Rectus Recession For Intermittent Exotropia Research Articles

Correlation between bilateral lateral rectus muscle recession and myopic progression in children with intermittent exotropia

Although several studies have reported about the relationship between the surgical correction of intermittent exotropia and myopic progression, it remains unclear, unlike the relationship between esotropia and hyperopia. Thus, this retrospective case control study evaluated the impact of bilateral lateral rectus recession in intermittent exotropia on myopic progression. This study included 388 patients with intermittent exotropia. The refractive errors and degree of exodeviation at each follow up period were analyzed. The rate of myopic progression was −0.46 ± 0.62 diopter (D)/year in patients who underwent surgery and −0.58 ± 0.78 D/year in patients who did not, with no significant difference between them (p = 0.254). Patients who had recurrences of more than 10 prism diopters were compared with patients who did not have. The rate of myopic progression was −0.57 ± 0.72 D/year in the recurrent group and −0.44 ± 0.61 D/year in the non-recurrent group, with no significant difference between them (p = 0.237). Patients with fast myopic progression had more recurrence than patients with slow progression (p = 0.042). Moreover, recurrence had a positive correlation with fast myopic progression (OR = 2.537, p = 0.021). Conclusively, the surgical correction of intermittent exotropia did not influence myopic progression.

Clinical factors affecting the rate of exodrift after surgery in patients with basic intermittent exotropia

We investigated the period of postoperative exodrift during follow-up and clinical factors that affect the rate of exodrift after surgery in the patients with intermittent exotropia (IXT). A retrospective review of medical records of patients with exodrift who underwent bilateral rectus recession for IXT was performed. Exodrift was defined as angle of deviation greater than 10 prism diopters (PD) at distance and near. The median survival period of postoperative exodrift was analyzed using Kaplan Meier survival analysis. The patients were divided into two groups according to the median period of postoperative exodrift (early and late group). The weighted Cox’s proportional hazards regression analysis to investigate the risk factors that affect rate of postoperative exodrift was performed. A total of 108 patients was included. The preoperative angle of deviation at distance and near were 30.3 ± 7.2 PD and 29.5 ± 8.6 PD, respectively. The median survival period of postoperative exodrift was 24 months (range, 6–48 months).The angle of deviation at postoperative day 1 in early and late group were − 3.8 ± 5.5 PD (range, − 16–8 PD) and − 7.7 ± 4.6 PD (range, − 16–4 PD) (p < 0.01). Minus value means esodeviation. In regression analysis, the angle of deviation at postoperative day 1 was the significantly related with rate of exodrift (p < 0.01). The median period of exodrift after surgery was 24 months, angle of deviation at postoperative day 1 could affect the rate of exodrift in patients with IXT.

Effect of inferior oblique myectomy on primary position when combined with lateral rectus recession for intermittent exotropia.

To evaluate the surgical success and need for adjustment due to overcorrection in patients who undergo inferior oblique myectomy (IOM) combined with lateral rectus recession (LRc) for intermittent exotropia in the setting of inferior oblique overaction. A retrospective chart review was conducted of patients with intermittent exotropia who underwent LRc using adjustable sutures alone versus LRc combined with IOM between January 2010 and July 2018 at our institution. Binocular alignment was recorded before and within one week of surgery. Evaluation measures noted were surgical success (defined as distance alignment of ⩽10 prism diopters) and need for postoperative adjustment due to overcorrection. Of 48 patients, 24 underwent LRc alone and 24 underwent LRc combined with IOM; all 48 patients had adjustable sutures. Surgical success was significantly higher in the LRc alone group (91.6%) compared with the LRc with IOM group (62.5%) (p = 0.036). The need for postoperative adjustment due to overcorrection was also significantly higher in the LRc with IOM group (20.8%) compared with the LRc alone group (0%) (p = 0.049). In this study, more patients needed adjustment for overcorrection after undergoing LRc combined with IOM versus LRc alone. Since the tertiary action of the inferior oblique is abduction it is possible that, in patients with inferior oblique overaction, surgically weakening the inferior oblique causes more esodeviation and overcorrection. Thus, surgical correction of exotropia and inferior oblique overaction using LRc combined with IOM may lead to overcorrection and increased need for postoperative adjustment.

