Richardson S, Gnanaraj L
Orthoptics, Royal Victoria Infirmary, Claremont Wing, Newcastle upon Tyne, UK, NE1 4LP.
Cochrane Database Syst Rev. 2003(2):CD003737. doi: 10.1002/14651858.CD003737.
The clinical management of intermittent distance exotropia has been discussed frequently in the literature but there is a lack of clarity regarding the indications for intervention, the most effective type and the optimum age at which it should be carried out.
The objective of this review is to assess intervention criteria, the effects of various surgical and non-surgical treatments in people with intermittent distance exotropia and to determine the significance of factors such as age with respect to outcome.
We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group trials register) on the Cochrane Library (Issue 4 2002), MEDLINE (1966 to November 2002), EMBASE (1980 to November 2002) and LILACS (Latin American and Caribbean Literature on Health Sciences) (1966 to 2002). We manually searched the British Orthoptic Journal, proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS). We contacted researchers who are active in the field for information about further published or unpublished studies. There were no language restrictions in the manual or electronic searches.
We planned to include randomised controlled trials of any surgical or non-surgical treatment for intermittent distance exotropia.
Each reviewer independently assessed study abstracts identified from database and manual searches. Reviewer analysis was then compared and full papers for appropriate studies were obtained.
No studies were found that met our selection criteria and therefore none were included for analysis.
REVIEWER'S CONCLUSIONS: The available literature consists mainly of retrospective case reviews. These are difficult to compare and analyse due to a large variation in the definition of intermittent distance exotropia, intervention criteria and outcome measures. However there seems to be general agreement that non-surgical treatment is most appropriate in small angle deviations or as a supplement to surgery. Studies were found supporting both early and late surgical intervention so the optimal timing of surgical intervention cannot be concluded. Recent work indicates that bilateral surgery may be the most effective surgical procedure in these cases. There is clearly a need for carefully planned clinical trials to be undertaken to improve the evidence base for the management of this condition.
间歇性外斜视的临床管理在文献中已有频繁讨论，但关于干预指征、最有效的治疗类型以及进行干预的最佳年龄仍不明确。
本综述的目的是评估间歇性外斜视的干预标准、各种手术和非手术治疗的效果，并确定年龄等因素对治疗结果的影响。
我们检索了Cochrane图书馆（2002年第4期）中的Cochrane对照试验中心注册库（CENTRAL，其中包含Cochrane眼科和视觉组试验注册库）、MEDLINE（1966年至2002年11月）、EMBASE（1980年至2002年11月）以及LILACS（拉丁美洲和加勒比地区健康科学文献）（1966年至2002年）。我们还手动检索了《英国斜视杂志》、欧洲斜视协会（ESA）会议论文集、国际斜视协会（ISA）会议论文集以及美国小儿眼科与斜视学会会议（AAPOS）论文集。我们联系了该领域的活跃研究人员，以获取有关进一步已发表或未发表研究的信息。手动检索和电子检索均无语言限制。
我们计划纳入任何针对间歇性外斜视的手术或非手术治疗的随机对照试验。
每位评审员独立评估从数据库和手动检索中识别出的研究摘要。然后比较评审员的分析结果，并获取适当研究的全文。
未发现符合我们入选标准的研究，因此无一纳入分析。
现有文献主要由回顾性病例综述组成。由于间歇性外斜视的定义、干预标准和结局测量存在很大差异，这些综述难以进行比较和分析。然而，似乎普遍认为非手术治疗最适用于小角度斜视或作为手术的补充。有研究支持早期和晚期手术干预，因此无法得出手术干预的最佳时机。近期研究表明，双侧手术可能是这些病例中最有效的手术方法。显然需要进行精心设计的临床试验，以改善这种疾病管理的证据基础。
