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1.
Sci Rep ; 12(1): 8591, 2022 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-35597850

RESUMO

To determine the efficacy of unilateral lateral rectus recession (ULR) for convergence insufficiency-type intermittent exotropia (CI-type IXT), we compared surgical outcomes following ULR and recess‒resect (RR) procedures for CI-type IXT. In this retrospective study, medical records of 57 children who underwent ULR (n = 30) or RR (n = 27) for CI-type IXT of less than 25 PD at distance with a postoperative follow-up of 6 months or more were reviewed. Surgical success was defined as an alignment between 10 PD exodeviation and 5 PD esodeviation at distance and near fixation. The postoperative exodeviation showed no significant difference between the two groups at the last follow-up. A significant reduction in the mean near-distance difference was achieved postoperatively in both groups: from 5.4 PD preoperatively to 2.5 at last follow-up after ULR, and from 8.2 to 2.4 after RR (both p = 0.001). However, this difference between ULR and RR was not statistically significant (p > 0.05). The success rate at the last follow-up was 63.3% for ULR and 70.4% for RR (p = 0.574). ULR was found to be an effective treatment for CI-type IXT, with similar surgical outcomes to RR.


Assuntos
Exotropia , Transtornos da Motilidade Ocular , Criança , Doença Crônica , Exotropia/cirurgia , Seguimentos , Humanos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular
2.
BMC Ophthalmol ; 22(1): 230, 2022 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-35597903

RESUMO

PURPOSE: To compare the effect of bilateral inferior oblique partial myectomy on V-pattern exotropia patients with bilateral symmetric inferior oblique overaction (IOOA) and asymmetric IOOA. METHODS: This was a retrospective study including 53 V-pattern exotropia patients with bilateral IOOA of all grades who underwent bilateral inferior oblique partial myectomy. Success was defined as the elimination of the IOOA and the collapse of the V pattern at the final follow-up. The fovea-disc angle (FDA) and V-pattern exotropia were compared before and after surgery. RESULTS: This study included 53 V-pattern exotropia patients, containing 29 patients with symmetric IOOA (Group I) and 24 patients with asymmetric IOOA (Group II). The last follow-up ranged from 3 to 16 months (mean of 5 months). After myectomy, 3 eyes in Group I and 2 eyes in Group II were observed with residual grade 1 IOOA. The surgical success rates of IOOA correction in Group I and Group II were 96% and 95%, respectively. The difference was not statistically significant (P = 0.808). V-pattern exotropia collapsed with residual 2 (min. 0, max. 6) PD for Group I and 2 (min. 0, max. 10) PD for Group II, and there was a statistically significant difference between pre- and postoperative V-pattern exotropia in the two groups (P = 0.000). No inferior oblique (IO) underaction or antielevation syndrome (AES) was found in either group. The average preoperative FDA of the right eye and the left eye was (8.93 ± 4.34)° and (10.86 ± 4.27)° in Group I and (9.08 ± 4.92)° and (11.00 ± 5.69)° in Group II. There was a significant difference in preoperative FDA between the right eye and the left eye in the two groups (Group I p = 0.029; Group II p = 0.038). CONCLUSIONS: Bilateral inferior oblique partial myectomy can bring "symmetric" effectiveness in the correction of IOOA and FDA. It can potentially be used as a safe and successful treatment for V-pattern exotropia with bilateral IOOA. In addition, the FDA may be a promising index for evaluating fundus extorsion.


Assuntos
Exotropia , Doenças Musculares , Transtornos da Motilidade Ocular , Doenças Orbitárias , Estrabismo , Exotropia/cirurgia , Movimentos Oculares , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Estrabismo/cirurgia , Resultado do Tratamento , Visão Binocular
3.
BMC Ophthalmol ; 22(1): 203, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508999

RESUMO

PURPOSE: To investigate the difference of spherical equivalent (SE) and pupil diameter in adult patients with intermittent exotropia (IXT) under various viewing conditions before and after surgery. METHODS: We retrospectively analyzed the medical records of 23 adult patients who underwent a surgery for IXT. The angle of deviation was measured by the prism and alternative cover test. Refractive error and pupil diameter were measured using the Grand Seiko WAM-5500 open-field autorefractor under binocular and monocular viewing conditions when patients stared at distance (6 m) and near (33 cm). Regression analyses were performed between accommodative load and the angle of deviation. RESULTS: Twenty-three patients (10 males, 13 females) with a mean age of 31.17±8.95 years, of whom 13 (56.5%) had the right eye as the dominant eye. The mean angle of deviation at near and at distance was 69.57±26.37 and 65.43±28.92 prism diopters respectively. There were no significant differences in accommodative response and pupil diameter between the dominant and non-dominant eyes. SE decreased when patients changed from monocular to binocular viewing, and from distant to near viewing (all P< 0.05), so as the pupil diameter (all P< 0.001). During binocular, not monocular viewing, SE was significantly greater after operation than it was before operation (P< 0.001). Accommodative load and pupillary constriction narrowed (p< 0.001) after the operation. Linear regression analysis showed a correlation between the angle of deviation at distance and accommodative load at distance (r2=0.278, p=0.010) and at near (r2=0.332, p=0.005). CONCLUSION: In order to maintain ocular alignment, patients with IXT suffer a large accommodative load, which is related to the angle of deviation. Surgery helps eliminating extra accommodation.


