Surgical Success Rate for Intermittent Exotropia


Article: Long-term outcomes of bilateral lateral rectus recession versus unilateral lateral rectus recession-medial rectus plication in children with basic type intermittent exotropia.  AuthorsHaeng-Jin Lee,  Seong-Joon Kim,  Young Suk Yu.  Journal: Eye (Journal of the Royal College of Ophthalmologists) April 2019.


Purpose:  To compare the long-term surgical outcomes between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus plication (RP) in intermittent exotropia.

Methods:  Children who underwent BLR or RP for basic type intermittent exotropia between 2015 and 2016 with a minimum follow-up period of 2 years were retrospectively reviewed. Surgical outcomes were classified based on postoperative angle of deviation as follows: success (esodeviation ≤ 5 prism diopters [PD] to exodeviation ≤ 10 PD), and failure (overcorrection [esodeviation > 5 PD] and undercorrection or recurrence [exodeviation > 10 PD]).

Results:  Of 144 patients, 90 underwent BLR and 54 underwent RP. The angle of exodeviation of the RP group steadily increased over time after the surgery. The BLR group showed an earlier exodrift and a more stable course compared to the RP group. Kaplan–Meier survival analysis showed a better survival in the BLR group, with final success rates of 48.9% in the BLR group and 25.9% in the RP group after a mean follow-up of 2.2 years. Patients with a successful outcome had greater esodeviation at 1 week postoperatively (at distance 7.6 PD in the BLR group, 11.4 in the RP group).

Conclusions: Surgical outcomes were better in the BLR group than in the RP group. The RP group showed higher rates of recurrence of exodeviation, while the BLR group presented a more stable course. Establishing more esodeviation at postoperative week 1 in the RP group compared to the BLR group would be required to achieve successful results.

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Those are interesting stats to keep in mind.  I’ve seen some remarkably good surgical outcomes for patients with non-comitant strabismus, and in select cases of constant strabismus.  Intermittent strabismus?  Not so much.  And from this article, you get the feeling that a 49% success rate is considered good and quite acceptable among surgeons.  One wonders if surgeons were to avail themselves of non-surgical interventions such as optometric vision therapy to stabilize surgical outcomes, would their long-term success rate be considerably higher?

One thought on “Surgical Success Rate for Intermittent Exotropia

  1. Addendum — Consider this powerful commentary by Dr. Shira Robbins, a pediatric ophthalmologist at UCSD: One must read these results with the understanding that the surgical dosage algorithm was individual to this surgical team. There has been a resurgence of the debate regarding relative potency of the muscle strengthening effect of plication (tuck) versus a resection in recent years with diametrically opposed study results making data interpretation difficult to incorporate into a clinical approach. The variability of results from the literature comparing resections and plications reveals a lack of our full understanding of muscle physiology, post-operative remodeling and cerebral input.”

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