This case report presents a child with intermittent exotropia who was treated with tuina. The main clinical manifestation was right eye deviation, which was diagnosed as liver and kidney deficiency and spleen and stomach qi deficiency. The treatment principles focused on harmonizing qi and blood, dispersing wind and unblocking orifices, and tonifying the liver and kidney. Tuina was applied at the head, face, and neck regions, including "opening the heavenly gate", "pushing kan palace", "rubbing the forehead" and point stimulation of Jingming (BL1), Cuanzhu (BL2), Yuyao (EX-HN4), Sizhukong (TE23), Tongziliao (GB1), as well as massaging Taiyang (EX-HN5), Qiuhou (EX-HN7), Quanliao (SI18), Chengqi (ST1), Sibai (ST2), Muchuang (GB16), Chengguang (BL6), Yifeng (TE17), and Yiming (EX-HN14). Tuina was also applied at upper limbs, including massaging Binao (LI14), Quchi (LI11), and the lower limbs, including pressing and plucking along the liver meridian. The treatment was combined with eye exercises with a "" character pattern. The tuina was administered daily during the first week; every other day from the second to fourth weeks; every four days in the second month; and once weekly in the third month. After 3 months of treatment, the patient's eye position returned to normal. A follow-up after 3 months revealed no recurrence.
Child ; Humans ; Acupuncture Points ; Exotropia/drug therapy*

BACKGROUND AND OBJECTIVE

There is no strict by-the-book rule as to which approach is the best strabismus surgery for patients with sensory exotropia. More commonly, a monocular lateral rectus recession and a medial rectus resection (monocular R & R; MRR) is performed in the eye with a poorer prognosis. Rarely, for larger deviations, a third or fourth horizontal muscle in the better eye is added. This study aimed to determine the outcomes of strabismus surgery performed for sensory exotropia in a tertiary hospital in the Philippines.

The medical records of all patients with sensory exotropia who underwent strabismus surgical correction from January 2015 to December 2019 were retrospectively reviewed.

A total of 29 medical records satisfied the inclusion criteria. Mean age at diagnosis and at the time of surgery were 7.5 ± 11.6 (range: 1 to 68 years) and 12.4 ± 16.2 years (range: 1 to 68 years) years old, respectively, with a mean follow-up of 6.2 months (range: 3 to 24 months). After a mean follow-up of 6.2 months, the overall success (alignment in primary position is within 10 prism diopters of orthotropia) was relatively low, where 34% were successful, 65.5% developed recurrence, and none had overcorrections. Survival plots of both surgeries revealed a decline in success probability in achieving desired alignment six months after surgery.

We reported the surgical outcomes of 29 patients with sensory exotropia. The general trend realized was that the decline in success rates of good alignment was evident beginning six months post-operatively. The retrospective design serves as a limitation and hence, readers should treat results with caution.

OBJECTIVE: Intermittent exotropia (IXT) is the most common form of strabismus that warrants standardized management for better and predictable outcomes. Currently there are no preferred practice guidelines on the non-surgical management of IXT. Among the aforementioned methods, orthoptics is the most favored by optometrists and ophthalmologists based in China and Israel. However, consensus statements on the use of such modality are yet to be established. This study aimed to identify preferred non-surgical management strategies for intermittent exotropia (IXT) among members of the Philippine Society of Pediatric Ophthalmology and Strabismus (PSPOS). METHODS: The survey collected data on respondent and patient demographics, perceived causes of IXT, clinical course, and management preferences. Incomplete responses were excluded, and data were analyzed using frequency distribution and the Fisher test. RESULTS: Forty of 54 (74%) PSPOS members participated, predominantly from urban settings (34 respondents). Most IXT cases were children aged 4 to 11 years. The proportion of pediatric patients was not significantly influenced by respondents’ age (p=0.1628) or practice region (p=0.451). Twenty-one (52.5%) respondents cited fusion defects as the primary cause of IXT. While twenty-one noted an unpredictable course, 14 identified it as a progressive course. Overminus lenses were preferred for younger patients (1-4 years), with an increasing preference for orthoptics in older age groups (5 to>18 years). Pediatric ophthalmologists aged 30 to 40 years (p=0.005) and those with 1 to 5 years of experience (p=0.020) favored overminus lenses for 5-10-year-olds. Preference for overminus lenses was stronger outside the NCR (p=0.044). Furthermore, 90% of respondents said surgery shouldn’t be performed at diagnosis, and 42.5% of respondents were against it for younger ages. CONCLUSION The findings revealed a strong preference for overminus lenses among PSPOS members, with increasing use of orthoptics for older patients. Factors influencing management decisions included respondent age, practice region, and perceptions of IXT’s cause and course. Future randomized controlled trials are essential to evaluate non-surgical interventions and develop comprehensive treatment guidelines.
Human ; ophthalmology ; strabismus ; exotropia

