Comparison of bilateral lateral rectus recession and unilateral recess-resection for basic intermittent exotropia
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Objective To compare the surgical outcomes of bilateral lateral rectus recession and unilateral recess-resection for patients with basic intermittent exotropia.Methods Forty-nine patients with basic intermittent exotropia were enrolled in this retrospective study.Patients were assigned to two groups:group A underwent bilateral lateral rectus recessions (26 cases)and group B underwent unilateral recess-resection (23cases).The exodeviations were measured by the alternate prisms cover test in primary gaze at both distance (6 m) and near (33 cm) with fixation on accommodative targets.The surgery was performed according to the amount of distance deviation.All of the surgeries were performed by the same ophthalmologist.Mean postoperative follow-up period was 13.8±9.4 months.A successful alignment was defined as±8 PD or less inprimary gaze while viewing distant and near targets.Results Successful alignment was achieved in 53.8% and 82.6% of patients in group A and group B,respectively.The difference between the two groups was statistically significant (x2=4.59,P=0.032).Conclusions The unilateral recess-resection is more effective procedure for patients with basic intermittent exotropia.
Key words:
Intermittent exotropia; Basic type; SurgeryKeywords:
Intermittent exotropia
To investigate the effect of unilateral medial rectus muscle resection for recurrent exotropia after bilateral lateral rectus muscle recession for intermittent exotropiaA 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.The 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.Considering 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.
Medial rectus muscle
Intermittent exotropia
Lateral rectus muscle
Inferior rectus muscle
Minimum deviation
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To report consecutive esotropia in contralateral lateral rectus recession and medial rectus resection for recurrent intermittent exotropia after unilateral lateral rectus recession and medial rectus resection and to evaluate the surgical outcome of modified contralateral lateral rectus recession and medial rectus resection for exotropia after unilateral lateral rectus recession and medial rectus resection.A total of 36 patients were included in this retrospective study. As a primary surgery for exotropia, all patients underwent unilateral lateral rectus recession and medial rectus resection on the non-dominant eye. Patients were subsequently assigned to either conventional contralateral lateral rectus recession and medial rectus resection (surgical dosages based on Wright's surgical table) (n = 19; conventional group) or modified contralateral lateral rectus recession and medial rectus resection (surgical dosages reduced by 5 prism diopters on Wright's surgical table) (n = 17; modified group) for recurrent exotropia. Surgical success rates were evaluated. Reoperation or prism glasses prescription rates due to consecutive esotropia were evaluated.The mean follow-up durations after reoperation were 25.8 and 24.0 months in the conventional and modified groups, respectively. The surgical success rates were 73.7% and 82.4% (P = .538, Fisher's exact test) and the recurrence rates were 0% and 17.6% (P = .059, Fisher's exact test), respectively. The reoperation or prism glasses prescription rates due to consecutive esotropia were 26.3% and 0%, respectively (P = .025, Fisher's exact test).Final outcomes were better in the modified group compared to the conventional group. Consecutive esotropia was significantly more frequent in the conventional group than in the modified group. In surgery for recurrent exotropia, a reduction of the surgical dosage will reduce the incidence of consecutive esotropia. [J Pediatr Ophthalmol Strabismus. 2018;55(1):53-58.].
Esotropia
Medial rectus muscle
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Purpose: To compare the surgical outcomes of recession-resection (R&R) on the contralateral eye and medial rectus reresection surgery for recurrent intermittent exotropia in patients who previously underwent unilateral recess-resection. Methods: A retrospective analysis was performed on patients who underwent either R&R on the contralateral eye or medial rectus re-resection surgery for recurrent intermittent exotropia who had unilateral R&R previously with a minimum follow-up period of at least 12 months. Results: Thirty-nine patients underwent contralateral R&R surgery and 13 patients underwent medial rectus re-resection surgery. The satisfactory surgical result was considered between -5 (prism diopters, PD) and +10PD. The success rate of the contralateral R&R group and medial rectus re-resection group was 84.6% and 100% (p=0.317) at postoperative 1 week, 79.5% and 46.2% (p=0.034) at postoperative 6 months, 69.2% and 38.5% (p=0.048) at postoperative 12 months, and 51.3% and 7.7% (p=0.006) at the last follow-up visit. Conclusions: The long-term surgical outcome of R&R surgery on the contralateral eye for the patients with recurrent intermittent exotropia who previously underwent unilateral R&R surgery was significantly better than medial rectus re-resection.
Intermittent exotropia
Medial rectus muscle
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Medial rectus muscle
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AIM: To assess the surgical outcome of intermittent exodeviation in the form of ocular alignment and stereopsis.MATERIALS AND METHODS: It was a prospective comparative study conducted at a teaching hospital in South India.Preoperative angle of deviation was measured for all patients with intermittent exotropia.Binocular function was measured using worth four dot test and stereopsis was measured using Titmus fly test.They underwent bilateral recession or unilateral recession/resection and were followed up at first week, first month and third month postoperatively.STATISTICAL ANALYSIS: Paired t test and unpaired t test were used.RESULTS: A total of 20 patients were studied.14 patients underwent unilateral recession/resection and four underwent bilateral lateral rectus resection with medial rectus recession and two underwent bilateral lateral rectus recession/resection.Successful surgical alignment was accomplished in 77.8% of patients after a mean follow-up of 3 months.85.71% success was seen with unilateral recession/resection, whereas bilateral recession/resection and lateral rectus recession had a success rate 50%.72.22% patients had 60 arc sec or better stereopsis at three months postoperatively.CONCLUSIONS: Unilateral recession/resection has better outcome compared to bilateral surgery.Surgery for intermittent exotropia can help preserve binocular vision.
