Lateral Rectus Recession Research Articles

Unilateral versus bilateral lateral rectus recession for correction of small to moderate angle exotropia.

To compare the effect of unilateral versus bilateral lateral rectus (LR) recession for correction of small to moderate exotropia. Records of all patients with exotropia 14-35 prism diopters (∆), operated upon by the authors, were included in a retrospective study to compare the effect of unilateral (Group 1) versus bilateral (Group 2) LR recession. The study end-point was the last follow-up visit scheduled at least 3months postoperatively. A successful outcome was defined as 0-10∆ of horizontal tropia. The study included 154 patients (47 in Group 1 and 107 in Group 2). Patients were followed up for 3-120months (26.7 ± 24.88). A successful outcome was achieved in 83% in Group 1 and 82.2% in Group 2 (p = .976), with higher success in group 1 for surgical target angles up to 25∆. All failures in Group 1 were due to undercorrections., while the 17.8% failure rate in Group 2 comprised 15% undercorrections and 2.8% overcorrections (p = .419). Persistent lateral incomitance was seen in 29.5% in Group 1 versus 2.3% in Groups 2 (p < .001). Lateral incomitance was encountered in 71% of those undergoing 10mm unilateral recessions, versus 20% of those who had smaller recession doses. Limited ductions were mild, and exceeded -1 in only 4 cases: 3 had had 10mm and 1 had had 9mm unilateral LR recession. Unilateral and bilateral LR recessions offer essentially equal success rates. Unilateral recessions are advised for angles up to 25∆, without exceeding 10mm.

Medial rectus re-advancement: more bang for your buck?

ABSTRACT Introduction: Although there are guidance tables in the literature on surgical dosage for primary medial rectus resection-lateral rectus recession surgery, there is a lack of consensus on the surgical gains in medial rectus re-advancement (MRR) for the management of consecutive exotropia. We compared the surgical outcomes of primary medial rectus resection-lateral recession (RR) surgery, to MRR in patients with consecutive exotropia. Methods: Retrospective, electronic note review of consecutive patients undergoing primary RR surgery for basic exotropia (RR group), convergence insufficiency-type exotropia, and divergence excess, and consecutive patients undergoing MRR with or without lateral rectus recession (MRR group) for consecutive exotropia in a teaching university hospital. Results: There were 84 patients in the RR group and 27 patients in the MRR group. The median age in the RR group was 25.50 years (range 4–79) and 45 years (18–87) in the MRR group (p = .002). Median follow-up was 7 months (3–43) in the RR group and 1 month (1–12) in the MRR group. Post-operatively, there was a median exotropia reduction of 27.00 prism diopters (PD) (range +5, –65; p < .0001) for near, and 27.00 PD (+10, –51; p < .0001) for distance in the RR group. In the MRR group, the median exotropia reduction was 34.50 PD (2, –67; p < .0001) for near and 33.00 PD (1, –67; p < .0001) for distance. There was a greater reduction in the exotropia in the MRR group compared to the RR group for distance (p = .047), but this did not meet statistical significance for near (p = 0.10). The median dose–effect relationship (PD/millimeter) was higher in the MRR group both for near deviation (2.90 vs 2.15, p = .0073) and for distance deviation (2.91 vs 2.15, =0.0041). Conclusion: Based on our study cohort, medial rectus re-advancement appears to have a greater dose-effect in reducing the distance angle of deviation for both near and distance compared to primary recess-resect surgery. Further prospective longitudinal studies would shed further light on the dose–effect relationship over time.

Corneal Curvature Change After Strabismus Surgery: An Experience from a Single-academic Center

