Abstract
Purpose
To evaluate and compare surgical outcomes with respect to refractive errors in strabismus surgery for the treatment of intermittent exotropia (IXT).
Methods
The medical records of patients with IXT who were treated by one surgeon from January 2005 and June 2011 were reviewed. Three hundred and thirty-three IXT patients were included and divided into three groups according to preoperative refractive error: IXT with hyperopia (group I), IXT with emmetropia (group II), and IXT with myopia (group III). The surgical outcomes with respect to sensory and motor criteria were compared among the three groups.
Results
The surgical success rates according to motor criteria and sensory and motor criteria combined were higher in groups I (29 patients) and III (124 patients) than in group II (180 patients) at postoperative 3 and 6 months and at the last follow-up. Stereopsis was significantly better in groups II and III than in group I preoperatively (P=0.002 by one-way analysis of variance test); however, the difference was not significant postoperatively. Twenty patients in group I (69.0%) were prescribed undercorrected hyperopic spectacles postoperatively, while only 22 patients in group III (17.7%) were prescribed spectacles with more myopic power than their refractive errors.
Conclusion
In the surgical treatment of IXT, hyperopia was not an indicator of poor prognosis. Taking into consideration the age effect, follow-up period after IXT surgery, and stereopsis improvement, hyperopic refractive error is rather a good prognostic factor.
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References
Friedmann Z, Neumann E, Hyams SW, Peleg B . Ophthalmic screening of 38,000 children, age 1 to 2 1/2 years, in child welfare clinics. J Pediatr Ophthalmol Strabismus 1980; 17: 261–7.
Nusz KJ, Mohney BG, Diehl NN . The course of intermittent exotropia in a population-based cohort. Ophthalmology 2006; 113: 1154–1158.
Preslan MW, Novak A . Baltimore vision screening project. Ophthalmology 1996; 103: 105–109.
Clarke WN, Noel LP . Surgical results in intermittent exotropia. Can J Ophthalmol 1981; 16: 66–69.
Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG . Postoperative outcomes in children with intermittent exotropia from a population-based cohort. J AAPOS 2009; 13: 4–7.
Hardesty HH, Boynton JR, Keenan JP . Treatment of intermittent exotropia. Arch Ophthalmol 1978; 96: 268–274.
Pratt-Johnson JA, Barlow JM, Tillson G . Early surgery in intermittent exotropia. Am J Ophthalmol 1977; 84: 689–694.
Richard JM, Parks MM . Intermittent exotropia: surgical results in different age groups. Ophthalmology 1983; 90: 1172–1177.
Weinstein GS, Biglan AW, Hiles DA . Postoperative residual small angle exodeviations. Ophthalmic Surg 1982; 13: 478–482.
Pineles SL, Ela-Dalman N, Zvansky AG, Yu F, Rosenbaum AL . Long-term results of the surgical management of intermittent exotropia. J AAPOS 2010; 14: 298–304.
Beneish R, Flanders M . The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol 1994; 29: 119–124.
Ko BW, Shin SY . The clinical features of patients with early recurrence and with orthophoria after intermittent exotropia surgery. J Korean Ophthalmol Soc 2008; 49 (7): 1108–1113.
Kim SJ, Choi DG . The clinical features in patients with orthophoria over three years after surgery of exotropia. J Korean Ophthalmol Soc 2006; 47 (12): 1999–2004.
Kim JH, Kim HJ, Choi DG . Contralateral lateral rectus recession versus recess-resect for recurrent exotropia after unilateral recess-resect. Br J Ophthalmol 2013; 97: 752–756.
Jang JH, Park JM, Lee SJ . Factors predisposing to consecutive esotropia after surgery to correct intermittent exotropia. Graefes Arch Clin Exp Ophthalmol 2012; 250: 1485–1490.
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: 274–279.
Suh SY, Kim MJ, Choi J, Kim SJ . Outcomes of surgery in children with early-onset exotropia. Eye 2013; 27: 836–840.
Pineless SL, Deltz LW, Velez FG . Postoperative outcomes of patients initially overcorrected for intermittent exotropia. J AAPOS 2011; 15: 527–531.
Buck D, Powell CJ, Rahi J, Cumberland P, Tiffin P, Taylor R et al. The improving outcomes in intermittent exotropia study: outcomes at 2 years after diagnosis in an observational cohort. BMC Ophthalmol 2012; 12: 1.
