Analysis of postoperative exodrift according to surgical methods for intermittent exotropia.

PURPOSE: This study aimed to compare the periods for exodrift stabilization and the long-term surgical outcomes among different surgical methods in intermittent exotropia. METHODS: The medical records of 350 patients who had undergone intermittent exotropia correcting surgery [unilateral lateral rectus recession-medial rectus resection (R&R, n = 221), bilateral lateral rectus recession (BLR, n = 51) and unilateral lateral rectus recession (ULR, n = 78)] with a postoperative follow-up period of 1.5 years or more were retrospectively reviewed. The deviation angles every 6 months after surgery, periods of exodrift stabilization and surgical outcomes were analysed. The period of postoperative exodrift stabilization was defined as when exodrift was no longer significantly different from that at the next visit (p > 0.05). An alignment of 5 PD (prism diopters) esotropia to 10 PD exotropia at a distance and near fixation was considered surgical success. RESULTS: The mean angle of exodeviation was significantly different among surgical procedures at postoperative 1 month (BLR > ULR > R&R, p < 0.001); however, there were no differences among the procedures at 6 months (p = 0.088). The periods of exodrift stabilization were 6 months after ULR, 1 year after BLR and 4.5 years after R&R. The surgical success and reoperation rates did not show significant differences among procedures at the final follow-up. CONCLUSION: Patients undergoing R&R showed smaller exodeviation shortly after surgery but required a longer period to stabilize the exodrift. Following ULR, exodeviation was larger in the early postoperative period, but the exodrift was stabilized earlier. Therefore, the long-term surgical outcomes were similar among ULR, BLR and R&R.

Shaving Papillary Thyroid Carcinoma Involving Functioning Recurrent Laryngeal Nerve: Safety of Incomplete Tumor Resection and Nerve Sparing.

BACKGROUND: Whether to sacrifice or spare the recurrent laryngeal nerve (RLN) when papillary thyroid carcinoma (PTC) involves a functioning RLN remains controversial. Oncological outcomes after shaving PTC with gross remnant on the RLN have been rarely reported. The objective of this study was to evaluate the oncological outcomes of patients who underwent shaving of a PTC from the RLN, leaving a gross residual tumor with the intent of vocal function preservation. METHODS: A retrospective, cohort study was conducted in 47 patients who were determined to have PTC invasion of the RLN via intraoperative inspection and underwent tumor shaving with macroscopic remnant (R2 resection) less than 1 cm in length and 4 mm in thickness. Median follow-up period was 93 (range, 60-215) months. The primary endpoint was the recurrence-free survival and the progression-free survival. Secondary endpoints were biochemical outcomes (serum thyroglobulin) and vocal cord function. RESULTS: Of the 47 patients, five (10.6%) patients showed recurrence (central neck, 3; lateral neck, 2) without death or distant metastasis. The RLN was resected along with the tumor in one (2.1%) patient who presented with progression of the residual tumor. Postoperative temporary vocal cord paralysis occurred in six (12.8%) patients without permanent cases. The final nonstimulated serum thyroglobulin was 0.7 ± 1.8 ng/ml. CONCLUSIONS: Shaving a tumor from a RLN with gross residual disease may be considered an alternative strategy to preserve vocal function when complete tumor resection with nerve preservation is impossible in patients with PTC invading a functioning RLN.

A cross-sectional study of ophthalmologic examination findings in 5385 Koreans presenting with intermittent exotropia.

The Korean Intermittent Exotropia Multicenter Study (KIEMS) was a retrospective, cross-sectional and multicenter study for the investigation of intermittent exotropia involved 65 strabismus specialists from 53 institutions in Korea. Purpose of this study was to present ophthalmologic findings of intermittent exotropia from the KIEMS. Consecutive patients with intermittent exotropia of ≥ 8 prism diopters (PD) at distance or near fixation were included. Best-corrected visual acuity, cycloplegic refraction data, angles of deviation at several cardinal positions, ocular dominance, fusion control, oblique muscle function, and binocular sensory outcomes were collected. A total of 5385 participants (2793 females; age 8.2 years) were included. Non-dominant eye was more myopic than the dominant eye (- 0.60 vs. - 0.47 diopters, P < 0.001). Mean exodeviation angles were 23.5 PD at distance and 25.0 PD at near fixation. Basic type (86.2%) was the most, followed by convergence insufficiency (9.4%) and divergence excess (4.4%) types. Alternating ocular dominance and good fusion control were more common at near than at distance fixation. Good stereopsis at 40 cm was observed in 49.3% in Titmus stereo test (≤ 60 arcsec) and in 71.0% in Randot stereo test (≤ 63 arcsec). Intermittent exotropia was mostly diagnosed in childhood and patients with the condition showed relatively good binocular functions. This study may provide objective findings of intermittent exotropia in a most reliable way, given that the study included a large study population and investigated comprehensive ophthalmology examinations.

