Journal of Pediatric Ophthalmology and Strabismus

Original Article 

Immediate Postoperative Alignment Following Bimedial Rectus Recession for Esotropia in Children Compared to Adults

Mohamed B. Hassan, MD; Nancy N. Diehl, BS; Brian G. Mohney, MD

Abstract

Purpose:

To determine whether the immediate postoperative alignment among patients undergoing successful bilateral weakening surgery for esotropia is different in children compared to adults.

Methods:

The medical records of all patients undergoing surgery for esotropia by a single surgeon at a major academic referral center between January 1, 2002, and July 1, 2014 (n = 544), were retrospectively reviewed. Exclusion criteria included those with prior strabismus surgery, unilateral surgery, strengthening procedures, vertical or superior oblique surgery, and those wearing hyperopic spectacles for accommodative esotropia. Additionally, all patients had to have a 1- and 6-week postoperative examination and 8 prism diopters (PD) or less of deviation at their 6-week examination.

Results:

Ninety-five (17.5%) of the 544 patients met the inclusion criteria. Surgery was performed at a median age of 3.7 years (range: 7 months to 86 years) for a median esodeviation of 35 PD (range: 12 to 70 PD). Among the 73 patients younger than 11 years, the immediate mean postoperative alignment was 9 PD of exotropia (range: 14 PD esotropia to 30 PD exotropia) compared to 2 PD of exotropia (range: 9 PD esotropia to 30 PD exotropia) in the 22 patients 11 years or older (P = .001). Seventy-one percent of successfully aligned patients younger than 11 years were exotropic in the immediate postoperative week compared to 23% of those 11 years or older (P < .001). Twenty-four (32.8%) of the younger cohort had an immediate overcorrection of 15 PD or more compared to 1 (4.5%) in the older cohort (P = .006).

Conclusions:

Successful bilateral strabismus surgery for children with esotropia results in a significantly greater overcorrection, compared to adults, in the immediate postoperative period.

[J Pediatr Ophthalmol Strabismus. 2018;55(5):299-305.]

Abstract

Purpose:

To determine whether the immediate postoperative alignment among patients undergoing successful bilateral weakening surgery for esotropia is different in children compared to adults.

Methods:

The medical records of all patients undergoing surgery for esotropia by a single surgeon at a major academic referral center between January 1, 2002, and July 1, 2014 (n = 544), were retrospectively reviewed. Exclusion criteria included those with prior strabismus surgery, unilateral surgery, strengthening procedures, vertical or superior oblique surgery, and those wearing hyperopic spectacles for accommodative esotropia. Additionally, all patients had to have a 1- and 6-week postoperative examination and 8 prism diopters (PD) or less of deviation at their 6-week examination.

Results:

Ninety-five (17.5%) of the 544 patients met the inclusion criteria. Surgery was performed at a median age of 3.7 years (range: 7 months to 86 years) for a median esodeviation of 35 PD (range: 12 to 70 PD). Among the 73 patients younger than 11 years, the immediate mean postoperative alignment was 9 PD of exotropia (range: 14 PD esotropia to 30 PD exotropia) compared to 2 PD of exotropia (range: 9 PD esotropia to 30 PD exotropia) in the 22 patients 11 years or older (P = .001). Seventy-one percent of successfully aligned patients younger than 11 years were exotropic in the immediate postoperative week compared to 23% of those 11 years or older (P < .001). Twenty-four (32.8%) of the younger cohort had an immediate overcorrection of 15 PD or more compared to 1 (4.5%) in the older cohort (P = .006).

Conclusions:

Successful bilateral strabismus surgery for children with esotropia results in a significantly greater overcorrection, compared to adults, in the immediate postoperative period.

[J Pediatr Ophthalmol Strabismus. 2018;55(5):299-305.]

