We reviewed the relationship between primary inferior oblique overaction and the anatomical position of the inferior oblique muscle insertion. We measured the distance from the limbus to the lower portion of the lateral rectus muscle insertion and from the lower portion of the lateral rectus muscle insertion to the anterior portion of the inferior oblique muscle insertion. Of 79 eyes examined, there were exotropia and primary inferior oblique overaction in 23 eyes and exotropia only in 56 eyes. There was no statistically significant difference of the insertion site between the two groups (IOOA group and non-raOA group). It is ours impression that the anatomical position of the inferior oblique muscle insertion is not closely related to primary inferior oblique overaction, and a histopathologic change of the inferior oblique muscle is an important factor in primary inferior oblique overaction.
Exotropia

No abstract available.
Exotropia*

There have been several reports that classical unilateral lateral rectus recession of 7-8mm obtained the high rate of undercorrection in the surgical treatment of intermittent exotropia of 15-20PD, at 4 years of age or older. We evaluated surgical correction amount, success rate between unilateral lateral rectus recession of 7-8mm and 11-12mm, and amount of abduction limiations of 11-12mm recession. Mean surgical correction amount were 9.1+/-4.5PD in 7-8mm recession group, and 14.4+/-3.0PD in 11-12mm recession group.The difference of surgical correction amount between the two groups was statistically significant(p<0.05). The percentage of undercorrection over 8PD were 66.7% in 7-8mm group, none in 11-12mm recession group. Abduction limitation was minimal in 12mm recession group. In conclusion, 11-12mm unilateral lateral rectus recession had more decreased rate of undercorrection than 7-8mm unilateral lateral rectus recession group in the treatment of intermittent exotropia of 15-20PD, at 4 years of age or older.
Exotropia*

No abstract available.
Exotropia*

PURPOSE: This study was to evaluate the influence of monocular occlusion on the preoperative ocular alignment and the surgical outcome of basic intermittent exotropia. METHODS: We examined 42 patients with basic intermittent exotropia who were operated and followed for at least 6 months postoperatively from January 2001 to August 2002. In all patients, angle of misalignment measured while the patients fixate on an accommodative target at 6m and 33cm, and after 2 hours of monocular occlusion. The subjects were divided into two groups: Gruop 1-far angle of misalignment did not increase after 2 hours of monocular occlusion, Group 2-far angle of misalignment increased in 3PD or more after 2 hours of monocular occlusion. Group 2 underwent surgery for the increased deviation of far angle. RESULTS: Among 42 patients with basic intermittent exotropia, Group 1 included 27 (64.3%) patients and Group 2 15 (35.7%) patients. In Group 2, the mean ( +/- SD) increase in the angle of exotropia after 2 hours of monocular occlusion was 5.33 ( +/- 2.74)PD. The success rate of surgery was 77.8% (21/27 patients) in Group 1, 93.3% (14/15 patients) in Group 2 at 6 months after surgery and 70.4% (19/27 patients), 93.3% (14/15 patients) at the final visit. There was no statistically significant difference (p> 0.05). CONCLUSIONS: This study showed the significant influence of monocular occlusion on the ocular misalignment before surgery and surgical outcome in basic intermittent exotropia. Angle of misalignment measured after 2 hours or more of monocular occlusion seemed to be meaningful.
Exotropia* ; Humans

PURPOSE: To determine the correlation between the grade of inferior oblique overaction and the change of deviation angle according to gaze position. METHODS: We classified 90 patients into 4 groups according to the grade of inferior oblique overaction. Deviation angle was respectively measured in upward, primary and downward position at far and the difference between them was analyzed. And we assessed the frequency of V and Y pattern and the concordance of deviating eye between at primary position and at upgaze. RESULTS: Mean bilateral sum of the IOOA was +3.58 and average of deviation angle was 33.64 PD in upward position, 27.82 PD in primary position and 24.72 PD in downward position. Difference of deviation angle between upward and primary position was 5.82 PD (P<0.05) in that 3.10 PD between primary and downward position (p>0.05). The frequency of V pattern exotropia was 17.6% in group A, 17.1% in group B, 50% in group C and 85.7% in group D while the frequency of Y pattern among V pattern was 100%, 66.7%, 75% and 25% respectively. The chief deviating eye or IOOA predominant eye at primary position diverged during upgaze only in 67% of patients. CONCLUSIONS: The larger the inferior oblique overaction, the more V pattern exotropia was observed and deviation angle was increased at higher IOOA groups. Overall exotropia patients with IOOA shows rather Y shape than V shape. And chief deviating eye was not always deviating eye at upgaze.
Exotropia ; Humans

