Postoperative Esotropia: Initial Overcorrection or Consecutive Esotropia?

PURPOSE: To investigate the length of time required for diagnosing consecutive esotropia rather than initial overcorrection and examine risk factors for persistent postoperative esotropia after intermittent exotropia surgery.

METHODS: This is a retrospective case series in a tertiary medical center. Fifty consecutive patients with postoperative esotropia ≥6 prism diopters at 1 week following exotropia surgery, managed with nonsurgical management and followed up for more than 6 months from 2014 to 2015, were included. Patients were allocated to 1 of 2 groups depending on whether the postoperative esotropia was resolved at 1 month after surgery. Patients with ongoing nonsurgical management were reevaluated monthly. Timing that significant resolution occurred was assessed. Clinical characteristics and motor and sensory successes were evaluated at 6 months after surgery.

RESULTS: Thirty-two patients were allocated to group 1 and 18 to group 2. Significant resolution occurred between 1 week and 1 month after surgery. Patients were older and preoperative deviation at distance was larger in group 2 than in group 1 (p = 0.006 and 0.015). A significantly larger proportion of patients in group 2 showed combined vertical deviation (p = 0.019). Motor and sensory success rates were comparable.

CONCLUSIONS: When initial postoperative esotropia persists for more than 1 month, it should be regarded as consecutive esotropia. Older age, a larger preoperative deviation, and concurrent vertical deviation are risk factors for persistent postoperative esodeviations. Therefore, more postoperative attention should be given to these patients.