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Decreased postoperative drift in intermittent exotropia associated with A and V patterns.

ABSTRACT: Few data exist concerning postoperative drift in patients with intermittent exotropia who have coexistent A or V patterns. In addition, the impacts of pattern collapse and surgical method on postoperative drift have not been well addressed.We retrospectively reviewed the records of 132 patients who had surgery for intermittent exotropia and had >or=6 months' follow-up. Mean postoperative drift in 66 patients with pattern exotropia was compared with a nonpattern (comitant) group matched for surgeon, age, surgical method, and initial deviation. Postoperative drift was calculated by subtracting the deviation at postoperative day 1 from that at approximately 6 weeks, 6 months, 9 months, and >1 year.Pattern and comitant groups were similar in mean +/- SD age (15 +/- 17 years), follow-up (2.3 +/- 2 years), preoperative exotropia (23(Delta) +/- 11(Delta)), initial postoperative deviation (1(Delta) +/- 5(Delta) esotropia), and surgical technique. Patients with pattern intermittent exotropia showed significantly (p < 0.02) less exotropic drift postoperatively at all times than did patients without a pattern. In contrast to undercorrected patients, in those who were sufficiently overcorrected, the effect of pattern became statistically insignificant after 6 months. Patients with persisting postoperative patterns had a significantly less postoperative drift (p < 0.01).Postoperative drift in patients with A- or V-pattern intermittent exotropia is consistently less than in comitant exotropia, particularly if the pattern persists postoperatively and if the exotropia is undercorrected. Therefore, surgeons should consider smaller early overcorrections in pattern than comitant intermittent exotropia. Lesser postoperative drift in pattern exotropia may suggest differing underlying causes of pattern vs nonpattern exotropia.

SUBMITTER: Pineles SL

PROVIDER: S-EPMC2768551 | biostudies-literature | 2009 Apr

REPOSITORIES: biostudies-literature

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Decreased postoperative drift in intermittent exotropia associated with A and V patterns.

Pineles Stacy L SL Rosenbaum Arthur L AL Demer Joseph L JL

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 20090120 2

<h4>Introduction</h4>Few data exist concerning postoperative drift in patients with intermittent exotropia who have coexistent A or V patterns. In addition, the impacts of pattern collapse and surgical method on postoperative drift have not been well addressed.<h4>Methods</h4>We retrospectively reviewed the records of 132 patients who had surgery for intermittent exotropia and had >or=6 months' follow-up. Mean postoperative drift in 66 patients with pattern exotropia was compared with a nonpatte ...[more]

PMID: 19157935

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Project description:BackgroundThe clinical management of intermittent exotropia has been discussed extensively in the literature, yet there remains a lack of clarity regarding indications for intervention, the most effective form of treatment and whether or not there is an optimal time in the evolution of the disease at which any treatment should be carried out.ObjectivesThe objective of this review was to analyse the effects of various surgical and non-surgical treatments in randomised trials of participants with intermittent exotropia, and to report intervention criteria and determine the significance of factors such as age with respect to outcome.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2012), MEDLINE (January 1966 to May 2012), EMBASE (January 1980 to May 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 May 2012. We are no longer searching the UK Clinical Trials Gateway (UKCTG) for this review. We manually searched the British Orthoptic Journal up to 2002, and the proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) up to 2001. We contacted researchers who are active in the field for information about further published or unpublished studies.Selection criteriaWe included randomised controlled trials of any surgical or non-surgical treatment for intermittent exotropia.Data collection and analysisEach review author independently assessed study abstracts identified from the electronic and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained.Main resultsWe found one randomised trial that was eligible for inclusion. This trial showed that unilateral surgery was more effective than bilateral surgery for correcting the basic type of intermittent exotropia.Authors' conclusionsThe available literature consists mainly of retrospective case reviews, which are difficult to reliably interpret and analyse. The one randomised trial included found unilateral surgery more effective than bilateral surgery for basic intermittent exotropia. However, across all identified studies, measures of severity and thus criteria for intervention are poorly validated, and there appear to be no reliable natural history data. There is therefore a pressing need for improved measures of severity, a better understanding of the natural history and carefully planned clinical trials of treatment to improve the evidence base for the management of this condition.

Dataset Information

Decreased postoperative drift in intermittent exotropia associated with A and V patterns.

Publications

Decreased postoperative drift in intermittent exotropia associated with A and V patterns.

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