Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
J Korean Med Sci. 2019 Oct 7;34(38):e252. doi: 10.3346/jkms.2019.34.e252.
To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children.
Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance.
Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery ( = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle ( = 0.027 and = 0.022, respectively).
Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).
描述影响儿童复发性间歇性外斜视（X[T]）术后预后的因素。
回顾了一位外科医生为 50 例复发性 X[T]患者进行手术的临床记录。分析了诊断 X[T]的年龄、第 1 次和第 2 次手术、远距和近距偏斜角、手术方法、合并垂直斜视、立体视锐度和再手术前 Worth 四点（W4D）检查，以及术后偏斜角。手术成功的定义为正位，外斜视≤5 棱镜度，或内斜视≤10 棱镜度。
在 50 例接受手术并随访 1 年以上的复发性外斜视患者中，13 例出现复发性外斜视，1 例出现连续内斜视。再次手术的平均年龄为 8.49 ± 2.19 岁，术后平均随访时间为 27.78 ± 12.02 个月。再手术前有良好的近立体视是手术成功的重要因素（ = 0.006）。术后即刻和 2 个月测量的较小术后偏斜角与最终偏斜角较小相关（ = 0.027 和 = 0.022）。
周边抑制降低了儿童复发性 X[T]手术的成功率。过矫正而不是正位应该是术后即刻偏斜角的目标。周边抑制状态以及术后即刻和 2 个月的偏斜角可能是预测复发性 X[T]手术最终结果的重要线索。
