الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 149 |  |  |
| | | from | 149 | | |
Abstract
The aim of this study is to evaluate the management of consecutive esotropia (ET) using conservative management and surgical management, after intermittent exotropia (IXT) surgery. This study was carried out on 30 patients with established diagnosis of consecutive esotropia after intermittent exotropia surgery who met with all the inclusion criteria. All patients underwent complete ophthalmologic examination before and after surgery, including visual acuity assessment, anterior segment examination, ocular media examination, fundus examination, and cycloplejic refraction and strabismic examination. Motor assessment included; office assessment of control, measurement of the angle of deviation at distance (6 meters) and near (33 centimeters), with spectacle corrections, using the prolonged alternate cover and prism test. By revising medical records of our studied cases we found that all consecutive esotropia patient in the study had strabismus surgery for intermittent exotropia in the form of bilateral lateral rectus recession and average amount of exodeviation was 67.00 PD (30-90 PD). About 26 patients showed the basic type of IXT and 4 patients had divergence excess type. Follow up of patients was done in the postoperative period for 6 months. Onset of consecutive esotropia was on the 1st day in (93.3%) of cases and only 2 cases had delayed onset consecutive esotropia which appeared 1 month after IXT. The whole 30 cases of our study undergone conservative treatment .Alternate occlusion was the main conservative treatment and was performed in 30 cases (100%). Twelve cases had correction of hyperopia and only 2 cases had prism therapy in addition. By the end of conservative management 16 patients were responsive to conservative treatment and 14 patients were not responsive and needed surgery. Surgery for consecutive esotropia (second surgery) was performed 3-6months after the first surgery. Bilateral medial rectus muscle recession was performed in 8 cases, unilateral medial rectus muscle recession was performed in 4 cases, and 2 patients received unilateral lateral rectus muscle advancement. By comparing responsive and unresponsive cases to conservative treatment, there was no statistically significant difference between the two groups as regard to sex of the patient and the mean age of the patients at the time of surgery for IXT. Also the average of the spherical equivalent of the both eyes were statistically insignificant and the distribution of the conservative and surgical cases in the various types of IXT according to the Burian classification was statistically insignificant. Preoperative exodeviation at distance was significantly larger in the surgical group (conservative group vs. surgical group: -58.75 ± 19.62 vs - 76.43 ± 13.93, p =0.028). Regarding change in postoperative angle of deviation, there were no significant differences in the angle of deviation at distance in the first week after surgery. However, beginning 1 month after surgery, the angle of esodeviation was larger in the surgical group than in the conservative group. Total success rate among both conservative and surgical management group was 93.3% and success rate in surgical management group only was 85.7%. Consider success if patient become ortho, Et angle 5pd or XT angle within 10pd with fixation on an accommodative target at 6 m (distance fixation) with spectacle correction worn.