The Clinical Course of Recurrent Intermittent Exotropia After Previous Unilateral Recess-Resection Surgery

Won Jae Kim; Myung Mi Kim

doi:10.3341/jkos.2009.50.9.1386

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Kim and Kim: The Clinical Course of Recurrent Intermittent Exotropia After Previous Unilateral Recess-Resection Surgery

Original Article

J Korean Ophthalmol Soc 2009;50(9):1386-1391.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1386

The Clinical Course of Recurrent Intermittent Exotropia After Previous Unilateral Recess-Resection Surgery

Won Jae Kim, MD, Myung Mi Kim, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Myung Mi Kim, MD, PhD Department of Ophthalmology, Yeungnam University College of Medicine #317-1 Daemyung-dong, Nam-gu, Daegu 705-717, Korea Tel: 82-53-620-3441, Fax: 82-53-626-5936, E-mail: mmk@med.yu.ac.kr

Received 17 January 2009 Accepted 2 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical course of recess-resection (R & R) on the contralateral eye for recurrent intermittent exotropia after previous unilateral R & R surgery.

Methods

A retrospective analysis was conducted on patients who had unilateral R & R surgery and patients who had a second R & R surgery on the contralateral eye for recurrent intermittent exotropia with at least 12 months of postoperative followup.

Results

Our study included 490 patients with unilateral R & R and 119 patients with contralateral R & R. Recurrence was defined as an ocular misalignment of greater than 11PD during followup. Cumulative probabilities of surgical success rates were 42.7% and 66.4%, respectively (p=0.000).

Conclusions

Exotropia reappeared in recurrent intermittent exotropia after contralateral R & R. However, when considering a long-term prognosis, the cumulative probabilities of surgical success were significantly higher in the second surgery.

Keywords: Recess-resection, Recurrent intermittent exotropia, Survival curve

References

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Figure 1.

Kaplan-Meier survival curve showing the cumulative probability of surgical success following primary R&R group and repeat R&R group. There were greater probabilities of success in repeat R&R group than in primary R&R group (p=0.000, log rank test).

Figure 2.

Comparison of cumulative probability of surgical success between group 1, group 2, group 3, and repeat R & R group (p=0.000, log rank test).

Table 1.

Characteristics of patients

	Primary R&R^∗ group	Repeat R&R group	p-value
No. of patient	490	119	-
Sex (male : female)	223:267	46:73	0.177^†
Mean age (years, mean± SD)	8.87±6.15 (4∼27)	8.40±3.43 (6∼27)	0.265^‡
Preoperative deviation (PD^§, mean± SD)	32.56±6.3	27.71±3.78	0.000^‡
Postoperative deviation at 1 week (PD, mean± SD)	0.4±4.7	-0.4±5.4	0.115^†

^∗ R&R=unilateral lateral rectus recession and medial rectus resection;

^† Chai-square test;

^‡ Unpaired t-test;

^§ PD=prism diopters.

Table 2.

Comparisons of cumulative probability of surgical success rate between primary R&R group and repeat R&R group

Postoperative followup period	No. of patients (success rate, %)
Postoperative followup period	Primary R&R^∗ group	Repeat R&R group
1 wk	487/490 (99.4)	119/119 (100)
1 mo	464/490 (94.7)	117/119 (98.3)
3 mo	411/490 (83.9)	112/119 (94.1)
6 mo	354/490 (72.7)	103/119 (86.6)
12 mo	284/490 (58.0)	93/119 (78.2)
Final followup	209/490 (42.7)	79/119 (66.4)

^∗ R&R=unilateral lateral rectus recession and medial rectus resection.

Table 3.

Characteristic of patient according to preoperative deviation in primary R&R group

	Group 1	Group 2	Group 3
	≤ 30PD^∗	31∼40PD	≥41PD
No. of patient	286	172	32
Mean preoperative deviation (PD)	28.40±2.37	36.44±2.54	48.90±4.54

^∗ PD=prism diopters.

Table 4.

Statistical correlation in primary and repeat R&R group

Factors	Primary R&R^∗ group		Repeat R&R group
Factors	p-value	Odds ratio	p-value	Odds ratio
Sex	0.619	1.103	0.817	0.900
Age	0.000	0.900	0.175	0.887
Preoperative deviation	0.138	0.974	0.730	0.980
Deviation at postoperation 1 wk	0.001	1.126	0.007	1.249
Overcorrection at postoperation 1 wk	0.403	0.749	0.756	0.791

Logistic regression analysis.

^∗ R&R=unilateral lateral rectus recession and medial rectus resection.

Table 5.

Clinical studies on surgical outcomes of unilateral recess-resection and bilateral lateral rectus recession in intermittent exotropia

	Total No. of patient	Type of surgery & No. of patient	Mean F/U^∗(mo)	Definition of success	Results (success rate, %)
Mun and Kim (2002)¹³	364 (376 cases)	R&R^† 174 (186 cases)	27.3	-5∼10 XT	64.5
		BLR^‡ 190			75.3
Im et al (2004)¹⁴	65	R&R 24	16.6	-10∼10 XT	62.5
		BLR 41			58.5
Lee et al (2004)¹⁵	49	R&R 17	14.8	-8∼10 XT	70.6
		BLR 32	18.5		68.8
Jeong et al (2006)¹⁶	98	R&R 98	12.5	-5∼10 XT	60
Chia et al (2006)²	118	R&R 54	12	0∼10 XT	74.2
		BLR 64			42.2
Fiorelli et al (2007)⁴	115	R&R 66	14.6±2.0	-10∼10 XT	69
		BLR 49	15.1±2.5		77
Kim and Kim (This study)	609	Primary R&R 490	16.1±13.3	-5∼10 XT	42.7
		Repeat R&R 119	19.9±16.2		66.4

^∗ F/U=followup;

^† R&R=unilateral lateral rectus recession and medial rectus resection;

^‡ BLR=bilateral lateral rectus recession.

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