Treatment of Sub-V Pattern Intermittent Exotropia

Jung Hyun Lee; Jae Ho Jung; Hee Young Choi

doi:10.3341/jkos.2011.52.7.846

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Lee, Jung, and Choi: Treatment of Sub-V Pattern Intermittent Exotropia

Original Article

J Korean Ophthalmol Soc 2011;52(7):846-851.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.7.846

Treatment of Sub-V Pattern Intermittent Exotropia

Jung Hyun Lee, MD, Jae Ho Jung, MD, Hee Young Choi, MD, PhD

Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Hee Young Choi, MD, PhD Department of Ophthalmology, Pusan National University Hospital #1-10 Ami-dong, Seo-gu, Busan 602-739, Korea Tel: 82-51-240-7324, Fax: 82-51-242-7341, E-mail: hychoi@pusan.ac.kr

Received 23 March 2010 Revised 17 November 2010 Accepted 12 April 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 compare the surgical methods for the treatment of sub-V pattern intermittent exotropia.

Methods

Sub-V pattern intermittent exotropia is defined as 8–15 prism diopters (PD) less horizontal deviation in downgaze than in upgaze. The present study included 65 patients who underwent a standard recession procedure of the lateral rectus muscle (group I), oblique muscle surgery (group II) or vertical transposition of the horizontal rectus muscle (group III) and who were followed up for six months after the surgery.

Results

Surgical success was defined as vertical incomitance ≤5 PD; the success rate was 92% (23/25) in group I, 88.8% (16/18) in group II and 86.4% (19/22) in group III. Surgical success of the horizontal strabismus was defined as horizontal deviation ≤10 PD at primary position; the success rate was 87.9% (51/58) in the patients with vertical incomitance less than 5 PD, and 42.9% (3/7) in the patients with vertical incomitance greater than 6 PD. There was statistical significance in the success rate of horizontal strabismus according to the decrease in vertical incomitance (p=0.01).

Conclusions

There was no statistical significance of the difference in success rates of horizontal strabismus surgery regardless of vertical transposition of the horizontal rectus muscle or oblique muscle surgery. There was statistical significance in the difference in success rates of horizontal strabismus according to the reduction in vertical incomitance.

Keywords: Horizontal rectus surgery, Sub-V pattern intermittent exotropia, Vertical incomitance

References

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Table 1.

Preoperative characteristics of patients with sub-V pattern intermittent exotropia

	Group I	Group II	Group III
Number	25	18	22
Age (mean ± SD, yr)	7.9 ± 3.1	7.0 ± 2.6	6.9 ± 2.6
Sex (M:F, n)	13:12	9:9	9:13
Follow up period (mean ± SD, mon)	7.3 ± 3.9	7.6 ± 4.0	8.5 ± 4.3

Group I: Patients with horizontal muscle surgery. Group II: Patients with horizontal muscle and inferior oblique muscle surgery. Group III: Patients with horizontal muscle surgery with vertical transposition.

Table 2.

Preoperative angle of patients with sub-V pattern intermittent exotropia

Preoperative angle of strabismus	Group I	Group II	Group III
Primary position (mean ± SD, prism diopter)	31.0 ± 8.0	27.0 ± 8.9	25.0 ± 5.2
p-value (vs Group I)		0.15^*	0.08^*
Vertical incomitance (mean ± SD, prism diopter)	10.0 ± 3.8	11.0 ± 4.1	10.3 ± 3.9
p-value (vs Group I)		0.26^*	0.74^*

^* Student's t-test.

Table 3.

Comparison of surgical success of vertical incomitance and horizontal deviation

Group		Group I	Group II	Group III	p-value
Vertical incomitance	Success	23	16	19	2.47^*
	Fail	2	2	3
	Total	25	18	22
Horizontal deviation	Success	21	15	18	2.93^*
	Fail	4	3	4
	Total	25	18	22

Group I: Patients with horizontal muscle surgery. Group II: Patients with horizontal muscle and oblique surgery. Group III: Patients with horizontal muscle surgery and vertical transposition. Success: defined as vertical incomitance ≤5 prism diopters. Success: defined as horizontal deviation ≤10 prism diopters.

^* Chi-square test with Bonferoni.

Table 4.

Relative relationship between postoperative vertical incomitance and success of horizontal strabismus

	Vertical incomitance ≤5 PD	Vertical incomitance >6 PD	p-value
Success	51	3	0.01^*
Failure	7	4
Total	58	7

Success: defined as horizontal deviation ≤10 prism diopters at primary position.

PD = prism diopter.

^* Fisher's exact test.

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