Factors associated with atypical postoperative drift following surgery for consecutive exotropia

Steven D. Maxfield, Sarah R. Hatt, David A. Leske, Jae Ho Jung, Jonathan M Holmes

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Abstract

Purpose: To evaluate the associations of clinical and surgical factors with atypical postoperative drift following surgery for consecutive exotropia. Methods: A total of 66 patients with consecutive exotropia (≥10δ at distance), after historical surgery for esotropia were retrospectively identified at a tertiary medical center. All patients underwent unilateral lateral rectus recession (on adjustable suture) with medial rectus advancement and/or resection. Immediate postoperative target angle was 4δ-10δ of esotropia at distance, anticipating mild postoperative exodrift. Actual postoperative drift was calculated as change in distance deviation from immediately postadjustment to 6 weeks. Typical drift was defined as 0δ-9δ of exodrift. Excessive exodrift was defined as ≥10δ. Esodrift was defined as 1δ or more. Univariate and multiple logistic regression analyses were performed to evaluate for associations with a wide range of clinical and surgical factors. Results: Overall there was a median exodrift (4δ, quartiles 0δ-10δ). Of the 66 patients, 18 (27%) showed excessive exodrift; 15 (23%), esodrift. In multiple logistic analyses, larger preoperative distance exodeviation was associated with excessive exodrift (P = 0.01), and non-normal medial rectus attachment status (abnormal [stretched scar, pseudo-tendon], attached to pulley, or behind pulley) was associated with esodrift (P = 0.02). Conclusions: Approximately half of patients show atypical drift following unilateral surgery for consecutive exotropia, with larger preoperative distance exodeviation associated with exodrift and non-normal medial rectus muscle status with esodrift. Knowing these associations may help when counseling patients regarding surgical outcomes.

Original languageEnglish (US)
JournalJournal of AAPOS
DOIs
StateAccepted/In press - 2017

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Exotropia
Esotropia
Tendons
Sutures
Cicatrix
Counseling
Logistic Models
Regression Analysis
Muscles

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Ophthalmology

Cite this

Factors associated with atypical postoperative drift following surgery for consecutive exotropia. / Maxfield, Steven D.; Hatt, Sarah R.; Leske, David A.; Jung, Jae Ho; Holmes, Jonathan M.

In: Journal of AAPOS, 2017.

Research output: Contribution to journalArticle

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abstract = "Purpose: To evaluate the associations of clinical and surgical factors with atypical postoperative drift following surgery for consecutive exotropia. Methods: A total of 66 patients with consecutive exotropia (≥10δ at distance), after historical surgery for esotropia were retrospectively identified at a tertiary medical center. All patients underwent unilateral lateral rectus recession (on adjustable suture) with medial rectus advancement and/or resection. Immediate postoperative target angle was 4δ-10δ of esotropia at distance, anticipating mild postoperative exodrift. Actual postoperative drift was calculated as change in distance deviation from immediately postadjustment to 6 weeks. Typical drift was defined as 0δ-9δ of exodrift. Excessive exodrift was defined as ≥10δ. Esodrift was defined as 1δ or more. Univariate and multiple logistic regression analyses were performed to evaluate for associations with a wide range of clinical and surgical factors. Results: Overall there was a median exodrift (4δ, quartiles 0δ-10δ). Of the 66 patients, 18 (27{\%}) showed excessive exodrift; 15 (23{\%}), esodrift. In multiple logistic analyses, larger preoperative distance exodeviation was associated with excessive exodrift (P = 0.01), and non-normal medial rectus attachment status (abnormal [stretched scar, pseudo-tendon], attached to pulley, or behind pulley) was associated with esodrift (P = 0.02). Conclusions: Approximately half of patients show atypical drift following unilateral surgery for consecutive exotropia, with larger preoperative distance exodeviation associated with exodrift and non-normal medial rectus muscle status with esodrift. Knowing these associations may help when counseling patients regarding surgical outcomes.",
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