Exotropia Is the Main Pattern of Childhood Strabismus Surgery in the South of China: A Six-Year Clinical Review
Exotropia Is the Main Pattern of Childhood Strabismus Surgery in the South of China: A Six-Year Clinical Review
Xinping Yu,1 Zhouduo Ji,2 Huanyun Yu,1 Meiping Xu,1 and Jinling Xu1
1The Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China
2Ophthalmology Department, Zhengzhou Second Hospital, Zhengzhou 450006, China
Received 17 December 2015; Accepted 4 February 2016
Academic Editor: Lisa Toto
Copyright © 2016 Xinping Yu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose. To evaluate the distribution pattern and changes of strabismus surgery in children based on the data collected from a local eye hospital in the south of China between 2006 and 2011. Methods. A retrospective analysis of all strabismus surgeries in children (<18 years) performed in the Eye Hospital of Wenzhou Medical University between 2006 and 2011 using the integrated information system. Result. A total of 2,219 strabismus surgeries were performed during the study period, with concomitant exotropia (44% of all surgeries) more than esotropia (27%, , ). Total number of surgeries increased from 250 in 2006 to 508 in 2011, with a significant increase in concomitant exotropia: 38% of all surgeries in 2006 increased to 47% in 2011 (, ). The increase of intermittent exotropia was approximately 26% of all increments of strabismus surgery between 2006 and 2011. Conclusion. Surgery for childhood exotropia was more frequent than esotropia in China. The proportion of exotropia progressively increased, while the proportion of esotropia decreased during these years. Intermittent exotropia was the main increment of strabismus surgery. Further population-based studies are needed to confirm the proportion of surgery and whether the incidence of strabismus surgery increased in China.
1. Introduction
Previous epidemiologic studies suggested a relatively higher prevalence of exotropia and a lower prevalence of esotropia in Chinese and other Asian children compared to that of Western children [1–3]. Data based on the clinical reviews in Hong Kong and Singapore supported the same trend [4, 5]. It is also implied from studies that surgery for childhood esotropia was much more common than surgery for exotropia, although the proportion of surgery for esotropia has continued to decline in UK [6–8], Italy [9], and USA [10]. While a study based on an eye center of China showed that surgery for concomitant exotropia was more common than those for esotropia, the amounts of surgery for esotropia also increased from 2003 to 2006. However, the study included patients of all ages who underwent strabismus surgery in the hospital [11]. Whether the pattern distribution of primary surgery for childhood strabismus is significantly different from that of Western populations remains under debate.
The present study aimed to evaluate the pattern distribution and the changes of strabismus surgery in child patients in one region of China based on the data from a local eye hospital.
2. Subjects and Methods
This study was approved by the ethics committee of the Eye Hospital of Wenzhou Medical University. All the strabismus surgeries that were performed on patients <18 years of age in our department from 2006 to 2011 were included. All of the data came from the integrated information system of the Eye Hospital of the Wenzhou Medical University. The patients were diagnosed by pediatric ophthalmologist. The following data were recorded for each patient: name, sex, date of birth, age of onset of strabismus, age at the time of surgery, date of strabismus surgery, diagnosis, routine eye examination (including visual acuity and the best corrected visual acuity (BCVA), anterior segment, and refractive and fundus examination), eye movements (EOM), degree of strabismus, stereopsis, sensory fusion, and surgical procedure performed. Strabismus deviation was measured using alternate prism cover tests at 33 cm for nearness and 6 meters for distance. Sensory fusion was tested using Worth 4-dot test and stereoacuity was tested using Titmus stereopsis tests.
The SPSS 19.0 software package was used (SPSS Inc., Chicago, IL, USA). The statistical techniques used were Fisher’s exact test (when the total number of observations was <20) and the chi-square test to compare proportions between groups. Independent -test was used to compare the onset age between subjects with some binocular function and those without. The result was regarded as statistically significant when .
3. Results3.1. Basic Data
In the 6-year period, 2,219 surgeries were performed in our hospital on patients aged 1–17 (9.55 ± 4.31) years, with 54% subjects being male. Table 1 showed the distribution between sexes and ages for the 6 years. The deviation was 10–145 (47.1 ± 24.6) prism diopters (pd) horizontally and 6–90 (18.2 ± 11.8) p (...truncated)