Decision for Proper Surgical Amount in Consecutive Esotropia Following Bilateral Lateral Rectus Recession

Ji Won Seo; Hae Jung Paik

doi:10.3341/jkos.2018.59.1.67

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Seo and Paik: Decision for Proper Surgical Amount in Consecutive Esotropia Following Bilateral Lateral Rectus Recession

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(1): 67-72.

Published online: 12 January 2018

DOI: https://doi.org/10.3341/jkos.2018.59.1.67

Decision for Proper Surgical Amount in Consecutive Esotropia Following Bilateral Lateral Rectus Recession

Ji Won Seo, MD¹, Hae Jung Paik, MD, PhD²

¹Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

²Department 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, hjpaik@gilhospital.com

Received 13 April 2017 Revised 29 September 2017 Accepted 13 December 2017

The Korean Ophthalmological Society

(open-access):

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 determine the amount of additional surgery required for patients with consecutive esotropia, who had an esodeviation angle similar to their pre-operative exodeviation angle, following bilateral lateral rectus recession surgery for intermittent exotropia.

Methods

The medical records of 29 patients who underwent surgery for intermittent exotropia from 1998 through 2013 were reviewed. These patients had consecutive esotropia with an unchanged postoperative esodeviation angle. Thirteen patients underwent esotropia surgery with the aim of full correction (Group A), while 16 patients underwent esotropia surgery with the aim of partial correction (Group B). The postoperative ocular alignment and stereopsis of both groups were compared.

Results

A total of 29 patients were evaluated including 13 patients in Group A and 16 patients in Group B. At the final follow-up visit, at least 24 months post procedure, Group B had a significantly greater success rate than Group A (62.5% vs. 23.1%, p = 0.039). Over-correction rates were higher in Group A than Group B (76.9% vs. 37.5%, p = 0.039). The changes during the follow-up period (6 months to their last follow-up) showed that the over-correction rate had increased from 30.8% to 76.9% in Group A (p = 0.034) and from 12.5% to 37.5% in Group B (p = 0.046).

Conclusions

Consecutive esotropia surgery with the aim of partial correction showed favorable motor and sensory outcomes in patients who had a postoperative esodeviation angle similar to that of their pre-operative exodeviation. This strategy may also be helpful in preventing long-term postoperative over-correction in patients presenting with consecutive esotropia.

Keywords: Consecutive esotropia, Full correction, Intermittent exotropia, Partial correction

Figures and Tables

Table 1

Clinical characteristics of Group A and B

Values are presented as mean ± SD unless otherwise indicated. ‘Group A’ means ‘the patients who underwent esotropic surgery with the aim of full correction’ and ‘Group B’ means ‘the patients who underwent esotropic surgery with the aim of partial correction’.

PD = prism diopters; BLR = bilateral lateral rectus muscle; SE = spherical equivalent.

^*Two surgeries = Surgery for initial extropia surgery and for consecutive esotropia; ^†p-value by Fisher's exact test; ^‡p-value by Mann-Whitney U-test.

Table 2

Long-term motor outcome of surgical correction for consecutive esotropia in Group A and B

‘Group A’ means ‘the patients who underwent esotropic surgery with the aim of full correction’ and ‘Group B’ means ‘the patients who underwent esotropic surgery with the aim of partial correction’. (−) means esodeviation; (+) means exodeviation.

PD = prism diopters.

^*p-value by χ² test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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