Soveeta Rath¹*, Jinal Gore² and Suma Ganesh¹

¹Department of Pediatric Ophthalmology and Strabismus and Neuro-ophthalmology, Dr Shroff’s Charity Eye Hospital, New Delhi, India
²Dr Shroff’s Charity Eye Hospital, New Delhi, India

*Corresponding Author: Soveeta Rath, Department of Pediatric Ophthalmology and Strabismus and Neuro-ophthalmology, Dr Shroff’s Charity Eye Hospital, New Delhi, India.

Received: May 23, 2021; Published: August 06, 2021

Abstract

The purpose of our study is to determine the motor and sensory outcomes in children undergoing surgery for infantile exotropia after age of 2 years and to review the association of pre-operative variables with surgical outcomes. In this retrospective study, we included patients who were diagnosed as infantile exotropia with a deviation of > 25 Prism diopters (PD) before 12 months age and subsequently underwent strabismus surgery at a single centre from 2014 to 2019. Postoperative motor alignment was assessed at 6 weeks and binocular sensory status was assessed using Worth 4-Dot (WFDT) and Titmus stereoacuity tests at 6 months follow up. A total of 30 patients were analysed. At 6 weeks post-op, motor success was seen in 24 patients (80%), whereas 6 patients (20%) constituted failure group which included 5 patients (17%) with a recurrence and 1 (3%) with an overcorrection. At 6 months post-op, measurable stereopsis was present in 15 patients (50%) with a stereopsis better than 400 sec of arc in 12 patients (40%), binocular single vision was present in 6 patients (20%) on WFDT. Smaller pre-operative angle of deviation was significantly associated with motor success for distance (p = 0.009) and near (p = 0.020). Smaller pre-operative angle for distance was associated with better sensory outcomes (p = 0.041). Pre-operative vision, age at surgery and duration of misalignment did not show statistically significant association with motor and sensory outcomes. Thus we conclude, smaller pre-operative angle of deviation for distance and near are associated with good motor and sensory outcomes. Older age at surgery in this study had outcomes comparable to younger age group reported in previous studies. The association of surgical outcomes with pre-operative vision and duration of misalignment could not be proven by this study.

Keywords: Strabismus; Exotropia; Infantile; Surgery; Binocularity; Outcomes; Intermittent Exotropia

References

1. Kraft SP. “Selected exotropia entities and principles of management”. In: Rosenbaum AL, Santiago AP, editions. Clinical Strabismus Management: Principles and Surgical Techniques. Philadelphia, PA: Saunders (1999): 176-181.
2. Biedner B. “Congenital constant exotropia: surgical results in six patients”. Binocular Vision 8 (1993): 137-140.
3. Choi YM and Kim SH. “Comparison of clinical features between two different types of exotropia before 12 months of age based on stereopsis outcome”. Ophthalmology 120 (2013): 3-7.
4. Hunter DG., et al. “Long-term outcome of uncomplicated infantile exotropia”. Journal of AAPOS 5 (2001): 352-356.
5. Saunders RA and Trivedi RH. “Sensory results after lateral rectus muscle recession for intermittent exotropia operated before two years of age”. Journal of AAPOS 12 (2008): 132-135.
6. Paik HJ and Yim HB. “Clinical effect of early surgery in infantile exotropia”. Korean Journal of Ophthalmology 16 (2002): 97-102.
7. Pratt-Johnson JA., et al. “Early surgery in intermittent exotropia”. American Journal of Ophthalmology 84 (1977): 689-694.
8. Richard JM and Parks MM. “Intermittent exotropia. Surgical results in different age groups”. Ophthalmology 90 (1983): 1172-1177.
9. Jampolsky A. “Treatment of exodeviations”. Trans New Orleans Academic Ophthalmology 34 (1986): 201-234.
10. Rajavi Z., et al. “Motor and Sensory Outcomes of Infantile Exotropia: A 10-Year Study (2008-2017)”. Korean Journal of Ophthalmology 2 (2020): 143-149.
11. Yam JC., et al. “Preoperative factors predicting the surgical outcome of bilateral lateral rectus recession surgery in patients with infantile exotropia”. The Japanese Journal of Ophthalmology 57 (2013): 481-485.
12. Yam JC., et al. “Long-term ocular alignment after bilateral lateral rectus recession in children with infantile and intermittent exotropia”. Journal of AAPOS 16 (2012): 274-279.
13. Yoo EJ and Kim SH. “Optimal surgical timing in infantile exotropia”. The Canadian Journal of Ophthalmology4 (2014): 358-362.
14. Park JH and Kim SH. “Clinical features and the risk factors of infantile exotropia recurrence”. American Journal of Ophthalmology 150 (2010): 464-467.
15. Noorden GK. “Binocular Vision and Ocular Motility: Theory and Management of Strabismus”. 6th edition. St. Louis, Mo.: Mosby (2002): 330-334.
16. Suh SY., et al. “Outcomes of surgery in children with early-onset exotropia”. Eye 27 (2013): 836-840.
17. Bagheri M and Farvardin M. “The clinical effect of surgical timing in infantile exotropia”. JAAPOS3 (2018): 167-169.
18. Biglan AW., et al. “Infantile exotropia”. Journal of Pediatric Ophthalmology and Strabismus 33 (1996): 79-84.
19. Na KH and Kim SH. “Different surgical outcomes in infantile exotropia according to onset time”. Journal of AAPOS6 (2019): 317.
20. Nam KT and Kim SH. “Traditional and reduced recession surgical dosage for bilateral lateral rectus recession for infantile exotropia”. British Journal of Ophthalmology 98 (2014): 1420-1423.
21. Cho YA and Kim SH. “Postoperative minimal overcorrection in the surgical management of intermittent exotropia”. British Journal of Ophthalmology 97 (2013): 866-869.

Citation

Citation: Soveeta Rath., et al. “Surgical Outcomes of Late Surgery in Uncomplicated Infantile Exotropia".Acta Scientific Ophthalmology 4.9 (2021): 02-08.

Copyright

Copyright: © 2021 Soveeta Rath., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.