King et al[40] advocated that it was more stable and predictable than bilateral medial rectus re-recession and felt that except in cases where medial restrictive factors or obvious errors in magnitude of the original surgery were noted, bilateral lateral rectus resection was the surgery of choice in patients with undercorrected or recurrent esotropia following bilateral medial rectus recession. To determine the preferred eye for fixation, a repeated cover-uncover test was performed for each patient. This study had several limitations. Clark et al[25] retrospectively analyzed the outcome of pulley posterior fixation on 9 patients with recurrent and excess near esotropia after bilateral medial rectus recessions. Shin DB, Lee YH, Lee SB, Xu YG, Min BM. The incidence of successful outcome and recurrence at last follow-up were not significantly different between the two groups, but the overcorrection rate was significantly lower after unilateral medial rectus resection than that was after bilateral medial rectus resection. Medial rectus pulley posterior fixation is as effective as scleral posterior fixation for acquired esotropia with a high AC/A ratio. Trigler L, Siatkowski RM. Most of them reported a postoperative myopic shift [610], although some showed a hyperopic shift or no significant change in spherical equivalent [11, 12]. Lee JY, Ko SJ, Baek SU. Clark RA, Ariyasu R, Demer JL. The .gov means its official. [ 1 3] The prevalence of consecutive exotropia has been reported as being from 3% to 29% [ 1, 2, 4 6] following surgery for esotropia and higher rates have been reported with longer follow-up. At a follow-up of 6mo, 51% (36/70) of patients were successfully aligned (10 PD of orthophoria). Exotropia (Outward Turning Eyes): Types, Causes Bethesda, MD 20894, Web Policies Careers, Unable to load your collection due to an error. As a library, NLM provides access to scientific literature. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The study was conducted in accordance with the tenets of the Declaration of Helsinki. Unauthorized use of these marks is strictly prohibited. However, mild with-the-rule astigmatism is induced and sustained after surgery, and the type of surgery affects the postoperative change of astigmatism. Biedner et al[32] reviewed the results of re-recession previously recessed medial rectus muscle with reinsertion at 13.5 mm from the limbus in 10 patients with undercorrected esotropia. Received 2013 Dec 1; Accepted 2014 Jun 11. Although many studies regarding postoperative SER have suggested an initial myopic shift after horizontal muscle surgery, it remains controversial as to whether the myopic shift is transient or permanent [710]. https://doi.org/10.1371/journal.pone.0280274.g001. Although many studies have reported no correlation between the magnitude of surgery and refractive change, Chun et al. Bilateral lateral rectus resection as a secondary surgical method was appropriate for the treatment of residual esotropia[39]. A linear mixed model analysis with interaction revealed that there was no significant effect on the difference in postoperative cylindrical power between both eyes when age, sex, preoperative SER, and cylindrical power changed, which means that these factors were not correlated with changes in postoperative astigmatism. Bookshelf Bilateral lateral rectus resection for residual esotropia. No, Is the Subject Area "Refractive surgery" applicable to this article? I am 1 day post op and this is me looking in the camera, but when I look in the mirror my left eye seems to go out toward the left corner. The advantage of medial rectus re-recession was that it remained an intact lateral rectus to provide a possibility for further surgery treatment; the disadvantages were: it lacked an accurate dosing of surgery, which might lead to a higher incidence of consecutive exotropia and mild underaction of medial rectus adduction. The type of surgery showed a significant interaction with the difference in postoperative astigmatism between eyes (Table 4). Therefore, potential confounding factors should be controlled or eliminated to assess the true effect on refractive error. FOIA Kim JH, Kim HJ, Choi DG. exotropia No, Is the Subject Area "Eye muscles" applicable to this article? Definition and Classification. 