Unilateral Recession Resection Research Articles

Stability of the angle of deviation in basic intermittent exotropia (IXT) following surgical correction: a retrospective observational study from southern India

ABSTRACT Introduction: Intermittent exotropia (IXT) is commonly seen in areas with more sunlight, females and Asians. Surgical alignment is recommended to improve binocular function, but a high recurrence rate has been reported. This study aimed to assess the stability of ocular alignment and factors contributing to exodrift post-surgery for IXT over 6-month follow-up. Methods: We retrospectively reviewed the medical records of patients with IXT who underwent unilateral recess resect procedures and attended follow-up examinations for at least six months post-surgery. A significant exodrift was defined as exodrift of more than 10PD at distance and near. Ocular deviation, binocularity, and stereopsis at one and six-month post-operative visits were studied to assess the incidence of exodrift post-surgery and the probable factors causing such drift. Results: Of the 50 patients studied, 26 (52%) were males, 42 (84%) were <20 years. The median age at surgery was 10 years (range 6–14), and the median preoperative angle of deviation was 37 PD. Majority of patients (62%) had exodrift within six months of surgery, and about a quarter of the study population had significant exodrift >10 PD. No clinical factors were found to contribute significantly to exodrift in this study.16 (61.5%) patients attained near and distance BSV post-surgery (p-value: <0.001). Six (12%) and 10 (20%) patients with subnormal near and distance stereopsis, respectively, attained normal stereopsis post-surgery. Conclusion: Over half of the patients operated for IXT had some Exodrift, and one-fourth had significant exodrift within six months post-surgery. Despite improved BSV, many patients failed to attain normal stereopsis with just motor alignment.

Botulinum Toxin A Augmentation of Strabismus Surgery for Large-Angle Strabismus: A Retrospective Case Series and Literature Review.

To report the results of botulinum toxin A (BTA)-augmented bilateral recession or monocular recession/resection surgery in a case series of patients with large-angle strabismus and review the relevant literature. This retrospective study reviewed the medical records of 24 patients treated with BTA-augmented strabismus surgery for large-angle horizontal strabismus (55 prism diopters or greater) with a minimum 6-month follow-up. Patients underwent unilateral recession-resection or bilateral rectus muscle recession surgery with intraoperative BTA injection into the recessed muscle(s). Main outcome measures were postoperative angle of deviation and success rate, defined as a final deviation of 10 prism diopters or less. Of 24 patients (20 esotropia, 4 exotropia), the mean age was 9.2 years (range: 1 to 64 years). Mean preoperative deviation was 61.2 prism diopters for esotropia and 66.2 prism diopters for exotropia. Mean final postoperative deviation was 6.6 prism diopters for esotropia and 14.5 prism diopters for exotropia. Successful outcomes were achieved in 75% of patients with esotropia and 50% of patients with exotropia. BTA augmentation of conventional strabismus surgery dosages is a promising approach for managing large-angle strabismus, particularly esotropia. Optimal patient selection and follow-up are needed to maximize surgical success rates. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Characteristics and Surgical Outcomes of Comitant Esotropia in an Adult Population Between 18 and 60 Years Old

