Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus · 2026
Comparison between bilateral lateral rectus recession and bilateral primary medial rectus resection in basic type intermittent exotropia.
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Marei Nehal, Assar Khafagy Amr, Awadein Ahmed, Fouad Heba M
Аннотация
PURPOSE: To compare the outcomes of bilateral lateral rectus recession (BLRc) and bilateral primary medial rectus resection (BMRs) for the management of basic type intermittent exotropia (IXT).
METHODS: This prospective, randomized, controlled study, included 38 children with basic type IXT with an angle of deviation of 20Δ-40Δ treated at a single institution from June 2023 through January 2025. Patients were divided into two groups: the BLRc group and the BMRs group. Angles of deviation, ductions, versions, sensory functions, and vertical palpebral fissure height (PFH) were evaluated 6 months after surgery. Success was defined as orthophoria or deviation between exotropia/phoria ≤10Δ and esotropia/phoria ≤5Δ RESULTS: Mean patient age at time of surgery was 6.8 ± 2.3 years in the BMRs group and 7.0 ± 2.5 years in the BLRc group. At the 6-month follow-up, success was higher in the BLRc than in the BMRs group (70% vs 55.5% [P = 0.564]), and the mean postoperative angle of deviation was higher in the BMRs group than in the BLRc group (10Δ vs 1Δ [P < 0.01]). Undercorrection was more common in BMRs group (44% vs 20%), whereas overcorrection was more common in BLRc group (10% vs 0%). There was an improvement of 0.336 log arcsec in near stereoacuity; however, only 20% of cases showed an improvement of >2 octaves. Moreover, the difference in improvement between both groups was statistically insignificant. There was no significant change in the PFH in either group.
CONCLUSIONS: Both surgeries can effectively manage basic type IXT, but BMRs may be more prone to undercorrection by 6 months postoperatively.
METHODS: This prospective, randomized, controlled study, included 38 children with basic type IXT with an angle of deviation of 20Δ-40Δ treated at a single institution from June 2023 through January 2025. Patients were divided into two groups: the BLRc group and the BMRs group. Angles of deviation, ductions, versions, sensory functions, and vertical palpebral fissure height (PFH) were evaluated 6 months after surgery. Success was defined as orthophoria or deviation between exotropia/phoria ≤10Δ and esotropia/phoria ≤5Δ RESULTS: Mean patient age at time of surgery was 6.8 ± 2.3 years in the BMRs group and 7.0 ± 2.5 years in the BLRc group. At the 6-month follow-up, success was higher in the BLRc than in the BMRs group (70% vs 55.5% [P = 0.564]), and the mean postoperative angle of deviation was higher in the BMRs group than in the BLRc group (10Δ vs 1Δ [P < 0.01]). Undercorrection was more common in BMRs group (44% vs 20%), whereas overcorrection was more common in BLRc group (10% vs 0%). There was an improvement of 0.336 log arcsec in near stereoacuity; however, only 20% of cases showed an improvement of >2 octaves. Moreover, the difference in improvement between both groups was statistically insignificant. There was no significant change in the PFH in either group.
CONCLUSIONS: Both surgeries can effectively manage basic type IXT, but BMRs may be more prone to undercorrection by 6 months postoperatively.