Pattern strabismus in consecutive esodeviation after bilateral lateral rectus muscle recession for intermittent exotropia

After bilateral lateral rectus recession for intermittent exotropia, children can develop V- or A-pattern esodeviation and adopt a chin-down or chin-up position to facilitate fusion. The aim of this study was to discuss possible causes and management of this pattern. The medical records of children who developed consecutive esodeviation with V- or A-pattern strabismus after surgery for intermittent exotropia but with no pre- or postoperative oblique muscle dysfunction were reviewed retrospectively. Ductions, versions, angles of deviation, and fundus torsion were evaluated before and after surgery. Patient management and outcomes were analyzed. A total of 37 patients were identified (mean age, 5.7±1.5years), with a mean preoperative deviation of 30.6Δ±5.2Δ; no patient had a preoperative pattern strabismus. Mean bilateral lateral rectus recession was 6.2±0.9mm. Of the 37, 34 (89%) returned postoperatively with V pattern, 2 with an A pattern, and 1 with an hourglass-like pattern. No patient showed oblique muscle dysfunction or fundus torsion. Reoperation for the consecutive deviation was performed in 19 patients, in all of whom the lateral rectus muscles were not vertically displaced. The pattern disappeared completely after reoperation and reestablishment of adequate alignment in the primary position. In our patient cohort, pattern strabismus after bilateral lateral rectus recession was successfully reversed by correction of the consecutive esodeviation.

Effect of Bilateral Lateral Rectus Recession in Intermittent Exotropia according to the Limbus Insertion Distance

Purpose: The aim of this work was the evaluation of the effect of the limbus insertion distance (LID) of the lateral rectus on the surgical results of bilateral lateral rectus recession in intermittent exotropia (IXT) in children and adults. Patients and Methods: This retrospective study included 76 patients. The patients were divided into two groups: group I (age 5 - 13 y), group II (>13 y). All the patients had basic type of intermittent exotropia (IXT) and all of them underwent bilateral lateral recessions according to the preoperative angle of deviation. Intraoperatively, the distance of limbus insertion was measured by surgical calipers. The dose response effect was calculated as the difference between the preoperative angle and postoperative angle divided by total amount of recession and cases were followed at 1 month, 3 months, 6 months and 12 months postoperative. Results: The mean LID in group I was (6.2 ± 0.61 mm) and (6.1 ± 0.55 mm) in group II. The mean dose response (MDR) at 1 year postoperative was (2.32 ± 0.25 mm) in group I and (2.26 ± 0.23) in group II. In patients with LID 6.25 mm who had larger mean dose response (2.52 ± 0.15). There was a significant positive correlation between the LR muscle LID and the dose-response effect. Conclusion: There is positive correlation between the LID of the LR muscle and the recession effect in bilateral lateral rectus recession in treatment of IXT.

Type of the recurrent exotropia after bilateral rectus recession for intermittent exotropia

BackgroundThe aim of this study was to investigate the type of exotropia (XT) based on the distance-near (D/N) difference in recurrent XT after bilateral lateral rectus (BLR) recession to treat intermittent XT (IXT) to look into the possibility of secondary convergence insufficiency (CI)-type strabismus.MethodsA total of 121 patients with recurrent XT after BLR recession for basic-type and divergence excess (DE)-type IXT were retrospectively enrolled at a single institution. The distributions in the XT types were compared according to the D/N difference between primary and recurrent XT.ResultsPreoperatively, the population comprised 14 divergence excess (DE) types and 107 basic types. After the BLR recession, the XT-type composition changed to 59 basic types, 33 CI types, and 29 DE types. In one of the 14 preoperatively identified DE-type XT cases, the XT type changed to CI type, it changed to basic type in four cases, and the remaining nine cases showed no change in the DE type. The 107 preoperatively identified basic-type XT cases postoperatively became 55 basic-type, 32 CI-type, and 20 DE-type recurrent XT cases, and their postoperative distance XT control grades and near stereoacuity values did not significantly differ.ConclusionThe XT type composition changed after the BLR recession. The XT types in recurrent XT after BLR recession showed an increasing proportion of CI-type. We suspect that an individual fusion mechanism might also influence the XT-type in recurrent XT in view of the somewhat increased DE-type in recurrent XT.

Early results of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency.

The aim of this study was to evaluate the efficacy of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. This prospective study included 31 patients who underwent slanted lateral rectus recession for intermittent exotropia with convergence insufficiency between June 2010 and June 2012. Following parameters were recorded and analyzed: patient sex, age, preoperative and postoperative near and distance ocular alignment, and changes in stereopsis. The mean age of the patients was 9.2 years. The preoperative mean deviation angle was 32.4 PD at distance and 43.4 PD at near. After 6 months, slanted lateral rectus recession reduced the deviation angles to 2 PD at distance and 3.4 PD at near. In addition, the mean difference between distance and near deviation angles was significantly reduced from 11 PD to 1.4 PD at 6 months postoperatively. Slanted lateral rectus recession for intermittent exotropia with convergence insufficiency in children successfully reduced the distance and near exodeviations and the near-distance difference without increasing the risk of long-term postoperative esotropia or diplopia.