PurposeTo describe the clinical characteristics and surgical outcomes of adults with comitant non-accommodative esotropia. DesignRetrospective case series MethodsRetrospective review of medical records of patients 18 to 60 years old with comitant esotropia who underwent strabismus surgery at a tertiary eye care center between 2014 and 2023. The etiology of esotropia was categorized into three groups based on the disparity between near-distance angles of deviation: 1. basic esotropia (ETBA); 2. esotropia divergence insufficiency pattern (ETDI); or 3. esotropia convergence excess pattern (ETCE). The main outcome measures were strabismus characteristics and motor and sensory surgical outcomes. Surgical motor success was defined as a deviation that measured ≤ 10 prism diopters (PD). ResultsOf the 219 that met the inclusion criteria, most patients were female (140, 64%) and had a mean age of 36.7 ± 12.3 years (range 18-60 years). The majority were myopic (157, 72%) and reported diplopia (176/219, 80.3%). The ETCE group had the largest mean deviations at both distance (45.5 ± 11.5 PD) and near (64 ± 12.3 PD) while the ETBA group had the largest ranges at distance (31 ± 13.5 PD, range 3-90) and near (30 ± 15 PD, range 2- 85). Bilateral medial rectus recession (BMR) and unilateral recess-resect (R&R) procedures were performed with equal frequency (both 48%). Motor and sensory success were achieved more often with R&R than BMR, although only motor success was statistically significant (87.8% vs. 73.2%, p=0.0375 and 93.3% vs. 85.5%, p=0. 15 respectively). At the last encounter, 88.1% (119/135) of patients with pre-operative diplopia achieved single binocular vision. ConclusionsRegardless of the pattern of esotropia, strabismus surgery in adults with comitant non-accommodative esotropia resulted in good motor and sensory outcomes.

Long-Term Effects of Botulinum Toxin A Versus Incisional Surgery for Management of Partially Accommodative Esotropia in Children: Comparison of Three Approaches

Purpose: To compare the effect of bilateral medial rectus injection of botulinum toxin A (BTX-A), bilateral medial rectus muscle recession surgery (BMR rc), or unilateral medial rectus muscle recession combined with lateral rectus muscle resection surgery (R&R), in the management of partially accommodative esotropia (PAET) in children.Design: Retrospective comparative clinical study.Methods: The study cohort included 98 patients diagnosed with PAET who had BTX-A injection or incisional surgery between December 2014 and January 2023. The main outcome measures included motor and sensory results as well as complications. Follow-up was at least 12 months for all patients.Results: There were 28 patients in the BTX-A group, 45 in the R&R group, and 25 in the BMR rc group. The motor success rates at distance and near fixation respectively were 50% (14/28) and 54% (15/28) in the BTX-A group, which were lower than that of the R&R group [78% (35/45), 84% (38/45)] and the BMR rc group [72% (18/25), 84% (21/25)] (P = 0.042 for near and P=0.006 for distance). For patients with onset age <2.5 years old, there was no statistical difference amongst the three surgical approaches (P=0.656). For patients with onset age ≥2.5 years, the motor success rate of the R&R group [81% (26/32)] and the BMR rc group [88% (14/16)] was higher than that in the BTX-A group [38% (5/13); P=0.004]. There was no statistical difference in sensory outcomes for patients regardless of onset age or treatment methods (P>0.05 for all). During follow-up, 4% (2/45) of patients in the R&R group and 20% (5/25) in the BMR rc group developed consecutive exotropia; no patient in the BTX-A group was overcorrected (P=0.017).Conclusions: Bilateral medial rectus muscle injection with BTX-A in patients with PAET is a safe, accessible, and low-cost alternative. Although motor success rates were higher, overall, in patients treated with incisional surgery, for patients with earlier age of onset (≤ 2.5 years old), BTX-A injection may be preferred to incisional surgery. In older children treated with unilateral recession-resection surgery, fewer developed consecutive exotropia.

Medial rectus resection versus plication in basic type intermittent exotropia

Purpose To compare the efficacy of unilateral recession-resection (RR) versus unilateral recession-plication (RP) in basic-type intermittent exotropia (X (T)). Patients and methods A prospective study included 27 patients, aged 10–45 years with a diagnosis of basic type of X (T), divided into two groups: group I (14 patients) underwent RR and group II (13 patients) underwent RP, follow-up period was 3 months following surgery. Successful outcome defined as postoperative exophoria/exotropia less than 10 Prism diopters (PD) to esophoria/esotropia less than 5 Prism diopters. Results Postoperative, the success rate was 71.43% in group I and 76.92% in group II, without significant difference (P=0.683). Patients with fair and good control of deviation preoperatively had more chances of success than patients with preoperative poor control (OR=12.0, 95% CI = 1.482–97.179, P=0.020), other factors including the age, preoperative angle, surgical procedure, errors of refraction had no significant association with successful surgical outcome. Conclusion Both the RR and RP procedures exhibit comparable effectiveness in treating basic-type X (T). Plication may be chosen as a substitute tightening technique due to its additional benefits over resection. Poor Preoperative control of deviation decreased the chances of a successful outcome.

