Indian Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2015  |  Volume : 63  |  Issue : 3  |  Page : 294-

Comment on: Intentional overcorrection in pediatric patients with intermittent exotropia: Indicated?


Vishaal Bhambhwani, Pramod Kumar Pandey, Shagun Sood, Poonam Gupta, PC Ranjith 
 Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India

Correspondence Address:
Dr. Vishaal Bhambhwani
Guru Nanak Eye Centre, Ranjit Singh Marg, New Delhi - 110 002
India




How to cite this article:
Bhambhwani V, Pandey PK, Sood S, Gupta P, Ranjith P C. Comment on: Intentional overcorrection in pediatric patients with intermittent exotropia: Indicated?.Indian J Ophthalmol 2015;63:294-294


How to cite this URL:
Bhambhwani V, Pandey PK, Sood S, Gupta P, Ranjith P C. Comment on: Intentional overcorrection in pediatric patients with intermittent exotropia: Indicated?. Indian J Ophthalmol [serial online] 2015 [cited 2019 Dec 14 ];63:294-294
Available from: http://www.ijo.in/text.asp?2015/63/3/294/156974


Full Text

Dear Editor,

We read with interest the article by Arda et al. [1] We would like to make the following observations/queries.

Although most authors would agree to an early postoperative overcorrection in adult patients with intermittent exotropia, the same may not be true for pediatric patients. In contrast, most investigators believe that intentional overcorrection should be avoided in children with immature systems because of the risk of developing a suppression scotoma and an irreversible monofixation esotropia, which can lead to loss of stereopsis and amblyopia. [2],[3],[4] The age group in this study by Arda et al. is 2-12 years. It is questionable whether intentional overcorrection is indicated in this age group. As the authors have not evaluated sensory outcomes and only motor surgical success rate has been evaluated, the effect of intentional overcorrection on binocularity, stereopsis and development of amblyopia is not assessed and may, therefore, be considered a major limitation of the study.

In the evaluation of postoperative deviations, no mention of deviation at near is found. Near-distance disparity may occur after bilateral lateral rectus (LR) recessions. Small overcorrections at distance may in turn produce excess overcorrections at near. This is even more important in young pediatric patients whose daily activities may be limited to near and intermediate vision. The esotropia at near may lead to amblyopia in this age group. In this regard, it is also important to highlight that the authors have excluded cases with true divergence excess and high accommodative convergence: accommodation (AC/A) ratio in whom intentional overcorrections may lead to extreme near-distance disparity with esotropia at near, which may be detrimental in pediatric patients with immature visual systems.

Thus, in our view, augmented LR recessions may be valuable in adult patients, and after evaluation for near-distance disparity; however, its use in visually immature children, especially those with true divergence excess and high AC/A ratio, requires caution.

References

1Arda H, Atalay HT, Orge FH. Augmented surgical amounts for intermittent exotropia to prevent recurrence. Indian J Ophthalmol 2014;62:1056-9.
2Santiago AP, Ing MR, Kushner BJ, Rosenbaum AL. Intermittent exotropia. In: Rosenbaum A, Santiago AP, editors. Clinical Strabismus Management: Principles and Surgical Techniques. Philadelphia, PA: Saunders; 1999.
3Jampolsky A. Treatment of exodeviations. Trans New Orleans Acad Ophthalmol 1986;34:201-34.
4Edelman PM, Brown MH, Murphree AL, Wright KW. Consecutive esodeviation: Then what? Am Orthopt J 1988;38:111-6.