Ocular motility disorders following coronavirus disease-19 vaccination.

PURPOSE: To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination. METHODS: Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed. RESULTS: Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22-81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0-28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively. CONCLUSION: This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.

Palatopharyngeal muscle suspension suture technique for patients with obstructive sleep apnea.

PURPOSE: Palatal surgery remains a major option for patients with obstructive sleep apnea (OSA). We sought to evaluate the therapeutic outcomes of the palatopharyngeal muscle suspension suture technique (PSST) as a novel palatal surgery for patients with OSA. MATERIALS AND METHODS: Of the 816 patients who underwent polysomnography (PSG) from February 1, 2017, to June 30, 2020, 30 patients with OSA who underwent PSST were retrospectively reviewed. The medical records of the patients were also recorded. Among the 30 patients with OSA, nine who underwent preoperative and postoperative PSG were analyzed. RESULTS: Of the 30 patients with OSA, 28 (93.3 %) were male. The mean (SD, standard deviation) age was 43.3 (12.7) years, and the mean (SD) body mass index was 27.3 (3.2). As objective parameters, the mean (SD) apnea-hypopnea index was significantly decreased from 45.9 (21.20) to 29.03 (21.62) (p < 0.05) and the mean (SD) lowest oxygen saturation improved significantly from 77.6 % (7.14 %) to 84.6 (5.17 %) (p < 0.05). As a subjective parameter, the mean (SD) Epworth Sleepiness Scale score decreased significantly from 10 (4.95) to 6.9 (4.57) (p < 0.05), and the mean (SD) visual analog scale score for snoring decreased significantly from 6.3 (1.8) to 3.1 (1.9) (p < 0.001). No complications, such as upper airway obstruction, intractable postoperative bleeding, or velopharyngeal insufficiency, were observed in any of the patients postoperatively. CONCLUSIONS: A novel palatal surgery, PSST, has numerous advantages as a useful surgical option for patients with OSA. It is minimally invasive, easy, time-saving, and relatively reversible.

Comparison of sensory outcomes in patients with successful motor outcome versus recurrent exotropia after surgery for intermittent exotropia.

Here, we compared sensory outcomes between patients with successful motor outcomes and recurrent exotropia after intermittent exotropia surgery. We retrospectively analyzed 303 patients who underwent surgery for intermittent exotropia, divided into two groups: successful motor outcome defined as an alignment between 10 prism diopters (PD) exodeviation and 5PD esodeviation at the final follow-up (Group A, n = 177) and residual or recurrent exotropia defined as exodeviation > 10 PD (Group B, n = 126). Preoperative and postoperative (at final visit) sensory outcomes were compared using the Titmus stereotest and distance Worth 4-dot test. Stereoacuity significantly improved postoperatively in both successful motor outcome group (Group A) and residual or recurrent exotropia group (Group B). However, stereoacuity did not differ between groups preoperatively and postoperatively. On the other hand, fusion rates for the Worth 4-dot test were significantly higher in group A than in group B, preoperatively and postoperatively, and significantly increased postoperatively only in group A. Therefore, the distance Worth 4-dot test may be useful for evaluating postoperative prognosis and preoperative sensory status.

Changes in contrast sensitivity after surgery for intermittent exotropia.

To determine whether intermittent exotropia (IXT) surgery affects contrast sensitivity (CS), this retrospective study evaluated the changes in monocular and binocular CS and the binocular summation ratio (BSR) quantified as the ratio between the values of the binocular and the better monocular CS score (BSR = binocular CS score/better monocular CS score) after surgery for IXT. The subjects were patients who had undergone IXT-correcting surgery with a postoperative follow-up of > 3 months and had pre- and postoperative records of Mars CS test scores. In total, 64 patients (128 eyes) were evaluated. Both the binocular and monocular CS scores of the operated eyes were significantly worse on postoperative 1 day than the preoperative scores, but they were recovered after 1 week. The monocular CS scores of the operated eyes were significantly worse than those of the non-operated eyes until 1 week. There was no significant difference in monocular CS scores between the one-muscle and two-muscle surgeries and in binocular CS scores between the successful alignment and overcorrection groups even on the first day after surgery. The mean BSR was significantly decreased until postoperative month 1, however, recovered to preoperative levels after month 3. In conclusion, IXT-correcting surgery may temporarily worsen the CS, but it is recovered to preoperative levels. Thus, changes in CS in the immediate postoperative period after strabismus surgery should not be of concern.

