Japanese Journal of Ophthalmology

, Volume 60, Issue 4, pp 333–340 | Cite as

Risk factors for consecutive exotropia after esotropia surgery

  • So Young Han
  • Jinu Han
  • Soolienah Rhiu
  • Jong Bok Lee
  • Sueng-Han HanEmail author
Clinical Investigation



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.


Consecutive 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.


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Copyright information

© Japanese Ophthalmological Society 2016

Authors and Affiliations

  • So Young Han
    • 1
    • 2
  • Jinu Han
    • 2
  • Soolienah Rhiu
    • 3
  • Jong Bok Lee
    • 2
    • 4
  • Sueng-Han Han
    • 2
    Email author
  1. 1.Department of Ophthalmology, Chuncheon Sacred Heart HospitalHallym University College of MedicineGangwon-doRepublic of Korea
  2. 2.Department of Ophthalmology, Severance Hospital, Institute of Vision ResearchYonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Ophthalmology, Dongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
  4. 4.Kong Eye ClnicSeoulRepublic of Korea

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