|
|
Long-term surgical results of children with Intermittent Exotropia |
Min Zhang ,Meiping Xu, Xinping Yu ,Junxiao Zhang ,Huanyun Yu |
Zhejiang Industry & Trade Vocational College, Wenzhou 325003, China Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China |
|
|
Abstract Objective: To investigate the long-term clinical effects and postoperative changes in children with intermittent exotropia. Methods: In this retrospective case series study, 139 children with intermittent exotropia and who underwent strabismus surgery were followed for more than 12 months. Distant and near squint angles as well as binocular visual function parameters were collected preoperatively, at 1 week and 1 month postoperatively, and at the last follow-up. Independent sample t-tests were used to compare the distant and near squint angles between the pre- and postoperative periods. Chi-square tests were used to analyze distant and near sensory fusion and stereopsis. results: The mean age was 7.4 ± 2.6 years (range 4-14 years), and the follow-up time was 21.0 ± 10.5 months (range 12-51 months).The preoperative distant and near deviation were -33.9 △ ± 10.9 △ (range -20 △ - -75 △ ) and -38.2 △ ± 10.2 △ (range-20 △ - -85 △ ), respectively. At the final follow-up examination, the mean postoperative distant and near squint angles were -6.4 △ ± 8.0 △ (+16 △ - -35 △ ) and -7.7 △ ± 9.6 △ (+ 20 △ - -40 △ ) respectively. Among the patients, 103 cases (74.1%) were orthophoric, 35 cases (25.2%) had recurrent exotropia, and 1 case (0.7%) showed overcorrected strabismus. Bilateral visual acuity was significantly improved at the final follow-up examination. The distant and near perceptual fusion were significantly improved ( χ 2 =26.88,26.24, P < 0.001), as was the distant and near stereopsis ( χ 2 =64.38, P < 0.001; χ 2 =14.63, P=0.002). The 35 patients who relapsed at the last follow up had significantly improved perceptual fusion function ( χ 2 =14.58, P=0.002) and better distant and near stereopsis acuity, although the changes were not
statistically significant. conclusions: Approximately 75% of the children with intermittent exotropia maintained long-term orthophoria after surgery, and their binocular vision was significantly improved.Even in children with postoperative recurrence, binocular visual function was better than before surgery.
|
Received: 21 March 2018
|
Corresponding Authors:
Xinping Yu, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China(Email: yu-xinping@163.com)
|
|
|
|
[1] |
Pathai S, Cumberland PM, Rahi JS. Prevalence of and early-life influences on childhood strabismus: findings from the Millennium Cohort Study. Arch Pediatr Adolesc Med, 2010,
|
16 |
4(3): 250-257. DOI: 10.1001/archpediatrics.2009.297.
|
[2] |
Nusz KJ, Mohney BG, Diehl NN. The course of intermittent exotropia in a population—based cohort. Ophthalmology, 2006,113(7): 1154-1158. DOI: 10.1016/j.ophtha.2006.01.033.
|
[3] |
王利华, 赵堪兴. 间歇性外斜视治疗中的热点问题. 中华眼科杂志, 2015, 51(6): 465-469. DOI: 10.3760/cma.j.issn.0412-4081.2015.06.019.
|
[4] |
Koklanis K, Georgievski Z. Recurrence of intermittent exotropia: factors associated with surgical outcomes. Strabismus, 2009,17(1): 37-40. DOI: 10.1080/09273970802678750.
|
[5] |
Pineles SL, Ela-Dalman N, Zvansky AG, et al. Long-term results of the surgical management of intermittent exotropia. JAAPOS,2010, 14(4): 298-304. DOI: 10.1016/j.jaapos.2010.06.007.
|
[6] |
Choi J, Chang JW, Kim SJ, et al. The long-term survival analysis of bilateral lateral rectus recession versus unilateral recession-resection for intermittent exotropia. Am J Ophthalmol, 2012,153(2): 343-351.e1. DOI: 10.1016/j.ajo.2011.06.024.
|
[7] |
Choi J, Kim SJ, Yu YS. Initial postoperative deviation as a predictor of long-term outcome after surgery for intermittent exotropia. JAAPOS, 2011, 15(3): 224-229. DOI: 10.1016/j.jaapos.2010.12.019.
|
[8] |
Oh JY, Hwang JM. Survival analysis of 365 patients with exotropia after surgery. Eye (Lond), 2006, 20(11): 1268-1272.DOI: 10.1038/sj.eye.6702091.
|
[9] |
Jeoung JW, Lee MJ, Hwang JM. Blateral lateral rectus recession versus unilateral recess-resect procedure for exotropia with a dominant eye. Am J Ophthalmol, 2006, 141(4): 683-688. DOI:10.1016/j.ajo.2005.11.021.
