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Liu P, Fu J, Zhang R, Chu H. Initial postoperative plasticity as a predictor of mid-term stereoacuity outcome after surgery for intermittent exotropia. BMC Ophthalmol 2023; 23:213. [PMID: 37189107 DOI: 10.1186/s12886-023-02958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Intermittent exotropia (IXT) would cause different degrees of damage to stereopsis. We aimed to introduce a visual perception plasticity score (VPPS) that reflects initial postoperative plasticity and evaluate its effectiveness in predicting the mid-term surgical outcome in IXT patients. METHODS A total of 149 patients with intermittent exotropia who underwent surgery in November 2018 and October 2019 were recruited. All subjects underwent detailed ocular examinations before and after surgery. VPPS were calculated based on visual perception examination system at one week postoperatively. Demographic, angle of deviation and stereopsis were collected and analyzed with regard to the VPPSs preoperatively and at one week, one month, three months, six months postoperatively. Predictive performances of VPPS were assessed using receiver operating characteristic (ROC) curves, the area under the curve (AUC) and cut-offs were obtained. RESULTS Of the 149 patients, the average deviation was 43Δ at distance and 46Δ at near. The average rate of normal stereopsis before surgery was 22.81% at distance and 29.53% at near. Higher VPPS was associated with preoperative better near stereoacuity (r = 0.362, p = 0.000), less angle of deviation at distance (r=-0.164, p = 0.046), and better near (r = 0.400, p = 0.000) and distant stereoacuity (r = 0.321, p = 0.000) during the early postoperative period (1 week). The areas under the curves suggested that VPPS could be an effective predictor of sensory outcome(AUC>0.6). Cut-off values of 50 and 80 were calculated for VPPS using ROC curve analysis. CONCLUSION Higher VPPSs were associated with a greater possibility of stereopsis improvement in patients with IXT. VPPS is a potentially promising indicator to predict the mid-term surgical outcome of intermittent exotropia.
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Affiliation(s)
- Peipei Liu
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China
| | - Jing Fu
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China.
| | - Ronghan Zhang
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China
| | - Hang Chu
- Office of Academic Research, National Engineering Research Center for Healthcare Devices, Guangzhou, China
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Eshaghi M, Arabi A, Banaie S, Shahraki T, Eshaghi S, Esfandiari H. Predictive factors of stereopsis outcomes following strabismus surgery. Ther Adv Ophthalmol 2021; 13:25158414211003001. [PMID: 33855272 PMCID: PMC8010845 DOI: 10.1177/25158414211003001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: To determine the predictive factors of post-operative stereopsis in patients with strabismus. Method: In this retrospective study, records of patients who received surgical treatment for strabismus were reviewed. All types of strabismus were included. Pre- and post-treatment stereoacuity were measured using the Titmus Stereo Fly test, and predictive factors of stereopsis were evaluated. Results: A total of 194 patients (132 females and 62 males) with a mean age of 14.8 ± 8.4 years were included. There was a statistically significant improvement in stereopsis following surgery (p value < 0.001). Patients with a higher amount of deviation at baseline had poorer stereopsis on the final examination (p value < 0.001). Stereopsis improvement was more prominent in the pure horizontal strabismus group, compared to combined horizontal and vertical deviations. Baseline and the final stereopsis were higher in the “exotropia” group as compared to the “esotropia” group (p value = 0.003 and 0.0155, respectively); however, the within group change of stereopsis was not significantly different between these two groups (p value = 0.144). Post surgical residual deviation was associated with a poorer stereopsis (p value = 0.002, r = 0.251). A longer duration of strabismus before surgery was associated with poorer final stereopsis levels (p value = 0.026). The presence of amblyopia before surgery was associated with poorer stereopsis on last examination (p value < 0.001 for both correlations). Conclusion: Based on the result of this study, final stereopsis after strabismus surgery could be affected by the type, duration, and the amount of deviation before surgery, amblyopia, and post operative ocular deviation.