Introduction

Strabismus, a common disorder of ocular alignment, affects up to 4% of children and a similar proportion of adults.1–3 Esodeviations predominate, especially among children in Western populations, for which strabismus surgery is commonly recommended.1 The success of strabismus surgery can often be gauged by the immediate postoperative angle of deviation. For example, surgery for intermittent exotropia is more likely to be successful if the immediate postoperative angle of deviation is 5 to 10 prism diopters (PD) of esotropia.4,5 Literature regarding the ideal immediate postoperative alignment for patients undergoing successful surgery for esotropia is lacking, making it difficult to predict the long-term success of strabismus surgery based on initial postoperative measurements. The purpose of this study was to investigate the immediate postoperative alignment among patients undergoing successful surgery for esotropia and to determine whether there are differences between children and adults.

Patients and Methods

The medical records of all patients (n = 544) undergoing surgery for esotropia by a single surgeon (BGM) from January 1, 2002, through July 1, 2014, were retrospectively reviewed for demographic and ophthalmic findings. Institutional review board approval was obtained for this study and Health Insurance Portability and Accountability Act compliance was ensured for all research participants.

The angle of deviation was determined by the alternate prism cover test at both 3 m and 33 cm in most patients older than 1 year and by the Krimsky technique in infants. Cycloplegic refraction was performed using 2% cyclopentolate in patients older than 1 year and 1% cyclopentolate in those younger than 1 year. Patients were excluded if they had prior strabismus surgery, unilateral surgery, strengthening procedures, and vertical or superior oblique surgery. Children with sensory or paralytic strabismus and patients with partially accommodative esotropia were excluded because many failed to wear glasses to their first postoperative examination. None of the patients had adjustable strabismus surgery because this technique is not performed by the study surgeon. The millimeter amount of bimedial recession performed for the angle of esotropia, shown in Table 1, is based on the maximum angle observed preoperatively. The crossed-sword technique of reattaching the recessed muscle to the sclera was performed for all patients. Motor alignment was assessed by the surgeon at the 1-week (range: 1 to 7 days) and 6-week (range: 4 to 8 weeks) postoperative follow-up examinations. Only patients who had a 1-week postoperative examination and those considered to have successful surgery (≤ 8 PD of deviation) at their 6-week postoperative examination were included in the study.

Amount of Bimedial Recession for Measured Amount of Esodeviation

Table 1:

Amount of Bimedial Recession for Measured Amount of Esodeviation

Continuous data are presented as a median with a range, whereas categorical data are presented as numbers and percentages. Comparisons between the age groups for continuous variables were completed using Wilcoxon ranked-sum tests and comparisons between the age groups for categorical variables were completed using the Fisher's exact test. All statistical tests were two-sided, with the threshold of significance set at .05 and an alpha level of 0.05.

Results

Ninety-five (17.5%) of the 544 cases met the inclusion criteria and their demographic and perioperative characteristics are shown in Table 2. Seventy-three (76.8%) of the 95 patients were younger than 11 years, whereas 22 (23.2%) were 11 years or older (only 2 of these were younger than 18 years). Males represented 48 (50.5%) of the study patients. Surgery was performed at a median age of 3.7 years (range: 7 months to 86 years) for a median esodeviation of 35 PD (range: 12 to 70 PD). Patients younger than 11 years had a mean preoperative deviation of 39 PD (range: 12 to 70 PD) of esotropia compared to 27.6 PD (range: 12 to 45 PD) for those 11 years or older (P = .001). The median age at surgery was 2.4 years (range: 7.4 months to 10.7 years) for those younger than 11 years and 55 years (range: 12.8 to 85.6 years) for those 11 years or older. Eighty-two (86.3%) of the 95 patients had a recession of both medial rectus muscles only, whereas the remaining 13 (13.7%) had inferior oblique surgery concurrently. The median recession was 5.5 mm (range: 3 to 7 mm) in those younger than 11 years and 4.75 mm (range: 3.5 to 6.5 mm) in those 11 years or older (P = .006). Fifty (68.5%) of those younger than 11 years had a recession of 5 mm or greater compared to 11 (50.0%) of those 11 years or older (P = .13).

