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PubMed2004

The surgical management of consecutive exotropia.

PURPOSE: To review the results and techniques of surgical treatment of consecutive exotropia. METHODS: We performed a retrospective chart review of all patients who underwent surgery for consecutive exotropia in a pediatric ophthalmology practice between 1992 and 2001. Patients were excluded if follow-up lasted < 6 weeks or if exotropia was caused by other ocular disorders such as previous trauma or congenital cataracts. RESULTS: Fifty-nine patients were identified. The procedure performed in the majority of cases was unilateral lateral rectus recession and medial rectus advancement to the original insertion. Seven patients underwent bilateral lateral rectus recession, and 6 underwent lateral rectus recession combined with medial rectus resection. The mean interval between original surgery and surgery for consecutive exotropia was 14.1 years (range 4 months to 47.5 years). The mean preoperative distance exodeviation was 31.7 prism diopters (PD). Satisfactory alignment (ie, within 10 PD of orthophoria) was achieved in 36 patients (61%) at week 1 and 42 patients (71%) at final follow-up. Mean follow up was 16.0 months. Thirty-nine patients (66%) demonstrated an exodrift after surgery (mean 7.6 PD). CONCLUSION: Consecutive exotropia may occur many years, even decades, after esotropia surgery. Lateral rectus recession with advancement of the previously recessed medial rectus is an effective treatment. An exotropic drift occurs after consecutive exotropia surgery, usually within the first 6 weeks. A suitable ocular alignment immediately after surgery for consecutive exotropia is a small-angle esotropia of 5 to 10 PD.

Adolescent↗

PubMed1993

Distance stereoacuity. Assessing control in intermittent exotropia.

BACKGROUND: A patient's ability to control an intermittent exotropic deviation is usually assessed by subjective means such as observation of control in the office, questioning the patient and/or family about control at home, and reports of monocular eye closure in bright light. An objective method of assessing control has not been developed. PURPOSE: The purposes of this study are to determine if distance stereoacuity was different in patients with intermittent exotropia than in normal subjects and to determine if distance stereoacuity could be used as a objective means of assessing control in intermittent exotropia. METHODS: The authors evaluated near and distance stereoacuity in 44 patients with intermittent exotropia and 50 normal subjects. Patients with intermittent exotropia also were assessed for office control, home control, and monocular eye closure in bright light. Additionally, six patients who underwent successful surgery were reevaluated postoperatively. CONCLUSION: Normal subjects and patients with intermittent exotropia had good near stereoacuity. Patients with intermittent exotropia demonstrated significantly worse distance stereoacuity than the population of normal subjects (P < 0.001). Five of six patients with poor distance stereoacuity preoperatively had dramatic improvement in distance stereoacuity postoperatively. Diminished distance stereoacuity seems to be an objective measure of poor control of the exotropic deviation. This test may provide important objective criteria for deciding when to perform surgery in patients with intermittent exotropia.

Adolescent↗

PubMed2005

'Largest angle to target' in surgery for intermittent exotropia.

PURPOSE: To evaluate the safety of the approach based on the notion that the surgical dose for intermittent exotropia should be based on the largest angle ever measured. DESIGN: Prospective case series of 33 patients. METHODS: A total of 33 patients with intermittent exotropia, in whom angles of misalignment at distance or near showed a difference of 15 prism diopters (PD) or more among visits, were included. All the patients were treated by bilateral lateral rectus recession by the same surgeon (JMH), and all were followed up for a minimum of 6 months postoperatively. Short- and long-term surgical results after the initial procedure for intermittent exotropia were analysed. RESULTS: The short-term average result at a postoperative 1 week was 9.3 PD esotropia at distance (range 30 esotropia-16 exotropia). The long-term average results postoperative 6 or 9 months were 4.8 PD exotropia at distance (range 12 esotropia-30 exotropia). At the last follow-up, no overcorrection over 2 PD esophoria at distance was found, and 9 PD of intermittent esotropia and esophoria at near was observed in two patients, respectively. CONCLUSIONS: The strategy of surgical dose for intermittent exotropia based on the largest angle ever measured did not result in overcorrections and is believed to be safe.

Child↗

PubMed2006

Distance stereoacuity in intermittent exotropia.