Intermittent exotropia
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Objectives To compare the efficacy of bilateral lateral rectus recession (BLR) surgery versus BLR plus one medial rectus resection surgery in the management of exotropia (XT). Background The exact nature of this surgery remains debatable, with some surgeons preferring the BLR procedure and others the unilateral recession resection procedure. Patients and methods A total of 40 patients with XT were classified into two equal groups according to the type of surgical technique used: group 1 included 20 patients who underwent BLR surgery, and group 2 included 20 patients who underwent BLR plus one medial rectus resection surgery in the management of XT. Results The outcome of surgery after the end of the follow-up period (6 months) was recorded as follows: 14 (70%) patients and 11 (55%) patients were corrected in groups 1 and 2, respectively; one (5%) patient and eight (40%) patients were overcorrected in groups 1 and 2, respectively; and five (25%) patients and one (5%) patient were undercorrected in groups 1 and 2, respectively. There was a statistically highly significant difference between groups 1 and 2 (P Conclusion The study indicates that both two-muscle and three-muscle surgeries effectively treat different degrees of XT, with a low rate of induced lateral incomitance; however, the three-muscle techniques showed more successful treatment than the two-muscle techniques.
Medial rectus muscle
Rectus muscle
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Objective To compare lateral rectus marginal myotomy with wedge excision combined with resection of medial rectus with over-routine-quantity recession of lateral rectus and resection of medial rectus in treatment of large angle exotropia and observe the clinical effect.Methods Thirty-seven cases of large angle exotropia were divided into 2 groups.Group A(18 cases)underwent over-routine-quantity recession of lateral rectus and resection of medial rectus,Group B(19 cases)underwent lateral rectus marginal myotomy with edge excision and resection of medial rectus.All patients were measured the deviation before and after operation by using Hirschberg test and prism cover test.The surgery was performed according to the amount of distance deviation.All the surgeries were performed by the same ophthalmologist.A successful alignment was defined as ± 10△ or less in primary gaze while viewing distant and near targets.Results Before operation,the difference of strabismus angle between the two groups was no statistically significant(P ＞0.05),the cosmetic success rate(±10△)was (88.89%)in group A and(89.47%)in group B.The difference between the two groups was not statistically significant(x2=0.03,P＞0.05).Conclusions There is no significant difference between over-routine-quantity recession of lateral rectus combined with resection of medial rectus and lateral rectus marginal myotomy with edge excision combined with resection of medial rectus for large angle exotropia.
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Larg-angle; Exotropia; Rectus; Marginal-myotomy; Over-routine-quantity recession
Medial rectus muscle
Minimum deviation
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Introduction Consecutive exotropia has been reported in 20–27% of patients following surgical correction of esotropia. However, higher rates have been reported with longer durations of follow-up. Surgical options for correction of consecutive exotropia include medial rectus advancement, medial rectus resection and advancement, lateral rectus recession, and a combination of these methods. Purpose The aim of this study was to compare the effectiveness of both bilateral medial rectus advancement and bilateral lateral rectus recession in the management of consecutive exotropia. Patients and methods This study included 20 patients with consecutive exotropia. Patients presenting with exotropia of at least 20 prism diopter (PD), with a history of bilateral medial rectus recession, were included. Ten patients underwent bimedial rectus advancement and 10 patients underwent bilateral lateral rectus recession. They were followed up for 1 year. Results The mean age of the patients was 6.7±3.2 (range 3–10 years). Mean preoperative exotropia was 28.8±5.3 PD. Successful alignment was achieved in 70% of cases treated by bimedial rectus advancement and 80% of cases treated by bilateral lateral rectus recession. Conclusion There was no significant difference between bilateral medial rectus advancement and bilateral lateral rectus recession in the treatment of consecutive exotropia.
Esotropia
Medial rectus muscle
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Purpose: To measure changes in spatial localization following exotropia surgery using a computer touch-screen method of measurement.Methods: Enrolled in the study were 60 exotropia patients, all of whom had undergone corrective muscle surgeries under general anesthesia: 37 patients had undergone unilateral lateral rectus or bilateral lateral rectus muscle recession procedures (recession group) and 23 patients had undergone unilateral lateral and medial rectus muscle resection (R&R), or unilateral medial rectus resection only (resection group). We evaluated spatial localization by having patients point to targets on a computer touch-screen before surgery, and 1 day and 1 month after surgery. The pointing error, Δp, is defined as the difference between the actual location of the target and the pointed-to location of the target by unsigned value, was recorded as the mean of five tests. We compared the extent of postoperative changes in Δp between the two groups.Results: The mean Δp before surgery did not differ statistically between the two groups (p = 0.93). One day after surgery, however, the postoperative change in Δp of the resection group compared with that of the recession group (2.0 ± 0.7° and 0.4 ± 0.5°, respectively) was significant (p = 0.01 and p = 0.86 respectively).Conclusions: The ability for spatial localization is decreased in patients immediately following medial rectus resection, but is regained by 1 month following surgery.
Medial rectus muscle
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Objective To investigate the surgical effect in intermittent exotropia. Methods The surgical decision was made by the guidelines of 1 mm lateral rectus recession equal to 2-3 prism diopters and 1 mm of medial rectus resection equal to 4-5 prism diopters.56 cases received surgery which included single lateral rectus recession in 3 cases,single lateral recuts recession combined medial rectus resection or both lateral recti recession in 42 cases,both lateral recti recession and medial recti resection in 10 cases.Local anesthesia was used in 45 cases and general anesthesia used in 11 cases. Results the 56 cases,48 cases (85.7%) got ocular alignment after surgery.Conclusion For the treatment of intermittent exotropia,well-timed surgery is benefical to the stereopsis recovery.
Intermittent exotropia
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