Survival analysis following early surgical success in intermittent exotropia surgery

AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success [≤5 prism diopters (PD) esophoria (E) to ≤10 PD exophoria (X) on the postoperative sixth month] were enrolled in this study. Their consecutive survival on the postoperative first year, second year and third year and at the last visit of fourth year or more, and the factors that might affect their survival, were analyzed. The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group (≤5 PD E to ≤10 PD X) and the failure group (>5 PD esodeviation or >10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%, 92.89%, 83.70% and 50.49% on the postoperative first, second and third years and fourth year or more, respectively. None of the clinical factors was determined to have affected the survival. The amount of the exodrift was largest (2.29 PD) between the first year and the second year, and smallest (1.47 PD) between the fourth year and the last visit. Sixty-three patients had their final visit after the postoperative fourth year, and 29 of them were in the failure group. Twenty-five patients in the failure group had an intermittent exotropia (IXT) of <20 PD with good to fair distant fusion; two had an IXT of <20 PD with poor distant fusion; one had an IXT of ≥20 PD with fair distant fusion; and another had delayed-onset consecutive esotropia. The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group (2.81 PD vs 5.86 PD, P=0.012). The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift, but the amount of the exodrift decreases with long-term follow-up. The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients. A smaller deviation on the postoperative sixth month is associated with long-term survival.     

间歇性外斜视手术效果分析

目的 探讨间歇性外斜视手术的疗效、方法手术量按外直肌后徙1mm，矫正2^Δ～3^Δ及内直肌截除1mm，矫正4^Δ～5^Δ计算，3例行单眼外直肌后徙，1例行内直肌缩短，42例行单眼外直肌后徙加内直肌缩短或双眼外直肌后徙术，10例行双眼外直肌后徙加内直肌缩短术。45例局麻下手术，11例全麻下手术。结果56例中完全功能治愈23例，临床治愈25例，总治愈者48例，占85．7％。结论间歇性外斜视应止确选择手术时机，有利于双眼单视功能的建立。     

间歇性外斜视不同术式的效果比较

目的 比较间歇性外斜视(基本型)病人双眼外直肌后徙加非主导眼外直肌后徙+内直肌截腱的手术效果.方法 对116例斜视度在-25△～-50△间歇性外斜视(基本型)患者.随机分为AB两组,每组各58例(A组)行双眼外直肌后徙手术,B组行非主导眼外直肌后徙+内直肌截腱手术,并将手术效果进行比较.术后斜视度≤±10△认为效果满意.结果 A组46例(79.31%)术后效果满意,12例术后欠矫(20.69%),无过矫发生.B组52例(89.66%)术后效果满意,2例(3.45%)术后欠矫,4例(6.89%)术后过矫,1例过矫病人二次行鼻侧结膜松解术后眼位正位.结论 对于间歇性外斜视(基本型)病人,非主导眼外直肌后徙+内直肌截腱,手术效果比双眼外直肌后徙效果好,但其过矫率较高.

Abstract：

Objective To compare the surgical outcomes of bilateral lateral rectus muscle recession (BLR) and unilateral medial rectus muscle resection and lateral rectus muscle recession (R&R) procedure on the nondominant eye for the patients of basic intermittent exotropia. Methods A total of 116 patients who underwent either BLR (group A) or R&R (group B) surgery were reviewed. Surgical outcome between the 2groups were analyzed. Surgical outcome was considered successful if there was a strabismus ≤ 10 PD. Results Among the patients in group A, 46 of the 58 patients (79.31%) had a satisfactory outcome, and 12 patients (20.69%) were with undercorrection. There was no case of overcorrection in group A. In group B, 52 of the 58patients (89.66%) had a satisfactory outcome, and 2 patients (3.45%) were with undercorrection. There were 4patients (6.89%) were overcorrected in group B. One overcorrected patient in group B had satisfactory outcome after conjunctival release operation. Conclusions Surgical success was significantly higher in the R&R group than in the BLR group, but its overcorrect rate is significantly higher.     

