Consecutive Exotropia following Strabismus Surgery

Abstract

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.

Unilateral Lateral Rectus Muscle Recession and Medial Rectus Muscle Resection With or Without Advancement for Postoperative Consecutive Exotropia

“…3,4,6,13 Approximately 61% our patients had amblyopia. We did not find any influence of amblyopia on the successful result, as observed by Donaldson and associates.…”

Reoperação nas esotropias congênita e essencial adquirida não acomodativa

“…Os fatores associados mais comuns se devem à falta de colaboração do paciente à semiologia, ao planejamento inadequado, à acomodação residual e à presença de ambliopia (4) . A exotropia consecutiva é observada em10% a 27% dos casos, principalmente na EC (5)(6)(7) . Dentre as principais causas relatadas, estão a ambliopia, a limitação pós-operatória de adução após grandes retrocessos do reto medial, a ausência de estereopsia e a cirurgia simultânea em 3 ou 4 músculos retos horizontais (5,7,8) .…”

“…A exotropia consecutiva é observada em10% a 27% dos casos, principalmente na EC (5)(6)(7) . Dentre as principais causas relatadas, estão a ambliopia, a limitação pós-operatória de adução após grandes retrocessos do reto medial, a ausência de estereopsia e a cirurgia simultânea em 3 ou 4 músculos retos horizontais (5,7,8) . O objetivo deste estudo foi observar a incidência de reoperações, e possíveis fatores associados às reintervenções cirúrgicas nos casos de EC e EEANA.…”

Midoperative Forced Duction Test as a Guide to Titrate the Surgery for Consecutive Exotropia

“…1,2 It may occur soon after the original surgery or many years later. If it happens early, slipped muscle must be suspected and prompt surgical intervention instigated.…”

“…3 Late deviations have been associated with factors such as amblyopia, high hypermetropia, absence of binocularity, presence of A-or V-pattern, limitation of adduction, developmental delay, esotropia surgery before 6 months of age, and multiple previous strabismus surgeries. 2 One operative study found 73% of reoperated muscles having some anomaly, suggesting poor technique of initial surgery as a factor in causing late deviations. 4 Conventional surgical nomograms may not hold good in these cases because of altered anatomy and muscle dynamics.…”