WebFeeling hopeful but still worried. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Several previous studies have described changes in spherical equivalent after horizontal muscle surgery. Inclusion in an NLM database does not imply endorsement of, or agreement with, https://doi.org/10.1371/journal.pone.0280274.g002. Six of these patients also underwent an 8 mm resection of the ipsilateral lateral rectus in addition to the medial rectus recession. New York. 2022 Jul;42(7):2195-2204. doi: 10.1007/s10792-022-02219-3. Habot-Wilner Z, Spierer A, Barequet IS, Wygnanski-Jaffe T. Long-term results of esotropia surgery in children with developmental delay. Olitsky SE, Kelly CJ, Lee H, Nelson LB. Choi J, Kim SJ, Yu YS. Consecutive exotropia is an exotropia that develops with a previous history of esotropia, usually after surgical treatment for esotropia. Kim and Kim [44] reported 70 patients who had undergone unilateral medial rectus resection for treatment of undercorrected or recurrent exotropia (mean deviation, 22.244.86 PD). Bilateral medial rectus resections can be applied to the patients with undercorrected or recurrent exotropia after bilateral lateral rectus recessions for exotropia, while unilateral medial rectus resection can be appropriate for small-angle recurrent exodeviation. The mean age at surgery was 7.5 2.4 years, and 56.1% of the patients were female. WebAlthough most strabismus surgeries aim to align the eyes as closely as possible, it has been widely accepted that, for intermittent exodeviations, the initial postoperative alignment should be targeted to esodeviation for favorable long-term motor alignment because of a tendency toward postoperative exotropic drift [ 1, 3, 6, 12 16 ]. Horizontal muscle surgery has no long-term effect on the change in the spherical equivalent. Would not want to risk infection, with sutures still healing. PMC Infantile exotropia is a relatively rare strabismus disorder characterized by outward deviation of one or both eyes. Yes The baseline demographic and clinical data are summarised in Table 2. Esotropia: One or both of your eyes turn inward toward your Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures, medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. We also conducted an observational study to investigate the horizontal EOM insertion location in a Taiwanese population and compared the data with Dr. After confirming the cycloplegic state 30 min after the last cycle of cycloplegic eye drops, manual retinoscopic refraction was performed. Color atlas of strabismus surgery: strategies and techniques. WebBefore Surgery After Surgery 1 2 3 4 5 6 7 8 9 10 11 12 13 14 .. Exotropia is a type of strabimus or eye misalignment. Data curation, The resected muscle was reattached to the sclera. On the other hand, Trigler et al[8] suggested that preoperative angle of deviation was a prognostic factor for the success of esotropia surgery. Postoperative outcomes of patients initially overcorrected for The amount of recession was greater in the LRc group than in the RP group. sharing sensitive information, make sure youre on a federal The following exclusion criteria were applied: (1) best-corrected visual acuity worse than 0.3 logMAR (20/40) in at least one eye; (2) concurrent intraocular diseases such as congenital cataract, glaucoma, retinal disease, and optic atrophy or abnormal lid conditions such as ptosis; (3) previous history of strabismus surgery or lid surgery; (4) horizontal rectus muscle surgery with vertical transposition; (5) any combined vertical rectus or oblique muscle surgery; (6) a previous history of treatment for myopia control; and (7) a history of syndromic disorders known to be associated with myopia, such as Stickler syndrome, Marfan syndrome, and Knobloch syndrome. Honglertnapakul W, Capo H, Cavuoto KM, McKeown CA. Results. After a mean follow-up of 25mo, all the patients were successfully aligned (esotropia 10 PD and exotropia 8 PD) and the mean correction of each mm of re-recession was 7.5 PD. Effects of the gaze fixation position on AS-OCT measurements of the limbus and extraocular muscle insertion site distance. Patel HI, Dawson E, Lee J. As a library, NLM provides access to scientific literature. Shin DB, Lee YH, Lee SB, Xu YG, Min BM. Kim HJ, Kim D, Choi DG. Often, your eye will alternate between looking straight and turning outward. There was no significant difference in the change in the spherical equivalent of refractive error between both eyes throughout the postoperative period. Surgery is a major treatment for intermittent exotropia (IXT), a common form of childhood ocular misalignment [1, 2]. Similarly, factors such as age, preoperative deviation, refractive error, lateral rectus incomitance are also involved in postoperative recurrence of exotropia. [ 4, 7] The .gov means its official. Briefly, locking bites using two single-armed 60 polyglactin 910 sutures were made away from the muscle insertion using the desired amount of plication. The articles of consecutive strabismus would be excluded by the authors for validity. A paired t-test and analysis of variance were used to compare preoperative clinical characteristics. Treatment for this condition should be prescribed early in order to recover proper binocular vision. For incomitant strabismus, see page 601. Children with esotropia are Chae et al[46] retrospectively reported the results of 5 to 7 mm unilateral medial rectus resection in 30 patients with recurrent exotropia ranging from 20 to 39 PD with the mean follow-up of 16.4mo. Surgery with orthoptic/occlusion therapy was more effective in reducing exodeviation (prism diopters per millimeter of horizontal rectus surgery), compared with surgery alone. Hoerantner R, Priglinger S, Haslwanter T. Reduction of ocular muscle torque by splitting of the rectus muscle II: technique and results. The type of surgery showed a significant interaction with the difference in postoperative astigmatism between eyes (Table 4). 