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EL Raab; Occlusion For Overcorrected Exotropia . Invest. Ophthalmol. Vis. Sci. 2002;43(13):220.
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Purpose: Concern for persistence of an initial surgical overcorrection of exotropia and for unfavorable binocular sensory consequences has led to employment of various treatments (prisms, discouraging accommodation and occlusion) either singly or in combination. This study, which enlarges and extends a previous report, compares the effects on binocular alignment of observation alone v. early occlusion in initially overcorrected exotropia patients. Method: A retrospective study of patients with the capacity for fusion undergoing a first operation for exotropia that resulted initially in esodeviation. Exclusion criteria included unilateral uncorrectable poor vision; previous extraocular muscle surgery; nystagmus; limited rotations or noncomitance; primary position hyperdeviation greater than 6 prism diopters, and major neurologic abnormalities. Results: Twenty-six (89.7%)of 29 initially overcorrected patients receiving majority- or part-time occlusion in the first two postoperative months were aligned satisfactorily (no more than 10 prism diopters of eso- or exodeviation) at 5 to 8 weeks following surgery. Ninety-seven (85.8%) of 113 patients who were not occluded reached satisfactory alignment at the same interval. Where observations could be made, 16 (80.0%) of 20 occluded patients and 64 (86.5%) of 74 patients not occluded were aligned satisfactorily at this initial interval and at 1 to 2 years after operation. These differences are not significant (chi-square; Fischer’s Exact Test). A similar trend was noted at the 3rd to 4th postoperative year in a limited sample of 9 (90.0%) of 10 and 33 (82.5%) of 40 patients satisfactory at all 3 intervals, respectively. Conclusion: Occlusion for overcorrection of exotropia was not shown to enhance the likelihood of satisfactory alignment, whether or not this treatment is useful to prevent sensory consequences.
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