Interventions for intermittent exotropia.
BACKGROUND
The clinical management of intermittent exotropia has been discussed frequently in the literature, but there is a lack of clarity regarding the indications for intervention, the most effective type and if there is a time point at which it should be carried out.


OBJECTIVE
The objective of this review was to analyse the effects of various surgical and non-surgical treatments in randomised trials of people with intermittent exotropia, to report intervention criteria and determine the significance of factors such as age with respect to outcome.


METHODS
We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006) National Research Register (2006, Issue 1), PubMed (searched on 13 March 2006; last 90 days) and LILACS (Latin American and Caribbean Literature on Health Sciences) (1966 to 2002). We manually searched the British Orthoptic Journal, proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS). We contacted researchers who are active in the field for information about further published or unpublished studies. There were no language restrictions in the manual or electronic searches.


METHODS
We included randomised controlled trials of any surgical or non-surgical treatment for intermittent exotropia.


METHODS
Each review author independently assessed study abstracts identified from the database and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained.


RESULTS
We found one randomised trial that was eligible for inclusion. This trial showed that unilateral surgery was more effective than bilateral surgery for correcting basic intermittent exotropia.


CONCLUSIONS
The available literature consists mainly of retrospective case reviews which are difficult to reliably interpret and analyse. The one randomised trial included found unilateral surgery more effective than bilateral for basic intermittent exotropia but there remains a need for more carefully planned clinical trials to be undertaken to improve the evidence base for the management of this condition.
Hatt
S
S
International Centre for Eye Health, c/o Cochrane Eyes and Vision Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK WC1E 7HT. sarahrhatt@gmail.com
Gnanaraj
L
L
D005099:Exotropia / Q000601:surgery* / Q000628:therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic