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Outcome study of bilateral lateral rectus recession for intermittent exotropia in children
Insights
Bilateral lateral rectus recession successfully aligned most children with intermittent exotropia. Six-month postoperative alignment predicted long-term success, not early esotropia or patient age.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Intermittent exotropia is a common strabismus condition in children.
- Surgical intervention, such as bilateral lateral rectus recession, is often necessary for alignment.
Purpose of the Study:
- To statistically analyze surgical outcomes in children with intermittent exotropia treated with bilateral lateral rectus recession.
- To identify factors predicting long-term surgical success.
Main Methods:
- Retrospective chart review of 52 children undergoing bilateral lateral rectus recession.
- Data collected included age, deviation size, refraction, and motor alignment at various postoperative intervals.
- Incidence of secondary surgery and monofixation syndrome were also determined.
Main Results:
- 62% of patients achieved successful alignment at six months post-surgery.
- Alignment at six months was predictive of long-term success.
- Factors like age at surgery, initial deviation size, and early postoperative esotropia were not predictive of success.
Conclusions:
- Bilateral lateral rectus recession is effective for intermittent exotropia in children.
- Six-month alignment is a key predictor of sustained successful outcomes.
- Secondary surgery was required in 20% of cases, with a 10% incidence of monofixation syndrome.
Background And Objective:
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.
Patients And Methods:
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.
Results:
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.
Conclusion:
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.
