Check for oblique dysfunction and “A” or “V” patterns. Purpose: To determine the factors that influence surgical success in patients with intermittent exotropia. Better control grade was accompanied by higher surgical success rate but with no statistical significance. The patients were classified according to age at surgery-the patients of group 1 had undergone surgery before 4 years, Intermittent exotropia, X(T), is a relatively common form of strabismus among children in Singapore. The incomitance may partially dissipate over time, but adults often complain of persistent diplopia on side gaze. However, surgical treatment of this complication is usually effective. Korean J Ophthalmol, 33(5): 446-450. Of the 73 patients, 36 were allocated to group 1 and 37 to group 2. A satisfactory result was defined as a residual manifest motor deviation of 10 prism diopters or less or a conversion to a constant phoria in all positions of gaze with fusion and stereopsis. exodeviation types, surgical ages, operation types, preoperative and postoperative deviation amounts, presence of anisometropia and amblyopia, presence of A- or V-pattern, and presence of binocular vision and stereoacuity of patients were evaluated. Print Version What is exotropia? Of all the children treated with the toxin, 1143 additional children developed posttreatment exotropia that decreased after reaching a maximum between 15 and 35 days postinjection. The preoperative suppression status included 23 (9.7%), 55 (23.2%), and 159 (67.1%) patients who showed no, alternate, or constant suppression, respectively. Strabismus surgery involves loosening or tightening the eye muscles in order to achieve proper alignment of the eyes. The clinical findings, Access scientific knowledge from anywhere. The age at surgery, sex, preoperative angle of deviation, suppression status, and near stereopsis were investigated. Strabismus can be intermittent or constant. A matter of debate is whether a small consecutive exotropia, as is the case in 2 of the patients described (patients 4 and 7), should be treated with surgery or could be left without treatment. Families were contacted to obtain retinoscopic refraction, visual acuity, deviation angle, Bagolini test, vectography, and stereoacuity data 1 to 8 years after surgery. To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up. The preoperative angle of deviation was 26.3 ± 5.9 PD and the follow-up postoperative period was 21.6 ± 7.6 months. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Faden Operation (Posterior Fixation Suture), Torticollis, Nystagmus, and Incomitant Strabismus, Horizontal Rectus Muscle Offsets and the Y-Splitting Procedure. All underwent, as a primary surgery for intermittent exotropia, unilateral RR on the non-dominant eye. No significant differences in the motor or sensory success rates were observed between the two groups (p = 0.46 and 0.32, respectively). The timing of surgery depends on the size of the angle, direction, and amount of change. Preinjection variables recorded included estimated age at onset of deviation, retinoscopic refractive error (determined 30 minutes after instillation of 1% cyclopentolate), visual acuity when possible (Teller Acuity Cards [Vistech Consultants Inc, Dayton, Ohio], Cardiff Acuity test [Keeler Ltd, Windsor, England], or logMAR Crowded Glasgow Acuity Cards [Keeler Ltd, London, England]), deviation angle as measured by the simultaneous prism and cover test or Krimsky test with refractive correction, age at treatment, and dosage of botulinum toxin. Strabismus surgery is thought to be an effective method for the treatment of intermittent exotropia (Maruo et al., 2001). At 2 years after surgery, 13 of the 36 (36.1%) patients in group 1 and 12 of the 37 (32.4%) in group 2 had achieved successful alignment; 32 (88.9%) patients in group 1 and 35 (94.6%) in group 2 achieved normal stereoacuity. Fusional convergence is naturally strong (25–30 PD), so exodeviations are better controlled than esodeviations, as divergence amplitudes are small (6–8 PD). Not all cases are progressive so watchful waiting may be a reasonable approach in 12-36 months old but monitoring control, suppression and strereopsis are clinical guides as to the need for surgical intervention. The changes during the follow-up period (6 months to their last follow-up) showed that the over-correction rate had increased from 30.8% to 76.9% in Group A (p = 0.034) and from 12.5% to 37.5% in Group B (p = 0.046). A total of 287 patients satisfied the entry requirements of this study. (2019). The success group was noted to have more patching pre-operatively (P=0.003). Discussion: The success rate of surgical treatment of intermittent exotropia increases in the patients with presence of fusion and low preoperative deviation amounts. Characteristics of Children With Consecutive Exotropia Before Botulinum Toxin A Injection, Table 3. Overcorrection (small esotropia after surgery) rather than orthotropia should be the target immediate postoperative deviation angle, to offset the exotropic drift. to download free article PDFs, 5.1).When fusing, the eyes are straight and stereo acuity is excellent, usually 40 s of arc. Methods: A child with exotropia may close one eye particularly in bright sunlit environments. All the patients received BLR only. We defined exotropia lasting more than 1 year after injection, despite conservative treatment, as nonresolving consecutive exotropia. Subjects at 5-year follow-up were assigned to the success group if they had a post-operative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test, and had moderate to good strabismus control. Thirty-seven patients were included. We used a restrictive criterion to include all patients with exodeviation, but those in the lower end of the exodeviation angle range could have been left