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Intermittent exotropia: Surgical treatment strategies

July 2015
Indian Journal of Ophthalmology 63(7):566

July 2015
63(7):566

DOI:10.4103/0301-4738.167109

License
CC BY-NC-SA 3.0

Authors:

Jai Kelkar

national insititute of ophthalmology

Santhan Gopal

kamalanethralaya Hoppital, india Bengaluru

Aditya S Kelkar

Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.

Available via license: CC BY-NC-SA 3.0

Content may be subject to copyright.

Intermient exotropia: Surgical treatment strategies

JaiAdityaKelkar,SanthanGopal1,RachanaBShah,AdityaSKelkar

           

             

  





Key words: 

  





    



      













 

     



          

        

  

     

        

       



      









Clinical Presentation

      

    







 

      













       







      









    

          

         

     











Etiological Factors

     

         

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Cite this article as: Kelkar JA, Gopal S, Shah RB, Kelkar AS. Intermittent

exotropia: Surgical treatment strategies. Indian J Ophthalmol 2015;63:566-9.

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  

Kelkar, et al.: Surgical treatment strategies for intermient exotropia

   



  





   





       





Indications for Surgery



 

     



  

  



    



         

       







       

         

       









Time of Intervention and Goals of Surgery









    

     





  

         





    

  

     

   









      

     



       



  

      

    











Classication and Choice of Procedure

  

     

       



  

    

  



         

     

















       

   

      





     





 Burian

    







     

        

    

         









  

         





  







[Downloaded free from http://www.ijo.in on Wednesday, December 13, 2017, IP: 5.200.91.111]

  

          

       

      





 



  





      











    

 







Surgical Outcome





   



         

 











 









        





      

      















Conclusion







     

 





       





  



       













        

       









 







Acknowledgment



Financial support and sponsorship



Conicts of interest



References

 





       

  



       



 





   



     



   



 





      

    



       

   



[Downloaded free from http://www.ijo.in on Wednesday, December 13, 2017, IP: 5.200.91.111]

  

Kelkar, et al.: Surgical treatment strategies for intermient exotropia

 



 



   

     



     



    

et al.



          





 

     



 



 



 





     



 et al.

   



    



    

 





 





 





 





         

     



 

 



    

  





 



       



  





 

     



 



 



 



 



 



 



 





   





    



 





 



 





 





 



 



 



      





         



  

 



 

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Assessment of binocular functions in intermittent exotropia before and after surgical correction

Article

Jan 2024

Advances in artificial intelligence models and algorithms in the field of optometry

Article

Full-text available

Apr 2023

The rapid development of computer science over the past few decades has led to unprecedented progress in the field of artificial intelligence (AI). Its wide application in ophthalmology, especially image processing and data analysis, is particularly extensive and its performance excellent. In recent years, AI has been increasingly applied in optometry with remarkable results. This review is a summary of the application progress of different AI models and algorithms used in optometry (for problems such as myopia, strabismus, amblyopia, keratoconus, and intraocular lens) and includes a discussion of the limitations and challenges associated with its application in this field.

Efficacy of using laser assisted adjustable suture in the management of residual angle exotropia

Article

Full-text available

Mar 2022

To assess the efficacy of using argon laser suture lysis of adjustable sutures used in strabismus surgery in the management of residual exotropia following surgery for intermittent exotropia. A prospective interventional study was conducted on 30 patients with basic type of intermittent exotropia. Sixty eyes were included from November 2018 to December 2019. All patients were operated on with Ripcord adjustable sutures under general anesthesia. On the first day postoperatively, if alignment was satisfactory (within 10 DP), the ripcord suture was kept in place. If there was residual exotropia more than 10 DP, suture can be cut in less than five applications by argon laser lysis and the muscle retracts posteriorly, producing additional recession of the muscle. Thirty patients were enrolled with ages ranging from 15 to 47 years and an average of 25.93±10.5 years. The mean preoperative angle was 44.3±8.8 DP, ranging from 25 to 60 DP. There was no postoperative significant residual angle in 12 patients (40%) immediately after the operation and throughout the follow-up period of 3 months but there were 18 patients (60%) with postoperative significant residual angle and argon laser suture lysis was done for them, then they were followed-up for 3 months.

Value of Atrial Fibrillation Prophylaxis after Coronary Artery Bypass Graft Surgery

Article

Oct 2021

An Overview for Concomitant Exotropia Management: Review Article

Article

Oct 2021

Background: A common type of strabismus known as concomitant exotropia (XT) occurs when mismatched eyes deviate outward and the angle of deviation is the same regardless of which eye is fixed. Among ophthalmologists, there is no agreement on non-surgical treatment options for XT. For those who suffer from strabismus, surgery is an option for correcting their visual axis and restoring their ability to see in both eyes simultaneously. Instead, then severing the muscle, muscle plication involves folding the muscle around itself and stitching it in place, essentially shortening and tightening the muscle. Muscle plication has been found to reduce the risk of anterior segment ischemia by protecting the anterior ciliary arteries. Objective: To hallmark the new guidelines options of concomitant exotropia management. Conclusion: Muscle-tightening techniques such as excision, plication, advancement, and transposition have been documented in the literature. Technical simplicity, the ability to reverse it, shorter operating times, reduced surgical trauma, and the preservation of anterior ciliary arteries are only a few of the many advantages of plication. © 2021, Ain Shams University Faculty of Medicine. All rights reserved.

