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
Objective Previous studies have yielded contradictory conclusions on the relationship between intermittent exotropia(IXT)and the magnitude of myopia,especially in children.The aim of this study was to determine the cl...Objective Previous studies have yielded contradictory conclusions on the relationship between intermittent exotropia(IXT)and the magnitude of myopia,especially in children.The aim of this study was to determine the clinical characteristics of IXT in children with myopia and myopic anisometropia.Methods We retrospectively evaluated the clinical data of patients(4–15 years of age)with convergence insufficiency(CI)-IXT and basic IXT who underwent surgery between 2022 and 2023.All patients underwent cycloplegia before the examinations and surgery.The degree of strabismus was measured when the patient viewed from the center of the glasses.Ocular dominance was routinely tested in children with IXT via the“hole-in-card test”after best-corrected visual acuity was obtained.Children were subsequently grouped into 2 groups(anisometropia and nonanisometropia)according to the difference in binocular spherical equivalent(SE)values(≥1.0 diopters[D]).Results A total of 197 patients were included in the study.The preoperative deviation at near was significantly lower in the basic IXT group than in the CI-IXT group,whereas the distance exodeviation was significantly greater in the basic IXT group than in the CI-IXT group(P<0.05).Patients with anisometropia were older than those without anisometropia(P<0.001).The dominant eyes had significantly less myopia than the nondominant eyes did in the CI-IXT and anisometropia groups(P=0.049 and P=0.003,respectively).High myopia was more prevalent in middle school students with IXT(16.67%)than in preschool students(4.55%)and primary schoolchildren(3.18%).The percentage of individuals with anisometropia(≥3.0 D)varied in the low(1.68%),moderate(8.7%),and high myopia groups(22.22%).Binomial logistic regression analysis revealed that age and SE of the dominant eye were independent factors related to anisometropia in children with IXT(P<0.001 and P<0.001,respectively).Conclusion Patients with IXT,especially those with anisometropia and CI-IXT,were shown to have less myopia in the dominant eye.Age and SE of the dominant eye were found to be independent factors related to anisometropia in children with IXT.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
AIM:To summarize publication trends in the field of strabismus over the past 30y and predict future research hotspots.METHODS:A total of 2915 English-language articles and reviews on strabismus,published between 1993 ...AIM:To summarize publication trends in the field of strabismus over the past 30y and predict future research hotspots.METHODS:A total of 2915 English-language articles and reviews on strabismus,published between 1993 and 2022,were retrieved from the Web of Science Core Collection.Bibliometric analyses were performed using VOSviewer and CiteSpace software to explore publication trends,as well as the contributions and collaborative networks of countries/regions,authors,institutions,and journals.RESULTS:The annual number of publications on strabismus showed a consistent upward trend.The United States(USA)maintained a leading position in this research field while Republic of Korea and China emerged as rapidly advancing contributors over the last decade.The University of California,Los Angeles ranked as the most productive institution,and Jonathan M.Holmes from USA was the most productive author.Journal of AAPOS was the leading journal with the most strabismus publications,whereas the two most highly cited articles were both published in Ophthalmology.Co-occurrence analysis identified pivotal keywords and burst terms,including intermittent exotropia(IXT),acute acquired comitant esotropia(AACE),functional magnetic resonance imaging(fMRI),and surgical treatment,which were confirmed as predominant and frontier topics.CONCLUSION:This study provides a comprehensive bibliometric analysis of strabismus research,revealing the evolution of research hotspots over the past 30y and outlining several cutting-edge directions for future investigation.展开更多
AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retro...AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.展开更多
AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in...AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparityonly components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests,respectively. Patients with a long disease course(>1 y) had worse dynamic stereopsis than those with a short disease course(<1 y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparityonly, or the motion-only test components(all P>0.05, Chisquare test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.展开更多
AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underw...AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success[≤5 prism diopters(PD)esophoria(E)to≤10 PD exophoria(X)on the postoperative sixth month]were enrolled in this study.Their consecutive survival on the postoperative first year,second year and third year and at the last visit of fourth year or more,and the factors that might affect their survival,were analyzed.The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group(≤5 PD E to≤10 PD X)and the failure group(】5 PD esodeviation or】10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%,92.89%,83.70%and 50.49%on the postoperative first,second and third years and fourth year or more,respectively.None of the clinical factors was determined to have affected the survival.The amount of the exodrift was largest(2.29 PD)between the first year and the second year,and smallest(1.47 PD)between the fourth year and the last visit.Sixty-three patients had their final visit after the postoperative fourth year,and 29 of them were in the failure group.Twentyfive patients in the failure group had an intermittent exotropia(IXT)of【20 PD with good to fair distant fusion;two had an IXT of【20 PD with poor distant fusion;one had an IXT of≥20 PD with fair distant fusion;and another had delayed-onset consecutive esotropia.The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group(2.81 PD vs 5.86 PD,P=0.012).The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift,but the amount of the exodrift decreases with long-term follow-up.The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients.A smaller deviation on the postoperative sixth month is associated with long-term survival.展开更多
AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral re...AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.展开更多
AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for...AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：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.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative 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.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：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.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.展开更多
AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHOD...AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHODS： This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2 y. The results were evaluated at 2 y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1 wk was used to evaluate relationship with long-term outcome. The longterm outcome was classified into 3 groups： successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters（PD） and exodeviation 10 PD.RESULTS： Forty-two patients were enrolled. The mean age at surgery was 26 y（range, 15-49 y）. The median follow-up period was 30 mo（range, 24-108 mo）. Successful outcome was found in 81% of patients at 2 y and in 71% at the final visit. Overcorrection at 1 wk postoperatively was associated with a successful outcome at 2 y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome（RR=2.2）. The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2 y.CONCLUSION： Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1 wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.展开更多
AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic reson...AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic resonance imaging（f MRI） data.METHODS： Totally, 32 CEs（25 males and 7 females） and 32 healthy control subjects（HCs）（25 males and 7 females） were enrolled in the study and underwent the MRI scanning. Two-sample t-test was used to examine differences in FC maps between the CE patients and HCs. RESULTS： The CE patients showed significantly less FC between the left brodmann area（BA17） and left lingual gyrus/cerebellum posterior lobe, right middle occipital gyrus, left precentral gyrus/postcentral gyrus and right inferior parietal lobule/postcentral gyrus. Meanwhile, CE patients showed significantly less FC between right BA17 and right middle occipital gyrus（BA19, 37）.CONCLUSION： Our findings show that CE involves abnormal FC in primary visual cortex in many regions, which may underlie the pathologic mechanism of impaired fusion and stereoscopic vision in CEs.展开更多
AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Kno...AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Knowledge Infrastructure were searched prior to December 16,2019.From this broad database search,we performed some Meta-analysis including eleven independent studies,to further evaluate the outcome(s)when comparing early versus late surgery for IXT.The boundaries between early and late surgery and the surgery methods were not inconsistent,so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches.The pooled odds ratios(ORs)and the 95%confidence interval(CI)were estimated according to the random-effects model for high heterogeneity between studies.RESULTS:Eleven retrospective studies were included in this Meta-analysis.No significant difference between early and late surgery was observed for IXT patients(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final follow-up)=1.48,95%CI 0.94-2.31,P=0.09).However,sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable.Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession(BLR)subgroup for the final follow-up(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=2.25,95%CI 1.36-3.74,P=0.00).CONCLUSION:Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.展开更多
Objective： To investigate the time and postoperative binocular vision of strabismus surgery for children with intermittent exotropia （X（T））. Methods： A retrospective investigation was conducted in 80 child patie...Objective： To investigate the time and postoperative binocular vision of strabismus surgery for children with intermittent exotropia （X（T））. Methods： A retrospective investigation was conducted in 80 child patients with intermittent exotropia. Pre- and postoperative angles of deviation fixating at near （33 cm） and distant targets （6 m） were measured with the prolonged alternate cover testing. The binocular function was assessed with synoptophore. Twenty-one patients took the postoperative synoptophore exercise. Results： （1） A week after surgery, 96.2% of the 80 patients had binocular normotopia, while a year after surgery, 91.3% of the 80 patients had binocular normotopia; （2） Preoperatively, 58 patients had near stereoacuity, while postoperatively, 72 patients achieved near stereoacuity （P〈0.05）; （3） Preoperatively, 64 patients had Grade Ⅰ for the synoptophore evaluation and postoperatively, 76 patients achieved Grade Ⅰ. Meanwhile, 55 patients had Grade Ⅱ preoperatively and 72 achieved Grade Ⅱ postoperatively. For Grade Ⅲ, there were 49 patients preoperatively and 64 patients postoperatively （P〈0.05）; （4） Patients of 5-8 years old had a significantly better recovery rate of binocular vision than those of 9-18 years old （P〈0.05）; （5） Patients taking postoperative synoptophore exercise had a better binocular vision than those taking no exercise （P〈0.05）. Conclusions： （1） Strabismus surgery can help to preserve or restore the binocular vision for intermittent exotropia; （2） Receiving the surgery at young ages may develop better postoperative binocular vision; （3） The postoperative synoptophore exercise can help to restore the binocular vision.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.82371093 and No.81970844).
