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Selective surgery for intermittent exotropia based on distance/near differences

B J Kushner1

  • 1Pediatric Eye & Adult Strabismus Clinic, Department of Ophthalmology & Visual Sciences, University of Wisconsin, Madison, USA. bkushner@facstaff.wisc.edu

Archives of Ophthalmology (Chicago, Ill. : 1960)
|March 26, 1998
PubMed
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For basic intermittent exotropia, recess/resect surgery yields better outcomes than lateral rectus recessions. Both surgical approaches equally impact distance/near differences in basic exotropia patients.

Area of Science:

  • Ophthalmology
  • Strabismus Surgery
  • Pediatric Ophthalmology

Background:

  • Traditional surgical guidelines for intermittent exotropia recommend procedures based on distance/near differences.
  • Divergence excess is typically treated with symmetric lateral rectus recessions, while basic deviations and simulated divergence excess use recess/resect procedures.
  • These traditional surgical recommendations have not been systematically evaluated.

Purpose of the Study:

  • To assess the effectiveness of selective surgical strategies for intermittent exotropia based on distance/near differences.
  • To determine if bilateral lateral rectus recessions have a differential impact on distance versus near deviations.

Main Methods:

  • Patients with basic intermittent exotropia were randomized to receive either unilateral recess/resect or symmetric lateral rectus recession surgery.

Related Experiment Videos

  • Patients with simulated divergence excess intermittent exotropia underwent symmetric lateral rectus recessions.
  • Surgical outcomes were evaluated one year post-operation.

    • Main Results:

    • A satisfactory outcome was achieved in 82% of basic exotropia patients undergoing recess/resect procedures versus 52% of those receiving lateral rectus recessions (P<.05).
    • 80% of simulated divergence excess patients had satisfactory outcomes following bilateral lateral rectus recessions.
    • The reduction in distance/near difference was comparable between lateral rectus recessions (2.4 PD) and recess/resect procedures (2.1 PD) in basic exotropia.

    Conclusions:

    • Recess/resect procedures are recommended for basic type intermittent exotropia due to superior outcomes compared to lateral rectus recessions.
    • Symmetric lateral rectus recessions appear effective for treating simulated divergence excess intermittent exotropia.
    • Both recess/resect and symmetric surgical techniques demonstrate similar effects on distance/near differences in basic exotropia.