Curso clínico de una endotropía consecutiva una cirugía de estrabismo. Reporte de un caso / Clinical course of a consecutive esotropia from an strabismus surgery. Case Report

Propósito: analizar y describir el curso clínico de una exotropía recurrente, que luego de la re operación presenta un endotropía consecutiva. Métodos: paciente femenina de 4 años 5 meses, con diagnóstico de exotropía intermitente. Se le realizó retroinserción derechos laterales a 6,5 mm en ambos ojos. La exotropía recurrió en un año. Posteriormente se le realizó resección de rectos medios de 6 mm. El resultado posoperatorio fue una endotropía consecutiva de involución espontánea. Resultados: al realizar la primera cirugía para exotropía, se obtuvo un resultado de micro endotropía que evolucionó a exotropía recurrente. En la re operación se obtuvo una endotropía consecutiva de 20 dioptrías prismáticas que actualmente está en involución. Conclusión: Debe considerarse una hipercorrección inicial en la cirugía de exotropía. En el caso de una segunda operación para exotropía recurrente, se debe tener en cuenta que ésta puede volvera recurrir, aun cuando la tasa de recurrencia es menorque en la primera cirugía, y una nueva hipercorrección puede también ser recomendable. La endodesviación pos tiende a disminuir y dejar de persistir a los seis meses posoperatorios.

Purpose: to analyze and describe the clinical course of a recurrent exotropia, which after re-surgery developed a consecutive esotropia. Methods: female subject, 4 year and 5 months old, with an intermittent exotropia diagnosis. A retro insertion of the lateral rectus to 6,5 mm in both eyes was performed. Exotropia reappeared in one year. Subsequently, a 6 mm resection of both middle rectus was performed. The postoperatory result was a self involutive consecutive esotropia. Results: after first surgery for exotropia, a micro esotropia was obtained and it evolved to recurrent exotropia. In the new surgery a 20 prismatic diopters consecutive esotropia was obtained and it is currently involutioning. Conclusion: an hypercorrection should be considered in the procedure. In the case of a second surgery for recurrent exotropia, it should be considered that exotropia could reappear, although in a less recurrence rate that in the first one, so another hypercorrection should be considered too. Postoperative esodeviation after exotropia surgery tends to diminish and stop persisting after six months.

Consecutive Esodeviation After Exotropia Surgery in Patients Older than 15 Years: Comparison with Younger Patients

PURPOSE: The purpose of this study was to investigate the clinical course of esodeviation after exotropia surgery in older patients (older than 15 years) and to compare it with that in younger patients (15 years or younger). METHODS: The medical records of all surgeries for exodeviation from December 2004 to February 2007 were reviewed and 82 patients were found with consecutive esodeviation. The patients were divided into two groups according to their age: Group A (patients older than 15 years) and Group B (patients age 15 or younger). The clinical course of esodeviation in Group A was compared to that in Group B by means of survival analysis. RESULTS: The median survival times of the esodeviation were 2.0+/-0.1 months in Group A and 1.0+/-0.1 months in Group B (p=0.40). The prevalence of consecutive esotropia at six months was 0% in Group A and 6.1% in Group B (p=0.32). The myopic refractive error, worse sensory condition, and a larger preoperative exodeviation in Group A did not affect the clinical course of the two groups differently. CONCLUSIONS: The postoperative esodeviation of patients older than 15 years after exotropia surgery tended to persist longer during the early postoperative period than that of patients 15 years or younger, however, the difference did not persist at postoperative six months.

Comparison of Surgical Results Between Bilateral Recession and Unilateral Resection-Recession in Intermittent Exotropia

