Augmented Asymmetric Lateral Rectus Recession in Intermittent Exotropia With Fixing Eye

Hyun Jai Song; Hye Jung Paik

doi:10.3341/jkos.2010.51.7.992

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Song and Paik: Augmented Asymmetric Lateral Rectus Recession in Intermittent Exotropia With Fixing Eye

Original Article

J Korean Ophthalmol Soc 2010;51(7):992-997.

Published online: 31 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.7.992

Augmented Asymmetric Lateral Rectus Recession in Intermittent Exotropia With Fixing Eye

Hyun Jai Song, MD, Hye Jung Paik, MD, PhD

Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea

Address reprint requests to Hye Jung Paik, MD, PhD, Department of Ophthalmology, Gachon University Gil Hospital #1198, Kuwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: hjpaik@gilhospital.com

Received 18 January 2010 Accepted 14 May 2010

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 document and compare the clinical results of symmetrical rectus muscle recession and asymmetrical rectus muscle recession in intermittent exotropia.

Methods

The medical records of 27 patients who had symmetric bilateral rectus recession and 24 patients who had asymmetric bilateral rectus recession for intermittent exotropia with at least six months of postoperative follow-up from March 2004 to March 2007 were reviewed retrospectively. The authors performed a recession of 2 mm or greater in the deviating eye than in the fixing eye.

Results

The mean age was 7.14±4.23 (range 3 to 15) years for symmetric bilateral rectus recession and 7.33±4.01 (range 3 to 14) years for asymmetric bilateral rectus recession. The mean follow-up was 11.83±5.74 (range 6 to 26) months in the sym-metric bilateral rectus recession group and 11.14±5.05 (range 6 to 30) months in the asymmetric bilateral rectus recession group. The mean preoperative angle deviations were 27.5±4.8 prism diopter (PD) (range 30 to 40PD) and 27.3±4.6PD (range 20 to 40PD) in each group. The outcome of final follow-up (postoperative 24 months) was favorable in both groups, and slightly more successful in the asymmetric bilateral recession group but not a statistically significant amount (75.5% in the symmetric bilateral recession group and 81.2% in the asymmetric bilateral recession group).

Conclusions

The present study suggests that there are no significant differences at postoperative 24 months between sym-metric bilateral recession and asymmetric bilateral recession in intermittent exotropia having a fixing and a deviating eye.

Keywords: Intermittent exotropia, Fixing eye, Symmetric lateral rectus recession, Asymmetric lateral rectus recession

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Table 1.

Patient characteristics of symmetric and asymmetric recession groups

Characteristics	Symmetric LROU Rec (N=27)	Asymmetric LROU Rec (N=24)	P value
Sex			0.326^*
Male	12	11
Female	15	13
Age at operation (yr)(mean± SD)	7.14±4.23	7.33±4.01	0.185^†
Follow up (mon) (mean± SD)	11.83±5.74	11.14±5.05	0.168^†
Deviated eye			0.257^*
Right/Left	13/14	10/14

LROU Rec=bilateral lateral rectus recession; N=number of patients.

^* P value was calculated by Fisher's exact

^† P value was calculated by Mann-Whitney U test.

Table 2.

Comparison of preoperative deviation between symmetric and asymmetric recession group

Deviation (PD)	Symmetric LROU Rec (N=27)	Asymmetric LROU Rec (N=24)
20∼25	16 (59.3%)	14 (58.3%)
26∼30	9 (33.3%)	9 (37.5%)
31∼40	2 (7.4%)	1 (4.2%)
Mean deviation (PD)(mean± SD)	22.8±3.7^*	22.7±3.4^*

LROU Rec: bilateral lateral rectus recession; PD: prism diopter.

P^*=0.974 by Mann-Whitney U test.

Table 3.

Comparison of preoperative best corrected visual acuity (BCVA) between symmetric and asymmetric re-cession group

BCVA	Symmetric LROU Rec (N=27)		Asymmetric LROU Rec (N=24)
BCVA	Fixing eye	Deviated eye	Fixing eye	Deviated eye
0.4∼0.5	0 (0.0%)	3 (11.1%)	0 (0.0%)	2 (8.4%)
0.6∼0.7	0 (0.0%)	3 (11.1%)	0 (0.0%)	5 (20.8%)
0.8∼1.0	27 (100.0%)	21 (77.8%)	24 (100.0%)	17 (70.8%)
Mean BCVA (LogMAR) (mean± SD)	0.01±0.24^*	0.06±0.69^*	0.01±0.22^†	0.06±0.72^†

^* P=0.017 by Mann-Whitney U test

^† P=0.029 by Mann-Whitney U test; LROU Rec=bilateral lateral rectus recession.

Table 4.

Comparison of preoperative stereopsis between symmetric and asymmetric recession group

Stereopsis (seconds of arc)	Symmetric LROU Rec (N=27)	Asymmetric LROU Rec (N=24)
3000	1 (3.7%)	2 (8.4%)
400	1 (3.7%)	2 (8.4%)
200	3 (11.1%)	1 (4.2%)
≤100	22 (81.5%)	18 (75.0%)

LROU Rec=bilateral lateral rectus recession.

Table 5.

Surgical outcome at postoperative 6, 12 and 24 months of follow-up between symmetric recession group and asymmetric recession group

	Symmetric LROU rec	Asymmetric LROU rec	P value
6 months follow-up(N)	27	24
Success	25 (92.6%)	22 (91.7%)	0.649
Overcorrection	1 (3.7%)	2 (8.3%)
Recurrence	1 (3.7%)	0 (0.0%)
12 months follow-up(N)	22	21
Success	18 (81.8%)	18 (85.7%)	0.327
Overcorrection	1 (4.5%)	1 (4.8%)
Recurrence	3 (13.6%)	2 (9.5%)
24 months follow-up(N)	16	16
Success	12 (75.0%)	13 (81.2%)	0.415
Overcorrection	0 (0.0%)	0 (0.0%)
Recurrence	4 (25.0%)	3 (18.8%)

LROU Rec=bilateral lateral rectus recession; N=number of patients.

Overcorrection: Esotropia ≥6PD, Recurrence: Exotropia ≥11 PD. P value was calculated by Fisher's exact test.

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