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EP Simmons, A Marcotty, S Crowe, EI Traboulsi; Surgical Outcomes in Exotropia . Invest. Ophthalmol. Vis. Sci. 2002;43(13):222.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine preoperative and operative factors that lead to superior surgical alignment and sensory outcomes in patients with exotropia Methods: This retrospective chart review identified 31 pediatric patients who had an initial surgery for constant or intermittent exotropia and were followed for at least 9 months. 19 patients had intermittent exotropia and 12 had constant exotropia. 24 patients underwent bilateral lateral rectus recessions while 7 had unilateral recess-resect procedures. We stringently defined superior horizontal alignment as less than 10 prism diopters of exophoria or 5 prism diopters of esophoria at both distance and near without an intermittent or constant tropia. Superior stereopsis was defined as bifixation at better than 60 seconds of arc. Results: Average follow-up was 21 months (range: 9-78 months). Children who had surgery at or after 7 years of age were more likely to have bifixation than those patients who had surgery earlier (p=0.002). Superior stereopsis was attained by 8 of 12 older patients but only 2 of 17 younger ones. (Two younger patients whose stereoacuity could not be refined beyond 100 seconds of arc were excluded.) A duration of strabismus of at least 5 years was associated with excellent stereopsis (p=0.007). 5 of 7 patients in this group achieved bifixation while only 2 of 16 cases with a duration less than 5 years attained bifixation. Children with excellent preoperative stereopsis were more likely to obtain bifixation postoperatively (p=0.004). 6 of 7 known bifixators maintained superior stereopsis while only 3 of 17 monofixators gained bifixation. A family history of strabismus, the constancy of the exotropia, or the magnitude of the deviation did not significantly influence outcomes. 13 of 31 patients (42%) achieved superior horizontal alignment after one surgery. 12 (39%) had an intermittent exotropia at distance and/or near. 1 had a constant exotropia. 5 (16%) were overcorrected for distance and/or near. 5 (16%) required a second surgery. Conclusion: The presence of bifixation preoperatively is a good predictor of postoperative bifixation. Postoperatively, bifixation is more likely to be maintained or achieved in children who are older than 7 years and who have had exotropia longer than 5 years.
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