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.].

Assessment of retinal and choroidal microcirculation after unilateral recession–resection surgery for horizontal strabismus by swept-source optical coherence tomography angiography

This study explored the possible hemodynamic changes of the retina and choroid after horizontal strabismus surgery using swept-source optical coherence tomography angiography (SS-OCTA). 32 eyes of 32 patients who underwent unilateral horizontal rectus muscle recession–resection surgery were included. SS-OCTA examinations were performed preoperatively and one week postoperatively. Several OCTA measurements were used, including vessel density (VD) of the superficial vascular complex (SVC), VD of the deep vascular complex (DVC), VD of the choriocapillaris (CC), choroidal vascular index (CVI) and choroidal thickness (CT). No significant change in VD of SVC, DVC, and CC was observed whereas CT increased significantly with CVI unchanged. Recession–resection surgery for horizontal strabismus seemed not to significantly influence the microcirculation of the retina and CC in the early postoperative period. However, choroidal thickening happened with a constant CVI probably due to the postoperative inflammation. Further studies are needed to investigate the long-term effects of unilateral recession–resection surgery for horizontal strabismus on the microcirculation of the retina and choroid.

Eight-Year Outcomes of Bilateral Lateral Rectus Recessions versus Unilateral Recession-Resection in Childhood Basic-Type Intermittent Exotropia

To report 8-year outcomes from a randomized controlled trial (RCT) comparing bilateral lateral rectus muscle recession (BLRc) with unilateral recession-resection (R&R) for childhood intermittent exotropia (IXT). Eight-year follow-up of RCT cohort. Of 197 randomized participants, 123 agreed to continue follow-up after the 3-year outcome visit (baseline age, 3-< 11 years; basic-type IXT, 15-40 prism diopters [Δ] by prism and alternate cover test [PACT]; baseline stereoacuity, ≤ 400 arcsec; no prior surgery). After the RCT primary outcome at 3 years, annual follow-up from 4 through 8 years with treatment at investigator discretion. Suboptimal surgical outcome by 8 years after randomization, defined as any of the following at any visit: exotropia of 10 Δ or more by simultaneous prism cover test (SPCT) at distance or near, constant esotropia (ET) of 6 Δ or more by SPCT at distance or near, loss of near stereoacuity by 0.6 log arcsec or more from baseline, or reoperation. Secondary outcomes included (1) reoperation by 8 years and (2) complete or near-complete resolution at 8 years, defined as exodeviation of less than 10 Δ by SPCT and PACT at distance and near and 10 Δ or more reduction from baseline by PACT at distance and near, ET of less than 6 Δ at distance and near, no decrease in stereoacuity by 0.6 log arcsec or more from baseline, and no reoperation or nonsurgical treatment for IXT. The Kaplan-Meier cumulative probability of suboptimal surgical outcome through 8 years was 68% (55 events among 101 at risk) for BLRc and 53% (42 events among 96 at risk) for R&R (difference, 15%; 95% confidence interval [CI], -2% to 32%; P= 0.08). Complete or near-complete resolution at 8 years occurred in 15% (7/46) for BLRc and 37% (16/43) for R&R (difference, -22%; 95% CI, -44% to -0.1%; P= 0.049). The cumulative probability of reoperation was 30% for BLRc and 11% for R&R (difference, 19%; 95% CI, 2%-36%; P= 0.049). Despite no significant difference for the primary outcome, the 95% CI did not exclude a moderate benefit of R&R, which together with secondary outcomes suggests that unilateral R&R followed by usual care may yield better long-term outcomes than BLRc followed by usual care for basic-type childhood IXT using these surgical doses. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Long-term motor and sensory outcomes after unilateral recession-resection for pseudodivergence excess intermittent exotropia

