Exodeviations: Their Classification, Diagnosis And Treatment

Burian, Hermann M.

doi:10.1016/0002-9394(66)92570-0

Cited by 179 publications

(146 citation statements)

References 2 publications

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“…3,4,[7][8][9]12 In contrast, symptoms documented in the present study deviated from those reported previously. The probable cause for this discrepancy is that different criteria were used for patient recruitment.…”

Section: Discussioncontrasting

confidence: 94%

“…[1][2][3][4] The surgical procedures recommended for this form of exotropia include bilateral lateral rectus (LR) muscle recession with or without a slanting procedure, bilateral medial rectus (MR) muscle resection with or without a slanting procedure, LR recession with MR resection, or MR resection with an adjustable suture. 1,2,[5][6][7][8][9][10][11] Surgical success rates have been reported to vary between 18 and 92%.…”

Section: Introductionmentioning

confidence: 99%

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Unilateral recession–resection in children with exotropia of the convergence insufficiency type

2005

Eye

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Purpose The surgical success rates for intermittent exotropia of the convergence insufficiency type have been reported to be variable, and most were studied retrospectively in adults. The purpose of this study was to evaluate prospectively the long-term surgical results of unilateral lateral rectus (LR) muscle recession and medial rectus (MR) muscle resection in children with intermittent exotropia of the convergence insufficiency type. Methods A total of 14 children with intermittent exotropia greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. The amounts of resection and recession were based on near and distance deviation, respectively. Minimum follow-up was 1 year (mean 26.6 months; range, 12-68 months) after surgery. The paired t-test was used to compare preoperative and postoperative measurements of the angle of deviation at distance and near, near-distance difference. Results Significant postoperative reduction was achieved in terms of mean distance exodeviation, from 22.5 PD to 9.1 PD (P ¼ 0.000), and mean near exodeviation from 33.8 PD to 13.6 PD (P ¼ 0.000). Mean neardistance difference reduced from 11.3 PD preoperatively to 4.6 PD postoperatively (P ¼ 0.000). Fresnel prism was used temporarily to treat postoperative esotropia in only one patient for postoperative 6 months. Conclusions Unilateral surgery biased to MR strengthening more than LR weakening in children with intermittent exotropia of the convergence insufficiency type, was found to successfully reduce both distance and near deviation and to collapse near-distance differences with a low risk of long-term postoperative esotropia.

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Section: Discussioncontrasting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Unilateral recession–resection in children with exotropia of the convergence insufficiency type

2005

Eye

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“…Good correlations between the initial and final measurements after surgery for intermittent exotropia have been reported by other investigators. 15,16 The aim of this study was to determine how to achieve the magnitude of overcorrection the surgeon desires (10 PD) in the early postoperative period and to provide information to surgeons regarding the amount of lateral rectus recession required in the intermittent exotropia. The effect of the lateral rectus recession is approximately 3 PD per millimetre.…”

Section: Discussionmentioning

confidence: 99%

Bilateral lateral rectus recession considering the tendon width in intermittent exotropia

2009

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Purpose The tendon width of the lateral rectus muscle can be a useful indicator of the effect of unilateral lateral rectus recession in intermittent exotropia. 1 The aim of this study was to determine whether the tendon width of lateral rectus would be useful for predicting the effect of bilateral lateral rectus (BLR) recession. Methods We studied a total of 45 patients between 3 and 15 years of age who had undergone bilateral rectus recession for the basic type of intermittent exotropia. The actual effect of lateral recession was calculated by adding the absolute value of the angle of preoperative deviation and the postoperative deviation on the second day and dividing the figure by the total amount of recession. We then calculated the hypothetical effect of lateral rectus recession, considering the tendon width of each eye, and added the effects of both eyes. The hypothetical effects were defined as 3 PD when the tendon width was 8-8.5 mm; 3.5 PD when it was 7-7.5 mm; and 2.5 PD when it was 9-9.5 mm, based upon earlier statistical analysis. 1 We compared both effects using a paired t-test. Results The mean difference between the actual and the hypothetical effects of BLR recession in all patients was 2.88 PD (P ¼ 0.001, range: 0-5.50 PD). However, when the amount of preoperative exodeviation was below 25 PD, the differences were not statistically significant (P ¼ 0.086). Conclusion The tendon width may also be useful indicator in BLR recession if the preoperative exodeviation is below 25 PD.

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“…The need to uncover latent exodeviation by occlusion of one eye for 30-45 minutes 5,6 or outdoor measurement 3 has been stressed by many authors. Abbasoglu et al 7 suggested that the lack of agreement in terms of factors influencing response may be due to the greater variation of preoperative angles of deviation in exotropic patients.…”

Section: Discussionmentioning

confidence: 99%

‘Largest angle to target’ in surgery for intermittent exotropia

2005

Eye

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Purpose To evaluate the safety of the approach based on the notion that the surgical dose for intermittent exotropia should be based on the largest angle ever measured. Design Prospective case series of 33 patients. Methods A total of 33 patients with intermittent exotropia, in whom angles of misalignment at distance or near showed a difference of 15 prism diopters (PD) or more among visits, were included. All the patients were treated by bilateral lateral rectus recession by the same surgeon (JMH), and all were followed up for a minimum of 6 months postoperatively. Short-and long-term surgical results after the initial procedure for intermittent exotropia were analysed. Results The short-term average result at a postoperative 1 week was 9.3 PD esotropia at distance (range 30 esotropia -16 exotropia). The long-term average results postoperative 6 or 9 months were 4.8 PD exotropia at distance (range 12 esotropia -30 exotropia). At the last follow-up, no overcorrection over 2 PD esophoria at distance was found, and 9 PD of intermittent esotropia and esophoria at near was observed in two patients, respectively. Conclusions The strategy of surgical dose for intermittent exotropia based on the largest angle ever measured did not result in overcorrections and is believed to be safe.

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Exodeviations: Their Classification, Diagnosis And Treatment

Cited by 179 publications

References 2 publications

Unilateral recession–resection in children with exotropia of the convergence insufficiency type

Unilateral recession–resection in children with exotropia of the convergence insufficiency type

Bilateral lateral rectus recession considering the tendon width in intermittent exotropia

‘Largest angle to target’ in surgery for intermittent exotropia

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