BACKGROUND: Studies of distance stereoacuity in intermittent exotropia suggest that normal stereoacuity corresponds to good control of the deviation and that reduced or negative stereoacuity signifies poorer control. AIM: : To evaluate distance stereoacuity in intermittent exotropia using the Frisby Davis Distance stereo test (FD2). METHODS: Children with intermittent exotropia where the near angle was less than or equal to distance were eligible for recruitment. Standardised prospective data collection included FD2 distance stereoacuity. This was a longitudinal study in which outcomes are reported for baseline, last follow-up (> or =6 months before any surgery) or preoperative and last postoperative visits for those undergoing surgery. RESULTS: 110 children with intermittent exotropia had FD2 stereoacuity tested at baseline: 70 comprehended the test. Mean (standard deviation (SD)) age was 4.6 (1.7) years (range 2-10 years). 41/70 (59%) showed positive responses: mean (SD) stereoacuity 30 (12) s of arc. The mean follow-up period before any surgery was 13 months (range 6-27 months). At follow-up, mean (SD) stereoacuity was 24 (11) s of arc. Preoperative and postoperative stereoacuity were not significantly different from those not undergoing surgery. CONCLUSION: This study was the first to report distance stereoacuity in intermittent exotropia using the FD2 stereo test: patients with intermittent exotropia can achieve normal levels of distance stereoacuity, but a considerable proportion, despite comprehending, showed a negative response. This suggests that using the FD2, distance stereoacuity in intermittent exotropia is either absent or normal rather than reduced. Possible reasons for this and its implications are discussed.

Child↗

PubMedDate not supplied

Infantile exotropia.

BACKGROUND: Exotropia is uncommon in healthy children between 6 months and 1 year old. METHODS: The charts of patients treated in our practice between January 1980 and August 1994 were reviewed for a diagnosis of infantile exotropia. All of them had an exodeviation during the first year of life. Children with neurologic defects, prematurity, trauma, craniofacial syndromes, or orbital abnormalities or ocular defects that would reduce vision were eliminated. RESULTS: Sixty-six healthy patients with normal eyes had an exodeviation of 15 prism diopters (delta) or more that persisted through the first year of life. Fifty-four were eliminated because the diagnosis had not been confirmed by a pediatric ophthalmologist before they were 1 year old or they had not been followed for more than 4 years. The 12 remaining patients were followed for at least 4 years (mean, 7.9 years). The mean age at the first examination was 7.8 months (range, 4 to 12 months). On early evaluation, exotropia was intermittent in four and constant in eight. Three had amblyopia. Ten required surgical correction. Exotropia was corrected with one operation in six patients; four required additional procedures, mostly to correct oblique muscle overaction and dissociated vertical deviation (DVD). At the most recent visit, all 12 patients had equal visual acuity in both eyes and satisfactory ocular alignment. Five had fusion at distance and near, but only two had stereo acuity of 100 seconds of arc or better. CONCLUSION: Infantile exotropia is rare. But, like patients with infantile esotropia, those with exotropia can be expected to have good visual acuity but unstable ocular alignment. Also, as with early-onset esotropia, although surgical intervention is usually required, high levels of binocular function develop in some patients with exotropia. Oblique muscle overaction and DVD are common, often becoming manifest by the first year of age. Unlike infantile esotropia, nystagmus is rare.

Depth Perception↗

PubMed1999

Does overcorrecting minus lens therapy for intermittent exotropia cause myopia?

BACKGROUND: Overcorrecting minus lens therapy has been used as a treatment for intermittent exotropia. It is based on the principle that an exotropic deviation will be decreased by stimulating accommodative convergence with additional minus power in spectacles. Because excessive accommodation has been implicated as a cause of myopia, there is theoretical concern that overcorrecting minus lens therapy for exotropia may cause myopia. OBJECTIVE: To investigate the effect of overcorrecting minus lens therapy for exotropia on the progression of myopia. DESIGN: A retrospective chart review. SUBJECTS AND METHODS: Seventy-four patients with intermittent exotropia were treated with overcorrecting minus lens therapy for at least 6 months (6-month treatment group), and a 34-patient subset of them received overcorrecting minus lens therapy for 5 years (5-year treatment group). The mean change in refractive error (spherical equivalent of the fixing eye) of these 2 groups 5 years after initial examination was compared with the mean change in refractive error of a control group of 45 patients with intermittent exotropia who did not receive overcorrecting minus lens therapy. RESULTS: At the time of initial examination, the mean (+/-SD) refractive error was 0.00 +/- 1.40 diopters (D) in the control group, 0.00 +/- 1.50 D in the study group, and -0.10 +/- 1.50 D in the 5-year study group, all of which were essentially identical. Five years after initial examination, the mean change in refractive error was -1.40 +/- 2.80 D in the control group, -1.52 +/- 1.80 D in the 6-month treatment group, and -1.54 +/- 1.80 D in the 5-year treatment group. These differences in the change in refractive error (myopic shift) were not statistically significant (t test), and the differences are clinically unimportant. CONCLUSION: Overcorrecting minus lens therapy for intermittent exotropia does not appear to cause myopia.

