Occurrence and subsequent development of vertical deviations in patients treated surgically for infantile esotropia

Purpose: The purpose of this study was to evaluate the onset of dissociated vertical deviation (DVD) and inferior oblique overaction (IOOA), their subsequent development, and their correlation with pre and postoperative parameters. Methods: Medical records of patients with infantile esotropia who underwent surgery between 2005 and 2017 were retrospectively reviewed. DVD and IOOA were measured before and after surgery. Patients were divided into two groups based on horizontal and vertical deviation at the time of presentation: those with infantile esotropia only (group A) and patients with infantile esotropia who developed vertical deviation (group B). Results: Out of a total of 102 patients, DVD occurrence was seen in 53 patients (51.9%) and IOOA was seen in 50 patients (48.04%). DVD was seen in 22 patients at the time of initial examination and in 31 patients postoperatively. IOOA at presentation was seen in 45 patients (44.1%) and 5 patients (8.8%) postoperatively. No statistical difference was found in the age of surgery, angle of deviation, mean follow?up, and mean refractive error within both groups. The postoperative motor outcome was statistically comparable between the two groups (P = 0.29). Sensory outcomes of fusion (P = 0.048) and stereopsis (P?value = 0.00063) were better in group A. Conclusion: No correlation was found between the age of occurrence and development of vertical deviation with refractive error, angle of deviation, age, or type of surgery. We found that motor outcomes are not affected but sensory outcomes are affected in patients with vertical deviations. This indicates that DVD and IOOA are developed due to inherent disruption of fusion and stereopsis

Infantile esotropia in Malaysian children: The impact of surgery on health-related quality of life assessment in patients and their parents

@#Introduction: Limited information is available on healthrelated quality of life (HRQoL) in children with strabismus in South East Asia. We aimed to evaluate the HRQoL and associated factors pre- and post-strabismus surgery in Malaysian children with infantile esotropia and their parents/guardians. Methods: A prospective study was conducted on children with infantile esotropia aged 8-17 years old and their parents/guardians who attended two tertiary hospitals with a paediatric ophthalmology service from 2017 to 2018. The patients and parents answered the Intermittent Exotropia Questionnaire (IXTQ), translated into Malay, at the time of enrolment and three months after the surgery. Results: Thirty-four children and one (each) of their parents/guardians were enrolled. Thirteen (38.2%) children had esotropia with angles of deviation of more than 50 prism dioptres. A total of 33 (97.1%) children achieved successful alignment correction three months after surgery. Surgery significantly improved the total mean scores of the children, which were 62.87 (17.05) preoperatively and 87.13 (13.26) postoperatively (p<0.001). There was statistically improvement in the total mean scores in the parent/guardian group, which was 37.07 (22.01) preoperatively and 75.39 (22.09) postoperatively (p<0.001). The parents/guardians functional, psychosocial and surgery subscales also had a significant increment in the score postoperatively (p<0.001). Older children and children with poorer visual acuity on presentation had a lower score preoperatively, while girls scored better postoperatively (p<0.05). Mothers scored significantly lower preoperatively and postoperatively (p<0.05). Conclusion: Surgery significantly improved the HRQoL score in Malaysian children with infantile esotropia and their parents/guardians. The score was significantly higher in female children after the surgery. Mothers exhibited poor scores before and after surgery

Risk Factors for Consecutive Exotropia and Hyperopic Changes after Bilateral Medial Rectus Recession

PURPOSE: To define risk factors for and to analyze changes in hyperopic refractive error during development of postoperative exotropia (XT) after bilateral medial rectus (BMR) recession to treat infantile esotropia. METHODS: We retrospectively examined 50 patients with infantile esotropia who underwent BMR recession from January 2005 to December 2010. All were +2.0 D) prior to BMR recession and a marked fall in the extent of hyperopia (−1.0 D/year) after recession may be associated with a high risk of consecutive XT. Thorough follow-up is necessary when IOOA develops after BMR recession.