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Affiliation(s)
- Mohammad Eshaghi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfdard St., Boostan 9 St., Pasadaran Ave., Tehran 16666, Iran
| | - Shahram Banaie
- Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sarvin Eshaghi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Olmsted Medical Center, Rochester, MN, USA
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Quantitative measurement of passive duction force tension in intermittent exotropia and its clinical implications. Graefes Arch Clin Exp Ophthalmol 2021; 259:1617-1623. [PMID: 33415355 DOI: 10.1007/s00417-020-05030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the passive duction force (PDF) in extraocular muscles (EOMs) in patients with intermittent exotropia (IXT) using a quantitative tension-measuring device. METHODS This prospective, case-control study enrolled 25 patients with IXT and 26 age- and sex-matched controls. PDF was measured under general anesthesia as the eyeball was rotated medially or laterally away from the direction of the force being tested. The preferred eye for fixation was determined using a cover-uncover test. RESULTS The PDF in the IXT and control groups were 60.9 g and 52.1 g, respectively, for the lateral rectus (LR) (p = 0.046) and 53.0 g and 48.8 g for the medial rectus (MR) (p = 0.293). When the eyes were examined separately in the IXT group, the PDF of LR was larger in the nonpreferred eye for fixation than in the control group (p = 0.039), whereas there was no difference in the preferred eye for fixation (p = 0.216). Additionally, the relative PDF of LR in the nonpreferred eye compared to the ipsilateral PDF of MR was positively associated with the duration of manifest deviation (p = 0.042) and the average angle of the near and far deviations (p = 0.023). CONCLUSIONS The PDF in the LR in patients with IXT in the nonpreferred eye for fixation was larger than normal and could increase with the duration of manifest deviation and the angle of deviation. Evaluating the PDF in EOMs could provide information that is useful for managing strabismus and understanding its pathophysiology.
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Morikawa S, Okamoto F, Sugiura Y, Murakami T, Hiraoka T, Oshika T. Stereopsis after Intravitreal Ranibizumab Injections for Branch Retinal Vein Occlusion. ACTA ACUST UNITED AC 2019; 3:777-783. [DOI: 10.1016/j.oret.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/24/2022]
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Zhong J, Deng DM, Chen ZD, Li JR, Yuan JP, Feng L, Wang AH, Yu MB. Evaluation of dynamic stereopsis in intermittent exotropia patients. Int J Ophthalmol 2019; 12:83-88. [PMID: 30662845 DOI: 10.18240/ijo.2019.01.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/29/2018] [Indexed: 11/23/2022] Open
Abstract
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 disparity-only components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests, respectively. Patients with a long disease course (>1y) had worse dynamic stereopsis than those with a short disease course (<1y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparity-only, or the motion-only test components (all P>0.05, Chi-square 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.
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Affiliation(s)
- Jing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Da-Ming Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Zi-Dong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Jin-Rong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Jun-Peng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ai-Hou Wang
- Department of Ophthalmology, Cathay General Hospital, Taipei 10001, Taiwan, China.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10001, Taiwan, China
