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Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

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International Journal of Ophthalmology(English edition) 2022年第10期15卷 1665-1670页

作者： Hala Kamal Mattout Sameh Mosaad Fouda Wael M El-Haig Department of Ophthalmology Faculty of MedicineZagazig UniversityZagazig 44519Egypt

AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre(PD)] were retrospectively reviewed. Two groups of patients were identified;Group Ⅰ(21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A(BTA) injection into the recessed muscles and group Ⅱ(30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group Ⅰ(47.6%) and 20 patients in group Ⅱ(66.7%) achieved esotropia/esophoria exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant(P=0.1) but there was a statistically significant higher rate of undercorrection in group Ⅰ(P=0.03). On the other hand, 3 patients in group Ⅰ(14.3%) and 5 patients in group Ⅱ(16.7%) had improved stereopsis;this difference in the sensory outcome was not statistically significant(P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate(P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilater

关键词： botulinum toxin intermittent exotropia large angle deviation augmented surgery

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Surgery at early versus late for intermittent exotropia:a Meta-analysis and systematic review

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International Journal of Ophthalmology(English edition) 2021年第4期14卷 582-588页

作者： Yi Dong Li Nan Yu—Yan Liu Tianjin Eye Hospital Tianjin Key Lab of Ophthalmology and Visual ScienceTianjin Eye InstituteClinical College of Ophthalmology Tianjin Medical UniversityTianjin 300020China

AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a ***:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Knowledge Infrastructure were searched prior to December 16,*** this broad database search,we performed some Meta-analysis including eleven independent studies,to further evaluate the outcome(s)when comparing early versus late surgery for *** boundaries between early and late surgery and the surgery methods were not inconsistent,so subgroup analyses were conducted by different boundaries of age at surgery and different surgical *** pooled odds ratios(ORs)and the 95%confidence interval(CI)were estimated according to the random-effects model for high heterogeneity between ***:Eleven retrospective studies were included in this *** significant difference between early and late surgery was observed for IXT patients(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final follow-up)=1.48,95%CI 0.94-2.31,P=0.09).However,sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not *** analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession(BLR)subgroup for the final follow-up(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=2.25,95%CI 1.36-3.74,P=0.00).CONCLUSION:Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.

关键词： Meta-analysis intermittent exotropia surgery timing

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Long-term postoperative outcomes of bilateral lateral rectus recession vs unilateral recession-resection for intermittent exotropia

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International Journal of Ophthalmology(English edition) 2014年第6期7卷 1043-1047页

作者： Xian Yang Teng-Teng Man Qiao-Xia Tian Gui-Qiu Zhao Qing-Lan Kong Yan Meng Yan Gao Mei-Zhen Ning Department of Ophthalmology Qingdao University Medical College Department of Ophthalmology the Affiliated Hospital of Medical College Qingdao University Department of Ophthalmology the Ninth People's Hospital of Qingdao

AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent ***: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria >5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria >10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 0.05) between ***, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P <0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P <0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y ***: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.

关键词： intermittent exotropia operation treatment effect

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Comparison of bilateral/unilateral lateral rectus recession and unilateral recession-resection for intermittent exotropia:a Meta-analysis

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International Journal of Ophthalmology(English edition) 2018年第12期11卷 1984-1993页

作者： De-Sheng Song Zhi-Jun Chen Jing Qian Department of Ophthalmology Children's Hospital of Nanjing Medical University

AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence ***: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [2 y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85(0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37(0.18, 0.74)] and a lower undercorrection [OR 3.50(1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T)(20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08(0.65, 1.79)] and undercorrection rate [OR 0.89(0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic typeIX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.

关键词： intermittent exotropia unilateral lateral rectus recession recess-resect moderate-angle exotropia

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Quality of life in adult intermittent exotropia and the risk factors

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International Journal of Ophthalmology(English edition) 2021年第3期14卷 442-447页

作者： Bo-Wen Zhao Jing Fu Jing-Hui Wang Hai-Xia Bai Pei-Pei Liu Ya-Nan Guo Rong-Han Zhang Han Su Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical UniversityBeijing Ophthalmology&Visual Sciences Key LaboratoryBeijing 100730China Eye Center Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310009Zhejiang ProvinceChina

