Three-Year Observation of Children 3 to 10 Years of Age with Untreated Intermittent Exotropia

Mohney, Brian G.; Cotter, Susan A.; Chandler, Danielle L.; Holmes, Jonathan M.; Wallace, David K.; Yamada, Tomohiko; Petersen, David B.; Kraker, Raymond T.; Morse, Christie L.; Melia, B. Michele; Wu, Rui

doi:10.1016/j.ophtha.2019.01.015

Cited by 38 publications

(26 citation statements)

References 19 publications

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“…However, several studies suggested that IXT had a stable course and even got resolved spontaneously [41,42]. Recently, PEDIG [30] conducted a randomized clinical trial, which suggested stable exotropia control, stereoacuity, and magnitude of deviation over 3-year observation in children with untreated IXT. According to the data, the baseline stereoacuity seems to be unpredictable of the change of the ocular alignment.…”

Section: Discussionmentioning

confidence: 99%

“…One possible explanation is that the angle of deviation [ 28 ] and stereoacuity [ 23 ], as well as control [ 29 ], could vary considerably over the day in patients with IXT, even after surgery. Recent prospective studies applied a nonconsecutive retest procedure to confirm the change in the severity of IXT [ 30 , 31 ]. However, our patients only had one assessment per follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Can Clinical Measures of Postoperative Binocular Function Predict the Long-Term Stability of Postoperative Alignment in Intermittent Exotropia?

Zhang

et al. 2020

Journal of Ophthalmology

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Purpose. To evaluate whether clinical measures of postoperative binocular functions could predict the long-term stability of postoperative ocular alignment in children with intermittent exotropia. Methods. A retrospective study was performed in thirty-nine children (median: 7 years) who have been surgically treated from intermittent exotropia without overcorrection (less than 10 prism diopters [pd] of exodeviation at 1 month postoperatively). Angles of deviation and binocular functions were measured preoperatively and at 1 month, 6 months, and the final follow-up visit (≥24 months) postoperatively. We examined the relationships between postoperative drift (change of ocular alignment) and binocular functions (sensory fusion, fusional convergence amplitude, and stereoacuity). Results. The surgical success rate (esophoria/tropia ≤5 pd to exophoria/tropia ≤10 pd) dropped to 76.9% at 6 months after surgery and to 53.8% at individuals’ last visit (mean: 37 months). The mean exodrift was 7.7 ± 9.2 pd from the postoperative month 1 to the final visit (p<0.001) on distance fixation. Distance stereoacuity, central fusion, and fusional convergence amplitude significantly improved following surgery (p<0.05). However, no significant correlation was found between their binocular functions measured at the beginning of each follow-up period and the postoperative drift (all p>0.13). Conclusion. Our findings suggest that the clinical measures of sensory fusion, fusional convergence amplitude, and stereoacuity cannot serve as a robust predictor for the long-term stability of postoperative ocular alignment in patients who underwent successful surgery without overcorrection at 1 month postoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Can Clinical Measures of Postoperative Binocular Function Predict the Long-Term Stability of Postoperative Alignment in Intermittent Exotropia?

Zhang

et al. 2020

Journal of Ophthalmology

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“…For this study, 18 subjects (11 females, 7 males) with typical findings of intermittent exotropia volunteered to participate. [13][14][15] They had a median age of 20 years (range, 8 to 60). They learned about the study from local ophthalmologists or were recruited from the University of California, San Francisco (UCSF) neuro-ophthalmology/pediatric ophthalmology service.…”

Section: Study Populationmentioning

confidence: 99%

Bilateral Occlusion Reduces the Ocular Deviation in Intermittent Exotropia

Economides

Adams

Horton

2021

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.The most common form of strabismus, intermittent exotropia, is thought to become manifest when the drive to fuse is overcome by excessive divergent muscle tone. This principle is tested by examining the alignment of the eyes in the absence of vision. We compare the ocular deviation in patients with intermittent exotropia under conditions of monocular versus binocular occlusion.METHODS. This prospective study of a patient cohort referred to our laboratory enrolled 18 patients with typical findings of well-controlled intermittent exotropia. Eye positions were recorded with video eye trackers while patients looked at a fixation spot at a distance of 57 cm. One eye was occluded, and the resulting ocular deviation was measured. Both eyes were then occluded, and the ocular deviation was re-measured. RESULTS.The majority of patients (11/18) had a smaller deviation when both eyes were covered. Occlusion of one eye resulted in a mean exotropia of 13.5°± 4.7°. Occlusion of both eyes reduced the mean exotropia to 6.0°± 6.5°(paired t-test, P < 0.001), corresponding to a 56% reduction in the ocular deviation. This reduction persisted during prolonged bilateral occlusion but reversed as soon as vision was restored. CONCLUSIONS.Bilateral occlusion reveals a fixation-free state of alignment that is different from orthotropia and usually less than the exotropia that occurs spontaneously during binocular viewing. This finding demonstrates that the deviation angle in patients with intermittent exotropia is actively mediated by visual feedback, which the fixating eye is capable of providing alone.

