AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen ca...AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen cases(23 affected eyes)of V-pattern exotropia with inferior oblique muscle overaction(+or++)who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed.The amount of V-pattern,grade of inferior oblique overaction,degree of vertical strabismus,abnormal head posture,and the fovea-disc angle were evaluated before and after surgery.RESULTS:The V-pattern was corrected in all cases,and the amount of V-pattern reduced by 17.85±5.13 prism diopter(PD)on average(t=16.07,P<0.001).The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0%(20/23).The degree of the foveadisc angle has a mean reduction of 5.45°±2.87°(t=3.95,P=0.003)after surgery.The mean vertical deviation in 5 cases with a small-angle hypertropia(5.23±3.06 PD)in the primary position reduced by 3.15±1.86 PD(t=6.10,P<0.001).No serious complications were observed.CONCLUSION:The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern,which is safe and easy to perform.展开更多
AIM:To evaluate the characteristics of exotropia(XT)and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery.METHODS:The medical records of all p...AIM:To evaluate the characteristics of exotropia(XT)and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery.METHODS:The medical records of all patients that were diagnosed with XT and underwent strabismus surgery in 13 major government hospitals in Thailand;from January 2012 to December 2019,were retrospectively reviewed.Univariable and multivariable logistic regression were performed to identify factors related to binocular vision.RESULTS:Data of five hundred and thirty-seven patients were analyzed.Two hundred and twenty-six patients were men(42.1%).The median age of onset was 3 years old[Interquartile range(IQR):1,8].The median age at diagnosis was 9.21 years old(IQR;4.64,21.06).intermittent exotropia[X(T)]was the most common type(52.1%);19.5%of the patients had amblyopia.For refractive error,spherical equivalent refraction on right eye(RE)and left eye(LE)were-0.53±2.45 diopters(D)(range-14.88 to+10 D)and-0.48±2.37 D(range-19.50 to+7.75 D),respectively.The mean angle of deviation at distance and near before surgery were 42.06±14.91 prism diopters(PD)and 40.81±16.09 PD,respectively.Follow-up time after first operation was 2.48±2.27y.Four hundred sixtytwo patients(86%)needed only one operation and 299(55.6%)patients had bilateral lateral rectus recession.At final visit,the mean angles of deviation at distance and near decreased to 5.76±8.96 PD and 5.01±8.73 PD,respectively.After surgery,two hundred seventy-three patients(50.8%)were evaluated for binocular function,but the others did not have result.From multivariable logistic regression in 273 patients,the factors related to better binocular function were type of XT which was X(T)[adjusted odds ratio(aOR)10.35;95%CI:4.73,22.66]compared to constant XT,without amblyopia(aOR 3.97;95%CI:1.84,8.53),underwent only single operation compared with more than 1 operation(aOR 3.80,95%CI:1.58,9.16),the angle of deviation at near in last visit less than 10 PD better than 10–30 PD with aOR 0.42(95%CI:0.18,0.96)and type of refraction revealed isometropia better than anisometropia with aOR 4.13(95%CI:1.19,14.32).CONCLUSION:The surgical outcomes of XT within one operation in Thailand is 86%.The factors related to achieve binocular function includes type of XT as X(T),without amblyopia,angle of deviation at final visit less than 10 PD,isometropia type of refraction and underwent only one surgical correction.展开更多
AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ab...AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ability of intermittent exotropia(IXT)patients in three conditions:natural 2D optotype viewing,2D optotype viewing with polarized glasses,and 3D optotype viewing with polarized glasses.Recording with a smartphone,we captured videos to analyze the accurate time of spontaneous exodeviation and subsequent realignment before and after breaking fusion.Additionally,the correlation of stereopsis were also analyzed.RESULTS:A total of 48 patients(age range:4-33y;54.17%male)participated in the study.When viewing 3D optotypes with polarized glasses,their median control scores were 1(interquartile range,0-4)at distance and 0(0-1)at near.These scores were significantly better than those observed under natural viewing conditions,which were 2.5(1-5)at a distance and 1(0-3)at near(Friedman test,P=0.049).Furthermore,those subjects who exhibited exophoria(realignment within 2 seconds)while viewing 3D optotypes with polarized glasses were more likely to have measurable stereo vision(Kendall’sτb=-0.344,P=0.018).CONCLUSION:IXT patients exhibit enhanced control ability when using polarized glasses to view 3D optotypes,notably improving realignment capabilities.This expands our understanding of current tests and offers a potentially sensitive method for assessing IXT severity.展开更多