Clinical and Perioperative Characteristics of Patients With Esotropia (N = 95)a

Table 2:

Clinical and Perioperative Characteristics of Patients With Esotropia (N = 95)

Tables 34 show the 1-week, 6-week, and final postoperative follow-up examination results. Among the 73 patients younger than 11 years, the immediate mean postoperative alignment was 8.8 PD of exotropia (range: 14 PD esotropia to 30 PD exotropia) compared to a mean of 1.8 PD of exotropia (range: 9 PD esotropia to 30 PD exotropia) in the 22 patients 11 years or older (P = .001). Exotropia was the most common deviation in the first postoperative week among those in their first decade of life (71.3%), whereas orthotropia was predominant in the older cohort (59.1%). Twenty-four (32.8%) of the younger cohort had an immediate overcorrection of 15 PD or more compared to 1 (4.5%) in the older cohort (P = .006), including 1 patient in each group who was initially overcorrected by 30 PD (Table 4).

Postoperative Findings in Esotropic Patients Successfully Aligned at 6 Weeks After Surgery

Table 3:

Postoperative Findings in Esotropic Patients Successfully Aligned at 6 Weeks After Surgery

Preoperative, 1-Week Postoperative, 6-Week Postoperative, and Last Visit Examination Deviations (PD) by Patient

Table 4:

Preoperative, 1-Week Postoperative, 6-Week Postoperative, and Last Visit Examination Deviations (PD) by Patient

At the 6-week postoperative examination, patients younger than 11 years had a mean postoperative alignment of 1.5 PD of esotropia (range: 8 PD esotropia to 8 PD exotropia) compared to 1.1 PD of esotropia (range: 8 PD esotropia to 6 PD exotropia) for those 11 years or older (P = .56). The most common deviation at the 6-week follow-up among those in their first decade was orthotropia (56.2%) and 67 (91.8%) were between orthotropia and 8 PD of esotropia. For those 11 years or older, orthotropia was also the most common deviation (68.2%), and 21 patients (95.5%) were between orthotropia and 8 PD of esotropia. Only 5 (5.3%) of the study patients had 6-week exotropic deviations of 6 PD or greater.

Sixty-two (84.9%) patients younger than 11 years had a follow-up examination after their 6-week follow-up compared to only 12 (54.5%) of those 11 years or older. The median time between surgery and last follow-up was 3.4 years (range: 6 months to 11.2 years) for patients younger than 11 years and 1.2 years (range: 4 months to 3.9 years) for patients 11 years or older (P = .001). Among the patients younger than 11 years, the final visit mean alignment was 1.2 PD of esotropia compared to a mean of 3.8 PD of esotropia for those 11 years or older. At the final examination, 33.9% of those younger than 11 years were found to be orthotropic, and 61.3% were between orthotropia and 8 PD of esotropia. For those 11 years or older, 16.7% were found to be orthotropic at the final visit and 83.3% were between orthotropia and 8 PD of esotropia.

Discussion

Children in the first decade of life undergoing bilateral surgery for esotropia have a larger mean overcorrection in the immediate postoperative period when compared to those 11 years or older. Seventy-one percent of the younger age group were exotropic in the immediate postoperative period compared to 23% of those 11 years or older. One-third of the younger cohort had an immediate overcorrection of 15 PD or more compared to less than 5% in the older cohort, including 1 patient in each cohort who was initially overcorrected by 30 PD. At the 6-week postoperative examination, this difference was lost and 92.6% of patients were aligned between orthotropia and 8 PD of esotropia.

Overcorrection in the immediate postoperative period to achieve success in strabismus surgery is not a novel concept. There are published reports advocating such an approach for children with intermittent exotropia.5–8 Ruttum5 reported that children who had surgery for intermittent exotropia had better long-term outcomes if they were initially overcorrected to 0 to 9 PD of esotropia immediately following surgery. Similarly, Choi et al.9 observed children who were overcorrected to more than 10 PD of esotropia immediately after surgery and found that they were aligned closer to orthotropia after 1 year, with a mean deviation of 1.8 PD of esotropia. However, less postoperative data exist for adults with exotropia and therefore it is unknown whether there is a difference in the immediate postoperative alignment in adults compared to children.

Overcorrection for esotropia in the immediate postoperative period has not been rigorously studied.10 Although Dankner et al.4 found that an immediate overcorrection of less than 10 PD in patients undergoing surgery for esotropia led to significantly higher rates of fusion, they cautioned that larger overcorrections could lead to worse outcomes, making the ideal immediate postoperative goal a more difficult one to gauge and achieve. There is otherwise a deficiency of studies analyzing the immediate postoperative state for patients with esotropia.