Initial overcorrection after surgery for intermittent exotropia in children less than 4 years old: Comparison with older children.

PURPOSE: While initial overcorrection after exotropia-correcting surgery is widely accepted for a favorable long-term outcome, some have not advocated such overcorrection in younger children owing to concerns regarding rapid deterioration of bifixation ability. This study aimed to evaluate the relationship between initial overcorrection after intermittent exotropia surgery and the surgical outcome in patients aged <4 years. METHODS: In this retrospective study, 391 patients who had undergone surgery for intermittent exotropia were classified into two groups according to the age at surgery: <4 years old (group Y [young], 130 patients) and 4-16 years old (group O [old], 261). The patients were subdivided into three groups according to the angle of deviation at postoperative 1 week: esophoria-tropia (ET) ≥10 prism diopters (PD) (subgroup I), ET 1-9 PD (II), and orthotropia or exophoria-tropia (XT) (III). We compared the surgical outcomes between the two groups and among subgroups; then, we analyzed consecutive esotropia patients. RESULTS: The mean exodeviation was smaller in the order of subgroup I, II, and III at every postoperative visit (p<0.05) in group Y but showed no difference among subgroups after 2 years in group O. Consecutive esotropia occurred at 1 month, postoperatively, in 6.9% and 2.6% of the patients in groups Y and O (p = 0.133), respectively. However, it persisted in two and one patient in groups Y and O, respectively, until the last visit. CONCLUSION: Early overcorrection after intermittent exotropia surgery was a safe and desirable result in terms of motor outcome in children aged under 4 years, as well as for children aged between 4-16 years.

An Overview of the Korean Intermittent Exotropia Multicenter Study by the Korean Association for Pediatric Ophthalmology and Strabismus.

The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.

MMPs, TIMPs and BMP-4 in medial rectus muscle obtained from intermittent exotropia patients and their clinical correlations.

BACKGROUND: To measure the amounts of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2 and bone morphogenetic protein (BMP)-4 in medial rectus muscle (MR) tissue obtained from intermittent exotropia (IXT) patients and to investigate the correlation between each protein amount and the clinical features of IXT including angles of deviation, age at surgery, duration of IXT and postoperative recurrence. METHODS: The protein amounts were measured by enzyme-linked immunosorbent assay (ELISA) in MR collected during surgery for 78 IXT patients. RESULTS: The mean amount of MMP-2 per mm of resected MR was 0.86 ng, of MMP-9, 2.72 ng, of TIMP-1, 1.99 ng, of TIMP-2, 0.92 ng and of BMP-4, 0.82 pg. MMP-2 showed a positive correlation with angle of deviation at distance and at near, age at surgery and duration of IXT (p = 0.000, p = 0.000, p = 0.000, p = 0.022, respectively, Spearman's rank correlation analysis). MMP-9 showed a positive correlation with angle of deviation at distance and at near (p = 0.001, p = 0.024) and BMP-4 showed a positive correlation with angle of deviation at distance (p = 0.012). TIMP-1 showed a negative correlation with angle of deviation at distance and at near (p = 0.003, p = 0.000). CONCLUSION: In IXT patients, MMPs and BMP-4 tended to increase and TIMPs to decrease with increasing angle of deviation, greater age at surgery and longer duration of IXT.

Do the primary surgical options for basic-type exotropia cause differences in distance-near discrepancy of recurrent exotropia after surgery?

PURPOSE: Most ophthalmologists appear to have no distinct preference between unilateral recess-resect (R&R) and bilateral lateral rectus (BLR) recessions to treat basic-type exotropia. This study aimed to determine whether differences in distance-near discrepancy and resultant exotropia types of recurrent exotropia following surgery for primary basic-type exotropia exist between the two surgical options. METHODS: Ninety-three patients with recurrent exotropia following BLR recessions for basic-type exotropia (BLR group) and 95 following R&R for basic-type exotropia (R&R group) were included in this retrospective study. The exotropia types in recurrent exotropia were classified into three types according to distance-near discrepancy: basic, divergence-excess, and convergence-insufficiency. The BLR and R&R groups were compared. RESULTS: After surgery for basic-type exotropia, the type composition changed differently in each group (p < 0.001). The basic-type of primary exotropia was more often maintained in recurrent exotropia in the R&R group than in the BLR group. The incidence of postoperative convergence-insufficiency type exotropia in the BLR group was 28.0% and 8.4% in the R&R group (p = 0.001). Postoperative near stereopsis and fusion control grade of distance deviation did not differ between the two groups (p > 0.05). CONCLUSIONS: Convergence-insufficiency type recurrent exotropia occurred more frequently after BLR recessions than after R&R for basic-type exotropia. The high rate of secondary convergence-insufficiency type exotropia after BLR recessions should be considered when clinicians select a surgical option to treat exotropia.

