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Mohan K, Sharma SK. Long-term Motor and Sensory Outcomes After Unilateral Medial Rectus Recession-Lateral Rectus Resection for Infantile Esotropia. J Pediatr Ophthalmol Strabismus 2024; 61:106-113. [PMID: 37615418 DOI: 10.3928/01913913-20230721-01] [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] [Indexed: 08/25/2023]
Abstract
PURPOSE To report long-term motor and sensory outcomes after unilateral medial rectus recession-lateral rectus resection for infantile esotropia. METHODS The medical records of patients who had undergone unilateral medial rectus recession-lateral rectus resection for infantile esotropia and were followed up postoperatively for a minimum of 10 years were reviewed retrospectively. RESULTS A total of 100 patients were included. The mean age at surgery was 2.9 ± 2.2 years (range: 2.5 months to 9.0 years). The mean postoperative follow-up was 15.7 ± 4.4 years (range:10.0 to 27.5 years). Overall, 54 patients (54%) had surgical success at their last follow-up visit. Age at first surgery, strabismus duration, degree of hyperopia, preoperative size of deviation, presence of dissociated vertical deviation, inferior oblique overaction, or both dissociated vertical deviation and inferior oblique overaction, and the number of esotropia surgeries did not predict motor outcome after surgery. Consecutive exotropia developed in 43% of patients (constant in 18% and intermittent in 25%). Residual and recurrent esotropia occurred in 20% and 21% of patients, respectively. Refractive accommodative esotropia developed in 17% of patients and there was a high accommodation convergence/accommodation ratio esotropia in 2%. Peripheral binocular single vision was achieved in 54% of patients and stereopsis in 1%. Patients with 1.5 years or less of strabismus duration had better chances of achieving peripheral binocular single vision. CONCLUSIONS Nearly half of the patients with infantile esotropia achieved a successful long-term motor outcome and peripheral binocular single vision. Consecutive exotropia occurred frequently. Recurrent esotropia and refractive accommodative esotropia developed in some patients, and a high accommodation convergence/accommodation ratio esotropia in a few. Stereopsis outcome was extremely poor. [J Pediatr Ophthalmol Strabismus. 2024;61(2):106-113.].
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Kennedy A, Lengwiler F, Dosanjh S, Jolly R, Jain S. Effect of bimedial recession on near-distance disparity in esotropia. Eye (Lond) 2023; 37:2294-2298. [PMID: 36463328 PMCID: PMC10366172 DOI: 10.1038/s41433-022-02334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/21/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Esotropia may be associated with a difference in the deviation at near and distance fixation termed near-distance disparity (NDD). Convention suggests patients with NDD may benefit more from bilateral medial rectus recessions (BMR) as opposed to a unilateral recession/resection (RR). The aim of this study is to establish the effect of BMR for the treatment of esotropia on both the near and distance deviation and NDD. METHODS Retrospective patient records search from 2011 to 2021. INCLUSION CRITERIA comitant esotropia, first surgery, equal and normal vision with free alternation. EXCLUSION CRITERIA incomitant, neurological or restrictive strabismus, previous surgery, clinically significant amblyopia. RESULTS 49 patients met the inclusion criteria. 19 patients were female; the average age was 17 years. Following surgery, the average near deviation reduced from 39PD base out (BO) to 11PD BO. The average distance deviation reduced from 33PD to 9PD. Average preoperative NDD was 12 PD. NDD resolved in 15 out of 18 patients with NDD (83%). The average PD gain per mm of recession was 2.7 for near and 2.2 for distance. CONCLUSIONS BMR is an effective surgical treatment for esotropia and has a greater effect on near deviation than distance. It is also an effective and simple technique for lesser degrees of NDD. BMR has several advantages over RR: no tissue loss, readily reversible, the scars are easier to hide and it avoids potential motility limitations due to leash effects following resection.