Surgical Outcomes Dependent on the Amount of Hyperopia in Infantile Esotropia

PURPOSE: In the present study, short-term and long-term surgical outcomes dependent on the amount of hyperopia in patients with infantile esotropia were analyzed. METHODS: In this study, 80 patients with infantile esotropia who underwent both medial rectus recession from 2007 to 2011 and followed up for at least 36 months were retrospectively examined. The patients were divided into two groups according to the degree of hyperopia: ≥ +3.0 D (high hyperopia [HH], n = 59 patients) and < +3.0 D (non-high hyperopia [NH], n = 21 patients). Clinical characteristics analyzed included surgical success rate and dose-response relationship at the 3-month and 3-year postoperative follow-ups. RESULTS: Initial preoperative alignment (NH: 44.8 ± 10.2 PD, HH: 42.7 ± 11.6 PD, p = 0.450), surgical success rates (NH: 69.5% (41/59), HH: 71.4% (15/21), p = 0.837), under-correction rates (NH: 23.7% (14/59), HH: 9.5% (2/21), p = 0.191) and over-correction rates (NH: 6.8% (4/59), HH: 19.1% (4/21), p = 0.138) were not statistically significantly different between the NH and HH groups. A tendency towards a larger dose-response relationship was observed with HH (NH: 3.9 PD/mm, HH: 4.3 PD/mm) at the 3-month postoperative follow-up, but was not significant (p = 0.105). At the 3-year postoperative follow-up, exodrift was in progress and the dose-response relationship was significantly higher in the HH group than NH group (NH: 3.9 PD/mm, HH: 4.9 PD/mm, p = 0.010). A difference between the groups with amblyopia was observed (NH: 8.5% (5/59), HH: 23.8% (5/21), p = 0.146), although without statistical significance. CONCLUSIONS: The surgical success rate of infantile esotropia was not statistically associated with the amount of hyperopia. There was no statistical association between the dose-response relationship and amount of hyperopia at the postoperative 3-month follow-up, but a statistical association was found in the high dose-response relationship in the HH group at the postoperative 3-year follow-up. Therefore, the conventional amount of recession or muscle resection should be modified in high hyperopic (≥ +3.0 D) infantile esotropia, and long-term postoperative follow-up is necessary.

What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?

PURPOSE: To analyze pre- and post-operative factors associated with favorable long-term sensory outcome after surgical correction for infantile esotropia. METHODS: This study retrospectively examined 40 patients with infantile esotropia who underwent surgery from January 2000 to December 2010. Clinical characteristics analyzed included age at onset, age at surgery, mean preoperative deviation, amblyopia on initial visit, other associated strabismus (Inferior oblique overaction (IOOA), dissociated vertical deviation (DVD), latent nystagmus), initial and subsequent postoperative motor alignment at 1-week and 2-year follow-up, recurrence rate, and stereopsis. Long-term sensory outcome was categorized as favorable (400 arcsec). RESULTS: The mean follow-up period was 92.53 +/- 46.46 months. There were 19 patients (47.5%) in the favorable group and 21 (52.5%) in the unfavorable group. There were no statistically significant differences between the groups with respect to age at onset or surgery, presence of amblyopia, and prevalence of IOOA and DVD, latent nystagmus, or initial postoperative alignment at 1-week. There was a tendency towards worse binocularity with larger preoperative angles of esodeviation, but it was not significant. Binocularity was significantly higher among those who had surgery at age 24 months. Orthotropic alignment within +/-10 PD at 2-year follow-up was 68.4% in the favorable group and 38.1% in the unfavorable group. Reoperation was performed on 8 patients (38.1%) in the unfavorable group and no patients (0.0%) in the favorable group. CONCLUSIONS: Surgical correction of infantile esotropia within the first 2 years of life and maintenance of orthotropic alignment within +/-10 PD without additional surgery with a minimum follow-up of 2 years may be associated with favorable long-term sensory outcome in infantile esotropia.

