Comparison between surgical outcome of bilateral recession and unilateral recession-resection in intermittent exotropia

Abstract

Purpose The aim of this study was to compare the postoperative drift after bilateral lateral rectus recession (BLR) compared to unilateral lateral rectus recession combined with medial rectus resection (R&R) in children with intermittent exotropia. Patients and methods This is a prospective comparative study that included 52 patients with intermittent exotropia [range=20–50 prism diopters (PD)] who were recruited from the Pediatric Ophthalmology Clinic of the Research Institute of Ophthalmology, Giza, and Beni-Suef University Hospital, Beni-Suef, Egypt between February and September 2020. The patients were randomly divided into two equal groups: BLR group and R&R group, each of 26 patients. The patients were subjected to complete ophthalmic examination including best corrected visual acuity and a full cycloplegic refraction. An alternate prism cover test with accommodative target was used to measure the deviations in the nine positions of gaze, both for distance and near. The cover test was used to examine the control of exodeviation. The ocular dominance was measured by hole in card test. Accommodative convergence/accommodation ratio was measured using the gradient method. The amblyopia cases were not included in this study. According to the postoperative results after 1 year, the patients were assigned to one of the following groups: success [esophoria or esotropia≤5 PD or exophoria or exotropia≤10 PD], overcorrection (esophoria or esotropia >5 PD), and undercorrection or recurrence (exophoria or exotropia >10 PD). Results There was a statistically significant improvement in the angle of deviation after surgery in both groups. In the BLR group, the mean angle of deviation significantly improved from 37.5±5.34 PD preoperatively to 0.58±1.39 PD at 6 months (P0.05). There were no serious intraoperative or postoperative complications in either group. Conclusion With long-term follow up, the BLR group appeared to have more stable results on ocular alignment compared to the R&R group.

Keywords

• bilateral recession; intermittent exotropia; ocular deviation; recess/resect; strabismus