Abstract
Purpose To evaluate whether clinical measures of postoperative binocular functions could predict the long-term stability of postoperative ocular alignment in children with intermittent exotropia. Methods A retrospective study was performed in thirty-nine children (median: 7 years) who have been surgically treated from intermittent exotropia without overcorrection (less than 10 prism diopters [pd] of exodeviation at 1 month postoperatively). Angles of deviation and binocular functions were measured preoperatively and at 1 month, 6 months, and the final follow-up visit (≥24 months) postoperatively. We examined the relationships between postoperative drift (change of ocular alignment) and binocular functions (sensory fusion, fusional convergence amplitude, and stereoacuity). Results The surgical success rate (esophoria/tropia ≤5 pd to exophoria/tropia ≤10 pd) dropped to 76.9% at 6 months after surgery and to 53.8% at individuals' last visit (mean: 37 months). The mean exodrift was 7.7 ± 9.2 pd from the postoperative month 1 to the final visit (p < 0.001) on distance fixation. Distance stereoacuity, central fusion, and fusional convergence amplitude significantly improved following surgery (p < 0.05). However, no significant correlation was found between their binocular functions measured at the beginning of each follow-up period and the postoperative drift (all p > 0.13). Conclusion Our findings suggest that the clinical measures of sensory fusion, fusional convergence amplitude, and stereoacuity cannot serve as a robust predictor for the long-term stability of postoperative ocular alignment in patients who underwent successful surgery without overcorrection at 1 month postoperatively.
Highlights
Intermittent exotropia (IXT), a disorder that causes either of the eyes to drift outward spontaneously [1, 2], is the most common form of childhood exotropia [3]
We asked a specific question in this study: can better postoperative binocular functions result in more stable ocular alignment following surgery in patients with IXT? We hypothesized that patients with better binocular functions following surgery could show a more stable binocular alignment
Clinical investigations on IXT on these two topics have been conducted: binocular functions serving as objective measures to assess the severity of this disorder [14, 15, 17] and binocular function serving as sensory outcomes following surgery [24, 25]
Summary
Intermittent exotropia (IXT), a disorder that causes either of the eyes to drift outward spontaneously [1, 2], is the most common form of childhood exotropia [3]. Accumulating evidence shows that patients with better binocular functions (sensory fusion, stereoacuity) preoperatively could achieve superior sensory outcomes postoperatively [14, 16, 17]. Ese findings suggest the predictive value of binocular functions Given these previous observations, we asked a specific question in this study: can better postoperative binocular functions result in more stable ocular alignment following surgery in patients with IXT? Preoperatively, 1 month postoperatively, 6 months postoperatively, and the individual’s final follow-up: angle of deviation, sensory fusion status, fusional convergence amplitude, and stereoacuity. E Friedman test was used to compare the angle of deviation, stereoacuity, and fusional convergence amplitude (pre-, 1 month, 6 months, and final follow-up). Sensory fusion status at each time point (pre-, 1 month, 6 months, and final follow-up), including post hoc analysis, was evaluated using a Chisquare test or a Fisher exact test. An α value was adjusted by the Bonferroni correction during multiple comparisons
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