1. Consecutive Exotropia
Lionel Kowal
Elaine Wong

2. CONSECUTIVE XT
Any XT happening after previous ET [usually after ET surgery]
Rare: spontaneous consecutive XT

3. CONSECUTIVE XT - WHY? 1. The ET correction doesn’t ‘grow’ with the pt
Ciancia: perfect early alignment after Cong ET surgery  30% consec XT after 25y
Recession MR : mechanical disadvantage

4. CONSECUTIVE XT - WHY? 2. Early consec XT: Wrong surgical dose
Poor surgical technique
Poor early healing

5. CONSECUTIVE XT - WHY? 3. Later consec XT:
‘Stretched scar’ - look for stretchmarks, healing of other surgical scars, ….
Irene Ludwig : Scar remodelling & Scar migration
Scar remodeling after strabismus surgery - very under recognised
Ludwig IH, Chow AY., J AAPOS. 2000
Ludwig IH Trans Am Ophthalmol Soc. 1999
Need to use non- absorbable sutures if recognised

6. Consecutive XT
Results of consecutive XT in LK’s practice over last 2 years
91 cases of consecutive XT
Average time to XT ~ 8 years
58 had XT surgery by LK
32 with follow up >1 yr
Number of surgeries: 1-4
Median: 1
Avg. no. of surgeries: 1.3
No. of Botox for ET : 4 (10%)
No. of Adjustables: 19 (45%)

7. Pre-op: Range 6 – 66 XT; Avg 31XT Post-op: Range 18ET – 45XT; Avg 0

12. Spontaneous consec XT 2 cases of spontaneous consec XT Case 1
accounts for 2% of all consecutive XT
Case 1
10 yo girl with infantile ET
Noted XT at ~ 2 yo
Now XT 10Δ with V pattern
Hypermetropia R L +7.00
R amblyopia 6/12
No surgical Rx

13. Spontaneous XT Case 2 30 yo female Infantile ET ? When noted XT
RXT of 35Δ
No obliques OA
Hypermetropia R +7.50, L +4.50
R Amblyopia 6/45
RMMRs 5.5mm, RLMRc 7.5mm
Post op – RET 7Δ

14. Conclusions Spontaneous consecutive XT – rare!
Consecutive XT a difficult surgical problem
69% with good surgical results