2012;96(5):679-82. showed a larger change after maximal recession compared with conventional recession in postoperative week one [21]. Olitsky et al[19] reviewed 21 patients who underwent unilateral medial rectus resection for correcting undercorrected or recurrent exotropia (mean deviation, 16.6 PD). 41 Further Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea. Refractive error was measured with an accuracy of 0.25D. This is thought to be caused by damage to the muscles that control eye movement, at some point during the procedure. Cifuentes DL, Pineles SL, Demer JL, Velez FG. The authors concluded that effect of medial rectus resection per millimeter was variable, and the laterality and previous amount of lateral rectus recession did not influence the effect of medial rectus resection. In 2006, Yazdian and Ghiassi[56] firstly reported the results of 15-17 mm bilateral lateral rectus re-recession from the limbus to the reinsertion for the average deviation of 2211 PD (distance) and 2111 PD (near) in 16 patients with recurrent exotropia. Our results also showed similar astigmatism changes between the RR and LRc groups. Bilateral lateral rectus resection was the most common surgical method for treating residual or recurrent esotropia[36],[37]. For more information about PLOS Subject Areas, click WebIn general, the more muscles requiring surgery and the performance of reoperations (previous eye or strabismus surgery) will increase the degree of discomfort. Methodology, Surgeons may require country-specific guidelines for strabismus surgery dosage. My ophthalmologist said to wait six weeks after surgery. Morrison DG, Emanuel M, Donahue SP. Curr Eye Res. strabismus Survival analysis following early surgical success in intermittent exotropia surgery. Future prospective and randomized controlled studies with larger samples are needed to provide reliable information for guiding the design of operation style for residual or recurrent strabismus. WebExotropia, depending on the severity, can be simply observed or may require treatment such as glasses, part-time patching or even eye muscle surgery. Reoperations for esotropia. Strabismus. https://doi.org/10.1371/journal.pone.0280274.t001. Competing interests: The authors have declared that no competing interests exist. Surgical dose-effect relationship in single muscle advancement in the treatment of consecutive strabismus. 2010 Sep;21(5):335-40. doi: 10.1097/ICU.0b013e32833bd953. It also allows to specify factorial interactions. Disclaimer. National Library of Medicine Exotropia Large unilateral medial rectus resection has more advantages than bilateral surgery, for instance, the lower rate of overcorrection, decreased surgery and anesthetic time, decreased postoperative discomfort, limitation of the risk of complications to one eye [47]. Ogt MS, Onal S, Demirtas S. Adjustable suture surgery for correction of various types of strabismus. WebIntermittent exotropia: In this type of strabismus, one eye will fixate (concentrate) on a target while the other eye points outward. All data were fully anonymized and the requirement for informed consent was waived owing to the retrospective study design. Therefore, the conventional surgical amount would not be able to explain the difference of postoperative astigmatism between the RR and RP groups, and the distinct features of plication should also be considered a protective factor for the change in astigmatism. This review aims to outline the current viewpoints in the treatment of residual or recurrent strabismus by summarizing and evaluating difference surgical procedures. You really dont want any type of infection before your eyes fully heal. Curr Opin Ophthalmol. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator's preference and experience. Strabismus is a condition where your eyes are not properly aligned with each other. One eye can either be intermittently or constantly turned inward (esotropia) or outward (exotropia). Exotropia is an ocular misalignment often accompanied by double vision, abnormal eye movement of one or both eyes, impaired vision and discomfort. Bethesda, MD 20894, Web Policies A three-dimensional surgical dose-response schedule for lateral rectus resection for residual congenital/infantile esotropia after large bilateral medial rectus recessions. Hong and Kang described astigmatic changes toward WTR after surgery in Korean children with IXT, which was sustained six months postoperatively. Surgery for residual convergence excess esotropia. This implies that the surgery might have initial effects on the change in astigmatism within three months and not have additional impact thereafter. Exotropia Strabismus All diplopia occurred on the first day after the operation. Bookshelf Would you like email updates of new search results? We evaluated the change in refractive error induced by the strabismus