Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus · 2026
Initial postoperative alignment versus long-term outcomes in intermittent exotropia surgery.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Pediatric Eye Disease Investigator Group
Аннотация
PURPOSE: To investigate whether immediate postoperative esodeviation is associated with superior long-term outcomes following surgery for childhood intermittent exotropia (IXT).
METHODS: We performed a post hoc analysis of randomized clinical trial data, where 185 children 3 to <11 years of age underwent surgery for IXT with a 1-week visit and at least one of the 6-month to 8-year visits. Participants had been randomized to bilateral lateral rectus recession (BLRc) or unilateral lateral rectus recession with medial rectus resection (R&R). One-week postoperative distance deviation by prism and alternate cover test (PACT) was analyzed according to 5 levels.
RESULTS: For 1-week postoperative distance exodeviation (n = 32), orthophoria (n = 30), 1Δ-7Δ esodeviation (n = 37), 8Δ-15Δ esodeviation (n = 45), and >15Δ esodeviation (n = 41), the cumulative probability of motor recurrence by 8 years was 54%, 57%, 35%, 28%, and 5%, respectively. The cumulative probability of problematic esotropia was 3%, 3%, 0%, 9%, and 12%, respectively. Compared with orthophoria, cumulative probability of motor recurrence by 8 years was lower with 1-week alignment of >15Δ esodeviation (difference, -52%; 95% CI, -77% to -27%) and 8Δ-15Δ esodeviation (difference, -29%; 95% CI, -57% to -1%) but not for 1Δ-7Δ esodeviation or exodeviation. Overall composite failure (recurrence or problematic esotropia) was lowest with an esodeviation >15Δ at 1 week (15% vs 53%, 55%, 31%, 40%, resp.).
CONCLUSIONS: Using current surgical doses, a 1-week alignment of >7Δ esodeviation is associated with a reduced rate of motor recurrence, albeit with a small increase in problematic esotropia.
METHODS: We performed a post hoc analysis of randomized clinical trial data, where 185 children 3 to <11 years of age underwent surgery for IXT with a 1-week visit and at least one of the 6-month to 8-year visits. Participants had been randomized to bilateral lateral rectus recession (BLRc) or unilateral lateral rectus recession with medial rectus resection (R&R). One-week postoperative distance deviation by prism and alternate cover test (PACT) was analyzed according to 5 levels.
RESULTS: For 1-week postoperative distance exodeviation (n = 32), orthophoria (n = 30), 1Δ-7Δ esodeviation (n = 37), 8Δ-15Δ esodeviation (n = 45), and >15Δ esodeviation (n = 41), the cumulative probability of motor recurrence by 8 years was 54%, 57%, 35%, 28%, and 5%, respectively. The cumulative probability of problematic esotropia was 3%, 3%, 0%, 9%, and 12%, respectively. Compared with orthophoria, cumulative probability of motor recurrence by 8 years was lower with 1-week alignment of >15Δ esodeviation (difference, -52%; 95% CI, -77% to -27%) and 8Δ-15Δ esodeviation (difference, -29%; 95% CI, -57% to -1%) but not for 1Δ-7Δ esodeviation or exodeviation. Overall composite failure (recurrence or problematic esotropia) was lowest with an esodeviation >15Δ at 1 week (15% vs 53%, 55%, 31%, 40%, resp.).
CONCLUSIONS: Using current surgical doses, a 1-week alignment of >7Δ esodeviation is associated with a reduced rate of motor recurrence, albeit with a small increase in problematic esotropia.