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Mehner L, Ng SM, Singh J. Interventions for infantile esotropia. Cochrane Database Syst Rev 2023; 1:CD004917. [PMID: 36645238 PMCID: PMC9841886 DOI: 10.1002/14651858.cd004917.pub4] [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] [Indexed: 01/17/2023]
Abstract
BACKGROUND Infantile esotropia (IE) is the inward deviation of the eye. Various aspects of the clinical management of IE are unclear; mainly, the most effective type of intervention and the age at intervention. OBJECTIVES To examine the effectiveness and optimal timing of surgical and non-surgical treatment options for IE to improve ocular alignment and achieve or allow the development of binocular single vision. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, one other database, and three trials registers (November 2021). We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA: We included randomized trials and quasi-randomized trials comparing any surgical or non-surgical intervention for IE. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and graded the certainty of the body of evidence for six outcomes using the GRADE classification. MAIN RESULTS We included two studies with 234 children with IE. The first study enrolled 110 children (mean age 26.9 ± 14.5 months) with an onset of esotropia before six months of age, and large-angle IE defined as esotropia of ≥ 40 prism diopters. It was conducted between 2015 and 2018 in a tertiary care hospital in South Africa. It compared a maximum of three botulinum toxin injections with surgical intervention of bimedial rectus muscle recession, and children were followed for six months. There were limitations in study design and implementation; the risk of bias was high, or we had some concerns for most domains. Surgery may increase the incidence of treatment success, defined as orthophoria or residual esotropia of ≤ 10 prism diopters, compared with botulinum toxin injections, but the evidence was very uncertain (risk ratio (RR) of treatment success 1.88, 95% confidence interval (CI) 1.27 to 2.77; 1 study, 101 participants; very low-certainty evidence). The results should be read with caution because 23 children with > 60 prism diopters at baseline in the surgery arm also received botulinum toxin at the time of surgery to augment the recessions. There was no evidence of an important difference between surgery and botulinum toxin injections for over-correction (> 10 prism diopters) of deviation (RR 0.29, 95% CI 0.06 to 1.37; 1 study, 101 participants; very low-certainty evidence), or additional interventions required (RR 0.66, 95% CI 0.36 to 1.19; 1 study, 101 participants; very low-certainty evidence). No major complications of surgery were observed in the surgery arm, while children experienced various complications in the botulinum toxin arm, including partial transient ptosis in 9 (16.7%) children, transient vertical deviation in 3 (5.6%) children, and consecutive exotropia in 13 (24.1%) children. No other outcome data for our prespecified outcomes were reported. The second study enrolled 124 children with onset of esotropia before one year of age in 12 university hospitals in Germany and the Netherlands. It compared bilateral recession with unilateral recession surgeries, and followed children for three months postoperatively. Very low-certainty evidence suggested that there was no evidence of an important difference between bilateral and unilateral surgeries in the presence of binocular vision (numbers with event unclear, P = 0.35), and over-correction (RR of having exotropia 1.09, 95% CI 0.45 to 2.63; 1 study, 118 participants). Dissociated vertical deviation, latent nystagmus, or both were observed in 8% to 21% of participants. AUTHORS' CONCLUSIONS Medial rectus recessions may increase the incidence of treatment success compared with botulinum toxin injections alone, but the evidence was very uncertain. No evidence of important difference was found between bilateral surgery and unilateral surgery. Due to insufficient evidence, it was not possible to resolve the controversies regarding type of surgery, non-surgical intervention, or age of intervention in this review. There is clearly a need to conduct good quality trials in these areas to improve the evidence base for the management of IE.
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Affiliation(s)
- Lauren Mehner
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sueko M Ng
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jasleen Singh
- Ophthalmology, Pepose Vision Institute, Chesterfield, MO, USA
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Bhate M, Flaherty M, Martin FJ. Timing of surgery in essential infantile esotropia - What more do we know since the turn of the century? Indian J Ophthalmol 2022; 70:386-395. [PMID: 35086202 PMCID: PMC9023972 DOI: 10.4103/ijo.ijo_1129_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 11/17/2022] Open
Abstract
This review summarizes the results and interpretations of studies pertaining to the long-standing debate regarding the timing of surgery in infantile esotropia, more recently referred to as essential infantile esotropia. A systematic search of studies from the year 2000 onward pertaining to the timing of surgery in infantile esotropia as listed in PubMed, Google Scholar, and the Cochrane database was performed. Appropriate cross-references from the articles were also included. Data collected included demographics, presentation, time of surgery, complications, and outcomes. Very early surgery, that is, within 6 months of the onset of infantile esotropia, offers significant advantages in terms of the quality of stereopsis and binocular vision as well as promoting the development of cortical visual processing, thereby benefiting cortical development in human infants. However, the postoperative alignment was not found to be significantly different in the very early, early, or late surgery groups. The reduction in the incidence of manifest dissociated vertical deviation postoperatively in the very early surgery group also showed measurable benefits. The results of this recent literature review demonstrated that very early surgery, within 6 months of misalignment, showed demonstrable benefits in essential infantile esotropia.
