Comparison of the Outcomes of Two- and Three-muscle Surgery in Exotropia over 45 Prism Diopters

Kyung Eun Kang; Hyung Chan Kim; Hyun Jin Shin

doi:10.3341/jkos.2019.60.3.268

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Kang, Kim, and Shin: Comparison of the Outcomes of Two- and Three-muscle Surgery in Exotropia over 45 Prism Diopters

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(3): 268-275.

Published online: 15 March 2019

DOI: https://doi.org/10.3341/jkos.2019.60.3.268

Comparison of the Outcomes of Two- and Three-muscle Surgery in Exotropia over 45 Prism Diopters

Kyung Eun Kang, MD, Hyung Chan Kim, MD, PhD, Hyun Jin Shin, MD, PhD

Department of Ophthalmology, Konkuk University School of Medicine, Seoul, Korea.

Address reprint requests to Hyun Jin Shin, MD, PhD. Department of Ophthalmology, Konkuk University Medical Center, #120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea. Tel: 82-2-2086-7656, Fax: 82-2-2030-5273, shineye@kuh.ac.kr

Received 5 July 2018 Revised 15 October 2018 Accepted 20 February 2019

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

We report the outcomes of two- or three-muscle surgery on patients with large-angle exotropia exceeding 45 prism diopters (PDs).

Methods

We retrospectively analyzed data on 45 exotropia patients (> 45 PDs) who underwent two- or three-muscle surgery. We excluded patients with paralytic or restrictive strabismus, A- or V-pattern strabismus, a coexistent oblique dysfunction or nystagmus, and/or a history of prior extraocular muscle surgery. Only patients for whom at least 6 months of follow-up data were available were included. Successful surgery was defined as postoperative esotropia ≤ 5 PD, orthophoria, and exotropia ≤ 10 PD at the last visit.

Results

We included 45 patients, of whom 22 and 23 underwent two- and three-muscle surgery, respectively. The mean postoperative deviations were 9.5 and 2.7 PD in the two- and three-muscle groups, respectively; the overall success rates were 54.55% (12/22) and 91.30% (21/23). Subgroup analyses revealed that the surgical success rate of two-muscle operations was 66.67% (12/18) in 45–55 PD patients and 0% (0/4) in ≥ 55 PD patients; the success rates of three-muscle operations were 100% (7/7) and 87.50% (14/16). The success rate did not differ significantly between those with postoperative deviations of 45–55 PD (p = 0.137), but did between those who underwent two- and three-muscle operations to treat postoperative deviations of ≥ 55 PD (p = 0.003).

Conclusions

Satisfactory results can be achieved via two-muscle surgery in patients with exotropia < 55 PD. However, for those with exotropia > 55 PD, three-muscle surgery is superior to two-muscle surgery. Therefore, large-angle exotropia is optimally treated via three-muscle surgery.

Keywords: Horizontal muscle surgery, Large angle exotropia, Strabismus muscle

Figures and Tables

Figure 1

The duration of follow up as measured by the survival analysis (^*Kaplan-Meier method). The mean duration of success of the two muscle group and the three muscle group was 86.59 ± 11.94 months and 124.65 ± 5.70 months, respectively.

Figure 2

Success case according to the preoperative angle of deviation. The overall success rates were 63.6% (12/22) in two muscle groups and 91.3% (21/23) in three muscle groups. PD = prism diopters.

Figure 3

ROC curve. The maximum AUC is 0.84 and the sensitivity and specificity were 95.65% and 63.64% using a cut-off value of 50 prism diopters. ROC = receiver operating characteristics; AUC = area under the curve; CI = confidence interval.

Figure 4

The duration of follow up as measured by the survival analysis (^*Kaplan-Meier method) in 50–65 prism diopters exotropia. The mean duration of success in the two muscle group and the three muscle group was 48.50 ± 23.15 months and 112.43 ± 9.96 months, respectively.

Table 1

Demographics of patients with large angle exotropia

Values are presented as mean ± standard deviation (range) unless otherwise indicated.

PD = prism diopters.

Table 2

Comparison of success rate according to the preoperative angle of deviation

Values are presented as number (%) unless otherwise indicated.

^*Fisher's exact test.

Table 3

Comparison of 2 and 3 muscle surgery group in 50–65 PD exotropia

Values are presented as mean ± standard deviation (range) or number (%) unless otherwise indicated.

PD = prism diopters.

^*Mann-Whitney U test; ^†Fisher's exact test.

Notes

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

References

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Comparison of the Outcomes of Two- and Three-muscle Surgery in Exotropia over 45 Prism Diopters

Abstract

Purpose

Methods

Results

Conclusions

Figures and Tables

Figure 1

The duration of follow up as measured by the survival analysis (*Kaplan-Meier method). The mean duration of success of the two muscle group and the three muscle group was 86.59 ± 11.94 months and 124.65 ± 5.70 months, respectively.

Figure 2

Success case according to the preoperative angle of deviation. The overall success rates were 63.6% (12/22) in two muscle groups and 91.3% (21/23) in three muscle groups. PD = prism diopters.

Figure 3

ROC curve. The maximum AUC is 0.84 and the sensitivity and specificity were 95.65% and 63.64% using a cut-off value of 50 prism diopters. ROC = receiver operating characteristics; AUC = area under the curve; CI = confidence interval.

Figure 4

The duration of follow up as measured by the survival analysis (*Kaplan-Meier method) in 50–65 prism diopters exotropia. The mean duration of success in the two muscle group and the three muscle group was 48.50 ± 23.15 months and 112.43 ± 9.96 months, respectively.

Table 1

Demographics of patients with large angle exotropia

Table 2

Comparison of success rate according to the preoperative angle of deviation

Table 3

Comparison of 2 and 3 muscle surgery group in 50–65 PD exotropia

Notes

References

The duration of follow up as measured by the survival analysis (^*Kaplan-Meier method). The mean duration of success of the two muscle group and the three muscle group was 86.59 ± 11.94 months and 124.65 ± 5.70 months, respectively.

The duration of follow up as measured by the survival analysis (^*Kaplan-Meier method) in 50–65 prism diopters exotropia. The mean duration of success in the two muscle group and the three muscle group was 48.50 ± 23.15 months and 112.43 ± 9.96 months, respectively.