Risk factors predicting the need for additional surgery in consecutive esotropia

Purpose: To evaluate the risk factors predicting surgical treatment in consecutive esotropia occurring after surgery for intermittent exotropia. Methods: The clinical records of 52 patients with consecutive esotropia who underwent exotropia surgery were retrospectively reviewed. All patients demonstrated consecutive esotropia with diplopia or suppression for more than 1 month after surgery for exotropia. Patients were divided into two groups (the surgical group and nonsurgical group) depending on whether surgery was required for consecutive esotropia. Surgery for esotropia was performed only in patients with more than 10 prism diopters (PD) esodeviation that persisted for a minimum of 6 months, those who had suppression in 1 eye or diplopia, and those who could not achieve fine stereopsis. The nonsurgical treatment up to 6 months postoperatively was part-time patching and prism therapy in both groups. Patient characteristics were evaluated in the two groups. Results: The surgical group was composed of 17 patients and the nonsurgical group was composed of 35 patients. Age, gender, refractive error, best-corrected visual acuity, and postoperative overcorrection at 1 day were not significantly different in the two groups (P > .05). However, the distance strabismic angle at 1 month postoperatively was 2.5 ±3.8 PD esodeviation (range: 14 PD esotropia to 4 PD exotropia) in the nonsurgical group and 5.4 ±5.1 PD esodeviation (range: 20 PD esotropia to orthotropia) in the surgical group; these values were statistically significant (P < .05). Conclusions: The clinically significant risk factor affecting the surgical decision for consecutive esotropia was a large esotropic angle at 1 month postoperatively in this study.