Factors associated with the angle of exodeviation in patients with recurrent exotropia

Recurrence of Intermittent Exotropia after Bilateral Lateral Rectus Recession

PURPOSE:

The purpose of this study was to evaluate predictive factors for intermittent exotropia (XT) recurrence after bilateral lateral rectus (BLR) recession.

METHODS:

This is a retrospective chart review of patients with XT who underwent BLR recession surgery between January 2007 and March 2017 with at least one postsurgical follow-up. Forty-one medical records were reviewed. Information collected included age, gender, systemic diseases, history of prematurity, family history of eye diseases, visual acuity, refraction, ocular alignment and control, stereoacuity, slit-lamp examination, fundoscopy, and amount of BLR recession. Successful alignment was defined as ≤8 prism diopters of esotropia or exotropia postoperatively.

RESULTS:

The mean age of patients at the time of surgery and follow-up time was 9.2 ± 12.3 years (y) and 23.6 ± 36.5 months (m), respectively. The mean amount of BLR recession was 6.5 ± 1.0 mm. Recurrence rate was 43.9% on the last follow-up. Age at surgery and at the time of last follow-up were significantly higher in the recurring group (P = 0.04 and P = 0.05, respectively). Postoperative angle of misalignment during the first 3 months was correlated with exotropia recurrence. No statistical significance was found among the remaining factors studied.

CONCLUSIONS:

The recurrence rate of XT in our study was 43.9%; it was increased in patients operated at older age and amid those with significant exotropia detected in the early postoperative period (within 3 months of surgery).

Risk factors associated with poor outcome after medial rectus resection for recurrent intermittent exotropia

PURPOSE

To describe characteristics of recurrent intermittent exotropia after bilateral lateral rectus (BLR) recession, and identify factors associated with poor outcome after unilateral medial rectus (MR) resection for recurrent intermittent exotropia.

METHODS

We retrospectively reviewed 124 patients who have undergone unilateral MR resection for recurrent intermittent exotropia after BLR recession. Patients were followed for at least 2 years after MR resection. Clinical characteristics and risk factors associated with poor outcome after unilateral MR resection were evaluated. Successful outcome was defined as distant deviation within the range of 4 prism diopters (PD) esotropia and 10 PD exotropia at last visit after MR resection.

RESULTS

Among 124 patients, 50 patients (41.1%) were male, and the mean age at the time of MR resection was 9.5 ± 3.1 years. The average follow-up period after MR resection was 43.8 ± 23.7 months. Forty-seven patients (37.9%) were classified to have poor outcome at last visit, and 29 patients (23.4%) underwent third operation. None of the patients was overcorrected after MR resection. Multiple logistic regression analyses showed that distant deviation at post-operative 3 months and male gender were associated with poor outcome (OR 1.49; 95% CI 1.27-1.73; P < 0.001, and OR 5.19; 95% CI 1.42-18.98; P = 0.013, respectively).

CONCLUSION

Ocular deviation at 3 months after unilateral MR resection for recurrent intermittent exotropia may play a valuable role in anticipating poor outcome. Patients whose exotropia exceeded 9 PD at distance at 3 months' follow-up tended to recur while those whose exotropia remained below 9 PD at distance showed a stable disease course.

Long-term evaluation of two reoperation groups for intermittent exotropia

PURPOSE

To evaluate the effect of initial postoperative deviation on subsequent reoperation in patients with intermittent exotropia and to compare the clinical factors and surgical outcomes between the two surgical failure groups.

METHODS

The medical records of patients who underwent reoperation after failed primary surgery for intermittent exotropia at a single center were reviewed retrospectively. Patients with recurrent intermittent exotropia and consecutive esotropia were considered surgical failures. Various clinical factors were compared between these two groups, including age at surgery, interval between surgeries, stereoacuity, spherical equivalent, office control, surgical type, presence of neurologic disease, amblyopia and other strabismus, and postoperative angles of deviation.

RESULTS

Of the 3,406 patients who underwent surgery for intermittent exotropia, 139 patients met inclusion criteria. Of these, 125 (3.8%) underwent reoperation for recurrent intermittent exotropia; 14 (0.4%), for consecutive esotropia. On postoperative day 1 the intermittent exotropia group showed esodeviation at distance fixation of 2^Δ ± 4^Δ; the esotropia group, esodeviation of 5^Δ ± 4^Δ. The intermittent exotropia group showed a significant progression of exodeviation from 2 months postoperatively (all P < 0.005). In the esotropia group, the amount of esodeviation significantly improved in postoperative months 2 and 6 (P = 0.024 and 0.013) then further worsened after 6 months. The interval between the first and second surgeries was 64 ± 28 months in the exotropia group and 55 ± 36 months in the esotropia group, a significant difference (P = 0.003).

CONCLUSIONS

Initial postoperative overcorrection following primary surgery for intermittent exotropia may not predict long-term success. Careful monitoring for consecutive esotropia is needed 6 months postoperatively, and annual check-ups are recommended for all patients with under- and overcorrections for a period of at least 5 years after surgery.

Post-operative strabismus control and motor alignment for basic intermittent exotropia

AIM

To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.

METHODS

The medical records of 80 consecutive patients aged less than 17 years of age, who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed. Pre- and post-operative characteristics were documented at 1wk, 6mo, 1, 3 and 5y follow-up. Subjects at 5-year follow-up were assigned to the success group if they had a post-operative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test, and had moderate to good strabismus control. The remaining subjects were assigned to the failure group.

RESULTS

Post-operative surgical success at one week was 75%, which decreased to 41% at 5y follow-up. The success group was noted to have more patching pre-operatively (P=0.003). The duration of patching a day (P=0.020) and total duration of patching pre-operatively (P=0.030) was higher in the success group. Surgical success at 1y (P=0.004) and 3y (P=0.002) were associated with higher surgical success at 5y follow-up.

CONCLUSION

Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up. There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.