likely to have measurable stereo vision(Kendall’sτb=-0.344,P=0.018).CONCLUSION:IXT patients exhibit enhanced control ability when using polarized glasses to view 3D optotypes,notably improving realignment capabilities.This expands our understanding of current tests and offers a potentially sensitive method for assessing IXT severity.
文摘Introduction: exotropia is a deviation outside the visual axes. In children, an association with ametropia is often observed, however, that with hyperopia is rare. The objective of this study was to highlight the particularities of the management of exotropia associated with hyperopia in children. Subjects and Methods: this was a retrospective study over 78 months including all children aged 0 to 15 years, treated for exotropia associated with hyperopia. Results: we found 20 cases of exotropia with hyperopia, or 57.15% of exotropia. The mean age was 4.3 years and the sex ratio was 0.82. Hyperopia was mild in 30 eyes (75%), moderate in 9 eyes (22.5%) and high in 2.5% of eyes. Over a one-year follow-up, 10 children (50%) had regular follow-up, including 6 with full hyperopic correction and 4 with partial hyperopic correction. After full hyperopic correction, one child had a resolution of his exotropia;2 had a decrease in the angle of deviation and 3 had no improvement of their exotropia. Among the 4 with partial hyperopic correction children, 2 had a resolution of their exotropia. Strabismus surgery was planned in 3 children after iso-acuity. Conclusion: the association of exotropia and hyperopia poses a management problem. The total correction or not of hyperopia is discussed according to several authors.
基金Supported by Young Medical Talents Foundation of Jiangsu Province(No.QNRC2016080)
文摘AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence rate.RESULTS: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [<2 y, OR 0.56(0.33-0.94) for success rate; OR 2.11(1.17, 3.81) for undercorrection rate]. However, BLR achieved a higher success rate [OR 2.49(1.61, 3.86)] and a lower undercorrection rate [OR 0.40(0.23, 0.71)], compared to that of R&R at a long-term followup(>2 y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85(0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37(0.18, 0.74)] and a lower undercorrection [OR 3.50(1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T)(20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08(0.65, 1.79)] and undercorrection rate [OR 0.89(0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic typeIX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.
文摘AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success[≤5 prism diopters(PD)esophoria(E)to≤10 PD exophoria(X)on the postoperative sixth month]were enrolled in this study.Their consecutive survival on the postoperative first year,second year and third year and at the last visit of fourth year or more,and the factors that might affect their survival,were analyzed.The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group(≤5 PD E to≤10 PD X)and the failure group(】5 PD esodeviation or】10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%,92.89%,83.70%and 50.49%on the postoperative first,second and third years and fourth year or more,respectively.None of the clinical factors was determined to have affected the survival.The amount of the exodrift was largest(2.29 PD)between the first year and the second year,and smallest(1.47 PD)between the fourth year and the last visit.Sixty-three patients had their final visit after the postoperative fourth year,and 29 of them were in the failure group.Twentyfive patients in the failure group had an intermittent exotropia(IXT)of【20 PD with good to fair distant fusion;two had an IXT of【20 PD with poor distant fusion;one had an IXT of≥20 PD with fair distant fusion;and another had delayed-onset consecutive esotropia.The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group(2.81 PD vs 5.86 PD,P=0.012).The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift,but the amount of the exodrift decreases with long-term follow-up.The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients.A smaller deviation on the postoperative sixth month is associated with long-term survival.
文摘AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.
基金Supported by National Natural Science Foundation of China (No.81600761)the Natural Science Foundation Team Projectof Guangdong Province (No.2015A030312016)
文摘AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparityonly components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests,respectively. Patients with a long disease course(>1 y) had worse dynamic stereopsis than those with a short disease course(<1 y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparityonly, or the motion-only test components(all P>0.05, Chisquare test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.