Long-term motor and sensory outcomes after unilateral recession-resection for pseudodivergence excess intermittent exotropia

Augmented-Dose Unilateral Recession-Resection Procedure in Acute Acquired Comitant Esotropia

To compare the surgical amount of unilateral recession-resection (RR) procedure in patients with acute acquired comitant esotropia (AACE) versus common forms of esotropia (ET), and to provide dose-response reference for surgical planning in AACE. Retrospective study. Consecutive patients who underwent unilateral RR for AACE or ET correction from January 2018 to January 2022. Only patients achieved motor (residual deviation <5 prism diopters [Δ] in primary position) and sensory (elimination of diplopia in primary position and for reading) success with a minimum follow-up of 3 months were analyzed. Group difference in the amount of medial rectus recession (MRrec) and lateral rectus resection (LRres) was analyzed using multivariate regression models. Moreover, surgical dose-responses in the AACE group were analyzed using multivariable regression models. Regression models were performed with and without adjustment for clinical confounders. Piecewise analysis was used to detect segmented results. Group difference in surgical amount of MRrec and LRres, as well as dose-responses of unilateral RR in AACE patients with different-sized deviations. 54 AACE patients and 98 ET patients were included. Compared with the ET group, surgical amount performed was significantly larger in the AACE group to achieve a comparable effect of deviation correction. The adjusted group difference was 0.49 mm (95%CI=0.34-0.65; P<0.001) in MRrec and 1.68 mm (95%CI=1.25-2.11; P<0.001) in LRres in patients with horizontal deviation <40Δ; while only a mean difference of 1.22 mm (95%CI=0.76-1.6871; P<0.001) in LRres was found in those with deviation ≥40Δ. In the second part, dose-response analysis in AACE patients was performed with a determined cutoff deviation of 30Δ. In patients with deviation <30Δ, the adjusted dose-responses of MRrec and LRres were 5.11Δ/mm (95%CI=0.98-9.23; P=0.02) and 2.51Δ/mm (95%CI=0.57-4.45; P=0.02), respectively; while for those with deviation ≥30Δ, the adjusted dose-response of additional LRres was 5.48Δ/mm (95%CI=4.56-6.40; P<0.001) to correct the remaining deviation above 30Δ. These findings provide quantitative evidence that augmented-dosed unilateral RR should be performed in AACE for favorable surgical outcomes. The new surgical dose calculation proposed provide reference for surgical planning.

Comparative Study of Bilateral Versus Unilateral Strabismus Surgery in the Management of Lateral Incomitance in Intermittent Exotropia.

To evaluate and compare bilateral asymmetric lateral rectus recession versus unilateral resection-recession surgery in the management of lateral incomitance in intermittent exotropia. A prospective randomized interventional comparative study was conducted consisting of 80 patients with intermittent exotropia (older than 7 years) having significant lateral incomitance. They were equally divided into two groups by a sealed envelope system. The bilateral group underwent bilateral asymmetric lateral rectus recession and the unilateral group underwent unilateral lateral rectus recession and medial rectus resection based on post-patch deviation. Parameters assessed were change in horizontal deviation, change in lateral incomitance, binocularity, motility limitation, and complications, if any. Surgical outcome was considered successful if the primary deviation was within ±8 prism diopters (PD) and lateral incomitance was less than 5 PD. The mean lateral incomitance preoperatively and postoperatively was 8.3 ± 1.6 and 2.8 ± 2.4 PD in the bilateral group and 8.9 ± 1.4 and 3.7 ± 2.5 PD in the unilateral group, respectively. There was no statistically significant difference in the postoperative lateral incomitance between the two groups (P = .25), but a statistically significant difference was observed between preoperative and postoperative lateral incomitance in each group (P < .0001). Both procedures are equally efficacious in achieving acceptable ocular alignment and improving significant lateral incomitance in patients with intermittent exotropia with deviations between 15 and 35 PD without causing significant motility limitation. [J Pediatr Ophthalmol Strabismus. 2023;60(4):277-281.].

