회선 편위란 각막의 정점과 황반부를 잇는 축을 중심 으로 회선되어 있는 사시를 말하며 1 내회선을 담당하는 상사근과 상직근, 외회선을 담당하는 하사근과 하직근 의 근육간의 불균형이 원인이다. 2 회선복시, 어지럼증 과 같은 회선사시의 증상들은 임상에서 보기 어렵기 때문에 회선 사시에 대한 연구는 많이 이루어지지 않 았다.그러나 안구의 회선여부를 관찰하여 상사근마비에서 발병 시기의 유추, 가면된 상사근마비의 진단, 떨어진 눈증후군(Fallen eye syndrome)에서 마비안의 판 별, 해리수직편위와 하사근기능항진의 감별, 수직사시 가 있는 환자에서 사근의 마비인지 수직근의 마비인지 감별하는데 도움을 주는 등 임상적으로 많은 효용성이 있으며, 비록 회선의 증상이 없다고 하더라도 수직사시 를 가진 환자의
Purpose: The authors report their experience with four cases of paralytic exotropia from a pit viper snakebite, accompanied with a literature review. Methods: Four patients (two males and two females) visited the emergency room in the hospital with symptoms including diplopia, limitation of eye movement, exotropia, and blepharoptosis, after being bitten by a presumed pit viper, and were treated by antivenom. Results: No visual disturbance was observed in the first examination, while limitation of adduction was found in four cases in the ocular movement test. As to the type of tropia, three patients showed intermittent exotropia and the other showed exotropia. The angle of strabismus in the distance was 20]30 prism diopters (PD) while that in the near was 1835 PD. Two cases were accompanied with blepharoptosis. Except one case which was unavailable for follow-up observation, three cases became normal in diplopia, blepharoptosis, and limitation of ocular movement between the 4th and 11th day after the snakebite. Conclusions: Neurotoxicity induced by a pit viper snakebite is rare. However, neurotoxicity including strabismus and blepharoptosis can occur because extraocular muscles have a higher ratio of nerve fibers to the extraocular muscle fibers compared with skeletal muscles.
To evaluate the efficacy of anterior segment swept-source optical coherence tomography (SS-OCT) for examining horizontal extraocular muscle thickness, distance from the corneal limbus to the insertion of the horizontal extraocular muscle (limbus to insertion distance), and scleral thickness in Korean pediatric strabismus patients.This study included pediatric strabismus patients between 5 and 10 years of age. Children with any ocular disease other than strabismus or a history of ocular surgery were excluded. SS-OCT was used to measure horizontal extraocular muscle thickness, limbus to insertion distance, and scleral thickness. Eyes were classified into subgroups by sex, spherical equivalent of the refractive error (measured with cycloplegic refraction), and fixating/deviating eye.One patient initially included in this study was excluded due to poor cooperation. Of the remaining 35 eyes of 20 patients, 19 eyes (54.3%) were from male patients and 16 eyes (45.7%) were from female patients. The mean patient age was 7.86 ± 1.38 years. Lateral scleral thickness was greater in male eyes than in female eyes (p = 0.048). No other differences were noted between male and female children. Additionally, there were no statistically significant differences between fixating and deviating eyes or among spherical equivalent groups for any parameter examined.Anterior segment SS-OCT can successfully and comfortably measure horizontal extraocular muscle and scleral anatomy in children. These measurements may be helpful for treatment and follow-up of pediatric strabismus patients.
Purpose: This study examines the change in distance from the corneal limbus to the insertion of the rectus muscles before and after disinsertion and retraction with a pair of fixation forceps during strabismus surgery. Methods: In 38 strabismus patients, on 30 medial rectus muscles and 38 lateral rectus muscles, before and after disinsertion and retraction with a pair of fixation forceps, the distances from the corneal limbus to the upper, middle and lower parts of the insertion of the medial and lateral rectus muscles marked with methylene blue solution were measured. Results: The distances between the corneal limbus and upper, middle and lower parts of the insertion after the disinsertion were reduced on, average 0.23 mm, 0.28 mm, and 0.18 mm, for the medial rectus muscle, respectively, and 0.21 mm, 0.28 mm, and 0.15 mm, for the lateral rectus muscle, respectively (P
Purpose: To identify differences in the refractive error of postoperative intermittent exotropia patients.Methods: A total of 71 patients who had an average refractive error of 2 D and a follow-up of more than 6 months after unilateral recession-resection (R&R) for intermittent exotropia were included in this study.Patients were divided into 3 groups according to their refractive error: Group 1, ≤-1.0 D; Group 2, -1.0 D ~ +1.0 D; Group 3, ≥+1.0 D. The amounts of deviation 1 day after surgery and 6 months after surgery were evaluated.Results: Out of the 71 total patients included in this study, group 1 included 20 patients, group 2 included 39, and group 3 included 12.The average refractive error in groups 1, 2, and 3 was -2.2 ± 0.9 D, 0.0 ± 0.4 D and +1.9 ± 0.9 D, respectively.The angle of deviation 1 day after surgery was measured in the 3 groups; A result labeled '+' was considered to be exodeviation and a result labeled '-' was considered to be esodeviation.The angle of deviation results for groups 1, 2, and 3 one day after surgery were -6.7 ± 6.0 PD, -7.5 ± 5.8 PD and -7.3 ± 5.9 PD (p = 0.937), respectively, and the results 6 months after surgery were +2.2 ± 4.3 PD, +4.7 ± 5.9 PD and +1.8 ± 2.8 PD (p = 0.076), respectively.Among the 3 groups, no statistically significant difference was observed in postoperative angle of deviation after 6 months.Conclusions: In basic intermittent exotropia patients with an average refractive error of 2 D, the amount of refractive error makes no difference in strabismus surgical outcomes.
