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.