Klin Monbl Augenheilkd 2020; 237(04): 506-509
DOI: 10.1055/a-1097-5653
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Strabismus Surgery of Consecutive Exotropia

Strabismuschirurgie der konsekutiven Exotropie
Lucas Janeschitz-Kriegl
1   Ophthalmology, Universitätsspital Basel Augenklinik, Basel, Switzerland
,
Francoise Roulez
1   Ophthalmology, Universitätsspital Basel Augenklinik, Basel, Switzerland
,
Monika Marina Wipf
2   Kantonsspital Baselland, Liestal, Switzerland
,
Anja Palmowski-Wolfe
1   Ophthalmology, Universitätsspital Basel Augenklinik, Basel, Switzerland
› Author Affiliations
Further Information

Publication History

received 26 September 2019

accepted 13 December 2019

Publication Date:
24 April 2020 (online)

Abstract

Purpose The purpose of this study was to determine the surgical outcome, dose-effect (DE), and degree of binocularity in patients undergoing surgery for consecutive exotropia following initial surgery of esotropia.

Patients/Methods Twenty-one patients were identified. We analyzed the mean angle of deviation pre- and postoperatively as measured with the alternate prism cover test, DE, and binocularity.

Results All patients had had previous strabismus surgery. The surgery for consecutive exotropia had been performed at a mean age of 35.92 ± 18.26 years. In 19 of these patients, surgery of consecutive exotropia involved at least one previously operated extraocular muscle, and the mean interval to the previous surgery was 25.67 ± 16.14 years. The mean angle of deviation (DE) at distance and in the primary position was − 33.43 ± 12.75 prism diopters (PD) preoperatively, + 0.76 ± 7.91 PD 1 week after surgery, and − 7.24 ± 12.14 PD 3 months after surgery. The mean DE was 3.58 ± 1.53 mm/PD at 1 week and 2.70 ± 1.78 mm/PD at 3 months post-surgery. Postoperatively, 62% patients had a binocularity of at least Bagolini positive, 33% had either a positive TNO or Titmus Test, and 24% were Lang I positive (550″).

Conclusion Performing strabismus surgery with consecutive exotropia results in restoration of some binocularity in a large number of patients, even in adults, and should be considered as a possibility. The dose-effect is comparable to conventional surgery of exotropia.

Zusammenfassung

Hintergrund Das Ziel dieser Studie war es, die operativen Ergebnisse, den Dosiseffekt sowie den Grad an erreichter Binokularität bei Patienten nach Operation einer konsekutiven Exotropie zu untersuchen.

Patienten und Methoden 21 Patienten wurden in die Studie eingeschlossen. Wir analysierten den prä- und postoperativen Schielwinkel, gemessen mit dem alternierenden Prismen-Cover-Test, den chirurgischen Dosiseffekt (DE) sowie die Stereofunktion.

Ergebnisse Alle Patienten waren aufgrund einer Esotropie im Kindesalter bereits operiert. Die Operation der konsekutiven Exotropie wurde im Mittel in einem Alter von 35,92 ± 18,26 Jahren durchgeführt. Bei 19 Patienten wurde an mindestens einem bereits voroperierten Muskel operiert. Das mittlere Intervall zur letzten Operation lag bei 25,67 ± 16,14 Prismendioptrien (PD). Der mittlere Schielwinkel lag bei − 33,43 ± 12,75 PD präoperativ, + 0,76 ± 7,91 PD 1 Woche postoperativ und − 7,24 ± 12,14 PD nach 3 Monaten. Der mittlere Dosiseffekt lag bei 3,58 ± 1,53 mm/PD 1 Woche postoperativ und bei 2,70 ± 1,78 mm/PD nach 3 Monaten. Postoperativ waren 62% zumindest Bagolini-positiv, 33% der Patienten waren entweder TNO- oder Titmus- und sogar 24% Lang-I-positiv (550″).

Schlussfolgerung Die Strabismuschirurgie der konsekutiven Exotropie erreicht in einer Vielzahl an Patienten ein gewisses Maß an Binokularität auch im Erwachsenenalter und sollte daher in Erwägung gezogen werden. Der Dosiseffekt ist vergleichbar mit der Chirurgie anderer Exotropieformen.

 
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