Factors associated with atypical postoperative drift following surgery for consecutive exotropia
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To investigate the effect of unilateral medial rectus muscle resection for recurrent exotropia after bilateral lateral rectus muscle recession for intermittent exotropiaA retrospective analysis was made of thirtypatients who underwent unilateral medial rectus resection for recurrent exotropia. All had prior bilateral lateral rectus recession for intermittent exotropia. Data were collected for age, the preoperative deviation, the postoperative deviation at 2 weeks, 3 months, 6 months and the last visit, and the amount of medial rectus resection performed.The average preoperative deviation was 27.0+/-3.6 PD. After unilateral medial rectus resection, average deviation at distance was 2.8 PD at postoperative 2 weeks, 4.5 PD at 3 months, 5.1 PD at 6 months and 5.8 PD at last visit. The average deviation corrected per millimeter of medial rectus resection was 3.53+/-0.17 PD/mm.Considering that deviation angles of recurrent exotropia is smaller than those of primary surgery and the possibility of saving the other medial rectus muscle, unilateral rectus muscle resection could be effective surgical method for recurrent exotropia.
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Intermittent exotropia
Lateral rectus muscle
Inferior rectus muscle
Minimum deviation
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Abstract Background To detect significant factors associated with excessive postoperative exo-drift in young patients with intermittent exotropia who had undergone unilateral lateral rectus muscle recession and medial rectus muscle resection. Methods We retrospectively examined the records of 64 consecutive patients < 18 years old who underwent surgery between April 2004 and December 2011. We sought risk factors for excessive postoperative exo-drift among patients’ demographic and clinical characteristics using univariate and multivariable linear regression analysis. Results Younger patients ( P = 0.007), and those with larger preoperative exo-deviation at distance ( P = 0.033), a lower incidence of peripheral fusion at distance ( P = 0.021) or a greater postoperative initial eso-deviation ( P = 0.001), were significantly more likely to have an excessive postoperative exo-drift (> 20 prism diopters). Univariate analysis revealed significant associations between excessive postoperative exo-drift and age at surgery ( P = 0.004), preoperative exo-deviation at distance ( P = 0.017) and postoperative initial eso-deviation at distance ( P < 0.001). Multivariable linear regression analysis showed that postoperative initial eso-deviation at distance ( P = 0.008) was significantly associated with postoperative exo-drift. Conclusions Postoperative exodrift in unilateral RR is predicted by the initial postoperative eso-deviation, which may offset the overcorrection. However, the exo-drift is greater in cases with a large preoperative exo-deviation and/or at a younger age, and should be followed carefully.
Medial rectus muscle
Univariate analysis
Intermittent exotropia
Minimum deviation
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Objective To compare the surgical outcomes of bilateral lateral rectus recession and unilateral recess-resection for patients with basic intermittent exotropia.Methods Forty-nine patients with basic intermittent exotropia were enrolled in this retrospective study.Patients were assigned to two groups:group A underwent bilateral lateral rectus recessions (26 cases)and group B underwent unilateral recess-resection (23cases).The exodeviations were measured by the alternate prisms cover test in primary gaze at both distance (6 m) and near (33 cm) with fixation on accommodative targets.The surgery was performed according to the amount of distance deviation.All of the surgeries were performed by the same ophthalmologist.Mean postoperative follow-up period was 13.8±9.4 months.A successful alignment was defined as±8 PD or less inprimary gaze while viewing distant and near targets.Results Successful alignment was achieved in 53.8% and 82.6% of patients in group A and group B,respectively.The difference between the two groups was statistically significant (x2=4.59,P=0.032).Conclusions The unilateral recess-resection is more effective procedure for patients with basic intermittent exotropia.
Key words:
Intermittent exotropia; Basic type; Surgery
Intermittent exotropia
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Purpose: To compare the success rates and stabilities of postoperative alignment between adjustable and the non-adjustable surgeries in the treatment of sensory exotropia.Methods: A retrospective analysis was performed on all patients with sensory exotropia who had undergone unilateral lateral rectus recession and medial rectus resection (R&R) between January 1998 and August 2005.Thirty-four patients underwent conventional R&R, and 20 patients underwent R&R with adjustable suture of the lateral rectus.The surgical results between the two groups were analyzed with regard to the preoperative and post-operative deviation angles and the postoperative drift.The postoperative deviation angle was measured on postoperative day 1 as well as at two weeks, three months, six months and the final visit after surgery.Results: There were no statistically significant differences in the mean preoperative and postoperative deviation angles between the two groups.In 30 (88%) patients in the non-adjustable group and 15 (75%) patients in the adjustable group, postoperative deviation was less than 15 prism diopters (PD) at the three month follow-up.There was no significant difference in the mean postoperative drift between the two groups.Conclusions: Strabismus surgery with adjustable sutures did not show a significantly better result than surgery without adjustable sutures in the treatment of sensory exotropia.Considering the amount of postoperative exodrift in both groups, we postulate that the immediate ocular alignment after surgery for sensory exotropia should be orthophoric or 5-6 PD of esodeviation.
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