Postoperative Exotropic Drift: Comparison of Surgical Methods Combined with Lateral Rectus Muscle Recession in Exotropia

Jin Woo Kim; Jong Hyuck Lee; Sang Hoon Rah

doi:10.3341/jkos.2011.52.11.1326

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Kim, Lee, and Rah: Postoperative Exotropic Drift: Comparison of Surgical Methods Combined with Lateral Rectus Muscle Recession in Exotropia

Original Article

J Korean Ophthalmol Soc 2011;52(11):1326-1330.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.11.1326

Postoperative Exotropic Drift: Comparison of Surgical Methods Combined with Lateral Rectus Muscle Recession in Exotropia

Jin Woo Kim, MD, Jong Hyuck Lee, MD, Sang Hoon Rah, MD

Department of Ophthalmology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea

Address reprint requests to Sang Hoon Rah, MD Department of Ophthalmology, Wonju Christian Hospital #62 IIsan-dong, Wonju 220-701, Korea Tel: 82-33-741-0631, Fax: 82-33-741-1144, E-mail: shrah@wonju.yonsei.ac.kr

Received 16 September 2010 Revised 9 May 2011 Accepted 22 September 2011

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 assess the difference in the change of postoperative ocular alignment in intermittent exotropia corrected by horizontal muscle transposition or inferior oblique muscle recession together with lateral rectus muscle recession.

Methods

A total of 110 patients with intermittent exotropia with a follow-up period of more than 6 months after lateral rectus muscle recession were enrolled in the present study. The patients who received lateral rectus muscle recession only were classified as group 1, patients who received both lateral rectus muscle recession and horizontal muscle vertical transposition in both eyes were classified as group 2, and patients who underwent lateral rectus muscle and inferior oblique muscle recession were classified as group 3. The differences in postoperative ocular alignment among the patient groups were compared.

Results

Among the 3 groups, group 2 demonstrated the smallest amount of esotropic deviation in mean postoperative ocular alignment measured 1 day and 1 month after surgery. There was no significant difference among the groups in the mean postoperative ocular alignment and mean amount of exotropic drift at 6 months. The difference in the amount of postoperative exotropic drift 1 year after surgery among the 3 groups was statistically significant. The largest amount of postoperative exotropic drift was observed in group 1.

Conclusions

In correcting intermittent exotropia, the largest amount of postoperative exotropic drift was observed in patients who received only lateral rectus muscle recession. By contrast, the smallest amount of postoperative exotropic drift was observed in patients who received lateral rectus muscle recession with vertical transposition of the horizontal muscle. J Korean Ophthalmol Soc 2011;52(11):1326–1330

Keywords: Intermittent exotropia, Lateral rectus muscle recession, Postoperative exotropic drift

References

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Table 1.

Characteristics of study participants (mean ± SD)

	Group 1 (N^* = 56)	Group 2(N = 24)	Group 3(N = 30)	p-value
Age (yr)	6.0 ± 1.81	7.0 ± 1.50	6.6 ± 2.29	0.320^‡
Sex (M/F)	26/30	4/20	16/14	0.015^§
Preoperative ocular alignment (PD^†)	23.6 ± 6.01	22.5 ± 4.74	25.3 ± 4.51	0.244^‡

^* N = number

^† PD = prism diopters

^‡ p-values were obtained by Kruskal-Wallis test

^§ or by Chi-square test.

Table 2.

Postoperative ocular alignment (mean ± SD)

	Immediate PostOp^* (PD^†)	PostOp 1 month (PD)	PostOp 6 months (PD)	PostOp 1 year (PD)
Group1 (N^‡ = 35)	−12.4 ± 5.69	−0.9 ± 5.96	2.7 ± 5.89	3.4 ± 7.22
Group2 (N = 20)	−8.9 ± 7.16	2.2 ± 5.56	2.2 ± 4.6	2.3 ± 4.73
Group3 (N = 16)	−12.5 ± 6.75	−2.9 ± 5.31	0.4 ± 3.65	1.4 ± 4.71
Total (N = 71)	−11.7 ± 6.42	−0.8 ± 5.99	2.0 ± 2.01	2.6 ± 6.07
p-value^§	0.044	0.03	0.098	0.754

Postoperative 1 year data excludes patients who were observed less than 1 year after surgery.

^* PostOP = postoperative

^† PD = prism diopters

^‡ N = number

^§ p-value by Kruskal-Wallis test.

Table 3.

Postoperative exotropic drift amount (mean ± SD)

	PostOp^* 6 months (PD^†)	PostOp 1 year (PD)
Group 1	15.1 ± 6.27 (15.4 ± 6.39)	16.4 ± 6.62
Group 2	11.1 ± 6.93 (9.9 ± 6.38)	10.2 ± 6.40
Group 3	12.8 ± 6.97 (11.8 ± 6.61)	12.9 ± 5.55
Total	13.6 ± 6.74 (13.0 ± 6.81)	13.9 ± 6.97
p-value^‡	0.057 (0.008)	0.004

Data within the parentheses demonstrate postoperative 6-month results of the patients who were observed for 1 year.

^* PostOp = postoperative

^† PD = prism diopters

^‡ p-value by Kruskal-Wallis test.

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