Clinical Features and Surgical Outcomes of Infantile Esotropia According to the Age at Surgery

PURPOSE: To evaluate the clinical features, surgical outcome and factors influencing the surgical outcome of infantile esotropia according to the age at surgery. METHODS: Seventy patients with infantile esotropia followed for at least 6 months after surgery, were enrolled in a retrospective study. Patients were divided into 2 groups. Group 1 included 25 patients who underwent surgery before the age of 24 months and group 2 included 45 patients who underwent surgery after 24 months of age. The clinical characteristics including age at the initial visit, refractive error, angle of deviation, associated strabismus, success rate and reoperation rate were analyzed according to the age at surgery. RESULTS: The mean angle of esodeviation before surgery was 41.71PD and refractive error was +1.26D. Patients underwent bimedial rectus recessions at the mean age of 67.33 months. The age at the initial visit was significantly older in group 2. Surgical success is defined as the ocular alignment within +/-10PD in primary position at the last visit. Fourteen patients (56%) from group 1 and 29 (64.4%) from group 2 obtained surgical success. Reoperation was performed in 8 patients (32%) from group 1 and 8 (17.8%) from group 2, which was not statistically significantly different. Stereopsis better than 3,000 seconds of arc was obtained in 3 patients (50%) from group 1 and 16 (76.2%) from group 2. CONCLUSIONS: In group 2, the late-surgery group, the success rate was 64.4% and stereopsis was obtained in 76.2%. Surgical results were not different between the two groups.

Clinical Features and Surgical Outcomes of Infantile Esotropia According to the Age at Surgery

PURPOSE: To evaluate the clinical features, surgical outcome and factors influencing the surgical outcome of infantile esotropia according to the age at surgery. METHODS: Seventy patients with infantile esotropia followed for at least 6 months after surgery, were enrolled in a retrospective study. Patients were divided into 2 groups. Group 1 included 25 patients who underwent surgery before the age of 24 months and group 2 included 45 patients who underwent surgery after 24 months of age. The clinical characteristics including age at the initial visit, refractive error, angle of deviation, associated strabismus, success rate and reoperation rate were analyzed according to the age at surgery. RESULTS: The mean angle of esodeviation before surgery was 41.71PD and refractive error was +1.26D. Patients underwent bimedial rectus recessions at the mean age of 67.33 months. The age at the initial visit was significantly older in group 2. Surgical success is defined as the ocular alignment within +/-10PD in primary position at the last visit. Fourteen patients (56%) from group 1 and 29 (64.4%) from group 2 obtained surgical success. Reoperation was performed in 8 patients (32%) from group 1 and 8 (17.8%) from group 2, which was not statistically significantly different. Stereopsis better than 3,000 seconds of arc was obtained in 3 patients (50%) from group 1 and 16 (76.2%) from group 2. CONCLUSIONS: In group 2, the late-surgery group, the success rate was 64.4% and stereopsis was obtained in 76.2%. Surgical results were not different between the two groups.

Clinical Manifestations and Surgical Outcome of Infantile Esotropia

PURPOSE: To study the clinical manifestations and surgical outcome of infantile esotropia. METHODS: This review retrospectively examined 165 patients of infantile esotropia who had undergone recession of bilateral medial rectus muscles from April 1991 to September 2001 at our institute. We measured the binocular alignment and analyzed the long term surgical outcome. RESULTS: The average angle of deviation of 165 patients was 45.9 +/- 13.99PD (25 ~ 90PD) and the average refractive error was +sph 1.18 +/- 2.25D (-sph 7.00 ~ +sph 6.00D). Amblyopia was found in 48.4% of the patients, DVD in 12.7%, IOOA in 11.3%, and manifest latent nystagmus in 6.0%. A binocular alignment within 10 PD was achieved in 73.9% and 57.9% at the 2nd and 4th post-operative year respectively. CONCLUSIONS: The surgical outcome of bimedial rectus muscle recession in infantile esotropia was satisfactory in 74%, and 58% of the patients at the 2nd and 4th post-operative year respectively.

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.