PURPOSE: The purpose of this study is to compare the postoperative results of surgery for 60 patients with intermittent exotropia (20-30PD). METHODS: They were classified into two groups: one group with bilateral lateral rectus recession (n=34) and another group with unilateral medial rectus resection and lateral rectus recession (n=26). We assessed the postoperative results by comparing the deviation at postoperative 1 year to those at 1day, 1week, 1month, and 6months after surgery. RESULTS: The stisfactory result defined as orthophoria and deviation between 10PD esodeviation and 10PD exodeviation. The postoperative success rates are as follows: 65% in the bilateral rectus recession group and 62% in the unilateral lateral rectus muscle recession and medial rectus resection group. In the bilateral lateral rectus recession group, postoperative 1 day alignment of 11-15PD esodeviation showed the success rate of 83%. In the unilateral medial rectus resection and lateral rectus recession group, postoperative 1 day alignment of 1-5PD esodeviation resulted in the success rate of 80%. CONCLUSIONS: The initial postoperative esodevation of 11-15PD in bilateral lateral rectus recession and esodeviation of 1-5PD in unilateral medial rectus resection and lateral rectus recession can lead to good results. Postoperative 1 year surgical results for exotropia of moderate degree could be predicted from angle of deviation at postoperative 6 months, regardless of the type of surgery.

Long Term Surgical Results after Early Surgery for Infantile Esotropia Before and After 1 year of Age

PURPOSE: To analyze the long term surgical results after early surgery for infantile esotropia before and after 1 year of age and to investigate postoperative eye alignments. METHODS: This retrospective study included 46 patients with infantile esotropia who underwent surgery before 2 years of age and were followed up for a minimum of 5 years. Subjects were divided into 2 groups: those who underwent surgery before 1 year of age (n=22, group 1), and the ones who underwent surgery between 1 year of age and 2 years of age (n=24, group 2). RESULTS: Long term postoperative alignment between two groups was not statistically significant. In postoperative stereopsis test, 11 patients (78.6%) of group 1 and 7 patients (41.2%) of group 2 had stereopsis and the patients of group 1 had more favorable stereoacuity than the patients of group 2. These differences were statistically significant, respectively (p=0.039). In postoperative eye alignment, patients of group 1 showed tendency to become exodeviated to esodeviated and patients of group 2 showed tendency to become esodeviated to exodeviated. These differences were statistically significant, respectively (p=0.023, p=0.042). CONCLUSIONS: To achieve better binocular function, early surgical alignment before 1 year of age is more recommended. Because early surgery before and after 1 year of age displays contradictory postoperative eye alignment, close follow up and careful consideration at reoperation is recommended.

Asymmetric Bilateral Lateral Recti Recession in Intermittent Exotropia

It is reported that the recurrence rate in intermittent exotropia is 20-50%. In this study, we evaluated whether the recurrence is reduced with asymmetric recession of bilateral lateral recti(LROU) in intermittent exotropia.Twenty-nine patients underwent the asymmetric LROU recession for intermittent exotropia with follow-up of 6-54 months. The amount of recession of lateral rectus muscle in deviating eye was 2mm more than in the fixating eye. Immediate postoperative overcorrection, the rate of orthophotia, and the occurrence of consecutive esotropia(ET) were analysed.The mean amount of immediate postoperative esodeviation was 16.5+/-7.4PD(0-34PD); four patients showed 0-4PD, 18 patients 11-20PD, and 7 patients showed considerable amount of ET as high as 21-30PD. Consecutive EToccurred in 6.8% of patients despite large amounts of postoeprative ET. The outcome of orthophoria was favorable, in 93.1% of patients in follow up of 6 months, 85.1% in 12 months and 78.5% in 24 months.This study suggests that asymmetric LROU recession is an effective procedure for the correction of intermittent exotropia.

A Case of Ocular Deviation after Excinier Laser Photorefractive Keratectomy

Patients undergoing monocular excimer laser photorefractive keratectomy (PRK) for myopic correction can develop strabismus secondary to decompensated heterophorias. We experienced a case of ocular esodeviation and diplopia that developed 8 nionths after monocular excimer laser phtorefractive keratectomy. So, we report this case with 8 review of the literature.

3 Cases of Mobius Syndrome

Mobius syndrome is a rare congenital disease characterized by unilateral or bilateral limitation of abduction and facial palsy due to the 6th and 7th cranial nerve paralysis. In addition, it may be associated with limb anomalies and other cranial nerve paralysis. We experienced three cases of Mobius syndrome characterized by esodeviation associated with bilateral limitation of abduction, bilateral facial atroph, tongue atrophy, congenital amputation of limb, and congenital clubfoot. We performed a large amount of bilateral medial rectus recession and unilateral lateral rectus resection, and obtained cosmetically successful results that orthophoric or less than 10 prism diopter of esotropia in primary postition, but mild limitation of adduction was observed as a complication.