It is the purpose of this study to compare the postoperative results of surgery for 39 patients with exotropia under 25 prism diopters (PD). Two surgical methods were done; 8 to 9mm unilateral recission of the lateral rectus muscle in 17 patients (unilateral gruop) and 4 to 6mm bilateal recession in 20 patients (bilateral group). The preoperative deviations on the average were 20.8PD in unilateral and 22.6PD in bilateral grou, and postoperatie corrections on the average were 16.5PD in unilateral and 22.8PD in bilateral group. The 41.2% in unilateral droup and 59.1% in bilateral group were under +/-5PD in postoperative deviation. There were 12 cases (70.6%) in unilateral and 20 cases (90.9%) in bilateral group showing the amount of deviation less than 10PD of under or overcorrection. InBilateral group, higher success rate was observed, but there was no statistical difference (p=0.053) between the two groups. The limitation of abduction was observed in the 4 cases of unilateral group but there was no significant cosmetic problem. From our surgical results, the outcome of the bilateral recission for the lateral rectus muscle is better than that ofthe unilateral recession for the correction of exotropia under 25PD although there was no statistical difference.
Exotropia* ; Humans

Horizontal incomitancy is a difference of deviation angle between right and left gaze and monocular recession-resection operation may cause horizontal incomitancy. We reviewed 85 patients of intermittent exotropia without oblique dysfunction and vertical deviation who underwent monocular recession-resection operation. The preoperative horizontal in comitancy was 1.0 delta in average with a range of 0 delta to 5 delta. The postoperative horizontal incomitancy after 7 months (mean) was 4.8 delta in average with a range of 0 delta to 17 delta. The postoperative remained deviation and horizontal incomitancy were significanty smaller in the group of patients who had fusion with worth 4-dot test (p Exotropia ; Humans

In order to evaluate the incidence of lateral incomitance after monocular recession and resection and compare the amount of correction achieved by monocular recession and resection according to the gaze direction and distance in exodeviations, we measured the angle of deviation in primary, right, left, up, down and near gaze before and after monocular recession and resection. Lateral incomitance was developed in11.4%(9/79) after monocular recession and resection. The amount of correction of the deviation toward the side of operated eye was larger than that of the deviation in primary position(p=0.002), but the amount of correction of the deviation toward the side of non-operated eye, up, down and near gaze was all smaller than that of the deviation in primary position(all, p<0.01).
Exotropia* ; Incidence

We attempted to predict the success, undercorrection, overcorrection rate at postoperative 1 year by examining alignment at postoperative 1 day and find out the relationship between alignment of postoperative 1 day and 1year. Forty-six patients with intermittent exotropia underwent bilateral lateral rectus recession at Keimyung university, Dongsan medical center and fifty-seven patients underwent unilateral medial rectus resection and lateral rectus recession at Catholic university, St.Mary`s hospital. The alignment at postoperative 1 day was classified as the overcorrected with 11-20PD, the overcorrected with 1-10PD,the orthotropia, and the undercorrected with residual exotropia of 1-10PD. There was a statistically significant relationship between alignment at postoperative 1 day and 1 year in unilateral medial rectus resection and lateral rectus recession and bilateral lateral rectus recession (r=0.74, r=0.51, p<0.05). Those patients who were overcorrected 1-20PD had a significantly higher success rate than those undercorrected 1-10PD at postoperative 1 day (p<0.05). In the unilateral medial rectus resection and lateral rectus recession group,postoperative 1 day alignment of 1-10PD resulted in the highest success rate of 73.7%. In the bilateral lateral rectus recession group,postoperative 1 day alignment of 11-20PD showed the highest success rate of 76.9%. There were no significant differences in the success rate,undercorrection rate, and overcorrection rate between the two kinds of surgery at postoperative 1 year. As a result, the alignment at postoperative 1 day can be one of the predictive factors of future surgical outcome. The initial postoperative overcorrection of 11-20PD in bilateral lateral rectus recession and overcorrection of 1-10PD in unilateral medial rectus resection and lateral rectus recession can lead to good results.
Exotropia ; Humans