Consecutive Exotropia

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Consecutive Exotropia

• Lionel Kowal
• Elaine Wong

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CONSECUTIVE XT

• Any XT happening after previous ET usually after
  ET surgery
• Rare spontaneous consecutive XT

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CONSECUTIVE XT - WHY?

• 1. The ET correction doesnt grow with the pt
• Ciancia perfect early alignment after Cong ET
  surgery ? 30 consec XT after 25y
• Recession MR mechanical disadvantage

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CONSECUTIVE XT - WHY?

• 2. Early consec XT
• Wrong surgical dose
• Poor surgical technique
• Poor early healing

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CONSECUTIVE XT - WHY?

• 3. Later consec XT
• Stretched scar - look for stretchmarks, healing
  of other surgical scars, .
• Irene Ludwig Scar remodelling Scar migration
• Scar remodeling after strabismus surgery - very
  under recognised
• Ludwig IH, Chow AY., J AAPOS. 2000
• Ludwig IH Trans Am Ophthalmol Soc. 1999
• Need to use non- absorbable sutures if recognised

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Consecutive XT

• Results of consecutive XT in LKs practice over
  last 2 years
• 91 cases of consecutive XT
• Average time to XT 8 years
• 58 had XT surgery by LK
• 32 with follow up gt1 yr
• Number of surgeries 1-4
• Median 1
• Avg. no. of surgeries 1.3
• No. of Botox for ET 4 (10)
• No. of Adjustables 19 (45)

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Pre-op Range 6 66 XT Avg 31XTPost-op Range
18ET 45XT Avg 0
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Spontaneous consec XT

• 2 cases of spontaneous consec XT
• accounts for 2 of all consecutive XT
• Case 1
• 10 yo girl with infantile ET
• Noted XT at 2 yo
• Now XT 10? with V pattern
• Hypermetropia R 8.75 L 7.00
• R amblyopia 6/12
• No surgical Rx

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Spontaneous XT

• Case 2
• 30 yo female
• Infantile ET ? When noted XT
• RXT of 35?
• No obliques OA
• Hypermetropia R 7.50, L 4.50
• R Amblyopia 6/45
• RMMRs 5.5mm, RLMRc 7.5mm
• Post op RET 7?

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Conclusions

• Spontaneous consecutive XT rare!
• Consecutive XT a difficult surgical problem
• 69 with good surgical results