| | - Min-Bin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Yan X, Lin X. Postoperative Stereopsis in Adult Patients With Horizontal Comitant Strabismus With Normal Vision Who Are Stereoblind. J Pediatr Ophthalmol Strabismus 2018; 55:407-411. [PMID: 30452768 DOI: 10.3928/01913913-20180822-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine stereopsis in patients with comitant horizontal strabismus who had normal vision and were stereoblind following the strabismus surgery. METHODS Twenty patients with primary comitant horizontal strabismus and normal corrected visual acuity were included in this study. The stereoacuity was quantitatively measured by the random dot butterfly stereotest, the Randot Preschool Stereoacuity Test (Stereo Optical, Inc., Chicago, IL), and synoptophore. RESULTS Twenty patients with comitant strabismus (14 exotropia and 6 esotropia) with normal corrected visual acuity but without stereopsis were included. The average prism deviation was 63.55 ± 18.52 prism diopters (PD) (range: 30 to 90 PD). The mean duration of strabismus was 17.93 ± 7.0 years (range: 5 to 30 years). At 3 days postoperatively, 22.2% (4 of 18) of the patients had improved stereopsis and the mean stereoacuity was 60 ± 28.28 seconds of arc by random dot butterfly stereotest and 150 ± 57.74 seconds of arc by Randot Preschool Stereoacuity Test (P < .05). For the fusion and stereopsis at far measured by the synoptophore, 11.1% (2 of 18) of the patients demonstrated recovery of fusion and substantial recovery of stereopsis. The mean stereoacuity (at far) was 200 seconds of arc. At the last follow-up visit (3 to 12 months, average 6.55 ± 3.46 months), 45% (9 of 20) of the patients demonstrated substantial near stereopsis recovery and the median stereoacuity was 53.33 ± 33.17 seconds of arc by random dot butterfly stereotest and 95.56 ± 63.07 seconds of arc by the Randot Preschool Stereoacuity Test (P < .01). A total of 25% (5 of 20) of the patients demonstrated recovery of fusion and 15% (3 of 20) of the patients showed substantial recovery of stereopsis at far. The median stereoacuity (at far) was 193.33 ± 179.26 seconds of arc. CONCLUSIONS The results demonstrated that adult patients with comitant strabismus who had good vision and were stereoblind benefited from strabismus surgery and the stereopsis improved. Near stereopsis was easier to regain than far stereopsis. [J Pediatr Ophthalmol Strabismus. 2018;55(6):407-411.].
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Chen YW, Lin SA, Lin PW, Huang HM. The difference of surgical outcomes between manifest exotropia and esotropia. Int Ophthalmol 2018; 39:1427-1436. [PMID: 29922977 DOI: 10.1007/s10792-018-0956-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 06/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the factors that affect ocular alignment and binocular sensory functions after strabismus surgery and compare surgical outcomes between manifest exotropia (XT) and esotropia (ET). METHODS In a retrospective study, 41 XT and 17 ET patients who had undergone strabismus surgery were recruited. Information on type and duration of strabismus, age at onset of deviation and surgery, pre- and postoperative strabismus deviation angles, and binocular sensory functions including stereoacuity and macular fusion capacity was recorded. RESULTS In all patients, the ocular alignment and binocular sensory functions improved with time following surgery. Residue strabismus deviation angles (≦ 10 prism diopters) at postoperative 1 month determined the final successful ocular alignment. In patients with final excellent binocular sensory functions, XT group restored macular fusion capacity and stereoacuity at postoperative 1 month, but ET group regained macular fusion capacity at postoperative 1 month and then restored stereoacuity at postoperative 3 months. Though XT patients showed better pre- and postoperative stereoacuity than ET patients, patients with successful ocular alignment had an odd of 4.5 in XT group and 22.5 in ET group to achieve excellent and fair binocular sensory functions. CONCLUSION Surgical correction of strabismus could improve ocular alignment and binocular sensory functions in patients with manifest strabismus, regardless of onset age, strabismus duration, or type. Postoperative 1-month status may help to predict the final motor and sensory outcomes. ET patients would benefit more final successful ocular alignment and excellent binocular sensory functions from early surgery and maintaining postoperative small deviation angle than XT patients.
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Affiliation(s)
- Yun-Wen Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd, Niaosong Dist, Kaohsiung, 833, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sue-Ann Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd, Niaosong Dist, Kaohsiung, 833, Taiwan
| | - Pei-Wen Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd, Niaosong Dist, Kaohsiung, 833, Taiwan
| | - Hsiu-Mei Huang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd, Niaosong Dist, Kaohsiung, 833, Taiwan.