Objective: This study aimed to explore corneal curvature changes following strabismus surgery using a quadric surface fitting model to address ocular misalignment. Material and Methods: In this prospective cross-sectional study, 54 completed cases (84 eyes) of patients aged 6–60 years old (mean 10 years old) undergoing horizontal rectus muscle surgery were examined using placido-based keratometry with the Oculus Keratograph 5M system. Data on corneal curvature were collected one week pre-operation, and again one week, one month, and three months post-operation. Asphericity in the vertical meridian (Qy) and horizontal meridian (Qx), and surgical-induced astigmatism (SIA) were calculated. Results: The 84 eyes included were categorized into three groups: horizontal muscle surgeries, oblique muscle surgery, and combined horizontal and oblique muscle surgeries. Significant corneal prolation (steep central, flat peripheral) was revealed in the vertical meridian (Qy) at 3 months postoperatively for lateral rectus (LR) recession in the first group (p &lt; 0.001), and the mean SIA was 0.45 D (95% CI: 0.35–0.56 D). A similar effect was seen in the vertical meridian of the third group (p &lt; 0.01), with a mean SIA at 3 months of 0.27 D (95% CI: 0.23–0.32 D). Conclusion: Lateral rectus muscle recession induces corneal vertical prolation for up to 3 months post-operation. Surgeons are thus advised to re-evaluate refraction and defer contact lens refitting, refractive surgery, and intraocular lens calculations for at least 3 months after the procedure.

Long-term Outcomes of Bilateral Lateral Rectus Recession Using a Modified Normogram for Targeting Small Overcorrection in Intermittent Exotropia.

To evaluate the surgical outcomes of a modified normogram for bilateral lateral rectus recession in the surgical management of intermittent exotropia, with a focus on achieving small overcorrection. A retrospective medical chart review of 242 patients who underwent surgery for intermittent exotropia between October 2014 and June 2020 was performed. Our modified normogram reducing amount of recession targeted for small postoperative overcorrection within 5 prism diopters (PD). Patients were observed for at least 3 years. Esodeviation was denoted by negative numbers and positive values indicated exodeviation. A satisfactory outcome was defined as if distant angle of deviation ranged between ≤10 PD of exotropia and ≤5 PD of esotropia. Recurrence was defined as an exodeviation of >10 PD at distance. Overcorrection was defined as an esodeviation of >5 PD at distance. The mean preoperative deviation angles were 29.32 ± 3.92 PD at distance and 29.88 ± 4.41 PD at near. At postoperative day 1, the mean deviation angles at distance and near were -6.22 ± 1.44 and -6.22 ± 1.49 PD, respectively. Overcorrection within 6 PD of esodeviation was seen in 168 patients (69.42%), undercorrection with exophoria was noted in 11 patients (4.55%), and overcorrection by more than 6 PD of esodeviation was seen in 63 patients (26.03%) at postoperative day 1. The long-term success rate at postoperative 3 years was 77.27% (187 of 242), with a recurrence rate of 19.83% (48 of 242) and an overcorrection rate of 2.89% (7 of 242). A positive correlation between the angle of deviation at postoperative day 1 and 3 years was observed (r = 0.22, p = 0.001). The final success rate at the final examination after a mean follow-up of 38.60 ± 7.99 months was 83.06%. Our modified normogram for bilateral lateral rectus recession in intermittent exotropia surgery resulted in successful surgical outcomes with small overcorrection, reducing the risk of consecutive esotropia due to excessive overcorrection.

Corneal changes after large (9mm) lateral rectus muscle recession measured with Pentacam®

ABSTRACT Introduction: The aim of this study was to evaluate alterations in corneal astigmatism, axial anterior corneal curvature, anterior chamber depth, and central corneal thickness (CCT) two months after the unilateral recession of lateral rectus muscle in children. Methods: This prospective study included 37 children with intermittent exotropia who would undergo unilateral lateral rectus muscle recession. All measurements were performed using Pentacam®. Comparisons were made between the operated and fellow unoperated eyes, pre- and post-operatively. The assessment was made for changes in the radius of axial curvature on major meridians at 3 and 3.5 mm from the optical corneal center in the mid-peripheral zone. Astigmatism changes of the anterior and posterior corneal surface were calculated using vector analysis software (astigMATIC®). The interaction between age or CCT and postoperative changes in anterior and posterior surface corneal astigmatism were examined with ANOVA model. Results: In the intervention group, changes in anterior and posterior corneal surface astigmatism were statistically significant, with a mean increase of 0.56Dx90 and 0.08Dx87, respectively. In the mid-peripheral corneal zone, an increase was observed in the radius of anterior corneal axial curvature, more evident temporal 3 and 3.5 mm from the corneal center on the horizontal meridian, with corresponding decrease superiorly and inferiorly at 3 and 3.5 mm from the corneal center on the vertical meridian. Discussion: The changes in total astigmatism of the operated eyes are mainly attributed to the anterior corneal surface. These changes are associated with flattening in the 180 meridian of the cornea, leading to a shift to “with-the-rule” astigmatism.