基金Project supported by the National Natural Science Foundation of China(No.30600693)Department of Education of Zhejiang Province(No.20030236),China
文摘Objective： To investigate the time and postoperative binocular vision of strabismus surgery for children with intermittent exotropia （X（T））. Methods： A retrospective investigation was conducted in 80 child patients with intermittent exotropia. Pre- and postoperative angles of deviation fixating at near （33 cm） and distant targets （6 m） were measured with the prolonged alternate cover testing. The binocular function was assessed with synoptophore. Twenty-one patients took the postoperative synoptophore exercise. Results： （1） A week after surgery, 96.2% of the 80 patients had binocular normotopia, while a year after surgery, 91.3% of the 80 patients had binocular normotopia; （2） Preoperatively, 58 patients had near stereoacuity, while postoperatively, 72 patients achieved near stereoacuity （P〈0.05）; （3） Preoperatively, 64 patients had Grade Ⅰ for the synoptophore evaluation and postoperatively, 76 patients achieved Grade Ⅰ. Meanwhile, 55 patients had Grade Ⅱ preoperatively and 72 achieved Grade Ⅱ postoperatively. For Grade Ⅲ, there were 49 patients preoperatively and 64 patients postoperatively （P〈0.05）; （4） Patients of 5-8 years old had a significantly better recovery rate of binocular vision than those of 9-18 years old （P〈0.05）; （5） Patients taking postoperative synoptophore exercise had a better binocular vision than those taking no exercise （P〈0.05）. Conclusions： （1） Strabismus surgery can help to preserve or restore the binocular vision for intermittent exotropia; （2） Receiving the surgery at young ages may develop better postoperative binocular vision; （3） The postoperative synoptophore exercise can help to restore the binocular vision.
基金Supported by the Natural Science Foundation of Tianjin(No.18JCZDJC36400)。
文摘AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Knowledge Infrastructure were searched prior to December 16,2019.From this broad database search,we performed some Meta-analysis including eleven independent studies,to further evaluate the outcome(s)when comparing early versus late surgery for IXT.The boundaries between early and late surgery and the surgery methods were not inconsistent,so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches.The pooled odds ratios(ORs)and the 95%confidence interval(CI)were estimated according to the random-effects model for high heterogeneity between studies.RESULTS:Eleven retrospective studies were included in this Meta-analysis.No significant difference between early and late surgery was observed for IXT patients(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final follow-up)=1.48,95%CI 0.94-2.31,P=0.09).However,sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable.Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession(BLR)subgroup for the final follow-up(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=2.25,95%CI 1.36-3.74,P=0.00).CONCLUSION:Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.
文摘AIM： To compare a group of patients with consecutive exotropia with patients who had ≤ 10 prism diopters （PD） esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. METHODS： The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. RESULTS： The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 （P=0.634）. There was no significant difference of preoperative near and distant deviations among two groups （P =0.835, 0.928 respectively）. The mean amount of medial rectus recession and lateral rectus resection was similar in both groups （P=0.412, 0.648 respectively）. Convergence insufficiency and neurological diseases were more frequent in group 1 （P-0.007, 0.045）. Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios （OR）： 5.75 （1.04-31.93）]. CONCLUSION： Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors.
基金Supported by the National Natural Science Foundation of China(No.81660158No.81160118No.81400372)
文摘AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic resonance imaging（f MRI） data.METHODS： Totally, 32 CEs（25 males and 7 females） and 32 healthy control subjects（HCs）（25 males and 7 females） were enrolled in the study and underwent the MRI scanning. Two-sample t-test was used to examine differences in FC maps between the CE patients and HCs. RESULTS： The CE patients showed significantly less FC between the left brodmann area（BA17） and left lingual gyrus/cerebellum posterior lobe, right middle occipital gyrus, left precentral gyrus/postcentral gyrus and right inferior parietal lobule/postcentral gyrus. Meanwhile, CE patients showed significantly less FC between right BA17 and right middle occipital gyrus（BA19, 37）.CONCLUSION： Our findings show that CE involves abnormal FC in primary visual cortex in many regions, which may underlie the pathologic mechanism of impaired fusion and stereoscopic vision in CEs.
基金Supported by the Ratchadapiseksompoch Fund (No.RA57/046)
文摘AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHODS： This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2 y. The results were evaluated at 2 y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1 wk was used to evaluate relationship with long-term outcome. The longterm outcome was classified into 3 groups： successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters（PD） and exodeviation 10 PD.RESULTS： Forty-two patients were enrolled. The mean age at surgery was 26 y（range, 15-49 y）. The median follow-up period was 30 mo（range, 24-108 mo）. Successful outcome was found in 81% of patients at 2 y and in 71% at the final visit. Overcorrection at 1 wk postoperatively was associated with a successful outcome at 2 y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome（RR=2.2）. The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2 y.CONCLUSION： Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1 wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.
文摘AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test,and had moderate to good strabismus control.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.
文摘AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.