Comparison of Unilateral and Bilateral Surgical Approaches for the Treatment of Age-Related Divergence Insufficiency Esotropia

ABSTRACT Purpose Age-related divergence insufficiency-esotropia (ARDIE) is characterized by greater esodeviation at distance than near. This study aims to compare the outcomes of unilateral and bilateral surgical approaches. Patients and Methods Sixty-two cases treated at the Kellogg Eye Center, the University of Michigan, from 1995 to 2018 were retrospectively reviewed. One surgeon used unilateral procedures including unilateral medial rectus recession (n = 24, group 1) or unilateral recession-resection (n = 18, group 2) with an adjustable suture. Another surgeon used bilateral medial rectus recession with fixed sutures (n = 20, group 3). Results For patients with distance esodeviation <15∆, postoperative distance deviations in both group 1 and group 3 were not statistically different (p = .352). For patients with esodeviations 15–20∆, postoperative distance deviations in all 3 groups were also not statistically different (p = .142). Similarly, patients with deviations >20∆ did not show significantly different postoperative distance alignment (p = .082) between group 2 and 3. Overall, group 2 had the highest overall success rate (90%) (mean at distance = 1.17∆ exodeviation, at near = 2.33∆ exodeviation). Conclusion Both unilateral medial rectus recession ± lateral rectus resection and bilateral medial rectus recession surgical approaches produced similar favorable outcomes in ARDIE.

Effect of bimedial recession on near distance disparity in esotropia

Bilateral medial rectus recession (BMR) and unilateral recession-resection (RR) are well-established surgical techniques for esotropia. There is no consensus on which is preferable although convention suggests a greater effect of BMR on near deviation. We present a series of patients who underwent BMR for esotropia and the effect on the near and distance angles.

Effects of Bilateral Medial Rectus Resection on Motor Outcomes in Infantile Exotropia.

PurposeTo evaluate the effects of bilateral medial rectus resection (BMRres) on motor outcomes in infantile exotropia.MethodsWe evaluated 19 cases of infantile exotropia surgery. The mean age at surgical alignment was 4.8±3.4 years (range, 1.5–11.8 years). The surgical procedures included BMRres (5 cases), BMRres with unilateral lateral rectus recession (ULRR) (3 cases), bilateral lateral rectus recession (BLRR) (8 cases), unilateral lateral rectus recession and medial rectus resection (uniRandR) with contralateral lateral rectus recession (2 cases), and uniRandR (1 case). After dividing the cases into two groups (BMRres group, n=8; other group, n=11), the outcomes at 1 day and at 1, 3, and 6 months after surgery were compared. Surgical outcomes were defined as (1) success: distant esotropia ≤5 prism diopters (Δ) or exotropia ≤10Δ, (2) recurrence: exotropia >10Δ, or (3) overcorrection: esotropia >5Δ.ResultsAlthough postoperative distant deviations at 1 day were not different between the two groups, the BMRres group showed smaller distant deviations at 1, 3, and 6 months than the other group (p=0.015, 0.019, and 0.006, respectively). Success rates of the BMRres and other groups were 88% and 73% at 1 day, 100% and 36% at 1 month, 88% and 27% at 3 months, 88% and 18% at 6 months, respectively. Although there were no significant differences between the two groups within 3 months after surgery, surgical outcomes in the BMRres group 6 months after surgery were significantly better than those in the other group (p=0.003).ConclusionBMRres is a better procedure than others for infantile exotropia to achieve desirable motor outcomes after surgery.

