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.

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.