Long-term Results of Slanted Recession of Bilateral Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency

PURPOSE: To evaluate the long-term efficacy of slanted lateral rectus recession in children for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency. METHODS: The medical records of 53 patients with convergence insufficiency intermittent exotropia who underwent slanted bilateral lateral rectus recession performed by a single surgeon and received follow-up for more than 12 months were retrospectively analyzed. Deviation angles at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively and on the last visit were reviewed. Surgical success was defined as postoperative residual distance and near deviation angles ≤8 prism diopters and a difference between the near and distance angles ≤8 prism diopters. RESULTS: The mean duration of follow-up was 24 months (range, 12 to 61 months). On the last visit, the residual deviation angles were ≤8 prism diopters in 75.5% for distance, 62.3% for near, and 81.1% for the near-distance difference. Surgical success was achieved in 31 (58.5%) patients, and none of them manifested limitations in eye movements or diplopia at the last follow-up visit. CONCLUSIONS: Slanted lateral rectus recession is an effective surgical method for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency.

The Effect of Bilateral Slanted Lateral Rectus Recession in Exotropia with Near-Far Disparity

PURPOSE: To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exodeviation with larger deviation angle at near than far fixation. METHODS: A retrospective chart review was conducted of 31 patients. Seventeen patients underwent slanted LR recession, the upper fiber of the LR was recessed according to the distance deviation angle and the lower fiber was recessed according to the near deviation. Fourteen patients underwent classic recession. To evaluate the effect of slant LR recession, postoperative ocular alignment between them was checked at 1 week, 1 month, 3 months and 6 months after operation. RESULTS: At the postoperative 6 months, bilateral slanted LR recession reduced the mean exodeviation at near from 33.82 PD to 7.29 PD, and same amount recession group reduced 33.67 PD to 11.13 PD. The far deviation change was from 25.59 PD to 2.59 PD, 23.67 PD to 4.00 PD in each group. The change of near-distance difference was from 10.29 PD to 4.71 PD in slanted recession group, and 9.67 PD to 7.93 PD in same amount recession group, showed that slanted recession group reduced angle more significantly (p = 0.002). Success rate was 35% in bilateral slanted LR recession group, 7% in classic recession group, showed that slanted recession group had significantly high success rate (p < 0.05). CONCLUSIONS: Bilateral slanted LR recession effectively reduces near and distance exodeviation angle, and reduces near-distance incomitance more superior to classic bilateral LR recession technique.