Changes in Types of Recurrent Intermittent Exotropia after Surgical Correction of Basic Type Intermittent Exotropia

Sung Ha Hwang; Hae Jung Paik

doi:10.3341/jkos.2018.59.8.760

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

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(8): 760-765.

Published online: 14 August 2018

DOI: https://doi.org/10.3341/jkos.2018.59.8.760

Changes in Types of Recurrent Intermittent Exotropia after Surgical Correction of Basic Type Intermittent Exotropia

Sung Ha Hwang, MD, Hae Jung Paik, MD, PhD

Department of Ophthalmology, Gachon University Gil Medical Center, Gachon University College of Medicine, 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: 82-32-460-2751, Fax: 82-32-460-3009, hjpaik@gilhospital.com

Received 26 April 2018 Revised 29 May 2018 Accepted 16 July 2018

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 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.

Keywords: Convergence insufficiency type exotropia, Intermittent exotropia, Recurrent 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).

Table 1

Demographics and preoperative characteristics of the 91 patients

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

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

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

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

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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