Clinical Course of Patients with Consecutive Esotropia Angle Larger Than Preoperative Angle After Exotropia Surgery

Kyeong Jin Woo; Mi Young Choi

doi:10.3341/jkos.2008.49.10.1641

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

Original Article

J Korean Ophthalmol Soc 2008;49(10):1641-1648.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.10.1641

Clinical Course of Patients with Consecutive Esotropia Angle Larger Than Preoperative Angle After Exotropia Surgery

Kyeong Jin Woo, M.D^1,², Mi Young Choi, M.D^1,^2,

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, E-mail: mychoi@chungbuk.ac.kr

Received 24 June 2008 Accepted 17 October 2007

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 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

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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.

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.

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.

Table 1.

Preoperatvie characteristics

No. A	Age (yr)/Sex	XT* (PD^†)	) Associated strabismus	Amount of lateral incomitancy (PD)	Oth	SE^‡	Type of surgery
No. A	Age (yr)/Sex	Far/Near	) Associated strabismus	Amount of lateral incomitancy (PD)	Oth	Right/Left	Type of surgery
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 ^‡
	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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