Long-term outcome following bilateral lateral rectus recession for intermittent exotropia

Abstract Background: Bilateral lateral rectus recession is the most common surgical treatment of intermittent exotropia in children. Success rates in previous studies differ because longer follow-up periods may change success rate as the eyes drift out with time. Initial overcorrection was thought to be appropriate management, but the preferred initial postoperative deviation has not been well quantified. Objective: To study long-term outcomes (≥3 years) of bilateral lateral rectus recession for intermittent exotropia and to evaluate factors influencing long-term success. Methods: This retrospective descriptive study reviews patients with intermittent exotropia who underwent bilateral lateral rectus recession with a minimum follow up of 3 years. Long-term motor outcome was classified as good (within 8 prism diopters (PD) of esodeviation and 10 PD of exodeviation), acceptable (exodeviation 11-20 PD), and poor (esotropia &gt;8 PD or exotropia &gt;20 PD). Stereoacuity testing pre- and postoperatively was used to evaluate sensory outcome. Correlation between long-term outcome and various pre- and postoperative factors were analyzed. Results: A total of 59 patients met the selective inclusion criteria. The mean age at time of surgery was 7.1 years with a mean follow-up time of 4.5 years. At the time of the last visit, 69% (41 patients) had good outcomes, 24% (14 patients) had acceptable outcomes, and 7% (4 patients) had poor outcomes. Initial postoperative ocular deviation significantly correlated with long-term outcome (P &lt; 0.05). Mean initial postoperative ocular deviation of patients with good outcome was esodeviation 12.7 PD (range ortho to esodeviation 25 PD). In 45 patients whose stereoacuity could be assessed, 58% (26 patients) had stereoacuity improvement. Conclusion: Good long-term motor outcome can be achieved in 69% of patients following bilateral lateral rectus recession for intermittent exotropia. Initial postoperative ocular deviation correlated with long-term motor success.

The Long-Term Outcome of Lateral Rectus Advancement in Patients with Consecutive Esotropia Following Bilateral Lateral Rectus Recession for Intermittent Exotropia

Purpose: To investigate the long-term outcome of lateral rectus (LR) advancement for consecutive esotropia following bilateral LR recession for intermittent exotropia. Methods: Medical records of 25 patients who underwent LR advancement for consecutive esotropia after bilateral LR recession and who were followed up for more than 24 months postoperatively were reviewed. Patients were divided into two groups: bilateral lateral rectus recession (BLR) group included 16 patients with consecutive esotropia greater than or the same magnitude as the initial exotropia and who underwent bilateral LR advancement; Unilateral lateral rectus recession (ULR) group included nine patients with consecutive esotropia less than the initial exotropia and who underwent unilateral LR advancement. Main outcome measurements were motor and sensory outcomes and the dose-effect relationship calculated from observed overall and group changes in the angle of deviation per millimeter. Motor success was defined as alignment from orthotropia to exodeviation less than 10 PD at distance. Sensory outcome was described by comparing the Titmus stereoacuity test before and after LR advancement. Sensory successvwas defined at 100 seconds of arc. Results: Eighteen patients (72.0%) showed satisfactory long-term motor and sensory outcomes. Seventeen (77.3%) of 22 patients showed favorable stereopsis of 100 seconds of arc or more at final observation. The long-term motor success rate of the ULR group was better than that of the BLR group (p = 0.025). The average observed change in the angle of deviation was 3.6 PD/mm at the final visit in all patients. A greater dose-effect relationship was observed in the ULR group than in the BLR group at the final visit (p = 0.043). Conclusions: LR advancement showed favorable motor and sensory outcomes in the majority of patients. The surgical outcome was not favorable in patients in the BLR group with consecutive esotropia of the same magnitude as the initial exotropia. These results require further investigation for verification. J Korean Ophthalmol Soc 2014;55(8):1180-1186

Predictive Factors Affecting the Short Term and Long Term Exodrift in Patients with Intermittent Exotropia after Bilateral Rectus Muscle Recession and Its Effect on Surgical Outcome

