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The goal is to achieve orthotropia within 10 PD of esotropia to establish high-grade stereo acuity. The surgical goal for partially accommodative esotropia is not to operate patients out of glasses but to achieve alignment and fusion with full hypermetropic correction. Patients having cycloplegic refraction of +2.5 sphere or more will require their...
Contexts in source publication
Context 1
... are patterns of strabismus in which the horizontal deviation alters on upgaze and downgaze so that the pattern resembles the letter A or V and is considered significant if the horizontal angle varies by more than 10 PD (A pattern) or 15 PD (V pattern) diopters between up-and downgaze. An example of a V pattern esotropia is shown in Figure 10. The underlying cause may be as follows: (1) horizontal muscle dysfunction caused by abnormal insertion or action of the medial/lateral recti (spontaneously or secondary to surgery); (2) vertical rectus dysfunction (tight superior rectus/inferior rectus muscle weakness for A pattern and vice versa for V pattern), or (3) oblique muscles dysfunction (inferior oblique under action/superior oblique overaction for A patterns and vice versa for V patterns). ...
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Purpose
To investigate the binocular summation (BiS) of visual acuity (VA) and contrast sensitivity (CS) in children with intermittent exotropia (IXT) before and after surgery and to probe the relationship between the two BiS phenomena and corresponding influencing factors.
Methods
This prospective study included 21 IXT children (11 males and 10 f...
Introduction:
The purpose of the present study was to determine the factors that affect the outcome of strabismus surgery in terms of improvement in stereopsis and binocularity.
Methods:
Data were collected prospectively from patients with childhood-onset, concomitant, constant strabismus greater than 30 prism diopters (PD) with postoperative al...
Patient: Male, 19-year-old
Final Diagnosis: Canine tooth syndrome • superior oblique palsy
Symptoms: Diplopia
Clinical Procedure: Strabismus surgery
Specialty: Ophthalmology
Objective
Unusual clinical course
Background
Pseudo-Brown syndrome is characterized by dysfunction of the superior oblique tendon-trochlear complex. Canine tooth syndrome, wh...
To determine whether intermittent exotropia (IXT) surgery affects contrast sensitivity (CS), this retrospective study evaluated the changes in monocular and binocular CS and the binocular summation ratio (BSR) quantified as the ratio between the values of the binocular and the better monocular CS score (BSR = binocular CS score/better monocular CS...
The preferred treatment for correcting strabismus in humans involves the surgical manipulation of extraocular muscles (EOM). Although widely practiced, this treatment has varying levels of success and permanence, possibly due to adaptive responses within the brain or at the muscle. We investigated neural plasticity following strabismus surgery by r...
Citations
... Since this theory guides most research on the behavior and physiology of the oculomotor system, classic models of eye movement control are constructed with a single input and a single output. The assumption of symmetric eye movements extends to the clinic in that it guides intervention in constant and intermittent strabismus [10,11,12,13]. ...
Visual perception is largely supported by tiny fixational eye movements (FEMs), the control of which is a mystery. Understanding eye movement control has been impeded by researchers recording one eye, assuming the other behaves symmetrically as if “yoked” (Hering’s Law). However, recent work revealed asynchronous smooth eye movements during vergence, challenged Hering’s Law, suggesting FEMs might also be decoupled. We assessed FEMs of both eyes during binocular and monocular viewing. During binocular viewing, eye movement variability (BCEA) was larger in one eye, implying the eyes were independently controlled. During monocular viewing, covered eyes’ BCEAs were larger than viewing ones. Eyes with larger BCEAs drifted faster, suggesting poorer eye control. In contrast, microsaccades were always binocular, yet larger in viewing eyes with larger BCEAs, indicating independent control improved their drift correction. Our results support independent control of smooth eye movements and elucidate the genesis of ocular misalignment relevant to strabismus intervention.
... The final postoperative alignment of the eyes 3 months postoperatively was compared in both study groups. Successful outocme was defined as alignment within 8 -10 PD for patients with esotropia and within 5 PD for those with exotropia at the last follow-up [27]. A masked observer performed the measurements at the last follow-up. ...
