The surgical treatment of consecutive strabismus following concomitant horizontal strabismus surgery

Abstract

Objective To investigate the results and techniques of surgical treatment of consecutive strabismus following concomitant horizontal strabismus surgery. Methods Fifty-five patients operated on for consecutive strabismus following their first surgical treatment of concomitant horizontal deviation were analyzed retrospectively. Preoperative visual acuity, deviation, mobility evaluation, stereoacuity with Titmus test and traction test were performed as well as post-operative residual deviation and binocular function. The mean postoperative follow-up time was 2years. Results Thirteen patients with consecutive exotropia due to overcorrection for primary concomitant esotropia were managed with exploratory operation (3 patients) or treated with unilateral lateral rectus muscle recession combined with medial rectus muscle advancement (10 patients),in which 10 patients (76.9%) achieved satisfactory alignment at final follow-up. Eleven patients with consecutive esotropia due to overcorrection for primary concomitant exotropia underwent medial rectus muscle resection and lateral rectus muscle complete of partial advancement to the original insertion and 9 patients in which achieved long-term satisfactory alignment. Fifteen patients with undercorrection for concomitant esotropia were treated with medial rectus marginal myotomy combined with lateral rectus muscle recession (8 patients), unilateral lateral rectus muscle recession (2 patients) or medial rectus recession and lateral rectus resection combined with inferior oblique muscle recession in fellow eye (5 patients with Oblique muscle abnormal), and postoperative orthophoria rate was 86.7%. Sixteen patients with undercorrection for concomitant exotropia were treated with lateral rectus muscle recession and medial rectus muscle resection (6 patients) or combined with inferior oblique muscle recession (2 patients with V-exotropia), cicatricotomy for lateral rectus muscle (4 patients) or adjusted of releasable sutures (4 patients), in which postoperative orthophoria rate was 87.5%. Conclusions The reversal of unilateral medial rectus and lateral rectus recession or resection is an effective alternative for treating postoperative consecutive exotropia due to overcorrection of concomitant horizontal strabismus. Adjusting of releasable sutures provide more stable expections of the results achieved by the re-operation. Key words: Consecutive strabismus; Strabismus surgery