Comparison of Postoperative Exodrift after First Unilateral and Second Contralateral Lateral Rectus Recession in Recurrent Exotropia

다국어 초록 (Multilingual Abstract)

Purpose: To compare postoperative exodrift of the first unilateral lateral rectus (ULR) muscle recession with theexodrift of the second contralateral ULR muscle recession in patients with recurrent small-angle exotropia (XT).
Methods: We evaluated the results of a second ULR muscle recession in 19 patients with recurrent XT with deviationangles under 25 prism diopter (PD), following a first procedure of ULR muscle recession for small-angleXT. Recession of the lateral rectus muscle ranged from 8 to 9 mm. The postoperative motor alignment anddegree of exodrift were investigated after the first ULR muscle recession and the second ULR muscle recessionin the same patients.
Results: Observed differences in postoperative ocular alignment between the first ULR muscle recession andthe second ULR muscle recession were statistically significant at follow-up periods of six months (7.84 ± 4.43vs. 3.89 ± 3.47 PD), one year (9.58 ± 4.97 vs. 5.21 ± 4.94 PD), and at a final follow-up (21.11 ± 2.98 vs. 7.52 ± 4.06PD) after surgery (p = 0.006, 0.013, and 0.000). Postoperative exodrift was statistically different between thefirst and second ULR muscle recessions at three to six months (2.89 ±3.75 vs. 0.63 ± 3.45 PD) and one yearto final follow-up (11.52 ± 5.50 vs. 2.32 ± 3.53 PD) (p = 0.034 and 0.000). All of the first ULR muscle recessionpatients showed XT with deviation angles of more than 15 PD at the final follow-up. Regardless, the surgicalsuccess rate (<8 PD) after the second ULR recession was 63.16% (12 patients) among the total amount ofpatients with recurrent XT.
Conclusions: This study shows that changes in exodrift after a second ULR muscle recession are less thanchanges after the first URL muscle recession among patients with recurrent XT. A second ULR muscle recessionmay be a useful surgery for small-angle XT patients with deviation angles of 25 PD or less after a firstULR muscle recession.

참고문헌 (Reference)

1 정태선, "간헐외사시에서 단안 내직근절제 및 외직근후전술의 수술성공인자" 대한안과학회 47 (47): 1987-1992, 2006

2 Weakley DR Jr, "Unilateral lateral rectus recessions in exotropia" 24 : 458-460, 1993

3 Deutsch JA, "Unilateral lateral rectus recession for the treatment of exotropia" 24 : 111-113, 1992

4 Wolff SM, "Strabismus and ocular motility disorder: proceedings of the 6th meeting of the International Strabismological Association" Macmillan Press 375-, 1990

5 von Noorden GK, "Some aspects of exotropia. Proceedings of Wilmer Resident's Association Meeting" Wilmer Resident's Association 1966

6 Lim SH, "Prognostic factors for recurrence with unilateral recess-resect procedure in patients with intermittent exotropia" 25 : 449-454, 2011

7 Lim SH, "Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia" 26 : 846-852, 2012

8 Wang L, "Outcome study of unilateral lateral rectus recession for small to moderate angle intermittent exotropia in children" 47 : 242-247, 2010

9 Wang L, "One muscle strabismus surgery" 21 : 335-340, 2010

10 Spierer O, "Moderate-angle exotropia: a comparison of unilateral and bilateral rectus muscle recession" 41 : 355-359, 2010

11 Sohn JH, "Management for reoperation in recurrent exotropia" 35 : 580-584, 1994

12 Olitsky SE, "Early and late postoperative alignment following unilateral lateral rectus recession for intermittent exotropia" 35 : 146-148, 1998

13 Pukrushpan P, "Drift of ocular alignment following strabismus surgery. Part 1: using fixed scleral sutures" 93 : 439-442, 2009

14 이경숙, "Comparison of Outcomes of Unilateral Lateral Rectus Recession for Exotropia between First and Second Operations" 대한안과학회 25 (25): 329-333, 2011

15 Kim SJ, "Clinical analysis of surgical results in exodeviation" 33 : 724-732, 1992