Comparison of different surgery procedures for convergence insufficiency-type intermittent exotropia in children

Wang, Bing; Wang, Lihua; Wang, Qi; Ren, Meiyu

doi:10.1136/bjophthalmol-2013-304442

Cited by 33 publications

(34 citation statements)

References 17 publications

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“…Wang et al found the success rate of unilateral R&R to be superior to either bilateral LR recession, bilateral MR resection, or unilateral MR resection in children with CI-XT. [14] In this study, the amount of MR resection was based on the near deviation and the LR recession based on the distance deviation. Utilizing this technique, a success rate of 85.7% was achieved, which was defined as the distance deviation in primary gaze to be between ≤10PD of exophoria/tropia and ≤5 PD of esotropia.…”

Section: Discussionmentioning

confidence: 99%

“…In a direct comparison of reports of bilateral R&R with or without slanting, unilateral MR resection with or without slanting and unilateral R&R, it was found that unilateral R&R with MR resection based on the near deviation, and LR recession based on the distance deviation achieved the best alignment. [14] However, the success rates of the above procedures vary widely, ranging from 18% to 92%.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Fry¹,

Pineles²,

Velez³

2018

cleverjournal

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Introduction: Treatment of adults with convergence insufficiency-type (CI-XT) exotropia is challenging as surgery frequently results in distance and lateral gaze esotropia. Recent evidence demonstrates differential compartmental function of extraocular muscle fiber groups. Selective surgery of muscle fiber groups may diminish near-distance disparities (NDD) while maintaining alignment at distance. Methods: Seven adults with a NDD ≥8 prism diopter (PD) were included in this study. Patients with a NDD <15 PD and a distance deviation of <10 PD were treated with lateral rectus (LR) inferior marginal tenotomy, those with NDD >15 PD and distance deviation of >10 PD were treated with LR slanted recessions, and those with limitation in adduction with negative forced duction testing were treated with medial rectus (MR) inferior fiber plication. Success was defined as <8 PD of XT at distance and near without overcorrection and a NDD ≤8 PD. Results: Postoperatively, the mean distance deviation was reduced from 7.71 ± 6.87 PD to an overcorrection of 1.43 ± 3.78 PD, and the near deviation from 20.29 ± 9.57 PD to 0.86 ± 1.57 PD. The NDD was reduced from 12.57 ± 3.15 to 2.29 ± 3.73 PD. Six of the 7 (85.7%) patients met criteria for success. One subject was overcorrected at distance and two were slightly undercorrected at near but without diplopia. Discussion: CI exotropia remains a surgical challenge. Treatment may be optimized when using an individualized approach favoring selective LR and MR procedures when possible. Conclusions: Preliminary data reveal that selective techniques may eliminate diplopia while collapsing NDD in patients with CI-XT. A focused algorithm will help surgeons select the procedure most likely to benefit each individual patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Fry¹,

Pineles²,

Velez³

2018

cleverjournal

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“…[2] Surgical management is required for patients that do not respond to these measures or for patients whose deviations are too large or poorly controlled [3]. The various surgical procedures for CI-IXT include unilateral or bilateral medial rectus (MR) resection(s), bilateral lateral rectus (LR) recessions, unilateral LR recession combined with MR resection [4][5][6][7], MR resection with adjustable sutures [3], slanted bilateral MR resections [8][9][10], improved unilateral LR recession combined with MR resection [11][12][13], and slanted bilateral lateral rectus recession (SBLR-rec) [1-2, 14,15]. The reported success rates range from 13.3-92%.…”

