PT  - JOURNAL ARTICLE
AU  - Deborah Buck
AU  - Christine J Powell
AU  - John J Sloper
AU  - Robert Taylor
AU  - Peter Tiffin
AU  - Michael P Clarke
TI  - Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study
AID  - 10.1136/bjophthalmol-2012-301981
DP  - 2012 Oct 01
TA  - British Journal of Ophthalmology
PG  - 1291--1295
VI  - 96
IP  - 10
4099  - http://bjo.bmj.com/content/96/10/1291.short
4100  - http://bjo.bmj.com/content/96/10/1291.full
SO  - Br J Ophthalmol2012 Oct 01; 96
AB  - 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.