Long-term results of the surgical management of intermittent exotropia

Pineles, Stacy L.; Ela-Dalman, Noa; Zvansky, Anna G.; Yu, Fei; Rosenbaum, Arthur L.

doi:10.1016/j.jaapos.2010.06.007

Cited by 111 publications

(60 citation statements)

References 22 publications

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“…Differences between distance and near stereoacuity have been suggested to approximate control in IXT given that distance stereoacuity seems to deteriorate more often in patients with poor control. 7,20 There was no significant difference in mean BiS in the distance-near stereoacuity disparity groups. This may be due to a true difference in the outcome that these two scales measure.…”

Section: Discussionmentioning

confidence: 77%

Binocular Summation and Control of Intermittent Exotropia

et al. 2017

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Background: Binocular summation (BiS), or improvement in binocular vision exceeding the better eye alone, is affected by strabismus. Being easily measured, BiS may be a useful indicator for subjective outcomes like stereopsis in strabismus. This study aims to investigate the relationship between BiS and measures of control of intermittent exotropia (IXT). Methods: Patients with IXT were recruited before undergoing strabismus surgery and underwent tests of binocular and monocular high and low contrast visual acuity, stereopsis at distance and near, and Newcastle Score (NCS), a score developed by incorporating home control and clinic control criteria into a control rating scale. BiS was calculated using high-contrast Early Treatment of Diabetic Retinopathy Study (ETDRS) and Sloan low-contrast acuity charts (LCA) at 2.5% and 1.25% contrast as the difference between the binocular score and that of the better eye. The relationship between BiS and measures of IXT control (NCS and distance near stereoacuity disparity) was evaluated using a correlation analysis by Spearman correlation coefficients and the Kruskal-Wallis test. Results: Thirty-four patients were included (mean [± standard deviation (SD)] age 19±16years) having a mean (± SD) of 26±16Δ IXT at distance and 20±16Δ at near. Mean (± SD) BiS for ETDRS and Sloan LCA at 2.5% and 1.25% was 0.8±3.6, 1.9±6.0 and −2.3±7.2, respectively. The Spearman correlation coefficient of BiS and NCS was −0.53 (95% CI −0.85 to −0.25) for 2.5% LCA and −0.43 (95% CI −0.77 to −0.13) for 1.25% LCA. BiS at 2.5% LCA (p=0.006) and at 1.25% LCA (p=0.029) significantly differed between the groups based on NCS score groupings (1–3, 4–6, and 7–9), with patients who had better control scores having higher levels of BiS. BiS did not differ significantly between patients grouped according to the difference between stereoacuity measured at near versus distance. Conclusion: Significantly lower low contrast BiS in patients with higher NCS may suggest that decreased BiS is associated with less control in IXT. This finding suggests that BiS may reflect control in IXT across a population of patients with IXT.

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Section: Discussionmentioning

confidence: 77%

Binocular Summation and Control of Intermittent Exotropia

et al. 2017

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“…22 The lack of persistence of the initial improvement in strabismus angle may be because improvement in alignment in the two study animals was beyond the range at which central binocular factors would be expected to be able to maintain the initial improvement in postsurgical ocular alignment. Therefore, remodeling at the level of the EOM 23,24 along with central neural adaptation could act to “fight” the intent of surgery (Pullela M, et al IOVS 2015;ARVO E-Abstract 5221) (Agaoglu MN, et al IOVS 2015;ARVO E-Abstract 5222).…”

Section: Discussionmentioning

confidence: 96%

“…19,20 By various accounts, approximately 40% of the subjects that undergo surgery, develop significant recurrent strabismus, and may have to undergo multiple surgeries. 21,22 Although it is not known why surgery sometimes works and sometimes does not, it is possible to speculate that both central (brain) and peripheral (muscle) factors influence the outcome of strabismus correction surgery. Muscle remodeling has been shown to occur on surgical manipulation of EOM in rabbits and in monkey.…”

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Longitudinal Evaluation of Eye Misalignment and Eye Movements Following Surgical Correction of Strabismus in Monkeys