To evaluate the effect of improvement in the control grade of intermittent exotropia using part-time occlusion therapy on the final postoperative outcome.Control of intermittent exotropia was graded as good, fair, or poor in 89 consecutive patients with intermittent exotropia during their first visit. The patients were reevaluated after part-time preoperative occlusion therapy and divided into two groups (improvement and no improvement) according to whether they showed improvement in control grade. The surgical success rate was compared retrospectively between the two groups.The mean angle of deviation on the first visit was 27.61 ± 5.40 prism diopters (PD) at distance and 29.82 ± 5.28 PD at near. There were significant improvements in the angles of deviation for distance (26.17 ± 5.09 PD) and near (27.26 ± 5.56 PD) after part-time occlusion (both P < .001). The 49 patients who had a significantly improved control grade had a significantly better surgical success rate (77.6%) than the 40 patients who did not (50%; P = .007).Part-time occlusion therapy improves the control grade of intermittent exotropia, leading to a better likelihood of successful surgery and a reduction of the angles of deviation for distance and near. [J Pediatr Ophthalmol Strabismus. 2018;55(1):59-64.].
Purpose:The purpose of this study is to compare the surgical outcomes and near stereoacuities after unilateral medial rectus (MR) muscle resection and lateral rectus (LR) recession according to deviation angle in basic intermittent exotropia, X(T).Methods: Ninety patients with basic type X(T) were included in this study.They underwent unilateral recession of the LR and resection of the MR and were followed postoperatively for at least 12 months.Patients were divided into three groups according to their preoperative deviation angle: group 1 ≤20 prism diopter (PD), 20 PD< group 2 <40 PD, and group 3 ≥40 PD.Surgical outcomes and near stereoacuities one year after surgery were evaluated.Surgical success was defined as having a deviation angle range within ±10 PD for both near and distance fixation.Results: Among 90 patients, groups 1, 2, and 3 included 30 patients each.The mean age in groups 1, 2, and 3 was 9.4 years, 9.4 years, and 11.0 years, respectively.The surgical success rates one year after surgery for groups 1, 2, and 3 were 80.0%, 73.3%, and 73.3% (chi-square test, p = 0.769), respectively.The undercorrection rates for groups 1, 2, and 3 were 16.7%, 23.3%, and 26.7%, and the overcorrection rates were 3.3%, 3.3%, and 0%, respectively.The mean preoperative near stereoacuities for groups 1, 2, and 3 were 224.3 arcsec, 302.0 arcsec, and 1,107.3arcsec, and the mean postoperative near stereoacuities were 218.3 arcsec, 214.7 arcsec, and 743.0 arcsec (paired t-test; p = 0.858, p = 0.379, p = 0.083), respectively.Conclusions: In basic X(T) patients, the amount of angle deviation has no influence on surgical outcomes in unilateral LR recession and MR resection.The near stereoacuities by one year after LR recession and MR resection for intermittent X(T) were not different among patient groups separated by preoperative deviation angle.
This study was conducted to identify the relationship between control grade, stereoacuity and surgical success in basic intermittent exotropia.This retrospective study involved 44 basic intermittent exotropia patients who underwent strabismus surgery and completed at least 6 months of follow-up. The 44 patients were divided into three subgroups according to their control grade: group 1 (good control group, n = 12), group 2 (fair control group, n = 18), and group 3 (poor control group, n = 14). Evaluation was done to identify the relationships between near and distance stereoacuity and control grade, and between surgical success and control grade. Surgical success was defined as ocular alignment between 5 prism diopters esodeviation and 10 prism diopters exodeviation in the primary position at the final visit.Mean near stereoacuity measured by the graded circle test was 57.50 seconds of arc (seconds) in group 1, 77.77 seconds in group 2, and 131.43 seconds in group 3 (p < 0.01). Mean distance steroacuity measured by Mentor B-VAT II BVS contour circle was 108.33 seconds in group 1, 148.33 seconds in group 2, and 262.82 seconds in group 3 (p < 0.01). Ten patients (83.33%) in group 1, 12 (66.67%) in group 2, and 9 (64.29%) in group 3 obtained surgical success (p = 0.28).In basic intermittent exotropia, better control grade was significantly accompanied by better stereoacuity. Better control grade was accompanied by higher surgical success rate but with no statistical significance.
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