Journal List > J Korean Ophthalmol Soc > v.59(8) > 1099856

Hwang and Paik: Changes in Types of Recurrent Intermittent Exotropia after Surgical Correction of Basic Type Intermittent Exotropia

Abstract

Purpose

To report the surgical outcomes and changes in types of recurrent exotropia after surgical correction of basic type intermittent exotropia.

Methods

We retrospectively analyzed the medical records of 91 patients who underwent reoperations for recurrent exotropia after primary surgical correction, and who visited our hospital for a period of at least one year after the reoperation. When distant deviation was >30 prism diopters (PD), we defined convergence insufficiency type (CI type) if the difference of the deviation angle was >10 PD and basic type exotropia if the difference was <10 PD. When distant deviation was <30 PD, we defined basic type exotropia if the difference of the deviation angle between at distant and near was <33% of the distant deviation angle, and CI type exotropia if the difference was >33% of the distant deviation angle.

Results

The types of recurrent exotropia were similar to those of the preoperative condition in 68 patients (74.7%), and newly emergent CI type was observed in 23 patients (25.3%). With regard to the incidence of CI type, bilateral lateral rectus recession was more common than unilateral lateral rectus recession after primary surgery and medial rectus resection and unilateral lateral rectus recession, but the difference was not significant (p = 0.615). Recurrent CI type exotropia was observed 6 months after primary surgery (p < 0.001), but there was no significant difference in the timing of the reoperation between the two groups (p > 0.05). There was no significant difference in the success of reoperations between the two groups (p > 0.05).

Conclusions

The types of recurrent exotropia after surgical correction of primary basic type intermittent exotropia differed from those of preoperative exotropia, which was not related to various factors before surgery. Recurrent exotropia was successfully treated by appropriately selected reoperations, regardless of the type of exotropia.

Figures and Tables

Figure 1

Postoperative linear progression of D/N difference of basic type and convergence insufficiency (CI) type. Mean D/N difference showed significant difference from 6 months after the first surgery. D/N difference = difference between near and distant horizontal deviations (Distant - Near). *Mann-Whitney U-test (p < 0.05).

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Table 1

Demographics and preoperative characteristics of the 91 patients

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Values are presented as mean ± SD unless otherwise indicated.

LR = lateral rectus muscle; MR = medial rectus muscle.

Table 2

Incidence of convergence-insufficiency (CI) type recurrent exotropia according to the types of 1st surgery

jkos-59-760-i002

LR = lateral rectus muscle; MR = medial rectus muscle.

*p-value by Fisher's exact test.

Table 3

Preoperative and postoperative characteristics of 2 types of recurrent exotropia

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

CI = convergence-insufficiency.

*p-value by Mann-Whitney U-test.

Table 4

Postoperative horizontal deviation of 2 types of recurrent exotropia

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Values are presented as mean ± SD unless otherwise indicated.

CI = convergence-insufficiency; PD = prism diopters.

*p-value by Mann-Whitney U-test, comparing between basic type and CI type about the difference of horizontal deviation (distant and near).

Table 5

Comparison of success rate according to the types of 2nd surgery

jkos-59-760-i005

MR = medial rectus muscle; LR = lateral rectus muscle.

*p-value by Fisher's exact test.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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