Dataset Information

Long-term surgical outcomes of bilateral vs. unilateral medial rectus resection for recurrent exotropia.

ABSTRACT:

Background/objectives

The objective of this study is to compare the long-term outcomes of bilateral and unilateral medial rectus (BMR/UMR) resection for recurrent exotropia after bilateral lateral rectus (BLR) recession.

Subjects/methods

Retrospective study was performed of 99 patients who underwent BMR resection (BMR group) or UMR resection (UMR group) for recurrent exotropia of 20-30 prism diopters (PD), with a minimum follow-up of 5 years. Surgical outcomes including success rate, exodrift rate, and average effect of MR resection were compared between two groups. The risk factors associated with poor outcomes were evaluated.

Results

At 5 years after surgery, 57% in the BMR group and 62% in the UMR group showed successful outcome. Success and recurrence rates were not significantly different between two groups, whereas the overcorrection rate was significantly higher in the BMR group (35% vs. 15%; p?=?0.039). The average effect of MR resection was significantly greater after BMR throughout the whole postoperative period. The average effect of UMR resection was significantly greater in those who had previously undergone a large amount of BLR recession compared with those with a smaller dosage (p?=?0.006). By multivariate analysis, a large amount of previous BLR recession and initial overcorrection of >10 PD of esotropia were found to be significant risk factors of overcorrection.

Conclusion

In moderate angles of recurrent exotropia, large UMR resection is a safe and efficient procedure. However, if a large BLR recession was performed previously, surgical dosage for UMR resection should be reduced because of the high risk of long-term overcorrection.

SUBMITTER: Sung JY

PROVIDER: S-EPMC6707272 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Long-term surgical outcomes of bilateral vs. unilateral medial rectus resection for recurrent exotropia.

Sung Jae Yun JY Yang Hee Kyung HK Hwang Jeong-Min JM

Eye (London, England) 20190227 7

<h4>Background/objectives</h4>The objective of this study is to compare the long-term outcomes of bilateral and unilateral medial rectus (BMR/UMR) resection for recurrent exotropia after bilateral lateral rectus (BLR) recession.<h4>Subjects/methods</h4>Retrospective study was performed of 99 patients who underwent BMR resection (BMR group) or UMR resection (UMR group) for recurrent exotropia of 20-30 prism diopters (PD), with a minimum follow-up of 5 years. Surgical outcomes including success ra ...[more]

PMID: 30814655

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Project description:PurposeTo compare long-term outcomes after bilateral lateral rectus recession (BLRc) or unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R) for primary treatment of childhood intermittent exotropia (IXT).DesignMulticenter, randomized clinical trial.ParticipantsOne hundred ninety-seven children 3 to younger than 11 years of age with basic-type IXT, a largest deviation by prism and alternate cover test at any distance of 15 to 40 prism diopters (PD), and near stereoacuity of at least 400 seconds of arc.MethodsRandom assignment to BLRc or R&R and masked examinations conducted every 6 months after surgery for 3 years.Main outcome measuresProportion of participants meeting suboptimal surgical outcome by 3 years, defined as: (1) exotropia of 10 PD or more at distance or near using simultaneous prism and cover test (SPCT); or (2) constant esotropia of 6 PD or more at distance or near using SPCT; (3) loss of 2 octaves or more of stereoacuity from baseline, at any masked examination; or (4) reoperation without meeting any of these criteria.ResultsCumulative probability of suboptimal surgical outcome by 3 years was 46% (43/101) in the BLRc group versus 37% (33/96) in the R&R group (treatment group difference of BLRc minus R&R, 9%; 95% confidence interval [CI], -6% to 23%). Reoperation by 3 years occurred in 9 participants (10%) in the BLRc group (8 of 9 met suboptimal surgical outcome criteria) and in 4 participants (5%) in the R&R group (3 of 4 met suboptimal surgical outcome criteria; treatment group difference of BLRc minus R&R, 5%; 95% CI, -2% to 13%). Among participants completing the 3-year visit, 29% (25 of 86) in the BLRc group and 17% (13 of 77) in the R&R group underwent reoperation or met suboptimal surgical outcome criteria at 3 years (treatment group difference of BLRc minus R&R, 12%; 95% CI, -1% to 25%).ConclusionsWe did not find a statistically significant difference in suboptimal surgical outcome by 3 years between children with IXT treated with BLRc compared with those treated with R&R. Based on these findings, we are unable to recommend one surgical approach over the other for childhood IXT.

