The Effect of Preoperative Occlusion Therapy on Long-term Outcome after Surgery for Early-onset Exotropia

Abstract

PurposeTo investigate the effect of preoperative part-time occlusion therapy on long-term surgical success in early-onset exotropia.MethodsThe medical records of patients who underwent surgery for exotropia with onset before the first year of age and who were followed for ≥3 years were reviewed. Patients were divided into two groups according to the degree of compliance with part-time occlusion therapy: the good compliance group (>50% adherence rate) and the poor compliance group (≤50% adherence rate). Surgical success was defined as orthophoria to exodeviation less than 10 prism diopters both at distance and near. The level of postoperative stereopsis was compared between the two study groups among total enrolled patients and among those with constant exotropia.ResultsOf the 51 patients, 26 were assigned to the good compliance group and the remaining 25 patients to the poor compliance group. The surgical success rate was significantly higher in the good compliance group than in the poor compliance group (80.8% vs. 52.0%, p = 0.040). Among 24 constant exotropia patients (12 patients for each group), the success rate was insignificantly higher in the good compliance group than in the poor compliance group (75.0% vs. 58.3%, p = 0.448). The good compliance group had a better level of stereopsis than the poor compliance group (p = 0.045 for all 44 patients, p = 0.020 for 19 patients with constant exotropia).ConclusionsPreoperative part-time occlusion therapy was useful for improving the surgical outcome of early-onset exotropia and postoperative stereopsis.

Factors Associated with Surgical Outcomes after Bilateral Lateral Rectus Recession in Children with Intermittent Exotropia

“…Our study showed that the surgical outcomes were favorable in patients who responded to preoperative part-time occlusion therapy, which is the most commonly used conservative treatment for IXT. Shin et al [24] have suggested that preoperative part-time occlusion therapy is a possible factor in improving long-term surgical outcomes. Our previous study reported improvements in the angle of deviation, control scores, and stereoacuity at distance and near after part-time occlusion therapy [29].…”

“…Numerous studies have suggested various factors that could be related to surgical success, including age at onset, timing of surgery [18][19][20], preoperative angle of deviation [16,20,21], visual acuity, type of surgery [21], type of exotropia [22], and stereopsis [23]. However, there is a paucity of information on the effectiveness of preoperative patching in maintaining successful outcomes after surgery for IXT [24,25].…”

Factors Associated with Surgical Outcomes of Intermittent Exotropia in Children

“…Our study showed that surgical outcomes were favorable for patients who responded to preoperative part-time occlusion therapy, the most commonly used conservative treatment for IXT. Shin et al 21 have suggested that preoperative part-time occlusion therapy is a possible factor improving long-term surgical outcome. Our previous study has reported improvement in angle of deviation, control scores, and stereoacuity at distance and near after part-time occlusion therapy.…”

İnfantil Ekzotropyada Preoperatif Deviasyonun Cerrahi Başarı ve Duyusal Fonksiyon Üzerindene Etkisi

“…More than 90% of patients with infantile exotropia eventually need surgery, resulting in successful alignment and limited binocularity in most patients (4). Although many studies have studied factors associated with infantile exotropia's surgical results, there is a shortage of knowledge about preoperative deviation effects on postoperative outcomes (5)(6)(7)(8). There is no study to assess the impact of preoperative deviation on sensory function in infantile exotropia to the best of our knowledge.…”

“…In another research, postoperative results seem to be affected by misalignment duration rather than age at surgery(7). Shin et al reported that preoperative part-time occlusion treatment improved the surgical result of ear-ly-onset exotropia and postsurgical stereopsis(8).…”