Comparison between Modified Bilateral Lateral Rectus Recession and Augmented Unilateral Recession-resection for Convergence Insufficiency Exotropia

Min Hwan Kim; Seok Hyeon Song; Hae Ri Yum

doi:10.3341/jkos.2018.59.1.60

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(1): 60-66.

Published online: 12 January 2018

DOI: https://doi.org/10.3341/jkos.2018.59.1.60

Comparison between Modified Bilateral Lateral Rectus Recession and Augmented Unilateral Recession-resection for Convergence Insufficiency Exotropia

Min Hwan Kim, MD, Seok Hyeon Song, MD, Hae Ri Yum, MD

Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea.

Address reprint requests to Hae Ri Yum, MD. Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro Seo-gu, Daejeon 35365, Korea. Tel: 82-42-600-9258, Fax: 82-42-600-9251, smile-ri@hanmail.net

Received 6 July 2017 Revised 17 October 2017 Accepted 13 December 2017

The Korean Ophthalmological Society

(open-access):

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 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.

Keywords: Bilateral lateral rectus recession, Convergence insufficiency type, Intermittent exotropia, Recession and resection, Surgical outcome

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.

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.

Table 1

Demographic characteristics and clinical features of the patients

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

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

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.

References

1. Burian HM. Exodeviations: their classification, diagnosis and treatment. Am J Ophthalmol. 1966; 62:1161–1166.

2. Daum KM. Convergence insufficiency. Am J Optom Physiol Opt. 1984; 61:16–22.

3. Daum KM. Characteristics of convergence insufficiency. Am J Optom Physiol Opt. 1988; 65:426–438.

4. Birnbaum MH, Soden R, Cohen AH. Efficacy of vision therapy for convergence insufficiency in an adult male population. J Am Optom Assoc. 1999; 70:225–232.

5. Choi DG, Rosenbaum AL. Medial rectus resection(s) with adjustable suture for intermittent exotropia of the convergence insufficiency type. J AAPOS. 2001; 5:13–17.

6. Choi MY, Hwang JM. The long-term result of slanted medial rectus resection in exotropia of the convergence insufficiency type. Eye (Lond). 2006; 20:1279–1283.

7. Snir M, Axer-Siegel R, Shalev B, et al. Slanted lateral rectus recession for exotropia with convergence weakness. Ophthalmology. 1999; 106:992–996.

8. von Noorden GK. Resection of both medial rectus muscles in organic convergence insufficiency. Am J Ophthalmol. 1976; 81:223–226.

9. Hermann JS. Surgical therapy for convergence insufficiency. J Pediatr Ophthalmol Strabismus. 1981; 18:28–31.

10. Raab EL, Parks MM. Recession of the lateral recti. Effect of preoperative fusion and distance-near relationship. Arch Ophthalmol. 1975; 93:584–586.

11. Ohtsuki H, Hasebe S, Kono R, et al. Prism adaptation response is useful for predicting surgical outcome in selected types of intermittent exotropia. Am J Ophthalmol. 2001; 131:117–122.

12. Kushner BJ. Surgical pearls for the management of exotropia. Am Orthopt J. 1992; 42:65–71.

13. Kraft SP, Levin AV, Enzenauer RW. Unilateral surgery for exotropia with convergence weakness. J Pediatr Ophthalmol Strabismus. 1995; 32:183–187.

14. Kushner BJ. Exotropic deviations: a functional classification and approach to treatment. Am Orthopt J. 1988; 38:81–93.

15. Chun BY, Kang KM. Early results of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. J Ophthalmol. 2015; 2015:380467.

16. Yang HK, Hwang JM. Surgical outcomes in convergence insufficiency-type exotropia. Ophthalmology. 2011; 118:1512–1517.

17. Cooper J. Major review: intermittent exotropia. Basic and divergence excess type. Binoc Vis Eye Muscle Surg Q. 1993; 8:185–216.

18. Kushner BJ, Morton GV. Distant/near differences in intermittent exotropia. Arch Ophthalmol. 1998; 116:478–486.

19. Haldi BA. Surgical management of convergence insufficiency. Am Orthopt J. 1978; 28:106–109.

20. Kushner BJ. Selective surgery of intermittent exotropia based on distance/near differences. Arch Ophthalmol. 1998; 116:324–328.

21. Scott AB. Strabismus muscle forces and innervation.In : Lenerstrand G, Bach-y-Rita P, editors. Basic Mechanism of Ocular Motility and Their Clinical Implications, Wenner-Gren Center International Symposium Series (Proceedings of the International Symposium held in Wenner-Gren Center, Stockholm, June 4-6, 1974). 1st ed. New York: Pergamon Press;1975. p. 181–191.

22. Choi MY, Hyung SM, Hwang JM. Unilateral recession-resection in children with exotropia of the convergence insufficiency type. Eye (Lond). 2017; 21:344–347.

23. Kushner BJ. Insertion slanting strabismus surgical procedures. Arch Ophthalmol. 2011; 129:1620–1625.

24. Burian HM, Franceschetti AT. Evaluation of diagnostic methods for the classification of exodeviations. Trans Am Ophthalmol Soc. 1970; 68:56–71.

25. Kim SH, Kim SY, Kwon JY. Change of deviation angle after monocular occlusion in intermittent exotropia. J Korean Ophthalmol Soc. 2005; 46:1175–1182.

26. Ruttum MS. Initial versus subsequent postoperative motor alignment in intermittent exotropia. J AAPOS. 1997; 1:88–91.

27. Raab EL, Parks MM. Recession of lateral recti. Early and late postoperative alignments. Arch Ophthalmol. 1969; 82:203–208.

28. Ko KH, Min BM. Factors related to surgical results of intermittent exotropia. J Korean Ophthalmol Soc. 1996; 37:179–184.

29. Kim SJ. Comparison of surgical results between bilateral recession and unilateral recession-resection in intermittent exotropia. J Korean Ophthalmol Soc. 1992; 33:733–738.

30. Keech RV, Stewart SA. The surgical overcorrection of intermittent exotropia. J Pediatr Ophthalmol Strabismus. 1990; 27:218–220.

31. Jang JH, Park JM, Lee SJ. Factors predisposing to consecutive esotropia after surgery to correct intermittent exotropia. Graefes Arch Clin Exp Ophthalmol. 2012; 250:1485–1490.

32. Lee EK, Yang HK, Hwang JM. Long-term outcome of prismatic correction in children with consecutive esotropia after bilateral lateral rectus recession. Br J Ophthalmol. 2015; 99:342–345.

33. Kim HJ, Choi DG. Consecutive esotropia after surgery for intermittent exotropia: the clinical course and factors associated with the onset. Br J Ophthalmol. 2014; 98:871–875.

34. Park HS, Kim JB, Seo MS, Park YG. A study on the consecutive esotropia after intermittent exotropia surgery. J Korean Ophthalmol Soc. 1994; 35:1327–1334.

TOOLS

Similar articles