Results of conservative management for consecutive esotropia after intermittent exotropia surgery

Purpose To examine the clinical course of consecutive esotropia (ET) using conservative management, after intermittent exotropia (IXT) surgery. Methods This study included 149 out of 151 consecutive patients with ET after IXT surgery, who were managed conservatively. The clinical course of consecutive ET was examined and the patients were classified into two groups based on the duration of esodeviation: (1) >3 weeks (persistent ET group, n = 56) and (2) <3 weeks (transient ET group, n = 93). Patient characteristics and treatment outcomes, including the recurrence of exotropia and stereopsis, were compared between the two groups. Results All patients with ET were managed with full-time alternate occlusion and/or with a Fresnel prism. In 149 patients out of 151 consecutive patients, 82% of ET disappeared at 12-month follow-up and all at the last follow-up visit (31.4 +/- 23.5 months). At the final visit, a recurrence of exotropia of >10 prism dioptres was significantly less frequent in the persistent ET group than in the transient ET group (25% vs 62%, respectively; P = 0.01). However, stereopsis outcome was not significantly different between the two groups, and stereopsis change was not affected by age. Conclusions By using conservative management only, persistent consecutive ET after IXT surgery disappeared in most cases by the 1-year follow-up visit after surgery. Recurrence of exotropia was significantly less frequent in patients with persistent ET, yet the sensory outcome was not affected by the duration of consecutive ET or age.