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Hyun and Choi: The Effect of Alternating Occlusion Therapy in Patients with Early Recurrence after Intermittent Exotropia Surgery
Original Article

J Korean Ophthalmol Soc 2016;57(4):623-627.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.623

The Effect of Alternating Occlusion Therapy in Patients with Early Recurrence after Intermittent Exotropia Surgery

Sang Yoon Hyun, MD, Mi Young Choi, MD, PhD

Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea

Address reprint requests to Mi Young Choi, MD, PhD Department of Ophthalmology, Chungbuk National University Hospital, #776, 1sunhwan-ro, Seowon-gu, Cheongju 28644, Korea Tel: 82-43-269-6146, Fax: 82-43-269-6149 E-mail: mychoi@chungbuk.ac.kr

Received 3 December 2015       Revised 18 February 2016       Accepted 21 March 2016

Copyright © 2016 The 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

To analyze the effect of occlusion therapy in patients with early recurrence after intermittent exotropia surgery.

Methods

The present study included 36 patients with an exodeviated angle of 10 prism diopters (PD) or more within 3 months after intermittent exotropia surgery. Eighteen patients (treatment group) performed alternating occlusion therapy for 3 hours per day for 6 months and the other 18 patients (control group) were followed up without any therapy. Age, visual acuity, deviated angle (before operation, at recurrence, and 3 and 6 months after recurrence), and binocularity were retrospectively analyzed in both groups.

Results

Differences between the two groups in terms of age, visual acuity, score of binocularity, association with vertical strabismus or dissociated vertical deviation, period of recurrence and exodeviated angle at recurrence were not observed. Significant differences in change of deviated angle at a far distance were found 3 months after recurrence; 0.00 ± 3.69 PD in the treatment group and +2.88 ± 2.97 PD in the control group (p = 0.014) and at a near distance −1.33 ± 5.13 PD in the treatment group and +3.22 ± 3.99 PD in the control group (p = 0.005). Significant differences in the change of deviated angle were found after 6 months from recurrence at a far distance; +0.11 ± 5.78 PD in the treatment group and +4.50 ± 4.94 PD in the control group (p = 0.020), −0.56 ± 5.71 PD in the treatment group and +3.94 ± 6.46 PD in the control group at a near distance (p = 0.034). The binocularity index was not different between the two groups.

Conclusions

Although in the present study, the mean angle of deviation was not decreased, alternating occlusion therapy 3 hours per day for 6 months may be helpful in reducing the amount of exodrift in patients with early recurrence within 3 months after intermittent exotropia surgery.

Keywords: Alternating occlusion therapy, Early recurrence, Intermittent exotropia

References

1. Romano PE, Wilson MF, Robinson JA. World-wide surveys of current management of intermittent exotropia by MD strabologist. Binoc Vis Eye Surg Qrtly. 1993; 8:167–76.
2. Ing MR, Pang SW. The racial distribution of strabismus. A statistical study. Hawaii Med J. 1974; 33:22–3.
3. Yu YS, Kim SM, Kwon JY, et al. Preschool vision screening in Korea: preliminary study. J Korean Ophthalmol Soc. 1991; 32:1092–6.
4. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99:1814–8.
crossref
5. Ko BW, Shin SY. The clinical features of patients with early recurrence and with orthophoria after intermittent exotropia surgery. J Korean Ophthalmol Soc. 2008; 49:1108–13.
crossref
6. Lim SH, Hong JS, Kim MM. Prognostic factors for recurrence with unilateral recess-resect procedure in patients with intermittent exotropia. Eye (Lond). 2011; 25:449–54.
crossref
7. Cho SC, Yang HK, Hwang JM. Three-year surgical outcome of exotropia. J Korean Ophthalmol Soc. 2012; 53:1674–9.
crossref
8. Han DH, Paik HJ. The minimal postoperative follow-up period to determine secondary surgery in patients with intermittent exotropia. J Korean Ophthalmol Soc. 2014; 55:711–8.
crossref
9. Freeman RS, Isenberg SJ. The use of part-time occlusion for early onset unilateral exotropia. J Pediatr Ophthalmol Strabismus. 1989; 26:94–6.
crossref
10. Figueira EC, Hing S. Intermittent exotropia: comparison of treatments. Clin Experiment Ophthalmol. 2006; 34:245–51.
crossref
11. Flynn JT, McKenney S, Rosenhouse M. A method of feating intermittent divergence strabismus (author's transl). Klin Monbl Augenheilkd. 1975; 167:185–90.
12. Jin YH, Son JH. The effect of occlusion in intermittent exotropia. J Korean Ophthalmol Soc. 1991; 32:307–11.
13. Kim YH, Choi MY. The prospective comparison of the efficacy of intermittent atropine penalization and part-time occlusion therapy. J Korean Ophthalmol Soc. 2008; 49:958–66.
crossref
14. von Noorden GK, Campos EC. Principles of nonsurgical treatment. 5th ed.St. Louis: Mosby-Year Book;1996. p. 503.
15. Chutter CP. Occlusion treatment of intermittent divergent strabismus. Am Orthopt J. 1977; 27:80–4.
crossref
16. Spoor DK, Hiles DA. Occlusion therapy for exodeviations occurring in infants and young children. Ophthalmology. 1979; 86:2152–7.
crossref
17. Park JY, Sohn HY, Cho YA. Is the nonsurgical treatment effective on intermittent exotropia in children of school-age? J Korean Ophthalmol Soc. 1995; 36:1561–7.