Assuntos
Exotropia , Acomodação Ocular , Adulto , Doença Crônica , Exotropia/cirurgia , Feminino , Humanos , Masculino , Refração Ocular , Estudos Retrospectivos , Visão Binocular/fisiologia , Adulto Jovem
4.
Trials ; 23(1): 289, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410367

RESUMO

BACKGROUND: Intermittent exotropia (IXT) is the most common type of exotropia in China. Surgery is usually required to align the eye deviation to maintain or obtain better binocular visual function. However, there is a high rate of exodrift or recurrence in surgically treated patients. Orthoptic therapy is sometimes recommended for IXT patients after surgery. However, there is a lack of high-quality randomized controlled trials to prove that orthoptic therapy could be an effective supplement to surgical treatment for IXT patients. The main purpose of this study is to test the clinical effectiveness of orthoptic therapy in long-term stabilization of postoperative IXT patient. This report describes the design and methodology of the Intermittent Exotropia Postoperative Treatment Clinical Trial, which is the first large-sample, blank-controlled, randomized clinical trial. METHODS: A total of 136 IXT patients (aged 7 to 17 years) will be enrolled and assigned to the orthoptic therapy group or blank control group according to a simple randomization scheme. Patients in the orthoptic therapy group will receive at least 2 months of orthoptic therapy, such as anti-suppression, vergence, and accommodation training. Patients in the blank control group will receive only refractive correction. All enrolled patients will need regular follow-up observation until 24 months after surgery. The primary outcome will be the proportion of participants meeting suboptimal surgical outcomes in this 24-month follow-up, which is defined as (1) exodeviation of 10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT) or (2) loss of 2 or more octaves of stereoacuity from baseline, at any masked follow-up visit examination. The secondary outcomes will be the exodeviation at distance and near using the simultaneous prism and alternate cover test (PACT), magnitude of fusional convergence, stereoacuity, and accommodation. Measurements will be taken at baseline and at the 6-, 12-, 18-, and 24-month follow-ups. DISCUSSION: To the best of our knowledge, this will be the first prospective, randomized controlled study of orthoptic training in IXT patients after surgery. The aim of this work is to confirm the efficacy of orthoptic therapy in reducing the proportion of recurrence among IXT patients after surgery and improving binocular vision function. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900026891 . Registered on 25 October 2019.


Assuntos
Exotropia , Ortóptica , Adolescente , Criança , Doença Crônica , Exotropia/cirurgia , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Visão Binocular
5.
Sci Rep ; 12(1): 6542, 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35449175

RESUMO

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.


Assuntos
Exotropia , Doença Crônica , Sensibilidades de Contraste , Exotropia/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Visão Binocular/fisiologia
6.
Neuroreport ; 33(6): 259-265, 2022 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-35383657

RESUMO

BACKGROUND: Comitant exotropia (CE) is a common eye disease with abnormal eye movement, whereas altered synchronous neural activity in CE patients is poorly understood. The purpose of our study was to investigate local to remote functional connectivity of blood oxygen level-dependent (BOLD) signals changes in CE patients. MATERIAL AND METHODS: Thirty-four patients and thirty-four healthy controls (HCs) underwent resting-state MRI scans. The ReHo and FC method was applied to investigate the local to remote functional connectivity changes in CE patients. RESULTS: Compared to the HC group, CE patients showed significant increased ReHo values in the left cerebellar_crus2 and left middle frontal gyrus. Meanwhile, CE patients showed significant decreased ReHo values in the right middle temporal gyrus, left postcentral gyrus and right angular. Moreover, CE patients showed an increased FC between the cerebellar network, sensorimotor network (SMN) and default-mode network (DMN). The support vector machine (SVM) classification was up to a total accuracy of 94.12%. The AUC of the classification model was 0.99 on the basis of ReHo map. CONCLUSION: Our result highlights that CE patients had abnormal local to remote functional connectivity in the cerebellar network, SMN, DMN, which might indicate the neural mechanism of eye movements and stereo vision dysfunction in CE patients. Moreover, the SVM algorithm reveals ReHo maps as a potential biomarker for predicting clinical outcomes in CE patients.


