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Slanted and Standard Lateral Rectus Recession Procedures for Convergence Insufficiency-Type Intermittent Exotropia in
Yumi Suzuki1, Takafumi Aoki1, Akane Tomita1
1Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
Insights
Slanted bilateral lateral rectus recession (BLR-rec) surgery improved stereopsis in children with convergence insufficiency-type intermittent exotropia (CI-IXT). This surgical approach effectively reduced near-distance deviation differences compared to standard BLR-rec.
Area of Science:
- Ophthalmology
- Pediatric Strabismus Surgery
- Binocular Vision Disorders
Background:
- Convergence insufficiency-type intermittent exotropia (CI-IXT) is a common form of strabismus in children.
- Surgical management of CI-IXT aims to improve binocular vision and reduce exodeviation.
- Bilateral lateral rectus recession (BLR-rec) is a standard surgical technique for exotropia.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified surgical technique, slanted bilateral lateral rectus recession (BLR-rec), for treating CI-IXT in pediatric patients.
- To compare the outcomes of slanted BLR-rec with the standard BLR-rec procedure.
Main Methods:
- A retrospective cohort study involving 26 pediatric patients (<16 years) with CI-IXT.
- Patients were divided into two groups: slanted BLR-rec (n=14) and standard BLR-rec (n=12).
- Surgical outcomes, including exodeviation measurements and stereoacuity, were assessed at six months post-surgery.
Main Results:
- Both surgical groups showed comparable preoperative exodeviation at distance and near.
- The slanted BLR-rec group demonstrated a significantly greater reduction in the near-distance deviation difference ratio (0.44 ± 0.19) compared to the standard BLR-rec group (0.84 ± 0.24).
- Stereoacuity improved significantly in the slanted BLR-rec group, whereas it remained unchanged in the standard BLR-rec group.
Conclusions:
- Slanted BLR-rec is an effective surgical modification for treating CI-IXT in children.
- This technique successfully reduces the near-distance deviation difference and enhances stereoacuity.
- Slanted BLR-rec offers a potential advantage over standard BLR-rec in improving binocular function for CI-IXT patients.
Purpose:
To evaluate the efficacy and safety of slanted bilateral lateral rectus recession (BLR-rec) for treating convergence insufficiency-type intermittent exotropia (CI-IXT) in children.
Methods:
In this retrospective cohort study, 26 patients aged <16 years with CI-IXT who underwent BLR-rec between August 2016 and July 2021 with six months of follow-up data post-surgery were classified into slanted BLR-rec group (n = 14) and standard BLR-rec group (n = 12; equal-length recession of the upper and lower horns of the LR muscle). Surgical outcomes were compared between the groups.
Results:
In the slanted and standard groups, the preoperative distance exodeviation was 27.9 ± 5.5 and 30.8 ± 10.0 prism diopter (PD) (p = 0.63), near exodeviation was 41.1 ± 5.6 and 42.9 ± 9.2 PD (p = 0.75), and difference between near and distance deviation (N-D deviation difference) was 13.2 ± 3.2 and 12.1 ± 3.3 PD (p = 0.30), respectively. The ratio of postoperative and preoperative N-D deviation difference was compared between the slanted BLR and standard BLR groups at six months postoperatively. The results revealed that the ratio for slanted-BLR was 0.44 ± 0.19, and for standard-BLR was 0.84 ± 0.24. In the standard group, stereoacuity remained unchanged post-surgery compared to that pre-surgery, while the slanted group showed significant improvement (p < 0.05, Wilcoxon signed-rank test).
Conclusion:
Compared with the standard BLR-rec procedure, the slanted BLR-rec procedure reduced N-D deviation differences in CI-IXT, positively impacting gross stereopsis.
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