Long-term surgical outcomes of patients with consecutive exotropia

  • Haeng-Jin Lee
  • Young Suk Yu
  • Seong-Joon KimEmail author



To evaluate the long-term surgical outcome of patients with consecutive exotropia.


Patients who underwent surgery for the treatment of consecutive exotropia between January 2008 and July 2016 with a minimum follow-up period of 2 years were retrospectively reviewed. Surgical outcomes were classified based on postoperative angle of deviation at 2 years as follows: success (esodeviation ≤ 5 prism diopters [PD] to exodeviation ≤ 10 PD), and recurrence [exodeviation > 10 PD]). Postoperative angles of deviation at 1 week, 1 month, 6 months, 1 year, and 2 years and at the final follow-up were investigated.


A total of 37 patients (28 in the success group and 9 in the recurrence group) were included. Surgical success rate at 2 years was 75.7%, and reoperation rate was 10.8% during a mean follow-up period of 42.4 ± 18.3 months after consecutive exotropia surgery. After surgery, exodrift occurred mostly during 1-month follow-up in both groups, and those with no exodrift within 1 month presented a higher surgical success. Thereafter, patients in the success group showed a more stable course during follow-up than those in the recurrence group. Stereopsis was an important factor associated with surgical outcome.


Exodrift occurs mostly within 1 month after surgery for consecutive exotropia. Targeting initial overcorrection and establishing esodeviation at postoperative month 1 is important to achieve successful results.


Consecutive exotropia Surgical outcomes Esotropia Exodrift Target angle of deviation 


Funding information

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korean Government (MOE) (No. 2017R1D1A1B03032985). The grant had no role in the design or conduct of this research.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required. The Institutional Review Board of Seoul National University Hospital in South Korea granted a waiver of consent for this retrospective chart review study.


  1. 1.
    Ganesh A, Pirouznia S, Ganguly SS, Fagerholm P, Lithander J (2011) Consecutive exotropia after surgical treatment of childhood esotropia: a 40-year follow-up study. Acta Ophthalmol 89(7):691–695. CrossRefGoogle Scholar
  2. 2.
    Donaldson MJ, Forrest MP, Gole GA (2004) The surgical management of consecutive exotropia. J AAPOS 8(3):230–236. CrossRefGoogle Scholar
  3. 3.
    Stager DR, Weakley DR Jr, Everett M, Birch EE (1994) Delayed consecutive exotropia following 7-millimeter bilateral medial rectus recession for congenital esotropia. J Pediatr Ophthalmol Strabismus 31(3):147–150 discussion 151-142Google Scholar
  4. 4.
    Keskinbora KH, Pulur NK (2004) Long-term results of bilateral medial rectus recession for congenital esotropia. J Pediatr Ophthalmol Strabismus 41(6):351–355CrossRefGoogle Scholar
  5. 5.
    Caputo AR, Guo S, Wagner RS, Picciano MV (1990) Preferred postoperative alignment after congenital esotropia surgery. Ann Ophthalmol 22(7):269–272Google Scholar
  6. 6.
    Yurdakul NS, Ugurlu S (2013) Analysis of risk factors for consecutive exotropia and review of the literature. J Pediatr Ophthalmol Strabismus 50(5):268–273. CrossRefGoogle Scholar
  7. 7.
    Folk ER, Miller MT, Chapman L (1983) Consecutive exotropia following surgery. Br J Ophthalmol 67(8):546–548CrossRefGoogle Scholar
  8. 8.
    Sawada M, Hikoya A, Negishi T, Hotta Y, Sato M (2015) Characteristics and surgical outcomes of consecutive exotropia of different etiologies. Jpn J Ophthalmol 59(5):335–340. CrossRefGoogle Scholar
  9. 9.
    Taylan Sekeroglu H, Erkan Turan K, Karakaya J, Sener EC, Sanac AS (2016) Clinical risk factors for the development of consecutive exotropia: a comparative clinical study. Int J Ophthalmol 9(6):886–889. Google Scholar
  10. 10.
    Bradbury JA, Doran RM (1993) Secondary exotropia: a retrospective analysis of matched cases. J Pediatr Ophthalmol Strabismus 30(3):163–166Google Scholar
  11. 11.
    Mohan K, Sharma A, Pandav SS (2006) Unilateral lateral rectus muscle recession and medial rectus muscle resection with or without advancement for postoperative consecutive exotropia. J AAPOS 10(3):220–224. CrossRefGoogle Scholar
  12. 12.
    Chatzistefanou KI, Droutsas KD, Chimonidou E (2009) Reversal of unilateral medial rectus recession and lateral rectus resection for the correction of consecutive exotropia. Br J Ophthalmol 93(6):742–746. CrossRefGoogle Scholar
  13. 13.
    Rajavi Z, Feizi M, Mughadasifar H, Yaseri M, Haftabadi N, Sheibani K (2013) Surgical results of consecutive exotropia. J Pediatr Ophthalmol Strabismus 50(5):274–281. CrossRefGoogle Scholar
  14. 14.
    Kasi SK, Tamhankar MA, Pistilli M, Volpe NJ (2013) Effectiveness of medial rectus advancement alone or in combination with resection or lateral rectus recession in the management of consecutive exotropia. J AAPOS 17(5):465–470. CrossRefGoogle Scholar
  15. 15.
    Cho YA, Ryu WY (2013) The advancement of the medial rectus muscle for consecutive exotropia. Can J Ophthalmol 48(4):300–306. CrossRefGoogle Scholar
  16. 16.
    Gesite-de Leon B, Demer JL (2014) Consecutive exotropia: why does it happen, and can medial rectus advancement correct it? J AAPOS 18(6):554–558. CrossRefGoogle Scholar
  17. 17.
    Plager DA, Parks MM (1990) Recognition and repair of the “lost” rectus muscle. A report of 25 cases. Ophthalmology 97(1):131–136 discussion 136-137CrossRefGoogle Scholar
  18. 18.
    Ludwig IH, Chow AY (2000) Scar remodeling after strabismus surgery. J AAPOS 4(6):326–333. CrossRefGoogle Scholar
  19. 19.
    Hatt SR, Leske DA, Jung JH, Holmes JM (2017) Intraoperative findings in consecutive exotropia with and without adduction deficit. Ophthalmology 124(6):828–834. CrossRefGoogle Scholar
  20. 20.
    Birch EE, Stager DR Sr, Berry P, Leffler J (2004) Stereopsis and long-term stability of alignment in esotropia. J AAPOS 8(2):146–150. CrossRefGoogle Scholar
  21. 21.
    Birch EE, Stager DR Sr (2006) Long-term motor and sensory outcomes after early surgery for infantile esotropia. J AAPOS 10(5):409–413. CrossRefGoogle Scholar
  22. 22.
    Pediatric Eye Disease Investigator Group (2002) Spontaneous resolution of early-onset esotropia: experience of the Congenital Esotropia Observational Study. Am J Ophthalmol 133(1):109–118CrossRefGoogle Scholar
  23. 23.
    Mangla D, Simon JW, Mangla N, Zobal-Ratner J (2014) Treatment of consecutive exotropia: unilateral lateral rectus recession combined with medial rectus advancement or resection. J Pediatr Ophthalmol Strabismus 51(2):116–119. CrossRefGoogle Scholar
  24. 24.
    Marcon GB, Pittino R (2011) Dose-effect relationship of medial rectus muscle advancement for consecutive exotropia. J AAPOS 15(6):523–526. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OphthalmologySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Seoul Artificial Eye CenterSeoul National University Hospital Clinical Research InstituteSeoulSouth Korea

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