Postoperative Exodrift Patterns after Bilateral or Unilateral Lateral Rectus Recession in 20 Prism-diopter Intermittent Exotropia

Su Jin Park; Kwang Hoon Shin; Hae Jung Paik

doi:10.3341/jkos.2016.57.12.1926

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Park, Shin, and Paik: Postoperative Exodrift Patterns after Bilateral or Unilateral Lateral Rectus Recession in 20 Prism-diopter Intermittent Exotropia

Original Article

J Korean Ophthalmol Soc 2016;57(12):1926-1931.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1926

Postoperative Exodrift Patterns after Bilateral or Unilateral Lateral Rectus Recession in 20 Prism-diopter Intermittent Exotropia

Su Jin Park, MD, Kwang Hoon Shin, MD, Hae Jung Paik, MD, PhD

Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea

Address reprint requests to Hae Jung Paik, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358 E-mail: hjpaik@gilhospital.com

Received 26 May 2016 Revised 7 October 2016 Accepted 23 November 2016

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 the present study, the surgical outcome and postoperative exodrift pattern between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) in intermittent exotropia of 20 prism diopters (PDs) were compared.

Methods

In this retrospective study, 5.0 mm BLR or 8.5 mm ULR was performed on 82 patients for the treatment of intermittent exotropia of 20 PDs with a follow-up period of 2 years. The main outcome measures were postoperative 1-week, 1-month, 6-month, 1-year and 2-year exodeviation angles with their patterns and success rates. A surgical success was considered an alignment within 10 PDs and sensory success was defined at 100 seconds of arc.

Results

The mean deviation angles at postoperative 1 week were 4.7 ± 5.1 PD esodeviation in the BLR group (44 patients) and 1.2 ± 4.2 PD esodeviation in the ULR group (38 patients). The BLR group was significantly more overcorrected than the ULR group (p = 0.001), but postoperative exodrift occurred in the BLR group at 1 week, 1 month, 6 months, 1 year, and 2 years. In the ULR group, the postoperative exodrift occurred at 1 week, 1 month, and 6 months which was followed by stabilized alignment. Surgical success rate at the postoperative 2-year follow-up was 75.0% in the BLR group and 81.6% in ULR group (p = 0.717).

Conclusions

ULR showed less overcorrection and early exodrift up to only 6 months, resulting in stabilization of the alignment afterwards; surgical success rate at the final 2-year follow-up was similar to BLR.

Keywords: 20 prism diopter (PD), Exodrift, Intermittent exotropia, Unilateral lateral rectus recession

References

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Figure 1.

The Kaplan-Meier rate of success between patient with 20 PD intermittent exotropia who underwent bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) (p = 0.459). * Surgical success rate at the postoperative 24-months follow-up was 75.0% in the BLR group and 81.6% in ULR group (p = 0.717).

Table 1.

Preoperative characteristics of bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) group

	BLR group (n = 44)	ULR group (n = 38)	p-value
Age at surgery	8.3 ± 2.1	8.8 ± 2.4	0.294^*
Sex (male/female)	22/22	12/26	0.117^†
Good stereopsis (≤100 seconds)	40/44	34/38	1.000^†
BCVA
OD (range)	0.07 ± 0.09	0.03 ± 0.07	0.065^*
OS (range)	0.06 ± 0.09	0.02 ± 0.05	0.061^*
Lateral gaze incomitance (n)	6/44	8/38	0.396^†
Astigmatism (n)	6/44	6/38	1.000^†
Myopia (n)	4/44	6/38	0.502^†
Follow-up (months)	32.2 ± 17.3	29.7 ± 20.3	0.549^*

Values are presented as mean ± SD unless otherwise indicated. BCVA = best-corrected visual acuity; OD = oculus dexter; OS = oculus sinister; n = number.

^* Student t-test

^† Chi-square test.

Table 2.

Angle of deviation at distance preoperatively and during postoperative follow-up

	BLR group (n = 44)	ULR group (n = 38)	p-value^*
1 week	–4.7 ± 5.1 PD	–1.2 ± 4.2 PD	0.001
1 month	0.7 ± 3.7 PD	1.8 ± 3.8 PD	0.410
6 months	0.8 ± 3.8 PD	3.1 ± 3.7 PD	0.008
1 year	2.0 ± 4.1 PD	3.1 ± 4.9 PD	0.271
2 years	4.0 ± 4.2 PD	2.6 ± 4.2 PD	0.239

Values are presented as mean ± SD unless otherwise indicated. In the angle of deviation, the minus means esodeviation, and plus means exodeviation. BLR = bilateral lateral rectus recession; ULR = unilateral lateral rectus recession; PD = prism diopters.

^* Student t-test.

Table 3.

The mount of exodrift in bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) group

	BLR group (n = 44)	ULR group (n = 38)	p-value^*
1 month	5.4 ± 4.8 PD	3.0 ± 3.8 PD	0.081
6 months	5.5 ± 4.0 PD	4.3 ± 3.4 PD	0.210
1 year	6.6 ± 4.7 PD	4.3 ± 4.4 PD	0.052
2 years	8.6 ± 5.4 PD	3.8 ± 3.8 PD	<0.001

Values are presented as mean ± SD unless otherwise indicated. PD = prism diopters.

^* Student t-test.

Table 4.

The amount of corrected prism diopters per lateral recession (mm) in bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) groups (Dose-effect relationship)

	BLR group (n = 44)	ULR group (n = 38)	p-value^*
1 week	2.4 ± 0.5 PD	2.6 ± 0.5 PD	0.229
1 month	1.9 ± 0.4 PD	2.2 ± 0.5 PD	<0.001
6 months	1.9 ± 0.4 PD	2.0 ± 0.5 PD	0.037
1 year	1.8 ± 0.4 PD	2.0 ± 0.6 PD	0.029
2 years	1.6 ± 0.6 PD	2.1 ± 0.5 PD	<0.001

Values are presented as mean ± SD unless otherwise indicated. PD = prism diopters.

^* Student t-test.

Table 5.

Surgical results at 1 week postoperatively in bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) groups

	BLR group (n = 44)	ULR group (n = 38)
Undercorrection	0 (0.0)	0 (0.0)
Overcorrection	8 (18.2)	2 (5.3)
Limitation of abduction	0 (0.0)	4 (10.5)

Values are presented as n (%).

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