Longitudinal Rehabilitation of Binocular Function in Adolescent Intermittent Exotropia After Successful Corrective Surgery

Peng, Tingting; Xu, Meiping; Zheng, Fuhao; Zhang, Junxiao; Chen, Shuang; Lou, Jiangtao; Wang, Chunxiao; Wang, Yuwen; Yu, Xinping

doi:10.3389/fnins.2021.685376

“…Li Dan et al have surveyed different types of intermittent exotropia and indicated that surgery is helpful to the recovery of binocular regulatory set function [ 23 ]. The clinical study of binocular visual function in children with intermittent exotropia before and after operation suggests that surgical therapeutics is beneficial to the reconstruction of binocular visual function [ 24 ]. In a retrospective study on the clinical course of patients with intermittent exotropia, 73 patients with intermittent exotropia were followed up for 4 to 23 years with an average of 10 years.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Improvement Time and Influencing Factors of Diplopia after Intermittent Exotropia in Children

Wang

¹

,

Hong-ping

²

,

Zhang

³

et al. 2022

Journal of Healthcare Engineering

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Objective. To observe and analyze the occurrence rate, improvement time, and influencing factors of diplopia after intermittent exotropia in children. Methods. A total of 135 children with intermittent exotropia treated in our hospital from February 2019 to April 2021 were recruited. A reasonable surgical plan was exerted according to the preoperative examination of the children, the children were divided into groups according to their age, degree of strabismus, visual acuity, and binocular visual function, and the postoperative diplopia occurrence rate and improvement time of diplopia in different groups were observed and compared. Results. Postoperative diplopia occurred in 74 of 135 children with intermittent exotropia, and the postoperative incidence of diplopia was 54.81%. All diplopia occurred on the first day after the operation. There were 62 cases of contradictory diplopia (83.78%) and 12 cases of fusion of powerless diplopia (16.22%). Except for 1 case of amalgamated powerless diplopia, diplopia was not significantly improved after 6 months, which seriously affected the life of the children after the second operation, and all the others were significantly improved within 90 days. The improvement time of diplopia was 3–90 days, and the average improvement time of diplopia was 13.25 ± 3.16 days. According to their age, the children were divided into the 3–6 years old group (n = 69), the 7–10 years old group (n = 47), and the 11–14 years old group (n = 19). Postoperative diplopia occurred in 25 cases (36.23%) in the 3–6 years old group, 34 cases (72.34%) in the 7–10 years old group, and 16 cases (84.21%) in the 11–14 years old group. There was a significant difference in the incidence of postoperative diplopia among the three groups ( P < 0.05 ). There was a significant difference in the improvement time of diplopia among the three groups ( P < 0.05 ). According to the degree of strabismus before the operation, the children were divided into the <50△ group (n = 74) and the ≥50△ group (n = 61). Postoperative diplopia occurred in 32 cases (43.24%) in the <50△ group and 43 cases (70.49%) in the ≥50△ group. There was a significant difference in the incidence of postoperative diplopia between the two groups ( P < 0.05 ). There was a significant difference in the improvement time of diplopia among the three groups ( P < 0.05 ). According to the results of the