Pullela

Degler

Coats

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PurposeStrabismus correction surgery is well documented in both the literature and practice with varying levels of success and permanence. Our goal was to characterize longitudinal changes in eye alignment and eye movements following strabismus correction surgery in a monkey model for developmental strabismus.MethodsWe studied two juvenile rhesus monkeys with exotropia previously induced via an optical prism-rearing paradigm in infancy. Eye misalignment was corrected via a resection–recession surgery of the horizontal rectus muscles of one eye. Binocular search coils were used to collect eye movement data during smooth-pursuit, saccades, and fixation tasks before surgical treatment, immediately after surgery, and through 6 months after treatment.ResultsBoth animals showed an immediate ∼70% reduction in misalignment as a consequence of surgery that regressed to a 20%–40% improvement by 6 months after treatment. Significant changes were observed in saccade and smooth-pursuit gain of the nonviewing eye after surgery, which also reverted to presurgical values by 6 months. A temporary improvement in fixation stability of the nonviewing eye was observed after surgery; naso-temporal (N/T) asymmetry of monocular smooth-pursuit remained unchanged.ConclusionsSurgical realignment is followed by plastic changes that often lead to reversal of surgery effects. Immediate improvement in misalignment and changes in eye movement gains are likely a result of contractility changes at the level of the extraocular muscle, whereas longer-term effects are likely a combination of neural and muscle adaptation.

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“…Initial overcorrection has been shown to provide the best longterm results, but it is still not clear whether the amount of initial overcorrection has a role in determining surgical success. 5,6 Raab and Parks 6 found good outcomes for bilateral lateral rectus muscle recession with overcorrection of 0 Δ to 10 Δ but even better outcomes with overcorrection of 10 Δ to 20 Δ . Scott and colleagues 7 suggested 4 Δ to 14 Δ of overcorrection in bilateral lateral rectus muscle recession, and McNeer 8 recommended overcorrecting 0 Δ to 10 Δ .…”

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Postoperative outcomes of patients initially overcorrected for intermittent exotropia

Pineles¹,

Deitz²,

Velez³

2011

Journal of American Association for Pediatric Ophthalmology and

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BACKGROUND Esotropic overcorrection on postoperative day 1 after surgery for intermittent exotropia is generally thought to increase the likelihood of long-term satisfactory alignment; however, it is unclear why some patients who are initially overcorrected demonstrate recurrent intermittent exotropia whereas others maintain esotropic to orthotropic alignment. METHODS The records of all patients who underwent primary surgical correction of intermittent exotropia were reviewed; those with any degree of esotropia on postoperative day 1 were included. The status at the last visit was categorized as orthotropic to <8Δ exotropia or having recurrent exotropia >8Δ, monofixational esotropia <10Δ, or esotropia >10Δ. RESULTS A total of 63 patients met the inclusion criteria. The mean postoperative day 1 alignment was 6Δ ± 3Δ esotropia at distance and 5Δ ± 3Δ esotropia at near. At the last visit, 31 (49%) were orthotropic to <8Δ exotropia, 26 (41%) had recurrence of exotropia >8Δ, and 6 (10%) had monofixational esotropia <10Δ. There was no significant difference between outcome groups in onset age, age at surgery, stereopsis, deviation (preoperatively or on postoperative day 1), or follow-up length. Risk factor analysis revealed no association between exotropia type, surgical approach, or postoperative day 1 alignment and risk of recurrent intermittent exotropia or monofixational esotropia, although there was a trend toward recurrent intermittent exotropia in those least overcorrected. CONCLUSIONS Recommended overcorrection on postoperative day 1 for intermittent exotropia can result in esotropia, intermittent exotropia, or orthotropia. The results of overcorrection for exotropia are variable and unpredictable. We were unable to determine associations with the recurrence of exotropia or secondary esotropia.

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Long-term results of the surgical management of intermittent exotropia

Cited by 111 publications

References 22 publications

Binocular Summation and Control of Intermittent Exotropia

Binocular Summation and Control of Intermittent Exotropia

Longitudinal Evaluation of Eye Misalignment and Eye Movements Following Surgical Correction of Strabismus in Monkeys

Postoperative outcomes of patients initially overcorrected for intermittent exotropia

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