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Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children’s Eye Care Centre, L.V.Prasad Eye Institute, Hyderabad, India
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Lajmi H, El Fekih L, Khlifi K, Hmaied W. Infantile Esoropia: Management results and prognostic factors. LA TUNISIE MEDICALE 2021; 99:1180-1187. [PMID: 35288925 PMCID: PMC8974416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Infantile esotropia is characterized by a significant deviation angle and a marked sensory perversion. Although the motor surgical results are satisfactory, the sensory results remain disappointing. AIM Our work aims to describe the methods of surgical management, its motor and sensory results as well as its prognostic factors. METHODS Retrospective study of 68 cases of infantile esotropia. All patients underwent a complete ophthalmologic examination and sensorimotor assessment. They were operated on, under general anesthesia, by the same surgeon. We assessed the motor and sensory results. The prognostic factors studied were age of onset, treatment delay, amblyopia severity, strabismus deviation angle, and presence of a vertical element. RESULTS The mean minimum angle of deflection was 38.6 ± 13.2D. Inferior oblique muscle hyper action was noted in 73.5% and a dissociated vertical deviation in 5.8%. Bilateral medial rectus muscle recession was the most performed surgery (60.2% of cases). The overall success rate was 94.11%. No patient acquired stereoscopic vision. Multivariate logistic regression analysis showed that preoperative nail (p = 0.007), immediate postoperative outcome (p <0.001) and surgical dosage (p = 0.009) were associated with long-term motor success. CONCLUSION The motor results of early esotropia surgery are generally satisfactory; the sensory results are often disappointing. Detecting poor prognostic factors improves operative results.
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Ismail AA, Abdelkader MF, Mohamed AA, Abdelaziz ST. Evaluation of Efficacy and Lateral Gaze Incomitance in Symmetrical and Asymmetrical Surgery for Concomitant Esotropia and Exotropia. Clin Ophthalmol 2021; 15:3613-3621. [PMID: 34471346 PMCID: PMC8405227 DOI: 10.2147/opth.s326659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Evaluation of asymmetrical and symmetrical horizontal strabismus surgery as regards efficacy and postoperative lateral gaze incomitance. Patients and Methods This prospective comparative interventional case series study included 40 patients of age more than 3 years with alternating horizontal strabismus. Patients were divided according to the type of horizontal deviation into esotropia and exotropia groups, which were further subdivided into asymmetrical and symmetrical subgroups in each type. The surgery was defined as symmetrical procedure if the surgery was done on the same muscle in the two eyes and it was defined as asymmetric in recess-resect procedures in one eye, and three horizontal muscles surgery. Preoperative and postoperative measurements were done in primary position, right, and left gaze using alternate prism cover test and hand-held orthopedic goniometer. Results At the end of follow-up period, a statistically insignificant difference (P value = 0.8057) was present in the success rate between the asymmetrical and symmetrical subgroups of esotropia (90 and 86.67%, respectively) and it was 100% in both exotropia subgroups. Lateral gaze incomitance results were different between esotropia and exotropia subgroups. In esotropia, a statistically significant difference was reported at 1 month (0.009), which became insignificant at 6 months (0.077) and 12 months (0.077) between asymmetrical and symmetrical subgroups. In exotropia subgroups, there was a statistically insignificant difference in lateral gaze incomitance at 1, 6, and 12 months (P = 1). Conclusion Asymmetrical procedure had the same efficacy and success rate of symmetrical procedure for the correction of concomitant horizontal deviations in primary gaze without persistent postoperative lateral gaze incomitance, especially in exotropia. Clinical Trial Registration NCT04199286.
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Affiliation(s)
| | | | - Asmaa Anwar Mohamed
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt
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Abstract
The incidence of myopia is increasing worldwide. The associated increase in secondary and vision-threatening eye diseases will pose major challenges to patients, ophthalmologists, optometrists, opticians and healthcare systems. Since myopia begins in childhood and adolescence, progression can only be influenced in this phase of life. This article gives an overview of optical and pharmacological treatment options, which show average effect sizes of up to 50% progression reduction with a comparatively favorable side effect profile.