Background:
Adjustable sutures increase the success rate of strabismus surgery. However, the optimal timing of postoperative suture adjustment remains controversial. This trial was aimed at comparing the surgical outcomes and pain scores of early or 2 - 4 h and delayed or 24 h postoperative suture adjustment in adult patients undergoing strabismus surgery.
Methods:
An open-label, prospective, randomized, comparative interventional study was performed in consecutive adult patients scheduled for eye muscle surgery. Patients were randomized into two groups: the early group, with suture adjustment 2 - 4 h postoperatively, and the delayed group, with suture adjustment 24 h postoperatively. Subjective pain scores during the adjustment were also analyzed. The angles of misalignment at 1 and 3 months and the success rate at 3 months postoperatively were compared.
Results:
Forty-five (90%) patients completed the follow-up, including 23 (92%) in the early adjustment group and 22 (88%) in the delayed adjustment group, with a mean (standard deviation) age of 25.6 (9.5) years and a male-to-female ratio of 46.7:53.3. Thirty patients (66.7%) had exotropia, and 15 (33.3%) patients had esotropia. Both groups had comparable baseline characteristics (all P > 0.05). The mean pain scores during adjustment did not differ significantly between groups (P > 0.05). The postoperative angles of alignment were comparable between the groups before suture adjustment and at the 1- and 3-month follow-ups (all P > 0.05). The success rate in the early adjustment group was slightly higher (87.0% versus 63.6%), but the difference was not statistically significant (P > 0.05). The success rate was comparable between the groups in patients with esotropia or exotropia (both P > 0.05).
Conclusions:
Although the early adjustment group had a slightly higher success rate, the difference was not significant. Both groups had comparable subjective pain scores during adjustment, final motor alignment, or success rate. Future clinical trials should be performed different time intervals for postoperative suture adjustment, and subjective and objective outcomes, such as diplopia and stereopsis, should be compared between patients with a first strabismus surgery and those who underwent reoperation. This could better resolve the persistent controversy related to the optimal time for suture adjustment.
... Para as cirurgias de retrocesso, é habitual o uso do gancho sulcado de Wright, (9) que reduz, em parte, a interferência do auxiliar, porém, essa solução é incompleta, pois o cirurgião principal precisa manter uma de suas mãos ocupadas para a estabilização do gancho. Ainda nesse contexto, Moffatt apresentou dois ganchos que consistiam em uma placa retangular horizontal medindo 5mm no instrumento menor e 10mm no instrumento maior, os quais poderiam ser utilizados para estimar o tamanho do segmento do músculo a ser abordado cirurgicamente. ...
RESUMO Objetivo: Avaliar um novo tipo de gancho muscular (gancho milimetrado de Felício) e sua eficácia em cirurgias de estrabismo. Métodos: Buscando uma abordagem independente, com a mínima participação do auxiliar, o novo instrumento foi usado em cirurgias de retrocesso e ressecção, para comparar sua eficácia e segurança com a técnica tradicional. Participaram do estudo 14 pacientes divididos em dois grupos. Resultados: O grupo operado por meio da técnica tradicional teve média de idade foi de 14,7 anos, e o grupo que usou o novo gancho teve média de 17 anos. Ambos os grupos obtiveram redução semelhante do estrabismo inicial, sendo, em média, de 87,84% no grupo tradicional e de 93,04% com o novo gancho, porém sem relevância estatística (p=0,274). Conclusão: O gancho milimetrado de Felício mostrou-se opção útil ao cirurgião na realização da cirurgia de estrabismo com redução da importância do auxiliar, de forma segura e reprodutível.
... However, it has been for various years that in subjects with a high ratio of accommodative convergence to accommodation (AC/A) and when the near deviation is higher than 10 prism diopters (PD) to the distance deviation, in such cases, surgery, when performed using misalignment of 6 meters, often result in surgical under corrections in high numbers, which are unacceptable. 1 In subjects with a high AC/A ratio, Parks recommended the addition of 1mm to each medial rectus recession assessed. While Parks recommendations were being applied surgically of adding 1mm, surgical under corrections were very high in subjects, with the majority of subjects needing wearing bifocal continuously as to control their near deviation following the surgical procedure. ...
