Histopathologic Change in the Anterior Part of the Posterior Fixation Suture After a Faden Operation in an Animal Model.

PURPOSE: To observe postoperative histological changes in the anterior part of the posterior fixation suture after a Faden operation in an animal model. METHODS: A posterior fixation suture was placed at two points 6 mm posterior to the insertion of the extraocular muscle on the superior rectus muscle of the right eye in eight rabbits. The superior rectus muscle of the left eye was used as a control. The eyes were enucleated and the anterior portion of the posterior fixation suture, including the myoscleral junction, was extracted 4 weeks after surgery. Postoperative adhesion was graded from 0 to 4 based on histologic findings (hematoxylin-eosin and Masson's trichrome staining). RESULTS: Histological evaluation revealed diffuse fibrosis at the myoscleral junction and the anterior part of the posterior fixation suture after the Faden operation. The graded scores for fibrosis, acute inflammation, chronic inflammation, and foreign body reactions in the Faden operation group were significantly higher than those in the control group (P < .05). Postoperative diffuse fibrosis of the myoscleral junction and anterior-to-posterior fixation sutures were observed in an animal model. CONCLUSIONS: Histologic changes may affect ocular alignment and motility, making reoperation unpredictable after the Faden procedure. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Clinical features of excyclotorsion in the non-paretic eye of patients with congenital unilateral superior oblique palsy.

BACKGROUND: To investigate preoperative clinical features and postoperative results according to the correspondence between excyclotorsion and the paretic eye in patients with congenital unilateral superior oblique palsy (USOP). METHODS: A retrospective review of medical charts was performed. The patients were divided into the accordance (ocular excyclotorsion in the paretic eye) and disaccordance (ocular excyclotorsion in the non-paretic eye) groups. The degree of excyclotorsion (scale, 0-4) was measured. Age, sex, hypertropia at the primary position, fixation preference, inferior oblique overaction, and degree of excyclotorsion were measured. RESULTS: Ninety-eight patients were included in this study. There were 70 (71.4%) and 28 patients (28.6%) in the accordance and disaccordance groups. Sixteen patients (22.9%) in the accordance group and 12 patients (42.9%) in the disaccordance group were aged under 2 years (p = 0.04). A fixation preference of the paretic eye was observed in 2 (2.9%) and 8 (28.6%) patients in the accordance and disaccordance groups (p < 0.01). The postoperative degree of excyclotorsion in the accordance group (0.14 ± 0.39) was lower than that in the disaccordance group (0.28 ± 0.71) (p = 0.01). The residual postoperative excyclotorsion (> 1) were observed in the disaccordance group (14 patients, 50%) and accordance group (16 patients, 22.9%) (p = 0.01). CONCLUSION: Preoperative disaccordance between excyclotorsion and the paretic eye was observed in patients who were under 2 years of age and preferred fixation of the paretic eye. The postoperative degree of excyclotorsion was lower in the accordance group.

Effect of Classroom Illuminance on the Development and Progression of Myopia in School Children.

PURPOSE: To evaluate the effect of classroom illuminance on the development and progression of myopia in elementary school children. METHODS: The daylight factor, a ratio of inside and outside illuminance, was obtained in 50 elementary schools. The firstgrade students in the school with the lowest daylight (LD) factor (LD school, 145 subjects; 0.51%) and with the highest daylight (HD) factor (HD school, 147 subjects; 13.35%) were selected. A survey was conducted to evaluate parental myopia, the amount of near-work and outdoor activities. The refractive error and axial length (AL) were measured at initial and after 6 months. The spherical equivalent, AL, and the survey results were compared between the two schools. The mean AL of the emmetropic children was obtained, and all subjects were divided into two groups, more and less than mean AL. Changes in refractive errors and AL were also compared according to AL. RESULTS: The amount of change in spherical equivalent and AL after 6 months were not different between the two schools. Initial prevalence of myopia was high in the HD school. However, it became similar between the two schools after 6 months. The mean AL of 155 emmetropic children was 22.7 ± 0.63 mm. In the 185 children with AL ≥22.7 mm, there was no difference in the AL change between the two schools. However, the change in AL in 107 children with AL <22.7 mm was significantly larger in the LD school (0.19 mm) than that in the HD school (0.15 mm, p = 0.049). Parental myopia, near-work and outdoor activities were not different between the two schools. CONCLUSIONS: High classroom illuminance during the day reduced axial elongation in eyes of children with a shorter AL. Increase in classroom light level by permitting more sunlight can be a protective measure against the development of myopia.

