Clinical Course of Consecutive Esotropia after Surgery to Correct Recurrent Intermittent Exotropia

ABSTRACT

PURPOSE: To analyze the clinical aspects of consecutive esotropia after intermittent exotropia reoperation and study the prognosis and associated risk factors. METHODS: The present study included 34 patients with intermittent exotropia who underwent reoperation; incidence rate, risk factors, treatment methods and prognosis of the postoperative consecutive esotropia were analyzed. RESULTS: Of the 34 patients, 12 developed consecutive esotropia that persisted longer than a month after the reoperation; a higher incidence rate was observed in patients with esodeviation greater than 16 prism diopter (PD) on postoperative day 1 and in patients who received unilateral lateral muscle recession and medial muscle resection during the operation (p < 0.05). Conversely, factors such as age, deviation angle, refractive power, anisometropia, lateral incomitance and oblique muscle dysfunction prior to the reoperation did not affect the incidence of consecutive esotropia. The patients who developed consecutive esotropia received conservative treatments such as alternative occlusion therapy and fresnel prism wearing; 10 of 12 patients showed significant clinical improvements. CONCLUSIONS: Consecutive esotropia frequently occurs after intermittent exotropia reoperation if the patient had esodeviation greater than 16 PD on postoperative day 1 or received unilateral lateral muscle recession and medial muscle resection. The conservative treatments of the consecutive esotropia showed good clinical response and improved prognosis.