untreated for some time or indefinitely. Kushner, B. The medical records of 80 consecutive patients aged less than 17 years of age, who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed. Recovery From Suppression With Successful Motor Alignment After Surgery for Intermittent Exotropia January 2020 Journal of Pediatric Ophthalmology & Strabismus 57(1):21-26 Intermittent exotropia is an outward eye deviation that develops shortly after birth. However, successful motor alignment did not guarantee recovery of suppression when the preoperative angle of exotropia was greater than 20 PD. It is the opposite of crossed eyes, or esotropia.Exotropia may occur from time to time (intermittent exotropia) or may be constant, and is … The motor and sensory success rates as well as the surgical complications were compared. Exotropia can sometimes recur after surgery. The patients were grouped according to their 1st week (3–7 days) postoperative examination as: >10 PD esotropia (Group 1), ≤10 PD esotropia (Group 2), exotropia (Group 3), and orthotropic (Group 4), respectively. Results: Intermittent exotropia may progress to constant exotropia. The mean amount of distant exotropia was 36.4 +/- 12.5 prism diopters (PD). All Rights Reserved. This study was conducted to identify the relationship between control grade, stereoacuity and surgical success in basic intermittent exotropia. This treatment included alternate occlusion, near-point orthoptic exercises, and minus overcorrection. surgery, neurobehavioral and musculoskeletal conditions, strabismus different from that mentioned above X(T) were excluded. Final surgical outcomes were classified as “good” (≤10 PD exotropia and ≤5 PD esotropia), “recurrence” (>10 PD exotropia) and “overcorrected” (>5 esotropia). Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up. BMJ Open Ophthalmol, 4(1): e.000243. Conclusions: Three children had poor stereoacuity. Suppression is the reason why affected children do not complain of seeing double. Comparison of surgery versus observation for small angle intermittent exotropia. Orthoptics: Convergence exercises (pencil push-ups or base out prisms) are the treatment of choice for convergence insufficiency. The relationship of age and other baseline factors to outcome of initial surgery for intermittent exotropia. The mean age of presentation was 6.1 +/- 3.1 years. Yoo, G., Ha, S., and Kim, S. (2019). The surgical success rates for intermittent exotropia were comparable between the patients operated upon before 4 years of age and those operated upon after 4 years of age. Pre- and post-operative characteristics, Purpose: When exotropia lasts more than 3 months, most practitioners wait until a decision about eventual surgery is reached, because the possibility of recovery is contemplated. Postoperative mean deviation was 6 PD (range, 4-8 PD), and mean stereoacuity was 447.14 arc seconds. We retrospectively reviewed the medical records of 114 patients who had been surgically treated for intermittent exotropia and followed-up on postoperatively for 1 month or more. Twenty-eight of them had good results at the end of the 6 months. To study motor and sensory results of surgery for exotropia following botulinum toxin A injection to correct childhood esotropia. Sci Rep, 10(1): 4631.  BJFisher Thirteen patients underwent esotropia surgery with the aim of full correction (Group A), while 16 patients underwent esotropia surgery with the aim of partial correction (Group B). Clinical characteristics and motor and sensory successes were evaluated at 6 months after surgery. Of the 144 patients who demonstrated constant suppression preoperatively but achieved the target motor alignment postoperatively, 12 (8.3%) patients demonstrated residual suppression. J Pediatr OIphthalmol Strabismus, 57(1): 51-56. Retinoscopic refractive error, visual acuity, deviation angle, and stereoacuity before surgery for consecutive exotropia were also recorded. A noticeable outward deviation of the eyes is usually the primary sign. Materials and methods: In basic intermittent exotropia, better control grade was significantly accompanied by better stereoacuity. These small hyperphorias can be ignored if they are not associated with oblique dysfunction, as they disappear after correction of the exotropia with bilateral lateral rectus recessions. Occluding one eye breaks fusion and will manifest the exotropia (Fig. The angle of deviation was -3.3 (esodeviation) ± 7.0 PD at distance and -0.7 ± 7.1 PD at near at postoperative 6 h, and -3.7 ± 6.9 PD and -0.8 ± 6.8 PD at postoperative 1 day. Intermittent exotropia (IXT) is the most common form of childhood exotropia 1, 2 with an incidence of 32.1 per 100,000 in children under 19 years of age. were documented at 1wk, 6mo, 1, 3 and 5y follow-up. To investigate the long-term outcomes of intermittent exotropia surgery for children less than 4 years of age. It usually begins as an exophoria, which means that the child’s ability to fuse controls the deviation. The mean age at surgery was 8.2 ± 3.2 years and 115 (48.5%) patients were male. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 2007;125(9):1210-1213. doi:10.1001/archopht.125.9.1210. Methods: They were assigned to the, Purpose: All rights reserved. Results  The mean follow-up duration after the reoperation was 32.3±26.4 months in the LR group and 30.5±26.8 in the RR group (p=0.945). To investigate recovery from suppression when the target motor alignment is achieved following surgery for intermittent exotropia. Balkan Patients with hypermetropia (>+4.00 sphere OU) may present with a small exotropia. This Man's Photos Capture How Lazy Eye Surgery Changed His Life ... to show the progress of his recovery since the ... and turns inward as a result. If decreased vision is present, think about an organic cause (e.g., optic nerve disease).