It is unclear why children with esotropia would have a greater immediate postoperative overcorrection compared to adults. Park et al.11 hypothesized that differences in adaptation to sensory input between children and adults with exotropia could explain the differences in postoperative responses and alignment. Additionally, the co-activation of both the agonist and antagonist muscles of paired skeletal muscles has been shown to occur at higher levels in children.12,13 Similar to skeletal muscles, the extraocular muscles are also striated, voluntarily controlled, and have agonist-antagonist pairing. A higher level of co-activation of the pair could potentially explain the larger immediate postoperative overcorrection seen in children. Finally, the lateral rectus muscle has been found to be longer than the medial rectus muscle.14 This muscle length difference may be accentuated in children, given their smaller orbit, with recession of the medial rectus muscle.

The age at which this cohort was divided for comparison (ie, younger than 11 years compared to 11 years or older) was arbitrary. In fact, statistical significance for a difference in the postoperative deviation was obtained at several age cut-offs. An immediate overcorrection of 15 PD or more occurred only once beyond 6 years of age in this cohort and that, remarkably, in a patient 43 years of age who, 4 years after surgery, maintained an alignment of 2 PD of esotropia. Regardless of whether the tendency to exhibit less overcorrection in the immediate postoperative period occurs as the patient approaches the first decade of life or sometime before or after, this study found significantly less overcorrection occurs with increasing age in patients undergoing successful surgery for esotropia. A similar effect seems likely in patients undergoing successful bilateral surgery for exotropia.

There are limitations to the findings of this study. The retrospective nature of this investigation is hindered by incomplete data and irregular follow-up. Moreover, the study cases were drawn from the practice of one surgeon. This study is also restricted by a small sample size, especially the number of patients aged 11 years or older, which limits the conclusions drawn from these findings. However, statistical significance in the postoperative alignment was still observed, and significance was maintained even if the cut-off age for the two groups was increased, leaving even fewer patients in the older cohort. Finally, given the inclusion criteria of requiring both 1- and 6-week postoperative examinations, this was not a consecutive series of patients undergoing surgery for esotropia and may have unexpectedly eliminated some patients with less overcorrection.

The decision to assign the 6-week postoperative alignment as a measure of success in this cohort is not without problems and may be considered by some as being too short. However, our primary aim was to evaluate and compare immediate postoperative alignment for patients of various ages who met some measure of success, and the 6-week postoperative examination is generally acknowledged as the full healing period. For example, there were no differences in alignment between the two age groups at the 6-week examination, with most patients (92.6%) demonstrating alignment between orthotropia and 8 PD of esotropia.

Children younger than 11 years who undergo successful surgery for esotropia are significantly more likely to exhibit overcorrection in the immediate postoperative period when compared to those 11 years or older. Successfully aligned esotropic children were more significantly exotropic, including one-third with 15 PD or more of exotropia, in the first postoperative week compared to adults undergoing the same procedure.

