Characteristics of Patients with Accommodative Esotropia Who Need Glasses for Stable Alignment after Myopic Shift

Purpose@#We analyzed the characteristics of patients with refractive accommodative esotropia (RAET) who required glasses for stable alignment after a myopic shift. @*Methods@#We retrospectively analyzed the medical records of patients diagnosed with RAET at the initial visit, and who had developed a myopic shift in both eyes over the 5-year follow-up period. To evaluate clinical factors associated with the persistence of esotropia after myopia, the enrolled patients were divided into two groups; patients with RAET who needed glasses for stable alignment after a myopic shift (unstable group) and patients with RAET whose esotropia resolved after a myopic shift (stable group). @*Results@#A total of 55 patients met the inclusion criteria. The mean follow-up period was 13.8 ± 5.7 years (5-27 years). Spherical equivalent (SE) refractive errors at the initial visit were +3.1 ± 1.6 diopters (D) (+1.00 to +7.25 D) and -1.5 ± 0.9 D (-4.38 to -0.5 D) at the last visit. Of the 55 RAET patients, 24 were included in the unstable group and 31 were included in the stable group. No significant differences in gender, age at diagnosis, SE refractive error, or angle of esotropia with glasses were observed between the two groups. However, significantly more patients failed the Lang I test or had anisometropia over 1.5 D at the last visit, and the duration between the onset of esotropia and prescribing glasses was significantly longer in the unstable group than in the stable group. @*Conclusions@#Glasses may be needed for stable alignment even after a myopic shift in RAET patients with long durations of misalignment, poor stereopsis, and anisometropia.

Characteristics of Patients with Accommodative Esotropia Who Need Glasses for Stable Alignment after Myopic Shift

Purpose@#We analyzed the characteristics of patients with refractive accommodative esotropia (RAET) who required glasses for stable alignment after a myopic shift. @*Methods@#We retrospectively analyzed the medical records of patients diagnosed with RAET at the initial visit, and who had developed a myopic shift in both eyes over the 5-year follow-up period. To evaluate clinical factors associated with the persistence of esotropia after myopia, the enrolled patients were divided into two groups; patients with RAET who needed glasses for stable alignment after a myopic shift (unstable group) and patients with RAET whose esotropia resolved after a myopic shift (stable group). @*Results@#A total of 55 patients met the inclusion criteria. The mean follow-up period was 13.8 ± 5.7 years (5-27 years). Spherical equivalent (SE) refractive errors at the initial visit were +3.1 ± 1.6 diopters (D) (+1.00 to +7.25 D) and -1.5 ± 0.9 D (-4.38 to -0.5 D) at the last visit. Of the 55 RAET patients, 24 were included in the unstable group and 31 were included in the stable group. No significant differences in gender, age at diagnosis, SE refractive error, or angle of esotropia with glasses were observed between the two groups. However, significantly more patients failed the Lang I test or had anisometropia over 1.5 D at the last visit, and the duration between the onset of esotropia and prescribing glasses was significantly longer in the unstable group than in the stable group. @*Conclusions@#Glasses may be needed for stable alignment even after a myopic shift in RAET patients with long durations of misalignment, poor stereopsis, and anisometropia.

Continuously Progressive Abducens Palsy after Coil Embolization

Purpose@#To report a case of continuously progressive abducens palsy after transarterial coil embolization.Case summary: A 42-year-old male was referred to the clinic due to binocular horizontal diplopia. The patient had a history of left direct carotid cavernous fistula (CCF) after head trauma, and his ocular symptoms developed 15 months after coil embolization for CCF. Visual acuity and pupil reaction of both eyes were normal. The ocular motility examination showed 14 prism diopters (PD) of left esotropia in the primary gaze with abduction limitation; therefore, the patient was diagnosed with left abducens palsy. There was no evidence of fistula recanalization or new abnormal lesions in follow-up brain imaging. After strabismus was stabilized with 35 PD of esotropia, strabismus surgery including left medial rectus muscle recession and lateral rectus resection was performed, and ocular alignment was normalized in the primary position. However, 2 years after surgery, left abducens palsy recurred and abduction limitation worsened to -4 over 10 months. Finally, the patient underwent superior rectus transposition and medial rectus re-recession, which improved his ocular alignment at primary position. Binocular diplopia was resolved at primary position. @*Conclusions@#Late-onset abducens palsy can occur after coil embolization and is likely to continue to progress. Because spontaneous regression is rare in late-onset palsy compared with acute-onset palsy, surgery should be considered when the strabismus becomes stabilized.

