K404

The main advantage of the bilateral medial rectus fadenoperation for the treatment of essential infantile esotropia is the low number of delayed consecutive exotropia. Nevertheless occasionally this unwanted complication occurs also after fadenoperations.

Patients: All patients operated between 1988 and 1997 for consecutive exotropia following bimedial fadenoperation (without recession) were included in this study. Surgery for exotropia consists in uni- or bilateral lateral rectus muscle recession or in removing of the faden (with or without resection).

Results: Altogether 49 patients were operated for a consecutive exotropia after fadenoperation within the examined ten years. On the other hand in 1569 patients a bimedial fadenoperation (without recession) was performed in the same time period. 34 (69.4%) of the consecutive exotropes showed an exodeviation at far immediately following the surgery (group I). 15 (30.6 %) patients developed a manifest exotropia 1-53 months later (group II). The hyperopia at the time of the first operation was 2.5 D in group I and 2.3 D in group II (spherical equivalent). A bilateral fadenoperation with simultaneous unstretching the anterior muscle segment was performed in four patients of group II and only in two patients of group I. A cerebral palsy was evident in three patients of group II and just so in three patients of group I.

Conclusion: While exotropia appearing immediately after surgery is most likely a complication of an individual overdosed operation, this conclusion isn’t sufficient for delayed exotropia. Motor and sensory instabilities as e.g. there are in patients needing fadenoperation with simultaneous unstretching the anterior muscle segment for the treatment of a nonaccommodative convergence excess or in patients showing a cerebral palsy, seem to increase the risk of delayed consecutive exotropia. The time from initial surgery until the appearance of consecutive exotropia is lower than it is known after other surgical procedures for infantile esotropia.

Klinik für Orth- u. Pleoptik, Univ.-Augenklinik, Hegewischstr. 2, D-24109 Kiel