Risk Factors for Consecutive Exotropia and Hyperopic Changes after Bilateral Medial Rectus Recession

Ki Woong Lee; Hae Jung Paik

doi:10.3341/jkos.2018.59.3.276

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Lee and Paik: Risk Factors for Consecutive Exotropia and Hyperopic Changes after Bilateral Medial Rectus Recession

Original Article

J Korean Ophthalmol Soc 2018;59(3):276-281.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.3.276

Risk Factors for Consecutive Exotropia and Hyperopic Changes after Bilateral Medial Rectus Recession

Ki Woong Lee, 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: 82-1577-2299, Fax: 82-32-467-9302, E-mail: hjpaik@gilhospital.com

Received 2 November 2017 Revised 20 December 2017 Accepted 14 February 2018

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 define risk factors for and to analyze changes in hyperopic refractive error during development of postoperative exotropia (XT) after bilateral medial rectus (BMR) recession to treat infantile esotropia.

Methods

We retrospectively examined 50 patients with infantile esotropia who underwent BMR recession from January 2005 to December 2010. All were <10 years of age and underwent S36 months of follow-up. We recorded age at operation, the preoperative strabismus angle, the extent of medial rectus recession, strabismus status, pre- and post-operative changes in the refractive errors of both eyes, any postoperative overcorrection, any dissociated vertical deviation (DVD), and inferior oblique overaction (IOOA) status.

Results

Consecutive XT developed in 18 (36%) patients. The preoperative refractive error was +0.90 ± 0.79 D in the consecutive XT group and +1.94 ± 1.48 D in the surgical success (SS) group (p = 0.019). The extent of hyperopic decrease was significantly greater in the consecutive XT group than the SS group (consecutive XT group: 1.59 ± 1.38 D, SS group: 2.86 ± 1.97 D) at 3 years of post-operative follow-up (p = 0.008). Postoperative IOOA was detected in 10 (70.5%) patients in the consecutive XT group and 3 (29.55%) in the SS group (p = 0.002). No significant between-group difference in the incidence of overcorrection or DVD was apparent.

Conclusions

The presence of hyperopia (>+2.0 D) prior to BMR recession and a marked fall in the extent of hyperopia (−1.0 D/year) after recession may be associated with a high risk of consecutive XT. Thorough follow-up is necessary when IOOA develops after BMR recession.

Keywords: Consecutive exotropia, Hyperopia, Infantile esotropia, Myopic change, Risk factor

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Figure 1.

Postoperative angle of deviation according to postoperative durations between consecutive exotropia (XT) group and surgical success group. The amount of postoperative exotropic shift was higher in the consecutive exotropia group. POD = postoperative day.

*Statistically significant difference (Mann-Whitney U-test: p < 0.05).

Figure 2.

Changes of hyperopic refractive error during the follow-up after surgery for postoperative refractive error at 1 month, 3 months, 1 year, and 3 years postoperatively in each group. The extent of hyperopic decrease was significantly greater in the consecutive exotropia (XT) group than the surgical success (SS) group.

Table 1.

Patient demographics, preoperative data, operative and postoperative data

	Total	Consecutive exotropia	Surgical success	p-value
No. patients	44	18	26
Preoperative
Ratio (female:male)	26:18	11:15	10:8	0.358^†
Mean age at surgery (years)	3.92 ± 1.59	3.66 ± 1.87	4.10 ± 1.38	0.429*
Mean refractive errors of both eyes (D)	1.32 ± 1.23	1.94 ± 1.48	0.90 ± 0.79	0.019*
Preoperative deviation (PD)
At distance	34.26 ± 9.96	33.89 ± 11.45	34.57 ± 9.03	0.689*
Near	35.20 ± 12.14	35.83 ± 15.07	34.77 ± 9.93	0.874*
IOOA (n, %)	7 (15.9)	5 (28.8)	2 (7.7)	0.103^†
DVD (n, %)	2 (4.5)	2 (11.1)	0 (0)	0.162^†
Postoperative
Medial rectus recess amount (mm)	4.69 ± 0.75	4.43 ± 0.93	4.87 ± 0.54	0.145*
Amount of hyperopic decrease (PD/3yr)	2.62 ± 0.74	2.56 ± 0.75	2.66 ± 0.75	0.008*
Overcorrection (n, %)	0 (0)	0 (0)	0 (0)
IOOA (n, %)	13 (29.5)	10 (70.5)	3 (11.5)	0.003^†
DVD (n, %)	2 (4.5)	2(11.11)	0 (0)	0.162^†
Follow-up (months)	49.36 ± 17.16	53.44 ± 25.26	49.36 ± 17.16	0.145*
Mean age at last follow up	7.66 ± 2.09	7.26 ± 2.47	7.94 ± 1.77	0.518*

Values are presented as mean ± SD or n (%) unless otherwise indicated.

D = diopters; PD = prism diopters; IOOA = inferior oblique overaction; DVD= dissociated vertical devation.

^* Mann-Whitney U-test;

^† Tisher's exact test.

Table 2.

Postoperative refractive error at 1 month, 3 months, 1 year, and 3 years postoperatively in each group

Time after surgery	Refractive error
Time after surgery	Consecutive exotropia	Surgical success	p-value
1 month	1.49 ± 1.28	0.28 ± 0.65	<0.001*
3 months	0.74 ± 0.96	0.45 ± 0.70	0.243*
1 year	0.28 ± 0.96	0.41 ± 0.63	0.724*
3 years	−0.92 ± 1.49	−0.69 ± 1.07	0.151*

Values are presented as mean ± SD unless otherwise indicated. Minus (−) value in the angle of deviation means myopia.

^* Mann-Whitney U-test.

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