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Kang, Lee, and Lee: The Surgical Outcome and Stereopsis between Pseudodivergence Excess Type and Convergence Insufficiency Type
Original Article

J Korean Ophthalmol Soc 2016;57(6):951-956.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.6.951

The Surgical Outcome and Stereopsis between Pseudodivergence Excess Type and Convergence Insufficiency Type

Sung Il Kang, MD1, Young Chun Lee, MD, PhD2, Se Youp Lee, MD, PhD1

1Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

2Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea

Address reprint requests to Se Youp Lee, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-7720, Fax: 82-53-250-7705 E-mail: lsy3379@dsmc.or.kr

Received 27 August 2015       Revised 12 October 2015       Accepted 16 January 2016

Copyright © 2016 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 compare the surgical outcomes and stereopsis between pseudodivergence excess type and convergence insufficiency type in intermittent exotropia.

Methods

In a retrospective comparative analysis of 42 eyes, 18 eyes that were of the convergence insufficiency type (group 1) and 24 eyes that were or the pseudodivergence excess type (group 2) were analyzed. Recession-resection was performed in the same eye. Success was defined to be within ±8 PD after 12 months postoperatively; more than ±8 PD was defined as recurrence. Stereopsis was measured by the Titmus test.

Results

After the patch test, the mean preoperative near angle in group 1 was 35.56 ± 6.62 PD and the far angle was 23.06 ±6.22 PD. In group 2, the mean preoperative near angle was 26.92 ± 6.30 PD and the far angle was 28.29 ± 7.41 PD. The group 1 postoperative (12 months) mean near angle was 6.89 ± 8.46 PD and the far angle was 6.11 ± 7.90 PD. In group 2, the mean postoperative near angle was 1.75 ± 2.85 PD and the far angle was 3.42 ± 3.98 PD. The success rate of group 1 was 50% and the success rate of group 2 was 83.3%. The success rate of both group were statistically significant differences (p = 0.021). The postoperative (12 months) mean of near stereopsis for group 1 was 588 ± 1,124 seconds, and group 2 was 101.25 ± 102 seconds. There were no statistically differences in postoperative (12 months) stereopsis.

Conclusions

The success rate of the pseudodivergence excess type was significantly higher than in the convergence insufficiency type.

Keywords: Convergence insufficiency type, Intermittent exotropia, Pseudodivergence excess type, Stereopsis

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Table 1.
Preoperative status
  Group 1 (n = 18) Group 2 (n = 24) p-value
Age (years) 8.28 ± 1.74 7.29 ± 2.10 0.055*
Sex (male/female) 9/9 12/12 1.000†
Preoperative BCVA OD (log MAR) 0.08 ± 0.11 0.06 ± 0.08 0.549*
Preoperative BCVA OS (log MAR) 0.08 ± 0.11 0.06 ± 0.10 0.645*
Symptom duration (months) 36.67 ± 34.31 30.50 ± 30.64 0.374*
Follow-up (months) 13.65 ± 4.30 15.45 ± 4.44 0.325*

Values are presented as mean ± SD unless otherwise indicated. Group 1: Convergence insufficiency type; Group 2: Pseudodivergence excess type.

BCVA = best corrected visual acuity; OD = oculus dexter; OS = oculus sinister.

* Statistical significance were tested by Mann-Whitney U-test

† Statistical significance were tested by Chi-squared test.

Table 2.
Angle of exotropia
  Group 1 (n = 18) Group 2 (n = 24) p-value*
Preop.      
 Near before patch test (PD) 35.56 ± 6.62 11.50 ± 4.23 0.000
 Near after patch test (PD) 35.56 ± 6.62 26.92 ± 6.30 0.000
 Far (PD) 23.06 ± 6.22 28.29 ± 7.41 0.004
Postop. 1 day      
 Near (PD) −5.33 ± 7.45 −8.96 ± 7.94 0.254
 Far (PD) −9.61 ± 7.04 −8.42 ± 5.93 0.531
Postop. 12 months      
 Near (PD) 6.89 ± 8.46 1.75 ± 2.85 0.019
 Far (PD) 6.11 ± 7.90 3.42 ± 3.98 0.250

Values are presented as mean ± SD unless otherwise indicated. Group 1: Convergence insufficiency type; Group 2: Pseudodivergence excess type.

Preop. = preoperation; Postop. = postoperation; PD = prism diopter.

* Statistical significance were tested by Mann-Whitney U-test.

Table 3.
Surgical success rate and stereopsis
  Group 1 (n = 18) Group 2 (n = 24) p-value
Success rate (%) 50.0 83.3 0.021†
Preop. stereopsis (sec of arc) 576.67 ± 1,118.06 334.17 ± 835.13 0.074*
Postop. 12 months stereopsis (sec of arc) 588.33 ± 1,123.53 101.25 ± 102.97 0.694*
Preop. Stereopsis– Postop. Stereopsis (sec of arc) −11.67 ± 98.77 232.92 ± 740.21 0.329*

Values are presented as mean ± SD unless otherwise indicated. Group 1: Convergence insufficiency type; Group 2: Pseudodivergence excess type.

Preop. = preoperation; Postop. = postoperation.

* Statistical significance were tested by Mann-Whitney U-test

† Statistical significance were tested by Chi-squared test.

Table 4.
Comparisons of surgical success rate and stereopsis
  Success Fail p-value*
Group 1      
 Preop. stereopsis (sec of arc) 432.22 ± 969.40 721.11 ± 1,292.16 0.863
 Postop. 12 months stereopsis (sec of arc) 468.89 ± 980.40 707.78 ± 1,299.67 0.666
 Preop. Stereopsis– Postop. Stereopsis (sec of arc) −36.67 ± 137.39 13.33 ± 21.21 0.297
Group 2      
 Preop. stereopsis (sec of arc) 354.00 ± 905.19 235.00 ± 376.79 0.852
 Postop. 12 months stereopsis (sec of arc) 105.00 ± 108.51 82.50 ± 78.48 0.682
 Preop. Stereopsis– Postop. Stereopsis (sec of arc) 249.00 ± 804.70 152.50 ± 298.60 0.431
Group 1 + Group 2      
 Preop. stereopsis (sec of arc) 378.28 ± 908.76 571.54 ± 1,096.88 0.468
 Postop. 12 months stereopsis (sec of arc) 217.93 ± 558.54 515.38 ± 1,103.57 0.572
 Preop. Stereopsis– Postop. Stereopsis (sec of arc) 160.34 ± 680.36 56.15 ± 164.496 0.103

Values are presented as mean ± SD unless otherwise indicated. Group 1: Convergence insufficiency type; Group 2: Pseudodivergence excess type.

Preop. = preoperation; Postop. = postoperation.

* Statistical significance were tested by Mann-Whitney U-test.

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