Decompensation of exodeviation after corneal refractive surgery for moderate to high myopia

To evaluate strabismus and binocular decompensation of exodeviation and their surgical treatment following corneal refractive surgery.

A retrospective study of a noncomparative case series was conducted. Seven patients whose strabismus worsened after photorefractive keratectomy or laser in-situ keratomileusis for correction of myopia underwent orthoptic evaluation before and after refractive surgery, as well as after corrective strabismus surgery. The motor alignment and regaining of binocularity after strabismus surgery to correct the misalignment following refractive corneal surgery were evaluated and compared at three time points.

After corneal refractive surgery, there was a deterioration in mean distance exodeviation from 7.1 +/- 5.2 to 25.7 +/- 10.1 prism diopters (PD) (P = .028) and in mean near exodeviation from 7.1 +/- 5.1 to 29.7 +/- 8.1 PD (P = .18), with loss of binocular function in 6 of the 7 patients. Following strabismus surgery, the mean distance exodeviation was reduced from 25.7 +/- 10.1 to 2.0 +/- 1.8 PD (P = .027) and the mean near exodeviation from 29.7 +/- 8.1 to 3.7 +/- 1.5 PD (P = .028). Five of the six patients regained binocular function.

All at-risk patients with exophoria and exotropia should undergo a thorough orthoptic evaluation before corneal refractive surgery. Patients with ocular motility and misalignment problems should be warned preoperatively of the risk of decompensation of their strabismus.