Accommodation, Ocular↗

PubMed1996

Associations between siblings for esotropia and exotropia.

OBJECTIVE: To quantify familial aggregation of esotropia and exotropia in children examined in a large multicenter study. METHODS: Pregnant women and their children were examined in the Collaborative Perinatal Project of the National Institute of Neurological Disorders and Stroke, Bethesda, Md. Strabismus was evaluated in the children during follow-up examinations up to the age of 7 years. The second-order generalized estimating equations approach to logistic regression was used to estimate familial aggregation of esotropia and exotropia. RESULTS: For any pair of siblings, the odds for one sibling having esotropia more than doubled when the other sibling had esotropia. For exotropia, there were differences in sibling associations based on birth relationships. In particular, there was no statistically significant association between siblings from separate single births. On the other hand, for the pairs of siblings from multiple births (ie, twins, triplets, and quadruplets), the odds for exotropia in one sibling were increased by at least a factor of 17 when the other sibling from that birth also had exotropia. For both esotropia and exotropia, adjustment for previously identified risk factors only somewhat reduced the magnitudes of the observed associations. Limited data on zygosity showed a stronger association between monozygotic twins than between dizygotic twins. CONCLUSIONS: There is a significant familial component in the cause of strabismus. Furthermore, there are important contributions to this familial aggregation beyond those associated with known risk factors for strabismus.

Child↗

PubMed2006

[Surgical results in childhood primary comitant large-angle exotropia].

INTRODUCTION: The purpose of this study was to evaluate the surgical results in childhood primary comitant large-angle exotropia (>30Delta) after a single operation and to analyze the factors that could influence these results. PATIENTS AND METHODS: We carried out a retrospective study in all children presenting with comitant primitive exotropia at an angle greater than 30Delta, who were operated on in our department from January 1996 to December 2000 by various surgeons. One hundred thirty-eight (138) cases were reviewed. The children with a substantial A or V phenomenon, retraction syndromes, nystagmus, those presenting with a neurological disease and those who had had previous eye surgery were excluded. The postoperative results were classified in three categories: residual exotropia over 10Delta, good postoperative result (esotropia<10Delta, orthotropia or exotropia<10Delta), and consecutive esotropia over 10Delta. RESULTS: Ninety-seven children fulfilled the study criteria. Forty (41.2%) were boys and 57 (58.8%) girls. The average age at the time of surgery was 6.5 years (SD 3.1). Sixty-eight of 97 (70.1%) had intermittent exotropia. Twenty-six children (26.8%) underwent a bilateral recession of the lateral rectus, 67 (69.1%) a unilateral operation, recession of a lateral rectus/resection of a medial rectus, and four (4.1%) an operation on three horizontal muscles. Sixty-nine percent of the children operated on had a good postoperative result, according to criteria defined in our study, 1 year after surgery. DISCUSSION/CONCLUSION: Childhood primary comitant large-angle exotropia can be corrected with a single surgical procedure, unilateral or bilateral, with a success rate which, in our study, reached 69%.

Adolescent↗

PubMed2003

The clinical course of intermittent exotropia.

