Surgical Management of Convergence Insufficiency

Haldi, Betty Anne

doi:10.1080/0065955x.1978.11982466

Cited by 32 publications

(15 citation statements)

References 3 publications

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“…[1][2][3][4] The surgical procedures recommended for this form of exotropia include bilateral lateral rectus (LR) muscle recession with or without a slanting procedure, bilateral medial rectus (MR) muscle resection with or without a slanting procedure, LR recession with MR resection, or MR resection with an adjustable suture. 1,2,[5][6][7][8][9][10][11] Surgical success rates have been reported to vary between 18 and 92%. 1,2,[5][6][7][8][9][10][11] The majority of previous studies have been performed in adults with intermittent exotropia (X(T)) of the convergence insufficiency type.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,[5][6][7][8][9][10][11] Surgical success rates have been reported to vary between 18 and 92%. 1,2,[5][6][7][8][9][10][11] The majority of previous studies have been performed in adults with intermittent exotropia (X(T)) of the convergence insufficiency type. 1,[6][7][8][9][10][11] The convergence insufficiency type is much less frequent in children with X(T) and surgical results have rarely been reported.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,[5][6][7][8][9][10][11] The majority of previous studies have been performed in adults with intermittent exotropia (X(T)) of the convergence insufficiency type. 1,[6][7][8][9][10][11] The convergence insufficiency type is much less frequent in children with X(T) and surgical results have rarely been reported. Kraft et al 5 described a technique wherein the monocular strengthening of MR resection exceeds LR weakening; the amount of MR resection used was based on near deviation, and the amount of LR recession was based on far deviation.…”

Section: Introductionmentioning

confidence: 99%

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Unilateral recession–resection in children with exotropia of the convergence insufficiency type

2005

Eye

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Purpose The surgical success rates for intermittent exotropia of the convergence insufficiency type have been reported to be variable, and most were studied retrospectively in adults. The purpose of this study was to evaluate prospectively the long-term surgical results of unilateral lateral rectus (LR) muscle recession and medial rectus (MR) muscle resection in children with intermittent exotropia of the convergence insufficiency type. Methods A total of 14 children with intermittent exotropia greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. The amounts of resection and recession were based on near and distance deviation, respectively. Minimum follow-up was 1 year (mean 26.6 months; range, 12-68 months) after surgery. The paired t-test was used to compare preoperative and postoperative measurements of the angle of deviation at distance and near, near-distance difference. Results Significant postoperative reduction was achieved in terms of mean distance exodeviation, from 22.5 PD to 9.1 PD (P ¼ 0.000), and mean near exodeviation from 33.8 PD to 13.6 PD (P ¼ 0.000). Mean neardistance difference reduced from 11.3 PD preoperatively to 4.6 PD postoperatively (P ¼ 0.000). Fresnel prism was used temporarily to treat postoperative esotropia in only one patient for postoperative 6 months. Conclusions Unilateral surgery biased to MR strengthening more than LR weakening in children with intermittent exotropia of the convergence insufficiency type, was found to successfully reduce both distance and near deviation and to collapse near-distance differences with a low risk of long-term postoperative esotropia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Unilateral recession–resection in children with exotropia of the convergence insufficiency type

2005

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“…7 The surgical procedures recommended for this form of X(T) include bilateral lateral rectus (LR) recession using a slanting procedure, bilateral medial rectus (MR) resection using a slanting procedure, or MR resection(s) with an adjustable suture. 1,2,[7][8][9][10][11][12] Surgical success rates have been reported to vary between 18 and 92%. 1,2,[7][8][9][10][11][12] Nemet and Stolovitch 8 adopted slanted procedures for bilateral MR resection in three patients.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,[7][8][9][10][11][12] Surgical success rates have been reported to vary between 18 and 92%. 1,2,[7][8][9][10][11][12] Nemet and Stolovitch 8 adopted slanted procedures for bilateral MR resection in three patients. Slanted MR resection shortens and tautens MR muscle lower fibres for near vision, and good surgical results have been reported over a year of follow-up.…”

Section: Introductionmentioning

confidence: 99%

The long-term result of slanted medial rectus resection in exotropia of the convergence insufficiency type

2005

Eye

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Purpose To evaluate the long-term results of slanted medial rectus (MR) resection for intermittent exotropia (X(T)) of the convergence insufficiency type. Methods In all, 10 patients with an X(T) greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. Patients received slanted bilateral MR resection. The upper edge of the MR was resected according to the distance exodeviation and the lower edge of the MR was resected according to near exodeviation. The postoperative follow-up period was between 6 and 62 months with a mean of 38.9 months. The paired t-test was used to compare: mean distance angle of deviation preoperatively and postoperatively; mean near angle of deviation preoperatively and postoperatively; and mean near-distance exodeviation difference preoperatively and postoperatively. Results Bilateral slanted MR resections reduced mean exodeviation at distance from 23.077.2 to 16.375.4 PD (P ¼ 0.03); mean exodeviation at near from 34.377.7 to 24.676.9 PD (P ¼ 0.01); and mean near-distance difference from 11.472.6 to 8.373.5 PD (P ¼ 0.04). At the final follow-up examination, all patients demonstrated an exodeviation of 10 PD or more at distance and near, and the exodeviation difference between distance and near deviation was within 10 PD in five of the 10 patients. Three patients had an esodeviation at distance after surgery, but all resolved within 4 weeks. Conclusions Bilateral slanted MR resections in patients with X(T) of the convergence insufficiency type resulted in undercorrection in all patients.

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The Distance Angle to Target in Surgery for Intermittent Exotropia

Kushner¹

1998

Arch Ophthalmol

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Background: Patients with intermittent exotropia may have an increase in their angle of strabismus in the distance when the angle is measured either after 1 hour of monocular occlusion or while the patients fixate on a distant target outdoors. The hypothesis that surgery should be performed for this larger deviation has been suggested but not tested. Objectives: To test the hypothesis that surgery should be performed for the increased angle of strabismus in the distance in patients with intermittent exotropia and to investigate the factors that influence the angle of misalignment. Methods: A prospective, clinical trial was conducted of patients with intermittent exotropia in whom the angle of misalignment in the distance increased after 1 hour of monocular occlusion or while the patients fixated on an outdoor target. The study group underwent surgery for the largest deviation measured; the control group underwent surgery for the initial angle measured at 6 m. All patients in whom the angle of misalignment increased while the patients were looking at an outdoor target were additionally measured in indoor illumination at 24 m and also at 6 m under floodlights that simulated outdoor illumination. Ninety patients undergoing surgery were randomized. Results: Forty-three (86.0%) of the 50 patients undergoing surgery for the largest angle measured had a satisfactory outcome vs 25 (62.5%) of the 40 patients in the control group (PϽ.001). The mechanism for the increase in exotropia while fixating on an outdoor target was studied in 76 patients, and the results were variable. Conclusions: The angle of strabismus in patients with intermittent exotropia undergoing surgery should be measured while the patients fixate on an outdoor target and after 1 hour of monocular occlusion. Surgery should be performed for the largest angle measured.

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Surgical Management of Convergence Insufficiency

Cited by 32 publications

References 3 publications

Unilateral recession–resection in children with exotropia of the convergence insufficiency type

Unilateral recession–resection in children with exotropia of the convergence insufficiency type

The long-term result of slanted medial rectus resection in exotropia of the convergence insufficiency type

The Distance Angle to Target in Surgery for Intermittent Exotropia

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