Indications and results of exotropia surgical management

##plugins.themes.academic_pro.article.main##

Lamia El Fekih
Houda Lajmi
Achraf Ben Yakhlef

Abstract

Abstract
Aim:
To study the clinical particularities and the surgical management of the different forms of exotropia, and to analyze the prognostic factors influencing the surgical result.
Methods:
Medical records of 132 patients who underwent exotropia surgery from 1995 to 2015, were retrospectively reviewed. Ophthalmological examination and a complete sensorimotor assessment were performed for each patient. All surgeries were performed by the same surgeon.
Results:
We had 57 cases of intermittent exotropia (IE), 22 cases of infantile exotropia (IfE), 43 cases of sensory exotropia (SE) and 10 cases of concecutive exotropia (CE). The average age of onset of exotropia was 6.8 years +/- 8 SD. Amblyopia was noted in 36.4% of cases  of  IfE.  The mean deviation angle was  36.5  DP in (IE),  39.6  DP in (IfE)  and  44.5  DP  in  (SE). A vertical syndrome was frequently found in (IfE) patients. Bilateral recession of  lateral  rectus  was  the  most  performed  surgery  type.  The overall success rate after a  single  surgery  was  72%.  A multivariate logistic regression analysis  showed  that good prognosis  factors  were  the absence  of  amblyopia, the intermittent form of the strabismus,  a low  preoperative deviation angle and the ocular alignment on day one postoperatively.
Conclusions:
IE is the most common divergent strabismus.  Surgery resulted in successful alignment in most of the cases.  Early management and rigorous analysis of  patients sensorimotor status are the best guarantors of long-term success

Keywords:

