The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised
Meiping Xu1,2, Yiyi Peng1, Fuhao Zheng1,2
1Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China.
Insights
Postoperative orthoptic therapy significantly improved outcomes for children with intermittent exotropia (IXT). This therapy enhanced binocular function, reducing suboptimal surgical results and improving stereopsis and fusional amplitude.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
- Orthoptics
Background:
- Intermittent exotropia (IXT) is a common condition in children.
- Surgical correction is often followed by a need for stabilization and rehabilitation of binocular function.
- Assessing the effectiveness of postoperative orthoptic therapy is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the clinical effectiveness of orthoptic therapy in the postoperative period for children with intermittent exotropia (IXT).
- To determine if orthoptic therapy improves the stabilization and rehabilitation of binocular function after surgery for IXT.
Main Methods:
- A prospective, parallel, randomized controlled trial was conducted.
- 136 patients with IXT (aged 7-17) were enrolled; 117 completed 12-month follow-up (58 in the orthoptic therapy group, 58 controls).
- Primary outcome: proportion of patients with suboptimal surgical outcomes (exodeviation ≥10 PD, constant esotropia ≥6 PD, or loss of ≥2 octaves of stereopsis).
Main Results:
- The cumulative probability of suboptimal surgical outcome at 12 months was significantly lower in the orthoptic therapy group (20.5%) compared to the control group (42.6%) (p=0.007).
- Improvements were observed in stereopsis, fusional exotropia control, and fusional convergence amplitude in the orthoptic therapy group.
- A smaller exodrift at near fixation was noted in the orthoptic therapy group (p=0.025).
Conclusions:
- Early postoperative orthoptic therapy is effective in improving surgical outcomes for children with intermittent exotropia.
- Orthoptic therapy enhances stereopsis and fusional amplitude post-surgery.
- This therapeutic approach aids in the successful rehabilitation of binocular function.
Background:
To assess the clinical effectiveness of orthoptic therapy in the postoperative stabilisation and rehabilitation of binocular function in children with intermittent exotropia (IXT) after surgery.
Methods:
This was a prospective, parallel, randomised controlled trial. A total of 136 IXT patients (aged from 7 to 17 years) who had been successfully corrected at 1 month after surgery were enrolled in this study, and 117 patients (58 controls) completed the 12-month follow-up visit. The primary outcome was established as the proportion of patients with suboptimal surgical outcomes, which were defined as: (1) exodeviation ≥10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT), or (2) constant esotropia ≥6 PD at distance or near using SPCT, or (3) loss of 2 or more octaves of stereopsis from baseline. The secondary outcomes were the exodeviation at distance and near using the prism and alternate cover test (PACT), stereopsis, fusional exotropia control and convergence amplitude.
Results:
The cumulative probability of suboptimal surgical outcome by 12 months was 20.5% (14/68) in the orthoptic therapy group and 42.6% (29/68) in the control group. There was a significant difference between these two groups (χ2 = 7.402, p = 0.007). Improvements in stereopsis, fusional exotropia control and fusional convergence amplitude were found in the orthoptic therapy group. A smaller exodrift was found in the orthoptic therapy group at near fixation (t = 2.26, p = 0.025).
Conclusions:
Early postoperative orthoptic therapy can effectively improve the surgical outcome as well as stereopsis and fusional amplitude.
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