Clinical risk factors for the development of consecutive exotropia:a comparative clinical study

AIM： To compare a group of patients with consecutive exotropia with patients who had ≤ 10 prism diopters （PD） esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. METHODS： The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. RESULTS： The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 （P=0.634）. There was no significant difference of preoperative near and distant deviations among two groups （P =0.835, 0.928 respectively）. The mean amount of medial rectus recession and lateral rectus resection was similar in both groups （P=0.412, 0.648 respectively）. Convergence insufficiency and neurological diseases were more frequent in group 1 （P-0.007, 0.045）. Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios （OR）： 5.75 （1.04-31.93）]. CONCLUSION： Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors.

Relation between preoperative hyperopia and surgical outcome in infantile esotropia

AIM: To evaluate the relation between preoperative hyperopia and surgical outcomes of infantile esotropia in patients younger than 24 months of age.METHODS: Medical records of patients who underwent bilateral medial rectus muscle recession for infantile esotropia between November 1, 2002 and December 1, 2011 were retrospectively reviewed. Patients were divided into two groups according to the degree of preoperative hyperopia. Group I had less than +3.0 diopter(D) of hyperopia and group II had between +3.0 and +5.0 D of hyperopia. Postoperative alignments were evaluated 1 wk, 3, 6 mo, and 1 y after surgery. Following the 1-year postoperative visit, patients were monitored yearly. Relationships between preoperative factors including hyperopia and postoperative outcomes were evaluated. RESULTS: Forty-six patients were included, with 33 patients in group I and 13 patients in group II. The preoperative mean refractive error was +0.88 D in group I and +3.45 D in group II. Surgical outcomes were not significantly different between groups at any postoperative time point examined. Cumulative probability of surgical success, prevalence of inferior oblique overaction, dissociated vertical deviation, and re-operation rate were not significantly different between groups.CONCLUSION: Preoperative moderate hyperopia(less than +5.0 D) did not affect the surgical outcome of infantile esotropia. Therefore, the surgical correction of esotropia should be considered when the angle of esodeviation is unchanged following hyperopia correction, even in children with moderate hyperopia.