Surgical outcomes of intermittent exotropia according to exotropia type based on distance/near differences.

We compare the surgical outcomes of intermittent exotropia of the basic, pseudo-divergence excess (pseudo-DE) and true divergence excess (true DE) types. A study was performed with 342 patients who had undergone surgery for intermittent exotropia of the basic, pseudo-DE or true DE type with a postoperative follow-up period of 6 months or more. The main outcome measures were postoperative angles of deviation at distance and near, and surgical success rates. Surgical success was defined as alignment between exodeviation of 10 PD and esodeviation of 5 PD at distance and near. Additionally, survival curves of recurrence were analyzed by the Kaplan-Meier method. The postoperative angles of deviation at both distance and near in pseudo-DE type were significantly smaller than those in basic type at the final examination (p = 0.003, <0.001). The final surgical success rate in pseudo-DE (70.2%) was better than in basic (46.3%) or true DE (28.6%) (p = 0.003, 0.01). Reoperation for recurrent exotropia was performed in 27% of the basic, 17% of the pseudo-DE, and 35.7% of the true DE cases. According to a survival analysis for recurrence, patients with pseudo-DE showed lower incidence of recurrence than did patients with basic and true DE (p = 0.003, 0.02). In conclusion, the patients with intermittent exotropia of the pseudo-DE type showed better surgical outcomes than those with the basic or true DE type. Pseudo-DE also showed a lower recurrence rate than did the other 2 groups.

Comparison of Surgical Outcomes Between Bilateral Medial Rectus Recession and Unilateral Recess-Resect for Infantile Esotropia.

PURPOSE: To compare surgical outcomes between bilateral medial rectus recession (BMR) and unilateral medial rectus recession-lateral rectus resection (RR) for infantile esotropia. METHODS: In this retrospective study, BMR was performed on 57 patients (BMR group) and RR on 23 (RR group) for treatment of infantile esotropia with the postoperative follow-up period of 6 months or more. The main outcome measures were angle of esodeviation, rate of surgical success, rate of reoperation, rate of postoperative development of DVD, and postoperative sensory status. Surgical success was defined as esotropia or exotropia of 10 PD or less. RESULTS: The mean preoperative esodeviation at near was 44.1 prism diopters (PD) in BMR, and 40.2 PD in RR (p = 0.161). There was no statistically significant difference in angles of deviation between BMR and RR from postoperative day 1 to final follow-up, respectively (p > 0.05). Whereas until postoperative month 6 the surgical success rate did not significantly differ, from postoperative year 1 to final follow-up it was significantly higher in BMR than in RR (p < 0.05). The final success rates were 80.70% and 56.52% for BMR and RR, respectively (p = 0.047). The reoperation rate, correspondingly, was significantly lower for BMR (17.54%) than for RR (60.78%) (p = 0.000). CONCLUSION: There was no significant difference in the mean postoperative angle of deviation between BMR and RR for infantile esotropia. However, the final success rate was higher (p = 0.047) and the reoperation rate was lower for BMR than for RR (p = 0.000).

Postoperative changes of intermittent exotropia type as classified by 1-hour monocular occlusion.

