Purchase this article with an account.
Maria Fernandez-Ruiz, John Hunt Lillvis, Reecha S Bahl; The role of stereopsis and binocular fusion in surgical treatment of intermittent exotropia. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2456.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To identify the appropriate timing for surgical treatment of intermittent exotropia (XT) in the pediatric population by examining different parameters that could contribute to surgical planning.
A retrospective chart review was conducted including patients between the ages of 3-17 years undergoing surgical management for intermittent XT. Inclusion criteria consisted of patients who underwent bilateral lateral rectus recession with recorded visual acuity, stereopsis, alignment amplitude and control. Younger patients and those unable to cooperate with these measurements were excluded, as well as patients with prior ocular surgery and a history of surgical procedure other than bilateral lateral rectus recession. Preoperative and postoperative data regarding age, past medical history, visual acuity, stereopsis, alignment amplitude and control was recorded. Medical records were reviewed and analyzed to determine if preoperative control of near misalignment, stereopsis and presence of amblyopia might play a role in surgical outcome. A successful outcome was determined by postoperative alignment as within 10 prism diopters of orthophoria at distance and near. Statistical analysis was conducted using Fisher’s exact test and a p-value of 0.05 was deemed significant.
From all charts reviewed, 95 met inclusion criteria. Age range was between 3-17 years (mean=6.72 median=6). Average follow up period was 10.79 months (median= 5). According to our data, 34 patients had at least 140 sec arc of stereopsis using Titmus testing, while 48 patients had less than 140 sec arc, indicative of poor fusion at near. 34 patients had good control of the near misalignment preoperatively and 38 patients had fair to poor control preoperatively. There was no statistically significant difference in surgical outcomes when comparing control of misalignment at near (P=0.2284) and stereopsis (P=0.2537). Presence of amblyopia preoperatively had no association with surgical outcome (P= 1.00).
The use of worsening stereopsis and/or alignment control as parameters to determine the appropriate time for surgical intervention does not predict improved outcomes in patients with intermittent XT. While there was a trend of more surgical success in the good stereopsis and control of near misalignment group, it was not significant enough to establish these parameters as guides for surgical planning.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only