Botulinum toxin therapy in exotropia
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Intermittent exotropia
Purpose: To report the clinical characteristics of patients undergoing reoperation after strabismus surgery during childhood. Methods: Sixty-one patients who had undergone strabismus surgery in childhood and later reoperation were included. Age, visual acuity, type of strabismus at the first and second operations and postoperative angle of deviation were analyzed. The causes of reoperation were classified into recurrent, consecutive, or newly developed strabismus. Recurrent strabismus was defined as strabismus developed in the same direction after correction within 10 prism diopters (PD). Consecutive strabismus was defined as strabismus developed in the opposite direction after surgical overcorrection. Results: The mean duration between the first operation and reoperation was 5.6 years. Recurrent exotropia was the most common cause of reoperation. The incidence of vertical strabismus was higher in reoperations than in first operations (4.9 vs 26.2%, P=0.020). Most incidences of vertical strabismus in the reoperation were newly developed after first operation for horizontal strabismus. At the last follow-up, 63.9% had ocular alignment within 10PD in the horizontal plane and within 8PD in the vertical plane. The frequency of amblyopia was 16.4%. Conclusions: Recurrent exotropia was the most common cause of reoperation for strabismus. The incidence of vertical strabismus was higher in reoperations than in first operations. J Korean Ophthalmol Soc 47(6):954-959, 2006
Strabismus Surgery
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The surgical correction of intermittent exotropia occasionally results in a monofixational sensory pattern. Stereopsis as a measure of bifixation was studied preoperatively and postoperatively in 39 cases of intermittent exotropia. Of 26 patients with bifixation, 25 remained so after surgery. Of 13 patients with monofixation, 11 remained unchanged by surgery, one improved, and one lost all binocularity. The presence of preoperative monofixational intermittent exotropia, to explain a monofixation result from intermittent exotropia surgery, is proposed.
Intermittent exotropia
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Purpose: To describe clinical characteristics of horizontal strabismus in Sudanese patients. Study Design: A retrospective chart review (RCR), a hospital-based study. Place and Duration of Study: Al-Neelain Eye Hospital, Khartoum, Sudan, from January 2017 to May 2021. Methods: There were 773 patients, who presented with horizontal strabismus. Data regarding demographics and eye examination including visual acuity, refractive error, and angle of deviation, type of strabismus (intermittent, constant, or alternating)were collected. Data analysis was done by SPSS 23, and statistical significance was set at P< 0.05. Results: The commonest strabismus was esotropia 522(71.5%). There were 415(56.8%) females. Most patients had alternating strabismus 436(59.7%), followed by constant strabismus 206(28.2%). Vision differed by types of strabismus (P =0.032) with worse vision found in esotropia(mean, 0.69±0.34)compared to exotropia (mean, 0.78±0.33). Refractive error varied by types of strabismus. Hyperopia was common with esotropia (mean, +3.9±3.8 D) and myopia was associated with exotropia (-3.4±2.8 D). The main cause of horizontal strabismus was congenital and presence of refractive error. Hyperopia was a major cause of esotropia for children aged 6 – 10 years which was highly significant (P <0.003) and myopia was the primary reason for exotropia at ˃15 years (P =0.485). Conclusion: The most common type of strabismus among Sudanese was esotropia. Causes of strabismus differed by age group with refractive error and congenital disorders accounting for most of the children aged less than six years and myopia for the majority of exotropia aged more than15 years.
