The Effect of Medial Rectus Resection in Reccurent Exotropia After Lateral Rectus Recession

Won Kyung Cho; Se Yup Lee; Young Chun Lee

doi:10.3341/jkos.2009.50.7.1093

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Original Article

J Korean Ophthalmol Soc 2009;50(7):1093-1097.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.1093

The Effect of Medial Rectus Resection in Reccurent Exotropia After Lateral Rectus Recession

Won Kyung Cho, MD¹, Se Yup Lee, MD², Young Chun Lee, MD¹

¹Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea

²Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Young Chun Lee, MD Department of Ophthalmology, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea #65-1 Keumo-dong, Uijeongbu 480-717, Korea Tel: 82-31-820-3116, Fax: 82-31-847-3418, E-mail: yclee@cmcnu.or.kr

Received 10 November 2008 Accepted 6 May 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 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.

Keywords: Lateral rectus recession, Recurrent exotropia, Unilateral medial rectus resection

References

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

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.

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.

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.

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 (1^st op)	Number of patients (2^nd 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^*)
Amount of resection (mm)	2 ^nd Pre Op Exodeviation (PD^*)	N^†	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