|
[10] |
Lim SH, Hwang BS, Kim MM. Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia. Eye (Lond), 2012, 26(6): 846-852. DOI:10.1038/eye.2012.55.
|
[11] |
Lee SY, Hyun KJ, Thacker NM. Augmented bilateral lateral rectus recessions in basic intermittent exotropia. J AAPOS,2007, 11(3): 266-268. DOI: 10.1016/j.jaapos.2007.02.014.
|
[12] |
任艳红, 赵堪兴, 陈霞, 等. 间歇性外斜视术后远期疗效及其影响因素分析. 中国实用眼科杂志, 2009, 27(5): 489-492. DOI:10.3760/cma.j.issn.1006-4443.2009.05.020.
|
[13] |
Holmes JM, Hatt SR, Leske DA. Is intermittent exotropia a curable condition? Eye (Lond), 2015, 29(2): 171-176. DOI:10.1038/eye.2014.268.
|
[14] |
吴奇志, 吴晓, 卢炜, 等. 间歇性外斜视手术前后双眼视觉的临床研究. 中华眼科杂志, 2007, 43(11): 968-971. DOI: 10.3760/j.issn:0412-4081.2007.11.003.
|
[15] |
Ekdawi NS, Nusz KJ, Diehl NN, et al. Postoperative outcomes in children with intermittent exotropia from a population-based cohort. J AAPOS, 2009, 13(1): 4-7. DOI: 10.1016/j.jaapos.2008.06.001.
|
[16] |
Leow PL, Ko ST, Wu PK, et al. Exotropic drift and ocular alignment after surgical correction for intermittent exotropia.J Pediatr Ophthalmol Strabismus, 2010, 47(1): 12-16. DOI:
|
[1] |
Pathai S, Cumberland PM, Rahi JS. Prevalence of and early-life influences on childhood strabismus: findings from the Millennium Cohort Study. Arch Pediatr Adolesc Med, 2010,
|
16 |
4(3): 250-257. DOI: 10.1001/archpediatrics.2009.297.
|
[2] |
Nusz KJ, Mohney BG, Diehl NN. The course of intermittent exotropia in a population—based cohort. Ophthalmology, 2006,113(7): 1154-1158. DOI: 10.1016/j.ophtha.2006.01.033.
|
[3] |
王利华, 赵堪兴. 间歇性外斜视治疗中的热点问题. 中华眼科杂志, 2015, 51(6): 465-469. DOI: 10.3760/cma.j.issn.0412-4081.2015.06.019.
|
[4] |
Koklanis K, Georgievski Z. Recurrence of intermittent exotropia: factors associated with surgical outcomes. Strabismus, 2009,17(1): 37-40. DOI: 10.1080/09273970802678750.
|
[5] |
Pineles SL, Ela-Dalman N, Zvansky AG, et al. Long-term results of the surgical management of intermittent exotropia. JAAPOS,2010, 14(4): 298-304. DOI: 10.1016/j.jaapos.2010.06.007.
|
[6] |
Choi J, Chang JW, Kim SJ, et al. The long-term survival analysis of bilateral lateral rectus recession versus unilateral recession-resection for intermittent exotropia. Am J Ophthalmol, 2012,153(2): 343-351.e1. DOI: 10.1016/j.ajo.2011.06.024.
|
[7] |
Choi J, Kim SJ, Yu YS. Initial postoperative deviation as a predictor of long-term outcome after surgery for intermittent exotropia. JAAPOS, 2011, 15(3): 224-229. DOI: 10.1016/j.jaapos.2010.12.019.
|
[8] |
Oh JY, Hwang JM. Survival analysis of 365 patients with exotropia after surgery. Eye (Lond), 2006, 20(11): 1268-1272.DOI: 10.1038/sj.eye.6702091.
|
[9] |
Jeoung JW, Lee MJ, Hwang JM. Blateral lateral rectus recession versus unilateral recess-resect procedure for exotropia with a dominant eye. Am J Ophthalmol, 2006, 141(4): 683-688. DOI:10.1016/j.ajo.2005.11.021.
|
[10] |
Lim SH, Hwang BS, Kim MM. Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia. Eye (Lond), 2012, 26(6): 846-852. DOI:10.1038/eye.2012.55.
|
[11] |
Lee SY, Hyun KJ, Thacker NM. Augmented bilateral lateral rectus recessions in basic intermittent exotropia. J AAPOS,2007, 11(3): 266-268. DOI: 10.1016/j.jaapos.2007.02.014.
