Purpose: To investigate the clinical characteristics and determine the effective surgical managements of A-pattern exotropia.Methods: Thirty-two patients with A-pattern exotropia underwent superior oblique muscle weak...Purpose: To investigate the clinical characteristics and determine the effective surgical managements of A-pattern exotropia.Methods: Thirty-two patients with A-pattern exotropia underwent superior oblique muscle weakening procedures, medial rectus resection or (and) lateral rectus recession. Pre- and post-operative eye position, deviation angle, superior oblique function and binocular vision were examined and analyzed in the cases.Results: Overaction of the superior oblique muscles (31/32) and underaction of the medial rectus muscle (20/32) were presented in the cases. Postoperatively, a satisfactory ocular alignment was obtained in 28 cases (87.5%), and the A-pattern was corrected in 31 cases (96.9%). Four cases got binocular vision after surgery.Conclusions: As one of the most common forms of A and V patterns, A-pattern exotropia showed clinical characteristics of superior oblique muscle overaction and medial rectus muscle underacion, which should be the primary factors in the etiology of A-pattern exotropia, and superior oblique weakening procedures combined with horizontal surgery should be an effective approach to A-pattern exotropia treatment.展开更多
AIM:To observe the surgical effects of slanted bilateral lateral recession(S-BLR)versus conventional bilateral lateral recession(C-BLR)in convergence insufficiency intermittent exotropia(CI-IXT).METHODS:Using a random...AIM:To observe the surgical effects of slanted bilateral lateral recession(S-BLR)versus conventional bilateral lateral recession(C-BLR)in convergence insufficiency intermittent exotropia(CI-IXT).METHODS:Using a randomized,double-blind,prospective design,22 patients with CI-IXT who were admitted to Renmin Hospital of Wuhan University from July 2019 to December 2020 were included.Patients were randomly divided into either S-BLR or C-BLR group for their subsequent strabismus surgery.All patients were followed up for 12mo.Near deviation,distant deviation,and neardistance difference(NDD)were measured in all patients.RESULTS:Twelve months after surgery,NDD improvement was 10(8,13)prismatic degrees(PD)in S-BLR group and 3(1,6)PD in C-BLR group(P=0.011).The near deviation of S-BLR group was 0(-2,2)PD,while that of C-BLR group was-4(-6,-3)PD(P=0.005).Before and after surgery,the difference in the distant deviation between the two groups was not statistically significant.There was no statistically significant difference in near stereopsis between the two groups(P=0.380)at 12mo.The success rate at 12mo after operation was 90.91%and 72.73%in the two groups(P=0.280).CONCLUSION:CI-IXT patients treated with S-BLR have better surgical outcomes than those treated with C-BLR,which indicates S-BLR is a safe and effective operation pattern.展开更多
AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen ca...AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen cases(23 affected eyes)of V-pattern exotropia with inferior oblique muscle overaction(+or++)who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed.The amount of V-pattern,grade of inferior oblique overaction,degree of vertical strabismus,abnormal head posture,and the fovea-disc angle were evaluated before and after surgery.RESULTS:The V-pattern was corrected in all cases,and the amount of V-pattern reduced by 17.85±5.13 prism diopter(PD)on average(t=16.07,P<0.001).The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0%(20/23).The degree of the foveadisc angle has a mean reduction of 5.45°±2.87°(t=3.95,P=0.003)after surgery.The mean vertical deviation in 5 cases with a small-angle hypertropia(5.23±3.06 PD)in the primary position reduced by 3.15±1.86 PD(t=6.10,P<0.001).No serious complications were observed.CONCLUSION:The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern,which is safe and easy to perform.展开更多
目的:通过文献计量学方法分析间歇性外斜视的研究现状和未来发展趋势。方法:检索2003-2022年Web of Science数据库核心合集中收录的文献计量学相关文献,运用文献计量学方法,使用CiteSpace6.2.R2软件对年发文量、国家、机构、杂志、作者...目的:通过文献计量学方法分析间歇性外斜视的研究现状和未来发展趋势。方法:检索2003-2022年Web of Science数据库核心合集中收录的文献计量学相关文献,运用文献计量学方法,使用CiteSpace6.2.R2软件对年发文量、国家、机构、杂志、作者、参考文献和关键词进行可视化分析。结果:2003-2022年共检索到620篇间歇性外斜视相关文献,年发文量呈稳定增加的趋势。韩国和美国为发文量最多的国家,最具有生产力的机构为梅奥诊所。发文量最多的作者为Holmes JM。刊文量最多的期刊是The Journal of American Association for Pediatric Ophthalmology and Strabismus(J AAPOS)(共计78篇文献)。关键词和突现词分析可总结出目前该领域的研究热点为间歇性外斜视的手术治疗、流行病学、正位、复发。结论:应用CiteSpace软件进行可视化分析,可客观反映出2003-2022年间歇性外斜视文献数量变化及分布情况,间歇性外斜视的研究热点已从其手术和流行病学逐渐转移到融合和复发等方面。展开更多
AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retro...AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.展开更多
AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underw...AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success[≤5 prism diopters(PD)esophoria(E)to≤10 PD exophoria(X)on the postoperative sixth month]were enrolled in this study.Their consecutive survival on the postoperative first year,second year and third year and at the last visit of fourth year or more,and the factors that might affect their survival,were analyzed.The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group(≤5 PD E to≤10 PD X)and the failure group(】5 PD esodeviation or】10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%,92.89%,83.70%and 50.49%on the postoperative first,second and third years and fourth year or more,respectively.None of the clinical factors was determined to have affected the survival.The amount of the exodrift was largest(2.29 PD)between the first year and the second year,and smallest(1.47 PD)between the fourth year and the last visit.Sixty-three patients had their final visit after the postoperative fourth year,and 29 of them were in the failure group.Twentyfive patients in the failure group had an intermittent exotropia(IXT)of【20 PD with good to fair distant fusion;two had an IXT of【20 PD with poor distant fusion;one had an IXT of≥20 PD with fair distant fusion;and another had delayed-onset consecutive esotropia.The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group(2.81 PD vs 5.86 PD,P=0.012).The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift,but the amount of the exodrift decreases with long-term follow-up.The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients.A smaller deviation on the postoperative sixth month is associated with long-term survival.展开更多
AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in...AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparityonly components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests,respectively. Patients with a long disease course(>1 y) had worse dynamic stereopsis than those with a short disease course(<1 y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparityonly, or the motion-only test components(all P>0.05, Chisquare test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.展开更多
AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for...AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test,and had moderate to good strabismus control.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.展开更多
AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral re...AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.展开更多
AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic reson...AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic resonance imaging（f MRI） data.METHODS： Totally, 32 CEs（25 males and 7 females） and 32 healthy control subjects（HCs）（25 males and 7 females） were enrolled in the study and underwent the MRI scanning. Two-sample t-test was used to examine differences in FC maps between the CE patients and HCs. RESULTS： The CE patients showed significantly less FC between the left brodmann area（BA17） and left lingual gyrus/cerebellum posterior lobe, right middle occipital gyrus, left precentral gyrus/postcentral gyrus and right inferior parietal lobule/postcentral gyrus. Meanwhile, CE patients showed significantly less FC between right BA17 and right middle occipital gyrus（BA19, 37）.CONCLUSION： Our findings show that CE involves abnormal FC in primary visual cortex in many regions, which may underlie the pathologic mechanism of impaired fusion and stereoscopic vision in CEs.展开更多
AIM： To compare a group of patients with consecutive exotropia with patients who had ≤ 10 prism diopters （PD） esotropia or no deviation postoperatively in terms of probable clinical risk factors for the developmen...AIM： To compare a group of patients with consecutive exotropia with patients who had ≤ 10 prism diopters （PD） esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. METHODS： The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. RESULTS： The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 （P=0.634）. There was no significant difference of preoperative near and distant deviations among two groups （P =0.835, 0.928 respectively）. The mean amount of medial rectus recession and lateral rectus resection was similar in both groups （P=0.412, 0.648 respectively）. Convergence insufficiency and neurological diseases were more frequent in group 1 （P-0.007, 0.045）. Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios （OR）： 5.75 （1.04-31.93）]. CONCLUSION： Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors.展开更多
AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Kno...AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.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(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final 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(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=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.展开更多
AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHOD...AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHODS： This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2 y. The results were evaluated at 2 y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1 wk was used to evaluate relationship with long-term outcome. The longterm outcome was classified into 3 groups： successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters（PD） and exodeviation 10 PD.RESULTS： Forty-two patients were enrolled. The mean age at surgery was 26 y（range, 15-49 y）. The median follow-up period was 30 mo（range, 24-108 mo）. Successful outcome was found in 81% of patients at 2 y and in 71% at the final visit. Overcorrection at 1 wk postoperatively was associated with a successful outcome at 2 y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome（RR=2.2）. The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2 y.CONCLUSION： Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1 wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.展开更多
文摘Purpose: To investigate the clinical characteristics and determine the effective surgical managements of A-pattern exotropia.Methods: Thirty-two patients with A-pattern exotropia underwent superior oblique muscle weakening procedures, medial rectus resection or (and) lateral rectus recession. Pre- and post-operative eye position, deviation angle, superior oblique function and binocular vision were examined and analyzed in the cases.Results: Overaction of the superior oblique muscles (31/32) and underaction of the medial rectus muscle (20/32) were presented in the cases. Postoperatively, a satisfactory ocular alignment was obtained in 28 cases (87.5%), and the A-pattern was corrected in 31 cases (96.9%). Four cases got binocular vision after surgery.Conclusions: As one of the most common forms of A and V patterns, A-pattern exotropia showed clinical characteristics of superior oblique muscle overaction and medial rectus muscle underacion, which should be the primary factors in the etiology of A-pattern exotropia, and superior oblique weakening procedures combined with horizontal surgery should be an effective approach to A-pattern exotropia treatment.
