Unilateral recession and resection surgery with adjustable suture in adult sensory exotropia: long-term success and exotropic drift

ABSTRACT

This retro-prospective study aimed to evaluate the correlation between initial postoperative deviation and long-term outcome of unilateral recession and resection surgery with adjustable suture in adult sensory exotropia, factors associated with long-term outcome, exotropic drift, and time to failure following surgery.

We included adult patients (age ≥18 years) with sensory exotropia who underwent unilateral lateral rectus recession with adjustable suture and medial rectus resection with at least 2-year follow-up. Preoperative and postoperative data was collected. Either Krimsky or alternate and prism cover testing was used to measure the angle of deviation depending on patients’ fixation ability. Glasses with full refractive correction were worn if they can provide better visual acuity. Exodeviation at near fixation was used in statistical analysis.

A total of 38 patients (mean age at surgery 32 ± 13 years) were included. Median preoperative exotropia was 45 PD (IQR 40–55, range 25–70) and median initial postoperative deviation was esotropia 8 PD (IQR 0–11, range from exotropia 8 to esotropia 30). Mean follow-up time was 5 ± 2.5 years (range 2–10). Motor success, defined as a deviation within 10 PD of orthotropia, was found in 50% and 42% of patients at 2-year and last follow-up. Initial postoperative deviation and amount of lateral rectus recession were significantly associated with long-term outcome (p = .006 and 0.029). Patients with initial moderate and minimal overcorrection had higher success rates (67% and 62%) than patients with initial orthotropia or undercorrection (10%) (p = .002). Median overall rate of exotropic drift was 8 PD/year (IQR 6–13, range from esotropic drift 8 to exotropic drift 26). Time to failure in nonsuccess group was 24 months (IQR 21–24, range 2–24).

In conclusion, unilateral recession and resection surgery with adjustable suture in adult sensory exotropia achieved 50% success at 2 years. Initial postoperative moderate overcorrection results provide the highest chance for long-term success. The majority of patients developed exotropic drift with time and time to failure was 2 years.

KEYWORDS:

• Sensory exotropia
• unilateral surgery
• recession and resection
• exotropic drift

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of King Chulalongkorn Memorial Hospital and Rutnin Eye Hospital (IRB number 607/57). Informed consent was obtained from all participants. The clinical trial registration was obtained since June 28, 2015 (TCTR20150629001)

Additional information

Funding

This clinical study was supported by the Ratchadapisek Sompoch Fund, Faculty of Medicine, Chulalongkorn University (Grant number RA58/022). The funding supported study design, data collection, analysis, and interpretation of data.