Korean J Ophthalmol.  2015 Dec;29(6):411-417. 10.3341/kjo.2015.29.6.411.

Comparison of Surgical Outcomes with Unilateral Recession and Resection According to Angle of Deviation in Basic Intermittent Exotropia

Affiliations
  • 1Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea.
  • 2Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. lsy3379@dsmc.or.kr
  • 3Department of Ophthalmology, Myongji Hospital, Goyang, Korea.

Abstract

PURPOSE
The purpose of this study is to compare the surgical outcomes and near stereoacuities after unilateral medial rectus (MR) muscle resection and lateral rectus (LR) recession according to deviation angle in basic intermittent exotropia, X(T).
METHODS
Ninety patients with basic type X(T) were included in this study. They underwent unilateral recession of the LR and resection of the MR and were followed postoperatively for at least 12 months. Patients were divided into three groups according to their preoperative deviation angle: group 1 < or =20 prism diopter (PD), 20 PD< group 2 <40 PD, and group 3 > or =40 PD. Surgical outcomes and near stereoacuities one year after surgery were evaluated. Surgical success was defined as having a deviation angle range within +/-10 PD for both near and distance fixation.
RESULTS
Among 90 patients, groups 1, 2, and 3 included 30 patients each. The mean age in groups 1, 2, and 3 was 9.4 years, 9.4 years, and 11.0 years, respectively. The surgical success rates one year after surgery for groups 1, 2, and 3 were 80.0%, 73.3%, and 73.3% (chi-square test, p = 0.769), respectively. The undercorrection rates for groups 1, 2, and 3 were 16.7%, 23.3%, and 26.7%, and the overcorrection rates were 3.3%, 3.3%, and 0%, respectively. The mean preoperative near stereoacuities for groups 1, 2, and 3 were 224.3 arcsec, 302.0 arcsec, and 1,107.3 arcsec, and the mean postoperative near stereoacuities were 218.3 arcsec, 214.7 arcsec, and 743.0 arcsec (paired t-test; p = 0.858, p = 0.379, p = 0.083), respectively.
CONCLUSIONS
In basic X(T) patients, the amount of angle deviation has no influence on surgical outcomes in unilateral LR recession and MR resection. The near stereoacuities by one year after LR recession and MR resection for intermittent X(T) were not different among patient groups separated by preoperative deviation angle.

Keyword

Angle of deviation; Exotropia; Stereopsis; Surgical outcome

MeSH Terms

Child
Exotropia/physiopathology/*surgery
Female
Follow-Up Studies
Humans
Male
Oculomotor Muscles/physiopathology/*surgery
*Ophthalmologic Surgical Procedures
Retrospective Studies
Treatment Outcome
Vision, Binocular/physiology
Visual Acuity/physiology

