Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

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Unilateral Lateral Rectus Recession is an Effective Surgery for Intermittent Exotropia in Young Children

10.21203/rs.3.rs-69992/v1 ◽

2020 ◽

Author(s):

Oriel Spierer ◽

Abraham Spierer

Keyword(s):

Young Children ◽

Success Rate ◽

Lateral Rectus ◽

Intermittent Exotropia ◽

Age At Surgery ◽

Surgical Methods ◽

Before And After ◽

The Mean ◽

Consecutive Esotropia

Abstract Background: Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤25 PD (prism diopters)) in children.Methods: The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006-2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented.Results: Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusion: In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

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Unilateral Lateral Rectus Recession is an Effective Surgery for Intermittent Exotropia in Young Children

10.21203/rs.3.rs-69992/v2 ◽

2020 ◽

Author(s):

Oriel Spierer ◽

Abraham Spierer

Keyword(s):

Young Children ◽

Success Rate ◽

Lateral Rectus ◽

Intermittent Exotropia ◽

Age At Surgery ◽

Surgical Methods ◽

Before And After ◽

The Mean ◽

Consecutive Esotropia

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Lateral rectus advancement versus medial rectus recession for consecutive esotropia

European Journal of Ophthalmology ◽

10.1177/1120672119870094 ◽

2019 ◽

pp. 112067211987009 ◽

Cited By ~ 1

Author(s):

Masoud Aghsaei Fard ◽

Hossein Ghahvehchian

Keyword(s):

Success Rate ◽

Lateral Rectus ◽

Medial Rectus ◽

Intermittent Exotropia ◽

Chi Square ◽

Similar Measure ◽

Second Surgery ◽

Group Success ◽

Consecutive Esotropia

Purpose: To compare lateral rectus advancement with medial rectus recession for patients with consecutive esotropia without abduction limitation. Methods: Forty-three patients who developed consecutive esotropia following bilateral lateral rectus recession for intermittent exotropia were reviewed retrospectively. Twenty-two patients underwent lateral rectus advancement (lateral rectus advancement group) and medial rectus recession was performed in 21 patients (medial rectus recession group). Success rate of the surgery was based on the percentage of postoperative esophoria or exophoria of less than 8 PD, which did not require a third surgery. Mean follow-up after second surgery was 23.5 ± 8.7 months. Results: Mean consecutive esotropia in the lateral rectus advancement group was 24.8 ± 9.0 PD. Eight patients were orthophoric after second surgery; mean postoperative esophoria and exophoria/tropia was 5.4 ± 3.4 PD and 6.5 ± 5 PD, respectively. Postoperative success rate in this group was 90.9%. Mean consecutive esotropia in the medial rectus recession group was 21 ± 98.4 PD. Three patients were orthophoric after second surgery; mean postoperative esotropia/phoria and exophoria was 9.5 ± 5.0 PD and 5.2 ± 1.3 PD, respectively. Postoperative success rate in this group was 71.4%. Postoperative undercorrection rate of 4.5% in lateral rectus advancement group was significantly less than the similar measure of 28.6% in medial rectus recession group (chi-square, P = 0.03). Conclusion: Advancement of the previously recessed lateral rectus has improved consecutive esotropia better than medial rectus recession.

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Unilateral Inferior Oblique Anterior Transposition for Markedly Asymmetric Dissociated Vertical Deviation with Unilateral Inferior Oblique Over-action

10.21203/rs.2.420/v2 ◽

2019 ◽

Author(s):

Shuang-Qing Wu ◽

Qi-Bin Xu ◽

Wen-Yan Sheng ◽

Li-Wei Zhu

Keyword(s):

