J Korean Ophthalmol Soc.  2015 Dec;56(12):1926-1932. 10.3341/jkos.2015.56.12.1926.

Surgical Outcomes and Prognostic Factors of Consecutive Exotropia

Affiliations
  • 1Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. mmk@med.yu.ac.kr

Abstract

PURPOSE
In this study we evaluated the prognostic factors by comparing the clinical manifestation of consecutive exotropia after consecutive exotropia surgery.
METHODS
We performed a retrospective study of 65 patients who had surgery due to consecutive exotropia after esotropia surgery in Yeungnam University Medical Center between July 1988 and December 2013. The type of esotropia, age at diagnosis of esotropia, type of esotropia surgery, age at esotropia surgery, type of consecutive exotropia surgery, age at consecutive exotropia surgery, presence of adduction limitation, presence of amblyopia, and preoperative and postoperative angles of strabismus were analyzed.
RESULTS
The mean follow-up time after consecutive exotropia surgery was 5.1 +/- 5.2 years and 50 of 65 patients showed successful surgical outcomes at the last follow-up. Cumulative success rate of consecutive exotropia remained stable postoperatively in 68.2% of patients after 7.7 years. When comparing the success group and the recurrent group, the age at consecutive exotropia surgery was significantly younger and mean follow-up time was significantly longer in the recurrent group. The mean interval between consecutive exotropia surgery and recurrence of exotropia was 16.9 months in the recurrent group. The mean angle of strabismus at postoperative 1 week was significantly different between the 2 groups; 0.5 prism diopters (PD) esodeviation in the success group and 4.5 PD exodeviation in recurrent group.
CONCLUSIONS
Recurrence of consecutive exotropia frequently developed with younger age at consecutive exotropia surgery and exodeviation at postoperative 1 week. Recurrent consecutive exotropia should be observed for an extended period, thus requiring periodic long-term postoperative follow-ups.

Keyword

Consecutive exotropia; Consecutive exotropia surgery; Prognostic factors; Recurrent consecutive exotropia; Surgical outcomes

MeSH Terms

Academic Medical Centers
Amblyopia
Diagnosis
Esotropia
Exotropia*
Follow-Up Studies
Humans
Recurrence
Retrospective Studies
Strabismus

Figure

  • Figure 1. Kaplan-Meier survival curve of surgical outcome of surgery of consecutive exotropia.


