J Korean Ophthalmol Soc.  2009 Sep;50(9):1386-1391. 10.3341/jkos.2009.50.9.1386.

The Clinical Course of Recurrent Intermittent Exotropia After Previous Unilateral Recess-Resection Surgery

• Kim WJ
• Kim MM

• KMID: 2212623
• DOI: http://doi.org/10.3341/jkos.2009.50.9.1386

Abstract

PURPOSE
To investigate the clinical course of recess-resection (R & R) on the contralateral eye for recurrent intermittent exotropia after previous unilateral R & R surgery. METHODS: A retrospective analysis was conducted on patients who had unilateral R & R surgery and patients who had a second R & R surgery on the contralateral eye for recurrent intermittent exotropia with at least 12 months of postoperative follow-up. RESULTS: Our study included 490 patients with unilateral R & R and 119 patients with contralateral R & R. Recurrence was defined as an ocular misalignment of greater than 11PD during follow-up. Cumulative probabilities of surgical success rates were 42.7% and 66.4%, respectively (p=0.000). CONCLUSIONS: Exotropia reappeared in recurrent intermittent exotropia after contralateral R & R. However, when considering a long-term prognosis, the cumulative probabilities of surgical success were significantly higher in the second surgery.

Keyword

Recess-resection; Recurrent intermittent exotropia; Survival curve

MeSH Terms

Exotropia
Eye
Follow-Up Studies
Humans
Prognosis
Recurrence
Retrospective Studies

Figure

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  Figure 1. Kaplan-Meier survival curve showing the cumulative probability of surgical success following primary R&R group and repeat R&R group. There were greater probabilities of success in repeat R&R group than in primary R&R group (p=0.000, log rank test).

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  Figure 2. Comparison of cumulative probability of surgical success between group 1, group 2, group 3, and repeat R & R group (p=0.000, log rank test).

Reference

References

1. Figueira EC, Hing S. Intermittent exotropia: comparison of treatments. Clin Experiment Ophthalmol. 2006; 34:245–51.

2. Chia A, Seenyen L, Long QB. Surgical experiences with two- muscle surgery for the treatment of intermittent exotropia. J AAPOS. 2006; 10:206–11.

3. Jeoung JW, Lee MJ, Hwang JM. Bilateral lateral rectus recession versus unilateral recess-resect procedure for exotropia with a dominant eye. Am J Ophthalmol. 2006; 141:683–8.

4. Fiorelli VM, Goldchmit M, Uesugui CF, Souza-Dias C. Intermittent exotropia: comparative surgical results of lateral recti- recession and monocular recess-resect. Arq Bras Oftalmol. 2007; 70:429–32.

5. Maruo T, Kubota N, Sakaue T, Usui C. Intermittent exotropia surgery in children: long term outcome regarding changes in binocular alignment. A Study of 666 Cases. Binocul Vis Strabismus Q. 2001; 16:265–70.

6. Oh JY, Hwang JM. Survival analysis of 365 patients with exotropia after surgery. Eye. 2006; 20:1268–72.

7. Kim MM, Cho ST. Long-term surgical results of intermittent exotropia. J Korean Ophthalmol Soc. 1994; 35:1321–6.

8. Chang BL. Operative results in exotropia. J Korean Ophthalmol Soc. 1983; 24:729–34.

9. Park JL, Son MH, Yun IH, Won IG. The clinical analysis of surgical methods in intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:526–32.

10. Hahm IR, Yoon SW, Baek SH, Kong SM. The clinical course of recurrent exotropia after reoperation for exodeviation. Korean J Ophthalmol. 2005; 19:140–4.

11. Kim SJ, Choi DG. The Clinical analysis after reoperation for recurrent intermittent exotropia. J Korean Ophthalmol Soc. 2007; 48:321–7.

12. Kim SJ. Comparison of surgical results between bilateral recession and unilateral recession-resection in intermittent exotropia. J Korean Ophthalmol Soc. 1992; 33:95–100.

13. Mun HJ, Kim MM. Comparison of surgical results between bilateral recession and unilateral recession-resection in 25PD intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:2202–7.

14. Im SK, Park SW, Park YG. Effects of bilateral lateral rectus recession and unilateral recession-resection in large angle exotropia. J Korean Ophthalmol Soc. 2004; 45:990–4.

15. Lee SY, Sim JH, Lee YC. Comparison of surgical results according to surgical methods in simulated divergence excess exotropia. J Korean Ophthalmol Soc. 2004; 45:614–9.

16. Jeong TS, You IC, Park SW, Park YG. Factor of surgical success with unilateral recessionand resection in intermittent exotropia. J Korean Ophthalmol Soc. 2006; 47:1987–92.

17. Lew HL, Lee JB, Kim TK. Comparison of surgical results between bilateral rectus muscle recessions and lateral rectus muscle recession and muscle rectus resection in exotropia. J Korean Ophthalmol Soc. 1995; 36:115–9.

18. Yang SW, Chang BL. Pathologic finding after recession and resection of extraocular muscles in rabbits. Korean J Ophthalmol. 1989; 3:75–9.

19. Koo NK, Lee YC, Lee SY. Clinical study for the undercorrection factor in intermittent exotropia. Korean J Ophthalmol. 2006; 20:182–7.

20. Roh JH, Paik HJ. Clinical study on factors associated with recurrence and reoperation in intermittent exotropia. J Korean Ophthalmol Soc. 2008; 49:1114–9.

21. Lee SY, Lee YC. Comparison of surgical results by initial postoperative alignment following bilateral lateral rectus recession and unilateral lateral rectus recession-medial rectus resection in inter-mittent exotropes. J Korean Ophthalmol Soc. 1999; 40:2604–10.