Clinical factors affecting the rate of exodrift after surgery in patients with basic intermittent exotropia.

We investigated the period of postoperative exodrift during follow-up and clinical factors that affect the rate of exodrift after surgery in the patients with intermittent exotropia (IXT). A retrospective review of medical records of patients with exodrift who underwent bilateral rectus recession for IXT was performed. Exodrift was defined as angle of deviation greater than 10 prism diopters (PD) at distance and near. The median survival period of postoperative exodrift was analyzed using Kaplan Meier survival analysis. The patients were divided into two groups according to the median period of postoperative exodrift (early and late group). The weighted Cox's proportional hazards regression analysis to investigate the risk factors that affect rate of postoperative exodrift was performed. A total of 108 patients was included. The preoperative angle of deviation at distance and near were 30.3 ± 7.2 PD and 29.5 ± 8.6 PD, respectively. The median survival period of postoperative exodrift was 24 months (range, 6-48 months).The angle of deviation at postoperative day 1 in early and late group were - 3.8 ± 5.5 PD (range, - 16-8 PD) and - 7.7 ± 4.6 PD (range, - 16-4 PD) (p < 0.01). Minus value means esodeviation. In regression analysis, the angle of deviation at postoperative day 1 was the significantly related with rate of exodrift (p < 0.01). The median period of exodrift after surgery was 24 months, angle of deviation at postoperative day 1 could affect the rate of exodrift in patients with IXT.

Initial Postoperative Alignment in Strabismus Related to Thyroid Eye Disease.

PURPOSE: To investigate the surgical outcome according to the initial postoperative angle of deviation in patients with thyroid eye disease. METHODS: The medical records of patients who underwent strabismus surgery were retrospectively reviewed. The patients were divided into overcorrection (> 5 prism diopters [PD]), full correction, or undercorrection (> 5 PD) groups, according to the angle of deviation on postoperative day 1. The surgical outcome was considered successful when there was no diplopia vertically (< 5 PD) and horizontally (< 10 PD) at primary gaze. Surgical success rates were evaluated according to the initial postoperative angle of deviation at the final visit. RESULTS: Seventy-eight patients were enrolled in this study. The mean age of the patients was 53.4 ± 9.5 years, and the mean follow-up duration was 17.4 ± 8.7 months. There were 51 patients with hypotropia and 27 patients with esotropia. Success rates for hypotropia were higher in the undercorrection (80.0%) and full correction (66.7%) groups than in the overcorrection (35.7%) group on postoperative day 1 (P = .02). Regarding esotropia, the success rates were higher in the undercorrection (84.6%) and full correction (83.3%) groups than in the overcorrection (37.5%) group on postoperative day 1 (P = .02). Reoperation for residual or overcorrected strabismus was performed in 15 patients (29.4%) with hypotropia and 7 patients (25.9%) with esotropia. CONCLUSIONS: Intended minimal undercorrection or full correction after hypotropia and esotropia surgery during early postoperative periods could improve surgical success rates in patients with thyroid eye disease. [J Pediatr Ophthalmol Strabismus. 2021;58(1):23-27.].

Long-term follow-up study on surgical outcomes of the Faden operation in consecutive esotropia.

We evaluated the long-term surgical outcomes of medial rectus (MR) recession with the Faden operation in consecutive esotropia (CET). We retrospectively analyzed patients who underwent MR recession with the Faden operation for CET between 2013 and 2018, and compared surgical outcomes between patients who underwent MR recession with the Faden operation (Faden group) and MR recession only (control group). We followed up the patients at 24 months postoperatively. Postoperative success was defined as final deviation of less than distant 5 prism diopters (PD) of eso- or exodeviation at the final visit. We compared postoperative alignment and stereoacuity between the two groups. Stereoacuity was classified as good (60 or better seconds of arc), fair (80-3000 s of arc) or nil. The Faden and control group included 11 and 13 patients, respectively. All patients in the Faden group showed orthophoria and eight patients (72.7%) showed good stereoacuity at the final visit. One patient (9.1%) in the Faden group showed adduction limitation at the final visit. Eight patients (61.5%) in the control group had successful outcomes at the final visit. Six patients (46.2%) in the control group showed good stereoacuity at the final visit. One patient (7.7%) in the control group underwent reoperation for recurrent esotropia at 18 months postoperatively. The surgical outcomes after MR recession with the Faden operation for CET were excellent in long-term follow- up. The Faden operation could be a good surgical option for CET.