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“…Eine mögliche Erklärung ist, dass der Schielwinkel [28] und die Stereosehschärfe [23] sowie auch die Kontrolle [29] bei Patienten mit intermittierender Exotropie auch nach der Operation signifikant über den Tagesverlauf schwanken könnten. In neueren prospektiven Studien wurde ein nicht-konsekutives Retest-Verfahren eingesetzt, um die Änderung im Schweregrad der intermittierenden Exotropie zu bestätigen [30, 31]. Dagegen erfolgte bei unseren Patienten nur eine Untersuchung je Nachbeobachtungstermin.…”

Section: Diskussionunclassified

“…Dagegen wiesen mehrere Studien darauf hin, dass die intermittierende Exotropie einen stabilen Verlauf hatte und sogar spontan abklang [41, 42]. In jüngerer Vergangenheit unternahm die PEDIG [30] eine randomisierte klinische Studie, der zufolge die Exotropie-Kontrolle, die Stereosehschärfe und der Grad der Schielstellung bei Kindern mit unbehandelter intermittierender Exotropie über den Beobachtungszeitraum von 3 Jahren stabil waren. Den Daten zufolge scheint die Baseline-Stereosehschärfe keine Vorhersage über die Änderung der Augenstellung zuzulassen.…”

Section: Diskussionunclassified

Lässt sich anhand von klinischen Variablen der Binokularfunktion die langfristige Stabilität der postoperativen Augenstellung nach Korrektur einer intermittierenden Exotropie vorhersagen?

Zhang

et al. 2020

Kompass Ophthalmol

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Zielsetzung: Untersuchung, ob klinische Variablen der postoperativen Binokularfunktion die langfristige Stabilität der postoperativen Augenstellung nach Korrektur einer intermittierenden Exotropie bei Kindern vorhersagen können. Methode: Es erfolgte eine retrospektive Studie zu 39 Kindern (medianes Alter: 7 Jahre), die wegen einer intermittierenden Exotropie operativ behandelt worden waren und bei denen keine Überkorrektur erfolgt war (weniger als 10 Prismen-Dioptrien (PDPT) Exodeviation 1 Monat nach der Operation). Präoperativ sowie 1 Monat und 6 Monate nach der Operation und bei der letzten Nachuntersuchung (≥24 Monate) des Patienten wurden die Schielwinkel und Variablen der Binokularfunktion bestimmt. Wir untersuchten die Beziehung zwischen postoperativer Drift (Änderung der Augenstellung) und Variablen der Binokularfunktion (sensorische Funktion, konvergente Fusionsbreite und Stereosehschärfe). Ergebnisse: Die Erfolgsrate der Operation (Esophorie/-tropie ≤5 PDPT bis Exophorie/-tropie ≤10 PDPT) hatte 6 Monate nach der Operation auf 76,9% und zum Zeitpunkt der letzten Nachuntersuchungen der Patienten (im Mittel nach 37 Monaten) auf 53,8% abgenommen. Die mittlere Exodrift betrug zwischen 1 Monat nach der Operation und der letzten Nachuntersuchung bei Fernfixation 7,7 ± 9,2 PDPT (p < 0,001). Die Stereosehschärfe in der Ferne, die zentrale Fusion und die konvergente Fusionsbreite verbesserten sich nach der Operation signifikant (p < 0,05). Allerdings wurde keine signifikante Korrelation zwischen den Binokularfunktionen zu Beginn jeder Nachbeobachtungsphase und der postoperativen Drift beobachtet (alle p > 0,13). Schlussfolgerung: Unsere Beobachtungen weisen darauf hin, dass die klinischen Variablen sensorische Fusion, konvergente Fusionsbreite und Stereosehschärfe bei erfolgreich operierten Patienten, die 1 Monat nach der Operation keine Überkorrektur zeigen, nicht als robuste Prädiktoren für die langfristige Stabilität der postoperativen, korrigierten Augenstellung geeignet sind.

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Three-Year Observation of Children 3 to 10 Years of Age with Untreated Intermittent Exotropia

Cited by 38 publications

References 19 publications

Can Clinical Measures of Postoperative Binocular Function Predict the Long-Term Stability of Postoperative Alignment in Intermittent Exotropia?

Can Clinical Measures of Postoperative Binocular Function Predict the Long-Term Stability of Postoperative Alignment in Intermittent Exotropia?

Bilateral Occlusion Reduces the Ocular Deviation in Intermittent Exotropia

Lässt sich anhand von klinischen Variablen der Binokularfunktion die langfristige Stabilität der postoperativen Augenstellung nach Korrektur einer intermittierenden Exotropie vorhersagen?

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