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E Chimonidou - One of the best experts on this subject based on the ideXlab platform.

  • three horizontal muscle surgery for large angle infantile or presumed infantile esotropia long term motor outcomes
    JAMA Ophthalmology, 2013
    Co-Authors: Klio Chatzistefanou, K D Droutsas, Ioannis Ladas, Cryssanthi Koutsandrea, E Chimonidou
    Abstract:

    Importance Bilateral medial rectus muscle recession and one lateral rectus muscle resection surgery for the correction of large-angle infantile esotropia may be associated with a favorable long-term motor outcome. A consecutive exotropic drift was encountered more commonly than a recurrent esotropic drift in the long run, especially in the smaller (50-69 prism diopters [Δ]) range of preoperative Esodeviation. Objective To outline the short- and long-term motor outcomes of graded bilateral medial rectus muscle recession and one lateral rectus muscle resection for the correction of large-angle esotropia (≥50Δ). Design Retrospective analysis. Setting Strabismus service, tertiary care university referral center. Participants A total of 194 consecutive patients with infantile or presumed infantile esotropia. Exposure All patients underwent bilateral medial rectus recession and a lateral rectus resection in the nondominant eye by the same surgeon. Main Outcomes and Measures Short-term (8 weeks) and long-term rates of postoperative successful alignment (±10Δ), undercorrection, and overcorrection. Results The median age of patients at surgery was 2.7 years (range, 20 months–36 years). The median follow-up time was 4.5 years (range, 6 weeks–25 years). The mean preoperative deviation was 68.2Δ. Of the 194 patients, 121 (62.4%) were successfully aligned at the last follow-up visit or prior to reoperation, and 154 (79.4%) were successfully aligned at the 8-week postoperative evaluation. A comparison of early vs late outcomes revealed a higher rate of late overcorrections (5.15% vs 24.1%, respectively; P  = .001) but the same rate of undercorrections (15.4% vs 15.1%; P  = .85). The outcome of surgery was not associated with the presence of amblyopia, high hyperopia, or the total amount of millimeters of surgery but was adversely influenced by the presence of inferior oblique overaction and the magnitude of the preoperative Esodeviation. Delayed consecutive exotropia was more prevalent in the 50Δ to 69Δ range of preoperative Esodeviation. Conclusions and Relevance Three horizontal muscle surgery for the correction of large-angle esotropia is associated with a high success rate. Long-term follow-up indicated that an exotropic drift may be expected 3 times more often than an esotropic drift.

  • Reversal of unilateral medial rectus recession and lateral rectus resection for the correction of consecutive exotropia.
    The British journal of ophthalmology, 2009
    Co-Authors: Klio Chatzistefanou, K D Droutsas, E Chimonidou
    Abstract:

    Background/aims: To evaluate the effectiveness and dose–effect relationship of unilateral medial rectus advancement to the original insertion and lateral rectus recession in the surgical management of consecutive exotropia. Patients/methods: The charts of 62 patients operated on for consecutive exotropia in a single-surgeon paediatric ophthalmology practice with a minimum follow-up time of 6 weeks were reviewed. Results: Fifty-two patients were managed with unilateral surgery involving medial rectus advancement and lateral rectus recession. The medial rectus was advanced to the original insertion, and the lateral rectus was recessed by the amount of millimetres it had originally been resected for patients with precise records on previous surgery (within one millimetre of the above). The mean age at surgery for exotropia was 12.86 years. The mean postoperative follow-up time was 2.5 years. The mean preoperative distance exodeviation was 33.4 prism dioptres (PD), and the mean reduction in the angle of strabismus was 33.5 PD. A successful surgical outcome, defined as ocular alignment within 10 PD of orthophoria, was obtained in 41 patients (78.8%) at final follow-up. The mean dose–effect relationship between the reduction in the angle of deviation and the sum of millimetres of the reoperation was 2.9 PD/mm. It varied widely among patients and was strongly correlated with the amount of preoperative exodeviation, that is the patients tended to respond more per millimetre of surgical intervention the greater the preoperative exodeviation. Conclusion: The standard reversal of unilateral medial rectus recession and lateral rectus resection is a simple and effective means for correcting secondary exotropia. The dose–effect relationship varied widely among patients and tended to correlate with the amount of preoperative exodeviation.

Shu Wang - One of the best experts on this subject based on the ideXlab platform.

