Recession-medial Rectus Resection Research Articles

Efficacy of medial rectus plication versus resection for exotropia: a meta-analysis.

To compare the outcomes of medial rectus plication and medial rectus resection procedures in the treatment of exotropia. Articles from Pubmed, EMBASE, Web of Science, and Cochrane Library databases until July 2021 with a minimum follow-up period of 1month were retrieved. No restriction on language was applied. Eligible studies must comply with the inclusion criteria. Only studies with comparisons between unilateral medial rectus plication versus unilateral medial rectus resection, unilateral lateral rectus recession-medial rectus plication (RP) versus unilateral lateral rectus recession-medial rectus resection (RR), or bilateral medial rectus plication(BMRP) versus bilateral medial rectus resection (BMRR) would be included for subsequent analysis. Two primary outcomes were specified: success rate and mean postoperative deviation. Dichotomous data were calculated as pooled odds ratios (ORs) with 95% confidence intervals (CIs) and continuous data as weighted mean differences (WMD) with 95% CIs. A total of 8 studies with 557 participants were enrolled in the meta-analysis based on the inclusion criteria. Seven studies compared lateral rectus recession + medial rectus plication to unilateral lateral rectus recession + medial rectus resection and one study compared bilateral medial rectus plication to bilateral medial rectus resection. Differences in success rates between plication and resection groups were not statistically significant (OR = 0.66; 95% CI, 0.43-1.02; P = 0.06), and the unsatisfactory effects (the undercorrection and overcorrection rates) between the two groups were comparable. Additionally, there were also no significant differences in postoperative deviation and the amount of exodrift between the two groups. This meta-analysis provides evidence that both the medial rectus plication and medial rectus resection procedures have similar efficacy in the treatment of exotropia.

Long-term outcomes following resection-recession versus plication-recession in children with intermittent exotropia

Background/AimsTo compare the long-term surgical outcomes between unilateral lateral rectus recession-medial rectus resection (RR) and lateral rectus recession-medial rectus plication (RP) in children with intermittent exotropia.MethodsChildren who underwent RR or...

Surgical outcomes of unilateral recession and resection in intermittent exotropia according to forced duction test results.

PurposeTo compare the surgical outcomes of unilateral lateral rectus recession–medial rectus resection (RR) according to forced duction test (FDT) results with those of conventional RR in intermittent exotropia.MethodsA total of 129 patients aged 3 to 10 years with intermittent exotropia who underwent RR between 2006 and 2011 were included. The operator compared the tension of the lateral rectus (LR) between both eyes. When FDT results were asymmetric, RR was performed on the eye with more LR tension. RR was performed on the nondominant eye when FDT results were symmetric. Patients were divided into two groups; one group (n = 64) underwent RR without FDT (RR group) and the other group (n = 65) underwent RR considering FDT results (RR-FDT group). Success, recurrence, reoperation rates and cumulative probabilities of success were evaluated in both groups. Surgical outcome was considered satisfactory if the distance deviation in the primary position was between ≤ 10 PD of exophoria/tropia and ≤ 10 PD of esophoria/tropia. Recurrence was defined as an alignment of > 10 PD of exophoria/tropia, and overcorrection defined as > 10 PD of esophoria/tropia. Reoperation for recurrence was recommended for constant exotropia ≥ 14 PD at distance.ResultsThe total follow-up periods were 4.4±2.3 years in the RR group, and 3.9±2.0 years in the RR-FDT group (P = .310). In the RR group, 50 patients (78.1%) were successful, 13 patients (20.3%) had recurrence, and 1 patient (1.6%) had overcorrection at 2 years after surgery. In the RR-FDT group, 58 patients (89.2%) were successful, 5 patients (7.7%) had recurrence, and 2 patients (3.1%) were overcorrected. The recurrence rate at 2 years after operation was significantly lower in the RR-FDT group (P = .045). Recurrence rates during the follow-up period were 5.6% per person-year in the RR group and 2.7% per person-year in the RR-FDT group. Reoperation for recurrence was performed on 7 patients (10.8%) in the RR-FDT group and 16 patients (25.0%) in the RR group (P = .035). Postoperative sensory outcomes were similar between both groups.ConclusionsThe forced duction test was useful in reducing the risk of recurrence at 2 years after surgery when RR was performed on the eye with more passive tension of the LR. Intraoperative FDT may be considered to choose which eye to operate on when planning RR in intermittent exotropia.