AIM:To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia.METHODS:A retrospective review was conducted on the medical records of patients with basic-type strabismus.De...AIM:To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia.METHODS:A retrospective review was conducted on the medical records of patients with basic-type strabismus.Demographic data,refractive error,best-corrected distance visual acuity(BCVA),and the horizontal and vertical angle of deviation between basic esotropia and exotropia patients were compared.RESULTS:Among the 7129 patients(mean age 22.98±14.81y)evaluated,44.7%(3185 cases,54.9%male)exhibited basic-type esotropia,while 55.3%(3944 cases,53.9%male)presented with basic-type exotropia.Basic esotropia cases exhibited more hyperopic spherical equivalent measurements in both eyes(right:0.53±3.07 vs left:0.56±2.98 D)than those with basic exotropia(right eye:-0.33±2.84 vs left eye:-0.24±2.68 D,P<0.001 for both eyes).Patients with basic esotropia had significantly greater horizontal deviation angles(near:36.08±18.87 PD and far:35.56±18.75 PD)compared to those with basic exotropia(near:33.75±16.11 PD and far:33.26±15.90 PD,P<0.001).Conversely,patients with basic exotropia had slightly higher vertical deviation angles(near:1.67±5.80 PD and far:1.72±5.89 PD)compared to those with basic esotropia(near:1.12±4.57 PD and far:1.12±4.58 PD,P<0.001).Patients with basic esotropia underwent surgical intervention at younger ages compared to basic exotropia individuals(19.68±15.99 vs 25.66±13.20,P<0.001).CONCLUSION:Basic esotropia patients present more hyperopic refractive errors,better visual acuity,larger horizontal yet smaller vertical ocular misalignments,and tend to undergo strabismus surgery at younger ages relative to basic exotropia cases.展开更多
AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who u...AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.展开更多
Introduction: exotropia is a deviation outside the visual axes. In children, an association with ametropia is often observed, however, that with hyperopia is rare. The objective of this study was to highlight the part...Introduction: exotropia is a deviation outside the visual axes. In children, an association with ametropia is often observed, however, that with hyperopia is rare. The objective of this study was to highlight the particularities of the management of exotropia associated with hyperopia in children. Subjects and Methods: this was a retrospective study over 78 months including all children aged 0 to 15 years, treated for exotropia associated with hyperopia. Results: we found 20 cases of exotropia with hyperopia, or 57.15% of exotropia. The mean age was 4.3 years and the sex ratio was 0.82. Hyperopia was mild in 30 eyes (75%), moderate in 9 eyes (22.5%) and high in 2.5% of eyes. Over a one-year follow-up, 10 children (50%) had regular follow-up, including 6 with full hyperopic correction and 4 with partial hyperopic correction. After full hyperopic correction, one child had a resolution of his exotropia;2 had a decrease in the angle of deviation and 3 had no improvement of their exotropia. Among the 4 with partial hyperopic correction children, 2 had a resolution of their exotropia. Strabismus surgery was planned in 3 children after iso-acuity. Conclusion: the association of exotropia and hyperopia poses a management problem. The total correction or not of hyperopia is discussed according to several authors.展开更多
目的:探究双眼外直肌倾斜后徙术(Slanted lateral rectus recession,S-LR)矫治集合不足型间歇性外斜视(Convergence insufficiency type of IXT,CI-IXT)的美学效果及对视觉功能的影响。方法:回顾性分析2021年8月-2023年8月笔者医院收治...目的:探究双眼外直肌倾斜后徙术(Slanted lateral rectus recession,S-LR)矫治集合不足型间歇性外斜视(Convergence insufficiency type of IXT,CI-IXT)的美学效果及对视觉功能的影响。方法:回顾性分析2021年8月-2023年8月笔者医院收治的80例CI-IXT患儿的临床资料,按手术治疗方式的不同分成双眼外直肌后徙术组(LR组,42例)和S-LR组(38例)。随访3个月比较两组疗效、视斜视度[视远/近斜视度、远/近斜视度差(Near-distant disparity,NDD)]、视觉功能(立体视、融合视、同时视功能)、间歇性外斜视生活质量量表(The Chinese version of intermittent exotropia questionnaires,CIXTQ)评分、复发率和美学效果的差异。结果:术后3个月,S-LR组手术矫正的优良率高于LR组,复发率低于LR组(P<0.05);两组视近斜视度、远斜视度、NDD均低于同组术前,且S-LR组低于LR组(P<0.05);两组立体视、融合视、同时视功能恢复占比均高于同组术前(P<0.05),而S-LR组与LR组间视功能恢复情况无明显差异(P>0.05);两组CIXTQ量表中儿童/家长代理量表、家长量表评分均高于同组术前,且S-LR组高于LR组(P<0.05);S-LR组斜视角度、眼球位置、眼球对称、眼部外观、面部整体外观等美学效果评分均高于LR组(P<0.05)。结论:应用S-LR治疗CI-IXT能有效提高手术矫正优良率,改善患儿的斜视度,促进视觉功能恢复,提高生活质量和美学效果,减少病情复发。展开更多
文摘AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen cases(23 affected eyes)of V-pattern exotropia with inferior oblique muscle overaction(+or++)who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed.The amount of V-pattern,grade of inferior oblique overaction,degree of vertical strabismus,abnormal head posture,and the fovea-disc angle were evaluated before and after surgery.RESULTS:The V-pattern was corrected in all cases,and the amount of V-pattern reduced by 17.85±5.13 prism diopter(PD)on average(t=16.07,P<0.001).The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0%(20/23).The degree of the foveadisc angle has a mean reduction of 5.45°±2.87°(t=3.95,P=0.003)after surgery.The mean vertical deviation in 5 cases with a small-angle hypertropia(5.23±3.06 PD)in the primary position reduced by 3.15±1.86 PD(t=6.10,P<0.001).No serious complications were observed.CONCLUSION:The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern,which is safe and easy to perform.
