Comparison of Unilateral Versus Bilateral Lateral Rectus Recession for Small Angle Intermittent Exotropia: Outcomes
Insights
Unilateral lateral rectus recession showed similar success rates to bilateral surgery for small angle intermittent exotropia. Further research should explore unilateral recession as a treatment option.
Area of Science:
- Ophthalmology
- Strabismus Surgery
- Pediatric Eye Care
Background:
- Intermittent exotropia is a common strabismus condition in children.
- Surgical management aims to realign eye muscles to improve binocular vision.
- Lateral rectus recession is a standard surgical approach.
Purpose of the Study:
- To compare surgical outcomes of unilateral lateral rectus recession versus bilateral lateral rectus recession.
- To evaluate efficacy in pediatric patients with small angle intermittent exotropia (16-20 PD).
Main Methods:
- Retrospective cohort study at a tertiary pediatric hospital.
- Compared unilateral vs. bilateral lateral rectus recession.
- Primary outcome: success at 12 months (exotropia <10 PD, esotropia <5 PD, stereopsis, no reoperation).
Main Results:
- Success rates at 12 months were 70% for unilateral and 46% for bilateral recession (P=.10).
- A trend towards higher failure rates was observed in the bilateral group (P=.04).
- No long-term lateral incomitance occurred in either group.
Conclusions:
- Unilateral and bilateral lateral rectus recession demonstrate comparable success rates for small angle intermittent exotropia.
- Unilateral lateral rectus recession warrants consideration as a treatment arm in future randomized trials for intermittent exotropia.
Purpose:
To compare the surgical outcomes of unilateral lateral rectus recession to bilateral lateral rectus recession for small angle intermittent exotropia.
Methods:
This was a retrospective cohort study of pediatric patients with an intermittent exotropia between 16 and 20 prism diopters (PD) who underwent unilateral lateral rectus recession or bilateral lateral rectus recession at a single tertiary care pediatric hospital. The primary outcome was success (exotropia < 10 PD of esotropia < 5 PD, no decrease in stereopsis > 0.6 log arcsec, and no reoperation) at 12 months postoperatively. Secondary outcomes included survival analysis of time to surgical failure, surgical dose-response, and improvement in central fusion or stereopsis.
Results:
At 12 months, successful outcomes were achieved in 13 of 27 patients (46%) in the bilateral lateral rectus recession group and 19 of 28 patients (70%) in the unilateral lateral rectus recession group, which was not a statistically significant difference (P = .10). Survival analysis showed a trend toward a higher rate of failure in the bilateral lateral rectus recession group compared to the unilateral lateral rectus recession group (P = .04). The mean surgical dose-response was 1.7 PD/mm at 1 week and 1.0 PD/mm at 12 months for the bilateral lateral rectus recession group, and 2.0 PD/mm at 1 week postoperatively and 1.4 PD/mm at 12 months postoperatively for the unilateral lateral rectus recession group. There were no cases of long-term postoperative lateral incomitance in either group.
Conclusions:
Unilateral lateral rectus recession and bilateral lateral rectus recession have similar success rates for small angle intermittent exotropia after at least 12 months of follow-up. Randomized controlled trials in surgical management of intermittent exotropia should consider unilateral lateral rectus recession as a treatment arm. [.
