Major Article
Comparison of surgical outcomes between bilateral recession and unilateral recession-resection in moderate-angle intermittent exotropia

https://doi.org/10.1016/j.jaapos.2018.11.007Get rights and content

Purpose

To compare postoperative drift after bilateral lateral rectus recession (BLR) and after unilateral recession combined with medial rectus resection (R&R) in children with primary moderate-angle intermittent exotropia.

Methods

The medical records of children with intermittent exotropia in the range of 25Δ-50Δ who underwent BLR or R&R from July 2015 to September 2016 were reviewed retrospectively. Outcomes were classified according to postoperative angle of deviation at distance as overcorrection (esophoria or -tropia of >5Δ), success (esophoria or -tropia of ≤5Δ to exophoria/tropia of ≤10Δ), or recurrence (exophoria or -tropia of >10Δ). Patients were examined on postoperative day 1 and at 6 weeks, 6 months, and 12 months. Sensory status was evaluated using the Titmus stereoacuity test.

Results

A total of 330 children were included (BLR, 175; R&R, 155). Exotropic drift was greater in the R&R group in the period between day 1 and 6 weeks and from 6 to 12 months (P <0.05). Surgical successful rates in each group were comparable: 57.7% in the BLR group and 60.6% in the R&R group (P > 0.05). However, higher overcorrection rates were noted in the BLR group at 6 and 12 months (16.6% vs 6.5 % at 12 months [P = 0.003]). There were more patients with deteriorated stereopsis after surgery in the BLR group (P = 0.025).

Conclusions

In our study cohort, BLR was associated with more stable long-term ocular alignment and a higher rate of overcorrection than R&R. Postoperative day 1 overcorrection of <16Δ following R&R and of <10Δ following BLR were associated with relatively good results.

Section snippets

Subjects and Methods

The medical records of patients with intermittent exotropia treated at Tianjin Eye Hospital, China from July 2015 to September 2016 were reviewed retrospectively. The research protocol was reviewed and approved by the Medical Ethical Committee of Tianjin Eye Institute, China.

Patients with intermittent exotropia who underwent surgery between the ages of 4 to 14 years were included. All patients with intermittent exotropia were graded at both distance and near fixation on a scale from 0 (phoria,

Results

After excluding 21 patients who missed regular follow-up, 175 patients who underwent BLR and 155 patients who underwent R&R were included. The preoperative patient characteristics were not significantly different between groups (Table 2).

Discussion

Mixed findings have been reported when comparing R&R and BLR surgery for intermittent exotropia. Kim and colleagues2 demonstrated comparable long-term surgical outcome between BLR and R&R over time despite a higher initial postoperative overcorrection rates in R&R. Choi and colleugues3 reported higher long-term recurrent rates in R&R group when preoperative baseline characteristics of preoperative deviations and fixation preference rates were different.

Initial postoperative overcorrection is

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