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Jeongmin Hwang - One of the best experts on this subject based on the ideXlab platform.
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changes in refractive errors related to spectacle correction of hyperopia
PLOS ONE, 2014Co-Authors: Hee Kyung Yang, Jung Yeon Choi, Dae Hyun Kim, Jeongmin HwangAbstract:Background Hyperopic undercorrection is a common clinical practice. However, less is known of its effect on the change in refractive errors and emmetropization throughout the later years of childhood. Objectives To evaluate the effect of spectacle correction on the change in refractive errors in hyperopic children less than 12 years of age with or without strabismus. Data Extraction A retrospective cohort study was performed by a computer based search of the hospital database of patients with hyperopia, accommodative esotropia or Exotropia. A total of 150 hyperopic children under 12 years of age were included. Patients were classified into four groups: 1) accommodative esotropia with full correction of hyperopia, 2) Exotropia with undercorrection of hyperopia, 3) orthotropia with full correction of hyperopia, 4) orthotropia with undercorrection of hyperopia. The 4 groups were matched by initial age on examination and spherical equivalent refractive errors (SER). The main outcome measure was the change in SER (Diopter/year) in both eyes after two years of follow-up. Results An overall negative shift in SER was noted during the follow-up period in all groups, except for the group with esotropia and full correction. The mean negative shift of hyperopia was more rapid in groups receiving undercorrection of hyperopia with or without strabismus. The amount of undercorrection of hyperopia was positively correlated to the magnitude of decrease in hyperopia in all patients (r = 0.289, P<0.001) and in the subgroup of patients with orthotropia (r = 0.304, P = 0.011). The amount of undercorrection of hyperopia was the only factor associated with a more negative shift in SER (OR, 2.414; 95% CI, 1.202–4.849; P = 0.013). Conclusions The amount of undercorrection is significantly correlated to the change in hyperopic refractive errors. Full correction of hyperopia may inhibit emmetropization during early and late childhood.
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prismatic correction of consecutive esotropia in children after a unilateral recession and resection procedure
Ophthalmology, 2013Co-Authors: Eun Kyoung Lee, Jeongmin HwangAbstract:Purpose To determine the long-term efficacy of prismatic correction in consecutive esotropia after a unilateral recession and resection (RR) procedure for primary Exotropia. Design Retrospective cohort study. Participants A total of 110 patients with esodeviation of 5 prism diopters (PD) or more at 4 weeks after the unilateral RR procedure for primary Exotropia who were fitted with prism glasses and were followed up for a minimum of 2 years after primary surgery. Methods Patients were divided into 2 groups based on whether they were weaned off the prism glasses within 1 year: (1) the prism-weaned group whose esotropia decreased enough for them to be weaned off the prism within 1 year; (2) the prism-wearing group who wore prism glasses for more than 1 year. Clinical characteristics and changes in deviation angle were compared between groups. Main Outcome Measures The period of prism wearing, the rate of decline in deviation angle after prismatic correction, and preoperative and postoperative motor and sensory outcomes. Results The average age of patients was 4.7 years. Overall, the average period of prism wearing was 20.9 months, and the rate of decrease in the deviation angle was 2.9 PD per 6 months. Thirty-four patients (32%) were weaned off the prism glasses within 1 year. The prism-weaned group showed more preoperative constant deviation and anisometropia compared with the prism-wearing group. Overall, successful motor outcome was achieved in 71% of patients. The rate of recurrence during follow-up was higher in the prism-weaned group, and the rate of overcorrection was higher in the prism-wearing group ( P = 0.003). No patients demonstrated new onset amblyopia, and 1 of the 105 patients (0.95%) demonstrated loss of stereoacuity as a result of overcorrection. At the final visit, stereoacuity was improved or was maintained in 92% of patients compared with preoperative values. Conclusions Prismatic correction can lead to good motor outcomes while maintaining favorable sensory status in most patients with consecutive esotropia. Patients showed different clinical manifestations and outcome according to the period of prismatic correction. Patients in the prism-weaned group showed a faster change in esodeviation after prismatic correction and more exotropic drift after prism weaning, resulting in a higher rate of recurrence of Exotropia. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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survival analysis of 365 patients with Exotropia after surgery
Journal of Aapos, 2007Co-Authors: Jeongmin HwangAbstract:Few reports have included large numbers of Exotropia patients. Thus, we undertook this study to perform a survival analysis of over 350 patients with Exotropia and to determine which factors might affect the outcome of Exotropia surgery. The clinical records of 365 patients who underwent Exotropia surgery by one surgeon were retrospectively reviewed. Preoperative patient characteristics, surgical procedures performed, and early postoperative ocular alignment were evaluated as potential risk factors of surgical outcome using survival analysis. The estimated median time from surgery to recurrence was 48.3 months. None of the characteristics or procedures were found to be significantly associated with surgical outcome. The likelihood of a good postoperative surgical outcome was highest with an initial postoperative alignment of more than 10 prism diopters of esotropia (P<0.001). Early postoperative overcorrection was the only predictor of a successful long-term outcome after Exotropia surgery.