  • application of srt plus mr recession in supra maximal esotropia from chronic sixth nerve palsy
    Graefes Archive for Clinical and Experimental Ophthalmology, 2019
    Co-Authors: Sujia Wu, Shu Wang
    Abstract:

    BACKGROUND: To investigate prognostic factors in patients with augmented superior rectus transposition (SRT) for sixth nerve palsy. METHODS: Thirteen patients who were diagnosed with sixth nerve palsy and underwent augmented SRT between January 2015 and February 2017 in EENT Hospital of Fudan University were reviewed retrospectively. Data including age, sex, etiology of the abducens nerve palsy, degree of pre- and postoperative deviation in the primary position, pre- and postoperative abduction deficit, any induced vertical or torsional deviations, reoperations, and other complications was collected. Patients with undercorrection of SRT surgeries received additional inferior rectus transposition (IRT) surgery. RESULTS: Mean Esodeviation in primary position improved from 81.92△ to 30.54△ (p < 0.001) with a 1.54-unit improvement in abduction (p = 0.001). Six patients achieved alignment defined as Esodeviation in primary position within 10△ of orthotropia and seven patients were undercorrected after the first SRT surgery. Multivariable linear regression analysis showed that among factors (disease duration, preoperative Esodeviation, preoperative abduction deficit), only the degree of preoperative abduction deficit (β = - 13.68) was the prognostic factor for success of SRT surgery. After IRT procedures, the mean Esodeviation in primary position improved from 40△ to 8△ (p < 0.01). CONCLUSION: The degree of preoperative abduction deficit is the prognostic factor for augmented SRT for sixth nerve palsy. Patients with worse abduction deficit have a greater likelihood of needing a secondary operation, and IRT could be a good choice for reoperation after SRT.

  • application of srt plus mr recession in supra maximal esotropia from chronic sixth nerve palsy
    Graefes Archive for Clinical and Experimental Ophthalmology, 2019
    Co-Authors: Yan Liu, Shu Wang, Wen Wen, Leilei Zou, Rui Liu, Hong Liu
    Abstract:

    To investigate prognostic factors in patients with augmented superior rectus transposition (SRT) for sixth nerve palsy. Thirteen patients who were diagnosed with sixth nerve palsy and underwent augmented SRT between January 2015 and February 2017 in EENT Hospital of Fudan University were reviewed retrospectively. Data including age, sex, etiology of the abducens nerve palsy, degree of pre- and postoperative deviation in the primary position, pre- and postoperative abduction deficit, any induced vertical or torsional deviations, reoperations, and other complications was collected. Patients with undercorrection of SRT surgeries received additional inferior rectus transposition (IRT) surgery. Mean Esodeviation in primary position improved from 81.92△ to 30.54△ (p < 0.001) with a 1.54-unit improvement in abduction (p = 0.001). Six patients achieved alignment defined as Esodeviation in primary position within 10△ of orthotropia and seven patients were undercorrected after the first SRT surgery. Multivariable linear regression analysis showed that among factors (disease duration, preoperative Esodeviation, preoperative abduction deficit), only the degree of preoperative abduction deficit (β = − 13.68) was the prognostic factor for success of SRT surgery. After IRT procedures, the mean Esodeviation in primary position improved from 40△ to 8△ (p < 0.01). The degree of preoperative abduction deficit is the prognostic factor for augmented SRT for sixth nerve palsy. Patients with worse abduction deficit have a greater likelihood of needing a secondary operation, and IRT could be a good choice for reoperation after SRT.

Klio Chatzistefanou - One of the best experts on this subject based on the ideXlab platform.

  • three horizontal muscle surgery for large angle infantile or presumed infantile esotropia long term motor outcomes
    JAMA Ophthalmology, 2013
    Co-Authors: Klio Chatzistefanou, K D Droutsas, Ioannis Ladas, Cryssanthi Koutsandrea, E Chimonidou
    Abstract:

    Importance Bilateral medial rectus muscle recession and one lateral rectus muscle resection surgery for the correction of large-angle infantile esotropia may be associated with a favorable long-term motor outcome. A consecutive exotropic drift was encountered more commonly than a recurrent esotropic drift in the long run, especially in the smaller (50-69 prism diopters [Δ]) range of preoperative Esodeviation. Objective To outline the short- and long-term motor outcomes of graded bilateral medial rectus muscle recession and one lateral rectus muscle resection for the correction of large-angle esotropia (≥50Δ). Design Retrospective analysis. Setting Strabismus service, tertiary care university referral center. Participants A total of 194 consecutive patients with infantile or presumed infantile esotropia. Exposure All patients underwent bilateral medial rectus recession and a lateral rectus resection in the nondominant eye by the same surgeon. Main Outcomes and Measures Short-term (8 weeks) and long-term rates of postoperative successful alignment (±10Δ), undercorrection, and overcorrection. Results The median age of patients at surgery was 2.7 years (range, 20 months–36 years). The median follow-up time was 4.5 years (range, 6 weeks–25 years). The mean preoperative deviation was 68.2Δ. Of the 194 patients, 121 (62.4%) were successfully aligned at the last follow-up visit or prior to reoperation, and 154 (79.4%) were successfully aligned at the 8-week postoperative evaluation. A comparison of early vs late outcomes revealed a higher rate of late overcorrections (5.15% vs 24.1%, respectively; P  = .001) but the same rate of undercorrections (15.4% vs 15.1%; P  = .85). The outcome of surgery was not associated with the presence of amblyopia, high hyperopia, or the total amount of millimeters of surgery but was adversely influenced by the presence of inferior oblique overaction and the magnitude of the preoperative Esodeviation. Delayed consecutive exotropia was more prevalent in the 50Δ to 69Δ range of preoperative Esodeviation. Conclusions and Relevance Three horizontal muscle surgery for the correction of large-angle esotropia is associated with a high success rate. Long-term follow-up indicated that an exotropic drift may be expected 3 times more often than an esotropic drift.

