Can we effectively delay surgery for intermittent exotropia in children less than 4 years of age?.

Kim, Seong Ho; Cho, Yoonae A

Original Article

Journal of the Korean Ophthalmological Society 1996;37(8):1382-1388.
Published online August 1, 1996.

Can we effectively delay surgery for intermittent exotropia in children less than 4 years of age?.

Seong Ho Kim, Yoonae A Cho

Department of Ophthalmology, College of Medicine, Korea University, Seoul, Korea.

4세이하 어린이의 간헐외사시에서 조기수술의 지연대책

김성호(Seong Ho Kim),조윤애(Yoon Ae A . Cho)

Abstract

Many surgeons prefer to postpone surgery of intermittent exotropia after 4 years of age because small angle esotropia, amblyopia and sensory anomaly could be caused by early surgery. The purpose of this paper is to determine whether the nonsurgical treatment is effective to delay surgery in intermittent exotropes less than 4 years of age. Short-time patching for 3-4 hours (patching) was performed in 39 children and compared to those with patching combined with overcorrecting minus glasses added by minus power between 1.00 and 2.75D (combined therapy) in 21 children. Before treatment, the average amount of exo-deviation in 60 patients was 29.4 prism diopters(PD) at distance and 23.4 PD at near at initial visit. The improvement of 6 PD or more in exodeviation was obtained in 32 patients(82.1 %) with the patching and 20 patients(95.2%) with the combined therapy. After treatment, the average amount of improved exo-deviation with the patching group was 7.9 PD at distance and 13.5 PD at near, while it was 8.9 PD at distance and 16.9 PD at near with the group that received the combined therapy. The improvement in exodeviation was greater at near than at distance, and greater in paitents treated with the combined therapy than in patients with the patching. In conclusions, surgery can be delayed effectively with the 3-4 hours patching and the small amount of overcorrecting minus glasses in young intermittent exotropes less than 4 years of age, in light of considerable reduction of exoangle and frequency of exodeviation.

Key Words: Early surgery before 4 years of age;Intermittent exotropia;Overcorrecting minus glasses;Patching;Reduction of exo-angle