PURPOSE: To evaluate postoperative changes of the intermittent exotropia type as classified by 1-hour monocular occlusion test. DESIGN: Institutional, retrospective study. METHODS: We retrospectively reviewed the medical records of 179 patients who had undergone surgery for intermittent exotropia with a postoperative follow-up of 6 months or more. We evaluated the exodeviation obtained before and after 1-hour monocular occlusion preoperatively and again at postoperative 1, 3 and 6 months. Intermittent exotropia was divided into 4 types according to Burian's classification. The main outcome measure was the distribution of intermittent exotropia type based on 1-hour monocular occlusion in both pre- and postoperative periods. RESULTS: Of the 179 patients, 152 (84.9%) were assigned preoperatively to the basic type, 14 (7.8%) to the pseudo-divergence excess type, and 13 (7.8%) to the convergence insufficiency type. At postoperative 1, 3, and 6 months, the exotropia-type distribution was shifted predominantly to the basic type (p<0.001, p = 0.004, p = 0.029, respectively). Among the preoperative basic-type patients, 96.9% maintained that type postoperatively. However, only 18.2 and 11.1% of the pseudo-divergence excess and convergence insufficiency types maintained the same type. The proportions of the basic type had increased at postoperative 6 months, from 87.8 to 95.7% for bilateral lateral rectus (BLR) recession, from 73.7 to 92.3% for unilateral recess-resect (R&R), and from 88.0 to 95.0% for unilateral lateral rectus (ULR) recession. CONCLUSION: The type of intermittent exotropia changed mostly to the basic type postoperatively even as classified after 1-hour monocular occlusion. This finding was consistent regardless of the surgical methods (BLR, ULR recession and R&R).

Changes of corneal topographic measurements and higher-order aberrations after surgery for exotropia.

PURPOSE: To analyze changes in corneal topographic measurements and higher-order aberrations (HOAs) after horizontal muscle surgery for exotropia. DESIGN: Retrospective, observational study. METHODS: A total of 131 eyes of 121 patients who had undergone surgery for exotropia were included. The eyes with unilateral lateral rectus (ULR) or bilateral lateral rectus (BLR) recession(s) were assigned to group A, and those with unilateral lateral rectus recession & medial rectus resection (R&R) to group B. Corneal topographic measurements and HOAs were compared between the preoperative and postoperative periods using a Placido-dual Scheimpflug analyzer (Galilei 2TM, Ziemer, Port., Switzerland) for each group. RESULTS: In group A, simulated keratometery (sim K) was significantly changed until 3 months postoperatively relative to the preoperative value (postoperative 1 week, p = 0.017; 1 month, p = 0.037; and 3 months, p = 0.023, respectively). All steep K (steep sim K, steep-Kpost, and TCP-steep K) parameters also were significantly changed at postoperative 1 month (p<0.001, p = 0.015, p<0.001, respectively), but not at 3 months. Among the higher-order aberrations, spherical aberration (Z40) and secondary horizontal astigmatism (Z42) at postoperative 1 week had significantly changed from the preoperative values, as had horizontal quadrafoil (Z44) at 1 month. However, in group B, only vertical quadrafoil (Z4-4) showed statistically significant changes, at postoperative 1 and 3 months. None of the other postoperative parameters was significantly different from the corresponding preoperative value. CONCLUSION: Lateral rectus recession induced changes in both corneal topographic measurements and HOAs, whereas R&R did so only in HOAs. These changes might explain some patients' complaints about poor quality of vision.

Effect of combining inferior oblique muscle weakening procedures with exotropia surgery on the surgical correction of exotropia.

PURPOSE: To determine whether the inferior oblique (IO) muscle weakening procedure combined with exotropia surgery affects the surgical correction of exotropia. DESIGN: Institutional, retrospective study. METHODS: We retrospectively reviewed the medical records of 310 patients who had undergone exotropia-correcting surgery combined with IO weakening (group A, 64 patients) or without IO weakening (group B, 246) with a postoperative follow-up of 6 months or more. The main outcome measures were the postoperative mean angle of horizontal deviation, the success rate, and the overcorrection rate. Surgical success was defined as an alignment between 10 prism diopters (PD) of exodeviation and 5 PD of esodeviation. RESULTS: The postoperative mean angles of exodeviation, throughout the follow-up period, did not significantly differ between the groups. Although the surgical success rate was higher in group B at postoperative 1 month (p = 0.035), there was no statistical difference between the 2 groups from postoperative 6 months.: The final success rates were 56.3 and 51.6% (p = 0.509). The overcorrection rate was significantly higher in group A at postoperative 1, 6 and 24 months (p = 0.017, p = 0.028, p = 0.030, respectively); however, at the final follow-up, there was no overcorrection in either group. CONCLUSION: The overcorrection rate was higher in group A until postoperative 2 years, even though the mean angles of exodeviation and the success rates did not significantly differ between the 2 groups. Surgeons should be mindful of overcorrection when planning exotropia surgery combined with the IO weakening procedure.

A Randomized Clinical Trial of Topical Diclofenac, Fluorometholone, and Dexamethasone for Control of Inflammation After Strabismus Surgery.

