Retroceso bilateral de rectos laterales comparado con retroceso/resección unilateral para el tratamiento de la exotropia intermitente básica / Bilateral lateral rectus recession versus unilateral recession/resection for basic intermittent exotropia

Resumen INTRODUCCIÓN: En determinadas circunstancias clínicas, la exotropia intermitente básica requiere resolución quirúrgica. Existen dos técnicas para ello: el retroceso bilateral de rectos laterales y el retroceso/resección unilateral. Aunque el retroceso bilateral es la técnica más utilizada, no está claro cuál de estas técnicas tiene mejores resultados. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron siete estudios primarios, de los cuales tres son ensayos aleatorizados. Concluimos que el retroceso/resección unilateral podría tener un mayor éxito quirúrgico y probablemente disminuiría la tasa de subcorrección/recurrencia, cuando se le compara al retroceso bilateral de rectos laterales.

Abstract INTRODUCTION: Intermittent exotropia requires surgical resolution under some clinical circumstances. The main techniques are bilateral lateral rectus recession and unilateral recess/resection. Although bilateral recession is the most widely used, it is not clear whether it leads to better results. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including seven studies overall, of which three were randomized trials. We concluded unilateral recess/resection might achieve greater surgical success and probably decrease the rate of undercorrection/recurrence when compared to bilateral lateral rectus recession.

Effects of Bilateral Lateral Rectus Recession and Unilateral Recession-Resection in Large Angle Exotropia

PURPOSE: To evaluate the effect of bilateral lateral rectus recession and of unilateral rectus recession and resection in the patients who showed large angle exotropia. METHODS: Sixty-five patients who underwent either bilateral lateral rectus recession or unilateral recession-resection and who were followed up for more than 1 year between 1996 to 2001 at Chonnam University Hospital, were reviewed. The effect of bilateral lateral recession and unilateral recession-resection was compared according to preoperative angle of deviation. Successful outcome was defined as esotropia

Comparison of Surgical Results between Bilateral Recession and Unilateral Recession-Resection in 25 PD Intermittent Exotropia

PURPOSE: It is the purpose of this paper to study the long-term results of surgically treated intermittent exotropia of 25 prism diopters (PD) of preoperative deviation. METHODS: We analyzed and compared 364 patients (376 cases) with at least 6 months of postoperative follow-up. Two surgical methods were done : 6 mm bilateral recession of lateral rectus muscle in 190 patients (190 cases) and unilateral 4 mm recession of lateral rectus muscle combined with 3 mm resection of medial rectus muscle in 174 patients (186 cases). RESULTS: The average age of operation was 6.2 years, ranging from 3 to 16 years, and the follow-up period after surgery ranged 6 to 128 months (mean 27.3 months). The satisfactory surgical result defined as orthophoria and deviation between 5 PD esodeviation and 10 PD exodeviation. The final success rates were 75.3% in bilateral recession group and 64.5% in unilateral recession-resection group. This difference in success rates between the two groups was statistically significant (P=0.023), and the age at operation did not influence the surgical results. Those cases who were over-corrected 6 to 10 PD had a higher success rate and there was a statistically significant relationship between alignment immediately after surgery and on the final postoperative day in the two surgical groups (P=0.0001). CONCLUSIONS: The outcome of the bilateral recession is better than that of the unilateral recession-resection for correction of 25 PD intermittent exotropia in any age group.

The Effect of Unilateral Lateral Rectus Muscle Recession over 11mm in the Treatment of Intermittent Exotropia of 15-20PD

There have been several reports that classical unilateral lateral rectus recession of 7-8mm obtained the high rate of undercorrection in the surgical treatment of intermittent exotropia of 15-20PD, at 4 years of age or older. We evaluated surgical correction amount, success rate between unilateral lateral rectus recession of 7-8mm and 11-12mm, and amount of abduction limiations of 11-12mm recession. Mean surgical correction amount were 9.1+/-4.5PD in 7-8mm recession group, and 14.4+/-3.0PD in 11-12mm recession group.The difference of surgical correction amount between the two groups was statistically significant(p<0.05). The percentage of undercorrection over 8PD were 66.7% in 7-8mm group, none in 11-12mm recession group. Abduction limitation was minimal in 12mm recession group. In conclusion, 11-12mm unilateral lateral rectus recession had more decreased rate of undercorrection than 7-8mm unilateral lateral rectus recession group in the treatment of intermittent exotropia of 15-20PD, at 4 years of age or older.

Surgical Results of Unilateral and Bilateral Lateral Rectus Recessions in Exotropia under 25 Prism Diopter

It is the purpose of this study to compare the postoperative results of surgery for 39 patients with exotropia under 25 prism diopters (PD). Two surgical methods were done; 8 to 9mm unilateral recission of the lateral rectus muscle in 17 patients (unilateral gruop) and 4 to 6mm bilateal recession in 20 patients (bilateral group). The preoperative deviations on the average were 20.8PD in unilateral and 22.6PD in bilateral grou, and postoperatie corrections on the average were 16.5PD in unilateral and 22.8PD in bilateral group. The 41.2% in unilateral droup and 59.1% in bilateral group were under +/-5PD in postoperative deviation. There were 12 cases (70.6%) in unilateral and 20 cases (90.9%) in bilateral group showing the amount of deviation less than 10PD of under or overcorrection. InBilateral group, higher success rate was observed, but there was no statistical difference (p=0.053) between the two groups. The limitation of abduction was observed in the 4 cases of unilateral group but there was no significant cosmetic problem. From our surgical results, the outcome of the bilateral recission for the lateral rectus muscle is better than that ofthe unilateral recession for the correction of exotropia under 25PD although there was no statistical difference.