  • Reversal of unilateral medial rectus recession and lateral rectus resection for the correction of consecutive exotropia.
    The British journal of ophthalmology, 2009
    Co-Authors: Klio Chatzistefanou, K D Droutsas, E Chimonidou
    Abstract:

    Background/aims: To evaluate the effectiveness and dose–effect relationship of unilateral medial rectus advancement to the original insertion and lateral rectus recession in the surgical management of consecutive exotropia. Patients/methods: The charts of 62 patients operated on for consecutive exotropia in a single-surgeon paediatric ophthalmology practice with a minimum follow-up time of 6 weeks were reviewed. Results: Fifty-two patients were managed with unilateral surgery involving medial rectus advancement and lateral rectus recession. The medial rectus was advanced to the original insertion, and the lateral rectus was recessed by the amount of millimetres it had originally been resected for patients with precise records on previous surgery (within one millimetre of the above). The mean age at surgery for exotropia was 12.86 years. The mean postoperative follow-up time was 2.5 years. The mean preoperative distance exodeviation was 33.4 prism dioptres (PD), and the mean reduction in the angle of strabismus was 33.5 PD. A successful surgical outcome, defined as ocular alignment within 10 PD of orthophoria, was obtained in 41 patients (78.8%) at final follow-up. The mean dose–effect relationship between the reduction in the angle of deviation and the sum of millimetres of the reoperation was 2.9 PD/mm. It varied widely among patients and was strongly correlated with the amount of preoperative exodeviation, that is the patients tended to respond more per millimetre of surgical intervention the greater the preoperative exodeviation. Conclusion: The standard reversal of unilateral medial rectus recession and lateral rectus resection is a simple and effective means for correcting secondary exotropia. The dose–effect relationship varied widely among patients and tended to correlate with the amount of preoperative exodeviation.

Dong Gyu Choi - One of the best experts on this subject based on the ideXlab platform.

J-m Hwang - One of the best experts on this subject based on the ideXlab platform.

  • Long-term outcome of prismatic correction in children with consecutive esotropia after bilateral lateral rectus recession
    2020
    Co-Authors: Eun Kyoung Lee, Hee Kyung Yang, J-m Hwang
    Abstract:

    ABSTRACT Aims To determine the long-term outcome of prismatic correction in consecutive esotropia after bilateral lateral rectus (BLR) recession in children. Methods Of 392 children with exotropia who received BLR recession, 44 developed consecutive esotropia. Five children underwent reoperation and 39 were treated with base-out prism glasses. The clinical characteristics and the efficacy of prismatic correction defined as the duration of prism treatment and the annual rate of decline in Esodeviation angle ( prism dioptres (PD)/year) after prismatic correction, clinical success rates based on postoperative alignment at distance, and the change in stereopsis were evaluated in the children who were treated with base-out prism glasses. Results After a mean follow-up duration of 37.0 ±11.5 months, a successful motor outcome was achieved in 66.7% of patients and stereoacuity was improved or maintained in 79.2%. No patient lost stereopsis as a result of overcorrection. Prism glasses were prescribed an average of 7.4±8.1 months after surgery. During prism wear, the annual rate of decline in Esodeviation was 4.2±6.7 PD. The mean duration of prism wear was 24.0±10.5 months and 82.1% were weaned off prisms at the last follow-up examination. Conclusions In patients with consecutive esotropia after BLR recession, the angle of Esodeviation continuously decreased and 82% were weaned off prism glasses after 3 years. Prismatic correction achieves good motor outcome while maintaining a favourable sensory status in most patients with consecutive esotropia after BLR recession