Esotropia
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Purpose: The epicanthal fold in Korean children is a common cause of pseudoesotropia. Therefore, the present study was undertaken to evaluate the clinical characteristics of strabismus in children diagnosed with pseudoesotropia. Methods: We reviewed the charts of children diagnosed with strabismus from February 2004 to January 2005. Strabismic children with a history of pseudoesotropia were included in this study. We recorded the age and chief complaints at the time of pseudoesotropia diagnosis as well as the type of strabismus, the visual acuity, chief complaints, and refractive error at the time of strabismus diagnosis. Results: One hundred and two of 734 children with strabismus (13.9%) had a history of pseudoesotropia. The mean age at the time of pseudoesotropia diagnosis was 2.9 years. The mean age at the time of strabismus diagnosis was 4.4 years. The type of strabismus was exotropia in 58 (56.9%) and esotropia in 39 (38.2%) cases. Refractive accommodative esotropia was seen in 89.7% of esotropia cases and the basic type was seen in 86.2% of exotropia cases. The concurrence rate between chief complaints of pseudoesotropia and the type of strabismus diagnosed was lower in exotropia than in esotropia. There was hyperopia in all the esotropia cases, and the distribution of refractive error was variable in exotropia. The frequency of amblyopia was 19.6%. Conclusions: The incidence of strabismus is high in the case of children diagnosed with pseodoesotropia. Therefore, regular examinations for strabismus, refractive error and amblyopia may be necessary.
Esotropia
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Abstract Background The hospital-based cross-sectional study aimed to explore the high risk for Attention-Deficit Hyperactive Disorder (ADHD) in Pediatric inpatients with Strabismus. Methods Using data from the Tianjin Eye Hospital, we performed a study comparing the incidence, risk factors, and severity of ADHD in children with and without strabismus by the SNAP-IV tool. Results A total of 401 patients with strabismus (exotropia:313; esotropia:42; vertical deviation:46) that ranged from 4 to 24 yrs and 200 healthy controls. SNAP screening detected that incidence of ADHD with strabismus was higher than controls (P=0.005).'' Inattentiveness '', as one subitem of SNAP, showed higher score in strabismic patients than control groups (P=0.027) and significantly associated with age (r=-0.126, P=0.011) and gender (r=-0.129, P=0.010). ADHD with exotropia was higher than other strabismus types(P=0.019), especially in intermittent exotropia patients (P=0.025). Additionally, the incidence of ADHD was significantly greater in male (HR = 0.539; 95% CI 0.331 - 0.331; P = 0.013) and left eye corrected visual acuity (the most dominant eyes) (HR = 0.097; 95% CI 0.012 - 0.775; P = 0.028) for strabismus patients. Subitems analysis of SNAP, except for inattentiveness, were only influenced by gender in strabismus group. Concomitant strabismic patients were more likely presented with oppositional defiant (P=0.009). Conclusions Patients with strabismus, especially in those with exotropia, had a high possibility of ADHD, which were closely linked to gender and the dominant eye‘s visual acuity, and might have an increased risk for ADHD .
Esotropia
Cross-sectional study
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Purpose: To investigate whether there has been a changing trend of strabismus surgery in a provincial eye hospital in the central part of China over the past decade. Methods: This was a retrospective analysis of data on all strabismus surgery performed in Shanxi Province Eye Hospital in China during the past 10 years. Recorded characteristics included patient demographics, type of strabismus, age, and gender. Results: A total of 12,327 patients received strabismus surgery in the eye hospital from 2005 to 2014. The number of surgeries increased steadily from 800 in 2005 to 1,723 in 2014 ( P < .01). Constant exotropia was the most common type among all types of strabismus. Superior oblique muscle palsy was the most common type of paralytic strabismus. Exotropia oblique A- and V-pattern type was the most common type of special strabismus. Conclusions: The amount of strabismus surgery increased during the past decade. The proportion of patients with intermittent exotropia increased over time compared to those with other types of strabismus. [ J Pediatr Ophthalmol Strabismus. 2017;54(2):112–116.]