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Seol BR, Choung HK, Kim SJ. Stereopsis before and after Inferior Oblique Weakening Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:134-139. [PMID: 29560617 PMCID: PMC5906398 DOI: 10.3341/kjo.2016.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/10/2017] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze stereopsis change before and after inferior oblique weakening surgery. Methods We retrospectively reviewed the medical records of 31 patients who had undergone inferior oblique weakening surgery. The factors analyzed included sex, age at surgery, preoperative and postoperative visual acuity (VA), time from first detection to surgery, degree of inferior oblique overaction (IOOA), primary/secondary IOOA, exotropia/hypertropia, bilaterality, and type of surgery. Results Eighteen patients with a mean age 7.3 ± 3.1 years exhibited stereopsis of 60 arc seconds or better before surgery and 17 had stereopsis better than 60 arc seconds after surgery. Postoperatively, stereopsis improved in 13 patients and deteriorated in 9. Better preoperative VA and the absence of superior oblique underaction were associated with better preoperative stereopsis. Better preoperative VA, postoperative VA, and the presence of head tilt were associated with better postoperative stereopsis. Unilateral inferior oblique weakening surgery and accompanying hypertropia were associated with improved stereopsis, while the absence of hypertropia was associated with deteriorated stereopsis. Conclusions In this retrospective study, 58.1% of patients tended to have bifoveal fixation. When a vertical deviation is present in the primary position due to unilateral IOOA, IO weakening surgery can be expected to improve binocular function.
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Affiliation(s)
- Bo Ram Seol
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, VHS Medical Center, Seoul, Korea
| | - Ho Kyung Choung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Seong Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.
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Eustis HS, Janot A, Jhaveri C. Development of Monofixation Syndrome After Extraction of Dense Cataracts. J Pediatr Ophthalmol Strabismus 2017; 54:39-42. [PMID: 27783092 DOI: 10.3928/01913913-20160831-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/20/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE If the interruption of macular fusion for an extended period of time is the key event that results in the development of monofixation syndrome, then the decreased macular input caused by dense cataracts may cause monofixation syndrome in adults. This study was designed to test this hypothesis. METHODS The study design was a retrospective chart review that identified patients with unilateral cataracts at two southern Louisiana medical centers. Patients were assigned to the dense cataract group if a unilateral cataract had been present for at least 3 months and led to a visual acuity of worse than 20/200. Patients in the control group had a unilateral cataract for more than 3 months and visual acuity better than 20/200 in the affected eye. Stereoacuity was assessed using the Titmus or Randot stereo test. A Worth 4-dot test viewed at a distance of 20 feet was used to assess the presence of a macular scotoma. The criteria for monofixation syndrome were met if stereoacuity was less than 60 seconds and the Worth 4-dot test demonstrated central macular scotoma at 20 feet. RESULTS The dense cataract group's association with monofixation syndrome was statistically significant when compared to the control group (P < .0001). CONCLUSIONS This study adds dense adult-onset cataracts to the list of causes of monofixation syndrome and reduced stereoacuity. A delay in treating dense lens opacities can result in good visual outcome but an inferior binocular visual outcome (poor stereoacuity). [J Pediatr Ophthalmol Strabismus. 2017;54(1):39-42.].
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Abstract
PURPOSE To quantify stereopsis at distance resulting from binocular fusion in patients with impaired binocular vision using a three-dimensional (3-D) display stereotest. METHODS A total of 68 patients (age range, 6 to 85 years) with strabismus (40 esotropes and 28 exotropes) whose stereoacuity could not be measured with the near and distance Randot stereotests were included. Contour-based circles with a wide range of crossed horizontal disparities (2500 to 20 arcsec) displayed on a 3-D monitor were presented to subjects at 3 m. Between the patients who had stereoacuity of at least 2500 arcsec and those with no measurable stereoacuity, parameters including age, sex, best-corrected visual acuity, spherical equivalent refractive error, Worth 4 dot test results, and type and angle of deviation were compared. RESULTS Stereoacuity at distance of 2500 arcsec or better was detected in 25 (63%) of 40 esotropes, and 16 (57%) of 28 exotropes, although stereoacuity of 800 arcsec or better was found only in two (5%) esotropes and one (4%) exotrope. Patients with stereopsis were significantly younger (19.3 ± 16.9 years) than those with no measurable stereopsis (31.5 ± 26.4 years) (p = 0.040). There were no significant differences in best-corrected visual acuity, presence of amblyopia >20/100, spherical equivalent refractive error, type of deviation, deviation angle, sex, and Worth 4 dot test results between these groups. CONCLUSIONS Stereopsis at distance resulting from binocular fusion that cannot be measured with conventional stereoacuity tests may be preserved in patients with impaired binocular vision. The 3-D display stereotest can be useful for quantifying stereopsis at distance resulting from binocular fusion.