Surgical outcomes of unilateral lateral rectus recession versus recess-resect in children with convergence insufficiency type intermittent exotropia

To determine the efficacy of unilateral lateral rectus recession (ULR) for convergence insufficiency-type intermittent exotropia (CI-type IXT), we compared surgical outcomes following ULR and recess‒resect (RR) procedures for CI-type IXT. In this retrospective study, medical records of 57 children who underwent ULR (n = 30) or RR (n = 27) for CI-type IXT of less than 25 PD at distance with a postoperative follow-up of 6 months or more were reviewed. Surgical success was defined as an alignment between 10 PD exodeviation and 5 PD esodeviation at distance and near fixation. The postoperative exodeviation showed no significant difference between the two groups at the last follow-up. A significant reduction in the mean near-distance difference was achieved postoperatively in both groups: from 5.4 PD preoperatively to 2.5 at last follow-up after ULR, and from 8.2 to 2.4 after RR (both p = 0.001). However, this difference between ULR and RR was not statistically significant (p > 0.05). The success rate at the last follow-up was 63.3% for ULR and 70.4% for RR (p = 0.574). ULR was found to be an effective treatment for CI-type IXT, with similar surgical outcomes to RR.

Newly developed abnormal head position and secondary esotropia after strabismus surgery for children with intermittent exotropia.

To review cases of newly developed AHP and secondary esotropia (ET) after surgical correction for IXT. Medical records of cases with newly developed AHP and secondary ET after surgical correction for IXT were retrospectively reviewed. Fifteen cases were included and the mean pre-operative exodeviation was 31.7 ± 10.6 prism diopters (PD) (range: 16-50) at distance. They received bilateral lateral rectus (LR) recessions (13/15), unilateral LR recession and medial rectus (MR) resection (1/15) or bilateral LR recession plus unilateral MR resection (1/15). Fourteen patients developed chin-down AHP with secondary V-pattern ET and 1 presented chin-up AHP with secondary A-pattern ET. The mean esodeviation in primary gaze was 22.7 ± 10.0 PD (range: 3-40) at distance. Twelve cases underwent a second surgery for correction of AHP and secondary ET, and approximately half (5/11) of the recessed LR muscles explored showed a 3-5mm downward displacement of the new attachment. Surgical management mainly included advancement of LR to the original insertion with a 3-5mm upward transposition. The AHP dissipated and ocular alignment returned to normal in all of these cases. Three cases did not require further surgery, and their AHP and secondary ET were no longer present at 2-5months after the first surgery. A downward shift of the recessed LR in IXT may lead to secondary V-pattern ET and development of a chin-down AHP. Advancement of LR with an upward transposition serves as an effective procedure for the correction of this complication.

Outcome of Strabismus Surgery for Exotropia in a 4-year-old with Silver-Russell Syndrome (SRS): A Case Report

Silver-Russell Syndrome (SRS) is a rare disorder associated with prenatal and postnatal growth retardation with associated characteristic facial and ocular features including strabismus. We report the outcome of strabismus surgery performed for exotropia in a 4-year-old patient with SRS. The patient presented with decreased visual acuity and constant exotropia of the right eye noted since 3 months of age. Systemic SRS characteristics consisted of relative macrocephaly, short stature, forehead prominence and stunted growth pattern. An X-pattern exotropia is consistent with bilateral tight lateral recti muscles with over-elevation in adduction of the left eye was present. Patient underwent unilateral right lateral rectus recession and right medial rectus resection for a 50-prism diopter constant exotropia. Patient had a favorable outcome of within 8 prism diopters from orthotropia at 1st, 3rd-, 6th- and 12th-month post-operatively.

