Journal List > J Korean Ophthalmol Soc > v.49(11) > 1008136

Kyeong and Mi: Clinical Course of Patients With Delayed Consecutive Esotropia After Exotropia Surgery

Abstract

Purpose

To report the characteristics and therapeutic results of patients with delayed consecutive esotropia after undergoing surgery for exotropia.

Methods

Ten patients with delayed consecutive esotropia of more than 10 prism diopters (PD) after orthotropia was obtained postoperatively were included in this study. The authors investigated the clinical characteristics, the deviated angle at postoperative day one, the duration between surgery and orthotropia, the duration between surgery and delayed esotropia, the angle of esotropia, and the result of treatment in delayed consecutive esotropia.

Results

The average of the preoperative angle of exodeviation was 30PD at distance and 31PD at near. The patients underwent surgery for exotropia at a mean age of 5.3 years, and one day postoperatively, the angle of esodeviation was 12PD at distance and 10PD at near. All 10 patients demonstrated orthotropia at 0.9 months after surgery. However, esotropia of 21PD occurred 4 months after surgery for all patients. Six of the 10 patients demonstrated orthotropia or 10PD or less at the last visit after patching therapy or fitting for Fresnel prism glasses. The remaining four patients did not improve or showed aggravated esotropia with a doubled-angle of esotropia.

Conclusions

In patients with orthotropia after exotropia surgery, delayed consecutive esotropia can occur, and the prognosis of non-surgical treatment is relatively poor.

References

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Table 1.
Preoperative characteristics
No Age (yr)/Sex XT* (PD) Far/Near Lateral incomitancy, PD (%) Other disease SE Strabismus
Right/Left surgery
1 3.3/M 35/35 0 (0) 1.75/1.5 BLR§
2 6.3/F 20/25 0 (0) -3.00/-3.25 BLR
3 6.9/F 25/30 0 (0) Amblyopia -2.00/-3.50 BLR
4 6.5/F 35/35 5 (14) 0.75/0.75 BLR
5 7.5/M 35/35 5 (14) -0.50/-0.75 R&R
6 5.1/F 35/38 5 (14) 0.75/0.75 BLR
7 5.1/M 35/35 7.5 (21) Hyper# (6PD) 0/0 R&R
8 3.9/F 25/25 0 (0) 0/0 BLR
9 4.5/F 25/25 0 (0) 0/1 BLR
10 3.6/F 25/25 0 (0) Amblyopia 0.25/-0.25 BLR

* Exotropia

Prism diopters

Spherical equivalent

§ Bilateral rectus recession

Π Lateral rectus recession and medial rectus

# Hypertropia.

Table 2.
Clinical course and therapeutic results in the patients with delayed consecutive esotropia
No. Duration (mo) Degree of FP§ at treatment (PD) Angle of esodeviation# (PD) Follow-up (mo)
Op* ~ ortho Op ~ ET At diagnosis At final visit
1 0.5 2.5 15 20 0 53.4
2 1.25 2.5 15 30 30 15.4
3 0.75 2.0 20 20 4 37.1
4 0.5 3.0 24 30 6 32.6
5 1.0 6.0 12.5 15 25.2
6 1.5 3.0 30 55 6.0
7 1.0 2.25 25 4 8.4
8 0 12.0 10 12 8 20.2
9 1.0 4.0 15 4 13.7
10 1.3 3.0 15 15 45 6.0

* Operation for exotropia

Orthotropia

Delayed esotropia

§ Fresnel prism

Π Prism diopters

# Angle of delayed esodeviation.

Table 3.
Comparison between preoperative binocularity and postoperative binocularity in patients with delayed consecutive esotropia
No. Fusion Before surgery After surgery Stereopsis (seconds of arc) Before surgery After surgery
Before surgery After surgery Before surgery After surgery
1 NA* Far 200 50
2 Near Near 80 100
3 Far None 50 140
4 Far None 80 40
5 Near None 40 60
6 Near None Fly (+) None
7 Far Near Fly (+) 80
8 NA Near NA 140
9 Near Near Fly (+) 40
10 Far None None None

* Not available.

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