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Song and Lee: The Effect of Bilateral Slanted Lateral Rectus Recession in Exotropia with Near-Far Disparity
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(2): 311-315.

Published online: 15 February 2012

DOI: https://doi.org/10.3341/jkos.2012.53.2.311

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

In Je Song, MD, Sul Gee Lee, MD, PhD

Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to Sul Gee Lee, MD, PhD. Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. Tel: 82-51-890-6563, Fax: 82-51-890-6329, judysg@daum.net

Received 8 June 2011       Accepted 19 January 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

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.

Keywords: Bilateral slanted lateral rectus recession, Exodeviation, Near-far disparity

Figures and Tables

Figure 1
Slanted lateral rectus (LR) recession; Upper horn (A) is recessed according to the distance exodeviation, lower horn (B) is recessed according to the near exodeviation. The lower horn is more recessed than upper horn.
jkos-53-311-g001
Table 1
Clinical characteristics of both groups
jkos-53-311-i001

Values are presented as mean ± SD (range) or number (%).

*p-value tested by Fisher's exact; †p-value tested by Mann-Whitney U test; ‡Titmus circle >5/9 or W4DT fusion at near.

Table 2
Mean changes of preoperative and postoperative deviations
jkos-53-311-i002

Values are presented as mean ± SD.

D = distance deviation; N = near deviation; NFD = near-far difference; PD = prism diopters.

*p < 0.001; †p = 0.002; ‡p = 0.020. Tested by Wilcoxon test for paired samples.

Table 3
Postoperative changes of near-far incomitance
jkos-53-311-i003

Values are presented as mean ± SD.

*p<0.05, Mann-Whitney U test.

Table 4
Success* rate according to the operation method
jkos-53-311-i004

Values are presented as number (%).

*Success = residual near or far deviation within 8 PD from orthotropia, and a difference between the near and the far angle deviation of ≤5 PD; †p < 0.05, Chi-square test.

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