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To determine the preoperative characteristics and surgical results after medial rectus advancement in patients with secondary exotropia.Retrospective, interventional case series.Setting: Tertiary Care University Medical Center. PatientPopulation: 221 patients with a diagnosis of secondary exotropia who underwent medial rectus advancement surgery by a single surgeon.Preoperative demographics, exodeviation and motility, intraoperative findings, and postoperative results were recorded. MainOutcomeMeasure: Success of surgery, defined as Esotropia15 prism diopters (pd) at postoperative week 1, or any deviation of8 pd at postoperative month 2 (POM2).A total of 98 patients underwent unilateral medial rectus advancement (UMRadv), 89 underwent UMRadv with lateral rectus recession (LRc), and 34 underwent bilateral medial rectus advancement (BMRadv). POM2 success rates were 66.7% in UMRadv patients, 62.1% in UMRadv + LRc, and 56% in BMRadv. A total of 117 patients had preoperative adduction deficits, which were significantly associated with the finding of an intraoperative stretched scar (P.001). Larger preoperative duction deficits were associated with larger stretched scars (P.001). At POM2, the mean effect of surgery (pd of correction/mm) was 2.3 ± 1.4 pd/mm for UMRadv, 2.5 ± 0.8 pd/mm for UMRadv + LRc, and 2.8 ± 1.1 pd/mm for BMRadv. Patients with a stretched scar had significantly less correction per millimeter (2.2 ± 1.2 pd/mm) compared with those without (2.6 ± 1.2 pd/mm, P.001). A total of 38.6% of patients experienced exodrift greater than 10 pd. Exodrift was significantly larger in the BMRadv group (P.005).These results provide guidance for surgical correction based on preoperative deviation and ductions. Adduction deficits indicate a stretched scar, which must be treated with resection and advancement of the medial rectus. A larger amount of surgery is needed in patients with a stretched scar. Exodrift is common, and therefore aiming for approximately 10 pd of overcorrection at postoperative week 1 can improve final outcomes.Medial rectus advancement results in successful surgical results at POM2 for secondary exotropia.

Purpose: The aim of this study was to analyze the amount of medial rectus (MR) advancement in the treatment of consecutive exotropia by comparing it with the amount of MR resection in a sample of patients with constant exotropia and evaluate the effectiveness of MR advancement with lateral rectus (LR) recession in the management of consecutive exotropia.Materials and Methods: A retrospective chart review of patients who underwent unilateral MR strengthening with LR weakening due to consecutive or constant exotropia was performed. Patients with consecutive exotropia underwent MR advancement with LR recession, and those with constant exotropia underwent MR resection with LR recession. The surgical dosages were determined according to a standard table. A successful result was defined as alignment within 10 prism diopters of orthotropia.Results: A total of 36 patients fulfilled the inclusion criteria: 18 had consecutive exotropia and 18 had constant exotropia. Successful alignment was obtained in 83.3% of patients with consecutive exotropia and 88.9% of patients with constant exotropia. There was no difference between the amount of MR advancement performed in consecutive patients with exotropia and the amount of MR resection performed in patients with constant exotropia. Postoperatively, while consecutive exotropes with a poor result showed overcorrection, constant exotropes with a poor result showed undercorrection.Conclusion: This study suggests that there is no difference between the amount of previously recessed MR advancement and that of untouched MR resection. They also showed that MR advancement with LR recession is an effective means of correcting secondary exotropia., Amaç: Bu çalışmada konsekütif ekzotropya tedavisinde medial rektus (MR) ilerletme miktarını sabit ekzotropyası olan hastalardaki MR rezeksiyonu ile karşılaştırarak incelemek ve konsekütif ekzotropya tedavisinde MR ilerletmesi ile birlikte lateral rektus (LR) geriletmesinin etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Konsekütif veya sabit ekzotropya nedeniyle tek taraflı MR güçlendirilmesi ile birlikte LR zayıflatılması yapılmış hastaların kayıtları retrospektif olarak incelendi. Konsekütif ekzotropyalı hastalarda MR ilerletmesi ile birlikte LR geriletmesi ve sabit ekzotropyalı hastalarda MR rezeksiyonu ile birlikte LR geriletmesi yapılmıştı. Cerrahi dozlar standart bir tabloya göre belirlenmişti. 10 prizma dioptri ve daha az kayma başarılı sonuç olarak kabul edildi.Bulgular: 18 konsekütif ekzotropyalı ve 18 sabit ekzotropyalı toplamda 36 hasta çalışmaya kabul edilme kriterlerini karşıladı. Başarılı hizalanma konsekütif ekzotropyalı hastaların %83.3’ ünde, sabit ekzotropyalı hastaların %88.9’unda elde edildi. Konsekütif ekzotropya olan hastalarda yapılan MR ilerletme miktarı ile sabit ekzotropya olan hastalarda yapılan MR rezeksiyonu miktarı arasında fark yoktu. Postoperatif dönemde, başarısız sonuç elde edilen konsekütif ekzotropyalı hastalarda fazla düzelme mevcut iken, başarısız sonuç elde edilen sabit ekzotropyalı hastalarda yetersiz düzelme vardı.Sonuç: Bu çalışma daha önceden geriletilmiş MR’nin ilerletilme miktarı ile cerrahi olarak hiç dokunulmamış MR’nin rezeksiyon miktarı arasında bir fark olmadığını öne sürmektedir. Bu çalışma aynı zamanda MR ilerletmesi ile birlikte LR geriletmesinin sekonder ekzotropyayı düzeltmek için etkili bir yöntem olduğunu göstermiştir.