PURPOSE: To evaluate the comparative effects and safety of topical diclofenac sodium, fluorometholone, and dexamethasone for controlling inflammation after routine strabismus surgery. METHODS: This was a randomized clinical trial. Ninety-nine patients admitted for surgery to treat intermittent exotropia were randomly assigned to receive 1 of 3 postoperative eye drops between January 2015 and February 2016. The primary efficacy outcomes were pain and conjunctival injection. Pain score from 0 to 10 was evaluated in each patient at postoperative days 1, 2, 3, and 5, in addition to weeks 1, 2, and 4. Conjunctival injection was graded from 1 to 4 at postoperative weeks 1, 2, and 4. We also evaluated intraocular pressure (IOP), discomfort attributed to the drops, and development of any other side effects. RESULTS: Conjunctival injection grade was the lowest in the diclofenac sodium group at postoperative weeks 1 and 2 (P < 0.001 and P = 0.03). There was no significant difference in pain score among the 3 groups. Mean IOP was the highest in the dexamethasone group at postoperative weeks 1, 2, and 4 (P < 0.001, P < 0.001, and P = 0.02). Significant IOP elevation (≥10 mmHg relative to preoperative IOP) was observed in 6 patients in the dexamethasone group. There was no difference in discomfort upon administration of the drops among the 3 groups, and no other adverse events developed. CONCLUSION: Diclofenac sodium was more effective against conjunctival injection than the 2 topical corticosteroids tested, but had a similar effect on postoperative pain as them. IOP elevation developed only in the dexamethasone group.

Early postoperative changes of motor alignment after surgery for intermittent exotropia.

PURPOSE: To evaluate the early postoperative changes of the angle of deviation after surgery for intermittent exotropia. METHODS: We retrospectively reviewed the medical records of 114 patients who had been surgically treated for intermittent exotropia and followed-up on postoperatively for 1 month or more. Patients were observed at postoperative 6 h, 1 day, 1 week, and 1 month. The main outcome measure was the change of the angle of deviation during the early postoperative period (from 6 h to 1 day postoperatively). RESULTS: The mean preoperative angle of exodeviation was 26.3 ± 7.6 PD at distance and 25.4 ± 10.3 PD at near. The angle of deviation was -3.3 (esodeviation) ± 7.0 PD at distance and -0.7 ± 7.1 PD at near at postoperative 6 h, and -3.7 ± 6.9 PD and -0.8 ± 6.8 PD at postoperative 1 day. Neither of these sets represented a significant change from 6 h to 1 day postoperatively (p = 0.300 at distance, p = 0.945 at near). However, in 25 patients (21.9%) the angle of deviation changed 5 PD or more from 6 h to 1 day. Among them, ten showed exodrift and 15 esodrift. At postoperative 1 month, the deviations became significantly more exotropic compared with postoperative 1 day (p < 0.001). CONCLUSIONS: The mean angle of deviation showed no significant change from 6 h to 1 day postoperatively, but 21.9% of patients showed a change of 5 PD or more in this period. These results should be considered in determining the time and the target angle of adjustment in adjustable strabismus surgery for exotropia.

Outcomes after the surgery for acquired nonaccommodative esotropia.

BACKGROUND: To analyze the surgical outcomes for patients diagnosed with acquired nonaccommodative esotropia (ANAET). METHODS: In this retrospective study, the medical records of 35 patients who had undergone the surgery for ANAET with a postoperative follow-up period of 6 months or more were reviewed. The main outcome measures were postoperative esodeviation angle, final success rate, and factors affecting surgical outcome. Surgical success was considered to be an alignment within 8 prism diopters (PD) at distance and near. RESULTS: The preoperative mean esodeviation angles were 37.3 ± 13.7 PD at distance and 38.6 ± 16.6 PD at near. The postoperative mean esodeviation angles at distance were as follows: 4.2 PD at day 1, 4.0 PD at month 1, 3.9 PD at month 3, 4.9 PD at month 6, 4.7 PD at year 1, and 4.8 PD at final follow-up. There was no statistically significant difference in angle of esodeviation between the initial postoperative period (day 1 to month 6) and the final follow-up day (p > 0.05). The surgical success rate at final follow-up was 65.7% (23/35). Among the 12 patients for whom the surgery failed, 9 (24.3%) showed esotropia and 3 (8.1%) exotropia of more than 8 PD. Six patients (16.2%) underwent reoperation (4 for esotropia and 2 for exotropia). There was no factor influencing surgical outcome (p > 0.05). CONCLUSIONS: The surgical outcome in patients with ANAET was relatively favorable: the final success rate was 65.7% and the reoperation rate was 17.1%.