J Korean Ophthalmol Soc.  2017 Nov;58(11):1269-1275. 10.3341/jkos.2017.58.11.1269.

A Clinical Analysis of Intermittent Exotropia Patients Requiring More than Three Reoperations

• Kim MJ
• Ha SG
• Kim SH

• KMID: 2395869
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1269

Abstract

PURPOSE
To evaluate the clinical analysis of intermittent exotropia patients who required more than three reoperations and to investigate the factors leading to situations that require more than three reoperations.
METHODS
We retrospectively analyzed the results of 13 patients who underwent more than three reoperations for recurrence after the second operation, as well as for 29 patients who had successful results for operation at least 1 year after the second operation. We investigated the factors associated with surgical outcomes of the second operation using multiple logistic regression analysis, which included; onset of symptom, primary, secondary, tertiary, and fourth ages of surgery, stereopsis before and after surgery, distance and near deviation before and after surgery, and constancy of exotropia.
RESULTS
There were more cases in which symptoms occurred before 1 year of age (p = 0.011) and which had constant exotropia (p = 0.023), with a large deviation at first operation (p = 0.003) after more than three operations compared to patients who only had two operations. There were less cases that achieved initial overcorrection after first operation (p = 0.003) and successful postoperative stereopsis after second operation (p = 0.043) in the three operations group than in the two operations group. Among these factors, the most important factor affecting reoperation and success after second operation was related to successful recovery of stereopsis using multiple regression analysis (odds ratio [OR] = 50.00, 95% confidence interval [CI] = 4.392-569.224, p = 0.002).
CONCLUSIONS
In cases of intermittent exotropia occurring before 1 year of age, constant exotropia with a large deviation at first operation, and insufficient initial overcorrection after operation, it may be necessary for patients to receive more than three operations because of recurrence. Further, recovery of postoperative stereopsis after the second operation was the most important predictor for postoperative results.

Keyword

Intermittent exotropia; Multiple reoperations; Recurrent exotropia

MeSH Terms

Depth Perception
Exotropia*
Humans
Logistic Models
Recurrence
Reoperation
Retrospective Studies

Reference

1. Friedmann L, Biedner B, David R, Sachs U. Screening for refractive errors, strabismus and other ocular anomalies from ages 6 months to 3 years. J Pediatr Ophthalmol Strabismus. 1980; 17:315–317.

2. Friedman Z, Neumann E, Hyams SW, Peleg B. Ophthalmic screening of 38,000 children, age 1 to 2 1/2 years, in child welfare clinics. J Pediatr Ophthalmol Strabismus. 1980; 17:261–267.

3. Preslan MW, Novak A. Baltimore vision screening project. Ophthalmology. 1996; 103:105–109.

4. Rah SH, Jun HS, Kim SH. An epidemiologic survey of strabismus among school-children in Korea. J Korean Ophthalmol Soc. 1997; 38:2195–2199.

5. Yu YS, Kim SM, Kwon JY, et al. Preschool vision screening in Korea: preliminary study. J Korean Ophthalmol Soc. 1991; 32:1092–1096.

6. Park JY, Sohn HY, Cho YA. Is the nonsurgical treatment effective on intermittent exotropia in children school-age? J Korean Ophthalmol Soc. 1995; 36:1561–1567.

7. Oh JY, Hwang JM. Survival analysis of 365 patients with exotropia after surgery. Eye (Lond). 2006; 20:1268–1272.

8. Scott WE, Keech R, Marsh AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99:1814–1818.

9. Chun KI, Rah SH. The comparison of outcomes between lateral rectus muscles re-recession and medial rectus muscles resection in recurrent exotropia. Korean J Ophthalmol. 2008; 22:111–114.

10. Yang HK, Hwang JM. Bilateral vs unilateral medial rectus resection for recurrent exotropia after bilateral lateral rectus recession. Am J Ophthalmol. 2009; 148:459–465.

11. Jampolsky A. Treatment of exodeviations. Trans New Orleans Acad Ophthalmol. 1986; 34:201–234.

12. Yam JC, Wu PK, Chong GS, et al. Long-term ocular alignment after bilateral lateral rectus recession in children with infantile and intermittent exotropia. J AAPOS. 2012; 16:274–279.

13. Gezer A, Sezen F, Nasri N, Gözüm N. Factors influencing the outcome of strabismus surgery in patients with exotropia. J AAPOS. 2004; 8:56–60.

14. Beneish R, Flanders M. The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol. 1994; 29:119–124.

15. Choi YM, Kim SH. Comparison of clinical features between two different types of exotropia before 12 months of age based on stereopsis outcome. Ophthalmology. 2013; 120:3–7.

16. Hunter DG, Kelly JB, Buffenn AN, Ellis FJ. Long-term outcome of uncomplicated infantile exotropia. J AAPOS. 2001; 5:352–356.

17. Wu H, Sun J, Xia X, et al. Binocular status after surgery for constant and intermittent exotropia. Am J Ophthalmol. 2006; 142:822–826.

18. 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.

19. Pratt-Johnson JA, Barlow JM, Tillson G. Early surgery for intermittent exotropia. Am J Ophthalmol. 1977; 84:689–694.

20. Edelman PM, Brown MH, Murphree AL, Wright KW. Consecutive esodeviation… then what? Am Orthopt J. 1988; 38:111–116.

21. Raab EL, Parks MM. Recession of the lateral recti. Early and late postoperative alignments. Arch Ophthalmol. 1969; 82:203–208.

22. Hahm IR, Yoon SW, Baek SH, Kong SM. The clinical course of recurrent exotropia after reoperation for exodeviation. Korean J Ophthalmol. 2005; 19:140–144.

23. Gill MK, Drummond GT. Indications and outcomes of strabismus repair in visually mature patients. Can J Ophthalmol. 1997; 32:436–440.

24. Yeo SI, Kim SY, Hwang WS, Kong SM. Surgical results according to sensory function tests in intermittent exotropia. J Korean Ophthalmol Soc. 1999; 40:3174–3179.