Unilateral Recession-Resection Versus Re-resection of Medial Rectus in Recurrent Intermittent Exotropia

Won Jae Kim; Myung Mi Kim

doi:10.3341/jkos.2009.50.7.1088

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Kim and Kim: Unilateral Recession-Resection Versus Re-resection of Medial Rectus in Recurrent Intermittent Exotropia

Original Article

J Korean Ophthalmol Soc 2009;50(7):1088-1092.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.1088

Unilateral Recession-Resection Versus Re-resection of Medial Rectus in Recurrent Intermittent Exotropia

Won Jae Kim, MD, Myung Mi Kim, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Myung Mi Kim, MD, PhD Department of Ophthalmology, Yeungnam University College of Medicine #317-1 Daemyung-dong, Nam-gu, Daegu 705-717, Korea Tel: 82-53-620-3441, Fax: 82-53-626-5936, E-mail: mmk@med.yu.ac.kr

Received 28 July 2008 Accepted 4 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the surgical outcomes of recession-resection (R&R) on the contralateral eye and medial rectus re-resection surgery for recurrent intermittent exotropia in patients who previously underwent unilateral recess-resection.

Methods

A retrospective analysis was performed on patients who underwent either R&R on the contralateral eye or medial rectus re-resection surgery for recurrent intermittent exotropia who had unilateral R&R previously with a minimum follow-up period of at least 12 months.

Results

Thirty-nine patients underwent contralateral R&R surgery and 13 patients underwent medial rectus re-resection surgery. The satisfactory surgical result was considered between −5 (prism diopters, PD) and +10PD. The success rate of the contralateral R&R group and medial rectus re-resection group was 84.6% and 100% (p=0.317) at postoperative 1 week, 79.5% and 46.2% (p=0.034) at postoperative 6 months, 69.2% and 38.5% (p=0.048) at postoperative 12 months, and 51.3% and 7.7% (p=0.006) at the last follow-up visit.

Conclusions

The long-term surgical outcome of R&R surgery on the contralateral eye for the patients with recurrent intermittent exotropia who previously underwent unilateral R&R surgery was significantly better than medial rectus re-resection.

Keywords: Recession-resection, Recurrent intermittent exotropia, Re-resection, Surgical outcome

References

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Figure 1.

Comparison of mean angle of deviation after operation according to type of surgery.^* R&R=unilateral lateral rectus recession and medial rectus resection; † MR=medial rectus muscle.

Table 1.

Characteristics of patients

	R&R^* group	MR^† re-resection group	p-value
Number of patient	39	13	−
Sex (male:female)	15:24	5:8	1.000^‡
Age (years, mean± SD)	8.1±3.7	7.6±1.65	0.684^§
Preoperative deviation (PD^∏, mean± SD)	25.0±2.0	23.1±3.3	0.063^§

^* R&R=unilateral lateral rectus recession and medial rectus resection

^† MR=medial rectus muscle

^‡ Chi-square test

^§ Unpaired t-test

^∏ PD=prism diopters.

Table 2.

Mean angle of deviation after operation according to type of surgery

	R&R^* group	MR^† re-resection group	p-value^‡
Preoperative deviation (PD^§)	25.0±2.0	23.1±3.3	0.063
Deviation at 1 week	−0.2±6.6	3.0±3.3	0.107
Deviation at 6 months	4.5±6.2	10.0±3.4	0.000
Deviation at 12 months	5.9±7.9	12.1±5.9	0.011
Deviation at last F/U^∏	9.8±9.5	18.7±8.5	0.004

^* R&R=unilateral lateral rectus recession and medial rectus resection

^† MR=medial rectus muscle

^‡ Unpaired t-test

^§ PD=prism diopters

^∏ F/U=follow-up.

Table 3.

Success rates according to type of surgery

	Number of patients (success rate, %)		p-value^‡
	R&R^* group (n=39)	MR^† re-resection group (n=13)	p-value^‡
1 week	33/39 (84.6)	13/13 (100)	0.317
6 months	31/39 (79.5)	6/13 (46.2)	0.034
12 months	27/39 (69.2)	5/13 (38.5)	0.048
Last F/U^§	20/39 (51.3)	1/13 (7.7)	0.006

^* R&R=unilateral lateral rectus recession and medial rectus resection

^† MR=medial rectus muscle

^‡ Chi-square test

^§ F/U =follow-up.

Table 4.

Statistical correlation factors in R&R group

Factors	p-value^*	Odds ratio
Sex	0.669	1.420
Age at repeat operation	0.290	0.886
Preoperative deviation	0.110	0.690
Deviation at post-operation 1 week	0.107	1.256
Overcorrection at post-operation 1 week	0.096	0.129

^* Logistic regression analysis.

Table 5.

Average correction for medial rectus re-resection at postoperative 1 week

Resection (mm)	Number of cases	Average corrected deviation /mm (PD^*)
4	7	4.7±0.9
5	5	4.1±0.9
6	1	4.3

^* PD=prism diopters.

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