Effect of Both Medial Rectus Recession in Large Angle Infantile Esotropia

PURPOSE: To evaluate of the effect of bilateral medial rectus recession in the patients who showed large angle (>50 prism diopters, PD) infantile esotropia as comparing small angle (50 PD, 14 patients) and small angle group (

Long-Term Alignment after Bimedial Rectus Recessions for Infantile Esotropia

PURPOSE: Long-term alignment after bimedial recti recessions for infantile esotropia were evaluated in 51 infantile esotropes with angle less than 55 PD. All patients were followed up for more than 2 years (Mean 4.5+/-2.0 years). METHODS: All the patients'charts were reviewed retrospectively. They were divided into three groups as follows: 1) orthophoria within +/-8PD, 2) esotropia, and 3) exotropia by final alignment. In each group, immediate postoperative angle of deviation, success rate and stereopsis were evaluated. And the relation between final alignment and immediate postoperative angle of deviation were studied. RESULTS: The mean preoperative deviation of all patients was 44.1+/-6.67 PD (22~54 PD). Monocular preference was shown in 49.1% (25 patients) at the initial visit. Twenty-eight patients (54.9%) were aligned within +/-8 PD of orthotropia after initial surgery and forty-three patients (83.4%) after the second operation. The immediate postoperative deviation averaged 1.2+/-5.17% PD of exotropia in 28 patients who were aligned within +/-8 PD of orthotropia at the last visit. The patients with deviation of +/-3PD immediately after surgery were found to be mostly aligned within +/-8 PD of orthotropia at the last visit (51.7%, p=0.07). Thirty-one of 42 patients (73.8%) had measurable stereopsis and 47.6% of these patients favorable stereopsis better than 800 seconds of arc. The most satisfactory results in the obtaining stereopsis was shown in the patients undergoing surgery between 1~2 years of age. CONCLUSIONS: Bimedial recti recessions for infantile esotropia less than 55 PD were effective as an initial procedure in long-term follow-up for more than 2 years. Orthotropia within +/-3 PD in the immediate postoperative period was desirable for the long-term alignment. Binocularity was best obtained by undergoing early surgery between 1~2 years of age.

Long-Term Results of Three or Four Horizontal Muscles Surgery in Large Angle Infantile Esotropia

Long-term surgical results for 3 or 4 horizontal muscles surgery were evaluated in 58 infantile esotropes with large angle of 55 PD or more. They were followed up for 2 years or more(mean 5.6+/-2.16 years). The mean preoperative deviation was 63.2(+/-5.30)PD, ranging from 55 to 75 PD. Monocular preference was shown in fifty seven percent(34 patients)at the first visit. Thirty eight patients(65.5%)were aligned within+/-8 PD of orthotropia after primary procedure and forty nine patients(84.5%)after the second operation. The immediate postoperative deviation averaged 4.8+/8.99 PD of exotropia in 38 patients all of whom were aligned within+/-8 PD of orthotropia at the last visit. Prospectively, the patients with immediate overcorrection of 4 to 9 PD of orthotropia after surgery were found to be mostly aligned within 8 PD of orthotropia at the last visit. Among the 49 patients with stereopsis testing, 29 patients(58%)had measurable stereopsis and 70%of these patients had favorable stereopsis of 800 seconds or less. In conclusion, 3 or 4 horizontal muscles surgery was effective as initial procedure in large angle infantile esotropia with 55 PD or more deviation. Small amount of exotropia less than 10 PD in the immediate postoperative period was desirable for the best long-term alignment.

Spontaneous Resolution of Infantile Esotropia

Infantile esotropia is an esodeviation with onset before six months of age, characterized by a large stable angle and initial alternation with cross fixation. The natural history of infantile esotropia has not yet been verified. A 39-month-old girl presented with a history of esotropia. She was firstnoted to constantly cross her eyes at three months of age. At the age of five months, she was diagnosed by one of the authors[SHH]to have 25 prism-diopters of esotropia with a low hyperopic refractive error of 0.50D sphere. At that time, she fixed and followed with either eye. Ductions and versions were full. On three more examinations in her first year, she consistently showed 25~30 prism-diopters of esotropia. Against medical recommendation, she did not undergo any surgery. At the age of 39 months, she was found to be orthophoric at distance and at near by another author[JMH]. She could not identify flies or animals in random dot stereograms or Titmus stereograms. At the age of four years, she was still orthophoric at distance and at near. All the ophthalmologic findings remained the same. At the age of five years, she developed exophoria and DVD OS. She still could not identify flies. In conclusion, in rare cases infantile esotropia with a relatively small angle may spontaneously resolve without any treatment.