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Affiliation(s)
- L Joachimsen
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - W A Lagrèze
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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Kim E, Choi DG. Comparison of Surgical Outcomes Between Bilateral Medial Rectus Recession and Unilateral Recess-Resect for Infantile Esotropia. Ophthalmic Epidemiol 2018; 26:102-108. [PMID: 30252566 DOI: 10.1080/09286586.2018.1523440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare surgical outcomes between bilateral medial rectus recession (BMR) and unilateral medial rectus recession-lateral rectus resection (RR) for infantile esotropia. METHODS In this retrospective study, BMR was performed on 57 patients (BMR group) and RR on 23 (RR group) for treatment of infantile esotropia with the postoperative follow-up period of 6 months or more. The main outcome measures were angle of esodeviation, rate of surgical success, rate of reoperation, rate of postoperative development of DVD, and postoperative sensory status. Surgical success was defined as esotropia or exotropia of 10 PD or less. RESULTS The mean preoperative esodeviation at near was 44.1 prism diopters (PD) in BMR, and 40.2 PD in RR (p = 0.161). There was no statistically significant difference in angles of deviation between BMR and RR from postoperative day 1 to final follow-up, respectively (p > 0.05). Whereas until postoperative month 6 the surgical success rate did not significantly differ, from postoperative year 1 to final follow-up it was significantly higher in BMR than in RR (p < 0.05). The final success rates were 80.70% and 56.52% for BMR and RR, respectively (p = 0.047). The reoperation rate, correspondingly, was significantly lower for BMR (17.54%) than for RR (60.78%) (p = 0.000). CONCLUSION There was no significant difference in the mean postoperative angle of deviation between BMR and RR for infantile esotropia. However, the final success rate was higher (p = 0.047) and the reoperation rate was lower for BMR than for RR (p = 0.000).
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Affiliation(s)
- Eunbi Kim
- a Department of Ophthalmology , Hallym University College of Medicine , Seoul , South Korea
| | - Dong Gyu Choi
- a Department of Ophthalmology , Hallym University College of Medicine , Seoul , South Korea
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Wenner Y, Kuhli-Hattenbach C, Kohnen T. [Unilateral combined strabismus surgery to correct esotropia : Video article on recession of the medial rectus muscle and plication of the lateral rectus muscle]. Ophthalmologe 2018; 115:961-966. [PMID: 30194471 DOI: 10.1007/s00347-018-0784-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE OF SURGERY The aim of strabismus surgery to correct esotropia is orthotropic alignment or microstrabismus to achieve best possible binocularity, a larger visual field, better appearance, and a frequently connected improved self-esteem. A widely used technique to correct esotropia is combined unilateral strabismus surgery with recession of the medial rectus muscle and plication of the lateral rectus muscle. INDICATIONS Indications are esotropia of various origins or decompensating esophoria over 15 prism diopters. CONTRAINDICATIONS Absolute contraindications are insufficient optical correction of hyperopia and sixth nerve palsy with unfinished spontaneous regeneration. A relative contraindication in children is untreated amblyopia. SURGICAL TECHNIQUE The technique consists of unilateral recession of the medial rectus muscle and tucking of the lateral rectus muscle. The surgical technique is demonstrated in detail in two videos of the operation, which are available online. FOLLOW-UP Antibiotic and lubricating eye drops are applied during the first week after surgery. In the early postoperative period, patients should be monitored for postoperative infection, conjunctival dehiscence, or corneal laceration. We review patients 4 months postoperatively for evaluation of the long-term result. EVIDENCE Recent randomized controlled studies have shown that unilateral medial rectus muscle recession and resection surgery is comparable to bilateral recession surgery with regards to postoperative results in esotropia. The effect of lateral rectus muscle tuck is comparable to muscle resection with less trauma and potential reversibility during the first days after surgery.
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Affiliation(s)
- Y Wenner
- Klinik für Augenheilkunde, Goethe-Universität, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - C Kuhli-Hattenbach
- Klinik für Augenheilkunde, Goethe-Universität, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - T Kohnen
- Klinik für Augenheilkunde, Goethe-Universität, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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Schöffler C, Sturm V. Repeated Surgery for Acute Acquired Esotropia: Is It Worth the Effort? Eur J Ophthalmol 2018; 20:493-7. [DOI: 10.1177/112067211002000301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Corinna Schöffler
- Department of Ophthalmology, University Hospital of Hamburg, Hamburg - Germany
| | - Veit Sturm
- Department of Ophthalmology, University Hospital of Hamburg, Hamburg - Germany
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario - Canada
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Chatzistefanou KI, Brouzas D, Droutsas KD, Koutsandrea C, Chimonidou E. Unilateral Recession-Resection Surgery for Infantile Esotropia: Survival of Motor Outcomes and Postoperative Drifts. Semin Ophthalmol 2017; 33:498-505. [PMID: 28488915 DOI: 10.1080/08820538.2017.1312465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To outline the short- and long-term motor outcomes of unilateral medial rectus muscle recession and lateral rectus muscle resection for the correction of moderate angle infantile esotropia. METHODS A retrospective study of 109 consecutive patients with moderate angle infantile esotropia treated with graded unilateral recession-resection surgery. Criteria for successful motor outcome included alignment ±10Δ from orthophoria. Outcome evaluation was a comparison of successful alignment versus an overcorrection or undercorrection at eight weeks postoperatively as well as on the final follow-up examination. RESULTS The mean preoperative deviation was 35.5 prism diopters (Δ) and mean follow-up time was 4.9 years. At the eight-week postoperative examination, 99 patients (89.9%) were successfully aligned, as opposed to 75 of 95 patients (78.9%) at the final postoperative visit (P=0.041). There was no statistically significant difference between the rate of early versus late undercorrections (7.3% versus 12.5%, P=0.267) or overcorrections (2.7% versus 8.3%, P=0.125). Ten patients had an esotropic drift over time and 10 patients had an exotropic drift. Recurrent esotropia was associated with high hyperopia and presumed infantile esotropia diagnostic entity. The Kaplan-Meier estimate of survivorship of a successful motor outcome was 75.5% at five years and 71% at 15 years postoperatively. The mean response to surgery was 2.9Δ per mm of muscle recessed and resected and was positively related to the preoperative angle of deviation (R=0.615). CONCLUSIONS The unilateral recession-resection procedure for the correction of infantile esotropia is shown to be associated with a favorable survival of motor outcomes and a relatively balanced rate of undercorrections versus overcorrections tending to be maintained through the follow-up period.