Exotropia; surgery; management

##plugins.themes.academic_pro.article.details##

References

  1. References 1. Audren F. Exotropie précoce. In: Péchereau A, Denis D, Speeg-Schatz C, dir. Strabisme. Issy-les-Moulineaux: Elsevier Masson; 2013, p. 208‑11. 2. Carta A, Pinna A, Aini MA, Carta A, Carta F. Intermittent exotropia: evaluation of results on the basis of different treatments. J Fr Ophtalmol 1994;17(3):161 6. PMID: 8182252 3. Abroms AD, Mohney BG, Rush DP, Parks MM, Tong PY. Timely surgery in intermittent and constant exotropia for superior sensory outcome. Am J Ophthalmol 2001;131(1):111 6. DOI: 10.1016/s0002-9394(00)00623-1 4. Suh SY, Kim MJ, Choi J, Kim SJ. Outcomes of surgery in children with early-onset exotropia. Eye 2013;27(7):836 40. DOI:10.1038/eye.2013.75 5. Hardesty HH. Management of intermittent exotropia. In: Seminars in Ophthalmology. Taylor & Francis; 1988, p. 169 74. 6. Schlossman A, Muchnick RS, Stern KS. The surgical management of intermittent exotropia in adults. Ophthalmology 1983;90(10):1166 71. DOI:10.1016/s0161-6420(83)34411-0 7. Kushner BJ. Selective surgery for intermittent exotropia based on distance/near differences. Arch Ophthalmol 1998;116(3):324 8. DOI:10.1001/archopht.116.3.324 8. Donahue SP, Chandler DL, Holmes JM, et al. Randomized trial comparing bilateral lateral rectus recession versus unilateral recess-resect for basic-type intermittent exotropia. JAAPOS 2017 ;21(4) :e7-e8. DOI: https://doi.org/10.1016/j.jaapos.2017.07.020 9. Chiu AK, Din N, Ali N. Standardising Reported Outcomes of Surgery for Intermittent Exotropia. A Systematic Literature Review. Strabismus 2014;22(1):32 6. DOI: 10.3109/09273972.2013.877940 10. Kelkar JA, Gopal S, Shah RB, Kelkar AS. Intermittent exotropia: Surgical treatment strategies. Indian J Ophthalmol 2015;63(7):566. DOI:10.4103/0301-4738.167109 11. Paik HJ, Yim HB. Clinical effect of early surgery in infantile exotropia. Korean J Ophthalmol 2002;16(2):97 102. DOI:10.3341/kjo.2002.16.2.97 12. Stoller SH, Simon JW, Lininger LL. Bilateral lateral rectus recession for exotropia: a survival analysis. J Pediatr Ophthalmol Strabismus 1994;31(2):89 92. PMID:8014793 13. Livir-Rallatos G, Gunton KB, Calhoun JH. Surgical results in large-angle exotropia. JAAPOS 2002;6(2):77 80. PMID:11997802 14. Schwartz RL, Calhoun JH. Surgery of large angle exotropia. J Pediatr Ophthalmol Strabismus 1980;17(6):359 63. PMID:7205515 15. Aslanis D, Follidi V, Constantopoulos I, Spyropoulos G, Paikos P. Résultats chirurgicaux des exotropies primitives concomitantes à grand angle chez les enfants. J Fr Ophtalmol 2006;29(1):37 42. Doi : JFO-01-2006-29-1-0181-5512-101019-200504054 16. Pratt-Johnson JA, Barow JM, Tillson G. Early surgery in intermittent exotropia. Am J Ophthalmol 1977;84(5):689-94. DOI:10.1016/0002-9394(77)90385-3 17. Maruo T, Kubota N, Sakaue T, Usui C. Intermittent exotropia surgery in children: long term outcome regarding changes in binocular alignment. A study of 666 cases. Binocul Vis Strabismus Q 2001;16(4):265 70. PMID:11720592 18. Richard JM, Parks MM. Intermittent exotropia: surgical results in different age groups. Ophthalmology 1983;90(10):1172 7. PMID:6657192 19. Wu H, Sun J, Xia X, Xu L, Xu X. Binocular status after surgery for constant and intermittent exotropia. Am J Ophthalmol 2006;142(5):822 6. DOI: 10.1016/j.ajo.2006.06.045 20. Ing MR, Nishimura J, Okino L. Outcome study of bilateral lateral rectus recession for intermittent exotropia in children. Ophthalmic Surg Lasers Imaging Retina 1999;30(2):110 7. PMID:10037205 21. Saleem QA, Cheema AM, Tahir MA, Dahri AR, Sabir TM, Niazi JH. Outcome of unilateral lateral rectus recession and medial rectus resection in primary exotropia. BMC Res Notes 2013;6(1):257. DOI:10.1186/1756-0500-6-257 22. Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG. Postoperative outcomes in children with intermittent exotropia from a population-based cohort. JAAPOS 2009;13(1):4 7. DOI:10.1016/j.jaapos.2008.06.001 23. Burian HM, Spivey BE. The Surgical Management of Exodeviations. Am J Ophthalmol 1965;59(4):603 20. PMID:14270998 24. Hardesty HH, Boynton JR, Keenan JP. Treatment of intermittent exotropia. Arch Ophthalmol 1978;96(2):268 74. DOI:10.1001/archopht.1978.03910050136006 25. Jeoung JW, Lee MJ, Hwang JM. Bilateral lateral rectus recession versus unilateral recess-resect procedure for exotropia with a dominant eye. Am J Ophthalmol 2006;141(4):683 8. DOI:10.1016/j.ajo.2005.11.021 26. Park YC, Chun BY, Kwon JY. Comparison of the stability of postoperative alignment in sensory exotropia: adjustable versus non-adjustable surgery. Korean J Ophthalmol 2009;23(4):277 80. DOI:10.3341/kjo.2009.23.4.277 27. Merino P, Mateos C, De Liaño PG, Franco G, Nieva I, Barreto A. Horizontal sensory strabismus: characteristics and treatment results. Arch Soc Esp Oftalmol Engl Ed 2011;86(11):358 62. DOI:10.1016/j.oftal.2011.05.028 28. Gezer A, Sezen F, Nasri N, Gözüm N. Factors influencing the outcome of strabismus surgery in patients with exotropia. J AAPOS 2004;8(1):56 60. DOI:10.1016/S1091853103002519 29. Faridi UA, Saleh TA, Ewings P, Twomey JM. Factors affecting the surgical outcome of primary exotropia. Strabismus 2007;15(3):127 31. DOI:10.1080/09273970701506086 30. Gordon YJ, Bachar E. Multiple regression analysis predictor models in exotropia surgery. Am J Ophthalmol 1980;90(5):687 91. DOI:10.1016/s0002-9394(14)75138-4 31. Abbasoglu OE, Sener EC, Sanac AS. Factors influencing the successful outcome and response in strabismus surgery. Eye 1996;10(3):315 20. DOI:10.1038/eye.1996.66 32. Kushner BJ, Fisher MR, Lucchese NJ, Morton GV. Factors influencing response to strabismus surgery. Arch Ophthalmol 1993;111(1):75 9. DOI:10.1001/archopht.1993.01090010079030 33. Yam JCS, Chong GSL, Wu PKW, Wong USF, Chan CWN, Ko STC. Prognostic factors predicting the surgical outcome of bilateral lateral rectus recession surgery for patients with infantile exotropia. Jpn J Ophthalmol 2013;57(5):481 5. DOI:10.1007/s10384-013-0262-8 34. Portes AV, Franco AMBV, Tavares MF, Souza-Dias CR, Goldchmit M. Surgical correction of permanent exotropia outcomes in amblyopic and non-amblyopic patients. Arq Bras Oftalmol 2011;74(4):267 70. DOI:10.1590/s0004-27492011000400008 35. Roh JH, Paik HJ. Clinical study on factors associated with recurrence and reoperation in intermittent exotropia. J Korean Ophthalmol Soc 2008;49(7):1114 9. https://doi.org/10.3341/jkos.2008.49.7.1114 36. Beneish R, Flanders M. The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia. Can J Ophthalmol 1994;29(3):119 24. PMID:7922850