J Korean Ophthalmol Soc > Volume 59(3); 2018 > Article
Journal of the Korean Ophthalmological Society 2018;59(3):276-281.
DOI: https://doi.org/10.3341/jkos.2018.59.3.276    Published online March 15, 2018.
Risk Factors for Consecutive Exotropia and Hyperopic Changes after Bilateral Medial Rectus Recession.
Ki Woong Lee, Hae Jung Paik
Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea. hjpaik@gilhospital.com
영아내사시로 양안 내직근후전술 시행 후 속발외사시 발생 위험인자와 원시 굴절률의 변화
이기웅⋅백혜정
가천대학교 길병원 안과학교실
Correspondence:  Hae Jung Paik,
Email: hjpaik@gilhospital.com
Received: 2 November 2017   • Revised: 20 December 2017   • Accepted: 14 February 2018
Abstract
PURPOSE
To define risk factors for and to analyze changes in hyperopic refractive error during development of postoperative exotropia (XT) after bilateral medial rectus (BMR) recession to treat infantile esotropia. METHODS: We retrospectively examined 50 patients with infantile esotropia who underwent BMR recession from January 2005 to December 2010. All were < 10 years of age and underwent ≥36 months of follow-up. We recorded age at operation, the preoperative strabismus angle, the extent of medial rectus recession, strabismus status, pre- and post-operative changes in the refractive errors of both eyes, any postoperative overcorrection, any dissociated vertical deviation (DVD), and inferior oblique overaction (IOOA) status. RESULTS: Consecutive XT developed in 18 (36%) patients. The preoperative refractive error was +0.90 ± 0.79 D in the consecutive XT group and +1.94 ± 1.48 D in the surgical success (SS) group (p = 0.019). The extent of hyperopic decrease was significantly greater in the consecutive XT group than the SS group (consecutive XT group: 1.59 ± 1.38 D, SS group: 2.86 ± 1.97 D) at 3 years of post-operative follow-up (p = 0.008). Postoperative IOOA was detected in 10 (70.5%) patients in the consecutive XT group and 3 (29.55%) in the SS group (p = 0.002). No significant between-group difference in the incidence of overcorrection or DVD was apparent. CONCLUSIONS: The presence of hyperopia (>+2.0 D) prior to BMR recession and a marked fall in the extent of hyperopia (−1.0 D/year) after recession may be associated with a high risk of consecutive XT. Thorough follow-up is necessary when IOOA develops after BMR recession.
Key Words: Consecutive exotropia;Hyperopia;Infantile esotropia;Myopic change;Risk factor


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