Von Noorden GK . Exodeviations Binocular Vision and Ocular Motility, 6th ed. Mosby: : St Louis, USA, 2002; pp 365–366.
Iacobucci IL, Archer SM, Giles CL . Children with exotropia responsive to spectacle correction of hyperopia. Am J Ophthalmol. 1993; 116: 79–83.
Kushner BJ . Surgical pearls for the management of intermittent exotropia. Am Orthopt J 1992; 42: 65–71.
Lim SH, Hwang BS, Kim MM . Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia. Eye 2012; 26: 846–852.
Kushner BJ . Selective surgery for intermittent exotropia based on distance/near differences. Arch Ophthalmol 1998; 116: 324–328.
Gezer A, Sezen F, Nasri N, Gozum N . Factors influencing the outcome of strabismus surgery in patients with exotropia. J AAPOS 2004; 8: 56–60.
Burke MJ . Intermittent exotropia. Int Ophthalmol Clin 1985; 25: 53–68.
Scott WE, Keech R, Mash AJ . The postoperative results and stability of exodeviations. Arch Ophthalmol 1981; 99: 1814–1818.
Koklanis K, Georglevski Z . Recurrence of intermittent exotropia: factors associated with surgical outcomes. Strabismus 2009; 17: 37–40.
Scattergood KD, Brown MH, Guyton DL . Artifacts introduced by spectacle lenses in the measurement of strabismic deviations. Am J Ophthalmol 1983; 96: 439–448.
Vazquez RL . The effect of surgical technique and the radius of the eye on correction for horizontal strabismus. Ann Ophthalmol 1987; 19: 187–193.
Kushner BJ, Lucchese NJ, Morton GV . Variation in axial length and anatomical landmarks in strabismic patients. Ophthalmology 1991; 98: 400–406.
Kushner BJ, Lucchese NJ, Morton GV . The influence of axial length on the response to strabismus surgery. Arch Ophthalmol 1989; 107: 1616–1618.
Kushner BJ, Fisher MR, Lucchese NJ, Morton GV . Factors influencing response to strabismus surgery. Arch Ophthalmol 1993; 111: 75–79.
Chung SA, Kim IS, Kim WK, Lee JB . Changes in exodeviation following hyperopic correction in patients with intermittent exotropia. J Pediatr Ophthalmol Strabismus 2011; 48: 278–284.
Stathacopoulos RA, Rosenbaum AL, Zanoni D, Stager DR, McCall LC, Ziffer AJ et al. Distance stereoacuity. Assessing control in intermittent exotropia. Ophthalmology 1993; 100: 495–500.
O’Neal TD, Rosenbaum AL, Stathacopoulos RA . Distance stereo acuity improvement in intermittent exotropic patients following strabismus surgery. J Pediatr Ophthalmol Strabismus. 1995; 32: 353–357.
Yildrim C, Mutlu FM, Chen Y, Altinsoy HI . Assessment of central and peripheral fusion and near and distance stereoacuity in intermittent exotropic patients before and after strabismus surgery. Am J Ophthalmol 1999; 128: 222–230.
Holmes JM, Leske DA, Hatt SR, Brodsky MC, Mohney BG . Stability of near stereoacuity in childhood intermittent exotropia. J AAPOS 2011; 15: 462–467.
O’Connor AR, Birch EE, Anderson S, Draper H, FSOS Research Group. The functional significance of stereopsis. Invest Ophthalmol Vis Sci 2010; 51: 2019–2023.
Acknowledgements
This study was supported by Kim’s Eye Hospital Research Centre.
Author contributions
Study design: MKK, S-HB; data collection: MKK, S-HB; data analysis: MKK, USK, M-JC, S-HB; and manuscript drafting and revision: MKK, S-HB.
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Presented at the 2013 American Association for Pediatric Ophthalmology and Strabismus—Singapore National Eye Centre Joint Meeting, Singapore, 14–16 July 2013.
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Kim, M., Kim, U., Cho, MJ. et al. Hyperopic refractive errors as a prognostic factor in intermittent exotropia surgery. Eye 29, 1555–1560 (2015). https://doi.org/10.1038/eye.2015.152
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DOI: https://doi.org/10.1038/eye.2015.152
