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LACTOSE control scoring helps predict surgical outcomes for childhood intermittent exotropia
Yeji Moon1, Hyuna Kim2, Dae Hee Kim3
1Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Insights
Preoperative LACTOSE scores predict surgical success in children with intermittent exotropia. Higher scores indicate worse control and are linked to higher failure rates, guiding treatment decisions.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Intermittent exotropia is a common strabismus condition in children.
- Predicting surgical outcomes is crucial for effective management.
- The Look And Cover, then Ten seconds of Observation Scale for Exotropia (LACTOSE) is a tool to assess deviation control.
Purpose of the Study:
- To evaluate if preoperative LACTOSE control scores can predict surgical outcomes in children with intermittent exotropia.
- To determine the correlation between LACTOSE scores and surgical success rates.
Main Methods:
- A retrospective analysis of 350 children (3-10 years) with intermittent exotropia undergoing bilateral lateral rectus recession.
- Preoperative LACTOSE scores for distance and near control were recorded.
- Surgical success was defined as alignment within 10 PD exodeviation or 5 PD esodeviation at 12 months post-surgery.
Main Results:
- Worse LACTOSE scores (higher values) were associated with younger age, lower visual acuity, poorer stereoacuity, and larger deviation angles.
- Surgical success was achieved in 78.1% of patients at 12 months.
- Preoperative LACTOSE scores were significant predictors of surgical success, with an inverse relationship between scores and success rates (p=0.004 for distance, p=0.023 for near).
Conclusions:
- Higher preoperative LACTOSE scores, indicating poorer deviation control, are associated with increased surgical failure rates in intermittent exotropia.
- The LACTOSE scoring system can effectively predict surgical outcomes in pediatric intermittent exotropia.
- This tool aids in patient selection and managing expectations for strabismus surgery.
Objective:
To determine whether preoperative Look And Cover, then Ten seconds of Observation Scale for Exotropia (LACTOSE) control scores can predict surgical outcomes in children with intermittent exotropia.
Design:
Retrospective interventional case series from a university-based tertiary eye care centre.
Participants:
A total of 350 patients with basic-type intermittent exotropia who underwent bilateral lateral rectus recession between 3 and 10 years of age from January 2014 to December 2017.
Methods:
All patients were preoperatively assessed for their degree of control at both distance and near according to LACTOSE scoring system. Demographic, clinical, and oculomotor data before and after surgery were collected and analyzed with regard to the degree of control. Surgical success was defined as an alignment between 10 prism diopters (PD) of exodeviation and 5 PD of esodeviation at both distance and near.
Results:
Younger age, lower visual acuity, worse stereoacuity, and larger angle of deviation were associated with higher (i.e., worse) LACTOSE control scores. Of the 350 patients having surgery, 169 (48.3%) were followed for more than 12 months postoperatively. Surgical success was achieved in 132 (78.1%) patients at 12 months after surgery. The only significant predictor of surgical success was preoperative LACTOSE score. There was a significant inverse relationship between LACTOSE scores and surgical success rates for both distance and near scores (p = 0.004 and 0.023, respectively).
Conclusions:
Higher distance and near LACTOSE scores representing worse control of deviation were associated with higher rates of surgical failure in children with intermittent exotropia. This finding indicates that surgical outcome of intermittent exotropia can be predicted by preoperative LACTOSE scores.
