Surgical Outcomes and Prognostic Factors of Consecutive Exotropia

Min Seok Kim; Mi Rae Kim; Won Jae Kim; Myung Mi Kim

doi:10.3341/jkos.2015.56.12.1926

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Kim, Kim, Kim, and Kim: Surgical Outcomes and Prognostic Factors of Consecutive Exotropia

Original Article

J Korean Ophthalmol Soc 2015;56(12):1926-1932.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1926

Surgical Outcomes and Prognostic Factors of Consecutive Exotropia

Min Seok Kim, M.D, Mi Rae Kim, M.D, Won Jae Kim, M.D, Myung Mi Kim, M.D, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Myung Mi Kim, MD, PhD Department of Ophthalmology, Yeungnam University Medical Center, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: 82-53-620-3441, Fax: 82-53-626-5936 E-mail: mmk@med.yu.ac.kr

Received 6 June 201525 July 2015 Accepted 25 September 2015

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

In this study we evaluated the prognostic factors by comparing the clinical manifestation of consecutive exotropia after consecutive exotropia surgery.

Methods

We performed a retrospective study of 65 patients who had surgery due to consecutive exotropia after esotropia sur-gery in Yeungnam University Medical Center between July 1988 and December 2013. The type of esotropia, age at diagnosis of esotropia, type of esotropia surgery, age at esotropia surgery, type of consecutive exotropia surgery, age at consecutive exo-tropia surgery, presence of adduction limitation, presence of amblyopia, and preoperative and postoperative angles of stra-bismus were analyzed.

Results

The mean follow-up time after consecutive exotropia surgery was 5.1 ± 5.2 years and 50 of 65 patients showed suc-cessful surgical outcomes at the last follow-up. Cumulative success rate of consecutive exotropia remained stable post-operatively in 68.2% of patients after 7.7 years. When comparing the success group and the recurrent group, the age at consec-utive exotropia surgery was significantly younger and mean follow-up time was significantly longer in the recurrent group. The mean interval between consecutive exotropia surgery and recurrence of exotropia was 16.9 months in the recurrent group. The mean angle of strabismus at postoperative 1 week was significantly different between the 2 groups; 0.5 prism diopters (PD) eso-deviation in the success group and 4.5 PD exodeviation in recurrent group.

Conclusions

Recurrence of consecutive exotropia frequently developed with younger age at consecutive exotropia surgery and exodeviation at postoperative 1 week. Recurrent consecutive exotropia should be observed for an extended period, thus requir-ing periodic long-term postoperative follow-ups.

Keywords: Consecutive exotropia, Consecutive exotropia surgery, Prognostic factors, Recurrent consecutive exotropia, Surgical outcomes

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Figure 1.

Kaplan-Meier survival curve of surgical outcome of surgery of consecutive exotropia.

Table 1.

Demographic and clinical characteristics of patients (n = 65)

Variable	No. of patient (%)
Age (years)	16.1 ± 11.7
Gender (male:female)	24:41
Preoperative deviation (prism diopters)
At distance	32.2 ± 15.0
At near	32.2 ± 14.0
Type of esotropia
Infantile ET	59 (90.8)
Partially Acc	6 (9.2)
Type of esotropia surgery
MR rec
Unilateral	9 (13.8)
Bilateral	33 (50.8)
R & R^*	12 (18.5)
R & R^* and MR rec	8 (12.3)
Bilateral R & R^*	3 (4.6)
Amblyopia	36 (55.4)
A-V pattern	26 (40.0)
Limitation of adduction	20 (30.8)
Vertical deviation	24 (36.9)
Interval between surgery of ET and diagnosis of CXT (years)	8.7 ± 7.8
Follow-up time (years)	5.1 ± 5.2
Type of exotropia surgery
MR
Unilateral adv	30 (46.2)
Bilateral adv	4 (6.2)
Res & adv	3 (4.6)
R & R^†	3 (4.6)
LR
Unilateral rec	2 (3.1)
Bilateral rec	1 (1.5)
LR rec &
Unilateral MR adv	20 (30.7)
Bilateral MR adv	2 (3.1)

Values are presented as mean ± SD unless otherwise indicated. ET = esotropia; Acc = accommodative esotropia; MR = medial rectus muscle; rec = recession; CXT = consecutive exotropia; adv = advancement; Res = resection; LR = lateral rectus muscle. ^* Recession of MR and resection of LR; ^† Recession of LR and re-section of MR in unoperated eye.

Table 2.

Characteristics of 3 esotropia patients after surgery of consecutive exotropia

Patient No.	1	2	3
Gender	Male	Male	Female
Type of ET	Infantile ET	Infantile ET	Infantile ET
Interval between surgery of CXT and recurrence of ET (months)	9.6	11.6	11.8
Age at surgery of CXT (years)	16.0	7.4	15.5
Preoperative deviation (PD)
At distance	30XT	25XT	25XT
At near	40XT	25XT	25XT
Type of XT surgery	MR adv OD & LR rec OD	MR adv OD	MR adv OS
Postoperative deviation (PD)^*
At distance	4ET	Ortho	Ortho
At near	4ET	Ortho	2XT
Last visit deviation (PD)	20ET	10ET	10ET
Follow-up time (months)	155.5	194.3	37.2

ET = esotropia; CXT = consecutive exotropia; PD = prism diopters; XT = exotropia; MR adv = medial rectus advancement; OD = oculus dexter; LR rec = lateral rectus recession; OS = oculus sinister; Ortho = orthophoria.^* At postoperative 1 week.

Table 3.

Probable factors associated with surgical outcomes of consecutive exotropia

Characteristic	Success group (n = 50)	Recurrent group (n = 12)	p-value
Sex (male:female)	19:31	3:9	0.512
Age at surgery of ET (years)	7.7 ± 1.2	6.8 ± 2.2	0.476
Age at diagnosis of CXT (years)	16.7 ± 11.0	14.0 ± 15.7	0.84
Age at surgery of CXT (years)
≤10 (n = 12)	7/50 (14.0%)	5/12 (41.7%)	0.044
>10 (n = 50)	43/50 (86.0%)	7/12 (58.3%)
Interval between surgery of ET and diagnosis of CXT (months)	108.7 ± 92.9	86.5 ± 104.5	0.209
Preoperative deviation (PD)
At distance	31.6 ± 13.2	35.9 ± 21.0	0.653
At near	31.6 ± 12.6	35.1 ± 19.5	0.633
Postoperative deviation (PD)^*
At distance	-0.5 ± 5.5	4.5 ± 7.2	0.047
At near	-0.7 ± 6.2	6.5 ± 8.4	0.009
Distribution of postoperative deviation^*
At distance
Esodeviation or ortho	37 (74%)	5 (41.7%)	0.043
Exodeviation	13 (26%)	7 (58.3%)
At near
Esodeviation or ortho	37 (74%)	5 (41.7%)	0.043
Exodeviation	13 (26%)	7 (58.3%)
Follow-up time (years)	3.9 ± 4.2	8.6 ± 6.3	0.019
Amblyopia	26 (52.0%)	9 (75.0%)	0.149
A-V pattern	20 (40.0%)	6 (50.0%)	0.528
Limitation of adduction	15 (30.0%)	2 (16.7%)	0.484
Vertical deviation	16 (32.0%)	7 (58.3%)	0.108
Type of esotropia	1.000
Infantile ET	45 (90.0%)	11 (91.7%)
Partially Acc	5 (10.0%)	1 (8.3%)
Type of esotropia surgery	1.000
MR recession
Unilateral	8 (66.0%)	1 (8.3%)
Bilateral	25 (50%)	7 (58.4%)
R & R^†	9 (18%)	3 (25%)
R & R^† and MR rec	6 (12%)	1 (8.3%)
Bilateral R & R^†	2 (4%)	-
Type of exotropia surgery	1.000
MR
Unilateral adv	22 (44%)	6 (50%)
Bilateral adv	4 (8%)	-
Res & adv	3 (6%)	-
R & R^‡	3 (6%)	-
LR
Unilateral rec	1 (2%)	1 (8.3%)
Bilateral rec	1 (2%)	-
LR rec &
Unilateral MR adv	16 (32%)	4 (33.4%)
Bilateral MR adv	1 (2%)	1 (8.3%)

Values are presented as mean ± SD unless otherwise indicated. ET = esotropia; CXT = consecutive exotropia; PD = prism diopters; Ortho = orthophoria; Acc = accommodative esotropia; MR = medial rectus muscle; rec = recession; adv = advancement; Res = resection; LR = lateral rectus muscle.^* At postoperative 1 week; ^† Recession of MR and resection of LR; ^‡ Recession of LR and resection of MR in unoperated eye.

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