|
[12] |
任艳红, 赵堪兴, 陈霞, 等. 间歇性外斜视术后远期疗效及其影响因素分析. 中国实用眼科杂志, 2009, 27(5): 489-492. DOI:10.3760/cma.j.issn.1006-4443.2009.05.020.
|
[13] |
Holmes JM, Hatt SR, Leske DA. Is intermittent exotropia a curable condition? Eye (Lond), 2015, 29(2): 171-176. DOI:10.1038/eye.2014.268.
|
[14] |
吴奇志, 吴晓, 卢炜, 等. 间歇性外斜视手术前后双眼视觉的临床研究. 中华眼科杂志, 2007, 43(11): 968-971. DOI: 10.3760/j.issn:0412-4081.2007.11.003.
|
[15] |
Ekdawi NS, Nusz KJ, Diehl NN, et al. Postoperative outcomes in children with intermittent exotropia from a population-based cohort. J AAPOS, 2009, 13(1): 4-7. DOI: 10.1016/j.jaapos.2008.06.001.
|
[16] |
Leow PL, Ko ST, Wu PK, et al. Exotropic drift and ocular alignment after surgical correction for intermittent exotropia.J Pediatr Ophthalmol Strabismus, 2010, 47(1): 12-16. DOI:
|
10 |
3928/01913913-20100106-04.
|
[17] |
吴其正, 王晓明, 王利华, 等. 单眼外直肌后徙术治疗儿童间歇性外斜视的疗效. 中华眼视光学与视觉科学杂志, 2012, 14(1):34-37. DOI: 10.3760/cma.j.issn.1674-845X.2012.01.009.
|
[18] |
许江涛, 李辉, 夏红玉, 等. 儿童间歇性外斜视术后远期定量立体视觉测定与分析. 中国实用眼科杂志, 2012, 30(10): 1189-1192. DOI: 10.3760/cma.j.issn.1006-4443.2012.10.014.
|
[19] |
Kwon J, Kim SH, Cho YA. Postoperative stabilization of the strabismic angle in intermittent exotropia. Korean J Ophthalmol,2012, 26(6): 446-450. DOI: 10.3341/kjo.2012.26.6.446.
|
[20] |
Holmes JM, Leske DA, Hatt SR, et al. Stability of near stereoacuity in childhood intermittent exotropia. JAAPOS, 2011,15(5): 462-467. DOI: 10.1016/j.jaapos.2011.06.008.
|
[21] |
Hatt SR, Haggerty H, Buck D, et al. Distance stereoacuity in intermittent exotropia. Br J Ophthalmol, 2007, 91(2): 219-221.DOI: 10.1136/bjo.2006.099465.
|
[22] |
Adams WE, Leske DA, Hatt SR, et al. Improvement in distance stereoacuity following surgery for intermittent exotropia.JAAPOS, 2008, 12: 141-144. DOI: 10.1016/j.jaapos.2007.09.
|
10 |
3928/01913913-20100106-04.
|
[17] |
吴其正, 王晓明, 王利华, 等. 单眼外直肌后徙术治疗儿童间歇性外斜视的疗效. 中华眼视光学与视觉科学杂志, 2012, 14(1):34-37. DOI: 10.3760/cma.j.issn.1674-845X.2012.01.009.
|
[18] |
许江涛, 李辉, 夏红玉, 等. 儿童间歇性外斜视术后远期定量立体视觉测定与分析. 中国实用眼科杂志, 2012, 30(10): 1189-1192. DOI: 10.3760/cma.j.issn.1006-4443.2012.10.014.
|
[19] |
Kwon J, Kim SH, Cho YA. Postoperative stabilization of the strabismic angle in intermittent exotropia. Korean J Ophthalmol,2012, 26(6): 446-450. DOI: 10.3341/kjo.2012.26.6.446.
|
[20] |
Holmes JM, Leske DA, Hatt SR, et al. Stability of near stereoacuity in childhood intermittent exotropia. JAAPOS, 2011,15(5): 462-467. DOI: 10.1016/j.jaapos.2011.06.008.
|
[21] |
Hatt SR, Haggerty H, Buck D, et al. Distance stereoacuity in intermittent exotropia. Br J Ophthalmol, 2007, 91(2): 219-221.DOI: 10.1136/bjo.2006.099465.
|
[22] |
Adams WE, Leske DA, Hatt SR, et al. Improvement in distance stereoacuity following surgery for intermittent exotropia.JAAPOS, 2008, 12: 141-144. DOI: 10.1016/j.jaapos.2007.09.
|
|
015.
|
|
015.
|
|
|
|