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Purpose: To determine whether changes in ocular alignment following general anesthesia, as measured by interpupillary distance, can be used as a predictor for surgical outcomes in children with intermittent exotropia. Methods: The authors obtained digital photographs of 40 children with exotropia and 20 children with epiblepharon (control group) before and immediately after induction of general anesthesia in the primary supine position. Differences in the anatomic interpupillary distance (aIPD) for each patient were measured and compared with the preoperative angles of deviation. They were also correlated with surgical outcomes on the first day and 1 year after surgery. Results: All 60 patients demonstrated an increase in aIPD following general anesthesia. The mean change in aIPD in patients with exotropia was similar to that in patients with epiblepharon (3.78% ± 2.53% and 3.15% ± 1.05%, respectively). In patients with exotropia, there was a significant positive linear correlation between the preoperative distance deviation (P) and the change in eye position (A): A = 0.362 P – 4.488, r 2 = 0.476 ( P < .001). Five (71%) of seven patients whose changes were outside the 80% confidence interval for expected values had poor surgical outcomes on the first postoperative day and four had unsatisfactory results 1 year after surgery. Conclusions: Changes in aIPD following general anesthesia were strongly correlated with preoperative angle of deviation. Therefore, they may be a useful predictor of surgical outcomes in children with exotropia.

Purpose: To evaluate changes in the angle of deviation after spectacle correction in patients who had hyperopia and intermittent exotropia (X(T)) and to determine whether the changes and surgical outcomes differ when compared with those of myopic and emmetropic X(T). Methods: One hundred fourteen patients with X(T) were recruited and allocated into three groups: X(T) with hyperopia (group I; 38 patients), X(T) with emmetropia (group II; 35 patients), and X(T) with myopia (group III; 41 patients). After at least 6 months wearing spectacles, changes in exodeviation were compared. The results of surgery based on the spectacle-corrected distance angle and the ratios of accommodative convergence over accommodation (AC/A) were also assessed. Results: With spectacle correction, the mean exodeviation increased significantly in group I, but did not change in groups II or III. Thirteen patients in group I (34%) showed a more than 10 prism diopters (PD) exotropic shift after wearing spectacles. The mean AC/A ratio in group I was 2.63 (PD/D), whereas in groups II and III the ratios were 4.03 and 4.06, respectively. There was no difference in surgical results among the three groups. Conclusion: Although hyperopic correction in patients with X(T) resulted in a limited increase in exodeviation with a subnormal AC/A ratio, one-third of the patients experienced a significant increase in exodeviation. A spectacle correction trial should be considered before surgery in patients with hyperopia and X(T).

Purpose: To analyze the practical aspects and advantages of one-stage adjustable surgery under topical anesthesia in concomitant horizontal strabismus. Methods: A retrospective review of 363 patients was completed to assess (1) the frequency of need to perform adjustment, (2) the amount and pattern of adjustment, and (3) the final alignment at least 6 months after surgery. Intraoperative adjustment was performed strictly toward the aim of orthophoria or slight overcorrection (heterophoria < 6 prism diopters [PD]) while avoiding diplopia. Results: Of the 363 patients, 261 (72%) required intraoperative adjustment. Of these, 85% of exotropes underwent a decreased amount of surgery compared with the standard amount, whereas 58% of esotropes underwent an increased amount of surgery. Forty-two patients underwent a one-muscle surgery instead of the scheduled two-muscle surgery, and all had less than 35 PD preoperative angle of deviation. Success rates were 83% in all patients with one-stage adjustable sutures and 87% in patients who underwent adjustment. In 42 patients with one-muscle surgery instead of two-muscle surgery, 32 (76%) obtained successful results. Conclusion: Intraoperative adjustment was effective in concomitant horizontal strabismus surgery and can provide the opportunity to avoid a large overcorrection, especially in cases with moderate angle horizontal muscle surgery.

Purpose: Some patients complain of a foreign body sensation, a burning sensation, or dryness after strabismus surgery. We prospectively investigated the changes in corneal and conjunctival sensitivity, tear film stability, and tear secretion after strabismus surgery. Patiente and Methods: Corneal and conjunctival sensitivity were assessed with an esthesiometer, tear film breakup time was measured, and the Schirmer test was performed prospectively (preoperatively and 1 week, 1 month, and 3 months postoperatively) in 83 patients (124 eyes) who underwent strabismus surgery at our institution. Resulte: There were no significant changes in corneal sensitivity, tear film stability, or tear secretion after strabismus surgery (P > .05). Conjunctival sensitivity decreased significantly after strabismus surgery (P < .05). Conclusion: Discomfort and dryness after strabismus surgery do not seem to be related to changes in corneal sensitivity, tear film stability, or tear secretion. J Pediatr Ophthalmol Strabismus 2006;43:95-99.

Purpose: To study the effect of botulinum toxin type A chemodenervation in sensory strabismus. Methods: Twelve patients with sensory strabismus were treated with an injection of botulinum toxin type A (Botox; Allergan, Irvine, Calif). Botulinum toxin type A was diluted with 0.9% sodium chloride without preservative at a dose that ranged from 1 .25-5 U. A Teflon-coated needle electrode was inserted into the medial reclus muscle in cases of esotropia and into the lateral rectus muscle in cases of exotropia. Four patients were treated with 5=2 injections of botulinum toxin type A. Changes in the angle of strabismus and related complications were followed for >6 months postinjection. Results: The mean deviation before injection was 33.8 prism diopters (?) and the mean corrective effect on the deviation was 72.8% after injection in patients with sensory strabismus. The final deviation in 9 patients was Conclusion: Botulinum toxin type A is likely to prevent muscle contracture and affect muscle and neuronal tissues. This study on the effects of sensory strabismus with botulinum toxin type A injection suggests it has the potential to replace surgery or be used as an adjuvant therapy. Journal of Pediatrie Ophthalmology and Strabismus 2001:38:68-71.