Discussion of the optimal timing for surgery in early-onset exotropia and the long-term postoperative effect
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Abstract:
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, binocularKeywords:
Strabismus Surgery
Esotropia
Objective To investigate the relationship between preoperative fusion,age of onset,degree of strabismus,age of operation and postoperative outcome.Methods The preoperative fusion,age of onset and operation,binocular vision function,and the postoperative position of eye and stereopsis in 119 cases of intermittent exotropia were analyzed statistically.Results With and without fusion and stereopsis was significant for intermittent exotropia,and age of operation may had a role.Conclusions Postoperation outcome may be dependent on the age of onset and with or without fusion and stcreopsis,which is significant for binocular function to be cured.
Key words:
Intermittent exotropia ; Operation ; Fusion ; Stereopsis ; Eyeposition ;
Intermittent exotropia
Strabismus Surgery
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Objective
To study the restoration of binocular vision and the factors that impact adults after exotropia surgery.
Methods
Fifty-four adult patients with exotropia were divided into two groups, based on age of onset: before visual maturity(BVM, <9 years old)or after visual maturity(AVM, ≥9 years old). Binocular vision, both distance and near, was checked before surgery and 6 weeks after surgery with a synoptophore and Yan' s digital stereogram.
Results
The restoration rate of distance binocular vision was as follows: For grade I binocular vision, the rate was 77% in the AVM group, which was significantly higher than the rate for the BVM group(33%; χ2=10.240, P<0.01). For grade Ⅱ, the rate was the same as for grade I. For grade III, the rate was 47% in the AVM group and was 17% in the BVM group. Differences between the two groups were statistically significant(χ2=5.400, P<0.05). The restoration rate of near binocular vision was 73% in the AVM group, which was significantly higher than that for the BVM group(29%; χ2=10.461, P< 0.01). Logistic analysis showed that the age of onset and the age at the time of surgery are the important factors affecting the restoration of postoperative distance(OR=6.046, P<0.05; OR=0.140, P< 0.01)and near stereopsis(OR=10.825, P<0.05; OR=0.189, P<0.05). The type of exotropia and the degree of the preoperative strabismus had no marked influences on binocular vision.
Conclusion
Surgical correction of adult exotropia is helpful in the restoration of binocular visual functions and beneficial to obtaining a certain degree of stereopsis. The restoration of distance stereopsis is associated with the age of onset and the age at the time of surgery. The age of onset played a key role in obtaining stereopsis. In order to improve postoperative binocular vision, surgery should be performed as early as possible for adult exotropia patients.
Key words:
Adult; Exotropia; Binocular vision; Stereoacuity
Intermittent exotropia
Strabismus Surgery
Stereoscopic acuity
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Esotropia
Intermittent exotropia
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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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Objective To investigate children intermittent exotropia treatment,analysis stereopsis recovery influencing factors after treatment.Methods Retrospectively analyzed clinical data of 70 consecutive patients of our hospital with intermittent exotropia,from Jan 2010 to Mar 2012.Divided into three groups based on stereoacuity,Compared Preoperative with postoperative stereopsis mean,analyze the influential factors of stereopsis recovery.Results The three group stereopsis mean were lower than the preoperative,had Significant difference,P0.05.In univariate analysis,found that the strabismus age,duration,whether the control is the body and postoperative three-dimensional visual training had significant impact by univariate analysis(P0.05).Multivariate logistic regression,that the strabismus age,duration,postoperative three-dimensional visual training had significant impact by univariate analysis(P0.05).Conclusion Stereoscopic vision in patients after surgery were improved,according to recovery influencing factors to improve the stereopsis recovery effect.
Stereoscopic acuity
Intermittent exotropia
Univariate analysis
Univariate
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The purpose of this study was to investigate serial changes in stereopsis in patients with infantile exotropia during follow-up testing.
Intermittent exotropia
Stereoscopic acuity
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Purpose To analyze the clinical features of patients with exodeviation of more than 15 prism diopters (PDs) within one month and with orthophoria over three years after surgical correction of intermittent exotropia. Methods The early recurrence group consisted of patients with a final distance and near exodeviation more than 15PDs within one month after surgical correction of intermittent exotropia. The surgical success group was defined as patients with orthophoria over three years after surgical correction of intermittent exotropia. Sex, age at onset and surgery, office control status, refraction status, A-V pattern, preoperative and postoperative angles of ocular deviation, binocular sensory status, and the presence of diplopia on postoperative one day were retrospectively investigated and compared between these two groups. Results Out of a total of 68 patients, early recurrence occurred in 33 patients, and success was achieved in 35 patients. Factors including sex, age at onset and surgery, office control status, and diplopia on postoperative one day did not differ between the two groups. Preoperative near-angles of ocular deviation, A-V pattern of strabismus, preoperative stereopsis, and the range of postoperative overcorrection contributed to early recurrence. Conclusions Factors related to early recurrence were larger preoperative near-angles of ocular deviation, presence of A-V pattern, poor preoperative stereopsis, and a smaller amount of overcorrection on postoperative day 1.