8600 Rockville Pike Surgery for residual convergence excess esotropia. Data curation, The .gov means its official. Our results also showed similar astigmatism changes between the RR and LRc groups. Web2 Strabismus: Esotropia and Exotropia I. The surgical procedures for treating IXT are composed of lateral rectus muscle (LR) weakening, such as recession and medial rectus muscle (MR) strengthening, including resection and plication. Rajavi Z, Ferdosi AA, Eslamdoust M, Yaseri M, Haftabadi N, Kroji S, Sheibani K. The prevalence of reoperation and related risk factors among patients with congenital esotropia. Strabismus: The importance of timely, specialized care - Mayo Clinic Harcourt B. Faden operation (posterior fixation sutures. One muscle strabismus surgery. 1 - 6 However, little attention has been given to the psychosocial effects of childhood strabismus surgery, because the methodology is not well developed and is more difficult to apply in children than in adults. Wright KW. To evaluate and compare surgical outcomes with respect to refractive errors in strabismus surgery for the treatment of intermittent exotropia (IXT). Supervision, Future prospective and randomized controlled studies with larger samples are needed to provide reliable information for guiding the design of operation style for residual or recurrent strabismus. Adjustable suture strabismus surgery in infants and children. Mireskandari et al[62] retrospectively evaluated the success of adjustable suture and nonadjustable suture strabismus surgery in primary procedures and reoperations. Therefore, the long-term implications of strabismus surgery on refractive error remain unclear. The authors concluded that medial rectus muscle re-recession could be a substitute for lateral rectus muscle resection in patients with residual esotropia. With the mean follow-up of 14.4mo in adjustable suture group and 12.6mo in nonadjustable suture group, the surgical success rates (10 PD of orthophoria) had no statistically significant difference in patients undergoing reoperation of exotropia and esotropia. Exotropia may occur from time to We also demonstrated a simple method for young ophthalmologists to establish their own normograms to improve their surgical success rate. An alternative to marginal myotomy. To investigate the symptoms of attention deficit hyperactivity disorder (ADHD) as reported by parents in children with intermittent exotropia [X(T)] and to determine whether The cylindrical power in WTR astigmatism was recorded as minus (-) numbers and against-the-rule astigmatism as plus (+) numbers. Manual retinoscopic refraction was performed by our senior author (SJK). Although Exotropia commonly begins around age 2 to 4 years, it can appear at any age. The operation reduced the deviation in all but one patient and was more effective at near than at distance fixation. Roles Curr Opin Ophthalmol. Niyaz L, Yucel OE, Gul A. Medial and lateral rectus muscle insertion distance and width in esotropia and exotropia patients. Some authors advocate that medial rectus resection(s) is used to correct residual or recurrent exotropia; others suggest unilateral lateral rectus recession or unilateral lateral rectus recession-medial rectus resection are performed to correct residual or recurrent exotropia in the fellow eye, and although rare, lateral rectus re-recession may be performed to treat patients who underwent inadequate bilateral lateral recession (Table 2). Authors This site needs JavaScript to work properly. Exotropia - American Association for Pediatric PLoS ONE 18(1): J Pediatr Ophthalmol Strabismus. A mixed model was applied to compare the refractive error between the operated and fellow eyes and identify the factors associated with postoperative refractive changes. The authors concluded that unilateral medial rectus resection was an effective surgical method for the correction of small to moderate angle recurrent exotropia. In 2004, Clark et al[25] established a new technique named pulley posterior fixation which needed a suture to fixate the muscle belly directly to the pulley. McPhee et al[29] retrospectively reviewed the outcome of 70 patients treated by medial rectus width myotomy combined with ipsilateral lateral rectus resections as a secondary surgical procedure. Yes Inclusion in an NLM database does not imply endorsement of, or agreement with, The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University. The difference in astigmatism changes between both eyes was 0.25 D, which remained stable without further progression from three months after surgery. Awadein et al[61] retrospectively compared the results of adjustable sutures (primary surgeries, 202 patients; reoperations, 96 patients) with nonadjustable sutures (primary surgeries, 77 patients; reoperations, 21 patients) in children younger than 10y of age with