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At least 199 records · Page 11Linked to original sources
PubMed1999

Outcome study of bilateral lateral rectus recession for intermittent exotropia in children.

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

Adolescent↗
PubMed2000

[Binocular function of intermittent exotropia before and after surgery].

PURPOSE: We examined the binocular function of intermittent exotropia before and after surgery, and studied the effect of the surgery and the factor that might be involved in its result. MATERIALS AND METHODS: 402 intermittent exotropic patients, who underwent their first surgical correction for the strabismus at Teikyo University Hospital, were examined for retinal correspondence and stereo acuity before and after surgery. RESULTS: 367 patients (91.3%) had already had good stereo acuity before surgery when their eyes were straight. Regarding retinal correspondence, though 192 patients (47.8%) were abnormal (dual) before surgery, 301 patients (74.9%) were normal after surgery. The eye deviation of 101 patients who could not get normal retinal correspondence after surgery was significantly larger than normal (p < 0.001), and 77.2% of them had also vertical strabismus which was mainly composed of dissociated vertical deviation. CONCLUSION: Normal binocular function could be recovered by surgical treatment in most intermittent exotropic patients. When patients could not get normal retinal correspondence after surgery, we supposed that dissociated vertical deviation might exert an important effect upon their binocular function.

Adolescent↗
PubMed2001

[Consecutive exotropia surgery].

PURPOSE: To evaluate the factors involved in the development of consecutive exotropia (XTc), and the surgical procedures used for its treatment. PATIENTS AND METHODS: A retrospective study on 30 patients who underwent surgery for XTc was carried out in our Department. The following characteristics were studied prior to surgery: anamnesis, refraction, deviation angle measurement, detection of amblyopia and diplopia prior to the operation, abnormal head posture rotations and presence of any vertical deviation and anisotropy. The surgical technique used was individually considered for each patient and included bilateral lateral rectus recessions and/or unilateral medial rectus advancement to its/their original insertion site. RESULTS: Before surgery, 53.33% of our patients showed amblyopia, 66.66% of them showed rotation limitation, 46.66% showed dissociated vertical deviation (DVD), 20% had abnormal head posture and 10% diplopia. < > results (residual deviation of 10 prism diopters or less) were obtained in 70% of our patients. More than half of our cases were corrected with one single procedure. CONCLUSIONS: The presence of amblyopia, rotation limitations and vertical deviations (DVD and/or alphabetical syndromes) were found to be the most common factors in the development of a XTc in our study. The results indicate that a residual angle less than 10 prism diopters is obtained in 70% of our patients. The technique of choice is a bilateral lateral rectus muscle recession for deviations up to 35 prism diopters. The association of an advancement of one or both medial rectus muscles is necessary when the initial deviation exceeds 35 prism diopters.

Adolescent↗
PubMed1992

[Natural history of intermittent exotropia--statistical study of preoperative strabismic angle in different age groups].

To clarify the natural history of intermittent exotropia, the authors statistically analysed the size of deviations between the initial and the last visit of unoperated intermittent exotropes. In younger patients who were followed for over five years, the magnitudes were almost the same throughout the follow-up periods. A statistical analysis of preoperative strabismic angles in operated cases of different age groups was also done. From comparable studies of the preoperative size of exodeviations in three different age groups, the deviations in distance fixation in adults were apparently larger than in children. We think the size of the deviation in distance fixation tends to increase with aging, but the increase was not so great for the older adult group. However, the size of the deviation in near fixation tended to steadily increase throughout aging, showing statistical significance among all three groups, children, adults in their twenties and thirties, and adults over forty. In the over forty group, the convergence insufficiency type of deviation was present in the majority.

Adolescent↗
PubMed1992

Unilateral lateral rectus recession for the treatment of exotropia.

Thirty patients with moderate angle exotropia of 15 to 20PD were treated with a unilateral lateral rectus recession of 7.0 or 7.5mm. All 30 patients improved postoperatively to orthophoria, small angle exophoria, or small angle tropia of 10PD or less. Alignment was stable during an average follow-up of 21 months.

Adolescent↗
PubMed1983

Intermittent exotropia. Surgical results in different age groups.

