Journal List > J Korean Ophthalmol Soc > v.59(1) > 1010911

Kim, Song, and Yum: Comparison between Modified Bilateral Lateral Rectus Recession and Augmented Unilateral Recession-resection for Convergence Insufficiency Exotropia

Abstract

Purpose

To compare the surgical outcomes between modified bilateral lateral rectus muscle (BLR) recession and augmented unilateral recession-resection (R&R) for the convergence insufficiency intermittent exotropia (IXT).

Methods

37 patients with convergence insufficiency IXT were divided into two groups: 13 patients (underwent BLR recession) and 24 patients (underwent unilateral R&R). Success was defined as within 10 prism diopters (PD) at distance and near, and within 10 PD of the difference between them at postoperative 12 months.

Results

After the patch test, the preoperative distance deviation angle in the BLR group was 29.9 ± 8.4 PD, and the near deviation angle was 42.3 ± 9.7 PD; the difference between them was 12.5 ± 3.2 PD. In the R&R group, the preoperative distance deviation angle was 26.7 ± 5.8 PD, and the near deviation angle was 41.5 ± 7.4 PD; the difference between them was 14.8 ± 4.3 PD (p = 0.235, p = 0.987, and p = 0.123). At the 12-month follow-up in the BLR group, the distance angle was 3.8 ± 5.1 PD, and the near deviation angle was 4.9 ± 6.1 PD; the difference between them was 2.9 ± 5.9 PD. In the R&R group, the postoperative distance deviation angle was 4.7 ± 6.1 PD, and the near deviation angle was 7.9 ± 6.6 PD; the difference between them was 3.65 ± 5.1 PD (p = 0.708, p = 0.162, and p = 0.632, respectively). The surgical success rate did not differ significantly between groups at 12 months postoperatively (76.9%: BLR group and 70.8%: R&R group; p = 0.690).

Conclusions

Modified BLR recession showed a similar surgical success rate to augmented unilateral R&R, and was effective in reducing both distance and near exodeviation, and in decreasing the difference between distance and near deviation in convergence insufficiency IXT.

Figures and Tables

Figure 1

Mean preoperative and postoperative distant and near deviation angles according to the follow-up times. (A) At the 1-year follow-up in the bilateral lateral rectus muscle (BLR) group, the mean distance angle was 3.8 ± 5.1 PD, and the near deviation angle was 4.9 ± 6.1 PD; the difference between them was 2.9 ± 5.9 PD. (B) At the 1-year follow-up in the unilateral recession-resection (R&R) group, the mean distance angle was 4.7 ± 6.1 PD, and the near deviation angle was 7.9 ± 6.6 PD; the difference between them was 3.7 ± 5.1 PD. PD = prism diopter; Preop. = preoperative; POD = postoperative day; W = week; M = month(s); Y = year.

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Figure 2

Changes of mean difference between distance and near angles in two groups according to the follow-up times. The difference between distance and near angles in two groups showed no significant difference at 1 year postoperatively. BLR = bilateral lateral rectus muscle; R&R = unilateral recession-resection; PD = prism diopter; Preop. = preoperative; POD = postoperative day; W = week; M = month(s); Y = year.

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Table 1

Demographic characteristics and clinical features of the patients

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Values are presented as mean ± SD unless otherwise indicated.

BLR = bilateral lateral rectus muscle; R&R = unilateral recession-resection; Preop. = preoperative; BCVA = best corrected visual acuity; OD = oculus dexter; OS = oculus sinister; Postop. = postoperative.

*Mann-Whitney U-test: p-value < 0.05; Chi-squared test.

Table 2

Mean preoperative angles of exodeviation

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Values are presented as mean ± SD (range) unless otherwise indicated.

p-value1’ means ‘comparison between group BLR and R&R’, ‘p-value2’ means ‘comparison of distant deviation between before and after occlusion’, ‘p-value3’ means ‘comparison of near deviation between before and after occlusion’, and ‘p-value4’ means ‘comparison of difference (N–D) between before and after occlusion’.

BLR = bilateral lateral rectus muscle; R&R = unilateral recession-resection; PD = prism diopter; N = near angle; D = distance angle.

*Mann-Whitney U-test: p-value < 0.05.

Table 3

Postoperative surgical outcomes

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Values are presented as n (%) unless otherwise indicated.

BLR = bilateral lateral rectus muscle; R&R = unilateral recession-resection; POD = postoperative day; PD = prism diopter; N = near angle; D = distance angle.

*Fisher's Exact test: p-value < 0.05; Chi-squared test.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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