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Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study
  1. Deborah Buck1,
  2. Christine J Powell2,
  3. John J Sloper3,
  4. Robert Taylor4,
  5. Peter Tiffin5,
  6. Michael P Clarke1,2, for the Improving Outcomes in Intermittent Exotropia (IOXT) Study group
  1. 1Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
  2. 2Royal Victoria Infirmary Eye Department, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
  3. 3Department of Strabismus and Paediatric, Moorfields Eye Hospital, London, UK
  4. 4Department of Ophthalmology, York Hospitals NHS Trust, York, UK
  5. 5Ophthalmology Unit, Sunderland Eye Infirmary, Sunderland, UK
  1. Correspondence to Dr Deborah Buck, Institute of Neuroscience, c/o Clinical Trials Unit, 4th Floor William Leech Building, Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; deborah.buck{at}ncl.ac.uk

Abstract

Purpose To describe surgical outcomes in intermittent exotropia (X(T)), and to relate these to preoperative and surgical characteristics.

Methods 87 children (aged <11 years) underwent surgery in 18 UK centres; review data (mean 21 months post-surgery) were available for 72. The primary outcome measure was motor/sensory outcome (angle and stereoacuity). The secondary outcome measure was satisfactory control assessed by Newcastle Control Score (NCS).

Results 35% of patients had excellent, 28% had fair and 37% had poor primary outcome. Preoperative and surgical characteristics did not influence primary outcome. Satisfactory control was achieved in 65% of patients, while X(T) remained/recurred in 20%. Persistent over-correction occurred in 15% of children. There was no relationship between over-correction and preoperative characteristics or surgical dose/type. Median angle improved by 12 prism dioptres (PD) at near and 19 PD at distance (p<0.001). Median NCS improved by 5 (p<0.001). 40% of those initially over-corrected remained so by last postoperative assessment; no relationship was found between an initial over-correction and good outcome.

Conclusions Whilst excellent motor/sensory outcome was achieved in one-third and satisfactory control in two-thirds of patients, the 37% poor outcome and 15% persistent over-correction rate is of concern. Surgical dose was similar in those under- and over-corrected, suggesting that over-corrections cannot be avoided merely by getting the dosage right: a randomised controlled trial (RCT) would shed light on this issue. Initial over-correction did not improve the chance of a good outcome, supporting the growing literature on this topic and further highlighting the need for randomised controlled trials of X(T) surgery.

  • Treatment Surgery
  • Child health (paediatrics)

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