J Korean Ophthalmol Soc.  2008 Oct;49(10):1641-1648.

Clinical Course of Patients with Consecutive Esotropia Angle Larger Than Preoperative Angle After Exotropia Surgery

• Kyeong JW
• Choi MY

Abstract

PURPOSE
To report the clinical course of severe consecutive esotropia (ET) with an esotropic angle at postoperative day 1 larger than the preoperative exotropia angle (XT).
METHODS
Patients with ET angles at postoperative 1 day greater than their preoperative XT angles were included; the case of lost lateral rectus during surgery was excluded. Preoperative clinical characteristics and the course of postoperative alignment were analyzed, and binocularity was compared between the preoperative state and the postoperative state.
RESULTS
The mean preoperative angle of XT of 13 patients was 23 prism diopters (PD) at distance and 27PD at near. Lateral incomitancy was observed in 9 patients. One day postoperatively, the mean angle of ET was 27PD at distance and 25PD at near, and alternate occlusion therapy was performed in all patients. However, the angle of ET was decreased 10PD or less in only 3 patients. All 13 patients were managed with Fresnel prisms, and 4 patients had orthotropia. Another 4 patients used glass prisms because they had ET of 8PD or less, and the remaining 5 patients still showed an ET with 12PD or more. Binocularity after surgery was worse than that before surgery in 64% of patients.
CONCLUSIONS
For patients with ET angles at postoperative 1 day greater than preoperative XT angles, the frequency of lateral incomitancy was high. Alternate occlusion and Fresnel prism treatment were needed in all patients. Recovery from orthotropia and the prognosis of binocularity were relatively poor.

Keyword

Binocularity; Consecutive esotropia; Exotropia

MeSH Terms

Esotropia
Exotropia
Glass
Humans
Prognosis
Telescopes

Figure

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  Figure 1. This diagram shows treatment process and their result in the severe consecutive esotropia after surgery for intermittent exotropia.* Orthotropia without Fresnel prism.

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  Figure 2. Change of the angle of deviation during the follow-up after surgery for intermittent exotropia. (A) Orthotropia without treatment at the last follow-up. (B) Consecutive esotropia ≤10PD at the last follow-up. (C) Consecutive esotropia > 10PD at the last follow-up.* Prism diopters; † Preoperation; ‡ Day; § Month; п Year.

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  Figure 3. Comparison of stereopsis (A) and fusion (B) in between preoperation and postoperation.* Seconds of arc; † Gross stereopsis; ‡ No stereopsis; § Fusion at far and near; ∏ Fusion at near; # No fusion.

Reference

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