Clinical Manifestations of Delayed-onset Consecutive Esotropia after Surgical Correction of Intermittent Exotropia.

PURPOSE: To evaluate the clinical features and prognosis of a delayed-onset consecutive esotropia (ET) after surgical correction of intermittent exotropia. METHODS: Thirty-four patients who developed consecutive ET after primary bilateral lateral rectus recession for the surgical correction of intermittent exotropia were evaluated retrospectively and were divided into two groups: delayed-onset consecutive ET group and the continuous consecutive ET group. Patients who developed esodeviation after once recovering to orthotropia within 1 month after the operation were included in the delayed-onset consecutive ET group, and patients with continuous esodeviation after the operation were included in the continuous consecutive ET group. We evaluated preoperative and postoperative angle of deviation, suppression, stereopsis, and follow up periods between the two groups and compared re-operation and success following non-surgical treatment between the continuous consecutive ET group and the delayed-onset consecutive ET group. RESULTS: Among 34 patients with consecutive ET, 27 patients (79.4%) were included in the delayed-onset consecutive ET group, and seven patients (23.3%) were included in the continuous group. Success rate of non-surgical treatment was not statistically significant between two groups (p = 0.55), but it was higher in the delayed-onset group with 37.5%, and 25% of patients in continuous group were successfully recovered to straight alignment. Duration of orthotropia in delayed-onset group was 7.4 ± 6.0 months (range, 2-29 months). Age, sex, preoperative refractive error, preoperative exodeviation, suppression, and near steroacuity were not statistically significant between two groups (p > 0.05, all). In the delayed-onset group, three patients (11.1%) underwent re-operation, while three patients (42.9%) in continuous consecutive ET group underwent re-operation (p = 0.048). CONCLUSIONS: Re-operation rate of delayed-onset consecutive ET after surgical correction of intermittent exotropia was lower than that of continuous consecutive ET.

Recovery From Suppression With Successful Motor Alignment After Surgery for Intermittent Exotropia.

PURPOSE: To investigate recovery from suppression when the target motor alignment is achieved following surgery for intermittent exotropia. METHODS: The medical records of 237 patients who underwent surgery for exotropia were retrospectively reviewed. The age at surgery, sex, preoperative angle of deviation, suppression status, and near stereopsis were investigated. Suppression status was classified as no, alternate, or constant suppression. Target motor alignment was defined as 10 prism diopters (PD) or less of exodeviation or 2 PD of esodeviation at the final visit. RESULTS: The mean age at surgery was 8.2 ± 3.2 years and 115 (48.5%) patients were male. The preoperative angle of deviation was 26.3 ± 5.9 PD and the follow-up postoperative period was 21.6 ± 7.6 months. The preoperative suppression status included 23 (9.7%), 55 (23.2%), and 159 (67.1%) patients who showed no, alternate, or constant suppression, respectively. Two hundred fifteen (90.7%) patients obtained the target motor alignment by the final visit. Of the 144 patients who demonstrated constant suppression preoperatively but achieved the target motor alignment postoperatively, 12 (8.3%) patients demonstrated residual suppression. All 12 of these patients had a preoperative angle of exotropia of greater than 20 PD. CONCLUSIONS: Most patients undergoing surgery for intermittent exotropia obtained both successful motor alignment and fusion postoperatively. However, successful motor alignment did not guarantee recovery of suppression when the preoperative angle of exotropia was greater than 20 PD. The preoperative factors and functional implications underlying this finding are unclear and merit further study. [J Pediatr Ophthalmol Strabismus. 2020;57(1):21-26.].

Measurement of the Angle of Exodeviation With Polarized Glasses in Intermittent Exotropia.

