Consecutive Exotropia after Convergent Strabismus Surgery—Surgical Treatment

Ala Paduca

doi:10.4236/ojoph.2016.62014

Abstract

Purpose: In this study the results of consecutive exotropia surgical treatment by using different surgical technics are presented. Methods: This study included 34 patients, aged 21 to 47 years (mean 27.9), who underwent medial rectus muscle advancement alone or in combination with medial rectus resection and/or lateral rectus recession. The mean interval between original surgery and surgery for consecutive exotropia was 8.5 years (range: 5.5 years to 14 years). Most of patients had 2 and more prior surgeries (73.5%) sold by an adduction deficit (47.06%). Results: The overall mean preoperative exodeviation was 35.12 ± 10.13 PD. Satisfactory alignment (within 10 PD of orthophoria) was achieved in 20 patients (58.8%) at 10 days after surgery and 24 patients (70.5%) at final 6-month follow-up. The most common surgical procedures were unilateral MR advancement and LR recession—47%. Conclusion: Medial rectus advancement is an effective method of surgical treatment, especially in cases with adduction limitation, but the risk of the eyelid fissure narrowing in cases of MRM advancement more than 5 mm associated with resection is present. In our opinion for reducing this risk in cases of XT with big angle of deviation, performing a smaller amount of advancement associated with recession of LRM can prevent the development of a such complication.

Highlights

Exodeviation that develops iatrogenically after esotropia surgery is called consecutive exotropia
Large recessions, exceeding 5 mm of the Medial Rectus Muscle (MRM) can produce consecutive exotropia associated with limitation of adduction; large resections of the lateral rectus muscle can cause in contrary a limitation of abduction
We tried to find out about the previous oculomotor situation and surgery that patients included in our study had already undergone, the number of operations performed before the Medial Rectus Muscle (MRM) advancement

Summary

Introduction

Exodeviation that develops iatrogenically after esotropia surgery is called consecutive exotropia. This deviation occurs according to Von Noorden between 2% - 8% [1] while other studies found an incidence ranged from 4% to 27% [2] [3]. Large recessions, exceeding 5 mm of the MRM can produce consecutive exotropia associated with limitation of adduction; large resections of the lateral rectus muscle can cause in contrary a limitation of abduction. Recession is indicated for patients with consecutive exotropia with limited adduction after bilateral MRM recession, or in cases that underwent unilateral MRM recession/LRM resection surgery [5]. One thing is actual concerning consecutive exotropia—it requires special attention of the orthoptist and surgeons, due to the difficulties in pre-operative assessment, in planning and even performing the surgery [4]

Methods

Results

Conclusion