J Korean Ophthalmol Soc.  2017 Oct;58(10):1169-1175. 10.3341/jkos.2017.58.10.1169.

Comparison of Exodrift between Natural Group and Postoperative Group in Intermittent Exotropia Patients

Affiliations
  • 1Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea. kseeye@hanmail.net

Abstract

PURPOSE
To compare the exodrift between unilateral lateral rectus (ULR) recession and observation groups in moderate angle intermittent exotropia (IXT).
METHODS
A retrospective study was performed in 769 patients who were diagnosed with IXT from 2005 to 2015. Seventy-six patients were enrolled in this study that presented with IXT of 20 to 25 prism diopters (PD) on their first visit and were observed for more than 6 months without or after operation. The observation group (group 1) was composed of 29 patients who had regular examination without operation. The surgery group (group 2) was composed of 47 patients with ULR recession that were observed for deviation changes since surgery.
RESULTS
The mean age was 71.8 ± 22.0 months at first visit in group 1 and 91.1 ± 18.9 months before surgery in group 2 (p < 0.01). The distant exodeviation was 22.9 ± 2.5 PD at first visit in group 1 and 22.9 ± 2.4 PD before surgery in group 2 (p = 0.89). During follow-up, mean exodrift was 0.6 ± 9.0 PD in group 1 and 10.0 ± 7.4 PD in group 2 (p < 0.01). Exodrift up to postoperative 6 months in group 2 was 3.2 ± 4.0 PD and exodrift from postoperative 6 months to 2 years in group 2 was 7.1 ± 6.9 PD. More exodrift was noticed after post-operative 6 months (p = 0.04).
CONCLUSIONS
Comparing the exodrift between the groups in moderate angle IXT, patients in the observation group showed less exodrift. Patients who had a ULR recession presented more exodrift after postoperative 6 months. Even though they were orthotropic at postoperative 6 months when the operation was thought to be stabilized, an increase in exodrift after postoperative 6 months could not be excluded.

Keyword

Exodrift; Intermittent exotropia; Lateral rectus muscle recession

MeSH Terms

Exotropia*
Follow-Up Studies
Humans
Retrospective Studies

Figure

  • Figure 1. Exodrift 1 and exodrift 2 in each group. In group 2, exodrift 2 was 7.1 ± 6.9 PD which is more than exodrift 1 of 4.1 ± 5.7 (p = 0.01, paired t-test). Exodrift 1 was −0.5 ± 3.4 PD in group 1 and 4.4 ± 5.6 PD in group 2 and there was significant difference (p < 0.01, t-test). Exodrift 2 was 0.1 ± 4.0 PD in group 1 and 7.1 ± 6.9 PD in group 2 and there was significant difference (p < 0.01, t-test). Exodrift 1: difference of PD during first 1 year in group 1 and from postoperative 6 months to postoperative 18months in group 2. Exodrift 2: difference of PD during first 2 years in group 1 and from post-operative 6 months to postoperative 30 months in group 2. Post-OP = postoperative; mo = months.

  • Figure 2. Kaplan-meier survival curve. Group 1 is the observation group who didn't have a surgery and group 2 is the surgery group who had a unilateral lateral recession. Exodrift more than 10 PD was plotted in the survival curve. These survival curve indicated that the estimated mean times to exodrift more than 10 PD were 8.3 ± 3.1 years in group 1 and 3.7 ±3.8 years in group 2. The cumulative probability of exodrift was sinificantly higher in group 2 than group 1 (p < 0.01, log rank test).


