scholarly journals Outcomes of Early Surgery in Children under Four Years Old with Large Angle Intermittent Exotropia

2021 ◽  
Vol 62 (12) ◽  
pp. 1643-1649
Author(s):  
Yeon Sun Choi ◽  
Kumale Tolesa ◽  
Hae Jung Paik
Keyword(s):  
Large Angle ◽  
Rectus Muscle ◽  
Observation Point ◽  
Lateral Rectus ◽  
Early Surgery ◽  
Intermittent Exotropia ◽  
Younger Age ◽  
Long Term Follow Up ◽  
Complication Of Surgery

Purpose: To find out the significance of early surgery in children of 4 years old and under with large angle intermittent exotropia of 35 prism diopters (PD) and more by examining the results of bilateral lateral rectus recession surgery and factors influencing the surgical outcome.Methods: It was a retrospective study of patients who underwent bilateral lateral rectus muscle recession surgery between 2006 to 2016 with intermittent exotropia greater than or equal to 35 PD and who were able to follow-up for at least 2 years after surgery were divided into two groups based on age of 4 years old. The surgical motor success was defined as exodeviation less than 10 PD, esodeviation less than 8 PD. The angle of deviation, binocular function, best corrected visual acuity, and amount of corrected PD per lateral recession (PD/mm) were compared at each observation point after surgery.Results: The motor success of bilateral rectus muscle recession surgery was 85% in children of age 4 years and under, 65.5% in age over 4 years. Success rate of early surgery was 1.3 times higher in younger age group, but there was no statistical meaning. The complication of surgery after 2 years of follow up was less in younger group-the rate of recurrent exotropia was 15% in younger group, 31.3% in older group and the rate of consecutive esotropia was 0% and 3.1%, respectively. Stereoacuity after 2 years of surgery was not fall behind in younger group compared to older group.Conclusions: It is possible to obtain good surgical results by performing early surgery rather than hesitating to operate due to the younger age in patients younger than 4 years old with large angle exotropia of 35 PD and more for long-term follow up and efficient patient management.

scholarly journals Surgery at early versus late for intermittent exotropia: a Meta-analysis and systematic review

2021 ◽  
Vol 14 (4) ◽  
pp. 582-588
Author(s):  
Yi Dong ◽  
◽  
Yu-Yan Liu ◽  
Keyword(s):  
Meta Analysis ◽  
Early Surgery ◽  
Surgical Approaches ◽  
China National Knowledge Infrastructure ◽  
Intermittent Exotropia ◽  
Scientific Databases ◽  
Significant Difference ◽  
Subgroup Analyses ◽  
Long Term Follow Up

AIM: To compare the outcomes between early surgery and late surgery for intermittent exotropia (IXT) with a Meta-analysis. METHODS: Scientific databases including PubMed, Embase, Web of Science, Cochrane and China National Knowledge Infrastructure were searched prior to December 16, 2019. From this broad database search, we performed some Meta-analysis including eleven independent studies, to further evaluate the outcome(s) when comparing early versus late surgery for IXT. The boundaries between early and late surgery and the surgery methods were not inconsistent, so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches. The pooled odds ratios (ORs) and the 95% confidence interval (CI) were estimated according to the random-effects model for high heterogeneity between studies. RESULTS: Eleven retrospective studies were included in this Meta-analysis. No significant difference between early and late surgery was observed for IXT patients (ORFirst follow-up= 0.88, 95%CI 0.53-1.44, P=0.61; ORFinal follow-up=1.48, 95%CI 0.94-2.31, P=0.09). However, sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable. Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession (BLR) subgroup for the final follow-up (OR4y=2.64, 95%CI 1.57-4.44, P=0.00; ORBLR=2.25, 95%CI 1.36-3.74, P=0.00). CONCLUSION: Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.

scholarly journals Long term surgical outcomes of unilateral recession-resection versus bilateral lateral rectus recession in basic-type intermittent exotropia in children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dong Hyun Kim ◽  
Hee Kyung Yang ◽  
Jeong-Min Hwang
Keyword(s):  
Age Of Onset ◽  
Basic Type ◽  
Lateral Rectus ◽  
Long Term Results ◽  
Intermittent Exotropia ◽  
Younger Age ◽  
Significant Difference ◽  
Type Of Surgery

AbstractThe long-term results of surgical treatment of intermittent exotropia (X(T)) according to the type of surgery are controversial. We conducted a retrospective cohort study to compare the long-term results between unilateral recession-resection (RR) and bilateral lateral rectus recession (BLR) with an average follow-up of 9.5 years in children with basic-type X(T). Patients with basic-type X(T), who underwent RR (RR group) or BLR (BLR group) and were followed-up for more than 5 years postoperatively, were analyzed. Of the 560 patients, 363 patients received BLR and 197 patients underwent RR. There was no significant difference in the success rates between the two groups until postoperative 3 years. At an average of 9.5 ± 2.6 years after surgery, the success rate of the RR group was significantly higher than that of the BLR group starting from the fourth post-operative year until the last follow-up examination (64.5% vs 43.3%, P < 0.001). By multivariate analysis, preoperative hyperopia of more than + 2.00 diopters, younger age of onset, younger age at surgery, larger exodeviation at near than at distance of > 5 prism diopters, and the type of surgery (BLR) were risk factors of recurrence. In conclusion, RR was more successful than BLR with a lower recurrence rate in the long-term follow-up of patients with basic-type X(T).

