Intermittent Exotropia: How Do They “Turn Out”?

Pritchard, Cindy

doi:10.1080/0065955x.1993.11981980

Cited by 15 publications

(11 citation statements)

References 12 publications

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“…1 The cause of this high rate of undercorrection is still not clear. Pritchard 2 once mentioned variability in the measurement of exotropia and pointed out that the most simple and obvious potential explanation for this high rate of recurrence of intermittent exotropia may be not operating to the full angle of the deviation. Kushner 3 suggested that patients who had 'outdoor sensitivity' or 'vergence aftereffect at distance' in the outdoor measurement through the window or postocclusion measurement at 6 meters should undergo surgery for the largest angle measured, because undercorrections typically exceed overcorrections in exotropia.…”

Section: Introductionmentioning

confidence: 99%

‘Largest angle to target’ in surgery for intermittent exotropia

2005

Eye

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Purpose To evaluate the safety of the approach based on the notion that the surgical dose for intermittent exotropia should be based on the largest angle ever measured. Design Prospective case series of 33 patients. Methods A total of 33 patients with intermittent exotropia, in whom angles of misalignment at distance or near showed a difference of 15 prism diopters (PD) or more among visits, were included. All the patients were treated by bilateral lateral rectus recession by the same surgeon (JMH), and all were followed up for a minimum of 6 months postoperatively. Short-and long-term surgical results after the initial procedure for intermittent exotropia were analysed. Results The short-term average result at a postoperative 1 week was 9.3 PD esotropia at distance (range 30 esotropia -16 exotropia). The long-term average results postoperative 6 or 9 months were 4.8 PD exotropia at distance (range 12 esotropia -30 exotropia). At the last follow-up, no overcorrection over 2 PD esophoria at distance was found, and 9 PD of intermittent esotropia and esophoria at near was observed in two patients, respectively. Conclusions The strategy of surgical dose for intermittent exotropia based on the largest angle ever measured did not result in overcorrections and is believed to be safe.

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Section: Introductionmentioning

confidence: 99%

‘Largest angle to target’ in surgery for intermittent exotropia

2005

Eye

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“…Postoperative results for IXT can sometimes be discouraging for patients due to the high rate of recurrence over time [ 16 ]. Pritchard attributed this finding to variability in the measurement of exotropia and, consequently, not operating to the full angle of deviation [ 17 ]. Thus, the current trend is to target the largest angle for optimal surgical results [ 9 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Patients with Intermittent Exotropia According to the Response to Short-term Prism Adaptation Test

Yun

Kim

Jung

2020

Korean J Ophthalmol

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Purpose To evaluate the prevalence of the prism adaptation response in patients with intermittent exotropia (IXT) using the short-term prism adaptation test (PAT) and to assess factors associated with prism adaptation response in IXT patients. Methods A case-controlled retrospective analysis was performed on 113 patients with IXT without prior surgical treatment. Age, sex, visual acuity, refraction, stereoacuity, control scale, type of exotropia, history of occlusion, and presence of accompanying visual symptoms were recorded. Prism alternate cover test (PACT) was performed with fixation targets at 6 m and 1/3 m. All patients underwent short-term PAT wearing prism glasses that offset the exodeviation previously measured by PACT. After 30 minutes, angle deviation was measured, and patients were classified into either an increase group, which had an increase in deviation ≥5 prism diopters after short-term PAT, or a no-change group. Analysis was performed to investigate the clinical factors influencing the increase in exodeviation after short-term PAT. Results Fifty patients (44.2%) showed an increase ≥5 prism diopters during distance or near fixation after short-term PAT compared to the previous PACT: 12 patients (10.6%) showed an increment at distance fixation, and 45 patients (39.8%) showed an increase at near fixation. At distance fixation, the increase-group had a significantly smaller maximum angle measured by PACT. At near distance, age at PAT, maximum distance angle, minimum distance angle, maximum near angle, minimum near angle, angle fluctuation at near, and IXT type showed significant associations with positive short-term PAT response. In the multivariate analysis, older age and smaller maximum near angle were significantly associated with positive short-term PAT response at near fixation. Conclusions Short-term PAT could be helpful in older IXT patients with a small maximum angle of deviation at near fixation to mitigate the vergence aftereffect and show the maximum angle of deviation.

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“…Different surgical dosages are used for same amount of deviation which can potentially explain the wide variability of the outcomes reported in literature, however, no such relation was found in a study by Chia et al 22. Another potential cause for inconsistent surgical outcomes could be not operating for the maximum angle of deviation 91. Suggestions have been made to consider largest measured angle as the target angle for surgery for good outcomes, not necessarily the measurement of X(T) with a distant outdoor fixation target,92 without an increase in overcorrection.…”

Section: Factors Affecting Surgical Outcomesmentioning

confidence: 99%

Surgical management of intermittent exotropia: do we have an answer for all?

Chougule

Kekunnaya

2019

BMJ Open Ophth

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Intermittent exotropia (X(T)) is one of the most common form of strabismus with surgery being the mainstay of treatment. The main goal of surgery is to preserve binocular vision and stereopsis and to prevent its further loss. The decision to operate is mainly based on four aspects: increasing angle of exodeviation, deteriorating control of X(T), decrease in stereopsis for near or distance and quality of life. Bilateral lateral rectus muscle recession and unilateral lateral rectus recession with medial rectus resection, are the two most common surgical procedures performed and have been studied extensively in basic, divergence excess and convergence insufficiency types of X(T). However, there is no consensus over the relative efficacy of the two procedures in terms of postoperative alignment, residual or recurrent exotropia and consecutive esotropia with widely variable results, which can be attributed to poor understanding of the natural course of the disease. Multiple demographic, clinical and anatomic features that may influence the surgical outcomes have been studied to explain this variability. Moreover, most of the evidence regarding surgical outcomes of X(T) is from retrospective studies and the ongoing randomised prospective trials can shed light on long-term efficacy of these procedures. The goal of this review is to give a comprehensive overview of the outcomes of various surgical techniques in the management of different types of X(T), the preoperative and postoperative factors that may affect the surgical outcomes and to discuss the dilemmas faced by the treating surgeons including the effective management of overcorrection and undercorrection.

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Intermittent Exotropia: How Do They “Turn Out”?

Cited by 15 publications

References 12 publications

‘Largest angle to target’ in surgery for intermittent exotropia

‘Largest angle to target’ in surgery for intermittent exotropia

Clinical Characteristics of Patients with Intermittent Exotropia According to the Response to Short-term Prism Adaptation Test

Surgical management of intermittent exotropia: do we have an answer for all?

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