Optimal surgical timing in infantile exotropia

Published on Aug 1, 2014in Canadian Journal of Ophthalmology-journal Canadien D Ophtalmologie1.369
· DOI :10.1016/J.JCJO.2014.05.004
Eunjoo Yoo7
Estimated H-index: 7
(KU: Korea University),
Seung Hyun Kim29
Estimated H-index: 29
(KU: Korea University)
Sources
Abstract
Abstract Objective To evaluate age at surgery and duration of misalignment, which affect surgical outcomes of infantile exotropia in healthy children younger than 1 year. Methods The charts of 39 patients who have at least 1 year of follow-up period after surgery with a diagnosis of early-onset exotropia were reviewed retrospectively. Patients were divided into 2 groups (preoperative deviation [PD]): success (exodeviation ≤8 PD or esodeviation ≤5 PD at 1 year postoperatively without reoperation in the whole follow-up period) or failure (exodeviation >8 PD or esodeviation >5 PD at 1 year postoperatively, or reoperation for recurrence or overcorrection during the follow-up period). We evaluated the age at surgery and the duration of misalignment divided into 5 categories—before 6, 12, 18, 24, and 30 months—to suggest appropriate surgical timing affecting surgical outcome and compared between the 2 groups. Results Overall, 74% of the patients comprised the success group and 26% the failure group. There was no statistically significant difference in the age of alignment between 2 groups ( p = 0.91). The mean duration of misalignment was 16.7 months in the success group and 20.1 months in the failure group, with no significant difference ( p = 0.52). There were 4 patients (14%) with a misalignment duration of ≥24 months in the success group and 5 such patients (50%) in the failure group; the difference was statistically significant ( p = 0.024). Therefore, with a duration of misalignment of up to 24 months as the reference level, the odds of having a successful outcome decreased significantly over 24 months, with the multiple logistic regression model yielding a risk estimate over 6-fold of failure (odds ratio 6.25; p = 0.024). Conclusions The postoperative surgical outcome was influenced by the duration of the misalignment, rather than the age at surgery. Surgery within 24 months of misalignment favourably affected the percentage of patients who achieved successful outcome in the treatment of infantile exotropia.
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References14
Newest
#1Jason C. S. Yam (CUHK: The Chinese University of Hong Kong)H-Index: 19
#2Gabriela S. L. Chong (Tung Wah Eastern Hospital)H-Index: 5
Last. Simon T. C. Ko (Tung Wah Eastern Hospital)H-Index: 8
view all 6 authors...
Purpose To determine the presurgery factors affecting early and long-term favorable outcomes of bilateral lateral rectus recession surgery for infantile exotropia.
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PURPOSE: To determine the preoperative factors affecting the efficacy in bilateral lateral rectus recession surgery for infantile exotropia. METHODS: This was a retrospective study of 50 patients with infantile exotropia who had bilateral lateral rectus recession surgery correction with more than 1 year of follow-up. Preoperative parameters influencing the response of the surgery were obtained and evaluated using multiple regression analysis including age at onset, age at surgery, interval betwe...
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#1S. Y. Suh (New Generation University College)H-Index: 1
#2Min Jung Kim (Seoul National University Hospital)H-Index: 15
Last. Seong Joon Kim (SNU: Seoul National University)H-Index: 15
view all 4 authors...
Objective To evaluate the clinical characteristics and surgical outcomes of early-onset exotropia and to compare differences between constant and intermittent exotropia at presentation.
Source
#1Yong Min Choi (KU: Korea University)H-Index: 3
#2Seung Hyun Kim (KU: Korea University)H-Index: 29
Purpose To compare the clinical outcomes and characteristics of 2 different types of early-onset exotropia on the basis of stereopsis outcome. Design Retrospective case series. Participants A total of 24 patients with newly diagnosed exotropia before 12 months of age and at least 1 year of follow-up after surgery. Methods The clinical records of all patients were reviewed. Patients were divided into 2 groups according to stereopsis. The presumable early-onset intermittent exotropia (EIE) group w...
