Department of Ophthalmology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Sci Rep. 2020 Mar 13;10(1):4631. doi: 10.1038/s41598-020-61568-0.
In young children with small angle exotropia, making decisions for the individual patient whether to perform surgery or not, and choosing the optimal time for surgical intervention are quite difficult. We aimed to compare the long-term outcomes of small angle intermittent exotropia of 20 prism diopters (PD) or less after observation versus strabismus surgery. A retrospective study was performed on 164 patients aged 3 to 13 who underwent surgical intervention or observation with or without conservative management for intermittent exotropia of 14 to 20 PD. The minimum follow-up period was 2 years. The average follow-up period was 3.9 ± 2.2 years in the observation group and 4.5 ± 2.3 years in the surgery group. At the final examination, the mean angle of deviation at distance was 11.1 ± 8.9 PD in the observation group and 9.0 ± 7.5 PD in the surgery group, which was not significantly different (P = 0.121). Changes in sensory outcome and fusional control were not significantly different between both groups (P = 0.748 and P = 0.968). Subgroup analysis including patients with poor fusional control also showed similar results. By multivariate analysis, the type of surgery, unilateral recess-resect procedure, was the only predictive factor of good motor outcome in the surgery group. In conclusion, long-term surgical outcomes in small angle exotropia did not appear to be more satisfying than observation in terms of motor and sensory outcomes.
在患有小角度外斜视的幼儿中，为个体患者决定是否进行手术以及选择最佳手术干预时间非常困难。我们旨在比较 20 棱镜度（PD）或更小的小角度间歇性外斜视观察与斜视手术的长期结果。对 164 名年龄在 3 至 13 岁之间的患者进行了回顾性研究，这些患者因 14 至 20 PD 的间歇性外斜视接受了手术干预或观察，同时伴有或不伴有保守治疗。最短随访时间为 2 年。观察组的平均随访时间为 3.9±2.2 年，手术组为 4.5±2.3 年。在最终检查时，观察组的平均远距偏转角为 11.1±8.9 PD，手术组为 9.0±7.5 PD，差异无统计学意义（P=0.121）。两组之间感觉结果和融合控制的变化没有明显差异（P=0.748 和 P=0.968）。包括融合控制不良患者的亚组分析也显示出相似的结果。多变量分析显示，手术类型，单侧后退-切除术是手术组良好运动结果的唯一预测因素。总之，在运动和感觉结果方面，小角度外斜视的长期手术结果似乎并不比观察更令人满意。
