Objective To investigate the optimal timing for surgery in early-onset exotropia (XT) and the long-term postoperative effect. Methods One hundred eleven cases diagnosed with XT before 3 years old who were followed up for at least 2 years after surgery were retrospectively analyzed. Logistic regression was used to study the possible factors of the postoperative orthotropia rate and postoperative synoptophore/Titmus stereopsis, such as the age of onset, age at surgery, the type of strabismus, preoperative synoptophore/Titmus stereopsis and postoperative eye position. Results Based on a chi-square test and Spearman correlation analysis, classification of intermittent and constant XT had a statistically significant correlation with the rate of long-term orthotropia (χ²=4.125, P<0.05). Classification of intermittent and constant XT (χ²=3.951, P<0.05) and the postoperative orthotropia (χ²=4.269, P<0.05) had a statistically significant correlation to postoperative synoptophore stereopsis. Classification of intermittent and constant XT had a statistically significant correlation to postoperative Titmus stereopsis (χ²=6.988, P<0.01). Logistic regression analysis showed that the classification of intermittent and constant XT was the main factor affecting the long-term orthotropia rate (OR=0.445, P<0.05). Preoperative synoptophore stereopsis was the main factor affecting postoperative synoptophore stereopsis (OR=10.500, P<0.01). Preoperative Titmus stereopsis and the classification of intermittent and constant XT were the factors affecting postoperative Titmus stereopsis (OR=11.480, 0.175, P<0.05). Conclusion It is suggested that patients with early-onset XT undergo surgery before the loss of binocular vision function. The loss of stereopsis function and the loss of the ability to control deviation were indications for exotropia surgery.
于璐,李晓清,朱德海,庞琳,王丽红,刘嫚. 婴幼儿期外斜视的手术时机及远期疗效[J]. 中华眼视光学与视觉科学杂志, 2015, 17(4): 213-216.
Yu Lu*,Li Xiaoqing,Zhu Dehai,Pang Lin,Wang Lihong,Liu Man. Discussion of the optimal timing for surgery in early-onset exotropia and the long-term postoperative effect. Chinese Journal of Optometry Ophthalmology and Visual science, 2015, 17(4): 213-216. DOI: 10.3760/cma.j.issn.1674-845X.2015.04.006
Behrman RE, Shiono PH. Neonatal risk factors[M]//Fanaroff AA, Martin RJ, editors. Neonatal-perinatal medicine: diseases of the fetus and infant. 5th ed. St Louis:CV Mosby,1992:4.
von Noorden GK. Binocular vision and ocular motility[M]. 6th ed. St. Louis: CV Mosby,2002:356-376.
[8]
Maruo T, Kubota N, Sakaue T, et al. Intermittent exotropia surgery in children: long term outcome regarding changes in binocular alignment. A study of 666 cases[J]. Binocul Vis Strabismus Q,2001,16(4):265-270.
Suh SY, Kim MJ, Choi J, et al. Outcomes of surgery in children with early-onset exotropia[J]. Eye (Lond),2013,27(7):836-840.
[11]
Saunders RA, Trivedi RH. Sensory results after lateral rectus muscle recession for intermittent exotropia operated before two years of age[J]. J AAPOS,2008,12(2):132-135.
[12]
Asjes-Tydeman WL, Groenewoud H, van der Wilt GJ. Timing of surgery for primary exotropia in children[J]. Strabismus,2007, 15(2):95-101.
[13]
Ekdawi NS, Nusz KJ, Diehl NN,et al. Postoperative outcomes in children with intermittent exotropia from a population-based cohort[J]. J AAPOS,2009,13(1):4-7.
Sharma P, Saxena R, Narvekar M, et al.Evaluation of distance and near stereoacuityand fusional vergence in intermittentexotropia[J]. Indian J Ophthalmol,2008,56(2):121-125.