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Abstract
Purpose
To analyze the clinical aspects of consecutive esotropia after intermittent exotropia reoperation and study the prognosis and associated risk factors.
Methods
The present study included 34 patients with intermittent exotropia who underwent reoperation; incidence rate, risk factors, treatment methods and prognosis of the postoperative consecutive esotropia were analyzed.
Results
Of the 34 patients, 12 developed consecutive esotropia that persisted longer than a month after the reoperation; a higher incidence rate was observed in patients with esodeviation greater than 16 prism diopter (PD) on postoperative day 1 and in patients who received unilateral lateral muscle recession and medial muscle resection during the operation (p < 0.05). Conversely, factors such as age, deviation angle, refractive power, anisometropia, lateral incomitance and oblique muscle dysfunction prior to the reoperation did not affect the incidence of consecutive esotropia. The patients who developed consecutive esotropia received conservative treatments such as alternative occlusion therapy and fresnel prism wearing; 10 of 12 patients showed significant clinical improvements.
Conclusions
Consecutive esotropia frequently occurs after intermittent exotropia reoperation if the patient had esodeviation greater than 16 PD on postoperative day 1 or received unilateral lateral muscle recession and medial muscle resection. The conservative treatments of the consecutive esotropia showed good clinical response and improved prognosis.
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References
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Table 1.
Probable factors associated with onset of consecutive esotropia after reoperation of intermittent exotropia
| Variables | Consecutive ET (n = 12, %) | Non-consecutive ET (n = 22, %) | p-value |
|---|---|---|---|
| Sex (female:male) | 7:5 | 12:10 | 0.832* |
| Follow up period (years) | 4.15 ± 2.14 | 3.96 ± 2.68 | 0.626† |
| Age at first op (years) | 5.40 ± 2.03 | 6.41 ± 1.91 | 0.261† |
| Age at second op (years) | 7.32 ± 1.54 | 12.02 ± 9.04 | 0.238‡ |
| Interval from first to second-op (years) | 1.92 ± 1.35 | 5.61 ± 8.28 | 0.179† |
| Spherical equivalent | –1.23 ± 2.31 | –1.65 ± 2.32 | 0.261† |
| Anisometropia | 1 (50) | 1 (50) | 1.000 |
| Preoperative deviation (PD) | |||
| At distance | 22.67 ± 6.61 | 21.73 ± 5.04 | 0.790† |
| At near | 23.33 ± 7.70 | 22.09 ± 4.62 | 0.986† |
| Distance-near deviation (PD) | 1.000 | ||
| ≤-10 | 1 (50) | 1 (50) | |
| -10∼10 | 11 (34) | 21 (66) | |
| Lateral incomitance | 4 (44) | 5 (56) | 0.687§ |
| IOOA | 1 (20) | 4 (80) | 0.635§ |
| Angles of deviation at post reoperative day 1 (PD) | 0.000§ | ||
| ≥16 ET | 3 (75) | 1 (25) | |
| Orthotropia∼16 ET | 9 (47.4) | 7 (52.6) | |
| XT | 0 (0) | 14 (100) | |
| Surgical method | 0.014§ | ||
| RR + RR | 4 (80) | 1 (20) | |
| BLR + BMR | 7 (41) | 10 (59) | |
| BLR + UMR | 1 (8) | 11 (92) | |
| Titmus (arc/sec) | 0.218§ | ||
| ≤100 | 5 (26) | 14 (74) | |
| >100 | 7 (47) | 8 (53) | |
| Titmus changes between status prior to first and second op | 0.490§ | ||
| Maintenance, better | 8 (40) | 12 (60) | |
| Worse | 4 (29) | 10 (71) | |
| Suppression | 8 (38) | 13 (62) | 0.727§ |
| Suppression changes between status prior to first and second o | op | 1.000 | |
| Maintenance, better | 10 (37) | 17 (63) | |
| Worse | 2 (29) | 5 (71) |
Table 2.
Result of prismatic correction and clinical outcomes of consecutive esotropia patients after reoperation of intermittent exotropia
| Variable | Result (%) |
|---|---|
| Deviation angle of consecutive ET at 1 month after surgery (PD)* | –17.42 ± 5.26Π |
| Last follow-up (months) | 18.58 ± 13.20 |
| Timing of prism glasses prescription (PO months) | 2.17 ± 1.47 |
| Angle of esodeviation when starting prism wear (PD) | –15.67 ± 4.08 |
| Duration of prism wear (months) | 10.75 ± 6.64 |
| Patient who were weaned off prism glasses at last follow-up | 10 (83) |
| Final motor alignment | |
| Successful motor outcome§ | 10 (83.3) |
| More than 10 PD esodeviation | 2 (16.7) |
| New onset amblyopia | 0 (0) |
| Stereopsis† | |
| Improvement | 4 (33.3) |
| Maintenance | 8 (66.7) |
| Worsening | 0 (0) |
| Fusion ability‡ | |
| Improvement | 5 (41.6) |
| Maintenance | 7 (5.83) |
| Worsening | 0 (0) |
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