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Satisfactory control may be retained after surgery for intermittent exotropia
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Satisfactory control was achieved in two-thirds of patients undergoing surgical treatment for intermittent exotropia, and most of those patients retained control postoperatively, according to a study.
“There is little evidence regarding the natural course of childhood [intermittent exotropia] and we cannot be certain that spontaneous improvement over time is any less likely than a good outcome following surgery,” the study authors said. “In the absence of such knowledge, surgery will continue to be offered by clinicians and requested by parents, and although the chances of a good result are reasonable, the cause or causes of overcorrection remain unclear.”
The Improving Outcomes in Intermittent Exotropia study included 87 children who underwent surgery for intermittent exotropia.
Mean patient age was 16.7 months at onset of intermittent exotropia and 57.9 months at the time of surgery. The mean interval between preoperative assessment and surgery was 6.8 weeks.
The primary outcome measure was motor/sensory success for angle and stereoacuity. A secondary measure was the proportion of patients with satisfactory control quantified by the Newcastle Control Score.
Study results showed that motor/sensory outcomes were excellent in 35% of patients, fair in 28% and poor in 37%.
Satisfactory control was attained in 65% of patients. Intermittent exotropia persisted or recurred in 20% of patients. Overcorrection persisted in 15% of patients.
Median angle improved by 12 ∆D at near and 19 ∆D at distance (P < .001). Median Newcastle Control Score improved by 5 points (P < .001).
No relationship between overcorrection and preoperative characteristics, surgical dose or type of surgery was observed. Nor was any association between initial overcorrection and good outcome observed, the authors said.
Perspective
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Robert S. Gold, MD, MD
Buck and colleagues present the Improving Outcomes in Intermittent Exotropia study results from a cohort of 87 of 460 children who were operated on for intermittent exotropia with approximately 2 years follow-up; 36% of patients had excellent alignment, 28% had fair and 36% had poor results; 15% had persistent overcorrection.It was interesting to note that 60% of the patients had unilateral surgery (LR recess and MR resect) while 38% had bilateral lateral rectus recessions and 2% had three horizontal muscle surgery. No patient had single muscle surgery.
The question to be asked is whether the choice of surgical procedure itself has led to these results, in particular to the overcorrection rate. It is not clear from the manuscript the specific deviations on these patients and how the surgical procedure was chosen for each patient.
I concur that a randomized controlled study could bring light on both the choice of the appropriate surgical procedure as well as interpretation of the surgical results.
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