BACKGROUND: To analyse the incidence and factors associated with the onset of consecutive esotropia after surgery for intermittent exotropia, and to investigate its clinical course. METHODS: We retrospectively reviewed the medical records of 526 patients who had undergone exotropia surgery. We evaluated the risk factors for consecutive esotropia, defined as esodeviation ≥ 10 prism dioptres (PD) at postoperative month 1 or later. We also evaluated the clinical course of consecutive esotropia with non-surgical and surgical management. RESULTS: Consecutive esotropia occurred in 26 (4.94%) of 526 patients. Divergence excess type of exotropia (p=0.036), amblyopia (p=0.046), bilateral lateral rectus recession (p=0.008), esodeviation of ≥ 20 PD at postoperative day 1 (p=0.000), younger age at diagnosis and surgery (p=0.010, p=0.003) and shorter duration from onset to surgery (p=0.039) showed significant association with consecutive esotropia. Among 26 patients, 15 became orthophoric with full-time patching ± Fresnel prism glasses. Eleven patients failed to show improvement of the esodeviation with non-surgical management; seven of these underwent surgery for sustained esotropia. Among these patients, five showed orthophoria at the final follow-up. CONCLUSIONS: Divergence excess type, bilateral lateral rectus recession, amblyopia, younger age at diagnosis and surgery, shorter duration from onset to surgery and overcorrection of ≥ 20 PD at postoperative day 1 were predisposing factors for consecutive esotropia. In less than half the consecutive esotropia patients (11/26), esodeviation persisted with non-surgical management. Surgery for consecutive esotropia showed relatively favourable outcomes.
BACKGROUND: To analyse the incidence and factors associated with the onset of consecutive esotropia after surgery for intermittent exotropia, and to investigate its clinical course. METHODS: We retrospectively reviewed the medical records of 526 patients who had undergone exotropia surgery. We evaluated the risk factors for consecutive esotropia, defined as esodeviation ≥ 10 prism dioptres (PD) at postoperative month 1 or later. We also evaluated the clinical course of consecutive esotropia with non-surgical and surgical management. RESULTS: Consecutive esotropia occurred in 26 (4.94%) of 526 patients. Divergence excess type of exotropia (p=0.036), amblyopia (p=0.046), bilateral lateral rectus recession (p=0.008), esodeviation of ≥ 20 PD at postoperative day 1 (p=0.000), younger age at diagnosis and surgery (p=0.010, p=0.003) and shorter duration from onset to surgery (p=0.039) showed significant association with consecutive esotropia. Among 26 patients, 15 became orthophoric with full-time patching ± Fresnel prism glasses. Eleven patients failed to show improvement of the esodeviation with non-surgical management; seven of these underwent surgery for sustained esotropia. Among these patients, five showed orthophoria at the final follow-up. CONCLUSIONS: Divergence excess type, bilateral lateral rectus recession, amblyopia, younger age at diagnosis and surgery, shorter duration from onset to surgery and overcorrection of ≥ 20 PD at postoperative day 1 were predisposing factors for consecutive esotropia. In less than half the consecutive esotropiapatients (11/26), esodeviation persisted with non-surgical management. Surgery for consecutive esotropia showed relatively favourable outcomes.