Symmetric versus asymmetric surgery for the treatment of intermittent exotropia with equal dominance.

Long-term surgical outcomes were compared between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R) for therapy of basic type intermittent exotropia (IXT) with equal dominance. Two hundred and sixty-eight subjects (3-11 years old) with basic IXT with equal dominance who underwent BLR or R&R surgery were enrolled to this study, and with a minimum follow-up period of 18 months. One hundred and fourteen patients underwent BLR surgery and 144 underwent R&R surgery at a single centre. Surgical outcomes between groups were compared. Surgery results were divided into 3 categories: undercorrection/recurrence (exotropia/phoriaå 10PD), success(esotropia/phoria ≤5PD to exotropia/phoria≤10PD), and overcorrection (esotropia/phoriaå 5 PD) according to postoperative deviation angle. No statistical difference was detected between BLR group and R&R group at all intervals with the exception of the last examination, demonstrating a higher success rate and a lower recurrence rate in the BLR group than R&R group at last visit (P = 0.04). Additionally, the BLR group demonstrated a smaller exodrift than the R&R group at distance and near fixation (P = 0.01; P = 0.03). Stereoacuity and exotropia control showed overall improvement following both surgeries, and this improvement had no statistical difference between groups(P > 0.05). BLR showed better long-term results than R&R in the treatment of basic type intermittent exotropia with equal dominance given its low recurrence rate. Both BLR and R&R surgeries could improve stereoacuity function and exotropia control, and to same extents.

A challenging case of scleral buckle-related restricted strabismus with unexpected good postoperative outcomes: A case report

Abstract Strabismus surgery in a scleral buckle patient is a challenging task that requires precise planning and meticulous surgical skills to accomplish a successful outcome. We report a case of a 32-year-old male who presented with complaints of diminution of vision in the right eye (RE) for 23 years and outward deviation of RE for 5 years after blunt trauma with a ball. The patient was diagnosed with RE total retinal detachment (RD) with traumatic retinal dialysis. He underwent scleral buckling as RD surgery in 2004 followed by silicon oil removal 6 months later elsewhere. On ocular examination of the RE, the best corrected visual acuity was perception of light with accurate projection of rays in all four quadrants, there was grade III relative afferent pupillary defect with an exotropia of 20° on Hirschberg test. The prism bar reflex test revealed an exotropia of 50 prism diopters (PD) [Figure 1]. An anterior segment examination revealed posterior subcapsular and cortical cataracts. After taking a retina clinic opinion, the patient underwent uneventful RE cataract surgery with in-bag implantation of a foldable implant cataract surgery first, followed by strabismus surgery under a guarded visual prognosis. Clinically significant adhesion and the presence of the scleral buckle posed a magnificent challenge during the strabismus surgery. The plan was improvised to 8 mm lateral rectus recession with 4 mm hang loose recession irrespective of a large deviation under local anesthesia. To our surprise, a satisfactory primary position alignment within 10 PD (orthophoria) was achieved, which was maintained on subsequent follow-up visits. We report an interesting and challenging case of restrictive strabismus due to scleral buckle which emphasizes that surgical procedures and their outcomes may not always align with expectations. Therefore, it is necessary to adopt a flexible and customized approach to effectively manage such instances.

Modified Nishida procedure in managing medial rectus injury following endoscopic sinus surgery

To report a case of large-angle exotropia with adduction limitation that resulted from medial rectus injury following functional endoscopic sinus surgery and was successfully managed by transposing both vertical recti nasally using modified Nishida procedure combined with lateral rectus recession.

