Strabismus Surgery of Consecutive Exotropia.

PURPOSE: The purpose of this study was to determine the surgical outcome, dose-effect (DE), and degree of binocularity in patients undergoing surgery for consecutive exotropia following initial surgery of esotropia. PATIENTS/METHODS: Twenty-one patients were identified. We analyzed the mean angle of deviation pre- and postoperatively as measured with the alternate prism cover test, DE, and binocularity. RESULTS: All patients had had previous strabismus surgery. The surgery for consecutive exotropia had been performed at a mean age of 35.92 ± 18.26 years. In 19 of these patients, surgery of consecutive exotropia involved at least one previously operated extraocular muscle, and the mean interval to the previous surgery was 25.67 ± 16.14 years. The mean angle of deviation (DE) at distance and in the primary position was - 33.43 ± 12.75 prism diopters (PD) preoperatively, + 0.76 ± 7.91 PD 1 week after surgery, and - 7.24 ± 12.14 PD 3 months after surgery. The mean DE was 3.58 ± 1.53 mm/PD at 1 week and 2.70 ± 1.78 mm/PD at 3 months post-surgery. Postoperatively, 62% patients had a binocularity of at least Bagolini positive, 33% had either a positive TNO or Titmus Test, and 24% were Lang I positive (550″). CONCLUSION: Performing strabismus surgery with consecutive exotropia results in restoration of some binocularity in a large number of patients, even in adults, and should be considered as a possibility. The dose-effect is comparable to conventional surgery of exotropia.

Medial Rectus Tendon Elongation with Bovine Pericard (Tutopatch®) in Thyroid-Associated Orbitopathy: A Long-Term Follow-Up including Oculodynamic MRI.

INTRODUCTION: To assess long-term efficacy of bimedial rectus tendon elongation with Tutopatch in thyroid-associated orbitopathy (TAO). MATERIALS AND METHODS: Retrospective chart review of 5 patients with TAO undergoing bimedial rectus recession with Tutopatch tendon elongation between 2009 and 2015. We analyzed horizontal squint angles, motility, field of binocular single vision, dose effect of surgery, and when possible oculodynamic MRI (OD-MRI). Dose effect and motility were compared to 4 TAO patients with conventional bimedial recession. RESULTS AND DISCUSSION: In the Tutopatch group, preoperative angles ranged from 14 to 120∆ (prism diopters) at distance and 12-120∆ at near. Mean dose effect was 3.63∆/mm for the distance and 3.43∆/mm for the near angle. All patients were orthotropic at final FU (ranging from 1 to 10 years). OD-MRI showed the elasticity of Tutopatch. In the conventional recession group, preoperative angles ranged between 18 and 35∆ at distance and 12-33∆ at near. At final FU, 2 patients had reverted to their underlying microesotropia <2∆, 1 patient was orthophor, and one was reoperated for a remaining esotropia of 14∆. Dose effect was 2.95∆/mm for the distance and 2.18∆/mm for the near angle. Motility improved in both groups even after 3 months. CONCLUSIONS: Dose effect for medial rectus recessions with Tutopatch in TAO was higher than previously reported, presenting a good alternative to treat large squint angles while preserving good motility.

Botulinum Toxin for the Treatment of Cyclic Strabismus in Children: Three Case Reports.

Cyclic strabismus is a rare disease of unknown origin. If untreated, it leads to manifest strabismus with the risk of amblyopia in children. Treatment is generally surgical. Here we report on three children in whom cyclic esotropia was successfully treated with one bimedial injection of 5 IU Botox®. All patients remained orthotropic with good stereo functions at the last follow-ups at 16, 11, and 8 months. Botulinum toxin offered a minimally invasive treatment option in these patients.

Y-Split Recession of the Medial Rectus Muscle as a Secondary and/or Unilateral Procedure in the Treatment of Esotropia with Distance/Near Disparity.

INTRODUCTION: In esotropia with larger angles > near than at distance, splitting of the medial rectus muscle has been suggested as a treatment option. Previous reports of bilateral medial rectus Y-splitting as a first intervention showed a reduction of the distance/near disparity with fewer side effects compared to posterior fixation surgery. We address whether a medial rectus Y-splitting as a secondary and/or a unilateral procedure also reduce distance/near disparity. MATERIALS AND METHODS: We retrospectively reviewed the charts of four patients undergoing Y-split recession as a second and/or unilateral surgery. Main outcomes were distance/near disparity and squint angles. RESULTS AND DISCUSSION: Three of the four patients had undergone unilateral Y-splitting of the medial rectus as a secondary surgery, three as a unilateral procedure. Mean distance/near disparity was reduced from 17 PD preoperatively to zero at the final follow-up (FU). Preoperative angles ranged from 45 PD to 66 PD at near and from 25 PD to 55 PD at distance. At the final FU, these angles ranged from 0 PD to 20 PD at near and at distance. Mean FU was 42 months (range: 12-60 months). CONCLUSION: Y-split recession as a secondary and/or unilateral surgery for distance/near esotropia can reduce distance/near disparity with good long-term results. Residual esotropia can be corrected by adding resection of the lateral rectus muscle.