Strabismus surgery (group A)

Surgery is performed by specialized strabismus surgeons (Yan, Deng, Lin, Kang, Chen, Wu, Wang, Qiu, and Shen) according to agreed surgical formulae tailored to the clinical characteristics of the surgeon. Principles involved in the surgical procedure have been agreed as follows:

General anesthesia

Bilateral lateral rectus recession to be performed in divergence excessive IXT; unilateral recess/resect surgery to be performed in convergence insufficient IXT; either surgery in basic type of IXT

Standard sterile preparation of the operative sites

Conjunctival incisions

Standard isolation and cleaning of muscle to be operated

Muscle secured with 6/0 vicryl suture

Amount of recession and resection assessed on the basis of the maximum distance deviation angle (Table 1), modified according to standard practice of surgeon

Conjunctival incisions closed with 8/0 vicryl suture

Antibiotic ointments give at the end of procedure

Surgical amounts for SOMIX trial

Deviation angleUnilateral/bilateral recess surgeryUnilateral recess/resect surgery
(PD)ULR recession (mm)BLR recession (mm)LR recession (mm)MR resection (mm)
156
20843
255.553.5
3065.54
356.564.5
4076.55
457.575
50876

PD Prism diopter, ULR Unilateral lateral rectus, BLR Bilateral lateral rectus, LR Lateral rectus, MR Medial rectus

b) Follow-up visit    
The follow-up visits schedule of the study and corresponding clinical assessments for each group are showed in Fig. 2.

Standard protocol item. The follow-up visits schedule and corresponding clinical assessments. D, day; W, week; M, month; Y, year; BSV, binocular single vision; BCVA, best corrected visual acuity; PACT, prism and alternative cover test; NCS, Newcastle control score; IXTQ, intermittent exotropia questionnaire

Children in the observation group will be offered surgical treatment if a constant strabismus appears to be developing or parents request surgery and the responsible clinical team agrees that this is appropriate.
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