Abstract
Purpose
To compare the surgical outcome between V-pattern intermittent exotropia without inferior oblique overaction and comitant intermittent exotropia.
Methods
The authors of the present study investigated 15 patients (V-pattern group) who had standard horizontal surgery with half-tendon width vertical transposition and 36 patients (Comitant group) with unilateral rectus muscle recession/ resection. Preoperative visual acuity, presence of amblyopia, abnormal head posture, stereoacuity, amount of exotropia, and duration of postoperative diplopia were recorded. Surgical success was defined as final alignment of orthophoria or less than 10 PD orthophoria.
Results
The frequency of good stereoacuity with 80 sec of stereoacuity or more was higher in the V-pattern group (73.3%) than in the Comitant group (33.3%) (Fisher's exact test, p = 0.01). One case of V-pattern showed consecutive esotropia for 1 year postoperatively. Exotropia recurred in 2 patients in the V-pattern group (13.3%), and in 4 patients in the Comitant group (11.1%) 1 year postoperatively. Surgical success rates were statistically significant higher in the V-pattern group (86.7%) as compared to the Comitant group (58.3%) on final follow-up (Fisher's exact test, p = 0.04).
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Figure 1.
9-Gaze photograph shows V-pattern exotropia without overacting inferior oblique muscles. This case shows exotropia in primary gaze, decrease of exotropic deviation in downgaze and increase of exotropic deviation in upgaze. Inferior oblique muscles are not overacting when the patient fixates to the right, left, right and up, and left and up directions.
![jkos-54-324f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-324f1.gif)
Figure 3.
The change of postoperative deviation angle during follow-up. - means esotropia, + means exotropia. There was no statistically significance in postoperative deviation angle between the 2 treatment groups during each follow-up period (Mann-W hitney test, final follow-up p = 0.17).
![jkos-54-324f3.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-324f3.gif)
Table 1.
The Characteristics of patients with intermittent exotropia
V-Pattern X(T)* (n = 15) | Comitant X(T)* (n = 36) | p-value | |
---|---|---|---|
Sex (M:F) (No.) | 5:15 | 13:23 | 0.85† |
Age at diagnosis (years, mean ± SD) | 6.9 ± 2.9 (range, 2 to 13) | 7.2 ± 5.5 (range, 2 to 29) | 0.77‡ |
Age at surgery (years, mean ± SD) | 8.2 ± 1.9 (range, 4 to 13) | 8.4 ± 5.7 (range, 3 to 33) | 0.89‡ |
Follow-up (months, mean ± SD) | 24.9 ± 11.7 (range, 12 to 46) | 29.8 ± 18.9 (range 12 to 77) | 0.36‡ |
Surgical method (No.) | BLR, 2 | R&R, 36 | |
R&R, 11 | |||
ULR, 1 | |||
BMR. 1 |
Table 2.
Preoperative clinical characteristics of patients with intermittent exotropia
V-Pattern X(T)* (n = 15) | Comitant X(T)* (n = 36) | p-value | |
---|---|---|---|
Visual acuity (log MAR, mean ± SD) | |||
Right eye | 0.09 ± 0.09 | 0.11 ± 0.16 | 0.63† |
Left eye | 0.13 ± 0.19 | 0.10 ± 0.13 | 0.61† |
Deviated angle (PD, mean ± SD) | 25.6 ± 7.9 | 26.9 ± 6.6 | 0.59† |
Amblyopia treatment (No.) | 2/15 | 2/36 | 0.57‡ |
Abnormal head posture (No.) | 1/15 | 1/36 | 0.50‡ |
Titmus test (≤80 arc of sec, No.) | 11/15 | 12/36 | 0.01‡ |
Table 3.
Surgical success rates of the 2 treatment groups
V-Pattern X(T)* | Comitant X(T)* | p-value† | ||
---|---|---|---|---|
Postoperative 1 year | Recurred exotropia (No.) | 2 | 4 | 0.28 |
Consecutive esotropia (No.) | 1 | 0 | ||
Orthotropia (No.) | 12 | 32 | ||
Postoperative 2 years | Recurred Exotropia (No.) | 1 | 8 | 0.38 |
Orthotropia (No.) | 8 | 15 | ||
Final follow-up | Recurred Exotropia (No.) | 2 | 13 | 0.04 |
Orthotropia (No.) | 13 | 21 |
Table 4.