Silver-Russell Syndrome (SRS) is a rare disorder associated with prenatal and postnatal growth retardation with associated characteristic facial and ocular features including strabismus. We report the outcome of strabismus surgery performed for exotropia in a 4-year-old patient with SRS. The patient presented with decreased visual acuity and constant exotropia of the right eye noted since 3 months of age. Systemic SRS characteristics consisted of relative macrocephaly, short stature, forehead prominence and stunted growth pattern. An X-pattern exotropia is consistent with bilateral tight lateral recti muscles with overelevation in adduction of the left eye was present. Patient underwent unilateral right lateral rectus recession and right medial rectus resection for a 50-prism diopter constant exotropia. Patient had a favorable outcome of within 8 prism diopters from orthotropia at 1st, 3rd-, 6th- and 12th-month post-operatively.
Russell Syndrome ; exotropia ; macrocephaly

In this study, we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery. We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery, along with 18 healthy controls. Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli. Compared with controls, preoperative patients showed hypoactivation in higher-level dorsal (visual and parietal) areas and ventral visual areas. Pre- and postoperative activation did not significantly differ in patients overall; patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus. Worse stereopsis and fusional control were correlated with preoperative hypoactivation, suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia. The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis. Thus, additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.
Humans ; Exotropia/surgery* ; Depth Perception/physiology* ; Strabismus/surgery* ; Oculomotor Muscles/surgery*

Objective: To compare the postoperative alignment of patients surgically corrected for esotropia or exotropia 6 weeks and 6 months after surgery. Method: This retrospective study reviewed clinical records of patients who underwent horizontal muscle surgery at the University of the Philippines-Philippine General Hospital from 2010 to 2014. The changes in alignment from 1 week to 6 weeks and from 1 week to 6 months after surgery were compared for overcorrection, undercorrection, and adequate correction groups. ANOVA and Pearson correlation were used. Results: Twenty two esotropia and 10 exotropia patients were included. Overcorrected esotropia patients had an esotropic change in alignment (15.50+13.44 PD after 6 weeks, p=0.026; 25+18.38 PD after 6 months, p=0.008). Under corrected esotropia patients had an exotropic change in alignment (-1.25+5.91 PD after 6 weeks, p=0.026;-4.38+14.16 PD after 6 months, p=0.008). Undercorrected exotropia patients had an esotropic change in alignment (6.67+6.35 PD after 6 weeks, p=0.028; 6+9.85 PD after 6 months, p=0.024). The presence of vertical deviations in esotropia caused an exotropic change in alignment after 6 months (p=0.03). Conclusion Although an exotropic drift is more commonly reported, fusional vergences may account for postoperative alignment changes towards orthotropia.
Esotropia ; Exotropia

Pelizaeus-Merzbacher disease (PMD) is a progressive and degenerative chromosomal disorder of the central nervous system caused by defective myelin production. Few case reports have been issued on the anesthetic management of PMD, because of its extremely low incidence. We anesthetized a 13-year-old female patient diagnosed with PMD for ophthalmic surgery because of intermittent exotropia. General anesthesia was induced and maintained with propofol and sevoflurane in air and oxygen. Rocuronium was administered to facilitate orotracheal intubation, and residual neuromuscular blockage was reversed with pyridostigmine. Between emergence to 24 hours postoperatively, her muscle power completely recovered and no unpredictable events occurred. Summarizing, anesthesiologists should be concerned about the high possibility of aspiration, spasticity, and seizure during the perioperative period in patients with even mild PMD. Appropriate preoperative evaluation, intraoperative monitoring, and choice of proper anesthetic drugs enable safe anesthesia in patients with PMD.
Adolescent* ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Central Nervous System ; Chromosome Disorders ; Exotropia ; Female ; Humans ; Incidence ; Intubation ; Monitoring, Intraoperative ; Muscle Spasticity ; Myelin Sheath ; Oxygen ; Pelizaeus-Merzbacher Disease* ; Perioperative Period ; Propofol ; Pyridostigmine Bromide ; Seizures

