Journal List > J Korean Ophthalmol Soc > v.50(7) > 1008316

Cho, Lee, and Lee: The Effect of Medial Rectus Resection in Reccurent Exotropia After Lateral Rectus Recession

Abstract

Purpose

To investigate the effect of unilateral medial rectus resection in recurrent exotropia under 25 Prism Diopter after unilateral or bilateral lateral rectus recession.

Methods

A retrospective chart analysis was conducted for 21 patients who underwent unilateral medial rectus resection for recurrent exotropia under 25PD and uni- or bilateral lateral rectus recession for prior surgery of exotropia. The medial rectus was resected from 5.0 to 7.0 mm by 0.5 mm according to angle deviation at a distance. The postoperative deviated angle was checked at one week, three months and six months postoperatively to investigate the amount of corrected deviation per resected muscle.

Results

The average preoperative deviation was 20.57±3.37PD. We resected mean 6.1±0.62 mm of the medial rectus. At one week after the surgery, the postoperative deviated angle was 2.00±4.32PD, After six months it was 6.57±7.40PD, and there appeared to be an increase of deviation. Ten patients (48%) fused before surgery and 12 (57%) after surgery. The corrected deviation per resected muscle was 2.88±1.08PD.

Conclusions

Unilateral medial rectus resection is an effective surgical method for the treatment of recurrent exotropia under 25 PD after lateral rectus recession.

References

1. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99:1814–8.
crossref
2. Hahm KH, Shin MC, Sohn MA. The change in deviation angle with time cource after surgical correction of intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:2214–9.
3. Olitsky SE, Kelly C, Lee H, Nelson LB. Unilateral rectus resection in the treatment of undercorrected or recurrent strabismus. J Pediatr Ophthalmol Strabismus. 2001; 38:349–53.
crossref
4. Kim J-Y, Chang BL. The Effect of unilateral rectus recession in recurrent exotropia. J Korean Ophthalmol Soc. 1995; 36:2261–5.
5. Kim SC, Kim MM. The efficacy of unilateral rectus resection in reoperation of strabismus. Korean J Ophthalmol. 2003; 44:904–10.
6. Chae SH, Chun BY, Kwon J-Y. The effect of unilateral medial rectus resection in patients with recurrent exotropia. Korean J Ophthalmol. 2008; 22:174–7.
7. Chun K, Rah S. The comparison of outcomes between lateral rectus muscle re-recession and medial rectus muscles resection in recurrent exotropia. Korean J Ophthalmol. 2008; 22:111–4.
8. Grin TR, Nelson LB. Large unilateral medial rectus muscle recession for the treatment of esotropia. Br J Ophthalmol. 1987; 71:377–9.
9. Olitsky SE. Early and late postoperative alignment following unilateral lateral rectus recession for intermittent exotropia. J Pediatr Ophthalmol Strabismus. 1998; 35:146–8.
crossref
10. Chang BL. Operative results in exotropia. J Korean Ophthalmol Soc. 1983; 24:729–34.
11. Lee J-Y, Choi DG. The clinical analysis of recurrence after surgical correction of intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:2220–6.
12. Jampolsky A. Treatment of exodeviations. Trans New Orleans acad Ophthalmol. 1986; 201–34.
13. Stoller SH, Simon JW, Lininger LL. Bilateral lateral rectus recession for exotropia. A survival analysis. J Pediatr Ophthalmol Strabismus. 1994; 31:89–92.
crossref
14. Ryu JW, Lee SY, Lee YC. Result analysis according to surgical amount after unilateral lateral rectus recession in patients with exodeviation under 25PD. J Korean Ophthalmol Soc. 2006; 47:593–9.

Table 1.
Age and sex distribution at the first and second operation
Age (yrs) Number of patients (1st op) Number of patients (2nd op)
0–3 6 0
4–6 8 4
7–9 3 10
more than 10 4 7
Mean age (yrs) 6.02±3.42 9.59±4.11
Table 2.
Sensory status of Worth 4 Dot at near
Response to W4D at Near
Fusion Diplopia Suppression
Post 1 st Op (N*=15)(at POD 3 months) 8 (53%) 2 (13%) 5 (33%)
Pre 2 nd Op (N*=21) 10 (48%) 0 (0%) 11 (52%)
Post 2 nd Op (N*=21)(at POD 6 months) 12 (57%) 0 (0%) 9 (43%)

* N=number of patient

POD=post operative date.

Table 3.
Pre- and postoperative angle deviation at the first and second operation and the amount of rectus muscle recession or resection
CASE Primary deviated angle PD (Δ) 1 st OP: unilateral LR or BLR rec. (mm) Pre-2 nd OP deviated angle PD (Δ) 2 nd OP: Unilateral MR res. (mm) POD 7 days deviated angle PD (Δ) POD 6 months deviated angle PD (Δ)
1 25 5.5 16 5.0 0 10
2 25 5.5 16 5.0 0 0
3 20 8.0* 18 5.5 0 8
4 25 9.0* 18 5.5 0 0
5 30 6.8 18 6.0 −8 0
6 35 7.0 20 7.0 −3 0
7 25 5.5 20 6.0 10 10
8 35 7.25 20 6.0 0 0
9 30 6.35 20 6.5 6 8
10 35 7.0 20 5.5 6 8
11 30 6.0 20 5.5 10 14
12 20 8.0* 20 6.5 0 8
13 50 8.5 20 5.5 0 10
14 25 6.0 20 6.5 0 10
15 45 8.5 20 6.5 0 8
16 25 9.0* 25 6.5 10 14
17 30 7.5 25 6.5 7 10
18 30 6.35 25 6.5 0 0
19 30 7.0 25 6.0 4 10
20 40 7.5 25 7.0 0 6
21 30 6.5 25 7.0 0 8
Mean 28.33±10.62 6.25±1.33 20.57±3.37 6.1±0.62 2.00±4.32 6.57±7.40

-Esodeviation

* One muscle recession case.

Table 4.
Corrected prism diopter per resected medial rectus according to deviated angle
Angle deviation (XT Δ*) Number of patient Amount of MR res. (mm) Corrected PD at POD 6 months/ MR res.(Δ*/mm± SD)
16∼18 5 5.40±0.42 2.34±0.95
20 10 6.15±0.53 3.16±0.61
25 6 6.58±0.38 2.84±1.67
20.57±3.37 21 6.1±0.62 2.88±1.08

* Δ=prism diopter.

Table 5.
Amount of MR resection according to angle deviation and postoperative deviations
Amount of resection (mm) 2 nd Pre Op Exodeviation (PD*) N 2 nd Post operative deviation (PD*)
POD 7 days POD 3 months POD 6 months
5.0 16–18 2 0.00 0.00 5.00±7.07
5.5 16–18 2 1.50±2.12 4.00±5.66 4.00±5.66
20 3 5.33±5.03 6.00±5.29 12.00±2.83
6.0 16–18 1 −8.00 0.00 2.00
20 2 0.00 0.00 12.50±1.00
25 1 4.00 8.00 10.00
6.5 20 4 1.50±3.00 1.50±3.00 8.50±1.00
25 3 5.67±5.13 6.67±5.77 11.33±10.26
7.0 20 1 −3.00 0.00 0.00
25 2 0.00 5.00±4.24 7.00±1.41

* PD=prism diopter

N=number of patients

POD=postoperative date.

TOOLS
Similar articles