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Affiliation(s)
- Klio I Chatzistefanou
- a Strabismus Service, First Department of Ophthalmology , National and Kapodistrian University of Athens Medical School , Athens , Greece
| | - Dimitrios Brouzas
- a Strabismus Service, First Department of Ophthalmology , National and Kapodistrian University of Athens Medical School , Athens , Greece
| | - Konstantinos D Droutsas
- a Strabismus Service, First Department of Ophthalmology , National and Kapodistrian University of Athens Medical School , Athens , Greece
| | - Chryssanthi Koutsandrea
- a Strabismus Service, First Department of Ophthalmology , National and Kapodistrian University of Athens Medical School , Athens , Greece
| | - Eleutheria Chimonidou
- a Strabismus Service, First Department of Ophthalmology , National and Kapodistrian University of Athens Medical School , Athens , Greece
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Magli A, Carelli R, Chiariello Vecchio E, Esposito F, Rombetto L, Esposito Veneruso P. Essential infantile esotropia with inferior oblique hyperfunction: long term follow-up of 6 muscles approach. Int J Ophthalmol 2016; 9:1802-1807. [PMID: 28003983 DOI: 10.18240/ijo.2016.12.17] [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: 02/20/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate long term follow-up (10y) of 6 muscle surgical approach in essential infantile esotropia (EIE). METHODS A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique (IO) hyperfunction and lateral rectus (LR) pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach: bilateral medial recti (MR) recession (4-5 mm), bilateral LR resection (lower than 7 mm) and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥+30 prism diopters (PD) and IO hyperfunction were selected from larger cohort of patients (n=213, 103 females and 110 males) after excluding patients with: angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package (version 9.1, SAS Institute Inc., Cary, NC, USA). RESULTS Ten years follow up data analysis showed the following percentage of orthotropic patients: (0 PD): 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant (P<0.01), increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction (P=0.04). CONCLUSION Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.
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Affiliation(s)
- Adriano Magli
- Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy
| | - Roberta Carelli
- Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy
| | | | | | - Luca Rombetto
- Department of Ophthalmology, University Federico II, Naples 80131, Italy
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Yurdakul NS, Bodur S, Koç F. Surgical Results of Symmetric and Asymmetric Surgeries and Dose-Response in Patients with Infantile Esotropia. Turk J Ophthalmol 2016; 45:197-202. [PMID: 27800232 PMCID: PMC5082241 DOI: 10.4274/tjo.60973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/25/2014] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the results of symmetric and asymmetric surgery and responses to surgical amounts in patients with infantile esotropia. Materials and Methods: The records of patients with infantile esotropia who underwent bilateral medial rectus recession (symmetric surgery) and unilateral medial rectus recession with lateral rectus resection (asymmetric surgery) were analyzed. The results of the cases with symmetric (group 1) and asymmetric (group 2), successful (group 3) and failed (group 4) surgeries were compared, and responses to the amount of surgery were investigated. Results: There were no significant differences between group 1 (n=71) and group 2 (n=13) cases in terms of gender, refraction, preoperative distance deviation, anisometropia and postoperative deviation angles, binocular vision, surgical success or follow-up period (p>0.05). The rate of amblyopia, near deviation and amount of surgery were higher in group 2 cases (p<0.05). Between group 3 (n=64) and group 4 subjects (n=20), no significant differences were detected in terms of gender, surgical age, refraction, amblyopia, anisometropia, preoperative deviation angles, the number of symmetric and asymmetric surgeries, the amount of surgery, or postoperative binocular vision (p>0.05). The average postoperative follow-up period was 15.41±19.93 months (range, 6-98 months) in group 3 cases and 40.45±40.06 months (range, 6-143 months) in group 4 cases (p=0.000). No significant difference was detected in the amount of deviation corrected per 1 mm of surgical procedure between the successful cases in the symmetric and asymmetric groups (p>0.05). Conclusion: Symmetric or asymmetric surgery may be preferable in patients with infantile esotropia according to the clinical features. It is necessary for every clinic to review its own dose-response results.
