Three and four horizontal muscle surgery for large angle exotropia

Three and four horizontal muscle surgery for large angle exotropia

Volume 18 Number 4 / August 2014 childhood diseases. With increasing survival, many children require long-term follow-up for transplant-related compli...

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Volume 18 Number 4 / August 2014 childhood diseases. With increasing survival, many children require long-term follow-up for transplant-related complications. Ocular findings following BMT are well described in adults, but few reports describe ocular findings in children. Methods: We conducted a retrospective review of school-age children and adolescents receiving BMT between 1995 and 2009. All patients had an ophthalmic examination prior to BMT and at least one follow-up examination during the subsequent 5 years. Results: Of 188 patients meeting our inclusion criteria, the most common finding was posterior subcapsular cataract (PSC), which developed in 53 patients (28.2%). Additional manifestations included dry eye syndrome (DES) in 43 patients (22.9%) and infectious retinitis in 7 patients (3.7%). Variables including diagnosis, survival, donor type, conditioning treatment, development of graft versus host disease, and the use of calcineurin inhibitors and/or corticosteroids were evaluated to determine their effect on the development of cataract and DES. Discussion: School-age children and adolescents undergoing BMT are at risk for multiple ocular complications. Our most common finding was PSC, although not all cataracts became visually significant. The second most common finding was DES, which can be visually significant and affect quality of life. Children undergoing BMT are also immunosuppressed and at higher risk for developing devastating ocular opportunistic infections. They should be monitored closely for infections and treated aggressively as necessary. Conclusion: Survivors of childhood BMT should have long-term follow-up to monitor potential ocular complications, especially the development and progression of cataracts. References 1. Suh DW, Ruttum MS, Stuckenschneider BJ, et al. Ocular findings after bone marrow transplantation in a pediatric population. Ophthalmology 1999;106:1564-70. 2. De Marco R, Dassio DA, Vittone P. A retrospective study of ocular side effects in children undergoing bone marrow transplantation. Eur J Ophthalmol 1996;6:436-9.

085 Goal-determined metric to assess outcomes of surgery for exotropia. Yoon-Hee Chang, Patrice Melvin, Linda R. Dagi Introduction: Criteria for measuring success after exotropia surgery should be sensitive to the reason for surgery and desired goal. We developed a goal-determined outcomes analysis tool for exotropia surgery and present its application. Methods: The outcomes analysis tool was applied to surgery for exotropia performed between 2007 and 2012. A ranked order of four goals was prospectively assigned by surgeon: binocular potential; restoration of eye contact (reconstructive); diplopia control; or torticollis management. Pre- and postoperative sensory motor examinations and risk factors were noted. Goal-specific outcomes criteria were applied. Results: Of 852 cases (411 for restoration of eye contact, 347 for binocular potential, 78 for diplopia, and 16 for torticollis) excellent (62.0%) or good (16.0%) outcomes were obtained in 78.0%. Odds ratio for success was significantly greater for patients having surgery to resolve diplopia (6.6:1) or for restoration of eye contact (3.7:1) when compared to those having surgery for binocular potential. Risk factors significantly moderated outcomes in the reconstructive group (P 5 0.0057). Discussion: The methodology for monitoring postoperative deviation affects the reported outcome. When motor criteria for achieving binocular potental is applied to entire cohort, regardless of primary

Journal of AAPOS

e27 goal, the outcome shifts significantly (P \ 0.0001). Outcomes graded by simultaneous prism cover test results were 4.8 times more likely to be graded "excellent" than those for which only alternate prism cover test results were available. Conclusion: The goal-determined outcomes analysis tool for exotropia surgery provides an appraisal of surgical results germane to the reason for intervention. Secondary risk factor analysis is facilitated. 086 Three and four horizontal muscle surgery for large angle exotropia. John H. Chen, David G. Morrison, Sean P. Donahue Introduction: Surgery on two horizontal recti typically is most effective for angles \40D. We evaluated our experience operating on 3 or 4 rectus muscles for angles .40D. Methods: Retrospective chart review of 48 patients who underwent a first surgical procedure for a large angle comitant exodeviation over a 15-year period. Exclusion criteria were vertical misalignment, patterns, and oblique involvement. We assessed surgical outcomes, the role of adjustable sutures, and the stability of postoperative alignment. Successful alignment was defined as deviation  10D. Results: Thirty-five patients underwent three-muscle surgery and 13 underwent four-muscle surgery. Median age was 47 (range, 1-79) years and 48 (range, 1-69) years, respectively; mean preoperative angles were 54.5D and 72.1D. For patients undergoing three muscle surgery, rates of successful alignment, undercorrection, and overcorrection were 67.7%, 25.8%, and 6.5% at two months and 41.7%, 58.3%, and 0% at final follow-up (12.3  8.7 months). Rates for four muscle surgery were 44.4%, 33.3%, and 22.2 at 2 months and 50.0%, 37.5%, and 12.5% at final follow-up (10.9  12.2 months). Between 1 week and 2 months, 75.0% of patients experienced exotropic drift averaging 9.3D  9.1D. By final follow-up, 90.0% experienced exotropic drift averaging 15.2D  14.1D. Success rates at two months for traditional and adjustable suture surgeries did not differ. Discussion: Patients with large angle comitant exotropia do well with surgery on 3 or 4 horizontal rectus muscles. Postoperative exotropic drift should be anticipated. Conclusion: Three– and four– horizontal muscle surgeries are both effective for correcting large-angle exotropia. 087 Comparison of the Spot and plusoptiX A09 vision screeners for the detection of refractive error in various ethnic groups. Jennifer D. Davidson, Edward Cheeseman, Mae Millicent Peterseim, Carrie Papa, Rupal Trivedi, Courtney Kraus Introduction: The purpose is to evaluate the efficacy of two screening devices in the identification of refractive error amongst different ethnic groups. Methods: Children age 1-16 years underwent screening with the Spot and plusoptiX screeners, prior to cycloplegic refraction by a masked pediatric ophthalmologist. Data regarding ethnicity and refraction were analyzed. Results: Thirty Hispanic/Latinos (Hispanics), 133 African Americans (AA), and 203 non-Hispanic whites (Caucasians) with an average age of 5.96, 5.59, and 5.64 years were included. The percentage of patients with .3.00 D cylinder on cycloplegic refraction is 23.3% for Hispanic/Latino, 5.26% for AA and 2.96% for Caucasians. The Spot overestimated cylinder by 0.33  0.60D (p\ 0.007) in Hispanics and 0.43  0.83 D (P \ 0.001) in AA. The plusoptiX overestimated cylinder by 0.82  0.77 D (P \ 0.001) in Hispanics and by 0.58  0.60 D (P \ 0.001) in AA.