Consecutive Exotropia After Bilateral Medial Rectus Recession for Infantile Esotropia

PURPOSE: To evaluate associated factors by comparing the patients with consecutive exotropia to the patients with orthophoria after undergoing surgery for infantile esotropia. METHODS: The study consisted of 50 patients who underwent bilateral medial rectus recession and attended follow-ups until eight years of age. The authors retrospectively investigated the clinical characteristics ofage at operation, duration between diagnosis and operation, the spherical equivalent of both eyes, the deviated angle at the first visit and immediately before the operation, the recession amount, and the total follow-up period. RESULTS: During the mean follow-up period of 78.51+/-54.70 months, 13 patients (26%) had consecutive exotropia, 27 patients (54%) had orthophoria and 10 patients (20%) had remnant esotropia. As the result of comparing orthophoric patients to consecutive exotropic patients, there were no significant differences in the birth weights, the deviated angles at the first visit and immediately before the operation, the spherical equivalents of both eyes, the ages at operation, the recession amounts, and the durations between diagnosis and operation. However, in consecutive exotropia, inferior oblique muscle overaction was 46.5%, dissociated vertical deviation was 46.5% in orthophoric patients, inferior oblique muscle overaction was 19.24%, and dissociated vertical deviation was 8.7%. CONCLUSIONS: A thorough follow-up is necessary when inferior oblique muscle overaction and dissociated vertical deviation occur after undergoing a bilateral medial rectus operation.

The Vertical Effect of Anterior Transposition of the Inferior Oblique Muscle for DVD with IOOA

Anterior transposition(AT) of inferior oblique muscle is an effective method to treat dissociated vertical deviation(DVD) with inferior oblique overaction(IOOA). We evaulated the clinical results of the AT and the correlation between preoperative conditions(DVD, IOOA) and postoperative vertical correction. The results was that the amount of anterior transposition was related with that of postoperative vertical correction, which was determined by the amount of preoperative DVD.

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.