We analyzed preoperative clinical characteristics, incidence of amblyopia, surgical results according to the type, resolution of preoperative symptoms and postoperative complications in 62 patients with intermittent exotropia, who were more than 15 years of age. The most frequent preoperative annoying symptom was eye strain from fatigue(40%), and the next one was cosmesis(23%). But, diplopia(14%) was relatively infrequent presenting complaint. Among 62 patients, 45 (72%) patients had equal vision, and 11 patients (18%) had amblyopia with two line difference between two eyes. The overall surgical success rate were seventy-seven percent. The 3 patients with postoperative esodeviation more than 5 prism diopters(PD) showed persistent uncrossed diplopia. The 4 patients with undercorrection more than 15 PD did not improve symptomatically. All patients with` postoperative exodeviation less than 15 PD had improvement or resolution of the symptoms. Our results suggest that overcorrection often resulted in unexpected diplopia in adults with intermittent exotropia. Therefore, it may be desirable to make undercorrection within 15 PD or orthotropic state in the patients more than 15 years of age.
Adult ; Amblyopia ; Diplopia ; Esotropia ; Exotropia* ; Humans ; Incidence ; Postoperative Complications

OBJECTIVE: To investigate the characteristics of hypermetropic children whose visual acuity (VA) is declined or accompanied by esotropia. METHODS: One hundred and ninety children were given optometry, strabismus degree and binocular vision measurement. RESULTS: Declined VA appeared in 170 children, while esotropia occurred in 173. Sixty-one got binocular single vision, 17 had fusion function, and 11 had stereoaculty. Spherical equivalent had a linear relationship with VA (P < 0.01), but not with the strabismus degree (P > 0.05). The influence factors of binocular vision were age of discovery, VA and the strabismus degree, while the stereoaculty was influenced by the strabismus degree, spherical equivalent and VA. CONCLUSION Low VA and strabismus are the most common complaint in children. Ametropia and strabismus do great harm to juvenile binocular vision, and stereoaculty is damaged seriously. We suggest an early examination of visual function in children.
Adolescent ; Causality ; Child ; Esotropia ; complications ; Female ; Humans ; Hyperopia ; complications ; Male ; Vision, Binocular ; Visual Acuity

Intermittent Exotropia has been treated by various surgical methods such as bilateral medial rectus resection, lateral rectus recession and medial rectus resection of deviating eye, and bilateral lateral rectus recession. However, the outcomes of such operations are unsatisfactory because of high incidence of postoperative undercorrection and overcorrection. Authors have performed a surgical method which is the medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye in 68 patients. Authors considered the outcome successful if patients achieve deviation between 10 PD of exophoria and 5 PD of esophoria, good stereopsis, no suppression and no manifest deviation. The success rate was 83.8% (57/68) and there was no overcorrection over 6 months follow-up. As postoperative complications, 5 cases of temporary turning of face and 3 cases of asymmetric palpebral fissure were seen. Therefore, these results suggest that medial rectus resection of dominant eye and lateral rectus recession of non-dominant eye in intermittent exotropia may be an alternative surgical method for intermittent exotropia. However, further studies are necessary to determine the exact surgical amounts and mechanism of this surgical method.
Depth Perception ; Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Incidence ; Postoperative Complications

PURPOSE: To investigate and compare the clinical courses and surgical success rates of secondary operations in recurrent exotropia according to the type of first operation for correction of exotropia. METHODS: A retrospective chart review was performed for all patients with recurrent exotropia of the basic or pseudodivergence excess types. In group A (36 patients), bilateral lateral rectus (LR) recession was performed as the first operation and uni- or bilateral medial rectus (MR) resection was performed as the second operation. In group B (19 patients), unilateral LR recession-MR resection (R&R) was performed as the first operation and LR recession or R&R in contralateral eye as the second operation. RESULTS: There were no significant differences between the 2 groups when considering age at each operation, frequency of the amblyopia, prescription of prism, time interval for recurrence and reoperation and the final and cumulative success rates. No postoperative complications were observed in either group. The mean number of used muscles for the first and second operation was 3.9 +/- 0.4 in group A, and 3.4 +/- 0.5 in group B (p = 0.001). Mean time interval for occurrence of postoperative orthophoria was 3.7 +/- 6.2 months in group A and 6.5 +/- 16.2 in group B (p = 0.047). In group B, the incidence of esodeviation tended to increase after postoperative 1 month. CONCLUSIONS: The final success rates of reoperation between the 2 types of the first operation in recurrent exotropia were similar. Mean time between postoperative overcorrection of orthophoria was shorter in the group with bilateral LR recession followed by secondary MR resection than in the other group. Unilateral R&R followed by LR recession or R&R in contralateral eye may be more helpful to decrease the number of used muscles than in the bilateral LR recession followed by secondary MR resection.
Amblyopia ; Esotropia ; Exotropia* ; Humans ; Incidence ; Muscles ; Postoperative Complications ; Prescriptions ; Recurrence ; Reoperation* ; Retrospective Studies

