Lee Joo Yeon, Ko Sung Ju, Baek Sung Uk
Department of Ophthalmology, Hallym University College of Medicine, Anyang 431-070, Korea.
Int J Ophthalmol. 2014 Jun 18;7(3):528-33. doi: 10.3980/j.issn.2222-3959.2014.03.26. eCollection 2014.
To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.
One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success [≤5 prism diopters (PD) esophoria (E) to ≤10 PD exophoria (X) on the postoperative sixth month] were enrolled in this study. Their consecutive survival on the postoperative first year, second year and third year and at the last visit of fourth year or more, and the factors that might affect their survival, were analyzed. The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group (≤5 PD E to ≤10 PD X) and the failure group (>5 PD esodeviation or >10 PD exodeviation).
The survival rates from the Kaplan-Meier analysis were 97.78%, 92.89%, 83.70% and 50.49% on the postoperative first, second and third years and fourth year or more, respectively. None of the clinical factors was determined to have affected the survival. The amount of the exodrift was largest (2.29 PD) between the first year and the second year, and smallest (1.47 PD) between the fourth year and the last visit. Sixty-three patients had their final visit after the postoperative fourth year, and 29 of them were in the failure group. Twenty-five patients in the failure group had an intermittent exotropia (IXT) of <20 PD with good to fair distant fusion; two had an IXT of <20 PD with poor distant fusion; one had an IXT of ≥20 PD with fair distant fusion; and another had delayed-onset consecutive esotropia. The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group (2.81 PD vs 5.86 PD, P=0.012). The reoperation rate for recurrent IXT was 3.7%.
The survival rate steadily decreases with the exodrift, but the amount of the exodrift decreases with long-term follow-up. The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients. A smaller deviation on the postoperative sixth month is associated with long-term survival.
评估间歇性外斜视手术早期成功后的连续复发情况，并确定影响其复发的临床因素。
本研究纳入了135例行间歇性外斜视手术且早期手术成功的患者（术后第六个月内隐斜度≤5棱镜度（PD）至外隐斜度≤10 PD）。分析了他们在术后第一年、第二年、第三年以及第四年或更晚最后一次随访时的连续复发情况，以及可能影响其复发的因素。还通过将患者分为成功组（内隐斜度≤5 PD至外隐斜度≤10 PD）和失败组（内斜视度>5 PD或外斜视度>10 PD），对术后第四年的最终手术结果进行了研究。
根据Kaplan-Meier分析，术后第一年、第二年、第三年以及第四年或更晚的复发率分别为97.78%、92.89%、83.70%和50.49%。未确定任何临床因素会影响复发情况。外隐斜度在第一年和第二年之间最大（2.29 PD），在第四年和最后一次随访之间最小（1.47 PD）。63例患者在术后第四年进行了最后一次随访，其中29例属于失败组。失败组中，25例间歇性外斜视（IXT）度数<20 PD，远距离融合功能良好至中等；2例IXT度数<20 PD，远距离融合功能较差；1例IXT度数≥20 PD，远距离融合功能中等；另1例为迟发性连续性内斜视。成功组术后第六个月的外斜视度小于失败组（2.81 PD对5.86 PD，P = 0.012）。复发性IXT的再次手术率为3.7%。
复发率随外隐斜度增加而稳步下降，但外隐斜度会随着长期随访而减小。大多数患者通过手术成功或小角度IXT伴良好融合功能，最终结果良好。术后第六个月较小的斜视度与长期复发相关。
