A Randomized Trial Comparing Bilateral Lateral Rectus Recession versus Unilateral Recess and Resect for Basic-Type Intermittent Exotropia
| Autor: | Jonathan M. Holmes, B. Michele Melia, Aaron M. Miller, Evelyn A. Paysse, Sean P. Donahue, Danielle L. Chandler, Raymond T. Kraker, David K. Wallace, Brian W. Arthur, David B. Petersen |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Visual acuity Eye Movements Visual Acuity Ophthalmologic Surgical Procedures law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Humans Child Dioptre 030304 developmental biology 0303 health sciences Vision Binocular business.industry medicine.disease Confidence interval Surgery Stereoscopic acuity Ophthalmology Treatment Outcome Oculomotor Muscles Child Preschool 030221 ophthalmology & optometry Bilateral lateral rectus recession Exotropia Female medicine.symptom business Esotropia Intermittent exotropia Follow-Up Studies |
| Zdroj: | Ophthalmology. 126(2) |
| ISSN: | 1549-4713 |
| Popis: | To compare long-term outcomes after bilateral lateral rectus recession (BLRc) or unilateral lateral rectus recession combined with medial rectus resection in the same eye (RR) for primary treatment of childhood intermittent exotropia (IXT).Multicenter, randomized clinical trial.One hundred ninety-seven children 3 to younger than 11 years of age with basic-type IXT, a largest deviation by prism and alternate cover test at any distance of 15 to 40 prism diopters (PD), and near stereoacuity of at least 400 seconds of arc.Random assignment to BLRc or RR and masked examinations conducted every 6 months after surgery for 3 years.Proportion of participants meeting suboptimal surgical outcome by 3 years, defined as: (1) exotropia of 10 PD or more at distance or near using simultaneous prism and cover test (SPCT); or (2) constant esotropia of 6 PD or more at distance or near using SPCT; (3) loss of 2 octaves or more of stereoacuity from baseline, at any masked examination; or (4) reoperation without meeting any of these criteria.Cumulative probability of suboptimal surgical outcome by 3 years was 46% (43/101) in the BLRc group versus 37% (33/96) in the RR group (treatment group difference of BLRc minus RR, 9%; 95% confidence interval [CI], -6% to 23%). Reoperation by 3 years occurred in 9 participants (10%) in the BLRc group (8 of 9 met suboptimal surgical outcome criteria) and in 4 participants (5%) in the RR group (3 of 4 met suboptimal surgical outcome criteria; treatment group difference of BLRc minus RR, 5%; 95% CI, -2% to 13%). Among participants completing the 3-year visit, 29% (25 of 86) in the BLRc group and 17% (13 of 77) in the RR group underwent reoperation or met suboptimal surgical outcome criteria at 3 years (treatment group difference of BLRc minus RR, 12%; 95% CI, -1% to 25%).We did not find a statistically significant difference in suboptimal surgical outcome by 3 years between children with IXT treated with BLRc compared with those treated with RR. Based on these findings, we are unable to recommend one surgical approach over the other for childhood IXT. |
| Databáze: | OpenAIRE |
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