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largest angle to target in surgery for intermittent Exotropia
Eye, 2005Co-Authors: C Kim, Jeongmin HwangAbstract: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. Prospective case series of 33 patients. 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. 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. 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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initial overcorrection of 20 delta or more after surgery of Exotropia
Journal of The Korean Ophthalmological Society, 2003Co-Authors: Jeong Hun Kim, Jeongmin HwangAbstract:Purpose : In order to know the outcome in patients with initial overcorrection of 20 or more after the surgery of Exotropia. Methods : Sixty-eight patients initially overcorrected 20 or more following surgery for an Exotropia were managed with an alternate full time occlusion, echothiopate iodide, or prism glasses for the period of overcorrection. The alternate prism cover test was performed at near and distance during the follow up period. Reoperation was performed if esotropia of 20 or more persist more than three months postoperatively. Results : Most patients (87%) had a preoperative deviation of 35 or less at distance. Forty
Joseph L. Demer - One of the best experts on this subject based on the ideXlab platform.
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consecutive Exotropia why does it happen and can medial rectus advancement correct it
Journal of Aapos, 2014Co-Authors: Bhambi Uellyn Gesitede A Leon, Joseph L. DemerAbstract:Purpose To investigate whether consecutive Exotropia following medial rectus muscle recession is associated with muscle slippage and to assess the effectiveness of treating the condition with medial rectus advancement. Methods The records of patients with consecutive Exotropia after medial rectus recession were reviewed to determine medial rectus muscle insertion location at the time of advancement surgery. Measurements before and after medial rectus advancement were compared. Success was defined as alignment within 10 Δ of orthotropia. The dose effect of medial rectus advancement was determined by nonlinear regression. Results A total of 20 patients were included. The mean age (± standard deviation) at time of surgery was 19 ± 19 years (range, 1.1-65.4). The mean preoperative Exotropia was 28 Δ ± 16 Δ (range, 12 Δ -60 Δ ). Medial rectus slippage of 2.5 ± 1.7 mm (range, 1.0–5.0 mm) was found in 14 patients (36%) who had previously undergone medial rectus recession. Surgery corrected about 4 Δ of Exotropia per mm total medial rectus advancement. Although 95% of patients were aligned successfully immediately after surgery, averaging 2 Δ ± 4 Δ esotropia, there was significant late exodrift, averaging 17 Δ at final follow-up. At final follow-up, 1.6 ± 1.8 (range, 0.10-6.2) years after surgery, 50% of patients maintained alignment within 10 Δ of orthotropia (mean, 3 Δ ± 4 Δ Exotropia); the rest experienced recurrent Exotropia of 25 Δ ± 8 Δ . Conclusions Medial rectus slippage is common in consecutive Exotropia. Medial rectus advancement effectively treated consecutive Exotropia, whether or not there was muscle slippage. It is however, associated with late exodrift; hence patients should be warned about potential for further XT recurrence.
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Surgical outcomes following rectus muscle plication: a potentially reversible, vessel-sparing alternative to resection.