Table 1.
Patient characteristics
Treatment group (n = 18) Control group (n = 18) p-value
Age (years) 5.05 ± 4.43 5.21 ± 4.18 0.908†
Male/female (n) 13:5 7:11 0.092‡
Age at operation (years) 6.85 ± 3.89 6.63 ± 3.53 0.856†
Interval (months)* 0.44 ± 0.51 0.50 ± 0.62 0.771†
Preoperative VA (log MAR)
 Right eye 0.07 ± 0.14 0.08 ± 0.10 0.829†
 Left eye 0.04 ± 0.13 0.05 ± 0.13 0.890†
Deviated angle (PD)
 At distance 30.00 ± 8.04 25.56 ± 5.11 0.056†
 At near 32.22 ± 7.71 26.94 ± 5.98 0.028†
DVD 4 1 0.148‡
IOOA 2 0 0.146‡
Binocularity score 1.88 ± 1.65 2.70 ± 1.53 0.105†

Values are presented as mean ± SD unless otherwise indicated.

VA = visual acuity; PD = prism diopter; DVD = dissociated vertical deviation; IOOA = inferior oblique overaction.

* Interval between surgery and recurrence;

† Independent t-test;

‡ Person chi-Square test.

Table 2.
Changes of the deviated angle between the treatment and control groups
Distance deviation (PD)
 Near deviation (PD)
Treatment group(n = 18) Control group(n = 18) p-value Treatment group(n = 18) Control group(n = 18) p-value
At recurrence 10.22 ± 3.79 10.33 ± 3.27 0.926† 12.88 ± 3.00 12.61 ± 2.73 0.773†
At 3 months after recurrence 11.83 ± 3.63 13.22 ± 4.53 0.313† 13.50 ± 4.66 15.83 ± 5.04 0.158†
Change* +0.00 ± 3.69 +2.88 ± 2.97 0.014† −1.33 ± 5.13 +3.22 ± 3.99 0.005†
At 6 months after recurrence 11.94 ± 4.88 14.83 ± 5.76 0.114† 14.27 ± 5.15 16.56 ± 6.87 0.269†
Change‡ +0.11 ± 5.78 +4.50 ± 4.94 0.020† −0.56 ± 5.71 +3.94 ± 6.46 0.034†

Values are presented as mean ± SD unless otherwise indicated.

PD = prism diopter.

* The deviated angle at 3 months from recurrence - the deviated angle at recurrence;

† Independent t-test;

‡ The deviated angle at 6 months from recurrence - the deviated angle at recurrence.

Table 3.
Change of the binocularity score
Treatment group (n) Control group (n) p-value
Before operation 1.88 ± 1.65 (18) 2.70 ± 1.53 (18) 0.105†
At recurrence 2.50 ± 1.97 (15) 3.67 ± 0.51 (8) 0.201†
At 6 months after recurrence 3.40 ± 1.15 (15) 3.50 ± 1.08 (8) 0.853†
Change* +0.71 ± 1.12 (15) −0.14 ± 0.90 (8) 0.289†

Values are presented as mean ± SD unless otherwise indicated.

n = number of patients.

* Binocularity score at 6 months from recurrence – binocularity score at recurrence;

† Independent t-test.

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