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David A Leske, Sarah R Hatt, Steven Maxfield, Jae Ho Jung, Jonathan M Holmes; Factors associated with atypical postoperative drift following surgery for consecutive exotropia. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3440.
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To evaluate the associations of clinical and surgical factors with atypical postoperative drift, in patients undergoing surgery for consecutive exotropia (XT).
We reviewed records of 66 patients (aged 12-82 years) undergoing unilateral recess-advance/resect surgery for consecutive XT with the lateral rectus muscle on an adjustable suture. Pre-op distance angle of deviation (by prism and alternate cover test [PACT]) ranged from 12 to 60 prism diopters (PD) (median 25 PD) and immediate post-op target was 4 to 10 PD esotropia at distance, anticipating a small post-op exodrift. Post-op drift was calculated as change in distance angle by PACT from immediately post-adjustment to 6 weeks post-op. Typical drift was defined as 0 to 9 PD exodrift. Atypical drift was defined as either: 1) 10 PD or more exodrift, 2) any esodrift. Univariate and multiple logistic regression analyses were performed to evaluate associations with clinical and surgical factors. Univariate factors significant at a level of P<0.1 were included in multiple logistic regression analyses.
At 6 weeks, median overall drift was an exodrift of 4 PD (quartiles 0 to 10 PD, confirming our a priori definition of typical drift). 18 (27%) of 66 patients showed excessive exodrift and 15 (23%) showed esodrift. For excessive exodrift, in univariate analyses, there were associations with larger pre-op XT at distance (P=0.004) and near (P=0.07), and with greater post-adjustment distance esotropia (P=0.08). In multiple logistic analysis, only larger pre-op XT at distance remained associated (P=0.01). For esodrift, in univariate analyses there were associations with greater number of previous surgeries (P=0.04), medial rectus attachment status (P=0.009 [classified as either normal, abnormal, attached to pulley or behind pulley; esodrift associated with a non-normal attachment]) and larger medial rectus surgical dose (P=0.06). In multiple logistic analysis only medial rectus attachment status (non-normal) remained associated with esodrift (P=0.02).
The association of excessive post-op exodrift with larger pre-op exodeviations, and post-op esodrift with medial rectus attachment being non-normal, may guide pre-op and intra-op surgical planning for consecutive XT.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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