Reply to Letter to Editor: Overminus Lens Therapy in the Management of Children with Intermittent Exotropia

Article

Full-text available

Oct 2021

Extraocular muscle resection, recession length and surgery outcome modelling in strabismus treatment: a pilot study

Article

Full-text available

Nov 2021

Background Many surgical formulas have been developed and proposed based on the experience of surgeons to improve the predictability of strabismus surgery. However, the consent among strabismus surgeons regarding the dose effect of the extraocular muscle (EOM) recession or resection was not achieved yet and the disagreement about the appropriate amount of strabismus surgery still exists. Objective Our study aimed to propose an instrument for EOM resection (RsL) and recession length (RcL) estimation before the surgery and second to elaborate an postoperative angle of deviation (PAD) predictive model using simple potential predictors. Methods and Analysis The analytical prospective clinical study was conducted from April 2016 to July 2019, on a sample of 216 patients (aged between 2–58) with concomitant strabismus who underwent strabismus surgery in Clinical Republican Hospital ‘Timofei Mosneaga’and Children Hospital ‘Em Cotaga’ from Republic of Moldova. The correlations of patients’ age, strabismus type, amblyopia degree, RsL, RcL, preoperative angle of deviation (PreAD) with PAD were estimated using Pearson’s correlation analysis. Multiple linear regression analysis, multicollinearity analysis and residual analysis were performed. Results The EOM RsL was predicted using strabismus type, patient’s age, PreAD and EOM RcL. EOM RcL, in turn, was estimated by the similar covariates set, instead of RcL being RsL. PAD modelling showed the PreAD, EOM RsL and EOM RcL predictive ability for strabismus surgery outcome prediction. Conclusion In our study, we propose four mathematical models as potential instruments for EOM RsL, EOM RcL and PAD modelling in esotropia and exotropia surgery.

Outcomes of intermittent exotropia surgery

Article

Jun 2021
J FR OPHTALMOL

Purpose To study the epidemiological and clinical characteristics of intermittent exotropia and to describe our therapeutic choices as well as their results and prognostic factors. Materials and methods This was a retrospective study including 57 cases of intermittent exotropia. All patients underwent a complete ophthalmological examination with a sensory-motor assessment. Surgery was performed by the same surgeon, and the vertical component was addressed surgically at the same time as the exotropia. Statistical analysis was performed using SPSS software version 21.0. Results Our patients were classified as basic exotropia in 46 cases (80.7%), divergence excess in eight cases (14.1%), and convergence insufficiency in three cases (5.2%). Amblyopia was found in 26% of cases. The preoperative maximum angle of deviation was 36.5 DP ± 9.1 DS and a vertical component was found in 16 patients (28%). The most common was V pattern (8 patients). The mean age at the time of surgery was 14.8 years old. After a single surgery, we obtained motor success in 78.9% of the patients. Three patients were re-operated, with an overall motor success of 84.2%. Conclusions Motor and sensory success may be achieved in intermittent exotropia. Rigorous, early management is necessary, even if tropic episodes are still rare. The rate of early consultation among children is still low in our country; thus, a national strabismus screening program must be established to obtain the best results.

Clinical Usefulness of a Computerized Vision Chart for Distance Stereoacuity Assessment in Children with Intermittent Exotropia

Article

Feb 2021

Introduction The aim of this study is to evaluate distance stereoacuity in children with intermittent exotropia (IXT) using a computerized vision chart (CVC), to compare the results to the normal subjects, and to determine if any correlation between stereoacuity and IXT severity exits. Methods A prospective case–control study was conducted including 24 children with IXT and 25 age-matched normal subjects. The mean age was 8.9 ± 4.5 in IXT group and 9.4 ± 4.2 in control group. The majority of patients (n = 17) had basic type IXT. Full ophthalmic examinations, deviations and stereoacuity tests were evaluated. Stereoacuity was measured with the CVC for distance stereoacuity and Randot stereotest book for near stereoacuity. Level of fusional control in patients with IXT was assessed using Newcastle Control Score (NCS). Seven of the patients with IXT were also reevaluated postoperatively. Results Near stereoacuity was good in both IXT and control groups, and there was no significant difference between groups. There was a poor correlation between near stereoacuity and NCS (rs = 0.15, p = .48). Distance stereoacuity in the IXT group was significantly reduced compared to controls (p = .004). There was a positive correlation between distance stereoacuity values and NCS in patients with IXT (rs = 0.73, p < .001). Conclusion Diminished distance stereoacuity in children with IXT can be detected with the CVC and this test may be useful for deciding the timing of surgical intervention and postoperative evaluation.

