Variability of control in intermittent exotropia
Variability of control in intermittent exotropia
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DOI：
10.1016/j.ophtha.2007.03.084
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发表时间：
2008-02-01
期刊：
影响因子：
13.7
通讯作者：
Holmes, Jonathan M.
中科院分区：
文献类型：
--
作者：
Hatt, Sarah R.;Mohney, Brian G.;Holmes, Jonathan M.
目的：评估控制被认为是治疗间歇性外斜视的重要因素，包括决定是否进行手术。本研究的目的是使用先前描述的6点临床控制量表评估1天内发生的任何控制变化的存在和程度，并评估观察者之间和每分钟的变异性。设计：前瞻性病例系列。参与者：间歇性外斜视患者25例。方法：通过比较2名观察者同时评定的对照评分（kappa检验），确定17例患者的观察者间一致性。在同样的17例患者中，通过在5分钟内对对照进行两次评估，观察到每分钟的可变性。通过间隔至少2小时比较3或4次评估，对其中5例患者和另外8例患者（n = 13）进行了1天内的变异性评估。主要观察指标：间歇外斜视的控制采用6分制临床控制量表。结果：观察者间一致性高（kappa = 0.94, kappa = 0.95）。在控制量表上，分歧不超过1级；因此，为了进一步分析，我们将控制变化定义为>= 2个水平。对于每分钟的变异性，在5分钟内检测两次的17例患者中有4例（24%）显示控制性变化：1例（6%）在远处从斜视变为远视，3例（18%）在近处从远视变为斜视。在1天内评估的13例患者中，6例（46%）出现控制改变：2例仅远距离固定，3例仅近距离固定，1例近距离和远距离固定。结论：间歇性外斜视的控制在一天中甚至几分钟内都可能发生变化，包括从远视到回视，反之亦然。最糟糕的控制并不总是在当天晚些时候。这表明单独的对照评估可能不能对单个患者的间歇性外斜视的严重程度进行分类。
Purpose: Assessing control is thought to be important in the management of intermittent exotropia, including the decision to perform surgery. The purpose of this study was to assess the presence and degree of any change in control occurring over the course of 1 day using a previously described 6-point clinic control scale and to evaluate interobserver and minute-to-minute variability.Design: Prospective case series.Participants: Twenty-five patients with intermittent exotropia.Methods: Interobserver agreement was determined in 17 patients by comparing control scores assessed simultaneously by 2 observers (kappa test). Minute-to-minute variability was observed in the same 17 patients by assessing control twice within 5 minutes. Variability over 1 day was assessed in 5 of these patients plus 8 additional patients (n = 13) by comparing 3 or 4 assessments at least 2 hours apart.Main Outcome Measure: Control of intermittent exotropia measured using a 6-point clinic control scale.Results: Interobserver agreement was high (kappa = 0.94 for distance and kappa = 0.95 for near fixation). Disagreements were no more than 1 level on the control scale; therefore, for further analysis, change in control was defined as >= 2 levels. For minute-to-minute variability, 4 (24%) of the 17 patients tested twice within 5 minutes showed a change in control: 1 (6%) changed from tropia to phoria at distance and 3 (18%) changed from phoria to tropia at near. Of the 13 patients assessed over 1 day, 6 (46%) showed change in control: 2 at distance fixation only, 3 at near only, and 1 at near and distance.Conclusions: Control of intermittent exotropia can vary throughout the day, even within minutes, including from phoric to tropic and vice versa. The worst level of control was not always later in the day. This suggests that an isolated assessment of control may not categorize severity of intermittent exotropia in an individual patient.