Assuntos
Exotropia , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico/métodos , Exotropia/diagnóstico por imagem , Lobo Frontal , Humanos , Imageamento por Ressonância Magnética/métodos
7.
J Healthc Eng ; 2022: 2611225, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35320998

RESUMO

Objective: To observe and analyze the occurrence rate, improvement time, and influencing factors of diplopia after intermittent exotropia in children. Methods: A total of 135 children with intermittent exotropia treated in our hospital from February 2019 to April 2021 were recruited. A reasonable surgical plan was exerted according to the preoperative examination of the children, the children were divided into groups according to their age, degree of strabismus, visual acuity, and binocular visual function, and the postoperative diplopia occurrence rate and improvement time of diplopia in different groups were observed and compared. Results: Postoperative diplopia occurred in 74 of 135 children with intermittent exotropia, and the postoperative incidence of diplopia was 54.81%. All diplopia occurred on the first day after the operation. There were 62 cases of contradictory diplopia (83.78%) and 12 cases of fusion of powerless diplopia (16.22%). Except for 1 case of amalgamated powerless diplopia, diplopia was not significantly improved after 6 months, which seriously affected the life of the children after the second operation, and all the others were significantly improved within 90 days. The improvement time of diplopia was 3-90 days, and the average improvement time of diplopia was 13.25 ± 3.16 days. According to their age, the children were divided into the 3-6 years old group (n = 69), the 7-10 years old group (n = 47), and the 11-14 years old group (n = 19). Postoperative diplopia occurred in 25 cases (36.23%) in the 3-6 years old group, 34 cases (72.34%) in the 7-10 years old group, and 16 cases (84.21%) in the 11-14 years old group. There was a significant difference in the incidence of postoperative diplopia among the three groups (P < 0.05). There was a significant difference in the improvement time of diplopia among the three groups (P < 0.05). According to the degree of strabismus before the operation, the children were divided into the <50△ group (n = 74) and the ≥50△ group (n = 61). Postoperative diplopia occurred in 32 cases (43.24%) in the <50△ group and 43 cases (70.49%) in the ≥50△ group. There was a significant difference in the incidence of postoperative diplopia between the two groups (P < 0.05). There was a significant difference in the improvement time of diplopia among the three groups (P < 0.05). According to the results of the visual acuity examination, the patients were divided into the ≥0.8 (naked eye) group (n = 21), the ≥0.8 (ametropia) group (n = 32), and the <0.8 (amblyopia) group (n = 32). Among them, diplopia occurred in 10 cases (47.62%) in the ≥0.8 (naked eye) group, 40 cases (48.78%) in the ≥0.8 (ametropia) group, and 24 cases (75.00%) in the <0.8 (amblyopia) group. The incidence of diplopia in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant (P < 0.05). The postoperative diplopia improvement time in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant (P < 0.05). There was no significant difference in diplopia occurrence rate and diplopia improvement time between the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group (P > 0.05). According to the results of binocular visual function examination, 92 cases had a primary function, 45 cases (48.91%) had diplopia after the operation, the average recovery time of diplopia was 12.58 ± 3.16, 43 cases had no primary function, and 30 cases (69.77%) had diplopia after the operation. The average recovery time of diplopia was 13.02 ± 3.84. There was a significant difference in the incidence of diplopia between the two groups (χ 2 = 5.162). There was no significant difference in the recovery time of diplopia between the two groups (χ 2 = 0.570, P < 0.05). In 80 cases with secondary function, diplopia occurred in 36 cases (45.00%), and the average recovery time of diplopia was 10.14 ± 2.88; in 55 cases without secondary function, diplopia occurred in 39 cases (70.91%), and the average recovery time of diplopia was 14.86 ± 3.73. There was a significant difference in the incidence of diplopia between the two groups (χ 2 = 8.861, P < 0.002). There was a significant difference in the recovery time of diplopia between the two groups (χ 2 = 6.469, P < 0.001). In 77 cases with tertiary function, diplopia occurred in 32 cases (41.56%), and the average recovery time of diplopia was 9.61 ± 2.39; in 58 cases without tertiary function, diplopia occurred in 43 cases (74.14%), and the average recovery time of diplopia was 13.11 ± 3.05. There was a significant difference in the incidence of diplopia between the two groups (χ 2 = 14.221 P < 0.001). There was a significant difference in the recovery time of diplopia between the two groups (χ 2 = 5.355, P < 0.001). Conclusions: The age, degree of strabismus, visual acuity, and binocular visual function of children with intermittent exotropia are significant factors affecting the occurrence rate and recovery time of diplopia after the operation. The younger the age, the smaller the degree of strabismus, the better the vision and the second or third grade of visual function, the smaller the occurrence rate of diplopia, and the shorter the recovery time of diplopia. Thus, the above influencing factors have a certain guiding significance in predicting the improvement of postoperative diplopia and the time of diplopia disappearance. The purpose of intermittent exotropia surgery in children is not only to correct eye position and improve appearance but also to establish normal retinal correspondence in order to obtain binocular monocular function. Furthermore, postoperative diplopia in children with concomitant exotropia is very common; therefore, careful examination, comprehensive analysis, and surgical plan should be designed according to the above factors. Stereoscopic vision training as early as possible after the operation is beneficial to the establishment of normal retinal correspondence and the elimination of diplopia.