Model of a Support Vector Machine to Assess the Functional Cure for Surgery of Intermittent Exotropia

Article

Full-text available

Jun 2019

In this paper the optimum timing for the postoperative functional cure of basic intermittent exotropia is explored based on support vector machine (SVM). One hundred and thirty-two patients were recruited in this prospective cross-sectional study with 6 months of follow-up. Examinations included angle of deviation, central and peripheral fusion, controllability, and near and distance stereopsis. Influencing factors of postoperative alignment and stereopsis were analyzed with a chi-squared test and univariate and multivariate logistic regression analyses. At 6 months post-operation, there were 84 successful procedures for the angle of deviation, with 4 overcorrections and 44 undercorrections. The success rate was 63.6%. The angle of deviation on postoperative day 1 was the only significant associated factor. One hundred and thirty patients had normal near stereoacuity, 60 had normal distance stereoacuity according to a Functional Visual Analyzer assessment, and 108 had normal stereoacuity as assessed by the Frisby Davis Distance (FD2) stereotest. The age of onset and preoperative distance stereoacuity with FD2 were the influencing factors of postoperative distance stereopsis restoration. The accuracy of this method of SVM was 82.1%. The angle of deviation for distance on postoperative day 1 was the only significant factor that correlated with alignment at 6 months post-operation, and the model of SVM was useful to determine the optimal time of the postoperative functional cure.

Outcome Study of Bilateral Lateral Rectus Recession for Intermittent Exotropia in Children

Article

Feb 1999

* BACKGROUND AND OBJECTIVE: The purpose of this paper is to report a statistical analysis of the surgical results in a consecutive series of 52 children treated by bilateral lateral rectus recession for intermittent exotropia when the operating surgeon was confronted by an increase in manifestation of the strabismus. * PATIENTS AND METHODS: The charts were abstracted for age at initial surgery, quantity of initial deviation, initial refraction, motor alignment at one week, six months, and at the end of the study. The incidence and result of secondary surgery and the incidence of the monofixation syndrome result was also determined. * RESULTS: Thirty-two (62%) of the patients were successfully aligned at six months by the initial surgery performed for a mean of 25 prism diopters (PD) of preoperative deviation at a mean age of 4 years 8 months. Eleven patients (21%) were undercorrected and 9 patients (17%) were overcorrected at the six month exam. The patients were followed for a mean of 4 years, 4 months. Alignment at 6 months postoperatively was predictive of success by the end of the study, but the age at initial surgery, the size of the deviation, esotropia at 1 week, and initial refraction were not predictive of success. Secondary surgery was performed in 11 patients and the monofìxation syndrome result was found in 5 patients. * CONCLUSION: Successful alignment was achieved in the majority of children treated by an initial bilateral lateral rectus recession utilizing a currently popular surgical dosage table.10 Long term alignment success was not predicted by esotropia during the first postoperative week or the age at initial surgery but was correlated with the 6-month data. Secondary surgery was performed in 20% and the incidence of the monofixation syndrome was approximately 10% at the end of the study. [Ophthalmic Surg and Lasers 1999;30:110-117.]

Development of Monofixation Syndrome in Congenital Esotropia

Article

Jan 1981

Fifty patients with 8 prism diopters or less of esotropia after the last surgery were studied. Forty-nine percent of those straightened before 12 months of age and 41% of those straightened between 13-24 months developed the M.S. Only one of 22 patients straightened after the age of two developed the M.S. Although D.V.D and overaction of the inferior oblique muscles were associated findings, neither precluded the development of the M.S. Those patients without M.S. had a higher incidence of subsequent exotropia and manifest D.V.D.

Handbook of Pediatric Strabismus and Amblyopia

Book

Jan 2006

Based on Dr. Wright’s classic major reference, Handbook of Pediatric Strabismus and Amblyopia outlines the latest findings in diagnosing the most commonly presenting problems in pediatic cases, offering the most complete assessment tools for accurate diagnosis and then best treatment options. Distilling the essentials of these prevelant and sometimes complicated cases into a portable, complete and authorative pocket reference, this handbook offers a complete picture of how to best treat pediatric patients. Specifically, the introductory chapters on the specifics of pediatric ophthalmology (embryology, post-natal development and the pediatric exam) will help newcomers to pediatric practice fully grasp the subtle differences in pediatric care. The chapters are written by leading experts in the field and are presented in a user-friendly format, relying on heavily illustrated in color plates, clincally helpful tables, charts, and decision-making guidelines. This approach will enable the practitioner (whether specialist or generalist) to make the most accurate diagnosis and choose the most effective treatment option.

Association for Research in Vision and Ophthalmology Annual Meeting, Fort Lauderdale, Fla, April 21-26, 1996

Article