Primary Position ◽

Vertical Deviation ◽

Anterior Transposition ◽

Age At Surgery ◽

Dominant Eye ◽

Before And After ◽

The Mean ◽

Contralateral Eye ◽

Dissociated Vertical Deviation

Abstract Background: To evaluate the results of unilateral inferior oblique anterior transposition (IOAT) for markedly asymmetric dissociated vertical deviation (DVD) combined with inferior oblique over-action (IOOA). Methods：Retrospective chart review of the records of all patients with asymmetric DVD combined with unilateral IOOA in the non-dominant eye who received unilateral IOAT on the non-dominant eye. No other muscles were operated on simultaneously. The amount of DVD and IOOA were measured before and after the operation and statistically analysed. Results: Seventeen patients were included. The mean age at surgery was 23.5 ± 8.4 (range 12–38) years old. The mean postoperative follow-up period was 15.7 ± 7.2 (range 6–32) months. The primary position DVD was 19.6 ± 5.4 (range 14–36) PD preoperatively and decreased significantly to 2.9 ± 2.0 (range 0–8) PD postoperatively (P < 0.01). Preoperatively, there were 2, 7, and 8 patients with +1, +2, and +3 IOOA, respectively, and these were reduced from 2.4 ± 0.7 to 0.3 ± 0.4 postoperatively (P < 0.01). None of the patients were complicated obvious hypotropia, anti-elevation syndrome or IOOA in the contralateral eye. Conclusions: Unilateral IOAT was recommended in patients with asymmetric DVD coexists with unilateral IOOA.

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Surgical outcomes according to distance between preplaced suture and muscle insertion in lateral rectus recession

European Journal of Ophthalmology ◽

10.5301/ejo.5001045 ◽

2017 ◽

Vol 28 (3) ◽

pp. 253-258

Author(s):

Ki W. Jin ◽

Yoon P. Lee ◽

Dong G. Choi

Keyword(s):

Success Rate ◽

Surgical Outcomes ◽

Lateral Rectus ◽

Secondary Outcome ◽

Dose Ratio ◽

Surgical Success ◽

Muscle Insertion ◽

Angle Of Deviation ◽

The Mean

Purpose: To compare surgical outcomes according to the distance between the preplaced suture and the muscle insertion in lateral rectus (LR) recession for exotropia. Methods: We retrospectively reviewed 64 patients who had undergone unilateral LR recession by one right-handed surgeon and divided the patients into 2 groups: right LR recession (R group, 26 patients) and left LR recession (L group, 38 patients). In the R group, the preplaced suture was behind the hook, far from the insertion; in the L group, the suture was in front of the hook, near the insertion. The main outcome measures were postoperative alignment and surgical success rate and the secondary outcome measure was effect/dose ratio. Surgical success was defined as an alignment between 10 prism diopters (PD) of exodeviation and 5 PD of esodeviation both at distance and at near. The effect/dose ratio was defined as the corrected angle of deviation at postoperative 6 months divided by the amount of LR recession. Results: The mean angle of deviation at distance showed a significant difference between the groups at postoperative 3 months (p = 0.022), but not at final follow-up (p = 0.163). There was no difference between the groups in the mean angle of deviation at near postoperatively. Surgical success was achieved in 73.1% of the R group and 71.1% of the L group at final follow-up, which was not significant (p = 0.860). Conclusions: The distance between the preplaced suture and the muscle insertion in LR recession did not affect the surgical success rate or the postoperative alignment at final follow-up.

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Initial overcorrection after surgery for intermittent exotropia in children less than 4 years old: Comparison with older children

PLoS ONE ◽

10.1371/journal.pone.0257465 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257465

Author(s):

Jinju Choi ◽

Dong Gyu Choi

Keyword(s):

Older Children ◽

Intermittent Exotropia ◽

Term Outcome ◽

Long Term Outcome ◽

Age At Surgery ◽

Angle Of Deviation ◽

The Mean ◽

The Relationship ◽

Consecutive Esotropia

Purpose While initial overcorrection after exotropia-correcting surgery is widely accepted for a favorable long-term outcome, some have not advocated such overcorrection in younger children owing to concerns regarding rapid deterioration of bifixation ability. This study aimed to evaluate the relationship between initial overcorrection after intermittent exotropia surgery and the surgical outcome in patients aged <4 years. Methods In this retrospective study, 391 patients who had undergone surgery for intermittent exotropia were classified into two groups according to the age at surgery: <4 years old (group Y [young], 130 patients) and 4–16 years old (group O [old], 261). The patients were subdivided into three groups according to the angle of deviation at postoperative 1 week: esophoria-tropia (ET) ≥10 prism diopters (PD) (subgroup I), ET 1–9 PD (II), and orthotropia or exophoria-tropia (XT) (III). We compared the surgical outcomes between the two groups and among subgroups; then, we analyzed consecutive esotropia patients. Results The mean exodeviation was smaller in the order of subgroup I, II, and III at every postoperative visit (p<0.05) in group Y but showed no difference among subgroups after 2 years in group O. Consecutive esotropia occurred at 1 month, postoperatively, in 6.9% and 2.6% of the patients in groups Y and O (p = 0.133), respectively. However, it persisted in two and one patient in groups Y and O, respectively, until the last visit. Conclusion Early overcorrection after intermittent exotropia surgery was a safe and desirable result in terms of motor outcome in children aged under 4 years, as well as for children aged between 4–16 years.

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Unilateral Inferior Oblique Anterior Transposition for Asymmetric Dissociated Vertical Deviation with Unilateral Inferior Oblique Over-action

10.21203/rs.2.420/v1 ◽

2019 ◽

Author(s):

Shuang-Qing Wu ◽

Qi-Bin Xu ◽

Wen-Yan Sheng ◽

Li-Wei Zhu

Keyword(s):

Chart Review ◽

Primary Position ◽

Vertical Deviation ◽

Anterior Transposition ◽

Age At Surgery ◽

Dominant Eye ◽

Before And After ◽

The Mean ◽

Dissociated Vertical Deviation

Abstract Background: To evaluate the results of unilateral inferior oblique anterior transposition (IOAT) for dissociated vertical deviation (DVD) combined with inferior oblique over-action (IOOA). Methods：Retrospective chart review of the records of all patients with asymmetric DVD combined with unilateral IOOA in the non-dominant eye, who received unilateral IOAT on the non-dominant eye. No other muscles were operated simultaneously. The amount of DVD and IOOA before and after the operation was measured and statistically analyzed. Results: Seventeen patients were included. Mean age at surgery was 23.5 ± 8.4 years (range 12 - 38). The mean postoperative follow-up period was 15.7 ± 7.2 months (range 6 - 32). Primary position DVD was 19.6 ± 5.4 PD (range 14 - 36) preoperatively, which decreased significantly to 2.9 ± 2.0 PD (range 0 - 8) postoperatively (P < 0.01). There were 2, 7, and 8 patients with +1, +2, and +3 IOOA preoperatively, respectively, which was reduced significantly to 0.3 ± 0.4 postoperatively. Conclusions: Unilateral IOAT was recommended in patients with asymmetric DVD coexists with unilateral IOOA.

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Unilateral Inferior Oblique Anterior Transposition for Markedly Asymmetric Dissociated Vertical Deviation with Unilateral Inferior Oblique Over-action

10.21203/rs.2.420/v3 ◽

2019 ◽

Author(s):

Shuang-Qing Wu ◽

Qi-Bin Xu ◽

Wen-Yan Sheng ◽

Li-Wei Zhu

Keyword(s):

Chart Review ◽

Primary Position ◽

Vertical Deviation ◽

Anterior Transposition ◽

Age At Surgery ◽

Dominant Eye ◽

Before And After ◽

The Mean ◽

Dissociated Vertical Deviation

Abstract Background: To evaluate the results of unilateral inferior oblique anterior transposition (IOAT) for markedly asymmetric dissociated vertical deviation (DVD) combined with inferior oblique over-action (IOOA).Methods：Retrospective chart review of the records of all patients with asymmetric DVD combined with unilateral IOOA in the non-dominant eye who received unilateral IOAT on the non-dominant eye. No other muscles were operated on simultaneously. The amount of DVD and IOOA were measured before and after the operation and statistically analysed.Results: Seventeen patients were included. The mean age at surgery was 23.5 ± 8.4 (range 12–38) years old. The mean postoperative follow-up period was 15.7 ± 7.2 (range 6–32) months. The primary position DVD was 19.6 ± 5.4 (range 14–36) PD preoperatively and decreased significantly to 2.9 ± 2.0 (range 0–8) PD postoperatively (P < 0.01). Preoperatively, there were 2, 7, and 8 patients with +1, +2, and +3 IOOA, respectively, and these were reduced from 2.4 ± 0.7 to 0.3 ± 0.4 postoperatively (P < 0.01). None of the patients were complicated obvious hypotropia, anti-elevation syndrome or IOOA in the contralateral eye.Conclusions: Unilateral IOAT was recommended in patients with asymmetric DVD coexists with unilateral IOOA.