基金Supported by“323”Action Plan for Prominent Issues Affecting People’s Health of Hubei Province,Health Commission of Hubei Province,China。
文摘AIM:To observe the surgical effects of slanted bilateral lateral recession(S-BLR)versus conventional bilateral lateral recession(C-BLR)in convergence insufficiency intermittent exotropia(CI-IXT).METHODS:Using a randomized,double-blind,prospective design,22 patients with CI-IXT who were admitted to Renmin Hospital of Wuhan University from July 2019 to December 2020 were included.Patients were randomly divided into either S-BLR or C-BLR group for their subsequent strabismus surgery.All patients were followed up for 12mo.Near deviation,distant deviation,and neardistance difference(NDD)were measured in all patients.RESULTS:Twelve months after surgery,NDD improvement was 10(8,13)prismatic degrees(PD)in S-BLR group and 3(1,6)PD in C-BLR group(P=0.011).The near deviation of S-BLR group was 0(-2,2)PD,while that of C-BLR group was-4(-6,-3)PD(P=0.005).Before and after surgery,the difference in the distant deviation between the two groups was not statistically significant.There was no statistically significant difference in near stereopsis between the two groups(P=0.380)at 12mo.The success rate at 12mo after operation was 90.91%and 72.73%in the two groups(P=0.280).CONCLUSION:CI-IXT patients treated with S-BLR have better surgical outcomes than those treated with C-BLR,which indicates S-BLR is a safe and effective operation pattern.
文摘AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen cases(23 affected eyes)of V-pattern exotropia with inferior oblique muscle overaction(+or++)who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed.The amount of V-pattern,grade of inferior oblique overaction,degree of vertical strabismus,abnormal head posture,and the fovea-disc angle were evaluated before and after surgery.RESULTS:The V-pattern was corrected in all cases,and the amount of V-pattern reduced by 17.85±5.13 prism diopter(PD)on average(t=16.07,P<0.001).The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0%(20/23).The degree of the foveadisc angle has a mean reduction of 5.45°±2.87°(t=3.95,P=0.003)after surgery.The mean vertical deviation in 5 cases with a small-angle hypertropia(5.23±3.06 PD)in the primary position reduced by 3.15±1.86 PD(t=6.10,P<0.001).No serious complications were observed.CONCLUSION:The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern,which is safe and easy to perform.
文摘目的:通过文献计量学方法分析间歇性外斜视的研究现状和未来发展趋势。方法:检索2003-2022年Web of Science数据库核心合集中收录的文献计量学相关文献,运用文献计量学方法,使用CiteSpace6.2.R2软件对年发文量、国家、机构、杂志、作者、参考文献和关键词进行可视化分析。结果:2003-2022年共检索到620篇间歇性外斜视相关文献,年发文量呈稳定增加的趋势。韩国和美国为发文量最多的国家,最具有生产力的机构为梅奥诊所。发文量最多的作者为Holmes JM。刊文量最多的期刊是The Journal of American Association for Pediatric Ophthalmology and Strabismus(J AAPOS)(共计78篇文献)。关键词和突现词分析可总结出目前该领域的研究热点为间歇性外斜视的手术治疗、流行病学、正位、复发。结论:应用CiteSpace软件进行可视化分析,可客观反映出2003-2022年间歇性外斜视文献数量变化及分布情况,间歇性外斜视的研究热点已从其手术和流行病学逐渐转移到融合和复发等方面。
文摘AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.