  • P3-4: Binocular Visual Acuity in Exotropia
    SAGE Publishing, 2012
    Co-Authors: Hee Kyung Yang, Seong Joon Ahn, J-m Hwang
    Abstract:

    Purpose: To investigate binocular interaction of visual acuity in patients with intermittent exotropia and its relationship with accommodative responses during binocular vision. Methods: Sixty-seven patients with intermittent exotropia of 8 years or older were included. Binocular visual acuity (BVA) and monocular visual acuity (MVA) were measured in sequence. Accommodative responses of both eyes were measured using the WAM-5500 autorefractor/keratometer (GrandSeiko, Fukuyama, Japan) during binocular and monocular viewing conditions at 6 m. Accommodative responses during binocular vision were calculated using the difference between the refractive errors of binocular and monocular vision. Main outcome measures: Binocular interactions of visual acuity were categorized as binocular summation, equivalency, or inhibition. The prevalence of the 3 patterns of binocular interaction was investigated. Accommodative responses were correlated with differences between BVA and better MVA. Results: Most patients (41 patients, 61.2%) showed binocular equivalency. Binocular inhibition and summation were noted in 6 (9.0%) and 20 (29.9%) patients, respectively. Linear regression analysis revealed a significant correlation between binocular interaction and accommodative responses during binocular vision (p < .001). Accommodative responses significantly correlated with the angle of exodeviation at distance (p = .002). Conclusions: In patients with intermittent exotropia, binocular inhibition is associated with increased accommodation and a larger angle of exodeviation, suggesting that accommodative convergence is a mechanism that maintains ocular alignment. Thus, BVA inhibition may be attributed to diminishing fusional control in patients with intermittent exotropia

  • The long-term result of slanted medial rectus resection in exotropia of the convergence insufficiency type
    Eye, 2006
    Co-Authors: M Y Choi, J-m Hwang
    Abstract:

    Purpose To evaluate the long-term results of slanted medial rectus (MR) resection for intermittent exotropia (X(T)) of the convergence insufficiency type. Methods In all, 10 patients with an X(T) greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. Patients received slanted bilateral MR resection. The upper edge of the MR was resected according to the distance exodeviation and the lower edge of the MR was resected according to near exodeviation. The postoperative follow-up period was between 6 and 62 months with a mean of 38.9 months. The paired t -test was used to compare: mean distance angle of deviation preoperatively and postoperatively; mean near angle of deviation preoperatively and postoperatively; and mean near-distance exodeviation difference preoperatively and postoperatively. Results Bilateral slanted MR resections reduced mean exodeviation at distance from 23.0±7.2 to 16.3±5.4 PD ( P =0.03); mean exodeviation at near from 34.3±7.7 to 24.6±6.9 PD ( P =0.01); and mean near-distance difference from 11.4±2.6 to 8.3±3.5 PD ( P =0.04). At the final follow-up examination, all patients demonstrated an exodeviation of 10 PD or more at distance and near, and the exodeviation difference between distance and near deviation was within 10 PD in five of the 10 patients. Three patients had an Esodeviation at distance after surgery, but all resolved within 4 weeks. Conclusions Bilateral slanted MR resections in patients with X(T) of the convergence insufficiency type resulted in undercorrection in all patients.

  • The long-term result of slanted medial rectus resection in exotropia of the convergence insufficiency type
    Eye (London England), 2005
    Co-Authors: J-m Hwang
    Abstract:

    To evaluate the long-term results of slanted medial rectus (MR) resection for intermittent exotropia (X(T)) of the convergence insufficiency type. In all, 10 patients with an X(T) greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. Patients received slanted bilateral MR resection. The upper edge of the MR was resected according to the distance exodeviation and the lower edge of the MR was resected according to near exodeviation. The postoperative follow-up period was between 6 and 62 months with a mean of 38.9 months. The paired t-test was used to compare: mean distance angle of deviation preoperatively and postoperatively; mean near angle of deviation preoperatively and postoperatively; and mean near-distance exodeviation difference preoperatively and postoperatively. Bilateral slanted MR resections reduced mean exodeviation at distance from 23.0±7.2 to 16.3±5.4 PD (P=0.03); mean exodeviation at near from 34.3±7.7 to 24.6±6.9 PD (P=0.01); and mean near-distance difference from 11.4±2.6 to 8.3±3.5 PD (P=0.04). At the final follow-up examination, all patients demonstrated an exodeviation of 10 PD or more at distance and near, and the exodeviation difference between distance and near deviation was within 10 PD in five of the 10 patients. Three patients had an Esodeviation at distance after surgery, but all resolved within 4 weeks. Bilateral slanted MR resections in patients with X(T) of the convergence insufficiency type resulted in undercorrection in all patients.