文摘Objective Previous studies have yielded contradictory conclusions on the relationship between intermittent exotropia(IXT)and the magnitude of myopia,especially in children.The aim of this study was to determine the clinical characteristics of IXT in children with myopia and myopic anisometropia.Methods We retrospectively evaluated the clinical data of patients(4–15 years of age)with convergence insufficiency(CI)-IXT and basic IXT who underwent surgery between 2022 and 2023.All patients underwent cycloplegia before the examinations and surgery.The degree of strabismus was measured when the patient viewed from the center of the glasses.Ocular dominance was routinely tested in children with IXT via the“hole-in-card test”after best-corrected visual acuity was obtained.Children were subsequently grouped into 2 groups(anisometropia and nonanisometropia)according to the difference in binocular spherical equivalent(SE)values(≥1.0 diopters[D]).Results A total of 197 patients were included in the study.The preoperative deviation at near was significantly lower in the basic IXT group than in the CI-IXT group,whereas the distance exodeviation was significantly greater in the basic IXT group than in the CI-IXT group(P<0.05).Patients with anisometropia were older than those without anisometropia(P<0.001).The dominant eyes had significantly less myopia than the nondominant eyes did in the CI-IXT and anisometropia groups(P=0.049 and P=0.003,respectively).High myopia was more prevalent in middle school students with IXT(16.67%)than in preschool students(4.55%)and primary schoolchildren(3.18%).The percentage of individuals with anisometropia(≥3.0 D)varied in the low(1.68%),moderate(8.7%),and high myopia groups(22.22%).Binomial logistic regression analysis revealed that age and SE of the dominant eye were independent factors related to anisometropia in children with IXT(P<0.001 and P<0.001,respectively).Conclusion Patients with IXT,especially those with anisometropia and CI-IXT,were shown to have less myopia in the dominant eye.Age and SE of the dominant eye were found to be independent factors related to anisometropia in children with IXT.
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.
基金Supported by National Natural Science Foundation of China(No.82020108006,No.81730025).
文摘AIM:To summarize publication trends in the field of strabismus over the past 30y and predict future research hotspots.METHODS:A total of 2915 English-language articles and reviews on strabismus,published between 1993 and 2022,were retrieved from the Web of Science Core Collection.Bibliometric analyses were performed using VOSviewer and CiteSpace software to explore publication trends,as well as the contributions and collaborative networks of countries/regions,authors,institutions,and journals.RESULTS:The annual number of publications on strabismus showed a consistent upward trend.The United States(USA)maintained a leading position in this research field while Republic of Korea and China emerged as rapidly advancing contributors over the last decade.The University of California,Los Angeles ranked as the most productive institution,and Jonathan M.Holmes from USA was the most productive author.Journal of AAPOS was the leading journal with the most strabismus publications,whereas the two most highly cited articles were both published in Ophthalmology.Co-occurrence analysis identified pivotal keywords and burst terms,including intermittent exotropia(IXT),acute acquired comitant esotropia(AACE),functional magnetic resonance imaging(fMRI),and surgical treatment,which were confirmed as predominant and frontier topics.CONCLUSION:This study provides a comprehensive bibliometric analysis of strabismus research,revealing the evolution of research hotspots over the past 30y and outlining several cutting-edge directions for future investigation.
文摘AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.
基金Supported by National Natural Science Foundation of China (No.81600761)the Natural Science Foundation Team Projectof Guangdong Province (No.2015A030312016)
文摘AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparityonly components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests,respectively. Patients with a long disease course(>1 y) had worse dynamic stereopsis than those with a short disease course(<1 y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparityonly, or the motion-only test components(all P>0.05, Chisquare test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.
文摘AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success[≤5 prism diopters(PD)esophoria(E)to≤10 PD exophoria(X)on the postoperative sixth month]were enrolled in this study.Their consecutive survival on the postoperative first year,second year and third year and at the last visit of fourth year or more,and the factors that might affect their survival,were analyzed.The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group(≤5 PD E to≤10 PD X)and the failure group(】5 PD esodeviation or】10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%,92.89%,83.70%and 50.49%on the postoperative first,second and third years and fourth year or more,respectively.None of the clinical factors was determined to have affected the survival.The amount of the exodrift was largest(2.29 PD)between the first year and the second year,and smallest(1.47 PD)between the fourth year and the last visit.Sixty-three patients had their final visit after the postoperative fourth year,and 29 of them were in the failure group.Twentyfive patients in the failure group had an intermittent exotropia(IXT)of【20 PD with good to fair distant fusion;two had an IXT of【20 PD with poor distant fusion;one had an IXT of≥20 PD with fair distant fusion;and another had delayed-onset consecutive esotropia.The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group(2.81 PD vs 5.86 PD,P=0.012).The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift,but the amount of the exodrift decreases with long-term follow-up.The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients.A smaller deviation on the postoperative sixth month is associated with long-term survival.