Changes in Esodeviation after Inferior Oblique Recession in Patients with Refractive Accommodative Esotropia and Inferior Oblique Overaction

Purpose@#To evaluate the changes in esodeviation after inferior oblique (IO) recession in patients with refractive accommoda-tive esotropia and IO overaction. @*Methods@#Graded IO recession was performed in 68 patients who were diagnosed with refractive accommodative esotropia with IO overaction. The patients were followed for at least 3 months after surgery and the angle of esodeviation with cor-rection was evaluated at distance and near at each follow-up evaluation. The patients were divided into two groups: patients who underwent unilateral IO recession (UIO-Rec) and patients who underwent bilateral IO recession (BIO-Rec). The change in esodeviation after surgery was compared between the two groups. @*Results@#A total of 68 patients were enrolled in this study, with 38 patients in the UIO-Rec group and 30 in the BIO-Rec group.In the UIO-Rec group, there was no statistically significant difference in esodeviation before and after surgery. In the BIO-Rec group, esodeviation at distance increased significantly 1 day postoperatively (p = 0.033). However, esodeviation returned to the preoperative value one week after surgery (p = 0.665). Changes in esodeviation at distance were significantly greater in the BIO-Rec group than in the UIO-Rec group one day after surgery (p = 0.044). @*Conclusions@#Bilateral IO-weakening surgery induced a transient increase in esodeviation in patients with refractive accom-modative esotropia. However, we found no evidence that well-controlled esotropia with corrected hyperopia became de-compensated after IO-weakening surgery, as induced esodeviation was minor and temporary.

Orbital Infarction Syndrome after Thrombectomy for Internal Carotid Artery Occlusion

Purpose@#To report a case of orbital infarction syndrome after thrombectomy for internal carotid artery (ICA) occlusion.Case summary: A 69-year-old female with a history of diabetes mellitus and hypertension was referred to our clinic because of acute right ocular pain and visual disturbance. The patient had a history of a right middle cerebral artery territory infarction following right ICA occlusion and her ocular symptoms developed 6 hours after thrombectomy treatment. The visual acuity was hand motion in the right eye and 20/20 in the left eye. Pupil dilation and a relative afferent pupillary defect were seen in her right eye.There was ptosis of the right eyelid, and the ocular motility examination showed all gaze limitations in the right eye. In fundus examinations, multiple white focal ischemic retinal lesions were observed in the right eye suggesting branch retinal artery occlusion. Slit lamp examination showed chemosis in the right eye. The patient was diagnosed with ocular infarction syndrome due to micro-thromboembolism of the ophthalmic artery which developed after the thrombectomy. @*Conclusions@#Orbital infarction syndrome can occur after thrombectomy. Therefore, it is necessary to consider the development of orbital infarction when patients present with sudden-onset ocular pain, visual loss, and ocular movement limitations after the procedure.

Surgical Outcomes of Patients with Intermittent Exotropia Exhibiting High Hyperopia and Emmetropia

Purpose@#We analyzed the clinical factors and surgical outcomes of patients with intermittent exotropia exhibiting high hyperopia and emmetropia. @*Methods@#Patients with intermittent exotropia who underwent strabismus surgery and were followed-up for at least one year between April 1999 and January 2018 were retrospectively reviewed. The patients were divided into two groups according to their preoperative spherical equivalent refractive error (SERE): a high hyperopia group (≥+4.00 diopters [D], group 1) and an emmetropia group (+0.50 to -0.50 D, group 2). The surgical outcomes of the groups were compared. @*Results@#We enrolled 74 patients, of whom 24 and 50 were included in groups 1 and 2, respectively. In group 1, the mean SERE was +5.00 D (+4.00 to +8.00 D) in the more affected eye and +2.81 D (+0.00 to +7.25 D) in the better eye. In group 1, the changes in SERE at one year after surgery were as follows: +1.24 D in the worse eye and +0.90 D in the better eye (both, p < 0.001). The mean exodeviation at one day postoperatively for distance and near were -1.25 prism diopters (PD) and 0.21 PD, respectively, in group 1, and -4.62 PD and -2.16 PD in group 2. Thus, group 1 exhibited less exodeviation in terms of both distance and near than did group 2 on day one postoperatively. However, no significant group difference was evident at one year postoperatively. @*Conclusions@#The surgical outcomes of intermittent exotropia patients with high hyperopia did not differ from those of patients with emmetropia.