Purpose. To determine the predictive factors that affect short term and long term postoperative drift in intermittent exotropia after bilateral lateral rectus recession and to evaluate its effect on surgical outcome. Methods. Retrospective review of 203 patients with diagnosis of intermittent exotropia, who had surgical corrections with more than 3 years of followup. Different preoperative parameters were obtained and evaluated using Pearson's correlation analysis. Results. The proportion of exodrift increased from 62% at 6 weeks to 84% at 3 years postoperatively. The postoperative drift was 4.3 ± 8.1 PD at 6 weeks, 5.8 ± 8.4 PD at 6 months, 7.2 ± 8.3 PD at 1 year, 7.4 ± 8.4 PD at 2 years, and 7.7 ± 8.5 PD at 3 years. Preoperative deviation and initial overcorrection were significant factors affecting the postoperative drift at 3 years (r = 0.177, P = 0.011, r = −0.349, and P < 0.001, resp.). Conclusions. Postoperative exodrift along three years occurs in a majority of patients after bilateral lateral rectus recession for intermittent exotropia. The long term surgical success is significantly affected by this postoperative exodrift. A larger preoperative deviation and a larger initial overcorrection are associated with a larger early and late postoperative exodrift.

The tendon width of lateral rectus muscle in predicting the effect of recession: is it just age-related artifact?

The tendon width of the lateral rectus muscle is known to be a useful indicator for estimation of the effect of lateral rectus recession in intermittent exotropia. This study was conducted to investigate whether the tendon width of the lateral rectus would differ according to different age groups. We studied 133 patients ranging from 0 to 51 years of age who had undergone bilateral lateral rectus (BLR) recession for the basic type of intermittent exotropia. A total of 133 patients were divided into four groups; 16 patients who were younger than 2 years old (group 1), 20 patients who were 2-5 years old (group 2), 75 patients who were 5-13 years old (group 3), and 22 patients who were older than 13 years (group 4). Under general anesthesia and before dissection of the muscle tendon from the sclera, the tendon width of the lateral rectus of both eyes near insertion was measured with calipers. The tendon width of each group was as follows: in group 1, 7.84 ± 0.35 mm in the right eye and 7.66 ± 0.44 mm in the left eye; in group 2, 7.70 ± 0.50 mm and 7.65 ± 0.52; in group 3 8.11 ± 0.36, 7.95 ± 0.48. In group 4, measurements were 8.14 ± 0.49 mm and 8.05 ± 0.38 mm, respectively. The difference of tendon width in both eyes was statistically significant in all four groups (P<0.01) and the tendon widths of group 1 and 2 were narrower than that of group 3 and 4. Measurement of tendon width of the lateral rectus muscle for prediction of the effect in intermittent exotropia should be applied in patients ≥ 5 years of age.

Clinical Characteristics and Related Factors of Surgical Outcome in Patient who Underwent LR Recession After the age of 10 years

Purpose: To identify clinical characteristics and preoperative factors that influence the surgical results of an intermittent exotropia patient who underwent lateral rectus recession after the age of 10 years. Methods: A retrospective study was performed based on the medical records of 45 patients who underwent unilateral lateral rectus recession or bilateral lateral rectus recession for intermittent exotropia after the age of 10 years and who had undergone at least three months of postoperative follow-up. The authors investigated the clinical characteristics and factors associated with surgical success according to gender, age at surgery, fusion ability, preoperative angle of deviation, preoperative difference between near and far angles of deviation, vertical deviation, spherical equivalent of refractive error, Randot stereo test and postoperative angle of deviation at one week, one month, and three months. The postoperative deviation change according to the time between groups who underwent surgery before and after 10 years of age for intermittent exotropia was also compared. Results: Surgical success was defined as a final deviation of less than 10 prism diopters. Patients without vertical deviation had a better surgical outcome than did patients with vertical deviation (p=0.022). There was no significant difference in the postoperative deviation changes between groups who underwent surgery for intermittent exotropia before 10 years and after 10 years of age. Conclusions: Among the many preoperative influencing factors, vertical deviation showed a significant difference in postoperative improvement after intermittent exotropia surgery undergone after the age of 10 years. There was no difference in the aspects of surgical success between surgeries for intermittent exotropia before and after the age of 10 years.

