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Sundeep K. Kasi, Madhura Tamhankar, Nicholas J. Volpe; Long-Term Effectiveness of Medial Rectus Muscle Advancement in the Surgical Management of Consecutive Exotropia. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1604.
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Several methods to correct consecutive exotropia have been described in the literature, which include combinations of lateral rectus recession, medial rectus resection, and/or medial rectus advancement. The success rates of these procedures is reported between 60-80% at mean follow-up times ranging from 4 months to 2.5 years in prior retrospective studies (Tinley 2010, Chatzistefanou 2009). The purpose of our study was to prospectively determine the long-term success rate of medial rectus advancement performed with adjustable suture technique in the management of consecutive exotropia by inviting all patients for a follow-up examination.
We identified 67 patients who underwent medial rectus muscle advancement alone or in combination with medial rectus resection and/or lateral rectus recession performed by a single surgeon between 1999 and 2010. A retrospective review of these cases was first performed and then patients were invited to return for a follow-up examination to prospectively assess the success of the surgery. This examination was performed by an independent observer.
The mean age at surgery for exotropia was 42.9 years (range: 14.2-77.8). The mean exodeviation was 33.5 prism diopters (PD). The mean number of prior surgeries was 2.0, with 46.3% of patients having had only 1 prior surgery. The mean total advancement performed was 5.56 mm. The most common procedures were unilateral MR advancement and LR recession (16), unilateral MR advancement/resection and LR recession (14), unilateral MR advancement/resection (8), unilateral MR advancement (6), and bilateral MR advancement (5). The success rate, defined as ocular alignment within 10 PD of orthophoria, at longest-follow-up (mean 1.97 years) was 84% (n=61). For those patients with a follow-up time of at least 2 years and at least 5 years, the success rate was 68% (n=22, mean 4.97 years) and 75% (n=8, mean 7.21 years) respectively. Adduction deficits were improved in 92% of patients (n=50) at final follow-up.
Advancement of the medial rectus muscle or in combination with medial rectus resection and/or lateral rectus recession results in long-lasting improvement in the majority of patients with consecutive exotropia with improvement in adduction deficits after surgery. Our prospective long-term follow-up data suggests that medial rectus advancement is integral to the successful surgical strategy in the management of consecutive exotropia.
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