Clinical Characteristics of Intermittent Esotropia

Purpose: To evaluate clinical findings and surgical outcomes of intermittent esotropia.Methods: We retrospectively reviewed the medical records of 23 patients (aged 9-42 years) who presented with intermittent esotropia between January 2007 and December 2020. We analyzed the age at onset, angle of deviation, presence of symptomatic diplopia, fusional state, near stereoacuity, and surgical results.Results: The mean age at onset was 19.9 ± 8.0 years and mean duration of esodeviation was 23.4 ± 27.1 months. Mean follow-up time was 13.0 ± 15.6 months. All patients except three had symptomatic diplopia, and 78.3% showed intermittent diplopia. Mean angles of deviation were 21.6 ± 10.3 prism diopters (PD) at distance and 20.2 ± 10.4 PD at near. Twenty-one patients (91.3%) were myopia. No patients had amblyopia and one had dissociated vertical deviation. On Worth’s four-dot test, five patients (21.7%) showed diplopia and four showed suppression at both distance and near. The other patients showed fusion at near or distance. Eleven patients underwent surgical correction. At the final examination, all patients achieved successful motor alignment and fusion with resolution of diplopia. Only two patients (18.2%) achieved normal 60 arcsec stereopsis, and six attained subnormal stereopsis.Conclusions: The main symptom of intermittent esotropia was diplopia. Surgical treatment was effective in achieving good postoperative motor alignment and fusion. However, successful motor alignment did not guarantee recovery of fine stereopsis.

Combined Recession–Resection of The Superior Rectus Muscle in the Treatment of Dissociated Vertical Deviation.

Purpose This is retrospective study that evaluates the use of combined recession-resection of the superior rectus muscle in the treatment of dissociated vertical deviation (DVD) Methods The medical records of 21 patients with bilateral DVD were retrospectively reviewed. Preoperative data were extracted for age, gender, BCVA (logMAR), amblyopia, angle of stereopsis, previous strabismus surgeries and angle of deviation. All included patients received resection of 2.5 mm of the superior rectus muscle prior to its recession in an amount determined by the maximum DVD angle. The main outcome measure was postoperative angle of DVD at the end of six postoperative months and success was identified as absence of manifest DVD . Results The mean angle of preoperative DVD was 18.09 PD in the right eye and 16.76 PD in the left ‎eye‎. The mean amount of SR recession was 8.9 ‎±1.4 ‎mm in the right e‎‎ye and 8.7 ‎±1.5 in the left ‎eye with symmetrical surgery performed in only 7 patients. Mean postoperative angle of DVD was ‎5.96‎ in the right eye and ‎5.86 ‎in the left eye. Surgical success was achieved in 15 patients (71%). Conclusions Combined recession-resection of the superior rectus muscle seems to be an effective technique in the management of DVD and could represent a good alternative to other surgical procedures.

Bilateral hypotropic dissociated vertical deviation: a case report

Background Hypotropic dissociated vertical deviation (DVD) is a special form of strabismus characterized by a slow drift of the non-fixating eye when the other eye is fixating on a target. In contrast to hypertropic DVD, which is common, hypotropic DVD is exceedingly rare and seldom reported in previous literature. In this case, we report the clinical features of a rare case of a Syrian child with bilateral hypotropic DVD accompanied by manifest latent nystagmus and intermittent exotropia. Case presentation A 4-year-old Syrian Arab girl presented with intermittent exotropia of both eyes since the age of 7 months, without any prior treatment. The fixation was alternating. She had manifest latent nystagmus in both eyes and anomalous head posture. She had bilateral hypotropic DVD in both eyes which only appeared when covering each eye. The patient underwent bilateral lateral rectus recession with posterior fixation and bilateral inferior oblique recession. Three months after surgery, she was orthophoric in the primary gaze position with a normal head posture. No alteration of the appearance of the hypotropic DVD was observed after the surgery. Conclusion This is a rare case of hypotropic DVD showing bilateral hypotropic DVD with different characteristics from those previously reported cases (bilateral hypotropic DVD with intermittent exotropia, dissociated horizontal deviation, manifest latent nystagmus, and bilateral inferior oblique overaction). The hypotropic DVD only appeared when covering each eye, and thus there was no need for surgery. Moreover, the inferior oblique recession did not seem to negatively affect the appearance of the eyes.

Graded superior oblique tendon suture lengthening: A novel procedure

Purpose: Literature regarding different superior oblique (SO) weakening procedures showed variable results. Here, we aim to evaluate the effect of a novel superior oblique tendon suture lengthening (SOSL) procedure on weakening of SO in patients with A-pattern exotropia associated with dissociated vertical deviation and SO overaction (triad exotropia). Methods: The medical records of triad exotropia patients who underwent SOSL or SO tenotomy were reviewed. Surgical results of SOSL procedure mainly regarding the correction of A pattern, SO overaction, and fundus intorsion were analyzed and compared with those of SO tenotomy procedure. Results: SOSL demonstrated comparable efficacy in correction of A pattern (20.2△ ± 10.7△ vs 29.2△ ± 16.1△, p = 0.172), normalization of SO overaction (1.9 ± 0.9 vs 2.4 ± 1.5, p = 0.349), and conversion of fundus intorsion (11.1° ± 7.0° vs 11.3° ± 4.4°, p = 0.691) as SO tenotomy. Moreover, the success rate of A pattern collapse was significantly higher in the SOSL group than in the SO tenotomy group (86% vs 40%, p = 0.028). None of the patients in the SOSL group, but two in the SO tenotomy group, presented SO palsy postoperatively. In the SOSL group, the corrected magnitude of SO overaction strongly correlated with the dosage of suture lengthening ( p < 0.001). Conclusion: SOSL procedure could effectively eliminate the clinical manifestations associated with SO overaction. The graded dosage of SOSL leads to more controllable and predictable results compared to SO tenotomy, which makes SOSL a good alternative choice for SO weakening.

Factors Influencing the Result of Superior Oblique Weakening Procedures in Patients with Superior Oblique Overaction in Horizontal Strabismus

Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001). Conclusion There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus

Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from + 0.5 to + 3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p < 0.001). Conclusions There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.