Risk factors for consecutive exotropia after esotropia surgery

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Esotropia, a condition of inward eye turning, is often treated with bilateral medial rectus (BMR) recession surgery.
• Postoperative consecutive exotropia, an outward eye deviation, can occur after BMR recession, impacting visual outcomes.
• Identifying risk factors for consecutive exotropia is crucial for surgical planning and patient management.

Purpose of the Study:

• To evaluate risk factors associated with the development of postoperative exotropia following BMR recession for esotropia.
• To compare patients who developed consecutive exotropia with a control group who maintained satisfactory alignment post-surgery.

Main Methods:

• A retrospective study of 108 patients undergoing BMR recession for esotropia.
• Comparison of 54 patients with consecutive exotropia to 54 controls with minimal postoperative esotropia.
• Evaluation of pre-operative amblyopia, dissociated vertical deviation (DVD), refractive error, inferior oblique overaction, and surgical history as potential risk factors.

Main Results:

• Amblyopia was significantly more prevalent in the exotropia group (50.5%) compared to controls (11.1%) (P < 0.001).
• Dissociated vertical deviation (DVD) was also significantly higher in the exotropia group (29.06%) versus controls (7.4%) (P = 0.003).
• Logistic regression identified DVD (OR 5.27) and amblyopia (OR 8.00) as significant predictors of consecutive exotropia.

Conclusions:

• Pre-operative amblyopia and the presence of dissociated vertical deviation (DVD) are correlated with an increased risk of developing consecutive exotropia after BMR recession for esotropia.
• These findings highlight the importance of assessing for amblyopia and DVD prior to strabismus surgery to anticipate potential postoperative complications.