The Effect of Achieving Immediate Target Angle on Success of Strabismus Surgery in Children

Astudillo, Paulita Pamela P.; Cotesta, Melissa; Schofield, Jennifer; Kraft, Stephen P.; Mireskandari, Kamiar

doi:10.1016/j.ajo.2015.07.022

Cited by 18 publications

(20 citation statements)

References 30 publications

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“…In the cosmetic goal group, an excellent outcome was found in 68.8% at the first post-operative visit but dropped to 58.4% at the last visit, while a poor outcome was found in 20.8% at the first visit and increased to 32.5% at the last visit. These findings are generally similar to those in other studies 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. The reoperation rate was 10.1%, which is within the range of rates reported internationally (6–23.8%) in studies of patients with variable etiology of ET and of different ages 2, 4, 7, 8, 9.…”

Section: Discussionsupporting

confidence: 91%

“…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%

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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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Section: Discussionsupporting

confidence: 91%

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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“…proposed that exotropic patients with immediate postoperative target range of 0–8 PD of esotropia had significantly higher success rate than those outside it. [ 8 9 ] Larger amount of initial overcorrection up to 20 PD was shown to result in better surgical outcome in several studies. [ 5 6 10 ] However, some studies showed paradoxical findings.…”

Section: Discussionmentioning

confidence: 99%

“…The factors affecting the surgical outcome have been widely discussed and remained controversies. Preoperative angle of deviation[ 2 3 4 ] and early postoperative alignment[ 5 6 7 8 9 10 ] were proved to be significant factors affecting surgical outcome. Some authors proposed a correlation of refractive errors, binocularity, and the presence of postoperative day 1 (POD 1) diplopia with surgical success.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting surgical outcome of intermittent exotropia

Lee

Sun

Kao

et al. 2018

Taiwan J Ophthalmol

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PURPOSE:The purpose of this study was to investigate the factors affecting surgical outcome in intermittent exotropia.DESIGNS:This was a retrospective interventional study.METHODS:Intermittent exotropic patients who had undergone surgical correction with a postoperative follow-up period of 1 month or more were included in the study. Surgical success was defined as an alignment between 10 prism diopters (PD) of exotropia or 5 PD of esotropia at 1 month. After data collection, data were analyzed in SPSS version 23 software. The main outcome measures were the factors affecting surgical outcome.RESULTS:We included 101 patients, including 52 (51.5%) male and 49 (48.5%) female. Among them, 62 (61.4%) patients achieved surgical success. Undercorrection was the primary reason of surgical failure. Multivariate regression analysis showed that a larger preoperative angle of deviation was associated with unfavorable surgical outcome (P = 0.053, odds ratio [OR] =0.97, 95% confidence interval [CI] = 0.94–1.00), and the presence of postoperative day 1 (POD 1) diplopia correlated significantly with higher surgical success (P = 0.001, OR = 4.54, 95% CI = 1.80–11.43). The presence of POD 1 diplopia was highly associated with POD 1 esotropia (P = 0.005, OR = 7.26, 95% CI = 1.84–28.58).CONCLUSION:In intermittent exotropia, larger preoperative angle of deviation may predict a lower surgical success rate. Despite a worrisome issue, the presence of diplopia on first POD is associated with immediate postoperative alignment of esotropia and predicts a higher surgical success.

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“…Like us, Paulita, in a recent study on children <12 years ( n = 352), also found that surgical success was significantly greater with ET as compared to XT although to a lesser extent comparing with ours (their odds ratio [OR]: 1.9; 95% confidence interval [CI] 1.2–3, P = 0.008 vs. our OR: 4.46; 95% CI: 1.42–14.01, P = 0.010). [20]…”

Section: Discussionmentioning

confidence: 99%