Exotropic Drift and Ocular Alignment After Surgical Correction for Intermittent Exotropia

To evaluate changes in the angle of deviation over time and compare the motor success rate with different initial postoperative deviation in patients undergoing surgical correction for intermittent exotropia. Forty-eight patients aged between 1 and 10 years who underwent bilateral lateral rectus recession for intermittent exotropia were retrospectively evaluated. Preoperative and postoperative ocular deviations at 1 week, 1 month, and 6 months were analyzed. Full surgical correction was attempted in all patients. Motor success was defined as ocular deviation within 10 prism diopters of orthophoria at 6 months postoperatively. The follow-up period ranged from 6 months to 3 years. Although most patients had exotropic drift, this drift was greater in patients with initial esotropia (86.7%) and orthophoria (70.0%) compared to patients with exotropia (26.1%). Motor success was achieved in 29 (60.4%) patients. There was no statistical difference between ocular alignment at 1 week postoperatively and final motor success (P = .782). There was good correlation between ocular alignment at 1 week and 6 months postoperatively (rho = 0.585, P < .001). Age and preoperative deviation were not found to be associated with motor success. The success rate appears to be unaffected by initial ocular alignment, suggesting that deliberate initial overcorrection may be unnecessary. Future studies are warranted to evaluate the long-term stability of this alignment.

Augmented Asymmetric Lateral Rectus Recession in Intermittent Exotropia With Fixing Eye

Purpose: To document and compare the clinical results of symmetrical rectus muscle recession and asymmetrical rectus muscle recession in intermittent exotropia. Methods: The medical records of 27 patients who had symmetric bilateral rectus recession and 24 patients who had asymmetric bilateral rectus recession for intermittent exotropia with at least six months of postoperative follow-up from March 2004 to March 2007 were reviewed retrospectively. The authors performed a recession of 2 mm or greater in the deviating eye than in the fixing eye. Results: The mean age was 7.144.23 (range 3 to 15) years for symmetric bilateral rectus recession and 7.334.01 (range 3 to 14) years for asymmetric bilateral rectus recession. The mean follow-up was 11.835.74 (range 6 to 26) months in the symmetric bilateral rectus recession group and 11.145.05 (range 6 to 30) months in the asymmetric bilateral rectus recession group. The mean preoperative angle deviations were 27.54.8 prism diopter (PD) (range 30 to 40PD) and 27.34.6PD (range 20 to 40PD) in each group. The outcome of final follow-up (postoperative 24 months) was favorable in both groups, and slightly more successful in the asymmetric bilateral recession group but not a statistically significant amount (75.5% in the symmetric bilateral recession group and 81.2% in the asymmetric bilateral recession group). Conclusions: The present study suggests that there are no significant differences at postoperative 24 months between symmetric bilateral recession and asymmetric bilateral recession in intermittent exotropia having a fixing and a deviating eye.

Bilateral lateral rectus recession considering the tendon width in intermittent exotropia

The tendon width of the lateral rectus muscle can be a useful indicator of the effect of unilateral lateral rectus recession in intermittent exotropia. The aim of this study was to determine whether the tendon width of lateral rectus would be useful for predicting the effect of bilateral lateral rectus (BLR) recession. We studied a total of 45 patients between 3 and 15 years of age who had undergone bilateral rectus recession for the basic type of intermittent exotropia. The actual effect of lateral recession was calculated by adding the absolute value of the angle of preoperative deviation and the postoperative deviation on the second day and dividing the figure by the total amount of recession. We then calculated the hypothetical effect of lateral rectus recession, considering the tendon width of each eye, and added the effects of both eyes. The hypothetical effects were defined as 3 PD when the tendon width was 8-8.5 mm; 3.5 PD when it was 7-7.5 mm; and 2.5 PD when it was 9-9.5 mm, based upon earlier statistical analysis. We compared both effects using a paired t-test. The mean difference between the actual and the hypothetical effects of BLR recession in all patients was 2.88 PD (P=0.001, range: 0-5.50 PD). However, when the amount of preoperative exodeviation was below 25 PD, the differences were not statistically significant (P=0.086). The tendon width may also be useful indicator in BLR recession if the preoperative exodeviation is below 25 PD.

The Effect of Unilateral Medial Rectus Muscle Resection in Patients with Recurrent Exotropia

PurposeTo investigate the effect of unilateral medial rectus muscle resection for recurrent exotropia after bilateral lateral rectus muscle recession for intermittent exotropiaMethodsA retrospective analysis was made of thirtypatients who underwent unilateral medial rectus resection for recurrent exotropia. All had prior bilateral lateral rectus recession for intermittent exotropia. Data were collected for age, the preoperative deviation, the postoperative deviation at 2 weeks, 3 months, 6 months and the last visit, and the amount of medial rectus resection performed.ResultsThe average preoperative deviation was 27.0±3.6 PD. After unilateral medial rectus resection, average deviation at distance was 2.8 PD at postoperative 2 weeks, 4.5 PD at 3 months, 5.1 PD at 6 months and 5.8 PD at last visit. The average deviation corrected per millimeter of medial rectus resection was 3.53±0.17 PD/mm.ConclusionsConsidering that deviation angles of recurrent exotropia is smaller than those of primary surgery and the possibility of saving the other medial rectus muscle, unilateral rectus muscle resection could be effective surgical method for recurrent exotropia.

