Prognostic factors for recurrence with unilateral recess-resect procedure in patients with intermittent exotropia

Abstract

Purpose To evaluate the prognostic factors, particularly age at the time of surgery, for recurrence after unilateral medial rectus resection and lateral rectus recession (R&R) procedures in patients with intermittent exotropia, or X(T). Methods Medical records of 489 subjects who received unilateral R&R procedures with more than 12 months of follow-up were reviewed. The patients' surgical outcomes with a deviation of less than 10 prism diopters (PD) of exotropia and less than 5 PD of esotropia were defined as a success. Outcomes with more than 11 PD of exotropia were designated as recurrences, and those with esotropia of more than 5 PD after 3 months of operation were noted as overcorrection. The prognostic factors for recurrence were analyzed by the multivariate logistic regression test. Results Of the 489 subjects, 209 had successful surgical outcomes and 280 had recurrences, whereas overcorrection was not found. Mean age at operation was 8.9 ± 6.5 years, mean preoperative distant X(T) size was 32.9 ± 6.0 PD, and mean follow-up period was 27.5 ± 17.9 months. On the basis of the survival analysis in which survival represented time of recurrence, the mean duration was 31.2±1.7months. Age at onset, age at surgery, and immediate postoperative alignment proved to be significant factors influencing a favorable outcome by multivariate logistic regression analysis (Po0.05). However, gender, family history, and preoperative deviation size were not significantly predictive of success (P40.05). ConclusionIn unilateral R&R procedures, increasing patient age at the time of surgery was associated with lower recurrence rates. Recurrence rates also increased with the immediate postoperative angle and with the postoperative angle of deviation at 1, 3, 6, and 12 months.

The clinical course of recurrent intermittent exotropia following one or two surgeries over 24 months postoperatively

“…The risk of resurgery decreased with increased age at the first surgery. This result agrees with our previous study by Lim et al 8 There is controversy regarding the association between stereopsis and surgical outcome of intermittent exotropia. Beneish and Flanders 13 reported that poor preoperation stereopsis dose not necessarily preclude, and may enhance, long-term alignment stability postoperatively.…”

“…In addition, previous studies reported that immediate postoperative deviation showed significant association with favorable surgical result. 3,8,11 In the present study, recurrent intermittent exotropia after second surgery showed lower immediate postoperative deviation than intermittent exotropia with a single surgery (Po0.001). The difference in immediate postoperative deviation is also considered the reason of the lower exodrift of recurrent intermittent exotropia after a second surgery.…”

“…This result is consistent with previous reports of exodrift of intermittent exotropia after surgery. 1,3,8,9,11 Exodrift was also observed after a second surgery in recurrent intermittent exotropia patients. However, the postoperative angle of deviation of the resurgery 2 group was significantly lower than that of both the primary surgery group and resurgery 1 group over 24 months of follow-up.…”

“…This study design was used for the following two main reasons. First, the R&R procedure is one of the most common surgical methods used for correction of intermittent exotropia, [8][9][10] and we are of the opinion that the surgical data gained by a single surgical procedure performed by a single surgeon will be more valid than that gained by different surgeons performing different procedures. Second, the rmANOVA method is able to analyze the difference over time not only within groups but also between groups.…”

Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia

“…We suggested hypotheses in our previous study on prognostic factors for recurrence with unilateral recess-resect procedure in patients with X(T). 24 First, this could be attributed to difficulty in accurate measurement of the angle of deviation when dealing with a child. 9 In general, preoperative deviation is presumed to be an important determinant for strabismus surgery in patients with exotropia.…”