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• W4249532406 abstract "Our report examines our experience with hang-back and conventional suture technique for exotropia in our nonrandomized case series of pediatric patients.1Orlin A. Mills M. Ying G.S. Liu C. A comparison of hand-back with conventional recession surgery for exotropia.J AAPOS. 2007; 11: 597-600Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar We reported postoperative deviations at two periods, at 6 weeks after surgery and at the most recent follow-up (mean follow-up, 34 weeks for conventional and 25 weeks for hang-back groups). In designing our study, we chose to compare our postoperative measurements to orthophoria for three primary reasons: (1) the long-term goal of strabismus correction was ultimately orthophoria in all patients in this series; (2) previously published comparative series had used a measurement of orthophoria at 6 weeks as an early outcome,2Capo H. Repka M. Guyton D. Hang-back lateral rectus recessions for exotropia.J Pediatr Ophthalmol Strabismus. 1989; 26: 31-34PubMed Google Scholar, 3Rajavi Z. Ghadim H.M. Nikkhoo M. Dehsarvi B. Comparison of hang-back and conventional recession surgery for horizontal strabismus.J Pediatr Ophthalmol Strabismus. 2001; 3: 273-277Google Scholar and we were interested in placing our series in the context of prior publications; (3) the early postoperative exotropic drift seen in patients after lateral rectus recession occurs earlier, between 1 day and 4 weeks after surgery. We agree with the authors of the letter, that many surgeons target overcorrection with esotropia or esophoria immediately (1 day to 2 weeks) postoperatively. Initial overcorrection is associated with favorable long-term outcome.4Beneish R. Flanders M. The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia.Can J Ophthalmol. 1994; 29: 119-124PubMed Google Scholar, 5Ruttum M.S. Initial versus subsequent postoperative motor alignment in intermittent exotropia.J AAOPS. 1997; 1: 88-91Abstract Full Text PDF PubMed Scopus (71) Google Scholar, 6Lee S. Lee Y.C. Relationship between motor alignment at postoperative day 1 and at year 1 after symmetric and asymmetric surgery in intermittent exotropia.Jpn J Ophthalmol. 2001; 45: 167-171Crossref PubMed Scopus (47) Google Scholar However, this initial overcorrection is generally reported to have regressed to relatively stable long-term alignment by 4 weeks postoperatively,4Beneish R. Flanders M. The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia.Can J Ophthalmol. 1994; 29: 119-124PubMed Google Scholar, 5Ruttum M.S. Initial versus subsequent postoperative motor alignment in intermittent exotropia.J AAOPS. 1997; 1: 88-91Abstract Full Text PDF PubMed Scopus (71) Google Scholar, 6Lee S. Lee Y.C. Relationship between motor alignment at postoperative day 1 and at year 1 after symmetric and asymmetric surgery in intermittent exotropia.Jpn J Ophthalmol. 2001; 45: 167-171Crossref PubMed Scopus (47) Google Scholar, 7Lipton J.R. Willshaw H.E. Prospective multicentere study of the accuracy of surgery for horizontal strabismus.Br J Ophthalmol. 1986; 70: 840-843Crossref PubMed Scopus (7) Google Scholar, 8Weston B. Enzenauer R. Kraft S. Gayowsky G. Stability of the postoperative alignment in adjustable suture strabismus surgery.J Pediatr Ophthalmol Strabismus. 1991; 28: 206-211PubMed Google Scholar, 9Olitsky S.E. Early and later postoperative alignment following unilateral lateral rectus recession for intermittent exotropia.J Pediatr Ophtahlmol Strabismus. 1998; 35: 146-148PubMed Google Scholar, 10Mauro T. Kubota N. Sakaue T. Usui C. Intermittent exotropia surgery in children: Long term outcomes regarding changes in binocular alignment A study of 666 cases.Binocul Vis Strabismus Q. 2002; 16: 265-270Google Scholar and in our pediatric patient series the target for all patients was orthophoria after early postoperative shifts. Reexamining our data, we have found that three patients were overcorrected by more than 10Δ at the early outcome measurement at 6 weeks, two in the conventional surgery group and one in the hang-back group. Of these overcorrections at 6 weeks, 1 patient (conventional group) was within 10Δ of orthophoria at the final outcome measurement, and the other two (1 each in hang-back and conventional group) remained overcorrected with esodeviation >10Δ. One of 55 patients (1.8%) improved from overcorrection at 6 weeks to favorable outcome at the final outcome measurement. Based on this additional information, we do not believe our conclusions that conventional and hang-back lateral rectus recession demonstrate equivalent efficacy, and that no surgical dosage modification is necessary, require reconsideration. A comparison of hang-back with conventional recession surgery for exotropiaJournal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS}Vol. 12Issue 2PreviewIn the article by Orlin et al1 regarding surgical correction of exotropia, the authors compared two surgical techniques of lateral rectus recession (hang-back vs conventional) in a nonrandomized fashion and found no difference in the surgical outcomes between the two groups after an average of 6 to 8 months. In the mix of cases described, we feel that many surgeons would aim for overcorrection to leave a postoperative esotropia or esophoria of around 10Δ.2 With such a short follow-up, we feel that a trial such as this, particularly where patients were not randomized, should use a success criterion relating to the postoperative target deviation3 rather than orthophoria, as employed by the authors. Full-Text PDF" @default.
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