Comparison of Surgical Success for Infantile Esotropia and Strabismus Associated with Neurological Impairment

Kızıltunç, Pınar Bingöl; Atilla, Hüban; Çalış, Feyza; Alay, Cem

doi:10.1080/09273972.2016.1210173

Cited by 4 publications

(7 citation statements)

References 14 publications

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“…In particular, a larger surgical effect per mm in children with developmental disorders has been reported, suggesting that, in these patients, under-correction is more likely to give better results [18][19][20][21]. However, in the scientific literature there is no consensus on the most suitable surgical dosage adjustment in these patients; and some authors noticed that reducing the amount of surgery in delayed children (mostly esotropic [22][23][24][25] but also exotropic [25]) to prevent overcorrection, is associated with a high rate of surgical failure, mainly due to undercorrection. Nevertheless, the same authors also observed that, on long term follow-up, some of these undercorrected esotropic patients drifted towards exotropia [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…This approach results from the adaptation of the nomograms proposed in the scientific literature to our personal experience and is superimposable to the guidelines by Taylor et al [32]. As precise strabismus assessment and surgical planning is often challenging in AS patients, especially in subjects with greater deviations, and considering the exaggerated response to standard amounts of surgery [21] and the risk of consecutive strabismus on long term follow-up [22][23][24][25] reported by previous studies, we applied a small reduction of the amount of surgery to correct esotropia and a greater reduction to correct exotropia (i.e. we performed only 8 mm bilateral LR recession for 45 PD exotropic correction).…”

Section: Methodsmentioning

confidence: 97%

“…Considering the high prevalence of ocular motility and refractive disorders found in their study (75% and 97%, respectively), Michieletto and colleagues [16] suggested that early diagnosis and prompt treatment of ocular alterations should be part of the rehabilitative program of AS individuals, as it could have positive effects on cognitive aspects. Drover et al [17] already suggested that surgical correction of infantile strabismus in children may positively influence visual and motor development, but little has been published about children with developmental delays [18][19][20][21][22][23][24][25]; and even lesser with regards to AS [26].…”

Section: Introductionmentioning

confidence: 99%

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Strabismus surgery in Angelman syndrome: More than ocular alignment

et al. 2020

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Purpose To report and evaluate strabismus surgery in children with Angelman syndrome, in order to optimize and standardize surgical approach. Other purposes are to understand the possible relation between ocular findings and motor ability, and between improvement in ocular alignment and changes in motor skills in this population. Design Observational cross-sectional study. Methods Medical records of pediatric patients with Angelman syndrome, who underwent strabismus surgery, were investigated. Collected data included: genotype, gender, age at the time of surgery, refractive error, pre-operative strabismus, surgical procedure, surgical outcome, gross and fine motor development assessment pre- and post-operatively. Results Seventeen subjects, aged 3–15 years, were investigated. Fourteen patients were exotropic, three esotropic. Most patients presented astigmatism. Considering the exaggerated response to standard amounts of surgery and the risk of consecutive strabismus on long term follow-up reported by previous studies in children with developmental delay, a reduction of the amount of strabismus surgery was applied. Post-operatively, all patients presented with a significative reduction of the baseline deviation angle, with all esotropic patients and 7 exotropic patients (59%) achieving orthotropia. The surgical outcomes were variable according to the type and the amount of baseline strabismus, but no case presented with exaggerated surgical response. At baseline, patients showed important delays in all motor abilities, and, post-operatively, presented a significant improvement in walking and fine motor tasks. Pre- and post-operative motor abilities were negatively correlated to astigmatism, anisometropia, and amount of deviation. Conclusions According to our data, the standard nomograms for strabismus surgery may be successfully applied in subjects with Angelman syndrome and exotropia. Our data suggest that the reduction of the deviation angle improves motor skills in strabismic pediatric patients with Angelman syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Strabismus surgery in Angelman syndrome: More than ocular alignment

et al. 2020

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“…Individual patients will have different visual development experiences, and therefore limiting the explanation for difference in outcomes only to muscle tone may be artificial. This explanation does not consider the impact of visual acuity, which is also known to be reduced in individuals with Down syndrome (Zahidi et al 2018), or of the presence or absence of binocular single vision which influence the surgical outcome (Kiziltunc et al 2016).…”

