Department of Ophthalmology, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.
Department of Ophthalmology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
Sci Rep. 2024 Oct 29;14(1):26013. doi: 10.1038/s41598-024-77213-z.
To assess the response to monocular occlusion test in basic type intermittent exotropia (IXT) and to evaluate the surgical outcomes of titrated surgery based on the test's result. Medical records were retrospectively reviewed for patients who underwent bilateral lateral rectus recession for basic type IXT. Patients were categorized into two groups: those who underwent a preoperative diagnostic monocular occlusion test (occlusion group) and those who did not (no occlusion group). In the occlusion group, patients exhibiting a change in deviation angle of ≥ 5 prism diopters (PD), either at distance or near fixation following occlusion therapy, were classified as responders, and augmented surgery was performed for patients with an increased deviation. A total of 215 patients were included in this study, with 79 patients (36.7%) in the no occlusion group and 136 patients (63.3%) in the occlusion group. In the occlusion group, while the mean distance deviation did not significantly change, the mean near deviation significantly increased from 27.2 ± 7.7 PD to 32.5 ± 8.6 PD after diagnostic monocular occlusion (p < 0.001). 58% (58%) of patients showed an increase in near deviation angle of 5 PD or more. Patients with good fusional control at near fixation were more likely to show a change in their deviation after the occlusion (odds ratio = 1.722, p = 0.028). The success rate of the strabismus surgery was significantly higher, and recurrence rate was significantly lower in the occlusion group compared to the no occlusion group (p = 0.025 and p = 0.030), while overcorrection rate was not significantly different between the two groups (p = 1.000). Over half of the patients with basic type IXT demonstrated a significant increase in near deviation angle after diagnostic monocular occlusion. Diagnostic monocular occlusion may be useful for revealing the maximum deviation angle at near fixation and may help determine the optimal surgical dosage in basic type IXT.
评估基本型间歇性外斜视（IXT）对单眼遮盖试验的反应，并根据试验结果评估经滴定手术的治疗效果。对接受双侧外直肌后退术治疗基本型 IXT 的患者的病历进行回顾性分析。患者分为两组：接受术前诊断性单眼遮盖试验（遮盖组）和未接受（未遮盖组）的患者。在遮盖组中，如果患者在遮盖治疗后无论是远距还是近距注视时的斜视角度变化≥5 棱镜度（PD），则将其归类为反应者，并对斜视度数增加的患者进行增强手术。本研究共纳入 215 例患者，其中未遮盖组 79 例（36.7%），遮盖组 136 例（63.3%）。在遮盖组中，虽然平均远距斜视度没有显著变化，但平均近距斜视度从 27.2±7.7 PD 显著增加至 32.5±8.6 PD（p<0.001）。58%（58%）的患者近距斜视角度增加了 5 PD 或更多。近距融合控制良好的患者在遮盖后更有可能出现斜视变化（优势比=1.722，p=0.028）。与未遮盖组相比，遮盖组斜视手术的成功率显著更高，斜视复发率显著更低（p=0.025 和 p=0.030），但两组的过矫率无显著差异（p=1.000）。超过一半的基本型 IXT 患者在接受诊断性单眼遮盖后，近距斜视角度显著增加。诊断性单眼遮盖可能有助于揭示近距注视时的最大斜视角度，并有助于确定基本型 IXT 的最佳手术剂量。
