Risk factors analysis of consecutive exotropia

Abstract

To evaluate clinical factors associated with the onset of consecutive exotropia (XT) following esotropia surgery.By a retrospective nested case-control design, we reviewed the medical records of 193 patients who had undergone initial esotropia surgery between 2008 and 2015, and had follow-up longer than 6 months. The probable risk factors were evaluated between groups 1 (consecutive XT) and 2 (non-consecutive exotropia). Pearson chi-square test and Mann–Whitney U test were used for univariate analysis, and conditional logistic regression model was applied for exploring the potential risk factors of consecutive XT.Consecutive exotropia occurred in 23 (11.9%) of 193 patients. Patients who had undergone large bilateral medial rectus recession (BMR) (P = 0.017) had a high risk of developing consecutive XT. Oblique dysfunction (P = 0.001), adduction limitation (P = 0.000) were associated with a high risk of consecutive XT, which was confirmed in the conditional logistic regression analysis. In addition, large amount of BMR (6 mm or more) was associated with higher incidence of adduction limitation (P = 0.045). The surgical methods and preoperative factors did not appear to influence the risk of developing consecutive XT (P > 0.05).The amount of surgery could be optimized to reduce the risk of consecutive XT. The presence of oblique overaction and postoperative adduction limitation may be associated with a high risk of consecutive XT, which may require close supervision, and/or even earlier operation intervention.

Clinical characteristics and surgical outcome in patient with consecutive exotropia

“…3.47± 5.36 years. In contrary to Gong, Q.et al [9] who reported a mean interval between the initial surgery and the XT operation was 37 (range, 1-90) months. On the other hand, Gesite et al [7] reported that the mean interval between surgery for esotropia and consecutive exotropia was 14.6± 19.3 years.…”

“…Consecutive exotropia (XT) is a manifest exotropia that develops either spontaneously or after optical or surgical treatment in a patient that formerly had esotropia (ET). It has been reported in 4% to 27% of patients after surgical treatment of exotropia [9] . Our study included 30 patients (16 females and 14 males) with established diagnosis of consecutive exotropia after surgery for esotropia with deviation angle ≥ 10 PD, aged from 3 to 25 years with the Mean age±SD was 11.07± 6.26 years .…”

Characteristics and risk factors for spontaneous and postoperative consecutive exotropia in children with esotropia

“…Ceylan et al ( 11 ) reported that 26.7% of the CXT group showed inferior oblique muscle overaction compared to 7.4% of the nonexotropic group. Oblique dysfunction leads to orthotropic instability and is not beneficial for long-term alignment, which may even accelerate the development of misalignment ( 12 ). Our results highlighted the strong influence of vertical deviation in affecting long-term alignment.…”