文摘AIM:To evaluate the characteristics of exotropia(XT)and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery.METHODS:The medical records of all patients that were diagnosed with XT and underwent strabismus surgery in 13 major government hospitals in Thailand;from January 2012 to December 2019,were retrospectively reviewed.Univariable and multivariable logistic regression were performed to identify factors related to binocular vision.RESULTS:Data of five hundred and thirty-seven patients were analyzed.Two hundred and twenty-six patients were men(42.1%).The median age of onset was 3 years old[Interquartile range(IQR):1,8].The median age at diagnosis was 9.21 years old(IQR;4.64,21.06).intermittent exotropia[X(T)]was the most common type(52.1%);19.5%of the patients had amblyopia.For refractive error,spherical equivalent refraction on right eye(RE)and left eye(LE)were-0.53±2.45 diopters(D)(range-14.88 to+10 D)and-0.48±2.37 D(range-19.50 to+7.75 D),respectively.The mean angle of deviation at distance and near before surgery were 42.06±14.91 prism diopters(PD)and 40.81±16.09 PD,respectively.Follow-up time after first operation was 2.48±2.27y.Four hundred sixtytwo patients(86%)needed only one operation and 299(55.6%)patients had bilateral lateral rectus recession.At final visit,the mean angles of deviation at distance and near decreased to 5.76±8.96 PD and 5.01±8.73 PD,respectively.After surgery,two hundred seventy-three patients(50.8%)were evaluated for binocular function,but the others did not have result.From multivariable logistic regression in 273 patients,the factors related to better binocular function were type of XT which was X(T)[adjusted odds ratio(aOR)10.35;95%CI:4.73,22.66]compared to constant XT,without amblyopia(aOR 3.97;95%CI:1.84,8.53),underwent only single operation compared with more than 1 operation(aOR 3.80,95%CI:1.58,9.16),the angle of deviation at near in last visit less than 10 PD better than 10–30 PD with aOR 0.42(95%CI:0.18,0.96)and type of refraction revealed isometropia better than anisometropia with aOR 4.13(95%CI:1.19,14.32).CONCLUSION:The surgical outcomes of XT within one operation in Thailand is 86%.The factors related to achieve binocular function includes type of XT as X(T),without amblyopia,angle of deviation at final visit less than 10 PD,isometropia type of refraction and underwent only one surgical correction.
基金Supported by the National Natural Science Foundation of China(No.82070995,No.82301256)Youth S&T Talent Support Programme of Guangdong Provincial Association for Science and Technology.
文摘AIM:To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions.METHODS:This was a prospective observational study.We evaluated the control ability of intermittent exotropia(IXT)patients in three conditions:natural 2D optotype viewing,2D optotype viewing with polarized glasses,and 3D optotype viewing with polarized glasses.Recording with a smartphone,we captured videos to analyze the accurate time of spontaneous exodeviation and subsequent realignment before and after breaking fusion.Additionally,the correlation of stereopsis were also analyzed.RESULTS:A total of 48 patients(age range:4-33y;54.17%male)participated in the study.When viewing 3D optotypes with polarized glasses,their median control scores were 1(interquartile range,0-4)at distance and 0(0-1)at near.These scores were significantly better than those observed under natural viewing conditions,which were 2.5(1-5)at a distance and 1(0-3)at near(Friedman test,P=0.049).Furthermore,those subjects who exhibited exophoria(realignment within 2 seconds)while viewing 3D optotypes with polarized glasses were more likely to have measurable stereo vision(Kendall’sτb=-0.344,P=0.018).CONCLUSION:IXT patients exhibit enhanced control ability when using polarized glasses to view 3D optotypes,notably improving realignment capabilities.This expands our understanding of current tests and offers a potentially sensitive method for assessing IXT severity.