References

  1. Mohney BG. Common forms of childhood strabismus in an incidence cohort. Am J Ophthalmol. 2007;144:465–467. doi:10.1016/j.ajo.2007.06.011 [CrossRef]
  2. Greenberg AE, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood esotropia: a population-based study. Ophthalmology. 2007;114:170–174. doi:10.1016/j.ophtha.2006.05.072 [CrossRef]
  3. Martinez-Thompson JM, Diehl NN, Holmes JM, Mohoney BG. Incidence, types, and lifetime risk of adult-onset strabismus. Ophthalmology. 2014;121:877–882. doi:10.1016/j.ophtha.2013.10.030 [CrossRef]
  4. Dankner SR, Mash AJ, Jampolsky A. Intentional surgical overcorrection of acquired esotropia. Arch Ophthalmol. 1978;96:1848–1852. doi:10.1001/archopht.1978.03910060360013 [CrossRef]
  5. Ruttum MS. Initial versus subsequent postoperative motor alignment in intermittent exotropia. J AAPOS. 1997;1:88–91. doi:10.1016/S1091-8531(97)90004-5 [CrossRef]
  6. Raab EL, Parks MM. Recession of the lateral recti: early and late postoperative alignments. Arch Ophthalmol. 1969;82:203–208. doi:10.1001/archopht.1969.00990020205010 [CrossRef]
  7. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981;99:1814–1818. doi:10.1001/archopht.1981.03930020688013 [CrossRef]
  8. McNeer KW. Observations on the surgical correction of childhood intermittent exotropia. Am Orthopt J. 1987;37:135–150. doi:10.1080/0065955X.1987.11981748 [CrossRef]
  9. Choi J, Kim SJ, Yu YS. Initial postoperative deviation as a predictor of long-term outcome after surgery for intermittent exotropia. J AAPOS. 2011;15:224–229. doi:10.1016/j.jaapos.2010.12.019 [CrossRef]
  10. Pineles SL, Deitz LW, Velez FG. Postoperative outcomes of patients initially overcorrected for intermittent exotropia. J AAPOS. 2011;15:527–531. doi:10.1016/j.jaapos.2011.08.007 [CrossRef]
  11. Park HJ, Kong SM, Baek SH. Consecutive esodeviation after exotropia surgery in patients older than 15 years: comparison with younger patients. Korean J Ophthalmol. 2008;22:178–182. doi:10.3341/kjo.2008.22.3.178 [CrossRef]
  12. Dotan R, Mitchell C, Cohen R, Klentrou P, Gabriel D, Falk B. Child-adult differences in muscle activation: a review. Pediatr Exerc Sci. 2012;24:2–21. doi:10.1123/pes.24.1.2 [CrossRef]
  13. Frost G, Dowling J, Dyson K, Bar-Or O. Cocontraction in three age groups of children during treadmill locomotion. J Electromyogr Kinesiol. 1997;7:179–186. doi:10.1016/S1050-6411(97)84626-3 [CrossRef]
  14. Villarreal-Silva EE, Hinojosa Amaya JM, Bazaldua Cruz JJ, Fernández DM, Elizondo-Omaña RE, López SG. A morphometric study of the extraocular muscles. Int. J. Morphol. 2013;31:312–320. doi:10.4067/S0717-95022013000100049 [CrossRef]

Amount of Bimedial Recession for Measured Amount of Esodeviation

Esodeviation (PD)Bimedial Recession (mm)
123.0
153.5
204.0
254.5
305.0
355.5
406.0
456.25
506.5
60 and larger7.0

Clinical and Perioperative Characteristics of Patients With Esotropia (N = 95)a

CharacteristicOverall (N = 95)Age < 11 Years (n = 73)Age ≥ 11 Years (n = 22)P
Sex.63
  Male48 (50.5%)38 (52.1%)10 (45.5%)
  Female47 (49.5%)35 (47.9%)12 (54.5%)
Preoperative deviation.01
  ET90 (94.7%)72 (98.6%)18 (81.8%)
  ET & LHT4 (4.2%)1 (1.4%)3 (13.6%)
  ET & RHT1 (1.1%)0 (0%)1 (4.5%)
Preoperative PD (ET).001
  Median (range)35 (12 to 70)35 (12 to 70)28.5 (12 to 45)
  Mean ± SD36.3 ± 14.239.0 ± 14.527.6 ± 8.5
Method of alignment.04
  APCT80 (84.2%)59 (80.8%)21 (95.5%)
  Krimsky13 (13.7%)13 (17.8%)0 (0%)
  SPCT2 (2.1%)1 (1.4%)1 (4.5%)
Version.86
  Normal82 (86.3%)63 (86.3%)19 (86.4%)
  IO OA OS3 (3.2%)2 (2.7%)1 (4.5%)
  IO OA OU10 (10.5%)8 (11.0%)2 (9.1%)
A-V pattern.78
  None87 (91.6)67 (91.8)20 (90.9)
  A-pattern6 (6.3)4 (5.5)2 (9.1)
  V-pattern2 (2.1)2 (2.7)0 (0)
Median age at surgery (range)3.7 (7.4 m to 85.6 y)2.4 (7.4 m to 10.7 y)55 (12.8 y to 85.6 y)< .001
Surgical procedure.08
  Recession both medial82 (86.3)63 (86.3)19 (86.4)
  Recession both medial & both IO11 (11.6)10 (13.7)1 (4.5)
  Recession both medial & right IO1 (1.0)0 (0)1 (4.5)
  Recession both medial & anterior transposition left IO1 (1.0)0 (0)1 (4.5)
Median medial rectus recession, mm (range)5 (3 to 7)5.5 (3 to 7)4.75 (3.5 to 6.5).006
≥ 5 mm recessed61 (64.2%)50 (68.5%)11 (50.0%).13