PURPOSE: The purpose of this study was to investigate if the angle of deviation with Polarized glasses is effective for measuring maximal angles in patients with intermittent exotropia (IXT). DESIGN: Prospective cross-sectional study. METHODS: This study was conducted on patients with >10 prism diopters (PD) of basic-type IXT at distance and near. Three consecutive, different methods for measurement of the angle of deviation were used: alternate prism cover test (ACT), ACT with Polarized glasses (Polaroid test), and ACT after 1 hour of monocular occlusion (occlusion test). Comparison of the 3 methods of measurement was conducted using the Friedman repeated ANOVA and Wilcoxon signed rank test. RESULTS: A total of 60 patients were included in this study. Thirty (50%) patients were male. Mean age was 8.7 ± 5.1 years (range, 4-37 years) and measurements by ACT at distance and near were 25.2 ± 8.0 PD and 25.4 ± 8.2 PD, respectively. Angles of Polaroid and occlusion tests (29.0 ± 8.6 PD vs 30.6 ± 8.1 PD) were significantly increased compared to that of ACT at distance (P < .01), and there was no significant change between angles of Polaroid and occlusion tests at distance (P = .06). However, there was no significant change between angles of ACT and Polaroid tests (25.4 ± 8.2 PD vs 26.9 ± 8.1 PD) at near (P = .07). CONCLUSION: The angle of deviation with Polarized glasses at distance increased and was comparable to that after the monocular occlusion test. The angle of exodeviation with Polarized glasses may be an easy, simple and effective alternative to measurement of maximum angle of deviation in IXT.

Analysis of new attachment site in medial rectus resection with advancement using anterior segment optical coherence tomography.

OBJECTIVE: To evaluate the surgical outcome of unilateral medial rectus resection with small advancement for recurrent exotropia, ≤30 prism diopters (PD), and verify new attachment site anatomically using anterior segment optical coherence tomography (ASOCT). METHOD: This study is a retrospective chart review of patients who underwent 1.0 mm advancement of unilateral resected medial rectus from original medial rectus (OMR) insertion for recurrent exotropia since 2014. The age at operation, sex, preoperative angle of deviation, near stereopsis, and suppression were evaluated. Success was defined as ≤5 PD of esodeviation or ≤10 PD of exodeviation at the final visit. Preoperative scleral thickness was measured using ASOCT, 1.0 and 0.5 mm anterior to OMR insertion, and at the insertion. RESULTS: A total of 76 patients, including 30 males (40.2%), were reviewed retrospectively. Continuous values were presented as mean ± standard deviation. Age at operation was 11.6 ± 6.6 years. The preoperative deviation was 20.9 ± 3.6 PD, and the amount of resected unilateral medial rectus was 4.5 ± 0.6 mm. The minimum required follow-up period after operation was 12 months after surgery. The postoperative follow-up period was 21.3 ± 8.0 months. A total of 65 patients (87.8%) showed successful outcome at the final visit. Preoperative scleral thickness at 1.0 and 0.5 mm anterior to OMR insertion site, and at OMR insertion site were 0.52 ± 0.05, 0.52 ± 0.06, and 0.43 ± 0.04 mm, respectively. Scleral thickness at OMR insertion site was significantly less compared with 1.0 and 0.5 mm from the OMR insertion site (p = 0.03). CONCLUSION: The scleral thickness 1.0-0.5 mm anterior to OMR insertion site was thicker that than at the OMR insertion site. The new technique of medial rectus resection with small advancement may be safer and more effective than conventional technique.

Distance Suppression as a Predictive Factor in Progression of Intermittent Exotropia.

PURPOSE: To address the natural course of intermittent exotropia with small exodeviations (less than 20 prism diopters [PD]) according to the status of suppression, and to evaluate whether suppression testing at the initial visit can assist in predicting the progression of intermittent exotropia. METHODS: Clinical records of patients at the Korea University Anam Hospital, Seoul, Korea diagnosed between January 2014 and December 2018 with basic-type intermittent exotropia and initial distance deviations of less than 20 PD, older than four years of age and a minimum of three follow-up visits within a 6-month span were retrospectively reviewed. The participants were divided into two groups, the suppression group and the non-suppression group, based on the Vectogram results at the initial visit. Clinical characteristics, rate of surgery, and rate of progression were compared between the two groups. RESULTS: A total of 71 patients were included. Among them, 16 patients (22.5%) had visual suppression at the initial visit, while 55 patients (77.5%) had no suppression. At the initial visit, the mean distant angle of deviation was 13.7 ± 3.2 PD (range, 4 to 18 PD) in the suppression group and 12.7 ± 3.4 PD (range, 10 to 18 PD) in the non-suppression group. Ten patients (62.5%) underwent surgery in the suppression group and 12 patients (21.8%) underwent surgery in the non-suppression group (p < 0.01). Eleven patients (68.8%) in the suppression group and 13 (23.6%) in the non-suppression group developed progression (p < 0.01). CONCLUSIONS: Suppression testing was important to predict the progression of intermittent exotropia, in patients with exodeviation angles less than 20 PD at the initial visit.

