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S. P. Christiansen, C. T. Bramante; Recurrent Horizontal Strabismus with the Same or Larger Angle of Misalignment. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1135.
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To investigate potential predisposing factors for postoperative horizontal strabismus that recurs with an equivalent or larger angle.
The records of 1358 patients who underwent strabismus surgery by one surgeon were reviewed. Patients who met eligibility criteria and who had recurrent strabismus with a postoperative angle that matched or exceeded the original deviation were analyzed. All pre- and postoperative alignment testing was performed by the same surgeon with children wearing their full hyperopic correction if indicated. Preoperative clinical characteristics were assessed.
Sixteen patients (1.2%) met eligibility requirements. Of these, 4 (25%) had restrictive strabismus and 4 (25%) had paralytic strabismus. These were not analyzed further. Eight of 16 patients (50%) had non-restrictive, non-paralytic esotropia (7) or exotropia (1). Among these, 5 of 8 (62.5%) had a distance < near discrepancy of more than 10 prism diopters (PD). The mean preoperative deviation was 23 PD at distance and 35 PD at near. Three of 8 (37.5%) had hyperopia > 4.00 diopters. For all 16 patients, mean age at the time of initial surgery was 28 years (range 3.4-67.3, median 18.8). All patients underwent further surgery. Postoperative alignment improved to < 10 PD in 10 of 16 patients (62.5%) after their final surgery.
Recurrent horizontal strabismus that matches or exceeds the original deviation is rare but may be more common in patients with restrictive and paralytic forms of strabismus or in those with significant distance-near discrepancy. These data must be interpreted with caution due to the small number of patients.
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