Preoperative, 1-Week Postoperative, 6-Week Postoperative, and Last Visit Examination Deviations (PD) by Patient

Age at SurgeryPreop1 Week Postop6 Weeks PostopFinal Exam (Months After Surgery)Age at SurgeryPreop1 Week Postop6 Weeks PostopFinal Exam (Months After Surgery)
7m70ET10XT8ET4XT (67)3y18ETOrtho8ETOrtho (33)
8m70ET15XTOrthoOrtho (34)3y30ET4ET3ET4ET (18)
8m55ET15XT6XT6XT (10)3y40ET3XT6ET3ET (11)
9m70ET8XTOrtho18XT (36)3y18ET4XT6XT4XT (5)
9m40ET20XT4ET3y45ET5XTOrtho2XT (9)
10m60ET25XTOrtho12XT (28)3y25ET22XTOrtho10XT (15)
10m60ET20XT5ET8ET (49)3y30ET6ETOrtho
10m35ET20XTOrtho3y40ET2ETOrthoOrtho (29)
11m55ET10XTOrtho16ET (79)4y25ETOrtho8ETOrtho (116)
11m20ET20XTOrtho14XT (69)4y55ET14ETOrtho10ET (7)
135ET30XTOrtho0DHD (130)4y25ET4XTOrtho8ET (42)
135ET10XT8ET35ET (109)4y50ET2XTOrtho30XT (50)
150ETOrtho6ETOrtho (26)4y35ET18XTOrtho1ET (37)
130ET15XTOrtho4ET (25)5y25ET6XTOrtho2ET (24)
145ET14XTOrtho10XT (134)5y16ETOrtho3ET14ET (72)
120ET15XTOrthoOrtho (11)5y40ET10XT2ET
135ET10XT5ET5y45ETOrthoOrtho
135ET4XTOrtho8ET (78)6y25ET3ET6ET6ET (61)
150ET20XTOrtho6ET (86)6y25ET2XTOrtho4ET (44)
155ET18XT8ETOrtho (9)6y25ET20XT8XT20XT (28)
170ET20XT6ETOrtho (84)8y55ETOrthoOrthoOrtho (21)
135ET20XT5XT2ET (17)9y30ET&LHT4ET5ET7ET (34)
135ET20XTOrtho10XT (67)9y30ETOrthoOrtho8ET (58)
165ET25XT8ETOrtho (60)9y35ET9ET8ET20XT (25)
145ET10XT3ETOrtho (40)10y25ET6XT4ET6XT (14)
150ET25XTOrtho50ET (10)12y30ET5ET5ET4ET (8)
140ET8XT3XT15y27ETOrthoOrtho
155ET2XTOrthoOrtho (12)18y25ETOrthoOrthoOrtho (5)
155ET15XTOrtho26y20ET4XTOrtho
245ET20XTOrthoOrtho (8)37y34ET2XTOrthoOrtho (6)
230ET8XTOrtho40ET (107)37y20ETOrthoOrtho
225ETOrthoOrtho12ET (91)39y25ET2ET5ET6ET (16)
230ET2XTOrtho43y30ET&RHT30XTOrtho2ET (47)
230ET25XT8XT20XT (93)49y45ET10XT6XT5XT (24)
235ET14XT8ETOrtho (37)50y32ET9ET8ET5ET (20)
220ET10XTOrtho0DHD (73)54y40ETOrthoOrtho
240ET25XTOrthoOrtho (73)55y40ETOrtho2ET3ET (7)
260ETOrthoOrthoOrtho (8)57y20ET&LHTOrthoOrtho
240ET8XTOrthoOrtho (21)58y25ET&LHT3ET5ET10ET (14)
250ET10XT4ET4ET (72)59y30ETOrthoOrtho
230ETOrtho6ET14XT (50)59y32ET12XT4ET8ET (4)
235ET6XT6ET62y12ET&LHTOrthoOrtho
330ETOrthoOrthoOrtho (60)64y35ETOrthoOrtho
312ET4XTOrthoOrtho (44)66y14ETOrthoOrtho
360ETOrthoOrtho3ET (97)71y30ETOrthoOrtho
325ET4ET4ET75y20ETOrthoOrtho7ET (44)
330ET10XT2ET16ET (105)85y20ETOrthoOrtho6ET (20)
330ETOrthoOrtho4ET (61)

