Predicting Risk Factors for Consecutive Esotropia Failed with Conservative Therapy

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Consecutive esotropia can develop after surgical correction of intermittent exotropia.
• Nonsurgical treatments are often attempted for consecutive esotropia.
• Identifying risk factors for treatment failure is crucial for optimizing patient outcomes.

Purpose of the Study:

• To investigate risk factors associated with the failure of nonsurgical treatment in patients with consecutive esotropia.
• To identify predictors for unsuccessful conservative management of consecutive esotropia post-exotropia surgery.

Main Methods:

• Retrospective review of 270 patients (90 consecutive esotropia, 180 controls) who underwent surgery for intermittent exotropia (2013-2018).
• Case-control matching (1:2) comparing patients with failed nonsurgical treatment to those without.
• Analysis of factors including age at onset/surgery, amblyopia, preoperative deviation, surgical procedure type, and vertical deviations.

Main Results:

• Univariate analysis revealed significant associations between failed nonsurgical treatment and age at exotropia onset, age at surgery, amblyopia, preoperative deviation, surgical type, and vertical components.
• Conditional logistic regression identified age under 3 years at surgery and bilateral lateral rectus recession as significant risk factors for consecutive esotropia (p<0.01).

Conclusions:

• Early surgical intervention (before age 3) and bilateral symmetric procedures are associated with a higher risk of consecutive esotropia.
• Optimizing preoperative assessment, patient monitoring, and surgical techniques may help mitigate the risk of consecutive esotropia and improve treatment success.