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Kopmann S, Grenzebach U, Ehrt O, Biermann J. Effectiveness of Strabismus Surgery in Intermittent Exotropia and Factors Influencing Outcome. J Clin Med 2024; 13:1031. [PMID: 38398344 PMCID: PMC10889094 DOI: 10.3390/jcm13041031] [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: 01/12/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Intermittent exotropia (IXT) is known to relapse after surgery. No factors to predict or prevent recurrence are known with certainty. This study investigated surgical outcome, potential influencing factors, and reoperation rate in patients with IXT. Medical records of 537 patients who underwent surgery for IXT from 2000 to 2022 with preoperative angles of exodeviation of 6 to 50 prism diopters (PD) were retrospectively studied. Multivariate regression analyses of factors influencing surgical outcome on postoperative day 1 (POD1) and reoperation rate were performed. A Kaplan-Meier analysis was performed to illustrate the reoperation rate. After the first surgery, 83.8% of patients had a successful surgical outcome on POD1 (esodeviation ≤ 5 PD or exodeviation ≤ 10 PD). Logistic regression analysis revealed that small preoperative angles of exodeviation increased the probability for surgical success. Follow-up data at different times (4 days-20 years) after surgery were available for 176 patients: 40 patients were still in the range of surgical success, 133 patients had exotropia > 10 PD. Of the follow-up patients, 65 (12.1%) underwent reoperation. A total of 8.5% had their reoperation within one year after the first surgery, 52.9% within five years. Cox regression analysis revealed that large preoperative angles of exodeviation, far/near incomitance and alphabet pattern strabismus increased the risk of reoperation. Most patients achieved surgical success on POD1, yet the squint angles often increased after surgery, resulting in reoperation in some patients. Prospective studies are needed for a better assessment of pre-, peri- and postoperative factors for surgical success in IXT.
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Affiliation(s)
- Svenja Kopmann
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Ulrike Grenzebach
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Oliver Ehrt
- Department of Ophthalmology, LMU University Hospital, Ludwig-Maximilians Universität Muenchen, 80539 Muenchen, Germany
| | - Julia Biermann
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
- Department of Ophthalmology, Klinikum Bielefeld Gem. GmbH, 33604 Bielefeld, Germany
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Yagasaki T, Yokoyama Y, Yagasaki A, Tsukui M. Effects of Bilateral Medial Rectus Resection on Motor Outcomes in Infantile Exotropia. Clin Ophthalmol 2022; 16:2047-2056. [PMID: 35761960 PMCID: PMC9233542 DOI: 10.2147/opth.s370266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the effects of bilateral medial rectus resection (BMRres) on motor outcomes in infantile exotropia. Methods We evaluated 19 cases of infantile exotropia surgery. The mean age at surgical alignment was 4.8±3.4 years (range, 1.5–11.8 years). The surgical procedures included BMRres (5 cases), BMRres with unilateral lateral rectus recession (ULRR) (3 cases), bilateral lateral rectus recession (BLRR) (8 cases), unilateral lateral rectus recession and medial rectus resection (uniRandR) with contralateral lateral rectus recession (2 cases), and uniRandR (1 case). After dividing the cases into two groups (BMRres group, n=8; other group, n=11), the outcomes at 1 day and at 1, 3, and 6 months after surgery were compared. Surgical outcomes were defined as (1) success: distant esotropia ≤5 prism diopters (Δ) or exotropia ≤10Δ, (2) recurrence: exotropia >10Δ, or (3) overcorrection: esotropia >5Δ. Results Although postoperative distant deviations at 1 day were not different between the two groups, the BMRres group showed smaller distant deviations at 1, 3, and 6 months than the other group (p=0.015, 0.019, and 0.006, respectively). Success rates of the BMRres and other groups were 88% and 73% at 1 day, 100% and 36% at 1 month, 88% and 27% at 3 months, 88% and 18% at 6 months, respectively. Although there were no significant differences between the two groups within 3 months after surgery, surgical outcomes in the BMRres group 6 months after surgery were significantly better than those in the other group (p=0.003). Conclusion BMRres is a better procedure than others for infantile exotropia to achieve desirable motor outcomes after surgery.
