Lateral incomitancy and surgical results in intermittent exotropia

Yoon, Chang Ho; Kim, Seong-Joon

doi:10.1136/bjophthalmol-2014-305132

Cited by 11 publications

(7 citation statements)

References 20 publications

(26 reference statements)

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“…The factors reported to affect the surgical outcome after exotropia surgery vary widely, including age at surgery, preoperative angle of deviation, refractive errors, type of surgery, lateral incomitance and early postoperative ocular alignment. [6, 19, 26–29] In this study, younger age at onset of exotropia and smaller amount of postoperative overcorrection were associated with recurrence, and presence of neurodevelopmental disabilities and greater amount of postoperative overcorrection were risk factors for final overcorrection in the multivariable analyses. Kim et al reported that younger age at diagnosis and surgery and early postoperative overcorrection of ≥ 20 PD were predisposing factors for consecutive esotropia.…”

Section: Discussionmentioning

confidence: 60%

“…All patients underwent complete ophthalmological examinations before surgery, and the following data were recorded: gestational age, birth weight, sex, age at onset of deviation, age at diagnosis of exotropia, age at surgery, cycloplegic refraction, distance and near deviation angle, constancy of deviation, associated strabismus (dissociated vertical deviation, oblique muscle dysfunction, vertical deviation), presence of eye dominance, lateral incomitance (decrease in distant deviation of > 5 PD in a lateral gaze) [19], stereoacuity, and fusional status. Deviation was measured using the alternate prism and cover test at a distance (6 m) and close-up (33 cm) for the primary gaze, with appropriate spectacle correction when required.…”

Section: Methodsmentioning

confidence: 99%

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A comparison of surgical outcomes between pre-and full-term patients with exotropia

Jung

Kim

2018

PLoS ONE

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PurposeTo compare the surgical outcomes between pre- and full-term patients with exotropia and to examine the factors associated with surgical outcomes.MethodsThis retrospective study included 48 pre- and 432 full-term patients with basic-type exotropia who underwent unilateral or bilateral lateral rectus muscle (ULR or BLR) recession. Preoperative characteristics and surgical outcomes were compared between the pre- and full-term infants. Additionally, factors affecting the surgical outcomes were evaluated in all patients.ResultsThe preoperative characteristics were significantly different between the pre- and full-term groups in terms of neurodevelopmental disabilities (p = 0.020). There were no significant differences between the pre- and full-term groups in terms of the success, overcorrection, and recurrence rates after the mean follow-up period of 34.6 ± 13.9 months (p = 0.697). The major cause of surgical failure was recurrence in both groups. Pre-term birth was not a risk factor for overcorrection and recurrence. However, regardless of the pre- or full-term birth status, the presence of neurodevelopmental disabilities significantly affected final overcorrection (p = 0.004).ConclusionsPre-term patients with exotropia showed similar surgical outcomes to full-term controls. The presence of neurodevelopmental disabilities was a risk factor for final overcorrection.

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Section: Discussionmentioning

confidence: 60%

Section: Methodsmentioning

confidence: 99%

A comparison of surgical outcomes between pre-and full-term patients with exotropia

Jung

Kim

2018

PLoS ONE

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“… 41 , 43 In a recent study, 63/155 patients (41%) undergoing surgery for intermittent exotropia had lateral incomitance of >5 prism-diopters. 44 For patients with sizeable incomitance in primary gaze, such as those identified in our study, one might consider performing slightly asymmetrical surgery to obtain optimal results. For example, in a patient with a right larger than left exotropia, one might recess the right more than the left lateral rectus.…”

Section: Discussionmentioning

confidence: 96%

Incomitance and Eye Dominance in Intermittent Exotropia

Adams

Economides

Horton

2017

Invest. Ophthalmol. Vis. Sci.

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PurposeTo determine if the deviation angle changes in subjects with intermittent exotropia as they alternate fixation between the right and left eye in primary gaze.MethodsIn this prospective observational cohort study, 37 subjects with intermittent exotropia were tested for evidence of incomitance. The position of each eye was recorded with a video tracker during fixation on a small central target. A cover–uncover test was performed by occluding one eye with a shutter that passed infrared light, allowing continuous tracking of both eyes. The deviation angle was measured during periods of right eye and left eye fixation. Incomitance was assessed as a function of eye preference, fixation stability, and exotropia variability.ResultsThe mean exotropia was 18.2° ± 8.1°. A difference between right exotropia and left exotropia was detectable in 16/37 subjects. Allowing for potential tracking error, the incomitance had a mean amplitude of 1.7°. It was not related to a difference in accommodative effort, eye preference, fixation stability, or variability in deviation.ConclusionsComitance is regarded as a feature that distinguishes strabismus from paralytic or restrictive processes. Unexpectedly, eye tracking during the cover–uncover test showed that incomitance is present in approximately 40% of subjects with intermittent exotropia. It averages 10% of the exotropia, and can equal up to 5°. When substantial, it may be worth considering when planning surgical correction.

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“…Yoon and Kim reported significant postoperative lateral incomitance in the patients who had unilateral lateral rectus recession in comparison to the patients who had symmetrical bilateral lateral rectus recession (P = 0.006). 25 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Efficacy and Lateral Gaze Incomitance in Symmetrical and Asymmetrical Surgery for Concomitant Esotropia and Exotropia

Ismail

Abdelkader

Mohamed

et al. 2021

OPTH

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Purpose Evaluation of asymmetrical and symmetrical horizontal strabismus surgery as regards efficacy and postoperative lateral gaze incomitance. Patients and Methods This prospective comparative interventional case series study included 40 patients of age more than 3 years with alternating horizontal strabismus. Patients were divided according to the type of horizontal deviation into esotropia and exotropia groups, which were further subdivided into asymmetrical and symmetrical subgroups in each type. The surgery was defined as symmetrical procedure if the surgery was done on the same muscle in the two eyes and it was defined as asymmetric in recess-resect procedures in one eye, and three horizontal muscles surgery. Preoperative and postoperative measurements were done in primary position, right, and left gaze using alternate prism cover test and hand-held orthopedic goniometer. Results At the end of follow-up period, a statistically insignificant difference (P value = 0.8057) was present in the success rate between the asymmetrical and symmetrical subgroups of esotropia (90 and 86.67%, respectively) and it was 100% in both exotropia subgroups. Lateral gaze incomitance results were different between esotropia and exotropia subgroups. In esotropia, a statistically significant difference was reported at 1 month (0.009), which became insignificant at 6 months (0.077) and 12 months (0.077) between asymmetrical and symmetrical subgroups. In exotropia subgroups, there was a statistically insignificant difference in lateral gaze incomitance at 1, 6, and 12 months (P = 1). Conclusion Asymmetrical procedure had the same efficacy and success rate of symmetrical procedure for the correction of concomitant horizontal deviations in primary gaze without persistent postoperative lateral gaze incomitance, especially in exotropia. Clinical Trial Registration NCT04199286.

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Lateral incomitancy and surgical results in intermittent exotropia

Abstract: Surgical outcomes in ULR and BLR for intermittent exotropia correction showed no association with preLI+. The prevalences of significant LI were unchanged after surgery in both groups.

Cited by 11 publications

References 20 publications

A comparison of surgical outcomes between pre-and full-term patients with exotropia

A comparison of surgical outcomes between pre-and full-term patients with exotropia

Incomitance and Eye Dominance in Intermittent Exotropia

Evaluation of Efficacy and Lateral Gaze Incomitance in Symmetrical and Asymmetrical Surgery for Concomitant Esotropia and Exotropia

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