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Aroichane M. Planning Strabismus Surgery: How to Avoid Pitfalls and Complications. THE AMERICAN ORTHOPTIC JOURNAL 2016; 66:63-78. [PMID: 27799579 DOI: 10.3368/aoj.66.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND PURPOSE Good surgical results following strabismus surgery depend on several factors. In this article, detailed steps for planning strabismus surgery will be reviewed for basic horizontal strabismus surgery, vertical, and oblique muscle surgeries. The thought process behind each case will be presented to help in selecting the best surgical approach to optimize postoperative results. PATIENTS AND METHOD The surgical planning for strabismus will be developed with clinical examples from easy cases to more complex ones. Preoperative pictures of the ocular alignment are an integral part of planning surgery and help in documenting the strabismus before and after surgery. RESULTS Three cases of strabismus cases will be reviewed with several key factors for planning surgery, including visual acuity, refractive error, potential for stereovision, and risk of postoperative diplopia. The most important factor is accurate orthoptic measurements. The surgical planning for each patient is detailed along with preoperative pictures. CONCLUSION Strabismus surgery results can be improved by careful preoperative planning. The surgeon has the ability to discern potential pitfalls that can alter the surgical outcome. Surgical planning allows a dedicated time of reflection before surgery, foreseeing potential problems, and avoiding them during the surgery.
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Affiliation(s)
- Maryam Aroichane
- From the British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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Predictors of stereoacuity outcome in visually mature subjects with exotropia. Eye (Lond) 2015; 30:264-9. [PMID: 26584792 DOI: 10.1038/eye.2015.241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/19/2015] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to determine the predictors of stereoacuity outcome in visually mature subjects with exotropia following surgical correction. Visually mature subjects who were surgically aligned and had been tested for stereoacuity in the postoperative period were studied retrospectively. Subjects were grouped with respect to their responses to Titmus or TNO stereotests. Characteristics such as amblyopia, anisometropia, and characteristics of the exodeviation such as time of onset, duration, intermittency, presence of an A or V pattern, distance-near disparity, coexisting vertical deviation, and inferior oblique overaction, were compared between the groups. One hundred and four visually mature subjects with exotropia met the inclusion criteria. Stereoacuity was achieved in 77% of the study group and only 9% of these could achieve fine stereoacuity. Negative stereoacuity was more frequently associated with larger deviation angles, higher anisometropia, inferior oblique overaction, pattern strabismus, coexisting vertical strabismus, and distance-near disparity, but not at a statistically significant level. The optimal cutoff for strabismus duration was 20 years for a positive stereoacuity outcome. Any-level visual acuity difference was found to decrease the chance for positive stereoacuity significantly. The odds ratios for the stereoacuity positivity were 4.05 for strabismus duration <20 years, 7.9 for strabismus onset >1 year of age, 3.79 for weaker eye visual acuity >20/25 and 9.85 for intermittency of strabismus. Intermittence of exotropia was the strongest predictor for positive stereoacuity. Exotropia onset after 1 year of age, absence of any-level visual acuity difference, and strabismus duration <20 years were the other predictors with decreasing power.
