Dong Yi, Nan Li, Liu Yu-Yan
Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology Tianjin Medical University, Tianjin 300020, China.
Int J Ophthalmol. 2021 Apr 18;14(4):582-588. doi: 10.18240/ijo.2021.04.16. eCollection 2021.
To compare the outcomes between early surgery and late surgery for intermittent exotropia (IXT) with a Meta-analysis.
Scientific databases including PubMed, Embase, Web of Science, Cochrane and China National Knowledge Infrastructure were searched prior to December 16, 2019. From this broad database search, we performed some Meta-analysis including eleven independent studies, to further evaluate the outcome(s) when comparing early versus late surgery for IXT. The boundaries between early and late surgery and the surgery methods were not inconsistent, so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches. The pooled odds ratios (ORs) and the 95% confidence interval (CI) were estimated according to the random-effects model for high heterogeneity between studies.
Eleven retrospective studies were included in this Meta-analysis. No significant difference between early and late surgery was observed for IXT patients (OR=0.88, 95%CI 0.53-1.44, =0.61; OR=1.48, 95%CI 0.94-2.31, =0.09). However, sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable. Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession (BLR) subgroup for the final follow-up (OR=2.64, 95%CI 1.57-4.44, =0.00; OR=2.25, 95%CI 1.36-3.74, =0.00).
Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.
通过Meta分析比较间歇性外斜视（IXT）早期手术和晚期手术的疗效。
在2019年12月16日前检索包括PubMed、Embase、Web of Science、Cochrane和中国知网在内的科学数据库。从这个广泛的数据库搜索中，我们进行了一些Meta分析，包括11项独立研究，以进一步评估比较IXT早期手术与晚期手术时的疗效。早期手术和晚期手术的界限以及手术方法并不一致，因此按手术年龄的不同界限和不同手术方式进行亚组分析。根据随机效应模型估计合并比值比（OR）和95%置信区间（CI），用于研究间的高异质性。
本Meta分析纳入11项回顾性研究。对于IXT患者，早期手术和晚期手术之间未观察到显著差异（OR=0.88，95%CI 0.53-1.44，P=0.61；OR=1.48，95%CI 0.94-2.31，P=0.09）。然而，通过依次剔除个别研究进行的敏感性分析表明，最终随访结果不稳定。亚组分析显示，在4年界限亚组以及最终随访的双侧外直肌后徙（BLR）亚组中，早期手术可导致更好的疗效（OR=2.64，95%CI 1.57-4.44，P=0.00；OR=2.25，95%CI 1.36-3.74，P=0.00）。
对于4岁以下患者或选择BLR手术方法的IXT患者，早期手术可提供更好的长期随访疗效。