surgery comparing both eyes, not comparing pre- and postoperative refractive error. Conceptualization, Chun KI, Rah SH. sharing sensitive information, make sure youre on a federal Disclaimer. The authors concluded that resection of a single lateral rectus with a surgical dosage defined according to the double angle of strabismus was an effective surgical procedure for the treatment of small-angle residual esotropia following bilateral medial rectus recession. None was found underaction of lateral rectus abduction. Formal analysis, The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This was a retrospective review of the medical records of patients under 15 years of age who underwent unilateral strabismus surgery (lateral rectus recession and medial rectus resection (RR), lateral rectus recession and medial rectus plication (RP), or lateral rectus recession (LRc)) for IXT between January 2009 and December 2018 at Seoul National University Childrens Hospital in South Korea. The likelihood of the development of an overcorrection and the related complications associated with bilateral surgery is reduced[53]. Unauthorized use of these marks is strictly prohibited. We retrospectively reviewed the clinical data of patients aged < 15 years who underwent unilateral strabismus surgery (lateral rectus recession and medial rectus resection [RR, n = 47], lateral rectus recession and medial rectus plication [RP, n = 81], or lateral rectus recession [LRc, n = 68]). In contrast to resection, the extraocular muscle was not disinserted in plication procedure. During resection procedure, the extraocular muscle was disinserted and resected. Kim SC, Kim MM. persimnon 1 min. Strabismus: Infantile Exotropia - American Academy of They showed no difference in the postoperative refractive changes between eyes that underwent single muscle recession and those that underwent recession-resection. Prism adaptation test before strabismus surgery in patients with decompensated esophoria and decompensated microesotropia. Unilateral rectus resection in the treatment of undercorrected or recurrent strabismus. Web3.8K subscribers in the Strabismus community. New York: Springer; 2003. p. XXIII, 1087. Bethesda, MD 20894, Web Policies The study was conducted in accordance with the tenets of the Declaration of Helsinki. Lim SH, Hwang BS, Kim MM. HHS Vulnerability Disclosure, Help Mims JL, 3rd, Wood RC. Efforts to improve the surgical outcome for exotropia and - PubMed government site. Simonsz and Kolling [7] reported that age at surgery had Concomitant deviation means that the divergent deviation of the visual axis remains the same in all positions of gaze. The condition can be further described by the direction of the misalignment. Postoperative outcomes of patients initially overcorrected for intermittent exotropia. Careers, Unable to load your collection due to an error. Onset is before age 6 However, in the comparison of the postoperative astigmatism change between the RR and RP groups only in the patients whose deviation angle was 20 PD and < 40 PD, the RR group still showed greater change compared to the RP group by 0.37 D (95% CI, 0.170.56 D), although there was no difference in the amount of the LR recession. Intermittent exotropia Oh JY, Hwang JM. official website and that any information you provide is encrypted Before WebYou may need eye muscle surgery if you have: Exotropia: One or both of your eyes turn outward toward your ears. WebIntermittent exotropia (X (T)) is one of the most common form of strabismus with surgery being the mainstay of treatment. For measurement of preoperative refraction, cycloplegia was induced by three cycles of one drop of 1% cyclopentolate and one drop of 1% tropicamide, administered 5 min apart. WebOverview What is exotropia? Data curation, This can result in a larger change in refractive error immediately after surgery than the actual change. Overview Exotropia is a type of strabismus, which is a misalignment of the eyes. No, Is the Subject Area "Pediatric surgery" applicable to this article? The https:// ensures that you are connecting to the Careers. Reoperations for undercorrected esotropia. This prevented us to evaluate the immediate postoperative change in refractive error. Residual or recurrent strabismus is common problem found after the strabismus operations. Effect of resection of lateral rectus muscle in undercorrected esotropia. The surgical success rate (any distant manifest deviation<10 PD) was 76.7% at the final follow-up and the change in deviation each mm of resection was 3.530.17 PD/mm. Click through the PLOS taxonomy to find articles in your field. To determine the preferred eye for fixation, a repeated cover-uncover test was performed for each patient. The authors concluded that bilateral lateral rectus re-recession was a successful surgical procedure for correcting recurrent exotropia without leading to significant limitation of abduction. WebIn our previous retrospective study, we found that using the strabismus surgery dosages established by western strabismus mentors tends to result in undercorrection of Undercorrection or recurrence of exodeviation is common after bilateral lateral rectus recessions for intermittent exotropia, and these patients are usually treated by bilateral medial rectus resections[19]. Factors associated with horizontal reoperation in infantile esotropia. 