Background: Treating subjects with a high AC/A ratio and with esotropia is a challenging and complex procedure, often associated with increased near deviation which may lead to various outcomes following the surgery. Aims: The present study was conducted to assess outcomes following surgery in children with esotropia who were surgically treated with primary bilateral medial rectus (BMR) recessions. The study also compared preoperative and postoperative measurements in subjects with a high AC/A ratio to a normal AC/A ratio to assess surgical outcomes. Materials and Methods: 122 subjects were divided into 2 groups based on AC/A ratio into high AC/A ratio and normal AC/A ratio The subjects with high AC/A were treated with bifocal management if they had near persistent ET of ≥10Δ in full cycloplegic correction and not if they had far ET of ≥10Δ. Target angle at the time of the surgery was assessed with stereopsis presence via positive butterfly/fly, and near and distance deviations ≤10Δ within orthophoria. These success outcomes were compared in subjects with normal AC/A ratio and AC/A ratio groups. The collected data were subjected to statistical evaluation.
... In the group of patients with exotropia and convergence insufficiency, the small number of patients does not allow statistical analysis. In Table 2 (18). ...
... Инфантилната есотропия настъпва през първите 6 месеца от живота. Тази група включва няколко вида, като най-често това сa: неонатална есотропия с малък ъгъл, акомодативна инфантилна есотропия, синдром на Ciancia и конгенитална есотропия (18). Други видове есотропия се наблюдаваха при общо 17 пациенти (27% от всички оперирани деца) на средна възраст 5 г. ...
BACKGROUND
The surgical management of large-angle concomitant esotropia is challenging with high reoperation rates. This study aims to assess the effectiveness and safety of intraoperative botulinum toxin A (BTA) augmentation compared to surgery alone in large angle concomitant esotropia.
MATERIALS AND METHODS
This is a prospective randomized interventional study. Patients with large angle concomitant esotropia (≥55 prism diopter [PD]) were randomly allocated to either surgery only (Group I) or BTA augmented surgery (Group II). The surgical effect in PD/mm was calculated and compared between the study groups at all follow up intervals. Treatment was considered successful if the patients had orthotropia ± 10 PD at their final examinations.
RESULTS
A total of 23 patients were included in the study, 11 in Group I and 12 in group II. The surgical effect was significantly greater in Group II compared to Group I at all follow up durations. The 1-year surgical effect was 32.5% greater in Group II compared to Group I (5.99 ± 0.69 vs. 4.52 ± 0.91 PD/mm, respectively, P = 0.001). The success rate was greater for Group II compared to Group I (75% vs. 63.64%, respectively), but this difference was not statistically significant ( P = 0.901).
CONCLUSION
Botulinum toxin augmented surgery is a good alternative to surgery alone in the treatment of large angle concomitant esotropia. BTA injection exerts a significant augmentation effect on medial rectus muscle recessions.
Purpose: To investigate the surgical outcome of esotropia, and the possible factors leading to poor outcome regarding alignment. Patients and methods: This study included 81 patients who were enrolled in a retrospective cross-sectional manner, at Ibsar center in Al-Najaf city, from January 2012 to June 2019. The data were collected from medical records of patients who underwent surgical correction for esotropia, and included: patients' age, patients' gender , type of operation, presence of amblyopia, dissociated vertical deviation (DVD), degree of preoperative esotropia , type of esotropia, and the main surgical outcome regarding alignment in the last postoperative follow up. Results: The median age of participants was 5 years, and ranged from 1-37 years, with 43 (53.09%) males and 38 (46.91%) females. The main outcome was 63 (77.78%) patients with orthotropia, and 15 (18.52%) had undercorrection, while only 3 (3.7%) had overcorrection. Conclusions: The outcome regarding ocular alignment in the current study were satisfying and comparable to other studies in the world. Age, gender, degree of esodeviation preoperatively, type of surgery, type of squint, amblyopia or DVD were not associated with surgical outcome regarding alignment.