JAMA Ophthalmology, 2014Co-Authors: Zia Chaudhuri, Joseph L. DemerAbstract:Importance Extraocular muscle strengthening is a common treatment for strabismus. Plication is an alternative procedure for strengthening muscles with less tissue trauma than resection. Objective To compare the surgical dose effect of plication with that of resection. Design, Setting, and Participants Retrospective comparison of surgical outcomes in an academic pediatric ophthalmology and strabismus practice from July 25, 2005, through March 28, 2013, with a mean follow-up of 137 days for plication and 1243 days for resection. A single surgeon performed all procedures. Twenty-two consecutive patients underwent bilateral horizontal rectus plication or plication combined with antagonist recession (13 with esotropia and 9 with Exotropia; mean [SD] age, 38 [21] years). Thirty-one consecutive patients underwent bilateral resection or resection combined with antagonist recession (12 with esotropia and 19 with Exotropia; mean [SD] age, 28 [24] years). Six patients underwent vertical rectus plication. Exposures Rectus resection or plication performed by folding the anterior tendon posteriorly under the muscle margins oversewn to the poles of the scleral insertion, avoiding the anterior ciliary arteries. Main Outcomes and Measures Postoperative binocular alignment at the first postoperative and last available examinations. Results Lateral rectus plication (mean [SD], 6.5 [2.2] mm) and resection (6.6 [1.6] mm) were performed for similar magnitudes of esotropia (27.9 [13.4] prism diopters [PD] for plication, 29.0 [15.2] PD for resection; P = .44). Mean (SD) initial correction by lateral rectus plication was 5.17 (0.29) PD/mm, slightly less than the 95% CI (5.51-7.75 PD/mm) for resection (6.63 [0.50] PD/mm). Medial rectus plication (mean [SD], 4.9 [0.9] mm) vs resection (5.1 [1.1] mm) was performed for similar magnitudes of Exotropia (32.8 [14.2] PD for plication, 31.2 [15.6] PD for resection; P = .33). Mean (SD) initial correction by medial rectus plication (7.10 [1.65] PD/mm) was within the 95% CI (4.65-9.87 PD/mm) for resection (7.26 [1.23] PD/mm). Initial and late effects were similar. Ciliary circulation observed at surgery remained patent after plication. Plication was cosmetically acceptable and did not produce conspicuous tissue elevations. Conclusions and Relevance Horizontal rectus muscle plication is a rapidly performed, technically simple surgical procedure to strengthen the rectus muscles, with an equivalent (per millimeter) in surgical effect to that of medial rectus resection for treatment of esotropia and Exotropia. Plication diminishes surgical trauma and does not intentionally sacrifice ciliary circulation, with the potential for reversal by suture release in the first postoperative days.
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muscle path length in horizontal strabismus
Journal of Aapos, 2014Co-Authors: Ronen Rabinowitz, Joseph L. DemerAbstract:Background Sarcomere adaptation has been proposed as a mechanism for the adjustment of rectus muscle length in regulating binocular alignment. The purpose of this study was to investigate whether horizontal rectus muscle paths have abnormal lengths in subjects with intermittent or alternating strabismus. Methods High-resolution, surface coil magnetic resonance imaging was obtained in 2 mm thick axial planes in strabismic patients who had not undergone prior surgery and normal control subjects. The lengths of horizontal rectus muscle paths were measured digitally in central gaze for the fixating eye only and compared. Results A total of 12 strabismic subjects and 13 controls were included: 8 subjects had esotropia averaging 30 Δ , and 4 had Exotropia averaging 47 Δ . The sample had 80% power to detect muscle path length changes of at least the typical surgical doses appropriate to strabismus surgery for correction of the mean deviations in each group, had such changes existed. Mean (± standard deviation) medial rectus path length was 35.0 ± 4.1 mm in controls, not significantly different from 36.3 ± 1.7 mm in Exotropia ( P = 0.56) or 35.8 ± 2.9 mm in esotropia ( P = 0.62). Mean lateral rectus path length in controls was 35.7 ± 4.0 mm, not significantly different from the values of 39.6 ± 3.8 mm in Exotropia ( P = 0.09) and 37.8 ± 3.3 ( P = 0.19) mm in esotropia. Conclusions Horizontal rectus muscle path lengths are not significantly abnormal in commonly encountered intermittent or alternating esotropia and Exotropia.
