Interventions for intermittent distance exotropia: review

Abstract

Purpose Management decisions in intermittent distance exotropia vary and lack well-defined clinical guidelines. We undertook a systematic review in an attempt to clarify the effects of various surgical and nonsurgical treatments and to establish the significance of factors such as age with respect to outcome. The review was undertaken in collaboration with the Cochrane Eyes and Vision Group. Methods Electronic and manual searches were undertaken to identify randomised controlled trials of surgical or nonsurgical treatments for intermittent distance exotropia. We also contacted researchers active in this field for information about further published or unpublished studies. There were no language restrictions. Study abstracts identified from the searches were analysed independently by the two reviewers (SR and LG) and marked for inclusion, exclusion, or consideration. Reviewer analysis was compared and full papers for appropriate studies were requested. Results No randomised controlled trials were found that met our selection criteria. Conclusions The current literature consists mainly of retrospective reviews. These are difficult to compare and analyse due to variations in definition, intervention criteria, and outcome measures. However, there appears to be an agreement that the nonsurgical treatment is more appropriate in small-angle deviations or as a supplement to surgery. Studies supporting both early and late surgical intervention were found, so the optimal timing of surgical intervention could not be concluded. There is a need for robust clinical trials to improve the evidence base for the management of this condition.

Cochrane systematic reviews and co-publication: dissemination of evidence on interventions for ophthalmic conditions

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The use of the Newcastle Control Score in the management of intermittent exotropia

“…4 To this end, a variety of parameters may be measured, which indicate these consequences or progression towards them. There is no consensus about which of these parameters are the most important, although most authors include measures of ''control'' and stereoacuity as end points.…”

“…4 Some authors recommend early surgery to prevent the development of constant exotropia with loss of BSV. 5 However, surgery, particularly early surgery, is associated with a risk of overcorrection causing diplopia or loss of BSV and amblyopia in patients under 5 years of age.…”

New Tests of Distance Stereoacuity and Their Role in Evaluating Intermittent Exotropia

“…3 Authors of retrospective case series have reached opposing conclusions, some suggesting prolonged observation, since visual acuity and near stereoacuity are preserved in the vast majority of cases without intervention, 4 and others suggesting that surgery should be performed early before the deviation becomes constant. 5,6 The proportion of time that the deviation is manifest and the ease of re-fusion after dissociation has been termed "control."…”