Postoperative Findings in Esotropic Patients Successfully Aligned at 6 Weeks After Surgery

CharacteristicOverall (N = 95)Age < 11 years (n = 73)Age ≥ 11 Years (n = 22)P
1-week postoperative examination
  Days between surgery and 1-week follow-up examination
    Median (range)4 (1 to 7)4 (1 to 7)3.5 (1 to 6).26
  Deviation, PD.001
    Median (range)4 (−14 to 30)8 (−14 to 30)0 (−9 to 30)
    Mean ± SD7.2 ± 9.78.8 ± 9.71.8 ± 7.6
  Horizontal deviation type< .001
    > 8 ET3 (3.2%)2 (2.7%)1 (4.6%)
    8 ET to ortho35 (36.8%)19 (26.0%)16 (72.7%)
    1 to 8 XT19 (20.0%)17 (23.3%)2 (9.1%)
    > 8 XT38 (40.0%)35 (48.0%)3 (13.6%)
6-week postoperative examination
  Weeks between surgery and 6-week follow-up examination
    Median (range)6.6 (3.6 to 9.6)6.7 (3.6 to 9.6)6.6 (4.6 to 7.9).23
  Deviation, PD.56
    Median (range)0 (−8 to 8)0 (−8 to 8)0 (−8 to 6)
    Mean ± SD−1.4 ± 3.5−1.5 ± 3.7−1.1 ± 2.9
  Horizontal deviation type1.00
    > 8 ET0 (0%)0 (0%)0 (0%)
    8 ET to ortho88 (92.6%)67 (91.8%)21 (95.5%)
    1 to 8 XT7 (7.4%)6 (8.2%)1 (4.5%)
    > 8 XT0 (0%)0 (0%)0 (0%)
Final postoperative examination
  Patients with follow-up visit after 6-week examination77 (77.9%)62 (84.9%)12 (54.5%).006
  Years between surgery to last follow-up examination.001
    Median (range)2.9 (0.3 to 11.2)3.4 (0.5 to 11.2)1.2 (0.3 to 3.9)
    Mean ± SD3.6 ± 2.84.1 ± 2.81.5 ± 1.2
  Deviation, PD.08
    Median (range)0 (−50 to 30)0 (−50 to 30)−4.5 (−10 to 5)
    Mean ± SD−1.6 ± 11.9−1.2 ± 12.8−3.8 ± 4.1
  Horizontal deviation type.40
    > 8 ET9 (12.2%)8 (12.9%)1 (8.3%)
    8 ET to ortho48 (64.9%)38 (61.3%)10 (83.3%)
    1 to 8 XT6 (8.1%)5 (8.1%)1 (8.3%)
    > 8 XT11 (14.9%)11 (17.7%)0 (0%)
Authors

From the Department of Ophthalmology, Mayo Clinic and Foundation, Rochester, Minnesota (MBH, BGM); and the Department of Health Sciences Research, Mayo Clinic and Foundation, Jacksonville, Florida (NND).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Brian G. Mohney, MD, Department of Ophthalmology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905. E-mail: mohney@mayo.edu

Received: December 11, 2016
Accepted: October 19, 2017
Posted Online: June 19, 2018

10.3928/01913913-20180327-06

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