Korean J Ophthalmol.  2007 Dec;21(4):228-231. 10.3341/kjo.2007.21.4.228.

The Clinical Course of Consecutive Esotropia after Surgical Correction

• Jung SH
• Rah SH

• KMID: 754641
• DOI: http://doi.org/10.3341/kjo.2007.21.4.228

Abstract

PURPOSE: To investigate the clinical course in patients who underwent surgical correction of consecutive esotropia. METHODS: The medical records of 13 patients who underwent surgical correction of consecutive esotropia were reviewed retrospectively. The authors investigated the deviation and surgical method at the time of exotropia surgery. During the follow up period, the authors also studied incidence of amblyopia development, the effect of occlusion therapy, surgical methods for consecutive esotropia, and postoperative change of deviation. RESULTS: The average exodeviation was 27.1 prism diopter (PD). Bilateral lateral rectus muscle recession was performed in all patients. In all patients, alternate occlusion was tried from 2 weeks after development of consecutive esotropia. However, there was no effect on 7 patients. None of the patients developed amblyopia. Surgery for consecutive esotropia was performed on the average 15.3 months after exotropia surgery. The average esodeviation was 21.1PD. Medial rectus muscle recession was performed in 10 patients and lateral rectus muscle advancement in 3 patients. The average deviation of the subject group immediately after surgery was 1.2PD esodeviation, 0.9PD esodeviation one month after surgery, 2.4PD exodeviation 6 months after surgery, and 4.7PD exodeviation at the last follow up, and it showed a tendency to progress to exodeviation as the follow up period increased. Ten patients (76.9%) showed deviation within 8PD at the last follow up. CONCLUSIONS: The success rate of surgical correction for consecutive esotropia was a favorable outcome. But, careful decisions of the surgical method and amount is needed because the conversion of exodeviation during long-term follow-up is possible.

Keyword

Consecutive esotropia; Exodeviation; Intermittent exotropia; Surgical correction.

MeSH Terms

Adolescent
Child
Child, Preschool
Esotropia/epidemiology/*etiology/physiopathology
Exotropia/physiopathology/*surgery
Eye Movements/*physiology
Female
Follow-Up Studies
Humans
Incidence
Male
Oculomotor Muscles/physiopathology/*surgery
Ophthalmologic Surgical Procedures/*methods
Postoperative Complications
Retrospective Studies
Time Factors
Treatment Outcome

Reference

1. Burian HM, Spivey BE. The surgical management of exodeviations. Am J Ophthalmol. 1965. 59:603–620.

2. Fletcher MC, Silverman SJ. Strabismus I A summary of 1110 consecutive cases. Am J Ophthalmol. 1966. 61:86–94.

3. von Noorden GK. Divergence excess and simulated divergence excess: Diagnosis and surgical management. Doc Ophthalmol. 1969. 26:719–728.

4. Dunlap EA. Overcorrection in horizontal strabismus surgery. New Orleans Academy of Ophthalmology Symposium on Strabismus. 1971. St. Louis: Mosby;255–267.

5. Hardesty HH, Bonyton JR, Keenan JP. Treatment of intermittent exotropia. Arch Ophthalmol. 1978. 96:268–274.

6. Cho YA, Kang SM, Roh GH. Asymmetric bilateral lateral recti recession in intermittent exotropia. J Korean Ophthalmol Soc. 1999. 40:544–549.

7. von Noorden GK. Binocular Vision and Ocular Motility. 2002. 6th ed. St. Louis: Mosby;371–372.

8. Hardesty HH. Treatment of overcorrected intermittent exotropia. Am J Ophthalmol. 1968. 66:80–86.

9. Dawson EL, Marshman WE, Lee JP. Role of botulinum toxin in surgically overcorrected exotropia. JAAPOS. 1999. 3:269–271.

10. Burke MJ. Nelson LB, Wagner RS, editors. Intermittent exotropia. International Ophthalmology Clinics. 1985. v. 25. Boston: Brown and Company;chap. 4.

11. Jampolsky A. Surgical correction of overcorrection in strabismus. Am Orthopt J. 1976. 26:14–19.

12. Cooper EL. The surgical management of secondary exotropia. Trans Am Acad Opthalmol Otolaryngol. 1961. 65:595–608.

13. Son AN, Park SC, Lee WR. Clinical study of consecutive esotropia. J Korean Ophthalmol Soc. 1990. 31:1328–1334.

14. Park HS, Kim JB, Seo MS, Park YG. A study on the consecutive esotropia after intermittent exotropia surgery. J Korean Ophthalmol Soc. 1994. 35:1327–1334.

15. Kim SJ, Lee SH, Woo KH. The surgical correction of consecutive esotropia. J Korean Ophthalmol Soc. 1994. 35:332–336.

16. Shin YJ, Chang BL. The clinical outcome of the consecutive esotropia after surgical correction. J Korean Ophthalmol Soc. 2003. 44:2085–2090.