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Soo Jung Lee, Jung Min Park; Factors Associated with the Effectiveness of Alternate Patch Treatment in Patients with Overcorrected Intermittent Exotropia. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2447.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the characteristics of patients with overcorrected intermediate exotropia benefitting from and refractory to alternate patch treatment.
The medical records of 53 patients diagnosed with overcorrection were retrospectively reviewed. Patients with esodeviation ≥ 18 prism diopters (PD) were started on alternate patch treatment the day after surgery, whereas those with esodeviation ≥ 10 PD were started after 2 weeks. Patients refractory to treatment were defined as those with esodeviation ≥ 10 PD after 3 months of treatment. Gender, family history of strabismus, ages at diagnosis and surgery, refractive errors, amblyopia, stereopsis, suppression, type of exotropia, presence of lateral incomitance, vertical deviation, A-V pattern, surgical method, preoperative angle of exotropia, postoperative strabismus and start time of alternate patch treatment were compared.
Of the 53 patients, 30 (56.6%) responded to alternate patch treatment and 23 (43.4%) were refractory. The percentage of women and preoperative exodeviation at distance were significantly higher, and the mean starting time of alternate patch treatment significantly later in the refractory than in the responsive group. The mean angle of postoperative maximal esodeviation at near was larger, and the mean times of postoperative maximal esodeviation at distance and at near significantly later, in the refractory than in the responsive group. Although postoperative strabismus was similar in the two groups for two weeks postoperatively, the angles of esodeviation at both distance and near were larger in the refractory group, beginning at 1 month. Postoperative strabismus recovered to near orthotropia after 1 month in some patients, especially in the responsive group.
This study found that female sex and large preoperative exodeviation at distance predisposed patients to be refractory to alternate patch treatment for overcorrection. Start of alternate patch treatment was late in refractory group. The mean angle of postoperative maximal esodeviation was larger at near and the mean time of postoperative maximal esodeviation later in the refractory group at both distance and near. The angle of strabismus beginning 1 month after treatment was significantly larger in the refractory group.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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