Strabismus Surgery
Esotropia
Southern china
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We undertook a retrospective study to evaluate strabismus surgeries done at the University Hospital and at the University Pediatric Hospital of the Puerto Rico Medical Center.The surgery schedules ranging from January 2003 to December 2007 were reviewed. Three types of strabismus were evaluated, including esotropia, exotropia, and hypertopia. Differences in the distribution of strabismus type according to age group and gender were assessed using the extension of the Fisher's exact test.A total of 120 patients were included (56 males and 64 females); the patients ranged in age from 4 months to 70 years (average: 15.1 years. Analysis of the distribution of strabismus type showed that 63 (52.5%) had esotropia; 49 (40.8%) had exotropia; 4 (3.3%) had hypertropia; 3 (2.5%) had both hypertropia and exotropia; and 1 (0.9%) had both hypertropia and esotropia. Both esotropia and exotropia were significantly (p < 0.0001) more common in children than they were in adults; however, hypertropia and combined strabismus types were more common in adults than they were in children. There was no statistical (p > 0.05) significance found upon analyzing strabismus distribution according to gender.Among patients with this eye disorder at the Puerto Rico Medical Center, the most common type of surgically treated strabismus was esotropia. Further studies will elucidate the prevalence of strabismus in Puerto Rico.
Hypertropia
Esotropia
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Abstract Background To evaluate the distribution pattern and changes of strabismus surgery in northern China. Methods The records of strabismus patients at Qingdao Eye Hospital from January 2014 to December 2019 were reviewed retrospectively. The characteristics analyzed included gender, regional distribution, constituent ratio of age and type of strabismus. Changes during the periods 2014–2016 and 2017–2019 were compared and analyzed. Results A total of 5746 strabismus patients were recruited. The number of strabismus patients was relatively stable each year from 2014 to 2016 but gradually increased each year from 2017 to 2019. Of these, 51.7% (2968/5746) were male, and 48.3% (2778/5746) were female. The majority (89.8%, 5159/5746) of the patients were from Shandong Province. The statistical results of the constituent ratio of age showed that 32.4% (1860/5746) were 7–12 years old (primary school level). Patients under 12 years of age (preschool and primary school level) accounted for 60.0% (3447/5746) of all the patients. In terms of the types of strabismus, exotropia accounted for 63.5% (3650/5746), followed by esotropia and vertical rotational strabismus at 13.2% (758/5746) and 9.7% (555/5746), respectively. Intermittent exotropia was the most common type among the exotropia patients, accounting for 71.3% (2604/3650). Among the patients with intermittent exotropia, 62.5% (1627/2604) were children aged 4–12 years, and the basic type of intermittent exotropia was the main type. Four percent (231/5746) of the patients, of which adult patients comprised the main population, required reoperation. Conclusions Patients with strabismus at primary school level comprised the largest group of strabismus patients in north China. Exotropia was the most common type of strabismus, and intermittent exotropia was the most common type of exotropia. The rate of exotropia to esotropia was 5:1.
Esotropia
Strabismus Surgery
Intermittent exotropia
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To investigate the correlation between strabismus and the severity of white matter damage of immaturity (WMDI), based on MRI findings. Although strabismus is commonly associated with WMDI, its clinical features are not well established.This cross-sectional study involved 73 consecutive patients who visited the department of ophthalmology and were diagnosed with WMDI. The severity of WMDI was graded based on the MRI findings of the patients. All of the patients underwent complete ophthalmic examination, and strabismus was characterised in terms of direction, constancy, and angle of deviation. The prevalence and the characteristics of strabismus and their correlation with the grade of WMDI were investigated.The perinatal characteristics, age at MRI, and the number of MRIs per child did not differ between different grades of WMDI. Refractive errors, found in 56 (76.7%) patients, did not differ between the grades of WMDI either. Strabismus was observed in 38 (52.1%) patients, and its prevalence increased with the grade of the disorder; 20 patients had exotropia and 18 had esotropia. Constant strabismus was found more frequently in patients with higher grade WMDI. However, the direction and angle of deviation did not differ depending on the grade of WMDI.The prevalence of strabismus increased with the severity of WMDI and was higher among patients with WMDI than among healthy individuals. The severity of WMDI might be related to the presence and constancy of strabismus.
Esotropia
Anisometropia
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