Results of conservative management for consecutive esotropia after intermittent exotropia surgery

Abstract

Purpose To examine the clinical course of consecutive esotropia (ET) using conservative management, after intermittent exotropia (IXT) surgery. Methods This study included 149 out of 151 consecutive patients with ET after IXT surgery, who were managed conservatively. The clinical course of consecutive ET was examined and the patients were classified into two groups based on the duration of esodeviation: (1) 43 weeks (persistent ET group, n = 56) and (2) o3 weeks (transient ET group, n = 93). Patient characteristics and treatment outcomes, including the recurrence of exotropia and stereopsis, were compared between the two groups. Results All patients with ET were managed with full-time alternate occlusion and/or with a Fresnel prism. In 149 patients out of 151 consecutive patients, 82% of ET disappeared at 12-month follow-up and all at the last followup visit (31.4 ± 23.5 months). At the final visit, a recurrence of exotropia of 410 prism dioptres was significantly less frequent in the persistent ET group than in the transient ET group (25% vs 62%, respectively; P = 0.01). However, stereopsis outcome was not significantly different between the two groups, and stereopsis change was not affected by age. Conclusions By using conservative management only, persistent consecutive ET after IXT surgery disappeared in most cases by the 1-year follow-up visit after surgery. Recurrence of exotropia was significantly less frequent in patients with persistent ET, yet the sensory outcome was not affected by the duration of consecutive ET or age.

Characteristics of Patients Who Are Not Responsive to Alternate Patching for Overcorrected Intermittent Exotropia

“…Mild surgical overcorrection immediately after IXT surgery can be transient because of the exodrift that typically occurs with time [ 7 12 15 23 ]. Consecutive esotropia, however, can result from persistent overcorrection.…”

“…Excessive overcorrection and consecutive esotropia after surgery for IXT can cause diplopia. In children it can also lead to worsening stereopsis and amblyopia, indicating the need for timely and proper treatment [ 15 16 ].…”

Botulinum toxin injection without electromyographic guidance in consecutive esotropia

“…Persistent consecutive esotropia could be managed in the following manner. First, prism glasses could be helpful to maintain fusion; however, despite its advantage, it requires considerable time to wean off of prism glasses [4][5][6]. Second, long-standing persistent consecutive esotropia may ultimately require additional surgery; however, long-term results of surgery for consecutive esotropia remain highly variable and unpredictable [7].…”

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“…The optimal time and indications for botulinum toxin injection in consecutive esotropia remain unclear [10]. Considering the natural exodrift after exotropia surgery, it is likely that small angles of esotropia may resolve spontaneously over time [3,4]. Park et al have shown that more than 50% of the total amount of exodrift was observed within the first postoperative year, but no subsequent changes were observed after 3 years [21].…”

“…Initial overcorrection is a common outcome of surgical treatment of intermittent exotropia, as it is considered as a good prognostic factor for long-term surgical success of intermittent exotropia [1,2]. While most patients with initial postoperative overcorrection gradually improve due to postoperative exodrift after exotropia surgery [3,4], persistent consecutive esotropia may be intolerable to patients or their parents. Persistent consecutive esotropia could be managed in the following manner.…”