文摘AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success[≤5 prism diopters(PD)esophoria(E)to≤10 PD exophoria(X)on the postoperative sixth month]were enrolled in this study.Their consecutive survival on the postoperative first year,second year and third year and at the last visit of fourth year or more,and the factors that might affect their survival,were analyzed.The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group(≤5 PD E to≤10 PD X)and the failure group(】5 PD esodeviation or】10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%,92.89%,83.70%and 50.49%on the postoperative first,second and third years and fourth year or more,respectively.None of the clinical factors was determined to have affected the survival.The amount of the exodrift was largest(2.29 PD)between the first year and the second year,and smallest(1.47 PD)between the fourth year and the last visit.Sixty-three patients had their final visit after the postoperative fourth year,and 29 of them were in the failure group.Twentyfive patients in the failure group had an intermittent exotropia(IXT)of【20 PD with good to fair distant fusion;two had an IXT of【20 PD with poor distant fusion;one had an IXT of≥20 PD with fair distant fusion;and another had delayed-onset consecutive esotropia.The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group(2.81 PD vs 5.86 PD,P=0.012).The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift,but the amount of the exodrift decreases with long-term follow-up.The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients.A smaller deviation on the postoperative sixth month is associated with long-term survival.
基金Supported by National Natural Science Foundation of China (No.81600761)the Natural Science Foundation Team Projectof Guangdong Province (No.2015A030312016)
文摘AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparityonly components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests,respectively. Patients with a long disease course(>1 y) had worse dynamic stereopsis than those with a short disease course(<1 y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparityonly, or the motion-only test components(all P>0.05, Chisquare test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.
文摘AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test,and had moderate to good strabismus control.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.
文摘AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.
基金Supported by the National Natural Science Foundation of China(No.81660158No.81160118No.81400372)
文摘AIM： To evaluate the differences in the functional connectivity（FC） of the primary visual cortex（V1） between the youth comitant exotropia（CE） patients and health subjects using resting functional magnetic resonance imaging（f MRI） data.METHODS： Totally, 32 CEs（25 males and 7 females） and 32 healthy control subjects（HCs）（25 males and 7 females） were enrolled in the study and underwent the MRI scanning. Two-sample t-test was used to examine differences in FC maps between the CE patients and HCs. RESULTS： The CE patients showed significantly less FC between the left brodmann area（BA17） and left lingual gyrus/cerebellum posterior lobe, right middle occipital gyrus, left precentral gyrus/postcentral gyrus and right inferior parietal lobule/postcentral gyrus. Meanwhile, CE patients showed significantly less FC between right BA17 and right middle occipital gyrus（BA19, 37）.CONCLUSION： Our findings show that CE involves abnormal FC in primary visual cortex in many regions, which may underlie the pathologic mechanism of impaired fusion and stereoscopic vision in CEs.
文摘AIM： To compare a group of patients with consecutive exotropia with patients who had ≤ 10 prism diopters （PD） esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. METHODS： The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. RESULTS： The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 （P=0.634）. There was no significant difference of preoperative near and distant deviations among two groups （P =0.835, 0.928 respectively）. The mean amount of medial rectus recession and lateral rectus resection was similar in both groups （P=0.412, 0.648 respectively）. Convergence insufficiency and neurological diseases were more frequent in group 1 （P-0.007, 0.045）. Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios （OR）： 5.75 （1.04-31.93）]. CONCLUSION： Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors.
基金Supported by the Natural Science Foundation of Tianjin(No.18JCZDJC36400)。
文摘AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.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(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final 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(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=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.
基金Supported by the Ratchadapiseksompoch Fund (No.RA57/046)
文摘AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHODS： This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2 y. The results were evaluated at 2 y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1 wk was used to evaluate relationship with long-term outcome. The longterm outcome was classified into 3 groups： successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters（PD） and exodeviation 10 PD.RESULTS： Forty-two patients were enrolled. The mean age at surgery was 26 y（range, 15-49 y）. The median follow-up period was 30 mo（range, 24-108 mo）. Successful outcome was found in 81% of patients at 2 y and in 71% at the final visit. Overcorrection at 1 wk postoperatively was associated with a successful outcome at 2 y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome（RR=2.2）. The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2 y.CONCLUSION： Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1 wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.