基金Supported by the Beijing Talent Youth Training Program and Beijing Municipal Administration of Hospitals Incubating Program (No.PX2017045)Beijing Municipal Science&Technology Commission (No.Z171100001017066)Beijing Municipal Science&Technology Commission (No.Z201100005520044)。
文摘AIM: To study the quality of life of adult patients with intermittent exotropia(IXT) in China and analyze the factors affecting the quality of life in IXT patients.METHODS: Total y 109 cases of normal eye(control group), 77 cases of IXT(IXT group) and 115 cases of strabismus control group(except IXT) were collected. The quality of life of the patients was assessed by Chinese version of adult strabismus patient’s quality of life scale(CAS-20). The differences of general characteristics, visual function and quality of life were analyzed, and the effects of individual factors and visual function on quality of life of patients with IXT were analyzed.RESULTS: The IXT group had a high proportion of patients with family history, low proportion of patients with amblyopia compared with strabismus control group. The proportion with normal near and far stereopsis of IXT group were lower than that of normal control group. The best corrected visual acuity of IXT group was higher than that of strabismus control group, but lower than the control group. In addition, the median strabismus degree in IXT group was higher than that in other strabismus control group. The median psychosocial scores and median visual function scores of the IXT group was lower than that of the normal control group, but not different from strabismus control group. Occupation status, course of disease, far stereopsis and near stereopsis significantly affected the quality of life in IXT patients.CONCLUSION: Adult IXT patients in China have a certain proportion of family history and lower quality of life, The main factors affecting the quality of life of IXT patients is stereopsis, course of disease and occupation status.
文摘To evaluate the phacoemulsification and intraocular lens implantation in patients with sensory exotropia subsequent to senile cataract. The authors prospectively studied the role of phacoemulsification and intraocular lens implantation on 25 patients by observing visual acuity, ocular alignment, binocular vision and diplopia pre-, 1 month post- and 3 months post-operation. The patients underwent follow-up for three months. Postoperatively, one patient had a corrected visual acuity of 20/50, and 24 patients had 20/40 or better. The ocular alignment, binocular vision and diplopia were resolved spontaneously. Phacoemulsification and intraocular lens implantation performed together is effective on sensory exotropia subsequent to senile cataract.
文摘AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre(PD)] were retrospectively reviewed. Two groups of patients were identified;Group Ⅰ(21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A(BTA) injection into the recessed muscles and group Ⅱ(30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group Ⅰ(47.6%) and 20 patients in group Ⅱ(66.7%) achieved esotropia/esophoria <5 PD or exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant(P=0.1) but there was a statistically significant higher rate of undercorrection in group Ⅰ(P=0.03). On the other hand, 3 patients in group Ⅰ(14.3%) and 5 patients in group Ⅱ(16.7%) had improved stereopsis;this difference in the sensory outcome was not statistically significant(P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate(P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilateral medial rectus resection in the correction of large angle intermittent exotropia. The surgical success rate in BTA augmented surgery group is observed to be higher in patients with preoperative smaller angle of deviation and in patients with good stereoacuity.
文摘AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent bilateral lateral rectus muscle recession for IXT between 4 and 12 years old were reviewed retrospectively. They were categorized based on the surgical results;successful correction group(n=36) and overcorrection group(esotropia ≥10 PD at 3 mo postoperatively, n=18). Using CGT-2000 test for CS was performed binocularly, and subjective reports of photophobia was investigated preoperatively and at 3 mo postoperatively. Objective photophobia was defined as a significant decrease in CS in the presence of glare.RESULTS: Preoperatively, there was no difference in CS between the groups. Postoperatively, under mesopic conditions, significant improvement of CS was observed at 6.3°, 4°, and 2.5° in the successful correction group and at 6.3° and 4° in the overcorrection group, regardless of glare. Under photopic conditions, at all visual angles except 0.64°, improvement in CS was noted in both groups while CS worsened significantly at 0.64° in the overcorrection group postoperatively. At all visual angles under photopic conditions postoperatively, regardless of glare, CS in the overcorrected group was significantly worse than that in the successful correction group, and CS was significantly decreased by addition of glare in both groups. All patients except one(96.4%) in the successful correction group and 8 patients(61.5%) in overcorrection group showed improvement of photophobia postoperatively, which correlated with CS under photopic conditions(P=0.001, 0.03).CONCLUSION: After surgery for IXT, CS under photopic conditions improve at all visual angles except 0.64°, while CS is significantly worse in the overcorrection group postoperatively at 0.64°. Subjective photophobia havesignificant correlation with CS under photopic conditions, and may be used as an objective indicator of photophobia.
文摘I am Dr. Heeyoung Choi, from the Department of Ophthalmology of Pusan National University Hospital,Busan, Korea. I write to present a case report of abnormal medial rectus insertion presenting exotropia.