Long-term comparison of horizontal rectus surgery with vertical tendon transposition and combined vertical tendon transposition and inferior oblique–weakening in V-pattern exotropia

PurposeTo compare the efficacy of bilateral lateral rectus recession with vertical tendon transposition (LRVT) and LRVT combined with inferior oblique (IO) disinsertion for V-pattern exotropia. MethodsThe medical records of patients who had mild-to-moderate (+1 and +2) inferior oblique overaction (IOOA) and underwent half-tendon-width upward LRVT (transposition group), and LRVT with IO disinsertion (combined surgery group) for V-pattern exotropia and who had at least 3 years of postoperative follow-up were reviewed retrospectively. ResultsA total of 45 patients were included: 22 in the transposition group and 23 in the combined surgery group. Preoperatively, there were no differences in V pattern, IOOA, or horizontal misalignment in primary position, upgaze, or downgaze between groups. The amount of exotropia in the primary position was 30.2Δ ± 10.7Δ in the transposition group, and 31.6Δ ± 14.1Δ in the combined surgery group (P = 0.974). A significant decrease in V pattern was observed in the combined surgery group and the transposition group at 6 months and 3 years postoperatively (P < 0.001). The reduction of V pattern in the combined surgery group at 6 months (20.2Δ ± 7.8Δ vs 15.6Δ ± 6.9Δ [P = 0.02]) and 3 years (20.1Δ ± 8.1Δ vs 15.2Δ ± 7.1Δ [P = 0.014]) was found to be greater than the transposition group. There were no differences in the success rate in the primary position at 6 months (P > 0.05). ConclusionsBoth tendon transposition with horizontal rectus surgery and combined tendon transposition and IO-weakening surgery decreased V-pattern exotropia. However, combined surgery had a greater effect on decreasing V pattern in patients with mild-to-moderate IOOA.

The impact of simultaneous correction of the V pattern on the results of surgical treatment in children with intermittent exotropia.

This study is to investigate the impact of the coexistence of basic intermittent exotropia and vertical incomitance in the form of the V and sub-V pattern on the results of surgical correction of intermittent exotropia. The records of 81 pediatric patients who had surgery for intermittent exotropia and a follow-up of more than 1year were reviewed retrospectively. They were divided into groups: a concomitant group which underwent only horizontal muscle surgery of bilateral lateral rectus recession and a V pattern group which had additional inferior oblique recession, further separated into two subgroups: ≥ 15 prism diopters (classic V pattern group) and ≥ 10 < 15 prism diopters (sub-V pattern group). The surgical outcome, deviation control, stereoacuity, and postoperative drift were assessed after 3months and 1year postoperatively. Patients with sub-V and classic V pattern intermittent exotropia showed significantly better surgical success rate (p = 0.025) and less postoperative drift (p = 0.042) than patients without vertical incomitance. One year after surgery, successful surgical outcome was achieved in 83.72% of the vertically incomitant group: 80.76% for the classic V pattern and 88.24% for the sub-V pattern group, while only in 60.53% of nonpattern patients. Patients operated for intermittent exotropia with a coexistent V pattern have consistently better surgical long-term results than those with only horizontal deviation. Additional inferior oblique recessions in the sub V pattern group provided excellent outcomes with no overcorrections; therefore, surgeons should consider addressing vertical incomitance even when the typical criteria for the V pattern are not met.

A Case of Posner-Schlossman Syndrome following after Strabismus Surgery

Purpose: To report one case of Posner-Schlossman syndrome following after strabismus surgery.Case summary: A 21-year-old male patient with a previous history of scleral buckling due to rhegmatogenous retinal detachment in right eye, underwent left lateral rectus muscle recession and medial rectus muscle resection surgery for the intermittent exotropia. He complained of blurred vision and pain in the left eye starting from the day after the surgery. When he visited the clinic on the fourth day post-surgery, his best corrected visual acuity was 20/50 and intraocular pressure was 44 mmHg in the left eye. Slit lamp examination revealed corneal edema, 2+ anterior chamber cells, deep anterior chamber, and an open angle in the left eye. After treatment with antiglaucoma eyedrops and steroid eyedrops, the intraocular pressure decreased to 13 mmHg. There were no signs of recurrence during the two-month follow-up period.Conclusions: Posner-Schlossmann syndrome, which occurs after strabismus surgery, must be diagnosed early and treated immediately.

Outcomes for Intermittent Exotropia Using Three Common Surgical Approaches.

