Korean J Ophthalmol.  2018 Dec;32(6):483-487. 10.3341/kjo.2018.0023.

Comparison of Binocular Function and Surgical Outcomes of Tenacious Proximal Fusion and High Accommodative Convergence/Accommodation Ratio Types of Intermittent Exotropia

• Park JW
• Lee SJ

• KMID: 2427963
• DOI: http://doi.org/10.3341/kjo.2018.0023

Abstract

PURPOSE
To compare the characteristics and surgical outcomes in patients with tenacious proximal fusion (TPF) and high accommodative convergence/accommodation ratio (AC/A) types of intermittent exotropia.
METHODS
This study retrospectively enrolled 40 patients with intermittent exotropia, 23 with TPF and 17 with high AC/A. Binocular function was evaluated by Worth's 4-dot test. Patients underwent lateral rectus recession, and surgical outcomes were compared. Surgical success was defined as less than ±10 prism diopters (PD) at 12 months postoperatively.
RESULTS
The proportion of diplopia at near, evaluated by Worth's 4-dot test, was significantly higher in patients with high AC/A than in those with TPF (35.3% vs. 4.3%, p = 0.029). The mean preoperative angles of deviation in TPF and high AC/A types were 28.3 ± 4.4 and 28.8 ± 4.5 PD at distances, and 14.7 ± 4.2 and 15.1 ± 4.1 PD at near. Twelve months after surgery, the mean angles of deviation in TPF and high AC/A types were 2.9 ± 9.8 and 1.2 ± 9.6 PD, respectively, at distance and 1.7 ± 7.7 and −1.3 ± 11.3 PD at near. The surgical success rates were similar in the TPF and high AC/A types (74.0% vs. 64.7%). Five (21.7%) patients with TPF and 2 (11.8%) with high AC/A type experienced recurrence, with consecutive esotropia occurring in 1 (4.3%) patient with TPF and 4 (23.5%) patients with high AC/A.
CONCLUSIONS
The proportion of diplopia at near was higher in patients with high AC/A type than in those with TPF intermittent exotropia. However, the surgical success rates were not significantly different between the types.

Keyword

Exotropia; High accommodative convergence/accommodation ratio; Lateral rectus recession; Pseudodivergence excess; Tenacious proximal fusion

MeSH Terms

Diplopia
Esotropia
Exotropia*
Humans
Recurrence
Retrospective Studies
Telescopes*

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