Intermittent exotropia
Minimum deviation
Strabismus Surgery
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Citations (8)
Objective To investigate the surgery timing for patients with intermittent exotropia.Methods Far and near stereopsis of 36 patients with intermittent exotropia were measured preoperative and postoperative six months respectively,and the results were analyzed.Results Near stereopsis were measured preoperative in 30 cases (83.3％,30/36) with intermittent exotropia.But far stereopsis were measured preoperative in 7 cases (19.4％,7/36) with intermiuent exotropia.There was statistic significance (P ＜0.05).Near stereopsis were measured preoperative in 30 cases (83.3％,30/36) with intermittent exotropia and postoperative in 35 cases (97.2％,35/36).There was statistic significance (P＜0.05).Far stereopsis were measured preoperative in 7 cases (19.4％,7/36) with intermittent exotropia and postoperative in 14 cases (38.9％,14/36).There was statistic significance (P＜ 0.05).Conclusions Far stereopsis would be an important factor to choice the surgery timing for patients with intermittent exotropia.Operation is beneficial to restore far and near stereopsis.
Key words:
Exotropia; Depth perception
Intermittent exotropia
Statistic
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To explore the relationship between ocular position control ability and stereopsis recovery in children with intermittent exotropia, and to analyze the influencing factors of distance stereopsis recovery.In this retrospective study, 78 children with small angle intermittent exotropia received vision training for 3 months. All patients were examined for distance stereopsis with the synoptophore and for near stereopsis with the Titmus stereogram before and after the training. The patients were divided into low and high Newcastle Control Score (NCS) groups. The stereopsis of the two groups was compared. Logistic regression analysis was used to analyze the influencing factors of distance stereopsis recovery.Among 78 children with intermittent exotropia, 33 had near stereopsis (42.3%) and 22 had distance stereopsis (28.2%); the difference was significant (P < .05). After 3 months of training, there were statistically significant differences between distance and near stereopsis in the low NCS group and the high NCS group (chi-square = 7.127, P = .008; chi-square = 13.005, P < .001). The number of children with distance and near stereopsis in the low NCS group increased significantly compared with before training (chi-square = 13.471, P < .001; chi-square = 22.244, P < .001). Multivariate logistic regression analysis showed that age of onset (odds ratio [OR] = 3.768, P = .001), near point of convergence (OR = 0.347, P = .002), and NCS (OR = 0.142, P = .002) were risk factors that affected stereopsis recovery in children with small angle intermittent exotropia.Control ability is one of the important indicators to assess the severity of intermittent exotropia. The worse the control ability, the more difficult the recovery of stereopsis. Age of onset, near point of convergence, and NCS are risk factors that affect the recovery of distance stereopsis. [J Pediatr Ophthalmol Strabismus. 2021;58(6):350-354.].
Intermittent exotropia
Convergence insufficiency
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Surgical treatment for strabismus is to promote binocular vision, and the study is to evaluate the effect of surgical realignment on near stereopsis in exotropic and esotropic patients.The records of patients who underwent strabismus surgery were retrospectively reviewed. Visual acuity, ocular deviations, fusion control, ocular motility, strabismus subtype and duration, surgery procedures, and stereopsis at before and at one month after surgery were collected. RMANOVA was performed to analyze stereopsis improvement by surgery. A logistic analysis was used to investigate the factors for stereopsis improvement.143 exotropic and 40 esotropic patients were enrolled. The stereopsis was not significantly improved in patients with exotropia (p > .05), but not in esotropic patients (p < .01). Small degree of near deviation (β = 0.01), without vertical surgery (β = 0.11), and the high pre-surgery Titmus (β = -0.44) were related factors for stereopsis improvement in exotropia patients; male (β = 0.21) and the high pre-surgery Titmus (β = -0.36) were related factors for stereopsis improvement in esotropia patients.The loss of stereopsis was significantly restored by surgery in esotropia patients and the extent of stereopsis recovery by surgery depends on the deviation at near distance, vertical surgery, and pre-surgery stereopsis in exotropes and on sex and pre-surgery Titmus in esotropes.
Esotropia
Stereoscopic acuity
Strabismus Surgery
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