Background or purpose: Intermittent exotropia is the most common cause of divergent deviation. Pattern strabismus may coexist with horizontal deviations in up 35% of cases. Managing pattern strabismus concomitantly with the correction of horizontal strabismus poses a challenge due to imbalances in force vectors. This study aims to evaluate the effects of planning an intermittent exotropia surgery considering the presence of pattern strabismus and its surgical resolution. Methods: Observational retrospective study of patients with intermittent exotropia who underwent surgical correction at center between 2017 and 2022. Patients were categorized by the presence of pattern strabismus and furthermore by surgical technique for the correction of said incomitance (weakening of inferior oblique muscles or vertical transposition of lateral rectus muscles). Outcomes of post-surgical horizontal deviation and presence of postoperative pattern strabismus were statistical analyzed between groups using SPSS software v28.0. A p-value <0,05 was considered significant. Results: A total of 169 patients had surgical correction for intermittent exotropia. Pattern strabismus was observed in 35,5% of patients, primarily V-pattern (88,3%). Most were male (58, 35%) with mean age of 15,13±16,38 years. 41,7% patients with pattern strabismus underwent correction of the incomitance. All techniques showed significant reduction of horizontal near (p<0,001) and distance (p<0,001) deviation. However, incomitance correction favored strongly not only the collapsing of pattern strabismus (p=0,027) but also achieved better results in postoperative distance (p=0,002) and near (p=0,031) horizontal deviation. The two techniques for resolution of pattern strabismus showed comparable results in postoperative horizontal near deviation values and resolution of pattern strabismus, favoring vertical transposition in horizontal distance deviation values (p=0,015). Conclusions: The presence of pattern deviations should be actively persecuted in pre-operatively appointments to plan the surgery appropriately, as benefits in correcting the vertical incomitance are supported by this study findings. Both vertical transposition of lateral rectus muscles and weakening of inferior oblique muscles are effective techniques to correct vertical incomitances.
| Published in | International Journal of Science, Technology and Society (Volume 12, Issue 4) |
| DOI | 10.11648/j.ijsts.20241204.12 |
| Page(s) | 133-139 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Strabismus, Intermittent Exotropia, Pattern Strabismus, Surgical Correction
| [1] | Pang Y, Gnanaraj L, Gayleard J, Han G, Hatt SR. Interventions for intermittent exotropia. Cochrane Database Syst Rev. 2021; 2021(9). |
| [2] | Lavrich JB. Intermittent exotropia: Continued controversies and current management. Curr Opin Ophthalmol. 2015; 26(5): 375-81. |
| [3] | Elkamshoushy A, Awadein A, Arfeen SA. Pattern strabismus in consecutive esodeviation after bilateral lateral rectus muscle recession for intermittent exotropia. J AAPOS. 2020; 24(6): 342.e1-342.e7. |
| [4] | Dickmann A, Petroni S, Salerni A, Parrilla R, Savino G, Battendieri R, et al. Effect of vertical transposition of the medial rectus muscle on primary position alignment in infantile esotropia with A- or V-pattern strabismus. J AAPOS. 2011; 15(1): 14-6. |
| [5] | Galindez Iglesisas F, Navarro B, Zurdo M. Consideraciones sobre la cirugía de los síndromes alfabéticos. Acta Estrabológica. 1978; 6: 129-56. |
| [6] | Roth A, Bumbacher M, Rossillion B. Associated Incomitance in Concomitant Strabismus. Diagnosis and Surgical treatment. Klin Monbl Augenheilkd. 2015; 232(4): 459-66. |
| [7] | Deng H, Irsch K, Gutmark R, Phamonvaechavan P, Foo FY, Anwar DS, et al. Fusion can mask the relationships between fundus torsion, oblique muscle overaction/underaction, and A- and V-pattern strabismus. J AAPOS. 2013; 17(2): 177-83. |
| [8] | Wang X, Zhang W, Liu L. Effect of Isolated Oblique Muscle Weakening Procedures on Horizontal Deviation in A- and V-pattern Exotropia. Curr Eye Res. 2020; 45(2): 211-4. |
| [9] | Kushner BJ. Torsion and Pattern Strabismus. JAMA Ophthalmol. 2013; 131(2): 190. |
| [10] | Rossel M, Bergholz R, Salchow DJ. Effect of unilateral vertical transposition of the horizontal rectus muscles on vertical strabismus. Eur J Ophthalmol. 2021; 31(3): 1333-7. |
| [11] | Kekunnaya R, Mendonca T, Sachdeva V. Pattern strabismus and torsion needs special surgical attention. Eye. 2015; 29(2): 184-90. |
| [12] |
Metz HS, Schwartz L. The Treatment of A and V Patterns by Monocular Surgery. Arch Ophthalmol. 1977 Feb 1; 95(2): 251-3.
