Saunders Richard A, Trivedi Rupal H
Department of Ophthalmology, Miles Center for Pediatric Ophthalmology Storm Eye Institute, Medical University of South Carolina, Charleston, SC 29425, USA.
J AAPOS. 2008 Apr;12(2):132-5. doi: 10.1016/j.jaapos.2007.08.011. Epub 2007 Dec 21.
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.
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 > or =4 years, when testing with Worth 4-Dot and Titmus stereo circles would likely be reliable.
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 <10(Delta) at distance and near. No patient required treatment for amblyopia.
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.
早发性间歇性外斜视的早期手术治疗存在争议。这种情况并不总是进展，且术后内斜视会产生不良后果，如抑制、弱视和双眼视觉丧失，尤其是立体视丧失。尚不清楚两岁前手术是否会影响感觉功能预后。
采用非对照（非随机、无对照）干预性病例系列研究，我们回顾了14年间24例1岁前发病的间歇性外斜视患者的病历，这些患者在两岁前也接受了双侧外直肌后徙术。确定了12例在4岁及以上接受随访检查的患者，此时使用Worth 4点和Titmus立体视圈进行测试可能是可靠的。
末次随访检查时患者的平均年龄为87个月。2例患者的立体视锐度为40角秒，3例为100角秒，2例为140 - 400角秒，5例无立体视。在5例无立体视的患者中，1例有与先天性外斜视一致的病史和临床过程，1例因非斜视原因导致立体视差。总体而言，7例患者（58%）最终获得了良好的运动性眼位矫正，定义为远距离和近距离隐斜或间歇性斜视<10棱镜度。无患者需要弱视治疗。
早发性间歇性外斜视通常对手术治疗反应良好，部分病例可获得高级别立体视。婴儿期表现为间歇性外斜视的可能不止一种临床类型。