文摘AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.
文摘AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：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.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative 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.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：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.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.
基金Supported by the Ratchadapiseksompoch Fund (No.RA57/046)
文摘AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHODS： This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2 y. The results were evaluated at 2 y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1 wk was used to evaluate relationship with long-term outcome. The longterm outcome was classified into 3 groups： successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters（PD） and exodeviation 10 PD.RESULTS： Forty-two patients were enrolled. The mean age at surgery was 26 y（range, 15-49 y）. The median follow-up period was 30 mo（range, 24-108 mo）. Successful outcome was found in 81% of patients at 2 y and in 71% at the final visit. Overcorrection at 1 wk postoperatively was associated with a successful outcome at 2 y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome（RR=2.2）. The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2 y.CONCLUSION： Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1 wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.
基金Supported by the National Natural Science Foundation of China(No.81660158No.81160118No.81400372)
文摘AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic resonance imaging（f MRI） data.METHODS： Totally, 32 CEs（25 males and 7 females） and 32 healthy control subjects（HCs）（25 males and 7 females） were enrolled in the study and underwent the MRI scanning. Two-sample t-test was used to examine differences in FC maps between the CE patients and HCs. RESULTS： The CE patients showed significantly less FC between the left brodmann area（BA17） and left lingual gyrus/cerebellum posterior lobe, right middle occipital gyrus, left precentral gyrus/postcentral gyrus and right inferior parietal lobule/postcentral gyrus. Meanwhile, CE patients showed significantly less FC between right BA17 and right middle occipital gyrus（BA19, 37）.CONCLUSION： Our findings show that CE involves abnormal FC in primary visual cortex in many regions, which may underlie the pathologic mechanism of impaired fusion and stereoscopic vision in CEs.
基金Supported by the Natural Science Foundation of Tianjin(No.18JCZDJC36400)。
文摘AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Knowledge Infrastructure were searched prior to December 16,2019.From this broad database search,we performed some Meta-analysis including eleven independent studies,to further evaluate the outcome(s)when comparing early versus late surgery for IXT.The boundaries between early and late surgery and the surgery methods were not inconsistent,so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches.The pooled odds ratios(ORs)and the 95%confidence interval(CI)were estimated according to the random-effects model for high heterogeneity between studies.RESULTS:Eleven retrospective studies were included in this Meta-analysis.No significant difference between early and late surgery was observed for IXT patients(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final follow-up)=1.48,95%CI 0.94-2.31,P=0.09).However,sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable.Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession(BLR)subgroup for the final follow-up(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=2.25,95%CI 1.36-3.74,P=0.00).CONCLUSION:Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.
基金Project supported by the National Natural Science Foundation of China(No.30600693)Department of Education of Zhejiang Province(No.20030236),China
文摘Objective： To investigate the time and postoperative binocular vision of strabismus surgery for children with intermittent exotropia （X（T））. Methods： A retrospective investigation was conducted in 80 child patients with intermittent exotropia. Pre- and postoperative angles of deviation fixating at near （33 cm） and distant targets （6 m） were measured with the prolonged alternate cover testing. The binocular function was assessed with synoptophore. Twenty-one patients took the postoperative synoptophore exercise. Results： （1） A week after surgery, 96.2% of the 80 patients had binocular normotopia, while a year after surgery, 91.3% of the 80 patients had binocular normotopia; （2） Preoperatively, 58 patients had near stereoacuity, while postoperatively, 72 patients achieved near stereoacuity （P〈0.05）; （3） Preoperatively, 64 patients had Grade Ⅰ for the synoptophore evaluation and postoperatively, 76 patients achieved Grade Ⅰ. Meanwhile, 55 patients had Grade Ⅱ preoperatively and 72 achieved Grade Ⅱ postoperatively. For Grade Ⅲ, there were 49 patients preoperatively and 64 patients postoperatively （P〈0.05）; （4） Patients of 5-8 years old had a significantly better recovery rate of binocular vision than those of 9-18 years old （P〈0.05）; （5） Patients taking postoperative synoptophore exercise had a better binocular vision than those taking no exercise （P〈0.05）. Conclusions： （1） Strabismus surgery can help to preserve or restore the binocular vision for intermittent exotropia; （2） Receiving the surgery at young ages may develop better postoperative binocular vision; （3） The postoperative synoptophore exercise can help to restore the binocular vision.