Continuously Progressive Abducens Palsy after Coil Embolization

Purpose@#To report a case of continuously progressive abducens palsy after transarterial coil embolization.Case summary: A 42-year-old male was referred to the clinic due to binocular horizontal diplopia. The patient had a history of left direct carotid cavernous fistula (CCF) after head trauma, and his ocular symptoms developed 15 months after coil embolization for CCF. Visual acuity and pupil reaction of both eyes were normal. The ocular motility examination showed 14 prism diopters (PD) of left esotropia in the primary gaze with abduction limitation; therefore, the patient was diagnosed with left abducens palsy. There was no evidence of fistula recanalization or new abnormal lesions in follow-up brain imaging. After strabismus was stabilized with 35 PD of esotropia, strabismus surgery including left medial rectus muscle recession and lateral rectus resection was performed, and ocular alignment was normalized in the primary position. However, 2 years after surgery, left abducens palsy recurred and abduction limitation worsened to -4 over 10 months. Finally, the patient underwent superior rectus transposition and medial rectus re-recession, which improved his ocular alignment at primary position. Binocular diplopia was resolved at primary position. @*Conclusions@#Late-onset abducens palsy can occur after coil embolization and is likely to continue to progress. Because spontaneous regression is rare in late-onset palsy compared with acute-onset palsy, surgery should be considered when the strabismus becomes stabilized.

Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula

PURPOSE: We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF). CASE SUMMARY: A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a −4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed. CONCLUSIONS: Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.

Effects of Surgical Assistant's Level of Resident Training on Surgical Treatment of Intermittent Exotropia: Operation Time and Surgical Outcomes

PURPOSE: To evaluate the effects of the surgical assistant's level of resident training on operation time and surgical outcome in the surgical treatment of intermittent exotropia. METHODS: This study included 456 patients with intermittent exotropia who underwent lateral rectus recession and medial rectus resection and were followed up for 24 months after surgery. The patients were divided into two groups according to the surgical assistant's level of resident training: group F (surgery assisted by a first-year resident [n = 198]) and group S (surgery assisted by a second-, third-, or fourth-year resident [n = 258]). The operation time and surgical outcomes (postoperative exodeviation and the number of patients who underwent a second operation) were compared between the two groups. RESULTS: The average operation times in groups F and S were 36.54 ± 7.4 and 37.34 ± 9.94 minutes, respectively (p = 0.33). Immediate postoperative exodeviation was higher in group F (0.79 ± 3.82 prism diopters) than in group S (0.38 ± 3.75 prism diopters). However, repeated-measures analysis of variance revealed no significant difference in exodeviation between the two groups during the 24-month follow-up period (p = 0.45). A second operation was performed in 29.3% (58 / 198) of the patients in group F, and in 32.2% (83 / 258) of those in group S (p = 0.51). CONCLUSIONS: No significant difference in operation time was observed when we compared the effects of the level of resident training in the surgical treatment of intermittent exotropia. Although the immediate postoperative exodeviation was higher in patients who had undergone surgery assisted by a first-year resident, the surgical outcome during the 24-month follow-up was not significantly different.