Effects of unilateral lateral rectus recession according to the tendon width in intermittent exotropia

To verify the effect of unilateral lateral rectus recession for each millimeter according to the tendon width in intermittent exotropia. A total of 37 patients (37 eyes) of 7 to 11 years of age with basic-type intermittent exotropia and a deviation of 16-25 Prism Diopters (PD) were included in this study. Under general anaesthesia, the tendon width of the lateral rectus of the deviating eye near insertion was measured with calipers, prior to dissection of the muscle tendon from the sclera. Patients underwent 6.5-10 mm unilateral lateral rectus recession. The effect of lateral recession for each millimeter was the absolute value of the angle of preoperative deviation plus postoperative deviation on the second day divided by the total amount of recession. Mean tendon width of the lateral rectus of a deviating eye was 8.3 mm (range: 6.5-9.5). The mean effect per millimeter of unilateral rectus recession in those 37 patient was 2.98+/-0.42 PD (range: 2.4-4.1). The effect of recession was larger in cases in which the tendon width of the lateral rectus was narrower (P=0.000, r=0.72). The tendon width of the lateral rectus muscle can be a useful indicator to estimate the effect of lateral rectus recession in intermittent exotropia.

Long-Term Results of Unilateral Lateral Rectus Recession in Intermittent Exotropia

Unilateral lateral rectus recession is an alternative procedure in the treatment of moderate angle intermittent exotropia. However, long-term results of unilateral lateral rectus recession have not yet been studied. The aim of this study was to determine the long-term stability of alignment following unilateral lateral rectus recession in patients with intermittent exotropia with a deviation of 25 to 30 PD. Thirty-two patients with intermittent exotropia with a deviation of 25 to 30 PD were included in this study. All patients underwent 8-mm unilateral lateral rectus recession by conventional techniques. Satisfactory results (+/- 5 PD of orthophoria) were obtained in 77.7% of the patients after a 3-year follow-up period. The mean correction achieved was 22.9 PD. Our results indicate that 8-mm unilateral lateral rectus recession is an attractive alternative procedure in the treatment of intermittent exotropia with a deviation of 25 to 30 PD.

Outcome Study of Bilateral Lateral Rectus Recession for Intermittent Exotropia in Children

The purpose of this paper is to report a statistical analysis of the surgical results in a consecutive series of 52 children treated by bilateral lateral rectus recession for intermittent exotropia when the operating surgeon was confronted by an increase in manifestation of the strabismus. The charts were abstracted for age at initial surgery, quantity of initial deviation, initial refraction, motor alignment at one week, six months, and at the end of the study. The incidence and result of secondary surgery and the incidence of the monofixation syndrome result was also determined. Thirty-two (62%) of the patients were successfully aligned at six months by the initial surgery performed for a mean of 25 prism diopters (PD) of preoperative deviation at a mean age of 4 years 8 months. Eleven patients (21%) were undercorrected and 9 patients (17%) were overcorrected at the six month exam. The patients were followed for a mean of 4 years, 4 months. Alignment at 6 months postoperatively was predictive of success by the end of the study, but the age at initial surgery, the size of the deviation, esotropia at 1 week, and initial refraction were not predictive of success. Secondary surgery was performed in 11 patients and the monofixation syndrome result was found in 5 patients. Successful alignment was achieved in the majority of children treated by an initial bilateral lateral rectus recession utilizing a currently popular surgical dosage table. Long term alignment success was not predicted by esotropia during the first postoperative week or the age at initial surgery but was correlated with the 6-month data. Secondary surgery was performed in 20% and the incidence of the monofixation syndrome was approximately 10% at the end of the study.

Outcome study of bilateral lateral rectus recession for intermittent exotropia in children: Ing MR *, Nishimura J, Okino L. Trans Am Ophthalmol Soc 1997;95:433–443

Outcome study of bilateral lateral rectus recession for intermittent exotropia in children: Ing MR *, Nishimura J, Okino L. Trans Am Ophthalmol Soc 1997;95:433–443