Section: Type Of Surgerymentioning

confidence: 99%

Strabismus Surgery for Esotropia, Down Syndrome and Developmental Delay; Is an Altered Surgical Dose Required? A Literature Review

Harrison¹,

Allen²,

O’Connor

2020

British and Irish Orthoptic Journal

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Background and Purpose: There is a high rate of strabismus, in particular esotropia, in children with Down syndrome or developmental delay, which frequently requires surgical correction. A paper in 1994 advocated that the surgical dose be adjusted due to an altered response in these children. The aim of this literature review is to evaluate the available evidence to establish whether an altered surgical approach is required in either population. Methods: A literature review was conducted using PubMed and Web of Knowledge. Only English language papers were eligible for inclusion. The papers were collated in chronological order for analysis, and their references searched for further relevant papers. Forward citation searches were also undertaken. Results: A 2 × 2 comparison is made between publications on Down syndrome (in isolation) and developmental delay populations (including Down syndrome) with adjusted versus non-adjusted surgery. Published surgical success rates on esotropia from unaltered surgical doses range from 62.0%-85.7% (four papers) in the Down syndrome cohort, with none of the adjusted surgeries having a successful outcome. Surgical success rates from adjusted surgical doses in developmental delay cohort range from 37.5%-86.0% (seven papers), with one unadjusted surgical success rate of 76.0%. The results across the studies are summarised in a table and discussed. Conclusions: An exaggerated surgical effect in individuals with developmental delay has been reported, and this population may benefit from a reduced surgical dose. Published research does not support giving a reduced surgical dose in individuals with Down syndrome, but more research needs to be done to make a definitive conclusion.

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“…Surgeries to correct ET are reported to have successful outcomes in 48.5–89.7% of cases globally 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. The large variability in success rates is due to differences in the post-operative angle from orthophoria used to assess outcome, the etiology of ET, the type of procedure, the length of post-operative follow-up, and other associated risk factors.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of esotropia surgery in Saudi Arabia: An audit from a single center

Sulayem

Bin-Khathlan

2018

Saudi Journal of Ophthalmology

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PurposeTo monitor the outcomes of surgical correction of esotropia in order to improve preoperative counselling for patients and their families.MethodsA retrospective review audit of the medical charts at King Fahad Medical City. All patients treated surgically to correct esotropia, from January 2007 to December 2013. All operated cases were included regardless of age and esotropia etiology. The study used a goal-determined metric to assess the outcomes of strabismus surgery > 6 months post-operatively, and on last follow-up. The risk factors for poor surgical outcomes were identified using a Pareto chart.ResultsA total of 99 cases with sufficient documentation to determine the surgical goal were included in the analysis. The goal was to improve eye contact (cosmetic correction) in 77.8% cases, to establish binocularity in 15.2% cases, to resolve diplopia for 4% cases, and to improve anomalous head posture for 3%. The overall outcome was excellent for 70.7% at the first follow-up and for 57.6% at the final visit. Simultaneous vertical muscle surgery and/or superior oblique muscle palsy were risk factors for poor outcome (odds ratio 3.15, 95% CI 1.11–8.99).ConclusionsExcellent outcome of esotropia surgery in this study is comparable to outcomes reported internationally using the goal determined metrics. Quality improvement processes like the Pareto chart are simple to use and helpful for determining the risk factors associated with poor surgical outcomes after esotropia correction from different etiology.

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Comparison of Surgical Success for Infantile Esotropia and Strabismus Associated with Neurological Impairment

Abstract: This study was unable to find the differences between surgical success rates in IE and strabismus associated with neurological impairment.

Cited by 4 publications

References 14 publications

Strabismus surgery in Angelman syndrome: More than ocular alignment

Strabismus surgery in Angelman syndrome: More than ocular alignment

Strabismus Surgery for Esotropia, Down Syndrome and Developmental Delay; Is an Altered Surgical Dose Required? A Literature Review

Outcomes of esotropia surgery in Saudi Arabia: An audit from a single center

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