Purpose: To compare lateral rectus recession (LRc) and medial rectus advancement (MRadv) for correction of consecutive exotropia (CXT). Methods: Of the 43 exotropic patients 20 of them underwent LRc (group 1) and 23 of them underwent MRadv (group 2). Postoperative exodrift, strabismic angle, dose effect relationship were compared with minimum 2 years follow‑up. Results: An average dose-effect in group 2 is higher than group 1 in the early postoperative period, however there was no significant difference at the second year follow-up (p=0,109). An average exodrift after 2 year follow-up was 6,6±7,12 PD in group 1, and 8,13±7,45 PD in group 2. Postoperative overall success rate was 50% in group 1 and 65% in group 2 at the last follow-up. The success rates were not significantly different between the groups (chi-square, p =0.31). Conclusion: Although there was no statistically significant difference at the last follow-up, better results were obtained with MRadv than LRc in the treatment of CXT.

To compare the surgical outcomes of medial rectus advancement and lateral rectus recession in postoperative consecutive exotropia with single-stage adjustable suture surgery. Among 1003 patients who underwent bilateral medial rectus recession between November 1996 and March 2013, the patients who required surgery for consecutive exotopia were retrospectively reviewed. Nineteen patients underwent medial rectus advancement and 15 patients underwent lateral rectus recession. All patients underwent single-stage adjustable surgery under topical anesthesia and were followed up for at least 12 months. The mean follow-up duration was 2.4 years. At final follow-up, a successful surgical outcome was found in 12 patients (63.0%) in the medial rectus advancement group and 14 patients (93.3%) in the lateral rectus recession group (P = .039). The change in ocular deviation was correlated with the amount of recession (P = .008) and preoperative angle (P

Purpose: In this study the results of consecutive exotropia surgical treatment by using different surgical technics are presented. Methods: This study included 34 patients, aged 21 to 47 years (mean 27.9), who underwent medial rectus muscle advancement alone or in combination with medial rectus resection and/or lateral rectus recession. The mean interval between original surgery and surgery for consecutive exotropia was 8.5 years (range: 5.5 years to 14 years). Most of patients had 2 and more prior surgeries (73.5%) sold by an adduction deficit (47.06%). Results: The overall mean preoperative exodeviation was 35.12 ± 10.13 PD. Satisfactory alignment (within 10 PD of orthophoria) was achieved in 20 patients (58.8%) at 10 days after surgery and 24 patients (70.5%) at final 6-month follow-up. The most common surgical procedures were unilateral MR advancement and LR recession—47%. Conclusion: Medial rectus advancement is an effective method of surgical treatment, especially in cases with adduction limitation, but the risk of the eyelid fissure narrowing in cases of MRM advancement more than 5 mm associated with resection is present. In our opinion for reducing this risk in cases of XT with big angle of deviation, performing a smaller amount of advancement associated with recession of LRM can prevent the development of a such complication.

Purpose: Consecutive exotropia presents a difficult clinical problem, especially when previously recessed medial recti are to be strengthened. Surgical options include advancement, typically with a small resection, and resection alone. Methods: The authors retrospectively reviewed records of all patients who underwent a second two-muscle surgery on a single eye for consecutive exotropia. Patients with paralytic strabismus and those with less than 1 month of postoperative follow-up were excluded. In 2003, one of the authors began medial rectus resections without advancements in most cases, whereas a second author continued to perform advancements. Two treatment groups were thus reviewed. Results: Forty-two patients qualified for inclusion, including 23 for the resection group and 19 for the advancement group. Preoperative deviations were similar ( P = .35, 95% confidence interval: −2.64 to 9.82). Postoperative deviations averaged 11.4 prism diopters (PD) in the resection group and 11.5 PD in the advancement group ( P = .98, 95% confidence interval: −12.2 to 12.3). Forty-eight percent of the resection group and 63% of the advancement group achieved alignment within 10 PD of orthophoria ( P = .33, 95% confidence interval: −9.0% to 39%). Conclusions: Surgical results were favorable following both techniques. Although both techniques appear to be adequate, resection of previously recessed medial recti may be preferable because they allow use of standard surgical tables and avoid advancement of inflamed tissue into the palpebral fissure. [J Pediatr Ophthalmol Strabismus 2014;51(2):116–119.]

