Comparison And Analysis Of Clinical Effect In Concomitant Exotropia Patients After Bilateral External Rectus Recession For Different Age Groups

BackgroundIncidence rate of concomitant exotropia is from 0.6% to 1.2%,which pathogenesis is not clear.The main symptom are skewness unchanged,and eye movement in all directions without limitation,the eye no organic disease when eye gaze as the other eyeball temporal bias.Deflection of a long-term,if not timely diagnosis and treatment will produce monocular suppression and abnormal retinal correspondence,leading binocular shaft imbalance and abnormal binocular fusion images,undermining the basis for the formation of binocular vision,has seriously affected the development of binocular vision.At present,most experts advocate surgery early.In recent years,studies show that early treatment abroad for concomitant exotropia has important prognostic significance.Meanwhile surgery to improve the appearance of the binocular also been restored and reconstruction,but also play to reduce visual fatigue effect,but the effect of surgery was vulnerable age,influence the timing of surgery,type of strabismus,preoperative binocular vision,and many other factors,surgery the amount of difficult to control,which requires clinicians to be combined with preoperative strabismus degree of size,type of strabismus,the ability to regulate the collection,binocular vision function and other factors,a comprehensive understanding and a comprehensive assessment of the patient’s condition,surgery program designed to actively postoperative guidance training to improve patient prognosis.ObjectiveTo explore the changes of corrected visual acuity,eye position and binocular vision of migration technique eyes in different age groups patients suffering the non-convergence insufficiency concomitant exotropia after bilateral external rectus recession.MethodsEighty-one patients at First Affiliated Hospital of Xinxiang Medical University from January 2014 to February 2015 were assigned into three groups according to ages:3~6years 31 patients,average age(4.1±0.3)years;7~12 years old group of 27 patients,average age(9.2±1.8)years;≥ 13 years of age group 23 with a mean age(25.4±2.2)years.A total of 37 male patients,44 female patients,aged between 3 and 41 years old.All patients via the system routine eye examination to exclude the presence of organic eye disease,ophthalmic surgery,paralysis,sensory exotropia,convergence insufficiency concomitant exotropia,such as patients with other types of strabismus.Determination of preoperative uncorrected distance vision and wearing glasses,wearing glasses and measured the naked eye strabismus surgery calculation amount measured by the degree of strabismus special collection of functional assay exclude convergence insufficiency concomitant exotropia,same as the machine with Titmus random dot stereograms determination of binocular vision function is particularly near stereopsis,comprehensive patient underwent surgical planning situation "outside eyes after surgery rectus recession",after 1 week,1,3,6 months later followed up after an average follow-up(8.08 ± 1.31)month,when the 6 months after the evaluation,after the main observation of patients of all ages concomitant exotropia corrected visual acuity change,anteroposterior rate,close rate improved stereopsis.After recording the results of a comparative analysis by SPSS19.0statistical software,when P<0.05 the difference was significant.Results1.Vision correction: The postoperative cycloplegic retinoscopy under 79 patients were no significant changes in visual acuity,only 7 to 12 age group 2 patients had visual acuity improved corrected visual acuity in different age groups no significant difference between the change in value of the size(P>0.05).2.Postoperative eye position: The average follow-up(8.08 ±1.31)months,patients of all ages after June eye position are stable,eye position after 6 months is basically stable,three groups of patients was 94% of total anteroposterior,anteroposterior 3-6 age group the highest rate,only 3 months after when undercorrection two cases,one case of postoperative undercorrection January and June;7 to 12 age group anteroposterior low rate,high rate of undercorrection;≥ 13 age group anteroposterior lowest rate,the highest rate of undercorrection.Orthotropia three different groups of patients were followed up for Chi-square test sample rate in January: χ~2 = 7.131,P = 0.018;March: χ~2 = 4.548,P =0.037;June: χ~2 = 5.815,P = 0.021,three follow-up time point P <0.05,differences were statistically significant.Different age groups after January and March,the degree of difference between March and June strabismus compare results 3~6 age group: P1 = 0.002,P2 = 0.001;7 ~12 years old group: P1 = 0.000,P2 = 0.001;≥ 13 age group: P1= 0.001,P2 =0.000,the differences were statistically significant(P <0.05).3.Close stereopsis rate increase: after 3 to 6 age group close stereopsis increased by30 cases,1 change,close-stereoscopic increase of 97%;from 7 to 12 years old group close stereopsis increase 10 cases,unchanged in 15 cases,decreased in 2 cases,the rate of increase close stereopsis 37%;≥ 13 age group increased by 1 stereopsis close cases,unchanged in 19 cases,three cases reduce,increase rate of close stereopsis 4%.Three groups near stereopsis rate sample rate increase chi-square test: χ~2 = 12.554,P = 0.013,P<0.05,the difference was statistically significant.Conclusion1.Timing of surgery for non-convergence insufficiency concomitant postoperative anteroposterior rate outside perspective and binocular visual function in patients with high-impact reconstruction,should be early surgical treatment.2.There are still some long-term rate of undercorrection after row outer rectus eye surgery treatment of non-convergence insufficiency concomitant exotropia.