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Horng CT, Hsieh YS, Tsai ML, Chang WK, Yang TH, Yauan CH, Wang CH, Kuo WH, Wu YC. Effects of horizontal acceleration on human visual acuity and stereopsis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:910-26. [PMID: 25607601 PMCID: PMC4306901 DOI: 10.3390/ijerph120100910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Abstract
The effect of horizontal acceleration on human visual acuity and stereopsis is demonstrated in this study. Twenty participants (mean age 22.6 years) were enrolled in the experiment. Acceleration from two different directions was performed at the Taiwan High-Speed Rail Laboratory. Gx and Gy (< and >0.1 g) were produced on an accelerating platform where the subjects stood. The visual acuity and stereopsis of the right eye were measured before and during the acceleration. Acceleration <0.1 g in the X- or Y-axis did not affect dynamic vision and stereopsis. Vision decreased (mean from 0.02 logMAR to 0.25 logMAR) and stereopsis declined significantly (mean from 40 s to 60.2 s of arc) when Gx > 0.1 g. Visual acuity worsened (mean from 0.02 logMAR to 0.19 logMAR) and poor stereopsis was noted (mean from 40 s to 50.2 s of arc) when Gy > 0.1 g. The effect of acceleration from the X-axis on the visual system was higher than that from the Y-axis. During acceleration, most subjects complained of ocular strain when reading. To our knowledge, this study is the first to report the exact levels of visual function loss during Gx and Gy.
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Affiliation(s)
- Chi-Ting Horng
- Medical Education Center, Kaohsiung Armed Forced General Hospital, Kaohsiung City 802, Taiwan.
| | - Yih-Shou Hsieh
- Institute of Biochemistry and Biotechnology, Chung Shang Medical University and Chung Shang Medical University Hospital, Taichung City 402, Taiwan.
| | - Ming-Ling Tsai
- Department of Ophthalmology, Taipei Buddhist Tzu Chi General Hospital, Taipei City 231, Taiwan.
| | - Wei-Kang Chang
- Medical Affairs Bureau, Ministry of National Defense, Taipei City 104, Taiwan.
| | - Tzu-Hung Yang
- Medical Education Center, Kaohsiung Armed Forced General Hospital, Kaohsiung City 802, Taiwan.
| | - Chien-Han Yauan
- Department of Ear-Nose-Throat, Kaohsiung Armed Forced General Hospital, Kaohsiung City 802, Taiwan.
| | - Chih-Hung Wang
- Medical Affairs Bureau, Ministry of National Defense, Taipei City 104, Taiwan.
| | - Wu-Hsien Kuo
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 100, Taiwan.
| | - Yi-Chang Wu
- Medical Affairs Bureau, Ministry of National Defense, Taipei City 104, Taiwan.
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Fray KJ. Functional benefits of sensory and motor evaluation before strabismus surgery. THE AMERICAN ORTHOPTIC JOURNAL 2010; 60:33-42. [PMID: 21061882 DOI: 10.3368/aoj.60.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Evaluating the sensory and motor status of your strabismus patient is an important part of the preoperative examination. However, not all clinicians follow the same protocol for this assessment. Many rely on personal experience to determine what tests to do. Is this enough? Interpreting the evidence regarding the proper preoperative exam for strabismus patients and incorporating it into your practice can help to enhance your postoperative results.
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Affiliation(s)
- Katherine J Fray
- Arkansas Children's Hospital and Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA
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Fatima T, Amitava AK, Siddiqui S, Ashraf M. Gains beyond cosmesis: Recovery of fusion and stereopsis in adults with longstanding strabismus following successful surgical realignment. Indian J Ophthalmol 2009; 57:141-3. [PMID: 19237789 PMCID: PMC2684431 DOI: 10.4103/0301-4738.45505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We evaluated recovery of binocularity in 15 chronically strabismic, non-fusing (with neutralizing prisms) adults following successful surgical alignment. We included ≥12-year-olds, with best corrected visual acuity (BCVA) ≥20/60, and excluded those with: anisoacuity >2 lines-Snellen; failed realignment judged by >10 prism diopters (PD) horizontal and >4 PD vertical. Six-week outcomes were: fusion by Worth Four-Dots (WFDT) and Bagolini striated glasses (BSG) and stereopsis by Titmus test and the Netherlands organisation for applied scientific research (TNO) test. Baseline data in medians (range): age 18 (12-40) years, strabismus 45 (19-95) PD, duration 14 (0.5-24) years, 12 females; 12 exotropes, three esotropes; visual acuity was 20/20 in 10, while none had BCVA <20/60. Postoperative strabismus measured 6 PD (range:0-10). By six weeks none suppressed: WFDT findings showed eight fused at distance and 13 at near; and on BSG figures were 10 and 13 respectively. Stereopsis was demonstrated by 13 on Titmus and by 10 on TNO tests. It is concluded that longstanding strabismic adults with good vision can recover fusion and stereopsis following successful squint surgery.
