The Surgical Outcomes of Unilateral Lateral Rectus Recession in Recurrent Intermittent Exotropia after Unilateral Recession-Resection

A Young Choi; Young Chun Lee; Se Youp Lee

doi:10.3341/jkos.2015.56.11.1783

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Choi, Lee, and Lee: The Surgical Outcomes of Unilateral Lateral Rectus Recession in Recurrent Intermittent Exotropia after Unilateral Recession-Resection

Original Article

J Korean Ophthalmol Soc 2015;56(11):1783-1788.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1783

The Surgical Outcomes of Unilateral Lateral Rectus Recession in Recurrent Intermittent Exotropia after Unilateral Recession-Resection

A Young Choi, M.D¹, Young Chun Lee, M.D, PhD², Se Youp Lee, M.D, PhD^1,

¹Department of Ophthalmology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine^¹, Daegu, Korea

²Department of Ophthalmology and Visual Science, The Catholic University of Korea Uijeongbu St. Mary’s Hospital, The Catholic University of Korea School of Medicine, Uijeongbu, Korea

Address reprint requests to Se Youp Lee, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Dongsan-dong, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-8400, Fax: 82-53-250-7705 E-mail: lsy3379@dsmc.or.kr

‗ This study was presented as a narration at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 19 December 201428 February 2015 Accepted 14 August 2015

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 evaluate the surgical outcomes of unilateral lateral rectus (LR) recession on the contralateral eye for recurrent inter-mittent exotropia after unilateral recession-resection (R & R).

Methods

A retrospective analysis of 43 patients was performed. The patients were classified into 2 groups, 18 patients who un-derwent unilateral LR recession for intermittent exotropia of 18 to 20 prism diopters (PD) after unilateral R & R (reoperation group) and 25 patients who had primary unilateral LR recession (primary operation group).

Results

Significant differences in age, gender, refractive error, preoperative deviation, and near stereoacuity were not observed between the 2 groups ( p > 0.05). The mean follow-up duration was 14.28 ± 14.98 months in the reoperation group and 14.68 ±12.15 months in the primary operation group. Postoperative deviations were 1.11 ± 3.89 PD at near distance and 2.00 ± 4.70 PD at far distance in the reoperation group and 6.44 ± 5.26 PD at near distance and 7.00 ± 5.77 PD at far distance in the primary op-eration group on the final follow-up ( p = 0.000, p = 0.004). The final surgical successful rates were 94.4% in the reoperation group and 64.0% in the primary group ( p = 0.021).

Conclusions

The long-term surgical results of unilateral LR recession on the contralateral eye was better in patients with re-current intermittent exotropia of 18 to 20 PD after unilateral R & R than patients who had primary unilateral LR recession.

Keywords: Intermittent exotropia, Recurrence, Unilateral lateral rectus recession

References

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Figure 1.

Comparison of deviations at each follow-up after two different surgeries. ULR = unilateral lateral rectus muscle recession;F/U = follow up.

Table 1.

Characteristics of patients

	Primary ULR (n = 25)	Repeat ULR (n = 18)	p-value
Age (years)	9.20 ± 5.17	9.17 ± 2.40	0.332^†
Sex (male/female)	9/16	8/10	0.753^‡
Preoperative SE^* (diopter)	0.444^†
OD	-0.88 ± 1.76	-1.48 ± 2.31
OS	-0.93 ± 1.88	-1.63 ± 2.54
Amount of surgery (mm)	9.62 ± 0.39	10.11 ± 1.06	0.056^†
Follow up (months)	14.68 ± 12.15	14.28 ± 14.98	0.510^†
Values are presented as mean ± SD unless otherwise indicated.
ULR = unilateral lateral rectus muscle recession; SE = spherical equivalent; OD = oculus dexter; OS = oculus sinister.

^* Preoperative spherical equivalent measured by cycloplegic refraction; ^† Mann-Whitney U-test; ^‡ Chi-square test.

Table 2.

Mean angle of deviation and surgical success rate

	Primary ULR (n = 25)	Repeat ULR (n = 18)	p-value
Preoperative deviation (PD)
Near	21.32 ± 4.60	22.56 ± 4.71	0.485^†
Far	18.96 ± 1.02	18.89 ± 1.02	1.000^†
Postoperative deviation^* (PD)
Near	6.44 ± 5.26	1.11 ± 3.89	0.000^†
Far	7.00 ± 5.77	2.00 ± 4.70	0.004^†
Success rate (%)	16/25 (64.0%)	17/18 (94.4%)	0.028^‡

Values are presented as mean ± SD unless otherwise indicated.

ULR = unilateral lateral rectus recession; PD = prism diopters.^* Angle of deviation at final follow up examination; † Mann-Whitney U-test; ^‡ Fisher’s exact test.

Table 3.

Comparision of stereoacuity values between the two groups

	Primary ULR (n = 25)	Repeat ULR (n = 18)	p-value^‡
Stereoacuity^* (sec of arc)
Preoperative	84.58 ± 42.83	68.82 ± 41.97	0.102
Postoperative^†	89.20 ± 73.88	67.65 ± 40.86	0.158
Values are presented as mean ± SD unless otherwise indicated.
ULR = unilateral lateral rectus recession.
^* Stereopsis was measured at near distance using the Titmus stereo test; ^† Stereoacuity at final follow up examination; ^‡ Mann-Whitney U-test.

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