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

J Korean Ophthalmol Soc. 2008 Oct;49(10):1641-1648. Korean.
Published online October 30, 2008.  https://doi.org/10.3341/jkos.2008.49.10.1641
Copyright © 2008 The Korean Ophthalmological Society
Clinical Course of Patients with Consecutive Esotropia Angle Larger Than Preoperative Angle After Exotropia Surgery
Jin Woo Kyeong, M.D. and Mi Young Choi, M.D.
Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea.
Chungbuk National University Medical Research Institute, Cheongju, Korea.

Address reprint requests to Mi Young Choi, M.D. Department of Ophthalmology, College of Medicine, Chungbuk National University Hospital #410 Sung Bong-ro, Heungduk-gu, Cheongju 361-711, Korea. Tel: 82-43-269-6335, Fax: 82-43-264-5263, Email: mychoi@chungbuk.ac.kr
Received October 17, 2007; Accepted June 24, 2008.

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.

Keywords: Binocularity; Consecutive esotropia; Exotropia

Figures


Figure 1
This diagram shows treatment process and their result in the severe consecutive esotropia after surgery for intermittent exotropia.

*Orthotropia without Fresnel prism.

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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; Year.

Click for larger image


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.

Click for larger image

Tables


Table 1
Preoperatvie characteristics
Click for larger image


Table 2
Duration and types of treatment in the patients with consecutive esotropia
Click for larger image

References
1. Richard JM, Parks MM. Intermittent exotropia. Surgical results in different age groups. Ophthalmology 1983;90:1172–1177.
2. Ruttum MS. Initial versus subsequent postoperative motor alignment in intermittent exotropia. J AAPOS 1997;1:88–91.
3. McNeer KW. Observations on the surgical overcorrection of childhood intermittent exotropia. Am Orthopt J 1987;37:135–150.
4. Weston B, Enzenauer RW, Kraft SP, Gayowsky GR. Stability of the postoperative alignment in adjustable-suture strabismus surgery. J Pediatr Ophthalmol Strabismus 1991;28:206–211.
5. Hur J, Won IG. Surgical results of 79 cases of intermittent exotropia in children. J Korean Ophthalmol Soc 1990;31:114–119.
6. Ko KH, Min BM. Factors related to surgical results of intermittent exotropia. J Korean Ophthalmol Soc 1996;37:179–184.
7. Wright KW. Practical aspects of the adjustable suture technique for strabismus surgery. Int Ophthalmol Clin 1989;29:10–15.
8. Souza-Dias C, Uesugui CF. Postoperative evolution of the planned initial overcorrection in intermittent exotropia: 61 cases. Binocul Vis Eye Muscle Surg Q 1993;8:141–148.
9. Choi MY. Surgical results in basic exotropia of moderate degree. J Korean Ophthalmol Soc 2000;41:764–770.
10. Pratt-Johnson JA, Barlow JM, Tillson G. Early surgery in intermittent exotropia. Am J Ophthalmol 1977;84:689–694.
11. McDonald RJ. Secondary esotropia. Am Orthopt J 1970;20:91–95.
12. Moore S. The prognostic value of lateral gaze measurement in intermittent exotropia. Am Orthopt J 1969;19:69–71.
13. Son AN, Park SC, Lee WR. Clinical study of consecutive esotropia. J Korean Ophthalmol Soc 1990;31:1328–1334.
14. Jampolsky A. Surgical correction of overcorrections in strabismus. Am Orthopt J 1976;26:14–19.
15. Beneish R, Flanders M. The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol 1994;29:119–124.
16. Paik HJ, Cho YA. Recession of the lateral recti in intermittent exotropia evaluation of the amount of immediate postoperative deviation. J Korean Ophthalmol Soc 1990;31:1445–1450.
17. Park YH, Kim MM. Surgical results of intermittent exotropia. J Korean Ophthalmol soc 1989;30:969–974.
18. Raab EL, Parks MM. Recession of the lateral recti. Early and late postoperative alignments. Arch Ophthalmol 1969;82:203–208.
19. Kim JH, Hwang JM. Initial overcorrection of 20 Δ or more after surgery of exotropoia. J Korean Ophthalmol Soc 2003;44:121–127.
20. Kim HS, Suh YW, Kim SH, Cho YA. Consecutive esotropia in intermittent esotropia patients with immediate postoperative overcorrection more than 17 prism diopters. Korean J Ophthalmol 2007;21:155–158.
21. Wright KW. In: Color atlas of ophthalmic surgery: strabismus. Philadelphia: Lippincott; 1991. pp. 241-243.
22. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol 1981;99:1814–1818.
23. Clarke WN, Noel LP. Surgical results in intermittent exotropia. Can J Ophthalmol 1981;16:66–69.
24. Lee SY, Lee YC. Relationship between motor alignment at postoperative day 1 and at year 1 after symmetric and asymmetric surgery in intermittent exotropia. Jpn J Ophthalmol 2001;45:167–171.
25. Lew H, Lee JB, Han SH, Park HS. Clinical evaluation on the consecutive esotropia after exotropia surgery. J Korean Ophthalmol Soc 1999;40:3482–3490.
26. Park HS, Kim JB, Seo MS, et al. A study on the consecutive esotropia after intermittent exotropia surgery. J Korean Ophthalmol soc 1994;35:191–198.
27. Edelman PM, Brown MH. The stability of surgical results in patients with deep amblyopia. Am Orthopt J 1977;27:103–106.
28. von Noorden GK, Campos EC. In: Binocular vision and ocular motility. 6th ed. St. Louis: Mosby; 2002. pp. 345-347.
29. Keech RV, Stewart SA. The surgical overcorrection of intermittent exotropia. J Pediatr Ophthalmol Strabismus 1990;27:218–220.
30. Dunlap EA. In: Overcorrection in exotropia surgery. St. Louis: The C.V. Mosby Co; 1971. pp. 183.
31. Gill MK, Drummond GT. Indications and outcomes of strabismus repair in visually mature patients. Can J Ophthalmol 1997;32:436–440.
32. You IC, Yoon KC, Park YG. Assessment of esotropia more than 10PD after surgery of intermittent exotropia. J Korean Ophthalmol Soc 2003;44:2278–2284.
33. Lee JM, Shin SY. Recovery pattern of overcorrection after intermittent exotropia surgery. J Korean Ophthalmol Soc 2005;46:821–826.
34. Min BM, Lee SB. Consecutive esotropia following surgery for intermittent exotropia. J Korean Ophthalmol Soc 1999;40:3491–3496.
35. von Noorden GK. Esodeviation. In: von Noorden GK, editor. Binocular vision and ocular motility. 5th ed. St. Louis: Mosby; 1996.
chap. 14.
36. Elsas FJ. Consecutive esotropia. Am Orthopt J 1992;42:94–97.
37. Kim YH, Choi MY. The effect of Fresnel prism treatment in consecutive esotropia. J Korean Ophthalmol Soc 2006;47:1623–1629.
38. Smoot CN, Simon JW, Nelson LB. Binocularity following surgery for secondary esotropia in childhood. Br J Ophthalmol 1990;74:155–157.