Richard A Saunders1, Rupal H Trivedi. 1. Department of Ophthalmology, Miles Center for Pediatric Ophthalmology Storm Eye Institute, Medical University of South Carolina, Charleston, SC 29425, USA. saundric@musc.edu
Abstract
INTRODUCTION: Early surgical treatment of early-onset intermittent exotropia is controversial. The condition does not always progress, and postoperative esotropia can produce adverse consequences, such as suppression, amblyopia, and loss of binocular vision, particularly stereopsis. It is not known whether surgery before age two years affects the sensory outcome. METHODS: Using a noncomparative (nonrandomized, uncontrolled) interventional case series, we reviewed the medical records during a 14-year period of 24 patients with intermittent exotropia with onset before age 1 year who also received bilateral lateral rectus muscle recessions before two years of age. Twelve patients were identified who received follow-up examinations at ages > or =4 years, when testing with Worth 4-Dot and Titmus stereo circles would likely be reliable. RESULTS: Mean age of the patients at last follow-up examination was 87 months. Stereoacuity was measured at 40 arcsec in 2 patients, 100 arcsec in 3 patients, 140-400 arcsec in 2 patients, and none in 5 patients. Among the 5 patients without demonstrated stereopsis, 1 had a history and clinical course consistent with congenital exotropia, and 1 had a nonstrabismic explanation for poor stereopsis. Overall, 7 patients (58%) ultimately obtained favorable motor alignment, defined as a phoria or intermittent tropia <10(Delta) at distance and near. No patient required treatment for amblyopia. CONCLUSIONS: Early-onset intermittent exotropia usually responds well to surgical treatment, and high-grade stereopsis can be achieved in some cases. More than one clinical entity presenting as intermittent exotropia in infancy probably exists.
INTRODUCTION: Early surgical treatment of early-onset intermittent exotropia is controversial. The condition does not always progress, and postoperative esotropia can produce adverse consequences, such as suppression, amblyopia, and loss of binocular vision, particularly stereopsis. It is not known whether surgery before age two years affects the sensory outcome. METHODS: Using a noncomparative (nonrandomized, uncontrolled) interventional case series, we reviewed the medical records during a 14-year period of 24 patients with intermittent exotropia with onset before age 1 year who also received bilateral lateral rectus muscle recessions before two years of age. Twelve patients were identified who received follow-up examinations at ages > or =4 years, when testing with Worth 4-Dot and Titmus stereo circles would likely be reliable. RESULTS: Mean age of the patients at last follow-up examination was 87 months. Stereoacuity was measured at 40 arcsec in 2 patients, 100 arcsec in 3 patients, 140-400 arcsec in 2 patients, and none in 5 patients. Among the 5 patients without demonstrated stereopsis, 1 had a history and clinical course consistent with congenital exotropia, and 1 had a nonstrabismic explanation for poor stereopsis. Overall, 7 patients (58%) ultimately obtained favorable motor alignment, defined as a phoria or intermittent tropia <10(Delta) at distance and near. No patient required treatment for amblyopia. CONCLUSIONS: Early-onset intermittent exotropia usually responds well to surgical treatment, and high-grade stereopsis can be achieved in some cases. More than one clinical entity presenting as intermittent exotropia in infancy probably exists.
Authors: Deborah Buck; Christine J Powell; Jugnoo Rahi; Phillippa Cumberland; Peter Tiffin; Robert Taylor; John Sloper; Helen Davis; Emma Dawson; Michael P Clarke Journal: BMC Ophthalmol Date: 2012-01-18 Impact factor: 2.209
Authors: Xi Wang; Lu Lu; Meng Liao; Hong Wei; Xiaohang Chen; Xiaoqi Huang; Longqian Liu; Qiyong Gong Journal: Front Neurosci Date: 2022-10-04 Impact factor: 5.152