Risk factors for consecutive exotropia after esotropia surgery
- 465 Downloads
To evaluate the risk factors in development of postoperative exotropia following bilateral medial rectus (BMR) recession for esotropia.
108 patients who underwent BMR recession for esotropia between November 1996 and July 2010 were enrolled. 54 patients who required surgery for consecutive exotropia were compared to 54 controls whose angle of deviation showed less than five prism diopters of esotropia at all periods after BMR recession. Amblyopia, dissociated vertical deviation (DVD), refractive error, inferior oblique overaction, and multiple surgery history were evaluated as risk factors for the development of consecutive exotropia. The postoperative changes of angle of deviation were calculated.
Amblyopia was found in 27 patients (50.5 %) in the exotropia group, and in six patients (11.1 %) in the control group (P < 0.001) before esotropia surgery. DVD was detected in 16 (29.06 %) patients in the exotropia group as compared to 4 (7.4 %) in the control group (P = 0.003). With logistic regression analysis, the odds ratio of DVD was 5.27 (95 % CI 1.63–17.03; P = 0.006) and of amblyopia, 8.00 (95 % CI 2.94–21.80; P < 0.001). There were no significant differences between the two groups with regards to the pre-operative deviation, follow up periods, degree of hyperopia, presence of anisometropia or inferior oblique overaction, and history of multiple surgery. Using linear mixed model analysis, the exotropic shift across time was higher in the consecutive exotropia group relative to the controls (P < 0.001).
The presence of amblyopia before esotropia surgery and DVD correlated with risk of consecutive exotropia.
KeywordsConsecutive exotropia Bilateral medial rectus recession Amblyopia Dissociated vertical deviation
Professional English-language editing was provided by Bioscience.
Conflicts of interest
S. Y. Han, None; J. Han, None; S. Rhiu, None; J. B. Lee, None; S. -H. Han, None.
- 3.Donaldson MJ, Forrest MP, Gole GA. The surgical management of consecutive exotropia. JAAPOS. 2004;8:230–6.Google Scholar
- 4.Patel AS, Simon JW, Lininger LL. Bilateral lateral rectus recession for consecutive exotropia. JAAPOS. 2000;4:291–4.Google Scholar
- 5.Sachdeva V, Mittal V, Reddy PN, Rao HL, Kekunnaya R, Gupta A. Dose-effect relationship of medial rectus muscle advancement for consecutive exotropia. JAAPOS. 2012;16:314.Google Scholar
- 7.Mohan K, Sharma A, Pandav SS. Unilateral lateral rectus muscle recession and medial rectus muscle resection with or without advancement for postoperative consecutive exotropia. JAAPOS. 2006;10:220–4.Google Scholar
- 10.Ludwig IH, Chow AY. Scar remodeling after strabismus surgery. JAAPOS. 2000;4:326–33.Google Scholar
- 14.Parks MM. Concomitant exodeviations. In: Tasman W, Jaeger EA, editors. Duane’s clinical ophthalmology, vol. 12. Philadelphia: Lippincott; 1990.Google Scholar
- 15.Wright KW. Color Atlas of Strabismus surgery: strategies and techniques. 3rd ed. Berlin: Springer; 2007.Google Scholar
- 22.Berk AT, Kocak N, Ellidokuz H. Treatment outcomes in refractive accommodative esotropia. JAAPOS. 2004;8:384–8.Google Scholar