The outcome of strabismus surgery in childhood exotropia

Abstract

SUMMARYThe results of squint surgery in 42 children with primary, non-paralytic, childhood exotropia are analysed. A 'favourable outcome', defined as a final alignment for near and distance within ±10 dioptres of straight, or within ±20 dioptres of straight with evidence of bi nocular single vision, was achieved in 39 (93%) children.The factors affecting the final outcome are discussed, including age of onset, age at the time of surgery, pre operative and post-operative amblyopia, refractive error, anisometropia, the surgical procedures used, and post operative ocular alignment.Exotropia in childhood may be primary, secondary, con secutive or paralytic. 1 Primary childhood exotropia may be constant, when the exotropia is manifest for both near and distance, or intermittent, when the exotropia is mani fest for either near or distance. Intermittent distance exo tropia may be either true or simulated depending on the amount of exophoria controlled for near by accommo dation and fusional forces.2We reviewed children who underwent strabismus sur gery for primary childhood exotropia at the Birmingham Children's Hospital, in order to determine the results achieved, to identify the factors associated with favour able and less favourable outcomes, and to consider this information in the planning of future surgery for this condition. PATIENTS AND METHODSThe case notes of consecutive patients undergoing surgery for childhood exotropia at the Birmingham Children's Hospital in the 5 year period between January 1982 and December 1986 were reviewed. Any child with paralytic or consecutive exotropia, neurological disorder, ocular pathology, or a post-operative follow-up period of less than 24 months, was excluded. Information was obtained from the pre-operative examination, and from examin- Eye (1994) 8, 632-637 © 1994 Royal College of Ophthalmologists ations at 2 weeks, at 3-6 months, and at yearly intervals thereafter until discharge.True distance exotropia was defined as an exotropia at distance which exceeded the exophoria at near by more than 10 dioptres; simulated distance exotropia was con sidered present when the difference was 10 dioptres or less.3Amblyopia was defined as a difference of two lines or more between the monocular visual acuities. Anisometro pia was defined as a spherical or cylindrical difference of greater than 1.0 dioptre between the two eyes.4 All refrac tions were undertaken under cycloplegia using either cyclopentolate or atropine. Binocular single vision was assessed using tests of motor and sensory fusion as described in a previous publication, and one or more of these tests of motor or sensory fusion were used at each pre-operative or post -operative examination.5 A 'favourable outcome' was defined as a final align ment for near and distance within ± 10 dioptres of straight, or within ±20 dioptres of straight with evidence of bi nocular single vision.Statistical analysis was performed using medians and the non-parametric Mann-Whitney test for comparing continuous variables, and the chi-squared tes...

Comparative Study of Unilateral Recession Resection Versus Bilateral Recession in Intermittent Exotropia

“…The optimum age for surgery is when the child is able to undergo orthoptic assessment or when the functional and cosmetic symptoms become evident. 12,13 In our study, there was a female preponderance similar to that observed in study by Cass and Gregerson.…”

Surgical Outcome of Unilateral Lateral Rectus Recession and Medial Rectus Resection in Large-Angle Exotropia

“…The favourable age for operation is when the child can be assessed for orthoptic correction and also when the functional and cosmetic symptoms become too apparent. [15][16][17][18] According to the study conducted by Junejo SA et al, 19 the desired postop effect was seen with preoperative deviation of < 60 PD. With deviation > 60 PD, there was difficulty in aligning the eyes with operation only on one eye.…”

Resultados da correção cirúrgica da exotropia permanente em pacientes amblíopes e não-amblíopes

“…Para este estudo, foi adotado o critério de sucesso cirúrgico como ortotropia ± 10 Δ , assim como a maioria dos autores (1,(11)(12)(13)(14) . O sucesso desses procedimentos depende de avaliação pré-operatória completa, considerando-se os possíveis fatores desestabilizadores (15) .…”

“…Outros autores também identificaram idade como fator relacionado ao sucesso cirúrgico, relatando melhores resultados nos pacientes operados antes dos seis anos de idade (1) . Entretanto, na maioria dos trabalhos encontrados, a variável mais relacionada ao sucesso cirúrgico foi uma supercorreção inicial (7)(8)(9)13,17) . Como apresentado na tabela 3, os desvios pós-operatórios dos dois grupos mostraram-se semelhantes (desvio pós-operatório imediato: p=0,228, final: p=0,143), com valores discretamente superiores, tanto para as médias quanto para os desvio-padrões, para o grupo A, mas ainda assim dentro do que consideramos sucesso cirúrgico.…”