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Consecutive Exotropia

Consecutive Exotropia. Lionel Kowal Elaine Wong. CONSECUTIVE XT. Any XT happening after previous ET [usually after ET surgery] Rare: spontaneous consecutive XT. CONSECUTIVE XT - WHY?. 1. The ET correction doesn’t ‘grow’ with the pt

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Consecutive Exotropia

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  1. Consecutive Exotropia Lionel Kowal Elaine Wong

  2. CONSECUTIVE XT • Any XT happening after previous ET [usually after ET surgery] • Rare: spontaneous consecutive XT

  3. CONSECUTIVE XT - WHY? • 1. The ET correction doesn’t ‘grow’ with the pt • Ciancia: perfect early alignment after Cong ET surgery  30% consec XT after 25y • Recession MR : mechanical disadvantage

  4. CONSECUTIVE XT - WHY? • 2. Early consec XT: • Wrong surgical dose • Poor surgical technique • Poor early healing

  5. CONSECUTIVE XT - WHY? • 3. Later consec XT: • ‘Stretched scar’ - look for stretchmarks, healing of other surgical scars, …. • Irene Ludwig : Scar remodelling & Scar migration • Scar remodeling after strabismus surgery - very under recognised • Ludwig IH, Chow AY., J AAPOS. 2000 • Ludwig IH Trans Am Ophthalmol Soc. 1999 • Need to use non- absorbable sutures if recognised

  6. Consecutive XT • Results of consecutive XT in LK’s practice over last 2 years • 91 cases of consecutive XT • Average time to XT ~ 8 years • 58 had XT surgery by LK • 32 with follow up >1 yr • Number of surgeries: 1-4 • Median: 1 • Avg. no. of surgeries: 1.3 • No. of Botox for ET : 4 (10%) • No. of Adjustables: 19 (45%)

  7. Pre-op: Range 6 – 66 XT; Avg 31XTPost-op: Range 18ET – 45XT; Avg 0

  8. Spontaneous consec XT • 2 cases of spontaneous consec XT • accounts for 2% of all consecutive XT • Case 1 • 10 yo girl with infantile ET • Noted XT at ~ 2 yo • Now XT 10Δ with V pattern • Hypermetropia R +8.75 L +7.00 • R amblyopia 6/12 • No surgical Rx

  9. Spontaneous XT • Case 2 • 30 yo female • Infantile ET ? When noted XT • RXT of 35Δ • No obliques OA • Hypermetropia R +7.50, L +4.50 • R Amblyopia 6/45 • RMMRs 5.5mm, RLMRc 7.5mm • Post op – RET 7Δ

  10. Conclusions • Spontaneous consecutive XT – rare! • Consecutive XT a difficult surgical problem • 69% with good surgical results

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