PURPOSE: To report the clinical course for patients with intermittent exotropia. METHODS: The clinical records of patients diagnosed with intermittent exotropia from 1983 to 1991 who had at least 4 years of follow-up were reviewed. All patients with neurological or medical abnormalities, developmental delays, ocular disease, or having strabismus surgery during the follow-up period were excluded. RESULTS: Of the 468 records reviewed, 73 met the inclusion criteria. Forty-four patients were female, and 29 were male. Fifty-two patients had basic intermittent exotropia, 11 patients had divergence excess intermittent exotropia, and 10 patients had convergence insufficiency intermittent exotropia. The mean age at initial visit was 20 years (range, 1 to 63 years). The mean follow-up was 10 years (range, 4 to 23 years). Four patients had amblyopia of 20/30 or worse, nine patients had a vertical deviation in the primary position, and 10 patients had undergone extraocular muscle surgery before coming to our clinic. Sixty patients received some form of treatment during follow-up. The mean stereoacuity at the initial and final visits were 59 and 70 s arc, respectively. The initial mean spherical equivalent refraction was -0.48 D and increased to -1.15 D at the end of the study. The mean exodeviation changed from 17.2 Delta at distance and 17.6 Delta at near at the initial visit to 13.7 Delta at distance and 13.5 Delta at near at the final visit. At the initial visit, 63 patients were exotropic and 10 patients were either heterophoric or orthophoric at distance, whereas, 60 patients were exotropic and 13 patients were either heterophoric or orthophoric at near. At the final visit, 37 patients were exotropic and 36 patients were either heterophoric or orthophoric at distance whereas 33 patients were exotropic and 39 were either heterophoric or orthophoric at near. One patient was esotropic at near at the last visit. Changes in the size and quality of the exodeviation, although statistically significant (p < 0.001), were not associated with any specific treatment regimen or with longer periods of follow-up. Measurements exhibited a regression toward the mean. CONCLUSIONS: Intermittent exotropia improved for many patients quantitatively and qualitatively over time. That the improvement was unrelated to any treatment and length of follow-up suggests that the changes at least quantitatively are not associated with any physiologic process and may be due, in part, to regression toward the mean.

Adolescent↗

PubMed2006

Ultrastructural study of extraocular muscle tendon axonal profiles in infantile and intermittent exotropia.

PURPOSE: To investigate the ultrastructures of tendon axonal profiles in infantile and intermittent exotropia. Tendon axonal profiles are composed of myotendinous nerve endings that are presumed to serve as sensorial receptors in ocular proprioception. METHODS: The study subjects included 10 patients with exotropia who had undergone surgery in one eye (recession and resection). They were divided into two equal groups. Five patients with infantile exotropia that had developed at under 12 months of age were allocated to group A. Another five, with intermittent exotropia that had developed at over 12 months of age, were allocated to group B. In all patients, medial recti were resected by 3-4 mm in order to obtain tissue samples, which were then examined under an electron microscope. RESULTS: In group A, we noted many axonal degenerative findings, such as the retraction of axons from myelin sheaths with considerable shrinkage, axonal disintegration, and Schwann cell proliferation. On the other hand, we identified three unique findings in group B: intact axons with incomplete Schwann cell wrapping; intact Schwann cells not associated with axons, and disorganized Schwann cells with shrunken axons. CONCLUSION: Different patterns of tendon axonal profiles were seen in association with the two types of exotropia. These differences may be related to the pathogenesis of these exotropia types.

Age of Onset↗

PubMedDate not supplied

Consecutive exotropia following strabismus surgery.

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.

Adolescent↗

PubMedDate not supplied

Distance alternate-letter suppression test for objective assessment of sensorial status in intermittent exotropia.

PURPOSE: To investigate the value of distance alternate-letter suppression testing in the objective assessment of fusional control of intermittent exotropia. METHODS: A total of 71 consecutive patients with intermittent exotropia (study group) and 112 normal subjects (control group) underwent a series of measurements including distance alternate-letter suppression testing, Worth 4 Dot test at distance and near, and distance and near stereo acuity tests to see whether sensorial behavior differed in the study and control groups. The distance alternate-letter suppression test and distance stereo acuity tests were performed using the Mentor B-VAT II-SG Video Acuity Tester and Binocular Vision Testing System. The TNO test was used to measure near stereo acuity. RESULTS: Seventeen patients with intermittent exotropia (24%) presented suppression with the distance alternate-letter suppression test, but none of the normal subjects (p<0.001, chi2 test). Only, three patients (4%) showed suppression on the Worth 4 Dot test at distance, and all had fusion on the Worth 4 Dot test near. Patients with intermittent exotropia had significantly diminished distance stereo acuity compared to normal subjects (p<0.001). Normal subjects and patients had good near stereo acuity (p>0.05). Patients with intermittent exotropia who had fusion with the distance alternate-letter suppression test had significantly better distance stereo acuity than patients who had suppression (p<0.001). CONCLUSIONS: Distance alternate-letter suppression testing and distance stereo acuity tests may be useful as objective measures for assessing sensory loss in patients with intermittent exotropia.

Adolescent↗

PubMedDate not supplied

Large bilateral lateral rectus recession in large angle divergence excess exotropia.