The surgical results of 111 consecutive patients with intermittent exotropia treated via bilateral rectus muscle recession and having at least 2 years of follow-up are reviewed. These data are analyzed from a standpoint of three age groups at the time of surgery: younger than 3 years (41 patients), 3 years to younger than 6 years (42 patients), and 6 years to younger than 17 years (28 patients). The initial surgical results for all ages were as follows: 56% satisfactory, 38% undercorrected, and 6% overcorrected. After appropriate management (which was almost always surgical) in those patients initially either undercorrected or overcorrected, a satisfactory result was obtained in 95% of all patients comprising this series.

Adolescent↗
PubMed1984

Accommodation dynamics in divergence excess exotropia.

Objective recording of accommodation dynamics was performed in four patients with divergence excess exotropia (two true and two simulated) and in three visually normal control subjects. The accommodative peak velocity/amplitude relationship was normal in the exotropic patients and in the control subjects. Latency for decreasing accommodation was increased significantly, and overshoot frequency was decreased, in the divergence excess exotropes of the true variety, thus demonstrating slightly slowed accommodation dynamics in this diagnostic group. These subtle deviations in response dynamics reflect central rather than peripheral mechanisms.

Accommodation, Ocular↗
PubMed1994

The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia.

Despite the presence of good stereopsis, surgically corrected intermittent exotropes may show a gradual outward shift with time. The purpose of this study was to identify early factors that influence the success of corrective surgery. Sixty-seven consecutive patients treated surgically for intermittent exotropia (age range 1.9 to 76 years) constituted our final sample. Sensory status was evaluated with the Titmus stereotest. A successful surgical result was defined as phoria or intermittent tropia of +/- 10 prism dioptres or less for near and distance with maintained or improved stereopsis, 6 months or more after surgery. The average postoperative follow-up period was 3.3 (range 0.5 to 11) years. Good stereopsis (60 seconds of arc or better) was present in only 42% of the patients preoperatively and 61% postoperatively. The overall surgical success rate was 60%. Early overcorrection, defined as an esodeviation present within the first 4 weeks after surgery, caused a significant improvement in the success rate, to 79% (p = 0.03). Poor preoperative stereopsis combined with early overcorrection resulted in a further significant improvement in the surgical success rate, to 92% (p = 0.07). This suggests that poor preoperative stereopsis does not necessarily preclude, and may enhance, long-term alignment stability postoperatively. We suggest that it is peripheral rather than central fusion that keeps the eyes well aligned after surgery and prevents recurrence of the exodeviation.

Accommodation, Ocular↗
PubMed1997

[A case of basilar artery occlusion associated with one-and-a-half syndrome, paralytic pontine exotropia and WEBINO-syndrome].

We report a 79-year-old woman with basilar artery occlusion. She had a sudden onset of tetraplegia and disturbed consciousness, and within four days from the onset she showed a varied, fluctuating eye symptoms. On admission, she showed ocular bobbing, skew deviation with the right eye lower-positioned, upward gaze palsy, one-and-a-half syndrome, and paralytic pontine exotropia (PPE). On the third day after the onset, she showed wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome, and on the fourth day, she showed one-and-a-half syndrome again. Her right-gaze palsy improved repeatedly, and on the 19th day from the onset, only right MLF syndrome remained. Her eye symptoms fluctuated probably according to the distal migration of emboli, there by the responsible lesion and the mechanism of these eye symptoms are considered to be closely inter-correlated. On the fourth day after onset, the magnetic resonance imaging revealed cerebral infarctions in bilateral middle pons, the left paramedian lower pons, and the right paramedian midbrain, and a hemorrhagic infarction in the right inferior cerebellar hemisphere. We believe that that the eye symptoms of this patient were caused by lesions in the paramedian midbrain or pons.

Aged↗
PubMed1998

[Intermittent exotropia : postoperative prismatic treatment].

The surgical treatment of intermittent exotropia remains a difficult problem. We present our results about our prismatic approach of the postoperative under- and overcorrections. The treatment of the overcorrections has to adapt to each case but we propose a stereotyped prismatic method (with a total amount of prismatic diopters never exceeding 5PD) to treat the undercorrections. This method is simple and well tolerated for a long term. It is especially useful in the cases of discrepancy between the far and near measurements.

