J Korean Ophthalmol Soc.  2018 Mar;59(3):276-281. 10.3341/jkos.2018.59.3.276.

Risk Factors for Consecutive Exotropia and Hyperopic Changes after Bilateral Medial Rectus Recession

• Lee KW
• Paik HJ

• KMID: 2406963
• DOI: http://doi.org/10.3341/jkos.2018.59.3.276

Abstract

PURPOSE
To define risk factors for and to analyze changes in hyperopic refractive error during development of postoperative exotropia (XT) after bilateral medial rectus (BMR) recession to treat infantile esotropia.
METHODS
We retrospectively examined 50 patients with infantile esotropia who underwent BMR recession from January 2005 to December 2010. All were < 10 years of age and underwent ≥36 months of follow-up. We recorded age at operation, the preoperative strabismus angle, the extent of medial rectus recession, strabismus status, pre- and post-operative changes in the refractive errors of both eyes, any postoperative overcorrection, any dissociated vertical deviation (DVD), and inferior oblique overaction (IOOA) status.
RESULTS
Consecutive XT developed in 18 (36%) patients. The preoperative refractive error was +0.90 ± 0.79 D in the consecutive XT group and +1.94 ± 1.48 D in the surgical success (SS) group (p = 0.019). The extent of hyperopic decrease was significantly greater in the consecutive XT group than the SS group (consecutive XT group: 1.59 ± 1.38 D, SS group: 2.86 ± 1.97 D) at 3 years of post-operative follow-up (p = 0.008). Postoperative IOOA was detected in 10 (70.5%) patients in the consecutive XT group and 3 (29.55%) in the SS group (p = 0.002). No significant between-group difference in the incidence of overcorrection or DVD was apparent.
CONCLUSIONS
The presence of hyperopia (>+2.0 D) prior to BMR recession and a marked fall in the extent of hyperopia (−1.0 D/year) after recession may be associated with a high risk of consecutive XT. Thorough follow-up is necessary when IOOA develops after BMR recession.

Keyword

Consecutive exotropia; Hyperopia; Infantile esotropia; Myopic change; Risk factor

MeSH Terms

Esotropia
Exotropia*
Follow-Up Studies
Humans
Hyperopia
Incidence
Refractive Errors
Retrospective Studies
Risk Factors*
Strabismus

Figure

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  Figure 1. Postoperative angle of deviation according to postoperative durations between consecutive exotropia (XT) group and surgical success group. The amount of postoperative exotropic shift was higher in the consecutive exotropia group. POD = postoperative day.

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  Figure 2. Changes of hyperopic refractive error during the follow-up after surgery for postoperative refractive error at 1 month, 3 months, 1 year, and 3 years postoperatively in each group. The extent of hyperopic decrease was significantly greater in the consecutive exotropia (XT) group than the surgical success (SS) group.

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