Reference

References

1. Jenkins R. Demographics: geographic variations in the prevalence and management of exotropia. Am Orthopt J. 1992; 42:82–7.
Article
2. Park DG, Moon SH, Noh DH, Kim MM. Comparison between 20 and 25 prism diopters in bilateral rectus muscle recession for abdominal exotropia. J Korean Ophthalmol Soc. 2014; 55:1669–73.
3. von Noorden GK, Campos EC. Binocular vision and ocular abdominal: theory and management of strabismus. 6th ed.St. Louis: Mosby;2002. p. 631.
4. Burian HM. Exodeviations: their classification, diagnosis, and treatment. Am J Ophthalmol. 1966; 62:1161–6.
Article
5. Scott WE, Keech R, Mash AJ. The postoperative results and stabdominal of exodeviations. Arch Ophthalmol. 1981; 99:1814–8.
6. Ruttum MS. Initial versus subsequent postoperative motor abdominal in intermittent exotropia. J AAPOS. 1997; 1:88–91.
7. Reynolds JD, Hiles DA. Single lateral rectus muscle recession for small angle exotropia. Reinecke RD, editor. Strabismus 2: Proceedings of the Fourth Meeting of the International Strabismological Association, October 25–29, 1982, Asilomar, California (Pt. 2). New York: Grune & Stratton;1984. p. 247–53.
8. Kushner BJ. Selective surgery for intermittent exotropia based on distance/near differences. Arch Ophthalmol. 1998; 116:324–8.
Article
9. Lee SH, Kim JY, Kwon JY. The effect of unilateral lateral rectus abdominal for the treatment of moderate-angle exotropia. J Korean Ophthalmol Soc. 2005; 46:2045–9.
10. Spierer O, Spierer A, Glovinsky J, Ben-Simon GJ. Moderate-abdominals exotropia: a comparison of unilateral and bilateral rectus abdominal recession. Ophthalmic Surg Lasers Imaging. 2010; 41:355–9.
11. Menon V, Singla MA, Saxena R, Phulijele S. Comparative study of unilateral and bilateral surgery in moderate exotropia. J Pediatr Ophthalmol Strabismus. 2010; 47:288–91.
Article
12. Moon KJ, Choi WC, Park C. The long-term effect of unilateral abdominal rectus muscle recession for moderate angle exotropia. J Korean Ophthalmol Soc. 1998; 39:1885–90.
13. Hiles DA, Davies GT, Costenbader FD. abdominal observations on unoperated intermittent exotropia. Arch Ophthalmol. 1968; 80:436–42.
14. Sanfilippo S, Clahane AC. The effectiveness of orthoptics alone in selected cases of exodeviation: the immediate results and several years later. Am Orthopt J. 1970; 20:104–17.
Article
15. Kii T, Nakagawa T. Natural history of intermittent exotropia–stat-istical study of preoperative strabismic angle in different age groups. Nippon Ganka Gakkai Zasshi. 1992; 96:904–9.
16. Romanchuk KG, Dotchin SA, Zurevinsky J. The natural history of surgically untreated intermittent exotropia-looking into the distant future. J AAPOS. 2006; 10:225–31.
Article
17. Yang HK, Hwang JM. Bilateral vs unilateral medial rectus abdominal for recurrent exotropia after bilateral lateral rectus recession. Am J Ophthalmol. 2009; 148:459–65.
18. Cho SC, Yang HK, Hwang JM. Three-year surgical outcome of exotropia. J Korean Ophthalmol Soc. 2012; 53:1674–9.
Article
19. Lee JC, Lee YC, Lee SY. Comparison of postoperative outcomes according to deviation angle in moderate-angle intermittent abdominal of basic type. J Korean Ophthalmol Soc. 2013; 54:475–8.
20. von Noorden GK. Binocular vision and ocular motility: theory and management of strabismus. 4th ed.St. Louis: CV Mosby;1990. p. 330–9.
21. Stathacopoulos RA, Rosenbaum AL, Zanoni D, et al. Distance stereoacuity. Assessing control in intermittent exotropia. Ophthalmology. 1993; 100:495–500.
22. Zanoni D, Rosenbaum AL. A new method for evaluating distance stereo aciuty. J Pediatr Ophthalmol Strabismus. 1991; 28:255–60.
23. Roh YB, Kim CM, Oum BS, Lee JS. Distance stereoacuity in abdominal with intermittent exotropia using B-VAT II video acuity tester. J Korean Ophthalmol Soc. 1998; 39:578–82.
24. Suh WJ, Lee UK, Kim MM. Change of postoperative distance abdominal in intermittent exotropic patients. J Korean Ophthalmol Soc. 2000; 41:758–63.
25. O'Neal TD, Rosenbaum AL, Stathacopoulos RA. Distance stereo acuity improvement in intermittent exotropic patients following strabismus surgery. J Pediatr Ophthalmol Strabismus. 1995; 32:353–7. discussion 358.
26. Beneish R, Flanders M. The role of stereopsis and early abdominal alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol. 1994; 29:119–24.
27. Baker JD, Davies GT. Monofixational intermittent exotropia. Arch Ophthalmol. 1979; 97:93–5.
Article
28. Kim JH, Kim SH, Cho YA. A Study of patient concerns and return to daily life after strabismus surgery. J Korean Ophthalmol Soc. 2012; 53:440–5.
Article
29. Baek SU, Lee JY. abdominal outcome of surgery for intermittent exotropia. J Korean Ophthalmol Soc. 2013; 54:1079–85.
30. Cho YA, Lee JK. Early surgery before 4 years of age in intermittent exotropia. J Korean Ophthalmol Soc. 2004; 45:620–5.
31. Ing MR, Nishimura J, Okino L. Outcome study of bilateral lateral rectus recession for intermittent exotropia in children. Ophthalmic Surg Lasers. 1999; 30:110–7.
Article
32. Kim MM, Cho ST. abdominal surgical results of intermittent exotropia. J Korean Ophthalmol Soc. 1994; 35:1321–6.
33. Nelson LB, Bacal DA, Burke MJ. An alternative approach to the surgical management of exotropia–the unilateral lateral rectus recession. J Pediatr Ophthalmol Strabismus. 1992; 29:357–60.
Article
34. Weakley DR Jr, Stager DR. Unilateral lateral rectus recessions in exotropia. Ophthalmic Surg. 1993; 24:458–60.
Article
35. Roh YB, Choi HY. Surgical results of unilateral and bilateral lateral rectus recessions in exotropia under 25 prism diopter. J Korean Ophthalmol Soc. 1997; 38:474–8.
36. Cho HJ, Ma YR, Park YG. Comparison of surgical results between bilateral and unilateral lateral rectus recession in 20∼ 25 prism abdominal intermittent exotropia. J Korean Ophthalmol Soc. 2002; 43:1993–9.
37. Rabb EL, Parks MM. Recession of the lateral recti. Early and late postoperative alignments. Arch Ophthalmol. 1969; 82:203–8.
38. Knapp P. Symposium on strabismus: transactions of the New Orleans Academy of Ophthalmology. St. Louis: CV Mosby;1971. p. 233–41.
39. Roh JH, Paik HJ. Clinical study on factors associated with abdominal and reoperation in intermittent exotropia. J Korean Ophthalmol Soc. 2008; 49:1114–9.
40. Lee S, Lee YC. Relationship between motor alignment at abdominal day 1 and at year 1 after symmetric and asymmetric abdominal in intermittent exotropia. Jpn J Ophthalmol. 2001; 45:167–71.
41. Elsas FJ. Consecutive esotropia. Am Orthopt J. 1992; 42:94–7.
Article
42. Duane A. A New Classification of the Motor Anomalies of the Eye: Based upon Physiological Principles, Together with Their Symptoms, Diagnosis and Treatment. New York: J.H. Vail & Co.;1897. p. 49–51.
43. Bielschowsky A. Divergence excess. Arch Ophthalmol. 1934; 12:157–66.
Article
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