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Risk factors associated with poor outcome after medial rectus resection for recurrent intermittent exotropia

  • Pediatrics
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Abstract

Purpose

To describe characteristics of recurrent intermittent exotropia after bilateral lateral rectus (BLR) recession, and identify factors associated with poor outcome after unilateral medial rectus (MR) resection for recurrent intermittent exotropia.

Methods

We retrospectively reviewed 124 patients who have undergone unilateral MR resection for recurrent intermittent exotropia after BLR recession. Patients were followed for at least 2 years after MR resection. Clinical characteristics and risk factors associated with poor outcome after unilateral MR resection were evaluated. Successful outcome was defined as distant deviation within the range of 4 prism diopters (PD) esotropia and 10 PD exotropia at last visit after MR resection.

Results

Among 124 patients, 50 patients (41.1%) were male, and the mean age at the time of MR resection was 9.5 ± 3.1 years. The average follow-up period after MR resection was 43.8 ± 23.7 months. Forty-seven patients (37.9%) were classified to have poor outcome at last visit, and 29 patients (23.4%) underwent third operation. None of the patients was overcorrected after MR resection. Multiple logistic regression analyses showed that distant deviation at post-operative 3 months and male gender were associated with poor outcome (OR 1.49; 95% CI 1.27–1.73; P < 0.001, and OR 5.19; 95% CI 1.42–18.98; P = 0.013, respectively).

Conclusion

Ocular deviation at 3 months after unilateral MR resection for recurrent intermittent exotropia may play a valuable role in anticipating poor outcome. Patients whose exotropia exceeded 9 PD at distance at 3 months’ follow-up tended to recur while those whose exotropia remained below 9 PD at distance showed a stable disease course.

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Authors and Affiliations

  1. Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Jihei Sara Lee & Sueng-Han Han

  2. Department of Ophthalmology, Gangnam Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea

    Jinu Han

Authors
  1. Jihei Sara Lee
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  2. Jinu Han
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Correspondence to Sueng-Han Han.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Supplementary figure 1

The course of post-operative angle of deviation following BLR for intermittent exotropia. The two groups did not show significant differences in exodrift during the 2 years of follow-up in both near deviation (A) and distant deviation (B) except for post-operative 1 year. (*P value <0.05.) (PPTX 1085 kb)

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Lee, J.S., Han, J. & Han, SH. Risk factors associated with poor outcome after medial rectus resection for recurrent intermittent exotropia. Graefes Arch Clin Exp Ophthalmol 258, 445–450 (2020). https://doi.org/10.1007/s00417-019-04510-z

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  • DOI: https://doi.org/10.1007/s00417-019-04510-z

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