文摘AIM:To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia.METHODS:A retrospective review was conducted on the medical records of patients with basic-type strabismus.Demographic data,refractive error,best-corrected distance visual acuity(BCVA),and the horizontal and vertical angle of deviation between basic esotropia and exotropia patients were compared.RESULTS:Among the 7129 patients(mean age 22.98±14.81y)evaluated,44.7%(3185 cases,54.9%male)exhibited basic-type esotropia,while 55.3%(3944 cases,53.9%male)presented with basic-type exotropia.Basic esotropia cases exhibited more hyperopic spherical equivalent measurements in both eyes(right:0.53±3.07 vs left:0.56±2.98 D)than those with basic exotropia(right eye:-0.33±2.84 vs left eye:-0.24±2.68 D,P<0.001 for both eyes).Patients with basic esotropia had significantly greater horizontal deviation angles(near:36.08±18.87 PD and far:35.56±18.75 PD)compared to those with basic exotropia(near:33.75±16.11 PD and far:33.26±15.90 PD,P<0.001).Conversely,patients with basic exotropia had slightly higher vertical deviation angles(near:1.67±5.80 PD and far:1.72±5.89 PD)compared to those with basic esotropia(near:1.12±4.57 PD and far:1.12±4.58 PD,P<0.001).Patients with basic esotropia underwent surgical intervention at younger ages compared to basic exotropia individuals(19.68±15.99 vs 25.66±13.20,P<0.001).CONCLUSION:Basic esotropia patients present more hyperopic refractive errors,better visual acuity,larger horizontal yet smaller vertical ocular misalignments,and tend to undergo strabismus surgery at younger ages relative to basic exotropia cases.
文摘AIM:To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia.METHODS:The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed.The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period.Ocular alignment,best corrected visual acuity,oblique muscle function,and stereopsis records were collected.RESULTS:Among the 843 eligible patients,91(10.79%;39 males and 52 females)had A-pattern(54,6.4%)or V-pattern(37,4.4%).Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y.Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation(r=-0.198,P=0.016)and patterns(r=-0.207,P=0.015).Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia(both P<0.0001).There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern.Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery(both P<0.0001).CONCLUSION:The prevalence of sensory A-V pattern exotropia in our study is 10.79%.Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern.Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.
文摘Introduction: exotropia is a deviation outside the visual axes. In children, an association with ametropia is often observed, however, that with hyperopia is rare. The objective of this study was to highlight the particularities of the management of exotropia associated with hyperopia in children. Subjects and Methods: this was a retrospective study over 78 months including all children aged 0 to 15 years, treated for exotropia associated with hyperopia. Results: we found 20 cases of exotropia with hyperopia, or 57.15% of exotropia. The mean age was 4.3 years and the sex ratio was 0.82. Hyperopia was mild in 30 eyes (75%), moderate in 9 eyes (22.5%) and high in 2.5% of eyes. Over a one-year follow-up, 10 children (50%) had regular follow-up, including 6 with full hyperopic correction and 4 with partial hyperopic correction. After full hyperopic correction, one child had a resolution of his exotropia;2 had a decrease in the angle of deviation and 3 had no improvement of their exotropia. Among the 4 with partial hyperopic correction children, 2 had a resolution of their exotropia. Strabismus surgery was planned in 3 children after iso-acuity. Conclusion: the association of exotropia and hyperopia poses a management problem. The total correction or not of hyperopia is discussed according to several authors.
文摘目的:探究双眼外直肌倾斜后徙术(Slanted lateral rectus recession,S-LR)矫治集合不足型间歇性外斜视(Convergence insufficiency type of IXT,CI-IXT)的美学效果及对视觉功能的影响。方法:回顾性分析2021年8月-2023年8月笔者医院收治的80例CI-IXT患儿的临床资料,按手术治疗方式的不同分成双眼外直肌后徙术组(LR组,42例)和S-LR组(38例)。随访3个月比较两组疗效、视斜视度[视远/近斜视度、远/近斜视度差(Near-distant disparity,NDD)]、视觉功能(立体视、融合视、同时视功能)、间歇性外斜视生活质量量表(The Chinese version of intermittent exotropia questionnaires,CIXTQ)评分、复发率和美学效果的差异。结果:术后3个月,S-LR组手术矫正的优良率高于LR组,复发率低于LR组(P<0.05);两组视近斜视度、远斜视度、NDD均低于同组术前,且S-LR组低于LR组(P<0.05);两组立体视、融合视、同时视功能恢复占比均高于同组术前(P<0.05),而S-LR组与LR组间视功能恢复情况无明显差异(P>0.05);两组CIXTQ量表中儿童/家长代理量表、家长量表评分均高于同组术前,且S-LR组高于LR组(P<0.05);S-LR组斜视角度、眼球位置、眼球对称、眼部外观、面部整体外观等美学效果评分均高于LR组(P<0.05)。结论:应用S-LR治疗CI-IXT能有效提高手术矫正优良率,改善患儿的斜视度,促进视觉功能恢复,提高生活质量和美学效果,减少病情复发。
