OBJECTIVETo investigate the time and postoperative binocular vision of strabismus surgery for children with intermittent exotropia (X(T)).

METHODSA retrospective investigation was conducted in 80 child patients with intermittent exotropia. Pre- and postoperative angles of deviation fixating at near (33 cm) and distant targets (6 m) were measured with the prolonged alternate cover testing. The binocular function was assessed with synoptophore. Twenty-one patients took the postoperative synoptophore exercise.

RESULTS(1) A week after surgery, 96.2% of the 80 patients had binocular normotopia, while a year after surgery, 91.3% of the 80 patients had binocular normotopia; (2) Preoperatively, 58 patients had near stereoacuity, while postoperatively, 72 patients achieved near stereoacuity (P<0.05); (3) Preoperatively, 64 patients had Grade I for the synoptophore evaluation and postoperatively, 76 patients achieved Grade I. Meanwhile, 55 patients had Grade II preoperatively and 72 achieved Grade II postoperatively. For Grade III, there were 49 patients preoperatively and 64 patients postoperatively (P<0.05); (4) Patients of 5-8 years old had a significantly better recovery rate of binocular vision than those of 9-18 years old (P<0.05); (5) Patients taking postoperative synoptophore exercise had a better binocular vision than those taking no exercise (P<0.05).

CONCLUSIONS(1) Strabismus surgery can help to preserve or restore the binocular vision for intermittent exotropia; (2) Receiving the surgery at young ages may develop better postoperative binocular vision; (3) The postoperative synoptophore exercise can help to restore the binocular vision.

Adolescent ; Child ; Child, Preschool ; Exotropia ; physiopathology ; surgery ; therapy ; Female ; Humans ; Male ; Retrospective Studies ; Vision, Binocular

PURPOSE: To report the effectiveness of home-based pencil push-ups (HBPP) therapy for patients with symptomatic convergence insufficiency. METHODS: Data was collected prospectively on 16 patients who were diagnosed with convergence insufficiency beginning in January 2009. The study group was composed of ten male and six female patients. The duration of symptoms, refractive error, distant and near deviation angles, and near point of convergence (NPC) prior to and after 12 weeks of HBPP therapy were measured in all patients. RESULTS: The mean age of the patients was 19.3 years. The mean deviation angle of exophoria was 3 prism diopters (PD) at distant and 11.2 PD at near. The mean value of NPC prior to HBPP therapy was 36.3 cm; however, the near point of accommodation was within the normal range. After 12 weeks of HBPP therapy, the mean deviation angle of exophoria decreased to orthophoric at distant and 4 PD at near. The mean value of NPC decreased to 14.4 cm. CONCLUSIONS: Twelve weeks of HBPP therapy appears to be an easy, cost-free and effective therapy for patients with symptomatic convergence insufficiency.
Accommodation, Ocular ; Adolescent ; Adult ; Child ; *Convergence, Ocular ; Exotropia/*physiopathology/*therapy ; Female ; Humans ; Male ; Prospective Studies ; *Self Care ; Treatment Outcome ; Young Adult

PURPOSE: To evaluate the effect of acrylic refractive prism and Fresnel membrane prism on stereoacuity in intermittent exotropia. MATERIALS AND METHODS: Stereoacuities of fifty-two patients (mean age, 12.4 years; range 6 to 45 years) with intermittent exotropia were measured using the Titmus and TNO stereotests, while they wore prisms of varying power on nonfixating eye or evenly on each eye. RESULTS: Stereoacuities were significantly reduced with increasing prism power for both prisms, ranging from 8 to 25 prism dipotres. The effects on stereoacuity in single acrylic prism and single Fresnel prism were similar, whereas spilt Fresnel prisms reduced stereoacuity more than spilt acrylic prisms. Spilt prisms were found to have much less effect on stereoacuity than single prisms for both acrylic and Fresnel prisms. CONCLUSION: The use of acrylic refractive prism shared evenly on each eye would be optimal method to minimize the reduction of stereoacuity during the prismatic therapy for intermittent exotropia.
Adolescent ; Adult ; Child ; Depth Perception/*physiology ; Exotropia/physiopathology/*therapy ; *Eyeglasses ; Female ; Humans ; Male ; Refraction, Ocular/physiology ; Visual Acuity/*physiology ; Young Adult

An 11-year-old female presenting diplopia only at distance was found to have comitant esotropia of 20 prism diopters (PD) at distance and normal alignment at nearer proximity. Other ocular movement, including abduction, was normal and a thorough neurologic examination was also normal. The deviation angle of esotropia was increased to 35 PD in 6 months, and a brain magnetic resonance imaging with venogram at that time demonstrated no intracranial lesion. A lumbar puncture showed increased opening pressure but the cerebrospinal fluid composition was normal. The patient was diagnosed as having idiopathic intracranial hypertension and treated with oral acetazolamide. Three months after treatment, the deviation angle decreased to 10 PD. This is a case report of divergence insufficiency in pediatric idiopathic intracranial hypertension, with an increasing deviation angle of esotropia. Although sixth cranial nerve palsy is a common neurologic manifestation in intracranial hypertension, clinicians should be aware of the possibility of divergence insufficiency. Also, ophthalmoparesis may not be apparent and typical at first presentation, as seen in this case, and therefore ophthalmologists should be aware of this fact, while conducting careful and proper evaluation, follow-up, and intervention.
Acetazolamide/administration & dosage ; Administration, Oral ; Child ; Diagnosis, Differential ; Diuretics/administration & dosage ; Esotropia/diagnosis/*etiology/physiopathology ; Exotropia/diagnosis/*etiology/physiopathology ; Eye Movements ; Female ; Follow-Up Studies ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Pseudotumor Cerebri/*complications/diagnosis/drug therapy ; Spinal Puncture/methods ; Vision, Binocular ; Visual Acuity