Interventions for infantile esotropia

 

Abstract

Background

Infantile esotropia (IE) is the inward deviation of the eye. Various aspects of the clinical management of IE are unclear; mainly, the most effective type of intervention and the age at intervention.

Objectives

The objective of this review was to assess the effectiveness of various surgical and non-surgical interventions for IE and to determine the significance of age at treatment with respect to outcome.

Search methods

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 3), MEDLINE (January 1950 to April 2011), EMBASE (January 1980 to April 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to April 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 April 2011. We manually searched the conference proceedings of the European Strabismological Association (ESA) (1975 to 1997, 1999 to 2002), International Strabismological Association (ISA) (1994) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) (1995 to 2003). Efforts were made to contact researchers who are active in the field for information about further published or unpublished studies.

Selection criteria

We included randomised trials comparing any surgical or non-surgical intervention for infantile esotropia.

Data collection and analysis

Each review author independently assessed study abstracts identified from the electronic and manual searches.

Main results

No studies were found that met our selection criteria and therefore none were included for analysis.

Authors' conclusions

The main body of literature on interventions for IE are either retrospective studies or prospective cohort studies. It has not been possible through this review to resolve the controversies regarding type of surgery, non-surgical intervention and age of intervention. There is clearly a need for good quality trials to be conducted in these areas to improve the evidence base for the management of IE.

 

Plain language summary

Different treatments for a squint (deviation of the eye) that occurs within the first six months of life

Infantile esotropia can affect the vision in the eye, the ability to use the two eyes together (binocularity) and also be a cosmetic issue to the child/parents. Treatment includes surgical and non-surgical interventions to reduce the squint and to enhance/aid binocularity in children. This review looks at the various interventions and also the timing of such treatment. The review did not find any randomised trials that compared treatment to another treatment or to no treatment. A large, multi-centre, non-randomised trial found that children operated on earlier had better binocularity at age six compared to the late surgery group. This group had been operated on more frequently however and there was no significant difference in the angle of the squint after surgery in either group. This review does not resolve the controversy regarding the best type of surgery, the value of non-surgical interventions and the optimal timing of either type of intervention. It highlights a need for further research in this area.

 

摘要

背景

對於小兒斜視的介入措施

臨床上處理小兒斜視(infantile esotropia (IE))的各種觀點並不清楚－主要是關於最有效的介入措施類型與介入年齡。

目標

這篇回顧的目的為評估各種手術與非手術介入措施用於治療小兒斜視的效果，確定治療年齡的重要性與相關的結果。

搜尋策略

我們檢索考科藍圖書館的the Cochrane Central Register of Controlled Trials  CENTRAL (其包含the Cochrane Eyes and Vision Group Trials Register)(2006年，第3期)，MEDLINE (1966至2006年9月)，EMBASE (1980至2006年9月)與LILACS (2006年9月)。我們每年檢索the European Strabismological Association (ESA) (1975至1997年，1999至2002年)，International Strabismological Association (ISA) (1994年)與American Academy of Paediatric Ophthalmology and Strabismus會議(AAPOS) (1995至2003年)的會議記錄。努力聯繫該領域專長的研究人員以了解有關進一步發表或未發表研究的資訊。

選擇標準

比較任何手術或非手術介入措施用於治療小兒斜視的隨機試驗。

資料收集與分析

各回顧作者分別從電子與人工檢索內的研究摘要進行評估。

主要結論

沒有研究發現符合我們的篩選標準，因此沒有一篇研究被納入分析。

作者結論

小兒斜視介入措施的文獻主體不是回溯性研究就是前瞻性世代研究。不可能透過這篇回顧解決有關手術類型，非手術的介入措施與介入年齡的爭議。很清楚地這些部分需要建立品質良好的試驗以改善實證為基礎的小兒斜視處理方式。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於出生後前六個月內斜視(眼睛的偏差)的不同治療。小兒斜視會影響眼睛的視力，與同時使用兩眼的能力(雙眼的能力)，且也是一個對於兒童/父母外表的問題。治療包括手術與非手術介入措施以減少斜視，並增加/輔助兒童雙眼的能力。這篇回顧觀察各種介入措施以及這種治療的介入時機。回顧沒有發現任何比較治療與另一種其他治療或沒有治療的隨機對照試驗。一個大型的，多中心的，非隨機試驗發現相較於晚期的手術組，及早進行手術的六歲兒童有較佳的雙眼能力。然而這組有較多的手術次數且兩組手術後的斜視角度沒有顯著差異。這篇回顧沒有解決關於最佳手術類型，非手術介入措施的價值與這兩種介入措施其適當介入時機的爭議。突顯出需要這方面的進一步研究。