Postoperative Recovery of Stereopsis in Longstanding Adult Constant-Horizontal Strabismus
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Abstract:
Purpose: To evaluate postoperative binocularity after surgical correction of longstanding constant-horizontal adult strabismus without both stereopsis and previous surgery. Methods: Subjects included 43 adults over 18 years of age, who had constant-horizontal strabismus for more than 10 years without previous surgery and stereopsis. The patients were composed of 30 exotropes and 13 esotropes. Patients with a corrected visual acuity less than 20/40 in the deviating eye were excluded. After correcting for refractive error, the angle of deviation was measured, and pre- and postoperative stereopsis was assessed with the Titmus fly test(R) and Randot stereo test. The relationship between duration of deviation and recovery of stereopsis or obtained stereoacuity were evaluated. Results: The mean preoperative angle of deviation was 49.812.56 PD in exotropes and 34.712.41 PD in esotropes. All patients showed suppression of the deviating eye at distance and near before surgery. Postoperatively all patients showed orthophoria within 8 PD. Stereopsis was obtained in 80% of exotropes and in 30.8% of esotropes. The mean postoperative stereoacuity was 449.2815.29 seconds of arc (sec) in exotropes and 10001336.66 sec in esotropes. However, there was no significant relationship between the duration of deviation and the obtained stereoacuity (p>0.05), or between the duration of deviation and the recovery of stereopsis (p>0.05). Conclusions: Adults with longstanding constant-horizontal strabismus more than 10 years obtained stereopsis with good quality after surgical correction. The recovery of stereopsis was much better in exotropes than in esotropes. Recovery was not influenced by the duration of deviation.Keywords:
Stereoscopic acuity
Strabismus Surgery
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Aphakia
Monocular
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Purpose: To investigate about the influence of acquired strabismus, its angle and stereopsis on visual evoked potential (VEP). Methods: This study included 30 accommodative esotropes and 30 intermittent exotropes aged 5 to 10, who had not undergone strabismus surgery. Partially accommodative esotropes were excluded. Angle of deviation, stereopsis, and refractive error were measured in all subjects. The values of VEP to monocular and binocular pattern stimulation were recorded. Statistical significance were tested by t-test and Kruskall-Wallis test. Results: In intermittent exotropes, the P100 amplitude of deviating eye was smaller than that of normal eye in the test with 88 and 1616 check size (p16 check size was significantly short in intermittent exotropes, comparing to the normal eye. Angle of deviation and stereopsis did not influence on VEP. Conclusions: Acquired strabismus occurring beyond the end of the visual critical period can influence on VEP, but angle of deviation and stereopsis could not.
Esotropia
Monocular
Evoked potential
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Purpose: To determine the predictive factors of post-operative stereopsis in patients with strabismus. Method: In this retrospective study, records of patients who received surgical treatment for strabismus were reviewed. All types of strabismus were included. Pre- and post-treatment stereoacuity were measured using the Titmus Stereo Fly test, and predictive factors of stereopsis were evaluated. Results: A total of 194 patients (132 females and 62 males) with a mean age of 14.8 ± 8.4 years were included. There was a statistically significant improvement in stereopsis following surgery ( p value < 0.001). Patients with a higher amount of deviation at baseline had poorer stereopsis on the final examination ( p value < 0.001). Stereopsis improvement was more prominent in the pure horizontal strabismus group, compared to combined horizontal and vertical deviations. Baseline and the final stereopsis were higher in the “exotropia” group as compared to the “esotropia” group ( p value = 0.003 and 0.0155, respectively); however, the within group change of stereopsis was not significantly different between these two groups ( p value = 0.144). Post surgical residual deviation was associated with a poorer stereopsis ( p value = 0.002, r = 0.251). A longer duration of strabismus before surgery was associated with poorer final stereopsis levels ( p value = 0.026). The presence of amblyopia before surgery was associated with poorer stereopsis on last examination ( p value < 0.001 for both correlations). Conclusion: Based on the result of this study, final stereopsis after strabismus surgery could be affected by the type, duration, and the amount of deviation before surgery, amblyopia, and post operative ocular deviation.