Assuntos
Ambliopia , Exotropia , Erros de Refração , Estrabismo , Adolescente , Criança , Pré-Escolar , Doença Crônica , Diplopia/etiologia , Diplopia/cirurgia , Exotropia/cirurgia , Humanos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia
8.
Plast Reconstr Surg ; 149(5): 954e-961e, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35286295

RESUMO

BACKGROUND: The purpose of this study was to detail perioperative ophthalmologic evaluations to characterize functional ocular outcomes after facial bipartition surgery. METHODS: Patients with hypertelorbitism who underwent facial bipartition surgery were studied specifically for eye motility disorders by separating patients into rare craniofacial clefts (midline and paramedian) (n = 34) and craniofacial dysostosis (Apert, Crouzon, and Pfeiffer) (n = 74). Preoperative and postoperative (12 months) ophthalmologic examinations (with depth perception tests), computed tomography scans, and magnetic resonance imaging scans were analyzed. RESULTS: Among craniofacial cleft patients, mean interdacryon distance was reduced from 39 ± 4 mm to 17 ± 2 mm, with strabismus improved from 88 percent (exotropia 82 percent) preoperatively to only 29 percent postoperatively. Depth perception improved to a lesser degree, with abnormal tests at a rate of 79 percent preoperatively to 56 percent postoperatively. Wider hypertelorbitism had a higher degree of strabismus. Among craniofacial dysostotic patients, mean interdacryon distance was reduced from 37 ± 3 mm to 17 ± 2 mm, and strabismus improved from 55 percent to only 14 percent. Depth perception improved to a lesser degree, with 68 percent abnormal tests preoperatively and 46 percent postoperatively. Apert patients had more V-pattern strabismus and exotropia (79 percent) than did other craniofacial dysostosis patients (42 percent). CONCLUSIONS: The authors' data indicate that facial bipartition for hypertelorbitism-known to improve periorbital aesthetics-also improves eye motility disturbances. Thus, vision problems related to exotropia should be considered a functional indication for facial bipartition surgery in patients with hypertelorbitism. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Acrocefalossindactilia , Disostose Craniofacial , Exotropia , Acrocefalossindactilia/cirurgia , Disostose Craniofacial/complicações , Disostose Craniofacial/cirurgia , Exotropia/etiologia , Exotropia/cirurgia , Face/cirurgia , Humanos , Tomografia Computadorizada por Raios X
9.
Indian J Ophthalmol ; 70(4): 1321-1326, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35326047

RESUMO

Purpose: The aim of this study was to evaluate the outcomes of a simplified, fixed surgical dosage calculation for uncomplicated, horizontal, concomitant strabismus in adults. Methods: Outcomes analysis of a fixed-dose calculation method for uncomplicated, horizontal, concomitant strabismus in adults (≥18 years) wherein 1-mm recession/resection equals 2 PD for lateral rectus and 3 PD for medial rectus. This was a retrospective case series. Results: The mean age of the patients was 28.50 ± 8.43 years, the mean amount of preoperative deviation was 35.16 ± 9.97 PD, the mean expected correction was 36.26 ± 9.49 PD, and the mean correction achieved was 35.92 ± 10.74 PD. There were 22 monocular exotropias, six monocular esotropias, eight alternate divergent squints, and two alternate convergent squints. There were 20 cases of sensory strabismus (54.28%). There was no statistically significant difference between the expected correction and correction achieved (P = 0.519), meaning that our fixed-dose calculation method was effective. Thirty-five out of 38 patients had successful outcomes as per our criteria of less than 10-PD deviations from straight in primary position. Therefore, the success rate achieved by this procedure was 92.10%. There was no statistically significant correlation between age and the amount of deviation (P = 0.611). Conclusion: Our case series had a high postoperative success rate in terms of motor alignment. It is hoped that this simplified, fixed-dosage calculation method would help the numerous novice strabismus surgeons, make their starting steps easier and give them the confidence to do strabismus surgeries. They can modify the dosages later as per their own experiences.