Source
#1Jason C. S. Yam (Tung Wah Eastern Hospital)H-Index: 19
#2Patrick K W Wu (Tung Wah Eastern Hospital)H-Index: 5
Last. Simon T. C. Ko (Tung Wah Eastern Hospital)H-Index: 8
view all 6 authors...
Purpose To compare postoperative drift after bilateral lateral rectus recession for infantile exotropia (XT) and for intermittent XT and to compare initial postoperative alignment with long-term motor outcome. Methods Medical records of all patients with infantile exotropia or intermittent exotropia who had undergone bilateral lateral rectus muscle recession surgery with a follow-up longer than 3 years were reviewed. The pre- and postoperative angles of deviation at distance and at near and post...
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#1Ji Hye Park (KU: Korea University)H-Index: 7
#2Seung Hyun Kim (KU: Korea University)H-Index: 29
Purpose To evaluate the clinical features and the risk factors of recurrence in infantile exotropia. Design Retrospective, observational case series. Methods The clinical records of 20 infantile exotropia patients who underwent exotropia surgery were reviewed retrospectively. Patients were divided into 2 groups according to the amount of exodeviation present at 1 year after surgery. Preoperative patient characteristics and postoperative alignments were evaluated at 1 day and 1, 3, 6, and 12 mont...
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#1Richard A. Saunders (MUSC: Medical University of South Carolina)H-Index: 25
#2Rupal H. Trivedi (MUSC: Medical University of South Carolina)H-Index: 32
Introduction Early surgical treatment of early-onset intermittent exotropia is controversial. The condition does not always progress, and postoperative esotropia can produce adverse consequences, such as suppression, amblyopia, and loss of binocular vision, particularly stereopsis. It is not known whether surgery before age two years affects the sensory outcome. Methods Using a noncomparative (nonrandomized, uncontrolled) interventional case series, we reviewed the medical records during a 14-ye...
Source
#1Hae Jung PaikH-Index: 2
#2Hye Bin Yim (CUA: The Catholic University of America)H-Index: 1
: To evaluate the effects of early surgical intervention in infantile exotropia on the motor and sensory functions, we reviewed the records of 17 subjects diagnosed with exotropia before the age of 12 months, receiving surgery before the age of 24 months, with a follow-up period greater than one year, between 1996 and 2000. Of the 17 subjects (6 intermittent, 11 constant), 14 (82%) (6 intermittent, 8 constant) had a final horizontal deviation of <10 PD, with 3 (18%) needing a re-operation. Fusio...
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#1Malcolm R Ing (U.H.: University of Hawaii at Manoa)H-Index: 12
#2Lisa M. Okino (U.H.: University of Hawaii at Manoa)H-Index: 2
Abstract Purpose: A recent outcome study of Randot stereopsis in congenital esotropia reported early surgical alignment is associated with a higher percentage of patients with stereopsis and a higher quality of stereopsis because early surgery minimized the duration of misalignment. We compared the Titmus stereopsis with the duration of misalignment and the age of alignment for a group of patients who were surgically aligned by 24 months of age. Methods: The data previously obtained in a study o...
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#1David G. HunterH-Index: 42
#2Jane Barrett KellyH-Index: 1
Last. Forrest J. Ellis (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 5
view all 4 authors...
Abstract Purpose: The term congenital exotropia (XT) is typically reserved for patients presenting in the first year with a large, constant angle, however, no published study provides a rationale for this restrictive definition. In this study, the present classification system for XT was evaluated and differences between infants with constant versus intermittent XT at presentation were characterized. Methods: Medical records of all patients diagnosed with XT before 12 months of age between 1980 ...
Source
Cited By12
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#1Zhale Rajavi (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 10
#2Hamideh Sabbaghi (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 7
Last. Kourosh SheibaniH-Index: 9
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PURPOSE: We aimed to determine the long-term motor and sensory outcomes of patients with infantile exotropia. METHODS: In this longitudinal retrospective (historical cohort) study, the records of 76 patients with infantile exotropia were Studied. Subjects with constant exotropia manifesting before the age of 1 year who were at least 5 years old at recruitment time between 2008 and 2017 were included. RESULTS: The medical records of 26 patients were excluded due to not participating in follow-up ...