scholarly journals Long term Surgical Outcomes of Unilateral Recession-Resection versus Bilateral Lateral Rectus Recession in Basic-type Intermittent Exotropia in Children

2021 ◽  
Author(s):  
Dong Hyun Kim ◽  
Hee Kyung Yang ◽  
Jeong-Min Hwang
Keyword(s):  
Age Of Onset ◽  
Basic Type ◽  
Lateral Rectus ◽  
Long Term Results ◽  
Intermittent Exotropia ◽  
Younger Age ◽  
Significant Difference ◽  
Type Of Surgery

Abstract The long-term results of surgical treatment of intermittent exotropia (X(T)) according to the type of surgery are controversial. We compared the long-term results between unilateral recession-resection (RR) and bilateral lateral rectus recession (BLR) with an average follow-up of 10 years in children with basic-type X(T). Patients with basic-type X(T), who underwent RR (RR group) or BLR (BLR group) and were followed-up for more than 5 years postoperatively, were analyzed. Of the 560 patients, 363 patients received BLR and 197 patients underwent RR. There was no significant difference in the success rates between the two groups until postoperative 3 years. At an average of 9.5 ± 2.6 years after surgery, the success rate of the RR group was significantly higher than that of the BLR group starting from the fourth post-operative year until the last follow-up examination (64.1% vs 43.3%, p < 0.001). By multivariate analysis, preoperative hyperopia of more than + 2.00 diopters, younger age of onset, younger age at surgery, larger exodeviation at near than at distance of > 5 prism diopters, and the type of surgery (BLR) were risk factors of recurrence. In conclusion, RR was more successful than BLR with a lower recurrence rate in the long-term follow-up of patients with basic-type X(T).

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

Long-term outcomes following resection-recession versus plication-recession in children with intermittent exotropia

2019 ◽  
Vol 104 (3) ◽  
pp. 350-356 ◽  
Author(s):  
Haeng-Jin Lee ◽  
Seong-Joon Kim
Keyword(s):  
Surgical Outcomes ◽  
Lateral Rectus ◽  
Medial Rectus ◽  
Clinical Factors ◽  
Long Term Outcomes ◽  
Intermittent Exotropia ◽  
Surgical Success ◽  
Angle Of Deviation

Background/AimsTo compare the long-term surgical outcomes between unilateral lateral rectus recession-medial rectus resection (RR) and lateral rectus recession-medial rectus plication (RP) in children with intermittent exotropia.MethodsChildren who underwent RR or RP for intermittent exotropia between January 2008 and July 2016, with a minimum follow-up period of 2 years were retrospectively reviewed. Postoperative angle of deviations and clinical factors including sex, age, refractive errors, preoperative angle of deviation, types of exotropia and stereopsis were investigated. Based on the angle of deviation at year 2, surgical outcomes were classified into two groups as follows: success (esodeviation ≤5 prism dioptres (PD) to exodeviation ≤10 PD) and failure (overcorrection (esodeviation >5 PD) and undercorrection or recurrence (exodeviation >10 PD)).ResultsOf the 186 patients, 114 underwent RR and 72 underwent RP. The angle of exodeviation steadily increased over time in both groups after surgery. The durations of exodrift were longer in the RP group than in the RR group. The surgical success at postoperative year 2 was 55.3% in the RR group and 27.8% in the RP group (p<0.001). The amount of overcorrection was associated with successful outcomes in both groups.ConclusionsIn children with intermittent exotropia, RR group presented better surgical outcomes than RP group. The amount of initial overcorrection was important to achieve favourable outcomes in children with intermittent exotropia.

scholarly journals Early Results of Slanted Recession of the Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Bo Young Chun ◽  
Kyung Min Kang
Keyword(s):  
Rectus Muscle ◽  
Lateral Rectus ◽  
Mean Deviation ◽  
Intermittent Exotropia ◽  
Convergence Insufficiency ◽  
Lateral Rectus Muscle ◽  
Early Results ◽  
Distance Difference ◽  
The Mean

The aim of this study was to evaluate the efficacy of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. This prospective study included 31 patients who underwent slanted lateral rectus recession for intermittent exotropia with convergence insufficiency between June 2010 and June 2012. Following parameters were recorded and analyzed: patient sex, age, preoperative and postoperative near and distance ocular alignment, and changes in stereopsis. The mean age of the patients was 9.2 years. The preoperative mean deviation angle was 32.4 PD at distance and 43.4 PD at near. After 6 months, slanted lateral rectus recession reduced the deviation angles to 2 PD at distance and 3.4 PD at near. In addition, the mean difference between distance and near deviation angles was significantly reduced from 11 PD to 1.4 PD at 6 months postoperatively. Slanted lateral rectus recession for intermittent exotropia with convergence insufficiency in children successfully reduced the distance and near exodeviations and the near-distance difference without increasing the risk of long-term postoperative esotropia or diplopia.

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