Assuntos
Esotropia , Exotropia , Estrabismo , Adulto , Esotropia/cirurgia , Exotropia/cirurgia , Seguimentos , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Estrabismo/cirurgia , Resultado do Tratamento , Visão Binocular , Adulto Jovem
10.
J Healthc Eng ; 2022: 5387928, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35313518

RESUMO

At present, the main treatment for strabismus is still surgical treatment, but there is no unified standard for the evaluation of the timing of surgery. This study mainly explores the clinical effects of using meta-analysis of intelligent image sensors combined with visual training to treat children with intermittent exotropia. Cochrane systematic reviews collect, evaluate, and synthesize an increasing number of original clinical research results to obtain the comprehensive effect of relevant interventions, so as to provide real and reliable evidence for health decision-making and clinical practice. It uses scientific, clear, and reproducible research methods to reduce the influence of biased factors, so it is different from traditional reviews. Cochrane systematic reviews are especially suitable for certain interventions when the pros and cons of interventions are difficult to determine based on the results of a single clinical study or when there are large differences in the clinical application process. Poor quality systematic reviews can mislead policymakers and clinicians. In the meta-analysis, the Cochrane systematic evaluation method of evidence-based medicine was used to comprehensively search the published literature research on the treatment of intermittent exotropia with vision training. Using the Cochrane system evaluation method, computer search of CENTRAL, MEDLINE, Embase, Chinese Biomedical Literature Database, Chinese Journal Full-text Database, manual retrieval of relevant conference documents, and inclusion of all clinical trial documents of visual training in children with intermittent exotropia was conducted. Patients with intermittent exotropia were selected, simultaneous vision, fusion function, and far stereo vision with the same vision machine were measured, and near stereo vision with a stereo vision chart was measured. The number of simultaneous vision, fusion function, and distance and near stereo vision "with" and "without" cases were recorded for all patients, and the relationship with age of onset, type of strabismus, degree of strabismus, and degree of control was counted. Among them, 91 patients who underwent strabismus correction surgery were followed up for at least 6 months with correct eye position. The presence or absence of simultaneous vision, fusion function, far stereo vision, and near stereo vision were recorded and compared with preoperative. The number of recovery and nonrecovery cases was recorded, and the relationship between the age of operation, the type of strabismus, the degree of strabismus, and the degree of control was counted. It was statistically analyzed by SPSS22.0. The results of the meta-analysis showed that in terms of the effective rate of fundus lesions, the visual training group was better than the nontraining group, and the difference between the two groups was statistically significant (RR = 1.32, 95% CI: (1.25, 1.40), P < 0.0001). This study provides guidance for the early rehabilitation of children with intermittent exotropia.


Assuntos
Exotropia , Estrabismo , Criança , China , Doença Crônica , Meios de Contraste , Exotropia/cirurgia , Humanos , Imagem Molecular
11.
JAMA Ophthalmol ; 140(4): 373-381, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35266979

RESUMO

Importance: Children with strabismus have poorer functional vision and decreased quality of life than those without strabismus. Objective: To evaluate the association between strabismus and mental illness among children. Design, Setting, and Participants: This cross-sectional study analyzed claims data from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, from 12 005 189 patients enrolled in the health plan between January 1, 2007, and December 31, 2017. Eligibility criteria included age younger than 19 years at the time of strabismus diagnosis, enrollment in the health plan between 2007 and 2018, and having at least 1 strabismus claim based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes. Controls were children in the same database with no eye disease codes other than refractive error reported. Demographic characteristics and mental illness claims were compared. Statistical analysis was conducted from December 1, 2018, to July 31, 2021. Main Outcomes and Measures: Presence of mental illness claims. Results: Among the 12 005 189 patients (6 095 523 boys [50.8%]; mean [SD] age, 8.0 [5.9] years) in the study, adjusted odds ratios for the association of mental illnesses with strabismus were 2.01 (95% CI, 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59-1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and 0.99 (95% CI, 0.97-1.02) for substance use disorder. There was a moderate association between each strabismus type (esotropia, exotropia, and hypertropia) and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder; odds ratios ranged from 1.23 (95% CI, 1.17-1.29) for the association between esotropia and bipolar disorder to 2.70 (95% CI, 2.66-2.74) for the association between exotropia and anxiety disorder. Conclusions and Relevance: This cross-sectional study suggests that there was a moderate association between strabismus and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder but not substance use disorder. Recognizing that these associations exist should encourage mental illness screening and treatment for patients with strabismus.