Reference

References

1. von Noorden GK, Campos EC. Binocular Vision and Ocular Motility: Theory and Management of Strabismus, 6th ed. St. Louis: Mosby,. 2002; 356–76.
2. Vroman DT, Hutchinson AK, Saunders RA, Wilson ME. Two- muscle surgery for congenital esotropia: rate of reoperation in pa-tients with small versus large angles of deviation. J AAPOS. 2000; 4:267–70.
3. Caputo AR, Guo S, Wagner RS, Picciano MV. Long term fol-low-up of extraocular muscle surgery for congenital esotropia. Am Orthoptic J. 1991; 41:67–71.
Article
4. Burian HM. The principles of surgery on the extraocular muscles: Part I. Fundamental principles: choice of operation in concomitant strabismus: horizontal muscles. Am J Ophthalmol. 1950; 33:380–7.
5. Stoller SH, Simon JW, Lininger LL. Bilateral lateral rectus re-cession for exotropia: a survival analysis. J Pediatr Ophthalmol Strabismus. 1994; 31:89–92.
Article
6. Folk ER, Miller MT, Chapman L. Consecutive exotropia following surgery. Br J Ophthalmol. 1983; 67:546–8.
Article
7. Dunnington JH, Regan EF. Factors influencing the postoperative results in concomitant convergent strabismus. AMA Arch Ophthalmol. 1950; 44:813–22.
Article
8. Forrest MP, Finnigan S, Finnigan S, Gole GA. Three horizontal muscle squint surgery for large angle infantile esotropia. Clin Experiment Ophthalmol. 2003; 31:509–16.
Article
9. Berk AT, Koçak N, Ellidokuz H. Treatment outcomes in refractive accommodative esotropia. J AAPOS. 2004; 8:384–8.
Article
10. Bietie GB, Bagolini B. Problems related to surgical overcorrection in strabismus surgery. J Pediatr Ophthalmol Strabismus. 1965; 2:11–4.
11. Stager DR, Weakley DR Jr, Everett M, Birch EE. Delayed consec-utive exotropia following 7-millimeter bilateral medial rectus re-cession for congenital esotropia. J Pediatr Ophthalmol Strabismus. 1994; 31:147–50. discussion 151-2.
Article
12. Beneish R, Williams F, Polomeno RC, Little JM. Consecutive exo-tropia after correction of hyperopia. Can J Ophthalmol. 1981; 16:16–8.
13. Swan KC. Accommodative esotropia long range follow-up. Ophthalmology. 1983; 90:1141–5.
Article
14. Oğ uz V, Arvas S, Yolar M. . Consecutive exotropia following strabismus surgery. Ophthalmologica. 2002; 216:246–8.
Article
15. Knapp P. The surgical treatment of persistent horizontal strabismus. Trans Am Ophthalmol Soc. 1965; 63:75–90.
16. Ohtsuki H, Hasebe S, Tadokoro Y. . Advancement of medial rectus muscle to the original insertion for consecutive exotropia. J Pediatr Ophthalmol Strabismus. 1993; 30:301–5.
Article
17. Patel AS, Simon JW, Lininger LL. Bilateral lateral rectus recession for consecutive exotropia. J AAPOS. 2000; 4:291–4.
Article
18. Pickering JD, Simon JW, Lininger LL. . Exaggerated effect of bilateral medial rectus recession in developmentally delayed children. J Pediatr Ophthalmol Strabismus. 1994; 31:374–7.
Article
19. Lee JR, Roh YB. The factors affecting consecutive exotropia with angle of 20 prism diopters or more following surgery for esotropia. J Korean Ophthalmol Soc. 1995; 36:1778–83.
20. Biedner B, Yassur Y, David R. Advancement and reinsertion of one medial rectus muscle as treatment for surgically overcorrected esotropia. Binocul Vis. 1991; 6:197–200.
21. Rosenbaum AL, Santiago AP. Clinical Strabismus Management: Principles and Surgical Techniques. Philadelphia: WB Saunders;1999. p. 149–51.
22. Cooper EL. The surgical management of secondary exotropia. Trans Am Acad Ophthalmol Otolaryngol. 1961; 65:595–608.
23. Donaldson MJ, Forrest MP, Gole GA. The surgical management of consecutive exotropia. J AAPOS. 2004; 8:230–6.
Article
24. Rajavi Z, Feizi M, Mughadasifar H. . Surgical results of con-secutive exotropia. J Pediatr Ophthalmol Strabismus. 2013; 50:274–81.
Article
25. Chatzistefanou KI, Droutsas KD, Chimonidou E. Reversal of uni-lateral medial rectus recession and lateral rectus resection for the correction of consecutive exotropia. Br J Ophthalmol. 2009; 93:742–6.
Article
26. Mohan K, Sharma A, Pandav S. Unilateral lateral rectus muscle re-cession and medial rectus muscle resection with or without ad-vancement for postoperative consecutive exotropia. J AAPOS. 2006; 10:220–4.
Article
27. Baek SU, Lee JY. Long-term outcome of surgery for intermittent exotropia. J Korean Ophthalmol Soc. 2013; 54:1079–85.
Article
28. Lee JH, Paik HJ. What to predict favorable long-term sensory out-come after surgery for infantile esotropia? J Korean Ophthalmol Soc. 2014; 55:271–7.
29. Lim SH, Hwang BS, Kim MM. Prognostic factors for recurrence after bilateral rectus recession procedure in patients with inter-mittent exotropia. Eye (Lond). 2012; 26:846–52.
Article
30. Lee JH, Kim MM. Clinical manifestation and surgical outcomes of consecutive exotropia. J Korean Ophthalmol Soc. 2003; 44:1839–45.
31. Beneish R, Flanders M. The role of stereopsis and early post-operative alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol. 1994; 29:119–24.
32. Ing MR, Okino LM. Outcome study of stereopsis in relation to du-ration of misalignment in congenital esotropia. J AAPOS 2002; 6. 3–8.
Article
33. Bae SH, Choi DG. Clinical features and surgical outcomes of in-fantile esotropia according to the age at surgery. J Korean Ophthalmol Soc. 2008; 49:1961–7.
Article
Full Text Links
  • JKOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr