Abstract
Purpose
To evaluate the surgical result of patients who had intermittent or constant +3.00 diopter (D) or more exotropia and hyperopia.
Methods
Twenty-seven patients who had an operation for +3.00 D or more hyperopia and exotropia were included. The dura-tion of follow-up was 6 months or more after surgery. Age at the initial visit, visual acuity, refractive errors, presence of am-blyopia, reduced rate of hyperopic correction, changes in exodeviated angle after reduction of hyperopic correction, surgical re-sults and postoperative data were analyzed.
Results
The mean age at the initial visit was 5.4 years and at surgery was 7.3 years. The mean degree of hyperopia in the worse eye was 3.86 ± 1.35 D and the better eye 1.31 ± 1.19 D. Fourteen of the 27 patients had amblyopia. The degree of reduced hy-peropia correction was 1.35 ± 1.06 D during the preoperative period. The initial angles of deviation were 26.8 ± 7.7 prism diopters (PD) at distance and 28.2 ± 8.9 PD at near. At postoperative 12 months, 19 of 27 patients (70.4%) achieved deviated angle with-in 10 PD. The cause of surgical failure was recurrence of exotropia. All the surgically failed patients had reduced hyperopic cor-rection of the better eye before surgery. Reduction rate of hyperopic correction in the surgically failed group was significantly higher than in the surgically successful group ( p = 0.004).
Conclusions
There was a high incidence of amblyopia in the patients with +3.00 D or more exotropia and hyperopia before surgery. The cause of surgical failure was the recurrence of exotropia, and the degree of reduced hyperopic correction in the sur-gically failed group was larger than in the surgically successful group.
References
1. Choi KW, Koo BS, Lee HY. Preschool vision screening in Korea: results in 2003. J Korean Ophthalmol Soc. 2006; 47:112–20.
2. Yu YS, Kim SM, Kwon JY. . Preschool vision screening in Korea: preliminary study. J Korean Ophthalmol Soc. 1991; 32:1092–6.
3. Richard JM, Parks MM. Intermittent exotropia. Surgical results in different age groups. Ophthalmology. 1983; 90:1172–7.
5. Caltrider N, Jampolsky A. Overcorrecting minus lens therapy for treatment of intermittent exotropia. Ophthalmology. 1983; 90:1160–5.
6. Abroms AD, Mohney BG, Rush DP. . Timely surgery in inter-mittent and constant exotropia for superior sensory outcome. Am J Ophthalmol. 2001; 131:111–6.
7. Figueira EC, Hing S. Intermittent exotropia: comparison of treat-ments. Clin Experiment Ophthalmol. 2006; 34:245–51.
8. von Noorden GK, Campos EC. Exodeviations. In: von Noorden GK, Campos EC. Binocular Vision and Ocular Motility: Theory and Management of Strabismus. 6th. St. Louis: Mosby;2002. chap. 17.
9. Iacobucci IL, Archer SM, Giles CL. Children with exotropia re-sponsive to spectacle correction of hyperopia. Am J Ophthalmol. 1993; 116:79–83.
10. Kassem IS, Rubin SE, Kodsi SR. Exotropia in children with high hyperopia. J AAPOS. 2012; 16:437–40.
11. Bae SW, Kim M, Choi MY. Changes in hypermetropic spectacle correction after surgery in partially accommodative esotropia. J Korean Ophthalmol Soc. 2014; 55:719–25.
12. Wright KW, Ryan SJ. Color Atlas of Ophthalmic Surgery: Strabismus, 1st ed. Philadelphia: Lippincott,. 1991; 241–3.
13. Holmes JM, Leske DA, Hohberger GG. Defining real change in prism-cover test measurements. Am J Ophthalmol. 2008; 145:381–5.
14. Scattergood KD, Brown MH, Guyton DL. Artifacts introduced by spectacle lenses in the measurement of strabismic deviations. Am J Ophthalmol. 1983; 96:439–48.
15. Lim HT, Cho SI, Lee SJ, Park SH. Long-term observations on the emmetropization of the high hyperopia. J Korean Ophthalmol Soc. 2002; 43:1230–7.
16. Kim HY, Chang BL. Clinical evaluation of exotropia combined with amblyopia in children. J Korean Ophthalmol Soc. 1996; 37:662–8.
17. Ku M, Paik HJ. The association between amblyopia and anisome-tropia in intermittent exotropia. J Korean Ophthalmol Soc 2009; 50. 1686–91.
18. Kim SK, Choi MY. The clinical characteristics of hypermetropia in children. J Korean Ophthalmol Soc. 2002; 43:544–50.