Trochlear Nerve Palsy Caused by Quadrigeminal Cistern Lipoma

PURPOSE: To report a case of trochlear nerve palsy caused by quadrigeminal cistern lipoma located in the dorsal midbrain. CASE SUMMARY: A 65-year-old male visited our clinic for intermittent vertical diplopia over 2-year period. Symptoms of diplopia had worsened over the past two weeks. He had no previous medical history except having had diabetes for 1 month. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Pupillary examination was not remarkable. Extraocular examination showed 4 prism diopters (PD) left hypertropia at distant gaze and 4 PD exotropia at near gaze, with adduction elevation of the left eye. The Bielschowsky head tilt test revealed 6 PD left hypertropia on the left gaze and orthotropia on the right tilt. Fundus examination showed excyclotorsion of the right eye and incyclotorsion of the left eye. Brain magnetic resonance imaging revealed quadrigeminal cistern lipoma. Prism glasses were prescribed to alleviate diplopia, and we followed up the lesions without further treatment. CONCLUSIONS: Trochlear nerve palsy can be caused by quadrigeminal cistern lipoma; however, it is uncommon for this condition to be caused by a compressive lesion. Prompt neuroimaging can be helpful to rule out the causes of this condition in patients with atypical symptoms.

Wernicke's Encephalopathy Presenting with Bilateral Complete Horizontal and Downward Gaze Palsy in a Malnourished Patient

No abstract available.

Suddenly fixed upward ocular deviation under general anesthesia / 영남의대학술지

Various changes in ocular position are possible during general anesthesia as opposed to the awakening state. However, unexpected ocular deviation under general anesthesia is a disconcerting event as it can lead to difficult complications intraoperatively. To date, sudden fixed upward ocular deviation has been rarely reported previously. This phenomenon was observed in an 8-year-old boy during strabismus surgery. Suddenly fixed upward ocular deviation occurred when the speculum was inserted into the right eye. When the eyeball was pulled down, using forceps, there was some resistance, such as contracture of superior rectus. The eyeball sprang back into the upward position when the forceps was released. These changes could hamper the good exposition of the surgical field, leading to significant intraoperative difficulties and complications. Surgeons should be aware of this possibility, despite general anesthesia; if it occurs, proceed with the surgery as planned preoperatively, and both ophthalmic and anesthetic interventions should be used to solve this problem.

Slit Ventricle Syndrome in Pediatric Patient Presenting with Only Visual Symptoms

No abstract available.

A Case of Surgical Treatment of Large-angle Esotropia after Scleral Buckling without Buckle Removal

PURPOSE: Strabismus can occur after retinal reattachment surgery with scleral buckling (SB). We performed surgical treatment of a large-angle esotropia after SB without buckle removal and achieved good surgical outcome. CASE SUMMARY: A 21-year-male revisited our clinic for surgical treatment of esotropia. He had cicatricial retinopathy of prematurity in the right eye, and retinal detachment developed when he was 4 years old. Retinal reattachment surgery was performed with a 360-degree encircling band, a radial buckle at the 8 o'clock position, and a circumferential buckle ranging from the 7 to 11 o'clock position. He was not available for follow-up 2 years after surgery due to a change of residence, but exhibited a 5 prism diopters (PD) esotropia at the last visit. He demonstrated 55 PD esotropia of the right eye in the primary position with limited abduction. Surgery was performed without buckle removal, as recommended by a retinal specialist. Under general anesthesia, a forced duction test revealed a restriction of the medial rectus of the right eye. Exploration showed extensive adhesions around both the medial and lateral rectus with the buckle. Careful adhesiolysis and dissection were performed. A 8-mm resection of the lateral rectus and a 6-mm recession of the medial rectus were performed. The patient demonstrated favorable ocular alignment, and the limited abduction of the right eye improved after surgery. CONCLUSIONS: We report a case of surgical treatment of a large-angle esotropia after SB without buckle removal. This case can be helpful for surgeons planning the treatment of strabismus in patients who had undergone SB.

Suddenly fixed upward ocular deviation under general anesthesia / 영남의대학술지

Various changes in ocular position are possible during general anesthesia as opposed to the awakening state. However, unexpected ocular deviation under general anesthesia is a disconcerting event as it can lead to difficult complications intraoperatively. To date, sudden fixed upward ocular deviation has been rarely reported previously. This phenomenon was observed in an 8-year-old boy during strabismus surgery. Suddenly fixed upward ocular deviation occurred when the speculum was inserted into the right eye. When the eyeball was pulled down, using forceps, there was some resistance, such as contracture of superior rectus. The eyeball sprang back into the upward position when the forceps was released. These changes could hamper the good exposition of the surgical field, leading to significant intraoperative difficulties and complications. Surgeons should be aware of this possibility, despite general anesthesia; if it occurs, proceed with the surgery as planned preoperatively, and both ophthalmic and anesthetic interventions should be used to solve this problem.

