# Orthoptic Treatment After Strabismus Surgery in Child Intermittent Divergent Strabismus

## TL;DR

Orthoptic therapy after strabismus surgery improves sensory-motor eye function in children, even if eye alignment changes little.

## Contribution

Demonstrates that orthoptic therapy enhances binocular function and stability post-surgery in children with intermittent exotropia.

## Key findings

- Orthoptic therapy significantly improved fusional and convergence amplitudes in children after strabismus surgery.
- Static ocular alignment showed minimal change, indicating limited impact on physical eye alignment.
- Improvements in sensory-motor function may reduce the risk of postoperative recurrence in children with intermittent exotropia.

## Abstract

What are the main findings?
Postoperative orthoptic therapy producedlarge improvements in sensory–motor function, including fusional amplitudes and convergence measures (NPC and convergence amplitudes).Static ocular alignment changed only minimally, showing a small exo-drift consistent with the normal postoperative course rather than a therapeutic effect.

Postoperative orthoptic therapy producedlarge improvements in sensory–motor function, including fusional amplitudes and convergence measures (NPC and convergence amplitudes).

Static ocular alignment changed only minimally, showing a small exo-drift consistent with the normal postoperative course rather than a therapeutic effect.

What is the implication of the main finding?
Orthoptic therapyenhances binocular stability and functional controlafter strabismus surgery, even when ocular alignment itself remains largely unchanged.These sensory–motor gains maysupport long-term binocular function and reduce the risk of postoperative decompensation or recurrencein children with intermittent exotropia.

Orthoptic therapyenhances binocular stability and functional controlafter strabismus surgery, even when ocular alignment itself remains largely unchanged.

These sensory–motor gains maysupport long-term binocular function and reduce the risk of postoperative decompensation or recurrencein children with intermittent exotropia.

Purpose: To evaluate short-term motor and sensory–motor outcomes following postoperative OT in children with IXT after strabismus surgery. Methods: This prospective before–after observational study included children with IXT who underwent bilateral lateral rectus recession and were referred for postoperative OT based on predefined clinical criteria. A structured 12-week OTplan was initiated approximately six months after surgery. Outcome measures included angle of deviation (prism diopters, PD), near point of convergence (cm), positive fusional vergence amplitudes (PD), and convergence amplitudes at distance and near (PD). Pre- and post-therapy changes were analysed using paired-samples t-tests with effect sizes calculated using Cohen’s d. Final postoperative alignment was additionally compared cross-sectionally between children who underwent OT and those managed without OT. Results: Eighty-eight children had complete paired motor and sensory–motor data and were included in the analyses. Changes in static ocular alignment were small, with mean residual deviation improving from −7.02 ± 6.91 PD to −5.22 ± 6.60 PD after OT (mean change +1.80 PD; p < 0.01; d ≈ 0.30). No significant difference in final postoperative alignment was observed between the OT and non-OT groups (p = 0.827). In contrast, marked improvements were observed in sensory–motor outcomes. Positive fusional vergence amplitude increased from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD (p < 0.001; d ≈ 1.5). Distance convergence amplitude improved from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD, and near convergence amplitude from 10.95 ± 12.50 PD to 33.29 ± 13.89 PD (both p < 0.001; d ≈ 1.5). Near point of convergence showed a modest but significant improvement. Conclusions: Postoperative OT was associated with substantial short-term improvements in sensory–motor function, particularly fusional and convergence capacities, while changes in static ocular alignment were small and of limited clinical relevance. These findings support the role of OT as a functional adjunct to surgery, aimed at enhancing binocular control and postoperative sensory–motor stability in children with IXT.