Esodeviation without correction for tapering hyperopia in refractive accommodative esotropia.

OBJECTIVE: To investigate clinical features for prescription of tapered hyperopia in patients with refractive accommodative esotropia (RAET). METHODS: The clinical features in patients with RAET who began tapering of hyperopia were analyzed. Within a range that can sustain corrected visual acuity and stereoacuity, patients were prescribed for tapered hyperopic correction by 0.25-diopters (D) interval, up to a maximum of 1.0 D. At every visit, visual acuity and esodeviation with and without correction, amount of tapered hyperopia, and near stereoacuity were measured. RESULTS: One hundred and six patients were enrolled in this study. The follow-up period was 3.1 ± 0.2 years and frequency of visits was 6.3 ± 0.6. Tapering hyperopia was initiated at 6.1 ± 2.9 years, and baseline refraction was 7.6 ± 1.5 D. The esodeviation without correction was 24.3 ± 8.5 prism diopters (PD), and median near stereoacuity was 400 arc sec. The median amount of tapered hyperopia at visit was 0.5 D. At the final visit, there were no significant deteriorations in visual acuity, esodeviation with correction, or near stereoacuity (p > 0.05, all). The amount of tapered hyperopia was positively correlated with correction and the reduced esodeviation without correction (p = 0.03). CONCLUSIONS: Esodeviation without correction should be considered for tapering hyperopia for patients with RAET. Esodeviation without correction can be easily measured, and its decline may be used as a clinical indicator for tapering hyperopia.

Surgical factors affecting oculocardiac reflex during strabismus surgery.

BACKGROUND: To investigate surgical factors associated with the occurrence of oculocardiac reflex (OCR) and changes in heart rate (HR) during strabismus surgery. METHODS: Patients who underwent strabismus surgery under general anesthesia were enrolled in this study. The HR during surgery was measured at baseline, and at the following points during surgery: traction of the muscle, maximal increase after traction (adrenergic phase), and the cutting of the muscle. OCR was defined as an HR reduction of more than 20% at traction of the muscle, when compared to baseline HR. The HR at each stage during the surgery was compared between patients with and without OCR. RESULTS: A total of 162 operated muscles from 99 patients were enrolled. The incidence of OCR was 65% in patients. In patients with two muscle surgeries, there were significantly more OCRs in the first operated muscle than in the second operated muscle (p < 0.01). The difference in the decrease in HR in patients with OCR was significantly lower than that in patients without OCR at traction of the muscle, the adrenergic phase, and the cutting of the muscle (all, p < 0.01). The first operated muscle was a significant risk factor associated with the occurrence of OCR (OR = 3.95, p < 0.01). CONCLUSION: The first operated muscle in patients with two muscle surgeries was a significant risk factor for OCR. Decreased HR at the traction of the muscle during surgery did not fully recover in patients with OCR.

Bilateral Optic Nerve Involvement Combined with Unilateral Facial Palsy in a Patient with Acute Myeloid Leukaemia: A Case Report.

Central nervous system (CNS) involvement, including optic nerve involvement, in a patient with acute myeloid leukaemia (AML) is an extremely rare condition. We report a case of bilateral optic nerve involvement combined with unilateral facial palsy in a patient with AML who achieved complete remission following allogenic peripheral blood stem cell transplantation as a young patient. After further evaluation, the patient was diagnosed with a recurrence of AML with CNS involvement. The presentation of multiple types of CNS involvement in AML may be suspicious evidence of AML recurrence.

Early postoperative overcorrection in recurrent exotropia.