To compare a single surgeon's surgical outcomes for treating intermittent exotropia using bilateral lateral rectus recession (BLR), unilateral lateral rectus recession and medial rectus resection (RR), and unilateral lateral rectus recession and medial rectus plication (RP). A retrospective review of all surgeries for basic intermittent exotropia between 2015 and 2023 was performed. Only patients with initial correction using BLR, RR, or RP were included. Exclusion criteria included age older than 18 years, vertical deviation, any nonrefractive ocular diagnoses, prior ocular surgery, and inadequate follow-up. There were 460 patients identified; 123 met inclusion criteria with 54 in the BLR group, 41 in the RR group, and 28 in the RP group. The average pre-operative distance alignment (and standard error) values for the BLR, RR, and RP groups were 25.07 (7.35), 22.44 (5.95), and 23.84 (6.42) prism diopters (PD), respectively. At 1 year, the postoperative distance alignment values for the BLR, RR, and RP groups were 8.72 (7.89), 7.46 (6.31), and 12.83 (6.82) PD, respectively (P = .03). A subanalysis found a significant difference between the BLR and RP (P = .02) and RR and RP (P = .02) groups. There was no difference between the BLR and RR groups (P = .57). This study of three surgical approaches for intermittent exotropia found RP had a significantly larger angle of exodeviation compared to BLR and RR at 1 year of follow-up. Both BLR and RR were equally effective approaches for treating intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 2024;61(4):287-290.].

Combined recession and resection of the same lateral Rectus in the treatment of exotropia.

Besides rest position abnormalities, exotropia could also be due to hypertonia of the Lateral Recti (LR) given divergence frequently decreases under general anesthesia (GA). Combined Recession-Resection of the Same Muscle (RRSM) is a promising alternative to the Faden procedure in the surgical treatment of overacting MR in esotropia. We thus examined here the effectiveness of combined RRSM of the LR for the treatment of exotropia that decrease under GA. We performed a retrospective, single-center evaluation over a 16-month period of 100 patients operated on for exotropia that decreased under deep GA (91% of 110 consecutive operated cases). We excluded re-operations and pure convergence insufficiencies. We performed a combined RRSM of one or two LR. It included a 10mm-recession and a "fine-tuned" resection of LR based on Quantitative Forced Duction Test scores. MR resection was combined when exotropia exceeded 35PD or for unilateral surgery. We report on patient outcomes 6 months after surgery. Successful results were obtained (-8-+8 PD measured on Alternate Cover Test) among 83% of cases at distance fixation and 91% at near fixation after 6 months. The Newcastle Control Score also improved from 5.8 to 1.7 after 6 months. No surgery-related complications or repeat surgeries were reported. In our experience a majority of exotropias decrease under GA and our strategy of combined RRSM of the LR is effective for the treatment of such exotropias. Long-term follow-up of the cohort is required to investigate the stability of these outcomes, and confirmation of our results by other works.

SURGICAL OUTCOME OF THREE MUSCLES SURGERY IN ONE SINGLE PROCEDURE OF LARGE-ANGLE EXOTROPIA: A CASE REPORT

Introduction : The management of large-angle horizontal strabismus poses special difficulties. Literature has outlined large-angle strabismus in a variety of ways. A threshold of 40 to 60 PD has been employed to determine large-angle strabismus.&#x0D; Case Illustration : A 19-year-old male with complaint of right eye that had been crossed outward since he was 12 years old. There was 90 prism diopter exotropia in near, distance, upgaze, and downgaze. The patient underwent bilateral lateral rectus recession of 10 mm and unilateral medial rectus resection of 6.5 mm in the right eye. Post-operative outcome revealed orthophoria without any misalignment of prism diopter examination in 1 day, one week, and two weeks follow-up.&#x0D; Discussion : When the deviation exceeds 50 prism diopter, there is no established consensus regarding the number and quantity of extraocular rectus muscles for surgery. The lack of uniform criteria and suggested surgical dosage is the greatest obstacle in using three muscles surgery. In this case, we used surgical dose according to Kenneth Wright exotropia binocular surgery table. We performed bilateral rectus lateral recession of 10 mm and a right rectus medial resection of 6.5 mm. This surgical dose gives good outcome. Moreover, this option can leave one horizontal rectus muscle unharmed.&#x0D; Conclusion : Determination of the surgical dose is essential in the management of large-angle exotropia. Appropriate surgical dose results in excellent outcomes with low risk of residual deviation.

