Hatt Sarah R, Gnanaraj Lawrence
Ophthalmology Research, Mayo Clinic, Rochester, USA.
Cochrane Database Syst Rev. 2013 May 31;2013(5):CD003737. doi: 10.1002/14651858.CD003737.pub3.
The clinical management of intermittent exotropia has been discussed extensively in the literature, yet there remains a lack of clarity regarding indications for intervention, the most effective form of treatment and whether or not there is an optimal time in the evolution of the disease at which any treatment should be carried out.
The objective of this review was to analyse the effects of various surgical and non-surgical treatments in randomised trials of participants with intermittent exotropia, and to report intervention criteria and 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) (The Cochrane Library, Issue 4, 2012), MEDLINE (January 1966 to May 2012), EMBASE (January 1980 to May 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 May 2012. We are no longer searching the UK Clinical Trials Gateway (UKCTG) for this review. We manually searched the British Orthoptic Journal up to 2002, and the proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) up to 2001. We contacted researchers who are active in the field for information about further published or unpublished studies.
We included randomised controlled trials of any surgical or non-surgical treatment for intermittent exotropia.
Each review author independently assessed study abstracts identified from the electronic and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained.
We found one randomised trial that was eligible for inclusion. This trial showed that unilateral surgery was more effective than bilateral surgery for correcting the basic type of intermittent exotropia.
AUTHORS' CONCLUSIONS: The available literature consists mainly of retrospective case reviews, which are difficult to reliably interpret and analyse. The one randomised trial included found unilateral surgery more effective than bilateral surgery for basic intermittent exotropia. However, across all identified studies, measures of severity and thus criteria for intervention are poorly validated, and there appear to be no reliable natural history data. There is therefore a pressing need for improved measures of severity, a better understanding of the natural history and carefully planned clinical trials of treatment 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广泛讨论，但在干预指征、最有效的治疗形式以及疾病发展过程中是否存在进行任何治疗的最佳时机等方面仍不明确。
本综述的目的是分析各种手术和非手术治疗在间歇性外斜视参与者随机试验中的效果，并报告干预标准，确定年龄等因素对结果的影响。
我们检索了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）（《Cochrane图书馆》，2012年第4期）、MEDLINE（1966年1月至2012年5月）、EMBASE（1980年1月至2012年5月）、拉丁美洲和加勒比地区卫生科学文献数据库（LILACS）（1982年1月至2012年5月）、对照试验元注册库（mRCT）（www.controlled-trials.com）、ClinicalTrials.gov（www.clinicaltrials.gov）以及世界卫生组织国际临床试验注册平台（ICTRP）（www.who.int/ictrp/search/en）。在电子检索试验时，我们未使用任何日期或语言限制。我们最后一次检索电子数据库是在2012年5月4日。我们不再为本次综述检索英国临床试验网关（UKCTG）。我们手动检索了截至2002年的《英国斜视杂志》，以及截至2001年的欧洲斜视学会（ESA）、国际斜视学会（ISA）和美国小儿眼科与斜视学会会议（AAPOS）的会议记录。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。
我们纳入了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。
每位综述作者独立评估从电子和手动检索中识别出的研究摘要。然后比较作者的分析，并获取适当研究的全文。
我们发现一项符合纳入标准的随机试验。该试验表明，对于纠正基本型间歇性外斜视，单侧手术比双侧手术更有效。
现有文献主要由回顾性病例综述组成，难以进行可靠的解释和分析。纳入的一项随机试验发现，对于基本型间歇性外斜视，单侧手术比双侧手术更有效。然而，在所有已识别的研究中，严重程度的测量方法以及干预标准的验证都很差，而且似乎没有可靠的自然史数据。因此，迫切需要改进严重程度的测量方法，更好地了解自然史，并精心设计治疗的临床试验，以改善这种疾病管理的证据基础。