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Affiliation(s)
| | - Seda Bodur
- Atatürk Education and Research Hospital, Clinic of Ophthalmology, İzmir, Turkey
| | - Feray Koç
- Atatürk Education and Research Hospital, Clinic of Ophthalmology, İzmir, Turkey
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Magli A, Carelli R, Esposito F, Bruzzese D. Essential Infantile Esotropia: Postoperative Sensory Outcomes of Strabismus Surgery. Semin Ophthalmol 2016; 32:663-671. [PMID: 27367798 DOI: 10.3109/08820538.2016.1157614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The optimum age for Essential Infantile Esotropia surgery is a controversial subject. Sensory status was evaluated in patients who underwent surgery at different ages in a retrospective study. The setting of the study is the ophthalmology department of a teaching hospital. METHODS Different clinical characters were analyzed pre- and postoperatively; nine different surgeries were performed. A total of 188 patients presented valid postoperative sensorial data, divided in two groups: surgery at ≤2 years (n=69) or >2 years (n=119). Sensory status was dichotomized in binocular single vision (BSV) and exclusion. Univariate differences were assessed with the chi-square test (or Fisher exact test). To identify the independent role of factors associated with the sensory status, all variables showing in univariate analyses a significant association (p<0.05) with the outcome variable were entered into a multivariate logistic regression model. All statistical tests were two-sided. RESULTS Multivariate analysis confirmed that children operated >2 years were 0.4 times less likely to obtain BSV compared with children operated at ≤2 years (AOR. 0.38, 95% C.I. 0.17-0.89, p=0.025). Patients operated on by OO MR rec.+ OO LR res. + OO IO rec.-ap. (intervention type 6) were about 11 times more likely to have BSV than those by OO rec.MR + unilateral res. LR (operation type 2); AOR.: 10.67, 95% C.I.: 1.34 - 85.29, p=0.026). Twenty-nine patients (12.1%) operated at ≤2 years of age underwent a reoperation, compared to 33 (8.6%) who underwent surgery after two years (p>0.05). CONCLUSIONS Our findings suggest to perform EIE surgery between age 1 and 2 and, when indicated, to prefer a six-muscle approach in order to achieve a better sensory function.
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Affiliation(s)
- Adriano Magli
- a University of Salerno , Pediatric Eye Department , Salerno , Italy
| | - Roberta Carelli
- a University of Salerno , Pediatric Eye Department , Salerno , Italy
| | | | - Dario Bruzzese
- c University of Naples Federico II , Department of Preventive Medical Science , Naples , Italy
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Speeg-Schatz C, Gottenkiene S, Sauer A, Roth A. [Surgery for convergent strabismus in childhood: why and when?]. J Fr Ophtalmol 2015; 38:247-52. [PMID: 25682564 DOI: 10.1016/j.jfo.2014.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/24/2014] [Indexed: 11/19/2022]
Abstract
The authors explain the reasons for and the timing of surgery for convergent strabismus, or esotropia, in children as a function of the particular type of strabismus. The goal of surgery is to correct the cross-eyed deviation by choosing the most opportune time so as to obtain the best binocular result with the minimum number of surgeries. The authors take a position in the debate over age at time of surgery for childhood esotropia, which is still controversial. Their arguments are based on recent neurophysiological and clinical data.