2nd ed. FOIA No, Is the Subject Area "Eye muscles" applicable to this article? Methodology, These findings were similar to the results of Koklanis and Georgievski[18]. Int Ophthalmol. Harcourt B. Faden operation (posterior fixation sutures. One eye is either constantly or intermittently turned in (esotropia) or Exotropia: Symptoms, Management, and More Data Availability: Data cannot be shared publicly because data contain potentially identifying or sensitive patient information. the contents by NLM or the National Institutes of Health. WebPurpose: To investigate health-related quality of life (HRQOL) after strabismus surgery in children with intermittent exotropia (IXT) and relationships between HRQOL and surgical success. Bethesda, MD 20894, Web Policies Moreover, we found that this change persisted without deterioration up to four years after surgery. Therefore, there was a difference in the duration of surgery between the subgroups according to the type of surgery. Altintas AG, Arifoglu HB, Midillioglu IK, Gungor ED, Simsek S. Effectivity of intraoperative adjustable suture technique in horizontal strabismus. Pineles SL, Ela-Dalman N, Zvansky AG, Yu F, Rosenbaum AL. The authors believed that contralateral lateral rectus recession was a safe and effective procedure for the treatment of recurrent exotropia of 20-25 PD after unilateral recess-resect surgery for intermittent exotropia, and with unilateral lateral rectus recession, the intentional overcorrection in the immediate postoperative period could be avoided. Medial rectus resection can be undertaken according to standard surgical dosage table which can achieve predictable outcome of treatment for small to moderate recurrent exotropia. A mixed model was applied to compare the refractive error between the operated and fellow eyes and identify the factors associated with postoperative refractive changes. Our study confirms that LR insertion locations differ between Taiwanese and White Americans. All surgeries were performed using the same surgical dosages whereas unilateral medial rectus resection was performed twice the value of each muscle in the bilateral medial rectus resection up to a maximum of 10 mm. Mims JL., 3rd Outcome of 5 mm resection of one medial rectus extraocular muscle for recurrent exotropia. MeSH Zak and Morin[28] retrospectively reported 22 patients with recurrent esotropia who underwent marginal myotomy of medial rectus as secondary surgery. after surgery The eyes that underwent surgery were more myopic than the fellow eyes in the preoperative period (-1.06 2.09 vs -0.89 1.90, p = 0.020). Trigler L, Siatkowski RM. The mean age at surgery was 7.52.4years, and girls accounted for 56.1% of the study population. exotropia The authors concluded that unilateral medial rectus resection was an effective surgical method for the correction of small to moderate angle recurrent exotropia. Recurrence can occur shortly after bilateral lateral rectus recession and unilateral lateral rectus recession combined with medial rectus resection or years later. In our previous retrospective study, we found that using the strabismus surgery dosages established by western strabismus mentors tends to result in undercorrection of Taiwanese exotropia (XT) patients compared with those in western populations. 2020;28(2):85-90. Wang L, Nelson LB. However, its lack of predictability in preoperative design could lead to excessive re-recession followed by the limitation of abduction. Yes Instead, we compared the operated and fellow eyes of each patient, thereby eliminating the effects of the factors. Furthermore, tucking the muscle using the suture tied to the edges of the muscle insertion could compensate the corneal flattening induced by muscle recession. Clark RA, Ariyasu R, Demer JL. The results showed that 95% of the patients obtained a successful outcome with one of the patients overcorrected. Moreover, they had a limitation in that there was no control group for the natural course of refractive errors since they only evaluated the changes in refractive error before and after surgery. Incomitant deviation implies that the divergent deviation of the They concluded that the use of adjustable sutures could provide an improved success rate over nonadjustable sutures in eye muscle surgery in children aged 10y or younger. History of long-standing, stable strabismus; History of prior strabismus surgery without recent changes; Recent ophthalmic surgery (retina, glaucoma, retrobulbar block, pterygium surgery) that explains the strabismus Exotropia may occur from time to https://doi.org/10.1371/journal.pone.0280274.s001. The authors declare that they have no conflict of interest. In the mixed model analysis, there was no significant difference in the change in the spherical equivalent of refractive error (SER) between both eyes throughout the postoperative period from three months after surgery (Fig 1). The statistical assistance provided by the Medical Research Collaborating Center was greatly appreciated. Mims[45] retrospectively reviewed 45 patients who underwent 5 mm unilateral medial rectus resection for the treatment of recurrent exotropia. Many pediatric ophthalmologists made use of posterior fixation sutures or Faden operation to treat some special type of strabismus including high accommodative convergence/accommodation ratio esotropia, dissociated vertical divergence, and nystagmus blockage syndrome[20][22].

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