Abstract
BackgroundInitial overcorrection after exotropia surgery has been considered as a desirable result. Recently, there had been several studies that reported better surgical results of augmented bilateral lateral rectus muscle recession procedure over the conventional procedure.ObjectivesTo compare the long-term results of augmented unilateral lateral rectus recession-medial rectus resection procedure (RR) with the original surgery in exotropic children.Data extractionA retrospective cohort study was performed on a total of 121 children with exotropia who underwent RR from February 2005 to December 2012 and were followed-up for at least 24 months. In 64 patients, RR was performed based on the original surgical table (original RR group). In 57 patients, the amount of medial rectus muscle resection was increased by 1 mm (augmented RR group).ResultsIn the original RR group, 47 of 64 patients (73.4%) had a successful outcome, 13 patients (20.3%) had recurrence, and 4 patients (6.3%) had overcorrection at 2 years after surgery. In the augmented RR group, 45 of 57 patients (79.0%) were successful, 4 patients (7.0%) had recurrence and 8 patients (14.0%) had overcorrection at 2 years after surgery. The recurrence rate was significantly lower in the augmented RR group than the original RR group, whereas the overcorrection rate was not significantly different between two groups at 2 years after surgery (P = 0.036 and P = 0.153, respectively). The cumulative probability of recurrence was lower in the augmented group at 36 months after surgery (P = 0.046, log rank test).ConclusionsThe long-term success rate of augmented RR in exotropic children was 79.0% and the recurrence rate was significantly lower than original RR with comparable overcorrection rates. Augmented RR can be considered as an alternative procedure in children with basic and convergence insufficiency type exotropia.
Highlights
The recurrence rate was significantly lower in the augmented rectus resection (RR) group than the original RR group, whereas the overcorrection rate was not significantly different between two groups at 2 years after surgery (P = 0.036 and P = 0.153, respectively)
The long-term success rate of augmented RR in exotropic children was 79.0% and the recurrence rate was significantly lower than original RR with comparable overcorrection rates
Augmented RR can be considered as an alternative procedure in children with basic and convergence insufficiency type exotropia
Summary
Bilateral lateral rectus muscle recession (BLR) and unilateral lateral rectus recession-medial rectus resection (RR) have been the two most popular surgical techniques for exotropia.[1,2,3,4,5,6,7,8] There had been many studies comparing BLR and RR in intermittent exotropia showing various results.[1,2,3,4,5,6,7,8] RR tended to have better success rates compared to BLR until 1.3 years and lower success rates after 2 years, but overall surgical outcomes were comparable.[1, 2, 5] Choi et al [5] showed better final outcomes of BLR over RR, since RR showed continuous recurrence of exotropia after postoperative 6 months They suggested that a gradual loss of fusion by incomitance in horizontal gaze and decrease of the tethering effect of the medial rectus muscle by muscle stretching was the reason for continuous recurrence of exotropia after RR.
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