PURPOSE: To investigate and compare the clinical courses and surgical success rates of secondary operations in recurrent exotropia according to the type of first operation for correction of exotropia. METHODS: A retrospective chart review was performed for all patients with recurrent exotropia of the basic or pseudodivergence excess types. In group A (36 patients), bilateral lateral rectus (LR) recession was performed as the first operation and uni- or bilateral medial rectus (MR) resection was performed as the second operation. In group B (19 patients), unilateral LR recession-MR resection (R&R) was performed as the first operation and LR recession or R&R in contralateral eye as the second operation. RESULTS: There were no significant differences between the 2 groups when considering age at each operation, frequency of the amblyopia, prescription of prism, time interval for recurrence and reoperation and the final and cumulative success rates. No postoperative complications were observed in either group. The mean number of used muscles for the first and second operation was 3.9 +/- 0.4 in group A, and 3.4 +/- 0.5 in group B (p = 0.001). Mean time interval for occurrence of postoperative orthophoria was 3.7 +/- 6.2 months in group A and 6.5 +/- 16.2 in group B (p = 0.047). In group B, the incidence of esodeviation tended to increase after postoperative 1 month. CONCLUSIONS: The final success rates of reoperation between the 2 types of the first operation in recurrent exotropia were similar. Mean time between postoperative overcorrection of orthophoria was shorter in the group with bilateral LR recession followed by secondary MR resection than in the other group. Unilateral R&R followed by LR recession or R&R in contralateral eye may be more helpful to decrease the number of used muscles than in the bilateral LR recession followed by secondary MR resection.
Amblyopia ; Esotropia ; Exotropia* ; Humans ; Incidence ; Muscles ; Postoperative Complications ; Prescriptions ; Recurrence ; Reoperation* ; Retrospective Studies

PURPOSE: To describe the clinical features of Duane's retraction syndrome (DRS) in Korean patients. METHODS: We retrospectively analyzed the 78 DRS cases that presented to our department between 1995 and 2004. The clinical features investigated included sex distribution, laterality, type of presentation, deviation in primary position, anomalous vertical movements, face turn, amblyopia and anisometropia. RESULTS: There were 38 (48.7%) affected males and 40 (51.3%) females. Left eye predominance (83.3%) was observed, as was type I presentation (85.9%). Orthotropia was found to be the most common primary position in 46 cases (59.0%). Face turn in unilateral DRS was noted in 13 patients (17.1%). There were 6 cases (7.7%) with anisometropia and 4 (5.1%) with amblyopia. CONCLUSIONS: The clinical manifestations of DRS in our study were different from those of equivalent Caucasian studies yet similar to those previously reported for Asian groups. Racial and regional differences were noted, for which further research is needed to elaborate the reasons and mechanisms.
Adolescent ; Adult ; *Asian Continental Ancestry Group ; Child ; Child, Preschool ; Duane Retraction Syndrome/*complications/ethnology/*physiopathology ; Esotropia/*complications ; Exotropia/*complications ; Female ; Humans ; Male ; Retrospective Studies

PURPOSE: The purpose of this study was to investigate the clinical course of esodeviation after exotropia surgery in older patients (older than 15 years) and to compare it with that in younger patients (15 years or younger). METHODS: The medical records of all surgeries for exodeviation from December 2004 to February 2007 were reviewed and 82 patients were found with consecutive esodeviation. The patients were divided into two groups according to their age: Group A (patients older than 15 years) and Group B (patients age 15 or younger). The clinical course of esodeviation in Group A was compared to that in Group B by means of survival analysis. RESULTS: The median survival times of the esodeviation were 2.0+/-0.1 months in Group A and 1.0+/-0.1 months in Group B (p=0.40). The prevalence of consecutive esotropia at six months was 0% in Group A and 6.1% in Group B (p=0.32). The myopic refractive error, worse sensory condition, and a larger preoperative exodeviation in Group A did not affect the clinical course of the two groups differently. CONCLUSIONS: The postoperative esodeviation of patients older than 15 years after exotropia surgery tended to persist longer during the early postoperative period than that of patients 15 years or younger, however, the difference did not persist at postoperative six months.
Adult ; Age Factors ; Child ; Esotropia/*etiology/physiopathology ; Exotropia/*surgery ; Female ; Humans ; Kaplan-Meiers Estimate ; Male ; Oculomotor Muscles/*surgery ; *Postoperative Complications ; Vision, Binocular/physiology ; Visual Acuity/physiology