Bilateral Medial Recti Recession in Infantile Esotropia

Twenty-seven patients with congnital esotropia underwent bilateral medial recti recessions and were follwed up for 6 months or more. The relationship between the amount of bilateral medial rectus recession, the pre- and postoperative alignment was analyzed. The success of sugery was defined from the undercorrection less than 10 prism diopter(PD) to the overcorrection less than 5PD. Nineteen of 27 patients(70.3%) were successful. 3 patients(11.1%) were undercorrected and five(18.5%) were overcorrected. Three patients who showed overcorrection more than 20PD were recessed 7mm or more. The standard deviation of postoperative alignment was 2.2 in patients with preoperative alignment less than 50PD, and 17.4 in those with 50PD or more. The difference was significant(p<0.05). When preoperative alignment was 25 to 55PD and the amount of surgery was 4 to 7mm, there was high linear correlation between the amount of surgery and the corrected angle. However, close observation for consecutive exotropia will be necessary when preoperative alignment is more than 50PD and the amount of recession is more than 7mm.

A Case of Dandy-Walker Variant Associated with Infantile Esotropia of Abnormaly Directed Extraocular Muscle

The Dandy-Wlaker syndrome is a developmental disoeder characterized by cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis and is usually associated with hydrocephalus. This syndrome is also associated with intracranial malformations such as agenesis of corpus callosum, and extracranial malformations such as facial anormalies (cleft palate, cleft lip, and ocular anomalies), polycystic kidney, and cardiac anormalies. Reported associated ophthalmic anomalies are microphthalmos, coloboma, and congenital cataract.We experienced a case of infantile esotropia in abnormal insertion and direction of lateral rectus muscle as a variant of the Dandy-Walker syndrome accompanied by cleft palate and cleft lip in a 19-month-old male infant. Subsequent treatment of the 30delta esodeviation and left inferior oblique muscle overaction, including resection of the lateral rectus muscle in both eyes and the myectomy of the inferior oblique muscle in the left eye, yielded satisfactory results, so we report this case, with a review of the pertinent literature, as the first case of Dandy-Walker syndrome associated with esotropia with abnormal course of lateral rectus muscle in Korea.

Dissociated Vertical Deviation after Correction of Infantile Esotropia

Dissociated vrtical deviation(DVD) is frequently associated with infantile esotropia. It is hard to find DVD before surgery for esodeviation, and usually found after surgery. We studied the occurrence of DVD in 176 patients who had had horizontal rectus muscle surgery for the correction of infantile esotropia and followed up for 6 months or more. DVD was seen in 78 patients(44.3%), preoperatively in 27 patients(34.6%) and postoperatively in 51 patients(65.4%). Among 51 patients with DVD after surgery, DVD occurred in 24.0% of patients with preoperative angle of esodeviation less than 50 PD and in 44.6% of patients with preoperative angle of esodeviation more than 51 PD(P0.05). Inferior oblique overaction(IOOA) was accompanied with DVD in 71.8% and occurred without DVD in 28.6%. This study revealed postoperative DVD developed more in large angle esotropia such as deviation angle greater than 51 PD, and IOOA was frequently accompanied. The result suggests that in large angle infantile esotropia with mild IOOA and DVD or fundus extorsion we may need the preventive correction of DVD and IOOA.

Amblyopia in Infantile Esotropia

Sixty-eight children who had undergone surgery for infantile esotropia were analysed. The mean follow-up time was 2.7 years. Thirty-two patients without amblyopia prior to surgery remained as such postoperatively except one child(3.1%). There were twenty-seven children that received treatment for amblyopia prior to strabismus surgery. Out of these, twenty children(20/27, 74%) developed recurrent amblyopia in postoperative follow-up period. Dissociated vertical deviation and/or inferior oblique overaction occurred in 21 children(21/39, 54%) in the group free of amblyopia, while those occurred in 16 children(16/29, 55%) in amblyopic group, postoperatively. In conclusion, children without amblyopia before surgery remained as such postoperatively. The development of postoperative vertical deviation such as DVD and IOOA is not related to the existence of amblyopia in postoperative periods.

