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Comparison of different surgery procedures for convergence insufficiency-type intermittent exotropia in children
Bing Wang1, Lihua Wang1, Qi Wang1
1Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, People's Republic of China.
Insights
The improved recession-resection (R&R) surgery offers superior alignment for convergence insufficiency (CI)-type intermittent exotropia (IXT) in children compared to unilateral or bilateral medial rectus resection. All surgical methods effectively reduce near-distance differences.
Area of Science:
- Ophthalmology
- Pediatric Strabismus Surgery
- Surgical Outcomes Research
Background:
- Convergence insufficiency (CI)-type intermittent exotropia (IXT) is a common condition in children.
- Surgical management aims to improve ocular alignment and binocular function.
- Different surgical techniques exist, each with varying reported success rates.
Purpose of the Study:
- To prospectively compare the surgical outcomes of three procedures for CI-type IXT in children.
- To evaluate the efficacy of unilateral medial rectus resection (UMR), bilateral medial rectus resections (BMR), and an improved recession-resection (R&R) technique.
Main Methods:
- A prospective study involving 45 children with CI-type IXT, followed for 6 months.
- Random assignment to UMR (15), BMR (14), or improved R&R (16) groups.
- Surgical adjustments based on distance or near exodeviation; success defined as ≤10 PD distance exodeviation and ≤5 PD near esodeviation.
Main Results:
- The improved R&R group achieved a significantly higher success rate (87.5%) compared to UMR (13.3%) and BMR (42.9%).
- R&R demonstrated significantly better mean exodeviations at distance and near compared to UMR and BMR.
- No significant differences were found in near-distance differences among the three surgical groups.
Conclusions:
- The improved R&R procedure, utilizing near deviation for medial rectus resection and distance deviation for lateral rectus recession, provides superior alignment for CI-type IXT in children.
- UMR, BMR, and improved R&R surgeries are effective in reducing near-distance differences in patients with CI-type IXT.
Aims:
To compare prospectively the surgical outcomes of different surgery procedures for convergence insufficiency (CI)-type intermittent exotropia (IXT) in children.
Methods:
Forty-five children with CI-type IXT were included in this prospective surgical study with 6 months follow-up. According to the different surgical procedures, all children were randomly divided into three groups: the unilateral medial rectus resection (UMR) group (15 cases), the bilateral medial rectus resections (BMR) group (14 cases) and the improved unilateral recession-resection (R&R) group (16 cases). In the UMR and BMR groups, the medial rectus resection(s) were based on the distance exodeviation. In the R&R group, UMR was based on the near exodeviation while lateral rectus recession was based on the distance exodeviation. A successful surgical alignment was defined as the distant deviation in the primary gaze to be between ≤ 10 prism dioptres (PD) of exophoria/tropia and ≤ 5 PD of esophoria/tropia. The success rate, the preoperative and postoperative deviations at distance and near and near-distance differences among groups were compared.
Results:
At the last follow-up of 6 months, the success rate in the R&R (87.5%) group was significantly higher than those in the UMR (13.3%) and BMR (42.9%) groups (p=0.000 and 0.008); the mean exodeviations at distance and near in the R&R group were significantly different from those in the UMR and BMR groups (p=0.000 and 0.001); there were no significant differences in the mean near-distance differences between the R&R group and the other two groups (p>0.05).
Conclusions:
The improved R&R procedure in which medial rectus resection based on the near deviation with lateral rectus recession based on the distant deviation has a better alignment than the UMR and BMR surgeries for the treatment of children with CI-type IXT. All the UMR, BMR and improved R&R surgery can reduce near-distance differences in children with CI-type IXT.
