İnfantil Ekzotropyada Preoperatif Deviasyonun Cerrahi Başarı ve Duyusal Fonksiyon Üzerindene Etkisi

Abstract

Amaç: Bu çalışma, infantil ekzotropyada preoperatif deviasyonun cerrahi başarı ve duyusal fonksiyon üzerine etkisini değerlendirmeyi amaçlamaktadır. Ayrıca, bu hastalarda geç cerrahi zamanlamanın etkilerini değerlendirmektedir. Materyal ve metod: Bu retrospektif çalışmada, 2012-2018 yılları arasında infantil ekzotropyası olan ve cerrahi tedavi uygulanan 16 hasta değerlendirdi. Preoperatif kayma açısının cerrahi başarı ve duyusal fonksiyon üzerine etkisini değerlendirmek için kayma açısı ≤ 50 prizm diyoptri (PD) olan hastalar Grup 1'e, > 50 PD olan hastalar ise Grup 2'ye dahil edildi. Cerrahi başarı ≤5 PD esotropya ve ≤10 PD ekzotropya olarak tanımlandı. Duyusal fonksiyon değerlendirmesi için Titmus stereopsis ve Worth 4-Nokta testleri kullanıldı. Bulgular: Hastaların ortalama preoperatif kayma açısı 50,63 ± 18,7 PD (20-90) idi. Ameliyat anında ortanca yaş 73 (24-400) aydı. İlk ameliyattan sonra hastaların% 75'inde cerrahi başarı sağlanırken, ikinci ameliyattan sonra tüm hastalarda cerrahi başarı gözlendi. Duyusal fonksiyon 11 test edilebilir hastada (% 68.7) değerlendirildi. Bu hastaların 5'inde (% 45.4) Worth 4- nokta testinde füzyon görüldü ve 2'sinde (% 18.1) ölçülebilir stereopsis elde edildi. Preoperatif kayma açısının füzyon üzerine etkisi saptanırken stereopsis ve cerrahi başarı üzerine etkisi olmadığı gözlendi (sırasıyla p = 0,015; p = 0,45; p = 0,77). Sonuç: Daha düşük preoperatif kayma açısı, daha yüksek oranda duyusal füzyon gelişimi ile ilişkili olabilir. Ayrıca bu hastalarda geç cerrahi zamanlama ile nispeten yüksek cerrahi başarı elde edilebilir.

Keywords

• Ekzotropya
• Preoperatif kayma açısı
• Stereopsis
• Şaşılık

Project Number

yok

The Clinical Effect of Preoperative Deviation on Surgical Success and Sensory Function in Infantile Exotropia

Abstract

Background: This study aims to assess the impact of preoperative deviation on surgical success and sensory function in infantile exotropia. Furthermore, to assess the effects of late surgical timing in these patients.
Materials and Methods: This retrospective study evaluated 16 subjects with infantile exotropia that underwent surgical management between 2012 and 2018. Patients with deviation ≤ 50 prism diopters (PD) were added to Group 1, and Patients with deviation > 50 PD were added to Group 2 to assess the impact of preoperative deviation on surgical success and sensory function. The surgical success is descri-bed as ≤5 PD esotropia and ≤10 PD exotropia for patients. The Titmus stereopsis and Worth 4-Dot tests were used for sensory function assessment.
Results: The average preoperative deviation was 50,63 ± 18,7 PD (20-90). The median age at the time of surgery was 73 (24-400) months. Surgical success was observed in 75% of the patients after the first surgery, and surgical success was observed in all patients after the second surgery. The sensory function was assessed in 11 testable patients (68.7%), of which 5 (45.4%) fusion was observed in the Worth 4-Point test, and 2 (18.1%) achieved measurable stereopsis. While the preoperative deviation had an effect on fusion, it had no effect on stereopsis and surgical success(p=0,015; p=0,45; p=0,77 respectively).
Conclusions: The smaller preoperative deviation may be associated with a higher rate of sensorial fusion development. Furthermore, relatively high surgical success can be achieved with late surgical timing in these patients.

Keywords: Exotropia, Preoperative deviation, Strabismus, Stereopsis

Keywords

• Exotropia
• Preoperative deviation
• Strabismus
• Stereopsis

Supporting Institution

yok

Project Number

yok

Thanks

Acknowledgment: None

References

1. 1. Paik HJ, Yim HB. Clinical effect of early surgery in infantile exotropia. Korean J Ophthalmol. 2002;16(2):97-102.
2. 2. Choi YM, Kim SH. Comparison of clinical features between two different types of exotropia before 12 months of age based on stereopsis outcome. Ophthalmology. 2013;120(1):3-7.
3. 3. Hiles DA, Biglan AW. Early surgery of infantile exotropia. Trans Pa Acad Ophthalmol Otolaryngol. 1983;36(2):161-8.
4. 4. Hunter DG, Kelly JB, Buffenn AN, Ellis FJ. Long-term outcome of uncomplicated infantile exotropia. J AAPOS. 2001;5(6):352-6.
5. 5. Na KH, Kim SH. Comparison of Clinical Features and Long-term Surgical Outcomes in Infantile Constant and Intermittent Exotropia. J Pediatr Ophthalmol Strabismus. 2016;53(2):99-104.
6. 6. Yam JC, Chong GS, Wu PK, Wong US, Chan CW, Ko ST. Prognostic factors predicting the surgical outcome of bilateral lateral rectus recession surgery for patients with infantile exotropia. Jpn J Ophthalmol. 2013;57(5):481-5.
7. 7. Yoo EJ, Kim SH. Optimal surgical timing in infantile exotropia. Can J Ophthalmol. 2014;49(4):358-62.
8. 8. Shin KH, Kim IN, Paik HJ. The Effect of Preoperative Occlusion Therapy on Long-term Outcome after Surgery for Early-onset Exotropia. Korean J Ophthalmol. 2017;31(3):268-74.

9. 9. Park JH, Kim SH. Clinical features and the risk factors of infantile exotropia recurrence. Am J Ophthalmol. 2010;150(4):464-7 e2.
10. 10. Pratt-Johnson JA, Barlow JM, Tillson G. Early surgery in intermittent exotropia. Am J Ophthalmol. 1977;84(5):689-94.
11. 11. Rubin SE, Nelson LB, Wagner RS, Simon JW, Catalano RA. Infantile exotropia in healthy children. Ophthalmic surgery. 1988;19(11):792-4.
12. 12. Biglan AW, Davis JS, Cheng KP, Pettapiece MC. Infantile exotropia. J Pediatr Ophthalmol Strabismus. 1996;33(2):79-84.
13. 13. Bagheri M, Farvardin M. The clinical effect of surgical timing in infantile exotropia. J AAPOS. 2018;22(3):167-9 e1.
14. 14. Yam JC, Wu PK, Chong GS, Wong US, Chan CW, Ko ST. Long-term ocular alignment after bilateral lateral rectus recession in children with infantile and intermittent exotropia. J AAPOS. 2012;16(3):274-9.
15. 15. Rosenbaum AL, Santiago AP. Clinical strabismus management: principles and surgical techniques: David Hunter; 1999.