Section: Introductionmentioning

confidence: 99%

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Ren

Wang

2020

Preprint

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Background The present study sought to investigate the efficiency and safety of SBLR-rec for the treatment of CI-IXT.Methods This retrospective case series study included 34 patients who underwent SBLR-rec for CI-IXT in Shandong Provincial Hospital affiliated to Shandong University between September 2013 and October 2015 with a minimum follow-up of 6 months. A successful surgical alignment was defined as +5 to -10 prism diopters (PD) of orthophoria in the primary position while viewing distant or near targets and a difference between the distance and near deviation angles of ≤8PD.Results The mean age of the patients at surgery was 7.09±3.80 years (range, 3 to 18 years). The mean distance deviations were -26.09±6.5 PD (range, -15 to -35 PD) and the mean near deviations, -37.21±6.3 PD (range, -25 to -45 PD) preoperatively. The mean recession amount of upper pole of the lateral rectus was 5.97 mm (range, 4.0 to 7.5mm) and that of lower pole of the lateral rectus, 7.49 mm (range, 6.0 to 8.5mm). At a mean follow-up of 15.0 months (range, 6 to 37 months), the surgical success rate was 70.6% (24/34), the under-correction rate was 17.6% (6/34), and the overcorrection rate was 11.8% (4/34). The mean difference between the distance and near deviation angles was significantly reduced from 11.12±2.06 PD (range, 10 to 15 PD) preoperatively to 2.47±3.04 PD (range, 0 to 10 PD) postoperatively (P<0.001). Each millimeter of difference between the upper and lower poles of the lateral rectus recession was associated with an improvement of 5.65 PD in the near-distance difference of deviation. At the final follow up, a distance-near difference of deviation of ≤8PD was found in 32 (94.1%) patients. none of the patients developed A-V pattern, torsional diplopia, or restricted abduction of the eyes.Conclusions SBLR-rec for CI-IXT may successfully reduce the distance and near exodeviations and the distance-near deviation difference, thus was proved to be an effective and safe procedure for the treatment of CI-IXT.

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“…Bilateral medial rectus resection (BMRR) can be used in correcting CI‐type IXT (Hermann ; Choi & Rosenbaum ; Wang et al. ), because this approach can strengthen the medial rectus (MR), reduce near and distance deviations, and collapse the near‐distance differences.…”

Section: Introductionmentioning

confidence: 99%

Comparison of bilateral medial rectus plication and resection for the treatment of convergence insufficiency‐type intermittent exotropia

Wang

Zhang

Chen

et al. 2019

Acta Ophthalmologica

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Purpose: To compare the clinical outcomes of bilateral medial rectus plication and resection for the treatment of convergence insufficiency (CI)-type intermittent exotropia (IXT). Methods: Fifty-five patients with CI-type IXT were included in this prospective study and were followed for 6 months. The patients were randomized into two groups: the bilateral medial rectus plication (BMRP) group (n = 27) and the bilateral medial rectus resection (BMRR) group (n = 28). The eye examinations of each patient were carried out before the surgery and at 1 day and 1, 3 and 6 months postoperatively. The success rate, angle of deviation, stereoacuity, operative time and postoperative conjunctival swelling and redness score were analysed. Results: The mean deviation at distance at 1 day postoperatively was +6.6 AE 5.6 prism dioptres (PD) in the BMRP group, which was lower than the value of +10.8 AE 9.3 PD observed in the BMRR group (p = 0.046). There was more overcorrection in the BMRR group at first day after surgery. However, there were no significant differences in deviations or success rates were observed between the two groups at 1, 3 and 6 months after surgery (p > 0.05). The operative time in the BMRP (12.9 AE 1.4 min) group was shorter than that in the BMRR (14.7 AE 1.4 min) group (p < 0.001). Postoperative conjunctival swelling and redness were milder in the BMRP group than in the BMRR group (p < 0.001). Conclusion: The BMRP surgery could be an alternative procedure to BMRR for the treatment of CI-type IXT with less immediate postoperative overcorrection and simpler, safer, less traumatic characteristics.

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Comparison of different surgery procedures for convergence insufficiency-type intermittent exotropia in children

Cited by 33 publications

References 17 publications

Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm

Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

Comparison of bilateral medial rectus plication and resection for the treatment of convergence insufficiency‐type intermittent exotropia

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