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[Results of combined divergence operation in intermittent exotropia in 120 children]
1Augenklinik für Schielbehandlung und Neuroophthalmologie, Justus-Liebig-Universität Giessen, Friedrichstr. 18, 35385 Giessen. michael.h.graef@augen.med.uni-giessen.de
Insights
Recess-resect surgery for intermittent exotropia in children is effective, with a low risk of consecutive esotropia or impaired binocular vision. Residual exodeviations are common, but the surgery generally improves visual alignment.
Area of Science:
- Ophthalmology
- Pediatric surgery
- Strabismus surgery
Context:
- Intermittent exotropia is a common childhood eye condition requiring surgical intervention.
- Recess-resect surgery is frequently used to correct exodeviations.
- Overcorrection can lead to consecutive esotropia, potentially impacting binocular vision.
Purpose:
- To investigate the risk of overcorrection and its effect on binocular vision in children undergoing recess-resect surgery for intermittent exotropia.
- To analyze the dose/effect relationship of recess-resect surgery in pediatric patients.
Summary:
- A study of 120 children (up to 10 years) undergoing recess-resect surgery for intermittent exotropia showed significant reduction in squint angles (preop: 15-16 degrees; postop: 3-4 degrees).
- Surgery effectiveness was 1.3-1.4 degrees/mm, with a low incidence of consecutive esotropia (1 child) and need for re-operation (5 children).
- Binocular functions remained stable or improved in 82% of patients post-surgery, with diagnostic occlusion aiding in differentiating exotropia types.
Impact:
- The study demonstrates that recess-resect surgery, using established dosage schedules, is a safe and effective treatment for intermittent exotropia in children.
- It provides evidence that the risk of consecutive esotropia and long-term binocular vision impairment is minimal.
- Findings support the use of specific surgical techniques and dosage guidelines in pediatric strabismus correction.
Background:
Intermittent exotropia is the most frequent indication for surgical correction of exodeviations in childhood. Overcorrection with prolongated or persistent consecutive esotropia can impair binocular vision particularly in early childhood. We wanted to investigate this potential risk and the dose/effect relation of recess-resect surgery on children.
Patients And Methods:
120 children up to ten years of age underwent recess-resect surgery for intermittent exotropia in our clinic from 1991 to 1999 (< 2% of the surgical cases). The cycloplegic refraction was spectacle corrected with a reduction of 0.5 dpt. Preoperatively, a diagnostic occlusion was performed for three days. The amount of surgery was calculated using our dosage schedules based on effects one week postoperatively. The squint angles as measured by the alternate prism and cover test at 5 m and 0.3 m pre- and 3 months postoperatively and the binocular functions as measured by the Bagolini striated glasses, Titmus, Randot, TNO, or Lang tests were evaluated.
Results:
(Medians) Squint angles in primary position were: preoperative: distance (5 m)--15 degrees, near (0.3 m)--16 degrees; postoperative (n = 104); distance--4 degrees, near--3 degrees. Effectivity of surgery: distance: 1.3 degrees/mm, near 1.4 degrees/mm. Consecutive esotropia requiring surgical correction occurred in 1 child. Second surgery for intermittent exotropia in the years 1991 to 1999 was necessary in 5 children. Binocular functions (n = 95): Preoperative = postoperative: 61%, postoperative > preoperative 21%, postoperative < preoperative 18%. The diagnostic occlusion was helpful to differentiate "pseudo-divergence excess type" from "divergence excess type" exotropia. The average deviation did not increase under the diagnostic occlusion. The effectivity of surgery (degree/mm) in the children group was lower than in a compared group of older patients (> 10 years) with intermittent exotropia.
Conclusion:
Using our own dosage schedules and surgical technique, residual exodeviations are common after recess-resect surgery in childhood. The risk of consecutive esotropia or persistent impairment of binocular vision is low.