Observation on the curative effects of two surgical methods for basic intermittent exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the differences between unilateral recess-resection (R & R) and bilateral lateral rectus recession (BLR-rec) in the treatment of basic intermittent exotropia.METHODS: A retrospective analysis of treatment of basic intermittent exotropia in 89 patients,in which 49 cases underwent unilateral recess-resection,40 cases underwent bilateral lateral rectus recession of external rectus retroperitoneal surgery January 2013 to January 2015 in our hospital.The stereopsis and strabismus were observed in 1d,1,6mo,1 and 2a after operation.RESULTS: There was no significant difference in the success rate and oblique degree between the two groups after 1d,1,6mo,1 and 2a (all P>0.05),but the success rate of the operation was reducing as time passed.After 2d of the operation,the drift of the R & R group was 12.10±5.74PD and the drift of the BLR-rec group was 7.78±4.21PD,the difference was statistically significant (P=0.021).The R & R group was more likely to cause lateral slanting than BLR-rec group.Two groups of patients with nearly stereopsis were both significantly improved,there was no significant difference between the two groups in the two groups (x2=4.530,P=0.210).CONCLUSION: The long-term stability of BLR-rec is superior to R & R.

Comparison of Surgical Outcomes in Patients with Small Refractive Error and Intermittent Exotropia

PURPOSE: To identify differences in the refractive error of postoperative intermittent exotropia patients. METHODS: A total of 71 patients who had an average refractive error of 2 D and a follow-up of more than 6 months after unilateral recession-resection (R&R) for intermittent exotropia were included in this study. Patients were divided into 3 groups according to their refractive error: Group 1, or =+1.0 D. The amounts of deviation 1 day after surgery and 6 months after surgery were evaluated. RESULTS: Out of the 71 total patients included in this study, group 1 included 20 patients, group 2 included 39, and group 3 included 12. The average refractive error in groups 1, 2, and 3 was -2.2 +/- 0.9 D, 0.0 +/- 0.4 D and +1.9 +/- 0.9 D, respectively. The angle of deviation 1 day after surgery was measured in the 3 groups; A result labeled '+' was considered to be exodeviation and a result labeled '-' was considered to be esodeviation. The angle of deviation results for groups 1, 2, and 3 one day after surgery were -6.7 +/- 6.0 PD, -7.5 +/- 5.8 PD and -7.3 +/- 5.9 PD (p = 0.937), respectively, and the results 6 months after surgery were +2.2 +/- 4.3 PD, +4.7 +/- 5.9 PD and +1.8 +/- 2.8 PD (p = 0.076), respectively. Among the 3 groups, no statistically significant difference was observed in postoperative angle of deviation after 6 months. CONCLUSIONS: In basic intermittent exotropia patients with an average refractive error of 2 D, the amount of refractive error makes no difference in strabismus surgical outcomes.

The Meaning of Monocular Occlusion on Preoperative Evaluation in Basic Intermittent Exotropia

PURPOSE: To assess the clinical potential of one-hour monocular occlusion on preoperative alignment evaluation in basic intermittent exotropia. METHODS: Twenty-nine patients with basic intermittent exotropia who were preoperatively examined for one-hour monocular occlusion were selected (monocular occlusion group). Their records were reviewed retrospectively. The measured angle after one hour of monocular occlusion was used to determine the surgical target angle. The control group consisted of 29 patients whose age, sex and control state were similar to the monocular occlusion group. Measurement of the angle of strabismus was not done in the control group. Surgery was performed for the measured angle at six meters. The results of surgery were used to compare the groups relative to the control state. RESULTS: Fifteen patients (51.7%) had an increase in the distance deviation after one hour of monocular occlusion. Of the patients with good control, 78.6% (11/14) had an increase in the angle of misalignment. Only 26.7% (4/15) of patients with poor control experienced a change in the angle deviation (p<0.05). In all, 79.3% of patients in the study group and 75.9% of those in the control group had a satisfactory surgical outcome. Among the patients with good control, 85.7% of patients who underwent surgery for increased angle had a satisfactory outcome, compared with 71.4% of patients who underwent surgery for initial angle (p=0.375). CONCLUSIONS: One-hour monocular occlusion might help to prevent undercorrection after surgical treatment by identifying the hidden deviation, especially in the patients whose control over the distance deviation was good.

The Comparison of Binocular Function of Basic and Simulated Divergence Excess Type in Intermittent Exotropia

PURPOSE: The purpose of this study was to evaluate and compare the binocular function in patients with basic and simulated divergence excess types of intermittent exotropia [X(T)]. METHODS: Seventy-seven patients, 46 basic type and 31 simulated divergence excess type, were studied by Worth 4-dot test (W4D), Polarized 4-dot test (P4D), Titmus test, and distance stereoacuity test using Mentor B-VAT(R)II videoacuity tester. RESULTS: Near W4D, distant W4D and distant P4D were fused in 71.7%, 8.6% and 52.2% in basic type and in 100%, 25.8% and 87.1% in simulated divergence excess type, respectively. The fusion rate in simulated divergence excess type was significantly higher, than in basic type (P=0.001, 0.04, 0.001). However, the difference in near P4D between the two types was not significant (P=0.24). In distance stereoacuity test, basic type showed 272 seconds and simulated divergence excess type showed 177 seconds, showing a significant difference (P=0.02). There was no significant difference in near stereoacuity between the two types (P=0.08). CONCLUSIONS: The study demonstrated a difference in binocular function in patients with basic and simulated divergence excess types of X(T). A better binocular function was observed in the latter group.