Long-term ocular alignment after bilateral lateral rectus recession in children with infantile and intermittent exotropia

Abstract

To compare postoperative drift after bilateral lateral rectus recession for infantile exotropia (XT) and for intermittent XT and to compare initial postoperative alignment with long-term motor outcome. Medical records of all patients with infantile exotropia or intermittent exotropia who had undergone bilateral lateral rectus muscle recession surgery with a follow-up longer than 3 years were reviewed. The pre- and postoperative angles of deviation at distance and at near and postoperative drift at distance were compared. Surgical outcome was categorized as "success" (esotropia <6(Δ) or exotropia <11(Δ)), "recurrence" (>10(Δ) exotropia), or "overcorrection" (>5(Δ) of esotropia). The overall mean postoperative exotropic drift at 3 years was 10.4(Δ) in the infantile XT group and 7.2(Δ) in the intermittent XT group (P = 0.05). Both groups had a low success rate at 3 years: 41% in the infantile XT group and 51% in the intermittent XT group (P = 0.270). For patients with an initial esotropia of 0(Δ) to 10(Δ), the success rate at 3 years was 86% in the infantile XT group (12 of 14) and 65% in the intermittent XT group (28 of 43). Postoperative exotropic drift is clinically similar in patients with intermittent versus infantile exotropia. Esotropia of 0(Δ) to 10(Δ) during the early postoperative period may be associated with the best long-term ocular alignment.