SUCCESSFUL DIFFERENT TREATMENT IN INTERMITTENT EXOTROPIA: CASE SERIES

Introduction : In intermittent exotropia, management's goals are to diminish deviation by improving fusion control.&#x0D; Case Illustration : Case 1: A 19-year-old woman has complained of squinting and blurred vision since the age of 3 years. The visual acuity of both eyes (OU) was 0.05, with a BCVA of 0.63. Hirschberg's test was exotropia 15o . The exotropia after the cover test (Figure 1A) improved without blinking. The prism cover test was 35 D in near and distance. Patient was diagnosed with exotropia, an intermittent basic type with good control, astigmatism, and myopia compositus OU. Three months after, with refraction correction and occlusion, the Hirschberg test revealed orthotropia (Figure 1B). Case 2: A 7-year-old boy has suffered of squinting and blurred vision from the age of 6 years. The visual acuity of both eyes was 0.63 with a BCVA of 1.0. Hirschberg's test was exotropia 30° (Figure 2A). The prism cover test was 50 D in near and distance. Exotropia intermittent basic type, poor control, and bilateral astigmatism were diagnosed in the patients. The patient had surgery for bilateral lateral rectus recession. Hirschberg test 1 day Postoperatively, orthotropia was present (Figure 2B).&#x0D; Discussion : In exodeviation, control mechanisms relate to therapy compliance and different deviation angles. Intermittent exotropia can be progressive due to loss of fusion control and cause persistent deviation.&#x0D; Conclusion : For patients with exotropia with intermittent good control, non-surgical management can give good results. Surgical management is considered for large angle deviations in patients with poor control.

Factors Associated with Surgical Outcomes after Bilateral Lateral Rectus Recession in Children with Intermittent Exotropia

Backgroud: To analyze the factors associated with surgical outcomes after bilateral rectus recession (BLR) in children with intermittent exotropia (IXT). Methods: A retrospective study was performed on 125 patients who had all received preoperative patch treatment with a ≥1 year follow-up. The surgical outcomes were grouped as success (esodeviation ≤5 PD to exodeviation ≤10 PD) or failure (esodeviation &gt;5 PD or exodeviation &gt;10 PD) according to the angle of deviation at 1 year postoperatively. The patients’ magnitude of exodeviation, near and distant stereoacuity, and 3-mo patch responses were assessed. The factors associated with the surgical outcomes were determined using univariate and multivariate analyses. Results: Of the 125 patients, 102 (81.6%) and 23 (18.4%) were assigned to the success and failure groups, respectively. According to the univariate analysis, the absence of anisometropia, a smaller preoperative near exodeviation, a better near stereopsis, a smaller magnitude of deviation on day 1 postoperatively, and response to patching were significantly associated with surgical success for IXT after 1 year. In the multivariate analysis, distant esotropic deviation on day 1 postoperatively and response to patching were the factors affecting successful surgical outcomes. Conclusions: Esotropic distant deviation on day 1 postoperatively is a prognostic factor for favorable surgical outcomes. Preoperative patching could be a factor influencing surgical success in children with IXT.

Conventional vs. hangback technique in bilateral lateral rectus recession for basic intermittent exotropia: a retrospective study in Indonesian tertiary eye hospitals

Conventional vs. hangback technique in bilateral lateral rectus recession for basic intermittent exotropia: a retrospective study in Indonesian tertiary eye hospitals

Concurrent adjacent strabismus surgery with glaucoma drainage device placement in childhood glaucomas

BackgroundDetermine outcomes of concurrent strabismus surgery with placement of a glaucoma drainage device (GDD) in children.MethodsRetrospective review of pediatric patients who underwent simultaneous lateral rectus (LR) muscle surgery with superotemporal GDD placement. Strabismus and GDD success were defined as residual horizontal misalignment < 10 prism diopter (PD) and intraocular pressure (IOP) < 21 mmHg, no visually devastating complications, and no additional IOP-lowering surgeries.ResultsFifteen eyes of 13 patients (69% male) underwent LR surgery (14 recessions, 1 resection) for exotropia or esotropia simultaneous with GDD placement (13 Baerveldt, 2 Ahmed) at 8.34 ± 5.26 years. Preoperative visual acuity (VA) in operative eye (0.89 ± 0.54) was worse than non-operative eye (0.23 ± 0.44, p = 0.0032). Preoperative horizontal deviation was 38.3 ± 9.4 PD and LR recession was 7.4 ± 1.1 mm. At final follow-up, VA in operative eye (0.87 ± 0.52) was unchanged from preoperative (p = 0.4062). Final IOP was significantly decreased (12.4 ± 4.7 mmHg vs. 31.1 ± 11.4 mmHg, p = 0.0001) as was number of glaucoma medications (2.7 ± 1.7 vs. 1.1 ± 1.3, p = 0.0037). Five (38%) and 9 patients (69%) met criteria for strabismus and GDD success, respectively. Two eyes required tube revision and endoscopic cyclophotocoagulation and 2 eyes had additional strabismus surgery.ConclusionsConcurrent strabismus and GDD surgery decreased horizontal deviation and obtained IOP control. It is important to consider correction of strabismus at time of GDD placement to maximize visual development and improve cosmesis in children with glaucoma.

