Childhood Intermittent Exotropia Outcomes: PEDIG Report
Ophthalmology, February 2019
Donahue et al., of the Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), reported comparative long-term outcomes for bilateral lateral rectus recession (BLRc) and unilateral lateral rectus recession plus medial rectus resection in the same eye (R&R) as primary treatment for intermittent exotropia (IXT). By the three-year mark, there were no substantial differences in the incidence of suboptimal surgical outcome between these approaches. As a result, the authors do not recommend one procedure over the other.
This randomized multicenter trial included 197 children (aged 3 to <11 years) with basic-type IXT. The largest deviation by prism and alternate cover test, at any distance, ranged from 15 to 40 prism diopters (PD), and near stereoacuity was at least 400 seconds of arc. Patients were assigned randomly to receive BLRc (n = 101) or R&R (n = 96). During follow-up visits, which occurred every six months until three years postoperatively, a study-certified examiner who was masked to treatment assignment obtained measurements of stereoacuity, exotropia control, and ocular alignment. The main outcome measure was suboptimal surgical outcome by three years, defined as any of the following: exotropia of ≥10 PD (distance or near) according to the simultaneous prism and cover test (SPCT); constant esotropia of ≥6 PD (distance or near) per SPCT; loss of ≥2 octaves of stereoacuity from baseline at any follow-up exam; or reoperation.
The cumulative probability of suboptimal surgical outcome within three years was 46% (n = 43) for the BLRc group and 37% (n = 33) for the R&R group (95% confidence interval [CI], –6% to 23%). Nine patients (10%) in the BLRc group (eight of whom hada suboptimal outcome) needed reoperation, as did four patients (5%) in the R&R group (three of whom had a suboptimal outcome). Six of the 9 reoperations in the BLRc group were for recurrent exotropia, whereas 3 of the 4 reoperations in the R&R group were for esotropia. Among participants with three full years of follow-up, 29% of the BLRc group (25 of 86) and 17% of the R&R group (13 of 77) underwent reoperation or had a suboptimal outcome by three years (95% CI, –2% to 13%). With respect to improving IXT control and reducing deviation magnitude, the benefits of the two procedures were similar.
The authors acknowledged that three years is a relatively short assessment period; follow-up will continue for another five years.
The original article can be found here.