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decreased postoperative drift in intermittent Exotropia associated with a and v patterns
Journal of Aapos, 2009Co-Authors: Stacy L Pineles, Arthur L Rosenbaum, Joseph L. DemerAbstract:Introduction Few data exist concerning postoperative drift in patients with intermittent Exotropia who have coexistent A or V patterns. In addition, the impacts of pattern collapse and surgical method on postoperative drift have not been well addressed. Methods We retrospectively reviewed the records of 132 patients who had surgery for intermittent Exotropia and had ≥6 months' follow-up. Mean postoperative drift in 66 patients with pattern Exotropia was compared with a nonpattern (comitant) group matched for surgeon, age, surgical method, and initial deviation. Postoperative drift was calculated by subtracting the deviation at postoperative day 1 from that at approximately 6 weeks, 6 months, 9 months, and >1 year. Results Pattern and comitant groups were similar in mean ± SD age (15 ± 17 years), follow-up (2.3 ± 2 years), preoperative Exotropia (23 Δ ± 11 Δ ), initial postoperative deviation (1 Δ ± 5 Δ esotropia), and surgical technique. Patients with pattern intermittent Exotropia showed significantly ( p p Conclusion Postoperative drift in patients with A- or V-pattern intermittent Exotropia is consistently less than in comitant Exotropia, particularly if the pattern persists postoperatively and if the Exotropia is undercorrected. Therefore, surgeons should consider smaller early overcorrections in pattern than comitant intermittent Exotropia. Lesser postoperative drift in pattern Exotropia may suggest differing underlying causes of pattern vs nonpattern Exotropia.
Ramesh Kekunnaya - One of the best experts on this subject based on the ideXlab platform.
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duane minus duane sine retraction and duane sine limitation possible incomplete forms of duane retraction syndrome
Eye, 2020Co-Authors: Ahmed Awadein, Shaimaa A Arfeen, Pratik Chougule, Ramesh KekunnayaAbstract:To report ocular motility patterns that mimic, but do not fulfil the full clinical picture of Duane retraction syndrome (DRS) and to describe their clinical features and surgical management. This is a retrospective case series study conducted on patients with DRS, mimicking non-comitant Exotropia or esotropia and a face turn. Patients were included only if they lacked either globe retraction on adduction (sine retraction) or limitation of adduction or abduction on ductions (sine limitation not >0.5). Any overshoots or pattern strabismus was recorded. The ocular motility and alignment, details of surgery and their surgical outcomes were analysed. Twenty-one patients were identified; 13 in the sine retraction and 8 in the sine limitation group. All patients presented with a compensatory face turn. Overshoots were present in 10 (77%) and 7 patients (88%) in the sine retraction and sine limitation groups, respectively. Forced duction test showed tightness of the ipsilateral medial and the ipsilateral lateral rectus muscle in esotropic (n = 3) and exotropic patients (n = 18), respectively. Orthotropia was achieved in 82% of patients following ipsilateral medial or lateral rectus muscle recession. There is a subset of patients who present with motility pattern similar to DRS but lack its complete diagnostic criteria. The presence of a face turn, overshoots on adduction or an ipsilateral tightness of the affected muscle should make one consider DRS sine retraction/sine limitation. The patients in our study responded well to lines of management similar to those of DRS.
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duane retraction syndrome causes effects and management strategies
Clinical Ophthalmology, 2017Co-Authors: Ramesh Kekunnaya, Mithila NegalurAbstract:Duane retraction syndrome (DRS) is a congenital eye movement anomaly characterized by variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or down-shoot. The etiopathogenesis of this condition can be explained by a spectrum of mechanical, innervational, neurologic and genetic abnormalities occurring independently or which influence each other giving rise to patterns of clinical presentations along with a complex set of ocular and systemic anomalies. Huber type I DRS is the most common form of DRS with an earlier presentation, while Huber type II is the least common presentation. Usually, patients with unilateral type I Duane syndrome have esotropia more frequently than Exotropia, those with type II have Exotropia and those with type III have esotropia and Exotropia occurring equally common. Cases of bilateral DRS may have variable presentation depending upon the type of presentation in each eye. As regards its management, DRS classification based on primary position deviation as esotropic, exotropic or orthotropic is more relevant than Huber's classification before planning surgery. Surgical approach to these patients is challenging and must be individualized based on the amount of ocular deviation, abnormal head position, associated globe retraction and overshoots.
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a high prevalence of Exotropia in patients with duane retraction syndrome in a tertiary eye care center in south india
Journal of Pediatric Ophthalmology & Strabismus, 2017Co-Authors: Manjushree Bhate, Virender Sachdeva, Ramesh KekunnayaAbstract:Purpose To determine the prevalence and clinical characteristics of patients with Duane retraction syndrome presenting with Exotropia in a tertiary eye care center. Methods Medical records of 140 patients with Duane retraction syndrome and Exotropia (of the total 441 patients with Duane retraction syndrome) seen from 2000 to 2009 were reviewed. Characteristics studied included age at presentation, gender, laterality, manifest primary position, abnormal head posture, ocular motility, and overshoots. Data were collected regarding associated ocular or systemic abnormalities and amblyopia. Results The mean age of the patients at presentation was 16.96 ± 15.09 years (range: 1 to 70 years). Of the 140 patients with Duane retraction syndrome and Exotropia, 59 (42%) were male. Unilateral type I Duane retraction syndrome accounted for 118 (84.2%), type II for 7 (5%), and type III for 10 (7.1%) patients, whereas 5 (3.6%) had Duane retraction syndrome and bilateral Exotropia. Duane retraction syndrome was seen in the left eye, right eye, and both eyes in 97 (69%), 37 (26%), and 6 (4%) patients, respectively. Exotropia ranged from 10 to 60 prism diopters. An abnormal head posture was noted in 101 (72%) and upshoot in 26 (18.6%) patients. Reported ocular and systemic abnormalities in these patients included cataract (6), aniridia (1), nasolacrimal duct block (1), and retinal breaks (1). Conclusions This is an exclusive study on a large series of patients with Duane retraction syndrome and Exotropia. Almost one-third of patients with Duane retraction syndrome patients might have Exotropia. Although patients with Duane retraction syndrome and Exotropia had clinical characteristics and associations similar to those with Duane retraction syndrome and esotropia, there was an increased propensity for overshoots and face turn opposite to the affected eye, which the authors hypothesize to be due to a tight or short lateral rectus muscle. [J Pediatr Ophthalmol Strabismus. 2017;54(2):117-122.].
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outcomes in patients with esotropic duane retraction syndrome and a partially accommodative component
Indian Journal of Ophthalmology, 2013Co-Authors: Ramesh Kekunnaya, Federico G Velez, Stacy L PinelesAbstract:Background: The management of Duane retraction syndrome (DRS) is challenging and may become more difficult if an associated accommodative component due to high hyperopia is present. The purpose of this study is to review clinical features and outcomes in patients with partially accommodative esotropia and DRS. Setting and Design: Retrospective, non-comparative case series. Materials and Methods: Six cases of DRS with high hyperopia were reviewed. Results: Of the patients studied, the mean age of presentation was 1.3 years (range: 0.5-2.5 years). The mean amount of hyperopia was + 5D (range: 3.50-8.50) in both eyes. The mean follow up period was 7 years (range: 4 months-12 years). Five cases were unilateral while one was bilateral. Four cases underwent vertical rectus muscle transposition (VRT) and one had medial rectus recession prior to presentation; all were given optical correction. Two (50%) of the four patients who underwent vertical rectus transposition cases developed consecutive Exotropia, one of whom did not have spectacles prescribed pre-operatively. All other cases (four) had minimal residual esotropia and face turn at the last follow-up with spectacle correction. Conclusion: Patients with Duane syndrome can have an accommodative component to their esotropia, which is crucial to detect and correct prior to surgery to decrease the risk of long-term over-correction. Occasionally, torticollis in Duane syndrome can be satisfactorily corrected with spectacles alone.
Brian G Mohney - One of the best experts on this subject based on the ideXlab platform.
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strabismus in childhood eyelid ptosis
American Journal of Ophthalmology, 2014Co-Authors: Gregory J Griepentrog, Brian G MohneyAbstract:Purpose To report the prevalence and causes of strabismus in children with eyelid ptosis diagnosed in a well-defined population over a 40-year period. Design Retrospective, population-based cohort study. Methods We retrospectively reviewed the charts of 107 patients ( Results Strabismus was diagnosed in 20 (18.7%) of the 107 patients with childhood ptosis. Of the 81 patients, 8 (9.9%) were diagnosed with simple congenital ptosis and had strabismus, of which there were 4 (4.9%) cases of Exotropia and 4 (4.9%) cases of esotropia. There were no cases of isolated vertical deviation. Conclusions Strabismus occurred in 1 of 5 children diagnosed with any form of childhood ptosis in this population-based cohort. Strabismus affected approximately 1 of 10 patients diagnosed with simple congenital ptosis, and a predominance of isolated horizontal deviations was equally divided between esotropia and Exotropia.