The Stabilization of Postoperative Exo-drift in Intermittent Exotropia after Surgical Treatment

PURPOSE: To investigate the long-term clinical course of intermittent exotropia after surgical treatment to determine whether and when postoperative exo-drift stabilizes, and the required postsurgery follow-up duration in cases of intermittent exotropia. METHODS: We retrospectively reviewed the medical records of patients diagnosed with intermittent exotropia who underwent surgical treatment between January 1992 and January 2006 at Yeungnam University Hospital and postoperatively performed regular follow-up examinations for up to 7 years. We also analyzed the difference in exo-drift stabilization, according to surgical procedure. RESULTS: A total of 101 patients were enrolled in the study. Thirty-one patients underwent lateral rectus recession and medial rectus resection (R&R) and 70 patients underwent bilateral lateral rectus recession (BLR). The postoperative angles of deviation increased significantly during the initial 36 months, but no subsequent significant changes were observed for up to 84 months. Follow-ups for 7 years revealed that more than 50% of the total amount of exo-drift was observed within the first postoperative year. In addition, the angles of deviation at 1 year correlated with those at 7 years postoperatively (Pearson correlation coefficient r = 0.517, p < 0.001). No significant exo-drift was observed after 36 months in patients who underwent BLR, whereas after 18 months in patients who underwent R&R. CONCLUSIONS: The minimum postoperative follow-up required after surgical treatment to ensure stable results is 36 months. In particular, careful follow-up is necessary during the first postoperative year to detect rapid exo-drift. Patients who underwent BLR required a longer follow-up than those who underwent R&R to ensure stable postoperative alignment.

Ocular Syphilis Presenting as both Optic Neuritis and Chorioretinitis in both Eyes

PURPOSE: To report a patient with ocular syphilis, who showed variable ocular manifestations, including optic neuritis and chorioretinitis in both eyes over a short time period. CASE SUMMARY: A 44-year-male visited our clinic for central scotoma in the left eye. The visual acuity was 20/25 in the right eye and 20/40 in the left eye. The fundus of the left eye showed a slightly hyperemic optic disc and multiple yellowish deposits. One week later, visual acuity and fundus lesion improved to 20/20 without a definitive treatment. However, 1 month later, he reported a new deterioration of vision in his right eye to 20/40. The right eye had a relative afferent pupillary defect and the fundus examination showed a blurred optic disc margin. Serological work-up was recommended but the patient refused. He returned 3 weeks later with an improvement in the right eye vision (20/25) and a worsening in the left eye (20/200). The examination revealed an improvement of the previously blurred disc margin in the right eye and newly developed chorioretinitis with vasculitis in the left eye. A serological test was performed. The venereal diseases research laboratory titer was 1:32. The fluorescent treponemal antigen absorbance test as positive for IgG and IgM. He was diagnosed with ocular syphilis and referred to the infectious disease department. He was treated with antibiotics. Six months later, the visual acuity was 20/20 in both eyes and the previous fundus lesions had disappeared. CONCLUSIONS: Ocular syphilis should be considered in patients with atypical and variable clinical course.

