Abstract
Purpose:
To evaluate the risk factors predicting surgical treatment in consecutive esotropia occurring after surgery for intermittent exotropia.
Methods:
The clinical records of 52 patients with consecutive esotropia who underwent exotropia surgery were retrospectively reviewed. All patients demonstrated consecutive esotropia with diplopia or suppression for more than 1 month after surgery for exotropia. Patients were divided into two groups (the surgical group and nonsurgical group) depending on whether surgery was required for consecutive esotropia. Surgery for esotropia was performed only in patients with more than 10 prism diopters (PD) esodeviation that persisted for a minimum of 6 months, those who had suppression in 1 eye or diplopia, and those who could not achieve fine stereopsis. The nonsurgical treatment up to 6 months postoperatively was part-time patching and prism therapy in both groups. Patient characteristics were evaluated in the two groups.
Results:
The surgical group was composed of 17 patients and the nonsurgical group was composed of 35 patients. Age, gender, refractive error, best-corrected visual acuity, and postoperative overcorrection at 1 day were not significantly different in the two groups (P > .05). However, the distance strabismic angle at 1 month postoperatively was 2.5 ± 3.8 PD esodeviation (range: 14 PD esotropia to 4 PD exotropia) in the nonsurgical group and 5.4 ± 5.1 PD esodeviation (range: 20 PD esotropia to orthotropia) in the surgical group; these values were statistically significant (P < .05).
Conclusions:
The clinically significant risk factor affecting the surgical decision for consecutive esotropia was a large esotropic angle at 1 month postoperatively in this study.
[J Pediatr Ophthalmol Strabismus 2013;50(6):335–339.]
- 1.Santiago AP, Ing MR, Kushner BJ, Rosenbaum AL. Intermittent exotropia. In: , eds. Clinical Strabismus Management: Principles and Surgical Techniques.Philadelphia: Saunders; 1999:163–175. Google Scholar
- 2.Burian HM, Spivey BE. The surgical management of exodeviations. Am J Ophthalmol. 1965; 59:603–620. Crossref Medline, Google Scholar
- 3.Hardesty HH, Bonyton JR, Keenan JP. Treatment of intermittent exotropia. Arch Ophthalmol. 1978; 96:268–274.
10.1001/archopht.1978.03910050136006 Crossref Medline, Google Scholar - 4.Cho YA, Kim SH. Role of the equator in the early overcorrection of intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2009; 46:30–34.
10.3928/01913913-20090101-04 Link, Google Scholar - 5.von Noorden GK, Campos EC. Exodeviations. In: . Binocular Vision and Ocular Motility: Theory and Management of Strabismus, 6th ed. St. Louis: CV Mosby; 2002:371–372. Google Scholar
- 6.Elsas FJ. Consecutive esotropia. Am Orthopt J. 1992; 42:94–97. Crossref, Google Scholar
- 7.Raab EL, Parks MM. Recession of the lateral recti: early and late postoperative alignments. Arch Ophthalmol. 1969: 82:203–208.
10.1001/archopht.1969.00990020205010 Crossref Medline, Google Scholar - 8.Burian HM. Exodeviations: their classification, diagnosis and treatment. Am J Ophthalmol. 1966; 62:1161–1166. Crossref Medline, Google Scholar
- 9.Edelman PM, Brown MH, Murphree AL, Wright KW. Consecutive esodeviation, then what?Am Orthopt J. 1988; 38:111–116. Crossref, Google Scholar
- 10.Jang JH, Park JM, Lee SJ. Factors predisposing to consecutive esotropia after surgery to correct intermittent exotropia. Graefes Arch Clin Exp Ophthalmol. 2012; 250:1485–1490.
10.1007/s00417-012-1991-y Crossref Medline, Google Scholar - 11.Keech RV, Stewart SA. The surgical overcorrection of intermittent exotropia. J Pediatr Ophthalmol Strabismus. 1990; 27:218–220. Link, Google Scholar
- 12.Hardesty HH. Treatment of overcorrected intermittent exotropia. Am J Ophthalmol. 1968; 66:80–86. Crossref Medline, Google Scholar
- 13.Richard JM, Parks MM. Intermittent exotropia: surgical results in different age groups. Ophthalmology. 1983; 90:1172–1177.
10.1016/S0161-6420(83)34410-9 Crossref Medline, Google Scholar - 14.Pratt-Johnson JA, Barlow JM, Tilson G. Early surgery in intermittent exotropia. Am J Ophthalmol. 1977; 84:689–694. Crossref Medline, Google Scholar
- 15.Ruttum MS. Initial versus subsequent postoperative motor alignment in intermittent exotropia. J AAPOS. 1997; 1:88–91.
10.1016/S1091-8531(97)90004-5 Crossref Medline, Google Scholar - 16.Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99:1814–1818.
10.1001/archopht.1981.03930020688013 Crossref Medline, Google Scholar - 17.Jampolsky A. Treatment of exodeviations. Trans New Orleans Acad Ophthalmol. 1986; 34:201–234. Medline, Google Scholar
- 18.Hiles DA, Davies GT, Constenbader FD. Long-term observations on unoperated exotropia. Arch Ophthalmol. 1968; 80:136–142.
10.1001/archopht.1968.00980050438006 Crossref, Google Scholar - 19.Parks MM. Comitant exodeviations in children. In: Strabismus: Symposium of the New Orleans Academy of Ophthalmology.St. Louis: CV Mosby; 1962;31–55. Google Scholar
- 20.Moore S. The prognostic value of lateral gaze measurements in intermittent exotropia. Am Orthopt J. 1969; 19:69–71. Crossref Medline, Google Scholar

