TY - JOUR
T1 - Is intermittent exotropia a curable condition?
AU - Holmes, J. M.
AU - Hatt, S. R.
AU - Leske, D. A.
N1 - Funding Information:
This study was supported by National Institutes of Health Grants EY018810 and EY024333 (JMH), Research to Prevent Blindness, New York, NY (JMH as Olga Keith Weiss Scholar and an unrestricted grant to the Department of Ophthalmology, Mayo Clinic), and Mayo Foundation, Rochester, MN, USA. None of the sponsors or funding organizations had a role in the design or conduct of this research.
Publisher Copyright:
© 2015 Macmillan Publishers Limited. All rights reserved.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Surgical treatment of childhood intermittent exotropia (XT) is associated with high recurrence rates. In addition, the natural history of intermittent XT has not been rigorously studied and, anecdotally, some cases resolve without surgery. We compared long-term cure rates in children with surgically and non-surgically managed intermittent XT. Children undergoing surgery for intermittent XT who had 5 years follow-up were retrospectively identified. A non-surgical cohort of comparable children was selected by matching each surgical patient for age at onset and age at the 5-year examination. Cure was defined as no manifest tropia on examination or by history, no new monofixation (stereoacuity subnormal for age), and no additional surgery. Each group had 33 children (total follow-up from presentation 7.2±2.6 years in the surgical group vs 6.8±2.3 years). There were no significant differences between groups for age at onset, age at presentation, or distance or near angle of deviation at presentation (all P≥0.4). The cure rate at 5 years was 30% in the surgical group and 12% in the non-surgical group (P=0.1; difference 18%, 95% CI -1 to 37%). Only a small proportion of surgical and non-surgical patients met our definition of cure, with the vast majority demonstrating a constant or intermittent manifest deviation after an average of 7 years follow-up. In childhood intermittent XT, long-term cure is difficult to achieve with surgical intervention, and in some patients managed non-surgically the intermittent XT will spontaneously resolve.
AB - Surgical treatment of childhood intermittent exotropia (XT) is associated with high recurrence rates. In addition, the natural history of intermittent XT has not been rigorously studied and, anecdotally, some cases resolve without surgery. We compared long-term cure rates in children with surgically and non-surgically managed intermittent XT. Children undergoing surgery for intermittent XT who had 5 years follow-up were retrospectively identified. A non-surgical cohort of comparable children was selected by matching each surgical patient for age at onset and age at the 5-year examination. Cure was defined as no manifest tropia on examination or by history, no new monofixation (stereoacuity subnormal for age), and no additional surgery. Each group had 33 children (total follow-up from presentation 7.2±2.6 years in the surgical group vs 6.8±2.3 years). There were no significant differences between groups for age at onset, age at presentation, or distance or near angle of deviation at presentation (all P≥0.4). The cure rate at 5 years was 30% in the surgical group and 12% in the non-surgical group (P=0.1; difference 18%, 95% CI -1 to 37%). Only a small proportion of surgical and non-surgical patients met our definition of cure, with the vast majority demonstrating a constant or intermittent manifest deviation after an average of 7 years follow-up. In childhood intermittent XT, long-term cure is difficult to achieve with surgical intervention, and in some patients managed non-surgically the intermittent XT will spontaneously resolve.
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U2 - 10.1038/eye.2014.268
DO - 10.1038/eye.2014.268
M3 - Article
C2 - 25397782
AN - SCOPUS:84938397660
VL - 29
SP - 171
EP - 176
JO - Transactions of the Ophthalmological Societies of the United Kingdom
JF - Transactions of the Ophthalmological Societies of the United Kingdom
SN - 0950-222X
IS - 2
ER -