PURPOSE: Classic teaching suggests that surgery for intermittent exotropia should be based on distance/near differences. True divergence excess exotropia should be treated with symmetric lateral rectus recession. The aim of this study was to investigate the effect of large bilateral lateral rectus (LR) recession in large-angle intermittent exotropia. METHODS: Thirty-three consecutive patients with large-angle divergence excess exotropia ranging from 50 to 65 (mean 56.7 +/- 6.3) prism diopters were treated with 8.0 to 9.5 mm (mean 8.8 +/- 0.7 mm) recession of both LR muscles. RESULTS: Successful alignment was achieved in 25 cases (76%) while residual exotropia was seen in eight patients (24%) within the limit of 15 prism diopters. Mean follow-up time was 28.5 +/- 8.4 (range 13 to 38) months. Abduction deficit due to this procedure was not seen in any case. CONCLUSIONS: We conclude that large bilateral LR recession is an appropriate surgical method for large-angle divergence excess exotropia.

Adolescent↗

PubMed1998

The distance angle to target in surgery for intermittent exotropia.

BACKGROUND: Patients with intermittent exotropia may have an increase in their angle of strabismus in the distance when the angle is measured either after 1 hour of monocular occlusion or while the patients fixate on a distant target outdoors. The hypothesis that surgery should be performed for this larger deviation has been suggested but not tested. OBJECTIVES: To test the hypothesis that surgery should be performed for the increased angle of strabismus in the distance in patients with intermittent exotropia and to investigate the factors that influence the angle of misalignment. METHODS: A prospective, clinical trial was conducted of patients with intermittent exotropia in whom the angle of misalignment in the distance increased after 1 hour of monocular occlusion or while the patients fixated on an outdoor target. The study group underwent surgery for the largest deviation measured; the control group underwent surgery for the initial angle measured at 6 m. All patients in whom the angle of misalignment increased while the patients were looking at an outdoor target were additionally measured in indoor illumination at 24 m and also at 6 m under floodlights that simulated outdoor illumination. Ninety patients undergoing surgery were randomized. RESULTS: Forty-three (86.0%) of the 50 patients undergoing surgery for the largest angle measured had a satisfactory outcome vs 25 (62.5%) of the 40 patients in the control group (P<.001). The mechanism for the increase in exotropia while fixating on an outdoor target was studied in 76 patients, and the results were variable. CONCLUSIONS: The angle of strabismus in patients with intermittent exotropia undergoing surgery should be measured while the patients fixate on an outdoor target and after 1 hour of monocular occlusion. Surgery should be performed for the largest angle measured.

Accommodation, Ocular↗

PubMed1999

Diagnosis and treatment of exotropia with a high accommodation convergence-accommodation ratio.

BACKGROUND: Patients with exotropia often have a slow-to-dissipate fusional mechanism at near, which masks the true near deviation. Consequently, determination of the accommodation convergence-accommodation (AC/A) ratio in patients with exotropia must be based on near measurements obtained after prolonged monocular occlusion (typically 1 hour). When determined in that manner, the presence of a high AC/A ratio before surgery in an exotropic patient has been reported to be predictive of an esotropia at near after surgery. OBJECTIVE: To investigate the diagnosis and management of exotropia with a high AC/A ratio. METHODS: Three hundred four consecutive patients with exotropia were studied. In addition to the usual measurements, measurements were obtained at near after 1 hour of monocular occlusion, with and without additional +3.00-diopter lenses. Also, a gradient AC/A ratio was obtained by using additional minus lenses at distance fixation. RESULTS: One hundred fifty-four (50.7%) of 304 patients would have been thought to have a high AC/A ratio if that diagnosis was based on measurements obtained before prolonged monocular occlusion. In fact, only 22 patients (7.2%) actually had a high AC/A ratio; 132 patients (43.4%) had a pseudo-high AC/A ratio. Six of 22 patients with a high AC/A ratio underwent surgery to correct the exotropia. The presence of a high AC/A ratio before surgery had sensitivity, specificity, and positive and negative predictive values of 100% for predicting a postoperative esotropia at near associated with a high AC/A ratio. The remaining 16 patients with high AC/A ratios were treated with overcorrecting minus lens therapy (including a bifocal). Ten of them have been followed up to at least 18 years of age, by which time 9 have shown normalization of the AC/A ratio. CONCLUSIONS: Near measurements used to calculate the AC/A ratio in exotropic patients must be made after prolonged monocular occlusion. Otherwise, many patients with a pseudo-high AC/A ratio will be thought to have a true high AC/A ratio. The presence of a high AC/A ratio is infrequent in patients with esotropia, but it is highly predictive of a postoperative esotropia at near fixation.