Stereoscopic acuity
Esotropia
Strabismus Surgery
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To evaluate the factors affecting improvement of stereopsis following successful surgical correction of childhood strabismus in adults.In a prospective study, consecutive patients with childhood-onset, comitant, horizontal, constant strabismus; stereoacuity of more than 480 seconds of arc in TNO stereo test (absent stereopsis in TNO); and who had successful postoperative alignment (within 10 prism diopters [PD] of orthotropia) were enrolled. Postoperative stereopsis testing was performed using the TNO stereo test at 3 months after surgery.A total of 34 patients (20 exotropes and 14 esotropes) were included. The mean age at the time of surgery was 26.08±10.53 years (range, 14-53 years). Stereopsis was improved in 8 of 34 patients (23.5%). Postoperative alignment had influence on improvement of stereopsis; 38.1% of patients who had orthotropia gained stereopsis, whereas none of patients who had horizontal heterotropia (esotropia or exotropia) of 10 PD or less gained stereopsis (p=0.01). Misalignment of 10 years' duration or longer did not preclude the development of postoperative stereoacuity (p=0.31). There was a statistically insignificant increase in improvement of stereopsis in nonamblyopic group (30.4%) compared with amblyopic group (9.1%) (p=0.22). Also, there was a statistically insignificant increase in improvement of stereopsis in exotropes (35%) compared with esotropes (7.1%) (p=0.1). The angle of preoperative deviation had no influence on improvement of stereopsis (p=0.44).A postoperative correction of orthotropia was the only predictive factor for improvement of stereopsis in adults with childhood strabismus.
Stereoscopic acuity
Esotropia
Strabismus Surgery
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Esotropia
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Stereoscopic acuity
Esotropia
Anisometropia
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Purpose: To evaluate the postoperative changes of stereopsis after surgical correction of adult strabismus. Methods: We retrospectively evaluated strabismus patients older than 16 years at the time of operation at our hospital between April of 1999 and December of 2006. We retrospectively examined the medical records of 53 exotropia and 11 esotropia patients. We divided the pre-operative stereopsis into three groups:above 3000 arc of sec, between 3,000 to 100 arc of sec, and below 100 arc of sec. We analyzed the correlation between the post-operative status of stereopsis and the pre-op type of strabismus, the onset and duration of strabismus, and the presence or absence of amblyopia. Results: In patients who had pre-op stereopsis above 3,000 arc of sec, 31.6% showed improvement, whereas 77.8% of patients who had pre-operative stereopsis between 3,000~100 showed improvement; this value was 89.5% for patients with pre-operative stereopsis below 3000. 94.5% of patients in the intermittent exotropia group who had a good pre-operative stereopsis condition showed postoperative improvement and maintenance. For those patients with poor stereopsis at pre-operative, 32.2% of patients with exotropia and 18.1% of patients with esotropia showed improvement. Stereopsis decreased when consecutive esotropia occurred. Conclusions: This study showed deterioration of stereopsis in patients with consecutive esotropia. Post-operative stereopsis was correlated with the pre-operative stereopsis status and with the type of strabismus. No other factors that we examined were correlated with stereopsis. Post-operative stereopsis in exotropiaand intermittent exotropia were better than esotropia and constant exotropia. J Korean Ophthalmol Soc 2008;49(11):1807-1811
Esotropia
Intermittent exotropia
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Many studies have shown that patients with intermittent exotropia have different degrees of damage to their stereopsis function. The purpose of this study is to explore the effect of different refractive status on stereopsis in children with intermittent exotropia(IXT).We assessed 90 children of ages 4~ 16 years with intermittent exotropia at the Second Affiliated Hospital of Dalian Medical University during the years 2016-2017. According to their refractive status, the patients were divided into hyperopia group(spherical equivalent > or = - 1.00 diopters), myopia group(spherical equivalent < or = - 1.00 diopters), emmetropia group (spherical equivalent diopter: within ±1.00DS) and anisometropia group(binocular equivalent spherical difference > or = 1.50 diopter). The distant stereopsis of the patient was checked by the synoptophore, and the near stereopsis of the patients was checked by the Titmus stereogram. Then, we compared the difference between distant stereopsis and near stereopsis in the four groups.