Subgroup analysis of surgical success results
Postoperative 1 year | Postoperative final follow-up | |||||
---|---|---|---|---|---|---|
V-Pattern | Comitant | p-value* | V-Pattern | Comitant | p-value* | |
Initial deviation | ||||||
≤20 PD (No.) | 5/6 | 8/9 | 1.00 | 6/6 | 8/9 | 1.00 |
>20 PD (No.) | 7/9 | 25/27 | 0.25 | 7/9 | 13/27 | 0.24 |
Amount of correction | ||||||
Overcorrection (No.) | 8/11 | 31/33 | 0.09 | 9/11 | 20/33 | 0.28 |
Undercorrection (No.) | 4/4 | 2/3 | 0.42 | 4/4 | 1/3 | 0.14 |
Duration of diplopia | ||||||
≤2 weeks (No.) | 10/12 | 22/25 | 1.00 | 10/12 | 13/25 | 0.08 |
>2 weeks (No.) | 2/3 | 11/11 | 0.21 | 3/3 | 8/11 | 1.00 |
Stereopsis | ||||||
>80 sec (No.) | 4/4 | 22/24 | 1.00 | 4/4 | 12/24 | 0.11 |
≤80 sec (No.) | 8/11 | 11/12 | 0.31 | 9/11 | 9/12 | 1.00 |
Table 5.
Characteristics of patients with V-pattern exotropia
Patient no. | Sex | Age (years) | Follow-up (months) | Primary angle of deviation (PD) | Upgaze* (PD) | Downgaze† (PD) | V pattern‡ | |||
---|---|---|---|---|---|---|---|---|---|---|
Preop | Postop | Preop | Postop | Preop | Postop | |||||
1 | F | 2 | 45 | 25(X)T§ | 20(X)T§ | 35(X)T§ | 20(X)T§ | 20(X)T§ | 20(X)T§ | 15 |
2 | F | 8 | 33 | 45(X)T§ | 10(X)T§ | 60(X)T§ | 10(X)T§ | 35(X)T§ | 10(X)T§ | 25 |
3 | F | 9 | 35 | 25(X)T§ | 8(X)T§ | 35(X)T§ | 8(X)T§ | 20(X)T§ | 8(X)T§ | 15 |
4 | F | 3 | 36 | 20(X)T§ | 10(X)T§ | 30(X)T§ | 10(X)T§ | 10(X)T§ | 10(X)T§ | 20 |
5 | M | 6 | 12 | 25(X)T§ | 4(X)T§ | 30(X)T§ | 4(X)T§ | 15(X)T§ | 4(X)T§ | 15 |
6 | F | 7 | 13 | 25(X)T§ | 0 | 35(X)T§ | 0 | 20(X)T§ | 0 | 15 |
7 | F | 5 | 27 | 20(X)T§ | 6ET | 30(X)T§ | 6ET | 15(X)T§ | 6ET | 15 |
8 | F | 8 | 20 | 25(X)T§ | 20(X)T§ | 35(X)T§ | ||||
4RH | 4RH | 20(X)T§ | 20(X)T§ | 20(X)T§ | 15 | |||||
9 | F | 2 | 24 | 40(X)T§ | 4(X)T§ | 50(X)T§ | ||||
4RH | 4RH | 4(X)T§ | 30(X)T§ | 4(X)T§ | 20 | |||||
10 | M | 8 | 46 | 30(X)T§ | 6(X)T§ | 40(X)T§ | 6(X)T§ | 25(X)T§ | 6(X)T§ | 15 |
11 | M | 9 | 12 | 30(X)T§ | 6ET | |||||
4RH | 45(X)T§ | 6ET | 25(X)T§ | 6ET | 20 | |||||
12 | M | 9 | 21 | 20(X)T§ | 0 | 30(X)T§ | 0 | 15(X)T§ | 0 | 15 |
13 | M | 8 | 23 | 20(X)T§ | 0 | 30(X)T§ | 0 | 15(X)T§ | 0 | 15 |
14 | F | 7 | 15 | 20(X)T§ | 4(X)T§ | 30(X)T§ | 4(X)T§ | 15(X)T§ | 4(X)T§ | 15 |
15 | F | 13 | 12 | 15(X)T§ | 0 | 25(X)T§ | 0 | 10(X)T§ | 0 | 15 |