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Affiliation(s)
- Tarannum Fatima
- Institute of Ophthalmology, JN Medical College, Aligarh Muslim University, Aligarh-202 001, India
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Z-tenotomy of the superior oblique tendon and horizontal rectus muscle surgery for A-pattern horizontal strabismus. J AAPOS 2009; 13:27-30. [PMID: 19084442 DOI: 10.1016/j.jaapos.2008.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 08/31/2008] [Accepted: 09/12/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE Few studies have investigated combined surgeries for horizontal deviation and A pattern caused by superior oblique overaction (SOOA). This study presents our experience with combined surgery and examines the effect of the type of strabismus and prior surgery on outcome. METHODS The medical records of patients who underwent combined surgery for horizontal deviation occurring with A-pattern misalignment from 2000 through 2004 were reviewed. The procedure consisted of horizontal extraocular muscle recession or resection with superior oblique Z-tenotomy. The criteria for surgical success were horizontal deviation at primary gaze of </=10(Delta), A pattern of </=8(Delta), and SOOA of </=1.0. RESULTS The study group included 28 patients with a mean age of 13.4 years. Thirteen (46.4%) had A-pattern esotropia; 15 (53.6%) had A-pattern exotropia. Fifteen (50%) had undergone previous surgery. The success rate for the whole group was 60.7%. There was no statistically significant difference in success rate between patients with esotropia (53.8%) or exotropia (66.7%) (p = 0.48) or between patients in whom the combined procedure was the primary (71.4%) or secondary (50.0%) treatment (p = 0.246). Measurements of horizontal strabismus remained stable throughout follow-up in the esotropia group but were unpredictable in the exotropia group. CONCLUSIONS The success rate of combined horizontal deviation/A-pattern surgery is unaffected by type of horizontal deviation or prior surgery.
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Affiliation(s)
- Sean P Donahue
- Tennessee Lions Eye Center at Vanderbilt Children's Hospital and the Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, USA
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Weir CR, Agarwal PK, Bryce I. Recovery of stereoacuity 27 years after trauma: an unusual case. Eye (Lond) 2007; 21:858-9. [PMID: 17277750 DOI: 10.1038/sj.eye.6702723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
PURPOSE OF REVIEW This article reviews the most recent studies that address the loss of and restoration of binocular vision in childhood and adulthood and summarizes recent changes in treatment approaches. RECENT FINDINGS Studies during the last two years support the idea of continued plasticity of the binocular visual system throughout life. Children and adults with strabismus onset following binocular vision maturation are susceptibility to a permanent disruption of stereopsis and sensory fusion. Plasticity of the binocular visual system, however, also means continued restorability of function. Despite a rather short critical time interval for restoration of normal function (three months in children and 12 months in adults), peripheral or extramacular binocular visual function can be restored in most patients whose onset of disruption follows binocular maturation. SUMMARY Stereoacuity loss can occur in the visually mature patient who develops strabismus later in life and delay of treatment can be deleterious to the restoration of normal macular binocular vision. However, despite any delay of treatment, most patients with strabismus acquired following binocular vision maturation will manifest some stereoacuity or sensory fusion following eye realignment. These findings suggest all patients with strabismus need to have their eyes aligned, either surgically or optically, to maximize their binocular vision outcome.
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Eustis HS. Maximizing binocular vision outcomes in strabismus patients. Am J Ophthalmol 2004; 138:1044-5. [PMID: 15629300 DOI: 10.1016/j.ajo.2004.08.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2004] [Indexed: 11/19/2022]
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