Seminars in ophthalmology · 2026
Early Changes In Accommodative Amplitude After Medial Rectus Resection Versus Plication In Primary Exotropia: A Prospective Comparative Study.
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Arabacı İdil Çelen, Bayraktar Havvanur, Gözel Mehmet Emin, Akgül Afşin Betül, Aydın Seyfi, Kaldırım Havva
Аннотация
PURPOSE: To compare postoperative changes in accommodative amplitude (AA) and motor alignment outcomes after medial rectus resection and plication in primary exotropia. Because accommodation depends on ciliary muscle function, AA was evaluated as a functional measure of accommodative performance.
METHODS: This prospective, comparative interventional study included 85 primary exotropia patients who underwent unilateral lateral rectus recession with medial rectus resection (n = 40) or plication (n = 45), assigned by alternating enrolment. Monocular AA was measured using the minus lens method preoperatively and at postoperative week 1, months 1 and 3. Deviation angle, surgical success and interval changes in AA (delta AA) were evaluated.
RESULTS: Baseline characteristics did not differ significantly between groups. Between-group comparisons likewise showed no statistically significant differences in postoperative deviation angles, month 3 surgical success (resection, 90.0%; plication, 86.7%; p = .743), or mean AA at any individual visit. In operated eyes, AA decreased significantly at week 1 after resection and subsequently recovered to approximately baseline levels by month 1, and remained stable by month 3. After plication, operated-eye AA did not decline at week 1 and increased progressively, becoming significantly higher than baseline by month 3. The mean change in operated-eye AA from baseline to week 1 differed significantly between procedures, reflecting a reduction after resection (-0.7 ± 0.8 D) and an increase after plication (+0.3 ± 1.1 D; Bonferroni-adjusted p < .001). Changes from baseline to postoperative months 1 and 3 did not differ significantly between the groups after Bonferroni adjustment.
CONCLUSION: Medial rectus resection and plication procedures improved postoperative alignment, with no statistically significant between-group differences in alignment or mean AA at individual visits. Nevertheless, their early accommodative trajectories differed, as AA decreased transiently after resection but did not decline after plication. However, between-group differences in change from baseline were not significant at months 1 or 3 after adjustment, indicating that the early divergence was not sustained; its clinical significance requires further investigation.
METHODS: This prospective, comparative interventional study included 85 primary exotropia patients who underwent unilateral lateral rectus recession with medial rectus resection (n = 40) or plication (n = 45), assigned by alternating enrolment. Monocular AA was measured using the minus lens method preoperatively and at postoperative week 1, months 1 and 3. Deviation angle, surgical success and interval changes in AA (delta AA) were evaluated.
RESULTS: Baseline characteristics did not differ significantly between groups. Between-group comparisons likewise showed no statistically significant differences in postoperative deviation angles, month 3 surgical success (resection, 90.0%; plication, 86.7%; p = .743), or mean AA at any individual visit. In operated eyes, AA decreased significantly at week 1 after resection and subsequently recovered to approximately baseline levels by month 1, and remained stable by month 3. After plication, operated-eye AA did not decline at week 1 and increased progressively, becoming significantly higher than baseline by month 3. The mean change in operated-eye AA from baseline to week 1 differed significantly between procedures, reflecting a reduction after resection (-0.7 ± 0.8 D) and an increase after plication (+0.3 ± 1.1 D; Bonferroni-adjusted p < .001). Changes from baseline to postoperative months 1 and 3 did not differ significantly between the groups after Bonferroni adjustment.
CONCLUSION: Medial rectus resection and plication procedures improved postoperative alignment, with no statistically significant between-group differences in alignment or mean AA at individual visits. Nevertheless, their early accommodative trajectories differed, as AA decreased transiently after resection but did not decline after plication. However, between-group differences in change from baseline were not significant at months 1 or 3 after adjustment, indicating that the early divergence was not sustained; its clinical significance requires further investigation.