Sensory results after lateral rectus muscle recession for intermittent exotropia operated before two years of age
Presented at the 33rd Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus Seattle WA, April 11-15, 2007.
Received 28 March 2007; accepted 19 August 2007. published online 14 December 2007.
Introduction
Early surgical treatment of early-onset intermittent exotropia is controversial. The condition does not always progress, and postoperative esotropia can produce adverse consequences, such as suppression, amblyopia, and loss of binocular vision, particularly stereopsis. It is not known whether surgery before age two years affects the sensory outcome.
Methods
Using a noncomparative (nonrandomized, uncontrolled) interventional case series, we reviewed the medical records during a 14-year period of 24 patients with intermittent exotropia with onset before age 1 year who also received bilateral lateral rectus muscle recessions before two years of age. Twelve patients were identified who received follow-up examinations at ages ≥4 years, when testing with Worth 4-Dot and Titmus stereo circles would likely be reliable.
Results
Mean age of the patients at last follow-up examination was 87 months. Stereoacuity was measured at 40 arcsec in 2 patients, 100 arcsec in 3 patients, 140-400 arcsec in 2 patients, and none in 5 patients. Among the 5 patients without demonstrated stereopsis, 1 had a history and clinical course consistent with congenital exotropia, and 1 had a nonstrabismic explanation for poor stereopsis. Overall, 7 patients (58%) ultimately obtained favorable motor alignment, defined as a phoria or intermittent tropia <10Δ at distance and near. No patient required treatment for amblyopia.
Conclusions
Early-onset intermittent exotropia usually responds well to surgical treatment, and high-grade stereopsis can be achieved in some cases. More than one clinical entity presenting as intermittent exotropia in infancy probably exists.
Department of Ophthalmology, Miles Center for Pediatric Ophthalmology Storm Eye Institute, Medical University of South Carolina, Charleston, SC
Reprint requests: Richard A. Saunders, MD, Storm Eye Institute Room 814, 167 Ashley Avenue, Charleston, SC 29425.
The authors have no financial, product or service interest in any for-profit company mentioned herein.
ABSTRACT