Botulinum toxin a treatment of consecutive esotropia in children.
Couser Natario L,Lambert Scott R
Strabismus
OBJECTIVE:To assess the outcome of botulinum A toxin (BTXA) to treat surgically overcorrected intermittent exotropia in children. METHODS:A retrospective analysis was performed on a series of children with consecutive esotropia treated with BTXA. RESULTS:Six children with a mean consecutive esotropia of 21 prism diopters (PD) were treated with BTXA at a mean of 19.8 months following strabismus surgery. Two patients underwent a single injection, three patients 2 injections, and one patient 3 injections. Complications included transient ptosis and a vertical deviation. Mean follow-up from last BTXA injection was 16 months. At last follow-up, 4 of the 6 patients were orthotropic and stereopsis was present in 4 of 5 patients old enough to cooperate with testing. One patient was treated with strabismus surgery following a single BTXA injection. CONCLUSIONS:BTXA is an efficacious treatment for consecutive esotropia in children. However, in our series, two-thirds of patients required multiple injections to achieve the desired outcome and one ultimately had an additional strabismus surgery.
10.3109/09273972.2012.702324
Long-term outcome of prismatic correction in children with consecutive esotropia after bilateral lateral rectus recession.
Lee Eun Kyoung,Yang Hee Kyung,Hwang Jeong-Min
The British journal of ophthalmology
AIMS:To determine the long-term outcome of prismatic correction in consecutive esotropia after bilateral lateral rectus (BLR) recession in children. METHODS:Of 392 children with exotropia who received BLR recession, 44 developed consecutive esotropia. Five children underwent reoperation and 39 were treated with base-out prism glasses. The clinical characteristics and the efficacy of prismatic correction defined as the duration of prism treatment and the annual rate of decline in esodeviation angle (prism dioptres (PD)/year) after prismatic correction, clinical success rates based on postoperative alignment at distance, and the change in stereopsis were evaluated in the children who were treated with base-out prism glasses. RESULTS:After a mean follow-up duration of 37.0±11.5 months, a successful motor outcome was achieved in 66.7% of patients and stereoacuity was improved or maintained in 79.2%. No patient lost stereopsis as a result of overcorrection. Prism glasses were prescribed an average of 7.4±8.1 months after surgery. During prism wear, the annual rate of decline in esodeviation was 4.2±6.7 PD. The mean duration of prism wear was 24.0±10.5 months and 82.1% were weaned off prisms at the last follow-up examination. CONCLUSIONS:In patients with consecutive esotropia after BLR recession, the angle of esodeviation continuously decreased and 82% were weaned off prism glasses after 3 years. Prismatic correction achieves good motor outcome while maintaining a favourable sensory status in most patients with consecutive esotropia after BLR recession.
10.1136/bjophthalmol-2014-305861
Consecutive esotropia in intermittent exotropia patients with immediate postoperative overcorrection more than 17 prism diopters.
Kim Hyoung-Seok,Suh Young-Woo,Kim Seung Hyun,Cho Yoonae A
Korean journal of ophthalmology : KJO
PURPOSE:To report the incidence and the factors of consecutive esotropia (ET) in patients with immediate postoperative overcorrection of at least 17 prism diopters (PD) after surgery for intermittent exotropia (X(T)). METHODS:Four-hundred-five patients under the age of 18 were included in this study. They underwent bilateral lateral rectus recession (LROU-rec) or unilateral recession-resection (R&R) for X(T). On postoperative day one, the patients with at least 17 PD overcorrection were classified as group 1 and those with less than 17 PD as group 2. Age, refractive error, type of surgery, lateral incomitancy, and the incidence of consecutive ET were analyzed for each group. RESULTS:Group 1 consisted of 116 patients (28.6%) and group 2 consisted of 289 (71.4%). At the six-month follow-up visit, consecutive ET had developed in 16 patients (13.8%) in group 1, and in five patients (1.7%) in group 2 (p<0.001). The occurrence of consecutive ET was not related to age at the time of surgery (p=0.46 in group 1; p=0.54 in group 2), refractive error (p=0.18 in group 1; p=0.08 in group 2), or the type of surgery (p=0.69 in group 1; p=1.00 in group 2). The incidence in group 1 was 23.8% in patients with lateral incomitancy and 8.1% in patients without lateral incomitancy (p<0.05). In group 2, the incidence was 4.4% in patients with lateral incomitancy and 0.5% in patients without lateral incomitancy (p=0.04). CONCLUSIONS:Consecutive ET developed in 13.8% of patients with immediate overcorrection of at least 17 PD. Lateral incomitancy was the most important risk factor.