esotropia and exotropia. Formal analysis, Epub 2017 Dec 1. PD: Prism diopters; UMR: Unilateral medial rectus; BMR: Bilateral medial rectus; ULR: Unilateral lateral rectus; R&R: Recess-resect procedures; LR-rec: Lateral rectus recession; MR-res: Medial rectus resection; BLR: Bilateral lateral rectus; aMedial rectus re-recession from the limbus to the reinsertion. The authors concluded that recession of the medial rectus muscle 13.5 mm from the limbus seemed to be a safe and effective method of treating surgically undercorrected esotropia. after surgery Gezer A, Sezen F, Nasri N, Gzm N. Factors influencing the outcome of strabismus surgery in patients with exotropia. The authors concluded that resection of a single lateral rectus with a surgical dosage defined according to the double angle of strabismus was an effective surgical procedure for the treatment of small-angle residual esotropia following bilateral medial rectus recession. Therefore, there was a difference in the duration of surgery between the subgroups according to the type of surgery. Contralateral lateral rectus recession versus recess-resect for recurrent exotropia after unilateral recess-resect. 2021;58(1):28-33. Simonsz HJ, Eijkemans MJ. https://doi.org/10.1371/journal.pone.0280274.s001. Hyperopic refractive errors as a prognostic factor in intermittent Second, manifest refraction was measured during the postoperative period, in contrast to preoperative cycloplegic refraction. sharing sensitive information, make sure youre on a federal Postoperative outcomes of patients initially overcorrected for For measurement of preoperative refraction, cycloplegia was induced by three cycles of one drop of 1% cyclopentolate and one drop of 1% tropicamide, administered 5 min apart. Before Clipboard, Search History, and several other advanced features are temporarily unavailable. National Library of Medicine Felius et al[33] retrospectively reviewed the outcome of 115 patients with recurrent esotropia who underwent bilateral medial rectus re-recessions (70 cases) for the average deviation of 23.9 PD and unilateral medial rectus re-recession (45 cases) for the average deviation of 15.3 PD. broad scope, and wide readership a perfect fit for your research every time. HHS Vulnerability Disclosure, Help Kim HJ, Kim D, Choi DG. For Taiwanese XT patients, augmented surgical dosages resulted in significantly better outcome at 6 months and 1 year postoperatively compared with original surgical dosages (p = 0.003 and p < 0.001, respectively). WebIn our previous retrospective study, we found that using the strabismus surgery dosages established by western strabismus mentors tends to result in undercorrection of In summary, horizontal muscle surgery had no long-term effect on myopia progression. Moreover, they had a limitation in that there was no control group for the natural course of refractive errors since they only evaluated the changes in refractive error before and after surgery. The outcome of bilateral medial rectus posterior fixation sutures with or without central tenotomy (dissecting the central fibers of from the insertion of the medial rectus and allowing them to hang back 2-3 mm) was assessed as a secondary procedure for residual convergence excess esotropia[24]. Moreover, we found that this change persisted without deterioration up to four years after surgery. Parent-Reported Symptoms of Attention Deficit Hyperactivity Strabismus surgery can help to preserve or restore the binocular vision in IXT. The effect of unilateral medial rectus muscle resection in patients with recurrent exotropia. In contrast, the operated eyes consistently and significantly showed higher cylindrical power in with-the-rule astigmatism by 0.25D than in fellow eyes. Accessibility Careers. Survival analysis of 365 patients with exotropia after surgery. and transmitted securely. 2010 Sep;21(5):335-40. doi: 10.1097/ICU.0b013e32833bd953. Methodology, Yes Initial postoperative deviation as a predictor of long-term outcome after surgery for intermittent exotropia. Because there was a significant difference in the angle of deviation and the amount of surgery depending on the type of surgery, the effects of these factors were analysed in each subgroup according to the type of surgery. Would you like email updates of new search results? Medial rectus resection can be undertaken according to standard surgical dosage table which can achieve predictable outcome of treatment for small to moderate recurrent exotropia. The present study investigated the long-term refractive changes after unilateral