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R.A. Saunders, R.L. Golub, L.M. Yarbrough; Early Surgery for Infantile Intermittent Exotropia . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2961.
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Purpose:To review surgical results in patients who underwent early surgical treatment of infantile intermittent exotropia. Methods:We reviewed medical records from 1993 through 2003 of all children with intermittent exotropia with onset prior to age one year and who received initial surgical correction before age two years. Postoperative follow up ranged from 6 to 89 months (mean 30.5 months). Exclusion criteria included "congential" or constant exotropia, evidence of dissociated strabismus, consecutive exodeviation after surgery for esotropia, or evidence of a sensory strabismus. A favorable surgical result was defined as a phoria or intermittent tropia < 10 pd at distance or near. Repeat operations were allowed when determining final outcome. Postoperative sensory testing was completed in those patients able to cooperate with the examination. Results:Twelve of 16 (75%) patients meeting entry criteria were found to have a favorable surgical result. Repeat surgery was required in 3 patients. Of the patients with favorable outcomes, 7 (58%) were orthophoric at both distance and near. Unfavorable surgical results were found in 4 patients (25%), 3 with over correction and 1 with under correction. None of the over corrected patients had constant esotropia. Initial surgical intervention was performed prior to one year of age in 4 patients. Three of these patients had a favorable result, 1 had an unfavorable result. Postoperative sensory testing could be obtained in 7 patients. Five demonstrated up to 100 arc–seconds of stereopsis and 2 demonstrated no stereopsis. Conclusions: Early surgery for infantile intermittent exotropia produces similar success to surgical treatment in older children. If patients are operated prior to development of constant strabismus, sensory status may be improved. There is little rationale for delaying surgical intervention based on age alone.
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