间歇性外斜视手术139例临床分析

目的：探讨间歇性外斜视手术时机及治疗效果。

方法：选取我院2014-05/2016-12期间收治入院的139例间歇性外斜视患儿进行前瞻性研究,根据年龄分3组：3～7岁58例(A组),8～12岁41例(B组),>12岁40例(C组),观察各组治疗效果。

结果：三组术后3d,1、3、6mo手术正位情况差异有统计学意义(P<0.05); 术后不同时间点A组正位率均显著高于其余两组,组间差异有统计学意义(P<0.05); 且B组术后3d,1mo正位率显著高于C组,组间差异有统计学意义(P<0.05)。术后6mo各组立体视功能均较术前显著改善,组间差异有统计学意义(P<0.05); 且A组恢复立体视患者所占比例显著高于B组和C组,组间差异均有统计学意义(P<0.05)。术前各组斜视度数比较差异无统计学意义(P>0.05)。术后6mo各组斜视度数差异有统计学意义(P<0.05); 且A组斜视度数≤30^△所占比例高于其余两组(均P<0.05)。术后三组BCVA变化情况差异均有统计学意义(P<0.01); 且A组术后各时间点BCVA均优于其余两组,差异均有统计学意义(P<0.05)。各组患儿术后3mo与术后6mo组内BCVA差异均无统计学意义(P>0.05)。术后6mo随访三组眼位回退发生率差异有统计学意义(P<0.05),且A组低于B组和C组,B组较C组低,差异均有统计学意义(P<0.05)。

结论：间歇性外斜视应尽早根据斜视分型选择适当术式,促进术后眼位及视功能恢复,继而提高视力,避免眼位回退。     

The surgical management of intermittent exotropia in adults

Most studies of intermittent exotropia deal primarily with children. However, the manifestations of this disorder in adults differ considerably from those in children. The case records of 44 adults (ages 15-70) who underwent surgery for intermittent exotropia were analyzed. These patients experienced a variety of preoperative symptoms including diplopia, headache, difficulty with reading, and ocular fatigue or pain. Cosmesis was a rare presenting complaint. The authors recommend that surgery in adults be conservative, aiming at slight undercorrection. Surgical management was successful in 41 of 44 patients. All patients with postoperative exodeviations under 15 delta had complete resolution of symptoms. Most patients with larger residual exodeviations did not improve symptomatically; patients with postoperative exodeviations tended to experience persistent diplopia.     

Binocular photophobia after surgical treatment in intermittent exotropia.

PURPOSE: This study examined the rate of binocular photophobia in intermittent exotropia patients before surgical correction, and the factors affecting this rate. The study also investigated the factors affecting postsurgical disappearance of binocular photophobia. METHODS: The study involved 162 basic type intermittent exotropia patients who underwent surgical correction between March 2001 and January 2006. The study did not include patients with entropion, congenital cataract, or retinal abnormalities. Parents of the patients were questioned to determine which patients had monocular eye closure in bright light and which had disappeared after bilateral lateral rectus recession. Data was analyzed to determine the factors affecting monocular eye closure before surgery and disappearance after surgery. RESULTS: Of 162 patients, 96 patients had binocular photophobia (60.2%). Photophobia was found to be associated with an angle of exodeviation at distance >25 Prism Diopter (Delta) (p = 0.02), and stereoacuity worse than 60 s (p = 0.02). We defined satisfactory surgical outcome as a deviation of <10 Delta. Of the 81 patients with satisfactory outcomes, 46 showed disappearance of binocular photophobia (53.5%). No factor was found to be associated with loss of binocular photophobia. CONCLUSION: The angle of strabismus and stereoacuity were found to affect the occurrence of binocular photophobia. Successful surgery treated binocular photophobia in 53.5% of patients. Regardless of the surgical result, clinicians should educate patients in terms of the possibility of persistence of postsurgical photophobia.     

手术治疗间歇性外斜视的临床观察

目的讨论间歇性外斜视手术治疗的效果。方法对72例间歇性外斜视进行手术治疗,并观察手术时机,手术过矫等对手术效果的影响。结果手术年龄越小,术后双眼单视功能恢复越好。结论大于20^△的间歇性外斜视早期手术治疗有利于双眼单视功能的重建。     

集合不足型间歇性外斜视不同手术方式的疗效分析

目的:探讨集合不足型间歇性外斜视采用不同手术方式对疗效的影响。方法:对98例记录资料完整的集合不足型间歇性外斜视分为两组,A组(49例)以减弱外直肌为主设计手术,B组(49例)以加强内直肌为主设计手术,并于术后1a内定期随访,进行疗效分析。结果:手术后1a正位率总体为88%。A组为86%,B组为90%,两组治愈率之间差异无统计学意义。术后的集合功能比较,两组集合近点之间差异有统计学意义(P<0.05)。结论:间歇性外斜视手术采用加强内直肌或减弱外直肌为主手术,均可取得较好疗效。以加强内直肌为主手术,术后集合功能恢复更好。