Slanted and Standard Lateral Rectus Recession Procedures for Convergence Insufficiency-Type Intermittent Exotropia in Children: A Retrospective Cohort Study.

To evaluate the efficacy and safetyof slanted bilateral lateral rectus recession (BLR-rec) for treating convergence insufficiency-type intermittent exotropia (CI-IXT) in children. In this retrospective cohort study, 26 patients aged <16 years with CI-IXT who underwent BLR-rec between August 2016 and July 2021 with six months of follow-up data post-surgery were classified into slanted BLR-rec group (n = 14) and standard BLR-rec group (n = 12; equal-length recession of the upper and lower horns of the LR muscle). Surgical outcomes were compared between the groups. In the slanted and standard groups, the preoperative distance exodeviation was 27.9 ± 5.5 and 30.8 ± 10.0 prism diopter (PD) (p = 0.63), near exodeviation was 41.1 ± 5.6 and 42.9 ± 9.2 PD (p = 0.75), and difference between near and distance deviation (N-D deviation difference) was 13.2 ± 3.2 and 12.1 ± 3.3 PD (p = 0.30), respectively. The ratio of postoperative and preoperative N-D deviation difference was compared between the slanted BLR and standard BLR groups at six months postoperatively. The results revealed that the ratio for slanted-BLR was 0.44 ± 0.19, and for standard-BLR was 0.84 ± 0.24. In the standard group, stereoacuity remained unchanged post-surgery compared to that pre-surgery, while the slanted group showed significant improvement (p < 0.05, Wilcoxon signed-rank test). Compared with the standard BLR-rec procedure, the slanted BLR-rec procedure reduced N-D deviation differences in CI-IXT, positively impacting gross stereopsis.

Outcomes for maximal bilateral lateral rectus recession in large-angle exotropia

Surgical treatment for large-angle exotropia can be challenging. The aim of this study was to evaluate short-term surgical outcomes of patients with large-angle exotropia (≥50Δ) undergoing maximal bilateral lateral rectus muscle recession of 10 mm. This was a retrospective study of consecutive patients at our institution who underwent maximal bilateral lateral rectus muscle recession for exodeviation ≥50Δ from January 1, 2008, to July 22, 2022. We subdivided the cohort into large-angle exotropia (largest amount of exodeviation at near and/or distance ≥50Δ and <65Δ) and very large-angle exotropia (largest exodeviation ≥65Δ). Patients with a history of prior eye muscle surgery, neurologic deficits, and three- or four-muscle surgery were excluded. A total of 22 patients were included. Mean preoperative exodeviation at distance was 51.9Δ in the large-angle group and 67.5Δ in the very-large-angle group (P = 0.001). Outcomes for the large-angle and very-large angle groups were, respectively, as follows: mean follow-up, 31.1 weeks and 11.8 weeks (P = 0.97); success, 75.0% and 16.7% (P = 0.02); undercorrection rates, 18.7% and 83.3% (P = 0.01); and mean postoperative exodeviation at distance, 3.7Δ ± 6.3Δ and 28.0Δ ± 13.5Δ (P = 0.001). Our study identified good surgical outcomes (75%) with maximal bilateral lateral rectus muscle recession of 10 mm in treating patients with large-angle exotropia between 50Δ and <65Δ. Other surgical techniques such as recession-resection and three- or four-muscle surgery may result in better outcomes when treating patients with exotropia ≥65Δ.