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Affiliation(s)
- C Speeg-Schatz
- Service d'ophtalmologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - S Gottenkiene
- Service d'ophtalmologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - A Sauer
- Service d'ophtalmologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - A Roth
- Service d'ophtalmologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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Agrawal S, Singh V, Gupta SK, Agrawal S. Evaluating a new surgical dosage calculation method for esotropia. Oman J Ophthalmol 2013; 6:165-9. [PMID: 24379550 PMCID: PMC3872565 DOI: 10.4103/0974-620x.122270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To evaluate a simplified method for correction of ocular deviation in patients of infantile and acquired basic esotropia. Materials and Methods: Thirty-six consecutive patients of infantile and acquired basic esotropia were selected for this study. Patients underwent unilateral recession–resection surgery as per the new norm gram. Patients underwent 3.5-7 mm recession of medial rectus (MR) in one eye depending on the pre-operative deviation and patient's age. Together they also underwent 6 or 7 mm resection of the lateral rectus (LR) in the same eye depending on patient's age (6 mm for 3 years and below and 7 mm for older age). In patients 3 years and below, a correction of 6, 7, or 8 PD/mm of recession of MR was expected when the pre-operative deviation was lesser than 30 PD, between 30 and 60 PD, or above 60 PD, respectively. Similarly, these values were 5, 6, and 7 PD/mm of MR recession in patients above 3 years. A ratio between achieved and expected correction was calculated and the calculation was deemed successful for a patient if this ratio fell between 0.9 and 1.1. Methods: Thirty-six consecutive patients of infantile and acquired basic esotropia were selected for this study. Patients underwent unilateral recession-resection surgery as per the new norm gram. Patients underwent 3.5-7 mm recession of medial rectus (MR) in one eye depending on the pre-operative deviation and patient's age. Together they also underwent 6 or 7 mm resection of the lateral rectus (LR) in the same eye depending on patient's age (6 mm for 3 years and below and 7 mm for older age). In patients 3 years and below, a correction of 6, 7, or 8 PD/mm of recession of MR was expected when the pre-operative deviation was lesser than 30 PD, between 30 and 60 PD, or above 60 PD, respectively. Similarly, these values were 5, 6, and 7 PD/mm of MR recession in patients above 3 years. A ratio between achieved and expected correction was calculated and the calculation was deemed successful for a patient if this ratio fell between 0.9 and 1.1. Results: The calculation procedure was successful in 33 out of 36 patients (91%). The two-tailed probability on paired Wilcoxon test was 0.187. Conclusions: This simplified method of surgical dosage calculation using MR recession as basis is predictable in patients of infantile and basic Esotropia. It may serve as a useful tool for minimizing variability of surgical results.
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Affiliation(s)
- Siddharth Agrawal
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
| | - Vinita Singh
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjiv Kumar Gupta
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
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Abstract
BACKGROUND Infantile esotropia (IE) is the inward deviation of the eye. Various aspects of the clinical management of IE are unclear; mainly, the most effective type of intervention and the age at intervention. OBJECTIVES The objective of this review was to assess the effectiveness of various surgical and non-surgical interventions for IE and to determine the significance of age at treatment with respect to outcome. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 June 2013. We manually searched the conference proceedings of the European Strabismological Association (ESA) (1975 to 1997, 1999 to 2002), International Strabismological Association (ISA) (1994) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) (1995 to 2003). Efforts were made to contact researchers who are active in the field for information about further published or unpublished studies. SELECTION CRITERIA We included randomised trials comparing any surgical or non-surgical intervention for infantile esotropia. DATA COLLECTION AND ANALYSIS Each review author independently assessed study abstracts identified from the electronic and manual searches. MAIN RESULTS No studies were found that met our selection criteria and therefore none were included for analysis. AUTHORS' CONCLUSIONS The main body of literature on interventions for IE are either retrospective studies or prospective cohort studies. It has not been possible through this review to resolve the controversies regarding type of surgery, non-surgical intervention and age of intervention. There is clearly a need for good quality trials to be conducted in these areas to improve the evidence base for the management of IE.
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Affiliation(s)
- Sue Elliott
- OphthalmologyDepartment, Salisbury Health Care NHS Trust, Salisbury, UK.
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Camuglia JE, Walsh MJ, Gole GA. Three horizontal muscle surgery for large-angle infantile esotropia: validation of a table of amounts of surgery. Eye (Lond) 2011; 25:1435-41. [PMID: 21818127 DOI: 10.1038/eye.2011.185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To validate a table of amounts of three horizontal muscle surgery in patients with large-angle infantile esotropia (≥60 prism dioptres, PD). METHODS A prospective interventional case series reporting the postoperative alignment of 51 patients (27 male, 24 female) over a 15-year period was conducted. Surgery amounts were according to a published table developed on a previous patient cohort (n=49), using bilateral medial rectus recession with graded unilateral lateral rectus resection. Kaplan-Meier life-table survival curves were formulated for success to orthotropia (±10 PD) after one and subsequent horizontal muscle surgeries for up to 8 years follow-up. RESULTS The median preoperative deviation was 65 PD (range 60-80 PD) and median age at surgery was 11.8 months (range 5.1 months-3.6 years). Surgical success to orthotropia (±10 PD) after one surgery was 100% at 2 months, 95.7% at 6 months, 91.3% at 12 months, 77.8% at 4 years, and 73.6% at 8 years. Postoperative failure requiring further horizontal surgery occurred in 17.6% (residual esotropia 4, consecutive exotropia 5). CONCLUSIONS Our second cohort has reproduced the success rate of the previous cohort (77.8% vs 77.1% at 4 years). If the published table of surgical amounts is used, three horizontal muscle surgery in large-angle infantile esotropia (≥60 PD) appears to have a good long-term success rate, and does not lead to the high rates of either residual esotropia or consecutive exotropia reported by others in the literature.
