الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Management of hyperopia in exotropic patients is a controversial subject. Although literature recommended spectacle hyperopic correction before surgery, none of them determined the amount of hyperopic correction must be given in such cases for best postoperative results.
This study assesses whether full hyperopic correction or lesser hyperopic correction (hyperopic correction -1), in patients who have exotropia and hyperopia (≥2.00 D), has the best post-operative results in treatment of exotropia.
The study was carried out on 31 patients of both genders of pediatric age group (3-14 years) who have exotropia (20-45PD) and hyperopia (2.00-8.75D). The cases were assigned in to two groups:
group A: Those who were given full hyperopic correction as spectacles.
group B: Those who were given under hyperopic correction (full hyperopic correction -1) as spectacles.
All patients received standardized ophthalmological examination comprising slit lamp examination, fundus examination, measurement of the cycloplegic refraction, measurement of BCVA and measurement of the initial angle of exotropia for far and near by prism and alternate cover test and there was no or very small (5PD) difference between far and near XT angles.
Follow up at 2, 4, 6 months preoperatively and 2, 4, 6 months postoperatively was done.
At each preoperative follow up visit, we measured the angle of exotropia with glasses, tested ocular motility. Best corrected visual acuity was done one week before surgery.
At each postoperative follow up visit, we tested alignment using alternate cover test, ocular motility. Best corrected visual acuity was done 6 months postoperatively.
At 2 months post-operative follow up, There was statistically significant increase in the no. of aligned cases in group B than in group A (P=0.018) and There was statistically significant increase in the no. of cases who were aligned with glasses but esotropic (5-16PD) without glasses in group A than in group B (p=0.002).
If we looked through 2,4 and 6 months post-operative follow up, we will find that the no. of cases which were aligned in group B decreased from 13 (81.3%) at 2 months to 9 (56.3%) at 6 months and these 4 cases became exotropic throughout follow up.
Additional 3 cases of group B who were aligned became exotropic at 1 year follow up. This may require further follow up of all cases which may augment our results. While the no. of aligned cases in group A increased because two of the cases who were esotropic without glasses and aligned with glasses became aligned with and without glasses.
At 4 and 6 months postoperative follow up, There was No statistically significant difference in the no. of cases which were aligned in both groups but, still there was statistically significant increase in the no. of cases which are aligned with glasses but esotropic (5-16PD) without glasses in group A (fully hyperopic corrected) than in group B (p=0.002 and p=0.018) respectively.
At 6 month post-operative follow up of BCVA, There is statistically significant increase in the no. of cases whose BCVA was 20/20 in the right eye and left eye in group A. (p=0.045, =0.037 respectively). However, this clinically significant increase in the BCVA was only after surgery. So, this can be related to postoperative improvement of binocularity as well as prescribing the full hyperopic error to those patients.