Factors associated with atypical postoperative drift following surgery for consecutive exotropia

Abstract

To evaluate the associations of clinical and surgical factors with atypical postoperative drift following surgery for consecutive exotropia. A total of 66 patients with consecutive exotropia (≥10Δ at distance), after historical surgery for esotropia were retrospectively identified at a tertiary medical center. All patients underwent unilateral lateral rectus recession (on adjustable suture) with medial rectus advancement and/or resection. Immediate postoperative target angle was 4Δ-10Δ of esotropia at distance, anticipating mild postoperative exodrift. Actual postoperative drift was calculated as change in distance deviation from immediately postadjustment to 6weeks. Typical drift was defined as 0Δ-9Δ of exodrift. Excessive exodrift was defined as ≥10Δ. Esodrift was defined as 1Δ or more. Univariate and multiple logistic regression analyses were performed to evaluate for associations with a wide range of clinical and surgical factors. Overall there was a median exodrift (4Δ, quartiles 0Δ-10Δ). Of the 66 patients, 18 (27%) showed excessive exodrift; 15 (23%), esodrift. In multiple logistic analyses, larger preoperative distance exodeviation was associated with excessive exodrift (P=0.01), and non-normal medial rectus attachment status (abnormal [stretched scar, pseudo-tendon], attached to pulley, or behind pulley) was associated with esodrift (P=0.02). Approximately half of patients show atypical drift following unilateral surgery for consecutive exotropia, with larger preoperative distance exodeviation associated with exodrift and non-normal medial rectus muscle status with esodrift. Knowing these associations may help when counseling patients regarding surgical outcomes.