title: The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia.
abstract: Despite the presence of good stereopsis, surgically corrected intermittent exotropes may show a gradual outward shift with time. The purpose of this study was to identify early factors that influence the success of corrective surgery. Sixty-seven consecutive patients treated surgically for intermittent exotropia (age range 1.9 to 76 years) constituted our final sample. Sensory status was evaluated with the Titmus stereotest. A successful surgical result was defined as phoria or intermittent tropia of +/- 10 prism dioptres or less for near and distance with maintained or improved stereopsis, 6 months or more after surgery. The average postoperative follow-up period was 3.3 (range 0.5 to 11) years. Good stereopsis (60 seconds of arc or better) was present in only 42% of the patients preoperatively and 61% postoperatively. The overall surgical success rate was 60%. Early overcorrection, defined as an esodeviation present within the first 4 weeks after surgery, caused a significant improvement in the success rate, to 79% (p = 0.03). Poor preoperative stereopsis combined with early overcorrection resulted in a further significant improvement in the surgical success rate, to 92% (p = 0.07). This suggests that poor preoperative stereopsis does not necessarily preclude, and may enhance, long-term alignment stability postoperatively. We suggest that it is peripheral rather than central fusion that keeps the eyes well aligned after surgery and prevents recurrence of the exodeviation.
authors.affiliation: Department of Ophthalmology, Montreal Children's Hospital, Que.
authors.forename: R
authors.initials: R
authors.lastname: Beneish
authors.forename: M
authors.initials: M
authors.lastname: Flanders
mesh_terms: D000065:Accommodation, Ocular; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003867:Depth Perception / Q000502:physiology*; D005099:Exotropia / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular