Effect of Inferior Oblique Weakening Procedures Combined with Surgery for Intermittent Exotropia

Jong Hoon Shin; Hae Jung Paik

doi:10.3341/jkos.2015.56.2.249

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Shin and Paik: Effect of Inferior Oblique Weakening Procedures Combined with Surgery for Intermittent Exotropia

Original Article

J Korean Ophthalmol Soc 2015;56(2):249-253.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.249

Effect of Inferior Oblique Weakening Procedures Combined with Surgery for Intermittent Exotropia

Jong Hoon Shin, MD¹, Hae Jung Paik, MD, PhD^2,

¹Department of Ophthalmology, Gachon University School of Medicine, Incheon, Korea

²Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea

Address reprint requests to Hae Jung Paik, MD, PhD, Department of Ophthalmology, Gachon University Gil Hospital, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea, Tel: 82-32-460-3364, Fax: 82-32-460-3358 E-mail: hjpaik@gilhospital.com

Received 7 February 201419 June 2014 Accepted 15 January 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

To investigate whether combining inferior oblique weakening procedures with bilateral lateral rectus recession as a surgical approach to intermittent exotropia enhances postoperative horizontal angle of deviation over bilateral lateral rectus recession alone.

Methods

Patients were allocated to one of two surgical groups: a bilateral lateral rectus recession group (Group 1) or a bilateral lateral rectus recession with bilateral inferior oblique weakening group (Group 2). Group differences in the angle of distance deviation were evaluated preoperatively and at 3- and 12-months postoperatively.

Results

There were no significant differences in preoperative factors or angles of deviation between Group 1 (n = 98) and Group 2 (n = 77); no significant intergroup difference in the angle of deviation was observed at any postoperative time point (p > 0.05).

Conclusions

Combined inferior oblique weakening procedures did not significantly influence the horizontal angle of deviation after surgery for intermittent exotropia. Accordingly, there is no need to revise the surgical amount of lateral rectus recession.

Keywords: Combined, Inferior oblique weakening procedures, Intermittent exotropia, Lateral rectus recession, Surgical outcome

References

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Table 1.

Clinical characteristics of the patients

	Group 1 (n = 98)	Group 2 (n = 77)	p-value
Sex (M:F)	45:53	45:32	0.100^†
Age at surgery (years)	7.99 ± 7.40	7.75 ± 6.39	0.824^∗
Age at onset (years)	4.57 ± 3.73	4.17 ± 4.73	0.530^∗
Interval from onset to hospital visits (months)	31.79 ± 77.10	33.92 ± 56.47	0.839^∗
Interval from hospital visits to surgery (months)	9.89 ± 7.65	9.57 ± 11.18	0.825^∗
Preoperative deviation (PD)	28.42 ± 6.72	30.10 ± 7.02	0.108^∗
Surgical amount (mm)	6.02 ± 0.76	6.19 ± 0.79	0.142^∗
No. of preoperative stereoacuity ≤ 100 sec (%)	86 (87.8)	62 (80.5)	0.188^†

Values are presented as mean ± SD unless otherwise indicated; Group 1: bilateral lateral rectus recession; Group 2: bilateral lateral rectus recession and bilateral inferior oblique weakening procedures.

^∗ t-test

^† Chi-square test.

Table 2.

The preoperative deviation and postoperative deviation in the two study groups

Surgical amount	l Preoperative deviation			Postoperative 3 months			Postoperative 12 months
Surgical amount	Group 1	Group 2	p-value^∗	Group 1	Group 2	p-value^∗	Group 1	Group 2	p-value^∗
5 mm	21.48 ± 2.33	22.78 ± 2.55	0.085	-2.19 ± 5.96	0.11 ± 5.23	0.062	0.74 ± 6.27	1.56 ± 10.15	0.376
6 mm	26.55 ± 3.40	28.46 ± 3.67	0.064	-1.69 ± 7.40	-0.77 ± 6.30	0.905	0.26 ± 7.81	-0.04 ± 7.52	0.968
7 mm	34.48 ± 5.88	35.39 ± 6.45	0.324	1.41 ± 6.50	-0.06 ± 8.85	0.190	1.00 ± 5.09	1.45 ± 9.94	0.766

Values are presented as mean ± SD; Group 1: bilateral lateral rectus recession; Group 2: bilateral lateral rectus recession and bilateral inferior oblique weakening procedures.

^∗ Mann-Whitney test, －: mean esotropia, +: mean exotropia.

Table 3.

The changes in postoperative deviation in the two groups at 3 and 12 months postoperatively

Surgical amount	Preoperative to postoperative 3 months			Preoperative to postoperative 12 months
Surgical amount	Group 1	Group 2	p-value^∗	Group 1	Group 2	p-value^∗
5 mm	23.67 ± 6.35	22.67 ± 5.72	0.627	20.74 ± 6.97	21.22 ± 10.56	0.743
6 mm	28.24 ± 8.18	29.23 ± 6.64	0.352	26.29 ± 8.99	28.50 ± 7.66	0.150
7 mm	33.07 ± 5.99	35.45 ± 10.83	0.127	33.48 ± 6.90	33.94 ± 12.16	0.579

Values are presented as mean ± SD; Group 1: bilateral lateral rectus recession; Group 2: bilateral lateral rectus recession and bilateral inferior oblique weakening procedures.

^∗ Mann-Whitney test.

Table 4.

Success rate at 12 months postoperatively in the two groups

	Group 1 (n = 98)	Group 2 (n = 77)	p-value^∗
Success rate (%)	84.7	83.1	0.778

Group 1: bilateral lateral rectus recession; Group 2: bilateral lateral rectus recession and bilateral inferior oblique weakening procedures.

^∗ Chi-square test.

Table 5.

Postoperative stereoacuity in the two groups

	Group 1 (n = 98)	Group 2 (n = 77)	p-value^∗
No. of postoperative stereoacuity ≤ 100 sec (%)	90 (91.8)	65 (84.4)	0.126

Group 1: bilateral lateral rectus recession; Group 2: bilateral lateral rectus recession and bilateral inferior oblique weakening procedures.

^∗ Chi-square test.

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