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Background: Adjustable sutures have been used in strabismus surgery for more than 40 years, but controversy remains regarding their application. This review sought to analyze studies comparing the efficacy of adjustable sutures (AS) and nonadjustable sutures (NAS) in the treatment of different ocular deviations. Materials and Methods: The PubMed literature database was searched using the keywords ‘adjustable sutures’ and ‘strabismus surgery’, yielding a total of 209 results. Only comparative stu...
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#1Mansooreh Bagheri (Shiraz University of Medical Sciences)H-Index: 9
#2Majid Farvardin (Shiraz University of Medical Sciences)H-Index: 5
Purpose To review the association of postoperative ocular alignment, sensory outcomes, and need for reoperation after surgical management of infantile exotropia. Methods The clinical records of patients who presented with constant infantile exotropia of >25 Δ and subsequently underwent strabismus surgery at a single center from 2004 to 2014 were reviewed retrospectively. Postoperative binocular sensory status was assessed using Worth 4-Dot and Titmus stereoacuity tests. Patients with postoperati...
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#1Kun Hoo Na (KU: Korea University)H-Index: 3
#2Seung Hyun Kim (KU: Korea University)H-Index: 29
Purpose To determine whether age at surgery influences postoperative outcome in infantile exotropia. Methods This longitudinal, retrospective study included children who underwent bilateral lateral rectus recession between 2004 and 2012 for an exotropia with onset by 12 months of age. Surgical outcomes were considered failures if recurrence with exodeviation of >8Δ or overcorrection with esodeviation of >5Δ developed during postoperative period. Univariate and multivariate analyses were conducte...
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#1Min Jung Kim (KU: Korea University)H-Index: 2
#2Seung Hyun Kim (KU: Korea University)H-Index: 29
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#1Kwang Hoon Shin (Gachon University)H-Index: 2
#2Iris Naheah Kim (Gachon University)H-Index: 4
Last. Hae Jung Paik (Gachon University)H-Index: 3
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PURPOSE: To investigate the effect of preoperative part-time occlusion therapy on long-term surgical success in early-onset exotropia. METHODS: The medical records of patients who underwent surgery for exotropia with onset before the first year of age and who were followed for ≥3 years were reviewed. Patients were divided into two groups according to the degree of compliance with part-time occlusion therapy: the good compliance group (>50% adherence rate) and the poor compliance group (≤50% adhe...
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PURPOSE: To determine the incidence and related risk factors of reoperation among patients with infantile exotropia who were operated on at Imam Hossein Medical Center, Tehran, Iran, from 2001 to 2015. METHODS: In this study, 82 children (55 girls and 27 boys) with infantile exotropia were divided into two groups 3 months after their first operation: children with horizontal deviation of 10 prism diopters (PD) or less (n = 64; success group) and those with horizontal deviation greater than 10 PD...
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Objective: To determine the preoperative variables affecting early and late favorable outcomes of bilateral lateral rectus recession surgery for concomitant exotropia. Material and Method: A retrospective study of 65 patients with concomitant exotropia (constant and intermittent) who had bilateral lateral rectus recession was conducted. The follow-up period was more than 1 year in all patients. Preoperative parameters were obtained and evaluated using univariate analysis. Results: Sixty-five pat...
#1Joshua R. Ehrlich (UM: University of Michigan)H-Index: 22
#2Rebecca Anthopolos (Rice University)H-Index: 12
Last. Joshua D. Stein (UM: University of Michigan)H-Index: 49
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Purpose To determine how strabismus diagnosis varies within a given community and across communities among children with Medicaid health insurance. Design Retrospective cohort analysis. Participants Children aged ≤10 years enrolled in Medicaid in Michigan or North Carolina during 2009. Methods Children who met the study inclusion criteria were identified from the Medicaid Analytic Extract database, which includes claims data for all children enrolled in Medicaid throughout the United States. Res...
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To evaluate the long-term surgical outcomes and the clinical features between infantile-onset constant and intermittent exotropia.The medical records of 67 patients diagnosed as having infantile exotropia before 12 months of age who underwent surgery were reviewed retrospectively. Patients were divided into intermittent exotropia and constant exotropia groups based on presentation before surgery. All patients underwent bilateral lateral rectus recession. Preoperative and postoperative clinical f...
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