Evaluation of Diagnostic Methods for the Classification of Exodeviations

Burian, Hermann M.; Franceschetti, A

doi:10.1016/0002-9394(71)91091-9

Cited by 30 publications

(30 citation statements)

References 4 publications

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“…20 It is understandable in light of our understanding of TPF. Consider a hypothetical patient with a 30⌬ exotropia at distance and orthophoria at near.…”

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confidence: 98%

Distance/Near Differences in Intermittent Exotropia

Kushner¹

1998

Arch Ophthalmol

136

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Background: Burian's classification of exotropia based on the difference between the distance deviation and near deviation (distance/near differences)leaves some questions unanswered. Controversy exists concerning whether the divergence excess pattern is caused by an excess of divergence or by excessive accommodative convergence. Much of the literature on this subject has been confusing because investigators did not eliminate tenacious proximal fusion as an artifact in calculating the ratio of accommodative convergence to accommodation (AC/A ratio). Previously, one of us (B.J.K.) proposed a classification system that respected this artifact and subdivided the classification system proposed by Burian.Methods: A total of 202 consecutive patients with an exotropia underwent a series of measurements to determine the respective role of accommodative convergence and tenacious proximal fusion as a cause for their distance/near differences. In addition, the value obtained by a rapid prism adaptation test as a possible substitute for 1 hour of monocular occlusion was studied.Results: In 98 patients, the initial distance deviation exceeded the near deviation. In 10 patients, the distance/ near differences were caused by a high AC/A ratio, which

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“…20 It is understandable in light of our understanding of TPF. Consider a hypothetical patient with a 30⌬ exotropia at distance and orthophoria at near.…”

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confidence: 98%

Distance/Near Differences in Intermittent Exotropia

Kushner¹

1998

Arch Ophthalmol

136

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“…Arch Ophthalmol. 1998;116:324-328 I N A SERIES of classic articles, Burian and colleagues [1][2][3][4][5] classified intermittent exotropia based on distance/near differences and recommended different surgical procedures based on this classification. They defined the condition of patients in whom the distance deviation equaled the near deviation as a basic type of exotropia and recommended it be treated with unilateral recess/resect surgery.…”

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confidence: 99%

“…Subsequently it was determined that approximately 1 hour of occlusion was sufficient to elicit this increase. 4,7,8 Burian and colleagues [1][2][3][4] defined the condition of these patients as a simulated divergence excess type of exotropia. Because they believed these patients really had a near deviation that equaled the distance deviation but that it was masked by fusional vergences at near, they recommended that they be treated as if the patients had a basic type of exotropia and undergo recess/resect surgery.…”

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confidence: 99%

Selective Surgery for Intermittent Exotropia Based on Distance/Near Differences

Kushner¹

1998

Arch Ophthalmol

192

165

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Background: Classic teaching suggests that surgery for intermittent exotropia should be based on distance/near differences. Divergence excess, according to tradition, should be treated with symmetric lateral rectus recessions; simulated divergence excess and basic deviations should be treated with a recess/resect procedure. This teaching, to our knowledge, has not been systematically tested. Objectives: To evaluate the appropriateness of selective surgery based on distance/near differences and to determine if bilateral lateral rectus recessions affect the distance deviation more than the near deviation. Patients and Methods: Patients with basic type intermittent exotropia were randomized to 2 groups, those receiving either unilateral recess/resect procedures or symmetric lateral rectus recessions. Patients with simulated divergence excess intermittent exotropia received symmetric lateral rectus recessions. Outcome was observed 1 year after surgery. Results: Of 19 patients with basic exotropia receiving lateral rectus recessions, 10 patients (52%) had a satisfactory outcome compared with 14 (82%) of the 17 pa

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“…Burian, 4 Burian et al, 7 and Kushner 13,14 state that patients with basic type intermittent exotropia should be treated with unilateral lateral rectus muscle recession/medial rectus muscle resection, patients with divergence excess type should be treated with bilateral lateral rectus muscle recession, patients with pseudodivergenceЈ excess type should be treated with lateral rectus recession, and patients with convergence insufficient type should be treated with bilateral medial rectus muscle resections. Therefore, it is obvious that the correct clinical classification is a prerequisite for successful surgical outcomes based on these recommendations.…”

Section: Discussionmentioning

confidence: 98%

“…5 Both classification systems suggest using the DOT to evaluate patients with intermittent exotropia. 7,8 The objective of the DOT is to eliminate fusional impulses. However, a consensus has not been reached in terms of the optimal period for the DOT.…”

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confidence: 99%