Assuntos
Esotropia , Exotropia , Esquizofrenia , Estrabismo , Adulto , Transtornos de Ansiedade/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Qualidade de Vida , Esquizofrenia/epidemiologia , Estrabismo/diagnóstico , Estrabismo/epidemiologia , Adulto Jovem
12.
Zhonghua Yan Ke Za Zhi ; 58(3): 165-168, 2022 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-35280022

RESUMO

Intermittent exotropia is the commonest type of strabismus, and surgery is the primary treatment. Follow-ups and other non-surgical management options can be used for patients who are younger, less cooperative, with well controlled exotropia, or unwilling to operate. However, there are many misconceptions regarding the treatment, especially the non-surgical treatment of intermittent exotropia in children, due to lack of thorough understanding about the natural course of intermittent exotropia, the timing for surgery, and the suitable candidates, effectiveness, and potential risks of different non-surgical options. This article provide an objective evaluation about the common non-surgical management options of intermittent exotropia based on the international research findings and clinical experience, in order to facilitate the correct understanding and rational use of the non-surgical treatment.


Assuntos
Exotropia , Estrabismo , Criança , Doença Crônica , Exotropia/cirurgia , Humanos , Estrabismo/cirurgia
13.
J Pediatr Ophthalmol Strabismus ; 59(2): e17-e19, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35343824

RESUMO

The authors present a case of absent multiple extraocular muscle insertions in Pfeiffer syndrome. An 8-year-old girl with Pfeiffer syndrome presented with V-pattern exotropia and left hypertropia. The absence of bilateral superior oblique, bilateral superior rectus, and left inferior rectus muscle insertions was found intraoperatively. [J Pediatr Ophthalmol Strabismus. 2022;59(2):e17-e19.].


Assuntos
Acrocefalossindactilia , Exotropia , Estrabismo , Acrocefalossindactilia/cirurgia , Criança , Exotropia/etiologia , Exotropia/cirurgia , Feminino , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/etiologia , Estrabismo/cirurgia
14.
BMC Ophthalmol ; 22(1): 134, 2022 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-35331195

RESUMO

PURPOSE: To evaluate the efficacy and safety of slanted bilateral lateral rectus recession (S-BLRc) for the treatment of convergence insufficiency-type intermittent exotropia (CI-IXT) in children and to probe the relationship of the slanted amount and surgical outcomes. METHODS: Retrospective study. Fifty-eight patients with CI-IXT, aged 4 to 10 years old, underwent S-BLRc procedures. According to the different slanted amount between the upper and lower poles of lateral rectus, all the patients were grouped: Group A (slanting 1 mm, n = 22), Group B (slanting 1.5 mm, n = 18) and Group C (slanting 2 mm, n = 18). The successful surgical outcome was defined as deviation in the primary position ranging from exotropia< 8△ to esotropia< 5△ both at near and at distant as well as the near-distance difference (NDD) < 5△. We analyzed and compared the preoperative and postoperative data including deviations both at near and at distance, NDD, objective torsion, horizontal deviation at up and down gaze, lateral incomitance, binocular vision and surgical success rate among three groups. RESULTS: The average deviations were significantly decreased from - 37.1△ ± 4.2△ (-,exotropia) to - 1.4△ ± 4.6△ at near (P < 0.05) and from - 25.8△ ± 3.7△ to - 0.1 ± 4.1△ at distance (P < 0.05). The postoperative NDD on average was significantly reduced from 10.0△ to 1.8△ in Group A (P < 0.05), from 11.2△ to 0.8△ in Group B (P < 0.05) and from 13.3△ to 0.9△ in Group C (P < 0.05). There was a significant difference in the mean corrections of NDD among the three groups (8.2△ in group A, 10.3△ in group B and 12.4△ in group C respectively, P < 0,05). All the patients attained various improvement of stereopsis after surgery. None had torsional diplopia, A-V pattern and lateral incomitance after strabismic surgery. Totally, the surgical success rate was 89.7% in our series at the 6- to 8-month follow-up. CONCLUSIONS: Slanted bilateral lateral rectus recession is an effective and safe procedure for the treatment of CI-IXT in children. S-BLRc can successfully collapse exotropia both at distance and at near, decrease NDD and benefit to gain binocular vision. The correction of NDD was associated with the slanted amount.


Assuntos
Esotropia , Exotropia , Transtornos da Motilidade Ocular , Criança , Pré-Escolar , Exotropia/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
15.
PLoS One ; 17(2): e0264037, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35176076