OBJECTIVE: To investigate the surgical outcome according to the angle of deviation at postoperative day 1 in patients with recurrent exotropia DESIGN: Retrospective case series METHODS: Surgical outcome in patients with recurrent exotropia for at least 1 year was analyzed retrospectively. Patients were divided into 3 subgroups according to the angle of deviation at postoperative day 1: overcorrection group (≥2 prism diopter [PD] of esodeviation), orthotropic group (orthotropia or <5 PD of exodeviation), and undercorrection group (≥5 PD of exodeviation). Success was defined as ≤5 PD of esodeviation or ≤10 PD of exodeviation at the final visit. RESULTS: One hundred and six patients were included in this study. Age at surgery was 11.8 ± 6.9 years, and preoperative angle of deviation was 22.9 ± 6.3 PD at distant. Patients were followed-up for 24.4 ± 12.8 months. There were 20 (18.9%), 82 (77.4%), and 4 (3.8%) patients in overcorrection, orthotropic, and undercorrection groups at postoperative day 1 (p = 0.001). The surgical success rate at the final visit in the overcorrection group (95%) was higher than that in orthotropic and undercorrection groups (76.8% and 25%, respectively, p = 0.004). In univariate regression analysis, overcorrection at postoperative day 1 was the only reliable factor for long-term success (odds ratio [OR] = 24.101, p = 0.01). CONCLUSION: Overcorrection at postoperative day 1 is a good surgical predictor of successful outcome in surgery for recurrent exotropia.

Clinical Features and Surgical Outcome of Triad Exotropia.

PURPOSE: To describe the clinical features and surgical outcome of A-pattern exotropia combined with dissociated vertical deviation and superior oblique overaction. METHODS: The medical records of patients with A-pattern exotropia combined with dissociated vertical deviation and superior oblique overaction who underwent horizontal muscle surgery alone or in combination with superior oblique muscle weakening surgery were retrospectively reviewed. The patients were divided into two groups according to their surgery: the horizontal muscle surgery alone group and the horizontal muscle surgery with bilateral superior oblique weakening surgery (combined surgery) group. The preoperative clinical features and postoperative surgical outcomes at the patients' final follow-up visits were analyzed. RESULTS: A total of 40 patients were included. The mean age at diagnosis was 5.5 ± 4.6 years. Amblyopia and latent nystagmus were observed in 18 (45%) and 10 (25%) patients, respectively. Six (15%) patients were associated with delayed development and hemiplegia. The mean angle of exodeviation was 27.7 ± 11.2 and 28.5 ± 10.9 prism diopters (PD) for distance and near, respectively. The mean degree of superior oblique overaction was 1.9 ± 1.1 and asymmetrical dissociated vertical deviation was observed in 24 (60%) patients. At the final follow-up visit, the horizontal angle of deviation was not significantly different between the groups. The success rates were 57.1% and 80% in the horizontal muscle surgery alone and combined surgery groups, respectively. These differences were statistically significant (P = .04). CONCLUSION: Amblyopia was common and the prognosis of binocularity was poor in triad exotropia. Some patients had neurological deficits. The surgical success rate in this study was variable, ranging from 57.1% to 80%. [J Pediatr Ophthalmol Strabismus. 2017;54(6):363-368.].

A Valid Indication and the Effect of Bilateral Inferior Oblique Transposition on Recurrent or Consecutive Horizontal Deviation in Infantile Strabismus.

