Surgical Treatment of Congenital Esotropia

Helveston, Eugene M.; Ellis, Forrest D.; Schott, Jean; Mitchelson, John; Weber, Janet C.; Taube, Susan; Miller, Kathy

doi:10.1016/s0002-9394(14)77790-6

Cited by 81 publications

(17 citation statements)

References 2 publications

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“…Birçok çalışmada erken (24 aydan önce) ve çok erken (6 aydan önce) cerrahi ile binoküler fonksiyonlarda daha iyi sonuçlar elde edildiği ve mümkün olan en erken dönemde cerrahi yapılması gerektiği öne sürülmüştür. [14][15][16][17][18] Bunun aksine bazı çalışmalarda da erken cerrahi tedavi ile kazanılan binoküler sonucun genellikle ince stereopsis kabiliyetinden yoksun olduğu ve cerrahi yaşın binoküler fonksiyonların gelişimini anlamlı olarak etkilemediği gösterilmiştir. 19,20 Ayrıca bazı cerrahlar erken yaşta kayma miktarı net değerlendirilemediğinden, 21,22 ardıl ekzotropya gelişme oranı daha fazla olmasına rağmen binoküler fonksiyonların gelişmesi açısından arada anlamlı fark olmadığından 23 geç dönem cerrahiyi önermektedirler.…”

Section: Discussionunclassified

İnfantil Ezotropyada Cerrahi Başarıyı Etkileyen Faktörler

Yusufoğlu¹,

Cinar²,

Somer³

et al. 2013

tjo

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ÖzetAmaç: İnfantil ezotropyalı olgularda cerrahi başarıyı etkileyen faktörleri incelemek ve bilateral iç rektus geriletme miktarı ile konverjans ilişkisini değerlendirmek. Ge reç ve Yön tem: Kliniğimizde cerrahi uygulanan 188 infantil ezotropyalı hastanın dosyası retrospektif olarak incelendi. Cerrahi başarı oranları, cerrahi başarıyı etkileyen faktörler ve bilateral iç rektus geriletme miktarı ile konverjans yetmezliği arasındaki ilişki değerlendirildi. Cerrahi sonrası kayma miktarının 10 prizm dioptrinin altında olması başarılı cerrahi olarak kabul edildi. So nuç lar: Çalışmaya dahil edilen 188 hastanın hastanemize başvuru yaşı 54,9±56,8 (5-276) ay, ortalama cerrahi yaşı 60,7±54,8 (7-276) ay idi. İlk cerrahi sonrası olguların %70,7'sinde, tekrarlayan cerrahiler sonrası ise %86,7'sinde başarı sağlandı. Cinsiyet, cerrahi yaş, refraksiyon kusuru, uygulanan cerrahi prosedür ve cerrahi öncesi füzyon varlığının cerrahi başarıyı etkilemediği görüldü. Cerrahi öncesi kayma miktarı yüksek olanlarda rezidü ezotropyanın, ambliyopisi olanlarda ise hem rezidü ezotropya hem de ardıl ekzotropyanın daha sık geliştiği tespit edildi. Arttırılmış bilateral iç rektus geriletmesinin cerrahi sonrası konverjans yetmezliğinde artışa neden olmadığı görüldü. Tar t›fl ma: Ambliyopi varlığı cerrahi başarıyı olumsuz etkilediğinden, cerrahiden önce saptanmalı ve tedavi edilmelidir. Cerrahi öncesi kayma açısı yüksek olanlarda ise rezidü ezotropya daha sık görülmekte ve ortoforya sağlamak için birden fazla cerrahi gerekebilmektedir. Bu olgularda arttırılmış bilateral iç rektus geriletmesi, hastayı tekrarlayan cerrahilerden kurtaran, üç veya dört kas cerrahisine tercih edilebilecek etkin ve güvenilir bir yöntemdir. (Turk J Ophthalmol 2013; 43: 413-8) Anah tar Ke li me ler: İnfantil ezotropya, cerrahi, ambliyopi, konverjans yetmezliği Sum maryPur po se: To determine the factors that influence the surgical success in patients with infantile esotropia and to evaluate the relationship between amount of bilateral medial rectus recession and convergence. Ma te ri al and Met hod: We retrospectively investigated the records of 188 patients with infantile esotropia who were operated on. The surgical success rate, the factors that influence the surgical success, and the relationship between amount of bilateral medial rectus recession and convergence deficiency were evaluated. Successful outcome was defined as deviation amount lower than 10 prism diopters postoperatively. Re sults: The mean age of the 188 patients included in the study at presentation was 54.9±56.8 (5-276) months, and the mean surgical age was 60.7±54.8 (7-276) months. Success was provided in 70.7% of patients after the first surgery and in 86.7% of patients after repeated surgeries. It was seen that gender, surgical age, refractive error, surgical procedure and the presence of fusion before surgery did not affect surgical success. Residual esotropia was found more frequently in patients with large-angle preoperative deviation, whilst both residual esotropia and consecutive exotropia were...