Changes in Ocular Excyclotorsion According to Graded Inferior Oblique Recession

PURPOSE: To investigate changes in ocular excyclotorsion in patients with inferior oblique overaction (IOOA) according to amount of correction by graded inferior oblique recession and to compare the amount of excyclotorsion between primary IOOA and secondary IOOA. METHODS: This study included 54 eyes of 54 patients who were diagnosed with unilateral IOOA and underwent graded inferior oblique recession. Fundus photographs were taken pre- and postoperatively. The sum of angles of torsion of both eyes was used to analyze changes in excyclotorsion. The angle of excyclotorsion was analyzed using the ImageJ program. RESULTS: Eighteen eyes were grade 2, 24 eyes were grade 3 and 12 eyes were grade 4. Preoperative angle of excyclotorsion was 16.23 ± 5.96° for the patients with grade 2 eyes, 18.83 ± 5.76° for the patients with grade 3 eyes and 29.00 ± 10.23° for the patients with grade 4 eyes. Therefore, as the degree of IOOA increased, the amount of excyclotorsion became larger. There was no statistical significance between grade 2 and grade 3 (p = 0.467), however, there was a statistically significant difference between grade 3 and grade 4 (p < 0.001). Postoperative angle of excyclotorsion was significantly decreased in each group (grade 2: p = 0.020, grade 3: p < 0.001, grade 4: p = 0.041). The amount of surgical recession of inferior oblique muscle showed a positive correlation with a decrease in the angle of excyclotorsion, but was not statistically significant. The amount of excyclotorsion and the decrease of excyclotorsion after surgery were larger in secondary IOOA than in primary IOOA, but were not statistically significant (p = 0.260). CONCLUSIONS: As the preoperative degree of IOOA increased, the amount of correction of excyclotorsion became larger but there is no statistical significance. Correction of IOOA and excylclotorsion is expected after graded inferior oblique recession.

A Case of Reverse Amblyopia of the Dominant Eye that was Refractory to Treatment

PURPOSE: The treatment for reverse amblyopia is to discontinue occlusion therapy with most cases showing improvement of visual acuity in the dominant eye. Herein, we report a case of reverse amblyopia after monocular cataract surgery which was refractory to treatment and showed strabismus. CASE SUMMARY: A 3-month-old female was diagnosed with congenital cataract in her left eye and underwent aspiration of lenses, posterior capsulectomy, and anterior vitrectomy. After the surgery, her mother performed strict 6:1 occlusion therapy on her right eye as prescribed. The best corrected visual acuity measured for the first time at the age of 32 months was 1.70 in the right eye and 0.52 in the left eye and the patient was referred to the Pediatric Ophthalmology clinic. At that time, eccentric fixation with slight exotropia was observed. With the diagnosis of reverse amblyopia in the right eye, the occlusion therapy was postponed for several months, however, visual acuity in the right eye did not recover after 4 months. After the age of 3 years, she was treated with left eye occlusion therapy, but the vision was still low and eccentric fixation was observed. At the age of 5 years she was continuously treated with left eye occlusion and the eccentric fixation improved, and at 6 years of age, a secondary intraocular lens implantation was performed. At 9 years of age, the patient underwent lateral rectus recession and medial rectus resection in the right eye for the treatment of exotropia. CONCLUSIONS: In the case of monocular congenital cataract, occlusion therapy should be prescribed after surgical treatment. However, because reverse amblyopia which is refractory to treatment can occur, the fixation pattern should be monitored carefully and the occlusion duration controlled appropriately.

Surgical Outcomes and Prognostic Factors of Consecutive Exotropia

PURPOSE: In this study we evaluated the prognostic factors by comparing the clinical manifestation of consecutive exotropia after consecutive exotropia surgery. METHODS: We performed a retrospective study of 65 patients who had surgery due to consecutive exotropia after esotropia surgery in Yeungnam University Medical Center between July 1988 and December 2013. The type of esotropia, age at diagnosis of esotropia, type of esotropia surgery, age at esotropia surgery, type of consecutive exotropia surgery, age at consecutive exotropia surgery, presence of adduction limitation, presence of amblyopia, and preoperative and postoperative angles of strabismus were analyzed. RESULTS: The mean follow-up time after consecutive exotropia surgery was 5.1 +/- 5.2 years and 50 of 65 patients showed successful surgical outcomes at the last follow-up. Cumulative success rate of consecutive exotropia remained stable postoperatively in 68.2% of patients after 7.7 years. When comparing the success group and the recurrent group, the age at consecutive exotropia surgery was significantly younger and mean follow-up time was significantly longer in the recurrent group. The mean interval between consecutive exotropia surgery and recurrence of exotropia was 16.9 months in the recurrent group. The mean angle of strabismus at postoperative 1 week was significantly different between the 2 groups; 0.5 prism diopters (PD) esodeviation in the success group and 4.5 PD exodeviation in recurrent group. CONCLUSIONS: Recurrence of consecutive exotropia frequently developed with younger age at consecutive exotropia surgery and exodeviation at postoperative 1 week. Recurrent consecutive exotropia should be observed for an extended period, thus requiring periodic long-term postoperative follow-ups.