Clinical Course of Patients With Delayed Consecutive Esotropia After Exotropia Surgery

Jin Woo Kyeong; Young Choi Mi

doi:10.3341/jkos.2008.49.11.1812

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

Original Article

J Korean Ophthalmol Soc 2008;49(11):1812-1818.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.11.1812

Clinical Course of Patients With Delayed Consecutive Esotropia After Exotropia Surgery

Jin Woo Kyeong, M.D., Young Choi Mi, 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 Sungbong-ro, Heungduk-gu, Cheongju 361-711, Korea Tel: 82-43-269-6335, Fax: 82-43-264-5263, E-mail: mychoi@chungbuk.ac.kr

Received 10 July 2008 Accepted 18 December 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 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.

Keywords: Consecutive esotropia, Exotropia, Fresnel prism, Patching

References

1. Clarke WN, Noel LP. Surgical results in intermittent exotropia. Can J Ophthalmol. 1981; 16:66–9.

2. Hardesty HH. Prisms in the management of intermittent exotropia. Am Orthopt J. 1972; 22:22–30.

3. Park HJ, Paik HJ. Comparison of surgical results between bilateral recession and unilateral resection-recession in intermittent exotropia. J Korean Ophthalmol Soc. 1999; 40:2604–10.

4. von Noorden GK. Binocular vision and ocular motility, 4th ed. St. Louis: Mosby;1990; 323–6.

5. Raab EL. Parks MM. Recession of the lateral recti. Early and late postoperative alignments. Arch Ophthalmol. 1969; 82:203–8.

6. Ko KH, Min BM. Factors related to surgical results between bilateral recession and unilateral recession-resection in 25PD intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:2202–7.

7. Choi DG, Kim PS. The surgical outcome of intermittent exotropia and the prognostic factors. J Korean Ophthalmol Soc. 1998; 39:1255–63.

8. Lee JY, Chi DG. The Clinical analysis of recurrence after surgical correction of intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:2220–6.

9. Hur J, Won IG. Surgical results of 79 cases of intermittent exotropia in children. J Korean Ophthalmol Soc. 1990; 31:114–9.

10. Kim MM, Cho ST. Long-term surgical results of intermittent exotropia. J Korean Ophthalmol Soc. 1994; 35:1321–6.

11. Kim HW, Yang JW, Won IG. Clinical study for risk factors of recurrence in intermittent exotropia. J Korean Ophthalmol Soc. 2000; 41:1417–24.

12. Kim HS, Suh YW, Kim SH, et al. Consecutive esotropia in intermittent exotropia patients with immediate postoperative overcorrection more than 17 prism diopters. Korean J Ophthalmol. 2007; 21:155–8.

13. Wright KW. Practical aspects of the adjustable suture technique for strabismus surgery. Int Ophthalmol Clin. 1989; 21:10–5.

14. Lee JR, Roh YB. The factors affecting consecutive exotropia with angle of 20 prism diopters or more following surgery for esotropia. J Korean Ophthalmol Soc. 1995; 36:1778–83.

15. Kim YH, Choi MY. Clinical analysis of reoperation for strabismus after strabismus surgery in childhood. J Korean Ophthalmol Soc. 2006; 47:954–9.

16. Yazawa K. Postoperative exotropia. J Pediatr Ophthalmol Strabismus. 1981; 18:58–64.

17. Spaeth EB. Factors related to postoperative exotropia. J Pediatr Ophthlalmol Strabismus. 1972; 9:47–51.

18. Son AN, Park SC, Lee WR. Clinical study of consecutive esotropia. J Korean Ophthalmol Soc. 1992; 31:1328–34.

19. Lew H, Lee JB, Han SH, Park HS. Clinical evaluation on the consecutive esotropia after exotropia surgery. J Korean Ophthalmol Soc. 1999; 12:3482–90.

20. Park HS, Kim JB, Seo MS, et al. A study on the consecutive esotropia after intermittent exotropia surgery. J Korean Ophthalmol Soc. 1990; 31:102–8.

21. Keech RV, Stewart SA. The surgical overcorrection of intermittent exotropia. J Pediatr Ophthalmol Strabismus. 1990; 27:218–20.

22. Richard JM, Parks MM. Intermittent exotropia surgical results in different age groups. Ophthalmology. 1983; 90:1172–7.

23. Dunlap EA. Overcorrection in exotropia surgery, In : symposium on horizontal ocular deviations. St. Louis: The C.V. Mosby Co.;1971; 183.

24. Moore S. The prognostic value of lateral gaze measurement in intermittent exotropia. Am Orthopt J. 1969; 19:69–71.

25. Jampolsky A. Surgical correction of overcorrections in strabismus. Am Orthopt J. 1976; 26:14–9.

26. Beneish R, Flanders M. The role of strabismus and early postoperative alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol. 1994; 29:119–24.

27. Gill MK, Drummond GT. Indications and outcomes of strabismus repair in visually mature patients. Can J Ophthalmol. 1997; 32:436–40.

28. Min BM, Lee SB. Consecutive esotropia following surgery for intermittent exotropia. J Korean Ophthalmol Soc. 1999; 40:3491–6.

29. You IC, Kyung CY, Park YG. Assessment of esotropia more than 10PD after surgery of intermittent exotropia. J Korean Ophthalmol Soc. 2003; 44:2278–84.

30. von Noorden GK. Esodeviation. von Noorden GK. Binocular vision and ocular motility, 5th ed. St. Louis: Mosby;1996; chap. 14.

31. Hardesty HH, Boynton JR, Keenan JP. Treatment of intermittent exotropia. Arch Ophthalmol. 1978; 96:268–74.

32. Kim YH, Choi MY. The effect of Fresnel prism treatment in consecutive esotropia. J Korean Ophthalmol Soc. 2006; 47:1623–9.

33. Scott WE, Keech R, March AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99:1814–8.

34. Veronneau-Troutman S. Fresnel prism membrane in the treatment of strabismus. Can J Ophthalmol. 1971; 6:249–57.

Table 1.

Preoperative characteristics

No	Age (yr)/Sex	XT^* (PD^†) Far/Near	Lateral incomitancy, PD (%)	Other disease	SE^‡	Strabismus
No	Age (yr)/Sex	XT^* (PD^†) Far/Near	Lateral incomitancy, PD (%)	Other disease	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)
No.	Op^* ~ ortho^†	Op ~ ET^‡	Degree of FP^§ at treatment (PD^∏)	At diagnosis	At final visit	Follow-up (mo)
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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