Result Comparison after Reoperation in Recurrent Exotropia According to the Type of First Operation

Moses Kim; Mi Young Choi

doi:10.3341/jkos.2014.55.5.726

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Kim and Choi: Result Comparison after Reoperation in Recurrent Exotropia According to the Type of First Operation

Original Article

J Korean Ophthalmol Soc 201;55(5):726-733.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.726

Result Comparison after Reoperation in Recurrent Exotropia According to the Type of First Operation

Moses Kim, MD, Mi Young Choi, MD, PhD

Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea

Address reprint requests to Mi Young Choi, MD, PhD, Department of Ophthalmology, Chungbuk National University Hospital, #776 1sunhwan-ro, Heungdeok-gu, Cheongju, 361-763, Korea, Tel: 82-43-269-6335, Fax: 82-43-264-5263, E-mail: mychoi@chungbuk.ac.kr

Received 13 July 2013 Revised 17 November 2013 Accepted 17 April 2014

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 and compare the clinical courses and surgical success rates of secondary operations in recurrent exotropia according to the type of first operation for correction of exotropia.

Methods

A retrospective chart review was performed for all patients with recurrent exotropia of the basic or pseudodivergence excess types. In group A (36 patients), bilateral lateral rectus (LR) recession was performed as the first operation and uni- or bilateral medial rectus (MR) resection was performed as the second operation. In group B (19 patients), unilateral LR recession- MR resection (R&R) was performed as the first operation and LR recession or R&R in contralateral eye as the second operation.

Results

There were no significant differences between the 2 groups when considering age at each operation, frequency of the amblyopia, prescription of prism, time interval for recurrence and reoperation and the final and cumulative success rates. No postoperative complications were observed in either group. The mean number of used muscles for the first and second operation was 3.9 ± 0.4 in group A, and 3.4 ± 0.5 in group B (p = 0.001). Mean time interval for occurrence of postoperative orthophoria was 3.7 ± 6.2 months in group A and 6.5 ± 16.2 in group B (p = 0.047). In group B, the incidence of esodeviation tended to increase after postoperative 1 month.

Conclusions

The final success rates of reoperation between the 2 types of the first operation in recurrent exotropia were similar. Mean time between postoperative overcorrection of orthophoria was shorter in the group with bilateral LR recession followed by secondary MR resection than in the other group. Unilateral R&R followed by LR recession or R&R in contralateral eye may be more helpful to decrease the number of used muscles than in the bilateral LR recession followed by secondary MR resection.

Keywords: Bilateral rectus muscle recession, Recurrent exotropia, Reoperation, Unilateral lateral rectus recession-medial rectus resection

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Figure 1.

Kaplan-Meier survival curve. (A) The cumulative probability of surgical success after 1st operation between Group A and B (p = 0.130, log rank test). (B) The cumulative probability of surgical success after 2nd operation between Group A and B (p = 0.877, log rank test). *Bilateral Lateral rectus muscles (LR) recession at first operation, and unilateral Medial rectus muscles (MR) or bilateral MR resection at second operation. ^†Unilateral Lateral rectus muscle recession and medial rectus muscle resection (R&R) at first operation, and contralateral unilateral LR recession or R&R at second operation.

Table 1.

Demographic data of patients

	Group A^*	Group B^†	p-value
Number of patients (n)	36	19
Sex (M/F) (n)	13/23	7/12
Mean age at 1st op. (years)	6.4 ± 5.5	6.4 ± 4.2	0.337
Time at recurrence after 1st op. (months)	21.8 ± 29.2	35.1 ± 33.6	0.060
Time interval between 1st and 2nd op. (months)	49.1 ± 27.1	62.7 ± 40.9	0.284
Mean age at 2nd operation (years)	10.3 ± 5.7	11.7 ± 5.1	0.100
Angle of exodeviation at 1st op. (PD)	32.2 ± 10.0	31.1 ± 12.5	0.467
Angle of exodeviation at 2nd op. (PD)	23.1 ± 5.0	23.3 ± 7.9	0.649
Follow-up after 2nd op. (months)	20.8 ± 14.4	30.3 ± 12.1	0.111
Number of operated muscles at total op. (n)	3.9 ± 0.4	3.4 ± 0.5	0.001

Values are presented as mean ± SD.

Op. = Operation.

^* Bilateral Lateral rectus muscles (LR) recession at first operation, and unilateral Medial rectus muscles (MR) or bilateral MR resection at second operation;

^† Unilateral Lateral rectus muscle recession and medial rectus muscle resection (R&R) at first operation, and contralateral unilateral LR recession or R&R at second operation.

Table 2.

Time interval between each operations and postoperative orthophoria

	1st operation (months)	2nd operation (months)	p-value§
Group A^*	0.2 ± 0.4	3.7 ± 6.2	0.000
Group B^†	2.1 ± 6.0	6.5 ± 16.2	0.238
p-value^‡	0.019	0.047

^* Values are presented as mean ± SD.

^* Bilateral Lateral rectus muscles (LR) recession at first operation, and unilateral Medial rectus muscles (MR) or bilateral MR resection at second operation;

^† Unilateral Lateral rectus muscle recession and medial rectus muscle resection (R&R) at first operation, and contralateral unilateral LR recession or R&R at second operation;

^‡ p-value comparing between Group A and Group B at each operation; §p-value comparing between 1st operation and 2nd operation at each group.

Table 3.

Incidence of esodeviation after 1st and 2nd operation in Group A and B

Follow-up after surgery	Group A^* (%)	p-value^‡	Group B^† (%)	p-value^§	p-value^π
1 day
1st operation	37.9	0.011	68.8	0.176	0.065
2nd operation	69.4	0.011	42.1	0.176	0.049
1 week
1st operation	17.2	0.000	43.8	0.311	0.080
2nd operation	69.4	0.000	26.3	0.311	0.004
1 month
1st operation	0.0	0.000	7.1	0.602	0.326
2nd operation	52.8	0.000	18.8	0.602	0.033
3 months
1st operation	4.2	0.123	21.4	0.455	0.132
2nd operation	20.6	0.123	36.8	0.455	0.198
6 months
1st operation	0.0	0.051	7.7	0.092	0.325
2nd operation	18.5	0.051	41.2	0.092	0.164

^* Bilateral Lateral rectus muscles (LR) recession at first operation, and unilateral Medial rectus muscles (MR) or bilateral MR resection at second operation;

^† Unilateral Lateral rectus muscle recession and medial rectus muscle resection (R&R) at first operation, and contralateral unilateral LR recession or R&R at second operation;

^‡ p-value comparing between 1st operation and 2nd operation at Group A;

^§ p-value comparing between 1st operation and 2nd operation at Group B;

^π p-value comparing between Group A and Group B at each operation.

Table 4.

Final success rates after second operation

	Group A^* (%)	Group B^† (%)	p-value^‡
Success	63.9	63.2	0.750
Undercorrection	30.1	26.3
Overcorrection	6	10.5

^* Bilateral Lateral rectus muscles (LR) recession at first operation, and unilateral Medial rectus muscles (MR) or bilateral MR resection at second operation;

^† Unilateral Lateral rectus muscle recession and medial rectus muscle resection (R&R) at first operation, and contralateral unilateral LR recession or R&R at second operation;

^‡ p-value comparing success rate, undercorrection rate and overcorrection rate by linear by linear association method.

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