http://archopht.jamanetwork.com/article.aspx?articleid=632089 |
| [13] | Zhu B, Wang X, Fu L, Yan J. Pattern Strabismus in a Tertiary Hospital in Southern China: A Retrospective Review. Med. 2022; 58(8). |
| [14] | Awadein A. Lateral rectus recession with/without transposition in V-pattern exotropia without inferior oblique overaction. Can J Ophthalmol. 2013; 48(6): 500-5. |
| [15] | Scott WE, Drummond GT, Keech R V. Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus. Aust N Z J Ophthalmol. 1989; 17(3): 281-8. |
| [16] | Anand K, Bharadwaj A, Dhiman S, Goel Y, Rastogi A, Agarwal R, et al. Comparison of conventional and Hang-back methods of inferior oblique recession in V-pattern strabismus with inferior oblique overaction. Int J Ophthalmol. 2020; 13(6): 985-90. |
| [17] | Rajavi Z, Nikanfar K, Sharahi Dizabadi M, Abdi S, Kheiri B, Sheibani K, et al. Fundus torsion following inferior oblique muscle weakening. J Am Assoc Pediatr Ophthalmol Strabismus. 2024 Feb; 28(1): 103827. |
APA Style
Correia, M., Ferreira, A. M., Magalhães, A. A. (2024). Surgical Planning for Pattern Strabismus in Patients with Intermittent Exotropia: Evaluating Techniques and Outcomes. International Journal of Science, Technology and Society, 12(4), 133-139. https://doi.org/10.11648/j.ijsts.20241204.12
ACS Style
Correia, M.; Ferreira, A. M.; Magalhães, A. A. Surgical Planning for Pattern Strabismus in Patients with Intermittent Exotropia: Evaluating Techniques and Outcomes. Int. J. Sci. Technol. Soc. 2024, 12(4), 133-139. doi: 10.11648/j.ijsts.20241204.12
AMA Style
Correia M, Ferreira AM, Magalhães AA. Surgical Planning for Pattern Strabismus in Patients with Intermittent Exotropia: Evaluating Techniques and Outcomes. Int J Sci Technol Soc. 2024;12(4):133-139. doi: 10.11648/j.ijsts.20241204.12
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Download@article{10.11648/j.ijsts.20241204.12,
author = {Marta Correia and Ana Margarida Ferreira and António Augusto Magalhães},
title = {Surgical Planning for Pattern Strabismus in Patients with Intermittent Exotropia: Evaluating Techniques and Outcomes
},
journal = {International Journal of Science, Technology and Society},
volume = {12},
number = {4},
pages = {133-139},
doi = {10.11648/j.ijsts.20241204.12},
url = {https://doi.org/10.11648/j.ijsts.20241204.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijsts.20241204.12},
abstract = {Background or purpose: Intermittent exotropia is the most common cause of divergent deviation. Pattern strabismus may coexist with horizontal deviations in up 35% of cases. Managing pattern strabismus concomitantly with the correction of horizontal strabismus poses a challenge due to imbalances in force vectors. This study aims to evaluate the effects of planning an intermittent exotropia surgery considering the presence of pattern strabismus and its surgical resolution. Methods: Observational retrospective study of patients with intermittent exotropia who underwent surgical correction at center between 2017 and 2022. Patients were categorized by the presence of pattern strabismus and furthermore by surgical technique for the correction of said incomitance (weakening of inferior oblique muscles or vertical transposition of lateral rectus muscles). Outcomes of post-surgical horizontal deviation and presence of postoperative pattern strabismus were statistical analyzed between groups using SPSS software v28.0. A p-value Results: A total of 169 patients had surgical correction for intermittent exotropia. Pattern strabismus was observed in 35,5% of patients, primarily V-pattern (88,3%). Most were male (58, 35%) with mean age of 15,13±16,38 years. 41,7% patients with pattern strabismus underwent correction of the incomitance. All techniques showed significant reduction of horizontal near (pConclusions: The presence of pattern deviations should be actively persecuted in pre-operatively appointments to plan the surgery appropriately, as benefits in correcting the vertical incomitance are supported by this study findings. Both vertical transposition of lateral rectus muscles and weakening of inferior oblique muscles are effective techniques to correct vertical incomitances.
},
year = {2024}
}
TY - JOUR T1 - Surgical Planning for Pattern Strabismus in Patients with Intermittent Exotropia: Evaluating Techniques and Outcomes AU - Marta Correia AU - Ana Margarida Ferreira AU - António Augusto Magalhães Y1 - 2024/08/06 PY - 2024 N1 - https://doi.org/10.11648/j.ijsts.20241204.12 DO - 10.11648/j.ijsts.20241204.12 T2 - International Journal of Science, Technology and Society JF - International Journal of Science, Technology and Society JO - International Journal of Science, Technology and Society SP - 133 EP - 139 PB - Science Publishing Group SN - 2330-7420 UR - https://doi.org/10.11648/j.ijsts.20241204.12 AB - Background or purpose: Intermittent exotropia is the most common cause of divergent deviation. Pattern strabismus may coexist with horizontal deviations in up 35% of cases. Managing pattern strabismus concomitantly with the correction of horizontal strabismus poses a challenge due to imbalances in force vectors. This study aims to evaluate the effects of planning an intermittent exotropia surgery considering the presence of pattern strabismus and its surgical resolution. Methods: Observational retrospective study of patients with intermittent exotropia who underwent surgical correction at center between 2017 and 2022. Patients were categorized by the presence of pattern strabismus and furthermore by surgical technique for the correction of said incomitance (weakening of inferior oblique muscles or vertical transposition of lateral rectus muscles). Outcomes of post-surgical horizontal deviation and presence of postoperative pattern strabismus were statistical analyzed between groups using SPSS software v28.0. A p-value Results: A total of 169 patients had surgical correction for intermittent exotropia. Pattern strabismus was observed in 35,5% of patients, primarily V-pattern (88,3%). Most were male (58, 35%) with mean age of 15,13±16,38 years. 41,7% patients with pattern strabismus underwent correction of the incomitance. All techniques showed significant reduction of horizontal near (pConclusions: The presence of pattern deviations should be actively persecuted in pre-operatively appointments to plan the surgery appropriately, as benefits in correcting the vertical incomitance are supported by this study findings. Both vertical transposition of lateral rectus muscles and weakening of inferior oblique muscles are effective techniques to correct vertical incomitances. VL - 12 IS - 4 ER -
Ophthalmology Department, Local Health Unit of Lisboa Ocidental, Lisbon, Portugal
Ophthalmology Department, Local Health Unit of São João, Oporto, Portugal
Ophthalmology Department, Local Health Unit of São João, Oporto, Portugal
