Comparative study of lateral rectus recession versus recession-resection in unilateral surgery for intermittent exotropia

Abstract

To compare outcomes of unilateral lateral rectus recession (ULR) vs lateral rectus recession-medial rectus resection (RR) in treatment of small to moderate angle exotropia in children. The medical records of intermittent exotropia patients with exodeviation measuring 20 to 25Δ, and underwent ULR or RR between 2002 and 2010 were retrospectively reviewed. The successful alignment after surgery was defined as esophoria/tropia ≤5Δ to exophoria/tropia ≤10Δ. Surgical outcomes were compared between the ULR group and the RR group. Of 85 patients, 44 underwent ULR and 41 underwent RR. The mean follow-up period was 43.2 months in the ULR group and 45.1 months in the RR group (P = 0.935). Mean preoperative exodeviation at distance and near was 21.9Δ ± 2.0Δ, 22.3Δ ± 3.6Δ in the ULR group and 24.3Δ ± 1.6Δ, 26.1Δ ± 3.8Δ in the RR group, respectively (P < 0.05). The incidence of successful outcome at the last follow-up visit was not significantly different between 2 groups which was 39% in the ULR group and 32% in the RR group (P = 0.650). Reoperation rate for recurrence of exodeviation was 18% in the ULR group and 27% in the RR group (P = 0.437). Reoperation for consecutive esotropia was done in 2 patients of the RR group. Cumulative probability of survival from recurrence did not differ between 2 groups (P = 0.83, log rank test). Surgical outcomes at a mean of 3.7 years were not significantly different between the ULR and the RR group. Unilateral lateral rectus recession could be considered as a primary approach in the treatment of small to moderate angle exotropia.