Long term surgical outcomes of unilateral recession-resection versus bilateral lateral rectus recession in basic-type intermittent exotropia in children

The long-term results of surgical treatment of intermittent exotropia (X(T)) according to the type of surgery are controversial. We conducted a retrospective cohort study to compare the long-term results between unilateral recession-resection (RR) and bilateral lateral rectus recession (BLR) with an average follow-up of 9.5 years in children with basic-type X(T). Patients with basic-type X(T), who underwent RR (RR group) or BLR (BLR group) and were followed-up for more than 5 years postoperatively, were analyzed. Of the 560 patients, 363 patients received BLR and 197 patients underwent RR. There was no significant difference in the success rates between the two groups until postoperative 3 years. At an average of 9.5 ± 2.6 years after surgery, the success rate of the RR group was significantly higher than that of the BLR group starting from the fourth post-operative year until the last follow-up examination (64.5% vs 43.3%, P < 0.001). By multivariate analysis, preoperative hyperopia of more than + 2.00 diopters, younger age of onset, younger age at surgery, larger exodeviation at near than at distance of > 5 prism diopters, and the type of surgery (BLR) were risk factors of recurrence. In conclusion, RR was more successful than BLR with a lower recurrence rate in the long-term follow-up of patients with basic-type X(T).

Extraocular Muscle Transplantation for Primary Treatment of Large-Angle Exotropia

ABSTRACT Aim To report the feasibility and outcomes of muscle transplantation combined with a unilateral recession-resection procedure for primary large-angle [≥60 Prism Diopters (PD)] exotropia. Methods We retrospectively reviewed medical records of patients from three tertiary eye-care institutes who underwent unilateral recess-resect with muscle transplantation for primary treatment of large angle exotropia between August 2017 and July 2020. Motor and restorative success were defined as alignment ≤10PD of orthotropia and ≤12PD of manifest deviation, respectively, at the final follow-up. Patients with at least 3 months of follow-up were included. Results Ten patients; six males and four females (median age 26 years) met the study criteria. The median follow-up was 12.89 months. The median preoperative exotropia reduced from 65PD (60 to 90PD) to 10PD (0 to 25PD) at final follow-up (p = .0019). The median correction obtained for the entire procedure (recession + resection + muscle transplantation) was 3.05 (1.8 to 4.3) PD/mm. Motor and restorative success was achieved in 60% and 70% of the patients, respectively. The median abduction limitation was −1 (0 to −1) at the final follow-up and there were no palpebral fissure changes beyond 6 weeks postoperatively. Conclusions Unilateral muscle transplantation combined with the recession-resection procedure could be a useful alternative for the management of large-angle exotropia.

Surgical Outcomes of Medial Rectus Recession and Lateral Rectus Resection for Large-angle Deviations of Acute Acquired Concomitant Esotropia.

PurposeThis study aimed to evaluate the surgical outcomes of unilateral medial rectus recession and lateral rectus resection (R&R) for patients with large-angle deviations of acute acquired concomitant esotropia (AACE) without a neurological disease. Further, we have also suggested the surgical dosage of R&R for large-angle deviations of AACE.MethodsThis was a retrospective study of patients with AACE who underwent surgery and followed up after surgery for at least 6 months between September 2016 and March 2020. Among them, patients with ocular deviations of ≥30 prism diopters (PD) who underwent unilateral R&R were included.ResultsSeventeen patients with AACE were enrolled in this study (mean age, 23.5 years; four females). The mean amount of deviation was 40.00 PD at distance and near (range, 30–55 PD). Fifteen patients (88.2%) had myopia. The mean interval between the initial visit and surgery was 7.7 months (range, 4–20 months). All included patients had resolved diplopia after the surgery. Most patients with decreased stereoacuity displayed stereoacuity recovery after surgical treatment. At the final visit (mean follow-up period, 12.8 months), the mean angle of esodeviation was 0.82 PD (range, 6–0 PD) at distance and 0.47 PD (range, 4–0 PD) near. No patient displayed over-correction or adduction limitations in the operated eye.ConclusionsThe unilateral R&R procedure presented favorable surgical outcomes for patients with large-angle deviations of AACE. These results and proposed surgical dosage guidelines may be useful for surgeons in planning the surgical treatment of large-angle deviations of AACE.