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Outcomes of Bilateral Lateral Rectus Recession vs Unilateral Lateral Rectus Recession–Medial Rectus Plication in Children With Basic Type Intermittent Exotropia
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
To compare the long-term surgical outcomes between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus plication (RP) in intermittent exotropia.
METHODS
Children who underwent BLR or RP for basic type intermittent exotropia between 2015 and 2016 with a minimum follow-up period of 2 years were retrospectively reviewed. Surgical outcomes were classified based on postoperative angle of deviation as follows: success (esodeviation ≤ 5 prism diopters [PD] to exodeviation ≤ 10 PD), and failure (overcorrection [esodeviation > 5 PD] and undercorrection or recurrence [exodeviation > 10 PD]).
RESULTS
Of 144 patients, 90 underwent BLR and 54 underwent RP. The angle of exodeviation of the RP group steadily increased over time after the surgery. The BLR group showed an earlier exodrift and a more stable course compared to the RP group. Kaplan-Meier survival analysis showed a better survival in the BLR group, with final success rates of 48.9% in the BLR group and 25.9% in the RP group after a mean follow-up of 2.2 years. Patients with a successful outcome had greater esodeviation at 1 week postoperatively (at distance 7.6 PD in the BLR group, 11.4 in the RP group).
CONCLUSIONS
Surgical outcomes were better in the BLR group than in the RP group. The RP group showed higher rates of recurrence of exodeviation, while the BLR group presented a more stable course. Establishing more esodeviation at postoperative week 1 in the RP group compared to the BLR group would be required to achieve successful results.
Additional Info
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Long-Term Outcomes of Bilateral Lateral Rectus Recession Versus Unilateral Lateral Rectus Recession-Medial Rectus Plication in Children With Basic Type Intermittent Exotropia
Eye (Lond) 2019 Apr 03;[EPub Ahead of Print], HJ Lee, SJ Kim, YS YuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The results of this study, limited to surgical intervention for basic IXT and excluding divergence excess and convergence insufficiency, are insightful. Apparently, unilateral lateral rectus recession–medial rectus plication (RP) has been suggested recently as an alternative to bilateral rectus recession (BLR). However, the long-term success rate in RP (25%) appears to be only half as good as the success rate in BLR (49%). It is suggested that consistently aiming for overcorrection in the immediate postoperative period, with some degree of esodeviation at the 1-week follow-up, would provide better long-term results. The authors do not consider the potential benefit of lenses, prisms, or other potentially complementary therapeutic interventions to enhance the long-term outcome.
Lee, Kim, and Yu report a retrospective comparison of two different strabismus techniques, the bilateral lateral rectus recession and unilateral lateral rectus recession with medial rectus plication, for basic type intermittent exotropia in the South Korean pediatric population. The uniqueness of this research lies in the pediatric population, comparison of bilateral recessions versus recession/plication combination, and relative long-term outcome measures.
This investigation yielded a larger esodrift (over-response) in the early postoperative period of the recession–plication technique with a larger long-term exodrift (under-response) outcome. Thus, the bilateral lateral rectus recession showed earlier exodrift with less total exodrift at 2-year follow-up (final surgical success, 48.9% BLR vs 25.9% RP). One must read these results with the understanding that the surgical dosage algorithm was individual to this surgical team.
There has been a resurgence of the debate regarding relative potency of the muscle-strengthening effect of plication (tuck) versus a resection in recent years, with diametrically opposed study results making data interpretation difficult to incorporate into a clinical approach. The variability of results from the literature comparing resections and plications reveals a lack of our full understanding of muscle physiology, postoperative remodeling, and cerebral input. Given all the unknowns in pediatric strabismus, this report elucidates the benefits of bilateral lateral rectus recessions for one of the most common forms of childhood strabismus.