Department of Ophthalmology & Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA.
J Binocul Vis Ocul Motil. 2022 Jul-Sep;72(3):131-138. Epub 2022 Jul 12.
There are three keys to understanding how the new way of classifying and treating intermittent exotropia (IXT) differs from Burian's classic classification. First, the assumption that lateral rectus surgery selectively affects the distance deviation, recess/resect procedures affect the distance and near equally, and that medial rectus surgery selectively affects the near deviation, are false assumptions. Second, AC/A ratios in IXT can be calculated in all the usual manners, provided that any near measurement used in the calculation be made after prolonged monocular occlusion to eliminate the contaminating effect of the Scobee phenomenon. Third, the use of +3 diopter (D) lenses at near and prolonged monocular occlusion are not interchangeable and work on different mechanisms, the former on accommodative convergence and the latter on fusional convergence. All patients with IXT should have a measurement taken after prolonged monocular occlusion, as well as while fixating on a far distant outdoor target prior to surgery, which should target the largest angle measured.
理解新的间歇性外斜视（IXT）分类和治疗方法与 Burian 经典分类的不同之处有三个关键。首先，认为外侧直肌手术选择性地影响远距离偏差，内收/外转手术同等程度地影响远距离和近距离，以及内侧直肌手术选择性地影响近距离偏差，这些都是错误的假设。其次，只要在计算中使用的任何近距离测量值都是在长时间单眼遮盖后进行的，以消除 Scobee 现象的污染影响，那么就可以以所有常见的方式计算 IXT 的 AC/A 比值。第三，在近距离使用+3 屈光度（D）镜片和长时间单眼遮盖不是可互换的，它们作用于不同的机制，前者作用于调节性集合，后者作用于融合性集合。所有 IXT 患者在手术前都应进行长时间单眼遮盖后的测量，以及在注视远处户外目标时的测量，手术应针对测量到的最大角度进行。
