Interventions for intermittent exotropia

Pang, Yi; Gnanaraj, Lawrence; Gayleard, Jessica; Han, Genie; Hatt, Sarah R.

doi:10.1002/14651858.cd003737.pub4

Cited by 18 publications

(30 citation statements)

References 109 publications

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“…We assumed that better fusional function would contribute to a stable postoperative outcome. Further research is needed to explore the role of mechanisms likely associated with exodeviation control to identify the non-surgical therapeutic implications [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial

Peng

Zheng

et al. 2023

JCM

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Background: To assess the clinical effectiveness of orthoptic therapy in the postoperative stabilisation and rehabilitation of binocular function in children with intermittent exotropia (IXT) after surgery. Methods: This was a prospective, parallel, randomised controlled trial. A total of 136 IXT patients (aged from 7 to 17 years) who had been successfully corrected at 1 month after surgery were enrolled in this study, and 117 patients (58 controls) completed the 12-month follow-up visit. The primary outcome was established as the proportion of patients with suboptimal surgical outcomes, which were defined as: (1) exodeviation ≥10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT), or (2) constant esotropia ≥6 PD at distance or near using SPCT, or (3) loss of 2 or more octaves of stereopsis from baseline. The secondary outcomes were the exodeviation at distance and near using the prism and alternate cover test (PACT), stereopsis, fusional exotropia control and convergence amplitude. Results: The cumulative probability of suboptimal surgical outcome by 12 months was 20.5% (14/68) in the orthoptic therapy group and 42.6% (29/68) in the control group. There was a significant difference between these two groups (χ2 = 7.402, p = 0.007). Improvements in stereopsis, fusional exotropia control and fusional convergence amplitude were found in the orthoptic therapy group. A smaller exodrift was found in the orthoptic therapy group at near fixation (t = 2.26, p = 0.025). Conclusions: Early postoperative orthoptic therapy can effectively improve the surgical outcome as well as stereopsis and fusional amplitude.

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Section: Discussionmentioning

confidence: 99%

The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial

Peng

Zheng

et al. 2023

JCM

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“…There is also a lack of consensus on the optimal timing for surgery in children with IXT . Repka et al reported that children who underwent surgery at ages 3 to younger than 5 years had fewer suboptimal outcomes compared with children who underwent surgery at ages 5 to younger than 11 years.…”

Section: Discussionmentioning

confidence: 99%

“…ebate exists regarding the optimal surgical intervention for intermittent exotropia (IXT) in childhood. 1 The initial surgery often involves bilateral lateral rectus recession (BLR) or unilateral lateral rectus recession with medial rectus resection (RR). A Cochrane systematic review, 1 including 2 randomized controlled studies that directly compared BLR with RR, did not find sufficient evidence to support a difference in outcomes between these 2 approaches.…”

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confidence: 99%

Surgical Approach and Reoperation Risk in Intermittent Exotropia in the IRIS Registry