visual acuity examination, the patients were divided into the ≥0.8 (naked eye) group (n = 21), the ≥0.8 (ametropia) group (n = 32), and the <0.8 (amblyopia) group (n = 32). Among them, diplopia occurred in 10 cases (47.62%) in the ≥0.8 (naked eye) group, 40 cases (48.78%) in the ≥0.8 (ametropia) group, and 24 cases (75.00%) in the <0.8 (amblyopia) group. The incidence of diplopia in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant ( P < 0.05 ). The postoperative diplopia improvement time in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant ( P < 0.05 ). There was no significant difference in diplopia occurrence rate and diplopia improvement time between the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group ( P > 0.05 ). According to the results of binocular visual function examination, 92 cases had a primary function, 45 cases (48.91%) had diplopia after the operation, the average recovery time of diplopia was 12.58 ± 3.16, 43 cases had no primary function, and 30 cases (69.77%) had diplopia after the operation. The average recovery time of diplopia was 13.02 ± 3.84. There was a significant difference in the incidence of diplopia between the two groups (χ2 = 5.162). There was no significant difference in the recovery time of diplopia between the two groups (χ2 = 0.570, P < 0.05 ). In 80 cases with secondary function, diplopia occurred in 36 cases (45.00%), and the average recovery time of diplopia was 10.14 ± 2.88; in 55 cases without secondary function, diplopia occurred in 39 cases (70.91%), and the average recovery time of diplopia was 14.86 ± 3.73. There was a significant difference in the incidence of diplopia between the two groups (χ2 = 8.861, P < 0.002 ). There was a significant difference in the recovery time of diplopia between the two groups (χ2 = 6.469, P < 0.001 ). In 77 cases with tertiary function, diplopia occurred in 32 cases (41.56%), and the average recovery time of diplopia was 9.61 ± 2.39; in 58 cases without tertiary function, diplopia occurred in 43 cases (74.14%), and the average recovery time of diplopia was 13.11 ± 3.05. There was a significant difference in the incidence of diplopia between the two groups (χ2 = 14.221 P < 0.001 ). There was a significant difference in the recovery time of diplopia between the two groups (χ2 = 5.355, P < 0.001 ). Conclusions. The age, degree of strabismus, visual acuity, and binocular visual function of children with intermittent exotropia are significant factors affecting the occurrence rate and recovery time of diplopia after the operation. The younger the age, the smaller the degree of strabismus, the better the vision and the second or third grade of visual function, the smaller the occurrence rate of diplopia, and the shorter the recovery time of diplopia. Thus, the above influencing factors have a certain guiding significance in predicting the improvement of postoperative diplopia and the time of diplopia disappearance. The purpose of intermittent exotropia surgery in children is not only to correct eye position and improve appearance but also to establish normal retinal correspondence in order to obtain binocular monocular function. Furthermore, postoperative diplopia in children with concomitant exotropia is very common; therefore, careful examination, comprehensive analysis, and surgical plan should be designed according to the above factors. Stereoscopic vision training as early as possible after the operation is beneficial to the establishment of normal retinal correspondence and the elimination of diplopia.