Project description:ObjectiveVenous insufficiency is commonly bilateral, and patients often prefer single-episode care compared with staged procedures. Few studies have investigated clinical outcomes after unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Here, we report data from the Vascular Quality Initiative regarding truncal venous ablation for chronic venous insufficiency.MethodsUsing data from the Vascular Quality Initiative, we investigated immediate postoperative as well as long-term clinical and patient-reported outcomes of patients undergoing unilateral vs bilateral truncal endovenous ablation from 2015 to 2019. We further investigated outcomes between staged bilateral and concurrent bilateral ablations. Preprocedural and postprocedural comparisons were performed using t-test, χ2 test, or their nonparametric counterpart when appropriate. Multivariable ordinal logistic regression was performed on ordinal outcome variables.ResultsA total of 5029 patients were included, of whom 3782 (75.2%) underwent unilateral procedures. Median follow-up was 227 days (interquartile range [IQR], 55-788 days). Unilateral patients were less likely to be female (67.0% vs 70.3%; P = .031) and white (86.3% vs 91.2%; P < .001) and had lower body mass index (30.3 ± 7.3 kg/m2 vs 31.8 ± 7.6 kg/m2; P < .001) compared with patients undergoing bilateral procedures. In addition, unilateral patients had fewer prior varicose vein treatments (23.0% vs 15.7%; P < .001) and had higher median preprocedural Venous Clinical Severity Score (VCSS; 8 [IQR, 6-10] vs 7 [IQR, 5.5-9]; P < .001). No difference was seen in complications (6.9% vs 8.2%; P = .292), and systemic complications were rare in both groups. No difference was seen in VCSS improvement after treatment (median, 3 [IQR, 1-6] for unilateral; median, 3 [IQR 1-5] for bilateral; P = .055). In comparing staged with concurrent bilateral procedures, there was no difference in overall complications (7.5% vs 12.2%; P = .144). Staged bilateral patients were older (56.9 ± 13.3 years vs 54.2 ± 12.9 years; P = .002), less likely to have had prior varicose vein treatment (14.3% vs 19.8%; P = .020), and more likely to be therapeutically anticoagulated (10.8% vs 6.5%; P = .028) compared with concurrent bilateral patients. Staged patients also have higher preprocedural VCSS compared with concurrent patients (median, 8 [IQR, 6-10] vs 7 [IQR, 5.5-9]; P < .001). In multivariable analysis, there was no difference in the likelihood of VCSS improvement for concurrent compared with staged procedures (odds ratio, 0.70; 95% confidence interval, 0.40-1.24; P = .226).ConclusionsConcurrent bilateral truncal endovenous ablation can be performed safely without increased morbidity compared with staged bilateral or unilateral ablations.

Project description:ImportanceBoth vertical rectus belly transposition (VRBT) and superior rectus transposition (SRT) can be performed simultaneously with ipsilateral medial rectus recession (MRc) and have been shown to be effective for chronic sixth nerve palsy. However, it is unclear whether VRBT is superior to SRT in correcting esotropia.ObjectiveTo compare the effectiveness of modified VRBT plus MRc (mVRBT-MRc) vs augmented SRT plus MRc (aSRT-MRc) in Chinese patients with chronic sixth nerve palsy.Design, setting, and participantsThis parallel-design, double-masked, single-center, randomized clinical trial was conducted from January 15, 2018, to May 24, 2021. The follow-up visits were scheduled at 1 month and 6 months. Eligible Chinese participants with unilateral chronic sixth nerve palsy were randomly assigned to receive either mVRBT-MRc (VRBT group) or aSRT-MRc (SRT group).InterventionsmVRBT-MRc or aSRT-MRc.Main outcomes and measuresChange of horizontal deviation in primary position from baseline to 6 months.ResultsOf the total 25 eligible participants, the mean (SD) age was 45.4 (12.6) years, with 10 male participants (40%) and 15 female participants (60%). Thirteen participants (52%) were randomly assigned to the VRBT group, and 12 (48%) were randomly assigned to the SRT group. At baseline, the mean (SD) horizontal deviation was 65.7 (10.8) prism diopters (Δ) in the VRBT group and 60.5Δ(14.1Δ) in the SRT group. Similar amounts of MRc were performed in both groups. At 6 months, the horizontal deviation changed from baseline by 66.3Δ in the VRBT group and by 51.5Δ in the SRT group. The adjusted group difference was 10.9Δ (95% CI, 5.3Δ-16.6Δ), favoring the VRBT group (P = .001). Four times as many participants corrected more than 60Δ with mVRBT-MRc compared with aSRT-MRc. The group difference of the improvement of abduction limitation was -0.2 (95% CI, -0.8 to 0.5; P = .64). Although there was a higher proportion of undercorrection in the SRT group (difference, 45%; 95% CI, 16%-75%; P = .01), no differences were identified for other suboptimal outcomes between groups.Conclusions and relevanceCompared with aSRT-MRc, mVRBT-MRc showed better effect in correcting esotropia with no differences detected for other suboptimal outcomes. mVRBT-MRc may be a promising alternative surgical procedure for chronic sixth nerve palsy, particularly for large esotropia of more than 60Δ, if these results are confirmed in larger, diverse cohorts with longer follow-up.Trial registrationChiCTR Identifier: ChiCTR-INR-17013705.

Dataset Information

Long-term surgical outcomes of bilateral vs. unilateral medial rectus resection for recurrent exotropia.

Background/objectives

Subjects/methods

Results

Conclusion

Publications

Long-term surgical outcomes of bilateral vs. unilateral medial rectus resection for recurrent exotropia.

Similar Datasets

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