PURPOSE: To evaluate the effects of bilateral inferior oblique transposition (BIOT) on horizontal deviation from primary position among patients with bilateral dissociated vertical deviation (DVD) associated with inferior oblique overaction (IOOA) in infantile strabismus. METHODS: Retrospective chart review was conducted among 19 patients with infantile strabismus. All patients had DVD and IOOA with consecutive or recurrent horizontal deviation and underwent modified BIOT surgery. Patients were divided into three subgroups: patients who underwent BIOT (BIOT group, n = 9) alone, BIOT with medial rectus recession or lateral rectus resection simultaneously (ET BIOT group, n = 6), or BIOT with lateral rectus recession or medial rectus resection simultaneously (XT BIOT group, n = 4). Postoperative angle of horizontal deviation (prism diopter, PD) and corrected magnitude of horizontal deviation (PD) at final visit after surgery were analyzed in each group. RESULTS: The mean age was 55.11 ± 21.05 months (range, 32 to 115). The mean follow-up period was 8.68 ± 2.87 months (range, 6 to 18). Preoperative horizontal deviation was 4.23 ± 5.99 PD (range, 0 to 16) in BIOT, -17.33 ± 6.76 PD (range, -30 to -10) in ET BIOT, and 17.50 ± 2.52 PD (range, 14 to 20) in XT BIOT. Esodeviation is represented by negative values. DVD and IOOA were reduced less than +1 in all patients. The corrected amount of horizontal deviation was 3.56 ± 5.18 PD (range, 0 to 16) in BIOT surgery alone and larger in XT BIOT (18.50 ± 3.41 PD) than in ET BIOT (12.33 ± 5.57 PD, p = 0.004). CONCLUSIONS: Minimal exodeviation was corrected by BIOT alone. In addition, secondary eso- or exodeviation at great magnitudes should be corrected with proper horizontal muscle surgery along with BIOT.

Esotropia Surgery Considering the Angle under General Anesthesia.

PURPOSE: To compare the amount of esotropia corrected by surgery under general anesthesia and in a conscious state in esotropia surgery. METHODS: The charts of 42 patients who underwent surgery under general anesthesia for correction of esotropia were reviewed. Angle of deviation was measured by the alternate prism cover test in awakened state one day before and after surgery. Under general anesthesia, angle of deviation was measured by Hirschberg or Krimsky test in 5 prism diopters (PD) scale 30 minutes after induction and at the end of the surgery. The amount of the angle of esodeviation corrected by surgery measured in awakened state (A-correction) and under general anesthesia (G-correction) was compared and analyzed to identify significant differences. RESULTS: The median age was 4.0 years and the median preoperative esodeviation angle was 30.0 PD. The median amount of G-correction of 30.0 PD was significantly different compared with that of A-correction at postoperative day one (p=0.003). However, differences between A-correction and G-correction were not evident at postoperative one week, one month, and final follow-up examination (p= 0.191, 0.215, and 0.396, respectively). CONCLUSIONS: Esotropia in A-correction was comparable to that in G-correction only at postoperative day one. These results suggest that it is desirable to perform esotropia surgery according to the initial surgical plan of awakened state regardless of the divergence of eye position. When in doubt, it could be useful to confirm whether the actual amount of surgical correction under general anesthesia is consistent with the plan and modifying the surgical dose nomogram.

Visual Discomfort While Viewing Three-dimensional Television as a Screening Tool for Pediatric Eye Diseases in Children.

PURPOSE: To investigate the efficacy of evaluating 3D asthenopia and 3D perception difficulty for screening of binocular vision abnormalities in children. METHODS: Patients aged 6-12 years with abnormal binocularity, including strabismus, amblyopia, and anisometropia, were included. Age-matched normal subjects without any ophthalmologic abnormality other than a refractive error were also recruited. The best-corrected visual acuity, refractive error, angle of strabismus, and stereopsis were measured. Presenting visual acuity (PVA) was measured as the uncorrected visual acuity for subjects without glasses and spectacle-corrected visual acuity for those with glasses. After watching 3D TV for 30 min, a survey was administered to evaluate the 3D perception and 3D asthenopia. Receiver operation characteristic (ROC) curve analysis was conducted to evaluate the efficacy of the survey for detecting abnormal binocularity and poor PVA. RESULTS: One hundred subjects were enrolled in this study. Among them, 59 had abnormal binocularity (strabismus, anisometropia, or amblyopia), and 41 were normal control. Among the entire subjects, the number of subjects with a PVA of 20/40 or worse in one or both eyes was 24 (7 from the normal control and 17 with abnormal binocularity). ROC curve analysis revealed that the survey did not effectively detect strabismus, anisometropia, or amblyopia. However, for detection of PVA 20/40 or worse in the subjects with abnormal binocularity, the total score of the survey yielded an area of 0.714 under the ROC curve (p = 0.010). The sensitivity was 88.2% and specificity was 61.9% with a cutoff at 0.50. CONCLUSION: The degree of 3D asthenopia and 3D perception while watching 3D TV were not effective for screening of abnormal binocularity. However, evaluation of the severity of 3D asthenopia and the quality of 3D perception can help screen of decrease in PVA that requires correction.