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“…Previous studies have confirmed that binocular function, such as sensory fusion, motor fusion and stereopsis, can be improved to a certain extent after surgery but only to a limited extent (16,34,35). In addition, postoperative binocular fusion has been reported to have no correlation with postoperative ocular alignment stability in retrospective studies (16,35). Therefore, it seems that the underlying mechanism of IXT is complex and has a neural basis in the visual cortex because merely correcting for the ocular misalignment does not sufficiently restore binocular visual functions.…”

Section: Discussionmentioning

confidence: 90%

“…There is no clear consensus on the causes of recurrence, such as age of onset, preoperative angle of deviation, and residual fusion, lateral incomitance (6,8,13). Previous studies have confirmed that binocular function, such as sensory fusion, motor fusion and stereopsis, can be improved to a certain extent after surgery but only to a limited extent (16,34,35). In addition, postoperative binocular fusion has been reported to have no correlation with postoperative ocular alignment stability in retrospective studies (16,35).…”

Section: Discussionmentioning

confidence: 99%

Binocular Summation Is Intact in Intermittent Exotropia After Surgery

Xu

¹

,

Chen

²

,

Peng

³

et al. 2021

Self Cite

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Purpose: To determine binocular summation of surgically treated intermittent exotropia (IXT) patients by measuring the contrast threshold.Methods: We recruited 38 surgically treated IXT patients aged 8–24 years and 20 age-matched healthy controls. All participants had normal or corrected-to-normal visual acuity (Snellen ≥ 20/20) in both eyes. The IXT patients had undergone the surgery at least a year prior to the study. Twenty-one of them obtained good alignment and 17 experienced a recurrence of exotropia. We measured the observers' monocular and binocular contrast sensitivities (CS) at six spatial frequencies (1.5, 3, 6, 12, 18, 24 cycles/degree) as an index of visual information processing at the threshold level. Binocular summation was evaluated against a baseline model of simple probability summation based on the CS at each spatial frequency and the area under the log contrast sensitivity function (AULCSF).Results: The exo-deviation of IXTs with good alignment was −6.38 ± 3.61 prism diopters (pd) at 33 cm and −5.14 ± 4.07 pd at 5 m. For the patients with recurrence, it was −23.47 ± 5.53 pd and −21.12 ± 4.28 pd, respectively. There was no significant difference in the binocular summation ratio (BSR) between the surgically treated IXT patients, including those with good alignment and recurrence, and normal controls at each spatial frequency [F(2,55) = 0.416, P = 0.662] and AULCSF [F(2,55) = 0.469, P = 0.628]. In addition, the BSR was not associated with stereopsis (r = −0.151, P = 0.365).Conclusion: Our findings of normal contrast sensitivity binocular summation ratio in IXT after surgical treatment suggest that the ability of the visual cortex in processing binocular information is intact at the contrast threshold level.

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“…Preoperative binocular vision function is often used to assess the severity of the disease [ 12 – 14 ], and postoperative binocular vision function reflects the level of visual function repair [ 15 , 16 ]. Theoretically, as IXT patients have a certain basis for binocular vision function, when the eye position of IXT patients is corrected after surgery, binocular vision function is significantly improved [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia

Zhao,

Fu,

Qi

et al. 2024

BMC Ophthalmol

0

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Objective To investigate the recovery of binocular stereopsis recovery and its influencing factors in children with intermittent exotropia after successful correction of eye position. Methods Prospective clinical study. A total of 178 patients, aged 9 ∼ 14 (10.8 ± 1.7) years, who were successfully corrected after intermittent exotropia surgery at the Beijing Tongren Hospital Affiliated to Capital Medical University from October 2023 to September 2023 were collected, the follow-up duration was six-month or longer. Paired t test, Pearson correlation analysis and multivariable linear regression analysis were used to probe preoperative clinical features that may predict the stereopsis six months after surgery. Results Six months after surgery, the angle of deviation of the patients met the orthotopic standard, and there was significant difference compared with that before surgery (distant: -2.7△±3.2△ vs. -30.5△±8.4△, t=-25.3, P < 0.001. Near:-3.7△±4.1△ vs. -33.7△±8.0△, t=-26.1, P < 0.001). Distant stereopsis (3.0 ± 0.6 vs. 3.9 ± 0.4, t = 4.9, P < 0.05) and near stereopsis (2.3 ± 0.5 vs. 2.6 ± 0.4, t = 3.8, P < 0.05) were both significantly improved compared with that of before surgery. 17% and 22% patients rebuilt normal distant stereopsis and normal near stereopsis, respectively. Preoperative distant stereopsis (r=-0.26, P = 0.004) and near stereopsis (r=-0.23, P = 0.011) was significantly negatively correlated with convergence reserve. Multivariable analysis showed that patients’ age (β = 0.003, p = 0.037), anisometropia (β = 0.015, p = 0.043), and preoperative distant stereopsis (β = 0.456, p < 0.001) were significantly associated with postoperative distant stereopsis. Patients’ age (β = 0.005, p = 0.044), anisometropia (β = 0.127, p = 0.034), angle of deviation (β=-0.230, p = 0.020), and preoperative near stereopsis (β = 0.136, p < 0.001) were significantly associated with postoperative near stereopsis. Conclusion IXT patients could get eye position fixed after surgery, about 20% patients benefited from stereopsis improvement. Patient’s age, binocular anisometropia, angle of deviation and preoperative stereopsis were independent factors influencing postoperative stereopsis.

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Longitudinal Rehabilitation of Binocular Function in Adolescent Intermittent Exotropia After Successful Corrective Surgery

Cited by 8 publications

References 40 publications

Analysis of Improvement Time and Influencing Factors of Diplopia after Intermittent Exotropia in Children

Analysis of Improvement Time and Influencing Factors of Diplopia after Intermittent Exotropia in Children

Binocular Summation Is Intact in Intermittent Exotropia After Surgery

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia

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