■目前,关于间歇性外斜视(IXT)的管理没有共识,包括手术和非手术治疗。已建议对IXT进行非手术治疗,包括观察观察,修补,超透镜,棱镜,和视力治疗/矫正术。虽然相当一部分IXT患者接受手术治疗,据报道,IXT有再次手术或复发的趋势。本文对IXT的非手术和手术治疗方案进行了全面综述。
■涉及关键词组合的搜索策略,包括间歇性外斜视,发散过度,基本的外斜视,屈光不正,眼镜,眼镜,自然史,未经处理,观察,遮挡,补丁,超减,过度校正减去,棱镜,视力疗法,正交光学,反抑制,融合练习,在Medline中使用了手术。审查了1900年1月1日至2020年1月9日的所有英文文章。还检查了已确定文章的参考列表中是否有其他相关文章。排除了与神经系统疾病或损伤相关的动物模型或斜视的研究。由于报告丰富,以下过滤器被用于手术治疗:全文,随机对照试验,review,在过去的5年里。
■适当的光学矫正屈光不正通常是所有管理方法的起点,但缺乏关于这种治疗方式的随机临床试验数据.随机临床试验数据表明,观察和闭塞是3-10岁儿童的合理管理选择,并且没有足够的数据推荐12-35个月大的儿童的闭塞。虽然在评估佩戴超减眼镜时发现超减镜片可以改善IXT的控制,这种改善在治疗结束后没有持续.唯一一项关于基础棱镜有效性的随机临床试验的结果表明,这种治疗方法在改善控制方面并不比非棱镜眼镜更有效。最近的一项随机临床试验表明,与单独观察相比,视觉疗法/矫正术可有效改善IXT的控制。发现手术改变了IXT的一些临床特征,包括减少偏离的距离和近角度,减少畏光,改善与健康相关的生活质量,立体视觉,和纽卡斯尔控制得分。然而,没有随机临床试验数据将手术与对照组(如安慰剂组)或不治疗的观察组进行比较.
■需要进行严格设计的临床试验,以研究非手术和手术治疗间歇性外斜视的有效性。
UNASSIGNED: Currently, there is no consensus regarding the management of intermittent exotropia (IXT), which includes both surgical and non-surgical treatment options. Nonsurgical management of IXT has been suggested and includes watchful observation, patching, overminus lenses, prism, and vision therapy/orthoptics. While a significant portion of IXT patients are treated by surgery, it is reported that there is a substantial tendency for reoperation or recurrence of IXT. This paper provides a comprehensive
review of non-surgical and surgical treatment options for the IXT.
UNASSIGNED: Search strategies involving combination of keywords including intermittent exotropia, divergence excess, basic exotropia, refractive error, glasses, spectacles, natural history, untreated, observe, occlusion, patch, overminus, overcorrecting minus, prism, vision therapy, orthoptic, anti-suppression, fusion exercise, and surgery were used in Medline. All English articles from 01/01/1900 to 01/09/2020 were reviewed. The reference list of the identified articles was also checked for additional relevant articles. Studies focused on animal models or strabismus associated with neurologic disorders or injury were excluded. The following filters were used for surgical management due to the abundance of reports: full text, randomized controlled trial,
review, in the last 5 years.
UNASSIGNED: Appropriate optical correction of refractive error is generally the starting point for all management approaches, but there is a lack of randomized clinical trial data regarding this treatment modality. Randomized clinical trial data indicate that both observation and occlusion are reasonable management options for children 3-10 years old, and there were insufficient data to recommend occlusion for children 12-35 months old. While overminus lenses were found to improve the control of IXT when assessed wearing overminus spectacles, this improvement did not persist after the treatment ended. The result of the only randomized clinical trial on the effectiveness of base-in prism indicated that this treatment is no more effective than nonprism spectacles for improving control. A recent randomized clinical trial showed that vision therapy/orthoptics is effective in improving the control of IXT when compared to observation alone. Surgery was found to alter a number of clinical characteristics of IXT, including reducing the distance and near angle of deviation, reducing photophobia, improving health-related quality of life, stereopsis, and the Newcastle Control Score. However, there are no randomized clinical trial data comparing surgery with a control group such as placebo or a no treatment observation group.
UNASSIGNED: Rigorously designed clinical trials to investigate the effectiveness of non-surgical and surgical treatments for intermittent exotropia are needed.