Journal of Yeungnam Medical Science

Original articles

Ophthalmology
Impact of simultaneous eyelid and exotropia surgery on the surgical outcomes of pediatric patients with intermittent exotropia: a retrospective observational study: Jinam Lim, Jun Hyuk Son, Won Jae Kim; J Yeungnam Med Sci. 2025;42:59. Published online September 25, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.59

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Abstract PDF: Background
This study aimed to compare the surgical outcomes of pediatric patients with intermittent exotropia who underwent simultaneous eyelid and exotropia surgery and those who underwent exotropia surgery alone.
Methods
The medical records of patients aged <18 years who underwent surgery for intermittent exotropia were retrospectively reviewed. The patients were grouped according to whether they underwent simultaneous eyelid surgery. In the simultaneous surgery group, the association between clinical factors, including the type of eyelid procedure, and surgical success was also analyzed. A favorable outcome was defined as an ocular alignment of ≤10 prism diopters (PD) for exodeviation and ≤4 PD for esodeviation at the final follow-up.
Results
This study included 118 patients, of whom 31 underwent simultaneous eyelid and exotropia surgery and 87 underwent exotropia surgery alone. Bilateral repair of lower eyelid epiblepharon was the most common eyelid procedure (27/31, 87.1%). Success rates did not differ significantly between the two groups (log-rank test, p=0.291). In the simultaneous surgery group, no clinical factors, including the type of eyelid surgery, were significantly associated with favorable outcomes (all p>0.05).
Conclusion
Simultaneous eyelid and exotropia surgery produced surgical outcomes comparable to those of exotropia surgery alone, validating the safety and feasibility of the combined procedure in appropriately selected pediatric patients.

Ophthalmology
Comparison of ganglion cell-inner plexiform layer thickness among patients with intermittent exotropia according to fixation preference: a retrospective observational study: Yeon Ju Lim, Soo Jung Lee; J Yeungnam Med Sci. 2025;42:6. Published online October 25, 2024; DOI: https://doi.org/10.12701/jyms.2024.00864

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Abstract PDF: Background
This study was performed to compare the thickness of the ganglion cell-inner plexiform layer (GCIPL) depending on the presence or absence of fixation preference in patients with intermittent exotropia (IXT) with refractive values close to emmetropia and with no amblyopia.
Methods
The study recruited pediatric patients diagnosed with IXT with a spherical equivalent within ±1.25 diopter and no amblyopia. The patients were categorized into two groups: a monocular exotropia group with fixation preference and an alternating exotropia group without fixation preference. GCIPL thickness was measured using spectral domain optical coherence tomography, and the macula was divided into nine sectors according to the Early Treatment Diabetic Retinopathy Study (ETDRS). GCIPL thickness in each sector was compared between the monocular and alternating exotropia groups.
Results
In the monocular exotropia group, GCIPL thickness was significantly thinner in the dominant eye than in the nondominant eye in the S1 sector (91.2±7.4 μm vs. 93.3±5.2 μm, p=0.019). However, in the alternating exotropia group, there were no significant differences between the eyes across all ETDRS sectors. When comparing the interocular differences in GCIPL thickness between the two groups, the monocular exotropia group (absolute value of the dominant eye minus the nondominant eye) exhibited significantly greater differences in several ETDRS sectors than the alternating exotropia group (absolute value of the right eye minus the left eye).
Conclusion
The significant interocular difference in GCIPL thickness in the monocular exotropia group suggests that fixation preference may influence the anatomical structure of the macula in patients with IXT.

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