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Factors affecting residual exotropia after two muscle surgery for intermittent exotropia

International Journal of Ophthalmology(English edition) 2017年第7期10卷 1120-1125页

作者： Shailja Tibrewal Nishtha Singh Marazul Islam Bhuiyan suma ganesh Pediatric Ophthalmology and Strabismology Services Dr.Shroff's Charity Eye Hospital Chittagong Eye Infirmary & Training Complex Pahartali

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 ***： 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.

关键词： residual exotropia intermittent exotropia strabismus exotropia rectus muscle

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Cycloplegic Refraction in Children: A Complete Audit Cycle

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Open Journal of Ophthalmology 2015年第1期5卷 41-45页

作者： suma ganesh Priyanka Arora Sumita Sethi Chandra Gurung Department of Pediatric Ophthalmology and Strabismus Dr Shroff’s Charity Eye Hospital New Delhi India Department of Ophthalmology Dayanand Medical College and Hospital Ludhiana India Department of Ophthalmology BPS Government Medical College for Women Sonepat India Department of Ophthalmology NNJS Banke Fateh Bal Eye Hospital Nepalganj Nepal

Purpose: Use of appropriate cycloplegic agent is an essential area of management in children with strabismus and refractive error. This study was designed to audit our own department’s understanding and practice with respect to cycloplegia. Methods: Children in age group of 0 - 12 years with refractive errors and strabismus were evaluated with respect to four parameters: adherence to cycloplegic refraction (group-I), choice of cycloplegic agent (group-II), dosage of cycloplegia (group-III) and duration of cycloplegia (group-IV). Following the initial audit, the hospital audit committee evaluated the results;thereafter concerned staff was educated and aidememoires of the dilatation protocol were introduced;a second audit cycle was carried out after 3 months. Results: First and second audit cycle included 334 children (mean age 6.2 ± 2.2 years) and 436 children (mean age 7.25 ± 2.9 years) respectively. A statistically significant improvement was found in all four parameters in the second audit cycle: adherence to dilation protocol (82.3% in first cycle to 94.3% in second cycle;p = 0.001), choice of cycloplegic agent (77% in the first cycle to 94.8% in the second cycle;p = 0.001), dosage of cycloplegic agent (84% in the first cycle to 96.3% in the second cycle;p = 0.001) and duration of cycloplegic agents (65% in the first cycle to 97.5% in the second cycle;p = 0.001 for CTC and 71.8% in the first cycle to 98% in the second cycle;p = 0.001 for Tropicamide). Conclusions: A complete audit cycle demonstrated a statistically significant improvement in all four parameters related to cycloplegic refraction in children. Regular auditing coupled with targeted interventions aimed to maintain the “best practice guidelines” for determination of refractive errors in children could prove effective in improving standards of clinical practice.

关键词： Cycloplegic Refraction Audit Children

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