10.3341/kjo.2007.21.3.155
Risk factors predicting the need for additional surgery in consecutive esotropia.
Choi Yong-Min,Lee Joo-Yeon,Jung Jae-Hoon,Kim Seung-Hyun,Cho Yoonae A
Journal of pediatric ophthalmology and strabismus
PURPOSE:To evaluate the risk factors predicting surgical treatment in consecutive esotropia occurring after surgery for intermittent exotropia. METHODS:The clinical records of 52 patients with consecutive esotropia who underwent exotropia surgery were retrospectively reviewed. All patients demonstrated consecutive esotropia with diplopia or suppression for more than 1 month after surgery for exotropia. Patients were divided into two groups (the surgical group and nonsurgical group) depending on whether surgery was required for consecutive esotropia. Surgery for esotropia was performed only in patients with more than 10 prism diopters (PD) esodeviation that persisted for a minimum of 6 months, those who had suppression in 1 eye or diplopia, and those who could not achieve fine stereopsis. The nonsurgical treatment up to 6 months postoperatively was part-time patching and prism therapy in both groups. Patient characteristics were evaluated in the two groups. RESULTS:The surgical group was composed of 17 patients and the nonsurgical group was composed of 35 patients. Age, gender, refractive error, best-corrected visual acuity, and postoperative overcorrection at 1 day were not significantly different in the two groups (P > .05). However, the distance strabismic angle at 1 month postoperatively was 2.5 ± 3.8 PD esodeviation (range: 14 PD esotropia to 4 PD exotropia) in the nonsurgical group and 5.4 ± 5.1 PD esodeviation (range: 20 PD esotropia to orthotropia) in the surgical group; these values were statistically significant (P < .05). CONCLUSIONS:The clinically significant risk factor affecting the surgical decision for consecutive esotropia was a large esotropic angle at 1 month postoperatively in this study.
10.3928/01913913-20130903-01
The clinical course of consecutive esotropia after surgical correction.
Korean journal of ophthalmology : KJO
PURPOSE:To investigate the clinical course in patients who underwent surgical correction of consecutive esotropia. METHODS:The medical records of 13 patients who underwent surgical correction of consecutive esotropia were reviewed retrospectively. The authors investigated the deviation and surgical method at the time of exotropia surgery. During the follow up period, the authors also studied incidence of amblyopia development, the effect of occlusion therapy, surgical methods for consecutive esotropia, and postoperative change of deviation. RESULTS:The average exodeviation was 27.1 prism diopter (PD). Bilateral lateral rectus muscle recession was performed in all patients. In all patients, alternate occlusion was tried from 2 weeks after development of consecutive esotropia. However, there was no effect on 7 patients. None of the patients developed amblyopia. Surgery for consecutive esotropia was performed on the average 15.3 months after exotropia surgery. The average esodeviation was 21.1PD. Medial rectus muscle recession was performed in 10 patients and lateral rectus muscle advancement in 3 patients. The average deviation of the subject group immediately after surgery was 1.2PD esodeviation, 0.9PD esodeviation one month after surgery, 2.4PD exodeviation 6 months after surgery, and 4.7PD exodeviation at the last follow up, and it showed a tendency to progress to exodeviation as the follow up period increased. Ten patients (76.9%) showed deviation within 8PD at the last follow up. CONCLUSIONS:The success rate of surgical correction for consecutive esotropia was a favorable outcome. But, careful decisions of the surgical method and amount is needed because the conversion of exodeviation during long-term follow-up is possible.
10.3341/kjo.2007.21.4.228