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Section: Discussionunclassified

İnfantil Ezotropyada Cerrahi Başarıyı Etkileyen Faktörler

Yusufoğlu¹,

Cinar²,

Somer³

et al. 2013

tjo

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“…25,31 In some series, no correlation has been found between the age at surgery and sensory outcome. [13][14][15][16] Today, the beneficial effect of alignment by age 2 in congenital esotropia has been well established. Ing 11,32 showed that over 80% of patients straightened before 2 years of age will achieve peripheral fusion, but only 20% will achieve peripheral fusion if alignment is obtained after 2 years of age.…”

Section: Binocular Visual Function In Congenital Esotropiamentioning

confidence: 99%

“…2,[10][11][12] However, no correlation was found between the age at surgery and sensory outcome in some other series. [13][14][15][16] In this study, we evaluated the sensory results in 40 children treated surgically for congenital esotropia and investigated the factors that may affect the outcome.…”

mentioning

confidence: 99%

Binocular visual function in congenital esotropia after bilateral medial rectus recession with loop suture

et al. 2002

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In congenital esotropia, not all infants may have the potential for normal binocular function owing to yet unknown constitutional factors. We determined that achieving some degree of binocular function may be related to early alignment of the eyes. Additionally, close follow-up and precise treatment of the accompanying vertical deviation, especially inferior oblique overaction and dissociated vertical deviation, in a timely manner may enhance the attainment of binocular sensory function.

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“…[11,[24][25][26] On the other hand, normal-appearing eye alignment is the outcome in more than 80% of infants after conventional extraocular muscle surgery. [27] For its supporters, bilateral medial rectus injections of 2.5U of botulinum toxin have an effective, reliable modality for the management of infantile esotropia in infants and young children, [25,26] producing binocular alignment of the visual axes with the potential for achieving satisfactory binocular function and acceptable long term effects. [28] 40% of patients received multiple (2 or more) bilateral injections.…”

Section: Botulinum Toxinmentioning

confidence: 99%

The Role of Drug Treatment in Children with Strabismus and Amblyopia

Chatzistefanou

Mills

2000

Pediatric Drugs

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Strabismus, or misalignment of the eyes, is a common ophthalmic problem in childhood, affecting 2 to 5% of the preschool population. Amblyopia is an important cause of visual morbidity frequently associated with strabismus, and both conditions should be treated simultaneously. Pharmacological means for treating strabismus and amblyopia can be divided into 3 categories: paralytic agents (botulinum toxin) used directly on the extraocular muscles to affect eye movements; autonomic agents (atropine, miotics) used topically to manipulate the refractive status of the eye and thereby affect alignment, focus and amblyopia; and centrally acting agents, including levodopa and citicoline, which affect the central visual system abnormalities in amblyopia. Botulinum toxin, the paralytic agent that causes the clinical symptoms of botulism poisoning, can be injected in minute quantities to achieve controlled paralysis of the extraocular muscles. Although the role of botulinum toxin is established in adults with paralytic strabismus, its usefulness in the treatment of comitant childhood strabismus (primary esotropia and exotropia) is not universally accepted. Botulinum injections tend to be more effective with smaller degrees of strabismus, in patients with good binocular fusion, and in managing overcorrections or undercorrections after traditional muscle surgery. Inadvertent ptosis and paralysis of adjacent muscles, unpredictable responses and technical constraints of the injections limit its use in children. Miotic therapy, by altering the refractive state of the treated eye, offers an alternative to optical correction with bifocals in treating esotropia due to excessive accommodative convergence. It is also effective in treating residual esotropia following surgery. The ease of use of glasses restricts the wide application of miotics in these common strabismus syndromes. Atropine, an anticholinergic agent, paralyses the ability of the eye to focus or accommodate. In amblyopia therapy, atropine is used to blur vision in the non-amblyopic eye and offers a useful alternative to traditional occlusion therapy with patching, especially in older children who are not compliant with patching. The neurotransmitter precursor levodopa and the related compound citicoline have been demonstrated to improve vision in amblyopic eyes. The therapeutic role of these centrally acting agents in the clinical management of amblyopia remains unproven.

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Surgical Treatment of Congenital Esotropia

Cited by 81 publications

References 2 publications

İnfantil Ezotropyada Cerrahi Başarıyı Etkileyen Faktörler

İnfantil Ezotropyada Cerrahi Başarıyı Etkileyen Faktörler

Binocular visual function in congenital esotropia after bilateral medial rectus recession with loop suture

The Role of Drug Treatment in Children with Strabismus and Amblyopia

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