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Effect of suppression during tropia and phoria on phoria maintenance in intermittent exotropia

  • Pediatrics
  • Published:
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Abstract

Background

Treatment for intermittent exotropia X(T) aims to keep the eye in a phoric position and to maintain the phoria. However, maintenance of phoria is difficult even after treatment, and the cause is unclear. The aim of this study was to investigate the presence of suppression during tropia and/or phoria in X(T), and to determine how the suppression affected patient’s ability to maintain phoria.

Methods

Medical records of 89 children with X(T) (mean age, 9.8 ± 2.7 years) were reviewed retrospectively. According to their previous treatment for X(T), the patients were divided into four groups and compared: untreated and under observation only (28 patients), surgical treatment (32 patients), orthoptic training (eight patients) and a combined treatment of surgery and orthoptic training (21 patients). Suppression during phoria was evaluated by a physiologic diplopia test, and suppression during tropia was evaluated by a convergence test or a cover test when fusion broke. Phoria maintenance was achieved if a phoric condition was maintained even when the fusion broke at both near and far. Furthermore, the Bagolini’s red filter bar was used to quantitatively assess patient’s ability to maintain phoria at near and far distances.

Results

No subject only suppressed during phoria. Patients who suppressed under both conditions could not maintain phoria. Suppression under both conditions significantly correlated with phoria maintenance and the ability to maintain phoria (P < 0.01, Fisher’s exact probability test). All the patients with a strong ability to maintain phoria did not suppress under either condition. As compared to the surgical treatment group, the combined treatment group had a higher percentage of patients who did not suppress under either condition and could maintain the phoria. Suppression under both conditions also significantly correlated the treatment methods (P < 0.01, Chi-square for the independence test).

Conclusions

Suppression under both tropic and phoric conditions significantly relates to the outcome of patients’ phoria maintenance and their ability to maintain a phoric position. Suppression under both conditions is an important indication of whether X(T) shifts to constant exotropia.

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Acknowledgments

The authors thank Ms. Reiyo Tahara for editorial support.

Conflict of interest

The authors declare that they have no conflict of interest.

The authors have no proprietary interest and received no financial support in the development or marketing of instruments or pieces of equipment mentioned in this article, or any competing instrument or equipment.

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Authors and Affiliations

  1. Department of Ophthalmology, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Akemi Wakayama, Kazuyo Nakada, Chota Matsumoto & Yoshikazu Shimomura

  2. Department of Ophthalmology, Kinki University Faculty of Medicine, Nara Hospital, Nara, Japan

    Kosuke Abe

Authors
  1. Akemi Wakayama
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  2. Kazuyo Nakada
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  3. Kosuke Abe
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  4. Chota Matsumoto
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  5. Yoshikazu Shimomura
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Corresponding author

Correspondence to Akemi Wakayama.

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The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data if requested.

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Wakayama, A., Nakada, K., Abe, K. et al. Effect of suppression during tropia and phoria on phoria maintenance in intermittent exotropia. Graefes Arch Clin Exp Ophthalmol 251, 2463–2469 (2013). https://doi.org/10.1007/s00417-013-2410-8

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  • DOI: https://doi.org/10.1007/s00417-013-2410-8

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