AIM: To study the quality of life of adult patients with intermittent exotropia(IXT) in China and analyze the factors affecting the quality of life in IXT ***: Total y 109 cases of normal eye(control group), 77 cases of IXT(IXT group) and 115 cases of strabismus control group(except IXT) were collected. The quality of life of the patients was assessed by Chinese version of adult strabismus patient’s quality of life scale(CAS-20). The differences of general characteristics, visual function and quality of life were analyzed, and the effects of individual factors and visual function on quality of life of patients with IXT were ***: The IXT group had a high proportion of patients with family history, low proportion of patients with amblyopia compared with strabismus control group. The proportion with normal near and far stereopsis of IXT group were lower than that of normal control group. The best corrected visual acuity of IXT group was higher than that of strabismus control group, but lower than the control group. In addition, the median strabismus degree in IXT group was higher than that in other strabismus control group. The median psychosocial scores and median visual function scores of the IXT group was lower than that of the normal control group, but not different from strabismus control group. Occupation status, course of disease, far stereopsis and near stereopsis significantly affected the quality of life in IXT ***: Adult IXT patients in China have a certain proportion of family history and lower quality of life, The main factors affecting the quality of life of IXT patients is stereopsis, course of disease and occupation status.

关键词： intermittent exotropia quality of life scale binocular function

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Advances in surgery procedures for convergence insufficiency-type intermittent exotropia

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World Journal of Ophthalmology 2014年第3期4卷 71-74页

作者： Ya-Nan Luan Li-Hua Wang Department of Ophthalmology Shandong Provincial Hospital Affiliated to Shandong University

intermittent exotropia with convergence insufficiency is defined as a greater exodeviation measured at near than at distance of at least 10 prism diopters and it is harmful to binocular vision at earlier time. This paper mainly introduces three operation patterns including lateral rectus recession(s) with or without a slanting procedure, unilateral lateral rectus recession with medial rectus resection, and medial rectus resection(s) with or without a slanting procedure.

关键词： intermittent exotropia Convergence insufficiency Surgery procedures Merits and demerits Deficiency of of prior research

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Effect of visual perception training on binocular visual function reconstruction in patients after strabismus surgery

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国际眼科杂志:英文版 2023年第10期16卷 1657-1661页

作者： Yu Su Fei Wang Tao Wang Qin-Mei Wang School of Optometry and Ophthalmology Wenzhou Medical UniversityWenzhou 325027Zhejiang ProvinceChina Department of Ophthalmology the Second Hospital of Anhui Medical UniversityHefei 230601Anhui ProvinceChina Department of Ophthalmology Anhui Provincial Children’s HospitalHefei 230041Anhui ProvinceChina

AIM:To explore the effect of visual perception learning software training(VPT)on binocular visual function reconstruction in children with intermittent exotropia after strabismus ***:Ninety children with intermittent exotropia admitted to our hospital from June 2018 to December 2018 were included,and randomly divided into VPT and control *** in the control group received basic binocular vision training,while those in the VPT group received VPT after strabismus *** visual function,visual perception function,Newcastle Control Score(NCS),and ocular position retraction rate were compared at 3 and 12mo after the ***:At 3 and 12mo after the surgery,the proportion of simultaneous perception,binocular fusion version and binocular stereo vision in the VPT group was conspicuously higher than that in the control group(Pintermittent exotropia children after strabismus surgery and reduces the strabismus severity and ocular position retraction rate.

关键词： children intermittent exotropia visual perception training ocular position binocular visual function

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Cortical Deficits are Correlated with Impaired Stereopsis in Patients with Strabismus

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Neuroscience Bulletin 2023年第7期39卷 1039-1049页

作者： Sida Xi Yulian Zhou Jing Yao Xinpei Ye Peng Zhang Wen Wen Chen Zhao Department of Ophthalmology and Visual Science Eye and ENT HospitalShanghai Medical CollegeFudan UniversityShanghai 200031China State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science Institutes of Brain ScienceFudan UniversityShanghai 200031China Key Laboratory of Myopia Fudan UniversityMinistry of HealthShanghai 200031China Shanghai Key Laboratory of Visual Impairment and Restoration Fudan UniversityShanghai 200031China Department of Radiology Eye and ENT HospitalShanghai Medical CollegeFudan UniversityShanghai 200031China State Key Laboratory of Brain and Cognitive Science Institute of BiophysicsChinese Academy of SciencesBeijing 100101China

In this study,we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus *** enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery,along with 18 healthy *** magnetic resonance imaging data were collected when participants viewed three-dimensional *** with controls,preoperative patients showed hypoactivation in higher-level dorsal(visual and parietal)areas and ventral visual ***-and postoperative activation did not significantly differ in patients overall;patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal *** stereopsis and fusional control were correlated with preoperative hypoactivation,suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent *** correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of ***,additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.

关键词： Stereopsis Binocular disparity Functional magnetic resonance imaging Strabismus intermittent exotropia

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