The Clinical Characteristics of V-Pattern Exotropia Without Inferior Oblique Muscle Overaction

Sin Woo Bae; Mi Young Choi

doi:10.3341/jkos.2013.54.2.324

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Bae and Choi: The Clinical Characteristics of V-Pattern Exotropia Without Inferior Oblique Muscle Overaction

Original Article

J Korean Ophthalmol Soc 2007;54(2):324-330.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.324

The Clinical Characteristics of V-Pattern Exotropia Without Inferior Oblique Muscle Overaction

Sin Woo Bae, MD, Mi Young Choi, MD, PhD

Department of Ophthalmology, Chungbuk National University School of Medicine, Cheongju, Koreaa

Address reprint requests to Mi Young Choi, MD, PhD Department of Ophthalmology, Chungbuk National University Hospital #776 1sunhwan-ro, Heungdeok-gu, Cheongju 361-711, Korea Tel: 82-43-269-6335, Fax: 82-43-264-5263, E-mail: mychoi@chungbuk.ac.kr

Received 16 March 201227 June 2012 Accepted 29 October 2012

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 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).

Conclusions

V-pattern exotropia patients without inferior oblique overaction who had standard horizontal surgery with half-tendon width vertical transposition showed a lower recurrence rate of exotropia than patients with comitant intermittent exotropia.

Keywords: Comitant exotropia, Inferior oblique overaction, V-Pattern exotropia

References

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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.

Figure 2.

Distribution of stereopsis between the 2 treatment groups.

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).

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

V = V-transposition; BLR = bilateral lateral rectus recession; R&R = unilateral recession/resection; ULR = unilateral lateral rectus recession; BMR = bilateral medial rectus resection.

^* Intermittent exotropia

^† Fisher's exact test

^‡ Mann-Whitney test.

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^‡

PD = prism diopter.

^* Intermittent exotropia

^† Fisher's exact test

^‡ Mann-Whitney test.

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

^* Intermittent exotropia

^† Fisher's exact test.

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

Surgical success was defined as orthophoria or less than 10 prism diopter deviation at final follow-up. The overcorrection and the undercorrection means the deviated status at postoperative 1 day.

^* Fisher's exact test.

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^‡
Patient no.	Sex	Age (years)	Follow-up (months)	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

PD = prism diopter; Preop = preoperative; Postop = postoperative; RH = right hypertropia; ET = esotropia.

^* Angle of deviation at 30° upgaze;

^† Angle of deviation at 30° downgaze

^‡ Amount of V-pattern (preoperation)

^§ Intermittent exotropia.

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