Oke,

Elze,

Miller

et al. 2024

JAMA Ophthalmol

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ImportanceThere is no consensus on the optimal surgical treatment for children with intermittent exotropia (IXT).ObjectiveTo compare the 5-year reoperation rates for children with IXT treated with horizontal muscle strabismus surgery using bilateral lateral rectus recession (BLR) vs unilateral lateral rectus recession with medial rectus resection (RR).Design, Setting, and ParticipantsThis cohort study examined data obtained from the Intelligent Research in Sight (IRIS) Registry on 7482 children (age, &lt;18 years) with IXT who underwent horizontal eye muscle strabismus surgery between January 1, 2013, and December 31, 2017. Children undergoing initial surgeries involving 3 or more horizontal muscles, vertical muscles, or reoperations were excluded.Main Outcomes and MeasuresThe primary outcome was the adjusted cumulative incidence of repeat horizontal muscle surgery within 5 years after the initial surgery. Reoperation risk was analyzed using adjusted hazard ratios (AHRs) derived from multivariable Cox regression models, adjusting for individual demographic and surgical factors (age, sex, race and ethnicity, US Census region, and surgeon subspecialty). Data were analyzed between January 16 and September 20, 2023.ResultsThe study included 7482 children (median [IQR] age at initial surgery, 6 [4-9] years; 3945 females [53%]) with IXT treated with horizontal muscle strabismus surgery. Bilateral lateral rectus recession was performed more frequently than RR (85.3% vs 14.7%, P &lt; .001), especially in younger children (rates of BLR vs RR by age: age 0 to ≤4 years, 88.4% vs 11.6%; age 5 to ≤11 years, 84.7% vs 15.3%; age 12 to ≤17 years, 78.1% vs 21.9%; P &lt; 0.001). After data adjustment, the 5-year cumulative incidence of reoperation was 21.3% (95% CI, 20.1%-22.5%). The adjusted 5-year cumulative incidence of reoperation was higher for BLR than for RR (22.2% vs 17.2%; difference, 4.9%; 95% CI, 1.9%-8.0%). Unilateral lateral rectus recession with medial rectus resection was associated with a lower 5-year reoperation risk compared with BLR (AHR, 0.77; 95% CI, 0.64-0.93). Younger age at time of initial surgery was associated with a higher reoperation risk (AHR per 1-year decrease, 1.09; 95% CI, 1.07-1.11) after adjusting for all other covariates.Conclusions and RelevanceIn this nationwide registry, approximately 1 in 5 children with IXT underwent reoperation within 5 years after the initial surgery. Children treated with RR were less likely to require a reoperation within 5 years compared with those treated with BLR. Further efforts to identify modifiable risk factors for reoperation are needed to reduce the surgical burden and improve outcomes for children with IXT.

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“…A meta-analysis of this issue was conducted by Pang et al [3] who found that PTO achieved better treatment outcomes in terms of near and distant alignment compared to observation, with no evidence that PTO or observation was superior in terms of near stereoacuity. Several controversial aspects of this meta-analysis are worth noting, including the small number of studies (only 2 studies) and cases, the lack of assessment of bias control, and the comparison of only posttreatment distance alignment, near alignment, and near stereopsis, which may have been influenced by baseline values.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Part-Time Occlusion Therapy on Control of Intermittent Exotropia: A Meta-Analysis of Randomized Controlled Trials

Song¹,

Yang²,

Qian³

et al. 2023

Ophthalmic Res

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Objective To compare the effectiveness of part-time occlusion therapy（PTO） and observation in the treatment of intermittent exotropia(IXT). Methods An exhaustive search of the literature from Pubmed, EMBASE, Web of Science, and Cochrane Library databases was carried out until July 2022. No language restrictions were applied. The literature was rigorously screened against eligibility criteria. Weighted mean differences (WMD) and 95% confidence interval (CI) was calculated. Results A total of 4 articles with 617 participants were included in this meta-analysis. Our pooled results showed that PTO exhibited superior effects compared to observation, with greater decrease in exotropia control at distance and near (MD=-0.38, 95% CI: -0.57 to -0.20, P<0.001; MD=-0.36, 95%CI, -0.54 to -0.18, P<0.001), patients subjected to PTO therapy had greater decrease in distance deviations (MD=-1.95, 95% CI: -3.13 to -0.76, P=0.001). And there was greater improvement in near stereoacuity among PTO group in comparison with observation group (P<0.001). Conclusion The present meta-analysis indicated that part-time occlusion therapy showed a better effect in improving control and near stereopsis, and decreasing distance exodeviation angle of children with intermittent exotropia in comparison with observation.

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Interventions for intermittent exotropia

Abstract: Asjes-Tydeman 2006Asjes-Tydeman WL, Groenewoud H, van der Wilt GJ. Timing of surgery for primary exotropia in children.

Cited by 18 publications

References 109 publications

The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial

The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial

Surgical Approach and Reoperation Risk in Intermittent Exotropia in the IRIS Registry

The Influence of Part-Time Occlusion Therapy on Control of Intermittent Exotropia: A Meta-Analysis of Randomized Controlled Trials

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