A Randomized Trial Comparing Bilateral Lateral Rectus Recession versus Unilateral Recess and Resect for Basic-Type...

Area of Science:

• Ophthalmology
• Pediatric ophthalmology
• Strabismus surgery

Background:

• Childhood intermittent exotropia (IXT) is a common strabismus condition requiring surgical intervention.
• Surgical options include bilateral lateral rectus recession (BLRc) and unilateral recession-resection (R&R).
• Long-term comparative outcomes of these primary surgical treatments are not well-established.

Purpose of the Study:

• To compare the long-term surgical outcomes of BLRc versus R&R as primary surgical treatments for childhood intermittent exotropia.
• To evaluate differences in reoperation rates and the proportion of participants meeting suboptimal surgical outcome criteria.

Main Methods:

• A multicenter, randomized clinical trial involving 197 children aged 3-10 years with basic-type IXT.
• Participants were randomly assigned to either BLRc or R&R surgery.
• Outcomes were assessed via masked examinations every 6 months for 3 years, focusing on refractive error, binocularity, and stereoacuity.

Main Results:

• The cumulative probability of suboptimal surgical outcome by 3 years was 46% for BLRc versus 37% for R&R (9% difference, not statistically significant).
• Reoperation rates by 3 years were 10% for BLRc and 5% for R&R (5% difference, not statistically significant).
• At 3 years, 29% of BLRc participants and 17% of R&R participants experienced reoperation or suboptimal outcomes.

Conclusions:

• No statistically significant difference in suboptimal surgical outcomes was observed between BLRc and R&R at 3 years for childhood IXT.
• Current evidence does not support recommending one surgical approach over the other for the primary treatment of childhood IXT.
• Further research may be needed to identify factors influencing long-term outcomes in IXT surgery.