Reference

1. Min EJ, Lee MK, Park BI. A clinical study on strabismus in children. J Korean Ophthalmol Soc. 1991; 32:319–328.
2. Wolff SM, Loupe DN. Binocularity after surgery for intermittent exotropia. In : Campos EC, editor. Strabismus and ocular motility disorders: proceedings of the sixth meeting of the International Strabismological Association, Surfers Paradise, Australia, 1990. Hampshire: Macmillan Press;1991. p. 375.
3. Burian HM, Spivey BE. The surgical management of exodeviations. Trans Am Ophthalmol Soc. 1964; 62:276–306.
4. Lee BH, Lee JW, Lee JH, et al. The accuracy of estimating postoperative deviation in exotropia with over 40 prism diopters. J Korean Ophthalmol Soc. 2010; 51:1614–1619.
5. Chang JH, Kim HD, Lee JB, Han SH. Supermaximal recession and resection in large-angle sensory exotropia. Korean J Ophthalmol. 2011; 25:139–141.
6. Lau FH, Fan DS, Yip WW, et al. Surgical outcome of single-staged three horizontal muscles squint surgery for extra-large angle exotropia. Eye (Lond). 2010; 24:1171–1176.
7. Livir-Rallatos G, Gunton KB, Calhoun JH. Surgical results in large-angle exotropia. J AAPOS. 2002; 6:77–80.
8. Currie ZI, Shipman T, Burke JP. Surgical correction of large-angle exotropia in adults. Eye (Lond). 2003; 17:334–339.
9. Schwartz RL, Calhoun JH. Surgery of large angle exotropia. J Pediatr Ophthalmol Strabismus. 1980; 17:359–363.
10. Abroms AD, Mohney BG, Rush DP, et al. Timely surgery in intermittent and constant exotropia for superior sensory outcome. Am J Ophthalmol. 2001; 131:111–116.
11. Sharma P, Saxena R, Narvekar M, et al. Evaluation of distance and near stereoacuity and fusional vergence in intermittent exotropia. Indian J Ophthalmol. 2008; 56:121–125.
12. Adams WE, Leske DA, Hatt SR, et al. Improvement in distance stereoacuity following surgery for intermittent exotropia. J AAPOS. 2008; 12:141–144.
13. Morrison D, McSwain W, Donahue S. Comparison of sensory outcomes in patients with monofixation versus bifoveal fusion after surgery for intermittent exotropia. J AAPOS. 2010; 14:47–51.
14. Wright KW, Ryan SJ, editors. Color atlas of ophthalmic surgery: strabismus. Philadelphia: Lippincott;1991. p. 261.
15. Jeoung JW, Lee MJ, Hwang JM. Bilateral lateral rectus recession versus unilateral recess-resect procedure for exotropia with a dominant eye. Am J Ophthalmol. 2006; 141:683–688.
16. Chia A, Seenyen L, Long QB. Surgical experiences with two-muscle surgery for the treatment of intermittent exotropia. J AAPOS. 2006; 10:206–211.
17. Lee S, Lee YC. Relationship between motor alignment at postoperative day 1 and at year 1 after symmetric and asymmetric surgery in intermittent exotropia. Jpn J Ophthalmol. 2001; 45:167–171.
18. Jeong TS, You IC, Park SW, Park YG. Factors of surgical success with unilateral recession and resection in intermittent exotropia. J Korean Ophthalmol Soc. 2006; 47:1987–1992.
19. Kim KE, Yang HK, Hwang JM. Comparison of long-term surgical outcomes of 2-muscle surgery in children with large-angle exotropia: bilateral vs unilateral. Am J Ophthalmol. 2014; 157:1214–1220.e2.
20. Baker JD, Davies GT. Monofixational intermittent exotropia. Arch Ophthalmol. 1979; 97:93–95.
21. Simons K. Stereoacuity norms in young children. Arch Ophthalmol. 1981; 99:439–445.
22. Yildirim C, Altinsoy HI, Yakut E. Distance stereoacuity norms for the mentor B-VAT II-SG video acuity tester in young children and young adults. J AAPOS. 1998; 2:26–32.
23. Holmes JM, Leske DA, Hatt SR, et al. Stability of near stereoacuity in childhood intermittent exotropia. J AAPOS. 2011; 15:462–467.
24. Feng X, Zhang X, Jia Y. Improvement in fusion and stereopsis following surgery for intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2015; 52:52–57.
25. Keenan JM, Willshaw HE. The outcome of strabismus surgery in childhood exotropia. Eye (Lond). 1994; 8(Pt 6):632–637.
26. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99:1814–1818.
27. Lee JY, Choi DG. The Clinical analysis of recurrence after surgical correction of intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:2220–2226.
28. Ko KH, Min BM. Factors related to surgical results of intermittent exotropia. J Korean Ophthalmol Soc. 1996; 37:179–184.
29. Hatt SR, Leske DA, Mohney BG, et al. Classification and misclassification of sensory monofixation in intermittent exotropia. Am J Ophthalmol. 2010; 150:16–22.
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