Management of Consecutive Exotropia

Zhale Rajavi; Hamideh Sabbaghi; Narges Behradfar; Mehdi Yaseri; Kourosh Sheibani

doi:10.4103/joco.joco_20_21

Management of Consecutive Exotropia

J Curr Ophthalmol. 2022 Jan 6;33(4):475-480. doi: 10.4103/joco.joco_20_21. eCollection 2021 Oct-Dec.

Authors

Zhale Rajavi^{1

2

3}, Hamideh Sabbaghi^{2

4}, Narges Behradfar⁴, Mehdi Yaseri⁵, Kourosh Sheibani⁶

Affiliations

¹ Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
⁶ Basir Eye Health Research Center, Tehran, Iran.

Abstract

Purpose: To determine the clinical characteristics and surgical outcomes of medial rectus (MR) advancement with or without lateral rectus (LR) recession in patients with consecutive exotropia.

Methods: This interventional case series was performed on patients with consecutive exotropia of more than 15 prism diopters (PD) at least 6 months after the esotropia surgery. All patients were operated using either unilateral or bilateral MR muscle advancement with or without simultaneous LR recession. Ocular deviation at far and near distances, adduction limitation, and exoshift were investigated at the follow-ups of 1 week, as well as 1, 3, and 6 months after the surgery. Operation was considered successful when the postoperative far deviation was <10 PD.

Results: Thirty patients were evaluated. The mean amount of MR advancement was 5.69 ± 1.33 mm with the mean dose response of 4.7 ± 3.3 and 4.55 ± 4.01 PD at 3 and 6-month follow-ups, respectively. Success rate was reduced from 93% at week 1 to 73% at month 6 due to postoperative exodrift, especially during the first 3 months. Preoperative exotropia was the only contributing factor in our study.

Conclusions: MR advancement was an effective surgical method for consecutive exotropia correction, especially in cases with MR underaction. Bilateral MR advancement and/or LR recession are suggested in cases with higher preoperative exodeviation. The presence of postoperative exodrift indicates longer follow-ups for patients.

Keywords: Advancement; Consecutive exotropia; Medial rectus muscle.