PubMed · 14868841
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D M FREEMAN. Constant exotropia.. https://pubmed.ncbi.nlm.nih.gov/14868841/
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BACKGROUND: The clinical management of intermittent distance 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 the optimum age at which it should be carried out. OBJECTIVES: The objective of this review is to assess intervention criteria, the effects of various surgical and non-surgical treatments in people with intermittent distance exotropia and to determine the significance of factors such as age with respect to outcome. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group trials register) on the Cochrane Library (Issue 4 2002), MEDLINE (1966 to November 2002), EMBASE (1980 to November 2002) 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 We contacted researchers who are active in the field for information about further published or unpublished studies.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. SELECTION CRITERIA: We planned to include randomised controlled trials of any surgical or non-surgical treatment for intermittent distance exotropia. DATA COLLECTION AND ANALYSIS: Each reviewer independently assessed study abstracts identified from database and manual searches. Reviewer analysis was then compared and full papers for appropriate studies were obtained. MAIN RESULTS: No studies were found that met our selection criteria and therefore none were included for analysis. REVIEWER'S CONCLUSIONS: The available literature consists mainly of retrospective case reviews. These are difficult to compare and analyse due to a large variation in the definition of intermittent distance exotropia, intervention criteria and outcome measures. However there seems to be general agreement that non-surgical treatment is most appropriate in small angle deviations or as a supplement to surgery. Studies were found supporting both early and late surgical intervention so the optimal timing of surgical intervention cannot be concluded. Recent work indicates that bilateral surgery may be the most effective surgical procedure in these cases. There is clearly a need for carefully planned clinical trials to be undertaken to improve the evidence base for the management of this condition.
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BACKGROUND: The majority of cases of exotropia with extreme deviations (30-45 degrees or 60-90 prism dioptres) are secondary forms of strabismus, either consecutive, following monolateral combined recession/resection procedures in childhood, extreme anisometropia or following trauma. For the surgical treatment the deviation is often too great to be corrected completely by conventional repositioning of the medial and lateral rectus muscle of the affected eye and patients justifiably refuse an operation even on the main eye because the indications are mostly more aesthetic than functional. METHODS: The paper presents a technique of a free mucosa transplant. The effect can be strengthened and made more secure following repositioning of the muscle. RESULTS: With this method even extreme deviations (up to 45 degrees corresponding to 90 prism dioptres) could be successfully and permanently corrected by surgery on the deviated one eye only. CONCLUSIONS: This method provides a new option for patients who are often incorrectly told that their deviation cannot be corrected by monolateral surgery.