RESUMO

BACKGROUND: This retrospective, cross-sectional study investigated changes in corneal lower- and higher-order aberrations that cause visual disturbance after lateral rectus recession and medial rectus resection in children. METHODS: Eighty-five eyes of 85 patients (44 boys; 8.64±2.88 years) who underwent lateral rectus recession and medial rectus resection to correct intermittent exotropia were assessed. The Galilei G4 Dual Scheimpflug Analyzer was used for wavefront analysis. Risk factors (age, sex, amount of surgery, preoperative axial length, preoperative intraocular pressure) were determined. Outcome measures included simulated and ray-tracing mode keratometry with secondary defocus, oblique, and vertical astigmatism (for lower-order aberrations) and the root mean square, 3rd-order vertical and horizontal coma, oblique and horizontal trefoil, 4th-order spherical aberration, oblique and vertical secondary astigmatism, and oblique and vertical quadrafoil (2nd‒8th sums) (for higher-order aberrations). RESULTS: Myopic with-the-rule changes in low-order aberrations and increases in simulated and ray-tracing mode keratometry during the 3 months following lateral rectus recession and medial rectus resection were attributed to muscle healing and stability changes. High-order aberrations altered in the week following surgery almost returned to normal within 3 months. Axial length, the amount of surgery, age, and sex affected astigmatism due to differences in patients' scleral states. CONCLUSIONS: Clinicians should consider changes in high-order aberrations of young individuals who underwent lateral rectus recession and medial rectus resection and may not be able to verbalize changes in vision.


Assuntos
Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Transtornos da Visão/patologia , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Exotropia/patologia , Feminino , Humanos , Masculino , Músculos Oculomotores/patologia , Estudos Retrospectivos , Transtornos da Visão/etiologia
16.
J AAPOS ; 26(2): 89-91, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35131481

RESUMO

Congenital superior oblique (SO) palsy is often associated with anomalies of its tendon, increased tendon laxity being the most common. Rarely, the tendon lies in an abnormal location nasal to the superior rectus (SR) muscle, either attaching to the sclera or to Tenon's capsule. We describe a case of a child who presented with abnormal head posture and exotropia. The orthoptic evaluation revealed a left hypertropia and V-pattern exotropia. The motility pattern and the Parks three-step test were suggestive of left-sided SO palsy. Intraoperatively, the left SO tendon was very lax and was absent from its usual insertion. Further exploration revealed it to be inserted entirely to the nasal border of the SR muscle, with no scleral attachment. This tendon was advanced to its normal attachment to the sclera, and 11 mm inferior oblique recession was also performed. Postoperative alignment was satisfactory.


Assuntos
Exotropia , Estrabismo , Doenças do Nervo Troclear , Criança , Exotropia/cirurgia , Humanos , Músculos Oculomotores/anormalidades , Músculos Oculomotores/cirurgia , Paralisia , Estrabismo/etiologia , Estrabismo/cirurgia , Tendões/cirurgia , Doenças do Nervo Troclear/cirurgia
17.
Indian J Ophthalmol ; 70(3): 948-951, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35225548

RESUMO

PURPOSE: To evaluate the surgical efficacy of reinforced plication of the medial rectus muscle to resection as an effective muscle strengthening procedure in exotropia. METHODS: This is a prospective randomized trial in patients with exotropia who underwent complete orthoptic evaluation followed by random assignment into two groups by using a computer-drawn random number table. Group 1 patients underwent standard resection with recession procedure, and group 2 patients underwent reinforced plication with recession procedure. Follow-up was performed at day 1, 1 week, 1 month, 3 months, and 6 months to assess the surgical efficacy. RESULTS: A total of 80 patients were included in the study of which 39 were in group 1 and 41 in group 2. The mean age in group 1 was 23.48 ± 11.94 years and 23.29 ± 10.02 years in group 2. The mean preoperative deviation in group 1 for distance was 50.13 ± 11.95 PD and 50.12 ± 9.79 PD in group 2 (P = 0.499). In group 1 with a mean surgical dose of 5.27 mm medial rectus resection and 8.04 mm lateral rectus recession, a 7.11 ± 3.95 PD deviation was noted at the end of 6 months. Similarly, in group 2 with a mean surgical dose of 5.16 mm medial rectus plication and 8.16 mm lateral rectus recession, a 6.00 ± 2.46 PD deviation was noted at the end of 6 months. Between groups, ocular surface changes, inter-surgeon comparison, and exotropia subtypes did not reveal any significant differences. CONCLUSION: In our observation, the reinforced medial rectus muscle plication showed clinically comparable results as compared to the standard resection procedure at the end of 6 months. Therefore, this innovative modification can be considered as an alternative to standard resection.


Assuntos
Exotropia , Adolescente , Adulto , Criança , Exotropia/cirurgia , Seguimentos , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular/fisiologia , Adulto Jovem
18.
BMJ Open ; 12(2): e055848, 2022 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-35210343