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Affiliation(s)
- Teiji Yagasaki
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan
- Correspondence: Teiji Yagasaki, Yagasaki Eye Clinic, 62-6 Gonaka, Kaimei, Ichinomiya, Aichi, 494-0001, Japan, Tel +81-586-61-8787, Fax +81-586-61-9210, Email
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan
| | - Ayaka Yagasaki
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan
- Department of Ophthalmology, Gifu Prefectural General Medical Center, Gifu, Gifu, Japan
| | - Makiko Tsukui
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan
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Abnormal biorbital angle in children with infantile exotropia. Jpn J Ophthalmol 2021; 66:81-86. [PMID: 34665373 DOI: 10.1007/s10384-021-00881-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The causative factors of infantile exotropia are unknown. The purpose of this study was to investigate the relationships between the biorbital angle and the pathogenesis of infantile exotropia. STUDY DESIGN Retrospective. METHODS Of all patients diagnosed as infantile exotropia with onset prior to 12 months of age between 2010 and 2017, 31 patients without any neurological disorders or developmental delay were identified. The angle between both lateral walls of the orbit, defined as the biorbital angle, was measured in the horizontal plane at the optic nerve and where the horizontal extraocular muscles appeared on axial magnetic resonance imaging (MRI) or computed tomography (CT) of the orbit. These patients' data were compared with those of 129 ophthalmologically normal children. All subjects of this study were Japanese. RESULTS The mean biorbital angle was significantly larger in patients with infantile exotropia than in the normal children (106.6 ± 5.7° vs 94.2 ± 5.1°, p < 0.001). Of the patients with infantile exotropia, 21 (68%) had an angle outside the 95% confidence interval calculated in normal children. All cases were divided into a constant (15 cases) and intermittent (16 cases) group; there was no significant difference between them in the mean biorbital angles (107.9 ± 5.6° vs 105.4 ± 5.8°, p = 0.224). No correlations were identified between the biorbital angle and the angle of exodeviation, either distant or near. CONCLUSIONS Children with infantile exotropia have a larger biorbital angle. This anatomical abnormality may be an associate factor of infantile exotropia.
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Dong Y, Nan L, Liu YY. Surgery at early versus late for intermittent exotropia: a Meta-analysis and systematic review. Int J Ophthalmol 2021; 14:582-588. [PMID: 33875952 DOI: 10.18240/ijo.2021.04.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the outcomes between early surgery and late surgery for intermittent exotropia (IXT) with a Meta-analysis. METHODS Scientific databases including PubMed, Embase, Web of Science, Cochrane and China National Knowledge Infrastructure were searched prior to December 16, 2019. From this broad database search, we performed some Meta-analysis including eleven independent studies, to further evaluate the outcome(s) when comparing early versus late surgery for IXT. The boundaries between early and late surgery and the surgery methods were not inconsistent, so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches. The pooled odds ratios (ORs) and the 95% confidence interval (CI) were estimated according to the random-effects model for high heterogeneity between studies. RESULTS Eleven retrospective studies were included in this Meta-analysis. No significant difference between early and late surgery was observed for IXT patients (ORFirst follow-up=0.88, 95%CI 0.53-1.44, P=0.61; ORFinal follow-up=1.48, 95%CI 0.94-2.31, P=0.09). However, sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable. Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession (BLR) subgroup for the final follow-up (OR4y=2.64, 95%CI 1.57-4.44, P=0.00; ORBLR=2.25, 95%CI 1.36-3.74, P=0.00). CONCLUSION Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.
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Affiliation(s)
- Yi Dong
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology Tianjin Medical University, Tianjin 300020, China
| | - Li Nan
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology Tianjin Medical University, Tianjin 300020, China
| | - Yu-Yan Liu
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology Tianjin Medical University, Tianjin 300020, China
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Rajavi Z, Sabbaghi H, Behradfar N, Abdi S, Bahraini R, Kheiri B, Sheibani K. Motor and Sensory Outcomes of Infantile Exotropia: A 10-Year Study (2008-2017). KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:143-149. [PMID: 32233148 PMCID: PMC7105794 DOI: 10.3341/kjo.2019.0090] [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: 08/02/2019] [Revised: 10/15/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose We aimed to determine the long-term motor and sensory outcomes of patients with infantile exotropia. Methods In this longitudinal retrospective (historical cohort) study, the records of 76 patients with infantile exotropia were Studied. Subjects with constant exotropia manifesting before the age of 1 year who were at least 5 years old at recruitment time between 2008 and 2017 were included. Results The medical records of 26 patients were excluded due to not participating in follow-up examinations or having incomplete records. In total, 54 infantile exotropic patients (51.9% male) with a mean age of 11.1 ± 6.8 years and follow-up of 4.99 ± 3.58 years were studied. Postoperative sensory outcomes (central stereopsis [<60 sec/arc], peripheral fusion [60–3,000 sec/arc], and non-stereopsis [>3,000 sec/arc]) were observed in 38.9%, 38.9%, and 21.2% of patients, respectively. In terms of postoperative motor outcomes, 69%, 24%, and 7% were achieved as orthophoria, residual exotropia, and consecutive esotropia, respectively. Patients with a higher surgical age (p = 0.022) and better visual acuity (p = 0.004) had significantly better sensory outcomes, while higher preoperative deviation resulted in more suppression (p = 0.039, rs = 0.218). Conclusions With rates of 69% for motor success and 78.8% for sensory success, surgical outcomes of infantile exotropic patients seems to be favorable. Further studies are recommended to verify our findings.
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Affiliation(s)
- Zhale Rajavi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Narges Behradfar
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Abdi
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Bahraini
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kourosh Sheibani
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
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