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Slanted versus conventional bilateral lateral rectus recession in children with convergence insufficiency
Jing Yao1, Xiying Wang1, Chenhao Yang2
1Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, China.
Insights
Slanted bilateral lateral rectus recession (S-BLR) surgery shows promise for improving near vision outcomes in children with convergence insufficiency intermittent exotropia (CI-IXT), despite similar overall success rates compared to conventional surgery.
Area of Science:
- Ophthalmology
- Strabismus Surgery
- Pediatric Eye Care
Background:
- Convergence insufficiency intermittent exotropia (CI-IXT) is a common strabismic condition in children.
- Surgical correction aims to improve binocular vision and reduce exodeviation.
- Evaluating novel surgical techniques like S-BLR is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To compare the efficacy of slanted bilateral lateral rectus recession (S-BLR) versus conventional bilateral lateral rectus recession (C-BLR) in treating CI-IXT.
- To assess the 12-month overall success rate and specific near-vision parameters post-surgery.
Main Methods:
- A multicenter, randomized controlled trial involving 188 Chinese children (aged 5-12) with CI-IXT.
- Participants were randomly assigned to either S-BLR or C-BLR (1:1 ratio).
- Primary outcome: 12-month overall success rate (postoperative deviation within 10Δ exodeviation to 5Δ esodeviation and near-distance disparity (NDD) < 10Δ).
Main Results:
- Overall success rates at 12 months were similar between S-BLR and C-BLR groups (P=0.27).
- S-BLR demonstrated a trend towards lower near undercorrection (P=0.06) and significantly improved near exodeviation control (P<0.001).
- S-BLR showed a greater reduction in NDD (P=0.001) and a higher proportion of improved stereoacuity (P=0.06).
Conclusions:
- While overall success rates were comparable, S-BLR appears to offer superior near-vision benefits for children with CI-IXT.
- Further research with larger cohorts, including those with NDD > 15Δ, and longer follow-up is warranted.
- S-BLR is a potentially advantageous surgical option for managing CI-IXT, particularly for near-point symptoms.
Purpose:
To assess the efficacy of slanted bilateral lateral rectus recession (S-BLR) versus conventional bilateral lateral rectus recession (C-BLR) in children with convergence insufficiency intermittent exotropia (CI-IXT).
Design:
Multicentre, randomized controlled trial.
Methods:
Chinese children aged 5-12 years with CI-IXT were consecutively enrolled, and randomly assigned (1:1) to receive either S-BLR or C-BLR. The primary outcome was the 12-month overall success rate, defined as a postoperative residual deviation between 10Δ of exodeviation and 5Δ of esodeviation with near-distance disparity (NDD) < 10Δ.
Results:
A total of 200 participants were enrolled, and 188 (97 S-BLR, 91 C-BLR) were finally included in the modified intention-to-treat analysis. The median age was 8 (6-9) years, and 90 (48 %) were male. The 12-month overall success rates did not differ significantly between the groups (group difference 8 %, P = 0.27, adjusted P = 0.36). However, S-BLR exhibited a lower rate of near undercorrection (group difference -12 %, P = 0.06), more collapse of NDD (-2.00Δ, P = 0.001), less residual near exodeviation (-4.00Δ, P < 0.001), better control of near exodeviation (0.00, P = 0.01), and a higher proportion of improved stereoacuity (12 %, P = 0.06). Subgroup analysis for NDD≤ 15Δ revealed a higher success rate of near deviation (86 % versus 69 %, P = 0.02), and a lower rate of near undercorrection (13 % versus 30 %, P = 0.01) in S-BLR group. Aside from undercorrection and overcorrection, no additional long-term suboptimal surgical outcomes were observed.
Conclusions:
Although the overall success rates did not differ, S-BLR showed potential superiority at near in children with CI-IXT. More participants with NDD> 15Δ, and a longer follow-up are needed to validate these findings.
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