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Sarah R. Hatt, David A. Leske, Laura Liebermann, Jonathan M. Holmes; Predictors of Surgery in Children With Intermittent Exotropia. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6336.
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To evaluate predictors of surgery in children with intermittent exotropia (XT).
Of 106 children with intermittent XT (median age 6 years, range 2 to 15), 19 (18%) went on surgery and 87 (82%) were managed conservatively. We evaluated the following possible predictors of surgery: prism and alternate cover test at distance (PACTD) and near (PACTN), distance and near control scores (mean of the 3 most recent scores, rated using 0- to 5-point scale), near Preschool Randot stereoacuity, Distance Randot stereoacuity, managing physician (n=4), and Intermittent Exotropia Questionnaire (IXTQ) health-related quality of life scores (Child [5-15 year olds], Proxy, Parent Function, Parent Psychosocial, and Parent Surgery [subscales of Parent IXTQ]). Data from the preoperative, or most recent follow-up examination were included for analysis. We assessed the association of each factor with surgery by univariate analysis and then by multivariate backwards logistic regression analysis.
By univariate analysis, PACTN, distance control score, near control score, Preschool Randot stereoacuity, Proxy IXTQ score, Parent Function subscale IXTQ score and Parent Psychosocial subscale IXTQ score were associated with surgery (P<0.05 for each). By multivariate analysis, only distance control score and Parent Function subscale IXTQ score were predictive of surgery (relative risk [RR] 1.83, CI 1.25, 2.68 and RR 0.95, CI 0.92, 0.99 respectively). Parent Psychosocial subscale score and Proxy score were highly correlated with Parent Function subscale score (r >0.6 for each comparison), and both were predictive of surgery when entered into multivariate analyses separately and without the Parent Function subscale score (Parent Psychosocial subscale RR 0.97, CI 0.95, 0.99; Proxy RR 0.97, CI 0.95, 1.00).
Predictors of surgery in intermittent XT were poor control at distance, Parent Function and Psychosocial IXTQ scores, and Proxy IXTQ scores. Understanding and addressing parental concerns are important prior to planning surgery for intermittent XT.
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