BACKGROUND: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children. METHODS: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance. RESULTS: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P = 0.027 and P = 0.022, respectively). CONCLUSION: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).
Child ; Diagnosis ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Methods ; Prognosis ; Reoperation ; Strabismus

PURPOSE: To evaluate the outcomes of modified medial rectus (MR) resection using a lowered amount of MR resection for recurrent exotropia after bilateral lateral rectus (LR) recessions. METHODS: Fifty-six patients, who underwent MR resection from 2003 to 2017 for recurrent exotropia after bilateral LR recessions, were included. MR resection was performed using modified MR resection with a smaller amount of resection than the standard of 4 mm resection at 20 prism diopters (PD) of exotropia. Postoperative surgical results at 1 month, 6 months, 1 year and 2 years were classified as a success (5 PD esotropia [ET]-10 PD exotropia [XT]), overcorrection (>5 PD ET), and undercorrection (>10 PD XT). The clinical factors affecting surgical results at postoperative 6 month and 2 years were also evaluated. RESULTS: The success rate was 78.2% at postoperative 1 month and 87.5% at postoperative 6 months. The overcorrection rate was 21.8% and the undercorrection rate was 0% at postoperative 1 month. At postoperative 6 months, the overcorrection rate decreased to 0% and the undercorrection rate was 12.5%. The success rate was 85.7% at postoperative 1 year and 66.6% at postoperative 2 years. There was no clinical factor affecting the surgical outcomes except the ocular alignment at postoperative 1 month. The deviation at postoperative 1 month was more esotropic in patients with success at postoperative 6 months and 2 years than that in patients with undercorrection (p < 0.05). CONCLUSIONS: The modified MR resection showed favorable results of 87.5% at postoperative 6 months and 85.7% at 1 year. The angle of deviation at postoperative 1 month was an indicator of subsequent surgical outcomes.
Esotropia ; Exotropia ; Humans

PURPOSE: We report a case of utilizing a previous silicone band track in the reoperation of scleral encircling. CASE SUMMARY: An 8-year-old male presented with rhegmatogenous retinal detachment in the right eye. Five days after this diagnosis, he received scleral buckling surgery and cryopexy to seal the retinal tear. One month after surgery, a fundus examination showed subretinal fluid at the inferior site of the scleral buckle. He underwent scleral encircling surgery and a cryopexy procedure. The patient has had an uneventful postoperative course, and the retina has remained attached over a follow-up period of 9 months. However, exotropia and hypotropia developed in the right eye. Diagnosis of restrictive strabismus due to tissue adhesion around the silicone band was made. The encircling band was therefore removed and laser photocoagulation was performed 360° around the retina. Twenty-four hours after surgery, a fundus examination showed subretinal fluid. He received 360° scleral encircling surgery not using the 360° conjunctival peritomy. After confirming a previous encircling tract using #0-0 polydioxanone as a guide, #5-0 Nylon was tied to the end of the guide and inserted through the encircling tract with the end sutured with the silicone band. The silicone band was inserted into the encircling tract by pulling the #5-0 Nylon as a guide. Ophthalmoscopy revealed an attached retina with indentation of the scleral buckle at 360°. CONCLUSIONS: For reoperation in patients who previously underwent scleral encircling surgery, using the previous scleral encircling tract may be effective in cases with conjunctival and tissue adhesion.
Child ; Diagnosis ; Exotropia ; Follow-Up Studies ; Humans ; Light Coagulation ; Male ; Nylons ; Ophthalmoscopy ; Polydioxanone ; Reoperation ; Retina ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Scleral Buckling ; Silicon ; Silicones ; Strabismus ; Subretinal Fluid ; Tissue Adhesions