Journal List > J Korean Ophthalmol Soc > v.49(10) > 1008107

Jin Woo and Young Choi: Clinical Course of Patients with Consecutive Esotropia Angle Larger Than Preoperative Angle After Exotropia Surgery

Abstract

Purpose

To report the clinical course of severe consecutive esotropia (ET) with an esotropic angle at postoperative day 1 larger than the preoperative exotropia angle (XT).

Methods

Patients with ET angles at postoperative 1 day greater than their preoperative XT angles were included; the case of lost lateral rectus during surgery was excluded. Preoperative clinical characteristics and the course of postoperative alignment were analyzed, and binocularity was compared between the preoperative state and the postoperative state.

Results

The mean preoperative angle of XT of 13 patients was 23 prism diopters (PD) at distance and 27PD at near. Lateral incomitancy was observed in 9 patients. One day postoperatively, the mean angle of ET was 27PD at distance and 25PD at near, and alternate occlusion therapy was performed in all patients. However, the angle of ET was decreased 10PD or less in only 3 patients. All 13 patients were managed with Fresnel prisms, and 4 patients had orthotropia. Another 4 patients used glass prisms because they had ET of 8PD or less, and the remaining 5 patients still showed an ET with 12PD or more. Binocularity after surgery was worse than that before surgery in 64% of patients.

Conclusions

For patients with ET angles at postoperative 1 day greater than preoperative XT angles, the frequency of lateral incomitancy was high. Alternate occlusion and Fresnel prism treatment were needed in all patients. Recovery from orthotropia and the prognosis of binocularity were relatively poor.

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Figure 1.
This diagram shows treatment process and their result in the severe consecutive esotropia after surgery for intermittent exotropia.* Orthotropia without Fresnel prism.
jkos-49-1641f1.tif
Figure 2.
Change of the angle of deviation during the follow-up after surgery for intermittent exotropia. (A) Orthotropia without treatment at the last follow-up. (B) Consecutive esotropia ≤10PD at the last follow-up. (C) Consecutive esotropia > 10PD at the last follow-up.* Prism diopters; Preoperation; Day; § Month; п Year.
jkos-49-1641f2.tif
Figure 3.
Comparison of stereopsis (A) and fusion (B) in between preoperation and postoperation.* Seconds of arc; Gross stereopsis; No stereopsis; § Fusion at far and near; Fusion at near; # No fusion.
jkos-49-1641f3.tif
Table 1.
Preoperatvie characteristics
No. A Age (yr)/Sex XT* (PD)
) Associated strabismus Amount of lateral incomitancy (PD) Oth SE
Type of surgery
Far/Near Right/Left
1 8.3/M 25/25 Hyper§ (10PD) 5 Amblyopia, Congenital cataract -0.5/-2 R&R
2 12.0/F 20/25 0 -2.25/-3 BLR#
3 7.5/F 20/28 5 -1/-1 R&R
4 9.5/F 30/40 10 -4/-4 R&R
5 9.0/M 15/23 0 -0.75/-1 R&R
6 5.0/F 25/30 5 1/0.5 R&R
7 14.0/M 30/30 Hyper (10PD) 10 -3/-2.25 R&R
8 8.7/F 25/30 5 -2.75/-2.75 BLR
9 6.3/F 25/28 IOOA** 5 0.25/0.25 BLR, Inferior oblique myectomy
10 9.7/M 25/25 Hyper (4PD) 5 -1.25/-1.75 R&R
11 6.3/F 20/25 0 -3.25/-3 BLR
12 8.0/F 15/20 3 -3/-3 ULR††
13 6.0/F 25/25 Hyper (10PD) 0 Amblyopia, Macular toxoplasmosis 0/0 R&R

* Exotropia

Prism diopters

Spherical equivalent

§ Hypertropia

Unilateral rectus recession and medial rectus resection

# Bilateral rectus recession

** Inferior oblique overaction

†† Unilateral lateral rectus recession.

Table 2.
Duration and types of treatment in the patients with consecutive esotropia
No. A Duration of treatment (mo)
Amount of FP A Angle of esodeviation at Type of surgery
Alternate occlusion FP* (PD) last visit (PD)
1 1.8 24.8 20 0
2 2.0 17.0 8 0
3 3.9 3.7 20 0
4 2.0 11.0 6 0
5 1.8 0.2 8 8
6 3.1 2.6 8 8
7 2.3 7.9 10 8
8 2.2 14.8 8 4
9 3.9 3.0 12 12
10 1.2 11.0 16 20
11 1.4 14.0 12 30
12 5.5 50.4 20 30 MR rec§
13 1.0 10.9 24 30 LR adv§

* Fresnel prism

Prism diopters

Surgery for consecutive esotropia

§ Unilateral medial rectus recession

Unilateral lateral rectus advancement

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