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Kyung, Duk, and Mi: The Surgical Outcome of Intermittent Exotropia with Good Binocular Function
Original Article

J Korean Ophthalmol Soc 2013;54(7):1097-1103.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.7.1097

The Surgical Outcome of Intermittent Exotropia with Good Binocular Function

Tae Kim Kyung, MD, Kyu Choi Duk, MD, Young Choi Mi, MD

1Department of Ophthalmology, Chungbuk National University School of Medicine, Cheongju, Korea

Address reprint requests to Mi Young Choi, MD Department of Ophthalmology, Chungbuk National University Hospital, #776 1Sunhwan-ro, Heungdeok-gu, Cheongju 361-711, Korea Tel: 82-43-269-6335, Fax: 82-43-264-5263 E-mail: mychoi@chungbuk.ac.kr

* This study was presented as a narration at the 105th Annual Meeting of the Korean Ophthalmology Society 2011.

* This work was supported by the clinical research grant of Chungbuk National University Hospital in 2013.

Received 20 October 2012       Revised 11 February 2013       Accepted 26 April 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated the success rate of surgery and binocular function after surgery in intermittent exotropia with good preoperative binocular function.

Methods

Thirty-eight intermittent exotropia patients who had good stereopsis of 40 seconds according to the Titmus test, showed fusion by Worth-4-dot test preoperatively, and had at least 1 year of postoperative follow-up were included in the present study. The age at operation, angle of exodeviation, visual acuity, stereopsis with Titmus test and fusional status with Worth-4-dot test after surgery were analyzed. A surgical success was defined as postoperative angle of deviation less than 10 prism diopter (PD).

Results

The patient mean age at the time of the operation was 7.9 years. The mean preoperative angle of exodeviation was 25.5 PD at far distance and 27.5 PD at near distance. The mean follow-up time was 22.9 months. The success rate of surgery was 81.6% at 6 months, 68.4% at 1 year and 60.5% on the last visit. Seventeen patients (44.7%) had stereopsis of 40 seconds and showed fusion at far and near distance after surgery. The stereopsis was worse than 100 seconds in 2 patients (5.3%), and fusion was maintained at only near distance in 15 patients (39.5%). In 7 patients (18.4%), the stereo-psis decreased to 200 seconds or worse, or there was no fusion after surgery.

Conclusions

The recurrence of exodeviation was a major cause of the surgical failure in the intermittent exotropia with good preoperative binocular function. Moreover, binocular function may decrease postoperatively in intermittent exotropia with good preoperative binocular function, so careful follow-up may be required to maintain this function.

Keywords: Binocular function, Fusion, Intermittent exotropia, Stereopsis

References

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Figure 1.
Distribution of preoperative angle of exodeviation.
jkos-54-1097f1.tif
Figure 2.
Change of the angle of deviation during the follow-up after surgery for intermittent exotropia.
jkos-54-1097f2.tif
Figure 3.
Postoperative streopsis (A) and fusion (B). * Fusion at far and near; † Fusion at near; ‡ No fusion.
jkos-54-1097f3.tif
Figure 4.
Change of the postoperative angle of deviation be-tween maintained binocular vision group and reduced binoc-ular vision group. (A) Patients who maintained preoperative good binocular function after surgery (n = 17). (B) patients who decreased preoperative binocular function after surgery (n = 21).
jkos-54-1097f4.tif
Table 1.
The characteristics of patients with intermittent exo-tropia
Patients (n = 38)
Sex (M:F [No.]) 15 : 23
Age of diagnosis (years, range) 6.6 ± 2.4 (3 to 12)
Age of surgery (years, range) 7.9 ± 2.0 (5 to 13)
Angle of exodeviation (PD, range)
Near 27.5 ± 5.8 (15 to 40)
Far 25.5 ± 6.2 (15 to 40)
Follow-up (month, range) 22.9 ± 11.6 (12 to 48)
Amblyopia (No.) 2
Pattern of exotropia (No.)
Divegence excess 0
Basic exodeviation 35
Convergence insufficiency 2
Pseudo-divergence excess 1
Surgical method (No.)
Bilateral lateral rectus recession 25
Unilateral lateral rectus recession 7
Unilateral recession and resection 6
Values are presented as mean ± SD.
Table 2.
Comparison of preoperative and postoperative data between maintained binocular vision group and reduced binocular vi-sion group
Maintained binocular vision group (n = 17) Reduced binocular vision group (n = 21) p-value
Sex (M:F) 6 : 11 9 : 12 0.74*
Age at surgery (years, range) 8.4 ± 2.2 (5 to 13) 7.4 ±1.7 (5 to 9) 0.13†
Follow-up (months, range) 19.1 ± 9.5 (12 to 36) 26.0 ± 12.5 (12 to 48) 0.07†
Preoperative angle of exodeviation (PD, range)
Far 26.5 ± 6.8 (15 to 40) 24.6 ± 5.7 (15 to 40) 0.37†
Near 28.5 ± 6.3 (20 to 40) 26.7 ± 5.5 (15 to 43) 0.34†
Postoperative angle of deviation at last visit (PD, range)
Far 3.1 ± 11.1 (-30 to 20) 8.9 ± 10.1 (-10 to 25) 0.10†
Near 3.5 ± 11.1 (-30 to 20) 9.9 ± 11.1 (-10 to 30) 0.09†
Postoperative patching therapy (No.) 8 9 0.51*
Duration of postoperative patching therapy (weeks, range) 1.8 ± 1.8 (1 to 6) 1.8 ± 0.9 (1 to 4) 0.31‡
Result at last visit (No.)
Surgical success 12 11
Overcorrection 1 0 0.20*
Recurrence 4 10

Values are presented as mean ± SD.

* Fisher’s exact test

† t-test

‡ Mann-Whitney test, - means esodeviation.

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