J Korean Ophthalmol Soc.  2019 Feb;60(2):176-180. 10.3341/jkos.2019.60.2.176.

The Period of Overcorrection after Surgery According to Age in Pediatric Patients with Intermittent Exotropia

• Cho SW
• Ha SG
• Kim SH

• KMID: 2438077
• DOI: http://doi.org/10.3341/jkos.2019.60.2.176

Abstract

PURPOSE
To investigate the recovery period of overcorrection and related factors after surgery in pediatric patients with basic intermittent exotropia (XT).
METHODS
Retrospective chart reviews of the medical records of patients who underwent bilateral lateral rectus recession for basic XT were analyzed. Preoperative age, sex, angle of deviation (prism diopters [PD]), and suppression at distance were measured. Patients were observed every week when the angle of deviation was > 2 PD of overcorrection at postoperative day 1. Recovery of overcorrection was defined as improvement of overcorrection with orthotropia. Patients were divided into two groups according to age: younger (group 1) and older (group 2) than 10 years of age. Success was defined as an angle of deviation between 10 PD of exodeviation and 5 PD of esodeviation at the final visit.
RESULTS
A total of 88 patients were included. At postoperative day 1, the angle of deviation at distance was −6.9 ± 2.2 PD, and the near angle of deviation was −6.9 ± 2.4 PD. Esodeviation presented as a minus value. The recovery period of overcorrection was 1.9 ± 3.9 weeks and the success rate was 80.7% (71 patients). The success rates of group 1 and group 2 were not statistically significant (p = 0.51). The recovery period of overcorrection in group 2 (2.7 ± 5.9 weeks) was significantly longer than in group 1 (1.8 ± 3.4 weeks) (p = 0.02).
CONCLUSIONS
In pediatric adolescents with basic XT, the surgical success rates did not differ significantly according to age, but recovery of overcorrection after strabismus surgery took longer in patients ≥ 10 years of age.

Keyword

Intermittent exotropia; Overcorrection; Pediatric adolescents

MeSH Terms

Adolescent
Esotropia
Exotropia*
Humans
Medical Records
Retrospective Studies
Strabismus

Figure

• 

  Figure 1 Comparison of recovery period of overcorrection between group 1 and 2. The recovery period of overcorrection in group 2 (2.7 ± 5.9 weeks) was significantly longer than in group 1 (1.8 ± 3.4 weeks) (p = 0.02). p-value was calculated by Mann-Whitney U test. PD = prism diopters.

Reference

1. Kim MJ, Ha SG, Kim SH. A clinical analysis of intermittent exotropia patients requiring more than three reoperations. J Korean Ophthalmol Soc. 2017; 58:1269–1275.

2. Ing MR, Pang SW. Strabismus III, Reinecke RD, editors. The racial distribution of strabismus. New York: Grune & Stratton;1978. p. 107–109.

3. Lee JH, Kang NY. Surgical outcomes of intermittent exotropia according to the constancy. J Korean Ophthalmol Soc. 2013; 54:310–316.

4. Cho YA, Kim SH. Postoperative minimal overcorrection in the surgical management of intermittent exotropia. Br J Ophthalmol. 2013; 97:866–869.

5. Kim JH, Kim SH, Cho YA. A study of patient concerns and return to daily life after strabismus surgery. J Korean Ophthalmol Soc. 2012; 53:440–445.

6. Kim EJ, Yeon DY, Ha SG, Kim SH. Relationship between early postoperative stereoacuity and surgical outcome in intermittent exotropia. J Korean Ophthalmol Soc. 2017; 58:1087–1091.

7. Romano RE. Worldwide survey of current management of intermittent exotropia by MD strabologist. Binoc Vision & Eye Muscle Surg Qtrly. 1993; 8:167–176.

8. Schlossman A, Muchnick RS, Stern KS. The surgical management of intermittent exotropia in adults. Ophthalmology. 1983; 90:1166–1171.

9. Abroms AD, Mohney BG, Rush DP, et al. Timely surgery in intermittent and constant exotropia for superior sensory outcome. Am J Ophthalmol. 2001; 131:111–116.

10. Park JK, Kyung SE. Clinical characteristics and related factors of surgical outcome in patients who underwent LR recession after the age of 10 years. J Korean Ophthalmol Soc. 2010; 51:981–987.

11. Oh JY, Hwang JM. Survival analysis of 365 patients with exotropia after surgery. Eye (Lond). 2006; 20:1268–1272.

12. Baek SU, Lee JY. Long-term outcome of surgery for intermittent exotropia. J Korean Ophthalmol Soc. 2013; 54:1079–1085.