Lateral rectus recession with/without transposition in V-pattern exotropia without inferior oblique overaction

To compare bilateral lateral rectus (BLR) recession with BLR recession combined with half-tendon upward transposition in the management of patients with V-pattern exotropia (XT; 15-20 prism diopters [PD] greater XT in upgaze than downgaze) with no or minimal inferior oblique overaction.

Retrospective, observational, cohort study.

Twenty-nine patients had BLR recession (Group A). Twenty-one patients had BLR recession combined with half-tendon upward transposition (Group B).

A retrospective study was performed on patients with V-pattern XT with no or minimal inferior oblique overaction. Ductions, versions, pattern strabismus, stereoacuity, and degree of fundus torsion were analyzed in all patients before and after surgery. Patients were included in the study only if they achieved a minimum follow-up of 6 months.

Normalization of V pattern (<5Δ) was achieved in 14% in Group A and 64% in Group B (p < 0.001). Mean reduction in V pattern after surgery was 7Δ ± 6Δ in Group A and 13Δ ± 4Δ in Group B (p < 0.001). No change in fundus intorsion occurred in Group A, whereas fundus extorsion occurred in 8 patients (44%) in Group B. Orthophoria within 8Δ in the primary position was achieved in 79% in Group A and 82% in Group B (p = 1.00). There was no statistically significant difference in the postoperative stereoacuity in both groups (p = 0.67).

BLR with half-tendon upward transposition is much more effective than BLR recession alone in correcting V pattern.