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Slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia: a retrospective study

10.21203/rs.3.rs-16029/v1 ◽

2020 ◽

Author(s):

Meiyu Ren ◽

Qi Wang ◽

Lihua Wang

Keyword(s):

Case Series ◽

Lateral Rectus ◽

Safe Procedure ◽

Intermittent Exotropia ◽

Retrospective Case ◽

Primary Position ◽

Case Series Study ◽

Distance Difference ◽

The Mean

Abstract Background The present study sought to investigate the efficiency and safety of SBLR-rec for the treatment of CI-IXT.Methods This retrospective case series study included 34 patients who underwent SBLR-rec for CI-IXT in Shandong Provincial Hospital affiliated to Shandong University between September 2013 and October 2015 with a minimum follow-up of 6 months. A successful surgical alignment was defined as +5 to -10 prism diopters (PD) of orthophoria in the primary position while viewing distant or near targets and a difference between the distance and near deviation angles of ≤8PD.Results The mean age of the patients at surgery was 7.09±3.80 years (range, 3 to 18 years). The mean distance deviations were -26.09±6.5 PD (range, -15 to -35 PD) and the mean near deviations, -37.21±6.3 PD (range, -25 to -45 PD) preoperatively. The mean recession amount of upper pole of the lateral rectus was 5.97 mm (range, 4.0 to 7.5mm) and that of lower pole of the lateral rectus, 7.49 mm (range, 6.0 to 8.5mm). At a mean follow-up of 15.0 months (range, 6 to 37 months), the surgical success rate was 70.6% (24/34), the under-correction rate was 17.6% (6/34), and the overcorrection rate was 11.8% (4/34). The mean difference between the distance and near deviation angles was significantly reduced from 11.12±2.06 PD (range, 10 to 15 PD) preoperatively to 2.47±3.04 PD (range, 0 to 10 PD) postoperatively (P<0.001). Each millimeter of difference between the upper and lower poles of the lateral rectus recession was associated with an improvement of 5.65 PD in the near-distance difference of deviation. At the final follow up, a distance-near difference of deviation of ≤8PD was found in 32 (94.1%) patients. none of the patients developed A-V pattern, torsional diplopia, or restricted abduction of the eyes.Conclusions SBLR-rec for CI-IXT may successfully reduce the distance and near exodeviations and the distance-near deviation difference, thus was proved to be an effective and safe procedure for the treatment of CI-IXT.

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Surgical Outcomes of Unilateral Lateral Rectus Recession Versus Recess-resect in Children With Small-to-medium Angle Convergence Insufficiency-type Intermittent Exotropia

10.21203/rs.3.rs-903565/v1 ◽

2021 ◽

Author(s):

Yoon Kyung Jang ◽

Seok Hyun Bae ◽

Dong Gyu Choi

Keyword(s):

Surgical Outcomes ◽

Medical Records ◽

Lateral Rectus ◽

Intermittent Exotropia ◽

Surgical Success ◽

Convergence Insufficiency ◽

Significant Difference ◽

Distance Difference ◽

The Mean

Abstract To determine the efficacy of unilateral lateral rectus recession (ULR) for convergence insufficiency-type intermittent exotropia (CI-type IXT), we compared surgical outcomes following ULR and recess‒resect (RR) procedures for CI-type IXT. In this retrospective study, medical records of 57 children who underwent ULR (n = 30) or RR (n = 27) for CI-type IXT of less than 25 PD at distance with a postoperative follow-up of 6 months or more were reviewed. Surgical success was defined as an alignment between 10 PD exodeviation and 5 PD esodeviation at distance and near fixation. The postoperative exodeviation showed no significant difference between the two groups at the last follow-up. A significant reduction in the mean near-distance difference was achieved postoperatively in both groups: from 5.4 PD preoperatively to 2.5 at last follow-up after ULR, and from 8.2 to 2.4 after RR (both p = 0.001). However, this difference between ULR and RR was not statistically significant (p > 0.05). The success rate at the last follow-up was 63.3% for ULR and 70.4% for RR (p = 0.574). ULR was found to be an effective treatment for CI-type IXT, with similar surgical outcomes to RR.

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