Child, Preschool↗
PubMed1998

[A case of non-paralytic pontine exotropia due to brainstem infarction].

A case with non-paralytic pontine exotropia due to brainstem infarction is reported. A 58-year-old male developed sudden onset diplopia. Ocular motor findings were as follows; in forward gaze, the left eye was in abduction position. Leftward gaze, the right eye did not adduct with left beating nystagmus of left eye. Rightward gaze, both eyes could make full excursion and upward, downward gaze were possible. These findings was noted at only acute phase, 7 days later NPPE was disappeared. MRI revealed spotty lesion in the paramedian portion of the mid pontine tegmentum. It is important to observe ocular movement at acute phase because NPPE is very important sign in diagnosis of brainstem disorders.

Brain Stem↗
PubMed1979

Lateral incomitancy in intermittent exotropia: cause and surgical therapy.

A hypothesis, previously proposed, of tight medial rectus muscles in conjunction with tight lateral rectus muscles associated with exodeviations as a cause of lateral incomitancy in intermittent exotropia is supported by clinical management. Three patients with these findings underwent bilateral medial rectus and lateral rectus recessions by means of the adjustable rectus recession technique. Primary position alignment was achieved, and rotations were balanced with the alleviation of the lateral incomitancy. The lateral rectus muscles were recessed an amount more than usual in order to compensate for the recession of the medial rectus muscles.

Adolescent↗
PubMed1980

Functional amblyopia in kittens with unilateral exotropia. II. Correspondence between behavioural and electrophysiological assessment.

In two dark reared, 40 day old kittens unilateral divergent squint was induced be resecting the insertion of the medial rectus muscle. Behavioural testing revealed that the kittens used only the normal eye for fixation. Contrast sensitivity functions of the two eyes had visual acuity were determined behaviourally in a jumping stand whereby the kittens had to discriminate sine-wave gratings or variable spatial frequency and contrast from a flux equated homogeneous field. At photopic luminance levels the deviated eye showed a significant deficit in both kittens. This impairment was apparent over the whole range of spatial frequencies (0.18-0.99 c/deg) except for the lowest spatial frequency in one kitten. The interocular difference of visual acuity disappeared at scotopic luminance levels. In subsequent electrophysiological experiments contrast sensitivity functions were determined from cortical evoked potentials that were elicited by phase reversing square wave grating. Comparison between behavioural and electrophysiological results revealed a very good correspondence between the two sets of data. It is concluded that exotropia without alternating fixation leads to functional amblyopia of the deviated eye.

Amblyopia↗
PubMed1975

Paralytic pontine exotropia in subarachnoid hemorrhage. A clinicopathological correlation.

A syndrome of combined right lateral gaze palsy and right internuclear ophthalmoplegia, followed by a left exotropia in a case of subarachnoid hemorrhage is presented. At necropsy a single small pontine end-zone infarction was found, involving the medial part of the right paramedian pontine reticular formation, the tectospinal tract and the ventral part of the right medial longitudinal fasciculus. The fila radicularia of the right abducens nerve passed through the necrotic area. The mechanism of these characteristic ocular motor disturbances in relation to the post mortem findings and the topopathogenesis of the pontine infarction are discussed.

Female↗
PubMed2001

Binocular Function of Intermittent Exotropia Before and After Surgery.

Purpose: We examined the binocular function of intermittent exotropia before and after surgery, and studied the effect of the surgery and the factor that might be involved in its result.Materials and Methods: 402 intermittent exotropic patients, who underwent their first surgical correction for the strabismus at Teikyo University Hospital, were examined for retinal correspondence and stereo acuity before and after surgery.Results: 367 patients (91.3%) had already had good stereo acuity before surgery when their eyes were straight. Regarding retinal correspondence, though 192 patients (47.8%) were abnormal (dual) before surgery, 301 patients (74.9%) were normal after surgery. The eye deviation of 101 patients who could not get normal retinal correspondence after surgery was significantly larger than normal (P <.001), and 77.2% of them had also vertical strabismus which was mainly composed of dissociated vertical deviation.Conclusion: Normal binocular function could be recovered by surgical treatment in most intermittent exotropic patients. When patients could not get normal retinal correspondence after surgery, we supposed that dissociated vertical deviation might exert an important effect upon their binocular function.

Journal Article↗