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Affiliation(s)
- J E Camuglia
- Department of Ophthalmology, Royal Children's Hospital, Herston, Queensland, Australia
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Christiansen SP, Antunes-Foschini RS, McLoon LK. Effects of recession versus tenotomy surgery without recession in adult rabbit extraocular muscle. Invest Ophthalmol Vis Sci 2010; 51:5646-56. [PMID: 20538996 PMCID: PMC3061502 DOI: 10.1167/iovs.10-5523] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 04/28/2010] [Accepted: 05/25/2010] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Surgical recession of an extraocular muscle (EOM) posterior to its original insertion is a common form of strabismus surgery, weakening the rotational force exerted by the muscle on the globe and improving eye alignment. The purpose of this study was to assess myosin heavy chain (MyHC) isoform expression and satellite cell activity as defined by Pax7 expression in recessed EOMs of adult rabbits compared with that in muscles tenotomized but not recessed and with that in normal control muscles. METHODS The scleral insertion of the superior rectus muscle was detached and sutured either 7 mm posterior to its original insertion site (recession surgery) or at the same site (tenotomy). One day before euthanization, the rabbits received bromodeoxyuridine (BrdU) injections. After 7 and 14 days, selected EOMs from both orbits were examined for changes in fast, slow, neonatal, and developmental MyHC isoform expression, Pax7 expression, and BrdU incorporation. RESULTS Recession and tenotomy surgery resulted in similar changes in the surgical EOMs. These included a decreased proportion of fast MyHC myofibers, an increased proportion of slow MyHC myofibers, and increased BrdU-positive satellite cells. Similar changes were seen in the non-operated contralateral superior rectus muscles. The ipsilateral inferior rectus showed reciprocal changes to the surgical superior rectus muscles. CONCLUSIONS The EOMs are extremely adaptive to changes induced by recession and tenotomy surgery, responding with modulations in fiber remodeling and myosin expression. These adaptive responses could be manipulated to improve surgical success rates.
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Affiliation(s)
- Stephen P. Christiansen
- From the Departments of Ophthalmology and
- Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Rosalia S. Antunes-Foschini
- the Department of Ophthalmology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil; and
| | - Linda K. McLoon
- the Departments of Ophthalmology and
- Neuroscience, University of Minnesota, Minneapolis, Minnesota
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Current World Literature. Curr Opin Ophthalmol 2010. [DOI: 10.1097/icu.0b013e32833e6970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Various aspects of the clinical management of infantile esotropia (IE) are unclear - mainly, the most effective type of intervention and the age at intervention. OBJECTIVES The objective of this review was to assess the effectiveness of various surgical and non-surgical interventions for IE and to determine the significance of age at treatment with respect to outcome. SEARCH STRATEGY Trials were identified from the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (Issue 3 2004), MEDLINE (1966 to July 2004), EMBASE (1980 to August 2004) and LILACS (July 2004). We manually searched the conference proceedings of the European Strabismological Association (ESA) (1975-1997, 1999-2002), International Strabismological Association (ISA) (1994) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) (1995-2003). Efforts were made to contact researchers who are active in the field for information about further published or unpublished studies. SELECTION CRITERIA Randomised trials comparing any surgical or non-surgical intervention for infantile esotropia. DATA COLLECTION AND ANALYSIS Each reviewer independently assessed study abstracts identified from the electronic and manual searches. MAIN RESULTS No studies were found that met our selection criteria and therefore none were included for analysis. AUTHORS' CONCLUSIONS The main body of literature on interventions for IE are either retrospective studies or prospective cohort studies. It has not been possible through this review to resolve the controversies regarding type of surgery, non-surgical intervention and age of intervention. There is clearly a need for good quality trials to be conducted in these areas to improve the evidence base for the management of IE.
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Affiliation(s)
- S Elliott
- Ophthalmology Department, Salisbury Health Care NHS Trust, Salisbury District Hospital, Salisbury, Wiltshire, UK, SP2 8BJ.
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