We report a case of acute comitant esotropia in a child with a cerebellar tumor. A 3-year-old boy was referred for management of a 9 month history of acute acquired comitant esotropia. On first presentation, the patient's angle of esodeviation was 50 prism-diopters (PD) at distance and near fixation without any lateral incomitance. The cycloplegic refraction revealed +0.75 diopters in both eyes. Very mild bilateral papilledema was found on the fundus examination, but the neurological examination did not reveal any other pathological findings. Brain MRI showed a 5 cm mass located in the midline of the cerebellum as well as hydrocephalus. The mass was completely excised and histological examination confirmed the diagnosis of pilocytic astrocytoma. Despite neurosurgery, the patient's strabismus remained unresolved. One year after neurosurgery, both medial rectus muscles were surgically recessed by 6 mm, resulting in esotropia of 8PD at distant and near fixation without restoration of bifoveal fusion at follow-up 2 years after the eye muscle surgery. Therefore, acute onset comitant esotropia in a child can be the first sign of a cerebellar tumor, even without any other neurological signs and symptoms.
Acute Disease ; Astrocytoma/*complications/surgery ; Brain/pathology ; Cerebellar Neoplasms/*complications/diagnosis/surgery ; Child, Preschool ; Esotropia/*etiology/pathology/physiopathology/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Neurosurgical Procedures ; Oculomotor Muscles/surgery ; Refraction, Ocular ; Time Factors

A 4-year-old boy visited the hospital with exotropia after brain hemorrhage caused by trauma. He had undergone decompressive craniectomy and cranioplasty 18 months prior to presentation at our hospital. An alternate prism cover test showed more than 50 prism diopters (PD) of left exotropia when he was fixing with the right eye and 30 PD of right exotropia when he was fixing with the left eye at near and far distance. On the Hirschberg test, 60 PD of left exotropia was noted in the primary position. Brain computerized tomography imaging performed 18 months prior showed hypodense changes in the right middle cerebral artery and anterior cerebral artery territories. Subfalcian herniation was also noted secondary to swelling of the right hemisphere. The patient underwent a left lateral rectus muscle recession of 7.0 mm and a left medial rectus muscle resection of 3.5 mm. Three weeks after the surgery, the Hirschberg test showed orthotropia. On alternate prism cover testing, 8 PD of left exotropia and 8 PD of right esotropia were noted at distance. We report a patient who developed dissociated horizontal deviation after right subfalcian subdural hemorrhage caused by trauma.
Brain Injuries/*complications ; Child, Preschool ; Decompressive Craniectomy/*adverse effects ; Esotropia/*etiology/surgery ; Exotropia/*etiology/surgery ; Hematoma, Subdural/etiology/radiography/*surgery ; Humans ; Male ; Oculomotor Muscles/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Unilateral or bilateral lateral rectus resection1-5 is commonly performed for the correction of residual esotropia, but few results have been reported. Twenty-eight patients with residual esotropia underwent bilateral lateral rectus (BLR) resection. Six months after operation (n = 25), there were 17 (68%) successful cases, 7 (28%) cases of undercorrection, and 1 (4%) case of overcorrection. The success rate at the 24th postoperative month (n = 11) was 72.7%. The success rate for cases of infantile esotropia (n = 18) was higher than that for acquired esotropia (n = 7) at the 6th postoperative month (p = 0.156). The results were not significantly affected by the presence of other deviations (p = 0.387), the performance of other surgery (p = 0.393), the presence of amblyopia (p = 1.00), or the amount of residual esotropia (p = 0.604). Performance of BLR resection in patients with residual esotropia after bilateral medial rectus (BMR) recession is considered appropriate due to its high success rate and provision of a stable alignment during two-year follow up.
Child ; Child, Preschool ; Comparative Study ; Esotropia/*surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Oculomotor Muscles/*surgery ; Ophthalmologic Surgical Procedures/methods ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Treatment Outcome ; Visual Acuity