horizontal muscle surgery for IXT by comparing the refractive error between both eyes. The authors believed that contralateral lateral rectus recession was a safe and effective procedure for the treatment of recurrent exotropia of 20-25 PD after unilateral recess-resect surgery for intermittent exotropia, and with unilateral lateral rectus recession, the intentional overcorrection in the immediate postoperative period could be avoided. The RR group still showed greater change of postoperative astigmatism compared to the RP group. Furthermore, we investigated the correlation between changes in postoperative refractive error and clinical factors, such as surgical amount and surgical technique. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. During resection procedure, the extraocular muscle was disinserted and resected. WebI definitely would not. However, there was no significant correlation between the conventional amount of surgery and the postoperative change of refractive error. Postoperatively, manifest refraction was assessed at every visit, and postoperative refractive data were obtained up to four years after surgery. During the follow-up of 2y, 82% of 45 patients were successfully aligned (-8 to +10 PD). POST-OPERATIVE INSTRUCTIONS FOR Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia. Liebermann L, Hatt SR, Leske DA, Holmes JM. after surgery In this subgroup analysis, the amount of LR recession was not difference between both subgroups (6.0 0.8 mm vs 5.9 0.4 mm, p = 0.273), whereas the amount of MR plication was significantly larger than the amount of MR resection (5.1 0.4 vs 6.2 0.6, p < 0.001). As with the spherical equivalent, an increase in with-the-rule (WTR) astigmatism has been reported in the majority of studies [69, 13, 14]. The baseline demographic and clinical data are summarised in Table 2. The angle of deviation was measured in five cardinal position (6 m) and near (0.33 m) as well as in both head tilt positions by a single experienced ophthalmologist (SJK). Spierer A, Ben-Simon GJ. ago. More recently, Kim et al[55] compared outcomes following contralateral lateral rectus recession (n=19) and recess-resect procedures (n=20) for treatment of recurrent exotropia of 20-25 PD after unilateral recess-resect surgery. Strabismus All diplopia occurred on the first day after the operation. yogoEx only use one eye, the myopia of the other eye gradually increased. Constant exotropia. The authors concluded that large unilateral medial rectus resection was a safe and effective procedure in the treatment of small to moderate angles of recurrent exotropia after bilateral lateral rectus recession. A procedure on the horizontal extraocular muscle can correct exodeviation by altering the action of the extraocular muscle. Gharabaghi D, Zanjani LK. Although the results suggest that strabismus surgery seems to have minimal long-term effects on changes in refractive error, postoperative changes in astigmatism were sustained. 1Department of Ophthalmology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China, 2Department of Ophthalmology, Weihai Municipal Hospital, Weihai 264200, Shandong Province, China. Disclaimer. Epub 2014 Feb 12. Simonsz and Kolling[7] reported that age at surgery had significant effect on recurrence rate. In: Wright KW, Spiegel PH, editors. Data curation, At the follow-up of 6mo, the success rates were 90% (8 PD) and none appeared a remarkable limitation of adduction. Although marginal myotomy is no longer a routine weakening procedure, it should not be completely abandoned, because it is a useful technique when an already recessed muscle requires additional weakening. The authors concluded that individual responses to lateral rectus resection surgery for residual or recurrent esotropia after maximal medial rectus recession could be highly variable. This technique mainly had been used in complex strabismus such as restrictive or paretic strabismus, reoperation, thyroid eye disease and so on[58][60]. The duration of the monocular occlusion was more than 30 minutes. Extraocular muscle insertion positions and outcomes of strabismus surgery: correlation analysis and anatomical comparison of Western and Chinese populations. Patel HI, Dawson E, Lee J. The surgery for consecutive exotropia had been performed at a mean age of 35.92 18.26 years. Exotropia WebIn our previous retrospective study, we found that using the strabismus surgery dosages established by western strabismus mentors tends to result in undercorrection of Taiwanese exotropia (XT) patients compared with those in western populations. Because strabismus surgery affects not only simple ocular deviations but also complex neuromuscular and sensory systems, many pediatric ophthalmologists have to confront the frustrating postoperative problems and treat them with empirical surgical procedures. Olitsky et al[19] firstly reported the results of 7 to 9 mm unilateral lateral rectus resection in 60 patients for the treatment of undercorrected or recurrent esotropia with preoperative mean deviation of 19.7 PD (range 14-25 PD). Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, Roles However, in the comparison of the postoperative astigmatism change between the RR and RP groups only in the patients whose deviation angle was 20 PD and < 40 PD, the RR group still showed greater change compared to the RP group by 0.37 D (95% CI, 0.170.56 D), although there was no difference in the amount of the LR recession. The operated eyes after RR showed greater changes toward WTR astigmatism by 0.41 D (95% CI, 0.300.52 D) compared to the fellow eyes (p < 0.001). STATEMENT OF THE PROBLEM Strabismus, often called "crossed-eyes" or "wall eyes," is a condition in which the eyes are not properly aligned with each other. Conceptualization, We also discovered that the location of extraocular muscle (EOM) insertion could vary by ethnicity. 8600 Rockville Pike The resected muscle was reattached to the sclera. Treatment of exotropia varies, depending on the severity of the condition and the desires of the family or person who has it. Sometimes, intermittent exotropia stays mild or goes away on its own. However, other treatments include: Eye patching: The stronger eye is covered so the weaker eye gets stronger. Residual or recurrent esotropia is a common problem following bilateral medial rectus recessions for esotropia. Mireskandari K, Cotesta M, Schofield J, Kraft SP. Continuous data were summarised and presented as the mean standard deviation and range, while categorical data were presented as proportions and percentages. Inagaki R, Suzuki H, Haseoka T, Arai S, Takagi Y, Hikoya A, et al. Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures, medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Wright advocated this procedure were performed for the patients with undercorrected or recurrent exotropia who had undergone more than 6 mm bilateral lateral rectus recessions [35]. New York: Springer; 2003. p. XXIII, 1087. All data were fully anonymized and the requirement for informed consent was waived owing to the retrospective study design. Habot-Wilner Z, Spierer A, Barequet IS, Wygnanski-Jaffe T. Long-term results of esotropia surgery in children with developmental delay. Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea. Yang and Hwang[47] compared outcomes after bilateral and unilateral medial rectus resection for the treatment of recurrent exotropia of 25 PD or less at distance after bilateral lateral rectus recession for intermittent exotropia. Similarly, factors such as age, preoperative deviation, refractive error, lateral rectus incomitance are also involved in postoperative recurrence of exotropia. McPhee TJ, Dyer JA, Ilstrup DM. Eye Exercises for Strabismus - WebMD In addition, the magnitude of refractive changes and their clinical significance remains controversial. Reoperations for esotropia. The efficacy of unilateral rectus resection in the reoperation of strabismus. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The distance from the lateral recuts muscle (LR) insertion location to the limbus was significantly shorter in Taiwanese than in white Americans (6.5 vs. 6.9 mm, respectively, p = 0.0001). Disclaimer. All procedures were performed by a single surgeon (SJK) under general anaesthesia. However, previous studies focused on the immediate refractive changes within up to one year after surgery. Efforts to improve the surgical outcome for exotropia and - PubMed Bookshelf persimnon 1 min. Web3.8K subscribers in the Strabismus community. This may prevent postoperative astigmatism changes. Each eye has six MeSH The choice of surgical procedure depends on the previous operation pattern and surgical dosages applied on patients, residual angle of deviation and the operator's preference and experience. Yazdian Z, Ghiassi G. Re-recession of the lateral rectus muscles in patients with recurrent exotropia. Mims JL., 3rd Outcome of 5 mm resection of one medial rectus extraocular muscle for recurrent exotropia. The Comparison of outcomes between lateral rectus muscles re-recession and medial rectus muscles resection in recurrent exotropia.