Postoperative outcomes of patients initially overcorrected for intermittent exotropia

Abstract

BACKGROUND Esotropic overcorrection on postoperative day 1 after surgery for intermittent exotropia is generally thought to increase the likelihood of long-term satisfactory alignment; however, it is unclear why some patients who are initially overcorrected demonstrate recurrent intermittent exotropia whereas others maintain esotropic to orthotropic alignment. METHODS The records of all patients who underwent primary surgical correction of intermittent exotropia were reviewed; those with any degree of esotropia on postoperative day 1 were included. The status at the last visit was categorized as orthotropic to <8Δ exotropia or having recurrent exotropia >8Δ, monofixational esotropia <10Δ, or esotropia >10Δ. RESULTS A total of 63 patients met the inclusion criteria. The mean postoperative day 1 alignment was 6Δ ± 3Δ esotropia at distance and 5Δ ± 3Δ esotropia at near. At the last visit, 31 (49%) were orthotropic to <8Δ exotropia, 26 (41%) had recurrence of exotropia >8Δ, and 6 (10%) had monofixational esotropia <10Δ. There was no significant difference between outcome groups in onset age, age at surgery, stereopsis, deviation (preoperatively or on postoperative day 1), or follow-up length. Risk factor analysis revealed no association between exotropia type, surgical approach, or postoperative day 1 alignment and risk of recurrent intermittent exotropia or monofixational esotropia, although there was a trend toward recurrent intermittent exotropia in those least overcorrected. CONCLUSIONS Recommended overcorrection on postoperative day 1 for intermittent exotropia can result in esotropia, intermittent exotropia, or orthotropia. The results of overcorrection for exotropia are variable and unpredictable. We were unable to determine associations with the recurrence of exotropia or secondary esotropia.

An external pilot study to test the feasibility of a randomised controlled trial comparing eye muscle surgery against active monitoring for childhood intermittent exotropia [X(T)]

“…In addition, there were four children who had eso deviations for near viewing only, three of which were intermittent and one that was constant. This is in line with previous studies 25,26 and permanent overcorrection with loss of stereoacuity remains the most significant complication of surgery. The management of surgical overcorrection should be standardised in a future trial.…”

“…Around 10-20% of children develop an intermittent or constant convergent strabismus following surgery for X(T), with some requiring further corrective procedures. 20,25,26 There are few data on the efficacy of non-surgical treatments for X(T) but, in general, they appear to be significantly less effective than eye muscle surgery. 24 A recently updated Cochrane review, 27 specifically addressing the treatment of X(T), identified only one trial that was eligible for inclusion.…”

Clinical analysis of childhood intermittent exotropia with surgical success at postoperative 2 years

“…However, Pineles et al. () found that the results of overcorrection for exotropia were variable and unpredictable; consequently, they were unable to uncover any associations with recurrence of exotropia or secondary esotropia. Leow et al.…”

Hyperopic refractive errors as a prognostic factor in intermittent exotropia surgery

“…Controversies partly stem from the highly variable surgical success rate in the published literature, ranging from 42 to 81%. [4][5][6][7][8][9] To evaluate the success of IXT surgery, functional outcomes are emphasized, [5][6][7][10][11][12][13][14][15][16][17][18][19] as well as motor alignment after surgery; however, few studies have considered functional outcomes for evaluating surgical success. 5,7,10 Several studies have investigated factors that possibly affect surgical outcomes, including refractive errors.…”