Clinical Feature and Factors of Operative Result on Infantile Esotropia

We present the retrospective study to identify the clinical characteristics and the results of surgical correction for 50 patients with diagnosis of infantile esotropia at Soonchunhyang Chunan University Hospital from January 1990 to August 1994. The following results were obtained. Of 50 patients, 29(58%) patients were male and 21(42%)patients were female. Initial visit was most common between age of 2 and 3 years. 14% of patients were seen at age of 2 years or less. Average initial visit was 5.16 years. Esotropia was noted most commonly 2 to 4 month after birth in 23 patients(46%). Preoperative deviation angle was over 30PD in 88% of patients, and preoperative cycloplegic refraction showed +2.0D-O in 62%. The prevalence of associated findings such as amblyopia, dissociated vertical deviation(DVD), inferior oblique muscle overaction, and nystagmus were 32%, 14%, 38%, 4% by sequence. Surgical correction was performed before age of 2 year if noted at initial visit. The average age of surgical correction was 5.42 years. Bilateral medial rectus muscle recessions were performed in 30%, Unilateral resection and recession were performed in 35 patients(70%), Orthophoria(within +10 prism diopters) was achieved in 58% of the patients postoperatively. In 16% of patients residual esotropia of more than 20PD remained, which required further operation. These patients had average preoparative esotropia of 51PD and amblopia and inferior oblique overaction were seen in 87.5% preoperatively. We found that the two variables of amblyopia and inferior oblique muscle overaction lead to less satisfactory outcomes(P<0.01). Since amblyopia and inferior oblique muscle overaciton were seen more commonly in those patients that required reoperation. The average follow up time was 9.4 months.

Early Surgery for Infantile Esotropia

It is known that early surgery between 6 and 24 months of age obtains better binocularity in infantile esotropia. We selected 59 patients who had infantile esotropia with onset before 6 months of age and underwent surgery at 10 years of age or less. Stereopsis was tested in 51 patients after surgery. Thirty four patients(66.7%) showed gross stereopsis. The patients who underwent surgery at 2 years of age or less, developed gross stereopsis in 80.8%. The patients who had their eyes aligned their eyes between 2 and 4 years of age, gross stereopsis was demonstrated in 64.3%, white the patients underwent surgery more than 4 years of age developed gross stereopsis in 36.3%. The younger the patients at the time of surgery, the greater the percentage of gross stereopsis was shown(p0.05). This study revealed that early surgery, before 2 years of age, yields better outcome for sensory fusion and good alignment.

Infantile Esotropia

Authors reviewed 53 infantile esotropia patients in 218 patients who had undergone surgery for esotropia from January, 1986 to March, 1988. Of 53 patients, male were 29(54.7%) and female were 24(45.3%). Age when first seen by us ranged from 6 months to 12 years and 4 months. Patients with age below 2 years old were 28(52.7%). 32 patients(60.4%) had alternate fixation and 21 patients(39.6%) had monocular fixation. Angle of deviation over 35 prism diopters was found in 41 patients(77.4%). By cycloplegic refraction, of 106 eyes, 81 eyes(76.4%) were low hyperopes(plano - +3.0D). Associated clinical findings were inferior oblique overactions in 37 patients(69.8%), dissociated vertical divergences in 18 patients(34.0%), latent nystagmus in 3 patients(5.7%), superior oblique overaction in 1 patient(1.9%). The monocular recession and resection was performed as an initial surgical procedure. If a second procedure was required, same procedure was performed in the fellow eye. In the patients with inferior oblique overaction, inferior oblique myectomy was performed. Mean age at the time of operation was 4 years and 2 months. After surgery, of 53 patients, 45 patients were followed up for 6 months or over. Of 45 patients, postoperative angle within 10 prism diopters of orthophoria was found in 16(35.6%) after initial operation and in 33(73.3%) after reoperation. In patients with large angle of esodeviation(greater than 40 prism diopters), 6mm recession seemed to provide better results than 5mm recession after initial recess-resect procedure.