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World J Ophthalmol. Aug 12, 2014; 4(3): 71-74
Published online Aug 12, 2014. doi: 10.5318/wjo.v4.i3.71
Advances in surgery procedures for convergence insufficiency-type intermittent exotropia
Ya-Nan Luan, Li-Hua Wang
Ya-Nan Luan, Li-Hua Wang, Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Author contributions: Luan YN was responsible for the data collection and drafting of the manuscript; Wang LH was mainly in charge of conception and design of the article and supervision.
Correspondence to: Dr. Li-Hua Wang, Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong Province, China. wang_glasses@aliyun.com
Telephone: +86-531-87921826 Fax: +86-531-87921778
Received: May 28, 2014
Revised: June 24, 2014
Accepted: July 17, 2014
Published online: August 12, 2014
Abstract

Intermittent exotropia with convergence insufficiency is defined as a greater exodeviation measured at near than at distance of at least 10 prism diopters and it is harmful to binocular vision at earlier time. This paper mainly introduces three operation patterns including lateral rectus recession(s) with or without a slanting procedure, unilateral lateral rectus recession with medial rectus resection, and medial rectus resection(s) with or without a slanting procedure.

Keywords: Intermittent exotropia, Convergence insufficiency, Surgery procedures, Merits and demerits, Deficiency of of prior research

Core tip: Although numerous operation patterns have been developed for intermittent exotropia with convergence insufficiency, there is not a standard protocol. This paper mainly summarizes three operation patterns including lateral rectus recession(s) with or without a slanting procedure, unilateral lateral rectus recession with medial rectus resection and medial rectus resection(s) with or without a slanting procedure. Merits and demerits of different surgery procedures and the deficiencies of different studies are also elucidated in this paper.

Convergence insufficiency-type intermittent exotropia is defined as a greater exodeviation measured at near than at distance of at least 10 prism diopters[1]. The symptoms of the convergence insufficiency include headaches, asthenopia, difficulty with reading or near tasks and diplopia[2]. In slight cases, symptoms could be alleviated by non-surgical means, such as orthoptic treatment, base-in prism reading glasses, vision therapy and psychotherapy[3,4]. Surgery is reserved for refractory cases that do not respond to these measures or for patients whose deviations are too poorly controlled, or too large at distance or at near to be treatable by nonsurgical means[5]. This review mainly aims to outline the current viewpoints in the surgical interventions to treat convergence insufficiency-type intermittent exotropia. The various surgical treatments for convergence insufficiency-type intermittent exotropia include lateral rectus recession(s) with or without a slanting procedure, unilateral lateral rectus recession with medial rectus resection and medial rectus resection(s) with or without a slanting procedure.