Accommodation, Ocular↗

PubMed2006

Interventions for intermittent exotropia.

BACKGROUND: The clinical management of intermittent exotropia has been discussed frequently in the literature, but there is a lack of clarity regarding the indications for intervention, the most effective type and if there is a time point at which it should be carried out. OBJECTIVES: The objective of this review was to analyse the effects of various surgical and non-surgical treatments in randomised trials of people with intermittent exotropia, to report intervention criteria and determine the significance of factors such as age with respect to outcome. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006) National Research Register (2006, Issue 1), PubMed (searched on 13 March 2006; last 90 days) and LILACS (Latin American and Caribbean Literature on Health Sciences) (1966 to 2002). We manually searched the British Orthoptic Journal, proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS). We contacted researchers who are active in the field for information about further published or unpublished studies. There were no language restrictions in the manual or electronic searches. SELECTION CRITERIA: We included randomised controlled trials of any surgical or non-surgical treatment for intermittent exotropia. DATA COLLECTION AND ANALYSIS: Each review author independently assessed study abstracts identified from the database and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained. MAIN RESULTS: We found one randomised trial that was eligible for inclusion. This trial showed that unilateral surgery was more effective than bilateral surgery for correcting basic intermittent exotropia. AUTHORS' CONCLUSIONS: The available literature consists mainly of retrospective case reviews which are difficult to reliably interpret and analyse. The one randomised trial included found unilateral surgery more effective than bilateral for basic intermittent exotropia but there remains a need for more carefully planned clinical trials to be undertaken to improve the evidence base for the management of this condition.

Exotropia↗

PubMed2006

Cyclic exotropia associated with retinitis pigmentosa.

PURPOSE: To report the occurrence of cyclic exotropia in a patient with retinitis pigmentosa. METHODS: A 31-year-old man presented with cyclic exotropia of the left eye of 4 years duration that alternated every 24 h. A detailed ophthalmologic examination was performed. RESULTS: The patient showed an orthotropia and a comitant left exotropia of 30 prism diopters at distance and 25 prism diopters at near in the primary position on an exotropic day with a cycle of 48 h. A fundoscopic examination showed bone spicule formation and arteriolar narrowing, and electroretinography showed no response in either eye. A Goldmann visual field examination showed a central island in both eyes. CONCLUSIONS: Cyclic exotropia may occur in patients with retinitis pigmentosa, an association that to the best of our knowledge has not been previously reported in the English ophthalmic literature. Cyclic exotropia is an unusual association with retinitis pigmentosa.

Adult↗

PubMed2006

Bilateral lateral rectus recession versus unilateral recess-resect procedure for exotropia with a dominant eye.

PURPOSE: To compare the surgical outcomes of bilateral lateral rectus recession and unilateral recess-resect (RR) procedure on the nondominant eye for the patients of exotropia with a dominant fixating eye. DESIGN: Prospective randomized comparative clinical trial. METHODS: One hundred twenty-four patients of exotropia with an invariably fixating eye were enrolled to this study. Patients were assigned randomly to two groups, those who underwent bilateral lateral rectus (BLR) recessions (BLR group) or unilateral RR procedures on the nondominant eye (RR group); surgical outcomes were compared. An outcome was considered satisfactory if there was between 10 prism diopters of exophoria/tropia and 10 prism diopters of esophoria/tropia at 6 months after surgery. RESULTS: In the BLR group, 28 of the 58 patients (48.3%) had a satisfactory outcome, and 30 patients (51.7%) had recurrence. There was no case of overcorrection in the BLR group. In the RR group, 55 of the 66 patients (83.3%) had a satisfactory outcome; 6 patients (9.1%) had recurrence, and 5 patients (7.6%) were overcorrected (P < .001, Fisher's exact test). All overcorrected patients in the RR group had poor stereoacuity and constant exotropia before the operation. The cumulative probability of surgical success was significantly higher in the RR group than in the BLR group (P = .012, log rank test). CONCLUSIONS: In the patients with exotropia with a dominant eye, the unilateral RR procedure resulted in a better outcome than BLR recession surgery. But, the overcorrection rate was significantly higher in the unilateral RR procedure group, especially in those patients with a poor preoperative stereopsis status and constant exotropia.

Adolescent↗