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Initial versus subsequent postoperative motor alignment in intermittent exotropia.

M S Ruttum1

  • 1Department of Ophthalmology, Children's Hospital of Wisconsin, Milwaukee, USA.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|June 1, 1997
PubMed
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Initial overcorrection after surgery for intermittent exotropia is not a guarantee of success. Postoperative alignment between orthotropia and 9 PD esotropia is desirable but doesn't ensure good outcomes.

Area of Science:

  • Ophthalmology
  • Strabismus Surgery
  • Pediatric Eye Care

Background:

  • Initial overcorrection is thought crucial for successful bilateral lateral rectus muscle recessions in intermittent exotropia.
  • However, not all patients achieving initial overcorrection experience favorable long-term results.

Purpose of the Study:

  • To investigate the correlation between immediate postoperative alignment and subsequent motor outcomes in intermittent exotropia patients.
  • To assess the predictability of surgical success based on early alignment measurements.

Main Methods:

  • A retrospective study included patients who underwent bilateral lateral rectus muscle recessions as their primary surgery for intermittent exotropia.
  • A minimum of 6 months of postoperative follow-up was required for inclusion.

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Main Results:

  • Good outcomes (≤10 PD exophoria or ≤5 PD esophoria) were achieved by 63% of 60 patients.
  • Undercorrection (>10 PD exodeviation) occurred in 25%, and overcorrection (>5 PD esodeviation) in 12%.
  • The highest likelihood of a good outcome was observed with initial alignment between orthotropia and 9 PD esotropia, though 22% in this group had suboptimal outcomes; 7 patients showed esotropic drift.

Conclusions:

  • While initial alignment between orthotropia and 9 PD esotropia is favorable for intermittent exotropia, it does not guarantee a successful final outcome.
  • Conversely, alignment outside this range does not predict a poor outcome.
  • The study highlights significant unpredictability in postoperative drift, potentially due to the artifactual nature of early measurements.