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postoperative outcomes in children with intermittent Exotropia from a population based cohort
Journal of Aapos, 2009Co-Authors: Noha S Ekdawi, Kevin J Nusz, Nancy N Diehl, Brian G MohneyAbstract:Purpose To describe the long-term surgical outcomes in a population-based cohort of children with intermittent Exotropia. Methods The medical records of all children ( Results Of 184 patients with intermittent Exotropia, 61 (33%) underwent surgery at a mean age of 7.6 years (range, 3.2 to 23 years). Twelve of the 61 children (19.7%) underwent a second surgery (10 for recurrent Exotropia and 2 for consecutive esotropia), and no patient received 3 or more surgeries during a mean follow-up of 10 years from the first surgery. The final postoperative measurements were recorded in 56 of 61 patients (92%) at a mean of 7.4 years (range, 0 to 18 years) after the first surgery: 31 of the 56 (55%) were within 9 Δ of orthotropia at distance and 25 of 55 (45%) had better than 60 seconds of stereopsis. The Kaplan-Meier rate of developing ≥10 Δ of misalignment after the first surgery was 54% by 5 years, 76% by 10 years, and 86% by 15 years. Conclusions In this population-based study of surgery in children with intermittent Exotropia, although only 1 in 5 received a second surgery, after a mean follow-up of 8 years, approximately half were successfully aligned and 45% had high-grade stereopsis.
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common forms of childhood strabismus in an incidence cohort
American Journal of Ophthalmology, 2007Co-Authors: Brian G MohneyAbstract:Purpose To report the prevalent forms of childhood strabismus. Design Retrospective, population-based cohort study. Methods The medical records of all Olmsted County, Minnesota, residents younger than 19 years diagnosed with esotropia, Exotropia, or hypertropia from January 1, 1985 through December 31, 1994, were reviewed. Results Six hundred twenty-seven new cases of childhood strabismus were identified during the 10-year study period, including 380 (60.1%) with esotropia, 205 (32.7%) with Exotropia, and 42 (6.7%) with hypertropia. The five most common forms of strabismus included accommodative esotropia (27.9%), intermittent Exotropia (16.9%), acquired nonaccommodative esotropia (10.2%), esotropia in children with an abnormal central nervous system (7.0%), and convergence insufficiency (6.4%). Conclusions This study provides population-based data on the most prevalent forms of childhood strabismus. Accommodative esotropia, intermittent Exotropia, and acquired nonaccommodative esotropia were the predominant forms of strabismus in this Western population.
Soo Jung Lee - One of the best experts on this subject based on the ideXlab platform.
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comparison of binocular function and surgical outcomes of tenacious proximal fusion and high accommodative convergence accommodation ratio types of intermittent Exotropia
Korean Journal of Ophthalmology, 2018Co-Authors: Jun Woo Park, Soo Jung LeeAbstract:Purpose To compare the characteristics and surgical outcomes in patients with tenacious proximal fusion (TPF) and high accommodative convergence/accommodation ratio (AC/A) types of intermittent Exotropia. Methods This study retrospectively enrolled 40 patients with intermittent Exotropia, 23 with TPF and 17 with high AC/A. Binocular function was evaluated by Worth's 4-dot test. Patients underwent lateral rectus recession, and surgical outcomes were compared. Surgical success was defined as less than ±10 prism diopters (PD) at 12 months postoperatively. Results The proportion of diplopia at near, evaluated by Worth's 4-dot test, was significantly higher in patients with high AC/A than in those with TPF (35.3% vs. 4.3%, p = 0.029). The mean preoperative angles of deviation in TPF and high AC/A types were 28.3 ± 4.4 and 28.8 ± 4.5 PD at distances, and 14.7 ± 4.2 and 15.1 ± 4.1 PD at near. Twelve months after surgery, the mean angles of deviation in TPF and high AC/A types were 2.9 ± 9.8 and 1.2 ± 9.6 PD, respectively, at distance and 1.7 ± 7.7 and -1.3 ± 11.3 PD at near. The surgical success rates were similar in the TPF and high AC/A types (74.0% vs. 64.7%). Five (21.7%) patients with TPF and 2 (11.8%) with high AC/A type experienced recurrence, with consecutive esotropia occurring in 1 (4.3%) patient with TPF and 4 (23.5%) patients with high AC/A. Conclusions The proportion of diplopia at near was higher in patients with high AC/A type than in those with TPF intermittent Exotropia. However, the surgical success rates were not significantly different between the types.