(1)The retention rates of distant stereopsis in the hyperopia group, emmetropia group, myopia group and anisometropia group were 33.3, 45.2, 34.6, and 33.3%, respectively. There was no significant difference between the groups with different refractive status. (2)The retention rates of near stereopsis in the hyperopia group, emmetropia group, myopia group and anisometropia group were 66.7, 83.9, 80.8, and 55.6%, respectively. There were statistically significant differences between the emmetropia group and the anisometropia group (P = 0.030). (3)The retention rate of distant stereopsis in children with intermittent exotropia was 37.8%, and the retention rate of near stereopsis was 74.4%. The difference between the two groups was statistically significant (P = 0.019).The damage to distant stereopsis in children with intermittent exotropia is more serious than that to near stereopsis. The damage to near stereopsis in children with intermittent exotropia and anisometropiais more serious.
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Objective] To investigate the rebuilding and the influencer of the stereopsis in the concomitant strabismus patients pre- and post-operation.[Methods] The deviation degree and visual function examination were performed by the synoptophore and prism pre- and post-operation in 128 concomitant strabismus patients.[Results] In 128 concomitant strabismus patients, 79 patients acquired stereopsis. The functional cure rate was 61.72%. The difference between pre and post opreation was significant. The episode age, operative age, strabismus property, preoperative corrected visual acuity, deviation degree, and postoperative eye position were all significantly correlative with the postoperative stereopsis.[Conlusions] The strabismus play an important influence in the development of stereopsis. The early correction of eye position will benefit the restoration of stereopsis and the achievement of functional cure.
Concomitant
Strabismus Surgery
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Objective
To investigate the optimal timing for surgery in early-onset exotropia(XT) and the long-term postoperative effect.
Methods
One hundred eleven cases diagnosed with XT before 3 years old who were followed up for at least 2 years after surgery were retrospectively analyzed. Logistic regression was used to study the possible factors of the postoperative orthotropia rate and postoperative synoptophore/Titmus stereopsis, such as the age of onset, age at surgery, the type of strabismus, preoperative synoptophore/Titmus stereopsis and postoperative eye position.
Results
Based on a chi-square test and Spearman correlation analysis, classification of intermittent and constant XT had a statistically significant correlation with the rate of long-term orthotropia (χ2= 4.125, P<0.05) . Classification of intermittent and constant XT (χ2=3.951, P<0.05) and the postoperative orthotropia (χ2=4.269, P<0.05) had a statistically significant correlation to postoperative synoptophore stereopsis. Classification of intermittent and constant XT had a statistically significant correlation to postoperative Titmus stereopsis (χ2=6.988, P<0.01) . Logistic regression analysis showed that the classification of intermittent and constant XT was the main factor affecting the long- term orthotropia rate (OR=0.445, P<0.05) . Preoperative synoptophore stereopsis was the main factor affecting postoperative synoptophore stereopsis (OR=10.500, P<0.01) . Preoperative Titmus stereopsis and the classification of intermittent and constant XT were the factors affecting postoperative Titmus stereopsis (OR=11.480, 0.175, P<0.05) .
Conclusion
It is suggested that patients with early-onset XT undergo surgery before the loss of binocular vision function. The loss of stereopsis function and the loss of the ability to control deviation were indications for exotropia surgery.
Key words:
Strabismus surgery; Exotropia; Infantile; Timing of operation; Vision, binocular
Strabismus Surgery
Esotropia
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