Purpose: Consecutive exotropia is a frequent consequence of surgery for convergent strabismus that may develop at differing rates postoperatively. Several surgical options on horizontal recti have been proposed, but none report a clearly standardized amount of surgery. The present study provides further results of the medial rectus muscle advancement. Methods: Twenty-eight patients, age range 6 - 55 years, who had undergone unilateral or bilateral medial rectus advancement to the physiological insertion, with or without contemporary unilateral lateral rectus muscle recession, were included in the study. Factors leading to the onset of consecutive exotropia were analyzed. Results: After 2 - 3 years, the overall mean angle reduction was 21.3 prismatic diopters (PD) for distance and 22.8 PD for near, with an effectiveness on near vision lower than expected. Only in the 7 cases with a preoperatively larger exotropia at near (of at least 10 PD), the reduction was 17.0 PD for distance and 24.6 PD for near. In unilateral medial rectus muscle advancement, the mean reduction was 14.3 PD for distance and 16.3 PD for near; in bilateral advancement it was 25.8 PD and 25.2 PD respectively. Conclusion: Medial rectus advancement is preferable to other options, especially in cases with convergence deficit, if no excess of divergence or limitation of bulb rotation is present, for which a lateral rectus muscle recession is indicated. Unilateral and bilateral surgeries are useful for exotropia of about 15 PD and 25 PD respectively. The effectiveness depends weakly or not at all by the amount of the previously executed recession.

Purpose To investigate whether consecutive exotropia following medial rectus muscle recession is associated with muscle slippage and to assess the effectiveness of treating the condition with medial rectus advancement. Methods The records of patients with consecutive exotropia after medial rectus recession were reviewed to determine medial rectus muscle insertion location at the time of advancement surgery. Measurements before and after medial rectus advancement were compared. Success was defined as alignment within 10 Δ of orthotropia. The dose effect of medial rectus advancement was determined by nonlinear regression. Results A total of 20 patients were included. The mean age (± standard deviation) at time of surgery was 19 ± 19 years (range, 1.1-65.4). The mean preoperative exotropia was 28 Δ ± 16 Δ (range, 12 Δ -60 Δ ). Medial rectus slippage of 2.5 ± 1.7 mm (range, 1.0–5.0 mm) was found in 14 patients (36%) who had previously undergone medial rectus recession. Surgery corrected about 4 Δ of exotropia per mm total medial rectus advancement. Although 95% of patients were aligned successfully immediately after surgery, averaging 2 Δ ± 4 Δ esotropia, there was significant late exodrift, averaging 17 Δ at final follow-up. At final follow-up, 1.6 ± 1.8 (range, 0.10-6.2) years after surgery, 50% of patients maintained alignment within 10 Δ of orthotropia (mean, 3 Δ ± 4 Δ exotropia); the rest experienced recurrent exotropia of 25 Δ ± 8 Δ . Conclusions Medial rectus slippage is common in consecutive exotropia. Medial rectus advancement effectively treated consecutive exotropia, whether or not there was muscle slippage. It is however, associated with late exodrift; hence patients should be warned about potential for further XT recurrence.

Introduction: Treatment of consecutive exotropia after bilateral medial rectus recessions has been rarely studied. Though several series have reported results of medial rectus advancement, none has described results of lateral rectus recessions. Methods: We reviewed our results in 31 patients who underwent bilateral lateral rectus recessions for consecutive exotropia after bilateral medial rectus recessions. Mean follow-up was 30 months (range, 1-140 months) after the exotropia repair. Results: At last follow-up, 20 of 31 patients (65%) had deviations of less than or equal to 10 PD. Limitation of adduction was not apparent. Discussion: Cooper's dictum states that lateral rectus recession should be performed instead of medial rectus advancement. Our results suggest that this approach is generally successful. The outcome after exotropia repair in consecutive deviations is comparable to that after repair of primary exotropia. (J AAPOS 2000;4:291-4)

Purpose To prospectively determine the long-term success of medial rectus advancement alone or in combination with other procedures in the management of consecutive exotropia. Methods All patients with consecutive exotropia who underwent medial rectus advancement alone or in combination with medial rectus resection or lateral rectus recession or both, performed by a single surgeon between 1999 and 2010, were included. Initially, a retrospective review was performed. Patients were then recalled and examined by a masked observer. Good results were defined as final alignment within 10 Δ of orthotropia. Results A total of 46 patients were enrolled in the study with a mean age of 43 ± 15.5 years (range, 14-76) and a mean exotropia of 32 ± 18 Δ (range, 10-90). Good results were achieved in 33 patients (72%) at a mean follow-up time of 2.5 years. Of the 21 patients returning for prospective examination, 15 (71%) had good alignment at an average follow-up of 4.2 years (range, 6.9 months to 8.6 years). Adduction deficits were improved in 30 of 33 (91%) patients at final follow-up. Conclusions In patients with consecutive exotropia, surgery including medial rectus advancement alone or in combination with resection or lateral rectus recession or both usually is effective.