Augmented bilateral lateral rectus recessions in basic intermittent exotropia

Lee, Se-Youp; Kim, Jong Hyun; Thacker, Neepa

doi:10.1016/j.jaapos.2007.02.014

Cited by 32 publications

(45 citation statements)

References 11 publications

(4 reference statements)

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“…Lee and his associates 25 have suggested increasing the amount of lateral rectus recession by 1.5-2.5 mm for each eye in patients with intermittent exotropia and they reported an increase in success rate from 43.9% to 68.2% with a drop of undercorrection from 53.7% to 30.3% in the augmented formula group. In our study, increasing the amount of recession by 1.5 mm has significantly improved the success rate similarly from 41% to 80% in patients older than 12 years old.…”

Section: Eyementioning

confidence: 99%

Intermittent exotropia: relation between age and surgical outcome: a change-point analysis

Awadein

Eltanamly

ElShazly

2014

Eye

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Purpose To study the relationship between age and response to surgery in patients with intermittent exotropia and to identify change points in response to surgery. Methods A retrospective analysis was conducted on 311 patients with intermittent exotropia who had bilateral lateral rectus recession using standard tables with minimum follow-up of 6 months. Data were analyzed using the change-point analysis software to identify cutoff points. A prospective pilot study was then performed on 171 consecutive patients with intermittent exotropia with the same clinical characteristics, in whom amount of recession was modified according to the identified cutoff points. In angles with two change points, 1-mm recession was reduced from patients younger than the lower change point and 1.5-mm recession was added to those older than the upper change point. In angles with one change point, 1.5-mm recession was added to those older than the change point. Satisfactory alignment was defined as esophoria/tropia r5D to exophoria/tropia r8D. Results There was a negative correlation (Po0.01) between response to surgery and age at surgery for all angles. In younger patients (o7 years) in whom surgical dose was reduced, there was no significant change in success rate (77%), compared with those who had surgery using standard tables (75%). In older patients (412 years) in whom surgical dose was increased, there was a statistically significant increase in success rate (80% vs 41%). Conclusions Modifying the surgical dose according to age can improve the success in patients with intermittent exotropia.

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Section: Eyementioning

confidence: 99%

Intermittent exotropia: relation between age and surgical outcome: a change-point analysis

Awadein

Eltanamly

ElShazly

2014

Eye

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“…Three studies included basic and divergence excess (simulated or true) types of X(T),2 12 15 while four studies involved basic type only,13 14 16 17 and four studies did not report on the type of X(T) examined 18–21. Only one study stated that their sample was recruited from multiple centres2; the remainder were single-centre studies.…”

Section: Resultsmentioning

confidence: 99%

“…Neither of the prospective studies used matched comparison groups. The remaining seven cohort studies were retrospective in design; two used consecutive recruitment,16 19 three studies identified cases used defined inclusion criteria,12 15 18 and in two studies, details of patient recruitment was poorly described17 21 or selective 13. In at least five of the studies, there is a possibility of selection bias associated with determining which patient received which procedure, as many of the studies state that the choice of intervention was at the ophthalmologist's or parents’ discretion 2 12 13 19 21.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…However, ‘success’ or ‘improvement’ was variously defined. The diversity in definitions of success employed is an important issue here, with some studies conceptualising a successful outcome as anything within 20PD of orthotropia17 18 while other authors operationalised a much stricter definition (eg, ≤5PD esophoria/tropia to ≤10PD exophoria/tropia,13 14 and various definitions in between (eg, deviation within ±8PD16 or deviation within ±10PD12 19 21). The distinction between phoria and tropia is important, as patients with a tropia are likely to have reduced stereoacuity, despite an improvement in alignment.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…In terms of assessment of outcome measures, only one study13 reported carrying out measurements of the angle of deviation on three different occasions. The time point at which outcomes were measured is another critical issue here, as outcomes can be unstable over time, and three studies reported outcomes at 6 months only 2 16 21…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

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A systematic review of the effectiveness of treatments in altering the natural history of intermittent exotropia

et al. 2014

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Evidence of effectiveness of interventions for treatment of childhood intermittent exotropia, X(T), is unclear. We conducted a systematic review to locate, appraise and synthesise evidence of effectiveness, including twelve electronic databases, supplemented with hand searches and expert contact. We included randomised controlled trials, quasi-experimental and cohort studies with a comparison group examining interventions for divergence excess, simulated divergence excess or basic type X(T) in children, up to and including 18 years of age, followed for at least 6 months. Dual data extraction and critical appraisal were conducted and a narrative synthesis undertaken. Eleven studies satisfied the eligibility criteria. Seven examined the comparative effectiveness of two surgical procedures; four compared surgery with other interventions, including botulinum toxin A therapy, orthoptic exercises, occlusion, binocular vision training and watchful waiting. The evidence retrieved was of limited extent and quality with differences across studies in terms of outcome assessment and most appropriate time-point for measuring long-term outcomes. There were mixed outcomes when comparing unilateral recession/resection (R&R) with bilateral lateral rectus recession (BLR) on improving angle of deviation, which makes it difficult to recommend either surgical option with confidence. While non-surgical interventions appear less effective in terms of improving angle of deviation, they are rarely associated with adverse outcomes. Given the limited evidence base, better designed studies are required to address the question of the most effective management for treatment of childhood X(T). Importantly, consensus is required on what constitutes a successful outcome as well as agreement on how this should be measured.

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Efforts to improve the surgical outcome for exotropia and investigation of the insertion locations of the extraocular muscles

Lai

Chang

2023

The Kaohsiung J of Med Scie

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In our previous retrospective study, we found that using the strabismus surgery dosages established by western strabismus mentors tends to result in undercorrection of Taiwanese exotropia (XT) patients compared with those in western populations. We also discovered that the location of extraocular muscle (EOM) insertion could vary by ethnicity. In this study, using a generalized estimation equation model, we compared the XT surgery outcome between augmented and original strabismus surgery dosages in Taiwanese patients. We also conducted an observational study to investigate the horizontal EOM insertion location in a Taiwanese population and compared the data with Dr. Apt L.'s study. For Taiwanese XT patients, augmented surgical dosages resulted in significantly better outcome at 6 months and 1 year postoperatively compared with original surgical dosages (p = 0.003 and p < 0.001, respectively). The distance from the lateral recuts muscle (LR) insertion location to the limbus was significantly shorter in Taiwanese than in white Americans (6.5 vs. 6.9 mm, respectively, p = 0.0001). Furthermore, the medial rectus muscle and LR insertion locations differed significantly between males and females (p < 0.001 and p = 0.023, respectively). The patients' sex did not affect the surgery outcome. Augmented surgery doses modified from western strabismus mentors produce better surgery outcome for Taiwanese XT patients. Surgeons may require country‐specific guidelines for strabismus surgery dosage. We also demonstrated a simple method for young ophthalmologists to establish their own normograms to improve their surgical success rate. Our study confirms that LR insertion locations differ between Taiwanese and White Americans.

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Augmented bilateral lateral rectus recessions in basic intermittent exotropia

Cited by 32 publications

References 11 publications

Intermittent exotropia: relation between age and surgical outcome: a change-point analysis

Intermittent exotropia: relation between age and surgical outcome: a change-point analysis

A systematic review of the effectiveness of treatments in altering the natural history of intermittent exotropia

Efforts to improve the surgical outcome for exotropia and investigation of the insertion locations of the extraocular muscles

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