RESUMO

INTRODUCTION: Intermittent exotropia (IXT) is the most common type of divergent squint. IXT is primarily a cortical neurologic dysfunction disorder, occurring as a result of the insufficient maintenance of sensory and motor fusion. Recent reports have demonstrated the relationship between IXT and visual cortical impairment. We planned to assess blood oxygen level-dependent (BOLD)-functional magnetic resonance imaging (fMRI) in patients with IXT during the preoperative and postoperative follow-ups to evaluate the functional changes in the visual cortex. METHODS AND ANALYSIS: A total of 90 Chinese subjects will be recruited, and their ages will be between 18 and 40 years old. The subjects will include the surgical treatment (ST) group (45 subjects with IXT who will undergo surgery) and the HC group (45 age-matched, sex-matched and education-matched healthy volunteers). The assessments will include the following aspects: fMRI and general ophthalmic examinations, optometry measurements and strabismus-related tests, such as the ocular deviation, binocular vision test and Newcastle Control Score (NCS). Each subject will complete the resting-state BOLD-fMRI, and the sequences will include echo planar imaging (EPI) pulse and 3-dimensional brain volume (3D-BRAVO) to acquire high-resolution images. The follow-up schedule will be 6 and 12 months after the surgery. The primary outcome will be determined by cortex changes in BOLD-fMRI in the ST group before and after surgery. We will also compare the HC group with the preoperative subjects in the ST group. The secondary outcomes will be changes in strabismus-related examinations, such as binocular visual function and NCS. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Medical Ethics Committee of Beijing Tongren Hospital. We plan to publish the results of this study in a peer-reviewed journal article. TRIAL REGISTRATION NUMBER: ChiCTR2100048852.


Assuntos
Exotropia , Estrabismo , Baixa Visão , Córtex Visual , Adolescente , Adulto , Estudos de Casos e Controles , Doença Crônica , Exotropia/cirurgia , Humanos , Visão Binocular , Córtex Visual/diagnóstico por imagem , Adulto Jovem
19.
BMC Ophthalmol ; 22(1): 53, 2022 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-35114960

RESUMO

BACKGROUND: The aim of this study was to observe the effectiveness of botulinum toxin type A (BTA) in the treatment of intermittent exotropia (IXT) in children compared with strabismus surgery. METHODS: One hundred forty-four children with a clear diagnosis of IXT and an indication for surgery were eligible for inclusion. Subjects were divided into two groups based on parental decision: the BTA injection group (injection group) or the conventional surgery group (surgery group). All cases were followed up for 6 months. The primary outcome was a comparison of the success rate (deviation between - 10 and + 10 PD) between the two groups at 6 months after the initial treatment. Secondary outcomes included change in deviation, visual function, and post-surgical complications. RESULTS: Seventy-two patients were enrolled in each group. At 6-month follow-up, there was no significant difference in the success rate between the injection and surgery groups (52.8% vs 66.7%, P = 0.13; postoperative deviation - 12.22 ± 10.80 PD vs - 9.17 ± 10.30 PD, P = 0.09). The binocular Visual function, except for near stereoacuity, improved after treatment in both groups, while the fusion recovery rate was higher in the surgical group (68.1% vs 95.8%, P < 0.001). Transient complications in the injection group included diplopia, ptosis, and subconjunctival hemorrhage, whereas subconjunctival hemorrhage, conjunctival edema, foreign body sensation, pain, and diplopia were seen in the surgical group. The complications of BTA were relatively mild. CONCLUSIONS: BTA is as effective as surgery in the treatment of IXT in children, but the recovery of the fusion is lower than surgery. TRIAL REGISTRATION: The study has completed the clinical registration on ( ChiCTR-INR-17013777 ).


Assuntos
Toxinas Botulínicas Tipo A , Exotropia , Toxinas Botulínicas Tipo A/uso terapêutico , Criança , Exotropia/tratamento farmacológico , Exotropia/cirurgia , Seguimentos , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular , Acuidade Visual
20.
J Binocul Vis Ocul Motil ; 72(1): 22-28, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35049416

RESUMO

PURPOSE: Identify demographic and clinical characteristics at the first presentation associated with later having surgery for intermittent exotropia (IXT). METHODS: Retrospective cohort study of 228 children with IXT and 5+ years of follow-up. Demographic and clinical data were extracted from medical records. A total 97 participants who underwent surgery during follow-up were compared to 131 participants who did not. Best subset regression was used to identify first visit variables associated with later having strabismus surgery. Surgery was then regressed on the selected variables using logistic models. RESULTS: Age and control were the only first visit variables significantly associated with having surgery for IXT. Notably, neither angle of deviation nor stereopsis were associated with later surgery. In an adjusted logistic model, each one-month increase in age at presentation was associated with a 1% decrease in the odds of having surgery (OR = 0.991, 95% CI: 0.982-0.999, P = .04). Children with poor control at initial visit had almost five times greater odds of having surgery than those with good control (OR = 4.95, 95% CI: 2.31-10.98, P < .0001). CONCLUSIONS: Age and control of IXT are important factors at presentation associated with future surgical intervention for IXT. The magnitude of deviation and stereopsis was not significantly associated with future surgical treatment for IXT.


Assuntos
Exotropia , Criança , Doença Crônica , Percepção de Profundidade , Exotropia/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
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