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clinical features of strabismus and nystagmus in bilateral congenital cataracts
International Journal of Ophthalmology, 2018Co-Authors: Sung Soo Hwang, Wansoo Kim, Soo Jung LeeAbstract:AIM To evaluate the prevalence, clinical features, and the factors affecting onset of strabismus and nystagmus in patients with bilateral congenital cataracts. METHODS This study evaluated 116 eyes of 58 patients who underwent lens removal for the treatment of bilateral congenital cataracts between January 1999 and January 2011. The presence and type of strabismus and nystagmus were determined before and after surgery. Type of strabismus and final visual acuity were compared in patients with and without nystagmus. Patients were divided into three groups (orthotropia/orthotropia, orthotropia/strabismus, and strabismus/strabismus) according to their preoperative and postoperative ocular alignment. Age at cataract surgery and associations of nystagmus and primary intraocular lens (IOL) implantation with strabismus were analyzed. RESULTS Six patients (10.3%) had strabismus preoperatively and an additional 11 (19.0%) developed postoperative strabismus. Exotropia was more common than esotropia both preoperatively and postoperatively. Eighteen patients (31.0%) had postoperative nystagmus, with sensory nystagmus being the most common type. Of the 18 patients with nystagmus, 10 had strabismus, with Exotropia being more common than esotropia. Postoperative visual acuity was poor in patients with nystagmus. Age at cataract surgery and rate of primary IOL implantation were significantly lower, and postoperative nystagmus was more common, in the orthotropia/strabismus group than in the other two groups. CONCLUSION Exotropia and sensory nystagmus are common in patients with bilateral congenital cataracts. Age at cataract surgery and rate of IOL implantation are lower and nystagmus more common in patients with postoperative onset of strabismus. Nystagmus is associated with poor visual prognosis.
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Unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia
BMC, 2017Co-Authors: Jung Yup Kim, Soo Jung LeeAbstract:Abstract Background To evaluate the efficacy of unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 prism diopters (PD) occurring after bilateral lateral rectus muscle recession for intermittent Exotropia. Methods Medical records of 11 patients who underwent unilateral lateral rectus muscle advancement for consecutive esotropia from 2011 to 2014 and who were observed for at least 6 months after surgery were retrospectively reviewed. The change in angle of deviation from before to after consecutive esotropia surgery, as well as the success rate and surgical effect, were evaluated. Results Preoperative esodeviation was −19.6 ± 4.7 PD [median − 20.0 PD, interquartile range (IQR) 9.0] at distance and −16.5 ± 7.4 PD [median − 18.0 PD, IQR 17.0] at near. The mean surgical amount of unilateral lateral rectus muscle advancement surgeries, based on one-fourth of the angle of consecutive esotropia, was 4.8 ± 1.1 mm [median 5.0 mm, IQR 2.0]. Of the 11 patients, 10 (91%) recovered to orthotropia or exodeviation within 8 PD. The surgical effects of unilateral lateral rectus muscle advancement were 3.3 ± 0.7 PD/mm [median 3.6 PD/mm, IQR 1.0] after 1 day, 3.7 ± 0.6 PD/mm [median 3.8 PD/mm, IQR 1.0] after 1 week, and 3.8 ± 0.7 PD/mm [median 3.8 PD/mm, IQR 1.5] after 6 months. Conclusions Unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 PD was successful in all 11 patients. The surgical effect was significantly greater in unilateral lateral rectus muscle advancement than in primary lateral rectus muscle recession. Reduction in the amount of surgery should be considered carefully in unilateral lateral rectus muscle advancement for consecutive esotropia
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factors predisposing to consecutive esotropia after surgery to correct intermittent Exotropia
Graefes Archive for Clinical and Experimental Ophthalmology, 2012Co-Authors: Jung Hyun Jang, Jung Min Park, Soo Jung LeeAbstract:Background To investigate the incidence of and factors predisposing to consecutive esotropia after intermittent Exotropia surgery, and to prevent the onset of consecutive esotropia.