Comparison of Long-term Surgical Outcomes Between Unilateral Recession and Unilateral Recession-Resection in Small-Angle Exotropia

To compare the surgical outcomes of unilateral lateral rectus recession-medial rectus resection (RR) and unilateral lateral rectus recession (ULR) for intermittent exotropia of ≤20 prism diopters (PD). Retrospective, nonrandomized clinical study. A total of 130 children with intermittent exotropia of ≤20 PD who underwent unilateral RR or ULR of 10mm were included. Patients were observed for at least 2 years. Success rates, cumulative probabilities of success, and factors related to recurrence and overcorrection were evaluated. The mean follow-up duration after surgery was 3.1 ± 1.0 years in the RR group and 3.6 ± 1.6 years in the ULR group. In the RR group, 38 of 61 patients (62%) had ocular alignment within 10 PD of exophoria/tropia and 5 PD of esophoria/tropia; 18 patients (30%) had recurrence, and 5 (8%) had overcorrection. In the ULR group, 26 of 69 patients (38%) had successful alignment, 41 patients (59%) had recurrence, and 2 patients (3%) were overcorrected. At 6months after surgery, the success rate was significantly higher in the ULR group (RR 61%; ULR 78%, P= .039), but it became comparable after 2 years (RR 60%; ULR 52%, P= .370). At the final examination after a mean duration of 3 years, the recurrence rates were lower in the RR group (30% vs 59%, P= .001), and the overcorrection rates were comparable (8% vs 3%, P= .252). Unilateral RR resulted in more successful alignment and lower recurrence compared to ULR for the treatment of small-angle intermittent exotropia of ≤20 PD.

Comparison of long‐term surgical outcomes of 2‐muscle surgery in intermittent exotropia: Bilateral vs Unilateral

PurposeTo compare long‐term surgical outcomes after bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession‐medial rectus resection (RR) for the treatment of intermittent exotropia.MethodsConsecutive patients who underwent BLR or RR for treatment of intermittent exotropia between 1999 and 2010 and had ≥ 5 years’ follow‐up were recruited. Surgical outcomes were grouped according to postoperative angle of deviation as overcorrection (esophoria/tropia>5△), success (esophoria/tropia ≤5△ to exophoria/tropia≤10△), or undercorrection/recurrence (exophoria/tropia>10△), and were compared between the BLR group and the RR group at postoperative 1 week, 1 month, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, and at the final examination.ResultsOf 99 patients, 37 underwent BLR and 62 underwent RR. The mean follow‐up period was 99.6 months in the BLR group and 96.2 months in the RR group. At 1 week, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years and at the final examination the surgical outcomes in each group were not different (p > 0.05). The surgical success rate was 44.6% in the BLR group and 45.0% in the RR group (p = 0.27). The re‐operation rate was 29.7% in the BLR group and 40.3% in the RR group (p = 0.67).ConclusionsSurgical outcomes by 5 years after surgery for intermittent exotropia were comparable between the BLR and RR groups. The surgical success rate and the re‐operation rate were not different between the BLR and RR groups.

Long-term postoperative outcomes of bilateral lateral rectus recession vs unilateral recession-resection for intermittent exotropia.

To discuss the long-term postoperative results of bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus resection (RR) in therapy of intermittent exotropia. We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between 2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection (esotropia/phoria >5(Δ)), orthophoria (esotropia/phoria ≤5(Δ) to exotropia/phoria ≤10(Δ)), and undercorrection/recurrence (exotropia/phoria >10(Δ)). Titmus test was used to evaluate stereoacuity, the stereoacuity <800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12, 24mo and at 36mo examination between groups. At 12, 24mo after surgery, the motor outcomes had no difference (P>0.05) between groups. However, the motor outcomes at 6, 36mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group (83.02% vs 82.24%, P<0.05) but the result was contrary at the 3y examination (60.75% vs 43.40%, P<0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up. The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the 3y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group's.

Surgical outcomes of symmetric and asymmetric surgery for intermittent exotropia with postoperative large early overcorrection

To compare surgical outcomes between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus resection (RR) for intermittent exotropia with overcorrection of 20 prism diopter (PD) or more on postoperative day 1. A retrospective chart review identified 319 patients who underwent either BLR or RR for primary surgical treatment of intermittent exotropia between July 2008 and June 2011. The patients with basic type intermittent exotropia and overcorrection of 20 PD or more, at either near or distance, on postoperative day 1 and had more than 6 months of follow-up were included. Patients with simultaneous vertical and/or oblique muscle surgery and those with paralytic or restrictive strabismus were excluded. The pre- and post-operative deviation, visual acuity, and near stereoacuity were analyzed. Twenty-four patients were included. The mean postoperative day 1 alignment was 21.5 ± 6.2 PD esotropia at distance, and 13.8 ± 8.0 PD at near. Fourteen patients underwent BLR and 10 underwent RR. Three patients were wearing the base out prism below 15 PD at the last follow-up. The mean duration from the surgery to esotropia below 10 PD was 2.9 ± 1.1 weeks and 8.0 ± 7.1 weeks in the BLR and RR groups, respectively (p = 0.030). All three recurrent patients underwent RR. None of the patients completely lost stereoacuity, postoperatively. In basic type intermittent exotropia with overcorrection of 20 PD or more on postoperative day 1, the overcorrection resolved faster and recurrence rates were lower in BLR group than in the RR group. Consecutive esotropia over 15 PD did not occur in both groups.

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

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.